Economic analysis of the randomised assessment of treatment using panel assay of cardiac markers trial

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A5.2-A5
Author(s):  
Steve Goodacre
Keyword(s):  
Economic Analysis ◽  
Resource Use ◽  
Standard Care ◽  
Point Of Care ◽  
Acute Chest Pain ◽  
Cost Effective ◽  
Health Utility ◽  
Cardiac Markers ◽  
Life Years ◽  
Care Costs

BackgroundThe randomised Assessment of Treatment using Panel Assay of Cardiac markers (RATPAC) trial showed that diagnostic assessment with a point-of-care biomarker panel increased successful discharges among patients presenting to hospital with acute chest pain. We aimed to determine whether point-of-care panel assessment reduced healthcare costs and whether it was likely to be cost-effective.MethodsEconomic analysis was undertaken using individual patient resource use data from the RATPAC trial (n=2263) and health utility measured on the EQ-5D at one and 3 months. Resource use was valued using national unit costs. Quality-adjusted life years (QALYs) were calculated from EQ-5D scores using the trapezium rule. Mean costs and QALYs accrued after point-of-care and standard care were compared and cost-effectiveness estimated in terms of probability of dominance and incremental cost per QALY.ResultsPoint-of-care panel assessment was associated with higher emergency department costs, coronary care costs and cardiac intervention costs, but lower general inpatient costs. Mean costs per patient were £1217 with point-of-care versus £1006 with standard care (p=0.047), while mean QALYs were 0.158 versus 0.161 (p=0.250). The probability of standard care being dominant (ie, cheaper and more effective) was 0.888, while the probability of the point-of-care panel being dominant was 0.004. These probabilities were not markedly altered by sensitivity analysis varying the costs of the point-of-care panel and excluding intensive care costs.ConclusionPoint-of-care panel assessment does not reduce costs despite reducing admissions and may even increase costs. It is unlikely to be considered a cost-effective use of national healthcare resources.

scholarly journals Economic analysis of the ‘Take Charge’ intervention for people following stroke: Results from a randomised trial

2021 ◽  
pp. 026921552110407
Author(s):  
Braden Te Ao ◽  
Matire Harwood ◽  
Vivian Fu ◽  
Mark Weatherall ◽  
Kathryn McPherson ◽  
...  
Keyword(s):  
Economic Analysis ◽  
Acute Stroke ◽  
Hospital Discharge ◽  
Randomised Trial ◽  
Intervention Group ◽  
Cost Effective ◽  
Health Utility ◽  
Quality Adjusted Life Year ◽  
Cost Of Care ◽  
Sensitivity Analyses

Objective: To undertake an economic analysis of the Take Charge intervention as part of the Taking Charge after Stroke (TaCAS) study. Design: An open, parallel-group, randomised trial comparing active and control interventions with blinded outcome assessment Setting: Community. Participants: Adults ( n = 400) discharged to community, non-institutional living following acute stroke. Interventions: The Take Charge intervention, a strengths based, self-directed rehabilitation intervention, in two doses (one or two sessions), and a control intervention (no Take Charge sessions). Measures: The cost per quality-adjusted life year (QALY) saved for the period between randomisation (always post hospital discharge) and 12 months following acute stroke. QALYs were calculated from the EuroQol-5D-5L. Costs of stroke-related and non-health care were obtained by questionnaire, hospital records and the New Zealand Ministry of Health. Results: One-year post hospital discharge cost of care was mean (95% CI) $US4706 (3758–6014) for the Take Charge intervention group and $6118 (4350–8005) for control, mean (95% CI) difference $ −1412 (−3553 to +729). Health utility scores were mean (95% CI) 0.75 (0.73–0.77) for Take Charge and 0.71 (0.67–0.75) for control, mean (95% CI) difference 0.04 (0.0–0.08). Cost per QALY gained for the Take Charge intervention was $US −35,296 (=£ −25,524, € −30,019). Sensitivity analyses confirm Take Charge is cost-effective, even at a very low willingness-to-pay threshold. With a threshold of $US5000 per QALY, the probability that Take Charge is cost-effective is 99%. Conclusion: Take Charge is cost-effective and probably cost saving.

scholarly journals Assessing the clinical impact and resource use of a 30-minute chlamydia and gonorrhoea point-of-care test at three sexual health services

