Real-world cost-effectiveness of denosumab for the treatment of postmenopausal osteoporosis in Taiwan

Abstract Summary This study assessed the cost-effectiveness of continued denosumab treatment, compared with discontinuation of denosumab after one dose, for the treatment of postmenopausal osteoporosis in Taiwan, using real-world fracture reduction effectiveness and cost data. Outcomes indicate that continued denosumab treatment produces an incremental cost-effectiveness ratio of USD $16,743 per QALY. Purpose To evaluate the cost-effectiveness of continued denosumab use versus discontinuation after one dose, for the treatment of postmenopausal osteoporosis in Taiwan, using real-world fracture reduction effectiveness and cost data. Methods A Markov cohort model was used to evaluate the lifetime costs and QALYs associated with continued denosumab treatment versus discontinuation of treatment after one dose. The evaluation was conducted from the perspective of Taiwan’s healthcare system and used a discount rate of 3% per annum. The patient population consisted of postmenopausal women with osteoporosis with a mean age of 77 years who initiated denosumab treatment. Fracture reduction effectiveness data, baseline fracture rates, mortality data, and costs of fracture were informed by Taiwan’s National Health Insurance Research Database. Results Model outcomes showed that continued treatment with denosumab produced an expected gain of 0.042 QALYs and an incremental cost of USD $704, compared with discontinuation of denosumab after one dose. This corresponds to an incremental cost-effectiveness ratio of USD $16,743 per QALY gained. Probabilistic and scenario analysis showed that results are stable to variations in model assumptions and parameters. Conclusion In a real-world setting, at a cost per QALY threshold equivalent to gross domestic product per capita in 2020 in Taiwan (USD $30,038), continued treatment with denosumab in postmenopausal women with osteoporosis is cost-effective compared with treatment discontinuation.

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Dacomitinib in first-line treatment of advanced EGFR-mutated non-small-cell lung cancer: a cost–effectiveness analysis

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2020-0233 ◽

2021 ◽

Author(s):

Javier Aguilar-Serra ◽

Vicente Gimeno-Ballester ◽

Alfonso Pastor-Clerigues ◽

Javier Milara ◽

Ezequiel Marti-Bonmati ◽

...

Keyword(s):

Cost Effectiveness ◽

Incremental Cost ◽

Quality Adjusted Life Year ◽

Incremental Cost Effectiveness Ratio ◽

Line Treatment ◽

Cost Effectiveness Ratio ◽

First Line ◽

Estimate Quality ◽

The Cost ◽

First Line Treatment

Aim: To assess the cost–effectiveness of first-line treatment with dacomitinib compared with gefitinib in patients newly diagnosed with advanced NSCLC EGFR-positive in the context of Spain. Materials & methods: A partitioned survival model was developed including costs, utilities and disutilities to estimate quality-adjusted life-year (QALY) and incremental cost–effectiveness ratio when treating with dacomitinib versus gefitinib. Results: Dacomitinib presented higher QALYs (0.51) compared with gefitinib (0.45). Dacomitinib costs were €33,061 in comparison with €26,692 for gefitinib arm. An incremental cost–effectiveness ratio of €111,048 was obtained for dacomitinib. Conclusion: Dacomitinib was more effective in terms of QALYs gained than gefitinib. However, to obtain a cost–effectiveness alternative, a discount greater than 25% in dacomitinib acquisition cost is required.

