scholarly journals Quality adjusted life years in the time of COVID-19

2021 ◽  
Vol 45 (1) ◽  
pp. 12
Author(s):  
Jane Hall ◽  
Rosalie Viney
Keyword(s):  
Economic Evaluation ◽  
Economic Activity ◽  
Economic Recession ◽  
Quality Adjusted Life Year ◽  
Economic Losses ◽  
Quality Adjusted Life Years ◽  
Trade Offs ◽  
Life Years ◽  
The Face ◽  
Quality Adjusted Life

The quality adjusted life year (QALY) as a basis of valuing additional expenditure on health is widely accepted. Although early in the COVID-19 pandemic, several commentators called for a similar approach in resolving trade-offs between economic activity and reducing the burden of COVID-19, this has not occurred. The value of a QALY has not been used to deny all intervention, as the rule of rescue attests. Further, while there was no other way of managing the pandemic, there were other means available to mitigate the economic losses. Now that vaccine programs have commenced in several countries, it is interesting to consider whether economic evaluation should now be applied. However, the recognised complexities of the evaluation of vaccines, plus the challenge of measuring opportunity costs in the face of an economic recession and the severity of the consequences of an outbreak even though the probability of transmission is exceedingly low, mean its use will be restricted. COVID-19 has changed everything, even the way we should think about economic evaluation.

scholarly journals The Costs and Benefits of Covid-19 Lockdowns in New Zealand

2021 ◽  
Author(s):  
Martin Lally
Keyword(s):  
New Zealand ◽  
Vaccination Campaign ◽  
Quality Adjusted Life Year ◽  
Mitigation Strategy ◽  
Health Interventions ◽  
Costs And Benefits ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Using Data ◽  
Quality Adjusted Life

This paper considers the costs and benefits of New Zealand's Covid-19 nation-wide lockdown strategy relative to pursuit of a mitigation strategy in March 2020. Using data available up to 28 June 2021, the estimated additional deaths from a mitigation strategy are 1,750 to 4,600, implying a Cost per Quality Adjusted Life Year saved by locking down in March 2020 of at least 13 times the generally employed threshold figure of $62,000 for health interventions in New Zealand; the lockdowns do not then seem to have been justified by reference to the standard benchmark. Using only data available to the New Zealand government in March 2020, the ratio is similar and therefore the same conclusion holds that the nation-wide lockdown strategy was not warranted. Looking forwards from 28 June 2021, if a new outbreak occurs that cannot be suppressed without a nation-wide lockdown, the death toll from adopting a mitigation strategy at this point would be even less than had it done so in March 2020, due to the vaccination campaign and because the period over which the virus would then inflict casualties would now be much less than the period from March 2020; this would favour a mitigation policy even more strongly than in March 2020. This approach of assessing the savings in quality adjusted life years and comparing them to a standard benchmark figure ensures that all quality adjusted life years saved by various health interventions are treated equally, which accords with the ethical principle of equity across people.

scholarly journals Methods for the economic evaluation of changes to the organisation and delivery of health services: principal challenges and recommendations

2018 ◽  
Vol 14 (1) ◽  
pp. 119-134 ◽  
Author(s):  
Rachel Meacock
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Health Services ◽  
Opportunity Costs ◽  
Quality Adjusted Life Years ◽  
Health Technologies ◽  
Life Years ◽  
Ex Ante ◽  
Delivery Of Health Services ◽  
Quality Adjusted Life

AbstractThere is a requirement for economic evaluation of health technologies seeking public funding across Europe. Changes to the organisation and delivery of health services, including changes to health policy, are not covered by such appraisals. These changes also have consequences for National Health Service (NHS) funds, yet undergo no mandatory cost-effectiveness assessment. The focus on health technologies may have occurred because larger-scale service changes pose more complex challenges to evaluators. This paper discusses the principal challenges faced when performing economic evaluations of changes to the organisation and delivery of health services and provides recommendations for overcoming them. The five principal challenges identified are as follows: undertakingex-anteevaluation; evaluating impacts in terms of quality-adjusted life years; assessing costs and opportunity costs; accounting for spillover effects; and generalisability. Of these challenges, methods for estimating the impact on costs and quality-adjusted life years are those most in need of development. Methods are available forex-anteevaluation, assessing opportunity costs and examining generalisability. However, these are rarely applied in practice. The general principles of assessing the cost-effectiveness of interventions should be applied to all NHS spending, not just that involving health technologies. Advancements in this area have the potential to improve the allocation of scarce NHS resources.

scholarly journals Cost-Effectiveness Evaluation of Etoricoxib versus Celecoxib and Nonselective NSAIDs in the Treatment of Ankylosing Spondylitis in Norway

