An evaluation of community-based comprehensive vision care for the ageing population

ABSTRACTObjectiveThis study was conducted to evaluate the real-world effectiveness and potential cost-effectiveness of a community-based vision care programme for the ageing population aged 60 years or above.MethodsData from a total of 8899 subjects participating in a community based comprehensive vision care programme from 2015 to 2019 were extracted and analyzed to evaluate the effectiveness of the programme in terms of the prevalence of visual impairment (VI), the change in the prevalence of VI after refractive error correction, and the types of ocular disorders detected. VI was defined by a) visual acuity (VA) worse than 6/18 in any eye (worse eye) and b) VA worse than 6/18 in the better eye. The cost-effectiveness from the funder’s perspective was also estimated in terms of cost per VI avoided from such a programme.ResultsThe study found that referenced to VA of the worse eye, the prevalence of VI was 39.1% (3482/8899, 95% CI: 38.1%-40.1%) based on presenting VA and reduced to 13.8% (1227/8899, 95% CI: 13.1%-14.5%) based on best-corrected VA. Referenced to the VA in the better eye, the prevalence of VI was 17.3% (1539/8899, 95% CI: 16.5%-18.1%) based on presenting VA and decreased to 4.2% (373/8899, 95% CI: 3.8%-4.6%) after best-corrected VA. Uncorrected refractive error was the major cause of presenting VI. From the funder’s perspective, the cost per VI case prevented was HK$1921 based on VA in the worse eye and HK$3715 based on the better eye.ConclusionA community-based programme was effective to detect the VI and reduced a relative 65% to 76% VI after refractive error correction for the community-dwelling ageing population. The ageing population can benefit from regular comprehensive vision care.

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Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

Journal of Telemedicine and Telecare ◽

10.1177/1357633x20982773 ◽

2021 ◽

pp. 1357633X2098277

Author(s):

Molly Jacobs ◽

Patrick M Briley ◽

Heather Harris Wright ◽

Charles Ellis

Keyword(s):

Cost Effectiveness ◽

Economies Of Scale ◽

Reference Group ◽

Unit Cost ◽

Community Based ◽

Face To Face ◽

Conduction Aphasia ◽

Aphasia Treatment ◽

The Cost ◽

The Relationship

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

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Cost-Effectiveness of an Exercise Programme that Provided Group or Individual Training to Reduce the Fall Risk in Healthy Community-Dwelling People Aged 65–80: A Secondary Data Analysis

Healthcare ◽

10.3390/healthcare9060714 ◽

2021 ◽

Vol 9 (6) ◽

pp. 714

Author(s):

Isaac Aranda-Reneo ◽

Laura Albornos-Muñoz ◽

Manuel Rich-Ruiz ◽

María Ángeles Cidoncha-Moreno ◽

Ángeles Pastor-López ◽

...

Keyword(s):

Economic Evaluation ◽

Cost Effectiveness ◽

Older People ◽

Incremental Cost ◽

Fall Risk ◽

Community Dwelling ◽

Effective Measure ◽

The Individual ◽

The Cost ◽

Individual Training

Research has demonstrated that some exercise programs are effective for reducing fall rates in community-dwelling older people; however, the literature is limited in providing clear recommendations of individual or group training as a result of economic evaluation. The objective of this study was to assess the cost-effectiveness of the Otago Exercise Program (OEP) for reducing the fall risk in healthy, non-institutionalized older people. An economic evaluation of a multicenter, blinded, randomized, non-inferiority clinical trial was performed on 498 patients aged over 65 in primary care. Participants were randomly allocated to the treatment or control arms, and group or individual training. The program was delivered in primary healthcare settings and comprised five initial sessions, ongoing encouragement and support to exercise at home, and a reinforcement session after six months. Our hypothesis was that the patients who received the intervention would achieve better health outcomes and therefore need lower healthcare resources during the follow-up, thus, lower healthcare costs. The primary outcome was the incremental cost-effectiveness ratio, which used the timed up and go test results as an effective measure for preventing falls. The secondary outcomes included differently validated tools that assessed the fall risk. The cost per patient was USD 51.28 lower for the group than the individual sessions in the control group, and the fall risk was 10% lower when exercises had a group delivery. The OEP program delivered in a group manner was superior to the individual method. We observed slight differences in the incremental cost estimations when using different tools to assess the risk of fall, but all of them indicated the dominance of the intervention group. The OEP group sessions were more cost-effective than the individual sessions, and the fall risk was 10% lower.