2021 ◽  
Vol 8 ◽  
pp. 204993612110616
Author(s):  
Susie Huntington ◽  
Georgie Weston ◽  
Elisabeth Adams
Keyword(s):  
Health Services ◽  
Sexual Health ◽  
Resource Use ◽  
Standard Care ◽  
Point Of Care ◽  
Structured Interviews ◽  
Process Data ◽  
Point Of Care Test ◽  
Clinical Benefits ◽  
Patient Groups

Objectives: To assess clinical metrics and resource use of a 30-minute point-of-care test (POCT) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) compared to laboratory-based testing. Methods: Three English sexual health services (SHSs) were recruited as part of a study. Existing processes for CT/NG testing and treatment were assessed, and adaptions to incorporate the CT/NG POCT were developed during semi-structured interviews. Staff time and consumables data were collected by clinic staff prior to and following introduction of the POCT. Results: SHSs selected patient groups for whom the CT/NG POCT would be used. Testing and treatment process data were collected for 225 patients (n = 118 POC; n = 107 standard). The percentage of patients receiving unnecessary CT treatment was 5% (5/95) and 13% (12/93) for POC and standard care respectively. The average CT/NG pathway cost varied and was on average £61.55 for POC and £50.88 for standard care. For the two SHSs where the POCT was used during a patient’s visit, for standard and POC respectively, the average time to CT treatment was 10.0 and 0.0 days and to NG treatment, 0.3 and 0.0 days. Conclusion: Use of a 30-minute POCT at three SHSs yielded clinical benefits by reducing time to treatment and unnecessary CT treatment.

scholarly journals Healthcare Costs and Life-years Gained From Treatments Within the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) Trial on Cryptococcal Meningitis: A Comparison of Antifungal Induction Strategies in Sub-Saharan Africa

2019 ◽  
Vol 69 (4) ◽  
pp. 588-595 ◽  
Author(s):  
Tao Chen ◽  
Lawrence Mwenge ◽  
Shabir Lakhi ◽  
Duncan Chanda ◽  
Peter Mwaba ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Resource Use ◽  
Cryptococcal Meningitis ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
Cost Effectiveness Ratio ◽  
Parametric Bootstrapping ◽  
Life Years ◽  
Sub Saharan ◽  
The Cost

Abstract Background Mortality from cryptoccocal meningitis remains high. The ACTA trial demonstrated that, compared with 2 weeks of amphotericin B (AmB) plus flucystosine (5FC), 1 week of AmB and 5FC was associated with lower mortality and 2 weeks of oral flucanozole (FLU) plus 5FC was non-inferior. Here, we assess the cost-effectiveness of these different treatment courses. Methods Participants were randomized in a ratio of 2:1:1:1:1 to 2 weeks of oral 5FC and FLU, 1 week of AmB and FLU, 1 week of AmB and 5FC, 2 weeks of AmB and FLU, or 2 weeks of AmB and 5FC in Malawi, Zambia, Cameroon, and Tanzania. Data on individual resource use and health outcomes were collected. Cost-effectiveness was measured as incremental costs per life-year saved, and non-parametric bootstrapping was done. Results Total costs per patient were US $1442 for 2 weeks of oral FLU and 5FC, $1763 for 1 week of AmB and FLU, $1861 for 1 week of AmB and 5FC, $2125 for 2 weeks of AmB and FLU, and $2285 for 2 weeks of AmB and 5FC. Compared to 2 weeks of AmB and 5FC, 1 week of AmB and 5FC was less costly and more effective and 2 weeks of oral FLU and 5FC was less costly and as effective. The incremental cost-effectiveness ratio for 1 week of AmB and 5FC versus oral FLU and 5FC was US $208 (95% confidence interval $91–1210) per life-year saved. Clinical Trials Registration ISRCTN45035509. Conclusions Both 1 week of AmB and 5FC and 2 weeks of Oral FLU and 5FC are cost-effective treatments.

scholarly journals Cost-effectiveness of a community-delivered multicomponent intervention compared with enhanced standard care of obese adolescents: cost-utility analysis alongside a randomised controlled trial (the HELP trial)

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018640 ◽  
Author(s):  
Monica Panca ◽  
Deborah Christie ◽  
Tim J Cole ◽  
Silvia Costa ◽  
John Gregson ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Resource Use ◽  
Standard Care ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Community Settings ◽  
Utility Analysis ◽  
Randomised Controlled

