PES6 COST EFFECTIVENESS OF LATANOPROST IN FIRST LINE TREATMENT OF PRIMARY OPEN ANGLE GLAUCOMA IN THE UK

ABSTRACTObjectivePrimary open-angle glaucoma (POAG) is the most common subtype of glaucoma worldwide. Early diagnosis and intervention is proven to slow disease progression and reduce disease burden. Currently, population-based screening for POAG is not generally recommended due to cost. In this study, we evaluate the cost-effectiveness of polygenic risk profiling as a screening tool for POAG.Methods and AnalysisWe used a Markov cohort model to evaluate the cost-effectiveness of implementing polygenic risk profiling as a new POAG-screening approach in the UK and Australia. Six health states were included in this model: death, early, mild, moderate, severe, and healthy individuals. The evaluation was conducted from the healthcare payer’s perspective. We used the best available published data to calculate prevalence, transition probabilities, utility and other parameters for each health state and age group. The study followed the CHEERS checklist. Our main outcome measure was the incremental cost-effectiveness ratio (ICER) and secondary outcomes were years of blindness avoided per person and a ‘Blindness ICER’. We did one-way and two-way deterministic and probabilistic sensitivity analyses to reflect the uncertainty around predicting ICERs.ResultsOur proposed genetic screening programme for POAG in Australia is predicted to result in ICER of AU$34,252 (95% CI AU$21,324-95,497) and would avoid 1 year of blindness at ICER of AU$13,359 (95% CI: AU$8,143-37,448). In the UK, this screening is predicted to result in ICER of £24,783 (13,373-66,960) and would avoid 1 year of blindness at ICER of £10,095 (95%CI: £5,513-27,656). Findings were robust in all sensitivity analyses. Using the willingness to pay thresholds of $54,808 and £30,000, the proposed screening model is 79.2% likely to be cost-effective in Australia and is 60.2% likely to be cost-effective in the UK, respectively.ConclusionsWe describe and model the cost-efficacy of incorporating a polygenic risk score for POAG screening in Australia and the UK. Although the level of willingness to pay for Australian Government is uncertain, and the ICER range for the UK is broad, we showed a clear target strategy for early detection and prevention of advanced POAG in these developed countries.Copyrightthe Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in BMJ editions and any other BMJPGL products and sublicences such use and exploit all subsidiary rights, as set out in our licence.

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Cost-effectiveness analysis of sequential biologic therapy with ixekizumab versus secukinumab as first-line treatment of moderate-to-severe psoriasis in the UK

Journal of Medical Economics ◽

10.1080/13696998.2018.1474747 ◽

2018 ◽

Vol 21 (8) ◽

pp. 810-820 ◽

Cited By ~ 2

Author(s):

Erin Colleen Johansson ◽

Susanne Hartz ◽

Sandeep Himatlal Kiri ◽

Gayathri Kumar ◽

Axel Svedbom

Keyword(s):

Cost Effectiveness ◽

Biologic Therapy ◽

Cost Effectiveness Analysis ◽

Severe Psoriasis ◽

Line Treatment ◽

First Line ◽

Effectiveness Analysis ◽

The Uk ◽

First Line Treatment

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A UK Cost-Effectiveness Analysis Comparing First Line Treatment with Rituximab in Combination with Fludarabine and Cyclophosphamide Versus Fludarabine and Cyclophosphamide Alone in Chronic Lymphocytic Leukemia (CLL) Patients

Blood ◽

10.1182/blood.v112.11.2392.2392 ◽

2008 ◽

Vol 112 (11) ◽

pp. 2392-2392 ◽

Cited By ~ 2

Author(s):

Konstantinos Papadakis ◽

David Oscier ◽

Emma SC Carr ◽

Gavin Lewis ◽

Rick Aultman

Keyword(s):

Quality Of Life ◽

Cost Effectiveness ◽

Life Expectancy ◽

Health State ◽

Line Treatment ◽

First Line ◽

The Uk ◽

Quality Adjusted Life ◽

First Line Treatment

Abstract Introduction: This analysis assesses whether Rituximab added to a Fludarabine Cyclophosphamide regimen (R-FC) is a cost-effective first-line treatment option for previously untreated CLL patients, using evidence from the phase III randomised controlled trial, ML17102 (CLL8) (Hallek et al., ASH 2008). In this trial, R-FC significantly prolonged the primary endpoint of progression–free survival (PFS) compared to FC alone and was well tolerated with no unexpected safety signals. Methods: A cost-effectiveness model was developed to evaluate the life-time health outcomes and direct costs of R-FC compared to FC as first-line treatment for CLL patients in the UK. Patients were modelled to be in one of three health states; PFS, Progressed or Death. The best parametric fit (Weibull) was used to extrapolate PFS beyond the end of the CLL8 trial follow-up period to a 15 year life-time horizon. The number of patients in each treatment arm that died while in PFS was based on the maximum of either the observed rate of death or background mortality. Because median overall survival had not been reached in CLL-8, a Markov process was used to model the transition from the progressed health state to death. Given the non significant difference in post progression survival by treatment (R-FC or FC), patients transitioning from progression to death were modelled as a single population with mean time to death (Kaplan-Meier) converted to a monthly probability of dying. This approach is conservative in that treatment benefit is exclusively a function of time spent in PFS. This Markovian approach is conservative in that treatment benefit is exclusively a function of time spent in PFS. Predicted time in each health state was weighted using CLL utility scores (Hancock et. al. 2002) to account for patient quality of life and estimate the Quality Adjusted Life Years (QALYs). Drug administration, patient monitoring and pharmacy costs were taken from the NHS schedule of reference costs 2006 and the published literature. Blood transfusions, bone marrow transplants, stem cell therapy and second line CLL treatments collected prospectively in CLL8 were included in monitoring costs. The cost of treatment related grade 3 or 4 infections were not included in the analysis as the incidence between the two treatment arms was comparable (Hallek et al., ASH 2008). Both costs and outcomes were discounted by 3.5%. RESULTS: R-FC improves mean life expectancy by 1.33 years compared to FC alone. After adjusting for quality of life, the incremental quality-adjusted life expectancy estimated was 1.06 years. Improvements in health outcomes were attributed to an increase in the time R-FC patients spent in the PFS health state (1.17 years).Total direct costs were higher for R-FC by £13,081 per patient, however, this was partially offset by a reduction in medication and monitoring costs incurred in the progressed health state. The incremental cost-effectiveness ratios (ICERs) were estimated to be £9558 per Life Year Gained with R-FC. When health-related quality of life was taken into account, the ICER was £12,387 per QALY gained for R-FC, well below commonly accepted thresholds in the UK. Although there is uncertainty associated with the progression of CLL and relapse treatment costs, the ICER did not exceed £22,458 per QALY despite a wide variation in each parameter value used in the probabilistic sensitivity analysis. CONCLUSIONS: Based on the significant prolongation of PFS demonstrated in CLL8, first-line R-FC substantially increases quality-adjusted life expectancy for CLL patients and is well within the UK threshold of cost-effectiveness. The sensitivity analysis provides adequate reassurance that the cost-effectiveness of R-FC held under most plausible scenarios.

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