Adalimumab for non-infectious uveitis: is it cost-effective?

Background/AimsUveitis is inflammation inside the eye. Our objective was to assess the cost-effectiveness of adalimumab compared with current practice (immunosuppressants and systemic corticosteroids) in patients with non-infectious intermediate, posterior or panuveitis and to identify areas for future research.MethodsA Markov model was built to estimate costs and benefits of the interventions. Systematic reviews were performed to identify the available relevant clinical and cost-effectiveness evidence. Data collected in two key randomised controlled trials (VISUAL I and VISUAL II) were used to estimate the interventions’ effectiveness compared with the trials’ comparator arms (placebo plus limited current practice (LCP)). The analysis was performed from the National Health Service and Personal Social Services perspective. Costs were calculated based on standard UK sources.ResultsThe estimated incremental cost-effectiveness ratios (ICERs) of adalimumab versus LCP for the base case are £92 600 and £318 075 per quality-adjusted life year (QALY) gained for active and inactive uveitis, respectively. In sensitivity analyses, the ICER varied from £15 579 to £120 653 and £35 642 to £800 775 per QALY for active and inactive uveitis.ConclusionThe estimated ICERs of adalimumab versus LCP are above generally accepted thresholds for cost-effectiveness in the UK. Adalimumab may be more cost-effective in patients with active uveitis at greater risk of blindness. However, there is an unmet need for additional primary data to provide more reliable estimates in several important areas, including effectiveness of adalimumab versus current practice (instead of LCP), incidence of long-term blindness, adalimumab effectiveness in avoiding blindness, and rates and time to remission while on adalimumab.

Download Full-text

Dexamethasone implant for non-infectious uveitis: is it cost-effective?

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312765 ◽

2019 ◽

Vol 103 (11) ◽

pp. 1639-1644 ◽

Cited By ~ 2

Author(s):

Hazel Squires ◽

Iñigo Bermejo ◽

Edith N Poku ◽

Katy Cooper ◽

John Stevens ◽

...

Keyword(s):

Cost Effectiveness ◽

Social Services ◽

Current Practice ◽

Controlled Trial ◽

Relative Proportion ◽

Cost Effective ◽

Quality Adjusted Life Year ◽

Future Research ◽

Dexamethasone Implant ◽

Relevant Evidence

BackgroundUveitis is inflammation inside the eye. The objective of this study is to assess the cost-effectiveness of a dexamethasone implant plus current practice (immunosuppressants and systemic corticosteroids) compared with current practice alone, in patients with non-infectious intermediate, posterior or pan-uveitis and to identify areas for future research.MethodsA Markov model was built to estimate the costs and benefits of dexamethasone. Systematic reviews were performed to identify available relevant evidence. Quality of life data from the key randomised-controlled trial (HURON) was used to estimate the interventions’ effectiveness compared with the trial’s comparator arm (placebo plus limited current practice (LCP)). The analysis took a National Health Service and Personal Social Services perspective. Costs were calculated based on standard UK sources.ResultsThe incremental cost-effectiveness ratio (ICER) of one dexamethasone implant compared with LCP is estimated as £19 509 per quality-adjusted life year (QALY) gained. The factors with the largest impact on the results were rate of blindness and relative proportion of blindness cases avoided by dexamethasone. Using plausible alternative assumptions, dexamethasone could be cost saving or it may be associated with an ICER of £56 329 per QALY gained compared with LCP.ConclusionsDexamethasone is estimated to be cost-effective using generally accepted UK thresholds. However, there is substantial uncertainty around these results due to scarcity of evidence. Future research on the following would help provide more reliable estimates: effectiveness of dexamethasone versus current practice (instead of LCP), with subgroup analyses for unilateral and bilateral uveitis, incidence of long-term blindness and effectiveness of dexamethasone in avoiding blindness.

Download Full-text

OP131 Cost-Effectiveness Of Dexamethasone And Adalimumab For Uveitis

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317001908 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 60-61 ◽

Cited By ~ 1

Author(s):

Inigo Bermejo ◽

Hazel Squires ◽

Edith Poku ◽

Katy Cooper ◽

John Stevens ◽

...

