Moving forward: Cost-Effectiveness of PrEP in HIV prevention for Men Who Have Sex with Men in Italy

Abstract Globally, in 2018 1.7 million people contracted Human Immunodeficiency Virus (HIV) and 770,000 people died from AIDS-related illnesses. Men Who Have Sex with Men (MSM) have one of the highest probabilities of HIV transmission. In Italy, in 2018 2,847 new HIV cases were diagnosed, of which 39% among MSM. The MSM population accounts for 16,690 individuals whereof 50% already underwent the Highly Active Antiretroviral Therapy (HAART). The aim of this study is to evaluate the cost-effectiveness of daily Pre-Exposure Prophylaxis (PrEP) in the Italian MSM susceptible population. A Markov transition model was calibrated to the HIV epidemic among MSM in Italy, comparing PrEP to naïve patients (NP). Model parameters were retrieved by querying scientific databases. Transition probabilities were adjusted for incidence of HIV while costs and benefits were discounted at an annual rate of 3%. The impact on results of critical parameters was explored through a Monte Carlo-based sensitivity analysis. The cost-effectiveness analysis results were reported as Incremental Cost-Effectiveness Ratio (ICER) express as € per Quality Adjusted Life Year (QALY) gained. The introduction of such a PrEP program would result in a total cost of €822,398,199 million and lead to a gain of 70,762 discounted QALYs over an 85-year time horizon. Assuming a 92% efficacy of PrEP therapy, the ICER for the PrEP program is €4,346.16/QALY gained. This value is definitively lower than acceptability NICE threshold (£20,000). PrEP can reduce the infection rate up to 60% in a five-year period. The Monte Carlo simulation confirmed the robustness of the model results. This analysis showed PrEP to be cost-effective when used in a susceptible population. Even if PrEP doesn't protect from other sex-related infectious diseases, it could prevent HIV transmission, thus breaking down HIV-infection incidence rate. Each country should reflect on the real possibility to implement a robust Public Health program pondering the adoption of PrEP. Key messages PrEP is very effective at reducing HIV infection when taken correctly. It is the backbone in the “combination prevention”, necessary to reach the SDG of ending the AIDS epidemic by 2030. This preliminary analysis suggests that the introduction of a daily PrEP program for MSM in Italy is cost-effective and possibly cost saving in the long term.

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Cost-effectiveness of TAS-102 plus bevacizumab versus TAS-102 monotherapy in patients with metastatic colorectal cancer

BMC Gastroenterology ◽

10.1186/s12876-021-01771-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kiyoaki Sugiura ◽

Yuki Seo ◽

Takayuki Takahashi ◽

Hideyuki Tokura ◽

Yasuhiro Ito ◽

...

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Combination Therapy ◽

Metastatic Colorectal Cancer ◽

Cost Effective ◽

Model Parameters ◽

Combination Regimen ◽

The Cost

Abstract Background TAS-102 plus bevacizumab is an anticipated combination regimen for patients who have metastatic colorectal cancer. However, evidence supporting its use for this indication is limited. We compared the cost-effectiveness of TAS-102 plus bevacizumab combination therapy with TAS-102 monotherapy for patients with chemorefractory metastatic colorectal cancer. Method Markov decision modeling using treatment costs, disease-free survival, and overall survival was performed to examine the cost-effectiveness of TAS-102 plus bevacizumab combination therapy and TAS-102 monotherapy. The Japanese health care payer’s perspective was adopted. The outcomes were modeled on the basis of published literature. The incremental cost-effectiveness ratio (ICER) between the two treatment regimens was the primary outcome. Sensitivity analysis was performed and the effect of uncertainty on the model parameters were investigated. Results TAS-102 plus bevacizumab had an ICER of $21,534 per quality-adjusted life-year (QALY) gained compared with TAS-102 monotherapy. Sensitivity analysis demonstrated that TAS-102 monotherapy was more cost-effective than TAS-102 and bevacizumab combination therapy at a willingness-to-pay of under $50,000 per QALY gained. Conclusions TAS-102 and bevacizumab combination therapy is a cost-effective option for patients who have metastatic colorectal cancer in the Japanese health care system.

