Identification of the Most Cost-effective Position of Vedolizumab Among the Available Biologic Drugs for the Treatment of Ulcerative Colitis

Abstract Background and Aims There are limited data on the most cost-effective sequencing of biologics for ulcerative colitis [UC]. Methods We used Markov modelling to identify the most cost-effective position for vedolizumab among biologics for steroid-dependent UC, with a base-case of a 35-year-old male. We assessed three treatment algorithms, with vedolizumab use: prior to an initial anti-tumour necrosis factor alpha [anti-TNFα] and azathioprine [Algorithm 1]; prior to a second anti-TNF and azathioprine [Algorithm 2]; and prior to colectomy [Algorithm 3]. The initial anti-TNF could be either infliximab or adalimumab. Transition probabilities, costs, and quality-adjusted life-year estimates were derived from published estimates, Medicare, and the Nationwide Inpatient Sample. Primary analyses included 100 trials of 100 000 individuals over 1 year, with a willingness-to-pay threshold of US$100,000. Multiple sensitivity analyses were conducted to assess our findings. Results From a population perspective, when both infliximab and adalimumab are available, vedolizumab was preferred as the first biologic if ≥14% of initial anti-TNF use was adalimumab. If infliximab is the primary biologic, vedolizumab use after infliximab [Algorithm 2] and prior to adalimumab was the most cost-effective strategy. All models were sensitive to biologic pricing. Conclusions This simulation demonstrated that the most cost-effective strategy in UC depends on the proportion of patients using adalimumab as the initial anti-TNF. If adalimumab was ≥14%, vedolizumab was preferred as the first biologic. When only infliximab was available for first-line therapy, the most cost-effective position of vedolizumab was prior to cycling to adalimumab.

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Detecting Germline PTEN Mutations Among At-Risk Patients With Cancer: An Age- and Sex-Specific Cost-Effectiveness Analysis

Journal of Clinical Oncology ◽

10.1200/jco.2014.60.3456 ◽

2015 ◽

Vol 33 (23) ◽

pp. 2537-2544 ◽

Cited By ~ 11

Author(s):

Joanne Ngeow ◽

Chang Liu ◽

Ke Zhou ◽

Kevin D. Frick ◽

David B. Matchar ◽

...

Keyword(s):

Cost Effectiveness ◽

Cleveland Clinic ◽

Cost Effective ◽

Cancer Surveillance ◽

Sensitivity Analyses ◽

Base Case ◽

Effective Strategy ◽

Female Patients ◽

Cost Effective Strategy ◽

The Cost

Purpose Cowden syndrome (CS) is an autosomal dominant disorder characterized by benign and malignant tumors. One-quarter of patients who are diagnosed with CS have pathogenic germline PTEN mutations, which increase the risk of the development of breast, thyroid, uterine, renal, and other cancers. PTEN testing and regular, intensive cancer surveillance allow for early detection and treatment of these cancers for mutation-positive patients and their relatives. Individual CS-related features, however, occur commonly in the general population, making it challenging for clinicians to identify CS-like patients to offer PTEN testing. Patients and Methods We calculated the cost per mutation detected and analyzed the cost-effectiveness of performing selected PTEN testing among CS-like patients using a semi-quantitative score (the PTEN Cleveland Clinic [CC] score) compared with existing diagnostic criteria. In our model, first-degree relatives of the patients with detected PTEN mutations are offered PTEN testing. All individuals with detected PTEN mutations are offered cancer surveillance. Results CC score at a threshold of 15 (CC15) costs from $3,720 to $4,573 to detect one PTEN mutation, which is the most inexpensive among the different strategies. At base-case, CC10 is the most cost-effective strategy for female patients who are younger than 40 years, and CC15 is the most cost-effective strategy for female patients who are between 40 and 60 years of age and male patients of all ages. In sensitivity analyses, CC15 is robustly the most cost-effective strategy for probands who are younger than 60 years. Conclusion Use of the CC score as a clinical risk calculator is a cost-effective prescreening method to identify CS-like patients for PTEN germline testing.

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Twin Vaginal Deliveries in Labor Rooms: A Cost-Effectiveness Analysis

American Journal of Perinatology ◽

10.1055/s-0041-1727213 ◽

2021 ◽

Author(s):

Jenny Y. Mei ◽

Divya Mallampati ◽

Ilina D. Pluym ◽

Christina S. Han ◽

Yalda Afshar

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Cost Effectiveness Analysis ◽