2011 ◽  
Vol 2011 ◽  
pp. 1-14 ◽  
Author(s):  
Jeroen P. Jansen ◽  
Stephanie D. Taylor
Keyword(s):  
Cost Effectiveness ◽  
Ankylosing Spondylitis ◽  
Time Horizon ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Cost Effective Treatment ◽  
Ceiling Ratio ◽  
Quality Adjusted Life

Objectives. To evaluate the cost-effectiveness of etoricoxib (90 mg) relative to celecoxib (200/400 mg), and the nonselective NSAIDs naproxen (1000 mg) and diclofenac (150 mg) in the initial treatment of ankylosing spondylitis in Norway.Methods. A previously developed Markov state-transition model was used to estimate costs and benefits associated with initiating treatment with the different competing NSAIDs. Efficacy, gastrointestinal and cardiovascular safety, and resource use data were obtained from the literature. Data from different studies were synthesized and translated into direct costs and quality adjusted life years by means of a Bayesian comprehensive decision modeling approach.Results. Over a 30-year time horizon, etoricoxib is associated with about 0.4 more quality adjusted life years than the other interventions. At 1 year, naproxen is the most cost-saving strategy. However, etoricoxib is cost and quality adjusted life year saving relative to celecoxib, as well as diclofenac and naproxen after 5 years of follow-up. For a willingness-to-pay ceiling ratio of 200,000 Norwegian krones per quality adjusted life year, there is a >95% probability that etoricoxib is the most-cost-effective treatment when a time horizon of 5 or more years is considered.Conclusions. Etoricoxib is the most cost-effective NSAID for initiating treatment of ankylosing spondylitis in Norway.

scholarly journals Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033567
Author(s):  
Aida Moure-Fernandez ◽  
Sandra Hollinghurst ◽  
Fran E Carroll ◽  
Harriet Downing ◽  
Grace Young ◽  
...  
Keyword(s):  
Primary Care ◽  
Economic Evaluation ◽  
Randomised Controlled Trial ◽  
Lower Respiratory Tract ◽  
Controlled Trial ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Oral Corticosteroids ◽  
Randomised Controlled ◽  
Quality Adjusted Life

ObjectiveTo estimate the costs and outcomes associated with treating non-asthmatic adults (nor suffering from other lung-disease) presenting to primary care with acute lower respiratory tract infection (ALRTI) with oral corticosteroids compared with placebo.DesignCost-consequence analysis alongside a randomised controlled trial. Perspectives included the healthcare provider, patients and productivity losses associated with time off work.SettingFifty-four National Health Service (NHS) general practices in England.Participants398 adults attending NHS primary practices with ALRTI but no asthma or other chronic lung disease, followed up for 28 days.Interventions2× 20 mg oral prednisolone per day for 5 days versus matching placebo tablets.Outcome measuresQuality-adjusted life years using the 5-level EuroQol-5D version measured weekly; duration and severity of symptom. Direct and indirect resources related to the disease and its treatment were also collected. Outcomes were measured for the 28-day follow-up.Results198 (50%) patients received the intervention (prednisolone) and 200 (50%) received placebo. NHS costs were dominated by primary care contacts, higher with placebo than with prednisolone (£13.11 vs £10.38) but without evidence of a difference (95% CI £3.05 to £8.52). The trial medication cost of £1.96 per patient would have been recouped in prescription charges of £4.30 per patient overall (55% participants would have paid £7.85), giving an overall mean ‘profit’ to the NHS of £7.00 (95% CI £0.50 to £17.08) per patient. There was a quality adjusted life years gain of 0.03 (95% CI 0.01 to 0.05) equating to half a day of perfect health favouring the prednisolone patients; there was no difference in duration of cough or severity of symptoms.ConclusionsThe use of prednisolone for non-asthmatic adults with ALRTI, provided small gains in quality of life and cost savings driven by prescription charges. Considering the results of the economic evaluation and possible side effects of corticosteroids, the short-term benefits may not outweigh the long-term harms.Trial registration numbersEudraCT 2012-000851-15 and ISRCTN57309858; Pre-results.

scholarly journals A Markov Analysis of Screening for Late-Onset Cytomegalovirus Disease in Cytomegalovirus High-Risk Kidney Transplant Recipients

2017 ◽  
Vol 13 (2) ◽  
pp. 290-298
Author(s):  
Chethan M. Puttarajappa ◽  
Sundaram Hariharan ◽  
Kenneth J. Smith
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Cytomegalovirus Infection ◽  
Late Onset ◽  
Quality Adjusted Life Year ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Quality Adjusted Life