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Modelling the cost-effectiveness of person-centred care for patients with acute coronary syndrome

The European Journal of Health Economics ◽

10.1007/s10198-020-01230-8 ◽

2020 ◽

Vol 21 (9) ◽

pp. 1317-1327 ◽

Cited By ~ 1

Author(s):

Laura Pirhonen ◽

Hanna Gyllensten ◽

Andreas Fors ◽

Kristian Bolin

Keyword(s):

Monte Carlo ◽

Acute Coronary Syndrome ◽

Cost Effectiveness ◽

Usual Care ◽

Time Perspective ◽

Controlled Trial ◽

Cost Effective ◽

Sensitivity Analyses ◽

Coronary Syndrome ◽

The Cost

Abstract Background Person-centred care has been shown to be cost-effective compared to usual care for several diseases, including acute coronary syndrome, in a short-term time perspective (< 2 years). The cost-effectiveness of person-centred care in a longer time perspective is largely unknown. Objectives To estimate the mid-term cost-effectiveness of person-centred care compared to usual care for patients (< 65) with acute coronary syndrome, using a 2-year and a 5-year time perspective. Methods The mid-term cost-effectiveness of person-centred care compared to usual care was estimated by projecting the outcomes observed in a randomized-controlled trial together with data from health registers and data from the scientific literature, 3 years beyond the 2-year follow-up, using the developed simulation model. Probabilistic sensitivity analyses were performed using Monte Carlo simulation. Results Person-centred care entails lower costs and improved effectiveness as compared to usual care, for a 2-year time and a 5-year perspective. Monte Carlo simulations suggest that the likelihoods of the person-centred care being cost-effective compared to usual care were between 80 and 99% and between 75 and 90% for a 2-year and a 5-year time perspective (using a 500,000 SEK/QALY willingness-to-pay threshold). Conclusions Person-centred care was less costly and more effective compared to usual care in a 2-year and a 5-year time perspective for patients with acute coronary syndrome under the age of 65.

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The Cost-Effectiveness of Epilepsy Surgery and Surgical Evaluation in the United States

Neurosurgery ◽

10.1093/neuros/nyz310_165 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Cited By ~ 2

Author(s):

Shehryar R Sheikh ◽

Michael P Steinmetz ◽

Michael W Kattan ◽

Mendel Singer ◽

Belinda Udeh ◽

...

Keyword(s):

United States ◽

Monte Carlo ◽

Cost Effectiveness ◽

Epilepsy Surgery ◽

Medical Management ◽

Cost Effective ◽

The United States ◽

Effective Strategies ◽

Surgical Evaluation ◽

The Cost

Abstract INTRODUCTION Surgery is an effective treatment for many pharmacoresistant temporal lobe epilepsy patients, but incurs considerable cost. It is unknown whether surgery and surgical evaluation are cost-effective strategies in the United States. We aim to evaluate whether 1) surgery is cost-effective for patients who have been deemed surgical candidates when compared to continued medical management, 2) surgical evaluation is cost-effective for patients who have drug-resistant temporal epilepsy and may or may not ultimately be deemed surgical candidates METHODS We use a Monte Carlo simulation method to assess the cost-effectiveness of surgery and surgical evaluation over a lifetime horizon. Patients transition between two health states (‘seizure free’ and ‘having seizures’) as part of a Markov process, based on literature estimates. We adopt both healthcare and societal perspectives, including direct healthcare costs and indirect costs such as lost earnings by patients and care providers. We estimate variability of model predictions using probabilistic and deterministic sensitivity analyses. RESULTS 1) Epilepsy surgery is cost effective in surgically eligible patients by virtue of being cost saving and more effective than medical management in the long run, with 95% of 10 000 Monte Carlo simulations favoring surgery. From a societal perspective, surgery becomes cost effective within 3 yr. At 5 yr, surgery has an incremental cost-effectiveness ratio (ICER) of $31,600, which is significantly below the societal willingness-to-pay (∼ $100,000/quality-adjusted life years (QALY)) and comparable to hip/knee arthroplasty. 2) Surgical evaluation is cost-effective in pharmacoresistant patients even if the probability of being deemed a surgical candidate is low (5%-10%). Even if the probability of surgical eligibility is only 10%, surgical referral has an ICER of $96,000/QALY, which is below societal willingness-to-pay. CONCLUSION Epilepsy surgery and surgical evaluation are both cost-effective strategies in the United States. Pharmacoresistant temporal lobe epilepsy patients should be referred for surgical evaluation without hesitation on cost-effectiveness grounds.

