scholarly journals Role of maintenance strategies in advanced epithelial ovarian cancer: a systematic review, network meta-analysis and cost-effectiveness analysis protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051037
Author(s):  
Qiancheng Hu ◽  
Wenli Kang ◽  
Qiuji Wu ◽  
Xin Wang ◽  
Qingfeng Wang ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cost Effectiveness ◽  
Meta Analysis ◽  
Advanced Ovarian Cancer ◽  
Cost Effectiveness Analysis ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Maintenance Strategies ◽  
Effectiveness Analysis ◽  
Life Years

IntroductionDifferent maintenance strategies have shown efficacy in patients with advanced ovarian cancer, but without drawing any conclusion on which strategy is preferred. Therefore, we will conduct a network meta-analysis and cost-effectiveness analysis to investigate maintenance strategies containing chemotherapy, poly (ADP-ribose) polymerase (PARP) inhibitors and anti-angiogenesis therapy for patients with advanced ovarian cancer.Methods and analysisThe search strategy to identify potentially relevant studies will include hand searches in EMBASE, PubMed, Cochrane library and Web of science. The primary outcome is progression-free survival, defined as the date of randomisation to the date of progression or death. The secondary outcome is overall survival (calculated from the time from randomisation to death from any cause), grade 3–4 haematological and non-haematological toxicities, quality-adjusted life years and incremental cost-effectiveness ratios. Two steps of meta-analysis will be carried out, traditional pair-wise meta-analysis and network meta-analysis. Methodological quality, risk of bias and the strength of evidence from randomised controlled trials (RCTs) will be proposed to assess the quality of RCTs. Heterogeneity, publication bias, subgroup analysis and sensitivity analysis will be explored.Ethics and disseminationThe purpose of our study is to perform a comprehensive efficacy, safety and cost-effectiveness analysis of all maintenance strategies in patients with advanced ovarian cancer. The results will be disseminated through international conference reports and peer-reviewed manuscripts. Ethics approval is not required for network meta-analysis and cost-effectiveness analysis.PROSPERO registration numberCRD42021231814.

Cost-effectiveness analysis of laparoscopic disease assessment in ovarian cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5556-5556
Author(s):  
Ross Harrison ◽  
Scott B. Cantor ◽  
Mariana Villanueva ◽  
Rudy Sam Suidan ◽  
Charlotte C. Sun ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cost Effectiveness ◽  
Progression Free Survival ◽  
Cost Effectiveness Analysis ◽  
Disease Assessment ◽  
Model Parameters ◽  
Alternative Strategies ◽  
Free Survival ◽  
Effectiveness Analysis ◽  
Life Years

5556 Background: Laparoscopic assessment of disease resectability can be useful for treatment planning for patients [pts] with advanced ovarian cancer [OC] but may be associated with added cost. Methods: We performed a cost-effectiveness analysis from a payer perspective to compare (1) a conventional strategy, where standard new pt evaluation was used to assign pts to either primary cytoreduction [PCS] or neoadjuvant chemotherapy with interval cytoreduction [NACT], and (2) an alternative approach, where pts considered candidates for PCS would undergo laparoscopy to evaluate disease resectability using a validated scoring system, who were then triaged to either PCS or NACT based on this evaluation. Diagnostic work-up, surgical and adjuvant treatment, perioperative complications, and progression-free survival [PFS] were included in the model. We derived model parameters from the literature and our institution’s experience with laparoscopic triage. Utility estimates for health states related to primary treatment were assessed prospectively and taken from the literature. Costs were estimated using Medicare reimbursement. Effectiveness was defined in quality-adjusted progression-free life years [QPFLYs]. We performed multiple sensitivity analyses. Results: Under baseline model parameters, the expected cost of treating one pt under the conventional and alternative strategies was $26,539 and $26,653, respectively. The expected quality-adjusted progression-free survival for pts in the conventional and alternative strategies was 0.70 and 0.94 QPFLYs, respectively. The calculated incremental cost-effectiveness was $473.97 per QPFLY saved. The alternative strategy became cost saving if pts found to have resectable disease by laparoscopy underwent cytoreduction during the same procedure. The conventional strategy may be preferred if PCS increased PFS over NACT by ≥5 months. Conclusions: For newly-diagnosed advanced stage OC pts, laparoscopic assessment of disease resectability prior to PCS was a cost-effective strategy. A conventional strategy may be preferred if PCS produced substantially longer PFS. Sensitivity analysis suggests the benefit of utilizing laparoscopic triage is influenced by mitigation of serious perioperative morbidity and associated costs.