Background and objectivesManagement strategies are unclear for late-onset cytomegalovirus infection occurring beyond 6 months of antiviral prophylaxis in cytomegalovirus high-risk (cytomegalovirus IgG positive to cytomegalovirus IgG negative) kidney transplant recipients. Hybrid strategies (prophylaxis followed by screening) have been investigated but with inconclusive results. There are clinical and potential cost benefits of preventing cytomegalovirus-related hospitalizations and associated increased risks of patient and graft failure. We used decision analysis to evaluate the utility of postprophylaxis screening for late-onset cytomegalovirus infection.Design, setting, participants, & measurementsWe used the Markov decision analysis model incorporating costs and utilities for various cytomegalovirus clinical states (asymptomatic cytomegalovirus, mild cytomegalovirus infection, and cytomegalovirus infection necessitating hospitalization) to estimate cost-effectiveness of postprophylaxis cytomegalovirus screening strategies. Five strategies were compared: no screening and screening at 1-, 2-, 3-, or 4-week intervals. Progression to severe cytomegalovirus infection was modeled on cytomegalovirus replication kinetics. Incremental cost-effectiveness ratios were calculated as a ratio of cost difference between two strategies to difference in quality-adjusted life-years starting with the low-cost strategy. One-way and probabilistic sensitivity analyses were performed to test model’s robustness.ResultsThere was an incremental gain in quality-adjusted life-years with increasing screening frequency. Incremental cost-effectiveness ratios were $783 per quality-adjusted life-year (every 4 weeks over no screening), $1861 per quality-adjusted life-year (every 3 weeks over every 4 weeks), $10,947 per quality-adjusted life-year (every 2 weeks over every 3 weeks), and $197,086 per quality-adjusted life-year (weekly over every 2 weeks). Findings were sensitive to screening cost, cost of hospitalization, postprophylaxis cytomegalovirus incidence, and graft loss after cytomegalovirus infection. No screening was favored when willingness to pay threshold was <$14,000 per quality-adjusted life-year, whereas screening weekly was favored when willingness to pay threshold was >$185,000 per quality-adjusted life-year. Screening every 2 weeks was the dominant strategy between willingness to pay range of $14,000–$185,000 per quality-adjusted life-year.ConclusionsIn cytomegalovirus high-risk kidney transplant recipients, compared with no screening, screening for postprophylactic cytomegalovirus viremia is associated with gains in quality-adjusted life-years and seems to be cost effective. A strategy of screening every 2 weeks was the most cost-effective strategy across a wide range of willingness to pay thresholds.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_12_18_CJASNPodcast_18_2_P.mp3

scholarly journals An Economic Evaluation of Thread Embedding Acupuncture for the Treatment of Lumbar Herniated Intervertebral Disc in a Randomized Controlled Clinical Trial

2021 ◽  
Vol 38 (4) ◽  
pp. 312-319
Author(s):  
Ha-Na Kim ◽  
Jun-Yeon Kim ◽  
Kyeong-Ju Park ◽  
Ji-Min Hwang ◽  
Jun-Yeong Jang ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Visual Analog Scale Score ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Randomized Controlled ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Background: Lumbar herniated intervertebral disc (LHIVD) is a frequently presented condition/disease in Korean medical institutions. In this study, the economics of thread embedding acupuncture (TEA) was evaluated in a randomized controlled trial comparing TEA with sham TEA (STEA).Methods: This economic evaluation was analyzed from a limited social perspective, and the per-protocol set was from a basic analysis perspective. The cost-effectiveness analysis was based on the change in visual analog scale score, and the cost-utility analysis was based on the quality-adjusted life years. The final results were expressed as the average cost-effectiveness ratio and incremental cost-effectiveness ratio, and furthermore sensitivity analysis was performed to confirm the robustness of the results observed.Results: The cost-effectiveness analysis showed that TEA was 9,908 won lower than STEA, while the decrease in 100 mm visual analog scale score was 8.5 mm greater in the TEA group compared with the STEA group (p > 0.05). The cost-utility analysis showed that TEA was 9,908 won lower than STEA, while the quality-adjusted life years of TEA was 0.0026 years higher than STEA (p > 0.05). These results were robust in the sensitivity analysis, but were not statistically significant.Conclusion: In treating LHIVD, TEA appeared to have cost-effectiveness and cost-utility compared with STEA. However, there were no significant differences between the groups in terms of cost, effectiveness, and utility indicators. Therefore, results must be interpreted prudently; this study was the 1st to conduct an economic evaluation of TEA for LHIVD.

scholarly journals An economic evaluation of a telephone outcall intervention for informal carers of cancer patients in Australia: An assessment of costs and quality-adjusted-life-years

