A Cost-Utility Analysis of Abdominal Hysterectomy Versus Transcervical Endometrial Resection for the Surgical Treatment of Menorrhagia

1998 ◽  
Vol 14 (2) ◽  
pp. 302-319 ◽  
Author(s):  
Mark Sculpher
Keyword(s):  
Cost Effective ◽  
Abdominal Hysterectomy ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Health State ◽  
Utility Analysis ◽  
Major Health ◽  
Parameter Values ◽  
Quality Adjusted Life

AbstractMenorrhagia, or heavy regular menstrual bleeding, represents a major health burden to women. Trials comparing abdominal hysterectomy (AH) with transcervical resection of the endometrium (TCRE) for the condition have shown that, although the duration and severity of convalescence is less with TCRE, AH produces a permanent solution to heavy bleeding while TCRE fails in a proportion of women by 2 years. However, by 2 years, TCRE costs only 71% that of AH. This paper presents a cost-utility analysis to assess which procedure is more cost-effective overall. Under most plausible parameter values and on the basis of health state values elicited from a sample of women with menorrhagia, AH is likely to be considered more cost-effective than TCRE if purchasers are willing to pay an additional cost of at least £6,500 per extra quality-adjusted life-year generated by AH.

scholarly journals A one-year cost–utility analysis of REBOA versus RTACC for non-compressible torso haemorrhage

Trauma ◽  
2017 ◽  
Vol 21 (1) ◽  
pp. 45-54 ◽  
Author(s):  
Maxwell S Renna ◽  
Cristiano van Zeller ◽  
Farah Abu-Hijleh ◽  
Cherlyn Tong ◽  
Jasmine Gambini ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Cost Effectiveness Ratio ◽  
One Year ◽  
Quality Adjusted Life

Introduction Major trauma is a leading cause of death and disability in young adults, especially from massive non-compressible torso haemorrhage. The standard technique to control distal haemorrhage and maximise central perfusion is resuscitative thoracotomy with aortic cross-clamping (RTACC). More recently, the minimally invasive technique of resuscitative endovascular balloon occlusion of the aorta (REBOA) has been developed to similarly limit distal haemorrhage without the morbidity of thoracotomy; cost–utility studies on this intervention, however, are still lacking. The aim of this study was to perform a one-year cost–utility analysis of REBOA as an intervention for patients with major traumatic non-compressible abdominal haemorrhage, compared to RTACC within the U.K.’s National Health Service. Methods A retrospective analysis of the outcomes following REBOA and RTACC was conducted based on the published literature of survival and complication rates after intervention. Utility was obtained from studies that used the EQ-5D index and from self-conducted surveys. Costs were calculated using 2016/2017 National Health Service tariff data and supplemented from further literature. A cost–utility analysis was then conducted. Results A total of 12 studies for REBOA and 20 studies for RTACC were included. The mean injury severity scores for RTACC and REBOA were 34 and 39, and mean probability of death was 9.7 and 54%, respectively. The incremental cost-effectiveness ratio of REBOA when compared to RTACC was £44,617.44 per quality-adjusted life year. The incremental cost-effectiveness ratio, by exceeding the National Institute for Health and Clinical Effectiveness’s willingness-to-pay threshold of £30,000/quality-adjusted life year, suggests that this intervention is not cost-effective in comparison to RTACC. However, REBOA yielded a 157% improvement in utility with a comparatively small cost increase of 31.5%. Conclusion Although REBOA has not been found to be cost-effective when compared to RTACC, ultimately, clinical experience and expertise should be the main factor in driving the decision over which intervention to prioritise in the emergency context.

scholarly journals Valuing Health for Clinical and Economic Decisions: Directions Relevant for Rheumatologists

