scholarly journals 1604. Cost-Effectiveness of Ceftazidime-Avibactam for Patients with Hospital-Acquired Pneumonia Caused by Multi-Drug Resistant Enterobacteriaceae or Pseudomonas in China

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S797-S798
Author(s):  
Wesley Furnback ◽  
YiXi Chen ◽  
Peng Dong ◽  
Bruce Wang ◽  
Wajeeha Ansari ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
High Dose ◽  
Drug Resistant ◽  
Double Blind ◽  
Hospital Acquired Pneumonia ◽  
Cost Effective Alternative ◽  
Resistance Rates ◽  
The Cost ◽  
Hospital Acquired

Abstract Background To estimate the cost-effectiveness of ceftazidime-avibactam (CAZ-AVI) for the treatment of hospital-acquired pneumonia (HAP) including ventilator-associated pneumonia (VAP) caused by multi-drug resistant enterobacteriaceae (MDRE) or MDR pseudomonas aeruginosa (MDRPA) in China. Methods A previously published patient-level simulation model was localized to China to estimate the cost-effectiveness of first-line CAZ-AVI compared to meropenem from a healthcare perspective. Patients flowed through the model which evaluates resistance status, response, and adverse events (AEs), which can all lead to a treatment switch. Second-line therapy of colistin plus high dose meropenem was used for both arms. Resistance rates were 0.7% (CAZ-AVI) and 7.6% (meropenem) for MDRE, and 10.7% (CAZ-AVI) and 35.5% (meropenem) for MDRPA. Effectiveness rates for CAZ-AVI and meropenem were based on a randomized, double-blind, phase 3 clinical trial. All cost data, including drugs, AEs, and hospitalization were localized to China. Utility values were based on response and sourced from the literature. Costs and benefits were discounted at 5% over the five year time horizon. Results At a cost-effectiveness threshold of three-times GDP per capita, CAZ-AVI was cost-effective compared to meropenem for HAP/VAP caused by both MDRE and MDRPA with ICERs of ¥147,500 and ¥30,496, respectively. Specifically, CAZ-AVI had ¥13,699 and 0.09 additional total costs and QALYs, respectively, within MDRE; ¥5,207 and 0.17 additional total costs and QALYs, respectively, within MDRPA. Length of stay was reduced by 0.65 days and 1.37 in the CAZ-AVI arms of the MDRE and MDRPA analyses, respectively. Conclusion CAZ-AVI is a cost-effective alternative to meropenem in the treatment of HAP/VAP caused by MDRE or MDRPA in China. Disclosures Wesley Furnback, BA, Pfizer (Consultant) YiXi Chen, MSc, Pfizer (Employee) Peng Dong, PhD, Pfizer (Employee) Bruce Wang, PhD, Pfizer (Consultant) Wajeeha Ansari, MSc, Pfizer (Employee) Claudie Charbonneau, PhD, Pfizer (Employee) Hengjing Dong, MD, Pfizer (Other Financial or Material Support, Honorarium)

Cost-effectiveness of nab-paclitaxel plus gemcitabine versus erlotinib plus gemcitabine in metastatic pancreatic cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 353-353 ◽  
Author(s):  
E. Gabriela Chiorean ◽  
Scott Whiting ◽  
Gary Binder ◽  
George Dranitsaris ◽  
Victoria Manax
Keyword(s):  
Pancreatic Cancer ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Phase Iii ◽  
Metastatic Pancreatic Cancer ◽  
Payer Perspective ◽  
The Us ◽  
Recent Phase ◽  
Cost Effective Alternative ◽  
The Cost

