PP135 Cost-Effectiveness Of Cryoballoon Ablation In China: Real-World Results

2018 ◽  
Vol 34 (S1) ◽  
pp. 119-119
Author(s):  
Jian Ming ◽  
Hui Sun ◽  
Gongru Wang ◽  
Yan Wei ◽  
Yingyao Chen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Real World ◽  
Cost Effective ◽  
Tertiary Hospital ◽  
Base Case ◽  
Cryoballoon Ablation ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Life Years ◽  
The Cost

Introduction:Paroxysmal atrial fibrillation (PAF) represents a significant economic burden to the healthcare system. Catheter ablation is a commonly adopted treatments for PAF, and cryoballoon ablation (CBA) has been recently proven to be as effective as radiofrequency ablation (RFA). This study aims to evaluate the cost-effectiveness of CBA versus RFA in patients with drug-refractory PAF in China.Methods:A Markov model was developed to study the effects and the costs of CBA versus RFA. Cost and probability inputs data were obtained mainly from a real-world study of 85 CBA and 284 RFA patients treated in a tertiary hospital between July 2014 and July 2016. Propensity score matching was used to overcome retrospective bias, resulting in including 75 patients in each group. Input data gaps were closed with literature review and advisory board. A simulation was carried out for 14 cycles/years, and a discount rate of 3 percent was used. Then, a probabilistic sensitivity analysis was carried out with Monte Carlo approach.Results:In the base case scenario, the cumulative costs incurred by the CBA and RFA groups were CNY 132,222 (USD 20,767) and CNY 147,304 (USD 23,136), respectively. Over the 14-year period, the quality-adjusted life years (QALYs) gained by the CBA group was 7.85 versus 7.71 in the RFA group. The incremental cost-effectiveness ratio for CBA versus RFA was thus CNY 107,729 (USD 16,920)/QALY. Model results were most sensitive to the cost incurred during the first hospitalization, recurrence rate, and relative utility weights. The probability of CBA being cost-effective for willingness to pay thresholds of per capita GDP in China was estimated to be 99 percent.Conclusions:Compared with RFA, CBA is a cost-saving treatment providing increased QALYs. It represents good value for money for patients with drug-refractory PAF in China. However, further evidence needs to be generated from larger-scale studies in China.

Cost-effectiveness of routine laparoscopic ultrasound for the assessment of resectability of gallbladder cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 272-272
Author(s):  
Thejus T. Jayakrishnan ◽  
Hasan Nadeem ◽  
Ryan Thomas Groeschl ◽  
Anthony J Zacharias ◽  
T. Clark Gamblin ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Laparoscopy ◽  
Hepatic Metastases ◽  
Cost Effective ◽  
Laparoscopic Ultrasound ◽  
Base Case ◽  
Case Scenario ◽  
Base Case Scenario ◽  
The Cost ◽  
Quality Adjusted Life

272 Background: In addition to a diagnostic laparoscopy (DL), aroutine laparoscopic ultrasound (LUS) has been proposed to identify undetected hepatic metastases and/or anatomically advanced disease in patients with T2 or higher gall bladder cancer (GBC) planned for surgical resection. It was hypothesized that a routine LUS is not a cost-effective strategy for these patients. Methods: Decision tree modeling was undertaken to compare DL-LUS vs. DL at the time of definitive resection of GBC (with no prior cholecystectomy). Costs in US dollars (payers’ perspective), quality-adjusted-life-weeks (QALWs) and incremental-cost-effectiveness-ratios (ICER) were calculated (horizon: 6 weeks, willingness-to-pay: $1,000/QALW or $50,000/ QALY). Results: DL-LUS was cost effective at the base case scenario (costs: $30,838 for DL vs. $30,791 for DL-LUS and effectiveness 3.81 QALWs DL vs. 3.82 QALW DL-LUS, resulting in a cost reduction of $9,220 per quality adjusted life week gained (or $479,469 per QALY). DL-LUS became less cost effective as the cost of ultrasound increased (threshold: $163.18) or the probability of exclusion from resection decreased (threshold 0.29) (Table represents the results of univariate analyses). Conclusions: Routine LUS with diagnostic laparoscopy for the assessment of resectability and exclusion of metastases is cost effective for patients with GBC. Until improvements in pre-operative imaging occur to decrease the probability of exclusion, this appears to be a feasible strategy. [Table: see text]

scholarly journals The hemodialysis prescription and cost effectiveness. Renal Physicians Association Working Committee on Clinical Guidelines.

