The Optimal Treatment for Partial Thickness Burns: A Cost-Utility Analysis of Skin Allograft vs. Topical Silver Dressings

2020 ◽  
Vol 41 (3) ◽  
pp. 450-456 ◽  
Author(s):  
Clifford C Sheckter ◽  
Nickolas L Meyerkord ◽  
Yunna L Sinskey ◽  
Pariss Clark ◽  
Katarina Anderson ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Skin Allograft ◽  
Partial Thickness ◽  
Partial Thickness Burns ◽  
Quality Adjusted Life

Abstract Introduction Partial thickness burns not undergoing surgical excision are treated with topical silver products including silver sulfadiazine (SSD) and Mepilex Ag. Skin allograft is a more costly alternative that acts as definitive wound coverage until autogenous epithelialization. Economic constraints and the movement toward value-based care demand cost and outcome justification prior to adopting more costly products. Methods A cost-utility analysis was performed comparing skin allograft to SSD and Mepilex Ag using decision tree analysis. The base case modeled a superficial partial thickness 20% total body surface area burn. Utilities were derived from expert opinion on the basis of personal experience. Costs were derived from 2019 Medicare payments. Quality adjusted life years were calculated using rollback method assuming standard life expectancies in the United States. Probabilistic sensitivity analysis was performed to asses model robustness. Results The incremental costs of skin allograft to Mepilex Ag and SSD were $907.71 and $1257.86, respectively. The incremental quality adjusted life year (QALY) gains from allograft over Mepilex Ag and SSD were 0.011 and 0.016. This yielded an incremental cost-utility ratio for allograft vs. Mepilex Ag of $84,189.29/QALY compared with an incremental cost-utility ratio of $79,684.63/QALY for allograft vs. SSD. Assuming willingness-to-pay thresholds of $100,000/QALY, probabilistic sensitivity analysis demonstrated that allograft was cost effective to Mepilex Ag in 62.1% of scenarios, and cost effective to SSD in 64.9% of simulations. Conclusion Skin allograft showed greater QALYs compared with topical silver dressings at a higher cost. Depending on willingness-to-pay thresholds, skin allograft may be a considered a cost-effective treatment of partial-thickness burns.

scholarly journals Cost-utility analysis of olanzapine in four-drug antiemetic therapy in Japanese patients treated with highly emetogenic cisplatin-containing chemotherapy

2021 ◽  
Author(s):  
Yu Kondo ◽  
Tomoya Tachi ◽  
Takayoshi Sakakibara ◽  
Jun Kato ◽  
Takahito Mizuno ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Effective ◽  
Japanese Patients ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Antiemetic Therapy ◽  
Utility Analysis ◽  
The Cost

Abstract Purpose Olanzapine has been shown to have an additive effect on the three-drug antiemetic therapy, consisting of aprepitant, palonosetron, and dexamethasone, in a highly emetogenic cisplatin-containing chemotherapy. Although olanzapine may be more economical than aprepitant or palonosetron, an adequate cost-efficacy analysis has not been conducted. We conducted a cost-utility analysis to evaluate the cost-effectiveness of olanzapine in four-drug antiemetic therapy among Japanese patients.Methods We simulated model patients treated with highly emetogenic cisplatin-containing chemotherapy and developed a decision-analytical model of patients receiving triple antiemetic therapy with or without olanzapine. The cost, probabilities, and incremental cost-effectiveness ratio (ICER) of each treatment were calculated from the perspective of the Japanese healthcare payer. The threshold ICER was set at 45,867 United States dollars (USD) (5 million Japanese yen) per quality-adjusted life-year (QALY). The probabilities, utility value, and other costs were obtained from published sources. The robustness of this model was validated by one-way sensitivity analysis and probabilistic sensitivity analysis.Results The calculated ICER was 5,156 USD/QALY, which was below the threshold. Under the set conditions, the probabilistic sensitivity analysis revealed a 100% probability that olanzapine was cost-effective. Based on the one-way sensitivity analysis, reducing the cost of olanzapine below 10.78 USD placed the ICER below the threshold. Conclusion Olanzapine was cost-effective in the four-drug antiemetic therapy for Japanese patients treated with highly emetogenic cisplatin-containing chemotherapy

scholarly journals A one-year cost–utility analysis of REBOA versus RTACC for non-compressible torso haemorrhage

Trauma ◽  
2017 ◽  
Vol 21 (1) ◽  
pp. 45-54 ◽  
Author(s):  
Maxwell S Renna ◽  
Cristiano van Zeller ◽  
Farah Abu-Hijleh ◽  
Cherlyn Tong ◽  
Jasmine Gambini ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Cost Effectiveness Ratio ◽  
One Year ◽  
Quality Adjusted Life