Keyword(s):

Cost Effectiveness ◽

Social Services ◽

Current Practice ◽

Cost Effective ◽

Quality Adjusted Life Year ◽

Treatment Comparison ◽

Relevant Evidence ◽

Systemic Corticosteroids ◽

Evidence Quality ◽

Effective Use

INTRODUCTION:Uveitis is inflammation inside the eye whose underlying cause may be infectious or non-infectious. The objective of our study was to assess the cost-effectiveness of the dexamethasone implant and adalimumab compared with current practice (immunosuppressants and systemic corticosteroids) in patients with non-infectious intermediate, posterior or pan-uveitis.METHODS:A Markov model was built to estimate costs and benefits of the interventions. Systematic reviews were performed to identify the relevant evidence. Quality of life data collected in three key randomized-controlled trials (1-3) was used to estimate the interventions effectiveness compared with the trials comparator arms, which consisted of placebo plus limited current practice (LCP). An indirect treatment comparison between adalimumab and dexamethasone was considered inappropriate due to lack of necessary evidence. For adalimumab, patients with active and inactive uveitis were considered separately. Due to the short duration of the trials, the rate of blindness, an important complication of uveitis, was highly uncertain. Substantial exploratory analyses were therefore undertaken. The analysis was performed from the perspective of the National Health Service (NHS) and Personal Social Services (PSS). Costs were calculated based on standard United Kingdom sources.RESULTS:The estimated incremental cost-effectiveness (ICER) of dexamethasone compared with LCP was GBP19,509 per quality-adjusted life year (QALY) gained. The estimated ICER of adalimumab compared with LCP was GBP94,523 and GBP317,547 per QALY in patients with active and inactive uveitis respectively. The factors with the largest impact upon the ICERs were the rate of blindness and the proportion of cases of blindness avoided by interventions.CONCLUSIONS:Dexamethasone and adalimumab resulted in health gains, but at significant extra costs, especially adalimumab which is unlikely to be considered a cost-effective use of NHS resources. The results of the analysis are highly uncertain due to the limited availability of evidence on: the comparative effectiveness of dexamethasone, adalimumab and current practice; the effectiveness of treatments in avoiding blindness; and, the effectiveness of interventions in different subgroups.

Download Full-text

An economic evaluation of nivolumab for the treatment of squamous and non-squamous NSCLC in the Swedish setting

Nordic Journal of Health Economics ◽

10.5617/njhe.5453 ◽

2020 ◽

Author(s):

Caitlin Smare ◽

Meena Venkatachalam ◽

Emma Medin ◽

Marcus Hultberg ◽

John R Penrod ◽

...

Keyword(s):

Cost Effectiveness ◽

Incremental Cost ◽

Scenario Analysis ◽

Progression Free Survival ◽

Cost Effective ◽

Quality Adjusted Life Year ◽

Sensitivity Analyses ◽

Base Case ◽

Health States ◽

Treatment Data

The cost-effectiveness of nivolumab versus docetaxel in patients with previously treated non-small cell lung cancer (NSCLC) was estimated in a cohort-based, partitioned survival model with three health states (progression-free, progressed disease, and death) and a time horizon of 15 years. The base-case model was developed using extrapolations of progression-free survival (PFS) and overall survival (OS) data from the CheckMate 017 and 057 randomized trials, and 2015 Swedish unit costs. An annual discount rate of 3% was applied. Base-case time-on-treatment was based on PFS (CheckMate 017) or time-to-treatment discontinuation (CheckMate 057), depending on whether PFS was a close proxy for time-on-treatment. Data extrapolations from CheckMate 017 and 057 were validated against external trial and registry data. Model utilities were derived from CheckMate 017 and 057 with UK weights (base-case) and Swedish weights (scenario analysis). Uncertainty was assessed using sensitivity analyses adjusted for clinical, utility, and cost data. Outcomes included incremental cost per quality-adjusted life-year (QALY) gained. The base-case model showed that nivolumab was associated with QALY gains of 0.72 (squamous) and 0.81 (non-squamous) versus docetaxel at an incremental cost of 734,573 SEK (€69,174) and 999,032 SEK (€94,078), respectively. This resulted in an incremental cost per QALY gained for nivolumab versus docetaxel of 1,013,697 SEK (€95,459) and 1,231,664 SEK (€115,985) in squamous and non-squamous NSCLC, respectively. Scenario analysis utilizing Swedish utility weights resulted in slightly lower incremental cost per QALY gained of 855,505 SEK (€80,562) (squamous) and 1,165,401 SEK (€109,745) (non-squamous). Deterministic sensitivity analysis showed that utility weights, treatment costs, discount rates, and body weight were key drivers of cost-effectiveness. Overall, the model showed that cost-effectiveness was driven by nivolumab price, but nivolumab remained cost-effective in squamous and non-squamous NSCLC in accordance with previous appraisals by the Dental and Pharmaceutical Benefits Agency (Tandvårds- och läkemedelsförmånsverket) and New Therapies Council in Sweden. Published: Online December 2019.