Sensitivity Analyses ◽

Base Case ◽

Decision Analysis Model ◽

Effective Strategy ◽

Cost Effective Strategy ◽

Effectiveness Analysis ◽

Vaginal Deliveries

Objective Twin vaginal deliveries (VDs) are often performed in the operating room (OR) given the theoretical risk of conversion to cesarean delivery (CD) for the aftercoming twin. We aim to evaluate the cost-effectiveness of performing VDs for twin gestations in the labor and delivery room (LDR) versus OR. Study Design We conducted a cost-effectiveness analysis using a decision-analysis model that compared the costs and effectiveness of two strategies of twin deliveries undergoing a trial of labor: (1) intended delivery in the LDR and 2) delivery in the OR. Sensitivity analyses were performed to assess strength and validity of the model. Primary outcome was incremental cost-effectiveness ratio (ICER) defined as cost needed to gain 1 quality-adjusted life year (QALY). Results In the base-case scenario, where 7% of deliveries resulted in conversion to CD for twin B, attempting to deliver twins in the LDR was the most cost-effective strategy. For every QALY gained by delivering in the OR, 243,335 USD would need to be spent (ICER). In univariate sensitivity analyses, the most cost-effective strategy shifted to delivering in the OR when the following was true: (1) probability of successful VD was less than 86%, (2) probability of neonatal morbidity after emergent CD exceeded 3.5%, (3) cost of VD in an LDR exceeded 10,500 USD, (4) cost of CD was less than 10,000 USD, or (5) probability of neonatal death from emergent CD exceeded 2.8%. Assuming a willingness to pay of 100,000 USD per neonatal QALY gained, attempted VD in the LDR was cost effective in 51% of simulations in the Monte Carlo analysis. Conclusion Twin VDs in the LDR are cost effective based on current neonatal outcome data, taking into account gestational age and associated morbidity. Further investigation is needed to elucidate impact of cost and outcomes on optimal utilization of resources. Key Points

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Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility

Canadian Urological Association Journal ◽

10.5489/cuaj.1873 ◽

2014 ◽

Vol 8 (9-10) ◽

pp. 619 ◽

Cited By ~ 5

Author(s):

Jason Ronald Kovac ◽

Jake Fantus ◽

Larry I Lipshultz ◽

Marc Anthony Fischer ◽

Zachery Klinghoffer

Keyword(s):

Cost Effectiveness ◽

Male Infertility ◽

Cost Effective ◽

Primary Treatment ◽

Sensitivity Analyses ◽

Decision Analysis Model ◽

Effective Strategy ◽

Percutaneous Embolization ◽

Cost Effective Strategy ◽

Varicocele Repair

Introduction: Varicoceles are a common cause of male infertility; repair can be accomplished using either surgical or radiological means. We compare the cost-effectiveness of the gold standard, the microsurgical varicocele repair (MV), to the options of a non-microsurgical approach (NMV) and percutaneous embolization (PE) to manage varicocele-associated infertility.Methods: A Markov decision-analysis model was developed to estimate costs and pregnancy rates. Within the model, recurrences following MV and NMV were re-treated with PE and recurrences following PE were treated with repeat PE, MV or NMV. Pregnancy and recurrence rates were based on the literature, while costs were obtained from institutional and government supplied data. Univariate and probabilistic sensitivity-analyses were performed to determine the effects of the various parameters on model outcomes.Results: Primary treatment with MV was the most cost-effective strategy at $5402 CAD (Canadian)/pregnancy. Primary treatment with NMV was the least costly approach, but it also yielded the fewest pregnancies. Primary treatment with PE was the least cost-effective strategy costing about $7300 CAD/pregnancy. Probabilistic sensitivity analysis reinforced MV as the most cost-effective strategy at a willingness-to-pay threshold of >$4100 CAD/pregnancy.Conclusions: MV yielded the most pregnancies at acceptable levels of incremental costs. As such, it is the preferred primary treatment strategy for varicocele-associated infertility. Treatment with PE was the least cost-effective approach and, as such, is best used only in cases of surgical failure.

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A multilayer polyurethane foam dressing for pressure ulcer prevention in older hip fracture patients: an economic evaluation

Journal of Wound Care ◽

10.12968/jowc.2020.29.2.120 ◽

2020 ◽

Vol 29 (2) ◽

pp. 120-127

Author(s):

Cristiana Forni ◽

Richard Searle

Keyword(s):

