COST-EFFECTIVENESS OF ADJUNCTIVE HYPERBARIC OXYGEN IN THE TREATMENT OF DIABETIC ULCERS

2003 ◽  
Vol 19 (4) ◽  
pp. 731-737 ◽  
Author(s):  
Shien Guo ◽  
Michael A. Counte ◽  
Kathleen N. Gillespie ◽  
Homer Schmitz
Keyword(s):  
Cost Effectiveness ◽  
Hyperbaric Oxygen ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Sensitivity Analyses ◽  
Tree Model ◽  
Diabetic Ulcers ◽  
Study Results ◽  
The Cost ◽  
Hbo2 Therapy

Objectives: This study estimates the cost-effectiveness (CE) of the adjunctive use of hyperbaric oxygen (HBO2) therapy in the treatment of diabetic ulcers based on the payer's and societal perspectives.Methods: The study population was a hypothetical cohort of 1,000 patients sixty years of age with severe diabetic foot ulcers. A decision tree model was constructed to estimate the CE of HBO2 therapy in the treatment of diabetic ulcers at years 1, 5, and 12. Scenario and one-way sensitivity analyses were also undertaken to identify parameters that may significantly influence the estimates.Results: The CE model estimated that the incremental cost per additional quality-adjusted life year (QALY) gained at years 1, 5, and 12, was $27,310, $5,166, and $2,255, respectively.Conclusions: The study results indicate that HBO2 therapy in the treatment of diabetic ulcers is cost-effective, particularly based on a long-term perspective. However, the results are limited by the clinical studies that provide the basis of the CE estimation.

P14.41 Cost-effectiveness of FET PET for early treatment response assessment in glioma patients following adjuvant temozolomide chemotherapy

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii46-ii46
Author(s):  
J Rosen ◽  
G Ceccon ◽  
E K Bauer ◽  
J M Werner ◽  
C Kabbasch ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Response Assessment ◽  
Sensitivity Analyses ◽  
Tree Model ◽  
Fet Pet ◽  
Conventional Mri ◽  
Adjuvant Temozolomide ◽  
The Cost ◽  
Temozolomide Chemotherapy

Abstract BACKGROUND In light of increasing healthcare costs, higher medical expenses should be justified socio-economically. Therefore, we calculated the effectiveness and cost-effectiveness of PET using the radiolabeled amino acid O-(2-[18F]-fluoroethyl)-L-tyrosine (FET) compared to conventional MRI for early identification of responders to adjuvant temozolomide chemotherapy. A recent study in IDH-wildtype glioma patients suggested that after two cycles, FET-PET parameter changes predicted a significantly longer survival while MRI changes were not significant. MATERIALS AND METHODS To determine the effectiveness and cost-effectiveness of serial FET-PET imaging, we analyzed published clinical data and calculated the associated costs in the context of the German healthcare system.Based on a decision-tree model, FET-PET and MRI’s effectiveness was calculated, i.e., the probability to correctly identify a responder as defined by an overall survival ≥15 months. To determine the cost-effectiveness, the incremental cost-effectiveness ratio (ICER) was calculated, i.e., the cost for each additionally identified responder by FET-PET who would have remained undetected by MRI. The robustness of the results was tested by deterministic and probabilistic (Monte Carlo simulation) sensitivity analyses. RESULTS Compared to MRI, FET-PET increases the rate of correctly identified responders to chemotherapy by 26%; thus, four patients need to be examined by FET-PET to identify one additional responder. Considering the respective cost for serial FET-PET and MRI, the ICER resulted in €4,396.83 for each additional correctly identified responder by FET-PET. The sensitivity analyses confirmed the robustness of the results. CONCLUSION In contrast to conventional MRI, the model suggests that FET PET is cost-effective in terms of ICER values. Concerning the high cost of temozolomide, the integration of FET-PET has the potential to avoid premature chemotherapy discontinuation at a reasonable cost.

scholarly journals A Cost-Effectiveness Analysis of Newborn Screening for Severe Combined Immunodeficiency in the UK

