scholarly journals Ending the HIV Epidemic Among Persons Who Inject Drugs: A Cost-Effectiveness Analysis in Six US Cities

2020 ◽  
Vol 222 (Supplement_5) ◽  
pp. S301-S311 ◽  
Author(s):  
Emanuel Krebs ◽  
Xiao Zang ◽  
Benjamin Enns ◽  
Jeong E Min ◽  
Czarina N Behrends ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Los Angeles ◽  
Implementation Strategies ◽  
Transmission Model ◽  
Evidence Based ◽  
Hiv Incidence ◽  
Persons Who Inject Drugs ◽  
Hiv Epidemic ◽  
Life Years ◽  
Us Cities

Abstract Background Persons who inject drugs (PWID) are at a disproportionately high risk of HIV infection. We aimed to determine the highest-valued combination implementation strategies to reduce the burden of HIV among PWID in 6 US cities. Methods Using a dynamic HIV transmission model calibrated for Atlanta, Baltimore, Los Angeles, Miami, New York City, and Seattle, we assessed the value of implementing combinations of evidence-based interventions at optimistic (drawn from best available evidence) or ideal (90% coverage) scale-up. We estimated reduction in HIV incidence among PWID, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) for each city (10-year implementation; 20-year horizon; 2018 $ US). Results Combinations that maximized health benefits contained between 6 (Atlanta and Seattle) and 12 (Miami) interventions with ICER values ranging from $94 069/QALY in Los Angeles to $146 256/QALY in Miami. These strategies reduced HIV incidence by 8.1% (credible interval [CI], 2.8%–13.2%) in Seattle and 54.4% (CI, 37.6%–73.9%) in Miami. Incidence reduction reached 16.1%–75.5% at ideal scale. Conclusions Evidence-based interventions targeted to PWID can deliver considerable value; however, ending the HIV epidemic among PWID will require innovative implementation strategies and supporting programs to reduce social and structural barriers to care.

Microscopic examination of Gram-stained smears for anogenital gonorrhoea in men who have sex with men is cost-effective: evidence from a modelling study

2018 ◽  
Vol 95 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Jolijn M Zwart ◽  
Marie-Josee J Mangen ◽  
Menne Bartelsman ◽  
Martijn S van Rooijen ◽  
Henry J C de Vries ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Nucleic Acid Amplification ◽  
Sensitivity Analyses ◽  
Transmission Model ◽  
Uncertainty Interval ◽  
Testing Strategies ◽  
Life Years ◽  
Additional Costs ◽  
Sex With Men

ObjectiveTo assess the cost-effectiveness of three testing strategies with or without light microscopic Gram-stained smear (GSS) evaluation for the detection of anogenital gonorrhoea among men who have sex with men (MSM) at the Amsterdam STI clinic using a healthcare payer perspective.MethodsThree testing strategies for MSM were compared: (1) GSS in symptomatic MSM only (currently practised strategy), (2) no GSS and (3) GSS in symptomatic and asymptomatic MSM. The three testing protocols include testing with nucleic acid amplification test to verify the GSS results in (1) and (3), or as the only test in (2). A transmission model was employed to calculate the influence of the testing strategies on the prevalence of anogenital gonorrhoea over 10 years. An economic model combined cost data on medical consultations, tests and treatment and utility data to estimate the number of epididymitis cases and quality-adjusted life years (QALY) associated with gonorrhoea. Incremental cost-effectiveness ratios (ICERs) for the testing scenarios were estimated. Uncertainty and sensitivity analyses were performed.ResultsNo GSS testing compared with GSS in symptomatic MSM only (current strategy) resulted in nine extra epididymitis cases (95% uncertainty interval (UI): 2–22), 72 QALYs lost (95% UI: 59–187) and €7300 additional costs (95% UI: −€185 000 (i.e.cost-saving) to €407 000) over 10 years. GSS testing in both symptomatic and asymptomatic MSM compared with GSS in symptomatic MSM only resulted in one prevented epididymitis case (95% UI: 0–2), 1.1 QALY gained (95% UI: 0.1–3.3), €148 000 additional costs (95% UI: €86 000 to–€217 000) and an ICER of €177 000 (95% UI: €67 000–to €705 000) per QALY gained over 10 years. The results were robust in sensitivity analyses.ConclusionsGSS for symptomatic MSM only is cost-effective compared with no GSS for MSM and with GSS for both symptomatic and asymptomatic MSM.