2019 ◽  
Vol 28 (3) ◽  
pp. 525-532 ◽  
Author(s):  
Scott Richards-Jones ◽  
Cathrine Mihalopoulos ◽  
Leila Heckel ◽  
Kate M. Gunn ◽  
Marcus Tan ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cancer Patients ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Informal Carers ◽  
Quality Adjusted Life

scholarly journals ANALISIS NILAI WILLINGNESS TO PAY PER QUALITY ADJUSTED LIFE YEAR TERAPI PENYAKIT MODERATE MASYARAKAT DI KOTA BANJARMASIN TAHUN 2019

2020 ◽  
Vol 4 (1) ◽  
pp. 1-11
Author(s):  
Melviani ◽  
Setia Budi
Keyword(s):  
Willingness To Pay ◽  
Stated Preference ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Cross Sectional ◽  
Bivariate Correlation ◽  
Life Years ◽  
Quality Adjusted Life

Pelayanan kesehatan di Indonesia belum maksimal dalam memenuhi kebutuhan pasien dengan penyakit moderate. Pendekatan farmakoekonomi yang paling direkomendasikan dalam rangka kendali mutu dan biaya adalah cost utility analysis. Interpretasi terhadap nilai rasio efektivitas biaya tersebut membutuhkan cost effectiveness threshold untuk menentukan suatu teknologi kesehatan bersifat costeffective atau tidak. Salah satu pendekatan yang dapat dilakukan adalah dengan estimasi nilai willingness to pay per quality adjusted life years. Tujuan penelitian adalah menganalisis nilai estimasi willingness to pay per quality adjusted life year pada penyakit moderate di masyarakat di Kota Banjarmasin dan faktor-faktor yang mempengaruhi WTP per QALY. Metode penelitian menggunakan pendekatan cross-sectional. Survei dilakukan pada masyarakat di Kota Banjarmasin tahun 2019 menggunakan metode stated preference dengan pendekatan contingent valuation. Jumlah sampel sebanyak 100 responden. Instrumen penelitian ini berupa kuesioner yang terdiri dari pengukuran nilai WTP menggunakan metode dichotomous bidding game, pengukuran utility menggunakan EQ-5D berdasarkan skenario hipotetik nilai utility penyakit moderate. Analisis mengunakan bivariate correlation analysis spearman.  Hasil penelitian menunjukan Rata-rata WTP per QALY EQ-5D-5L Rp19.538.910 dan analisis variabel karakteristik responden terhadap WTP per QALY di dapatkan R square 0,397(p=0,026) yang artinya bahwa 39% secara bersama-sama variabel dependen akan mempengaruhi WTP per QALY. Penelitian ini diharapkan dapat memberi masukan terhadap CE-Threshold berdasarkan preferensi masyarakat

Economic evaluation of stepped care for the management of childhood anxiety disorders: Results from a randomised trial

2019 ◽  
Vol 53 (7) ◽  
pp. 673-682 ◽  
Author(s):  
Mary Lou Chatterton ◽  
Ronald M Rapee ◽  
Max Catchpool ◽  
Heidi J Lyneham ◽  
Viviana Wuthrich ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Economic Evaluation ◽  
Confidence Interval ◽  
Anxiety Disorders ◽  
Health Sector ◽  
Stepped Care ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Quality Adjusted Life

Background: Stepped care has been promoted for the management of mental disorders; however, there is no empirical evidence to support the cost-effectiveness of this approach for the treatment of anxiety disorders in youth. Method: This economic evaluation was conducted within a randomised controlled trial comparing stepped care to a validated, manualised treatment in 281 young people, aged 7–17, with a diagnosed anxiety disorder. Intervention costs were determined from therapist records. Administrative data on medication and medical service use were used to determine additional health care costs during the study period. Parents also completed a resource use questionnaire to collect medications, services not captured in administrative data and parental lost productivity. Outcomes included participant-completed quality of life, Child Health Utility – nine-dimension and parent-completed Assessment of Quality of Life – eight-dimension to calculate quality-adjusted life years. Mean costs and quality-adjusted life years were compared between groups at 12-month follow-up. Results: Intervention delivery costs were significantly less for stepped care from the societal perspective (mean difference −$198, 95% confidence interval −$353 to −$19). Total combined costs were less for stepped care from both societal (−$1334, 95% confidence interval −$2386 to $510) and health sector (−$563, 95% confidence interval −$1353 to $643) perspectives but did not differ significantly from the manualised treatment. Youth and parental quality-adjusted life years were not significantly different between groups. Sensitivity analysis indicated that the results were robust. Conclusion: For youth with anxiety, this three-step model provided comparable outcomes and total health sector costs to a validated face-to-face programme. However, it was less costly to deliver from a societal perspective, making it an attractive option for some parents. Future economic evaluations comparing various models of stepped care to treatment as usual are recommended.

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