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A Computationally Efficient Method for Probabilistic Parameter Threshold Analysis for Health Economic Evaluations

Medical Decision Making ◽

10.1177/0272989x20937253 ◽

2020 ◽

Vol 40 (5) ◽

pp. 669-679

Author(s):

Zoë Pieters ◽

Mark Strong ◽

Virginia E. Pitzer ◽

Philippe Beutels ◽

Joke Bilcke

Keyword(s):

Monte Carlo ◽

Cost Effectiveness ◽

Cost Effective ◽

Routine Vaccination ◽

Threshold Analysis ◽

Threshold Values ◽

Threshold Probability ◽

Monte Carlo Approach ◽

Effectiveness Model ◽

The Cost

Background. Threshold analysis is used to determine the threshold value of an input parameter at which a health care strategy becomes cost-effective. Typically, it is performed in a deterministic manner, in which inputs are varied one at a time while the remaining inputs are each fixed at their mean value. This approach will result in incorrect threshold values if the cost-effectiveness model is nonlinear or if inputs are correlated. Objective. To propose a probabilistic method for performing threshold analysis, which accounts for the joint uncertainty in all input parameters and makes no assumption about the linearity of the cost-effectiveness model. Methods. Three methods are compared: 1) deterministic threshold analysis (DTA); 2) a 2-level Monte Carlo approach, which is considered the gold standard; and 3) a regression-based method using a generalized additive model (GAM), which identifies threshold values directly from a probabilistic sensitivity analysis sample. Results. We applied the 3 methods to estimate the minimum probability of hospitalization for typhoid fever at which 3 different vaccination strategies become cost-effective in Uganda. The threshold probability of hospitalization at which routine vaccination at 9 months with catchup campaign to 5 years becomes cost-effective is estimated to be 0.060 and 0.061 (95% confidence interval [CI], 0.058–0.064), respectively, for 2-level and GAM. According to DTA, routine vaccination at 9 months with catchup campaign to 5 years would never become cost-effective. The threshold probability at which routine vaccination at 9 months with catchup campaign to 15 years becomes cost-effective is estimated to be 0.092 (DTA), 0.074 (2-level), and 0.072 (95% CI, 0.069–0.075) (GAM). GAM is 430 times faster than the 2-level approach. Conclusions. When the cost-effectiveness model is nonlinear, GAM provides similar threshold values to the 2-level Monte Carlo approach and is computationally more efficient. DTA provides incorrect results and should not be used.

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P2-S6.11 The cost-effectiveness of screening men who have sex with men for rectal chlamydial and gonococcal infection to prevent HIV infection

Sexually Transmitted Infections ◽

10.1136/sextrans-2011-050108.363 ◽

2011 ◽

Vol 87 (Suppl 1) ◽

pp. A252-A252

Author(s):

T. Gift ◽

K. Bernstein ◽

H. Chesson ◽

J. Marcus ◽

S. Pipkin ◽

...

