P254 Effect of standard treatment (ST) versus episodic (ET) or maintenance (MT) infliximab on healthcare cost (HC) and quality-adjusted life years (QALYs) in a community-based incidence cohort of adult Crohn's disease patients with 10 years follow-up

Object Incremental cost-effectiveness analysis is critical to the efficient allocation of health care resources; however, the incremental cost-effectiveness ratio (ICER) of surgical versus nonsurgical treatment for adult spinal deformity (ASD) has eluded the literature, due in part to inherent empirical difficulties when comparing surgical and nonsurgical patients. Using observed preoperative health-related quality of life (HRQOL) for patients who later underwent surgery, this study builds a statistical model to predict hypothetical quality-adjusted life years (QALYs) without surgical treatment. The analysis compares predicted QALYs to observed postoperative QALYs and forms the resulting ICER. Methods This was a single-center (Baylor Scoliosis Center) retrospective analysis of consecutive patients undergoing primary surgery for ASD. Total costs (expressed in 2010 dollars) incurred by the hospital for each episode of surgical care were collected from administrative data and QALYs were calculated from the 6-dimensional Short-Form Health Survey, each discounted at 3.5% per year. Regression analysis was used to predict hypothetical QALYs without surgery based on preoperative longitudinal data for 124 crossover surgical patients with similar diagnoses, baseline HRQOL, age, and sex compared with the surgical cohort. Results were projected through 10-year follow-up, and the cost-effectiveness acceptability curve (CEAC) was estimated using nonparametric bootstrap methods. Results Three-year follow-up was available for 120 (66%) of 181 eligible patients, who were predominantly female (89%) with average age of 50. With discounting, total costs averaged $125,407, including readmissions, with average QALYs of 1.93 at 3-year follow-up. Average QALYs without surgery were predicted to be 1.6 after 3 years. At 3- and 5-year follow-up, the ICER was $375,000 and $198,000, respectively. Projecting through 10-year follow-up, the ICER was $80,000. The 10-year CEAC revealed a 40% probability that the ICER was $80,000 or less, a 90% probability that the ICER was $90,000 or less, and a 100% probability that the ICER was less than $100,000. Conclusions Based on the WHO's suggested upper threshold for cost-effectiveness (3 times per capita GDP, or $140,000 in 2010 dollars), the analysis reveals that surgical treatment for ASD is cost-effective after a 10-year period based on predicted deterioration in HRQOL without surgery. The ICER well exceeds the WHO threshold at earlier follow-up intervals, highlighting the importance of the durability of surgical treatment in assessing the value of surgical intervention. Due to the study's methodology, the results are dependent on the predicted deterioration in HRQOL without surgery. As such, the results may not extend to patients whose HRQOL would remain steady without surgery. Future research should therefore pursue a direct comparison of QALYs for surgical and nonsurgical patients to better understand the cost-effectiveness of surgery for the average ASD patient.

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Asymptomatic versus symptomatic metastatic breast cancer: Potential effects on prognosis and quality adjusted life years (QALYs).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e13073 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e13073-e13073

Author(s):

Kosho Yamanouchi ◽

Shigeto Maeda ◽

Tamotsu Kuroki

Keyword(s):

Breast Cancer ◽

Primary Breast Cancer ◽

Recurrent Breast Cancer ◽

Quality Adjusted Life Years ◽

Asymptomatic Group ◽

Symptomatic Group ◽

Life Years ◽

Recurrent Breast ◽

Quality Adjusted Life

e13073 Background: After radical surgery for breast cancer, routine laboratory or imaging studies for metastases screening are not indicated in the absence of clinical signs and symptoms suggestive of recurrence. While the goal of therapy is the extension of survival and maintenance of quality of life (QOL), therapies themselves could induce adverse events, resulting in deterioration of QOL. We evaluated quality adjusted life years (QALYs), which is survival adjusted by QOL, of the patients with recurrent breast cancer retrospectively and adequate follow-up measures. Methods: Fifty seven patients with recurrent breast cancer who died already were included. Survival curves were partitioned into two health states: time with ≥ grade 2 chemotherapy-related toxicity (TOX) and time without toxicity (TWiST). QALYs were acquired as follows: QALYs = TWiST + 0.7 * TOX. We compared clinical factors in the patients between with (symptomatic group, n = 32) and without symptoms (asymptomatic group, n = 25). Results: The median age of the patient at diagnosis of recurrence was 57 years. Luminal (hormone receptors (HR) - and human epidermal growth factor receptor-2 (HER2) -), HER2 (HER2 +), triple negative (TN) (HR - and HER2 -), and unknown were 29, 7, 15, and 6 cases, respectively. The proportion of HER2 and TN was significantly higher in the symptomatic group than that in the asymptomatic group (58.6, 21.7 %, p < 0.05). 44.6 % of the patients had visceral metastases at diagnosis of recurrence and the proportions were not different between the groups. Although post recurrent survival (PRS) was shorter significantly in the symptomatic group (22.5, 42,0 months, p < 0.01), overall survival from diagnosis of primary breast cancer (OS) was identical (60.5, 91.0 months). Additionally, QALYs after recurrence was shorter in the symptomatic group (23.0, 41.1 months, p < 0.01) and QALYs from diagnosis of primary breast cancer was identical (58.7, 91.0 months). Conclusions: Although there was no significant difference in OS between the both groups, the duration of therapy received was longer in the symptomatic group. In the present study, we acquired limited information due to retrospective manner. Prospective evaluation of QALYs, including patient reported outcome and symptoms derived from cancer itself, would turn out adequate measures of follow-up after radical surgery for primary breast cancer.

