scholarly journals An economic evaluation of implementing a decentralized dengue screening intervention under the National Vector Borne Disease Control Programme in Tamil Nadu, South India

2021 ◽  
Author(s):  
Malaisamy Muniyandi ◽  
Nagarajan Karikalan ◽  
Karunya Ravi ◽  
Senthilkumar Sengodan ◽  
Rajendran Krishnan ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Tamil Nadu ◽  
Screening Strategy ◽  
Early Screening ◽  
Current Strategy ◽  
Life Years ◽  
The Government ◽  
The Cost

Abstract Background Lack of effective early screening is a major obstacle for reducing the fatality rate and disease burden of dengue. In light of this, the government of Tamil Nadu has adopted a decentralized dengue screening strategy at the primary healthcare (PHC) facilities using blood platelet count. Our objective was to determine the cost-effectiveness of a decentralized screening strategy for dengue at PHC facilities compared with the current strategy at the tertiary health facility (THC) level. Methods Decision tree analysis followed a hypothetical cohort of 1000 suspected dengue cases entering the model. The cost-effectiveness analysis was performed at a 3% discount rate for the proposed and current strategy. The outcomes are expressed in incremental cost-effectiveness ratios (ICERs) per quality-adjusted life years gained. One-way sensitivity analysis and probabilistic sensitivity analysis were done to check the uncertainty in the outcome. Results The proposed strategy was found to be cost-saving and ICER was estimated to be −41 197. PSA showed that the proposed strategy had a 0.84 probability of being an economically dominant strategy. Conclusions The proposed strategy is cost-saving, however, it is recommended to consider optimal population coverage, costs to economic human resources and collateral benefits of equipment.

COST-EFFECTIVENESS ANALYSIS OF IVABRADINE IN TREATMENT OF PATIENTS WITH HEART FAILURE IN IRAN

2018 ◽  
Vol 34 (6) ◽  
pp. 576-583 ◽  
Author(s):  
Saeed Taheri ◽  
Elham Heidari ◽  
Mohammad Ali Aivazi ◽  
Mehran Shams-Beyranvand ◽  
Mehdi Varmaghani
Keyword(s):  
Heart Failure ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Transition Probabilities ◽  
Drug Acquisition ◽  
Sensitivity Analyses ◽  
Baseline Heart Rate ◽  
Life Years ◽  
The Cost

Objectives:This study aimed to assess the cost-effectiveness of ivabradine plus standard of care (SoC) in comparison with current SoC alone from the Iranian payer perspective.Methods:A cohort-based Markov model was developed to assess the incremental cost-effectiveness ratio (ICER) over a 10-year time horizon in a cohort of 1,000 patients. The baseline transition probabilities between New York Heart Association (NYHA), mortality rate, and hospitalization rate were extracted from the literature. The effect of ivabradine on mortality, hospitalization, and NYHA improvement or worsening were retrieved from the SHIFT study. The effectiveness was measured as quality-adjusted life-years (QALYs) using the utility values derived from Iranian Heart Failure Quality of Life study. Direct medical costs were obtained from hospital records and national tariffs. Deterministic and probabilistic sensitivity analyses were conducted to show the robustness of the model.Results:Ivabradine therapy was associated with an incremental cost per QALY of USD $5,437 (incremental cost of USD $2,207 and QALYs gained 0.41) versus SoC. The probabilistic sensitivity analysis showed that ivabradine is expected to have a 60 percent chance of being cost-effective accepting a threshold of USD $6,550 per QALY. Furthermore, deterministic sensitivity analysis indicated that the model is sensitive to the ivabradine drug acquisition cost.Conclusions:The cost-effectiveness model suggested that the addition of ivabradine to SoC therapy was associated with improved clinical outcomes along with increased costs. The analysis indicates that the clinical benefit of ivabradine can be achieved at a reasonable cost in eligible heart failure patients with sinus rhythm and a baseline heart rate ≥ 75 beats per minute (bpm).

