243: The cost-effectiveness of counseling interventions for young women at-risk of perinatal depression

ObjectivesPre-exposure prophylaxis (PrEP) users are routinely tested four times a year (3 monthly) for asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections on three anatomical locations. Given the high costs of this testing to the PrEP programme, we assessed the impact of 3 monthly screening(current practice), compared with 6 monthly on the disease burden. We quantified the difference in impact of these two testing frequencies on the prevalence of CT and NG among all men who have sex with men (MSM) who are at risk of an STI, and explored the cost-effectiveness of 3-monthly screening compared with a baseline scenario of 6-monthly screening.MethodsA dynamic infection model was developed to simulate the transmission of CT and NG among sexually active MSM (6500 MSM on PrEP and 29 531 MSM not on PrEP), and the impact of two different test frequencies over a 10-year period. The difference in number of averted infections was used to calculate incremental costs and quality-adjusted life-years (QALY) as well as an incremental cost-effectiveness ratio (ICER) from a societal perspective.ResultsCompared with 6-monthly screening, 3-monthly screening of PrEP users for CT and NG cost an additional €46.8 million over a period of 10 years. Both screening frequencies would significantly reduce the prevalence of CT and NG, but 3-monthly screening would avert and extra ~18 250 CT and NG infections compared with 6-monthly screening, resulting in a gain of ~81 QALYs. The corresponding ICER was ~€430 000 per QALY gained, which exceeded the cost-effectiveness threshold of €20 000 per QALY.ConclusionsThree-monthly screening for CT and NG among MSM on PrEP is not cost-effective compared with 6-monthly screening. The ICER becomes more favourable when a smaller fraction of all MSM at risk for an STI are screened. Reducing the screening frequency could be considered when the PrEP programme is established and the prevalence of CT and NG decline.

Download Full-text

Design of a trial-based economic evaluation on the cost-effectiveness of employability interventions among work disabled employees or employees at risk of work disability: The CASE-study

BMC Public Health ◽

10.1186/1471-2458-12-43 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 6

Author(s):

Cindy YG Noben ◽

Frans JN Nijhuis ◽

Angelique E de Rijk ◽

Silvia MAA Evers

Keyword(s):

At Risk ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Work Disability ◽

Disabled Employees ◽

The Cost

Download Full-text

The Cost-Effectiveness of a Chlamydia Trachomatis Vaccination Program in Young Women in the United States

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2016.12.143 ◽

2017 ◽

Vol 139 (2) ◽

pp. AB58

Author(s):

Jared Ditkowsky ◽

Afsana Rahman ◽

Margaret Hammerschlag ◽

Stephan Kohlhoff ◽

Tamar A. Smith-Norowitz

Keyword(s):

United States ◽

Cost Effectiveness ◽

Chlamydia Trachomatis ◽

Young Women ◽

The United States ◽

Vaccination Program ◽

The Cost

Download Full-text

PIN64 Assessing the Cost-Effectiveness (CE) of Vaccinating the Elderly and at-Risk Adults With the 23-Valent Pneumococcal Polysaccharide Vaccine (PPV23) Compared to the 13-Valent Pneumococcal Conjugate Vaccine (PCV13) or no Vaccination (NoVac) in the UK

Value in Health ◽

10.1016/j.jval.2012.08.1131 ◽

2012 ◽

Vol 15 (7) ◽

pp. A396-A397 ◽

Cited By ~ 1

Author(s):

Y. Jiang ◽

A. Gauthier ◽

S.T. Keeping ◽

S.M. Carroll

Keyword(s):

At Risk ◽

Cost Effectiveness ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

The Elderly ◽

Polysaccharide Vaccine ◽

Pneumococcal Polysaccharide Vaccine ◽

The Uk ◽

The Cost

Download Full-text

Cost-effectiveness analysis and budget impact of rivaroxaban compared with dalteparin in patients with cancer at risk of recurrent venous thromboembolism

BMJ Open ◽

10.1136/bmjopen-2020-039057 ◽

2020 ◽

Vol 10 (11) ◽

pp. e039057

Author(s):

Lisa A de Jong ◽

Annette W G van der Velden ◽

Marinus van Hulst ◽

Maarten J Postma

Keyword(s):

