scholarly journals How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations

2019 ◽  
Vol 220 ◽  
pp. 141-149 ◽  
Author(s):  
K. Hauck ◽  
A. Morton ◽  
K. Chalkidou ◽  
Y-Ling Chi ◽  
A. Culyer ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Health System Strengthening ◽  
The Cost

scholarly journals Evaluating the Cost-Effectiveness of Early Compared with Late or No Biologic Treatment to Manage Crohn’s Disease using Real-World Data

2019 ◽  
Vol 14 (4) ◽  
pp. 490-500 ◽  
Author(s):  
Nadia Pillai ◽  
Judith E Lupatsch ◽  
Mark Dusheiko ◽  
Matthias Schwenkglenks ◽  
Michel Maillard ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Cost Effectiveness ◽  
Crohn's Disease ◽  
Health System ◽  
Real World ◽  
Transition Probabilities ◽  
Cost Effective ◽  
Real World Data ◽  
World Data ◽  
The Cost

Abstract Background and Aims We evaluated the cost-effectiveness of early [≤2 years after diagnosis] compared with late or no biologic initiation [starting biologics >2 years after diagnosis or no biologic use] for adults with Crohn’s disease in Switzerland. Methods We developed a Markov cohort model over the patient’s lifetime, from the health system and societal perspectives. Transition probabilities, quality of life, and costs were estimated using real-world data. Propensity score matching was used to ensure comparability between patients in the early [intervention] and late/no [comparator] biologic initiation strategies. The incremental cost-effectiveness ratio [ICER] per quality-adjusted life year [QALY] gained is reported in Swiss francs [CHF]. Sensitivity and scenario analyses were performed. Results Total costs and QALYs were higher for the intervention [CHF384 607; 16.84 QALYs] compared with the comparator [CHF340 800; 16.75 QALYs] strategy, resulting in high ICERs [health system: CHF887 450 per QALY; societal: CHF449 130 per QALY]. In probabilistic sensitivity analysis, assuming a threshold of CHF100 000 per QALY, the probability that the intervention strategy was cost-effective was 0.1 and 0.25 from the health system and societal perspectives, respectively. In addition, ICERs improved when we assumed a 30% reduction in biologic prices [health system: CHF134 502 per QALY; societal: intervention dominant]. Conclusions Early biologic use was not cost-effective, considering a threshold of CHF100 000 per QALY compared with late/no biologic use. However, early identification of patients likely to need biologics and future drug price reductions through increased availability of biosimilars may improve the cost-effectiveness of an early treatment approach.

scholarly journals The cost-effectiveness of the treatment of acute ischemic stroke with the use of thrombolytics in Brazil

2021 ◽  
Author(s):  
Marcos Vinicius Teixeira Martins ◽  
Veronica Perius de Brito ◽  
Stefan Vilges de Oliveira
Keyword(s):  
Ischemic Stroke ◽  
Cost Effectiveness ◽  
Length Of Stay ◽  
Health System ◽  
Acute Stroke ◽  
Average Cost ◽  
Intravenous Thrombolysis ◽  
Private Institutions ◽  
Public And Private ◽  
The Cost

Introduction: Ischemic stroke causes major impacts on morbidity and mortality and intravenous thrombolysis is one of the main treatments. However, it has important temporal limitations, which justifies the study of other techniques. Objectives: Analyze the cost-effectiveness of treatments for acute stroke with the use of thrombolytics. Methodology: Epidemiological study with data from the Sistema de Informações Hospitalares do Ministério da Saúde, between 2015 and 2020 in Brazil. Results: There were 16488 hospitalizations, with an average cost of R$ 2687.70 (±379.40) and an average stay of 8.80 (±0.99) days. From 2015 to 2017, these values were, on average, 1829.67 (±917.46) hospitalizations, R$ 2715.50 (±190.86) and 9.80 (±1.62) days. Between 2018 and 2020, there are 3666.33 (±437.58), R$ 2773.22 (±108.86) and 8.13 (±0.29) days. The Northeast, Southeast and South of the country predominated with 36.09% (±0.73), 27.15% (±0.68) and 32.02% (±0.71) of occurrences, respectively. Average investments per hospitalization, for these regions, were R$ 2397.89 (±82.45), R$ 3178.29 (±38.89) and R$ 2806.16 (±56.33). As for the average stay, it was 7.30 (±1.11), 9.11 (±0.89) and 9.40 (±0.78) days. In public systems, 65.09% (±2.97) of registered treatments, the average cost was R$ 2815.09 (±122.34) and the average stay was 12.00 (±1.33) days. In private institutions these values were R$ 2747.14 (±98.13), and 8.90 (±0.92) days. Conclusions: There were increases in hospitalizations and costs with a reduction in length of stay. In addition, there were pronounced disparities between the regions of the country and public and private systems, which undermine equity in the health system.