1993 ◽  
Vol 4 (4) ◽  
pp. 1021-1027
Author(s):  
J C Hornberger
Keyword(s):  
Cost Effectiveness ◽  
Clinical Outcomes ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Base Case ◽  
Uremic Toxin ◽  
Intradialytic Hypotension ◽  
Case Scenario ◽  
Base Case Scenario ◽  
The Cost

Case-mix adjusted mortality rates for patients undergoing hemodialysis for ESRD increased during the 1980s, despite the introduction of advanced dialysis technologies. Variations in dialysis practices suggest that excess mortality may be caused by inadequate uremic-toxin clearances. Cost-effectiveness analysis was used to assess whether attempts to improve uremic-toxin clearance are cost effective, assuming that these therapies are clinically effective. The medical literature was surveyed by the use of MEDLINE to assess the likelihood of clinical outcomes on the basis of the type of treatment given to the patient. Options considered in the model were delivered fractional urea clearance (Kt/V), dialysis-treatment duration, type of dialyzer membrane, dialysate, and ultrafiltration. Clinical outcomes included in the model were survival, severity of uremic symptoms, hospital days per year, and intradialytic hypotension and symptoms. Lifetime costs were calculated from data collected from a northern California dialysis center and abstracted from the literature. In the base-case scenario, it was assumed that increasing Kt/V to levels greater than 1 was effective in reducing morbidity and mortality. Under these assumptions, outpatient cost increased significantly, but the cost effectiveness of Kt/V equal to 1.5 was less than $50,000 per quality-adjusted life-year saved. These calculations indicate that, if higher levels of Kt/V prove clinically effective, they are also cost effective.

scholarly journals Cost-Effectiveness Analysis of Dental Sealants versus Fluoride Varnish in a School-Based Setting

2016 ◽  
Vol 50 (Suppl. 1) ◽  
pp. 78-82 ◽  
Author(s):  
Matthew Neidell ◽  
Barbara Shearer ◽  
Ira B. Lamster
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Fluoride Varnish ◽  
Base Case ◽  
Case Scenario ◽  
Base Case Scenario ◽  
School Based ◽  
Occlusal Surfaces ◽  
Context Specific ◽  
The Cost

While sealants are more effective than fluoride varnish in reducing the development of new carious lesions on occlusal surfaces, and a course of treatment requires fewer clinical visits, they are more expensive per application. This analysis assessed which treatment is more cost-effective. We estimate the costs of sealants and fluoride varnish over a 4-year period in a school-based setting, and compare this to existing estimates of the relative benefits in terms of caries reduction to calculate the relative cost-effectiveness of these two preventive treatments. In our base case scenario, varnish is more cost-effective in preventing caries. Allowing for caries benefits to nonocclusal surfaces further improves the cost-effectiveness of varnish. Although we found that varnish is more cost-effective, the results are context specific. Sealants become equally cost-effective if a dental hygienist applies the sealants instead of a dentist, while varnish becomes increasingly cost-effective when making comparisons outside of a traditional dental clinic setting.

Abstract W P273: The Cost-Effectiveness of Telestroke Varies by Implementation Cost and Stroke Severity: Real World Data From a Pacific Northwest Network

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Elizabeth Baraban ◽  
Richard Nelson ◽  
Alexandra Lesko ◽  
Jennifer Majersik ◽  
Archit Bhatt ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Pacific Northwest ◽  
Real World ◽  
Cost Effective ◽  
Stroke Severity ◽  
Real World Data ◽  
World Data ◽  
Life Years ◽  
Implementation Costs ◽  
The Cost