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Societal and Economic Effect of Meniscus Scaffold Procedures for Irreparable Meniscus Injuries

The American Journal of Sports Medicine ◽

10.1177/0363546516639290 ◽

2016 ◽

Vol 44 (7) ◽

pp. 1724-1734 ◽

Cited By ~ 6

Author(s):

Jan J. Rongen ◽

Tim M. Govers ◽

Pieter Buma ◽

Janneke P.C. Grutters ◽

Gerjon Hannink

Keyword(s):

Cost Effectiveness ◽

Willingness To Pay ◽

Incremental Cost ◽

Medial Meniscus ◽

Relative Risk Reduction ◽

Cost Effective ◽

Incremental Cost Effectiveness Ratio ◽

Cost Effectiveness Ratio ◽

The Cost ◽

Meniscus Scaffolds

Background: Meniscus scaffolds are currently evaluated clinically for their efficacy in preventing the development of osteoarthritis as well as for their efficacy in treating patients with chronic symptoms. Procedural costs, therapeutic consequences, clinical efficacy, and future events should all be considered to maximize the monetary value of this intervention. Purpose: To examine the socioeconomic effect of treating patients with irreparable medial meniscus injuries with a meniscus scaffold. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: Two Markov simulation models for patients with an irreparable medial meniscus injury were developed. Model 1 was used to investigate the lifetime cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by the possibility of preventing the development of osteoarthritis. Model 2 was used to investigate the short-term (5-year) cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by alleviating clinical symptoms, specifically in chronic patients with previous meniscus surgery. For both models, probabilistic Monte Carlo simulations were applied. Treatment effectiveness was expressed as quality-adjusted life-years (QALYs), while costs (estimated in euros) were assessed from a societal perspective. We assumed €20,000 as a reference value for the willingness to pay per QALY. Next, comprehensive sensitivity analyses were performed to identify the most influential variables on the cost-effectiveness of meniscus scaffolds. Results: Model 1 demonstrated an incremental cost-effectiveness ratio of a meniscus scaffold treatment of €54,463 per QALY (€5991/0.112). A threshold analysis demonstrated that a meniscus scaffold should offer a relative risk reduction of at least 0.34 to become cost-effective, assuming a willingness to pay of €20,000. Decreasing the costs of the meniscus scaffold procedure by 33% (€10,160 instead of €15,233; an absolute change of €5073) resulted in an incremental cost-effectiveness ratio of €7876 per QALY. Model 2 demonstrated an incremental cost-effectiveness ratio of a meniscus scaffold treatment of €297,727 per QALY (€9825/0.033). On the basis of the current efficacy data, a meniscus scaffold provides a relative risk reduction of “limited benefit” postoperatively of 0.37 compared with standard treatment. A threshold analysis revealed that assuming a willingness to pay of €20,000, a meniscus scaffold would not be cost-effective within a period of 5 years. Most influential variables on the cost-effectiveness of meniscus scaffolds were the cost of the scaffold procedure, cost associated with osteoarthritis, and quality of life before and after the scaffold procedure. Conclusion: Results of the current health technology assessment emphasize that the monetary value of meniscus scaffold procedures is very much dependent on a number of influential variables. Therefore, before implementing the technology in the health care system, it is important to critically assess these variables in a relevant context. The models can be improved as additional clinical data regarding the efficacy of the meniscus scaffold become available.

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Evaluation of an Alternative Learning System for Youths at Risk of Involvement in Urban Violence in Bagong Silang, Manila, Philippines - Outcome Analysis, Cost-Analysis, and Economic Evaluation.

10.21203/rs.3.rs-137753/v1 ◽

2020 ◽

Author(s):

Nishant Mehra ◽

Shr-Jie Wang ◽

Juancho Reyes ◽

Mette Mohl Ambjornsen ◽

Johan Jarl

Keyword(s):

