scholarly journals Cost Analysis of Methylprednisolone Treatment of Multiple Sclerosis Patients

1998 ◽  
Vol 25 (3) ◽  
pp. 222-229 ◽  
Author(s):  
Lynda S. Robson ◽  
Charlene Bain ◽  
Shann Beck ◽  
Suzanne Guthrie ◽  
Peter C. Coyte ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cost Saving ◽  
Cost Analysis ◽  
Home Care ◽  
Care Program ◽  
Sensitivity Analyses ◽  
Patient Treatment ◽  
Fiscal Year ◽  
Multiple Sclerosis Patients ◽  
The Cost

ABSTRACT:Background:Intravenous methylprednisolone (IVMP) is the treatment of choice for multiple sclerosis (MS) patients undergoing acute exacerbation of disease symptoms and yet its cost has not been accurately determined. Determination of this cost in different settings is also pertinent to consideration of cost-saving alternatives to in-patient treatment.Methods:Cost analysis from the point of view of the health care system of IVMP treatment of MS patients receiving treatment in association with a selected Toronto teaching hospital in fiscal year 1994/95 was carried out. Costs of any concurrent treatments were excluded.Results:Total cost for 92 patients, based on a 4 dose regime, was estimated to be $78,527. The the cost per patient was $1,1181.84 for in-patients (IP), $714.64 for out-patients of the MS Clinic (OP) and $774.21 for patients whose treatment was initiated in the Clinic, but completed in the home (HC). Sensitivity analyses indicated: 1) IP treatment was in all cases more expensive than that of OP or HC; 2) the cost savings of OP vs. HC was sensitive to assumptions made regarding Clinic overhead, Clinic nursing costs and Home Care Program overhead.Conclusion:Alternatives to in-patient care must be considered carefully. In this study, both out-patient and in-home treatment were cost-saving alternatives to in-patient treatment, but large differences in the cost of hospital out-patient vs. in-home care could not be demonstrated.

scholarly journals Cladribine tablets are a cost-effective strategy in high-disease activity relapsing multiple sclerosis patients in Iran

2021 ◽  
Author(s):  
Nayyereh Ayati ◽  
Lora Fleifel ◽  
Mohammad Ali Sahraian ◽  
Shekoufeh Nikfar
Keyword(s):  
Multiple Sclerosis ◽  
Cost Effectiveness ◽  
Disease Activity ◽  
Cost Effective ◽  
High Disease Activity ◽  
Sensitivity Analyses ◽  
Life Years ◽  
Multiple Sclerosis Patients ◽  
The Cost ◽  
Relapsing Multiple Sclerosis

Background: Cladribine tablets are the foremost oral immune-reconstitution therapy for high disease activity relapsing multiple sclerosis (HDA-RMS). We aimed to assess the cost-effectiveness of cladribine tablets compared to natalizumab in patients with HDA-RMS in Iran. Methods: A 5-year cohort-based Markov model was developed with 11 expanded disability status score (EDSS) health states, including patients with HDA-RMS as on and off-treatment. All costs were identified from the literature and expert opinion and were measured in Iranian Rial rates, changed to the 2020 USD rate and were discounted by 7.2%. Quality adjusted life years (QALY), discounted by 3.5%, and life years gained (LYG) were adopted to measure efficacy. The final results were presented as incremental cost-effectiveness ratio that was compared to a national willingness to pay (WTP) threshold of 1 to 3 gross domestic product (GDP) per capita. Deterministic and probabilistic sensitivity analyses (D/PSA) were employed to evaluate uncertainty. Results: Cladribine tablets dominated natalizumab and yielded 6,607 USD cost-saving and 0.003 additional QALYs per patient. LYG was comparable. The main cost component was drug acquisition cost in both arms. DSA indicated the sensitivity of the results to the cost discount rates and also the patients’ body weight; while they were less sensitive to the main clinical variables. PSA indicated that cladribine tablets were cost-effective in Iran, with a probability of 57.5% and 58.6% at lower and higher limits of threshold, respectively. Conclusion: Cladribine tablets yielded higher QALYs and lower costs compared to natalizumab, in patients with HDA-RMS in Iran.

