scholarly journals Cost-effectiveness of mandatory folate fortification v. other options for the prevention of neural tube defects: results from Australia and New Zealand

2009 ◽  
Vol 13 (4) ◽  
pp. 566-578 ◽  
Author(s):  
Kim Dalziel ◽  
Leonie Segal ◽  
Rachelle Katz
Keyword(s):  
New Zealand ◽  
Cost Effectiveness ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Health Economic Evaluation ◽  
Cost Effective ◽  
Evidence Base ◽  
Considerable Uncertainty ◽  
Supplement Use ◽  
Disability Adjusted Life

AbstractObjectiveTo provide input to Australian and New Zealand government decision making regarding an optimal strategy to reduce the rate of neural tube defects (NTD).DesignStandard comparative health economic evaluation techniques were employed for a set of intervention options for promoting folate/folic acid consumption in women capable of or planning a pregnancy. Evidence of effectiveness was informed by the international literature and costs were derived for Australia and New Zealand.ResultsPopulation-wide campaigns to promote supplement use and mandatory fortification were the most effective at reducing NTD, at an estimated 36 and 31 fewer cases per annum respectively for Australia and New Zealand, representing an 8 % reduction in the current annual NTD rate. Population-wide and targeted approaches to increase supplement use were cost-effective, at less than $AU 12 500 per disability-adjusted life year (DALY) averted ($US 9893, £5074), as was extending voluntary fortification. Mandatory fortification was not cost-effective for New Zealand at $AU 138 500 per DALY ($US 109 609, £56 216), with results uncertain for Australia, given widely varying cost estimates. Promoting a folate-rich diet was least cost-effective, with benefits restricted to impact on NTD.ConclusionsSeveral options for reducing NTD appear to fall well within accepted societal cost-effectiveness norms. All estimates are subject to considerable uncertainty, exacerbated by possible interactions between interventions, including impacts on currently effective strategies. The Australian and New Zealand governments have decided to proceed with mandatory fortification; it is hoped they will support a rigorous evaluation which will contribute to the evidence base.

scholarly journals Cost-effectiveness of mandatory folic acid fortification of flours in prevention of neural tube defects: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258488
Author(s):  
Viviane Belini Rodrigues ◽  
Everton Nunes da Silva ◽  
Maria Leonor Pacheco Santos
Keyword(s):  
Systematic Review ◽  
Folic Acid ◽  
Cost Effectiveness ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Cost Benefit Analysis ◽  
Cost Effective ◽  
Quality Analysis ◽  
Positive Health ◽  
The Cost

Background Neural tube defects (NTDs) constitute the most frequent group among congenital malformations and are the main cause of neonatal morbimortality. Folic acid (FA) can reduce the risk of pregnancies affected by NTDs. Objective We aimed to investigate whether mandatory folic acid (FA) fortification of flours is cost-effective as compared to non-mandatory fortification, and to verify whether FA dosage, cost composition, and the quality of economic studies influence the cost-effectiveness of outcomes. Methods We conducted a systematic review. The protocol was registered on PROSPERO (CRD 42018115682). A search was conducted using the electronic databases MEDLINE/PubMed, Web of Science, Embase, Scopus, and EBSCO/CINAHL between January 2019 and October 2020 and updated in February 2021. Eligible studies comprised original economic analyses of mandatory FA fortification of wheat and corn flours (maize flours) compared to strategies of non-mandatory fortification in flours and/or use of FA supplements for NTD prevention. The Drummond verification list was used for quality analysis. Results A total of 7,859 studies were identified, of which 13 were selected. Most (77%; n = 10) studies originated from high-income countries, while three (23%) were from upper-middle-income countries. Results of a cost-effectiveness analysis showed that fortification is cost-effective for NTD prevention, except for in one study in New Zealand. The cost-benefit analysis yielded a median ratio of 17.5:1 (0.98:1 to 417.1:1), meaning that for each monetary unit spent in the program, there would be a return of 17.5 monetary units. Even in the most unfavorable case of mandatory fortification, the investment in the program would virtually payoff at a ratio of 1:0.98. All FA dosages were cost-effective and offered positive health gains, except in one study. The outcomes of two studies showed that FA dosages above 300 μg/100 g have a higher CBA ratio. The studies with the inclusion of “loss of consumer choice” in the analysis may alter the fortification cost-efficacy ratio. Conclusion We expect the findings to be useful for public agencies in different countries in decision-making on the implementation and/or continuity of FA fortification as a public policy in NTD prevention.