Is Banning Texturized Implants to Prevent Breast Implant-Associated Anaplastic Large Cell Lymphoma a Rational Decision? A Meta-Analysis and Cost-Effectiveness Study

2019 ◽  
Vol 40 (7) ◽  
pp. 721-731 ◽  
Author(s):  
Stefan V Danilla ◽  
Rocio P Jara ◽  
Felipe Miranda ◽  
Francisco Bencina ◽  
Marcela Aguirre ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cell Lymphoma ◽  
Meta Analysis ◽  
Breast Implant ◽  
Cost Effective ◽  
Large Cell ◽  
Life Years ◽  
Large Cell Lymphoma ◽  
The Cost

Abstract Background Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emergent disease that threatens patients with texturized breast implants. Major concerns about the safety of these implants are leading to global changes to restrict the utilization of this product. The principal alternative is to perform breast augmentation utilizing smooth implants, given the lack of association with BIA-ALCL. The implications and costs of this intervention are unknown. Objectives The authors of this study determined the cost-effectiveness of smooth implants compared with texturized implants for breast augmentation surgery. Methods A tree decision model was utilized to analyze the cost-effectiveness. Model input parameters were derived from published sources. The capsular contracture (CC) rate was calculated from a meta-analysis. Effectiveness measures were life years, avoided BIA-ALCL, avoided deaths, and avoided reoperations. A sensitivity analysis was performed to test the robustness of the model. Results For avoided BIA-ALCL, the incremental cost was $18,562,003 for smooth implants over texturized implants. The incremental cost-effectiveness ratio was negative for life years, and avoided death and avoided reoperations were negative. The sensitivity analysis revealed that to avoid 1 case of BIA-ALCL, the utilization of smooth implants would be cost-effective for a risk of developing BIA-ALCL equal to or greater than 1:196, and there is a probability of CC with smooth implants equal to or less than 0.096. Conclusions The utilization of smooth implants to prevent BIA-ALCL is not cost-effective. Banning texturized implants to prevent BIA-ALCL may involve additional consequences, which should be considered in light of higher CC rates and more reoperations associated with smooth implants than with texturized implants.

scholarly journals Cost-Effectiveness Analysis of Ultrasound Screening for Thyroid Cancer in Asymptomatic Adults

2021 ◽  
Vol 9 ◽  
Author(s):  
Nan Yang ◽  
Han Yang ◽  
Jeff Jianfei Guo ◽  
Ming Hu ◽  
Sheyu Li
Keyword(s):  
Sensitivity Analysis ◽  
Thyroid Cancer ◽  
Cost Effectiveness ◽  
Screening Strategy ◽  
Ultrasound Screening ◽  
Tree Model ◽  
Thyroid Screening ◽  
Cumulative Cost ◽  
Life Years

Objectives: This study evaluated the long-term cost-effectiveness of ultrasound screening for thyroid cancer compared with non-screening in asymptomatic adults.Methods: Applying a Markov decision-tree model with effectiveness and cost data from literature, we compared the long-term cost-effectiveness of the two strategies: ultrasound screening and non-screening for thyroid cancer. A one-way sensitivity analysis and a probabilistic sensitivity analysis were performed to verify the stability of model results.Results: The cumulative cost of screening for thyroid cancer was $18,819.24, with 18.74 quality-adjusted life years (QALYs), whereas the cumulative cost of non-screening was $15,864.28, with 18.71 QALYs. The incremental cost-effectiveness ratio of $106,947.50/QALY greatly exceeded the threshold of $50,000. The result of the one-way sensitivity analysis showed that the utility values of benign nodules and utility of health after thyroid cancer surgery would affect the results.Conclusions: Ultrasound screening for thyroid cancer has no obvious advantage in terms of cost-effectiveness compared with non-screening. The optimized thyroid screening strategy for a specific population is essential.

scholarly journals Cost-effectiveness of Ruxolitinib vs Best Available Therapy in the Treatment of Myelofibrosis in Spain

10.36469/9808 ◽  
2017 ◽  
Vol 5 (2) ◽  
pp. 162-174
Author(s):  
María Teresa Gómez-Casares ◽  
Juan Carlos Hernández-Boluda ◽  
Antonio Jiménez-Velasco ◽  
Joaquin Martínez-López ◽  
María Giovanna Ferrario ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
End Of Life ◽  
Societal Perspective ◽  
Primary Myelofibrosis ◽  
Janus Kinase ◽  
Lifetime Horizon ◽  
Life Years ◽  
The Cost