The cost implication of primary prevention in the HOPE 3 trial

2019 ◽  
Vol 5 (3) ◽  
pp. 266-271
Author(s):  
Andre Lamy ◽  
Eva Lonn ◽  
Wesley Tong ◽  
Balakumar Swaminathan ◽  
Hyejung Jung ◽  
...  
Keyword(s):  
Developing Countries ◽  
Primary Prevention ◽  
Cost Saving ◽  
Developed Countries ◽  
Sensitivity Analyses ◽  
Clinical Trial Registration ◽  
Pressure Lowering ◽  
The Cost ◽  
Care Costs ◽  
Country Specific

Abstract Aims The Heart Outcomes Prevention Evaluation-3 (HOPE-3) found that rosuvastatin alone or with candesartan and hydrochlorothiazide (HCT) (in a subgroup with hypertension) significantly lowered cardiovascular events compared with placebo in 12 705 individuals from 21 countries at intermediate risk and without cardiovascular disease. We assessed the costs implications of implementation in primary prevention in countries at different economic levels. Methods and results Hospitalizations, procedures, study and non-study medications were documented. We applied country-specific costs to the healthcare resources consumed for each patient. We calculated the average cost per patient in US dollars for the duration of the study (5.6 years). Sensitivity analyses were also performed with cheapest equivalent substitutes. The combination of rosuvastatin with candesartan/HCT reduced total costs and was a cost-saving strategy in United States, Canada, Europe, and Australia. In contrast, the treatments were more expensive in developing countries even when cheapest equivalent substitutes were used. After adjustment for gross domestic product (GDP), the costs of cheapest equivalent substitutes in proportion to the health care costs were higher in developing countries in comparison to developed countries. Conclusion Rosuvastatin and candesartan/HCT in primary prevention is a cost-saving approach in developed countries, but not in developing countries as both drugs and their cheapest equivalent substitutes are relatively more expensive despite adjustment by GDP. Reductions in costs of these drugs in developing countries are essential to make statins and blood pressure lowering drugs affordable and ensure their use. Clinical trial registration HOPE-3 ClinicalTrials.gov number, NCT00468923.

scholarly journals Cost-effectiveness of zoledronic acid compared with sequential denosumab/alendronate for older osteoporotic women in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Mori ◽  
Carolyn J. Crandall ◽  
Tomoko Fujii ◽  
David A. Ganz
Keyword(s):  
Health Economic ◽  
Cost Effectiveness ◽  
Zoledronic Acid ◽  
Cost Saving ◽  
Fragility Fracture ◽  
Community Dwelling ◽  
Sensitivity Analyses ◽  
Term Care ◽  
Lifetime Horizon ◽  
The Cost

Abstract Summary Among hypothetical cohorts of older osteoporotic women without prior fragility fracture in Japan, we evaluated the cost-effectiveness of two treatment strategies using a simulation model. Annual intravenous zoledronic acid for 3 years was cost-saving compared with biannual subcutaneous denosumab for 3 years followed by weekly oral alendronate for 3 years. Purpose Osteoporosis constitutes a major medical and health economic burden to society worldwide. Injectable treatments for osteoporosis require less frequent administration than oral treatments and therefore have higher persistence and adherence with treatment, which could explain better efficacy for fracture prevention. Although annual intravenous zoledronic acid and biannual subcutaneous denosumab are available, it remains unclear which treatment strategy represents a better value from a health economic perspective. Accordingly, we examined the cost-effectiveness of zoledronic acid for 3 years compared with sequential denosumab/alendronate (i.e., denosumab for 3 years followed by oral weekly alendronate for 3 years, making the total treatment duration 6 years) among hypothetical cohorts of community-dwelling osteoporotic women without prior fragility fracture in Japan at ages 65, 70, 75, or 80 years. Methods Using a previously validated and updated Markov microsimulation model, we obtained incremental cost-effectiveness ratios (Japanese yen [¥] (or US dollars [$]) per quality-adjusted life-year [QALY]) from the public healthcare and long-term care payer’s perspective over a lifetime horizon with a willingness-to-pay of ¥5 million (or $47,500) per QALY. Results In the base case, zoledronic acid was cost-saving (i.e., more effective and less expensive) compared with sequential denosumab/alendronate. In deterministic sensitivity analyses, results were sensitive to changes in the efficacy of zoledronic acid or the cumulative persistence rate with zoledronic acid or denosumab. In probabilistic sensitivity analyses, the probabilities of zoledronic acid being cost-effective were 98–100%. Conclusions Among older osteoporotic women without prior fragility fracture in Japan, zoledronic acid was cost-saving compared with sequential denosumab/alendronate.