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Cost-effectiveness of zoledronic acid compared with sequential denosumab/alendronate for older osteoporotic women in Japan

Archives of Osteoporosis ◽

10.1007/s11657-021-00956-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Takahiro Mori ◽

Carolyn J. Crandall ◽

Tomoko Fujii ◽

David A. Ganz

Keyword(s):

Health Economic ◽

Cost Effectiveness ◽

Zoledronic Acid ◽

Cost Saving ◽

Fragility Fracture ◽

Community Dwelling ◽

Sensitivity Analyses ◽

Term Care ◽

Lifetime Horizon ◽

The Cost

Abstract Summary Among hypothetical cohorts of older osteoporotic women without prior fragility fracture in Japan, we evaluated the cost-effectiveness of two treatment strategies using a simulation model. Annual intravenous zoledronic acid for 3 years was cost-saving compared with biannual subcutaneous denosumab for 3 years followed by weekly oral alendronate for 3 years. Purpose Osteoporosis constitutes a major medical and health economic burden to society worldwide. Injectable treatments for osteoporosis require less frequent administration than oral treatments and therefore have higher persistence and adherence with treatment, which could explain better efficacy for fracture prevention. Although annual intravenous zoledronic acid and biannual subcutaneous denosumab are available, it remains unclear which treatment strategy represents a better value from a health economic perspective. Accordingly, we examined the cost-effectiveness of zoledronic acid for 3 years compared with sequential denosumab/alendronate (i.e., denosumab for 3 years followed by oral weekly alendronate for 3 years, making the total treatment duration 6 years) among hypothetical cohorts of community-dwelling osteoporotic women without prior fragility fracture in Japan at ages 65, 70, 75, or 80 years. Methods Using a previously validated and updated Markov microsimulation model, we obtained incremental cost-effectiveness ratios (Japanese yen [¥] (or US dollars [$]) per quality-adjusted life-year [QALY]) from the public healthcare and long-term care payer’s perspective over a lifetime horizon with a willingness-to-pay of ¥5 million (or $47,500) per QALY. Results In the base case, zoledronic acid was cost-saving (i.e., more effective and less expensive) compared with sequential denosumab/alendronate. In deterministic sensitivity analyses, results were sensitive to changes in the efficacy of zoledronic acid or the cumulative persistence rate with zoledronic acid or denosumab. In probabilistic sensitivity analyses, the probabilities of zoledronic acid being cost-effective were 98–100%. Conclusions Among older osteoporotic women without prior fragility fracture in Japan, zoledronic acid was cost-saving compared with sequential denosumab/alendronate.

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Cost Effectiveness of a Home-Based Intervention That Helps Functionally Vulnerable Older Adults Age in Place at Home

Journal of Aging Research ◽

10.1155/2012/680265 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 25

Author(s):

Eric Jutkowitz ◽

Laura N. Gitlin ◽

Laura T. Pizzi ◽

Edward Lee ◽

Marie P. Dennis

Keyword(s):

Cost Effectiveness ◽

Community Dwelling ◽

Sensitivity Analyses ◽

Model Parameters ◽

Potential Cost ◽

Functional Difficulties ◽

Age In Place ◽

Home Based ◽

Occupational And Physical Therapy ◽

Home Based Intervention

Evaluating cost effectiveness of interventions for aging in place is essential for adoption in service settings. We present the cost effectiveness of Advancing Better Living for Elders (ABLE), previously shown in a randomized trial to reduce functional difficulties and mortality in 319 community-dwelling elders. ABLE involved occupational and physical therapy sessions and home modifications to address client-identified functional difficulties, performance goals, and home safety. Incremental cost-effectiveness ratio (ICER), expressed as additional cost to bring about one additional year of life, was calculated. Two models were then developed to account for potential cost differences in implementing ABLE. Probabilistic sensitivity analyses were conducted to account for variations in model parameters. By two years, there were 30 deaths (9: ABLE; 21: control). Additional costs for 1 additional year of life was $13,179 for Model 1 and $14,800 for Model 2. Investment in ABLE may be worthwhile depending on society's willingness to pay.

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The cost-effectiveness of a successful community-based obesity prevention program: The be active eat well program

Obesity ◽

10.1002/oby.20472 ◽

2013 ◽

Vol 21 (10) ◽

pp. 2072-2080 ◽

Cited By ~ 27

Author(s):

Marjory L. Moodie ◽

Jessica K. Herbert ◽

Andrea M. de Silva-Sanigorski ◽

Helen M. Mavoa ◽

Catherine L. Keating ◽

...

