scholarly journals Improving patient access to cancer drugs in India: Using economic modeling to estimate a more affordable drug cost based on measures of societal value

2011 ◽  
Vol 27 (1) ◽  
pp. 23-30 ◽  
Author(s):  
George Dranitsaris ◽  
Ilse Truter ◽  
Martie S. Lubbe ◽  
Nitin N. Sriramanakoppa ◽  
Vivian M. Mendonca ◽  
...  
Keyword(s):  
Economic Value ◽  
World Health ◽  
Cancer Drug ◽  
Base Case ◽  
Public Healthcare ◽  
Monthly Cost ◽  
New Drug ◽  
Societal Value ◽  
Life Years ◽  
Per Capita

Background: Using multiples of India's per capita gross domestic product (GDP) as the threshold for economic value as suggested by the World Health Organization (WHO), decision analysis modeling was used to estimate a more affordable monthly cost in India for a hypothetical new cancer drug that provides a 3-month survival benefit to Indian patients with metastatic colorectal cancer (mCRC).Methods: A decision model was developed to simulate progression-free and overall survival in mCRC patients receiving chemotherapy with and without the new drug. Costs for chemotherapy and side-effects management were obtained from both public and private hospitals in India. Utility estimates measured as quality-adjusted life-years (QALY) were determined by interviewing twenty-four oncology nurses using the Time Trade-Off technique. The monthly cost of the new drug was then estimated using a target threshold of US$9,300 per QALY gained, which is three times the Indian per capita GDP.Results: The base-case analysis suggested that a price of US$98.00 per dose would be considered cost-effective from the Indian public healthcare perspective. If the drug were able to improve patient quality of life above the standard of care or survival from 3 to 6 months, the price per dose could increase to US$170 and US$253 and offer the same value.Conclusions: The use of the WHO criteria for estimating the cost of a new drug based on economic value for a developing country like India is feasible and can be used to estimate a more affordable cost based on societal value thresholds.

scholarly journals The Clinical and Economic Value of a Successful Shutdown During the SARS-CoV-2 Pandemic in Germany

2020 ◽  
Author(s):  
Afschin Gandjour
Keyword(s):  
Economic Value ◽  
Health Gain ◽  
Mortality Data ◽  
Base Case ◽  
German Population ◽  
Case Scenario ◽  
Worst Case ◽  
Herd Protection ◽  
Life Years ◽  
Per Capita

Background and aim: A shutdown of businesses enacted during the SARS-CoV-2 pandemic can serve different goals, e.g., preventing the intensive care unit (ICU) capacity from being overwhelmed ("flattening the curve") or keeping the reproduction number substantially below one ("squashing the curve"). The aim of this study was to determine the clinical and economic value of a shutdown that is successful in "flattening" or "squashing the curve" in Germany. Methods: In the base case, the study compared a successful shutdown to a worst-case scenario with no ICU capacity left to treat COVID-19 patients. To this end, a decision model was developed using, e.g., information on age-specific fatality rates, ICU outcomes, and the herd protection threshold. The value of an additional life year was borrowed from new, innovative oncological drugs, as cancer reflects a condition with a similar morbidity and mortality burden in the general population in the short term as COVID-19. Results: A shutdown that is successful in "flattening the curve" is projected to yield an average health gain between 0.02 and 0.08 life years (0.2 to 0.9 months) per capita in the German population. The corresponding economic value ranges between 1543 and 8027 euros per capita or, extrapolated to the total population, 4% to 19% of the gross domestic product (GDP) in 2019. A shutdown that is successful in "squashing the curve" is expected to yield a minimum health gain of 0.10 life years (1.2 months) per capita, corresponding to 24% of the GDP in 2019. Results are particularly sensitive to mortality data and the prevalence of undetected cases.

