Evaluating the impact and cost-effectiveness of scaling-up HCV treatment among people who inject drugs in Ukraine

Introduction People who inject drugs (PWID) in Ukraine have a high prevalence of hepatitis C virus (HCV). Since 2015, PWID have been receiving HCV treatment, but their impact and cost-effectiveness has not been estimated. Methods We developed a dynamic model of HIV and HCV transmission among PWID in Ukraine, incorporating ongoing HCV treatment (5,933 treatments) over 2015-2021; 46.1% among current PWID. We estimated the impact of these treatments and different treatment scenarios over 2021-2030: continuing recent treatment rates (2,394 PWID/year) with 42.5/100% among current PWID, or treating 5,000/10,000 current PWID/year. We also estimated the treatment rate required to decrease HCV incidence by 80% if preventative interventions are scaled-up or not. Required costs were collated from previous studies in Ukraine. We estimated the incremental cost-effectiveness ratio (ICER) of the HCV treatments undertaken in 2020 (1,059) by projecting the incremental costs and disability adjusted life years (DALYs) averted over 2020-2070 (3% discount rate) compared to a counterfactual scenario without treatment from 2020 onwards. Results On average, 0.4% of infections among PWID were treated annually over 2015-2021, without which HCV incidence would have been 0.6% (95%CrI: 0.3-1.0%) higher in 2021. Continuing existing treatment rates could reduce HCV incidence by 10.2% (7.8-12.5%) or 16.4% (12.1-22.0%) by 2030 if 42.5% or 100% of treatments are given to current PWID, respectively. HCV incidence could reduce by 29.3% (20.7-44.7%) or 93.9% (54.3-99.9%) by 2030 if 5,000 or 10,000 PWID are treated annually. To reduce incidence by 80% by 2030, 19,275 (15,134-23,522) annual treatments are needed among current PWID, or 17,955 (14,052-21,954) if preventative interventions are scaled-up. The mean ICER was US$828.8/DALY averted; cost-effective at a willingness-to-pay threshold of US$3,096/DALY averted (1xGDP). Implications Existing HCV treatment is cost-effective but has had little preventative impact due to few current PWID being treated. Further treatment expansion for current PWID could significantly reduce HCV incidence.

Download Full-text

A Cost-Effectiveness Analysis of Newborn Screening for Severe Combined Immunodeficiency in the UK

International Journal of Neonatal Screening ◽

10.3390/ijns5030028 ◽

2019 ◽

Vol 5 (3) ◽

pp. 28 ◽

Cited By ~ 2

Author(s):

Alice Bessey ◽

James Chilcott ◽

Joanna Leaviss ◽

Carmen de la Cruz ◽

Ruth Wong

Keyword(s):

Cost Effectiveness ◽

Severe Combined Immunodeficiency ◽

Cost Effective ◽

Sensitivity Analyses ◽

Combined Immunodeficiency ◽

Tree Model ◽

Life Years ◽

The Uk ◽

The Cost ◽

The Impact

Severe combined immunodeficiency (SCID) can be detected through newborn bloodspot screening. In the UK, the National Screening Committee (NSC) requires screening programmes to be cost-effective at standard UK thresholds. To assess the cost-effectiveness of SCID screening for the NSC, a decision-tree model with lifetable estimates of outcomes was built. Model structure and parameterisation were informed by systematic review and expert clinical judgment. A public service perspective was used and lifetime costs and quality-adjusted life years (QALYs) were discounted at 3.5%. Probabilistic, one-way sensitivity analyses and an exploratory disbenefit analysis for the identification of non-SCID patients were conducted. Screening for SCID was estimated to result in an incremental cost-effectiveness ratio (ICER) of £18,222 with a reduction in SCID mortality from 8.1 (5–12) to 1.7 (0.6–4.0) cases per year of screening. Results were sensitive to a number of parameters, including the cost of the screening test, the incidence of SCID and the disbenefit to the healthy at birth and false-positive cases. Screening for SCID is likely to be cost-effective at £20,000 per QALY, key uncertainties relate to the impact on false positives and the impact on the identification of children with non-SCID T Cell lymphopenia.

