COST-EFFECTIVENESS ANALYSIS OF HERPES ZOSTER VACCINATION IN ITALIAN ELDERLY PERSONS

2016 ◽  
Vol 32 (4) ◽  
pp. 233-240 ◽  
Author(s):  
Silvia Coretti ◽  
Paola Codella ◽  
Federica Romano ◽  
Matteo Ruggeri ◽  
Americo Cicchetti
Keyword(s):  
Herpes Zoster ◽  
Cost Effectiveness ◽  
Vaccination Strategy ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Third Party ◽  
Elderly Persons ◽  
Lifetime Horizon ◽  
Italian National Health Service ◽  
Italian Context

Objectives:Herpes zoster (HZ) is characterized by a painful skin rash. Its main complication is postherpetic neuralgia (PHN), pain persisting or occurring after the rash onset. HZ treatment aims to reduce acute pain, impede the onset complications, and disease progression. The aim of this study was to assess the cost-effectiveness of HZ vaccination compared with no vaccination strategy, within the Italian context.Methods:The natural history of HZ and PHN was mapped through a Markov model with lifetime horizon. A population of patients aged between 60 and 79 years was hypothesized. Third party payer (Italian National Health Service, I-NHS) and societal perspectives were adopted. Data were derived from literature.Results and Conclusions:The incremental cost-effectiveness ratio of the vaccination equaled EUR 11,943 per quality-adjusted life-year (QALY) under the I-NHS perspective and EUR 11,248 per QALY under the societal perspective. Considering a cost-effectiveness threshold of EUR 30,000/QALY, the multi-way sensitivity analysis showed that vaccination is cost-effective regardless of the perspective adopted, in 99 percent of simulations.

scholarly journals A Cost-effectiveness Analysis of an Adjuvanted Subunit Vaccine for the Prevention of Herpes Zoster and Post-herpetic Neuralgia

2019 ◽  
Vol 6 (7) ◽  
Author(s):  
Christopher F Carpenter ◽  
Annas Aljassem ◽  
Jerry Stassinopoulos ◽  
Giovanni Pisacreta ◽  
David Hutton
Keyword(s):  
Herpes Zoster ◽  
Cost Effectiveness ◽  
Subunit Vaccine ◽  
Age Groups ◽  
Cost Effective ◽  
The United States ◽  
Quality Adjusted Life Year ◽  
Published Data ◽  
Disease Epidemiology

Abstract Background Herpes zoster (HZ) develops in up to 50% of unvaccinated individuals, accounting for >1 million cases annually in the United States. A live attenuated HZ vaccine (LAV) is Food and Drug Administration approved for those age 50 years or older, though Advisory Committee on Immunization Practices recommendations are only for those age 60 years or older. LAV efficacy is ~70% for persons 50–59 years of age, with lower efficacy in older adults. A new 2-dose adjuvanted subunit vaccine (SUV) has >95% efficacy in persons 50–69 years of age and remains ~90% efficacious in persons vaccinated at age 70 years. Methods To estimate the relative cost-effectiveness of SUV, LAV, and no vaccination (NoV) strategies, a Markov model was developed based on published data on vaccine efficacy, durability of protection, quality of life, resource utilization, costs, and disease epidemiology. The perspective was US societal, and the cycle length was 1 year with a lifelong time horizon. SUV efficacy was estimated to wane at the same rate as LAV. Outcomes evaluated included lifetime costs, discounted life expectancy, and incremental cost-effectiveness ratios (ICERs). Results For individuals vaccinated at age 50 years, the ICER for LAV vs NoV was $118 535 per quality-adjusted life-year (QALY); at age 60 years, the ICER dropped to $42 712/QALY. SUV was more expensive but had better ICERs than LAV. At age 50, the ICER was $91 156/QALY, and it dropped to $19 300/QALY at age 60. Conclusions Vaccination with SUV was more cost-effective than LAV in all age groups studied. Vaccination with SUV at age 50 years appears cost-effective, with an ICER <$100 000/QALY.

scholarly journals Cost-effectiveness analysis of fruquintinib for metastatic colorectal cancer third-line treatment in China

2020 ◽  
Author(s):  
Zhi Peng ◽  
Xingduo Hou ◽  
Yangmu Huang ◽  
Tong Xie ◽  
Xinyang Hua
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Line Treatment ◽  
Lifetime Horizon ◽  
Third Line ◽  
The Cost ◽  
Third Line Treatment