2019 ◽  
Vol 5 (3) ◽  
pp. 28 ◽  
Author(s):  
Alice Bessey ◽  
James Chilcott ◽  
Joanna Leaviss ◽  
Carmen de la Cruz ◽  
Ruth Wong
Keyword(s):  
Cost Effectiveness ◽  
Severe Combined Immunodeficiency ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Combined Immunodeficiency ◽  
Tree Model ◽  
Life Years ◽  
The Uk ◽  
The Cost ◽  
The Impact

Severe combined immunodeficiency (SCID) can be detected through newborn bloodspot screening. In the UK, the National Screening Committee (NSC) requires screening programmes to be cost-effective at standard UK thresholds. To assess the cost-effectiveness of SCID screening for the NSC, a decision-tree model with lifetable estimates of outcomes was built. Model structure and parameterisation were informed by systematic review and expert clinical judgment. A public service perspective was used and lifetime costs and quality-adjusted life years (QALYs) were discounted at 3.5%. Probabilistic, one-way sensitivity analyses and an exploratory disbenefit analysis for the identification of non-SCID patients were conducted. Screening for SCID was estimated to result in an incremental cost-effectiveness ratio (ICER) of £18,222 with a reduction in SCID mortality from 8.1 (5–12) to 1.7 (0.6–4.0) cases per year of screening. Results were sensitive to a number of parameters, including the cost of the screening test, the incidence of SCID and the disbenefit to the healthy at birth and false-positive cases. Screening for SCID is likely to be cost-effective at £20,000 per QALY, key uncertainties relate to the impact on false positives and the impact on the identification of children with non-SCID T Cell lymphopenia.

scholarly journals Cost-effectiveness of a Pharmacogenomic Test for Stratified Isoniazid Dosing in Treatment of Active Tuberculosis

2020 ◽  
Author(s):  
Neil E Rens ◽  
Carin A Uyl-de Groot ◽  
Jeremy D Goldhaber-Fiebert ◽  
Julio Croda ◽  
Jason R Andrews
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Tree Model ◽  
A Value ◽  
Life Years ◽  
Nat2 Gene ◽  
Potential Clinical Impact ◽  
The Cost

Abstract Background There is marked interindividual variability in metabolism and resulting toxicity and effectiveness of drugs used for tuberculosis treatment. For isoniazid, mutations in the N-acetyltransferase 2 (NAT2) gene explain >88% of pharmacokinetic variability. However, weight-based dosing remains the norm globally. The potential clinical impact and cost-effectiveness of pharmacogenomic-guided therapy (PGT) are unknown. Methods We constructed a decision tree model to project lifetime costs and benefits of isoniazid PGT for drug-susceptible tuberculosis in Brazil, South Africa, and India. PGT was modeled to reduce isoniazid toxicity among slow NAT2 acetylators and reduce treatment failure among rapid acetylators. The genotyping test was assumed to cost the same as the GeneXpert test. The main outcomes were costs (2018 US dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. Results In Brazil, PGT gained 19 discounted life-years (23 QALYs) and cost $11 064 per 1000 patients, a value of $476 per QALY gained. In South Africa, PGT gained 15 life-years (19 QALYs) and cost $33 182 per 1000 patients, a value of $1780 per QALY gained. In India, PGT gained 20 life-years (24 QALYs) and cost $13 195 per 1000 patients, a value of $546 per QALY gained. One-way sensitivity analyses showed the cost-effectiveness to be robust to all input parameters. Probabilistic sensitivity analyses were below per capita gross domestic product in all 3 countries in 99% of simulations. Conclusions Isoniazid PGT improves health outcomes and would be cost-effective in the treatment of drug-susceptible tuberculosis in Brazil, South Africa, and India.

scholarly journals Pharmacoeconomics of three therapeutic schemes for anti-tuberculosis therapy induced liver injury in China

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 53-63 ◽  
Author(s):  
Yu Chen ◽  
Peng Ye ◽  
Chongwu Ren ◽  
Pengfei Ren ◽  
Zheng Ma ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Liver Injury ◽  
Controlled Trial ◽  
Cost Effective ◽  
Unit Price ◽  
Sensitivity Analyses ◽  
Expert Advice ◽  
Cost Effectiveness Ratio ◽  
Tree Model ◽  
The Cost