353 Background: In a recent phase III trial nab-paclitaxel (albumin-bound paclitaxel) + gemcitabine (nab-P/G) demonstrated a 1.8 month, or 27%, improvement in median overall survival (OS) (HR = 0.72, P < 0.001) vs gemcitabine (G) in first-line metastatic pancreatic cancer (mPC). nab-P/G had higher 1 year OS (35% vs 22%) and improved PFS by 1.8 months (HR = 0.69, P < 0.01). nab-P/G is the first taxane based therapy to show a significant OS improvement in a phase III mPC trial. Erlotinib + gemcitabine (E/G) has also demonstrated activity in mPC, with a 0.3 month OS benefit vs G (HR = 0.82, P = 0.04), a 1 year OS of 23% vs 17%, and 0.2 months PFS benefit (HR = 0.77, P = 0.004) vs G. A cost-effectiveness analysis measuring the cost per life year (LY) gained for nab-P/G and E/G was conducted from the US payer perspective. Methods: Costs and clinical outcomes were evaluated fromnab-P/G vs G and E/G vs G trials of mPC. Health care resource use and the management of grade III/IV adverse events (AE) were collected from a large multisite US oncology clinic, expert opinion, and literature (2012 US dollars). Drug cost per cycle was multiplied by the median cycles delivered from the trials for nab-P/G and E/G. Results: Duration of therapy was 4 months for nab-P/G vs 3.9 months for E/G. Total cost for nab-P/G was $24,984 vs $23,044 for E/G, including drug, administration and AE management. AE costs were similar between the two therapies (Table). Differences of > 5% were noted in neutropenia (rates: nab-P/G = 33%; E/G = 24%), neuropathy (nab-P/G = 17%; E/G = 1%), and rash (nab-P/G = 0%; E/G = 6%). The net survival advantage for nab-P/G vs E/G was 1.5 incremental life months gained. Nab-P/G was cost-effective relative to E/G, at a cost of $15,522 per incremental life year gained. Conclusions: nab-P/G is a cost-effective alternative to E/G in mPC, bringing more months of OS at < $16,000 cost per incremental life year gained. [Table: see text]

Prescribing high-dose lipid-lowering therapy early to avoid subsequent cardiovascular events: is this a cost-effective strategy?

2011 ◽  
Vol 19 (3) ◽  
pp. 474-483 ◽  
Author(s):  
R Ara ◽  
A Pandor ◽  
J Stevens ◽  
R Rafia ◽  
SE Ward ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiovascular Events ◽  
Cost Effective ◽  
Effective Alternative ◽  
Lipid Lowering ◽  
High Dose ◽  
Lipid Lowering Therapy ◽  
Coronary Syndrome ◽  
Cost Effective Alternative ◽  
The Cost

Background: While evidence shows high-dose statins reduce cardiovascular events compared with moderate doses in individuals with acute coronary syndrome (ACS), many primary care trusts (PCT) advocate the use of generic simvastatin 40 mg/day for these patients. Methods and results: Data from 28 RCTs were synthesized using a mixed treatment comparison model. A Markov model was used to evaluate the cost-effectiveness of treatments taking into account adherence and the likely reduction in cost for atorvastatin when the patent expires. There is a clear dose–response: rosuvastatin 40 mg/day produces the greatest reduction in low-density lipoprotein cholesterol (56%) followed by atorvastatin 80 mg/day (52%), and simvastatin 40 mg/day (37%). Using a threshold of £20,000 per QALY, if adherence levels in general practice are similar to those observed in RCTs, all three higher dose statins would be considered cost-effective compared to simvastatin 40 mg/day. Using the net benefits of the treatments, rosuvastatin 40 mg/day is estimated to be the most cost-effective alternative. If the cost of atorvastatin reduces in line with that observed for simvastatin, atorvastatin 80 mg/day is estimated to be the most cost-effective alternative. Conclusion: Our analyses show that current PCT policies intended to minimize primary care drug acquisition costs result in suboptimal care.

Cost effectiveness of subaxial fusion—lateral mass screws versus transarticular facet screws

2012 ◽  
Vol 33 (1) ◽  
pp. E14 ◽  
Author(s):  
Wilson Z. Ray ◽  
Vijay M. Ravindra ◽  
Gregory F. Jost ◽  
Erica F. Bisson ◽  
Meic H. Schmidt
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Comparison ◽  
Lateral Mass ◽  
Fixation Technique ◽  
Institutional Experience ◽  
Cost Effective Alternative ◽  
Lateral Mass Screws ◽  
The Cost ◽  
Theoretical Cost

As health care reform continues to evolve, demonstrating the cost effectiveness of spinal fusion procedures will be of critical value. Posterior subaxial cervical fusion with lateral mass screw and rod instrumentation is a well-established fixation technique. Subaxial transarticular facet fixation is a lesser known fusion technique that has been shown to be biomechanically equivalent to lateral mass screws for short constructs. Although there has not been a widespread adoption of transarticular facet screws, the screws potentially represent a cost-effective alternative to lateral mass rod and screw constructs. In this review, the authors describe an institutional experience with the use of lateral mass screws and provide a theoretical cost comparison with the use of transarticular facet screws.

