Exploratory cost-effectiveness model of electromagnetic navigation bronchoscopy (ENB) compared with CT-guided biopsy (TTNA) for diagnosis of malignant indeterminate peripheral pulmonary nodules

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.

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Cost-Effectiveness Analysis of Biomarker-Guided Treatment for Metastatic Gastric Cancer in the Second-Line Setting

Journal of Oncology ◽

10.1155/2020/2198960 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Brianna Lauren ◽

Sassan Ostvar ◽

Elisabeth Silver ◽

Myles Ingram ◽

Aaron Oh ◽

...

Keyword(s):

Gastric Cancer ◽

Cost Effectiveness ◽

Targeted Therapies ◽

Cost Effective ◽

Metastatic Gastric Cancer ◽

Sensitivity Analyses ◽

Decision Analytic Model ◽

Effective Strategy ◽

Second Line ◽

Life Years

Background. The 5-year survival rate of patients with metastatic gastric cancer (GC) is only 5%. However, trials have demonstrated promising antitumor activity for targeted therapies/immunotherapies among chemorefractory metastatic GC patients. Pembrolizumab has shown particular efficacy among patients with programmed death ligand-1 (PD-L1) expression and high microsatellite instability (MSI-H). The aim of this study was to assess the effectiveness and cost-effectiveness of biomarker-guided second-line GC treatment. Methods. We constructed a Markov decision-analytic model using clinical trial data. Our model compared pembrolizumab monotherapy and ramucirumab/paclitaxel combination therapy for all patients and pembrolizumab for patients based on MSI status or PD-L1 expression. Paclitaxel monotherapy and best supportive care for all patients were additional comparators. Costs of drugs, treatment administration, follow-up, and management of adverse events were estimated from a US payer perspective. The primary outcomes were quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100,000/QALY over 60 months. Secondary outcomes were unadjusted life years (survival) and costs. Deterministic and probabilistic sensitivity analyses were performed to evaluate model uncertainty. Results. The most effective strategy was pembrolizumab for MSI-H patients and ramucirumab/paclitaxel for all other patients, adding 3.8 months or 2.0 quality-adjusted months compared to paclitaxel. However, this strategy resulted in a prohibitively high ICER of $1,074,620/QALY. The only cost-effective strategy was paclitaxel monotherapy for all patients, with an ICER of $53,705/QALY. Conclusion. Biomarker-based treatments with targeted therapies/immunotherapies for second-line metastatic GC patients substantially improve unadjusted and quality-adjusted survival but are not cost-effective at current drug prices.

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CT-guided biopsy of pulmonary nodules: is pulmonary hemorrhage a complication or an advantage?

Diagnostic and Interventional Radiology ◽

10.5152/dir.2014.14019 ◽

2014 ◽

Vol 20 (5) ◽

pp. 421-425 ◽

Cited By ~ 13

Author(s):

Massimo De Filippo ◽

Luca Saba ◽

Mario Silva ◽

Raffaella Zagaria ◽

Giorgio Concari ◽

...

Keyword(s):

Pulmonary Hemorrhage ◽

Pulmonary Nodules ◽

Ct Guided ◽

Guided Biopsy ◽

Ct Guided Biopsy

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COST-EFFECTIVENESS OF ALEMTUZUMAB FOR T-CELL PROLYMPHOCYTIC LEUKEMIA

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462312000244 ◽

2012 ◽

Vol 28 (3) ◽

pp. 241-248 ◽

Cited By ~ 5

Author(s):

Lanting Lu ◽

Jaime Peters ◽

Chris Roome ◽

Ken Stein

Keyword(s):