Abstract Background : In this study, we analyze the cost-effectiveness of fruquintinib as third-line treatment for patients with metastatic colorectal cancer in China, especially after a recent price drop suggested by the National Healthcare Security Administration. Methods : A Markov model was developed to investigate the cost-effectiveness of fruquintinib compared to placebo among patients with metastatic colorectal cancer. Effectiveness was measured in quality-adjusted life year (QALY). The Chinese healthcare payer’s perspective was considered with a lifetime horizon, including direct medical cost (2019 US dollars [USD]). A willing‐to‐pay threshold was set USD 27,130/QALY, which is 3 times gross domestic product (GDP) per capita. We examined the robustness of the model in one-way and probabilistic sensitivity analysis. Results : Fruquintinib was associated with better health outcomes than placebo (0.640 vs 0.478 QALYs) with a higher cost (USD 20750.9 vs USD 12042.2), resulting an incremental results effectiveness ratio (ICER) of USD 53508.7 per QALY. This ICER is 25% lower than the one calculated before the price drop (USD 70952.6 per QALY). Conclusion : After the price negotiation, the drug becomes cheaper and the ICER is lower, but the drug is still not cost effective under the standard of 3 times GDP willing‐to‐pay threshold. For patients with metastatic colorectal cancer in China, fruquintinib is not a cost-effective option under the current circumstances in China.

scholarly journals Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis

2021 ◽  
Vol 7 (6) ◽  
pp. 417
Author(s):  
Ai Leng Khoo ◽  
Ying Jiao Zhao ◽  
Glorijoy Shi En Tan ◽  
Monica Teng ◽  
Jenny Yap ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Antifungal Prophylaxis ◽  
Antifungal Treatment ◽  
Lifetime Horizon ◽  
Old Patients ◽  
Risk Patients ◽  
The Cost ◽  
Quality Adjusted Life

Serial galactomannan (GM) monitoring can aid the diagnosis of invasive aspergillosis (IA) and optimise treatment decisions. However, widespread adoption of mould-active prophylaxis has reduced the incidence of IA and challenged its use. We evaluated the cost-effectiveness of prophylaxis-biomarker strategies. A Markov model simulating high-risk patients undergoing routine GM surveillance with mould-active versus non-mould-active prophylaxis was constructed. The incremental cost for each additional quality-adjusted life-year (QALY) gained over a lifetime horizon was calculated. In 40- and 60-year-old patients receiving mould-active prophylaxis coupled with routine GM surveillance, the total cost accrued was the lowest at SGD 11,227 (USD 8255) and SGD 9234 (USD 6790), respectively, along with higher QALYs gained (5.3272 and 1.1693). This strategy, being less costly and more effective, dominated mould-active prophylaxis with no GM monitoring or GM surveillance during non-mould-active prophylaxis. The prescription of empiric antifungal treatment was influential in the cost-effectiveness. When the GM test sensitivity was reduced from 80% to 30%, as might be anticipated with the use of mould-active prophylactic agents, the conclusion remained unchanged. The likelihood of GM surveillance with concurrent mould-active prophylaxis being cost-effective was 77%. Routine GM surveillance remained cost-effective during mould-active prophylaxis despite lower IA breakthroughs. Cost-saving from reduced empirical antifungal treatment was an important contributing factor.

scholarly journals Cost-effectiveness of screening smokers and ex-smokers for lung cancer in the Netherlands in different age groups

2022 ◽  
Author(s):  
Mohamed N. M. T. Al Khayat ◽  
Job F. H. Eijsink ◽  
Maarten J. Postma ◽  
Ewoudt M. W. van de Garde ◽  
Marinus van Hulst
Keyword(s):  
Lung Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
The Netherlands ◽  
Age Groups ◽  
Lung Cancer Screening ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Lifetime Horizon ◽  
The Cost

