When is critical care medicine cost-effective? A systematic review of the cost-effectiveness literature*

2006 ◽  
Vol 34 (11) ◽  
pp. 2738-2747 ◽  
Author(s):  
Daniel Talmor ◽  
Nathan Shapiro ◽  
Dan Greenberg ◽  
Patricia W. Stone ◽  
Peter J. Neumann
Keyword(s):  
Systematic Review ◽  
Critical Care ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Critical Care Medicine ◽  
The Cost

The Critical Care Medicine Research: A Systematic Review

2020 ◽  
Author(s):  
Kawthar Hasan Jasim
Keyword(s):  
Systematic Review ◽  
Critical Care ◽  
Cost Effectiveness ◽  
Impact Factor ◽  
Journal Impact Factor ◽  
Journal Citation Report ◽  
Critical Care Medicine ◽  
Medicine Research ◽  
The Cost ◽  
Journal Impact

Objectives: The cost-effectiveness terminology is a common term used in the critical care medicine research. A systematic review analysis was conducted to study the patterns of the use and misuse of the cost-effectiveness terminology in the critical care medicine literature between 1998 and 2018. Methods: A search in the inCite journal citation report was done to identify all the critical care medicine journals. An independednt search done to identify all the articles between 1980 to 2018 that claimed in their abstracts/article to perform a cost-effectiveness analysis (CEA). Eligible articles were included and analyzed using x2-test. The articles were categorized into four different levels based on the appropriateness of CEA terminology use. The analysis performed to assess the association between the appropriateness of CEA terminology and the journal impact factor (IF), author background, and the publication year (5-year time points). Results: Out of 7,835 articles in targeted subject category, 76 met the inclusion criteria, but 50 of them were analyzed. Of these 50 articles, 32 (64.0%) met the appropriate criterion of CEA terminology use. 71.4% of articles published in journals with IF: 3.0 - 21.4 were appropriately using CEA term compared to 54.5% studies that are published in journals with IF: 0.4 - 2.8. Of these articles, which are appropriately use CEA terminology, 56.2% of the articles have at least one author with health economics expertise. Conclusion and recommendation: The preliminary data suggest that there is an association between the level of appropriateness and journal impact factor and the author health-economic background authorship. However, we did not demonstrate changes in the level of appropriateness with time. Decision-makers, authors, and editors should pay better attention in seeking ways to monitor the appropriate use of “cost-effectiveness” terminology. More future studies should be done in this context.

scholarly journals Systematic review of health economic studies in cranial neurosurgery

2018 ◽  
Vol 44 (5) ◽  
pp. E2 ◽  
Author(s):  
Won Hyung A. Ryu ◽  
Michael M. H. Yang ◽  
Sandeep Muram ◽  
W. Bradley Jacobs ◽  
Steven Casha ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Cost Effectiveness ◽  
Acute Ischemic Stroke ◽  
Cost Effective ◽  
Current Evidence ◽  
Cochrane Library ◽  
Endovascular Thrombectomy ◽  
Life Years ◽  
The Cost

OBJECTIVEAs the cost of health care continues to increase, there is a growing emphasis on evaluating the relative economic value of treatment options to guide resource allocation. The objective of this systematic review was to evaluate the current evidence regarding the cost-effectiveness of cranial neurosurgery procedures.METHODSThe authors performed a systematic review of the literature using PubMed, EMBASE, and the Cochrane Library, focusing on themes of economic evaluation and cranial neurosurgery following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Included studies were publications of cost-effectiveness analysis or cost-utility analysis between 1995 and 2017 in which health utility outcomes in life years (LYs), quality-adjusted life years (QALYs), or disability-adjusted life years (DALYs) were used. Three independent reviewers conducted the study appraisal, data abstraction, and quality assessment, with differences resolved by consensus discussion.RESULTSIn total, 3485 citations were reviewed, with 53 studies meeting the inclusion criteria. Of those, 34 studies were published in the last 5 years. The most common subspecialty focus was cerebrovascular (32%), followed by neurooncology (26%) and functional neurosurgery (24%). Twenty-eight (53%) studies, using a willingness to pay threshold of US$50,000 per QALY or LY, found a specific surgical treatment to be cost-effective. In addition, there were 11 (21%) studies that found a specific surgical option to be economically dominant (both cost saving and having superior outcome), including endovascular thrombectomy for acute ischemic stroke, epilepsy surgery for drug-refractory epilepsy, and endoscopic pituitary tumor resection.CONCLUSIONSThere is an increasing number of cost-effectiveness studies in cranial neurosurgery, especially within the last 5 years. Although there are numerous procedures, such as endovascular thrombectomy for acute ischemic stroke, that have been conclusively proven to be cost-effective, there remain promising interventions in current practice that have yet to meet cost-effectiveness thresholds.