AbstractTo evaluate the pharmacoeconomics of three therapeutic schemes in treating anti-tuberluosis therapy -induced liver injury (anti-TB DILI).MethodsIn the construction of a decision tree model, the efficacy and safety parameters came from the results of the randomized, controlled trial conducted here, the effect parameters were derived from expert advice, and the cost parameters, such as usage specification, number, and unit price, came from literature, expert advice, and so on.ResultsThe cost-effectiveness analysis (CEA) based on the effect degrees showed that bicyclol had the best effect (4.63562). The incremental cost-effectiveness ratio (ICER) (206.03270) of bicyclol was the lowest. The cost-effectiveness ratio of silibinin was the lowest (68.59987). The CEA based on the complete normalization rate showed that bicyclol had the highest complete normalization rate (83.562%), the lowest cost-effectiveness ratio (4.63627), and the smallest ICER (4.63504). Sensitivity analyses proved the robustness of the results.ConclusionsBicyclol is the most cost-effective therapy and the preferred choice for treating anti-TB DILI.

scholarly journals The use of patient-reported outcome measures to guide referral for hip and knee arthroplasty

2020 ◽  
Vol 102-B (7) ◽  
pp. 950-958 ◽  
Author(s):  
H. Dakin ◽  
P. Eibich ◽  
D. Beard ◽  
A. Gray ◽  
A. Price
Keyword(s):  
Cost Effectiveness ◽  
Knee Arthroplasty ◽  
Cost Effective ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Quality Adjusted Life Year ◽  
Sensitivity Analyses ◽  
Patient Reported ◽  
Hip And Knee Arthroplasty ◽  
The Cost

Aims To assess how the cost-effectiveness of total hip arthroplasty (THA) and total knee arthroplasty (TKA) varies with age, sex, and preoperative Oxford Hip or Knee Score (OHS/OKS); and to identify the patient groups for whom THA/TKA is cost-effective. Methods We conducted a cost-effectiveness analysis using a Markov model from a United Kingdom NHS perspective, informed by published analyses of patient-level data. We assessed the cost-effectiveness of THA and TKA in adults with hip or knee osteoarthritis compared with having no arthroplasty surgery during the ten-year time horizon. Results THA and TKA cost < £7,000 per quality-adjusted life-year (QALY) gained at all preoperative scores below the absolute referral thresholds calculated previously (40 for OHS and 41 for OKS). Furthermore, THA cost < £20,000/QALY for patients with OHS of ≤ 45, while TKA was cost-effective for patients with OKS of ≤ 43, since the small improvements in quality of life outweighed the cost of surgery and any subsequent revisions. Probabilistic and one-way sensitivity analyses demonstrated that there is little uncertainty around the conclusions. Conclusion If society is willing to pay £20,000 per QALY gained, THA and TKA are cost-effective for nearly all patients who currently undergo surgery, including all patients at and above our calculated absolute referral thresholds. Cite this article: Bone Joint J 2020;102-B(7):950–958.

scholarly journals Cost-effectiveness of everolimus for the treatment of advanced neuroendocrine tumours of gastrointestinal or lung origin in Canada

2018 ◽  
Vol 25 (1) ◽  
pp. 32 ◽  
Author(s):  
A. Chua ◽  
A. Perrin ◽  
J.F. Ricci ◽  
M.P. Neary ◽  
M. Thabane
Keyword(s):  
Cost Effectiveness ◽  
Neuroendocrine Tumours ◽  
Locally Advanced ◽  
Cost Effective ◽  
Best Supportive Care ◽  
Quality Adjusted Life Year ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Health States ◽  
The Cost