Cost Effectiveness ◽

T Cell ◽

Cost Effective ◽

Perfect Information ◽

Sensitivity Analyses ◽

Future Research ◽

Decision Analytic Model ◽

Prolymphocytic Leukemia ◽

The Cost ◽

The Impact

Objectives:The aim of this study was to evaluate the cost-effectiveness of alemtuzumab (CAMPATH-1H) compared with conventional chemotherapy in people with T-cell prolymphocytic leukemia (T-PLL).Methods:We developed a decision-analytic model to assess the costs and benefits of alemtuzumab or conventional therapy based on their effects on quality of life of patients. The main outcome was the incremental cost-effectiveness ratio incorporating costs per additional quality-adjusted life-year (QALY) gained over lifetime. Due to the limited data available, a large number of assumptions had to be made to construct the cost-utility model. One-way, multi-way, and probabilistic sensitivity analyses (PSA) were conducted to explore the impact of these uncertainties. Expected values of perfect information were also calculated for four specific scenarios.Results:Depending on different key assumptions made, the PSA suggested distinct conclusions using a willingness-to-pay threshold of 30,000 GBP per QALY gained. Using this threshold, the probability that alemtuzumab would be cost-effective varies from 0 percent to 53 percent for the four modeled scenarios. Population expected value of perfect information analysis suggests that resolving the parameter uncertainty in the analysis for people with T-PLL in the United Kingdom would have considerable value—up to 5.3 million euro.Conclusions:Alemtuzumab appears more likely to be cost-effective if used earlier in the course of T-PLL and where it replaces the use of multiple alternative therapies. However, cost-effectiveness is highly uncertain and future research is clearly justified. Nevertheless, our analysis demonstrates the feasibility of considering the cost-effectiveness of an agent despite the presence of significant uncertainty to provide appropriate assessment information to policy makers.

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Cost-effectiveness of cryptococcal antigen screening at CD4 counts of 101–200 cells/µL in Botswana

Wellcome Open Research ◽

10.12688/wellcomeopenres.16624.1 ◽

2021 ◽

Vol 6 ◽

pp. 55

Author(s):

Mark W. Tenforde ◽

Charles Muthoga ◽

Ponego Ponatshego ◽

Julia Ngidi ◽

Madisa Mine ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Treatment Costs ◽

World Health ◽

Sensitivity Analyses ◽

Decision Analytic Model ◽

High Coverage ◽

Cd4 Counts ◽

Cryptococcal Antigen ◽

Health Organization

Background: Cryptococcal antigen (CrAg) screening in individuals with advanced HIV reduces cryptococcal meningitis (CM) cases and deaths. The World Health Organization recently recommended increasing screening thresholds from CD4 ≤100 cells/µL to ≤200 cells/µL. CrAg screening at CD4 ≤100 cells/µL is cost-effective; however, the cost-effectiveness of screening patients with CD4 101–200 cells/µL requires evaluation. Methods: Using a decision analytic model with Botswana-specific cost and clinical estimates, we evaluated CrAg screening and treatment among individuals with CD4 counts of 101–200 cells/µL. We estimated the number of CM cases and deaths nationally and treatment costs without screening. For screening we modeled the number of CrAg tests performed, number of CrAg-positive patients identified, proportion started on pre-emptive fluconazole, CM cases and deaths. Screening and treatment costs were estimated and cost per death averted or disability-adjusted life year (DALY) saved compared with no screening. Results: Without screening, we estimated 142 CM cases and 85 deaths annually among individuals with CD4 101–200 cells/µL, with treatment costs of $368,982. With CrAg screening, an estimated 33,036 CrAg tests are performed, and 48 deaths avoided (1,017 DALYs saved). While CrAg screening costs an additional $155,601, overall treatment costs fall by $39,600 (preemptive and hospital-based CM treatment), yielding a net increase of $116,001. Compared to no screening, high coverage of CrAg screening and pre-emptive treatment for CrAg-positive individuals in this population avoids one death for $2440 and $114 per DALY saved. In sensitivity analyses assuming a higher proportion of antiretroviral therapy (ART)-naïve patients (75% versus 15%), cost per death averted was $1472; $69 per DALY saved. Conclusions: CrAg screening for individuals with CD4 101–200 cells/µL was estimated to have a modest impact, involve additional costs, and be less cost-effective than screening populations with CD4 counts ≤100 cells/µL. Additional CrAg screening costs must be considered against other health system priorities.

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Standardizing the Response to Category II Tracings during Induction with Oxytocin: A Cost-Effectiveness Analysis

American Journal of Perinatology ◽

10.1055/s-0037-1606605 ◽

2017 ◽

Vol 34 (12) ◽

pp. 1255-1263 ◽

Cited By ~ 1

Author(s):

Leah Savitsky ◽

Blake Zwerling ◽

Justin Williams ◽

Alison Cahill ◽

Aaron Caughey ◽

...

Keyword(s):

Heart Rate ◽

Cost Effectiveness ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Mode Of Delivery ◽