scholarly journals Ultra-radical surgery compared to standard surgical treatment for women with advanced ovarian cancer: a cost-effectiveness analysis

2020 ◽  
Author(s):  
Giovanna Bettoli ◽  
Andrew Phillips ◽  
Sudha Sundar ◽  
Carole Cummins ◽  
Anish Bali
Keyword(s):  
Ovarian Cancer ◽  
Cost Effectiveness ◽  
Radical Surgery ◽  
Advanced Ovarian Cancer ◽  
Progression Free Survival ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Decision Analytic Model ◽  
Effectiveness Analysis

Objective To compare current surgical practice for women with AOC to ultra-radical surgery; to assess whether the new approach would be cost-effective under NICE guidelines of approximately £20,000/QALY. Design Cost-effectiveness analysis. Setting NHS, using data from a variety of sources. Population Patients with advanced ovarian cancer (FIGO stages IIIC-IV). Methods A decision analytic model (microsimulation model) was built to examine the Objective; deterministic and probabilistic sensitivity analyses were used to test the susceptibilities of the baseline model and its assumptions. Main Outcome Measures ICER (incremental cost-effectiveness ratio). Results The standard model yielded an ICER of £5325.06; this is in spite of an associated overall decrease in utility due to predicted increase in surgical mortality. The parameters with the most significant impact on the ICER are the cost of ultra-radical surgery, the utility associated with progression-free survival, and the probability of death from ultra-radical surgery. Conclusions Ultra-radical surgery is cost-effective under NICE willingness-to-pay thresholds of £20000; the costs of ultra-radical surgery are bound to decrease as centres specialise further, and its effectiveness is also likely due to increase with development of newer techniques and more surgical training.

At What Cost Does a Potential Survival Advantage of Bevacizumab Make Sense for the Primary Treatment of Ovarian Cancer? A Cost-Effectiveness Analysis

2011 ◽  
Vol 29 (10) ◽  
pp. 1247-1251 ◽  
Author(s):  
David E. Cohn ◽  
Kenneth H. Kim ◽  
Kimberly E. Resnick ◽  
David M. O'Malley ◽  
J. Michael Straughn
Keyword(s):  
Ovarian Cancer ◽  
Cost Effectiveness ◽  
Bowel Perforation ◽  
Advanced Ovarian Cancer ◽  
Cost Effective ◽  
Primary Treatment ◽  
Cost Effectiveness Analysis ◽  
Gynecologic Oncology Group ◽  
Effectiveness Analysis ◽  
The Cost

Purpose To determine whether the addition of bevacizumab to paclitaxel and carboplatin for the primary treatment of advanced ovarian cancer can be cost effective. Methods A cost-effectiveness analysis compared the three arms of the Gynecologic Oncology Group (GOG) 218 study (paclitaxel plus carboplatin [PC], PC plus bevacizumab [PCB], and PCB plus bevacizumab maintenance [PCB+B]). Actual and estimated costs of treatment plus the potential costs of complications were established for each strategy. Progression-free survival (PFS) and bowel perforation rates were taken from recently reported results of GOG 218. Sensitivity analysis was performed for pertinent uncertainties in the model. Incremental cost-effectiveness ratios (ICERs) per progression-free life-year saved (PF-LYS) were estimated. Results For the 600 patients entered onto each arm of GOG 218 at the baseline estimates of PFS and bowel perforation, the cost of PC was $2.5 million, compared with $21.4 million for PCB and $78.3 million for PCB+B. These costs led to an ICER of $479,712 per PF-LYS for PCB and $401,088 per PF-LYS for PCB+B. When the cost of bevacizumab was reduced to 25% of baseline, the ICER of PCB+B fell below $100,000 per PF-LYS. ICERs were not substantially reduced when the perforation rate was equal across all arms. Conclusion The addition of bevacizumab to standard chemotherapy in patients with advanced ovarian cancer is not cost effective. Treatment with maintenance bevacizumab leads to improved PFS but is associated with both direct and indirect costs. The cost effectiveness of bevacizumab in the adjuvant treatment of ovarian cancer is primarily dependent on drug costs.