Cost Effectiveness ◽

Young People ◽

Incremental Cost ◽

Service Provider ◽

Incremental Cost Effectiveness Ratio ◽

Learning System ◽

Cost Effectiveness Ratio ◽

Alternative Learning ◽

The Cost ◽

Out Of School

Abstract Background: Globally, violence disproportionately affects young people, leading to injury, hospitalisation, death, social dysfunction, and poor mental wellbeing. Moreover, it has far-reaching economic consequences for whole nations, due to loss of productivity. Research suggests that attaining a higher level of education promotes factors which insulate youths from poverty and violence. Purpose: In this study we investigated the outcomes, the cost, and the efficiency of a non-formal education program with an additional psychosocial component. The short-term outcome measure was an increase in educational attainment, a crucial step for youth empowerment. The program analysed was the Alternative Learning System (ALS) offered by the Balay Rehabiliation Centre in Bagong Silang, an urban slum in Manila, which targeted out of school youth. Methods: The cost-effectiveness analysis of ALS compared to a ‘do nothing approach’ was performed from the perspective of the service provider. The study sample comprised 239 learners who were enrolled in the ALS during 2015-2018. For the comparator ‘do nothing approach’, a counterfactual scenario was hypothesised. The average cost of the intervention per enrolled learner, and the incremental cost effectiveness ratio (ICER) for passing the Accreditation and Evaluation (A&E) exam at elementary or secondary level, were calculated. Results: The ALS intervention studied resulted in 41%(n=97) of the learners passing the examination over a period of four years (from 2015 – 2018). The estimated total cost of the intervention was $371,110, corresponding to $1,550 per enrolled learner. The incremental cost-effectiveness ratio for a pass in the exam was found to be $3,830. Compared to other alternative learning interventions, the ALS intervention as used in Bagong Silang was found to be more cost-effective.Conclusion: From the service provider perspective, the ALS for out-of-school young people was found to be a valuable investment to benefit poor young people living in slums in Manila.

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Economic evaluation of sacubitril/valsartan versus enalapril in the treatment of heart failure with reduced ejection fraction

10.21203/rs.3.rs-21177/v1 ◽

2020 ◽

Author(s):

Haiqiang SANG ◽

Yaohui JIANG ◽

Zhe WANG ◽

Rujie ZHENG

Keyword(s):

Heart Failure ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Ejection Fraction ◽

Incremental Cost ◽

Cost Effective ◽

Incremental Cost Effectiveness Ratio ◽

Cost Effectiveness Ratio ◽

Reduced Ejection Fraction ◽

The Cost

Abstract Background: In 2020, sacubitril/valsartan(formerly LCZ696) will implement the new negotiated price of medical insurance in China, and the cost of treatment will be significantly reduced. The aim of study is to evaluate the economy of sacubitril/valsartan(SAC/VAL) compared with an angiotensin converting enzyme inhibitor (ACEI) (enalapril) in the treatment of heart failure with reduced ejection fraction (HFrEF) in China.Method: A Markov model was developed to project clinical and economic outcomes of SAC/VAL versus enalapril for 64-year-old patients with HFrEF over 10 years from the Chinese medical and health system perspective. A cost-utility analysis was performed mostly based on data from the PARADIGM trial. Other transition probability, costs, and utilities were obtained from published literature and public databases. The primary outcome were total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for SAC/VAL relative to enalapril. The model was verified the uncertainty using the sensitivity analysis furtherly.Results: Compared with enalapril, SAC/VAL cost more than enalapril (¥96532 vs. ¥34560) and was more cost-effective (4.6 QALYs vs. 4.3 QALYs), resulting in an incremental cost-effectiveness ratio of ¥185720 per QALY gained for patients with HFrEF at a WTP threshold of ¥212676 per QALY. Sensitivity analysis demonstrated the robustness of the model, identifying the death on the SAC/VAL group as a significant drivers of the cost-effectiveness. At the national negotiation price (¥9.95 per 100mg), probability of SAC/VAL being cost-effective was about 53% at a WTP threshold of ¥212676 per QALY.Conclusion: SAC/VAL was associated with clinical benefit and may be cost-effective compared with an ACEI (the current standard of care) in patients with HFrEF.