Introduction Major trauma is a leading cause of death and disability in young adults, especially from massive non-compressible torso haemorrhage. The standard technique to control distal haemorrhage and maximise central perfusion is resuscitative thoracotomy with aortic cross-clamping (RTACC). More recently, the minimally invasive technique of resuscitative endovascular balloon occlusion of the aorta (REBOA) has been developed to similarly limit distal haemorrhage without the morbidity of thoracotomy; cost–utility studies on this intervention, however, are still lacking. The aim of this study was to perform a one-year cost–utility analysis of REBOA as an intervention for patients with major traumatic non-compressible abdominal haemorrhage, compared to RTACC within the U.K.’s National Health Service. Methods A retrospective analysis of the outcomes following REBOA and RTACC was conducted based on the published literature of survival and complication rates after intervention. Utility was obtained from studies that used the EQ-5D index and from self-conducted surveys. Costs were calculated using 2016/2017 National Health Service tariff data and supplemented from further literature. A cost–utility analysis was then conducted. Results A total of 12 studies for REBOA and 20 studies for RTACC were included. The mean injury severity scores for RTACC and REBOA were 34 and 39, and mean probability of death was 9.7 and 54%, respectively. The incremental cost-effectiveness ratio of REBOA when compared to RTACC was £44,617.44 per quality-adjusted life year. The incremental cost-effectiveness ratio, by exceeding the National Institute for Health and Clinical Effectiveness’s willingness-to-pay threshold of £30,000/quality-adjusted life year, suggests that this intervention is not cost-effective in comparison to RTACC. However, REBOA yielded a 157% improvement in utility with a comparatively small cost increase of 31.5%. Conclusion Although REBOA has not been found to be cost-effective when compared to RTACC, ultimately, clinical experience and expertise should be the main factor in driving the decision over which intervention to prioritise in the emergency context.

scholarly journals Exploring the Appropriate Price of Semaglutide for Type 2 Diabetes Patients Based on Cost-Utility Analysis in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Shanshan Hu ◽  
Xiaorong Su ◽  
Xun Deng ◽  
Yong Wang
Keyword(s):  
Type 2 Diabetes ◽  
Sensitivity Analysis ◽  
Scenario Analysis ◽  
Probabilistic Sensitivity Analysis ◽  
Annual Cost ◽  
Cost Utility ◽  
Binary Search ◽  
Cost Utility Analysis ◽  
Utility Analysis

Introduction: Semaglutide is the first and only oral version of a glucagon-like peptide-1 analogue approved by the FDA for the treatment of type 2 diabetes (T2D). This research was designed to explore the appropriate price of once-weekly (OW) semaglutide for T2D patients in China based on cost-utility analysis.Methods: The baseline patient cohorts of OW semaglutide and once-daily (OD) empagliflozin were sourced from a patient-level meta-analysis integrating the SUSTAIN 2, SUSTAIN 3, SUSTAIN 8 and PIONEER 2 trials. The long-term health and economic outcomes were simulated using the United Kingdom Prospective Diabetes Study Outcome Model 2 from the Chinese healthcare provider’s perspective. The appropriate price of semaglutide was explored by binary search. One-way sensitivity analysis (one-way SA), probabilistic sensitivity analysis and scenario analysis were applied to solve the uncertainty.Results: Under the assumption that the annual cost of semaglutide is equal to that of OD empagliflozin, OW semaglutide was superior to OD empagliflozin due to its higher quality adjusted life years and lower total costs. After binary search, the incremental cost-utility ratio of OW semaglutide vs. OD empagliflozin was approximately equal to 3λ with an annual cost of semaglutide of $1,007.18 and approximately equal to λ with an annual cost of semaglutide of $708.11. Subsequently, the incremental cost-utility ratio of OW semaglutide vs. OD empagliflozin was approximately 3λ and λ, with annual costs of semaglutide of $877.43 and $667.04, respectively, adjusted by one-way SA. Ultimately, the cost-utility results with annual costs of semaglutide of $877.43 and $667.04 were robust to probabilistic sensitivity analysis and scenario analysis.Conclusion: In conclusion, the annual cost of semaglutide appears to be appropriate between $667.04 and $877.43 for T2D patients in China.

