The Cost, Quality of Life Impact, and Cost–Utility of Bariatric Surgery in a Managed Care Population

Background: The purpose of this project was to evaluate both health-related quality of life (HRQoL) and cost-utility associated with care for employees with musculoskeletal disorders who received vocational physiotherapy at a North London National Health Service (NHS) Foundation Trust in the United Kingdom. Methods: A pre- and post-physiotherapy EuroQol 5 Dimension (EQ-5D) questionnaire was administered to employees presenting to the vocational physiotherapy service (VPS) with musculoskeletal disorders. The cost-utility analysis of the physiotherapy service was calculated using cost data provided by VPS billing information and benefits measured using Quality-Adjusted Life Years (QALYs). Findings: Overall, there was a significant improvement in the EQ-5D index from baseline to discharge in all HRQoL domains. The visual analog scale (VAS) improved from a mean of 31.5 (SD = 18.3) at baseline to 73.2 (SD = 18.5) at discharge. A cost-utility analysis indicated that the VPS would continue to be cost-effective until the cost per employee increased by 82.5%. Conclusion/Application to Practice: The project supports integration of vocational physiotherapy services into an occupational health department.

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Economic evaluation of online computerised cognitive–behavioural therapy without support for depression in primary care: randomised trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.065748 ◽

2010 ◽

Vol 196 (4) ◽

pp. 310-318 ◽

Cited By ~ 89

Author(s):

S. A. H. Gerhards ◽

L. E. de Graaf ◽

L. E. Jacobs ◽

J. L. Severens ◽

M. J. H. Huibers ◽

...

Keyword(s):

Quality Of Life ◽

Cost Effectiveness ◽

Cognitive Behavioural Therapy ◽

Behavioural Therapy ◽

Cost Utility ◽

Significant Group ◽

Efficient Treatment ◽

Cognitive Behavioural ◽

The Cost

BackgroundEvidence about the cost-effectiveness and cost utility of computerised cognitive–behavioural therapy (CCBT) is still limited. Recently, we compared the clinical effectiveness of unsupported, online CCBT with treatment as usual (TAU) and a combination of CCBT and TAU (CCBT plus TAU) for depression. The study is registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236).AimsTo assess the cost-effectiveness of CCBT compared with TAU and CCBT plus TAU.MethodCosts, depression severity and quality of life were measured for 12 months. Cost-effectiveness and cost-utility analyses were performed from a societal perspective. Uncertainty was dealt with by bootstrap replications and sensitivity analyses.ResultsCosts were lowest for the CCBT group. There are no significant group differences in effectiveness or quality of life. Cost-utility and cost-effectiveness analyses tend to be in favour of CCBT.ConclusionsOn balance, CCBT constitutes the most efficient treatment strategy, although all treatments showed low adherence rates and modest improvements in depression and quality of life.

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Cost-Utility Analysis of Percutaneous and Surgery Methods in Extraction of Cardiac Leads Infection

10.21203/rs.3.rs-809065/v1 ◽

2021 ◽

Author(s):

zinab shaker ◽

Mohsen Barooni ◽

Asma Saber Mahani ◽

Zohreh Shaker

Keyword(s):

Quality Of Life ◽

Cardiovascular Diseases ◽

Cost Utility ◽

Utility Analysis ◽

Cross Sectional ◽

Life Score ◽

Pacemaker Leads ◽

The Cost ◽

Surgical Cost

Abstract Introduction: Cardiovascular diseases are currently major concern in the world and It is expected that Until 2030, 7 out of 10 deaths in world will be related to cardiovascular diseases. Despite the increase in Pasemaker and ICD implants in recent years, the complications of this devices are increasing. One of the most important complications is the pulsating lead infection. The purpose of this study was to analyze the cost-effectiveness of percutaneous and surgical method in extracting pacemaker leads with Qaly index.Methods: In this cross-sectional article (descriptive-analytical) using the Markov model, for compare the two methods of percutaneous and surgery for infectious lead. Sampling was census and ( sample size for percutaneous included 57 people) and information about utility was extracted by the SAQ questionnaire. A systematic review was performed to calculate utility of the surgical Cost from the perspective of the service provider. data analysis by SPSS software, and TreeAge software was used for Markov modeland and sensitivity analysis .Results: Changes in quality of life score in both intervention were incremental and significant and intervention is the only effective factor in changes in quality of life score (P <0.05). The ICER was 5470.44$.Conclusion: The results of the study show that utility and cost of surgery are higher than the percutaneous method.Sensitivity analysis shows If the cost of surgery increases more than 806.52$ (discount rate of 0.06), the percutaneous method dominates the surgery method.