Download Full-text

Milk Powder Fortified with Potassium and Phytosterols to Decrease the Risk of Cardiovascular Events among the Adult Population in Malaysia: A Cost-Effectiveness Analysis

Nutrients ◽

10.3390/nu11061235 ◽

2019 ◽

Vol 11 (6) ◽

pp. 1235

Author(s):

Anita E. Gandola ◽

Livia Dainelli ◽

Diane Zimmermann ◽

Maznah Dahlui ◽

Patrick Detzel

Keyword(s):

Cost Effectiveness ◽

Adult Population ◽

Grey Literature ◽

Milk Powder ◽

Cost Effective ◽

Sensitivity Analyses ◽

Base Case ◽

Discounted Cost ◽

Life Years ◽

The Impact

This study evaluated the cost-effectiveness of the consumption of a milk powder product fortified with potassium (+1050.28 mg/day) and phytosterols (+1200 mg/day) to lower systolic blood pressure and low-density lipoprotein cholesterol, respectively, and, therefore, the risk of myocardial infarction (MI) and stroke among the 35–75-year-old population in Malaysia. A Markov model was created against a do-nothing option, from a governmental perspective, and with a time horizon of 40 years. Different data sources, encompassing clinical studies, practice guidelines, grey literature, and statistical yearbooks, were used. Sensitivity analyses were performed to evaluate the impact of uncertainty on the base case estimates. With an incremental cost-effectiveness ratio equal to international dollars (int$) 22,518.03 per quality-adjusted life-years gained, the intervention can be classified as very cost-effective. If adopted nationwide, it would help prevent at least 13,400 MIs, 30,500 strokes, and more than 10,600 and 17,100 MI- and stroke-related deaths. The discounted cost savings generated for the health care system by those who consume the fortified milk powder would amount to int$8.1 per person, corresponding to 0.7% of the total yearly health expenditure per capita. Sensitivity analyses confirmed the robustness of the results. Together with other preventive interventions, the consumption of milk powder fortified with potassium and phytosterols represents a cost-effective strategy to attenuate the rapid increase in cardiovascular burden in Malaysia.

Download Full-text

Cost-effectiveness and budget impact of the microprocessor-controlled knee C-Leg in transfemoral amputees with and without diabetes mellitus

The European Journal of Health Economics ◽

10.1007/s10198-019-01138-y ◽

2020 ◽

Vol 21 (3) ◽

pp. 437-449 ◽

Cited By ~ 1

Author(s):

Alexander Kuhlmann ◽

Henning Krüger ◽

Susanne Seidinger ◽

Andreas Hahn

Keyword(s):

Diabetes Mellitus ◽

Cost Effectiveness ◽

Budget Impact ◽

Input Parameter ◽

Cost Effective ◽

Sensitivity Analyses ◽

Decision Analytic Model ◽

Life Years ◽

Transfemoral Amputees ◽

The Impact

Abstract Background The safe use of a prosthesis in activities of daily living is key for transfemoral amputees. However, the number of falls varies significantly between different prosthetic device types. This study aims to compare medical and economic consequences of falls in transfemoral amputees who use the microprocessor-controlled knee joint C-Leg with patients who use non-microprocessor-controlled (mechanical) knee joints (NMPK). The main objectives of the analysis are to investigate the cost-effectiveness and budget impact of C-Legs in transfemoral amputees with diabetes mellitus (DM) and without DM in Germany. Methods A decision-analytic model was developed that took into account the effects of prosthesis type on the risk of falling and fall-related medical events. Cost-effectiveness and budget impact analyses were performed separately for transfemoral amputees with and without DM. The study took the perspective of the statutory health insurance (SHI). Input parameters were derived from the published literature. Univariate and probabilistic sensitivity analyses (PSA) were performed to investigate the impact of changes in individual input parameter values on model outcomes and to explore parameter uncertainty. Results C-Legs reduced the rate of fall-related hospitalizations from 134 to 20 per 1000 person years (PY) in amputees without DM and from 146 to 23 per 1000 PY in amputees with DM. In addition, the C-Leg prevented 15 or 14 fall-related death per 1000 PY. Over a time horizon of 25 years, the incremental cost-effectiveness ratio (ICER) was 16,123 Euro per quality-adjusted life years gained (QALY) for amputees without DM and 20,332 Euro per QALY gained for amputees with DM. For the period of 2020–2024, the model predicted an increase in SHI expenditures of 98 Mio Euro (53 Mio Euro in prosthesis users without DM and 45 Mio Euro in prosthesis users with DM) when all new prosthesis users received C-Legs instead of NMPKs and 50% of NMPK user whose prosthesis wore out switched to C-Legs. Results of the PSA showed moderate uncertainty and a probability of 97–99% that C-Legs are cost-effective at an ICER threshold of 40,000 Euro (≈ German GDP per capita in 2018) per QALY gained. Conclusion Results of the study suggest that the C-Leg provides substantial additional health benefits compared with NMPKs and is likely to be cost-effective in transfemoral amputees with DM as well as in amputees without DM at an ICER threshold of 40,000 Euro per QALY gained.

