scholarly journals Quality-Adjusted Life-Year Losses Averted With Every COVID-19 Infection Prevented in the United States

2021 ◽  
Vol 24 (5) ◽  
pp. 632-640 ◽  
Author(s):  
Anirban Basu ◽  
Varun J. Gandhay
Keyword(s):  
United States ◽  
The United States ◽  
Quality Adjusted Life Year ◽  
Quality Adjusted Life

Annual Cost of Illness and Quality-Adjusted Life Year Losses in the United States Due to 14 Foodborne Pathogens†

2012 ◽  
Vol 75 (7) ◽  
pp. 1292-1302 ◽  
Author(s):  
SANDRA HOFFMANN ◽  
MICHAEL B. BATZ ◽  
J. GLENN MORRIS
Keyword(s):  
United States ◽  
Cost Of Illness ◽  
Foodborne Pathogens ◽  
Annual Cost ◽  
The United States ◽  
Quality Adjusted Life Year ◽  
Companion Article ◽  
Qaly Loss ◽  
Euroqol 5D ◽  
Quality Adjusted Life

In this article we estimate the annual cost of illness and quality-adjusted life year (QALY) loss in the United States caused by 14 of the 31 major foodborne pathogens reported on by Scallan et al. (Emerg. Infect. Dis. 17:7–15, 2011), based on their incidence estimates of foodborne illness in the United States. These 14 pathogens account for 95% of illnesses and hospitalizations and 98% of deaths due to identifiable pathogens estimated by Scallan et al. We estimate that these 14 pathogens cause $14.0 billion (ranging from $4.4 billion to $33.0 billion) in cost of illness and a loss of 61,000 QALYs (ranging from 19,000 to 145,000 QALYs) per year. Roughly 90% of this loss is caused by five pathogens: nontyphoidal Salmonella enterica ($3.3 billion; 17,000 QALYs), Campylobacter spp. ($1.7 billion; 13,300 QALYs), Listeria monocytogenes ($2.6 billion; 9,400 QALYs), Toxoplasma gondii ($3 billion; 11,000 QALYs), and norovirus ($2 billion; 5,000 QALYs). A companion article attributes losses estimated in this study to the consumption of specific categories of foods. To arrive at these estimates, for each pathogen we create disease outcome trees that characterize the symptoms, severities, durations, outcomes, and likelihoods of health states associated with that pathogen. We then estimate the cost of illness (medical costs, productivity loss, and valuation of premature mortality) for each pathogen. We also estimate QALY loss for each health state associated with a given pathogen, using the EuroQol 5D scale. Construction of disease outcome trees, outcome-specific cost of illness, and EuroQol 5D scoring are described in greater detail in a second companion article.

Cost-efficacy of Knee Cartilage Defect Treatments in the United States

2019 ◽  
Vol 48 (1) ◽  
pp. 242-251 ◽  
Author(s):  
Joshua S. Everhart ◽  
Andrew B. Campbell ◽  
Moneer M. Abouljoud ◽  
J. Caid Kirven ◽  
David C. Flanigan
Keyword(s):  
United States ◽  
Cost Effective ◽  
International Knee Documentation Committee ◽  
The United States ◽  
Quality Adjusted Life Year ◽  
Knee Cartilage ◽  
Osteochondral Autograft ◽  
Cost Efficacy ◽  
Quality Adjusted Life