Effect of Self - Care Program on the Self- Esteem of Multiple Sclerosis Patients

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
H. Madani ◽  
H. Navipoor ◽  
P. Roozbayani
Keyword(s):  
Multiple Sclerosis ◽  
Self Care ◽  
Care Program ◽  
Self Esteem ◽  
The Self ◽  
Self Report ◽  
The Mean ◽  
Muscular Spasm ◽  
Multiple Sclerosis Patients ◽  
Paired T Test

Aims:According to decreased self- esteem in multiple sclerosis (MS) patients, it is necessary to utilize appropriate methods in order to improve self- esteem in MS patients. So this study was conducted on patients with MS supported by the Iranian MS society for determining the effect of self - care program on their self- esteem.Method:In this semi - experimental study 34 patients with MS who were not in the acute phase of disease were selected. The data were collected via personal questionnaires, problem list, Cooper and smith standard questionnaire for self- esteem and self report check lists. Self - care program(self - care for muscular spasm, fatigue, constipation and amnesia and …) was educated, then it was performed for one month period and the data were analyzed using paired t- test, wilcoxon, croscal - wallis and manwithney tests.Results:Application of self - care program improve the self- esteem and reduced some symptoms such as muscular spasm, fatigue, constipation and amnesia in MS patients. The mean valve of self- esteem increased from 54 before performing the program to 68 after the program ( p < 0.05).Conclusion:Using self-care program can be an effective method for improving self- esteem of MS patients.

A Specialized Home Care Team Does Make a Difference

1992 ◽  
Vol 5 (3) ◽  
pp. 38-41
Author(s):  
Dorothy Larson ◽  
Ralph Odegard ◽  
N.E. Brown
Keyword(s):  
Health Care ◽  
Home Care ◽  
Health Care System ◽  
Care Program ◽  
Care Team ◽  
Research Facility ◽  
Teaching And Research ◽  
The Cost ◽  
Care System ◽  
At Home

Results of a study done in a large teaching and research facility in Alberta reveal that a specialized home care team can substantially lower the cost of caring for people who are ventilator dependent. With the assistance of a pulmonary physician, the Respiratory Home Care program has shown excellent results. Patients report that they “feel as safe at home as in the hospital”, and the savings to the health care system are estimated to be about $2,000,000 per year.

Cost Analysis Comparing Computed Tomographic Pulmonary Angiography (CTPA) and Ventilation-Perfusion (V/Q) Scanning for the Diagnosis of Pulmonary Embolism

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 567-567
Author(s):  
Alastair Dorreen ◽  
Chris Skedgel ◽  
Marc A. Rodger ◽  
Susan R. Kahn ◽  
Michael J. Kovacs ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cost Effectiveness ◽  
Cost Analysis ◽  
Incremental Cost ◽  
Cost Minimization ◽  
Imaging Modality ◽  
Sensitivity Analyses ◽  
Pulmonary Emboli ◽  
Cost Minimization Analysis ◽  
The Cost