Keyword(s):

Cost Effectiveness ◽

Hiv Infection ◽

Gonococcal Infection ◽

Sex With Men ◽

The Cost

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Real-World Cost-Effectiveness Analysis of Gemcitabine and Cisplatin Compared to Docetaxel and Cisplatin Plus Fluorouracil Induction Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma

Frontiers in Oncology ◽

10.3389/fonc.2020.594756 ◽

2020 ◽

Vol 10 ◽

Author(s):

Jiangping Yang ◽

Jiaqi Han ◽

Jinlan He ◽

Baofeng Duan ◽

Qiheng Gou ◽

...

Keyword(s):

Sensitivity Analysis ◽

Cost Effectiveness ◽

Nasopharyngeal Carcinoma ◽

Incremental Cost ◽

Real World ◽

Cost Effective ◽

Model Parameters ◽

The Cost ◽

The Impact ◽

Gemcitabine And Cisplatin

BackgroundAddition of gemcitabine and cisplatin (GP) or docetaxel and cisplatin plus fluorouracil (TPF) to concurrent chemoradiotherapy (CCRT) signiﬁcantly improved survival in locoregionally advanced nasopharyngeal carcinoma (NPC). However, an economic evaluation of these regimens remains unknown. The purpose of this study is to compare the cost-effectiveness of GP versus TPF regimen in the treatment of locoregionally advanced NPC in China.Materials and methodsA comprehensive Markov model was developed to evaluate the health and economic outcomes of GP versus TPF regimen for patients with locoregionally advanced NPC. Baseline and clinical outcome were derived from 158 patients with newly diagnosed stage III-IVA NPC between 2010 and 2015. We evaluated the quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) from the perspective of the Chinese healthcare system. One-way sensitive analysis explored the impact of uncertainty in key model parameters on results, and probabilistic uncertainty was assessed through a Monte Carlo probabilistic sensitivity analysis.ResultsGP regimen provided an additional 0.42 QALYs with incremental cost of $3,821.99, resulting in an ICER of $9,099.98 per QALY versus TPF regimen at the real-world setting. One-way sensitivity analysis found that the results were most sensitive to the cost and proportion of receiving subsequent treatment in two groups. The probability that GP regimen being cost-effective compared with TPF regimen was 86.9% at a willingness-to-pay (WTP) of $31,008.16 per QALY.ConclusionUsing real-world data, GP regimen was demonstrated a cost-effective alternative to TFP regimen for patients with locoregionally advanced NPC in China. It provides valuable evidence for clinicians when making treatment decisions to improve the cost-effectiveness of treatment.

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The cost-effectiveness of HIV pre-exposure prophylaxis in men who have sex with men and transgender women at high risk of HIV infection in Brazil

Journal of the International AIDS Society ◽

10.1002/jia2.25096 ◽

2018 ◽

Vol 21 (3) ◽

pp. e25096 ◽

Cited By ~ 8

Author(s):

Paula M Luz ◽

Benjamin Osher ◽

Beatriz Grinsztejn ◽

Rachel L Maclean ◽

Elena Losina ◽

...

Keyword(s):

Cost Effectiveness ◽

High Risk ◽

Hiv Infection ◽

Transgender Women ◽

Sex With Men ◽

Exposure Prophylaxis ◽

The Cost

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Is your syringe services program cost-saving to society? A methodological case study

Harm Reduction Journal ◽

10.1186/s12954-021-00575-4 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Don C. Des Jarlais ◽