NICE LESSONS TO BE LEARNED

2001 ◽  
Vol 17 (2) ◽  
pp. 222-235 ◽  
Author(s):  
Jane Farmer ◽  
Rosemary Chesson
Keyword(s):  
Cost Effectiveness ◽  
Implementation Strategies ◽  
Relevant Information ◽  
Policy Implications ◽  
Health Board ◽  
Evidence Based ◽  
Apparent Lack ◽  
Information Centre ◽  
Two Stages ◽  
The Impact

Objectives: This study examined users' perceptions of the role and value of the Scottish Health Purchasing Information Centre (SHPIC) from 1995 to 1998.Methods: Questionnaires and interviews were used to gather data from Scottish GP fundholders and health board managers at two stages.Results: Initially, purchasers sought help in identifying the most relevant information. By 1997, while some appreciated the clinical and cost-effectiveness information produced, others were critical of lack of timely production and apparent lack of cooperation between agencies.Conclusions: New U.K. agencies can learn from SHPIC's problems, specifically in producing clear, coordinated, timely, independent, and well-marketed information with implementation strategies.Policy Implications: It is important to evaluate the impact of agencies to produce and disseminate evidence-based information, even if this has to be done pragmatically rather than as an outcomes-based assessment. Evidence from evaluations can inform direction and strategy for existing and new agencies.

scholarly journals Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (ADEPT): approaches to adopting implementation strategies

2020 ◽  
Author(s):  
Andria B Eisman ◽  
David Hutton ◽  
Lisa Prosser ◽  
Shawna Smith ◽  
Amy Kilbourne
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Implementation Strategy ◽  
Technical Assistance ◽  
Implementation Strategies ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Implementation Support ◽  
Life Years ◽  
Effective Programs

Abstract Background: Theory-based methods to support the uptake of evidence-based practices (EBPs) are critical to improving mental health outcomes. Implementation strategy costs can be substantial, and few have been rigorously evaluated. The purpose of this study is to conduct a cost-effectiveness analysis to identify the most cost-effective approach to deploying implementation strategies to enhance the uptake of Life Goals, a mental health EBP. Methods: We used data from a previously conducted randomized trial to compare the cost-effectiveness of Replicating Effective Programs (REP) combined with external and/or internal facilitation among sites non-responsive to REP. REP is a low-level strategy that includes EBP packaging, training, and technical assistance. External facilitation (EF) involves external expert support, and internal facilitation (IF) augments EF with protected time for internal staff to support EBP implementation. We developed a decision tree to assess 1-year costs and outcomes for four implementation strategies: 1) REP only, 2) REP+EF 3) REP+EF add IF if needed, 4) REP+EF/IF. The analysis used a 1-year time horizon and assumed a health payer perspective. Our outcome was quality-adjusted life years (QALYs). The economic outcome was the incremental cost-effectiveness ratio (ICER). We conducted deterministic and probabilistic sensitivity analysis (PSA). Results: Our results indicate that REP+EF add IF is the most cost-effective option with an ICER of $593/QALY. The REP+EF/IF and REP+EF only conditions are dominated (i.e., more expensive and less effective than comparators). One-way sensitivity analyses indicate that results are sensitive to utilities for REP+EF and REP+EF add IF. The PSA results indicate that REP+EF, add IF is the optimal strategy in 30% of iterations at the threshold of $100,000/QALY. Conclusions: Our results suggest that the most cost-effective implementation support begins with a less intensive, less costly strategy initially and increases as needed to enhance EBP uptake. Using this approach, implementation support resources can be judiciously allocated to those clinics that would most benefit. Our results were not robust to changes in the utility measure. Research is needed that incorporates robust and relevant utilities in implementation studies to determine the most cost-effective strategies. This study advances economic evaluation of implementation by assessing costs and utilities across multiple implementation strategy combinations.

