scholarly journals The cost-effectiveness of the SPHERE intervention for the secondary prevention of coronary heart disease

2010 ◽  
Vol 26 (3) ◽  
pp. 263-271 ◽  
Author(s):  
Paddy Gillespie ◽  
Eamon O'Shea ◽  
Andrew W. Murphy ◽  
Mary C. Byrne ◽  
Molly Byrne ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cost Effectiveness ◽  
Secondary Prevention ◽  
Intervention Strategy ◽  
Cost Savings ◽  
Decision Makers ◽  
Level Of Evidence ◽  
Care Plans ◽  
Life Years ◽  
The Cost

Objectives: The Secondary Prevention of Heart disEase in geneRal practicE (SPHERE) trial has recently reported. This study examines the cost-effectiveness of the SPHERE intervention in both healthcare systems on the island of Ireland.Methods: Incremental cost-effectiveness analysis. A probabilistic model was developed to combine within-trial and beyond-trial impacts of treatment to estimate the lifetime costs and benefits of two secondary prevention strategies: Intervention - tailored practice and patient care plans; and Control - standardized usual care.Results: The intervention strategy resulted in mean cost savings per patient of €512.77 (95 percent confidence interval [CI], −1086.46–91.98) and an increase in mean quality-adjusted life-years (QALYs) per patient of 0.0051 (95 percent CI, −0.0101–0.0200), when compared with the control strategy. The probability of the intervention being cost-effective was 94 percent if decision makers are willing to pay €45,000 per additional QALY.Conclusions: Decision makers in both settings must determine whether the level of evidence presented is sufficient to justify the adoption of the SPHERE intervention in clinical practice.

scholarly journals The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam

2020 ◽  
Author(s):  
Colman Taylor ◽  
Annet C Hoek ◽  
Irene Deltetto ◽  
Adrian Peacock ◽  
Do Thi Phuong Ha ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Sodium Intake ◽  
Intervention Strategy ◽  
Cost Savings ◽  
Cost Effective ◽  
Dietary Sodium ◽  
Fish Sauce ◽  
Regulatory Strategies ◽  
Life Years ◽  
The Cost

Abstract Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and IHD events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (-3,445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (-43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (-243,530 ₫ US$ -10.49; 0.074 QALYs gained). Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment, however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.

scholarly journals The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam

2020 ◽  
Author(s):  
Colman Taylor ◽  
Annet C Hoek ◽  
Irene Deltetto ◽  
Adrian Peacock ◽  
Do Thi Phuong Ha ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cost Effectiveness ◽  
Ischaemic Heart Disease ◽  
Sodium Intake ◽  
Cost Savings ◽  
Cost Effective ◽  
Dietary Sodium ◽  
Fish Sauce ◽  
Regulatory Strategies ◽  
The Cost

Abstract BackgroundDietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.MethodsThe three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (-3,445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (-43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (-243,530 ₫ US$ -10.49; 0.074 QALYs gained). ConclusionThis research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment, however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.

scholarly journals 802-6 The Cost-Effectiveness of Pravastatin in Secondary Prevention of Coronary Heart Disease

1995 ◽  
Vol 25 (2) ◽  
pp. 390A ◽  
Author(s):  
Talat Ashraf ◽  
Joel W. Hay ◽  
John R. Crouse ◽  
Michael H. Davidson ◽  
Curt D. Furberg ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cost Effectiveness ◽  
Secondary Prevention ◽  
The Cost

scholarly journals 1209. Expanding an Economic Evaluation of the Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections to Include Prevention of Gram-Negative Bacteria

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S366-S367
Author(s):  
Richard E Nelson ◽  
Michihiko Goto ◽  
Matthew Samore ◽  
Makoto Jones ◽  
Vanessa Stevens ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Savings ◽  
Veterans Affairs ◽  
Economic Evaluations ◽  
Published Data ◽  
Department Of Veterans Affairs ◽  
Gram Negative ◽  
Trade Offs ◽  
Life Years ◽  
The Cost

