scholarly journals Cost-effectiveness of remdesivir and dexamethasone for COVID-19 treatment in South Africa

2020 ◽  
Author(s):  
Youngji Jo ◽  
Lise Jamieson ◽  
Ijeoma Edoka ◽  
Lawrence Long ◽  
Sheetal Silal ◽  
...  
Keyword(s):  
South Africa ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
South African ◽  
Standard Care ◽  
System Perspective ◽  
Healthcare System Perspective ◽  
Resource Limited ◽  
Time Required ◽  
Ventilated Patients

Background South Africa recently experienced a first peak in COVID-19 cases and mortality. Dexamethasone and remdesivir both have the potential to reduce COVID-related mortality, but their cost-effectiveness in a resource-limited setting with scant intensive care resources is unknown. Methods We projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed cost-effectiveness of 1) administration of dexamethasone to ventilated patients and remdesivir to non-ventilated patients, 2) dexamethasone alone to both non-ventilated and ventilated patients, 3) remdesivir to non-ventilated patients only, and 4) dexamethasone to ventilated patients only; all relative to a scenario of standard care. We estimated costs from the healthcare system perspective in 2020 USD, deaths averted, and the incremental cost effectiveness ratios of each scenario. Results Remdesivir for non-ventilated patients and dexamethasone for ventilated patients was estimated to result in 1,111 deaths averted (assuming a 0-30% efficacy of remdesivir) compared to standard care, and save $11.5 million. The result was driven by the efficacy of the drugs, and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone to ventilated and non-ventilated patients requires additional $159,000 and averts 1,146 deaths, resulting in $139 per death averted, relative to standard care. Conclusions The use of dexamethasone for ventilated and remdesivir for non-ventilated patients is likely to be cost-saving compared to standard care. Given the economic and health benefits of both drugs, efforts to ensure access to these medications is paramount.

scholarly journals Cost-effectiveness of remdesivir and dexamethasone for COVID-19 treatment in South Africa

2021 ◽  
Author(s):  
Youngji Jo ◽  
Lise Jamieson ◽  
Ijeoma Edoka ◽  
Lawrence Long ◽  
Sheetal Silal ◽  
...  
Keyword(s):  
South Africa ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
South African ◽  
Recovery Time ◽  
Standard Care ◽  
System Perspective ◽  
Uncertainty Range ◽  
Time Required ◽  
Ventilated Patients

Abstract Background Dexamethasone and remdesivir have the potential to reduce COVID-related mortality or recovery time, but their cost-effectiveness in countries with limited intensive care resources is unknown. Methods We projected intensive care unit (ICU) needs and capacity from August 2020 to January 2021 using the South African National COVID-19 Epi Model. We assessed cost-effectiveness of 1) administration of dexamethasone to ventilated patients and remdesivir to non-ventilated patients, 2) dexamethasone alone to both non-ventilated and ventilated patients, 3) remdesivir to non-ventilated patients only, and 4) dexamethasone to ventilated patients only; all relative to a scenario of standard care. We estimated costs from the healthcare system perspective in 2020 USD, deaths averted, and the incremental cost effectiveness ratios of each scenario. Results Remdesivir for non-ventilated patients and dexamethasone for ventilated patients was estimated to result in 408 [uncertainty range: 229-1891] deaths averted (assuming no efficacy [uncertainty range: 0-70%] of remdesivir) compared to standard care, and save $15 million. The result was driven by the efficacy of dexamethasone, and the reduction of ICU-time required for patients treated with remdesivir. The scenario of dexamethasone alone to non-ventilated and ventilated patients requires additional $159,000 and averts 689 [uncertainty range: 330-1118] deaths, resulting in $231 per death averted, relative to standard care. Conclusions The use of remdesivir for non-ventilated patients and dexamethasone for ventilated is likely to be cost-saving compared to standard care by reducing ICU days. Further efforts to improve recovery time with remdesivir and dexamethasone in ICU could save lives and costs in South Africa.