scholarly journals Dynamic transmission model of routine mumps vaccination in Japan

2018 ◽  
Vol 147 ◽  
Author(s):  
Taito Kitano
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Medical Costs ◽  
Social Costs ◽  
Transmission Model ◽  
National Immunisation Programme ◽  
Dynamic Transmission Model ◽  
Life Years ◽  
Number Of Patients ◽  
The One

AbstractThe mumps vaccine is not included in the national immunisation programme (NIP) of approximately 80 countries including Japan. To investigate the vaccine's cost-effectiveness, we developed a dynamic transmission model for routine one- and two-dose mumps vaccination programs in Japan. We calculated the incremental cost-effectiveness ratio compared with a current programme over a projected 50-year period. We created a Japanese population model and performed dynamic simulation to estimate the number of patients enrolled in the current programme, the routine one-dose programme, and the routine two-dose programme over the next 50 years using the Berkeley Madonna program. We estimated the medical and social costs of natural mumps infections and vaccinations to analyse cost-effectiveness. Finally, we performed a sensitivity analysis with parameters including vaccine cost, vaccine efficacy, medical costs per case, social costs per case, incidence of adverse events and discount rate. Base case analysis showed that both the one-dose and two-dose programmes predominated and that quality-adjusted life years (QALYs) were saved, compared with the current programme. The medical costs, total cost and QALYs saved during the study period in the two-dose programme compared with the current programme were 217 billion JPY, 860 billion JPY and 184 779, respectively. The two-dose programme surpassed the one-dose programme throughout the study period. In all the scenarios of the sensitivity analysis, two-dose vaccination was better than the one-dose programme. This simulation confirmed that the routine two-dose vaccination programme was more cost-effective and QALY-saving than either the one-dose programme or the current programme. Because of the variability of the results between the various models, further simulations with different models should be conducted.

scholarly journals Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (ADEPT): approaches to adopting implementation strategies

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Andria B. Eisman ◽  
David W. Hutton ◽  
Lisa A. Prosser ◽  
Shawna N. Smith ◽  
Amy M. Kilbourne
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Implementation Strategy ◽  
Technical Assistance ◽  
Implementation Strategies ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Implementation Support ◽  
Life Years ◽  
Effective Programs

Abstract Background Theory-based methods to support the uptake of evidence-based practices (EBPs) are critical to improving mental health outcomes. Implementation strategy costs can be substantial, and few have been rigorously evaluated. The purpose of this study is to conduct a cost-effectiveness analysis to identify the most cost-effective approach to deploying implementation strategies to enhance the uptake of Life Goals, a mental health EBP. Methods We used data from a previously conducted randomized trial to compare the cost-effectiveness of Replicating Effective Programs (REP) combined with external and/or internal facilitation among sites non-responsive to REP. REP is a low-level strategy that includes EBP packaging, training, and technical assistance. External facilitation (EF) involves external expert support, and internal facilitation (IF) augments EF with protected time for internal staff to support EBP implementation. We developed a decision tree to assess 1-year costs and outcomes for four implementation strategies: (1) REP only, (2) REP+EF, (3) REP+EF add IF if needed, (4) REP+EF/IF. The analysis used a 1-year time horizon and assumed a health payer perspective. Our outcome was quality-adjusted life years (QALYs). The economic outcome was the incremental cost-effectiveness ratio (ICER). We conducted deterministic and probabilistic sensitivity analysis (PSA). Results Our results indicate that REP+EF add IF is the most cost-effective option with an ICER of $593/QALY. The REP+EF/IF and REP+EF only conditions are dominated (i.e., more expensive and less effective than comparators). One-way sensitivity analyses indicate that results are sensitive to utilities for REP+EF and REP+EF add IF. The PSA results indicate that REP+EF, add IF is the optimal strategy in 30% of iterations at the threshold of $100,000/QALY. Conclusions Our results suggest that the most cost-effective implementation support begins with a less intensive, less costly strategy initially and increases as needed to enhance EBP uptake. Using this approach, implementation support resources can be judiciously allocated to those clinics that would most benefit. Our results were not robust to changes in the utility measure. Research is needed that incorporates robust and relevant utilities in implementation studies to determine the most cost-effective strategies. This study advances economic evaluation of implementation by assessing costs and utilities across multiple implementation strategy combinations. Trial registration ClinicalTrials.gov Identifier: NCT02151331, 05/30/2014.