Abstract Background In October 2007, the Department of Veterans Affairs (VA) launched the National MRSA Prevention Initiative, a nationwide effort to reduce MRSA transmission through (1) universal screening, (2) contact isolation for MRSA+ patients, (3) institutional culture change that “infection prevention is everyone’s business,” (4) emphasis on hand hygiene, and (5) increased infection control resources. While the initiative focused on MRSA, recent evidence suggests that it also led to a significant decrease in hospital-onset (HO) Gram-negative rod (GNR) bacteremia. The objective of this analysis was to evaluate the cost-effectiveness and the budget impact of the initiative taking into account both MRSA and GNR infections. Methods We developed an economic model using published data on the rate of MRSA HAIs and HO-GNR bacteremia in the VA from October 2007 to September 2015, estimates of the attributable cost and mortality of these infections, and the costs associated with the intervention obtained through a microcosting approach. We explored several different assumptions for the rate of infections that would have occurred if the initiative had not been implemented. Effectiveness was measured in life-years (LYs) gained. Results We found that during fiscal years 2008–2015, the initiative resulted in an estimated 4,761–9,236 fewer MRSA HAIs and 1,447–2,159 fewer HO-GNR bacteremia. The initiative itself was estimated to cost $206 million over this 8-year period while the cost savings from prevented MRSA HAIs ranged from $75–165 million and from prevented HO-GNR bacteremia ranged from $42–62 million. The incremental cost-effectiveness of the initiative ranged from $12,146–$46,500/LY when just including MRSA HAIs and from $7,945–$24,387/LY when including HO-GNR bacteremia. The overall impact on the VA’s budget ranged from $200–$334 million. Conclusion An MRSA surveillance and prevention strategy in VA may have prevented a substantial number of MRSA and GNR infections. The savings associated with the prevented infections helped to offset some but not all of the cost of the initiative. Economic evaluations of these interventions can help decision makers understand the trade offs between increased cost and improved health that can come from such interventions. Disclosures All authors: No reported disclosures.

scholarly journals The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Colman Taylor ◽  
Annet C. Hoek ◽  
Irene Deltetto ◽  
Adrian Peacock ◽  
Do Thi Phuong Ha ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cost Effectiveness ◽  
Ischaemic Heart Disease ◽  
Sodium Intake ◽  
Cost Savings ◽  
Cost Effective ◽  
Dietary Sodium ◽  
Fish Sauce ◽  
Regulatory Strategies ◽  
The Cost

Abstract Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~ 70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam. Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (− 3445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (− 43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (− 243,530 ₫ US$ -10.49; 0.074 QALYs gained). Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment; however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.

scholarly journals Cost-effectiveness of cardiovascular imaging for stable coronary heart disease

Heart ◽  
2020 ◽  
pp. heartjnl-2020-316990 ◽  
Author(s):  
Simon Walker ◽  
Edward Cox ◽  
Ben Rothwell ◽  
Colin Berry ◽  
Gerry P McCann ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cost Effectiveness ◽  
Magnetic Resonance ◽  
Health Benefits ◽  
Cost Effective ◽  
Nice Guidelines ◽  
Pretest Likelihood ◽  
Life Years ◽  
The Cost

ObjectiveTo assess the cost-effectiveness of management strategies for patients presenting with chest pain and suspected coronary heart disease (CHD): (1) cardiovascular magnetic resonance (CMR); (2) myocardial perfusion scintigraphy (MPS); and (3) UK National Institute for Health and Care Excellence (NICE) guideline-guided care.MethodsUsing UK data for 1202 patients from the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 trial, we conducted an economic evaluation to assess the cost-effectiveness of CMR, MPS and NICE guidelines. Health outcomes were expressed as quality-adjusted life-years (QALYs), and costs reflected UK pound sterling in 2016–2017. Cost-effectiveness results were presented as incremental cost-effectiveness ratios and incremental net health benefits overall and for low, medium and high pretest likelihood of CHD subgroups.ResultsCMR had the highest estimated QALY gain overall (2.21 (95% credible interval 2.15, 2.26) compared with 2.07 (1.92, 2.20) for NICE and 2.11 (2.01, 2.22) for MPS) and incurred comparable costs (overall £1625 (£1431, £1824) compared with £1753 (£1473, £2032) for NICE and £1768 (£1572, £1989) for MPS). Overall, CMR was the cost-effective strategy, being the dominant strategy (more effective, less costly) with incremental net health benefits per patient of 0.146 QALYs (−0.18, 0.406) compared with NICE guidelines at a cost-effectiveness threshold of £15 000 per QALY (93% probability of cost-effectiveness). Results were similar in the pretest likelihood subgroups.ConclusionsCMR-guided care is cost-effective overall and across all pretest likelihood subgroups, compared with MPS and NICE guidelines.