Economic Evaluation ◽

Cost Saving ◽

Polyurethane Foam ◽

Negative Impact ◽

Cost Effective ◽

Sensitivity Analyses ◽

Decision Analytic Model ◽

Effective Strategy ◽

Cost Effective Strategy ◽

The Us

Objective: Hospital-acquired pressure ulcers (PU) have a substantial negative impact on patients and continue to impose a cost burden on hospital providers. Since the incidence of fragility fracture is growing, driven by the increase in the older population, it is expected that the overall incidence of associated complications will also increase accordingly. The aim of this economic evaluation was to determine whether the use of a multilayer, silicone-adhesive polyurethane foam dressing (ALLEVYN LIFE, Smith & Nephew, UK) alongside standard prevention (SP) for the prevention of PUs in older patients with hip fractures is a cost-effective strategy, compared with SP alone. Method: A decision-analytic model was constructed to determine the incremental cost and effectiveness of the foam dressing strategy from the perspectives of the Italian and US hospital systems. We also performed one-way and probabilistic sensitivity analyses. Results: The foam dressing intervention was found to be cost saving and more effective than SP in both Italy and the US. Switching to foam dressing and standard prevention would result in an expected cost saving of €733 per patient in Italy and $840 per patient in the US, reducing the per-patient cost of treating PUs by 37-69% and 36–68%, respectively. The one-way and probabilistic sensitivity analyses demonstrate that the strategy remains dominant over a range of values of the input variables. Conclusion: The foam dressing intervention is likely to be a cost-effective strategy compared with standard prevention alone.

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Potential cost-effectiveness of telemonitoring program for heart failure patients during the COVID-19 pandemic in Hong Kong (Preprint)

10.2196/preprints.26516 ◽

2020 ◽

Author(s):

Xinchan Jiang ◽

Jiaqi Yao ◽

Joyce You

Keyword(s):

Heart Failure ◽

Sensitivity Analysis ◽

Hong Kong ◽

Cost Effectiveness ◽

Usual Care ◽

Healthcare Provider ◽

Cost Effective ◽

Base Case ◽

Effective Strategy ◽

Cost Effective Strategy

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring (TM) program in addition to usual care (UC) demonstrated improved effectiveness in managing heart failure (HF) patients. OBJECTIVE We aimed to examine the potential clinical and health economic outcomes of TM program for management of HF patients during COVID-19 pandemic from the perspective of healthcare provider in Hong Kong. METHODS A Markov model was designed to compare outcomes of (1) UC plus TM (TM group) and (2) UC alone (UC group) in a hypothetical cohort of elderly HF patients in Hong Kong. Model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to examine the model assumptions and robustness of base-case results. RESULTS In base-case analysis, TM group gained higher QALYs (1.9007) at higher costs (USD15,888), when compared to UC group (1.8345 QALYs at USD15,603).Adopting 48,937 USD/QALY (1× gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, the TM group was accepted as a highly cost-effective strategy, with ICER of 4,292 USD/QALY. No threshold value was identified in deterministic sensitivity analysis. In probabilistic sensitivity analysis, TM group was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. CONCLUSIONS Adding TM program to usual care for HF patients appears to be a cost-effective strategy from the perspective of healthcare provider in Hong Kong.

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Cost–utility of adjuvant zoledronic acid in patients with breast cancer and low estrogen levels

Current Oncology ◽

10.3747/co.22.2383 ◽

2015 ◽

Vol 22 (4) ◽

pp. 246

Author(s):

N.W.D. Lamond ◽

C. Skedgel ◽

D. Rayson ◽

T. Younis

Keyword(s):

Breast Cancer ◽

Zoledronic Acid ◽

Disease Free Survival ◽

Cost Effective ◽

Cost Utility ◽

Sensitivity Analyses ◽

Effective Strategy ◽

Natural Menopause ◽

Cost Effective Strategy ◽

Life Years

Background Adjuvant zoledronic acid (za) appears to improve disease-free survival (dfs) in women with earlystage breast cancer and low levels of estrogen (lle) because of induced or natural menopause. Characterizing the cost–utility (cu) of this therapy could help to determine its role in clinical practice.Methods Using the perspective of the Canadian health care system, we examined the cu of adjuvant endocrine therapy with or without za in women with early-stage endocrine-sensitive breast cancer and lle. A Markov model was used to compute the cumulative costs in Canadian dollars and the quality-adjusted life-years (qalys) gained from each adjuvant strategy, discounted at a rate of 5% annually. The model incorporated the dfs and fracture benefits of adjuvant za. Probabilistic and one-way sensitivity analyses were conducted to examine key model parameters.ResultsCompared with a no-za strategy, adjuvant za in the induced and natural menopause groups was associated with, respectively, $7,825 and $7,789 in incremental costs and 0.46 and 0.34 in qaly gains for cu ratios of $17,007 and $23,093 per qaly gained. In one-way sensitivity analyses, the results were most sensitive to changes in the za dfs benefit. Probabilistic sensitivity analysis suggested a 100% probability of adjuvant za being a cost-effective strategy at a threshold of $100,000 per qaly gained. ConclusionsBased on available data, adjuvant za appears to be a cost-effective strategy in women with endocrinesensitive breast cancer and lle, having cu ratios well below accepted thresholds.