scholarly journals Cost-effectiveness of artificial intelligence monitoring for active tuberculosis treatment: A modeling study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254950
Author(s):  
Jonathan Salcedo ◽  
Monica Rosales ◽  
Jeniffer S. Kim ◽  
Daisy Nuno ◽  
Sze-chuan Suen ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Cost Effectiveness ◽  
Los Angeles ◽  
Treatment Cost ◽  
Los Angeles County ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Directly Observed Therapy ◽  
Tb Treatment ◽  
Life Years

Background Tuberculosis (TB) incidence in Los Angeles County, California, USA (5.7 per 100,000) is significantly higher than the U.S. national average (2.9 per 100,000). Directly observed therapy (DOT) is the preferred strategy for active TB treatment but requires substantial resources. We partnered with the Los Angeles County Department of Public Health (LACDPH) to evaluate the cost-effectiveness of AiCure, an artificial intelligence (AI) platform that allows for automated treatment monitoring. Methods We used a Markov model to compare DOT versus AiCure for active TB treatment in LA County. Each cohort transitioned between health states at rates estimated using data from a pilot study for AiCure (N = 43) and comparable historical controls for DOT (N = 71). We estimated total costs (2017, USD) and quality-adjusted life years (QALYs) over a 16-month horizon to calculate the incremental cost-effectiveness ratio (ICER) and net monetary benefits (NMB) of AiCure. To assess robustness, we conducted deterministic (DSA) and probabilistic sensitivity analyses (PSA). Results For the average patient, AiCure was dominant over DOT. DOT treatment cost $4,894 and generated 1.03 QALYs over 16-months. AiCure treatment cost $2,668 for 1.05 QALYs. At willingness-to-pay threshold of $150K/QALY, incremental NMB per-patient under AiCure was $4,973. In univariate DSA, NMB were most sensitive to monthly doses and vocational nurse wage; however, AiCure remained dominant. In PSA, AiCure was dominant in 93.5% of 10,000 simulations (cost-effective in 96.4%). Conclusions AiCure for treatment of active TB is cost-effective for patients in LA County, California. Increased use of AI platforms in other jurisdictions could facilitate the CDC’s vision of TB elimination.

scholarly journals Cost-effectiveness of the Adaptive Implementation of Effective Programs Trial (Adept): Approaches to Adopting Implementation Strategies

2020 ◽  
Author(s):  
Andria B Eisman ◽  
David Hutton ◽  
Lisa Prosser ◽  
Shawna Smith ◽  
Amy Kilbourne
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Implementation Strategies ◽  
Cost Effective ◽  
Life Goals ◽  
Sensitivity Analyses ◽  
Implementation Support ◽  
Effective Implementation ◽  
Life Years ◽  
Effective Programs

