PP137 Colorectal Cancer Screening In The Philippines: Cost-Utility Analysis

2018 ◽  
Vol 34 (S1) ◽  
pp. 120-120
Author(s):  
John Wong ◽  
Stephanie Anne Co ◽  
Joy Bagas ◽  
Ma. Sophia Graciela Reyes ◽  
Hadrian Lim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Budget Impact ◽  
Discrete Event ◽  
Cost Effective ◽  
The Philippines ◽  
Cost Utility ◽  
World Health ◽  
Rapid Review ◽  
Primary Data ◽  
Screening Parameter

Introduction:Colorectal cancer (CRC) is the fourth leading cause of cancer deaths in the Philippines. In 2014, the Philippine Health Insurance Corporation (PhilHealth) created a CRC treatment package. The study aimed to determine the cost-utility and budget impact of CRC screening strategies.Methods:A discrete-event microsimulation model was used to simulate four screening modalities: (i) guaiac-fecal occult blood test (gFOBT) followed by colonoscopy every 10 years; (ii) fecal immunochemical test (FIT) followed by colonoscopy every 10 years; (iii) FIT followed by flexible sigmoidoscopy; and (iv) colonoscopy screening every 10 years. These interventions were all compared to no screening. Parameter values were taken from a rapid review of the medical literature and primary data collection from a nationally representative sample of tertiary hospitals.Results:All screening modalities were very cost effective considering that the incremental cost-effective ratios (ICERs) were lower than the gross domestic product per capita threshold suggested by the World Health Organization. Sensitivity analysis showed that the ICERs of all screening modalities evaluated remained below this threshold. The strategy of using FIT followed by colonoscopy every 10 years had an ICER of USD 6,025, with an annual budget impact of USD 6.5 million, assuming low compliance. With moderate compliance this could increase to USD 18.7 million annually.Conclusions:PhilHealth may introduce a benefit package for outpatient screening of colorectal cancer using the screening modality of annual FIT followed by colonoscopy every 10 years.

scholarly journals Economic Evaluation of Carbetocin as Prophylaxis for Postpartum Hemorrhage in the Philippines

2020 ◽  
Author(s):  
Jamaica Roanne Briones ◽  
Pattarawalai Talungchit ◽  
Montarat Thavorncharoensap ◽  
Usa Chaikledkaew
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Postpartum Hemorrhage ◽  
Budget Impact ◽  
Hospital Setting ◽  
Cost Effective ◽  
The Philippines ◽  
Cost Utility ◽  
Third Party ◽  
Additional Costs

Abstract Background: Cost-effectiveness and budget impact of carbetocin was evaluated as an alternative to oxytocin for postpartum hemorrhage (PPH) prophylaxis in the Philippines.Methods: A model-based economic evaluation was employed to assess cost-effectiveness of carbetocin compared to oxytocin for PPH. Population of interest were women undergoing either vaginal delivery (VD) or cesarean section (CS) in a public hospital setting with costs and outcomes evaluated in six weeks. Cost-utility was analyzed using a government and societal perspectives while the budget impact was determined using a third party payer’s perspective. Incremental Cost Effectiveness Ratio (ICER) was evaluated using the set threshold in the country of 150,000 PhP per QALY gained.Results: Carbetocin was not cost-effective in the Philippines. Deterministic results in a government perspective for CS was at 724,081 PhP while for VD was over 2 million PhP. Deterministic and probabilistic results in the societal perspective for CS and VD were near these respective ICER values and did not also favor carbetocin use. Moreover, the treatment effects of carbetocin in reference to oxytocin were identified as the most sensitive parameter used. On budget impact, if 50% of deliveries would switch to carbetocin for the fiscal years assessed, additional incremental cumulative costs of 1.08 billion PhP for VD and 1.86 billion PhP for CS would be needed.Conclusion: The incremental benefit of carbetocin does not justify the additional costs incurred from purchasing the drug given a Philippine context. Price reduction of carbetocin is recommended if the drug would be publicly reimbursed in the country.