The monetary value of disability-adjusted-life-years lost in Kenya in 2017.pdf

2019 ◽  
Author(s):  
Joses Kirigia ◽  
Rose Nabi Deborah Karimi Muthuri
Keyword(s):  
New York ◽  
International Monetary Fund ◽  
Health Expenditure ◽  
Analytical Framework ◽  
World Health ◽  
Gdp Per Capita ◽  
Current Health ◽  
Monetary Value ◽  
Life Years ◽  
Per Capita

<div>A variant of human capital (or net output) analytical framework was applied to monetarily value DALYs lost from 166 diseases and injuries. The monetary value of each of the 166 diseases (or injuries) was obtained through multiplication of the net 2019 GDP per capita for Kenya by the number of DALYs lost from each specific cause. Where net GDP per capita was calculated by subtracting current health expenditure from the GDP per capita. </div><div> </div><p>The DALYs data for the 166 causes were from IHME (Global Burden of Disease Collaborative Network, 2018), GDP per capita data from the International Monetary Fund world economic outlook database (International Monetary Fund, 2019), and the current health expenditure per person data from the WHO Global Health Expenditure Database (World Health Organization, 2019b). A model consisting of fourteen equations was calculated with Excel Software developed by Microsoft (New York).</p><p> </p>

scholarly journals The potential health and economic value of SARS-CoV-2 vaccination alongside physical distancing in the UK: transmission model-based future scenario analysis and economic evaluation

2020 ◽  
Author(s):  
Frank Sandmann ◽  
Nicholas Davies ◽  
Anna Vassall ◽  
W John Edmunds ◽  
Mark Jit ◽  
...  
Keyword(s):  
National Economy ◽  
Economic Value ◽  
Vaccine Effectiveness ◽  
Transmission Model ◽  
Base Case ◽  
Natural Immunity ◽  
Potential Health ◽  
Monetary Value ◽  
Life Years ◽  
The Uk

Background In response to the coronavirus disease 2019 (COVID-19), the UK adopted mandatory physical distancing measures in March 2020. Vaccines against the newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may become available as early as late 2020. We explored the health and economic value of introducing SARS-CoV-2 immunisation alongside physical distancing scenarios in the UK. Methods We used an age-structured dynamic-transmission and economic model to explore different scenarios of immunisation programmes over ten years. Assuming vaccines are effective in 5-64 year olds, we compared vaccinating 90% of individuals in this age group to no vaccination. We assumed either vaccine effectiveness of 25% and 1-year protection and 90% re-vaccinated annually, or 75% vaccine effectiveness and 10-year protection and 10% re-vaccinated annually. Natural immunity was assumed to last 45 weeks in the base case. We also explored the additional impact of physical distancing. We considered benefits from disease prevented in terms of quality-adjusted life-years (QALYs), and costs to the healthcare payer versus the national economy. We discounted at 3.5% annually and monetised health impact at 20,000 per QALY to obtain the net monetary value, which we explored in sensitivity analyses. Findings Without vaccination and physical distancing, we estimated 147.9 million COVID-19 cases (95% uncertainty interval: 48.5 million, 198.7 million) and 2.8 million (770,000, 4.2 million) deaths in the UK over ten years. Vaccination with 75% vaccine effectiveness and 10-year protection may stop community transmission entirely for several years, whereas SARS-CoV-2 becomes endemic without highly effective vaccines. Introducing vaccination compared to no vaccination leads to economic gains (positive net monetary value) of 0.37 billion to +1.33 billion across all physical distancing and vaccine effectiveness scenarios from the healthcare perspective, but net monetary values of physical distancing scenarios may be negative from societal perspective if the daily national economy losses are persistent and large. Interpretation Our model findings highlight the substantial health and economic value of introducing SARS-CoV-2 vaccination. Given uncertainty around both characteristics of the eventually licensed vaccines and long-term COVID-19 epidemiology, our study provides early insights about possible future scenarios in a post-vaccination era from an economic and epidemiological perspective.

scholarly journals Comparing the direct human impact of natural disasters for two cases in 2011: The Christchurch earthquake and the Bangkok flood

2021 ◽  
Author(s):  
Ilan Noy
Keyword(s):  
New Zealand ◽  
Natural Disasters ◽  
World Health ◽  
Disability Adjusted Life Years ◽  
Catastrophic Events ◽  
Disability Adjusted Life ◽  
Life Years ◽  
The World ◽  
Per Capita ◽  
Burden Of Diseases