scholarly journals Efficient routes to land conservation given risk of covenant failure

2015 ◽  
Author(s):  
Richard Schuster ◽  
Peter Arcese
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Private Land ◽  
Legal Challenges ◽  
Monitoring And Enforcement ◽  
Cost Effective Alternative ◽  
The Cost ◽  
Conservation Investment ◽  
Term Monitoring

Conservation initiatives to protect valued species communities in human-dominated landscapes face challenges linked to their potential costs. Conservation covenants on private land may represent a cost-effective alternative to land purchase, although many questions on the long-term monitoring and enforcement costs of covenants and the risk of violation or legal challenges remain unquantified. We explore the cost-effectiveness of conservation covenants, defined here as the fraction of the high-biodiversity landscape potentially protected via investment in covenants versus land purchase. We show that covenant violation and dispute rates substantially affect the estimated long-term cost-effectiveness of a covenant versus land purchase strategy. Our results suggest the long-term cost-effectiveness of conservation covenants may outperform land purchase as a strategy to protect biodiversity as long as disputes and legal challenges are low, but point to a critical need for monitoring data to reduce uncertainty and maximize conservation investment cost-effectiveness.

scholarly journals 1-year cost-utility analysis of prostate artery embolization (PAE) versus transurethral resection of the prostate (TURP) in benign prostatic hyperplasia (BPH)

2021 ◽  
Vol 3 (1) ◽  
pp. e000071
Author(s):  
Nikisha Patel ◽  
Nathan Yung ◽  
Ganesh Vigneswaran ◽  
Laure de Preux ◽  
Drew Maclean ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Artery Embolization ◽  
Prostate Artery Embolization ◽  
Cost Effective Alternative ◽  
The Cost

ObjectiveTo determine whether prostate artery embolization (PAE) is a cost-effective alternative to transurethral resection of the prostate (TURP) in the management of benign prostate hyperplasia (BPH) after 1-year follow-up.Design, setting and main outcome measuresA retrospective cost-utility analysis over a 12-month time period was conducted to compare the two interventions from a National Health Service perspective. Effectiveness was measured as quality-adjusted life years (QALYs) derived from data collected during the observational UK Register of Prostate Embolisation (UK-ROPE) Study. Costs for both PAE and TURP were derived from University Hospital Southampton, a tertiary referral centre for BPH and the largest contributor to the UK-ROPE. An incremental cost-effectiveness ratio (ICER) was derived from cost and QALY values associated with both interventions to assess the cost-effectiveness of PAE versus TURP. Further sensitivity analyses involved a decision tree model to account for the impact of patient-reported complications on the cost-effectiveness of the interventions.ResultsThe mean patient age for TURP (n=31) and PAE (n=133) was 69 and 65.6 years, respectively. In comparison to TURP, PAE was cheaper due to shorter patient stays and the lack of necessity for an operating theatre. Analysis revealed an ICER of £64 798.10 saved per QALY lost when comparing PAE to TURP after 1-year follow-up.ConclusionOur findings suggest that PAE is initially a cost-effective alternative to TURP for the management of BPH after 1-year follow-up. Due to a higher reintervention rate in the PAE group, this benefit may be lost in subsequent years.Trial registration numberNCT02434575.

scholarly journals Efficient routes to land conservation given risk of covenant failure

2015 ◽  
Author(s):  
Richard Schuster ◽  
Peter Arcese
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Private Land ◽  
Legal Challenges ◽  
Monitoring And Enforcement ◽  
Cost Effective Alternative ◽  
The Cost ◽  
Conservation Investment ◽  
Term Monitoring

Conservation initiatives to protect valued species communities in human-dominated landscapes face challenges linked to their potential costs. Conservation covenants on private land may represent a cost-effective alternative to land purchase, although many questions on the long-term monitoring and enforcement costs of covenants and the risk of violation or legal challenges remain unquantified. We explore the cost-effectiveness of conservation covenants, defined here as the fraction of the high-biodiversity landscape potentially protected via investment in covenants versus land purchase. We show that covenant violation and dispute rates substantially affect the estimated long-term cost-effectiveness of a covenant versus land purchase strategy. Our results suggest the long-term cost-effectiveness of conservation covenants may outperform land purchase as a strategy to protect biodiversity as long as disputes and legal challenges are low, but point to a critical need for monitoring data to reduce uncertainty and maximize conservation investment cost-effectiveness.

