The Cost-Effectiveness of the Improving Access to Psychological Therapies (IAPT) Programme in Severe Mental Illness: A Decision Analytical Model Using Routine Data

2019 ◽  
Vol 55 (5) ◽  
pp. 873-883 ◽  
Author(s):  
Darshan Zala ◽  
Alison Brabban ◽  
Alex Stirzaker ◽  
Muralikrishnan Radhakrishnan Kartha ◽  
Paul McCrone
Keyword(s):  
Mental Illness ◽  
Cost Effectiveness ◽  
Severe Mental Illness ◽  
Analytical Model ◽  
Routine Data ◽  
Psychological Therapies ◽  
Decision Analytical Model ◽  
The Cost

scholarly journals A Decision Analytical Model Investigating Cost-Effectiveness of Erlotinib

2020 ◽  
Author(s):  
Mohammed Alam
Keyword(s):  
Cost Effectiveness ◽  
Markov Model ◽  
Analytical Model ◽  
State Transition ◽  
Transition Probabilities ◽  
Qaly Gain ◽  
Health State ◽  
Time Varying ◽  
Decision Analytical Model ◽  
The Cost

Background: A decision analytical model investigating cost-effectiveness of Erlotinib was submitted to the UK NICE (National Institute for Health and Care Excellence), which was not based on actual health-state transition probabilities, leading to structural uncertainty in the model. The study adopted a Markov state-transition model for investigating the cost-effectiveness of Erlotinib versus Best Supportive Care (BSC) as a maintenance therapy for patients with non-small cell lung cancer (NSCLC). Methods: Unlike manufacturer submission (MS), the Markov model was governed by transition probabilities, and allowed a negative post-progression survival (PPS) estimate to appear in later cycle. Using published summary survival data, the study employs three fixed- and time-varying approaches to estimate state transition probabilities that are used in a restructured model. Results: Post-progression probabilities and probabilities of death for Erlotinib were different than fixed-transition approaches. The best fitting curves are achieved for both PPS and probability of death across the time for which data were available, but the curves start diverging towards the end of this period. The Markov model which extrapolates the curves forward in time suggests that this difference between a time-varying and fixed-transition becomes even greater. Our models produce an ICER of £54k -£66k per QALY gain, which is comparable to an ICER presented in the MS (£55k/QALY gain). Conclusions: Results from restructured Markov models show robust cost-effectiveness results for Erlotinib vs BSC. Although these are comparable to manufacturer submissions, in terms of magnitude, they vary, and which are crucial for interventions falling near a threshold value. The study will further explore the cost-effectiveness of therapies for NSCLC in Qatar.

scholarly journals Economic Evaluation of Voriconazole for the Treatment of Candidemia in Canadian Adults

2008 ◽  
Vol 19 (3) ◽  
pp. 219-226 ◽  
Author(s):  
Coleman Rotstein ◽  
Lael Cragin ◽  
Michel Laverdière ◽  
Gary Garber ◽  
Eric J Bow ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Analytical Model ◽  
Sensitivity Analyses ◽  
Decision Analytical Model ◽  
Number Of Patients ◽  
Neutropenic Patients ◽  
Canadian Setting ◽  
The Cost

BACKGROUND: Candidemia is a common cause of nosocomial bloodstream infection. When selecting therapeutic treatments for candidemia, cost-effectiveness is an important consideration. The present study assessed the cost-effectiveness of voriconazole for the treatment of candidemia.METHODS: A decision-analytical model was used for evaluating the cost-effectiveness of voriconazole compared with a regimen of conventional amphotericin B (CAB) followed by fluconazole (FLU) in the treatment of non-neutropenic patients diagnosed with candidemia in the Canadian setting, based on the Global Candidemia Study. The time frame of the model was 98 days (14 weeks). Model parameters were based primarily on clinical outcome, and resource use data collected from the clinical trial were used. Supplemental data were obtained from an independent panel of 12 Canadian experts for parameters not available from the clinical trial. Unit costs were collected from Canadian sources. The outcome variables selected in the study were the number of patients cured within 98 days, the number of patients surviving at 98 days and the number of patients avoiding toxicity. Incremental costs per outcome were calculated to compare the cost-effectiveness analyses (both probabilistic and one-way sensitivity analyses were performed).RESULTS: The cost-effectiveness analysis demonstrated a difference of $1,121 in the total average cost of treatment with voriconazole ($70,489) versus CAB/FLU ($69,368). While the costs of voriconazole exceeded the costs of CAB/FLU, these costs were almost completely offset by lower hospitalization costs. While patients in both treatment arms experienced cure rates of 41%, both the percentage of patients surviving at day 98 (64.5% versus 58.2%) and the percentage of patients avoiding toxicity (64.5% versus 52.5%) were higher in the voriconazole arm. Accounting for differences in total costs and clinical outcomes, this analysis estimated an incremental cost per patient surviving at day 98 of $17,739, and an incremental cost per patient avoiding toxicity of $9,298. In the case of cost per patient cured, voriconazole had a higher cost ($1,121) than CAB/FLU. The results of the deterministic and probabilistic sensitivity analyses indicated that the model was robust.CONCLUSIONS: Results of the decision-analytical model provided evidence to support the cost-effectiveness of voriconazole relative to a regimen of CAB/FLU in the treatment of non-neutropenic patients diagnosed with candidemia in the Canadian setting.

Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness

1999 ◽  
Vol 174 (4) ◽  
pp. 346-352 ◽  
Author(s):  
Anthony F. Lehman ◽  
Lisa Dixon ◽  
Jeffrey S. Hoch ◽  
Bruce Deforge ◽  
Eimer Kernan ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Cost Effectiveness ◽  
Severe Mental Illness ◽  
Usual Care ◽  
Assertive Community Treatment ◽  
Cost Effective ◽  
Homeless Persons ◽  
Community Treatment ◽  
Stable Housing

BackgroundHomelessness is a major public health problem among persons with severe mental illness (SMI). Cost-effective programmes that address this problem are needed.AimsTo evaluate the cost-effectiveness of an assertive community treatment (ACT) programme for these persons in Baltimore, Maryland.MethodsA total of 152 homeless persons with SMI were randomly allocated to either ACT or usual services. Direct treatment costs and effectiveness, represented by days of stable housing, were assessed.ResultsCompared with usual care, ACT costs were significantly lower for mental health in-patient days and mental health emergency room care, and significantly higher for mental health out-patient visits and treatment for substance misuse. ACT patients spent 31% more days in stable housing than those receiving usual care. ACT and usual services incurred $242 and $415 respectively in direct treatment costs per day of stable housing, an efficiency ratio of 0. 58 in favour of ACT. Patterns of care and costs varied according to race.ConclusionACT provides a cost-effective approach to reducing homelessness among persons with severe and persistent mental illnesses.

VP100 Disease Modelling Approaches In Multiple Sclerosis

2017 ◽  
Vol 33 (S1) ◽  
pp. 194-195
Author(s):  
Paolo Cortesi ◽  
Nilhan Uzman ◽  
Matteo Ferrario ◽  
Lorenzo Giovanni Mantovani
Keyword(s):  
Multiple Sclerosis ◽  
Cost Effectiveness ◽  
Natural History ◽  
Analytical Model ◽  
Treatment Option ◽  
Analytical Models ◽  
Good Tool ◽  
Health States ◽  
Expert Opinions ◽  
Decision Analytical Model

INTRODUCTION:In the past decades the cost-effectiveness of new effective disease-modifying therapies (DMTs) for Relapsing Remitting Multiple Sclerosis (RRMS) form was assessed through decision analytical models. Recently, new treatment option for the Primary Progressive (PPMS) form was developed. Aim of this work was assessing the similarities and differences of PPMS and RRMS and their impact in the development of decision analytical model for PPMS.METHODS:Literature review was performed to retrieve information on natural history of PPMS and RRMS and impact of DMTs agents on the progression of these conditions. Further, a review of the published cost-effectiveness models for RRMS was performed. Based on these data, an analysis on the difference and similarities between the two MS forms that could have an impact on the development of decision analytical model for PPMS was performed.RESULTS:Based on the analysis, similar structure model used for RRMS could be applied for PPMS. Health states of the model could be based on Expanded Disability Status Scale score as already done for RRMS. The relapse events considered for RRMS should not be included in PPMS model, and no possibility to develop another form, as the Secondary Progressive, should be included. While RRMS models should include at least a second line treatment option due to alternative DMTs available, only first treatment line should be considered for PPMS. Assessing data available to populate the model, poor data on the natural history, utility and cost associated to PPMS were available and assumption or expert opinions will be needed to overcome the lack of robust data.CONCLUSIONS:A decision analytical model for PPMS can use a similar structure used in the models for RRMS. However, more robust data on PPMS and some structural change are needed to provide a good tool to assess cost-effectiveness of DMTS in PPMS.

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