Abstract Background Theory-based methods to support clinician uptake of evidence-based practices (EBPs) are critical to improving mental health outcomes. Costs associated with effective implementation strategies can be substantial, and few have been rigorously evaluated. The purpose of this study is to conduct a cost-effectiveness analysis to identify the most cost-effective approach to deploying implementation strategies to enhance the uptake of Life Goals, a mental health EBP. Methods We used data from a previously conducted randomized trial to compare the cost-effectiveness of different augmentations to Replicating Effective Programs (REP) combined with external and/or internal facilitation to enhance uptake of Life Goals. REP is a low-level strategy that includes EBP packaging, training, and technical assistance. External facilitation (EF) involves external expert support, and internal facilitation (IF) augments EF with protected time for internal staff to support EBP implementation. We developed a decision tree to assess 1-year costs and outcomes for four implementation strategies: 1) REP only, 2) REP + EF 3) REP + EF add IF if necessary, 4) REP + EF/IF. The analyses used a 1-year time horizon and assumes a health payer perspective. Our outcome was quality-adjusted life years (QALYs). The economic outcome was the incremental cost-effectiveness ratio (ICER). We conducted deterministic and probabilistic sensitivity analysis (PSA). Results Our results indicate that REP + EF add IF is the most cost-effective option with an ICER of $593/QALY. The REP + EF/IF and REP + EF only conditions are dominated. One-way sensitivity analyses indicate that results are sensitive to utilities for REP + EF and REP + EF add IF. The PSA results indicate that REP + EF, add IF is the optimal strategy in 30% of iterations at the threshold of $100,000/QALY. Conclusions Our results suggest that the most cost-effective implementation support begins with a less intensive, less costly strategy initially and increases as needed to enhance EBP uptake. Using this approach, implementation support resources can be judiciously allocated to those clinics that would most benefit. Our results were not robust to changes in the utility measure. Further research is needed that incorporates robust and relevant utilities in implementation research to identify the most cost-effective strategies. This research advances economic evaluation of implementation by assessing costs and utilities across multiple implementation strategy combinations. Trial registration: ClinicalTrials.gov Identifier: NCT02151331, 05/30/2014

scholarly journals Prevention and control of dengue and Chikungunya in Colombia: A cost-effectiveness analysis

2021 ◽  
Vol 15 (12) ◽  
pp. e0010086
Author(s):  
Anneke L. Claypool ◽  
Margaret L. Brandeau ◽  
Jeremy D. Goldhaber-Fiebert
Keyword(s):  
Cost Effectiveness ◽  
Health Benefits ◽  
Cost Effective ◽  
Emerging Diseases ◽  
Transmission Model ◽  
Insecticide Treated Nets ◽  
Transmission Parameters ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Current Price

Background Chikungunya and dengue are emerging diseases that have caused large outbreaks in various regions of the world. Both are both spread by Aedes aegypti and Aedes albopictus mosquitos. We developed a dynamic transmission model of chikungunya and dengue, calibrated to data from Colombia (June 2014 –December 2017). Methodology/Principal findings We evaluated the health benefits and cost-effectiveness of residual insecticide treatment, long-lasting insecticide-treated nets, routine dengue vaccination for children aged 9, catchup vaccination for individuals aged 10–19 or 10–29, and portfolios of these interventions. Model calibration resulted in 300 realistic transmission parameters sets that produced close matches to disease-specific incidence and deaths. Insecticide was the preferred intervention and was cost-effective. Insecticide averted an estimated 95 chikungunya cases and 114 dengue cases per 100,000 people, 61 deaths, and 4,523 disability-adjusted life years (DALYs). In sensitivity analysis, strategies that included dengue vaccination were cost-effective only when the vaccine cost was 14% of the current price. Conclusions/Significance Insecticide to prevent chikungunya and dengue in Columbia could generate significant health benefits and be cost-effective. Because of limits on diagnostic accuracy and vaccine efficacy, the cost of dengue testing and vaccination must decrease dramatically for such vaccination to be cost-effective in Colombia. The vectors for chikungunya and dengue have recently spread to new regions, highlighting the importance of understanding the effectiveness and cost-effectiveness of policies aimed at preventing these diseases.