Keyword(s):

Cost Effectiveness ◽

Obesity Prevention ◽

Prevention Program ◽

Community Based ◽

The Cost ◽

Obesity Prevention Program

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Potential Cost-effectiveness of HIV Viral Load Sample Collection and Testing Methods in Malawi

10.21203/rs.2.13295/v1 ◽

2019 ◽

Author(s):

Joseph B. Babigumira ◽

Solomon J. Lubinga ◽

Mindy M. Cheng ◽

James K. Karichu ◽

Louis P. Garrison

Keyword(s):

Viral Load ◽

Cost Effectiveness ◽

Treatment Failure ◽

Test Accuracy ◽

Sample Collection ◽

Testing Methods ◽

Hiv Viral Load ◽

Potential Cost ◽

Testing Approach ◽

The Cost

Abstract Background HIV viral load (VL) monitoring informs antiretroviral therapy failure and helps to guide regimen changes. Typically, VL monitoring is performed using dried blood spot (DBS) samples transported and tested in a centralized laboratory. Novel sample collection technologies based on dried plasma stored on a plasma separation card (PSC) have become available. The cost-effectiveness of these different testing approaches to monitor VL is uncertain, especially in resource-limited settings. The objective of this study is to evaluate the potential cost-effectiveness of HIV VL testing approaches with PSC samples compared to DBS samples in Malawi. Methods We developed a decision-tree model to evaluate the cost-effectiveness of two different sample collection and testing methods—DBS and PSC samples transported and tested at central laboratories. The analysis used data from the published literature and was performed from the Malawi Ministry of Health perspective. We estimated costs of sample collection, transportation, and testing. The primary clinical outcome was test accuracy (proportion of patients correctly classified with or without treatment failure). Sensitivity analysis was performed to assess the robustness of results. Results The estimated test accuracy for a DBS testing approach was 87.5% compared to 97.4% for an approach with PSC. The estimated total cost per patient of a DBS testing approach was $19.39 compared to $17.73 for a PSC approach. Based on this, a PSC-based testing approach “dominates” a DBS-based testing approach (i.e., lower cost and higher accuracy). Conclusion The base-case analysis shows that a testing approach using PSC sample is less costly and more accurate (correctly classifies more patients with or without treatment failure) than with a DBS approach. Our study suggests that a PSC testing approach is likely an optimal strategy for routine HIV VL monitoring in Malawi. However, given the limited data regarding sample viability, additional real-world data are needed to validate the results.

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Community interventions for people with complex emotional needs that meet the criteria for ‘personality disorder’ diagnoses: a systematic review of economic evaluations

10.1101/2020.11.03.20225078 ◽

2020 ◽

Author(s):

Joe Botham ◽

Amy Clark ◽

Thomas Steare ◽

Ruth Stuart ◽

Sian Oram ◽

...

Keyword(s):

Mental Health ◽

Cost Effectiveness ◽

Personality Disorder ◽

Economic Evaluations ◽

Economic Evidence ◽

Emotional Needs ◽

Community Based Interventions ◽

Community Based ◽

Single Intervention ◽

The Cost

AbstractBackgroundDiagnoses of “personality disorder” are prevalent among people using community secondary mental health services. Whilst the effectiveness of a range of community-based treatments have been considered, as the NHS budget is finite, it is also important to consider the cost-effectiveness of those interventions.AimsTo assess the cost-effectiveness of primary or secondary care community-based interventions for people with complex emotional needs that meet criteria for a diagnosis of “personality disorder” to inform healthcare policy making.MethodSystematic review (PRESPORO #: CRD42020134068) of five databases, supplemented by reference list screening and citation tracking of included papers. We included economic evaluations of interventions for adults with complex emotional needs associated with a diagnosis of ‘personality disorder’ in community mental health settings published between before 18 September 2019. Study quality was assessed using the CHEERS statement. Narrative synthesis was used to summarise study findings.ResultsEighteen studies were included. The studies mainly evaluated psychotherapeutic interventions. Studies were also identified which evaluated altering the setting in which care was delivered and joint crisis plans. No strong economic evidence to support a single intervention or model of community-based care was identified.ConclusionThere is no robust economic evidence to support a single intervention or model of community-based care for people with complex emotional needs. The review identified the strongest evidence for Dialectical Behavioural Therapy with all three identified studies indicating the intervention is likely to be cost-effective in community settings compared to treatment as usual. Further research is needed to provide robust evidence on the cost-effectiveness of community-based interventions upon which decision makers can confidently base guidelines or allocate resources.