scholarly journals Economic evaluation of carbetocin as prophylaxis for postpartum hemorrhage in the Philippines

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jamaica Roanne Briones ◽  
Pattarawalai Talungchit ◽  
Montarat Thavorncharoensap ◽  
Usa Chaikledkaew
Keyword(s):  
Cost Effectiveness ◽  
Societal Perspective ◽  
Postpartum Hemorrhage ◽  
Budget Impact ◽  
Cost Effective ◽  
The Philippines ◽  
World Health ◽  
Sensitivity Analyses ◽  
Parameter Uncertainties ◽  
Effective Choice

Abstract Background The World Health Organization (WHO) recommends oxytocin as the drug of choice for postpartum hemorrhage (PPH) prevention. However, the WHO has also recently considered carbetocin for PPH prevention, but only if carbetocin were a cost-effective choice in the country. Consequently, we determined the cost-effectiveness and budgetary impact of carbetocin against oxytocin in the Philippines. Methods A cost-utility analysis using a decision tree was done to compare the costs and outcomes of carbetocin with oxytocin for PPH prophylaxis among women undergoing either vaginal delivery (VD) or cesarean section (CS) in a six-week time horizon using a societal perspective. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Additionally, budget impact analysis was conducted using a governmental perspective. Results were presented as incremental cost-effectiveness ratio (ICER) using a 2895 United States dollar (USD) per quality adjusted life year (QALY) gained as the ceiling threshold in the Philippines. Results Carbetocin was not cost-effective given the listed price of carbetocin at 18 USD. Given a societal perspective, the ICER values of 13,187 USD and over 40,000 USD per QALY gained were derived for CS and VD, respectively. Moreover, the ICER values were sensitive to the risk ratio of carbetocin versus oxytocin and carbetocin price. On budget impact, the five-year total budget impact of a drug mix of carbetocin and oxytocin was 25.54 million USD (4.23 million USD for CS and 21.31 million USD for VD) compared with ‘only oxytocin’ scenario. Conclusion Carbetocin is not a cost-effective choice in PPH prevention for both modes of delivery in the Philippines, unless price reduction is made. Our findings can be used for evidence-informed policies to guide coverage decisions on carbetocin not only in the Philippines but also in other low and middle-income countries.

scholarly journals Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants

BJPsych Open ◽  
2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Nicola S. Klein ◽  
Ben F. M. Wijnen ◽  
Joran Lokkerbol ◽  
Erik Buskens ◽  
Hermien J. Elgersma ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cognitive Therapy ◽  
Clinical Training ◽  
Impact Analysis ◽  
Budget Impact ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cost Utility ◽  
The European Union ◽  
Life Years

BackgroundAs depression has a recurrent course, relapse and recurrence prevention is essential.AimsIn our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT) to maintenance antidepressants (PCT+AD) yielded substantial protective effects versus antidepressants only in individuals with recurrent depression. Antidepressants were not superior to PCT while tapering antidepressants (PCT/−AD). To inform decision-makers on treatment allocation, we present the corresponding cost-effectiveness, cost-utility and budget impact.MethodData were analysed (n = 289) using a societal perspective with 24-months of follow-up, with depression-free days and quality-adjusted life years (QALYs) as health outcomes. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were derived to provide information about cost-effectiveness. The budget impact was examined with a health economic simulation model.ResultsMean total costs over 24 months were €6814, €10 264 and €13 282 for AD+PCT, antidepressants only and PCT/−AD, respectively. Compared with antidepressants only, PCT+AD resulted in significant improvements in depression-free days but not QALYs. Health gains did not significantly favour antidepressants only versus PCT/−AD. High probabilities were found that PCT+AD versus antidepressants only and antidepressants only versus PCT/−AD were dominant with low willingness-to-pay thresholds. The budget impact analysis showed decreased societal costs for PCT+AD versus antidepressants only and for antidepressants only versus PCT/−AD.ConclusionsAdding PCT to antidepressants is cost-effective over 24 months and PCT with guided tapering of antidepressants in long-term users might result in extra costs. Future studies examining costs and effects of antidepressants versus psychological interventions over a longer period may identify a break-even point where PCT/−AD will become cost-effective.Declaration of interestC.L.H.B. is co-editor ofPLOS Oneand receives no honorarium for this role. She is also co-developer of the Dutch multidisciplinary clinical guideline for anxiety and depression, for which she receives no remuneration. She is a member of the scientific advisory board of the National Insure Institute, for which she receives an honorarium, although this role has no direct relation to this study. C.L.H.B. has presented keynote addresses at conferences, such as the European Psychiatry Association and the European Conference Association, for which she sometimes receives an honorarium. She has presented clinical training workshops, some including a fee. She receives royalties from her books and co-edited books and she developed preventive cognitive therapy on the basis of the cognitive model of A. T. Beck. W.A.N. has received grants from the Netherlands Organisation for Health Research and Development and the European Union and honoraria and speakers' fees from Lundbeck and Aristo Pharma, and has served as a consultant for Daleco Pharma.