scholarly journals Cost-Effectiveness of Teriflunomide and Fingolimod in The First-Line Treatment of Relapsing-Remitting Multiple sclerosis：The Chinese Health System Perspective

2021 ◽  
Author(s):  
Zuojun Dong ◽  
Zhichao Hu ◽  
Xiaoying Zhou ◽  
Jingwen Wang ◽  
Jianwei Wang ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
First Line ◽  
Cost Of Treatment ◽  
System Perspective ◽  
Total Cost ◽  
Relapsing Remitting ◽  
The Cost ◽  
First Line Treatment ◽  
Health System Perspective

Abstract Objective The aim of this study is to evaluate the cost-effectiveness of teriflunomide and fingolimod in relapsing-remitting patients in the first-line treatment from the perspective of the Chinese health system perspective.Methods A Markov model was developed to evaluate the cost effectiveness of disease-modifying drugs (DMDs) from the Chinese health system perspective.Cost input includes medication, follow-up, nursing, recurrence treatment and adverse reaction management.Treatment effects, including monthly confrmed disability worsening and annualized relapse rate.The output result was ICER and the threshold of willingness to pay(WTP) was three times per capita GDP.One-way sensitivity analysis and probability sensitivity analysis are carried out to test the stability of the model results.Results In the context of medical insurance with Chinese characteristics.The total cost of treatment with teriflunomide was ¥423,816.61, and the total cost of treatment with fingolimod was ¥656,055.95.The cumulative QALYs of teriflunomide was 5.14, and the cumulative QALYs of fingolimod was 5.25.The ICER value of Fingolimod and Liflunomide is ¥2139444.61/QALY, which is higher than WTP , so teriflunomide has a dominant advantage.Sensitivity analysis proves that the model was stable.Conclusion From the perspective of Chinese health system perspective, teriflunomide is the more cost-effective of the two interventions.

scholarly journals Modelling the cost-effectiveness of essential and advanced critical care for COVID-19 patients in Kenya

2021 ◽  
Vol 6 (12) ◽  
pp. e007168
Author(s):  
Angela Kairu ◽  
Vincent Were ◽  
Lynda Isaaka ◽  
Ambrose Agweyu ◽  
Samuel Aketch ◽  
...  
Keyword(s):  
Critical Care ◽  
Cost Effectiveness ◽  
Health System ◽  
Incremental Cost ◽  
Resource Scarcity ◽  
Status Quo ◽  
Healthcare Provision ◽  
Tree Model ◽  
System Perspective ◽  
The Cost

BackgroundCase management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care (ACC) needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and ACC persist. This study assessed the cost-effectiveness of investments in essential and ACC to inform the prioritisation of investment decisions.MethodsWe employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and ACC (EC +ACC) compared with current healthcare provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data were obtained from primary empirical analysis while outcomes data were obtained from epidemiological model estimates. We used univariate and probabilistic sensitivity analysis to assess the robustness of the results.ResultsThe status quo option is more costly and less effective compared with investment in EC and is thus dominated by the later. The incremental cost-effectiveness ratio of investment in essential and ACC (EC+ACC) was US$1378.21 per disability-adjusted life-year averted and hence not a cost-effective strategy when compared with Kenya’s cost-effectiveness threshold (US$908).ConclusionWhen the criterion of cost-effectiveness is considered, and within the context of resource scarcity, Kenya will achieve better value for money if it prioritises investments in EC before investments in ACC. This information on cost-effectiveness will however need to be considered as part of a multicriteria decision-making framework that uses a range of criteria that reflect societal values of the Kenyan society.

scholarly journals Allocation of Resources for Diagnostic and Therapeutic Interventions in Rare Diseases”

2021 ◽  
Author(s):  
Mohammadreza Mobinizade ◽  
Zeinab Fakoorfard
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Rare Diseases ◽  
National Level ◽  
Therapeutic Interventions ◽  
World Health ◽  
Financial Resources ◽  
The World ◽  
Health Organization ◽  
The Cost