Introduction: Primary myelofibrosis (MF) is a rare hematologic disease belonging to the group of Philadelphia-negative chronic myeloproliferative neoplasms. Identification of the Janus Kinase (JAK) gene mutations inaugurated a new era in the targeted therapy of myeloproliferative diseases. Ruxolitinib is the first JAK1/JAK2 inhibitor specifically approved for the treatment of disease-related splenomegaly or symptoms in adult patients with primary myelofibrosis. The objective of this study was to assess the cost-effectiveness of ruxolitinib vs best available therapy (BAT) in MF patients in Spain. Methods: A decision-tree and Markov model were adapted to the Spanish setting to assess the cost-effectiveness of ruxolitinib vs. BAT on a lifetime horizon (≤15 years) from the societal perspective, while healthcare system perspective was included in the one-way sensitivity analysis. The population was assumed to be similar to that of the COMFORT-II clinical trial (CT), which was also the source of treatment efficacy data. BAT composition was derived from the same CT and validated with Spanish experts. Utilities were derived from the COMFORT-I CT. Costs included treatment, management, hospitalizations, emergency and outpatient visits, as well as adverse events and end-of-life costs. Additionally, costs associated to productivity loss were taken into account. Resource use was validated with experts and costs were extracted from Spanish sources. A probabilistic sensitivity analysis was also performed to evaluate the consistency of the results under the uncertainty or variability of the input data. Results: Patients on ruxolitinib accumulated 6.1 life years gained (LYGs), resulting in 73% extra life-years compared to patients treated with BAT (3.5LYs gained). Ruxolitinib provided 4.4 quality-adjusted life years (QALYs), with a 99% improvement compared to BAT (2.2 QALYs). This analysis gave an incremental cost of €47 199 per LYG and an incremental cost of €55 616 per QALY gained from the societal perspective. Conclusions: Ruxolitinib would be cost-effective in Spain according to the end-of-life criteria defined by the NICE and commonly referred for Spain (cost-effectiveness threshold of €61 500/QALY), in line with results published for other European countries.

Cost-Effectiveness and Budget Impact of Emicizumab Prophylaxis in Haemophilia A Patients with Inhibitors

2019 ◽  
Vol 120 (02) ◽  
pp. 216-228 ◽  
Author(s):  
Paolo Angelo Cortesi ◽  
Giancarlo Castaman ◽  
Gianluca Trifirò ◽  
Simona Serao Creazzola ◽  
Giovanni Improta ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Budget Impact ◽  
Economic Evaluations ◽  
Extensive Literature ◽  
Haemophilia A ◽  
Old Patients ◽  
Life Years ◽  
The Cost

AbstractRecent evidence demonstrated that weekly prophylaxis with subcutaneous bispecific antibody (emicizumab) has shown higher efficacy in adolescent and adults patients affected by haemophilia A (HA) with inhibitor, compared with patients treated on demand or on prophylaxis with bypassing agents (BPAs). However, no economic evaluations assessing the value and sustainability of emicizumab prophylaxis have been performed in Europe. This study assessed the cost-effectiveness of emicizumab prophylaxis compared with BPA prophylaxis and its possible budget impact from the Italian National Health Service (NHS) perspective. A Markov model and a budget impact model were developed to estimate the cost-effectiveness and budget impact of emicizumab prophylaxis in HA patients with inhibitors. The model was populated using treatment efficacy from clinical trials and key clinical, cost and epidemiological data retrieved through an extensive literature review. Compared with BPAs prophylaxis, emicizumab prophylaxis was found to be more effective (0.94 quality adjusted life-years) and cost saving (–€19.4/–€24.4 million per patient lifetime) in a cohort of 4-year-old patients with HA and inhibitors who failed immune tolerance induction. In the probabilistic sensitivity analysis, emicizumab prophylaxis had always 100% probability of being cost-effective at any threshold. Further, the use of emicizumab prophylaxis was associated to an overall budget reduction of €45.4 million in the next 3 years. In conclusion, the clinically effective emicizumab prophylaxis can be considered a cost-saving treatment for HA with inhibitor patients. Furthermore, emicizumab treatment is also associated to a significant reduction of the health care budget, making this new treatment a sustainable and convenient health care option for Italian NHS.

scholarly journals Cost-effectiveness of docetaxel in high-volume hormone-sensitive metastatic prostate cancer

2019 ◽  
Vol 13 (12) ◽  
Author(s):  
Jaclyn Beca ◽  
Habeeb Majeed ◽  
Kelvin K.W. Chan ◽  
Sebastian J. Hotte ◽  
Andrew Loblaw ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Survival Data ◽  
High Volume ◽  
Base Case ◽  
Castration Resistant Prostate Cancer ◽  
Life Years ◽  
Hormone Sensitive ◽  
The Cost

