scholarly journals Modelling-based evaluation of the costs, benefits and cost-effectiveness of multipathogen point-of-care tests for sexually transmitted infections in symptomatic genitourinary medicine clinic attendees

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e020394 ◽  
Author(s):  
Susie E Huntington ◽  
Richéal M Burns ◽  
Emma Harding-Esch ◽  
Michael J Harvey ◽  
Rachel Hill-Tout ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Sexually Transmitted Infections ◽  
Point Of Care ◽  
Secondary Outcome ◽  
Annual Number ◽  
Base Case ◽  
Sexually Transmitted ◽  
Life Years ◽  
Genitourinary Medicine ◽  
Point Of Care Tests

ObjectivesTo quantify the costs, benefits and cost-effectiveness of three multipathogen point-of-care (POC) testing strategies for detecting common sexually transmitted infections (STIs) compared with standard laboratory testing.DesignModelling study.SettingGenitourinary medicine (GUM) services in England.PopulationA hypothetical cohort of 965 988 people, representing the annual number attending GUM services symptomatic of lower genitourinary tract infection.InterventionsThe decision tree model considered costs and reimbursement to GUM services associated with diagnosing and managing STIs. Three strategies using hypothetical point-of-care tests (POCTs) were compared with standard care (SC) using laboratory-based testing. The strategies were: A) dual POCT forChlamydia trachomatis(CT) andNeisseria gonorrhoeae(NG); B) triplex POCT for CT-NG andMycoplasma genitalium(MG); C) quadruplex POCT for CT-NG-MG andTrichomonas vaginalis(TV). Data came from published literature and unpublished estimates.Primary and secondary outcome measuresPrimary outcomes were total costs and benefits (quality-adjusted life years (QALYs)) for each strategy (2016 GB, £) and associated incremental cost-effectiveness ratios (ICERs) between each of the POC strategies and SC. Secondary outcomes were inappropriate treatment of STIs, onward STI transmission, pelvic inflammatory disease in women, time to cure and total attendances.ResultsIn the base-case analysis, POC strategy C, a quadruplex POCT, was the most cost-effective relative to the other strategies, with an ICER of £36 585 per QALY gained compared with SC when using microcosting, and cost-savings of £26 451 382 when using tariff costing. POC strategy C also generated the most benefits, with 240 467 fewer clinic attendances, 808 fewer onward STI transmissions and 235 135 averted inappropriate treatments compared with SC.ConclusionsMany benefits can be achieved by using multipathogen POCTs to improve STI diagnosis and management. Further evidence is needed on the underlying prevalence of STIs and SC delivery in the UK to reduce uncertainty in economic analyses.

Abstract MP019: Should Global Cardiovascular Risk Guide Treatment of Stage One Hypertension? A Cost-effectiveness Analysis

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Andrew Moran ◽  
Petra Rasmussen ◽  
Rachel Zhao ◽  
Pamela G Coxson ◽  
David Guzman ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Risk Function ◽  
Annual Number ◽  
Base Case ◽  
Cvd Risk ◽  
Policy Model ◽  
Life Years ◽  
Stage 1