The standard way in which disaster damages are measured involves examining separately the number of fatalities, of injuries, of people otherwise affected, and the financial damage that natural disasters cause. Here, we implement a novel way to aggregate these separate measures of disaster impact and apply it to two catastrophic events from 2011: the Christchurch (New Zealand) earthquakes and the Greater Bangkok (Thailand) flood. This new measure, which is similar to the World Health Organization's calculation of Disability Adjusted Life Years (DALYs) lost due to the burden of diseases and injuries, is described in detail in Noy [7]. It allows us to conclude that New Zealand lost 180 thousand lifeyears as a result of the 2011 events, and Thailand lost 2644 thousand lifeyears. In per capita terms, the loss is similar, with both countries losing about 15 days per person due to the 2011 catastrophic events in these two countries. © This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/

scholarly journals The monetary value of disability-adjusted-life-years lost in Kenya in 2017.pdf

2019 ◽  
Author(s):  
Joses Kirigia ◽  
Rose Nabi Deborah Karimi Muthuri
Keyword(s):  
New York ◽  
International Monetary Fund ◽  
Health Expenditure ◽  
Analytical Framework ◽  
World Health ◽  
Gdp Per Capita ◽  
Current Health ◽  
Monetary Value ◽  
Life Years ◽  
Per Capita

<div>A variant of human capital (or net output) analytical framework was applied to monetarily value DALYs lost from 166 diseases and injuries. The monetary value of each of the 166 diseases (or injuries) was obtained through multiplication of the net 2019 GDP per capita for Kenya by the number of DALYs lost from each specific cause. Where net GDP per capita was calculated by subtracting current health expenditure from the GDP per capita. </div><div> </div><p>The DALYs data for the 166 causes were from IHME (Global Burden of Disease Collaborative Network, 2018), GDP per capita data from the International Monetary Fund world economic outlook database (International Monetary Fund, 2019), and the current health expenditure per person data from the WHO Global Health Expenditure Database (World Health Organization, 2019b). A model consisting of fourteen equations was calculated with Excel Software developed by Microsoft (New York).</p><p> </p>

scholarly journals P424 Economic evaluation of vedolizumab SC for the treatment of moderate-to-severe ulcerative colitis in Canada

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S387-S387
Author(s):  
A FISCHER ◽  
M Oppe ◽  
S Stypa ◽  
V Lukyanov ◽  
I Petrakis
Keyword(s):  
Ulcerative Colitis ◽  
Cost Effectiveness ◽  
Meta Analysis ◽  
Cost Effective ◽  
Future Research ◽  
Base Case ◽  
Public Healthcare ◽  
Payer Perspective ◽  
Life Years ◽  
Public Payer

Abstract Background Vedolizumab intravenous (IV), a gut selective humanised monoclonal antibody, is indicated for the management of moderately to severely active Ulcerative Colitis (UC) and has been shown in the only head-to-head clinical trial within UC to be superior to adalimumab (NCT02497469). Furthermore, the novel vedolizumab subcutaneous (SC) has recently been proven to be an effective treatment of UC (NCT02611830). The objective of this study is to estimate the comparative cost-effectiveness of vedolizumab IV with updated efficacy data, and vedolizumab SC for the first time. Both vedolizumab IV and SC have been compared with other publicly reimbursed biologics for the treatment of patients with moderate-to-severe UC from a Canadian public healthcare payer perspective. Methods A hybrid decision tree/Markov model was developed to simulate the clinical course of UC, translating the disease course into costs and quality-adjusted life-years (QALYs). Comparative efficacy of vedolizumab SC, vedolizumab IV, adalimumab, infliximab IV, and golimumab were sourced from a network meta-analysis. Drug and disease management costs (2019 $CAD) were sourced from Ontario public payer schedules of benefits. Utilities were sourced from the literature. Clinical and economic outcomes were projected over a lifetime and discounted at 1.5% annually. Results Within a mixed bio-naïve/experienced population, vedolizumab SC resulted in slightly more QALYs than vedolizumab IV and dominated adalimumab (Table 1); vedolizumab SC yielded an incremental cost-effectiveness ratio (ICER) of $CAD 6,727 per QALY and $CAD 52,673 per QALY relative to golimumab and to infliximab (for which the price of a biosimilar was used), respectively. Further scenario analysis within bio-naïve populations supported the robustness of the base-case results, demonstrating that vedolizumab SC or vedolizumab IV were either dominant or cost-effective across all scenarios. Conclusion Our analysis suggests that vedolizumab SC and vedolizumab IV are a cost-effective therapeutic alternative relative to other biologics for moderate-to-severe UC in Canada. Future research will expand the analysis across all biologic comparators as they are used in the real world.

scholarly journals Economic value of insertable cardiac monitors in unexplained syncope in the United States