scholarly journals Cost/effectiveness analysis of atorvastatin in patients with acute coronary syndromes

2010 ◽  
Vol 11 (2) ◽  
pp. 83-89 ◽  
Author(s):  
Simona Cammarota ◽  
Enrica Menditto ◽  
Daria Putignano ◽  
Anna Citarella
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Standard Dose ◽  
Cost Effective ◽  
High Dose ◽  
Effectiveness Analysis ◽  
Italian National Health Service ◽  
Coronary Syndromes ◽  
Italian National Health ◽  
The Cost

Introduction: recent clinical trials found that high-dose statin therapy, compared with conventional-dose statin therapy, reduces the risk of cardiovascular events in patients with acute coronary syndromes (ACS) and stable coronary artery disease (CAD). With the introduction of simvastatin and pravastatin generics and the next patent expiration of atorvastatin, projected for 2011 in Italy, it is natural to ask: what is the most cost-effective treatment for a rational use of resources?Aim: the aim of this study was to estimate the cost-effectiveness of high-dose atorvastatin versus conventional standard-dose statins based on the scenario of atovastatin price evolution.Methods: a cost-effectiveness analysis was conducted in the perspective of the Italian National Health Service over the 4.9 years time horizon. Clinical data were obtained from a pooled analyses of the 3 clinical trials that directly compared high-dose atorvastatin with conventional standard-dose statins in patients with either ACS or CAD. Hospitalizations were quantified based on the Italian National Health Service tariffs and drug costs according to the Italian National Therapeutic Formulary (2009). Assuming the cost of atorvastatin reduces in line with that observed for simvastatin when the patent expires, 3 scenarios were constructed: atorvastatin current price (scenario 1); 55% price discount (scenario 2); 65% price discount (scenario 3). Effects were measured in terms of primary composite endpoint (coronary death or any adverse cardiovascular event). All costs were discounted at 3% per annum. Sensitivity analyses were performed to assess the robustness of findings. Results: intensive therapy with atorvastatin provided a hospitalization cost saving of 245,519.36 € per 1,000 patients. Under the assumptions established for scenario 1 and scenario 2, the incremental cost-effectiveness of treatment with atorvastatin 80 mg was estimated to be 20,289.72 € and 917.05 € for patient free from event, respectively; it was cost-saving for the scenario 3. Conclusions: high-dose atorvastatin represented a cost-effective use of healthcare resources in Italy. If the cost of atorvastatin reduces by 65% when the patent expires, for every million patient with SCA or CAD stable, treated for 5 years, the high-dose atorvastatin strategy potentially yields a cost-saving of ~2,4 billion € for the NHS.

scholarly journals Markov Models for Economic Evaluation in Osteoporosis Treatment

Mathematics ◽  
2021 ◽  
Vol 9 (18) ◽  
pp. 2331
Author(s):  
Marta Osca-Guadalajara ◽  
Javier Díaz-Carnicero ◽  
Silvia González-de-Julián ◽  
David Vivas-Consuelo
Keyword(s):  
Cost Effectiveness ◽  
Age Of Onset ◽  
Bone Fractures ◽  
Cost Effective ◽  
Osteoporosis Treatment ◽  
Effective Alternative ◽  
Duration Of Treatment ◽  
Life Years ◽  
Cost Effective Alternative ◽  
The Cost

Osteoporosis is frequent in elderly people, causing bone fractures and lowering their quality of life. The costs incurred by these fractures constitute a problem for public health. Markov chains were used to carry out an incremental cost-utility analysis of the four main drugs used in Spain to treat osteoporosis (alendronate, risedronate, denosumab and teriparatide). We considered 14 clinical transition states, from starting osteoporotic treatment at the age of 50 until death or the age of 100. Cost-effectiveness was measured by quality adjusted life years (QALYs). The values used in the Markov model were obtained from the literature. Teriparatide is the cost-effective alternative in the treatment of osteoporosis in patients with fractures from the age of 50, establishing a payment threshold of 20,000 EUR/QALY. However, it is the most expensive therapy, not appearing cost-effective in cases that do not present fracture and in ages over 80 years with fracture. Alendronate and denosumab therapies are presented as cost-effective osteoporosis treatment alternatives depending on the age of onset and duration of treatment. From the perspective of cost-effectiveness, establishing a payment threshold of 20,000 EUR/QALY, teriparatide is the cost-effective alternative in patients with fracture from the age of 50 to 70 years old in Spain.