Download Full-text

Economic evaluation of ‘Men on the Move’, a ‘real world’ community-based physical activity programme for men

European Journal of Public Health ◽

10.1093/eurpub/ckaa152 ◽

2020 ◽

Author(s):

Liam Kelly ◽

Michael Harrison ◽

Noel Richardson ◽

Paula Carroll ◽

Tom Egan ◽

...

Keyword(s):

Public Health ◽

Physical Activity ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Health Benefits ◽

Cost Effective ◽

Health Improvement ◽

Community Based ◽

Life Years ◽

The Impact

Abstract Background Physical activity (PA) interventions capable of producing health benefits cost effectively are a public health priority across the Western world. ‘Men on the Move’ (MOM), a community-based PA intervention for men, demonstrated significant health benefits up to 52-weeks (W) post-baseline. This article details the economic evaluation of MOM with a view to determining its cost-effectiveness as a public health intervention to be rolled out nationally in Ireland. Methods Cost-effectiveness was determined by comparing the costs (direct and indirect) of the programme to its benefits, which were captured as the impact on quality-adjusted life-years (QALYs). For the benefits, cost–utility analysis was conducted by retrospectively adapting various health-related measures of participants to generate health states using Brazier et al.’s (2002) short form-6D algorithm. This in turn allowed for ‘utility measures’ to be generated, from which QALYs were derived. Results Findings show MOM to be cost-effective in supporting an ‘at risk’ cohort of men achieves significant improvements in aerobic fitness, weight loss and waist reduction. The total cost per participant (€125.82 for each of the 501 intervention participants), the QALYs gained (11.98 post-12-W intervention, or 5.3% health improvement per participant) and estimated QALYs ratio costs of €3723 represents a cost-effective improvement when compared to known QALY guidelines. Conclusions The analysis shows that the cost per QALY achieved by MOM is significantly less than the existing benchmarks of £20 000 and €45 000 in the UK and Ireland respectively, demonstrating MOM to be cost-effective.

Download Full-text

Incarceration of People who inject Drugs – Modelling its Role in HCV Transmission and the Impact of Scaled-Up HCV Treatment in Prisons

Journal of Hepatology ◽

10.1016/s0168-8278(16)01584-1 ◽

2016 ◽

Vol 64 (2) ◽

pp. S811

Author(s):

J. Stone ◽

N.K. Martin ◽

M. Hickman ◽

S. Hutchinson ◽

E. Aspinall ◽

...

Keyword(s):

People Who Inject Drugs ◽

Hcv Treatment ◽

Hcv Transmission ◽

The Impact

Download Full-text

Cost Effectiveness Analysis Using Disability-Adjusted Life Years for Cataract Surgery

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17166010 ◽

2020 ◽

Vol 17 (16) ◽

pp. 6010

Author(s):

Thinni Nurul Rochmah ◽

Anggun Wulandari ◽

Maznah Dahlui ◽

Ernawaty ◽

Ratna Dwi Wulandari

Keyword(s):