Abstract Objective We aimed to assess the cost-effectiveness of screening smokers and ex-smokers for lung cancer in the Netherlands. Methods A Markov model was used to evaluate the health effects and costs of lung cancer screening from the healthcare perspective. The effects and costs of ten screening scenarios with different start and stop ages of screening were examined across a lifetime horizon in a cohort of 100,000 smokers and ex- smokers 50 years and older. Results The incremental cost-effectiveness ratios (ICERs) of screening smokers and ex-smokers aged 50–60 years, 50–70 years, and 50 years and older are below the cost-effectiveness threshold of € 20,000 per quality adjusted life year (QALY) gained. Screening 50–60-year-old smokers and ex-smokers was the most cost-effective scenario with an ICER of € 14,094 per QALY gained. However, screening smokers and ex-smokers 50 years and older yielded the highest QALYs and resulted in an ICER of € 16,594 per QALY, which is below the threshold of € 20,000 per QALY. All screening scenarios compared to no screening resulted in CERs between the € 14,000 and € 16,000 per QALY gained. The efficiency frontier showed that screening smokers and ex-smokers in the age groups 70 years and older, 60–70 years, 60 years and older are excluded by extended dominance by no screening, screening smokers and ex-smokers aged 50–60 years and 50–70 years. Conclusion This study showed that lung cancer screening is cost-effective in the Netherlands.

scholarly journals Epidemiological impact and cost-effectiveness of varicella vaccination strategies in the United Kingdom (UK)

2020 ◽  
Author(s):  
E I Hervé Akpo ◽  
Olivier Cristeau ◽  
Manjit Hunjan ◽  
Giacomo Casabona
Keyword(s):  
United Kingdom ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Varicella Vaccination ◽  
Lifetime Horizon ◽  
The United Kingdom ◽  
The Uk ◽  
The Impact

Abstract Background Despite the burden of varicella, there is no universal varicella vaccination (UVV) programme in the United Kingdom (UK) due to concerns this could increase herpes zoster (HZ) incidence. This study assessed the cost-utility of a first-dose monovalent (V) or quadrivalent (MMRV) followed by a second-dose quadrivalent (MMRV) UVV programmes. GSK and MSD varicella-containing vaccines (VCVs) were considered. Methods A dynamic transmission and cost-effectiveness models were adapted to the UK. Outcomes measured included varicella and HZ incidences, the incremental cost-utility ratio (ICURs) over a lifetime horizon. The payer and societal perspectives were evaluated. Results The impact of V-MMRV and MMRV-MMRV UVV programmes on varicella incidence was comparable between both VCVs at equilibrium. HZ incidence increased by 1.6%-1.7% over seven years after UVV start, regardless of the strategies, then decreased by >95% at equilibrium. ICURs ranged from £5,665 (100 years) to £18,513 (20 years) per quality-adjusted life year (QALY) gained with V-MMRV; and from £9,220 to £27,101 per QALY gained with MMRV-MMRV (payer perspective). MMRV-MMRV was cost-effective in medium- and long-terms with GSK VCV, and only cost-effective at long-term with MSD VCV at £20,000 per QALY gained threshold. Without the exogenous boosting hypothesis, HZ incidence decreased through UVV implementation. ICURs were most sensitive to discount rates and MMRV price. Conclusions A 2-dose UVV was demonstrated to be a cost-effective alternative to no vaccination. With comparable effectiveness as MSD VCV at lower costs, GSK VCV may offer higher value for money.

Within trial cost-effectiveness of a structured lifestyle intervention in adults with overweight/obesity and type 2 diabetes: Results from the Action for Health in Diabetes (Look AHEAD) Study

2020 ◽  
Author(s):  
Ping Zhang ◽  
Karen M. Atkinson ◽  
George Bray ◽  
Haiying Chen ◽  
Jeanne M. Clark ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Lifestyle Intervention ◽  
Health Utility Index ◽  
Health Benefit ◽  
Cost Effective ◽  
Health Utility ◽  
Health Care Expenditures ◽  
Quality Adjusted Life Year

<b>OBJECTIVE </b>To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared to standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. <p><b>RESEARCH DESIGN AND METHODS</b> Data were from 4,827 participants during the first 9 years of the study from 2001 to 2012. Information on Health Utility Index-2 and -3, SF-6D, and Feeling Thermometer [FT]), cost of delivering the interventions, and health expenditures were collected during the study. CE was measured by incremental cost-effectiveness ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 US dollars. </p> <p><b>RESULTS </b><a>Over the </a>9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.17 and 0.16, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs, to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. </p> <p><b>Conclusions </b>Whether<b> </b>ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions. </p>

scholarly journals Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Kinoshita ◽  
Kensuke Moriwaki ◽  
Nao Hanaki ◽  
Tetsuhisa Kitamura ◽  
Kazuma Yamakawa ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Emergency Room ◽  
Healthcare Costs ◽  
Cost Effective ◽  
Severe Trauma ◽  
Third Party ◽  
Trauma Patients ◽  
Short Term ◽  
The Third