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Cost-effectiveness and safety of ramucirumab plus paclitaxel chemotherapy in the treatment of advanced and recurrent gastric cancer

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155217707335 ◽

2017 ◽

Vol 24 (6) ◽

pp. 403-411

Author(s):

Michio Kimura ◽

Eiseki Usami ◽

Hitomi Teramachi ◽

Tomoaki Yoshimura

Keyword(s):

Gastric Cancer ◽

Cost Effectiveness ◽

Incremental Cost ◽

Clinical Information ◽

Cost Effective ◽

Incremental Cost Effectiveness Ratio ◽

Cost Effectiveness Ratio ◽

Chemotherapy Agent ◽

Recurrent Gastric Cancer ◽

The Cost

Introduction Weekly paclitaxel (PTX), irinotecan (CPT-11) and ramucirumab plus paclitaxel (Ram + PTX) are currently recommended as the standard second-line or later chemotherapies for advanced and recurrent gastric cancer. This study aims to compare the cost-effectiveness of using Ram + PTX vs. PTX or CPT-11. Furthermore, we investigated the safety and treatment continuity of Ram + PTX in Japan. Methods Expected costs were calculated based on data from patients with advanced and recurrent gastric cancer who were treated with PTX, CPT-11 and Ram + PTX. A literature review was performed to obtain clinical information so that the probability of the efficacy of each chemotherapy could be calculated. The cost-effectiveness ratio of each chemotherapy agent was calculated by dividing the expected cost by the median survival time (MST). Results The cost-effectiveness ratio per month was JPY 85,395.8/MST for the PTX regimen, JPY 132,735.4/MST for the CPT-11 regimen and JPY 657,175.4/MST for the Ram + PTX regimen (p < 0.001). The incremental cost-effectiveness ratio per month of the Ram + PTX regimen to the PTX regimen was JPY 2,780,432.4/MST. The incremental cost-effectiveness ratio of the Ram + PTX regimen to the CPT-11 regimen was JPY 2,185,179.0/MST. With regard to the reasons for discontinuation of treatment, the Ram + PTX regimen had only one case of being discontinued owing to adverse events, and had a profile similar to that of the PTX and CPT-11 regimens. Conclusion These findings show that the Ram + PTX regimen is less cost-effective compared to both the PTX and CPT-11 regimen, but the Ram + PTX regimen is a well-tolerated regimen with sufficient efficacy.

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Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina

Cadernos de Saúde Pública ◽

10.1590/0102-311x00172512 ◽

2013 ◽

Vol 29 (12) ◽

pp. 2459-2472 ◽

Cited By ~ 8

Author(s):

Pablo Wenceslao Orellano ◽

Nestor Vazquez ◽

Oscar Daniel Salomon

Keyword(s):

Cost Effectiveness ◽

Early Diagnosis ◽

Incremental Cost ◽

Cost Effective ◽

Incremental Cost Effectiveness Ratio ◽

Sensitivity Analyses ◽

Cost Effectiveness Ratio ◽

Tegumentary Leishmaniasis ◽

Life Years ◽

The Cost

The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.

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Costs and Cost-Effectiveness of a Low-Intensity Patient-Directed Intervention to Promote Colorectal Cancer Screening

Journal of Clinical Oncology ◽

10.1200/jco.2007.13.4098 ◽

2007 ◽

Vol 25 (33) ◽

pp. 5248-5253 ◽

Cited By ~ 25

Author(s):

Veena Shankaran ◽

June M. McKoy ◽

Neal Dandade ◽

Narissa Nonzee ◽

Cara A. Tigue ◽

...