A Cost-Utility Analysis of Abdominal Hysterectomy Versus Transcervical Endometrial Resection for the Surgical Treatment of Menorrhagia

1998 ◽  
Vol 14 (2) ◽  
pp. 302-319 ◽  
Author(s):  
Mark Sculpher
Keyword(s):  
Cost Effective ◽  
Abdominal Hysterectomy ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Health State ◽  
Utility Analysis ◽  
Major Health ◽  
Parameter Values ◽  
Quality Adjusted Life

AbstractMenorrhagia, or heavy regular menstrual bleeding, represents a major health burden to women. Trials comparing abdominal hysterectomy (AH) with transcervical resection of the endometrium (TCRE) for the condition have shown that, although the duration and severity of convalescence is less with TCRE, AH produces a permanent solution to heavy bleeding while TCRE fails in a proportion of women by 2 years. However, by 2 years, TCRE costs only 71% that of AH. This paper presents a cost-utility analysis to assess which procedure is more cost-effective overall. Under most plausible parameter values and on the basis of health state values elicited from a sample of women with menorrhagia, AH is likely to be considered more cost-effective than TCRE if purchasers are willing to pay an additional cost of at least £6,500 per extra quality-adjusted life-year generated by AH.

scholarly journals Cost–utility analysis of low-intensity case management to increase contact with health services among ex-prisoners in Australia

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e023082 ◽  
Author(s):  
Qinglu Cheng ◽  
Stuart A Kinner ◽  
Xing J Lee ◽  
Kathryn J Snow ◽  
Nicholas Graves
Keyword(s):  
Sensitivity Analysis ◽  
Health Service ◽  
Probabilistic Sensitivity Analysis ◽  
Intervention Group ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Control Group ◽  
Service Utilisation ◽  
Utility Analysis ◽  
Health Related

ObjectivesThe economic burden of incarceration is substantial in Australia. People released from prison are at high risk of poor health and this is an important predictor of recidivism. The ‘Passports Study’ was a randomised controlled trial of an intervention designed to increase health service utilisation after release from prison. The aim of this study is to conduct a cost–utility analysis of this transitional programme.SettingAustraliaDesignA hybrid simulation model was developed to estimate the changes to total economic costs and effectiveness expressed as quality-adjusted life-years (QALYs) from the adoption of the ’Passports’ intervention compared with the control group. Model parameters were informed by linked data from Queensland Corrective Services, Medicare, Pharmaceutical Benefits Scheme, Queensland Hospital Admission Patient Data Collection, Emergency Department Information System and National Death Index. Health-related quality of life was measured using the Short-Form 8 Health Survey (SF-8). The primary outcomes were the costs and estimated QALYs associated with the intervention group and the control group. Probabilistic sensitivity analysis was conducted to test parameter uncertainties.ResultsCompared with the control group where no attempt was made to encourage health service utilisation, an average participant in the intervention group incurred an extra cost of AUD 1790 and experienced slightly reduced QALYs, which indicated that the intervention was dominated in the baseline analysis. Probabilistic sensitivity analysis revealed that the transitional programme had a low probability of being cost-effective with the outcome measures selected.ConclusionThe findings of this study do not provide economic evidence to support the widespread adoption of the Passports intervention. Due to the reductionist nature of the cost–utility approach, it may be that important health-related benefits have been omitted. Another research approach using a wider range of health-related measures might generate different conclusions.

scholarly journals Cost-Utility Analysis of Palbociclib, Ribociclib and Letrozole in the First Line Treatment of Metastatic Breast Cancer in Iran Using Partitioned Survival Model

2021 ◽  
Author(s):  
Ali Darvishi ◽  
Rajabali Daroudi ◽  
Aliakbar Fazaeli
Keyword(s):  
Breast Cancer ◽  
Sensitivity Analysis ◽  
Metastatic Breast ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Line Treatment ◽  
Utility Analysis ◽  
First Line ◽  
First Line Treatment

Abstract Background and ObjectivesPalbociclib and Ribociclib are a cyclin-dependent kinase (CDK 4/6) oral molecular inhibitors may improve overall survival (OS), progression free survival (PFS) and quality of life (QoL) in metastatic breast cancer (MBC) patients. We aimed to cost utility analysis (CUA) of Palbociclib in comparison with other alternative regimens in the first line treatment of patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2–) MBC in Iran.MethodsCUA was performed using partitioned survival model (PSM) from Iranian healthcare system perspective. Comparative strategies were Palbociclib+letrozole, Ribociclib+letrozole and Letrozole mono-therapy. Model structured with 1-month cycle length and 15 years as time horizon. Clinical safety and efficacy of interventions and survival functions in terms of PFS and OS for Palbociclib+letrozole, and Ribociclib+Letrozole was obtained from the latest update of PALOMA-1, 2 and MONALEESA-2 study, respectively. Direct medical costs include the cost of drugs, visits, hospitalization, CT scan, bone x-rays, monitoring and testing, and the medications side effects were considered. In order to uncertainty evaluations, deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were performed. Excel 2016 and TreeAge 2020 were used in all stages of evaluation.ResultsBase case results showed that despite the lower effectiveness, Letrozole mono-therapy was the most cost-effective strategy and Palbociclib+letrozole and Ribociclib+letrozole were not cost effective. The incremental cost effectiveness ratio (ICER) of the Palbociclib+Letrozole and Ribociclib+Letrozole compared to Letrozole mono-therapy was estimated at $137,302 and $120,478 per quality adjusted life year (QALY), respectively, indicating a large interval from the target threshold ($4956). DSA showed that the results of the CUA were not significantly sensitive to changes in the values of uncertain variables. PSA also showed Palbociclib+letrozole and Ribociclib+letrozole did not have a chance to be cost effective based on changes in various parameters and simulations.Conclusionsalbociclib and Ribociclib showed significant efficacy in the addition to Letrozole based on the PFS but were not cost effective strategies in the first line treatment of MBC.

