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

1998 ◽  
Vol 14 (4) ◽  
pp. 735-742 ◽  
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.

scholarly journals Cost–utility analysis of minimally invasive surgery for lung cancer: a randomized controlled trial

2019 ◽  
Vol 56 (4) ◽  
pp. 754-761 ◽  
Author(s):  
Morten Bendixen ◽  
Christian Kronborg ◽  
Ole Dan Jørgensen ◽  
Claus Andersen ◽  
Peter Bjørn Licht
Keyword(s):  
Lung Cancer ◽  
Controlled Trial ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Randomized Controlled ◽  
Life Years ◽  
Stage 1 ◽  
Quality Adjusted Life

Abstract OBJECTIVES: Minimally invasive video-assisted thoracic surgery (VATS) was first introduced in the early 1990s. For decades, numerous non-randomized studies demonstrated advantages of VATS over thoracotomy with lower morbidity and shorter hospital stay, but only recently did a randomized trial document that VATS results in lower pain scores and better quality of life. Opposing arguments for VATS have always been increased costs and concerns about oncological adequacy. In this paper, we aim to investigate the cost-effectiveness of VATS. METHODS: The study was designed as a cost–utility analysis of the first 12 months following surgery and was performed together with a clinical randomized controlled trial of VATS versus thoracotomy for lobectomy of stage 1 lung cancer during a 6-year period (2008–2014). All health-related expenses were retrieved from a national database (Statistics Denmark) including hospital readmissions, outpatient clinic visits, prescription medication costs, consultations with general practitioners, specialists, physiotherapists, psychologists and chiropractors. RESULTS: One hundred and three VATS patients and 103 thoracotomy patients were randomized. Mean costs per patient operated by VATS were 103 108 Danish Kroner (Dkr) (€13 818) and 134 945 Dkr (€18 085) by thoracotomy, making the costs for VATS 31 837 Dkr (€4267) lower than thoracotomy (P < 0.001). The difference in quality-adjusted life years gained over 52 weeks of follow-up was 0.021 (P = 0.048, 95% confidence interval −0.04 to −0.00015) in favour of VATS. The median duration of the surgical procedure was shorter after thoracotomy (79 vs 100 min; P < 0.001). The mean length of hospitalization was shorter following VATS (4.8 vs 6.7 days; P = 0.027). The use of other resources was not significantly different between groups. The costs of resources were lower in the VATS group. This difference was primarily due to reduced costs of readmissions (VATS 29 247 Dkr vs thoracotomy 51 734 Dkr; P < 0.001) and costs of outpatient visits (VATS 51 412 Dkr vs thoracotomy 61 575 Dkr; P = 0.012). CONCLUSIONS: VATS is a cost-effective alternative to thoracotomy following lobectomy for stage 1 lung cancer. Economical outcomes as measured by quality-adjusted life years were significantly better and overall costs were lower for VATS. Clinical Trial Registration Number: NCT01278888.

Utilities and Quality-Adjusted Life Years

1989 ◽  
Vol 5 (4) ◽  
pp. 559-575 ◽  
Author(s):  
George W. Torrance ◽  
David Feeny
Keyword(s):  
Quality Of Life ◽  
Cost Utility ◽  
Health Improvement ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Quality Adjustment ◽  
Life Years ◽  
Quality Adjusted Life ◽  
Broad Overview

Utilities and quality-adjusted life years (QALYs) are reviewed, with particular focus on their use in technology assessment. This article provides a broad overview and perspective on these two techniques and their interrelationship, with reference to other sources for details of implementation. The historical development, assumptions, strengths/weaknesses, and applications of each are summarized.Utilities are specifically designed for individual decision-making under uncertainty, but, with additional assumptions, utilities can be aggregated across individuals to provide a group utility function. QALYs are designed to aggregate in a single summary measure the total health improvement for a group of individuals, capturing improvements from impacts on both quantity of life and quality of life– with quality of life broadly defined. Utilities can be used as the quality-adjustment weights for QALYs; they are particularly appropriate for that purpose, and this combination provides a powerful and highly useful variation on cost-effectiveness analysis known as cost-utility analysis.

scholarly journals An Economic Evaluation of Thread Embedding Acupuncture for the Treatment of Lumbar Herniated Intervertebral Disc in a Randomized Controlled Clinical Trial