Introduction: Current U.S. hypertension guidelines base treatment on clinic blood pressure (BP) alone. International guidelines recommend adding global cardiovascular disease (CVD) risk to guide treatment. We projected incremental effectiveness and costs of treating stage 1 hypertension based on CVD risk assessment. Methods: We used the Coronary Heart Disease (CHD) Policy Model, a validated state-transition simulation of the CVD epidemic in the US, to model CHD and stroke events, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness (ICE) of increasingly aggressive treatment of hypertensive patients. Census and national survey data were used to estimate joint distributions of risk factors by age and sex; the CVD risk function was based on Framingham. We modeled treatment of BP to an approximate target <140/90 mmHg using standard dose medications, including averaged annual drug costs (e.g., $253 for a systolic BP reduction of 11.5 mmHg; $1,036 for reduction of 36.7 mmHg) and monitoring costs (2 or 4 visits/year for stage 1 or 2 plus 1 lab test/year for all). We compared a strategy in which only stage 2 hypertensives (≥160/≥100 mmHg) were treated to increasingly aggressive strategies in which stage 1 hypertensives (140-159/90-99 mmHg) with successively lower global CVD risk (15%, 10%, 5% risk, then all of stage 1) were also treated. Results: Reaching hypertension treatment targets with any policy simulated would prevent between 389,000 and 478,000 CVD events annually ( Table ). Treating all stage 2 and ≥15% CVD risk stage 1 hypertensives would be cost-saving and treating stage 1 with ≥10% or ≥5% CVD risk would incur modest costs. Treating all stage 1 would cost $161,000/QALY more than treating only ≥5% CVD risk. Conclusions: Treatment of low risk stage 1 hypertensives appears to come at high cost and limited added benefit unless treatment costs can be minimized. Using global CVD risk assessment might allow re-allocation of resources toward controlling hypertension in the highest risk patients. Table Simulated CVD outcomes, costs, and cost-effectiveness, 2010-2011, the CHD Policy Model Scenario Annual number hypertensives treated Annual CVD events Annual QALYs (millions) Annual costs (millions, $US) ICER * Base case, no intervention - 2,387,000 127.67 $827,313 reference Treat only stage 2 23,364,180 1,997,000 128.78 $825,264 cost saving Treat stage 2 + stage 1 >=15% CVD risk 30,654,361 1,943,000 128.93 $824,541 cost saving Treat stage 2 + stage 1 >=10% CVD risk 34,947,200 1,928,000 128.97 $824,898 $9,381 Treat stage 2 + stage 1 >= 5% CVD risk 44,321,985 1,913,000 129.02 $826,433 $28,931 Treat stage 2 + all stage 1 50,863,390 1,909,000 129.04 $828,290 $160,630 *ICER = difference in cost/difference in QALY in comparison with the next less effective strategy

scholarly journals Economic evaluation of nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e039201
Author(s):  
Daan P J Verberne ◽  
Ghislaine A P G van Mastrigt ◽  
Rudolf W H M Ponds ◽  
Caroline M van Heugten ◽  
Mariëlle E A L Kroese
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Social Participation ◽  
Psychosocial Functioning ◽  
Cost Effective ◽  
Secondary Outcome ◽  
Base Case ◽  
Psychosocial Outcome ◽  
Post Stroke ◽  
Life Years

ObjectiveTo examine the cost-effectiveness of nurse-led stroke aftercare addressing psychosocial outcome at 6 months post stroke, compared with care-as-usual.DesignEconomic evaluation within a comparative effectiveness research design.SettingPrimary care (2016–2017) and community settings (2011–2013) in the Netherlands.ParticipantsPersons who suffered from ischaemic or haemorrhagic stroke, or a transient ischaemic attack and were discharged home after visiting the emergency department, hospitalisation or inpatient rehabilitation.InterventionsNurse-led stroke aftercare at 6 months post stroke addressing psychosocial functioning by providing screening, psycho-education, emotional support and referral to specialist care when needed. Care-as-usual concerned routine follow-up care including secondary prevention programmes and a consultation with the neurologist at 6 weeks post stroke.Primary and secondary outcome measuresMain outcome measure of cost-effectiveness was quality-adjusted life years (QALYs) estimated by the quality of life measured by the five-dimensional, three-level EuroQol. Costs were assessed using a cost-questionnaire. Secondary outcomes were mood (Hospital Anxiety and Depression Scale) and social participation (Utrecht Scale for Evaluation of Rehabilitation-Participation) restrictions subscale.ResultsHealth outcomes were significantly better in stroke aftercare for QALYs (Δ=0.05; 95% CI 0.01 to 0.09) and social participation (Δ=4.91; 95% CI 1.89 to 7.93) compared with care-as-usual. Total societal costs were €1208 higher in stroke aftercare than in care-as-usual (95% CI −€3881 to €6057). Healthcare costs were in total €1208 higher in stroke aftercare than in care-as-usual (95% CI −€3881 to €6057). Average costs of stroke aftercare were €91 (SD=€3.20) per person. Base case cost-effectiveness analyses showed an incremental cost-effectiveness ratio of €24 679 per QALY gained. Probability of stroke aftercare being cost-effective was 64% on a €50 000 willingness-to-pay level.ConclusionsNurse-led stroke aftercare addressing psychosocial functioning showed to be a low-cost intervention and is likely to be a cost-effective addition to care-as-usual. It plays an important role by screening and addressing psychosocial problem, not covered by usual care.