Cost Effective ◽

The United States ◽

Sensitivity Analyses ◽

Decision Analytic Model ◽

Cesarean Deliveries

Background Oxytocin is one of the most frequently used medications in obstetrics. It is generally considered to be safe and effective for induction and augmentation of labor but has been implicated in uterine hyperstimulation and adverse fetal outcomes. The management of labor with oxytocin in response to changes in fetal status remains an area of debate. Objective This study sought to assess the cost-effectiveness of reducing or ceasing oxytocin administration in response to Category II fetal heart rate tracings. Study Design A decision-analytic model was built using TreeAge 2016 software (TreeAge Software Inc.) with probabilities, costs, and utilities derived from the literature. Primary outcomes included cerebral palsy (CP), neonatal mortality, and mode of delivery. Secondary outcomes included cost per quality-adjusted life year (QALY; cost-effectiveness threshold set at $100,000/QALY), admission to the neonatal intensive care unit (NICU), and low 5-minute Apgar score (<7). Sensitivity analyses were performed to determine the robustness of our baseline assumptions. Results In a theoretical cohort of 900,000 women (estimated number of women undergoing induction at term in the United States), decreasing or stopping oxytocin in response to Category II tracings prevented 12,510 NICU admissions, 4,410 low Apgar scores, 204 neonatal deaths, and 126 cases of CP. However, there were 81,900 more cesarean deliveries. The strategy cost $356 million more, but was cost-effective with an ICER of $9,881.5 per QALY. Sensitivity analysis revealed that the intervention would be cost-effective up to a cesarean rate of 54%. Conclusion Decreasing or stopping oxytocin in response to Category II fetal heart rate tracings is cost-effective. This intervention increases the rate of cesarean deliveries but reduces neonatal morbidity and mortality. Further work on this guideline should be performed to ascertain how the approach using different aspects of the Category II tracing to guide care might lead to similar improved outcomes without increasing the cesarean delivery rate.

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CT-guided biopsy of pulmonary nodules less than 3 cm: usefulness of the spring-operated core biopsy needle and frozen-section pathologic diagnosis.

American Journal of Roentgenology ◽

10.2214/ajr.170.2.9456939 ◽

1998 ◽

Vol 170 (2) ◽

pp. 329-331 ◽

Cited By ~ 36

Author(s):

N Hayashi ◽

T Sakai ◽

M Kitagawa ◽

T Kimoto ◽

R Inagaki ◽

...

Keyword(s):

Core Biopsy ◽

Frozen Section ◽

Pulmonary Nodules ◽

Ct Guided ◽

Biopsy Needle ◽

Pathologic Diagnosis ◽

Guided Biopsy ◽

Ct Guided Biopsy

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Cost-effectiveness of cryptococcal antigen screening at CD4 counts of 101–200 cells/µL in Botswana

Wellcome Open Research ◽

10.12688/wellcomeopenres.16624.2 ◽

2021 ◽

Vol 6 ◽

pp. 55

Author(s):

Mark W. Tenforde ◽

Charles Muthoga ◽

Ponego Ponatshego ◽

Julia Ngidi ◽

Madisa Mine ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Treatment Costs ◽

World Health ◽

Sensitivity Analyses ◽

Decision Analytic Model ◽

High Coverage ◽

Cd4 Counts ◽

Cryptococcal Antigen ◽

Health Organization

Background: Cryptococcal antigen (CrAg) screening in individuals with advanced HIV reduces cryptococcal meningitis (CM) cases and deaths. The World Health Organization recently recommended increasing screening thresholds from CD4 ≤100 cells/µL to ≤200 cells/µL. CrAg screening at CD4 ≤100 cells/µL is cost-effective; however, the cost-effectiveness of screening patients with CD4 101–200 cells/µL requires evaluation. Methods: Using a decision analytic model with Botswana-specific cost and clinical estimates, we evaluated CrAg screening and treatment among individuals with CD4 counts of 101–200 cells/µL. We estimated the number of CM cases and deaths nationally and treatment costs without screening. For screening we modeled the number of CrAg tests performed, number of CrAg-positive patients identified, proportion started on pre-emptive fluconazole, CM cases and deaths. Screening and treatment costs were estimated and cost per death averted or disability-adjusted life year (DALY) saved compared with no screening. Results: Without screening, we estimated 142 CM cases and 85 deaths annually among individuals with CD4 101–200 cells/µL, with treatment costs of $368,982. With CrAg screening, an estimated 33,036 CrAg tests are performed, and 48 deaths avoided (1,017 DALYs saved). While CrAg screening costs an additional $155,601, overall treatment costs fall by $39,600 (preemptive and hospital-based CM treatment), yielding a net increase of $116,001. Compared to no screening, high coverage of CrAg screening and pre-emptive treatment for CrAg-positive individuals in this population avoids one death for $2440 and $114 per DALY saved. In sensitivity analyses assuming a higher proportion of antiretroviral therapy (ART)-naïve patients (75% versus 15%), cost per death averted was $1472; $69 per DALY saved. Conclusions: CrAg screening for individuals with CD4 101–200 cells/µL was estimated to have a modest impact, involve additional costs, and be less cost-effective than screening populations with CD4 counts ≤100 cells/µL. Additional CrAg screening costs must be considered against other health system priorities.

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