Cost-effectiveness Analysis of Submandibular Gland Preservation With Sialendoscopy for the Management of Sialolithiasis

2021 ◽  
pp. 019459982110268
Author(s):  
Joseph R. Acevedo ◽  
Ashley C. Hsu ◽  
Jeffrey C. Yu ◽  
Dale H. Rice ◽  
Daniel I. Kwon ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Submandibular Gland ◽  
Average Cost ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Probability Of Success ◽  
Markov Decision Model ◽  
The Cost

Objective To compare the cost-effectiveness of sialendoscopy with gland excision for the management of submandibular gland sialolithiasis. Study Design Cost-effectiveness analysis. Setting Outpatient surgery centers. Methods A Markov decision model compared the cost-effectiveness of sialendoscopy versus gland excision for managing submandibular gland sialolithiasis. Surgical outcome probabilities were found in the primary literature. The quality of life of patients was represented by health utilities, and costs were estimated from a third-party payer’s perspective. The effectiveness of each intervention was measured in quality-adjusted life-years (QALYs). The incremental costs and effectiveness of each intervention were compared, and a willingness-to-pay ratio of $150,000 per QALY was considered cost-effective. One-way, multivariate, and probabilistic sensitivity analyses were performed to challenge model conclusions. Results Over 10 years, sialendoscopy yielded 9.00 QALYs at an average cost of $8306, while gland excision produced 8.94 QALYs at an average cost of $6103. The ICER for sialendoscopy was $36,717 per QALY gained, making sialendoscopy cost-effective by our best estimates. The model was sensitive to the probability of success and the cost of sialendoscopy. Sialendoscopy must meet a probability-of-success threshold of 0.61 (61%) and cost ≤$11,996 to remain cost-effective. A Monte Carlo simulation revealed sialendoscopy to be cost-effective 60% of the time. Conclusion Sialendoscopy appears to be a cost-effective management strategy for sialolithiasis of the submandibular gland when certain thresholds are maintained. Further studies elucidating the clinical factors that determine successful sialendoscopy may be aided by these thresholds as well as future comparisons of novel technology.

scholarly journals Systematic review of cost-effectiveness analysis of behavior change communication apps: Assessment of key methods

2021 ◽  
Vol 7 ◽  
pp. 205520762110005
Author(s):  
Cynthia Afedi Hazel ◽  
Sheana Bull ◽  
Elizabeth Greenwell ◽  
Maya Bunik ◽  
Jini Puma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Behavior Change ◽  
Quantitative Measure ◽  
Cost Effectiveness Analysis ◽  
Behavior Change Communication ◽  
Change Communication ◽  
Effectiveness Analysis ◽  
Life Years ◽  
The Cost

Objective Evidence backing the effectiveness of mobile health technology is growing, and behavior change communication applications (apps) are fast becoming a useful platform for behavioral health programs. However, data to support the cost-effectiveness of these interventions are limited. Suggestions for overcoming the low output of economic data include addressing the methodological challenges for conducting cost-effectiveness analysis of behavior change app programs. This study is a systematic review of cost-effectiveness analyses of behavior change communication apps and a documentation of the reported challenges for investigating their cost-effectiveness. Materials and methods Four academic databases: Medline (Ovid), CINAHL, EMBASE and Google Scholar, were searched. Eligibility criteria included original articles that use a cost-effectiveness evaluation method, published between 2008 and 2018, and in the English language. Results Out of the 60 potentially eligible studies, 6 used cost-effectiveness analysis method and met the inclusion criteria. Conclusion The evidence to support the cost-effectiveness of behavior change communication apps is insufficient, with all studies reporting significant study challenges for estimating program costs and outcomes. The main challenges included limited or lack of cost data, inappropriate cost measures, difficulty with identifying and quantifying app effectiveness, representing app effects as Quality-adjusted Life Years, and aggregating cost and effects into a single quantitative measure like Incremental Cost Effectiveness Ratio. These challenges highlight the need for comprehensive economic evaluation methods that balance app data quality issues with practical concerns. This would likely improve the usefulness of cost-effectiveness data for decisions on adoption, implementation, scalability, sustainability, and the benefits of broader healthcare investments.

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