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The cost and quality of life impact of glaucoma in Tanzania: An observational study

PLoS ONE ◽

10.1371/journal.pone.0232796 ◽

2020 ◽

Vol 15 (6) ◽

pp. e0232796

Author(s):

Ian Murdoch ◽

Andrew F. Smith ◽

Helen Baker ◽

Bernadetha Shilio ◽

Kazim Dhalla

Keyword(s):

Quality Of Life ◽

Observational Study ◽

Life Impact ◽

The Cost

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Comparison of Hemodialysis and Peritoneal Dialysis — a Cost–Utility Analysis

Peritoneal Dialysis International ◽

10.1177/089686080202200107 ◽

2002 ◽

Vol 22 (1) ◽

pp. 39-47 ◽

Cited By ~ 75

Author(s):

Karin Sennfält ◽

Martin Magnusson ◽

Per Carlsson

Keyword(s):

Quality Of Life ◽

Health Care ◽

Peritoneal Dialysis ◽

Kidney Failure ◽

Quality Adjusted Life Year ◽

Cost Utility ◽

Age Group ◽

The Cost ◽

Quality Adjusted Life

Objective Our aim was to compare both health-related quality of life and costs for hemodialysis (HD) and peritoneal dialysis (PD) in a defined population. Design Decision-tree modeling to estimate total costs and effects for two treatment strategies, HD and PD, among patients with chronic kidney failure, for 5 years following the start of treatment. Courses of events and health-care consumption were mapped in a retrospective matched-record study. Data on health status were obtained from a matched population by a quality-of-life questionnaire (EuroQol). The study has a societal perspective. Setting All dialysis departments in the southeastern health-care region of Sweden. Patients 136 patients with kidney failure, comprising 68 matched pairs, were included in a retrospective record study; 81 patients with kidney failure, comprising 27 matched triplets, were included in a prospective questionnaire study. Main Outcome Measures Cost per life year and cost per quality-adjusted life year. Results The cost per quality-adjusted life year for PD was lower in all analyzed age groups. There was a 12% difference in the age group 21 – 40 years, a 31% difference in the age group 41 – 60 years, and an 11% difference in the age group 61+ years. Peritoneal dialysis and HD resulted in similar frequencies of transplantation (50% and 41%, respectively) and expected survival (3.58 years and 3.56 years, respectively) during the first 5 years after the initiation of treatment. Conclusion The cost–utility ratio is most favorable for PD as the primary method of treatment for patients eligible for both PD and HD.

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Economic Decision Model for First-Time Traumatic Patellar Dislocations in Adolescents

The American Journal of Sports Medicine ◽

10.1177/0363546517703347 ◽

2017 ◽

Vol 45 (10) ◽

pp. 2267-2275 ◽

Cited By ~ 11

Author(s):

Benedict U. Nwachukwu ◽

Conan So ◽

William W. Schairer ◽

Beth E. Shubin-Stein ◽

Sabrina M. Strickland ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Treatment ◽

Nonoperative Treatment ◽

Cost Utility ◽

Base Case ◽

Delayed Surgery ◽

Immediate Surgery ◽

The Cost ◽

First Time

Background: The surgical management of traumatic patellar dislocations in adolescents is associated with a lower rate of recurrent dislocations compared with nonoperative care. However, the attendant cost of surgery and the quality-of-life benefit of a surgical treatment strategy are unclear. Purpose: To compare the cost-utility of 3 management strategies for acute first-time patellar dislocations in adolescents: (1) nonoperative treatment only, (2) initial nonoperative treatment with surgery only for recurrent dislocations, and (3) immediate surgery. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: A 10-year state-transition Markov model was constructed to compare the cost-utility of the 3 index treatment protocols. Utilities used to define health states were derived from a telephone interview of 60 adolescents with a history of acute patellar dislocations. The probability of transition between each health state was informed by the available literature. Direct costs were estimated using a statewide ambulatory surgery database, and indirect costs were estimated based on parental lost productivity. Effectiveness was expressed in quality-adjusted life years (QALYs). The principal outcome measure was the incremental cost-effectiveness ratio (ICER). Results: In the base case for our model, nonoperative treatment only was the least costly ($7300) but also the least effective (5.30 QALYs); initial nonoperative treatment with delayed surgery cost $10,500 for a 5.93 QALY benefit, while immediate surgical treatment cost $17,100 and provided 6.32 QALY benefits. Compared with nonoperative treatment only, initial nonoperative treatment with delayed surgery was associated with an ICER of $5100 per QALY. When immediate surgery was compared with a strategy of delayed surgery, immediate surgery provided incremental benefits at an ICER of $17,000 per QALY. The model was sensitive to the probability of surgical versus nonoperative treatment to achieve a full return to preinjury activity versus an intermediate lower state. When the probability of achieving a full return to preinjury activity with initial nonoperative treatment exceeds 47.5% (compared with 34.2% in the base case), then initial nonoperative treatment with delayed surgery is preferred to immediate surgery. Similarly, when the probability of achieving a full return to full preinjury activity with surgery falls below 51% (compared with 64% in the base case), then delayed surgery after initial nonoperative treatment is preferred. Conclusion: Immediate surgery and delayed surgical treatment are both cost-effective treatment options; however, immediate surgical treatment provides the highest QALY gains within a 10-year time horizon. Our model sensitivity analysis highlights the role of optimizing functional and quality-of-life benefits in the treatment of acute traumatic patellar dislocations. These findings have implications for clinical guidelines and policy decisions relating to adolescent patellar dislocations.

