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

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.

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O124 : Is increased HCV case-finding combined with 8 or 12 week interferon-free direct-acting antiviral treatment cost-effective in UK prisons? a cost utility analysis including treatment as prevention benefits

Journal of Hepatology ◽

10.1016/s0168-8278(15)30143-4 ◽

2015 ◽

Vol 62 ◽

pp. S255-S256 ◽

Cited By ~ 1

Author(s):

N.K. Martin ◽

P. Vickerman ◽

I.F. Brew ◽

J. Williamson ◽

W.J. Irving ◽

...

Keyword(s):

Treatment Cost ◽

Antiviral Treatment ◽

Cost Effective ◽

Cost Utility ◽

Case Finding ◽

Cost Utility Analysis ◽

Treatment As Prevention ◽

Utility Analysis ◽

Direct Acting Antiviral ◽

Direct Acting

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Identifying The Most Cost-Effective Way of Diagnosing Asthma In Adults Using Multiple Tests – A Cost-Utility Analysis From The Nice Asthma Guideline

Value in Health ◽

10.1016/j.jval.2015.09.698 ◽

2015 ◽

Vol 18 (7) ◽

pp. A361

Author(s):

A Haines ◽

E Davies ◽

B Higgins ◽

A Menzies-Gow ◽

M Thomas ◽

...

Keyword(s):

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Multiple Tests ◽

Asthma Guideline

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Cost-Utility Analysis of Tympanomastoidectomy for Adults with Chronic Suppurative Otitis Media

Otolaryngology ◽

10.1016/j.otohns.2005.05.045 ◽

2005 ◽

Vol 133 (3) ◽

pp. 352-356 ◽

Cited By ~ 8

Author(s):

Pa-Chun Wang ◽

Chul-Ho Jang ◽

Yu-Hsiang Shu ◽

Chih-Jaan Tai ◽

Ko-Tsung Chu

Keyword(s):

Otitis Media ◽

Health Care Cost ◽

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Chronic Suppurative Otitis Media ◽

Total Direct Cost ◽

Utility Analysis ◽

Suppurative Otitis Media ◽

Utility Gain

OBJECTIVE: To undertake cost-utility analysis for tympanomastoid surgery to analyze its cost-effectiveness in treating adult chronic suppurative otitis media (CSOM). METHODS: Seventy-seven patients with CSOM were evaluated with the Chronic Ear Survey (CES) before and 1 year after tympanomastoid surgery. Direct health care cost data during the 1st year after operation were retrieved. The utility gain was defined as change in the CES total score. The cost-utility ratio (CUR) was defined as cost per utility gain. Patients were stratified by disease type into wet-ear and dry-ear groups. RESULTS: The average total direct cost attributable to tympanomastoid surgery is (in New Taiwan dollars [NT$]) 45,716.3 in the 1st postoperative year, and the average CUR is NT$ 1850.9. The lower CUR of NT$ 1280.9 for the wet-ear group is due to the greater utility gain (37.6 ± 3.4 versus 24.4 ± 6.8, P >0.05) despite its higher cost (NT$ 48,163.2 versus NT$ 38,419.7, P >0.05). CONCLUSIONS: Treating continuously or intermittently draining ears is more cost-effective, as compared with managing a quiescent infection, because of its favorable utility gain.

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Economic Evaluation of an Internet-Based Stress Management Intervention Alongside a Randomized Controlled Trial (Preprint)

10.2196/preprints.10866 ◽

2018 ◽

Author(s):

Fanny Kählke ◽

Claudia Buntrock ◽

Filip Smit ◽

Matthias Berking ◽

Dirk Lehr ◽

...

Keyword(s):

Cost Effectiveness ◽

Stress Management ◽

Perceived Stress ◽

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Management Interventions ◽

Life Years ◽

The Cost

BACKGROUND Work-related stress is widespread among employees and associated with high costs for German society. Internet-based stress management interventions (iSMIs) are effective in reducing such stress. However, evidence for their cost-effectiveness is scant. OBJECTIVE The aim of this study was to assess the cost-effectiveness of a guided iSMI for employees. METHODS A sample of 264 employees with elevated symptoms of perceived stress (Perceived Stress Scale≥22) was assigned to either the iSMI or a waitlist control condition (WLC) with unrestricted access to treatment as usual. Participants were recruited in Germany in 2013 and followed through 2014, and data were analyzed in 2017. The iSMI consisted of 7 sessions plus 1 booster session. It was based on problem-solving therapy and emotion regulation techniques. Costs were measured from the societal perspective, including all direct and indirect medical costs. We performed a cost-effectiveness analysis and a cost-utility analysis relating costs to a symptom-free person and quality-adjusted life years (QALYs) gained, respectively. Sampling uncertainty was handled using nonparametric bootstrapping (N=5000). RESULTS When the society is not willing to pay anything to get an additional symptom-free person (eg, willingness-to-pay [WTP]=€0), there was a 70% probability that the intervention is more cost-effective than WLC. This probability rose to 85% and 93% when the society is willing to pay €1000 and €2000, respectively, for achieving an additional symptom-free person. The cost-utility analysis yielded a 76% probability that the intervention is more cost-effective than WLC at a conservative WTP threshold of €20,000 (US $25,800) per QALY gained. CONCLUSIONS Offering an iSMI to stressed employees has an acceptable likelihood of being cost-effective compared with WLC. CLINICALTRIAL German Clinical Trials Register DRKS00004749; https://www.drks.de/DRKS00004749 INTERNATIONAL REGISTERED REPOR RR2-10.1186/1471-2458-13-655

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Cost-utility analysis of an implant treatment in dentistry

BMC Oral Health ◽

10.1186/s12903-021-01790-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Johana Losenická ◽

Ondřej Gajdoš ◽

Vojtěch Kamenský

Keyword(s):

Markov Models ◽

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Dental Prosthesis ◽

Utility Analysis ◽

Fixed Dental Prosthesis ◽

Single Crown ◽

Implant Treatment ◽

Missing Tooth

Abstract Background When dealing with the replacement of one missing tooth, the patient has the option of choosing between different types of treatment interventions. Several important factors play a role in his decision-making process, including his limited financial means and his efforts to solve the problem of missing teeth as effectively as possible. The main goal of the study is the economic-clinical evaluation of implant treatment, as a surgical-prosthetic method in dentistry, in case of replacement of one missing tooth of the molar area. Methods Cost-utility analysis from the patient's perspective is used for evaluation. The selected comparator is a purely prosthetic solution with the help of a three-unit fixed dental prosthesis. Cost-utility analysis is modelled using Markov models, which consider a 30-year time horizon. Results Based on the results of modelling, the intervention evaluated by the patient, i.e. treatment with the help of implant-supported single crown, brings exactly 15.31 quality-adjusted prosthesis years (QAPY) after 30 years. The value of incremental cost-utility ratio amounted to USD − 1434. Conclusion The results of the cost-utility analysis suggest that implant treatment with an implant-supported single crown is more cost-effective than treatment with the three-unit fixed dental prosthesis.

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