VALUE-BASED MEDICINE, COST-UTILITY ANALYSIS WHAT IS COST-EFFECTIVE?

2010 ◽  
Vol 11 (3) ◽  
pp. 180-186
Author(s):  
Gary C. Brown ◽  
Melissa M. Brown ◽  
Peter Kertes ◽  
Heidi B. Lieske ◽  
Philip Alex Lieske ◽  
...  
Keyword(s):  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Based Medicine

scholarly journals Cost-Utility Analysis of Saxagliptin/Dapagliflozin Versus Gliclazide and Insulin Glargine: Economic Implications of the Outcomes of the CVD-Real Studies I and II

2020 ◽  
Vol 13 ◽  
pp. 117863292092998
Author(s):  
Enrico Torre ◽  
Giacomo Matteo Bruno ◽  
Sergio Di Matteo ◽  
Chiara Martinotti ◽  
Maria Chiara Valentino ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Sensitivity Analysis ◽  
Insulin Glargine ◽  
Annual Cost ◽  
Basal Insulin ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Bodyweight Loss ◽  
Utility Analysis

Diabetes treatment cost represents an ever-growing problem. The adoption of new drugs in therapy, although they can guarantee an improvement in patient’s quality of life, can meet obstacles when it involves an increase in costs. We decided to compare the costs and benefits of the new saxagliptin and dapagliflozin combination versus traditional therapies. Bodyweight loss and the sharp reduction in hypoglycemic episodes were the 2 main clinical outcomes that emerged from registered studies of saxagliptin and dapagliflozin compared with the sulfonylureas. These results, combined with the good cardiovascular risk profile, led to develop a cost-utility analysis. We aimed to show the economic value of this new association therapy. We carried out a cost-utility analysis from the Italian National Healthcare System (NHS) perspective, focused on direct costs related to the treatment and management of main diabetes complications. Utility scores adopted have been measured based on the patient’s perception of weight changes. In light of the better durability profile of saxagliptin/dapagliflozin compared with gliclazide, we also considered a simulation scenario to assess the impact on costs of switching to basal insulin, starting from gliclazide and the fixed combination, respectively, and based on the related probabilities to switch. To assess the robustness of the results, a 1-way sensitivity analysis was performed by changing the main parameters by ±20%. Furthermore, the sensitivity of the results was tested considering the addition of a percent discount, because the purchase costs of drugs are usually subject to hidden discounts. We calculated the total direct annual cost per patient of saxagliptin/dapagliflozin versus gliclazide and insulin glargine for patients with type 2 diabetes mellitus not achieving glycemic control on metformin plus saxagliptin alone, dapagliflozin alone, or gliclazide at a lower dosage. Total treatment costs have been obtained adding the direct cost of the drug, needles, glycemic self-monitoring, hypoglycemic events, cardiovascular complications, and effect on consumption of other drugs. The total direct cost of saxagliptin/dapagliflozin fixed dose combination was €414.62 higher than gliclazide (€1.067.72 vs €653.10), and greater than basal insulin, with a difference of €166.99 (€1067.72 vs €900.72). Despite the higher annual direct total cost, the additional cost per quality-adjusted life year (QALY) gained, compared with gliclazide, has been €11 517, and €4639, when compared with insulin glargine in the base-case scenario, and the robustness of the results has been shown in the sensitivity analysis. The results of our cost-utility analysis, expressed as incremental cost-effectiveness ratios, were fully compliant with the threshold adopted for Italy. Then, saxagliptin/dapagliflozin can be considered a cost-effective oral hypoglycemic agent. The positive effect of this drug on the quality of life, induced by the bodyweight loss, has allowed this outcome, despite the higher annual cost per patient, mainly determined by the drug purchase cost.

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