Background In 2016, everolimus was approved by Health Canada for the treatment of unresectable, locally advanced or metastatic, well-differentiated, non-functional, neuroendocrine tumours (NET) of gastrointestinal (GI) or lung origin in adult patients with progressive disease. This analysis evaluated the cost-effectiveness of everolimus in this setting from a Canadian societal perspective.Methods A partitioned survival model was developed to compare the cost per life-year (LY) gained and cost per quality-adjusted life-year (QALY) gained of everolimus plus best supportive care (BSC) versus BSC alone in patients with advanced or metastatic NET of GI or lung origin. Model health states included stable disease, disease progression, and death. Efficacy inputs were based on the RADIANT-4 trial and utilities were mapped from quality-of-life data retrieved from RADIANT-4. Resource utilization inputs were derived from a Canadian physician survey, while cost inputs were obtained from official reimbursement lists from Ontario and other published sources. Costs and efficacy outcomes were discounted 5% annually over a 10-year time horizon, and sensitivity analyses were conducted to test the robustness of the base case results.Results Everolimus had an incremental gain of 0.616 QALYs (0.823 LYs) and CA$89,795 resulting in an incremental cost-effectiveness ratio of CA$145,670 per QALY gained (CA$109,166 per LY gained). The probability of cost-effectiveness was 52.1% at a willingness to pay (WTP) threshold of CA$150,000 per QALY.Conclusions Results of the probabilistic sensitivity analysis indicate that everolimus has a 52.1% probability of being cost-effective at a WTP threshold of CA$150,000 per QALY gained in Canada.

scholarly journals Use of Impulse oscillometry for Diagnostic of Asthma in Preschoolers: A Cost-effectiveness Analysis

2021 ◽  
Author(s):  
Jefferson Antonio Buendía ◽  
Diana Guerrero_Patiño
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Impulse Oscillometry ◽  
Tree Model ◽  
Health Technologies ◽  
Patient Cooperation ◽  
The One ◽  
The Cost

Abstract BackgroundImpulse oscillometry is an alternative to measure lung function in preschoolers because is much simpler and can be performed in tidal breathing with minimal patient cooperation. The introduction of new health technologies such as impulse oscillometry raises concerns as if the extra benefit offered outweighs the additional cost compared to spirometry This study aimed to evaluate the cost-effectiveness of impulse oscillometry in preschoolers in Colombia.Methods We conducted a decision tree model to estimate the cost and proportion of correctly diagnosed cases of asthma of impulse oscillometry compared to spirometry in preschooler’s children between 3-6 years old . The analysis was carried out from a societal perspective. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. ResultsWith impulse oscillometry, the proportion of correctly diagnosed cases was 42%, while with spirometry was 39%. The expected cost estimated by the model for a patient diagnosed with IOS was U$ 174 while with spirometry was U$ 99. The incremental cost-effectiveness ratio estimated in the probabilistic model was US$ 6881. The one-way and probabilistic sensitivity analyses, our base‐case results were robust to variations of all assumptions and parameters Conclusion Impulse oscillometry was found to be cost-effective for the diagnosis of asthma in preschoolers. Our results should stimulate further research to expand the use of this diagnostic test in developing countries.

scholarly journals Cost-Effectiveness of Dengue Vaccination in Indonesia: Considering Integrated Programs with Wolbachia-Infected Mosquitos and Health Education

2020 ◽  
Vol 17 (12) ◽  
pp. 4217 ◽  
Author(s):  
Auliya A. Suwantika ◽  
Angga P. Kautsar ◽  
Woro Supadmi ◽  
Neily Zakiyah ◽  
Rizky Abdulah ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Education ◽  
Treatment Cost ◽  
Dengue Infection ◽  
Intervention Strategy ◽  
Dengue Shock Syndrome ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Tree Model ◽  
The Cost