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Comparative effectiveness of treatment options for pediatric craniopharyngiomas

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.11.peds1320 ◽

2014 ◽

Vol 13 (2) ◽

pp. 178-188 ◽

Cited By ~ 16

Author(s):

Zarina S. Ali ◽

Robert L. Bailey ◽

Lawrence B. Daniels ◽

Venus Vakhshori ◽

Daniel J. Lewis ◽

...

Keyword(s):

Quality Of Life ◽

Treatment Guidelines ◽

Treatment Options ◽

Surgical Approaches ◽

Quality Adjusted Life Years ◽

Life Years ◽

Subtotal Removal ◽

Quality Adjusted Life

Object No clear treatment guidelines for pediatric craniopharyngiomas exist. The authors developed a decision analytical model to evaluate outcomes of 4 surgical approaches for craniopharyngiomas in children, including attempted gross-total resection (GTR), planned subtotal removal plus radiotherapy, biopsy plus radiotherapy, and endoscopic resections of all kinds. Methods Pooled data, including the authors' own experience, were used to create evidence tables, from which incidence, relative risks, and summary outcomes in quality-adjusted life years (QALYs) were calculated for the 4 management strategies. Results Quality-adjusted life years at the 5-year follow-up were 2.3 ± 0.1 for attempted GTR, 2.9 ± 0.2 for planned subtotal removal plus radiotherapy, 3.9 ± 0.2 for biopsy plus radiotherapy, and 3.7 ± 0.2 for endoscopic resection (F = 17,150, p < 0.001). Similarly, QALYs at 10-year follow-up were 4.5 ± 0.2 for attempted GTR, 5.7 ± 0.5 for planned subtotal removal plus radiotherapy, and 7.8 ± 0.5 for biopsy plus radiotherapy (F = 6,173, p < 0.001). On post hoc pairwise comparisons, the differences between all pairs compared were also highly significant (p < 0.001). Since follow-up data at 10 years are lacking for endoscopic cases, this category was excluded from 10-year comparisons. Conclusions Biopsy with subsequent radiotherapy is the preferred approach with respect to improved overall quality of life. While endoscopic approaches also show promise in preserving quality of life at five-year follow-up, there are not sufficient data to draw conclusions about this comparison at 10 years.

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P577 Cost-effectiveness of episodic or maintenance infliximab versus standard treatment in an incidence cohort of Crohn's disease patients with 10-years follow-up

Journal of Crohn s and Colitis ◽

10.1016/s1873-9946(13)60598-x ◽

2013 ◽

Vol 7 ◽

pp. S242

Author(s):

S. Odes ◽

D. Greenberg ◽

H. Vardi ◽

M. Friger ◽

R. Stockbrugger ◽

...

Keyword(s):

Crohn’S Disease ◽

Cost Effectiveness ◽

Crohn's Disease ◽

Standard Treatment

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Cost-Utility Analysis of Total Hip Arthroplasties: Technology Assessment of Surgical Procedures by Mailed Questionnaires

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462300012046 ◽

1998 ◽

Vol 14 (4) ◽

pp. 735-742 ◽

Cited By ~ 13

Author(s):

Uri Givon ◽

Gary M. Ginsberg ◽

Henri Horoszowski ◽

Joshua Shemer

Keyword(s):

Cost Utility ◽

Cost Utility Analysis ◽

Quality Adjusted Life Years ◽

Utility Analysis ◽

Total Hip ◽

Cementless Implant ◽

Life Years ◽

Hip Arthroplasties ◽

Quality Adjusted Life

AbstractA retrospective study comparing 700 consecutive total hip arthroplasties, utilizing four types of implants, was performed. Questionnaires based on hip scores were sent to 593 living patients. Useful responses were received from 363 (61 %) patients. Hip scores and quality-adjusted life-years were calculated. Multiple regression analysis, controlling for all possible biases, demonstrated one cementless implant as superior to all others. We believe that the use of mailed questionnaires is a simple and convenient system of follow-up, saving patients the need for outpatient clinic visits. The validity of such replies, however, has yet to be established.

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Quality Adjusted Life Years in Older Adults With Depressive Symptoms and Chronic Medical Disorders

International Psychogeriatrics ◽

10.1017/s1041610200006177 ◽

2000 ◽

Vol 12 (1) ◽

pp. 15-33 ◽

Cited By ~ 113

Author(s):

Jürgen Unützer ◽

Donald L. Patrick ◽

Paula Diehr ◽

Greg Simon ◽

David Grembowski ◽

...

Keyword(s):

Depressive Symptoms ◽

Chronic Medical Conditions ◽

Medical Conditions ◽

Quality Adjusted Life Years ◽

Health Maintenance ◽

Medical Disorders ◽

Life Years ◽

Clinically Significant ◽

Quality Adjusted Life

We used data from a 4-year prospective study of 2,558 primary care patients age 65 and older in a large staff model health maintenance organization to examine the association of clinically significant depressive symptoms and eight other chronic medical conditions with quality adjusted life years (QALYs). We developed linear regression models to examine the association of clinically significant depressive symptoms as defined by a score of 16 or greater on the Center for Epidemiological Studies Depression Scale and eight common chronic medical disorders at baseline with QALYs over the 4-year study period. Estimates of QALYs were derived from Quality of Well-Being Scale scores at baseline, at 2-year follow-up, and at 4-year follow-up. Individuals with clinically significant depressive symptoms at baseline had significantly lower QALYs over the 4-year study period than nondepressed subjects, even after adjusting for differences in age, gender, and the eight other chronic medical conditions. In terms of the entire study population, only arthritis and heart disease were more strongly associated with QALYs than depression.

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