2011 ◽  
Vol 38 (8) ◽  
pp. 1770-1775 ◽  
Author(s):  
MARK J. HARRISON ◽  
NICK J. BANSBACK ◽  
CARLO A. MARRA ◽  
MICHAEL DRUMMOND ◽  
PETER S. TUGWELL ◽  
...  
Keyword(s):  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Point Of View ◽  
Health State ◽  
Utility Analysis ◽  
Economic Decisions ◽  
Pros And Cons ◽  
Allocation Decisions ◽  
Qaly Approach ◽  
Quality Adjusted Life

The quality-adjusted life-year (QALY) is a construct that integrates the value or preference for a health state over the period of time in that health state. The main use of QALY is in cost-utility analysis, to help make resource allocation decisions when faced with choices. Although the concept of the QALY is appealing, there is ongoing debate regarding their usefulness and approaches to deriving QALY. In 2008, OMERACT engaged in an effort to agree on QALY approaches that can be used in rheumatology. Based on a Web questionnaire and a subsequent meeting, rheumatologists questioned whether it was relevant for OMERACT (1) to investigate use of a QALY that represents the patients’ perspective, (2) to explore the validity of the visual analog scale (VAS) to value health, and (3) to understand the validity of mapping health-specific instruments on existing preference instruments. This article discusses the pros and cons of these points in light of current insight from the point of view of health economics and decision-making theory. It also considers the further research agenda toward a QALY approach in rheumatology.

The Optimal Treatment for Partial Thickness Burns: A Cost-Utility Analysis of Skin Allograft vs. Topical Silver Dressings

2020 ◽  
Vol 41 (3) ◽  
pp. 450-456 ◽  
Author(s):  
Clifford C Sheckter ◽  
Nickolas L Meyerkord ◽  
Yunna L Sinskey ◽  
Pariss Clark ◽  
Katarina Anderson ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Skin Allograft ◽  
Partial Thickness ◽  
Partial Thickness Burns ◽  
Quality Adjusted Life

Abstract Introduction Partial thickness burns not undergoing surgical excision are treated with topical silver products including silver sulfadiazine (SSD) and Mepilex Ag. Skin allograft is a more costly alternative that acts as definitive wound coverage until autogenous epithelialization. Economic constraints and the movement toward value-based care demand cost and outcome justification prior to adopting more costly products. Methods A cost-utility analysis was performed comparing skin allograft to SSD and Mepilex Ag using decision tree analysis. The base case modeled a superficial partial thickness 20% total body surface area burn. Utilities were derived from expert opinion on the basis of personal experience. Costs were derived from 2019 Medicare payments. Quality adjusted life years were calculated using rollback method assuming standard life expectancies in the United States. Probabilistic sensitivity analysis was performed to asses model robustness. Results The incremental costs of skin allograft to Mepilex Ag and SSD were $907.71 and $1257.86, respectively. The incremental quality adjusted life year (QALY) gains from allograft over Mepilex Ag and SSD were 0.011 and 0.016. This yielded an incremental cost-utility ratio for allograft vs. Mepilex Ag of $84,189.29/QALY compared with an incremental cost-utility ratio of $79,684.63/QALY for allograft vs. SSD. Assuming willingness-to-pay thresholds of $100,000/QALY, probabilistic sensitivity analysis demonstrated that allograft was cost effective to Mepilex Ag in 62.1% of scenarios, and cost effective to SSD in 64.9% of simulations. Conclusion Skin allograft showed greater QALYs compared with topical silver dressings at a higher cost. Depending on willingness-to-pay thresholds, skin allograft may be a considered a cost-effective treatment of partial-thickness burns.