Download Full-text

Cost-effectiveness of everolimus for the treatment of advanced neuroendocrine tumours of gastrointestinal or lung origin in Canada

Current Oncology ◽

10.3747/co.25.3532 ◽

2018 ◽

Vol 25 (1) ◽

pp. 32 ◽

Cited By ~ 2

Author(s):

A. Chua ◽

A. Perrin ◽

J.F. Ricci ◽

M.P. Neary ◽

M. Thabane

Keyword(s):

Cost Effectiveness ◽

Neuroendocrine Tumours ◽

Locally Advanced ◽

Cost Effective ◽

Best Supportive Care ◽

Quality Adjusted Life Year ◽

Sensitivity Analyses ◽

Base Case ◽

Health States ◽

The Cost

Background In 2016, everolimus was approved by Health Canada for the treatment of unresectable, locally advanced or metastatic, well-differentiated, non-functional, neuroendocrine tumours (NET) of gastrointestinal (GI) or lung origin in adult patients with progressive disease. This analysis evaluated the cost-effectiveness of everolimus in this setting from a Canadian societal perspective.Methods A partitioned survival model was developed to compare the cost per life-year (LY) gained and cost per quality-adjusted life-year (QALY) gained of everolimus plus best supportive care (BSC) versus BSC alone in patients with advanced or metastatic NET of GI or lung origin. Model health states included stable disease, disease progression, and death. Efficacy inputs were based on the RADIANT-4 trial and utilities were mapped from quality-of-life data retrieved from RADIANT-4. Resource utilization inputs were derived from a Canadian physician survey, while cost inputs were obtained from official reimbursement lists from Ontario and other published sources. Costs and efficacy outcomes were discounted 5% annually over a 10-year time horizon, and sensitivity analyses were conducted to test the robustness of the base case results.Results Everolimus had an incremental gain of 0.616 QALYs (0.823 LYs) and CA$89,795 resulting in an incremental cost-effectiveness ratio of CA$145,670 per QALY gained (CA$109,166 per LY gained). The probability of cost-effectiveness was 52.1% at a willingness to pay (WTP) threshold of CA$150,000 per QALY.Conclusions Results of the probabilistic sensitivity analysis indicate that everolimus has a 52.1% probability of being cost-effective at a WTP threshold of CA$150,000 per QALY gained in Canada.

Download Full-text

Cost-effectiveness analysis of ranibizumab for retinal vein occlusion patients in China from the societal perspective

BMC Ophthalmology ◽

10.1186/s12886-021-01997-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Weiyi Ni ◽

Jia Liu ◽

Yawen Jiang ◽

Jing Wu

Keyword(s):

Cost Effectiveness ◽

Retinal Vein Occlusion ◽

Societal Perspective ◽

Laser Photocoagulation ◽

Cost Effective ◽

Sensitivity Analyses ◽

Gdp Per Capita ◽

Base Case ◽

Vein Occlusion ◽

Per Capita

Abstract Background Clinical trials in China have demonstrated that ranibizumab can improve the clinical outcomes of branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). However, no economic evaluation of ranibizumab has been conducted among Chinese patient population. Methods To provide insights into the economic profile of ranibizumab among Chinese RVO population, a Markov state-transition model was used to predict the outcomes of ranibizumab comparing to laser photocoagulation and observational-only care from the societal perspective. This model simulated changes in patient visuality, quality-adjusted of life years (QALY), medical costs, and direct non-medical costs of individuals with visual impairment due to BRVO or CRVO in lifetime. The base-case analysis used an annual discount rate of 5% for costs and benefits following the China Guidelines for Pharmacoeconomic Evaluations. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of the model. Results The base-case incremental cost-effectiveness ratio (ICER) comparing ranibizumab to laser photocoagulation was ¥65,008/QALY among BRVO patients and was ¥65,815/QALY among CRVO patients, respectively. Comparing to the 2019 gross domestic product (GDP) per capita of ¥71,000, both two ICERs were far below the cost-effective threshold at three times of GDP per capita (¥213,000). The deterministic and probabilistic sensitivity analyses demonstrated the base-case results were robust in most of the simulation scenarios. Conclusion The current Markov model demonstrated that ranibizumab may be cost-effective compared with laser photocoagulation to treat BRVO and cost-effective compared to observation-only care to treat CRVO in China from the societal perspective.