ObjectiveTo undertake a cost-utility analysis of a motivational multicomponent lifestyle-modification intervention in a community setting (the Healthy Eating Lifestyle Programme (HELP)) compared with enhanced standard care.DesignCost-utility analysis alongside a randomised controlled trial.SettingCommunity settings in Greater London, England.Participants174 young people with obesity aged 12–19 years.InterventionsIntervention participants received 12 one-to-one sessions across 6 months, addressing lifestyle behaviours and focusing on motivation to change and self-esteem rather than weight change, delivered by trained graduate health workers in community settings. Control participants received a single 1-hour one-to-one nurse-delivered session providing didactic weight-management advice.Main outcome measuresMean costs and quality-adjusted life years (QALYs) per participant over a 1-year period using resource use data and utility values collected during the trial. Incremental cost-effectiveness ratio (ICER) was calculated and non-parametric bootstrapping was conducted to generate a cost-effectiveness acceptability curve (CEAC).ResultsMean intervention costs per participant were £918 for HELP and £68 for enhanced standard care. There were no significant differences between the two groups in mean resource use per participant for any type of healthcare contact. Adjusted costs were significantly higher in the intervention group (mean incremental costs for HELP vs enhanced standard care £1003 (95% CI £837 to £1168)). There were no differences in adjusted QALYs between groups (mean QALYs gained 0.008 (95% CI −0.031 to 0.046)). The ICER of the HELP versus enhanced standard care was £120 630 per QALY gained. The CEAC shows that the probability that HELP was cost-effective relative to the enhanced standard care was 0.002 or 0.046, at a threshold of £20 000 or £30 000 per QALY gained.ConclusionsWe did not find evidence that HELP was more effective than a single educational session in improving quality of life in a sample of adolescents with obesity. HELP was associated with higher costs, mainly due to the extra costs of delivering the intervention and therefore is not cost-effective.Trial registration numberISRCTN99840111.

scholarly journals The Cost-effectiveness of a Point-of-Care Paper Transaminase Test for Monitoring Treatment of HIV/TB Co-Infected Persons

2017 ◽  
Vol 4 (4) ◽  
Author(s):  
Radha Rajasingham ◽  
Nira R Pollock ◽  
Benjamin P Linas
Keyword(s):  
South Africa ◽  
Cost Effectiveness ◽  
Point Of Care ◽  
Cost Effective ◽  
Clinical Monitoring ◽  
Automated Testing ◽  
Decision Analytic Model ◽  
Laboratory Monitoring ◽  
Life Years ◽  
The Cost

Abstract Background Persons with HIV and tuberculosis (TB) co-infection require transaminase monitoring while on hepatotoxic medications. A novel paper-based, point-of-care transaminase test is in development at an anticipated cost of $1 per test. Methods To project long-term clinical outcomes and estimate the cost-effectiveness of using a paper-based fingerstick test to monitor for drug-induced liver injury (DILI), as compared with automated testing and with no laboratory monitoring. The design was a decision analytic model, including deterministic and probabilistic sensitivity analyses. Data sources were observational cohorts and a validation study of the paper-based test. The target population was HIV/TB co-infected persons in South Africa on antiretroviral therapy who were initiating TB therapy. Interventions: (1) clinical (no laboratory) monitoring; (2) monitoring using the paper-based test with a ≥120 IU/mL threshold for positivity; (3) monitoring using the paper-based test with a ≥200 IU/mL threshold for positivity; (4) monitoring using the paper-based test using 1 of 3 categories: <120 IU/mL, 120 to 200 IU/mL, and >200 IU/mL (“bin placement”); (5) monitoring using automated ALT testing using the same 3 categories (“automated testing”). The outcome measures were discounted quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). Results The ICER of automated testing was $5180/QALY. Use of the paper-based test with the bin placement strategy was cost-effective compared with clinical monitoring alone. Conclusion At its current performance, monthly DILI monitoring by bin placement using the paper-based test was cost-effective, compared with clinical monitoring, in HIV/TB co-infected persons in South Africa.

scholarly journals A Telemonitoring Programme in Patients with Heart Failure in France: A Cost-Utility Analysis

2021 ◽  
Author(s):  
Mégane Caillon ◽  
Rémi Sabatier ◽  
Damien Legallois ◽  
Laurène Courouve ◽  
Valérie Donio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Standard Care ◽  
Care Setting ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Life Years