Introduction: Three pivotal trials have considered the addition of docetaxel (D) chemotherapy to conventional androgen-deprivation therapy (ADT) for the treatment of metastatic hormone-sensitive prostate cancer (HSPC). While an initial small trial was inconclusive, two larger trials demonstrated significant clinical benefit, including pronounced survival benefits (added 17 months) among patients with high-volume metastatic disease. Given the evolving clinical evidence, the cost-effectiveness of this approach warrants exploration. Methods: The cost-effectiveness of six cycles of ADT+D compared to ADT alone to treat patients with high-volume metastatic HSPC was assessed from a Canadian public payer perspective. We included three health states: HSPC, metastatic castration-resistant prostate cancer (CRPC), and death. Survival data were obtained from the CHAARTED trial, which reported outcomes specifically for high-volume disease. We used Ontario costs data and utilities from the literature. Results: In the base case analysis, ADT+D cost an additional $25 757 and produced an extra 1.06 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $24 226/QALY gained. Results from one-way sensitivity analysis across wide ranges of estimates and a range of scenarios, including an alternate model structure, produced ICERs below $35 000/QALY gained in all cases. Conclusions: The use of D with ADT in high-volume metastatic HSPC appears to be an economically attractive treatment approach. The findings were consistent with other studies and robust in sensitivity analysis across a variety of scenarios.

Abstract 1: Impact of Predicted Bleeding Risk on the Cost-Effectiveness of Direct Thrombin Inhibition vs. Heparin Monotherapy for Patients Undergoing PCI

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Amit P Amin ◽  
Steven P Marso ◽  
Sunil V Rao ◽  
John Messenger ◽  
John House ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Major Bleeding ◽  
Cost Effective ◽  
Bleeding Risk ◽  
Thrombin Inhibitors ◽  
Published Data ◽  
Life Years ◽  
The Cost ◽  
Predicted Risk

Introduction Direct thrombin inhibitors (DTI) reduce bleeding and are cost-saving in patients (pts) undergoing PCI when compared to unfractionated heparin (UFH) plus routine glycoprotein IIb/IIIa inhibition (GPI). Little is known about the cost-effectiveness of DTI alone vs. UFH alone, however. Methods We combined data on patient-level bleeding risk with several external data sources to estimate the economic impact of substituting DTI for UFH among unselected PCI patients. We used a validated model to predict the risk of major bleeding for 81,628 NCDR® CathPCI Registry® patients who received UFH only in 2004-06. DTI costs were estimated based on current FDA dosing guidelines and acquisition costs. The cost of major bleeding ($8722) was estimated based on data from the Mid America Heart Institute. The benefit of DTI vs. UFH alone was based on bleeding risk reduction from ISAR-REACT 3. A Markov model based on published data was used to estimate the loss in life expectancy associated with major bleeding. Results The overall rate of major bleeding in the reference population was 2.2%, the estimated cost of a major bleed was $8722, projected DTI costs were $641/pt and heparin costs were negligible ($4). Assuming that DTI use reduces the risk of bleeding by 33%, use of DTI for all patients was estimated to increase costs by $573/patient and was cost saving only for patients with a predicted risk of major bleeding >20% (0.16% of the overall population). When life years lost due to bleeding were included, at willingness-to-pay thresholds of $50K and $100K per life year gained, DTI was cost effective for patients with a bleeding risk ≥8% (2.5% patients) and ≥5% (7.9% of patients), respectively. Conclusions For patients undergoing PCI, substitution of DTI for UFH monotherapy is projected to increase costs for virtually all patients, but may be reasonably cost-effective for patients with a high predicted risk (≥5%) of bleeding.

Cost-effectiveness of superabsorbent wound dressing versus standard of care in patients with moderate-to-highly exuding leg ulcers

2020 ◽  
Vol 29 (4) ◽  
pp. 235-246
Author(s):  
Vladica M. Veličković ◽  
Paul Chadwick ◽  
Mark G. Rippon ◽  
Ivana Ilić ◽  
Emma Rose McGlone ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Wound Dressing ◽  
Healing Rate ◽  
Standard Of Care ◽  
Leg Ulcers ◽  
Expected Cost ◽  
The Cost ◽  
Quality Adjusted Life

Objective: To determine the cost-effectiveness/utility of a superabsorbent wound dressing (Zetuvit Plus Silicone) versus the current standard of care (SoC) dressings, from the NHS perspective in England, in patients with moderate-to-high exudating leg ulcers. Method: A model-based economic evaluation was conducted to analyse the cost-effectiveness/utility of a new intervention. We used a microsimulation state-transition model with a time horizon of six months and a cycle length of one week. The model uses a combination of incidence base and risk prediction approach to inform transition probabilities. All clinical efficiency, health-related quality of life (HRQoL), cost and resource use inputs were informed by conducting a systematic review of UK specific literature. Results: Treatment with the superabsorbent dressing leads to a total expected cost per patient for a six month period of £2887, associated with 15.933 expected quality adjusted life weeks and 10.9% healing rate. When treated with SoC, the total expected cost per patient for a six month period is £3109, 15.852 expected quality adjusted life weeks and 8% healing rate. Therefore, the superabsorbent dressing leads to an increase in quality-adjusted life weeks, an increase in healing rate by 2.9% and a cost-saving of £222 per single average patient over six months. Results of several scenario analyses, one-way deterministic sensitivity analysis, and probabilistic sensitivity analysis confirmed the robustness of base-case results. The probabilistic analysis confirmed that, in any combination of variable values, the superabsorbent dressing leads to cost saving results. Conclusion: According to the model prediction, the superabsorbent dressing leads to an increase in health benefits and a decrease in associated costs of treatment.