Download Full-text

Cost-effectiveness of mobile health-based integrated care for atrial fibrillation: Model development and data analysis (Preprint)

10.2196/preprints.29408 ◽

2021 ◽

Author(s):

Xueyan Luo ◽

Wei Xu ◽

Quan Yuan ◽

Han Lai ◽

Chunji Huang

Keyword(s):

Atrial Fibrillation ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Integrated Care ◽

Mobile Health ◽

Cost Effective ◽

Sensitivity Analyses ◽

Base Case ◽

Life Years ◽

Mhealth Technology

BACKGROUND Mobile health (mhealth) technology is increasingly used in disease management. Using mhealth tools to integrate and streamline care was found to improve atrial fibrillation (AF) patients’ clinical outcomes. OBJECTIVE This study aimed to investigate the potential clinical and health economic outcomes of mhealth-based integrated care for AF from the perspective of a public healthcare provider in China. METHODS A Markov model was designed to compare outcomes of mhealth-based care and usual care in a hypothetical cohort of AF patients in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to examine the robustness of base-case results. RESULTS In the base-case analysis, mhealth-based care gained higher QALYs of 0.0818 with an incurred cost of USD1,778. Using USD33,438 per QALY (three times gross domestic product) as the willingness-to-pay threshold, mhealth-based care was cost-effective, with an ICER of USD21,739 per QALY. The one-way sensitivity analysis found compliance to mhealth-based care had the greatest impact on the ICER. In probabilistic sensitivity analysis, mhealth-based care was accepted as cost-effective in 80.91% of 10,000 iterations. CONCLUSIONS This study suggested that the use of mhealth technology in streamlining and integrating care for AF patients was cost-effective in China.

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

Measles CEA

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.153 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S64-S65

Author(s):

Emily Hyle

Keyword(s):

Cost Effectiveness ◽

Cost Saving ◽

Economic Value ◽

Cost Effective ◽

Incremental Cost Effectiveness Ratio ◽

International Travel ◽

Sensitivity Analyses ◽

Base Case ◽

Cost Effectiveness Ratio ◽

The Impact

Abstract Background Most measles importations are due to returning US travelers infected during international travel. We projected clinical outcomes and assessed cost-effectiveness of pretravel evaluation for measles immunity and MMR vaccination among eligible adult US international travelers. Methods We designed a decision tree to investigate pretravel evaluation compared with no evaluation from the societal perspective. Data from the Global TravEpiNet Consortium and published literature informed input parameters (Figure 1). Outcomes included measles cases averted per 10 million travelers, costs, and the incremental cost-effectiveness ratio (ICER, Δcosts/Δmeasles cases averted); we considered ICERs < $100,000/measles case averted to be cost-effective. We performed sensitivity analyses to assess the impact of varying the probability of exposure based on travel destination, and the percentage of travelers with pre-existing measles immunity. Results In the base case, departure after pretravel evaluation resulted in 16 measles importations and 46 transmissions per 10 million travelers and cost $132 million, vs without pretravel evaluation (26 importations and 87 transmissions per 10 million travelers, costing $22 million). Pretravel evaluation averted 51 measles cases per 10 million travelers with an ICER of $2.2 million per case averted. Results were most sensitive to the probability of measles exposure and the traveler’s pre-existing immunity (Figure 2). Pretravel evaluation was cost-effective for travelers to Asia if pre-existing measles immunity was <80%. Evaluation was always cost-effective for travelers to Africa when pre-existing immunity was less than 100% and became cost saving when the percentage of immune travelers was lower (<70%). Travelers who were more likely to be non-immune and were visiting destinations with higher probabilities of exposure were most likely to benefit from pretravel evaluation for measles immunity at excellent economic value. Conclusion As risk of measles exposure increases and likelihood of travelers’ pre-existing immunity decreases, it can be cost-effective or cost saving to assess US international travelers’ measles immunity status and vaccinate with MMR prior to departure. Disclosures All authors: No reported disclosures.