Cost-Effectiveness of Interventions To Control Campylobacter in the New Zealand Poultry Meat Food Supply

2013 ◽  
Vol 76 (7) ◽  
pp. 1161-1167 ◽  
Author(s):  
ROBIN J. LAKE ◽  
BEVERLEY J. HORN ◽  
ALEX H. DUNN ◽  
RUTH PARRIS ◽  
F. TERRI GREEN ◽  
...  
Keyword(s):  
New Zealand ◽  
Cost Effectiveness ◽  
Risk Model ◽  
Cost Effective ◽  
Poultry Meat ◽  
Processing Stage ◽  
Primary Processing ◽  
Effective Interventions ◽  
Disability Adjusted Life ◽  
Life Years

An analysis of the cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry supply examined a series of interventions. Effectiveness was evaluated in terms of reduced health burden measured by disability-adjusted life years (DALYs). Costs of implementation were estimated from the value of cost elements, determined by discussions with industry. Benefits were estimated by changing the inputs to a poultry food chain quantitative risk model. Proportional reductions in the number of predicted Campylobacter infections were converted into reductions in the burden of disease measured in DALYs. Cost-effectiveness ratios were calculated for each intervention, as cost per DALY reduction and the ratios compared. The results suggest that the most cost-effective interventions (lowest ratios) are at the primary processing stage. Potential phage-based controls in broiler houses were also highly cost-effective. This study is limited by the ability to quantify costs of implementation and assumptions required to estimate health benefits, but it supports the implementation of interventions at the primary processing stage as providing the greatest quantum of benefit and lowest cost-effectiveness ratios.

OP02 A Managed Access Approach To Appraising New Cancer Drugs In England

2017 ◽  
Vol 33 (S1) ◽  
pp. 1-2
Author(s):  
Linda Landells ◽  
Martyn Burke ◽  
Meindert Boysen
Keyword(s):  
Cost Effective ◽  
Integrated Approach ◽  
Evidence Base ◽  
Phase Iii ◽  
Appraisal Committee ◽  
Cancer Drugs ◽  
Cancer Treatments ◽  
Considerable Uncertainty ◽  
Health Technologies ◽  
Current Price

INTRODUCTION:The changing regulatory landscape brings new challenges to Health Technology Assessment (HTA). Marketing authorizations are being granted as the evidence base evolves to facilitate timely patient access to promising health technologies. Consequently, some products come to HTA bodies sooner in their development cycles with less evidence, which ultimately leads to greater uncertainty in decision making. A key challenge for payer and HTA bodies is providing access to promising medicines while the evidence is still emerging, in a financially sustainable way.METHODS:Changes to the Cancer Drugs Fund (CDF) have resulted in a managed access fund for cancer medicines in England. The National Institute for Health and Care Excellence (NICE) can now recommend a treatment for use within the CDF if there is plausible potential to satisfy the criteria for routine use in the National Health Service (NHS) at its current price, but the evidence is not robust enough and associated with significant uncertainty. Further evidence is then generated in clinical trials, through observational data collection, or a combination of the two, while the drug's price reflects the decision uncertainty. At the end of the managed access period, NICE reviews the guidance to determine if the treatment can be recommended for routine commissioning.RESULTS:The first treatment recommended for use within the new CDF was osimertinib for non-small cell lung cancer (1). At the time of NICE appraisal, there was considerable uncertainty in osimertinib's clinical and cost effectiveness because only short-term phase II trial results were available. NICE's independent appraisal committee considered there was plausible potential for osimertinib to be cost effective and identified that an ongoing phase III trial would provide longer-term data addressing the key uncertainties.CONCLUSIONS:An integrated approach between payer and HTA decision-maker has significantly changed how cancer treatments in England are appraised. This collaborative way of working heralds a more sustainable approach to introducing promising cancer treatments.

scholarly journals Challenges in synthesising cost-effectiveness estimates

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Gemma E. Shields ◽  
Jamie Elvidge
Keyword(s):  
Cost Effectiveness ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cost Effective ◽  
Evidence Base ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Study Designs

AbstractEconomic evaluations help decision-makers faced with tough decisions on how to allocate resources. Systematic reviews of economic evaluations are useful as they allow readers to assess whether interventions have been demonstrated to be cost effective, the uncertainty in the evidence base, and key limitations or gaps in the evidence base. The synthesis of systematic reviews of economic evaluations commonly takes a narrative approach whereas a meta-analysis is common step for reviews of clinical evidence (e.g. effectiveness or adverse event outcomes). As they are common objectives in other reviews, readers may query why a synthesis has not been attempted for economic outcomes. However, a meta-analysis of incremental cost-effectiveness ratios, costs, or health benefits (including quality-adjusted life years) is fraught with issues largely due to heterogeneity across study designs and methods and further practical challenges. Therefore, meta-analysis is rarely feasible or robust. This commentary outlines these issues, supported by examples from the literature, to support researchers and reviewers considering systematic review of economic evidence.