Abstract Abstract 567 Background: Accurate diagnosis of a pulmonary embolism remains problematic due to the nonspecific findings of the clinical presentation and the limitations of radiographic imaging. Computed tomography pulmonary angiography (CTPA) has surpassed ventilation-perfusion (V/Q) scanning as the primary imaging modality in the investigation of patients with suspected pulmonary emboli due to its superior diagnostic accuracy. Data from a large randomized controlled trial has indicated that while strategies using both CTPA and V/Q are equally safe at excluding the diagnosis, CTPA detects significantly more pulmonary emboli (1). The purpose of this study was to perform a cost analysis comparing CTPA and V/Q scanning for the investigation of patients with suspected pulmonary emboli based upon this large trial. Methods: A cost analysis was performed using a decision-analysis model. The costs and outcomes of CTPA and V/Q scanning in detecting or ruling out pulmonary embolism over a 90 day analysis horizon were incorporated into a decision tree where the probabilities for each outcome were taken from (1) and a systematic literature review. The decision tree incorporated the thromboembolic and major bleeding complications associated with the diagnosis and treatment of pulmonary embolism in 100,000 patients. Outcomes in the model were measured in terms of quality-adjusted life years (QALYs). The economic model took a direct-payer perspective, considering direct costs to the health care system and patients. All costs were based on 2009 Canadian dollars. The primary economic evaluation was conducted within a deterministic cost-effectiveness analysis framework in terms of incremental cost per QALY. If the clinical benefits were found to be statistically insignificant the primary evaluation would be collapsed to a cost-minimization analysis and a secondary analysis would be performed to using probabilistic methods to estimate the expected incremental costs and outcomes based upon probability distributions around mean point estimates. Sensitivity analyses around key parameters were also performed. Results: The primary deterministic analysis collapsed to a cost-minimization analysis on the grounds that no statistically differences in the proportion of false negative results or mortality were observed in the randomized trial comparing CTPA with VQ scanning for the diagnosis of pulmonary embolism (1). The cost minimization analysis demonstrated a strategy using V/Q scanning as the primary imaging modality was less costly. CTPA was associated with an incremental cost of $11.3 million per 100,000 patients compared to V/Q scanning. CTPA was associated with an additional 3760 additional diagnoses of pulmonary embolism and 111 major bleeding episodes compared to V/Q scanning. The secondary probabilistic cost-effectiveness analysis revealed that CTPA was associated with an incremental cost of $4.8 million per 100,000-person cohort and 3134 QALYs gained relative to V/Q scanning for a cost-effectiveness of $1543 per QALY gained. Furthermore, the cost-effectiveness acceptability curve demonstrated CTPA had an 89% likelihood of being cost-effective relative to the threshold of $50,000 per QALY gained. Sensitivity analyses demonstrated cost-effectiveness ratio was most impacted by varying prevalence of pulmonary embolism and the relative and absolute differences in the proportions of fatal pulmonary embolism from falsely negative scans between the two tests. Conclusions: The results of the cost-minimization analysis imply that V/Q scanning is a less costly alternative to CTPA resulting from less pulmonary emboli diagnosed while maintaining similar 3-month rate of thromboembolic complications relative to CTPA. Secondary analysis, however, concluded that diagnostic algorithms incorporating CTPA may be cost-effective under defined circumstances. (1) Anderson et al. JAMA 2007; 298:2743-2753 Disclosures: No relevant conflicts of interest to declare.

scholarly journals Cost Analysis of Single-Dose Hepatitis B Revaccination Among Infants Born to Hepatitis B Surface Antigen-Positive Mothers and Not Responding to the Initial Vaccine Series

2018 ◽  
Vol 133 (3) ◽  
pp. 338-346 ◽  
Author(s):  
Eric W. Hall ◽  
Eli S. Rosenberg ◽  
Monica Trigg ◽  
Noele Nelson ◽  
Sarah Schillie
Keyword(s):  
Single Dose ◽  
Hepatitis B ◽  
Cost Analysis ◽  
Surface Antigen ◽  
Lower Cost ◽  
Hepatitis B Surface Antigen ◽  
Sensitivity Analyses ◽  
The Cost ◽  
Antibody Levels ◽  
Lower Cost Option