Cost Effectiveness ◽

Cataract Surgery ◽

Cost Effective ◽

Disability Adjusted Life Years ◽

Cost Effectiveness Ratio ◽

Small Incision Cataract Surgery ◽

Post Surgery ◽

Disability Adjusted Life ◽

Life Years ◽

The Cost

Cataracts are the second most prioritized eye disease in the world. Cataracts are an expensive treatment because surgery is the only method that can treat the disease. This study aims to analyze the cost effectiveness of each operating procedure. Specifically, phacoemulsification and Small Incision Cataract Surgery (SICS) with Disability-Adjusted Life Years (DALYs) as the effectiveness indicator is used. This study is an observational analytic study with a prospective framework. The sample size is 130 patients who have undergone phacoemulsification and 25 patients who have undergone SICS. The DALY for phacoemulsification at Day-7 (D-7) is 0.3204, and at Day-21 (D-21), it is 0.3204, while the DALY for SICS at D-7 is 0.3060, and at D-21, it is 0.3158. The incremental cost effectiveness ratio (ICER) for cataract surgery at D-7 is USD $1872.49, and at D-21, it is USD $5861.71, whereas the Indonesian Gross Domestic Product (GDP) is USD $4174.90. In conclusion, the phacoemulsification technique is more cost effective than the SICS technique. The ICER value is very cost effective at D-7 post-surgery compared to at D-21 post-surgery because the ICER is less than 1 GDP per capita per DALY.

Download Full-text

Modelling the impact of incarceration and prison-based hepatitis C virus (HCV) treatment on HCV transmission among people who inject drugs in Scotland

Addiction ◽

10.1111/add.13783 ◽

2017 ◽

Vol 112 (7) ◽

pp. 1302-1314 ◽

Cited By ~ 51

Author(s):

Jack Stone ◽

Natasha K. Martin ◽

Matthew Hickman ◽

Sharon J. Hutchinson ◽

Esther Aspinall ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

People Who Inject Drugs ◽

Hcv Treatment ◽

Hcv Transmission ◽

The Impact

Download Full-text

Cost effectiveness of tension-free vaginal tape for the surgical management of female stress incontinence

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462304001357 ◽

2004 ◽

Vol 20 (4) ◽

pp. 455-463 ◽

Cited By ~ 36

Author(s):

Mary Kilonzo ◽

Luke Vale ◽

Sally C. Stearns ◽

Adrian Grant ◽

June Cody ◽

...

Keyword(s):

Cost Effectiveness ◽

Surgical Procedures ◽

Cost Effective ◽

Sensitivity Analyses ◽

Sling Procedure ◽

Tension Free ◽

Tension Free Vaginal Tape ◽

Life Years ◽

Cure Rates ◽

The Impact

Objectives: Stress urinary incontinence affects between 10 percent and 50 percent of women. Surgery is commonly recommended for troublesome incontinence that does not respond to nonsurgical management. Tension-free vaginal tape (TVT) is a newer, minimal access surgical sling procedure, which is being increasingly adopted worldwide. The cost-effectiveness of TVT in comparison with other surgical procedures, particularly open colposuspension, is assessed.Methods: Effectiveness estimates came from a systematic review of TVT compared with other surgical procedures (open and laparoscopic colposuspension, traditional slings, and injectables). Deterministic and probabilistic analyses were used to assess the likelihood of TVT being cost-effective. Sensitivity analyses assessed the impact of changing assumptions about cure rates and costs for TVT, cure rates for retreatment open colposuspension, and proportions of women who choose retreatment.Results: Reliable estimates of relative effectiveness were difficult to derive because the few randomized controlled comparisons had not been optimally analyzed or fully reported. Results of the economic model suggested that TVT dominates open colposuspension (lower cost and same quality of life years[QALYs]) within 5 years after surgery. Stochastic analysis indicated that the likelihood of TVT being cost-effective was 100 percent if decision-makers are unwilling to pay for additional QALYs. TVT's dominance depended on the assumption fact that retreatment open colposuspension has lower cure rates than a first colposuspension.Conclusions: Analysis based on current short-term data indicates dominance of TVT over open colposuspension from approximately 5 years. There is a need for longer-term follow-up data from methodologically rigorous randomized trials to provide a sounder basis for estimating the relative benefits and cost implications.