scholarly journals Cost–utility and budget impact analysis of tocilizumab for the treatment of refractory systemic juvenile idiopathic arthritis in Thailand

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037588
Author(s):  
Nitichen Kittiratchakool ◽  
Disorn Kulpokin ◽  
Chonticha Chanjam ◽  
Soamarat Vilaiyuk ◽  
Sirirat Charuvanij ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Standard Treatment ◽  
Budget Impact ◽  
Disease Onset ◽  
Systemic Juvenile Idiopathic Arthritis ◽  
Cost Effective ◽  
Medical Costs ◽  
Cost Utility ◽  
Base Case ◽  
Health State

ObjectivesThis study aimed to analyse the cost–utility and budget impact of adding tocilizumab to the standard treatment for patients with refractory systemic juvenile idiopathic arthritis (sJIA) in Thailand.DesignEconomic evaluation using a decision-analytical model.SettingThailand.ParticipantsPatients with refractory sJIA who were ≥2 years old.MethodsThe use of tocilizumab as an add-on therapy to standard treatment was compared with standard treatment alone. A simulated health state transition model was used to estimate the lifetime costs and health outcomes from a societal perspective. Direct medical costs were collected from tertiary hospital databases while direct non-medical costs were derived from interviews. Health-related quality of life (QoL) was measured using the proxy version of three-level EuroQol five-dimensional questionnaire (EQ-5D-3L). Future costs and outcomes were discounted at an annual rate of 3%. The base case population was patients aged 9.41 years old at refractory disease onset. The results were reported as incremental cost-effectiveness ratios (ICER) in US dollar (USD). One-way and probabilistic sensitivity analysis were conducted to investigate parameter uncertainty. The 5-year budget impact was estimated from a governmental perspective.ResultsThe ICER of standard treatment plus tocilizumab was US$35 799 per quality-adjusted life-year (QALY) gained compared with standard treatment alone, which was not cost-effective at the threshold of US$5128 per QALY gained. The estimated 5 years budget impact was approximately US$4.8 million.ConclusionsThe use of standard treatment plus tocilizumab was not cost-effective in the Thai context, which has limited data. However, there is currently no second-line treatment for refractory sJIA in the Thai National List of Essential Medicines; thus, patients must receive higher doses of standard treatment which can cause many side effects. In contrast, tocilizumab showed obvious efficacy in clinical trials in improving treatment response and QoL. Therefore, the price of tocilizumab should be negotiated to reduce the financial impact on the healthcare system.

scholarly journals Adding Rituximab to Chemotherapy for Diffuse Large B-Cell Lymphoma Patients in Indonesia: A Cost Utility and Budget Impact Analysis