Objectives: Infants born to mothers who are hepatitis B surface antigen (HBsAg) positive are at risk for perinatal hepatitis B infection. As prevention, these infants receive a series of 3 or 4 doses of hepatitis B vaccine starting at birth and postvaccination serologic testing. Infants with antibody levels <10 mIU/mL are considered vaccine nonresponders and should be revaccinated. The objective of this cost analysis was to assess a single-dose revaccination strategy among infant nonresponders. Methods: We used a decision analytic tree to compare the costs of a single-dose revaccination strategy with the costs of a 3-dose revaccination strategy. The analysis consisted of 3 epidemiologic scenarios that varied levels of previous protection among infants indicated for revaccination. We assumed health outcomes in each strategy were the same, and we evaluated costs from the societal perspective using 2016 US dollars. We conducted sensitivity analyses on key variables, including the minimum required efficacy of a single revaccination dose. Results: In all analyses, the single-dose revaccination strategy was a lower-cost option than the 3-dose revaccination strategy. Under the assumption that all revaccination visits were previously unscheduled, single-dose revaccination reduced the cost per infant by $119.81 to $155.72 (depending on the scenario). Across all scenarios, the most conservative estimate for the threshold efficacy (the minimum efficacy required to result in a lower-cost option) value of single-dose revaccination was 67%. Conclusions: For infants who were born to HBsAg-positive mothers and who were not responding to the initial vaccine series, a single-dose revaccination strategy, compared with a 3-dose revaccination strategy, reduced costs across several scenarios. These results helped inform the Advisory Committee on Immunization Practices’ vote in February 2017 to recommend single-dose revaccination.

scholarly journals Cost-effectiveness of teduglutide in adult patients with short bowel syndrome: Markov modeling using traditional cost-effectiveness criteria

2019 ◽  
Vol 111 (1) ◽  
pp. 141-148 ◽  
Author(s):  
Vikram K Raghu ◽  
David G Binion ◽  
Kenneth J Smith
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Short Bowel Syndrome ◽  
Adult Patients ◽  
Sensitivity Analyses ◽  
Published Data ◽  
Model Parameters ◽  
Short Bowel ◽  
Life Years ◽  
The Cost

ABSTRACT Background Adults with short bowel syndrome have a high mortality and significant morbidity due to unsuccessful attempts at rehabilitation that necessitate chronic use of parenteral nutrition (PN). Teduglutide is a novel therapy that promotes intestinal adaptation to improve rehabilitation but with a price &gt;$400,000/y. Objective The current study evaluated the cost-effectiveness of using teduglutide in US adult patients with short bowel syndrome. Methods A Markov model evaluated the costs (in US dollars) and effectiveness (in quality-adjusted life years, or QALYs) of treatment compared with no teduglutide use, with a presumed starting age of 40 y. Parameters were obtained from published data or estimation. The primary effect modeled was the increased likelihood of reduced PN days per week when using teduglutide, leading to greater quality of life and lower PN costs. Sensitivity analyses were performed on all model parameters. Results In the base scenario, teduglutide cost $949,910/QALY gained. In 1-way sensitivity analyses, only reducing teduglutide cost decreased the cost/QALY gained to below the typical threshold of $100,000/QALY gained. Specifically, teduglutide cost would need to be reduced by &gt;65% for it to reach the threshold value. Probabilistic sensitivity analysis favored no teduglutide use in 80% of iterations at a $100,000/QALY threshold. However, teduglutide therapy was cost-saving in 13% of model iterations. Conclusions Teduglutide does not meet a traditional cost-effectiveness threshold as treatment for PN reduction in adult patients with short bowel syndrome compared with standard intestinal rehabilitation. Subpopulations that demonstrate maximum benefit could be cost-saving, and complete nonuse could lead to financial loss. Teduglutide becomes economically reasonable only if its cost is substantially reduced.

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