PP329 An Australian Cost-Effectiveness Analysis Of The EluviaTM Drug-Eluting Stent For Treatment Of Symptomatic Lower-Limb Peripheral Artery Disease

2020 ◽  
Vol 36 (S1) ◽  
pp. 28-29
Author(s):  
William A. Gray ◽  
Thathya V. Ariyaratne ◽  
Robert I. Griffiths ◽  
Peter W.M. Elroy ◽  
Stacey L. Amorosi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Healthcare System ◽  
Lower Limb ◽  
Sensitivity Analyses ◽  
Public Healthcare ◽  
System Perspective ◽  
Healthcare System Perspective ◽  
Drug Eluting ◽  
Zilver Ptx ◽  
Cost Parameters

IntroductionDespite advances in endovascular interventions, including the introduction of drug-eluting stents (DES), high target lesion revascularization (TLR) rates still burden the treatment of symptomatic lower-limb peripheral arterial disease (PAD). EluviaTM, a novel, sustained-release, paclitaxel-eluting DES, was shown to further reduce TLRs when compared with the paclitaxel-coated Zilver® PTX® stent, in the IMPERIAL randomized controlled trial. This evaluation estimated the cost-effectiveness of Eluvia when compared with Zilver PTX in Australia, based on 12-month clinical outcomes from the IMPERIAL trial.MethodsA state-transition, decision-analytic model with a 12-month time horizon was developed from an Australian public healthcare system perspective. Cost parameters were obtained from the Australian National Hospital Cost Data Collection Cost Report (2016–17). All costs were captured in Australian dollars (AUD), where AUD 1 = USD 0.69 (June 2020). Complete sets of clinical parameters (primary patency loss, TLR, amputation, and death) and cost parameters from their respective distributions were bootstrapped in samples of 1,000 patients, for each intervention arm of the model. One-way and probabilistic sensitivity analyses were performed.ResultsAt 12 months, modeled TLR rates were 4.5 percent for Eluvia and 8.9 percent for Zilver PTX, and mean total direct costs were AUD 6,537 [USD 4,511] and AUD 6,908 [USD 4,767], respectively (Eluvia average per patient savings; overall cohort=AUD 371 [USD 256]; diabetic cohort=AUD 625 [USD 431]). In probabilistic sensitivity analyses, Eluvia was cost-effective relative to Zilver PTX in 92.0 percent of all simulations at a threshold of $10,000 per TLR avoided. Eluvia was more effective and less costly (dominant) than Zilver PTX in 76.0 percent of simulations.ConclusionsIn the first year after the intervention, Eluvia was more effective and less costly than Zilver PTX, making Eluvia the dominant treatment strategy for treatment of symptomatic lower-limb PAD, from an Australian public healthcare system perspective. These findings should be considered when formulating policy and practice guidelines in the context of priority setting and making evidence-based resource allocation decisions for treatment of PAD in Australia.

scholarly journals Intensive Care Unit Capacity Strain and Outcomes of Critical Illness in a Resource-Limited Setting: A 2-Hospital Study in South Africa

2018 ◽  
Vol 35 (10) ◽  
pp. 1104-1111 ◽  
Author(s):  
George L. Anesi ◽  
Nicole B. Gabler ◽  
Nikki L. Allorto ◽  
Carel Cairns ◽  
Gary E. Weissman ◽  
...  
Keyword(s):  
South Africa ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Primary Outcome ◽  
Resource Limited Setting ◽  
Icu Mortality ◽  
Icu Admission ◽  
Resource Limited ◽  
Limited Setting

Objective: To measure the association of intensive care unit (ICU) capacity strain with processes of care and outcomes of critical illness in a resource-limited setting. Methods: We performed a retrospective cohort study of 5332 patients referred to the ICUs at 2 public hospitals in South Africa using the country’s first published multicenter electronic critical care database. We assessed the association between multiple ICU capacity strain metrics (ICU occupancy, turnover, census acuity, and referral burden) at different exposure time points (ICU referral, admission, and/or discharge) with clinical and process of care outcomes. The association of ICU capacity strain at the time of ICU admission with ICU length of stay (LOS), the primary outcome, was analyzed with a multivariable Cox proportional hazard model. Secondary outcomes of ICU triage decision (with strain at ICU referral), ICU mortality (with strain at ICU admission), and ICU LOS (with strain at ICU discharge), were analyzed with linear and logistic multivariable regression. Results: No measure of ICU capacity strain at the time of ICU admission was associated with ICU LOS, the primary outcome. The ICU occupancy at the time of ICU admission was associated with increased odds of ICU mortality (odds ratio = 1.07, 95% confidence interval: 1.02-1.11; P = .004), a secondary outcome, such that a 10% increase in ICU occupancy would be associated with a 7% increase in the odds of ICU mortality. Conclusions: In a resource-limited setting in South Africa, ICU capacity strain at the time of ICU admission was not associated with ICU LOS. In secondary analyses, higher ICU occupancy at the time of ICU admission, but not other measures of capacity strain, was associated with increased odds of ICU mortality.