At Risk ◽

Venous Thromboembolism ◽

Cost Effectiveness ◽

Cost Saving ◽

Cancer Patients ◽

Time Horizon ◽

Budget Impact ◽

Patients With Cancer ◽

Effectiveness Analysis ◽

The Cost

ObjectivesIn the ‘Comparison of an Oral Factor Xa Inhibitor With Low Molecular Weight Heparin in Patients With Cancer With Venous Thromboembolism’ (SELECT-D) trial, rivaroxaban showed relatively low venous thromboembolism (VTE) recurrence but higher bleeding compared with dalteparin in patients with cancer. We aim to calculate the cost-effectiveness and budget impact of rivaroxaban compared with dalteparin in patients with cancer at risk of recurrent VTE.SettingWe built a Markov model to calculate the cost-effectiveness from a societal perspective over a 5-year time horizon for the Dutch healthcare setting.ParticipantsA hypothetical cohort of 1000 cancer patients with VTE entered the model with baseline characteristics based on the SELECT-D trial.InterventionSix months of treatment with rivaroxaban (15 mg two times per day for first 3 weeks followed by 20 mg once daily) was compared with 6 months of treatment with dalteparin (200 IU/kg daily during month 1 followed by 150 IU/kg daily).Primary and secondary outcome measuresThe primary outcome of the cost-effectiveness analysis was the incremental cost-effectiveness ratio (ICER). The robustness of the model was evaluated in probabilistic and univariate sensitivity analyses. A budget impact analysis was performed to calculate the total annual financial consequences for a societal perspective in the Netherlands.ResultsIn the base case and all scenarios, rivaroxaban were cost-saving while also slightly improving the patient’s health, resulting in economically dominant ICERs. In the probabilistic sensitivity analysis, 77.8% and 98.7% of the simulations showed rivaroxaban to be cost-saving and more effective for a 5-year and 6-month time horizon, respectively. Rivaroxaban can save up to €11 326 763 (CI €5 164 254 to €17 363 231) in approximately 8000 cancer patients with VTE per year compared with dalteparin based on a 1-year time horizon.ConclusionsTreatment with rivaroxaban is economically dominant over dalteparin in patients with cancer at risk for recurrent VTE in the Netherlands. The use of rivaroxaban instead of dalteparin can save over €10 million per year, primarily driven by the difference in drug costs.

Download Full-text

Cost of pre-exposure prophylaxis delivery in family planning clinics to prevent HIV acquisition among adolescent girls and young women in Kisumu, Kenya

PLoS ONE ◽

10.1371/journal.pone.0249625 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249625

Author(s):

Valentine Wanga ◽

Kathryn Peebles ◽

Alfred Obiero ◽

Felix Mogaka ◽

Victor Omollo ◽

...

Keyword(s):

Cost Effectiveness ◽

Family Planning ◽

Adolescent Girls ◽

Young Women ◽

Average Cost ◽

Budget Impact ◽

Prep Implementation ◽

Exposure Prophylaxis ◽

The Cost

Introduction Oral pre-exposure prophylaxis (PrEP) is increasingly being implemented in sub-Saharan Africa. Adolescent girls and young women (AGYW) in Kenya contribute more than half of all new infections among young people aged 15–24 years, highlighting the need for evidence on the cost of PrEP in real-world implementation to inform the budget impact, cost-effectiveness, and financial sustainability of PrEP programs. Methods We estimated the cost of delivering PrEP to AGYW enrolled in a PrEP implementation study in two family planning clinics in Kisumu county, located in western Kenya. We derived total annual costs and the average cost per client-month of PrEP by input type (variable or fixed) and visit type (initiation or follow-up). We estimated all costs as implemented in the study, and under implementation by the Kenyan Ministry of Health (MoH), both at the program volume observed and if the facilities were delivering PrEP at full capacity (scaled-MoH). Results For the costing period between March 2018 and March 2019, 615 HIV-negative women contributed 1,128 (502 initiation and 626 follow-up) visits. The average cost per client-month of PrEP dispensed per study protocol and per the MoH scenario was $28.92 and $14.52, respectively. If the MoH scaled the program so that facilities could see PrEP clients at capacity, the average cost per client-month of PrEP was $10.88. Medication costs accounted for the largest proportion of the total annual costs (48% in MoH scenario and 65% in the scaled-MoH scenario). Conclusions Using data from a PrEP implementation program, we found that the cost per client-month of PrEP dispensed is reduced by 62% if PrEP delivery at the two clinics is scaled up by the MoH. Our findings are valuable for informing local resource allocation and budgetary cost projections for scale-up of PrEP delivery to AGYW. Additionally, previous cost-effectiveness studies have been limited by the use of fixed assumptions of the cost of PrEP per person-month. Our study provides cost estimates from practical data which will better inform cost-effectiveness and budget impact analyses.

Download Full-text