scholarly journals TECHNIQUES FOR DIAGNOSING OSTEOPOROSIS: A SYSTEMATIC REVIEW OF COST-EFFECTIVENESS STUDIES

2014 ◽  
Vol 30 (3) ◽  
pp. 273-281 ◽  
Author(s):  
Davide Minniti ◽  
Ottavio Davini ◽  
Maria Rosaria Gualano ◽  
Maria Michela Gianino
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Postmenopausal Women ◽  
Cost Effective ◽  
Economic Evaluations ◽  
Clear Cut ◽  
Step Procedure ◽  
Database Research ◽  
The Cost ◽  
Effectiveness Studies

Objectives:The study question was whether dual-energy X-ray absorptiometry (DXA) alone is more cost-effective for identifying postmenopausal women with osteoporosis than a two-step procedure with quantitative ultrasound sonography (QUS) plus DXA. To answer this question, a systematic review was performed.Methods:Electronic databases (PubMed, INAHTA, Health Evidence Network, NIHR, the Health Technology Assessment program, the NHS Economic Evaluation Database, Research Papers in Economics, Web of Science, Scopus, and EconLit) were searched for cost-effectiveness publications. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using the Drummond checklist.Results:Seven journal articles and four reports were reviewed. The cost per true positive case diagnosed by DXA was found to be higher than that for diagnosis by QUS+DXA in two articles. In one article it was found to be lower. In three studies, the results were not conclusive. These articles were characterized by the differences in the types of devices, parameters and thresholds on the QUS and DXA tests and the unit costs of the DXA and QUS tests as well as by variability in the sensitivity and specificity of the techniques and the prevalence of osteoporosis.Conclusions:The publications reviewed did not provide clear-cut evidence for drawing conclusions about which screening test may be more cost-effective for identifying postmenopausal women with osteoporosis.

COST-EFFECTIVENESS OF ADHERENCE INTERVENTIONS FOR HIGHLY ACTIVE ANTIRETROVIRAL THERAPY: A SYSTEMATIC REVIEW

2013 ◽  
Vol 29 (3) ◽  
pp. 227-233 ◽  
Author(s):  
Tim Mathes ◽  
Dawid Pieper ◽  
Sunya-Lee Antoine ◽  
Michaela Eikermann
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Baseline Scenario ◽  
Highly Active ◽  
Adherence Interventions ◽  
The Cost

Objectives: The objective of this systematic review was to evaluate the cost-effectiveness of interventions aiming to increase the adherence to highly active antiretroviral therapy (HAART) in HIV-infected patients in developed countries (WHO stratum A).Methods: A systematic search for comparative health economic studies was conducted in the following databases: EMBASE, MEDLINE, NHS Economic Evaluation Database, CINAHL, HEED, and EconLit. The identified publications were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Furthermore, these were evaluated according to a standardized checklist and finally extracted, analyzed, and summarized.Results: After reviewing the abstracts and full texts four relevant studies were identified. Different educational programs were compared as well as the Directly Observed Therapy (DOT). A critical aspect to be considered in particular was the poor transparency of the cost data. In three cost-utility analyses the costs per quality-adjusted life-year (QALY) in the baseline scenario were each under USD 15,000. The sensitivity analyses with a presumed maximum threshold of USD 50,000/QALY showed a predominantly cost-effective result. In one study that examined DOT the costs add up to over USD 150,000/QALY.Conclusions: It seems that adherence interventions for HAART in HIV-infected patients can be cost-effective. Nevertheless, the quality of the included studies is deficient and only a few of the possible adherence interventions are taken into consideration. A final assessment of the cost-effectiveness of adherence interventions in general is, therefore, not possible.

scholarly journals Can polygenic risk scores contribute to cost-effective cancer screening? A systematic review

2021 ◽  
Author(s):  
Padraig Dixon ◽  
Edna Keeney ◽  
Jenny C Taylor ◽  
Sarah Wordsworth ◽  
Richard Martin
Keyword(s):  
Systematic Review ◽  
Health Economic ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Cost Effective ◽  
Risk Scores ◽  
Polygenic Risk ◽  
The Cost ◽  
Economic Studies