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001263
Author(s):  
Brad S Sutton ◽  
Sarah L Bermingham ◽  
Alexander Diamantopoulos ◽  
Sarah C Rosemas ◽  
Stelios I Tsintzos ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Economic Value ◽  
Cost Savings ◽  
The United States ◽  
Base Case ◽  
Payer Perspective ◽  
Life Years ◽  
Unexplained Syncope ◽  
The Cost ◽  
The Impact

IntroductionEarly use of insertable cardiac monitor (ICM) is recommended for patients with unexplained syncope following initial clinical workup, due to its superior ability to establish symptom-rhythm correlation compared with conventional testing (CONV). However, ICMs incur higher upfront costs, and the impact of additional diagnoses and resulting treatment on downstream costs and outcomes is unclear. We aimed to evaluate the cost-effectiveness of ICM compared with CONV for the diagnosis of arrhythmia in patients with unexplained syncope, from a US payer perspective.MethodsA Markov model was developed to estimate lifetime costs and benefits of arrhythmia diagnosis with ICM versus CONV, considering all related diagnostic and arrhythmia-related treatment costs and consequences. Cohort characteristics and costs were informed by original claims database analyses. Risks of mortality, syncopal recurrence, injury due to syncope and quality of life consequences from syncopal events were identified from the literature.ResultsICM was less costly and more effective than CONV. Most of the observed US$4532 cost savings were attributed to reduced downstream diagnostic testing. For every 1000 patients, ICM was projected to yield an additional 253 arrhythmia diagnoses and lead to treatment in an additional 168 patients. The ICM strategy resulted in overall improved outcomes (0.30 quality-adjusted life years gained), due to a reduction in syncope recurrence and injury resulting from arrhythmia treatment. The results were robust to changes in the base case parameters but sensitive to the model time horizon, underlying probability of syncope recurrence and prevalence of arrhythmias.ConclusionsOur model projected that early ICM for the diagnosis of unexplained syncope reduced long-term costs, and led to an improvement in overall clinical outcomes by shortening time to arrhythmia treatment. The cost of ICM was outweighed by savings arising from fewer downstream diagnostic episodes, and the increased cost of treatment was counterbalanced by fewer syncope-related event costs.

scholarly journals IMPLICATIONS OF GLOBAL PRICING POLICIES ON ACCESS TO INNOVATIVE DRUGS: THE CASE OF TRASTUZUMAB IN SEVEN LATIN AMERICAN COUNTRIES

2015 ◽  
Vol 31 (1-2) ◽  
pp. 2-11 ◽  
Author(s):  
Andres Pichon-Riviere ◽  
Osvaldo Ulises Garay ◽  
Federico Augustovski ◽  
Carlos Vallejos ◽  
Leandro Huayanay ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Developing Countries ◽  
Latin American ◽  
Transition Probabilities ◽  
Cancer Prognosis ◽  
World Health ◽  
Base Case ◽  
Pricing Policies ◽  
Life Years ◽  
Innovative Drugs

Objectives:Differential pricing, based on countries’ purchasing power, is recommended by the World Health Organization to secure affordable medicines. However, in developing countries innovative drugs often have similar or even higher prices than in high-income countries. We evaluated the potential implications of trastuzumab global pricing policies in terms of cost-effectiveness (CE), coverage, and accessibility for patients with breast cancer in Latin America (LA).Methods:A Markov model was designed to estimate life-years (LYs), quality-adjusted life-years (QALYs), and costs from a healthcare perspective. To better fit local cancer prognosis, a base case scenario using transition probabilities from clinical trials was complemented with two alternative scenarios with transition probabilities adjusted to reflect breast cancer epidemiology in each country.Results:Incremental discounted benefits ranged from 0.87 to 1.00 LY and 0.51 to 0.60 QALY and incremental CE ratios from USD 42,104 to USD 110,283 per QALY (2012 U.S. dollars), equivalent to 3.6 gross domestic product per capita (GDPPC) per QALY in Uruguay and to 35.5 GDPPC in Bolivia. Probabilistic sensitivity analysis showed 0 percent probability that trastuzumab is CE if the willingness-to-pay threshold is one GDPPC per QALY, and remained so at three GDPPC threshold except for Chile and Uruguay (4.3 percent and 26.6 percent, respectively). Trastuzumab price would need to decrease between 69.6 percent to 94.9 percent to became CE in LA.Conclusions:Although CE in other settings, trastuzumab was not CE in LA. The use of health technology assessment to prioritize resource allocation and support price negotiations is critical to making innovative drugs available and affordable in developing countries.