Background: Multiple knee cartilage defect treatments are available in the United States, although the cost-efficacy of these therapies in various clinical scenarios is not well understood. Purpose/Hypothesis: The purpose was to determine cost-efficacy of cartilage therapies in the United States with available mid- or long-term outcomes data. The authors hypothesized that cartilage treatment strategies currently approved for commercial use in the United States will be cost-effective, as defined by a cost <$50,000 per quality-adjusted life-year over 10 years. Study Design: Systematic review. Methods: A systematic search was performed for prospective cartilage treatment outcome studies of therapies commercially available in the United States with minimum 5-year follow-up and report of pre- and posttreatment International Knee Documentation Committee subjective scores. Cost-efficacy over 10 years was determined with Markov modeling and consideration of early reoperation or revision surgery for treatment failure. Results: Twenty-two studies were included, with available outcomes data on microfracture, osteochondral autograft, osteochondral allograft (OCA), autologous chondrocyte implantation (ACI), and matrix-induced ACI. Mean improvement in International Knee Documentation Committee subjective scores at final follow-up ranged from 17.7 for microfracture of defects >3 cm2 to 36.0 for OCA of bipolar lesions. Failure rates ranged from <5% for osteochondral autograft for defects requiring 1 or 2 plugs to 46% for OCA of bipolar defects. All treatments were cost-effective over 10 years in the baseline model if costs were increased 50% or if failure rates were increased an additional 15%. However, if efficacy was decreased by a minimum clinically important amount, then ACI (periosteal cover) of femoral condylar lesions ($51,379 per quality-adjusted life-year), OCA of bipolar lesions ($66,255) or the patella ($66,975), and microfracture of defects >3 cm2 ($127,782) became cost-ineffective over 10 years. Conclusion: Currently employed treatments for knee cartilage defects in the United States are cost-effective in most clinically acceptable applications. Microfracture is not a cost-effective initial treatment of defects >3 cm2. OCA transplantation of the patella or bipolar lesions is potentially cost-ineffective and should be used judiciously.

scholarly journals Quality-adjusted life expectancy (QALE) loss due to smoking in the United States

2012 ◽  
Vol 22 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Haomiao Jia ◽  
Matthew M. Zack ◽  
William W. Thompson ◽  
Shanta R. Dube
Keyword(s):  
United States ◽  
Life Expectancy ◽  
The United States ◽  
Quality Adjusted Life

scholarly journals Clinical Impact and Cost-effectiveness of Genotype Testing at Human Immunodeficiency Virus Diagnosis in the United States

2019 ◽  
Vol 70 (7) ◽  
pp. 1353-1363 ◽  
Author(s):  
Emily P Hyle ◽  
Justine A Scott ◽  
Paul E Sax ◽  
Lucia R I Millham ◽  
Caitlin M Dugdale ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
The United States ◽  
Clinical Impact ◽  
Reverse Transcriptase Inhibitors ◽  
First Line ◽  
Immunodeficiency Virus ◽  
Quality Adjusted Life

AbstractBackgroundUS guidelines recommend genotype testing at human immunodeficiency virus (HIV) diagnosis (“baseline genotype”) to detect transmitted drug resistance (TDR) to nonnucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), and protease inhibitors. With integrase strand inhibitor (INSTI)-based regimens now recommended as first-line antiretroviral therapy (ART), the of baseline genotypes is uncertain.MethodsWe used the Cost-effectiveness of Preventing AIDS Complications model to examine the clinical impact and cost-effectiveness of baseline genotype compared to no baseline genotype for people starting ART with dolutegravir (DTG) and an NRTI pair. For people with no TDR (83.8%), baseline genotype does not alter regimen selection. Among people with transmitted NRTI resistance (5.8%), baseline genotype guides NRTI selection and informs subsequent ART after adverse events (DTG AEs, 14%). Among people with transmitted NNRTI resistance (7.2%), baseline genotype influences care only for people with DTG AEs switching to NNRTI-based regimens. The 48-week virologic suppression varied (40%–92%) depending on TDR. Costs included $320/genotype and $2500–$3000/month for ART.ResultsCompared to no baseline genotype, baseline genotype resulted in &lt;1 additional undiscounted quality-adjusted life-day (QALD), cost an additional $500/person, and was not cost-effective (incremental cost-effectiveness ratio: $420 000/quality-adjusted life-year). In univariate sensitivity analysis, clinical benefits of baseline genotype never exceeded 5 QALDs for all newly diagnosed people with HIV. Baseline genotype was cost-effective at current TDR prevalence only under unlikely conditions, eg, DTG-based regimens achieving ≤50% suppression of transmitted NRTI resistance.ConclusionsWith INSTI-based first-line regimens in the United States, baseline genotype offers minimal clinical benefit and is not cost-effective.