2022 ◽  
Author(s):  
Septiara Putri ◽  
Ery Setiawan ◽  
Siti Rizny F. Saldi ◽  
Levina Chandra ◽  
Euis Ratna Sari ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Impact Analysis ◽  
Budget Impact ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Cost Effective ◽  
Cost Utility ◽  
Budget Impact Analysis ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background This study aims to estimate the cost-effectiveness and budget impact of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) compared to CHOP for the treatment of patients with diffuse large B-cell lymphoma (DLBCL) in Indonesia. Methods We conducted a cost utility analysis using Markov model over a lifetime horizon, from a societal perspective. Clinical evidence was derived from published clinical trials. Direct medical costs were gathered from hospital data. Direct non-medical costs, indirect costs, and utility data were primarily gathered by interviewing the patients. We applied 3% discount rate for both costs and effect. All monetary data are converted into USD (1 USD = IDR 14,000, 2019). Probabilistic sensitivity analysis was performed. In addition, from a payer perspective, budget impact analysis was estimated using price reduction scenarios. Results The incremental cost-effectiveness ratio (ICER) of R-CHOP was USD 4,674/LYG and 9,280/QALY. If we refer to the threshold three times the GDP per capita (USD 11,538), R-CHOP could thus be determined as a cost-effective therapy. Its significant health benefit has contributed to the considerable ICER result. Although the R-CHOP has been considered a cost-effective intervention, the financial consequence of R-CHOP if remain in benefit package under National Health Insurance (NHI) system in Indonesia is considerably substantial, approximately USD 66 million with 75% price reduction scenario. Conclusions As a favorable treatment for DLBCL, R-CHOP ensures value for money in Indonesia. Budget impact analysis provides results which can be used as further consideration for decision-makers in matters related to benefit packages.

scholarly journals Cost-utility analysis of adjuvant trastuzumab therapy for HER2-positive early-stage breast cancer in the Philippines

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Anne Julienne Genuino ◽  
Usa Chaikledkaew ◽  
Anna Melissa Guerrero ◽  
Thanyanan Reungwetwattana ◽  
Ammarin Thakkinstian
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Budget Impact ◽  
Early Stage ◽  
The Philippines ◽  
Cost Utility ◽  
Standard Chemotherapy ◽  
Her2 Positive ◽  
Adjuvant Trastuzumab ◽  
Trastuzumab Therapy

Abstract Background Breast cancer is the leading malignancy among Filipino women, with about 23.50% of cases characterized by human epidermal growth factor receptor-2 (HER2) overexpression. Trastuzumab, in addition to standard chemotherapy, is currently recommended as primary treatment for HER2-positive early-stage breast cancer (EBC) in the adjuvant settings, and has been listed in the Philippine National Formulary (PNF) since 2008, but with no current evidence yet on its value for money, to date. Hence, despite several policy enablers, its accessibility remains to be limited in the Philippines. We performed an economic evaluation to assess the cost-effectiveness and budget impact of adjuvant trastuzumab therapy for HER2-positive EBC in the Philippines, using healthcare system and societal perspectives, in aid of guiding coverage decisions. Methods A Markov model-based cost-utility and budget impact analyses were conducted to estimate the total costs incurred and outcomes gained in using 1 year of adjuvant trastuzumab added to standard chemotherapy versus standard chemotherapy alone, over a lifetime horizon. We discounted both costs and outcomes at 3.5% per annum. Parameters were estimated using country survival data, systematic review and meta-analysis of the relative treatment effect, local and international cost data, and published utility data. Univariate and probabilistic sensitivity analyses were used to account for parameter uncertainty. Results Trastuzumab therapy was dominated with an incremental cost-effectiveness ratio (ICER) at PHP 453,505 per QALY gained from a healthcare system perspective or PHP 458,686 per QALY gained from a societal perspective, with 10% cost-effectiveness probability at the country cost-effectiveness threshold of PHP 120,000 per QALY gained. National implementation will cost an additional amount of PHP 13,909 million in year one alone, plus about PHP 2000 to 3000 million annually for the succeeding fiscal years. Conclusion At its current cost, 1 year of adjuvant trastuzumab therapy compared to standard chemotherapy alone for HER2-positive EBC does not represent value for money in the Philippines. Its current cost will have to significantly lower down by one-half to achieve cost-effectiveness.