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Importance of the Evaluation in the Quality of life in bariatric surgery

Mexican Journal of Medical Research ◽

10.29057/mjmr.v8i15.3960 ◽

2020 ◽

Vol 8 (15) ◽

pp. 3-8

Author(s):

Iracema Islas-Vega ◽

Alfredo García-Alvarado ◽

Juan Roberto González Santamaría

Keyword(s):

Quality Of Life ◽

Bariatric Surgery ◽

Cosmetic Surgery ◽

Cost Benefit ◽

High Rate ◽

Obese Person ◽

Cost Benefit Ratio ◽

The Cost ◽

Metabolic Comorbidities

Obesity is a serious health problem that has increased in recent decades. It is a chronic disease responsible for serious physical, psychological and social problems, reaching to alter the quality of life of people who suffer from it. Bariatric surgery is the best treatment for obesity even in its most severe levels, since in addition to reducing excess weight, it achieves a high rate of improvement and remission of metabolic comorbidities, improving the quality and expectation of life of the operated patients. Within bariatric procedures, laparoscopic gastric bypass and laparoscopic sleeve gastrectomy are the most performed worldwide. Quality of life is defined as, the perception that the obese person has of their physical, psychological, and social limitations and the reduction of opportunities. The success of the surgery consists of changing the quality of life of the patient. The results should not be evaluated only according to the initial loss or late weight gain, complications or sequelae of one or another technique or the subsequent need for cosmetic surgery, but a series of factors derived from the patients themselves should be taken into account, which together define the quality of life and even the cost / benefit ratio.

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Cost-Utility Analysis of Preoperative Radiotherapy in Patients With Rectal Cancer Undergoing Total Mesorectal Excision: A Study of the Dutch Colorectal Cancer Group

Journal of Clinical Oncology ◽

10.1200/jco.2004.04.198 ◽

2004 ◽

Vol 22 (2) ◽

pp. 244-253 ◽

Cited By ~ 70

Author(s):

Mandy van den Brink ◽

Wilbert B. van den Hout ◽

Anne M. Stiggelbout ◽

Elma Klein Kranenbarg ◽

Corrie A.M. Marijnen ◽

...

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Cost Effectiveness ◽

Life Expectancy ◽

Preoperative Radiotherapy ◽

Cost Utility ◽

Cost Effectiveness Ratio ◽

The Cost ◽

Quality Adjusted Life

Purpose To compare the societal costs and the (quality-adjusted) life expectancy of patients with rectal cancer undergoing total mesorectal excision (TME) with or without short-term preoperative radiotherapy (5 × 5 Gy). Patients and Methods We used a Markov model to project the clinical and economic outcomes of preoperative radiotherapy. Data on local recurrence rates, quality of life, and costs were obtained from the patients of a multicenter randomized clinical trial. In this trial, 1,861 patients with resectable rectal cancer from 108 hospitals were randomly assigned for TME surgery with or without preoperative radiotherapy. Outcome measures of the model were life expectancy, quality-adjusted life expectancy, lifetime costs per patient, and the incremental cost-effectiveness ratio. Results The base case model estimates that the loss of quality of life due to preoperative radiotherapy is outweighed by the gain in life expectancy. Life expectancy increases by 0.67 years; quality-adjusted life expectancy, by 0.39 years; and costs, by $9,800 per patient. The corresponding cost-effectiveness ratio is $25,100 per quality-adjusted life year. Sensitivity analyses indicate that the cost-effectiveness ratio remains acceptable under a wide range of assumptions. Conclusion Assuming that the reduced local recurrence rate does lead to a survival advantage, the cost-utility analysis estimates that the improved survival outweighs the impaired quality of life and the increased costs. We conclude that short-term preoperative radiotherapy in patients with rectal cancer undergoing TME is both effective and cost-effective.

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Influence of Patient Preferences on the Cost-Effectiveness of Screening for Lynch Syndrome

Journal of Oncology Practice ◽

10.1200/jop.2011.000535 ◽

2012 ◽

Vol 8 (3S) ◽

pp. e24s-e30s ◽

Cited By ~ 13

Author(s):

Grace Wang ◽

Miriam Kuppermann ◽

Benjamin Kim ◽

Kathryn A. Phillips ◽

Uri Ladabaum

Keyword(s):

Quality Of Life ◽

Colorectal Cancer ◽

Cost Effectiveness ◽

Lynch Syndrome ◽

Patient Preferences ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

The Cost

This cost-utility analysis reports on the effect of quality of life on the value of screening all new patients with colorectal cancer for Lynch syndrome.

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