Background: The health system is facing limited financial resources in all countries. Resource allocation is one of the tasks of the health system. Prioritizing interventions is one of the strategies that can help health policymakers in allocating financial resources. Rare diseases require more attention than other diseases due to their high cost and complex treatments. The countries use different policies to determine the effectiveness of interventions in the field of rare diseases. The purpose of this study is to refer to some policies in the field of allocating resources for rare diseases and to explain the importance of determining the threshold of cost-effectiveness for rare diseases in Iran. Methods: This research is a review study. First, a study was conducted on how to prioritize health interventions in the world and the thresholds of cost-effectiveness in different countries. Articles related to the research topic were then searched in accessible databases in Iran such as SID, Google Scholar and Medline. Finally, the obtained articles were screened and analyzed based on a thematic approach. Results: The World Health Organization (WHO) has set a threshold for determining the cost-effectiveness of health system interventions , that is determined and calculated based on the per capita GDP of each country. There are many differences between countries on policies related to the treatment of rare diseases, medicines, health care budgets and patient access. Conclusions: Due to the very high cost of treating rare diseases, it is impossible to use the threshold used for general disease interventions in rare diseases and it is necessary to use a higher threshold for rare diseases. In addition to cost-effectiveness, budget, justice, feasibility, and other criteria that are considered important at the national level should be considered.

Estimating Cost-Effectiveness Thresholds Under a Managed Healthcare System: Experiences from Colombia

2021 ◽  
Author(s):  
Oscar Espinosa ◽  
Paul Rodríguez-Lesmes ◽  
Esteban Orozco ◽  
Diego Ávila ◽  
Hernán Enríquez ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Healthcare System ◽  
Health Expenditures ◽  
Middle Income Country ◽  
Income Country ◽  
Middle Income ◽  
The Cost ◽  
Cost Effectiveness Threshold ◽  
Effectiveness Threshold

Abstract Like most of the world, low- and middle-income countries have faced a growing demand for new health technologies and higher budget constraints. It is necessary to have technical instruments to make decisions based on real-world evidence that allows maximization of the population’s health with a limited budget. We estimated the supply-based cost-effectiveness elasticity, which was then used to determine the cost-effectiveness threshold for the healthcare system of Colombia, a middle-income country where multiple insurers, paid under capitation rules, manage the compulsory contributions of the citizens and government subsidies. Using administrative data, we explored the variation of health expenditures and outcomes at the insurer, geographical region, diagnosis group, and year levels. To deal with endogeneity in a two-way fixed-effects model, we instrumented health expenditures using characteristics of the health system such as drug-price regulation. We estimated the threshold to be US$ 4487.5 per YLL avoided (14.7 million COP at 2019 prices) and US$ 5180.8 per QALY gained (17 million COP at 2019 prices), around one times the GDP per capita. To our knowledge, this is the first estimation of the cost-effectiveness threshold elasticity supply-based in a middle-income country with a managed care health system.

scholarly journals Priority Setting in HIV, Tuberculosis, and Malaria – New Cost-Effectiveness Results From WHO-CHOICE

2021 ◽  
Author(s):  
Ambinintsoa H. Ralaidovy ◽  
Jeremy Addison Lauer ◽  
Carel Pretorius ◽  
Olivier JT Briët ◽  
Edith Patouillard
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
21St Century ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
World Health ◽  
Global Community ◽  
Development Goal ◽  
Life Years ◽  
The Cost

Background: This paper forms part of an update of the World Health Organization Choosing Interventions that are Cost-Effective (WHO-CHOICE) programmes. It provides an assessment of global health system performance during the first decade of the 21st century (2000-2010) with respect to allocative efficiency in HIV, tuberculosis (TB) and malaria control, thereby shining a spotlight on programme development and scale up in these Millennium Development Goal (MDG) priority areas; and examining the cost-effectiveness of selected best-practice interventions and intervention packages commonly in use during that period. Methods: Generalized cost-effectiveness analysis (GCEA) was used to determine the cost-effectiveness of the selected interventions. Impact modelling was performed using the OpenMalaria platform for malaria and using the Goals and TIME (TB Impact Model and Estimates) models in Spectrum for HIV and TB. All health system costs, regardless of payer, were included and reported in international dollars. Health outcomes are estimated and reported as the gain in healthy life years (HLYs) due to the specific intervention or combination. Analysis was restricted to eastern sub-Saharan Africa and Southeast Asia. Results: At the reference year of 2010, commonly used interventions for HIV, TB and malaria were cost-effective, with cost-effectiveness ratios less than I$ 100/HLY saved for virtually all interventions included. HIV, TB and malaria prevention and treatment interventions are highly cost-effective and can be implemented through a phased approach to full coverage to achieve maximum health benefits and contribute to the progressive elimination of these diseases. Conclusion: During the first decade of the 21st century (2000-2010), the global community has done well overall for HIV, TB, and malaria programmes as regards both economic efficiency and programmatic selection criteria. The role of international assistance, financial and technical, arguably was critical to these successes. As the global community now tackles the challenge of universal health coverage, this analysis can reinforce commitment to Sustainable Development Goal targets but also the importance of continued focus on these critical programme areas.

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