scholarly journals Cost Effectiveness Analysis Using Disability-Adjusted Life Years for Cataract Surgery

2020 ◽  
Vol 17 (16) ◽  
pp. 6010
Author(s):  
Thinni Nurul Rochmah ◽  
Anggun Wulandari ◽  
Maznah Dahlui ◽  
Ernawaty ◽  
Ratna Dwi Wulandari
Keyword(s):  
Cost Effectiveness ◽  
Cataract Surgery ◽  
Cost Effective ◽  
Disability Adjusted Life Years ◽  
Cost Effectiveness Ratio ◽  
Small Incision Cataract Surgery ◽  
Post Surgery ◽  
Disability Adjusted Life ◽  
Life Years ◽  
The Cost

Cataracts are the second most prioritized eye disease in the world. Cataracts are an expensive treatment because surgery is the only method that can treat the disease. This study aims to analyze the cost effectiveness of each operating procedure. Specifically, phacoemulsification and Small Incision Cataract Surgery (SICS) with Disability-Adjusted Life Years (DALYs) as the effectiveness indicator is used. This study is an observational analytic study with a prospective framework. The sample size is 130 patients who have undergone phacoemulsification and 25 patients who have undergone SICS. The DALY for phacoemulsification at Day-7 (D-7) is 0.3204, and at Day-21 (D-21), it is 0.3204, while the DALY for SICS at D-7 is 0.3060, and at D-21, it is 0.3158. The incremental cost effectiveness ratio (ICER) for cataract surgery at D-7 is USD $1872.49, and at D-21, it is USD $5861.71, whereas the Indonesian Gross Domestic Product (GDP) is USD $4174.90. In conclusion, the phacoemulsification technique is more cost effective than the SICS technique. The ICER value is very cost effective at D-7 post-surgery compared to at D-21 post-surgery because the ICER is less than 1 GDP per capita per DALY.

scholarly journals Assessment of the potential effect of incremental increases in folic acid intake on neural tube defects in Australia and New Zealand

2006 ◽  
Vol 30 (4) ◽  
pp. 369-374 ◽  
Author(s):  
Carol Bower ◽  
Nicholas de Klerk ◽  
Siobhan Hickling ◽  
Gina Ambrosini ◽  
Leon Flicker ◽  
...  
Keyword(s):  
Folic Acid ◽  
New Zealand ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Potential Effect ◽  
Folic Acid Intake ◽  
Acid Intake

scholarly journals The Cost-Effectiveness of Continuous Erythropoiesis Receptor Activator Once Monthly versus Epoetin Thrice Weekly for Anaemia Management in Chronic Haemodialysis Patients

Anemia ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-9 ◽  
Author(s):  
Omar Maoujoud ◽  
Samir Ahid ◽  
Hocein Dkhissi ◽  
Zouhair Oualim ◽  
Yahia Cherrah
Keyword(s):  
Cost Effectiveness ◽  
Health Economic Evaluation ◽  
Cost Effective ◽  
Erythropoietin Receptor ◽  
Chronic Haemodialysis ◽  
Period 2 ◽  
Receptor Activator ◽  
Anaemia Management ◽  
One Year ◽  
The Cost

Introduction. The aim of this study was to compare the cost-effectiveness of continuous erythropoietin receptor activator (CERA) once monthly to epoetin beta (EpoB) thrice weekly to maintain haemoglobin (Hb) within the range 10.5–12 g/dL.Methods. Prospective cohort study and cost-effectiveness analysis. Chronic haemodialysis patients (CHP), being treated with EpoB, were selected for two periods of follow-up: period 1, maintaining prior treatment with EpoB, and period 2, conversion to CERA once monthly. Hb concentrations and costs were measured monthly. Health care payer perspective for one year was adopted.Results. 75 CHP completed the study, with a mean age of52.9±14.3years. Baseline Hb was11.14±1.18 g/dL in EpoB phase and11.46±0.79 g/dL in CERA phase; we observed a significant increase in the proportion of patients successfully treated (Hb within the recommended range), 65.3% versus 70.7%,p: 0.008, and in the average effectiveness by 4% (0.55 versus 0.59). Average cost-effectiveness ratios were 6013.86 and 5173.64$, with an ICER CERA to EpoB at −6457.5$.Conclusion. Our health economic evaluation of ESA use in haemodialysis patients suggests that the use of CERA is cost-effective compared with EpoB.

scholarly journals Cost-effectiveness of an Improving Access to Psychological Therapies service