Objective: An obstacle for community hospitals in joining a telestroke network is often the cost of implementation. Yet, previous analyses examining the cost and cost-effectiveness have only used estimates from the literature. Using real-world data from a Pacific Northwest telestroke network, we examined the cost-effectiveness of telestroke for spokes by level of financial responsibility for these costs and how this changes with patient stroke severity. Methods: We constructed a decision analytic model and parameterized it using patient-level clinical and financial data from the Providence Telestroke Network (PTN) pre and post telestroke implementation. Data included patients presenting at 17 spokes within 4.5 hours of symptom onset. Probability inputs included observed IV-tPA treatment rates, transfer status and hospital costs and reimbursements. Effectiveness, measured as quality-adjusted life years (QALYs), and cost per patient were used to calculate incremental cost effectiveness ratios (ICERs). ICER’s of <$50,000-$120,000/QALY are considered cost-effective. Outcomes were generated overall and separately by admit NIHSS, defined as low (0-10), medium (11-20) and high (>20) and percentage of implementation costs paid by spokes (0%, 50%, 100%). Results: Data for 594 patients, 105 pre- and 489 post-implementation, were included. See Table 1. Conclusions: Our results support previous theoretic models showing good value, overall. However, costs and ICERs varied by stroke severity, with telestroke being most cost-effective for severe strokes. Telestroke was least cost effective if spokes paid for half or more of implementation costs.

scholarly journals Cost-effectiveness of a Contact Intervention and a Psychotherapeutic Program for Post-discharge Suicide Prevention: Rentabilité D’une Intervention de Contact et d’un Programme de Psychothérapie Pour la Prévention du Suicide Après le Congé de L’hôpital

2020 ◽  
pp. 070674372098013
Author(s):  
Gonzalo Martínez-Alés ◽  
José B. Cruz Rodríguez ◽  
Pablo Lázaro ◽  
Arce Domingo-Relloso ◽  
María Luisa Barrigón ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Suicide Prevention ◽  
Cost Effective ◽  
Cost Data ◽  
Base Case ◽  
Case Scenario ◽  
Post Discharge ◽  
Base Case Scenario ◽  
Augmentation Strategies

Objective: To determine the cost-effectiveness of 2 strategies for post-discharge suicide prevention, an Enhanced Contact intervention based on repeated in-person and telephone contacts, and an individual 2-month long problem-solving Psychotherapy program, in comparison to facilitated access to outpatient care following a suicide attempt. Methods: We conducted a cost-effectiveness analysis based on a decision tree between January and December 2019. Comparative effectiveness estimates were obtained from an observational study conducted between 2013 and 2017 in Madrid, Spain. Electronic health care records documented resource use (including extra-hospital emergency care, mortality, inpatient admission, and disability leave). Direct cost data were derived from Madrid’s official list of public health care prices. Indirect cost data were derived from Spain’s National Institute of Statistics. Results: Both augmentation strategies were more cost-effective than a single priority outpatient appointment considering reasonable thresholds of willingness to pay. Under the base-case scenario, Enhanced Contact and Psychotherapy incurred, respectively, €2,340 and 6,260 per averted attempt, compared to a single priority appointment. Deterministic and probabilistic sensitivity analyses showed both augmentation strategies to remain cost-effective under several scenarios. Enhanced Contact was slightly cost minimizing in comparison to Psychotherapy (base-case scenario: €−196 per averted attempt). Conclusions: Two post-discharge suicide prevention strategies based on Enhanced Contact and Psychotherapy were cost-effective in comparison to a single priority appointment. Increasing contacts between suicide attempters and mental health-care providers was slightly cost minimizing compared to psychotherapy.

scholarly journals P14.12 The cost-effectiveness of tumor-treating fields in patients with newly diagnosed glioblastoma

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii68-iii69
Author(s):  
X Armoiry ◽  
P Auguste ◽  
C Dussart ◽  
J Guyotat ◽  
M Connock
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Survival Model ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Tumor Treating Fields ◽  
Kaplan Meier ◽  
Life Years ◽  
Secondary Analyses ◽  
The Cost