scholarly journals Early Mortality in Patients With Muscle-Invasive Bladder Cancer Undergoing Cystectomy in the United States

2018 ◽  
Vol 2 (4) ◽  
Author(s):  
Kathryn E Marqueen ◽  
Nikhil Waingankar ◽  
John P Sfakianos ◽  
Reza Mehrazin ◽  
Scot A Niglio ◽  
...  
Keyword(s):  
United States ◽  
Bladder Cancer ◽  
High Risk ◽  
Mortality Risk ◽  
Cross Validation ◽  
The United States ◽  
Early Mortality ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive ◽  
Quality Adjusted Life

Abstract Background Although radical cystectomy (RC) is a standard treatment for muscle-invasive bladder cancer (MIBC), for many patients the risks versus benefits of RC may favor other approaches. We sought to define the landscape of early postcystectomy mortality in the United States and identify patients at high risk using pretreatment variables. Methods We identified patients with MIBC (cT2-T4aN0M0) who underwent RC without perioperative chemotherapy within the National Cancer Database (2003–2012). Using multistate multivariable modeling, we calculated time spent in three health states: hospitalized, discharged, and death more than 90 days postcystectomy. Cross-validation was performed by geographic region. Time spent in each state was weighted by utility to determine 90-day quality-adjusted life days (QALDs). Results Among 7922 patients, 90-day mortality was 7.6% (8.0% for lower and 6.7% for higher volume hospitals). Increasing age, clinical T stage, Charlson Comorbidity Index, and lower volume were associated with higher 90-day mortality and were included in the model. Cross-validation revealed appropriate performance (C-statistics of 0.53–0.74; calibration slopes of 0.50–1.67). The model predicted 25% of patients had a 90-day mortality risk higher than 10%, and observed 90-day mortality in this group was 14.0% (95% CI = 12.5% to 15.6%). Mean quality-adjusted life days (QALDs) was 63 (range = 44–68). Conclusions RC is associated with relatively high early mortality risk. Pretreatment variables may identify patients at particularly high risk, which may inform clinical trial design, facilitate shared decision making, and enhance quality improvement initiatives.

scholarly journals Cost-Effectiveness of Tafamidis Therapy for Transthyretin Amyloid Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 141 (15) ◽  
pp. 1214-1224 ◽  
Author(s):  
Dhruv S. Kazi ◽  
Brandon K. Bellows ◽  
Suzanne J. Baron ◽  
Changyu Shen ◽  
David J. Cohen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effective ◽  
The United States ◽  
Quality Adjusted Life Year ◽  
Life Years ◽  
The Us ◽  
Amyloid Cardiomyopathy ◽  
Quality Adjusted Life