2013 ◽  
Vol 202 (3) ◽  
pp. 220-227 ◽  
Author(s):  
Clara Mukuria ◽  
John Brazier ◽  
Michael Barkham ◽  
Janice Connell ◽  
Gillian Hardy ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Mental Health Problems ◽  
Short Form ◽  
Clinical Excellence ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Considerable Uncertainty ◽  
Psychological Therapies ◽  
Life Years ◽  
Demonstration Site

BackgroundEffective psychological therapies have been recommended for common mental health problems, such as depression and anxiety, but provision has been poor. Improving Access to Psychological Therapies (IAPT) may provide a cost-effective solution to this problem.AimsTo determine the cost-effectiveness of IAPT at the Doncaster demonstration site (2007–2009).MethodAn economic evaluation comparing costs and health outcomes for patients at the IAPT demonstration site with those for comparator sites, including a separate assessment of lost productivity. Sensitivity analyses were undertaken.ResultsThe IAPT site had higher service costs and was associated with small additional gains in quality-adjusted life-years (QALYs) compared with its comparator sites, resulting in a cost per QALY gained of £29 500 using the Short Form (SF-6D). Sensitivity analysis using predicted EQ-5D scores lowered this to £16 857. Costs per reliable and clinically significant (RCS) improvement were £9440 per participant.ConclusionsImproving Access to Psychological Therapies provided a service that was probably cost-effective within the usual National Institute for Health and Clinical Excellence (NICE) threshold range of £20 000-30 000, but there was considerable uncertainty surrounding the costs and outcome differences.

scholarly journals APPROACHES TO EVALUATE TRANSPORT COSTING IN INDIA – AN EXPLORATORY STUDY

2021 ◽  
pp. 15-18
Author(s):  
Mahesha, V
Keyword(s):  
Cost Effectiveness ◽  
Exploratory Study ◽  
Travel Demand ◽  
Cost Effective ◽  
Research Paper ◽  
Evidence Base ◽  
Transport Sector ◽  
Cost Factor ◽  
Carbon Reduction ◽  
Different Types

This research paper has made an attempt to study the background and strength of cost factor in transport sector. The analysis can be condense into three crucial issues which,depending on how they are handled in any analysis,together dictate whether or not transport measures will be deemed a more or less cost-effective route to carbon reduction. In short,these are the postulation about future costs and level of travel demand,the methods applied to compare policies for cost-effectiveness and the evidence base used in relation to different types and combinations of policy instrument.So in view of this,the present study assumes a great importance to put the light on transport costing.

scholarly journals The merits of sustaining pneumococcal vaccination after transitioning from Gavi support – a modelling and cost-effectiveness study for Kenya

2018 ◽  
Author(s):  
John Ojal ◽  
Ulla Griffiths ◽  
Laura L. Hammitt ◽  
Ifedayo Adetifa ◽  
Donald Akech ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Low Income ◽  
Disease Incidence ◽  
Pneumococcal Vaccination ◽  
Cost Effective ◽  
Low Income Countries ◽  
Pneumococcal Carriage ◽  
Disability Adjusted Life ◽  
Disability Adjusted Life Year

AbstractIntroductionMany low income countries soon will need to consider whether to continue pneumococcal conjugate vaccine (PCV) use at full costs as they transition from Gavi support. Using Kenya as a case study we assessed the incremental cost-effectiveness of continuing PCV use.MethodsWe fitted a dynamic compartmental model of pneumococcal carriage to annual carriage prevalence surveys and invasive pneumococcal disease (IPD) incidence in Kilifi, Kenya, and predicted disease incidence and related mortality for either continuing PCV use beyond 2022, the start of Kenya’s transition from Gavi support, or its discontinuation. We calculated the costs per disability-adjusted-life-year (DALY) averted and associated prediction intervals (PI).ResultsWe predicted that overall IPD incidence will increase by 93% (PI: 72% - 114%) from 8.5 in 2022 to 16.2 per 100,000 per year in 2032, if PCV use is discontinued. Continuing vaccination would prevent 15,355 (PI: 10,196–21,125) deaths and 112,050 (PI: 79,620– 130,981) disease cases during that time. Continuing PCV after 2022 will require an estimated additional US$15.6 million annually compared to discontinuing vaccination. The incremental cost per DALY averted of continuing PCV was predicted at $142 (PI: 85 - 252) in 2032.ConclusionContinuing PCV use is essential to sustain its health gains. Based on the Kenyan GDP per capita of $1445, and in comparison to other vaccines, continued PCV use at full costs is cost-effective. These arguments support an expansion of the vaccine budget, however, affordability may be a concern.FundingFunded by the Wellcome Trust.

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