scholarly journals The Use of Density-Based Spatial Clustering of Application With Noise (DBSCAN) for Record Linkage in An Observational HIV Cohort

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Victor Olago ◽  
Lina Bartels ◽  
Tafadzwa Dhokotera ◽  
Lina Bartels ◽  
Julia Bohlius ◽  
...  
Keyword(s):  
South Africa ◽  
Big Data ◽  
South African ◽  
Record Linkage ◽  
Patient Record ◽  
Data Deduplication ◽  
Resource Limited Settings ◽  
Dbscan Clustering ◽  
Resource Limited ◽  
F Measure

IntroductionThe South African HIV Cancer Match (SAM) study is a probabilistic record linkage study involving creation of an HIV cohort from laboratory records from the National Health Laboratory Service (NHLS). This cohort was linked to the pathology based South African National Cancer Registry to establish cancer incidences among HIV positive population in South Africa. As the number of HIV records increases, there is need for more efficient ways of de-duplicating this big-data. In this work, we used clustering to perform big-data deduplication. Objectives and ApproachOur objective was to use DBSCAN as clustering algorithm together with bi-gram word analyser to perform big-data deduplication in resource-limited settings. We used HIV related laboratory records from entire South Africa collated in the NHLS Corporate Data Warehouse for period 2004-2014. This involved data pre-processing, deterministic deduplication, ngrams generation, features generation using Term Frequency Inverse Document Frequency vectorizer, clustering using DBSCAN and assigning cluster labels for records that potentially belonged to the same person. We used records with national identification numbers to assess quality of deduplication by calculating precision, recall and f-measure. ResultsWe had 51,563,127 HIV related laboratory records. Deterministic deduplication resulted in 20,387,819 patient record deduplicates. With DBSCAN clustering we further reduced this to 14,849,524 patient record clusters. In this final dataset, 3,355,544 (22.60%) patients had negative HIV test, 11,316,937 (76.21%) had evidence for HIV infection, and for 177,043 (1.19%) the HIV status could not be determined. The precision, recall and f-measure based on 1,865,445 records with national identification numbers were 0.96, 0.94 and 0.95, respectively. Conclusion / ImplicationsOur study demonstrated that DBSCAN clustering is an effective way of deduplicating big datasets in resource-limited settings. This enabled refining of an HIV observational database by accurately linking test records that potentially belonged to the same person. The methodology creates opportunities for easy data profiling to inform public health decision making.

Cost-Effectiveness of Skin Surveillance Through a Specialized Clinic for Patients at High Risk of Melanoma

2017 ◽  
Vol 35 (1) ◽  
pp. 63-71 ◽  
Author(s):  
Caroline G. Watts ◽  
Anne E. Cust ◽  
Scott W. Menzies ◽  
Graham J. Mann ◽  
Rachael L. Morton
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Standard Care ◽  
Sensitivity Analyses ◽  
Model Parameters ◽  
System Perspective ◽  
Life Years ◽  
The Mean ◽  
Quality Adjusted Life ◽  
High Risk Clinic

Purpose Clinical guidelines recommend that people at high risk of melanoma receive regular surveillance to improve survival through early detection. A specialized High Risk Clinic in Sydney, Australia was found to be effective for this purpose; however, wider implementation of this clinical service requires evidence of cost-effectiveness and data addressing potential overtreatment of suspicious skin lesions. Patients and Methods A decision-analytic model was built to compare the costs and benefits of specialized surveillance compared with standard care over a 10-year period, from a health system perspective. A high-risk standard care cohort was obtained using linked population data, comprising the Sax Institute’s 45 and Up cohort study, linked to Medicare Benefits Schedule claims data, the cancer registry, and hospital admissions data. Benefits were measured in quality-adjusted life-years gained. Sensitivity analyses were undertaken for all model parameters. Results Specialized surveillance through the High Risk Clinic was both less expensive and more effective than standard care. The mean saving was A$6,828 (95% CI, $5,564 to $8,092) per patient, and the mean quality-adjusted life-year gain was 0.31 (95% CI, 0.27 to 0.35). The main drivers of the differences were detection of melanoma at an earlier stage resulting in less extensive treatment and a lower annual mean excision rate for suspicious lesions in specialized surveillance (0.81; 95% CI, 0.72 to 0.91) compared with standard care (2.55; 95% CI, 2.34 to 2.76). The results were robust when tested in sensitivity analyses. Conclusion Specialized surveillance was a cost-effective strategy for the management of individuals at high risk of melanoma. There were also fewer invasive procedures in specialized surveillance compared with standard care in the community.