scholarly journals Cost-effectiveness of teduglutide in adult patients with short bowel syndrome: Markov modeling using traditional cost-effectiveness criteria

2019 ◽  
Vol 111 (1) ◽  
pp. 141-148 ◽  
Author(s):  
Vikram K Raghu ◽  
David G Binion ◽  
Kenneth J Smith
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Short Bowel Syndrome ◽  
Adult Patients ◽  
Sensitivity Analyses ◽  
Published Data ◽  
Model Parameters ◽  
Short Bowel ◽  
Life Years ◽  
The Cost

ABSTRACT Background Adults with short bowel syndrome have a high mortality and significant morbidity due to unsuccessful attempts at rehabilitation that necessitate chronic use of parenteral nutrition (PN). Teduglutide is a novel therapy that promotes intestinal adaptation to improve rehabilitation but with a price >$400,000/y. Objective The current study evaluated the cost-effectiveness of using teduglutide in US adult patients with short bowel syndrome. Methods A Markov model evaluated the costs (in US dollars) and effectiveness (in quality-adjusted life years, or QALYs) of treatment compared with no teduglutide use, with a presumed starting age of 40 y. Parameters were obtained from published data or estimation. The primary effect modeled was the increased likelihood of reduced PN days per week when using teduglutide, leading to greater quality of life and lower PN costs. Sensitivity analyses were performed on all model parameters. Results In the base scenario, teduglutide cost $949,910/QALY gained. In 1-way sensitivity analyses, only reducing teduglutide cost decreased the cost/QALY gained to below the typical threshold of $100,000/QALY gained. Specifically, teduglutide cost would need to be reduced by >65% for it to reach the threshold value. Probabilistic sensitivity analysis favored no teduglutide use in 80% of iterations at a $100,000/QALY threshold. However, teduglutide therapy was cost-saving in 13% of model iterations. Conclusions Teduglutide does not meet a traditional cost-effectiveness threshold as treatment for PN reduction in adult patients with short bowel syndrome compared with standard intestinal rehabilitation. Subpopulations that demonstrate maximum benefit could be cost-saving, and complete nonuse could lead to financial loss. Teduglutide becomes economically reasonable only if its cost is substantially reduced.

scholarly journals Analysis of Cost-Effectiveness of Trametinib Plus Dabrafenib as First-Line Therapy for Metastatic BRAF V600-Mutated Melanoma in China

2021 ◽  
Author(s):  
Guojun Sun ◽  
Jingwen Wang ◽  
Xiaoying Zhou ◽  
Zhichao Hu ◽  
Zuojun Dong
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Transition Probabilities ◽  
Unit Cost ◽  
Cost Effective ◽  
First Line Therapy ◽  
Life Years ◽  
Melanoma Patients ◽  
The Cost

Abstract Background: Treatment with trametinib plus dabrafenib for patients exhibiting metastatic BRAF V600-mutated melanoma has been approved in China.Method: We developed a Markov model to evaluate and compare the cost-effectiveness of trametinib plus dabrafenib against vemurafenib. Information on clinical situations, the rate of adverse reactions, follow-up treatments, and estimated transition probabilities were derived from the results of a clinical trial that compared treatment with trametinib plus dabrafenib against vemurafenib alone. A one-way sensitivity analysis and a probabilistic sensitivity analysis were conducted to assess the influence of uncertainty on the key model.Result: Treatment with trametinib plus dabrafenib for one patient in the treatment period was estimated to cost CNY 332 294, and yield a total gain of 16.6 quality-adjusted life years (QALYs). Compared with vemurafenib, treatment involving trametinib plus dabrafenib yielded additional 3.96 QALYs, resulting in a unit cost-effectiveness of CNY 27 460 per QALY. Sensitivity analysis shows that the results are reliable.Conclusion：From the perspective of China's health system, applying China's per-capita GDP in 2020 as the threshold of willingness-to-pay, it is cost-effective to treat metastatic melanoma patients exhibiting BRAF V600 mutation with dabrafenib plus trametinib.

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