Polygenic risk is known to influence susceptibility to cancer. The use of data on polygenic risk, in conjunction with other predictors of future disease status, may offer significant potential for preventative care through risk-stratified screening programmes. An important element in the evaluation of screening programmes is their cost-effectiveness. We undertook a systematic review of papers evaluating the cost-effectiveness of screening interventions informed by polygenic risk scores compared to more conventional screening modalities. We included papers reporting cost-effectiveness outcomes in the English language published as articles or uploaded onto preprint servers with no restriction on date, type of cancer or form of polygenic risk modelled. We excluded papers evaluating screening interventions that did not report cost-effectiveness outcomes or which had a focus on monogenic risk. We evaluated studies using the Quality of Health Economic Studies checklist. Ten studies were included in the review, which investigated three cancers: prostate (n=5), colorectal (n=3) and breast (n=2). All study designs were cost-utility papers implemented as Markov models (n=6) or microsimulations (n=4). Nine of ten papers scored highly (score >75 on a 0-100) scale) when assessed using the Quality of Health Economic Studies checklist. Eight of ten studies concluded that polygenic risk informed cancer screening was likely to be more cost-effective than alternatives. However, the included studies lacked robust external data on the cost of polygenic risk stratification, did not account for how very large volumes of polygenic risk data on individuals would be collected and used, did not consider ancestry-related differences in polygenic risk, and did not fully account for downstream economic sequalae stemming from the use of polygenic risk data in these ways. These topics merit attention in future research on how polygenic risk data might contribute to cost-effective cancer screening.

A Systematic Review of the Cost-Effectiveness of Recombinant Factor VIIa (rFVIIa) and Activated Prothrombin Complex Concentrate (aPCC) in the Treatment of Mild to Moderate Bleeding Episodes for Haemophilia Patients with Inhibitors

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4678-4678
Author(s):  
Chris Knight ◽  
Anne Møller Danø ◽  
Tessa Kennedy-Martin
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Factor Viia ◽  
Cost Effective ◽  
Primary Treatment ◽  
Cost Utility ◽  
Economic Consequences ◽  
Modelling Framework ◽  
The Cost

Abstract Objectives: Although haemophilia patients with inhibitors are rare, the clinical, humanistic and economic consequences associated with this disorder are considerable. The primary treatment for such patients is either rFVIIa or aPCC. The aim of this study was to identify, review and evaluate the quality of the published literature on the relative cost-effectiveness of rFVIIa and aPCC in treating haemophilia patients with inhibitors. Methods: The review concentrates on the model type, the model design, model assumptions, and results. Results: The results of this study suggest that rFVIIa may be the cost-effective alternative to treatment with aPCC due to the superior efficacy of rFVIIa and hence the avoidance of subsequent lines of treatment. In 7 of the 9 studies, rFVIIa had the lower average treatment cost. The adapted modelling framework is similar in all the economic models reviewed, suggesting clinical acceptability of the approach used. The estimates of efficacy varied between the models, especially for aPCC. The efficacy for aPCC derived from retrospective studies was lower than reported in the literature. Sensitivity analysis had been undertaken in the majority of the economic analyses and the results were found to be robust to realistic parameter variations. Only one of the studies was a cost-utility study, showing the lack of measuring health status within this area. The results showed the large impact appropriate treatment can have on the quality of life for haemophilia patients with inhibitors. Conclusions: Ideally, there should be a systematic approach to identifying the relevant data and the lack of data from relevant randomized head-to-head trials is a contributing factor to the variation in efficacy rates and average dosages assumed. However, this systematic review has shown that despite differences in the estimates of efficacy, average dosage required, and unit costs the overall results are robust and appear to favour rFVIIa as the cost-effectiveness treatment for haemophilia patients with inhibitors.