scholarly journals Comparing the direct human impact of natural disasters for two cases in 2011: The Christchurch earthquake and the Bangkok flood

2021 ◽  
Author(s):  
Ilan Noy
Keyword(s):  
New Zealand ◽  
Natural Disasters ◽  
World Health ◽  
Disability Adjusted Life Years ◽  
Catastrophic Events ◽  
Disability Adjusted Life ◽  
Life Years ◽  
The World ◽  
Per Capita ◽  
Burden Of Diseases

The standard way in which disaster damages are measured involves examining separately the number of fatalities, of injuries, of people otherwise affected, and the financial damage that natural disasters cause. Here, we implement a novel way to aggregate these separate measures of disaster impact and apply it to two catastrophic events from 2011: the Christchurch (New Zealand) earthquakes and the Greater Bangkok (Thailand) flood. This new measure, which is similar to the World Health Organization's calculation of Disability Adjusted Life Years (DALYs) lost due to the burden of diseases and injuries, is described in detail in Noy [7]. It allows us to conclude that New Zealand lost 180 thousand lifeyears as a result of the 2011 events, and Thailand lost 2644 thousand lifeyears. In per capita terms, the loss is similar, with both countries losing about 15 days per person due to the 2011 catastrophic events in these two countries. © This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/

Affording Immune Checkpoint Inhibitors (ICI) in the treatment of advanced non-small cell lung cancer (NSCLC): Argentinean National Cancer Institute (ANCI) perspective.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19404-e19404
Author(s):  
Carolina Gabay ◽  
Santiago Pesci ◽  
Johana Caldano ◽  
Maria Celeste Diaz
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Transition Probabilities ◽  
Indirect Comparison ◽  
Sensitivity Analyses ◽  
Gdp Per Capita ◽  
Public Healthcare ◽  
Metastatic Nsclc ◽  
Life Years ◽  
Per Capita

e19404 Background: ICI agents proved clinical effectiveness in metastatic NSCLC; irrespectively PDL1 expression, but they increase costs considerably. Thus its cost-effectiveness (CE) needs to be established in low and middle-income countries. We aimed to assess CE of Pembrolizumab plus carboplatin and pemetrexed (PCP) vs. carboplatin and pemetrexed (CP) in the first-line setting for non-squamous NSCLC, according to PDL1expresion, in Argentinian public healthcare system (APHS). Methods: Clinical outcomes, utilities, and transition probabilities were collected from the available literature (Keynote 189/024) after a systematic review. The certainty of evidence according to GRADE methodology was qualified as high. A Markov model was developed. Model outcomes were measured in quality adjusted-life-years (QALY) and CE was estimated as the incremental cost-effectiveness ratio (ICER) over a 20 years time horizon. Only direct costs were considered from a public price database of the drugs accounted in the model. The WHO ICER threshold, defined as 1-3 GDP per capita, was selected to established CE. Sensitivity analyses were performed to assess the robustness of results. Results: In PDL1≥ 50 % subgroup, PCP increased life expectancy of patients by 1.06 QALY for an incremental cost of USD 71.551 vs. CP with an ICER of 67.352 per QALY. An indirect comparison of PCP vs. Pembolizumab monotherapy found no differences in QALY estimates, however, it was associated with an incremental cost of USD 5.516. QALY estimate for PDL1 1-49% was 0.73 with an ICER of USD 85.984/ QALY gained. PDL1 < 1% obtained a QALY of 0.42 related to the largest ICER (USD 97.095) for the same comparison. The sensitivity analyses using a threshold between 1- 3 Argentinian GDP per capita in 2018 (USD 11.8602) found that PCP has no chance of being considered CE in untreated NSCLC patients. If a 6 GDP threshold is adopted in PDL1≥ 50 %, PCP would have a 50% possibility of being CE. Conclusions: This model was part of the decision-making process in the development of treatment guidelines for metastatic NSCLC in the ANCI. PCP cannot be considered acceptable for the APHS. Strategies to reduce costs are mandatory to improve affordability in our region.

Sign in / Sign up

Export Citation Format

Share Document