Background: In patients with transthyretin amyloid cardiomyopathy, tafamidis reduces all-cause mortality and cardiovascular hospitalizations and slows decline in quality of life compared with placebo. In May 2019, tafamidis received expedited approval from the US Food and Drug Administration as a breakthrough drug for a rare disease. However, at $225 000 per year, it is the most expensive cardiovascular drug ever launched in the United States, and its long-term cost-effectiveness and budget impact are uncertain. We therefore aimed to estimate the cost-effectiveness of tafamidis and its potential effect on US health care spending. Methods: We developed a Markov model of patients with wild-type or variant transthyretin amyloid cardiomyopathy and heart failure (mean age, 74.5 years) using inputs from the ATTR-ACT trial (Transthyretin Amyloidosis Cardiomyopathy Clinical Trial), published literature, US Food and Drug Administration review documents, healthcare claims, and national survey data. We compared no disease–specific treatment (“usual care”) with tafamidis therapy. The model reproduced 30-month survival, quality of life, and cardiovascular hospitalization rates observed in ATTR-ACT; future projections used a parametric survival model in the control arm, with constant hazards reduction in the tafamidis arm. We discounted future costs and quality-adjusted life-years by 3% annually and examined key parameter uncertainty using deterministic and probabilistic sensitivity analyses. The main outcomes were lifetime incremental cost-effectiveness ratio and annual budget impact, assessed from the US healthcare sector perspective. This study was independent of the ATTR-ACT trial sponsor. Results: Compared with usual care, tafamidis was projected to add 1.29 (95% uncertainty interval, 0.47–1.75) quality-adjusted life-years at an incremental cost of $1 135 000 (872 000–1 377 000), resulting in an incremental cost-effectiveness ratio of $880 000 (697 000–1 564 000) per quality-adjusted life-year gained. Assuming a threshold of $100 000 per quality-adjusted life-year gained and current drug price, tafamidis was cost-effective in 0% of 10 000 probabilistic simulations. A 92.6% price reduction from $225 000 to $16 563 would be necessary to make tafamidis cost-effective at $100 000/quality-adjusted life-year. Results were sensitive to assumptions related to long-term effectiveness of tafamidis. Treating all eligible patients with transthyretin amyloid cardiomyopathy in the United States with tafamidis (n=120 000) was estimated to increase annual healthcare spending by $32.3 billion. Conclusions: Treatment with tafamidis is projected to produce substantial clinical benefit but would greatly exceed conventional cost-effectiveness thresholds at the current US list price. On the basis of recent US experience with high-cost cardiovascular medications, access to and uptake of this effective therapy may be limited unless there is a large reduction in drug costs.

scholarly journals Societal Costs of Sickle Cell Disease in the United States

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4706-4706
Author(s):  
Irene Agodoa ◽  
Deborah Lubeck ◽  
Nickhill Bhakta ◽  
Mark Danese ◽  
Kartik Pappu ◽  
...  
Keyword(s):  
United States ◽  
General Population ◽  
Life Expectancy ◽  
Research Funding ◽  
The United States ◽  
Cell Disease ◽  
Societal Costs ◽  
Lifetime Income ◽  
The Us ◽  
Quality Adjusted Life