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Cost-Effectiveness of Remdesivir Plus Supportive Care for Patients with COVID-19 in Iran

10.21203/rs.3.rs-757595/v1 ◽

2021 ◽

Author(s):

Mohammad Tasavon Gholamhoseini ◽

Reza Goudarzi ◽

Vahid Yazdi-Feyzabadi ◽

Mohammad Hossein Mehrolhassani ◽

Meysam Yousefi

Keyword(s):

Sensitivity Analysis ◽

Cost Effectiveness ◽

Supportive Care ◽

Purchasing Power Parity ◽

Transition Probabilities ◽

Cost Effective ◽

Sensitivity Analyses ◽

Base Case ◽

Power Parity ◽

System Perspective

Abstract Background: Remdesivir is a medication used for moderate to severe Coronavirus disease 2019 (COVID-19) patients with favorable effects. However, it is an expensive medication. Therefore, the present study aimed to assess the cost-effectiveness of remdesivir plus supportive care (SC) for COVID-19 patients in Iran.Methods: Markov model was used to compare costs and quality-adjusted life-days (QALDs) of remdesivir+SC and SC for patients with COVID-19. The model simulated a cycle length of one day and a 30-day time horizonin TreeAge 2020 software. The costs from the healthcare system perspective were obtained from Afzalipour hospital as a referral hospital for the hospitalization of COVID-19 patients in Kerman, Iran. All the costs were converted to 2018 purchasing power parity (PPP) US dollars. Utility values were derived from published sources. The results were presented as an incremental cost-effectiveness ratio (ICER) at a willingness-to-pay (WTP) threshold of three times the Gross Domestic Product per capita of Iran. Both deterministic and probabilistic sensitivity analyses were performed.Results: The base-case results showed that the treatment of COVID-19 patients with remdesivir+SC had a cost of 8795 PPP US dollars for 21.13 QALD gained. The SC alone cost 8637 PPP US dollars with a gain of 20.20 QALD. Our findings demonstrated that at a WTP threshold of 159 PPP US dollars per QALD, remdesivir+SC was not cost-effective with an ICER of 168 PPP US dollars per QALD. Deterministic sensitivity analysis indicated ICER to be sensitive to the transition probabilities and costs. Probabilistic sensitivity analysis revealed that remdesivir+SC was cost-effective at a WTP of 159 PPP US dollars per QALD in 47% of iterations.Conclusions: Our findings demonstrated thatremdesivir+SC is not cost-effective, compared to SC alone. Considering the lack of studies on the effectiveness of remdesivir, the findings should be interpreted with caution. Further evaluations are recommended to determine the efficacy and effectiveness of remdesivir in COVID-19 patients.

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Cost-Effectiveness Analysis of Local Ablation and Surgery for Liver Metastases of Oligometastatic Colorectal Cancer

Cancers ◽

10.3390/cancers13071507 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1507

Author(s):

Matthias F. Froelich ◽

Moritz L. Schnitzer ◽

Nils Rathmann ◽

Fabian Tollens ◽

Marcus Unterrainer ◽

...

Keyword(s):

Colorectal Cancer ◽

Cost Effectiveness ◽

Liver Metastases ◽

Cost Effective ◽

Comparable Efficacy ◽

Base Case ◽

Effective Strategy ◽

Cost Effective Strategy ◽

Life Years

Background: Colorectal cancer is among the most prevalent cancer entities worldwide, with every second patient developing liver metastases during their illness. For local treatment of liver metastases, a surgical approach as well as ablative treatment options, such as microwave ablation (MWA) and radiofrequency ablation (RFA), are available. The aim of this study is to evaluate the cost-effectiveness of RFA, MWA and surgery in the treatment of liver metastases of oligometastatic colorectal cancer (omCRC) that are amenable for all investigated treatment modalities. Methods: A decision analysis based on a Markov model assessed lifetime costs and quality-adjusted life years (QALY) related to the treatment strategies RFA, MWA and surgical resection. Input parameters were based on the best available and most recent evidence. Probabilistic sensitivity analyses (PSA) were performed with Monte Carlo simulations to evaluate model robustness. The percentage of cost-effective iterations was determined for different willingness-to-pay (WTP) thresholds. Results: The base-case analysis showed that surgery led to higher long-term costs compared to RFA and MWA (USD 41,848 vs. USD 36,937 vs. USD 35,234), while providing better long-term outcomes than RFA, yet slightly lower than MWA (6.80 vs. 6.30 vs. 6.95 QALYs for surgery, RFA and MWA, respectively). In PSA, MWA was the most cost-effective strategy for all WTP thresholds below USD 80,000 per QALY. Conclusions: In omCRC patients with liver metastases, MWA and surgery are estimated to provide comparable efficacy. MWA was identified as the most cost-effective strategy in intermediate resource settings and should be considered as an alternative to surgery in high resource settings.

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