Jonathan Feelemyer ◽

Courtney McKnight ◽

Kelly Knudtson ◽

Sara N. Glick

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Hiv Infection ◽

Hiv Transmission ◽

Hiv Infections ◽

Effectiveness Study ◽

Persons Who Inject Drugs ◽

Annual Budget ◽

The Cost ◽

Cost Effectiveness Study

Abstract Background While there is a general acceptance among public health officials and policy-makers that syringe services programs can be effective in reducing HIV transmission among persons who inject drugs, local syringe services programs are often asked to provide economic justifications for their activities. A cost-effectiveness study, estimating the cost of preventing one HIV infection, would be the preferred methods for addressing this economic question, but few local syringe services programs have the needed data, staff and epidemiologic modeling resources needed for a cost–effectiveness study. We present a method for estimating a threshold value for the number of HIV infections prevented above which the program will be cost-saving to society. An intervention is considered “cost-saving” when it leads to a desirable health outcome a lower cost than the alternative. Methods The research literature on the effectiveness of syringe services programs in controlling HIV transmission among persons who inject drugs and guidelines for syringe services program that are “functioning very well” were used to estimate the cost-saving threshold at which a syringe services program becomes cost-saving through preventing HIV infections versus lifetime treatment of HIV. Three steps are involved: (1) determining if HIV transmission in the local persons who inject drugs (PWID) population is being controlled, (2) determining if the local syringe services program is functioning very well, and then (3) dividing the annual budget of the syringe services program by the lifetime cost of treating a single HIV infection. Results A syringe services program in an area with controlled HIV transmission (with HIV incidence of 1/100 person-years or less), functioning very well (with high syringe coverage, linkages to other services, and monitoring the local drug use situation), and an annual budget of $500,000 would need to prevent only 3 new HIV infections per year to be cost-saving. Conclusions Given the high costs of treating HIV infections, syringe services programs that are operating according to very good practices (“functioning very well”) and in communities in which HIV transmission is being controlled among persons who inject drugs, will almost certainly be cost-saving to society.

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The cost-effectiveness of using results-based financing to reduce maternal and perinatal mortality in Malawi

BMJ Global Health ◽

10.1136/bmjgh-2019-002260 ◽

2020 ◽

Vol 5 (5) ◽

pp. e002260

Author(s):

Jobiba Chinkhumba ◽

Manuela De Allegri ◽

Stephan Brenner ◽

Adamson Muula ◽

Bjarne Robberstad

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Status Quo ◽

Sub Saharan Africa ◽

Sensitivity Analyses ◽

Model Parameters ◽

Service Utilisation ◽

The Cost ◽

Results Based Financing

IntroductionResults-based financing (RBF) is being promoted to increase coverage and quality of maternal and perinatal healthcare in sub-Saharan Africa (SSA) countries. Evidence on the cost-effectiveness of RBF is limited. We assessed the cost-effectiveness within the context of an RBF intervention, including performance-based financing and conditional cash transfers, in rural Malawi.MethodsWe used a decision tree model to estimate expected costs and effects of RBF compared with status quo care during single pregnancy episodes. RBF effects on maternal case fatality rates were modelled based on data from a maternal and perinatal programme evaluation in Zambia and Uganda. We obtained complementary epidemiological information from the published literature. Service utilisation rates for normal and complicated deliveries and associated costs of care were based on the RBF intervention in Malawi. Costs were estimated from a societal perspective. We estimated incremental cost-effectiveness ratios per disability adjusted life year (DALY) averted, death averted and life-year gained (LYG) and conducted sensitivity analyses to how robust results were to variations in key model parameters.ResultsRelative to status quo, RBF implied incremental costs of US$1122, US$26 220 and US$987 per additional DALY averted, death averted and LYG, respectively. The share of non-RBF facilities that provide quality care, life expectancy of mothers at time of delivery and the share of births in non-RBF facilities strongly influenced cost-effectiveness values. At a willingness to pay of US$1485 (3 times Malawi gross domestic product per capita) per DALY averted, RBF has a 77% probability of being cost-effective.ConclusionsAt high thresholds of wiliness-to-pay, RBF is a cost-effective intervention to improve quality of maternal and perinatal healthcare and outcomes, compared with the non-RBF based approach. More RBF cost-effectiveness analyses are needed in the SSA region to complement the few published studies and narrow the uncertainties surrounding cost-effectiveness estimates.

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