Cost-Effectiveness of Deferasirox (Exjade®) Versus No Chelation In Patients with Lower Risk Myelodysplastic Syndromes (MDS): A Canadian Perspective

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4962-4962
Author(s):  
Khalid El Ouagari ◽  
Kristen Migliaccio-Walle ◽  
Helen Lau ◽  
Duygu Bozkaya
Keyword(s):  
Cost Effectiveness ◽  
Lower Risk ◽  
Chelation Therapy ◽  
Sensitivity Analyses ◽  
Base Case ◽  
System Perspective ◽  
Healthcare System Perspective ◽  
Life Years ◽  
The Cost ◽  
Canadian Healthcare

Abstract Abstract 4962 Introduction: Guidelines for the treatment of MDS recommend iron chelation therapy (ICT) in iron-overloaded lower-risk patients with MDS and candidates for stem cell transplantation. In particular, recent reports indicate that ICT may improve overall survival (OS) in transfusion-dependent patients with low or intermediate-1 (int-1) MDS as per international prognostic scoring system (IPSS) criteria. Deferasirox is a once-daily oral chelator, with easy administration and potentially better compliance. The goal of this study is to evaluate the cost-effectiveness of deferasirox compared to receiving no chelation therapy in transfusion-dependent patients with lower-risk MDS from a Canadian healthcare system perspective. Methods: A Markov model was developed to evaluate the cost-effectiveness of deferasirox compared to receiving no chelation therapy in transfusion-dependent patients with lower-risk (eg, IPSS low or int-1) MDS. The data used in the model were obtained from published or presented studies. Model outcomes, including life years (LY) gained, quality-adjusted life years (QALYs) gained, developing complications of iron overload, progressing to acute myeloid leukemia (AML), death, and direct medical costs of ICT, transfusion, complications and AML, were estimated for each treatment group based on a simulation of 1000 patient lives. Finally, incremental cost-effectiveness ratios (ICER) were calculated as the ratio of total medical costs to LY and QALY gains. Extensive one-way sensitivity analyses were performed to examine the effects of changes in key model parameters. Probabilistic sensitivity analyses were also performed. The outcomes of the model were evaluated over a 20-year time frame and discounted annually at the rate of 5%. Costs are reported in 2009 Canadian dollars (CAD$). Results: Under base case assumptions, patients receiving deferasirox were less likely to progress to cardiac disease, AML, and death compared to patients receiving no chelation therapy. Adding deferasirox was projected to increase OS by 4.46 years (undiscounted); discounting for time, OS was projected to be increased by 2.93 years. Furthermore, undiscounted QALYs were increased by 4.20 years and discounted QALYs, by 2.99 years. The clinical benefits of deferasirox are obtained at an additional expected discounted total lifetime cost of CAD$185,429. The incremental cost-effectiveness ratios were therefore estimated to be CAD$62,001/QALY gained and CAD$63,286/LY saved. Deterministic sensitivity analyses showed the base case results to be robust with respect to variations in assumptions and estimates. The cost-effectiveness acceptability curve shows that deferasirox was preferred to no treatment in 96% of simulations when the willingness to pay for a QALY was CAD$100,000. Conclusion: The results of our analysis indicate that deferasirox offers a cost-effective treatment option for patients with lower-risk MDS as the ICER is within the thresholds that are considered acceptable (ie, $50,000 to $100,000 per QALY gained), from a Canadian healthcare system perspective. Additional clinical studies are ongoing to evaluate event-free survival with deferasirox in patients with lower-risk MDS and transfusional iron overload. Disclosures: El Ouagari: Novartis: Employment. Migliaccio-Walle: Novartis: Research Funding. Lau: Novartis: Employment. Bozkaya: Novartis: Research Funding.

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