scholarly journals The Effectiveness of Probiotics against Viral Infections: A Rapid Review with Focus on SARS-CoV-2 Infection

2020 ◽  
Vol 8 (T1) ◽  
pp. 496-508
Author(s):  
Jehan Abdul-Sattar Salman ◽  
Nibras Nazar Mahmood ◽  
Ban Oday Abdulsattar ◽  
Hussein Adil Abid
Keyword(s):  
Viral Infections ◽  
Antiviral Agents ◽  
Specific Treatment ◽  
Health Benefit ◽  
Cost Effective ◽  
World Health ◽  
Rapid Review ◽  
Protective Effects ◽  
Cost Effective Treatment ◽  
Health Organization

Viral infections have gained great attention following the rapid emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic around the globe. Even with the continuous research on developing vaccines and antiviral agents against various viral infections, no specific treatment or vaccine has been approved for many enteric or respiratory viral infections; in addition, the efficiency of currently available treatments is still limited. One of the most reliable and recommended strategies to control viral infections is prevention. Recently, intense studies are focusing on a promising approach for treating/preventing various viral infections using probiotics. As per the World Health Organization (WHO), probiotics can be defined as “live microorganisms which, when administered in adequate amount, confer a health benefit to the host.” The use of probiotics is a simple, cost-effective, and safe strategy to prevent viral infections, specifically; respiratory tract and intestinal ones, by different means such as stimulating the host’s immune response or modulating gut microbiota. In this rapid review, we emphasize the protective effects of probiotics against viral infections and proposed mechanisms for protection that might offer a novel and cost-effective treatment against current and newly discovered viruses like SARS-CoV-2.

Three versus six months of adjuvant chemotherapy for colorectal cancer: A multi-country cost-effectiveness and budget impact analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7076-7076
Author(s):  
Catherine Hanna ◽  
Jose Antonio Robles-Zurita ◽  
Robert J. Jones ◽  
Kathleen Boyd
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Impact Analysis ◽  
Budget Impact ◽  
Cost Utility ◽  
Practice Change ◽  
Phase Iii ◽  
Cancer Trial ◽  
Healthcare Budget ◽  
Economic Implications

7076 Background: The international Short Course Oncology Treatment (SCOT) trial demonstrated non-inferiority and significantly less toxicity of 3 versus 6 months of adjuvant chemotherapy for patients with colorectal cancer (CRC). This study assesses the value of shorter treatment and the economic implications of implementing the findings from the perspective of the countries that participated in the SCOT trial. Methods: Individual patient level data (n=6055) from the SCOT trial was used in a fully-pooled, cost utility analysis for the six participating countries. The incremental net monetary benefit (INMB) per patient was calculated using a willingness to pay threshold of one Gross Domestic Product per capita for each country. Responses to a clinician questionnaire (n=265 across 21 countries collected in April 2019) were used to estimate extent of practice change. The budget impact over 5 years of using shorter treatment was calculated, using 2019 and US dollars (USD) as the base year and currency, respectively. Results: Cost drivers for differences between the SCOT trial arms were reduced chemotherapy costs and fewer hospitalisations in the first treatment year. The INMB per patient of using shorter treatment and subsequent monetary impact on healthcare provider budgets resulting from implementation are shown in Table. This is a cost saving treatment strategy in all countries. The budget impact over 5 years amounts to savings of nearly half a billion USD. Conclusions: The economic burden of CRC treatment globally exceeds $39 billion per annum. Understanding the costs and consequences of widespread clinical practice change is important for optimal budget planning. This study has widened the transferability of results from a phase III cancer trial, showing shorter treatment is cost-effective from a multi-country perspective. The vast savings could provide benefit elsewhere within a limited healthcare budget, and justify the investment in conducting the SCOT trial. [Table: see text]