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Cancer Screening ◽

Incremental Cost ◽

Incremental Cost Effectiveness Ratio ◽

Screening Colonoscopy ◽

Cost Effectiveness Ratio ◽

Crc Screening ◽

Low Intensity ◽

The Cost

Purpose Colorectal cancer (CRC) screening is the most underused evidence-based cancer screening test in the United States. Few studies have reported the cost-effectiveness of CRC screening promotional efforts. In a recent randomized controlled trial, a patient-directed intervention for average-risk patients who had been referred for screening colonoscopy led to a 12% increase in CRC screening rates. The objective of this secondary analysis is to assess the cost-effectiveness of this intervention. Patients and Methods Patients in the intervention arm received a customized mailed brochure that included a reminder to schedule a screening colonoscopy and general information about CRC, the importance of CRC screening, and how to prepare for the procedure. The end point was completion of screening colonoscopy. The costs and incremental cost-effectiveness ratio of this patient-directed intervention were derived. Sensitivity analyses were based on varying the costs of labor and supplies. Results Rates of CRC screening for the intervention (n = 386 patients) versus control (n = 395) arms were 71% and 59%, respectively (P = .001). The total cost of the intervention was $1,927 and the incremental cost-effectiveness ratio was $43 per additional patient screened ($38 to $47 in a sensitivity analysis). Conclusion An intervention based on mailing a customized brochure to patients who were referred for a screening colonoscopy improved CRC screening rates at a university-based general medicine clinic. This intervention was comparable in effectiveness and cost-effectiveness to a similar recently reported low-intensity patient-directed CRC screening intervention, and markedly more affordable and cost-effective than a previously reported physician-directed CRC screening promotion intervention.

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Newborn Screening and Treatment of Phenylketonuria: Projected Health Outcomes and Cost-Effectiveness

Children ◽

10.3390/children8050381 ◽

2021 ◽

Vol 8 (5) ◽

pp. 381

Author(s):

Huey-Fen Chen ◽

Angela M Rose ◽

Susan Waisbren ◽

Ayesha Ahmad ◽

Lisa A Prosser

Keyword(s):

Cost Effectiveness ◽

Newborn Screening ◽

Incremental Cost ◽

Incremental Cost Effectiveness Ratio ◽

Primary Data ◽

Computer Simulation Model ◽

Cost Effectiveness Ratio ◽

Sapropterin Dihydrochloride ◽

Diet Treatment ◽

The Cost

The objective of this study was to evaluate the cost-effectiveness of newborn screening and treatment for phenylketonuria (PKU) in the context of new data on adherence to recommended diet treatment and a newly available drug treatment (sapropterin dihydrochloride). A computer simulation model was developed to project outcomes for a hypothetical cohort of newborns with PKU. Four strategies were compared: (1) clinical identification (CI) with diet treatment; (2) newborn screening (NBS) with diet treatment; (3) CI with diet and medication (sapropterin dihydrochloride); and (4) NBS with diet and medication. Data sources included published literature, primary data, and expert opinion. From a societal perspective, newborn screening with diet treatment had an incremental cost-effectiveness ratio of $6400/QALY compared to clinical identification with diet treatment. Adding medication to NBS with diet treatment resulted in an incremental cost-effectiveness ratio of more than $16,000,000/QALY. Uncertainty analyses did not substantially alter the cost-effectiveness results. Newborn screening for PKU with diet treatment yields a cost-effectiveness ratio lower than many other recommended childhood prevention programs even if adherence is lower than previously assumed. Adding medication yields cost-effectiveness results unlikely to be considered favorable. Future research should consider conditions under which sapropterin dihydrochloride would be more economically attractive.

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Cost-effectiveness of a mobile phone-based support intervention to increase uptake of post-abortion family planning in Cambodia (Preprint)

10.2196/preprints.16276 ◽

2019 ◽

Author(s):

Jeremy Hill ◽

Jourdan McGinn ◽

John Cairns ◽

Caroline Free ◽

Chris Smith

Keyword(s):

