Modified natural cycle IVF increases value and access to care over traditional IVF for good prognosis patients: a decision analytic model and cost effectiveness analysis

Abstract Introduction Bicuspid aortic valve (BAV) is the commonest congenital heart valve defect, found in 1% to 2% of the general population and associated with life-threatening complications. Given the high heritability index of BAV, many experts recommend echocardiography for first-degree relatives (FDRs) of an index patient. However, the cost-effectiveness of such cascade screening for BAV has not been fully evaluated. Materials and methods Using a decision-analytic model, we performed a cost-effectiveness analysis of echocardiographic screening of FDRs of BAV index cases. Data on BAV probabilities and BAV complications among FDRs were derived from our institution's BAV familial cohort and from the relevant literature on population-based BAV cohorts with long-term follow-up. Health gain was measured as quality-adjusted life years (QALYs). Cost inputs were based on list prices and literature data. One-way and probabilistic sensitivity analyses were performed to account for uncertainty in the model's variables. Results and disscusion Screening of FDRs was found to be the dominant strategy, being more effective and less costly than no screening, with savings of €208 and gains of 1.6 QALYs. Results were sensitive to the full range of reported BAV rates among FDRs across the literature, with the benefit gradually decreasing from the screening age of 55 years, with trend shifting at the age of 69. Conclusions This economic evaluation model revealed that echocardiographic screening of FDRs of BAV index case is not only clinically important but also highly cost effective and cost-saving. Health gains could be achieved from initiating screening program, along with costs saving. Sensitivity analysis supported the model's robustness, suggesting its generalization. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Center for Interdisciplinary Data Science Research fellowships grant

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Cost-effectiveness Analysis in R Using a Multi-state Modeling Survival Analysis Framework: A Tutorial

Medical Decision Making ◽

10.1177/0272989x16651869 ◽

2016 ◽

Vol 37 (4) ◽

pp. 340-352 ◽

Cited By ~ 19

Author(s):

Claire Williams ◽

James D. Lewsey ◽

Andrew H. Briggs ◽

Daniel F. Mackay

Keyword(s):

Cost Effectiveness ◽

Markov Property ◽

R Package ◽

Cost Effectiveness Analysis ◽

Sensitivity Analyses ◽

Survival Models ◽

Decision Analytic Model ◽

Modeling Approach ◽

Effectiveness Analysis ◽

Markov Decision

This tutorial provides a step-by-step guide to performing cost-effectiveness analysis using a multi-state modeling approach. Alongside the tutorial, we provide easy-to-use functions in the statistics package R. We argue that this multi-state modeling approach using a package such as R has advantages over approaches where models are built in a spreadsheet package. In particular, using a syntax-based approach means there is a written record of what was done and the calculations are transparent. Reproducing the analysis is straightforward as the syntax just needs to be run again. The approach can be thought of as an alternative way to build a Markov decision-analytic model, which also has the option to use a state-arrival extended approach. In the state-arrival extended multi-state model, a covariate that represents patients’ history is included, allowing the Markov property to be tested. We illustrate the building of multi-state survival models, making predictions from the models and assessing fits. We then proceed to perform a cost-effectiveness analysis, including deterministic and probabilistic sensitivity analyses. Finally, we show how to create 2 common methods of visualizing the results—namely, cost-effectiveness planes and cost-effectiveness acceptability curves. The analysis is implemented entirely within R. It is based on adaptions to functions in the existing R package mstate to accommodate parametric multi-state modeling that facilitates extrapolation of survival curves.

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PCV50 Cost-Effectiveness Analysis of Treating Acute Coronary Syndrome Patients With Ticagrelor Versus Clopidogrel in Hong Kong: A Markov Analytic Model

Value in Health ◽

10.1016/j.jval.2012.08.993 ◽

2012 ◽

Vol 15 (7) ◽

pp. A371

Author(s):

V.W.Y. Lee ◽

I.H.I. Chow ◽

B.P. Yan ◽

C.M. Yu ◽

Y.Y. Lam

Keyword(s):

Acute Coronary Syndrome ◽

Hong Kong ◽

Cost Effectiveness ◽

Cost Effectiveness Analysis ◽

Analytic Model ◽

Coronary Syndrome ◽

Effectiveness Analysis

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Ultra-radical surgery compared to standard surgical treatment for women with advanced ovarian cancer: a cost-effectiveness analysis

10.22541/au.160616177.75726197/v1 ◽

2020 ◽

Author(s):

Giovanna Bettoli ◽

Andrew Phillips ◽

Sudha Sundar ◽

Carole Cummins ◽

Anish Bali

Keyword(s):

Ovarian Cancer ◽

Cost Effectiveness ◽

Radical Surgery ◽

Advanced Ovarian Cancer ◽

Progression Free Survival ◽

Cost Effective ◽

Cost Effectiveness Analysis ◽

Sensitivity Analyses ◽

Decision Analytic Model ◽

Effectiveness Analysis

Objective To compare current surgical practice for women with AOC to ultra-radical surgery; to assess whether the new approach would be cost-effective under NICE guidelines of approximately £20,000/QALY. Design Cost-effectiveness analysis. Setting NHS, using data from a variety of sources. Population Patients with advanced ovarian cancer (FIGO stages IIIC-IV). Methods A decision analytic model (microsimulation model) was built to examine the Objective; deterministic and probabilistic sensitivity analyses were used to test the susceptibilities of the baseline model and its assumptions. Main Outcome Measures ICER (incremental cost-effectiveness ratio). Results The standard model yielded an ICER of £5325.06; this is in spite of an associated overall decrease in utility due to predicted increase in surgical mortality. The parameters with the most significant impact on the ICER are the cost of ultra-radical surgery, the utility associated with progression-free survival, and the probability of death from ultra-radical surgery. Conclusions Ultra-radical surgery is cost-effective under NICE willingness-to-pay thresholds of £20000; the costs of ultra-radical surgery are bound to decrease as centres specialise further, and its effectiveness is also likely due to increase with development of newer techniques and more surgical training.

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