Strategies for the Management of Hypercholesterolaemia: A Systematic Review of the Cost-Effectiveness Literature

1997 ◽  
Vol 2 (4) ◽  
pp. 231-250 ◽  
Author(s):  
Stephen Morris ◽  
Alistair McGuire ◽  
Jaime Caro ◽  
Daniel Pettitt
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
The Elderly ◽  
Pharmacological Intervention ◽  
Dietary Advice ◽  
Economic Evaluations ◽  
Economic Modelling ◽  
Cholesterol Management ◽  
The Cost

Objective: To review research addressing the management of cholesterol in the prevention of coronary heart disease in order to assess the cost-effectiveness of such interventions. Methods: A systematic review of economic evaluations identified through searches of MEDLINE and the Social Sciences Citation Index revealed 38 studies addressing the cost-effectiveness of cholesterol management. They were distinguished according to screening approaches, dietary advice and drug treatment. Most studies were not associated directly with clinical trial results, but adopted economic modelling approaches. Results: Whilst there is general agreement among the majority of analyses, studies of cholesterol management concerned with screening strategies were extremely sensitive to changes in their assumptions; so much so that only a limited emphasis may be placed on specific cost-effectiveness ratios and the conclusions drawn from them. All studies considered direct costs, though many were limited to drug costs. The cost-effectiveness of primary prevention by cholesterol-lowering drugs is highly variable, depending on age at initiation of treatment and cardiovascular risk profile. Pharmacological intervention is least cost-effective in the young and the elderly. The cost-effectiveness of cholesterol-reducing agents improves when they are targeted at those at high risk. HMG-CoA reductase inhibitors are generally more effective and more cost-effective at reducing cholesterol-related coronary events than other medications. Conclusion: The methods and economic data upon which these studies are based need to be improved if robust policy conclusions are to be formulated.

scholarly journals Assessment of Cost-Effectiveness on Remote Monitoring for Cardiovascular Devices in Japan

2019 ◽  
Vol 11 (11) ◽  
pp. 1
Author(s):  
Tomoya Shirane
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Remote Monitoring ◽  
Social Insurance ◽  
Cost Effective ◽  
Flow Diagram ◽  
Medical Council ◽  
Remote Monitoring System ◽  
Life Years ◽  
The Cost

BACKGROUND: 2018 revision of the health insurance reimbursement in Japan brought additional fee for Cardiovascular Implantable Electronic Devices (CIEDs) Management by Remote Monitoring. The adaption of CIEDs Remote Monitoring has already been recommended by the societies, but the cost-effectiveness evaluation about the system has not been enough. This research was designed, therefore, to evaluate the cost-effectiveness about CIEDs Remote Monitoring in Japan. METHODS: A systematic review was conducted along with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Certain criteria and search strategy were pre-defined to identify studies that could be included into this research. The process of the quality assessments was planned by Critical Appraisal Skills Programme (CASP). Quality Adjusted Life Years (QALYs) that were extracted from the included studies would be calculated into Incremental Cost-Effectiveness Ratio (ICER) with the reimbursement amount in Japan. RESULTS: Three studies met the systematic review criteria after the selection along with PRISMA flow diagram. The quality of the included studies was assured by CASP Checklists designed for RCT and Cohort Study. ICERs from the selected studies were provided as 569,697 JPY, 1,220,000 JPY, and 311, 111 JPY for the patient groups enrolled with Remote Monitoring system. CONCLUSION: ICERs for CIEDs Remote Monitoring were demonstrated as the cost-effective under the threshold set by Central Social Insurance Medical Council (Chuikyo). As this study put the validity of the cost-effectiveness approach in a certain field in Japan, this kind of evaluation should be performed on more areas along with the guideline by Chuikyo.

scholarly journals The Cost-Effectiveness of Digital Health Interventions on the Management of Cardiovascular Diseases: Systematic Review (Preprint)

2018 ◽  
Author(s):  
Xinchan Jiang ◽  
Wai-Kit Ming ◽  
Joyce HS You
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Digital Health ◽  
Cost Effective ◽  
Time Frame ◽  
Health Interventions ◽  
Decision Analytic Model ◽  
Analytic Model ◽  
Model Based ◽  
The Cost