Abstract BACKGROUND The addition of novel therapy “Tumor-Treating fields” (TTF) to standard radio-chemotherapy with Temozolomide (TMZ) has recently shown superiority over conventional TMZ regimen in patients with glioblastoma. Despite the clinical benefit of TTF, there is a strong concern regarding the cost of this new treatment. A first cost-effectiveness analysis, which was published in 2016, was based on effectiveness outcomes from an interim analysis of the pivotal trial and used a “standard” Markov model. Here, we aimed to update the cost-effectiveness evaluation using a partitioned survival model design and using the latest effectiveness data. MATERIAL AND METHODS A partitioned survival model was developed with three mutually exclusive health states: stable disease, progressive disease, and dead. Parametric models were fitted to the Kaplan-Meier data for overall and progression-free survival. These generated clinically plausible extrapolations beyond the observed data. The perspective of the French national health insurance was adopted and the time horizon was 20 years. Base case results were expressed as cost/life-years (LY) gained (LYG). Secondary analyses were undertaken, with the results presented as cost/per quality adjusted life years (QALY) gained. Last, we undertook deterministic and probabilistic sensitivity analyses. RESULTS After applying 4% annual discounting of benefits and costs, the base case model generated incremental benefit of 0.507 LY at a incremental cost of €258,695 yielding an incremental cost effectiveness ratio (ICER) of €510,273 / LYG. Secondary analyses yielded an ICER of €667,173/QALY. Sensitivity analyses and bootstrapping methods showed the model was relatively robust. The model was sensitive to TTF device costs and the parametric model fitted to the Kaplan-Meier data for overall survival. The cost-effectiveness acceptability curve showed TTF has 0% of being cost-effective under conventional thresholds. CONCLUSION Using a partitioned survival model, uprated costs and more mature survival outcomes, TTF when compared to standard radio-chemotherapy with TMZ is not likely to be cost-effective. This has major implications in terms of access of newly eligible patients

scholarly journals Cost-effectiveness of Memory Assessment Services for the diagnosis and early support of patients with dementia in England

2017 ◽  
Vol 22 (4) ◽  
pp. 226-235 ◽  
Author(s):  
Manuel Gomes ◽  
Mark Pennington ◽  
Raphael Wittenberg ◽  
Martin Knapp ◽  
Nick Black ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Base Case ◽  
Memory Assessment ◽  
Life Years ◽  
Follow Up Care ◽  
Related Quality ◽  
Mean Differences ◽  
The Cost

Background Policy makers in England advocate referral of patients with suspected dementia to Memory Assessment Services (MAS), but it is unclear how any improvement in patients’ health-related quality of life (HRQL) compares with the associated costs. Aims To evaluate the cost-effectiveness of MAS for the diagnosis and follow-up care of patients with suspected dementia. Method We analysed observational data from 1318 patients referred to 69 MAS, and their lay carers (n = 944), who completed resource use and HRQL questionnaires at baseline, three and six months. We reported mean differences in HRQL (disease-specific DEMQOL and generic EQ-5D-3L), quality-adjusted life years (QALYs) and costs between baseline and six months after referral to MAS. We also assessed the cost-effectiveness of MAS across different patient subgroups and clinic characteristics. Results Referral to MAS was associated with gains in DEMQOL (mean gain: 3.48, 95% confidence interval: 2.84 to 4.12), EQ-5D-3L (0.023, 0.008 to 0.038) and QALYs (0.006, 0.002 to 0.01). Mean total cost over six months, assuming a societal perspective, was £1899 (£1277 to £2539). This yielded a negative incremental net monetary benefit of −£1724 (−£2388 to −£1085), assuming NICE’s recommended willingness-to-pay threshold (£30,000 per QALY). These base case results were relatively robust to alternative assumptions about costs and HRQL. There was some evidence that patients aged 80 or older benefitted more from referral to MAS (p < 0.01 from adjusted mean differences in net benefits) compared to younger patients. MAS with over 75 new patients a month or cost per patient less than £2500 over six months were relatively more cost-effective (p < 0.01) than MAS with fewer new monthly patients or higher cost per patient. Conclusions Diagnosis, treatment and follow-up care provided by MAS to patients with suspected dementia appears to be effective, but not cost-effective, in the six months after diagnosis. Longer term evidence is required before drawing conclusions about the cost-effectiveness of MAS.

scholarly journals Cost-utility analysis of esketamine and electroconvulsive therapy in adults with treatment-resistant depression

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kinza Degerlund Maldi ◽  
Peter Asellus ◽  
Anna Myléus ◽  
Fredrik Norström
Keyword(s):  
Cost Effectiveness ◽  
Electroconvulsive Therapy ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Case Scenario ◽  
Base Case Scenario ◽  
Resistant Depression

Abstract Background Electroconvulsive therapy (ECT) has long been used for treating individuals with treatment-resistant depression (TRD). Esketamine has recently emerged as a new treatment for TRD due to its rapid antidepressant effects. To further inform the decision regarding choice of treatment, this paper aims to evaluate whether ECT or esketamine is the more cost-effective option. Methods The cost-effectiveness was derived as cost per quality-adjusted life-year (QALY) using a Markov model from a societal and life-time perspective. The incremental cost-effectiveness ratio (ICER) was calculated. Health states included different depression and remission states and death. Data to populate the model was derived from randomised controlled trials and other research. Various sensitivity analyses were carried out to test the robustness of the model. Results The base case scenario shows that ECT is cost-effective compared to esketamine and yields more QALYs at a lower cost. The sensitivity analysis shows that ECT is cost-effective in all scenarios and ECT dominates esketamine in 12 scenarios. Conclusions This study found that, from a cost-effectiveness point of view, ECT should be the first-hand option for individuals with TRD, when other first line treatments have failed. Considering the lack of economic evaluation of ECT and esketamine, this study is of great value to decision makers.