PD36 Scoping Of Interventions Of The Philippines' Most Burdensome Diseases

2018 ◽  
Vol 34 (S1) ◽  
pp. 142-143
Author(s):  
Nel Jason Haw ◽  
John Wong ◽  
Abigail Lim ◽  
Stephanie Anne Co
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
The Philippines ◽  
World Health ◽  
Life Stages ◽  
Health Coverage ◽  
Policy Window ◽  
Effective Interventions ◽  
Resource Requirements ◽  
Initial Work

Introduction:In 2016, Global Burden of Disease (GBD) data was used to identify the top twenty percent of disease causes in the Philippines, which happened to account for eighty percent of the burden, following the Pareto principle. This study follows from that initial work, aimed at creating a list of cost-effective interventions recommended for priority-setting to achieve universal health coverage (UHC).Methods:A comprehensive literature review search was done, from global sources such as the Disease Control Priorities (DCP) for Developing Countries Project and World Health Organization's (WHO) Choosing Interventions that are Cost-Effective (CHOICE), and local sources such as clinical practice guidelines (CPGs). Forty-seven local experts from thirty-eight medical societies were also consulted on the applicability, appropriateness, adaptability, feasibility of implementation, ability to maintain fidelity, ease of dissemination, and sustainability of selected interventions in the Philippine setting. Resource requirements were then derived using the WHO OneHealth Tool, CPGs, and key informant interviews.Results:A list of 745 interventions categorized by life stages and by level of intervention with estimates of cost-effectiveness was produced. From these, fifty seven percent had cost-effectiveness studies. Primary interventions were found to be the least costly for the pregnant women, newborn, infant, adolescents, adults, and elderly life stages, while tertiary interventions were found to be the least costly for children.Conclusions:The interventions are potential targets for inclusion by policymakers. Additional factors to consider include the appropriateness of the context in which the cost-effectiveness study was conducted, the feasibility of conducting primary HTA locally, the local costs of the intervention, and the need to act quickly before the policy window closes.

scholarly journals Breakdown of a Nonlinear Stochastic Nipah Virus Epidemic Models through Efficient Numerical Methods

Entropy ◽  
2021 ◽  
Vol 23 (12) ◽  
pp. 1588
Author(s):  
 Ali Raza ◽  
Jan Awrejcewicz ◽  
Muhammad Rafiq ◽  
Muhammad Mohsin
Keyword(s):  
Numerical Methods ◽  
Low Cost ◽  
Nipah Virus ◽  
Case Fatality ◽  
Cost Effective ◽  
The Philippines ◽  
World Health ◽  
Stochastic Methods ◽  
Long Run ◽  
Positivity And Boundedness

Nipah virus (NiV) is a zoonotic virus (transmitted from animals to humans), which can also be transmitted through contaminated food or directly between people. According to a World Health Organization (WHO) report, the transmission of Nipah virus infection varies from animals to humans or humans to humans. The case fatality rate is estimated at 40% to 75%. The most infected regions include Cambodia, Ghana, Indonesia, Madagascar, the Philippines, and Thailand. The Nipah virus model is categorized into four parts: susceptible (S), exposed (E), infected (I), and recovered (R). Methods: The structural properties such as dynamical consistency, positivity, and boundedness are the considerable requirements of models in these fields. However, existing numerical methods like Euler–Maruyama and Stochastic Runge–Kutta fail to explain the main features of the biological problems. Results: The proposed stochastic non-standard finite difference (NSFD) employs standard and non-standard approaches in the numerical solution of the model, with positivity and boundedness as the characteristic determinants for efficiency and low-cost approximations. While the results from the existing standard stochastic methods converge conditionally or diverge in the long run, the solution by the stochastic NSFD method is stable and convergent over all time steps. Conclusions: The stochastic NSFD is an efficient, cost-effective method that accommodates all the desired feasible properties.

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