BACKGROUND With the advancement in information technology and mobile internet, digital health interventions (DHIs) are improving the care of cardiovascular diseases (CVDs). The impact of DHIs on cost-effective management of CVDs has been examined using the decision analytic model–based health technology assessment approach. OBJECTIVE The aim of this study was to perform a systematic review of the decision analytic model–based studies evaluating the cost-effectiveness of DHIs on the management of CVDs. METHODS A literature review was conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature Complete, PsycINFO, Scopus, Web of Science, Center for Review and Dissemination, and Institute for IEEE Xplore between 2001 and 2018. Studies were included if the following criteria were met: (1) English articles, (2) DHIs that promoted or delivered clinical interventions and had an impact on patients’ cardiovascular conditions, (3) studies that were modeling works with health economic outcomes of DHIs for CVDs, (4) studies that had a comparative group for assessment, and (5) full economic evaluations including a cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, and cost-consequence analysis. The primary outcome collected was the cost-effectiveness of the DHIs, presented by incremental cost per additional quality-adjusted life year (QALY). The quality of each included study was evaluated using the Consolidated Health Economic Evaluation Reporting Standards. RESULTS A total of 14 studies met the defined criteria and were included in the review. Among the included studies, heart failure (7/14, 50%) and stroke (4/14, 29%) were two of the most frequent CVDs that were managed by DHIs. A total of 9 (64%) studies were published between 2015 and 2018 and 5 (36%) published between 2011 and 2014. The time horizon was ≤1 year in 3 studies (21%), >1 year in 10 studies (71%), and 1 study (7%) did not declare the time frame. The types of devices or technologies used to deliver the health interventions were short message service (1/14, 7%), telephone support (1/14, 7%), mobile app (1/14, 7%), video conferencing system (5/14, 36%), digital transmission of physiologic data (telemonitoring; 5/14, 36%), and wearable medical device (1/14, 7%). The DHIs gained higher QALYs with cost saving in 43% (6/14) of studies and gained QALYs at a higher cost at acceptable incremental cost-effectiveness ratio (ICER) in 57% (8/14) of studies. The studies were classified as excellent (0/14, 0%), good (9/14, 64%), moderate (4/14, 29%), and low (1/14, 7%) quality. CONCLUSIONS This study is the first systematic review of decision analytic model–based cost-effectiveness analyses of DHIs in the management of CVDs. Most of the identified studies were published recently, and the majority of the studies were good quality cost-effectiveness analyses with an adequate duration of time frame. All the included studies found the DHIs to be cost-effective.

scholarly journals Cost-effectiveness of mandatory folic acid fortification of flours in prevention of neural tube defects: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258488
Author(s):  
Viviane Belini Rodrigues ◽  
Everton Nunes da Silva ◽  
Maria Leonor Pacheco Santos
Keyword(s):  
Systematic Review ◽  
Folic Acid ◽  
Cost Effectiveness ◽  
Neural Tube ◽  
Neural Tube Defects ◽  
Cost Benefit Analysis ◽  
Cost Effective ◽  
Quality Analysis ◽  
Positive Health ◽  
The Cost

Background Neural tube defects (NTDs) constitute the most frequent group among congenital malformations and are the main cause of neonatal morbimortality. Folic acid (FA) can reduce the risk of pregnancies affected by NTDs. Objective We aimed to investigate whether mandatory folic acid (FA) fortification of flours is cost-effective as compared to non-mandatory fortification, and to verify whether FA dosage, cost composition, and the quality of economic studies influence the cost-effectiveness of outcomes. Methods We conducted a systematic review. The protocol was registered on PROSPERO (CRD 42018115682). A search was conducted using the electronic databases MEDLINE/PubMed, Web of Science, Embase, Scopus, and EBSCO/CINAHL between January 2019 and October 2020 and updated in February 2021. Eligible studies comprised original economic analyses of mandatory FA fortification of wheat and corn flours (maize flours) compared to strategies of non-mandatory fortification in flours and/or use of FA supplements for NTD prevention. The Drummond verification list was used for quality analysis. Results A total of 7,859 studies were identified, of which 13 were selected. Most (77%; n = 10) studies originated from high-income countries, while three (23%) were from upper-middle-income countries. Results of a cost-effectiveness analysis showed that fortification is cost-effective for NTD prevention, except for in one study in New Zealand. The cost-benefit analysis yielded a median ratio of 17.5:1 (0.98:1 to 417.1:1), meaning that for each monetary unit spent in the program, there would be a return of 17.5 monetary units. Even in the most unfavorable case of mandatory fortification, the investment in the program would virtually payoff at a ratio of 1:0.98. All FA dosages were cost-effective and offered positive health gains, except in one study. The outcomes of two studies showed that FA dosages above 300 μg/100 g have a higher CBA ratio. The studies with the inclusion of “loss of consumer choice” in the analysis may alter the fortification cost-efficacy ratio. Conclusion We expect the findings to be useful for public agencies in different countries in decision-making on the implementation and/or continuity of FA fortification as a public policy in NTD prevention.

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