2021 ◽  
Vol 38 (4) ◽  
pp. 312-319
Author(s):  
Ha-Na Kim ◽  
Jun-Yeon Kim ◽  
Kyeong-Ju Park ◽  
Ji-Min Hwang ◽  
Jun-Yeong Jang ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Visual Analog Scale Score ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Randomized Controlled ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Background: Lumbar herniated intervertebral disc (LHIVD) is a frequently presented condition/disease in Korean medical institutions. In this study, the economics of thread embedding acupuncture (TEA) was evaluated in a randomized controlled trial comparing TEA with sham TEA (STEA).Methods: This economic evaluation was analyzed from a limited social perspective, and the per-protocol set was from a basic analysis perspective. The cost-effectiveness analysis was based on the change in visual analog scale score, and the cost-utility analysis was based on the quality-adjusted life years. The final results were expressed as the average cost-effectiveness ratio and incremental cost-effectiveness ratio, and furthermore sensitivity analysis was performed to confirm the robustness of the results observed.Results: The cost-effectiveness analysis showed that TEA was 9,908 won lower than STEA, while the decrease in 100 mm visual analog scale score was 8.5 mm greater in the TEA group compared with the STEA group (p > 0.05). The cost-utility analysis showed that TEA was 9,908 won lower than STEA, while the quality-adjusted life years of TEA was 0.0026 years higher than STEA (p > 0.05). These results were robust in the sensitivity analysis, but were not statistically significant.Conclusion: In treating LHIVD, TEA appeared to have cost-effectiveness and cost-utility compared with STEA. However, there were no significant differences between the groups in terms of cost, effectiveness, and utility indicators. Therefore, results must be interpreted prudently; this study was the 1st to conduct an economic evaluation of TEA for LHIVD.

scholarly journals Cost–utility analysis of remote versus conventional monitoring of pacemakers in the Arctic Circle

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Lopez-Villegas ◽  
D Catalan-Matamoros ◽  
S Peiro ◽  
K T Lappegard ◽  
R Lopez-Liria
Keyword(s):  
Remote Monitoring ◽  
National Health System ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
The Arctic ◽  
Utility Analysis ◽  
System Perspective ◽  
Life Years ◽  
Monitoring Group

Abstract Introduction Several studies have demonstrated that remote monitoring (RM) of pacemakers is safe, effective and cost-saving. The aim of this study was to perform an economic assessment and check whether RM offers a cost-utility alternative to conventional monitoring in hospital (CM). Methods This is a controlled, randomized, non-masked clinical trial. Fifty patients with pacemaker were assigned to receive either RM (n = 25) or CM (n = 25). Data were collected during the 12 months. A cost-utility analysis was performed in order to assess whether RM of pacemakers is cost-effective compared to CM in hospital in terms of costs per gained quality-adjusted life years (QALY). The analysis was performed from the perspectives of the Norwegian Healthcare System (NHS) and patients. Results Overall, total costs from the NHS perspective were higher in the RM group (€2,079.84 vs. €271.97; p = 0.147). The costs related to the patients perspective were higher in the RM than those in the CM group (€223.99 vs. €158.42, respectively; P = 0.429). Patients included in the CM obtained 0.04 QALYs less than those in the RM group over 12 months and the total costs per QALY comprised €1,784.10 (P = 0.175) per user with a pacemaker implant. The total number of pacemaker transmissions per patient year comprised 86.46% of minors in the CM group. Conclusions The follow-up costs were similar between both groups. Cost-utility analysis showed broad confidence intervals with ICERs ranging from potential savings to high costs for an additional QALY, with most ICERs lower than the usual NHS thresholds for coverage decisions. Key messages Total costs from the National Health System perspective were higher in the remote monitoring group, although there were not significant differences between both groups of follow-up. The costs related to the patient perspective were higher in the remote monitoring than those in the conventional monitoring group, without significant differences.

scholarly journals ANALISIS NILAI WILLINGNESS TO PAY PER QUALITY ADJUSTED LIFE YEAR TERAPI PENYAKIT MODERATE MASYARAKAT DI KOTA BANJARMASIN TAHUN 2019

2020 ◽  
Vol 4 (1) ◽  
pp. 1-11
Author(s):  
Melviani ◽  
Setia Budi
Keyword(s):  
Willingness To Pay ◽  
Stated Preference ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Cross Sectional ◽  
Bivariate Correlation ◽  
Life Years ◽  
Quality Adjusted Life

Pelayanan kesehatan di Indonesia belum maksimal dalam memenuhi kebutuhan pasien dengan penyakit moderate. Pendekatan farmakoekonomi yang paling direkomendasikan dalam rangka kendali mutu dan biaya adalah cost utility analysis. Interpretasi terhadap nilai rasio efektivitas biaya tersebut membutuhkan cost effectiveness threshold untuk menentukan suatu teknologi kesehatan bersifat costeffective atau tidak. Salah satu pendekatan yang dapat dilakukan adalah dengan estimasi nilai willingness to pay per quality adjusted life years. Tujuan penelitian adalah menganalisis nilai estimasi willingness to pay per quality adjusted life year pada penyakit moderate di masyarakat di Kota Banjarmasin dan faktor-faktor yang mempengaruhi WTP per QALY. Metode penelitian menggunakan pendekatan cross-sectional. Survei dilakukan pada masyarakat di Kota Banjarmasin tahun 2019 menggunakan metode stated preference dengan pendekatan contingent valuation. Jumlah sampel sebanyak 100 responden. Instrumen penelitian ini berupa kuesioner yang terdiri dari pengukuran nilai WTP menggunakan metode dichotomous bidding game, pengukuran utility menggunakan EQ-5D berdasarkan skenario hipotetik nilai utility penyakit moderate. Analisis mengunakan bivariate correlation analysis spearman.  Hasil penelitian menunjukan Rata-rata WTP per QALY EQ-5D-5L Rp19.538.910 dan analisis variabel karakteristik responden terhadap WTP per QALY di dapatkan R square 0,397(p=0,026) yang artinya bahwa 39% secara bersama-sama variabel dependen akan mempengaruhi WTP per QALY. Penelitian ini diharapkan dapat memberi masukan terhadap CE-Threshold berdasarkan preferensi masyarakat