scholarly journals Economic evaluation of orphan drug Lutetium-Octreotate vs. Octreotide long-acting release for patients with an advanced midgut neuroendocrine tumour in the Netherlands

2021 ◽  
Author(s):  
Marije E. Hagendijk ◽  
Simon van der Schans ◽  
Cornelis Boersma ◽  
Maarten J. Postma ◽  
Simon van der Pol
Keyword(s):  
Cost Effectiveness ◽  
The Netherlands ◽  
Price Level ◽  
Cost Effective ◽  
List Price ◽  
High Dose ◽  
Positive Effects ◽  
Long Acting ◽  
The Cost ◽  
The Impact

Abstract Objectives Multiple studies showed positive effects of Lutetium-Octreotate (LO) treatment in neuroendocrine tumours. LO has been used in the Netherlands since the 1980s and recently received the orphan status shortly after the acquisition by Novartis. Since then, the official list price has increased sixfold. From a value-based pricing perspective, we analysed the impact of the increase in price on the incremental cost-effectiveness ratio (ICER) of LO treatment compared to optimal best supportive care, a high dose of Octreotide long-acting release (O-LAR), using the clinical data of the NETTER-1 trial. Methods A Markov model was developed to evaluate the costs per quality-adjusted life-year (QALY) for LO treatment compared to O-LAR from the healthcare perspective. A scenario analysis was conducted to compare the cost-effectiveness with the initial and increased price level of the LO-treatment. Results At the increased price level, the cost-effectiveness analysis rendered a deterministic ICER of €53,500 per QALY, while at the initial pricing, the ICER was €19,000 per QALY. The probabilistic sensitivity analysis (PSA) showed that LO had a high probability of being cost-effective at both the increased and initial price level, considering a cost-effectiveness threshold of €80,000. Conclusions Even at the increased price level, LO treatment can still be considered cost-effective using the applicable Dutch willingness-to-pay threshold of 80,000 euro per QALY. Considering the public scrutiny in relation to this price increase, these outcomes raise the question whether traditional cost-effectiveness methods are sufficient in fully capturing the societal acceptance of prices of new medicines.

scholarly journals Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study

Vaccines ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 707
Author(s):  
Afifah Machlaurin ◽  
Franklin Christiaan Karel Dolk ◽  
Didik Setiawan ◽  
Tjipke Sytse van der Werf ◽  
Maarten J. Postma
Keyword(s):  
Cost Effectiveness ◽  
Univariate Analysis ◽  
Cost Effective ◽  
Epidemiological Data ◽  
Control Programme ◽  
Detection Rates ◽  
Middle Income ◽  
Bcg Vaccination ◽  
Life Years ◽  
The Cost

Bacillus Calmette–Guerin (BCG), the only available vaccine for tuberculosis (TB), has been applied for decades. The Indonesian government recently introduced a national TB disease control programme that includes several action plans, notably enhanced vaccination coverage, which can be strengthened through underpinning its favourable cost-effectiveness. We designed a Markov model to assess the cost-effectiveness of Indonesia’s current BCG vaccination programme. Incremental cost-effectiveness ratios (ICERs) were evaluated from the perspectives of both society and healthcare. The robustness of the analysis was confirmed through univariate and probabilistic sensitivity analysis (PSA). Using epidemiological data compiled for Indonesia, BCG vaccination at a price US$14 was estimated to be a cost-effective strategy in controlling TB disease. From societal and healthcare perspectives, ICERs were US$104 and US$112 per quality-adjusted life years (QALYs), respectively. The results were robust for variations of most variables in the univariate analysis. Notably, the vaccine’s effectiveness regarding disease protection, vaccination costs, and case detection rates were key drivers for cost-effectiveness. The PSA results indicated that vaccination was cost-effective even at US$175 threshold in 95% of cases, approximating the monthly GDP per capita. Our findings suggest that this strategy was highly cost-effective and merits prioritization and extension within the national TB programme. Our results may be relevant for other high endemic low- and middle-income countries.

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