Adolescent Vulvovaginitis

2019 ◽  
Author(s):  
Mary Romano
Keyword(s):  
Sexually Transmitted Infections ◽  
Point Of Care ◽  
Sexual History ◽  
Specific Point ◽  
Sexually Transmitted ◽  
Presenting Symptoms ◽  
Point Of Care Tests ◽  
Underlying Pathology ◽  
Trichomonas Vaginitis ◽  
Special Patient

Vulvovaginitis is a common complaint in adolescents. There are specific and nonspecific causes. Specific causes include sexually transmitted infections and so it is important to take a sexual history in any adolescent presenting with vulvovaginal complaints. A sexual history should be taken in a sensitive and confidential manner. Diagnosis of vulvovaginitis requires an external genital examination and may require a pelvic examination based on other presenting symptoms. Microscopy is typically used to make a diagnosis. More sensitive or specific point of care tests are commercially available, but they can be cost prohibitive. Treatment of vulvovaginitis is based on underlying pathology and often a review of vaginal hygiene may be necessary.In special patient populations, extended or repeat treatment may be necessary. This review contains 3 figures, 2 tables, and 21 references. Key Words: adolescent, bacterial vaginosis, candidiasis, confidentiality, discharge, dysuria, sexually transmitted infections (STIs), trichomonas, vaginitis, wet prep

scholarly journals AN ECONOMIC MODEL OF SCHOOL-BASED BEHAVIORAL INTERVENTIONS TO PREVENT SEXUALLY TRANSMITTED INFECTIONS

2012 ◽  
Vol 28 (4) ◽  
pp. 407-414 ◽  
Author(s):  
Keith Cooper ◽  
Jonathan Shepherd ◽  
Jo Picot ◽  
Jeremy Jones ◽  
Josephine Kavanagh ◽  
...  
Keyword(s):  
Sexual Behavior ◽  
Cost Effectiveness ◽  
Young People ◽  
Sexually Transmitted Infections ◽  
Economic Model ◽  
Teenage Pregnancy ◽  
Behavioral Interventions ◽  
Sexually Transmitted ◽  
School Based ◽  
Life Years

Objectives: Reducing sexually transmitted infections (STI) and teenage pregnancy through effective health education is a high priority for health policy. Behavioral interventions which teach skills to practice safer sex may reduce the incidence of STIs. We evaluated the cost-effectiveness of school-based behavioral interventions in young people.Methods: We developed an economic model to estimate the total number of STI cases averted, consequent gain in health related quality of life (HRQoL) and savings in medical costs, based on changes in sexual behavior. The parameters for the model were derived from a systematic literature search on the intervention effectiveness, epidemiology of STIs, sexual behavior and lifestyles, HRQoL and health service costs.Results: The costs of providing teacher-led and peer-led behavioral interventions were €5.16 and €18 per pupil, respectively. For a cohort of 1000 boys and 1000 girls aged 15 years, the model estimated that the behavioral interventions would avert two STI cases and save 0.35 Quality Adjusted Life Years (QALYs). Compared to standard education, the incremental cost-effectiveness of the teacher-led and peer-led interventions was €24,268 and €96,938 per QALY gained, respectively.Conclusions: School-based behavioral interventions which provide information and teach young people sexual health skills can bring about improvements in knowledge and increased self-efficacy, though these may be limited in terms of impact on sexual behavior. There was uncertainty around the results due to the limited effect of the intervention on behavioral outcomes and paucity of data for other input parameters.

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