Download Full-text

PD-L1 Test-Based Strategy With Nivolumab as the Second-Line Treatment in Advanced NSCLC： A Cost-Effectiveness Analysis in China

Frontiers in Oncology ◽

10.3389/fonc.2021.745493 ◽

2021 ◽

Vol 11 ◽

Author(s):

Qiao Liu ◽

Xia Luo ◽

Zhen Zhou ◽

Liubao Peng ◽

Lidan Yi ◽

...

Keyword(s):

Cost Effectiveness ◽

Treatment Strategies ◽

Cost Effective ◽

Price Reduction ◽

Chinese Patients ◽

Sensitivity Analyses ◽

Line Treatment ◽

Second Line ◽

Life Years ◽

The Impact

ObjectiveOur previous economic assessment found that nivolumab was not cost-effective for Chinese patients with advanced non-small cell lung cancer (NSCLC) and without EGFR mutations or ALK translocations, when compared with the standard second-line drug docetaxel. However, a greater survival benefit with nivolumab was observed for patients with 1% or greater tumor programmed death ligand 1 (PD-L1) expression. In view of this, we designed the present analysis to explore whether it is cost-effective to use the PD-L1 test to guide second-line nivolumab treatment in China.Material and MethodsA Markov model was established to project the lifetime costs and quality-adjusted life-years (QALYs) of three second-line treatment strategies: nivolumab and docetaxel (strategies without a PD-L1 test) and PD-L1 test-based strategy. Deterministic and probabilistic sensitivity analyses were performed to examine the robustness of our results. Additional price reduction and willingness-to-pay (WTP) threshold scenario analyses were performed to explore the impact of economic and health policies with Chinese characteristics on our results.ResultsThe PD-L1 test-based strategy costs approximately CNY 194,607 (USD 28,210) or more and yielded an additional 0.27 QALYs compared to the docetaxel strategy without a PD-L1 test, equating an incremental cost-effectiveness ratio (ICER) of CNY 731,089 (USD 105,978)/QALY. Deterministic sensitivity analyses showed that the price of nivolumab was the strongest source of variation in the ICERs. Probability sensitivity analysis showed that the probability for the PD-L1 test-based strategy being cost-effective increases with the increase of WTP thresholds.ConclusionFrom the perspective of the Chinese healthcare system, using a PD-L1 test to guide second-line nivolumab treatment was not cost-effective. The National Healthcare Security Administration negotiation on the price reduction of nivolumab was found to be the most effective action to improve its cost-effectiveness in China.

Download Full-text

Control of snakebite envenoming: A mathematical modeling study

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009711 ◽

2021 ◽

Vol 15 (8) ◽

pp. e0009711

Author(s):

Shuaibu Ahijo Abdullahi ◽

Abdulrazaq Garba Habib ◽

Nafiu Hussaini

Keyword(s):

Public Health ◽

Cost Effectiveness ◽

Control Strategies ◽

Real Data ◽

Disability Adjusted Life Years ◽

Health Awareness ◽

Data Set ◽

Disability Adjusted Life ◽

Life Years ◽

The Impact

A mathematical model is designed to assess the impact of some interventional strategies for curtailing the burden of snakebite envenoming in a community. The model is fitted with real data set. Numerical simulations have shown that public health awareness of the susceptible individuals on snakebite preventive measures could reduce the number of envenoming and prevent deaths and disabilities in the population. The simulations further revealed that if at least fifty percent of snakebite envenoming patients receive early treatment with antivenom a substantial number of deaths will be averted. Furthermore, it is shown using optimal control that combining public health awareness and antivenom treatment averts the highest number of snakebite induced deaths and disability adjusted life years in the study area. To choose the best strategy amidst limited resources in the study area, cost effectiveness analysis in terms of incremental cost effectiveness ratio is performed. It has been established that the control efforts of combining public health awareness of the susceptible individuals and antivenom treatment for victims of snakebite envenoming is the most cost effective strategy. Approximately the sum of US$72,548 is needed to avert 117 deaths or 2,739 disability adjusted life years that are recorded within 21 months in the study area. Thus, the combination of these two control strategies is recommended.

Download Full-text