Cost-Utility Analysis of Group Living in Dementia Care

1995 ◽  
Vol 11 (1) ◽  
pp. 49-65 ◽  
Author(s):  
Anders Wimo ◽  
Bengt Mattson ◽  
Ingvar Krakau ◽  
Tua Eriksson ◽  
Anders Nelvig ◽  
...  
Keyword(s):  
Group Living ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Dementia Patients ◽  
Methodological Problems ◽  
Institutionalized Patients ◽  
The Cost ◽  
Quality Adjusted Life

AbstractA cost-utility analysis (CUA) was applied to group living for dementia patients. A Markov-model of an expected life-length of 8 years was used. Forty-six patients in group living were compared to 39 patients living at home by inclusion and 23 institutionalized patients. When the cost per gained quality-adjusted life-year (QALY) was calculated, the group living alternative was the most favorable for the patients, giving a cost per paired QALY of US dollars > 0. In the extensive sensitivity analysis the main result was consistent but methodological problems were indicated.

Cost–utility analysis of an integrated genetic/epigenetic test for assessing risk for coronary heart disease

Epigenomics ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 531-547 ◽  
Author(s):  
Younsoo Jung ◽  
David Frisvold ◽  
Timur Dogan ◽  
Meeshanthini Dogan ◽  
Rob Philibert
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cost Effectiveness ◽  
Healthcare Spending ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Potential Impact ◽  
Quality Adjusted Life

Aim: New epigenetically based methods for assessing risk for coronary heart disease may be more sensitive but are generally more costly than current methods. To understand their potential impact on healthcare spending, we conducted a cost–utility analysis. Methods: We compared costs using the new Epi + Gen CHD™ test with those of existing tests using a cohort Markov simulation model. Results: We found that use of the new test was associated with both better survival and highly competitive negative incremental cost–effectiveness ratios ranging from -$42,000 to -$8000 per quality-adjusted life year for models with and without a secondary test. Conclusion: The new integrated genetic/epigenetic test will save money and lives under most real-world scenarios. Similar advantages may be seen for other epigenetic tests.

VALUE-BASED MEDICINE, COST-UTILITY ANALYSIS WHAT IS COST-EFFECTIVE?

2010 ◽  
Vol 11 (3) ◽  
pp. 180-186
Author(s):  
Gary C. Brown ◽  
Melissa M. Brown ◽  
Peter Kertes ◽  
Heidi B. Lieske ◽  
Philip Alex Lieske ◽  
...  
Keyword(s):  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Based Medicine

scholarly journals Cost-Utility Analysis of Tympanomastoidectomy for Adults with Chronic Suppurative Otitis Media

2005 ◽  
Vol 133 (3) ◽  
pp. 352-356 ◽  
Author(s):  
Pa-Chun Wang ◽  
Chul-Ho Jang ◽  
Yu-Hsiang Shu ◽  
Chih-Jaan Tai ◽  
Ko-Tsung Chu
Keyword(s):  
Otitis Media ◽  
Health Care Cost ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Chronic Suppurative Otitis Media ◽  
Total Direct Cost ◽  
Utility Analysis ◽  
Suppurative Otitis Media ◽  
Utility Gain

OBJECTIVE: To undertake cost-utility analysis for tympanomastoid surgery to analyze its cost-effectiveness in treating adult chronic suppurative otitis media (CSOM). METHODS: Seventy-seven patients with CSOM were evaluated with the Chronic Ear Survey (CES) before and 1 year after tympanomastoid surgery. Direct health care cost data during the 1st year after operation were retrieved. The utility gain was defined as change in the CES total score. The cost-utility ratio (CUR) was defined as cost per utility gain. Patients were stratified by disease type into wet-ear and dry-ear groups. RESULTS: The average total direct cost attributable to tympanomastoid surgery is (in New Taiwan dollars [NT$]) 45,716.3 in the 1st postoperative year, and the average CUR is NT$ 1850.9. The lower CUR of NT$ 1280.9 for the wet-ear group is due to the greater utility gain (37.6 ± 3.4 versus 24.4 ± 6.8, P >0.05) despite its higher cost (NT$ 48,163.2 versus NT$ 38,419.7, P >0.05). CONCLUSIONS: Treating continuously or intermittently draining ears is more cost-effective, as compared with managing a quiescent infection, because of its favorable utility gain.

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