The Cost Effectiveness Of Idelalisib In Chronic Lymphocytic Leukaemia In England And Wales

Purpose. Five years of bisphosphonate treatment have proven efficacy in reducing fractures. Concerns exist that long-term bisphosphonate treatment may actually result in an increased number of fractures. This study evaluates, in the context of England and Wales, whether it is cost-effective to conduct a randomized controlled trial (RCT) and what sample size may be optimal to estimate the efficacy of bisphosphonates in fracture prevention beyond 5 years. Method. An osteoporosis model was constructed to evaluate the cost-effectiveness of extending bisphosphonate treatment from 5 years to 10 years. Two scenarios were run. The 1st uses long-term efficacy data from published literature, and the 2nd uses distributions elicited from clinical experts. Results of a proposed RCT were simulated. The expected value of sample information technique was applied to calculate the expected net benefit of sampling from conducting such an RCT at varying levels of participants per arm and to compare this with proposed trial costs. Results. Without further information, the better duration of bisphosphonate treatment was estimated to be 5 years using the published data but 10 years using the elicited expert opinions, although in both cases uncertainty was substantial. The net benefit of sampling was consistently high when between 2000 and 5000 participants per arm were recruited. Conclusions. An RCT to evaluate the long-term efficacy of bisphosphonates in fracture prevention appears to be cost-effective for informing decision making in England and Wales.

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Cost-Effectiveness Of Idelalisib Plus Rituximab In Chronic Lymphocytic Leukaemia

Value in Health ◽

10.1016/j.jval.2015.09.1190 ◽

2015 ◽

Vol 18 (7) ◽

pp. A460 ◽

Cited By ~ 4

Author(s):

H Leleu ◽

M Blachier ◽

S Mealing ◽

R Perard ◽

C Baujat ◽

...

Keyword(s):

Cost Effectiveness ◽

Chronic Lymphocytic Leukaemia ◽

Lymphocytic Leukaemia

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Designing Policies

Re-Reasoning Ethics ◽

10.7551/mitpress/9780262037693.003.0009 ◽

2018 ◽

pp. 221-248

Author(s):

Barry Hoffmaster ◽

Cliff Hooker

Keyword(s):

Health Care ◽

Cost Effectiveness ◽

Clinical Excellence ◽

Deliberative Process ◽

England And Wales ◽

The Cost ◽

Fundamental Values ◽

Over Time ◽

Health Care Technologies

Designing ethical policies is illustrated with two real examples. The first, allocating cadaver kidneys for transplantation, needs to develop a policy that satisfies the two conflicting fundamental values of equality and efficiency. Equality would require a lottery or a first-come, first-served policy. Efficiency would allocate kidneys to the candidates who would benefit the most. Because neither value may be dismissed, the values must be compromised. That compromise happens in two ways: by compromising the values of equality and efficiency within a policy at a time, and by cycling across policies over time, shifting the preference given to the two values back-and-forth. The second example is an illuminating account of how the National Institute for Health and Clinical Excellence in England and Wales designed a deliberative process for assessing the cost effectiveness of health care technologies.

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