Cost Effectiveness ◽

Family Planning ◽

Incremental Cost ◽

Mobile Phone ◽

Mobile Technology ◽

Incremental Cost Effectiveness Ratio ◽

Cost Effectiveness Ratio ◽

Disability Adjusted Life ◽

Post Abortion ◽

The Cost

BACKGROUND Despite progress over the last decade, there is a continuing unmet need for contraception in Cambodia. Interventions delivered by mobile phone could help increase uptake and continuation of contraception, particularly amongst hard-to-reach populations, by providing interactive, personalised support inexpensively wherever the person is located and whenever needed. OBJECTIVE The objective of this study was to evaluate the cost-effectiveness of mobile phone-based support added to standard post-abortion family planning care in Cambodia, based on results of the MObile Technology for Improved Family Planning (MOTIF) trial. METHODS A model was created to estimate the costs and effects of the intervention versus standard care. We adopted a societal perspective when estimating costs, including direct and indirect costs for users. The incremental cost-effectiveness ratio was calculated for the base case, as well as a deterministic and probabilistic sensitivity analysis, which we compared against a range of likely cost-effectiveness thresholds. RESULTS The incremental cost of mobile phone-based support was estimated to be an additional $8,160.49 per 1000 clients, leading to an estimated 518 couple-years of protection gained per 1,000 clients and 99 disability adjusted life years averted. The Incremental Cost-Effectiveness Ratio (ICER) was $15.75 per additional Couple Year of Protection (CYP) and $82.57 per Disability Adjusted Life Year (DALY) averted. The model was most sensitive to personnel and mobile service costs. Assuming a range of cost-effectiveness thresholds of $58 to $176 for Cambodia, the probability of the intervention being cost-effective ranged from 11% to 95%. CONCLUSIONS This study demonstrates that the cost-effectiveness of the intervention delivered by mobile phone studied in the MOTIF trial lies within the estimated range of cost-effectiveness thresholds for Cambodia. When assessing value in interventions to improve the uptake and adherence to family planning services, the use of interactive mobile phone messaging and counselling for women who have had an abortion should be considered as an option to policy makers. CLINICALTRIAL This study is a cost-effectiveness analysis of the intervention evaluated in the Mobile Technology for Improved Family Planning (MOTIF) trial: ClinicalTrials.gov NCT01823861.

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Evaluation of an Alternative Learning System for youths at risk of involvement in urban violence in the Philippines

Cost Effectiveness and Resource Allocation ◽

10.1186/s12962-021-00320-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Nishant Mehra ◽

Shr-Jie Sharlenna Wang ◽

Juancho Reyes ◽

Mette Møhl Ambjørnsen ◽

Johan Jarl

Keyword(s):

Cost Effectiveness ◽

Young People ◽

Incremental Cost ◽

Service Provider ◽

Incremental Cost Effectiveness Ratio ◽

Learning System ◽

Cost Effectiveness Ratio ◽

Alternative Learning ◽

The Cost ◽

Out Of School

Abstract Background Globally, violence disproportionately affects young people, leading to injury, hospitalisation, death, social dysfunction, and poor mental wellbeing. Moreover, it has far-reaching economic consequences for whole nations, due to loss of productivity. Research suggests that attaining a higher level of education promotes factors that insulate youths from poverty and violence. Purpose In this study, we investigated the outcomes, the cost, and the cost-effectiveness of a non-formal education program with an additional psychosocial component. The short-term outcome measure was an increase in educational attainment, a crucial step for youth empowerment. The program analysed was the Alternative Learning System (ALS) offered by the Balay Rehabiliation Centre in Bagong Silang, an urban slum in Manila, which targeted out of school youth. Methods The cost-effectiveness analysis of ALS compared to a ‘do nothing approach’ was performed from the perspective of the service provider. The study sample comprised 239 learners who were enrolled in the ALS during 2015–2018. For the ‘do nothing’ comparator, a counterfactual scenario was hypothesised. The average cost of the intervention per enrolled learner, and the incremental cost effectiveness ratio (ICER) for passing the Accreditation and Evaluation (A&E) exam at elementary or secondary level, were calculated. Results The ALS intervention studied resulted in 41% (n = 97) of the learners passing the examination over a period of four years (from 2015–2018). The estimated total cost of the intervention was $371,110, corresponding to $1550 per enrolled learner. The incremental cost-effectiveness ratio for a pass in the exam was found to be $3830. Compared to other, international, alternative learning interventions, the ALS intervention as used in Bagong Silang was found to be more cost-effective. Conclusion From the service provider perspective, the ALS for out-of-school young people was found to be a valuable investment to benefit poor young people living in slums in Manila.

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