Despite the fact that morbidity and mortality rates due to dengue infection in Indonesia are relatively high, a dengue vaccination has not yet been introduced. Next to vaccination, Wolbachia-infected mosquitoes and health education have been considered to be potential interventions to prevent dengue infection in Indonesia. This study was aimed to analyse the cost-effectiveness of dengue vaccination in Indonesia whilst taking Wolbachia and health education programs into account. An age-structured decision tree model was developed to assess the cost-effectiveness. Approximately 4,701,100 children were followed-up in a 10-year time horizon within a 1-year analytical cycle. We compared three vaccination strategies: one focussing on vaccination only, another combining vaccination and a Wolbachia program, and a third scenario combining vaccination and health education. All scenarios were compared with a no-intervention strategy. The result showed that only vaccination would reduce dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) by 123,203; 97,140 and 283 cases, respectively. It would save treatment cost at $10.3 million and $6.2 million from the healthcare and payer perspectives, respectively. The combination of vaccination and a Wolbachia program would reduce DF, DHF and DSS by 292,488; 230,541; and 672 cases, respectively. It would also save treatment cost at $24.3 million and $14.6 million from the healthcare and payer perspectives, respectively. The combination of vaccination and health education would reduce DF, DHF, and DSS by 187,986; 148,220; and 432 cases, respectively. It would save treatment cost at $15.6 million and $9.4 million from the healthcare and payer perspectives, respectively. The incremental cost-effectiveness ratios (ICERs) from the healthcare perspective were estimated to be $9995, $4460, and $6399 per quality-adjusted life year (QALY) gained for the respective scenarios. ICERs from the payer perspective were slightly higher. It can be concluded that vaccination combined with a Wolbachia program was confirmed to be the most cost-effective intervention. Dengue infection rate, vaccine efficacy, cost of Wolbachia program, underreporting factor for hospitalization, vaccine price and mortality rate were considered to be the most influential parameters affecting the ICERs.

Cost–effectiveness analysis of ribociclib plus fulvestrant for hormone receptor-positive/human EGF receptor 2-negative breast cancer

Immunotherapy ◽  
2021 ◽  
Author(s):  
Wei Jiang ◽  
Zhichao He ◽  
Tiantian Zhang ◽  
Chongchong Guo ◽  
Jianli Zhao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Hormone Receptor ◽  
Egf Receptor ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Cost Effectiveness Ratio ◽  
Hormone Receptor Positive ◽  
The Cost ◽  
Quality Adjusted Life

Aim: To evaluate the cost–effectiveness of ribociclib plus fulvestrant versus fulvestrant in hormone receptor-positive/human EGF receptor 2-negative advanced breast cancer. Materials & methods: A three-state Markov model was developed to evaluate the costs and effectiveness over 10 years. Direct costs and utility values were obtained from previously published studies. We calculated incremental cost–effectiveness ratio to evaluate the cost–effectiveness at a willingness-to-pay threshold of $150,000 per additional quality-adjusted life year. Results: The incremental cost–effectiveness ratio was $1,073,526 per quality-adjusted life year of ribociclib plus fulvestrant versus fulvestrant. Conclusions: Ribociclib plus fulvestrant is not cost-effective versus fulvestrant in the treatment of advanced hormone receptor-positive/human EGF receptor 2-negative breast cancer. When ribociclib is at 10% of the full price, ribociclib plus fulvestrant could be cost-effective.

scholarly journals Cost-effectiveness of psychotherapy for cluster B personality disorders

2010 ◽  
Vol 196 (5) ◽  
pp. 396-403 ◽  
Author(s):  
Djøra I. Soeteman ◽  
Roel Verheul ◽  
Jos Delimon ◽  
Anke M. M. A. Meerman ◽  
Ellen van den Eijnden ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Personality Disorders ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Decision Analytic Model ◽  
Day Hospital ◽  
Payer Perspective ◽  
Cluster B Personality Disorders ◽  
Effective Choice ◽  
The Cost

BackgroundRecommendations on current clinical guidelines are informed by limited economic evidence.AimsA formal economic evaluation of three modalities of psychotherapy for patients with cluster B personality disorders.MethodA probabilistic decision-analytic model to assess the cost-effectiveness of out-patient, day hospital and in-patient psychotherapy over 5 years in terms of cost per recovered patient-year and cost per quality-adjusted life-year (QALY). Analyses were conducted from both societal and payer perspectives.ResultsFrom the societal perspective, the most cost-effective choice switched from out-patient to day hospital psychotherapy at a threshold of €12 274 per recovered patient-year; and from day hospital to in-patient psychotherapy at €113 298. In terms of cost per QALY, the optimal strategy changed at €56 325 and €286 493 per QALY respectively. From the payer perspective, the switch points were at €9895 and €155 797 per recovered patient-year, and €43 427 and €561 188 per QALY.ConclusionsOut-patient psychotherapy and day hospital psychotherapy are the optimal treatments for patients with cluster B personality disorders in terms of cost per recovered patient-year and cost per QALY.

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