Download Full-text

Canadian cost-effectiveness model of BRCA-driven surgical prevention of breast/ovarian cancers compared to treatment if cancer develops

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462319003519 ◽

2020 ◽

Vol 36 (2) ◽

pp. 104-112 ◽

Cited By ~ 2

Author(s):

Manjusha Hurry ◽

Anthony Eccleston ◽

Matthew Dyer ◽

Paul Hoskins

Keyword(s):

Cost Effectiveness ◽

Brca Mutation ◽

Cost Savings ◽

Cost Effective ◽

Index Patient ◽

Quality Adjusted Life Year ◽

Base Case ◽

Degree Relative ◽

Uptake Rates ◽

Risk Reducing

ObjectivesTo assess the cost effectiveness from a Canadian perspective of index patient germline BRCA testing and then, if positive, family members with subsequent risk-reducing surgery (RRS) in as yet unaffected mutation carriers compared with no testing and treatment of cancer when it develops.MethodsA patient level simulation was developed comparing outcomes between two groups using Canadian data. Group 1: no mutation testing with treatment if cancer developed. Group 2: cascade testing (index patient BRCA tested and first-/second-degree relatives tested if index patient/first-degree relative is positive) with RRS in carriers. End points were the incremental cost-effectiveness ratio (ICER) and budget impact.ResultsThere were 29,102 index patients: 2,786 ovarian cancer and 26,316 breast cancer (BC). Using the base-case assumption of 44 percent and 21 percent of women with a BRCA mutation receiving risk-reducing bilateral salpingo-oophorectomy and risk-reducing mastectomy, respectively, testing was cost effective versus no testing and treatment on cancer development, with an ICER of CAD 14,942 (USD 10,555) per quality-adjusted life-year (QALY), 127 and 104 fewer cases of ovarian and BC, respectively, and twenty-one fewer all-cause deaths. Testing remained cost effective versus no testing at the commonly accepted North American threshold of approximately CAD 100,000 (or USD 100,000) per QALY gained in all scenario analyses, and cost effectiveness improved as RRS uptake rates increased.ConclusionsPrevention via testing and RRS is cost effective at current RRS uptake rates; however, optimization of uptake rates and RRS will increase cost effectiveness and can provide cost savings.

Download Full-text

P14.12 The cost-effectiveness of tumor-treating fields in patients with newly diagnosed glioblastoma

Neuro-Oncology ◽

10.1093/neuonc/noz126.247 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii68-iii69

Author(s):

X Armoiry ◽

P Auguste ◽

C Dussart ◽

J Guyotat ◽

M Connock

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Survival Model ◽

Sensitivity Analyses ◽

Base Case ◽

Tumor Treating Fields ◽

Kaplan Meier ◽

Life Years ◽

Secondary Analyses ◽

The Cost

Abstract BACKGROUND The addition of novel therapy “Tumor-Treating fields” (TTF) to standard radio-chemotherapy with Temozolomide (TMZ) has recently shown superiority over conventional TMZ regimen in patients with glioblastoma. Despite the clinical benefit of TTF, there is a strong concern regarding the cost of this new treatment. A first cost-effectiveness analysis, which was published in 2016, was based on effectiveness outcomes from an interim analysis of the pivotal trial and used a “standard” Markov model. Here, we aimed to update the cost-effectiveness evaluation using a partitioned survival model design and using the latest effectiveness data. MATERIAL AND METHODS A partitioned survival model was developed with three mutually exclusive health states: stable disease, progressive disease, and dead. Parametric models were fitted to the Kaplan-Meier data for overall and progression-free survival. These generated clinically plausible extrapolations beyond the observed data. The perspective of the French national health insurance was adopted and the time horizon was 20 years. Base case results were expressed as cost/life-years (LY) gained (LYG). Secondary analyses were undertaken, with the results presented as cost/per quality adjusted life years (QALY) gained. Last, we undertook deterministic and probabilistic sensitivity analyses. RESULTS After applying 4% annual discounting of benefits and costs, the base case model generated incremental benefit of 0.507 LY at a incremental cost of €258,695 yielding an incremental cost effectiveness ratio (ICER) of €510,273 / LYG. Secondary analyses yielded an ICER of €667,173/QALY. Sensitivity analyses and bootstrapping methods showed the model was relatively robust. The model was sensitive to TTF device costs and the parametric model fitted to the Kaplan-Meier data for overall survival. The cost-effectiveness acceptability curve showed TTF has 0% of being cost-effective under conventional thresholds. CONCLUSION Using a partitioned survival model, uprated costs and more mature survival outcomes, TTF when compared to standard radio-chemotherapy with TMZ is not likely to be cost-effective. This has major implications in terms of access of newly eligible patients

Download Full-text