scholarly journals Long-term cost-utility analysis of remote monitoring of older patients with pacemakers: the PONIENTE study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rafael Jesus Bautista-Mesa ◽  
Antonio Lopez-Villegas ◽  
Salvador Peiro ◽  
Daniel Catalan-Matamoros ◽  
Emilio Robles-Musso ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Remote Monitoring ◽  
Older Patients ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Life Years

Abstract Background Cost-effectiveness studies on pacemakers have increased in the last years. However the number of long-term cost-utility studies is limited. The objective of this study was to perform a cost-utility analysis comparing remote monitoring (RM) versus conventional monitoring (CM) in hospital of older patients with pacemakers, 5 years after implant. Methods Under a controlled, not randomized, nor masked clinical trial, 83 patients with pacemakers were initially selected. After five years of follow-up, a total of 55 patients (CM = 34; RM = 21) completed the study. A cost-utility analysis of RM in terms of costs per gained quality-adjusted life years (QALYs) was conducted. The costs from the Public Health System (PHS) as well as patients and their relatives were taken into account for the study. The robustness of the results was verified by the probabilistic analyses through Monte-Carlo simulations. Results After a five-year follow-up period, total costs were lower in the RM group by 23.02% than in the CM group (€274.52 versus €356.62; p = 0.033) because of a cost saving from patients’ perspective (€59.05 versus €102.98; p = 0.002). However, the reduction of in-hospital visits derived from RM exhibited insignificant impact on the costs from the PHS perspective, with a cost saving of 15.04% (€215.48 vs. €253.64; p = 0.144). Costs/QALYs obtained by the RM group were higher as compared to the CM group, although there were no significant differences. The incremental cost-effectiveness ratio of CM in comparison to RM became positive (€301.16). Conclusions This study confirms RM of older patients with pacemakers appears still as a cost-utility alternative to CM in hospital after 5 years of follow-up. Trial registration ClinicalTrials.gov: (Identifier: NCT02234245). Registered 09 September 2014 - Prospectively registered.

scholarly journals Using Published Health Utilities in Cost-Utility Analyses: Discrepancies and Issues in Cardiovascular Disease

2021 ◽  
pp. 0272989X2110045
Author(s):  
Ting Zhou ◽  
Zhiyuan Chen ◽  
Hongchao Li ◽  
Feng Xie
Keyword(s):  
Cardiovascular Disease ◽  
Health Utility ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Health Utilities ◽  
Life Years ◽  
Reported Health ◽  
Quality Adjusted Life ◽  
Value Of Health

Background Health utilities are commonly used as quality weights to calculate quality-adjusted life years in cost-utility analysis (CUA). However, if published health utilities are not properly used, the credibility of CUA could be affected. Objectives To identify discrepancies in using published health utilities in CUAs for cardiovascular disease (CVD). Methods CVD CUAs in the Tufts Cost-Effectiveness Analysis Registry that reported health utilities were included in the analysis. References cited for health utilities in these CUAs were reviewed to identify the original health utility studies. The description and value of health utilities used in the CUA were compared with those reported in the original utility studies. Logistic regression was used to identify the factors that can predict the discrepancy. Results A total of 585 eligible CUAs published between 1977 and 2016 were identified and reviewed. Of these studies, 74.5% were published between 2007 and 2016. 442 CUAs that used a total of 2235 health utilities published in 203 original utility studies were included for the comparison. As compared with those utilities originally reported, only 596 (26.7%) health utilities had the same description and value, whereas 991 health utilities (44.3%) differed in both description and value. Of 1290 health utilities with a different description, 69.1% were due to different severity or disease. No explanation or justification was provided for 1171 (87.4%) of 1340 health utilities with different value. Conclusions There are concerning discrepancies in using published health utilities for CVD CUAs. Given the important role health utilities play in CUAs, authors of CUAs should always refer to the original studies for health utilities and be transparent about how published health utilities are selected and incorporated into CUAs.

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