Abstract Background Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. Results The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.

scholarly journals Incremental Net Monetary Benefit of Bariatric Surgery: Systematic Review and Meta-Analysis of Cost-Effectiveness Evidences

2021 ◽  
Author(s):  
Prapaporn Noparatayaporn ◽  
Montarat Thavorncharoensap ◽  
Usa Chaikledkaew ◽  
Bhavani Shankara Bagepally ◽  
Ammarin Thakkinstian
Keyword(s):  
Systematic Review ◽  
Bariatric Surgery ◽  
Cost Effectiveness ◽  
Evaluation Studies ◽  
Meta Analysis ◽  
Cost Effective ◽  
Diabetes Group ◽  
Lifetime Horizon ◽  
Middle Income ◽  
Full Economic Evaluation

AbstractThis systematic review aimed to comprehensively synthesize cost-effectiveness evidences of bariatric surgery by pooling incremental net monetary benefits (INB). Twenty-eight full economic evaluation studies comparing bariatric surgery with usual care were identified from five databases. In high-income countries (HICs), bariatric surgery was cost-effective among mixed obesity group (i.e., obesity with/without diabetes) over a 10-year time horizon (pooled INB = $53,063.69; 95% CI $42,647.96, $63,479.43) and lifetime horizon (pooled INB = $101,897.96; 95% CI $79,390.93, $124,404.99). All studies conducted among obese with diabetes reported that bariatric surgery was cost-effective. Also, the pooled INB for obesity with diabetes group over lifetime horizon in HICs was $80,826.28 (95% CI $32,500.75, $129,151.81). Nevertheless, no evidence is available in low- and middle-income countries. Graphical abstract

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.

COST-UTILITY ANALYSIS OF MULTIPLE SCLEROSIS TREATMENT IN THAILAND

2018 ◽  
Vol 34 (6) ◽  
pp. 584-592
Author(s):  
Chalakorn Chanatittarat ◽  
Usa Chaikledkaew ◽  
Naraporn Prayoonwiwat ◽  
Sasitorn Siritho ◽  
Pakamas Pasogpakdee ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cost Effective ◽  
Best Supportive Care ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Outcome Data ◽  
Essential Medicines ◽  
Sensitivity Analyses ◽  
Lifetime Horizon ◽  
Cost Effective Treatment

Objectives:Although interferon beta-1a (IFNß−1a), 1b (IFNß−1b), and fingolimod have been approved as multiple sclerosis (MS) treatments, they have not yet been included on the National List of Essential Medicines (NLEM) formulary in Thailand. This study aimed to evaluate the cost-utility of MS treatments compared with best supportive care (BSC) based on a societal perspective in Thailand.Methods:A Markov model with cost and health outcomes over a lifetime horizon with a 1-month cycle length was conducted for relapsing–remitting MS (RRMS) patients. Cost and outcome data were obtained from published studies, collected from major MS clinics in Thailand and a discount rate of 3 percent was applied. The incremental cost-effectiveness ratio (ICER) was calculated and univariate and probabilistic sensitivity analyses were performed.Results:When compared with BSC, the ICERs for patients with RRMS aged 35 years receiving fingolimod, IFNβ−1b, and IFNβ−1a were 33,000, 12,000, and 42,000 US dollars (USD) per quality-adjusted life-year (QALY) gained, respectively. At the Thai societal willingness to pay (WTP) threshold of USD 4,500 per QALY gained, BSC had the highest probability of being cost-effective (49 percent), whereas IFNβ−1b and fingolimod treatments showed lower chance being cost-effective at 25 percent and 18 percent, respectively.Conclusions:Compared with fingolimod and interferon treatments, BSC remains to be the most cost-effective treatment for RRMS in Thailand based on a WTP threshold of USD 4,500 per QALY gained. The results do not support the inclusion of fingolimod or interferon in the NLEM for the treatment of RRMS unless their prices are decreased or special schema arranged.

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