Abstract Background Certain telemedicine programmes for heart failure (HF) have been shown to reduce all-cause mortality and heart failure-related hospitalisations, but their cost-effectiveness remains controversial. The SCAD programme is a home-based interactive telemonitoring service for HF, which is one of the longest-running and largest telemonitoring programmes for HF in France. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD programme with respect to standard hospital-based care in patients with HF. Methods A Markov model simulating hospitalisations and mortality in patients with HF was constructed to estimate outcomes and costs. The model included six distinct health states (three ‘not hospitalised’ states, two ‘hospitalisation for heart failure’ states, both depending on the number of previous hospitalisations, and one death state. The model lifetime in the base case was ten years. Model inputs were based on published literature. Outputs (costs and QALYs) were compared between SCAD participants and standard care. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the input parameters of the model. Results The number of quality-adjusted life years (QALYs) was 3.75 in the standard care setting and 4.41 in the SCAD setting. This corresponds to a gain in QALYs provided by the SCAD programme of 0.65 over the ten-year lifetime of the model. The estimated total cost was €30,932 in the standard care setting and €35,177 in the SCAD setting, with an incremental cost of €4,245. The incremental cost-effectiveness ratio for the SCAD programme over standard care was estimated at €4,579/QALY. In the deterministic sensitivity analysis, the variables that had the most impact on the ICER were HF management costs. The likelihood of the SCAD programme being considered cost-effective was 90% at a willingness-to-pay threshold of €11,800. Conclusions Enrolment of patients into the SCAD programme is highly cost-effective. Extension of the programme to other hospitals and more patients would have a limited budget impact but provide important clinical benefits. This finding should also be taken into account in new public health policies aimed at encouraging a shift from inpatient to ambulatory care.

scholarly journals Cost-Effectiveness Assessment of Different Glucosamines in Patients with Knee Osteoarthritis: a Simulation Model Adapted to Germany

2021 ◽  
Vol 14 ◽  
Author(s):  
Olivier Bruyère ◽  
Johann Detilleux ◽  
Jean-Yves Reginster
Keyword(s):  
Cost Effectiveness ◽  
Simulation Model ◽  
Area Under The Curve ◽  
Cost Effective ◽  
Health Utility ◽  
Economic Evaluations ◽  
Individual Health ◽  
Life Years ◽  
The Cost ◽  
Utility Scores

Background: The use of symptomatic slow-acting drugs for osteoarthritis (OA) (e.g., glucosamine, chondroitin) is largely debated in the scientific literature. Indeed, multiple formulations of these agents are available, both as pharmaceutical-grade products and as nutritional supplements, but while all preparations may claim to deliver a therapeutic effect, not all are supported by clinical evidence. Moreover, few data are available regarding the cost-effectiveness of all these formulations. Usually, access to individual patient data is required to perform economic evaluations of treatments, but it can be difficult to obtain. We previously developed a model to simulate individual health utility scores from aggregated data obtained from published OA trials. Objective: In the present study, using our new simulation model, we investigated the cost-effectiveness of different glucosamines used in Germany. Methods: We used our validated model to simulate the utility scores of 10 published trials that used different glucosamine preparations. Using the simulated utility scores, the quality-adjusted life years (QALYs) were calculated using the area-under-the-curve method. We used the 2018 public costs of glucosamine products available in Germany to calculate the Incremental Cost/Effectiveness Ratio (ICER). We performed analyses for pharmaceutical-grade Crystalline Glucosamine Sulfate (pCGS) and other formulations of glucosamine (OFG). A cost-effectiveness cut-off of 30,000 €/QALY was considered. Results: Of 10 studies in which utility was simulated, four used pCGS, and six used OFG. The ICER analyses showed that pCGS was cost-effective compared to a placebo, with an ICER of 4489 €/QALY at month 3, 4112 €/QALY at month 6 and 9983 €/QALY at year 3. The use of OFG was not cost-effective at any of the time points considered. Conclusion: Using our previously published model to simulate the individual health utility scores of patients, we showed that, in the German context, the use of pCGS could be considered cost-effective, while the use of OFG could not. These results highlight the importance of the formulation of glucosamine.

scholarly journals A Cost-Utility Analysis of Endovascular Thrombectomy in a Real-World Setting