scholarly journals Using large-scale respondent driven sampling to monitor the end of an HIV epidemic among persons who inject drugs in Hai Phong, Viet Nam

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259983
Author(s):  
Don C. Des Jarlais ◽  
Kamyar Arasteh ◽  
Duong Thi Huong ◽  
Khuat Thi Hai Oanh ◽  
Jonathan P. Feelemyer ◽  
...  
Keyword(s):  
Large Scale ◽  
Middle Income Country ◽  
Income Country ◽  
Respondent Driven Sampling ◽  
Hiv Incidence ◽  
Snowball Sampling ◽  
Persons Who Inject Drugs ◽  
Middle Income ◽  
Large Sample ◽  
Hiv Epidemic

Aims To describe the use of large-scale respondent driven sampling (RDS) surveys to demonstrate the “end of an HIV epidemic” (HIV incidence < 0.5/100 person-years) among persons who inject drugs (PWID) in a middle-income country. Large sample sizes are needed to convincingly demonstrate very low incidence rates. Methods 4 large surveys (Ns approximately 1500 each) were conducted among PWID in Hai Phong, Vietnam in 2016–2019. Respondent driven sampling (RDS) with a modification to add snowball sampling was used for recruiting participants. HIV incidence was measured through recency testing, repeat participants across multiple surveys and in a cohort study of PWID recruited from the surveys. RDS analytics (time to equilibria and homophilies for major variables) were used to assess similarities/differences in RDS only versus RDS plus snowball recruiting. Characteristics were compared among respondents recruited through standard RDS recruitment versus through snowball sampling. An overall assessment of the robustness of RDS to modification was made when adding a snowball sampling recruitment. Results RDS recruiting was very efficient in the first 5 weeks of each survey with approximately 180 respondents recruited per week. Recruiting then slowed considerably, and snowball sampling (permitting an individual respondent to recruit large numbers of new respondents) was added to the existing RDS recruiting. This led to recruiting within 13–14 weeks of 1383, 1451, 1444 and 1268 respondents, close to the target of 1500 respondents/survey. Comparisons of participants recruited through standard RDS method and respondents recruited through snowball methods showed very few significant differences. RDS analytics (quickly reaching equilibria, low homophilies) were favorable for both RDS recruited and total numbers of participants in each survey. DRug use and Infections in ViEtnam (DRIVE) methods have now been officially adopted in other provinces. Conclusions RDS appears to be quite robust with respect to adding a modest number of participants recruited through snowball sampling. Large sample sizes can provide compelling evidence for “ending an HIV epidemic” to policy makers in a PWID population in a middle income country setting.

scholarly journals Why Maximizing Quality-Adjusted Life Years, rather than Reducing HIV Incidence, Must Remain Our Objective in Addressing the HIV/AIDS Epidemic

2019 ◽  
Vol 18 ◽  
pp. 232595821882196 ◽  
Author(s):  
Bohdan Nosyk ◽  
Jeong Eun Min ◽  
Xiao Zang ◽  
Daniel J. Feaster ◽  
Lisa Metsch ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Implementation Strategies ◽  
Hiv Infections ◽  
Hiv Care ◽  
Hiv Incidence ◽  
Quality Adjusted Life Years ◽  
Aids Epidemic ◽  
Life Years ◽  
Quality Adjusted Life ◽  
Hiv Aids

With efficacious behavioral, biomedical, and structural interventions available, combination implementation strategies are being implemented to combat HIV/AIDS across settings internationally. However, priority statements from national and international bodies make it unclear whether the objective should be the reduction in HIV incidence or the maximization of health, most commonly measured with quality-adjusted life years (QALYs). Building off a model-based evaluation of HIV care interventions in British Columbia, Canada, we compare the optimal sets of interventions that would be identified using HIV infections averted, and QALYs as the primary outcome in a cost-effectiveness analysis. We found an explicit focus on averting new infections undervalues the health benefits derived from antiretroviral therapy, resulting in suboptimal and potentially harmful funding recommendations.

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