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The Cost-Effectiveness of Three Prevention Strategies in Alzheimer's Disease: Results from the Multidomain Alzheimer Preventive Trial (MAPT)

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2021.47 ◽

2021 ◽

pp. 1-11

Author(s):

N. Costa ◽

M. Mounié ◽

A. Pagès ◽

H. Derumeaux ◽

T. Rapp ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cost Effectiveness ◽

Community Dwelling ◽

Z Score ◽

Prevention Strategies ◽

Group Setting ◽

The Cost ◽

Preventive Trial ◽

Score Point

BACKGROUND: To date, no curative treatment is available for Alzheimer’s disease (AD). Therefore, efforts should focus on prevention strategies to improve the efficiency of healthcare systems. Objective: Our aim was to assess the cost-effectiveness of three preventive strategies for AD compared to a placebo. Design: The Multidomain Alzheimer Preventive Trial (MAPT) study was a multicenter, randomized, placebo-controlled superiority trial with four parallel groups, including three intervention groups (one group with Multidomain Intervention (MI) plus a placebo, one group with Polyunsaturated Fatty Acids (PFA), one group with a combination of PFA and MI) and one placebo group. Setting: Participants were recruited and included in 13 memory centers in France and Monaco. Participants: Community-dwelling subject aged 70 years and older were followed during 3 years. Interventions: We used data from the MAPT study which aims to test the efficacy of a MI along PFA, the MI plus a placebo, PFA alone, or a placebo alone. Measurement: Direct medical and non-medical costs were calculated from a payer’s perspective during the 3 years of follow-up. The base case incremental Cost-Effectiveness Ratio (ICER) represents the cost per improved cognitive Z-score point. Sensitivity analyses were performed using different interpretation of the effectiveness criteria. Results: Analyses were conducted on 1,525 participants. The ICER at year 3 that compares the MI + PFA and the MI alone to the placebo amounted to €21,443 and €21,543 respectively, per improved Z score point. PFA alone amounted to €111,720 per improved Z score point. Conclusion: Our study shows that ICERS of PFA combined with MI and MI alone amounted to €21,443 and €21,543 respectively per improved Z score point compared to the placebo and are below the WTP of €50,000 while the ICER of PFA alone amounted to €111,720 per improved Z score point. This information may help decision makers and serve as a basis for the implementation of a lifetime decision analytic model.

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An Economic Evaluation of a Community-Based Organization Led HIV Self-Testing Program Among Men Who Have Sex With Men in China

10.21203/rs.3.rs-132840/v1 ◽

2020 ◽

Author(s):

Shanzi Huang ◽

Jason Ong ◽

Wencan Dai ◽

Xi He ◽

Yi Zhou ◽

...

Keyword(s):

Cost Effectiveness ◽

Hiv Testing ◽

Variable Cost ◽

Community Based ◽

Self Testing ◽

Hiv Test ◽

Community Based Organization ◽

The Mean ◽

The Cost ◽

Mean Cost

Abstract Introduction: HIV self-testing (HIVST) is effective in improving the uptake of HIV testing among key populations. Complementary data on the cost-effectiveness of HIVST is critical for planning and scaling up HIVST. This study aimed to evaluate the cost-effectiveness of a community-based organization (CBO)-led HIVST model implemented in China. Method: A cost-effectiveness analysis (CEA) was conducted by comparing a CBO-led HIVST model with a CBO-led facility-based HIV rapid diagnostics testing (HIV-RDT) model. The full economic cost, including fixed and variable cost, from a health provider perspective using a micro costing approach was estimated. We determined the cost-effectiveness of these two HIV testing models over a two year time horizon (i.e. duration of the programs), and reported costs using US dollars (2020). Results: From January 2017 to December 2018, a total of 4,633 men tested in the HIVST model, and 1,780 men tested in the HIV-RDT model. The total number of new diagnosis was 155 for HIVST and 126 for the HIV-RDT model; the HIV test positivity was 3.3% (95% confidence interval (CI): 2.8-3.9) for the HIVST model and 7.1% (95% CI: 5.9-8.4) for the HIV-RDT model. The mean cost per person tested was $14.57 for HIVST and $24.74 for HIV-RDT. However, the mean cost per diagnosed was higher for HIVST ($435.52) compared with $349.44 for HIV-RDT.Conclusion: Our study confirms that compared to facility-based HIV-RDT, a community-based organization led HIVST program could have a cheaper mean cost per MSM tested for HIV in China. Better targeting of high-risk individuals would further improve the cost-effectiveness of HIVST.

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