2019 ◽  
Vol 47 (1) ◽  
pp. 50-60
Author(s):  
Prosper S. Koto ◽  
Sherry X. Hu ◽  
Karim Virani ◽  
Wendy L. Simpkin ◽  
Christine A. Christian ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Real World ◽  
Standard Care ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Real World Setting ◽  
Life Years

ABSTRACT:Objective:Endovascular thrombectomy (EVT) is efficacious for ischemic stroke caused by proximal intracranial large-vessel occlusion involving the anterior cerebral circulation. However, evidence of its cost-effectiveness, especially in a real-world setting, is limited. We assessed whether EVT ± tissue plasminogen activator (tPA) was cost-effective when compared with standard care ± tPA at our center.Method:We identified patients treated with EVT ± tPA after the Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing computed tomography to recanalization times trial from our prospective stroke registry from February 1, 2013 to January 31, 2017. Patients admitted before February 2013 and treated with standard care ± tPA constitute the controls. The sample size was 88. Cost-effectiveness was assessed using the net monetary benefit (NMB). Differences in average costs and quality-adjusted life years (QALYs) were estimated using the augmented inverse probability weighted estimator. We accounted for sampling and methodological uncertainty in sensitivity analyses.Results:Patients treated with EVT ± tPA had a net gain of 2.89 [95% confidence interval (CI): 0.93–4.99] QALYs at an additional cost of $22,200 (95% CI: −28,902–78,244) per patient compared with the standard care ± tPA group. The NMB was $122,300 (95% CI: −4777–253,133) with a 0.85 probability of being cost-effective. The expected savings to the healthcare system would amount to $321,334 per year.Conclusion:EVT ± tPA had higher costs and higher QALYs compared with the control, and is likely to be cost-effective at a willingness-to-pay threshold of $50,000 per QALY.

scholarly journals The cost-effectiveness of early goaldirected therapy: an economic evaluation alongside the ARISE trial

2021 ◽  
Vol 23 (3) ◽  
pp. 329-336
Author(s):  
Alisa M Higgins ◽  
◽  
Sandra L Peake ◽  
Rinaldo Bellomo AO ◽  
D Jamie Cooper AO ◽  
...  
Keyword(s):  
Health Care ◽  
Septic Shock ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Resource Use ◽  
Cost Effective ◽  
Evaluation Study ◽  
Life Years ◽  
The Cost

OBJECTIVE: To determine the cost-effectiveness of early goal-directed therapy (EGDT) for patients with early septic shock. DESIGN: Within-trial cost-effectiveness evaluation. SETTING: Nineteen hospitals in Australia and New Zealand. PARTICIPANTS AND INTERVENTIONS: Patients with early septic shock enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial were randomly assigned to EGDT versus usual care. A subgroup of patients participated in a nested economic evaluation study in which detailed resource use data were collected until 12 months after randomisation. OUTCOME MEASURES: Clinical outcomes included lives saved, life-years gained and quality-adjusted life-years (QALYs), with mortality collected until 12 months and health-related quality of life assessed at baseline, 6 and 12 months using the 3-level EuroQol five dimensions questionnaire (EQ-5D-3L). Economic outcomes included health care resource use, costs and cost-effectiveness from the Australian health care payer perspective. RESULTS: A total of 205 patients (100 EGDT, 105 usual care) participated in the nested economic evaluation study, of which 203 had complete resource use data. Unadjusted mean health care costs to 12 months were $67 223 (standard deviation [SD], $72 397) in the EGDT group and $54 179 (SD, $61 980) in the usual care group, with a mean difference of $13 044 (95% CI, −$5791 to $31 878). There was no difference between groups with regards to lives saved (EGDT, 69.4% v usual care, 68.6%; P = 1.0), life-years gained (mean EGDT, 0.746 [SD, 0.406] v usual care, 0.725 [SD, 0.417]; P = 0.72) or QALYs (mean EGDT, 0.318 [SD, 0.291] v usual care, 0.367 [SD, 0.295]; P = 0.24). EGDT was dominated (higher costs, lower effectiveness) by usual care in 80.4% of bootstrap replications. For a willingness-to-pay threshold of $50 000 per QALY, the probability of EGDT being cost-effective was only 6.4%. CONCLUSIONS: In patients presenting to the emergency department with early septic shock, EGDT compared with usual care was not cost-effective. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number NCT00975793.

Sign in / Sign up

Export Citation Format

Share Document