Abstract Introduction Sickle cell disease (SCD) is a lifelong and costly chronic disease characterized by hemolytic anemia, pain crisis, and multi-end organ damage. Published estimates of SCD prevalence in the United States (US) range from approximately 85,000 to 100,000 people, most of whom are African American or Hispanic American. Individuals with SCD on average live two to three decades less than the general US population (Piel et al 2017). They also have markedly impaired patient-reported health-related quality-of-life (HRQOL) due in part to fatigue, pain, and impaired physical functioning, which leads to a significant reduction in work productivity. However, there are limited data available on the societal costs of SCD, such as lost lifetime earnings, which may lead to an underestimate of the true impact of this disease in a vulnerable population. Objectives We developed a simulation model to estimate the differences in life expectancy measured in years, quality-adjusted life-years (QALY) and income lost due to reduced life expectancy. Results were compared between a population of patients born with SCD in the US and a sex- and race-matched US population born without SCD and to the general US population. Methods To build the model, we (1) generated a Poisson regression from published birth and mortality estimates for SCD supplemented with data from the Centers for Disease Control (CDC) Multiple Cause of Death database to create age-specific life tables for a population of individuals with SCD (SCD population); (2) used published life tables from the CDC to develop age-specific death rates for a population without SCD (non-SCD population); (3) incorporated published utility weights for SCD adolescents and adults, and for the US general population to estimate the impact of the disease on HRQOL; (4) used US Bureau of Labor Statistics Supplemental Survey of Annual Personal Income data to calculate the expected annual personal income based on age, race, and gender; (5) built a cohort simulation model using R (version 3.4.2) to estimate the life expectancy, QALYs, and lost income for the SCD population compared to the non-SCD population, and the US general population. All analyses used Monte Carlo sampling to characterize uncertainty. Results We estimated that there would be 1,950 newborns with SCD born in the US annually. The projected life expectancy at birth is 54 years for the SCD population compared with 76 years for the age- and race-matched non-SCD population and 79 years for the general US population. Moreover, the quality-adjusted life expectancy of the SCD population (33 years) is less than half that of the matched non-SCD population (67 years) and general US population (69 years). Projected lifetime income for an individual in the SCD population is approximately $1.2 million compared with $1.9 million for an individual in the matched non-SCD population and $2.0 million in the general US population (Figure). Therefore, our model estimates that each individual with SCD loses over $700,000 in lifetime income due to early mortality associated with SCD. Conclusions A contemporary simulated cohort of individuals born with SCD is projected to live 22 years less than a matched population of individuals without SCD. Moreover, when adjusted for diminished HRQOL, our model suggests that patients living with SCD lose over three decades in life expectancy compared to a matched non-SCD population. Given the 22-year difference in life expectancy results in approximately $700,000 in lost lifetime income for each person born with SCD, a contemporary SCD birth cohort of 1,950 individuals would lose over $1.4 billion in lifetime income due to premature mortality. These losses are a conservative estimate since they do not include any direct medical costs or other societal costs such as lost educational potential, lost workdays due to caregivers caring for their affected children, or patient time spent in the hospital or visiting the emergency department; nor do they account for additional challenges in finding and maintaining active employment that have been previously described as substantial among individuals with SCD. In conclusion, SCD has devastating societal consequences beyond the resources required to provide medical care for patients underscoring the urgent need to develop disease-modifying therapies that can improve the underlying morbidity and mortality of individuals living with SCD. Disclosures Agodoa: Global Blood Therapeutics: Employment. Lubeck:Global Blood Therapeutics: Research Funding. Danese:Global Blood Therapeutics: Consultancy, Research Funding. Pappu:Global Blood Therapeutics: Employment. Howard:Global Blood Therapeutics: Employment. Gleeson:Global Blood Therapeutics: Consultancy, Research Funding. Halperin:Global Blood Therapeutics: Consultancy, Research Funding. Lanzkron:PCORI: Research Funding; NHLBI: Research Funding; GBT: Research Funding; selexys: Research Funding; Ironwood: Research Funding; Pfizer: Research Funding; Prolong: Research Funding; HRSA: Research Funding.

Institute for Clinical and Economic Review

2021 ◽  
pp. 112-141
Author(s):  
Neumann Peter J. ◽  
Cohen Joshua T. ◽  
Ollendorf Daniel A
Keyword(s):  
Impact Analysis ◽  
The United States ◽  
Quality Adjusted Life Year ◽  
Value Assessment ◽  
Private Organization ◽  
Wide Range ◽  
Powerful Approach ◽  
Assessment Approach ◽  
Contextual Elements ◽  
Quality Adjusted Life

Although its origins date to 2006, the Institute for Clinical and Economic Review (ICER) gained prominence around 2015 when it focused its health technology assessment (HTA) efforts on a new highly effective, though expensive, treatment for hepatitis C. ICER, a small, private organization, seemed to fill a void in the United States because it offered a systematic value assessment approach and made its analyses publicly accessible. Drawing inspiration from England and Wales’ HTA body, ICER has used the quality-adjusted life year (QALY) and cost-effectiveness analysis. That decision gives ICER a powerful approach applicable to a wide range of technologies, but it has also spurred controversy. The organization has responded to criticisms by revising its “value framework.” Changes include separation of budget impact analysis from value determinations, introduction of other value measures beyond the QALY, increasing consideration of contextual elements, and adoption of a “societal perspective” where data support it.

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