Cost-Effectiveness of a School-Based Chlamydia Screening Program, Duval County, FL

2019 ◽  
pp. 105984051989002 ◽  
Author(s):  
Li Yan Wang ◽  
Kwame Owusu-Edusei ◽  
J. Terry Parker ◽  
Kristina Wilson
Keyword(s):  
Cost Effectiveness ◽  
Screening Program ◽  
Student Participation ◽  
Participation Rate ◽  
Cost Effective ◽  
Base Case ◽  
Chlamydia Screening ◽  
Program Cost ◽  
Life Years ◽  
The Cost

During the 2015–2016 school year, the Florida Department of Health in Duval County hosted Teen Health Centers (TeenHC) at five high schools of Jacksonville providing HIV/STD screening and pregnancy testing. The purpose of this study was to assess the cost-effectiveness of the TeenHC chlamydia screening program and determine at what student participation level, the program can be cost-effective. We assessed the costs and effectiveness of the chlamydia screening program compared with “no TeenHC”. Cost-effectiveness was measured as cost per quality-adjusted life years (QALY) gained. At a program cost of US$61,001 and 3% participation rate, the cost/QALY gained was $124,328 in the base-case analysis and $81,014–$264,271 in 95% of the simulation trials, all greater than the frequently citied $50,000/QALY benchmark. The cost/QALY gained could be <$50,000/QALY if student participation rate was >7%. The TeenHC chlamydia screening has the potential to be cost-effective. Future program efforts should focus on improving student participation.

scholarly journals Cost-effectiveness analysis of a physician deployment program to improve access to healthcare in rural and underserved areas in the Philippines

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033455
Author(s):  
Anton L.V. Avanceña ◽  
Kim Patrick S Tejano ◽  
David W. Hutton
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
The Philippines ◽  
Cost Effectiveness Analysis ◽  
Base Case ◽  
Rural Municipality ◽  
Healthcare Perspective ◽  
Effectiveness Analysis ◽  
Life Years ◽  
The Cost

ObjectivesThe objective of this study is to explore the cost-effectiveness of Doctor to the Barrios (DTTB), a physician deployment program in the Philippines.DesignCost-effectiveness analysis using decision tree models with a lifetime time horizon and probabilistic sensitivity analysis.SettingSocietal and healthcare perspectives.PopulationHypothetical cohort of children under 5 years in two provinces (Aklan and Nueva Ecija) and in a representative rural municipality.ParticipantsNone.InterventionsDTTB’s impact on paediatric pneumonia and diarrhoea outcomes compared with a scenario without DTTB.Main outcome measuresCosts, effectiveness (in terms of lives saved and quality-adjusted life years (QALYs) gained) and incremental cost-effectiveness ratio (ICER).ResultsDTTB is cost-effective in the two provinces that were included in the study from societal and healthcare perspectives. Looking at a representative rural municipality, base case analysis and probabilistic sensitivity analyses suggest that DTTB has an ICER of 27 192 per QALY gained from a societal perspective. From a healthcare perspective, the base case ICER of DTTB is Philippine pesos (PHP) 71 839 per QALY gained and PHP 2 064 167 per life saved, and 10 000 Monte Carlo simulations produced similar average estimates. The cost per QALY of DTTB from a healthcare perspective is lower than the WHO recommended willingness-to-pay threshold of 100% of the country’s per-capita gross domestic product.ConclusionsDTTB can be a cost-effective intervention, but its value varies by setting and the conditions of the municipality where it is implemented. By focusing on a narrow set of paediatric outcomes, this study has likely underestimated the health benefits of DTTB. Additional research is needed to understand the full extent of DTTB’s impact on the health of communities in rural and remote areas. Future cost-effectiveness analysis should empirically estimate various parameters and include other health conditions in addition to pneumonia and diarrhoea in children.

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