scholarly journals The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam

2021 ◽  
Author(s):  
Colman Taylor ◽  
Annet C Hoek ◽  
Irene Deltetto ◽  
Adrian Peacock ◽  
Do Thi Phuong Ha ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cost Effectiveness ◽  
Ischaemic Heart Disease ◽  
Sodium Intake ◽  
Cost Savings ◽  
Cost Effective ◽  
Dietary Sodium ◽  
Fish Sauce ◽  
Regulatory Strategies ◽  
The Cost

Abstract Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (-3,445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (-43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (-243,530 ₫ US$ -10.49; 0.074 QALYs gained). Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment; however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.

scholarly journals COST-EFFECTIVENESS OF VANCOMYCIN POWDER FOR DEEP WOUND INFECTION PROPHYLAXIS IN SPINE FUSION

2021 ◽  
Vol 20 (1) ◽  
pp. 38-41
Author(s):  
Alonso Alemán-Villalón ◽  
Alfredo Javier Moheno-Gallardo ◽  
Eulalio Elizalde-Martínez ◽  
Jorge Quiroz-Williams ◽  
Jorge Alvaro González-Ross
Keyword(s):  
Cost Effectiveness ◽  
Average Cost ◽  
Cost Savings ◽  
Cost Effective ◽  
Spine Fusion ◽  
Infection Prophylaxis ◽  
Level Of Evidence ◽  
Effective Option ◽  
Vancomycin Powder ◽  
The Cost

ABSTRACT Objective: To identify the cost effectiveness of vancomycin powder in the prophylaxis of posterior lumbar spine instrumentation, seeking potential savings. Methods: A retrospective, observational study was performed to evaluate the cost effectiveness. Data were retrieved from patients’ files from March 2016 to April 2017; costs were considered for the procedures, as well as which antibiotic was used. Results: A total of 184 patients were included. Of these, 102 received prophylactic treatment with 1g of cephalothin and 82 received 1g of cephalothin and 1g of vancomycin powder, which was applied to the wound prior to tissue closure. Of the 184 patients, 110 were women (59%) and 74 were men (41%), and the mean age was 55 years (24-77). The participants had a median BMI of 28.9 kg/m2 (19-39). The average cost per hospitalized patient was $3974 USD and the average cost of rehospitalization due to infection was, on average, $7700 USD. The use of vancomycin powder led to cost savings of $75,008.79 USD per 100 posterior spinal fusions performed for degenerative spine. Conclusion: The use of vancomycin powder is a cost-effective option for prophylaxis of surgical site infection in spine fusion. Level of evidence III; Economic and decision analysis.

scholarly journals Cost-effectiveness of palivizumab in infants with congenital heart disease: a Swedish perspective

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Eva Fernlund ◽  
Martin Eriksson ◽  
Jonas Söderholm ◽  
Jan Sunnegårdh ◽  
Estelle Naumburg
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Cost Effectiveness ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Cost Savings ◽  
Life Years ◽  
Increased Risk ◽  
Syncytial Virus ◽  
One Year

Abstract Background Infants with congenital heart disease (CHD) have an increased risk of morbidity and mortality during a respiratory syncytial virus (RSV) infection. The aim of this study was to estimate the cost-effectiveness of palivizumab as RSV-prophylaxis among infants with CHD, including the effect of delayed heart surgery and asthma. Methods A simulation model with data from the literature and health care authorities including costs and utilities was developed to estimate costs and health effects over a lifetime for a cohort of CHD infants receiving palivizumab compared to no RSV-prophylaxis. Results The prophylaxis treatment incurred a cost of 3664 EUR per treated infant. However, due to cost-savings from primarily avoiding hospitalizations (5145 EUR/treated infant) and avoiding heart complications due to delayed heart surgery (2082 EUR/treated infant), the RSV-prophylaxis treatment resulted in a total cost-saving of 3833 EUR per treated infant. At the same time, the prophylaxis-treated cohort accumulated more life-years and higher quality of life than the non-prophylaxis cohort. Conclusion This study confirms that RSV-prophylaxis in severe CHD infants less than one year of age is cost beneficial. Avoiding delayed heart surgeries is an important benefit of prophylaxis and should be taken into consideration.

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