Cost-effectiveness of two screening strategies for Chlamydia trachomatis and Neisseria gonorrhoeae as part of the PrEP programme in the Netherlands: a modelling study

2021 ◽  
pp. sextrans-2020-054741
Author(s):  
Francine van Wifferen ◽  
Elske Hoornenborg ◽  
Maarten F Schim van der Loeff ◽  
Janneke Heijne ◽  
Albert Jan van Hoek
Keyword(s):  
At Risk ◽  
Cost Effectiveness ◽  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
Infection Model ◽  
Baseline Scenario ◽  
Life Years ◽  
The Difference ◽  
The Cost ◽  
The Impact

ObjectivesPre-exposure prophylaxis (PrEP) users are routinely tested four times a year (3 monthly) for asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections on three anatomical locations. Given the high costs of this testing to the PrEP programme, we assessed the impact of 3 monthly screening(current practice), compared with 6 monthly on the disease burden. We quantified the difference in impact of these two testing frequencies on the prevalence of CT and NG among all men who have sex with men (MSM) who are at risk of an STI, and explored the cost-effectiveness of 3-monthly screening compared with a baseline scenario of 6-monthly screening.MethodsA dynamic infection model was developed to simulate the transmission of CT and NG among sexually active MSM (6500 MSM on PrEP and 29 531 MSM not on PrEP), and the impact of two different test frequencies over a 10-year period. The difference in number of averted infections was used to calculate incremental costs and quality-adjusted life-years (QALY) as well as an incremental cost-effectiveness ratio (ICER) from a societal perspective.ResultsCompared with 6-monthly screening, 3-monthly screening of PrEP users for CT and NG cost an additional €46.8 million over a period of 10 years. Both screening frequencies would significantly reduce the prevalence of CT and NG, but 3-monthly screening would avert and extra ~18 250 CT and NG infections compared with 6-monthly screening, resulting in a gain of ~81 QALYs. The corresponding ICER was ~€430 000 per QALY gained, which exceeded the cost-effectiveness threshold of €20 000 per QALY.ConclusionsThree-monthly screening for CT and NG among MSM on PrEP is not cost-effective compared with 6-monthly screening. The ICER becomes more favourable when a smaller fraction of all MSM at risk for an STI are screened. Reducing the screening frequency could be considered when the PrEP programme is established and the prevalence of CT and NG decline.

scholarly journals A Cost-Effectiveness Analysis of Newborn Screening for Severe Combined Immunodeficiency in the UK

2019 ◽  
Vol 5 (3) ◽  
pp. 28 ◽  
Author(s):  
Alice Bessey ◽  
James Chilcott ◽  
Joanna Leaviss ◽  
Carmen de la Cruz ◽  
Ruth Wong
Keyword(s):  
Cost Effectiveness ◽  
Severe Combined Immunodeficiency ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Combined Immunodeficiency ◽  
Tree Model ◽  
Life Years ◽  
The Uk ◽  
The Cost ◽  
The Impact

Severe combined immunodeficiency (SCID) can be detected through newborn bloodspot screening. In the UK, the National Screening Committee (NSC) requires screening programmes to be cost-effective at standard UK thresholds. To assess the cost-effectiveness of SCID screening for the NSC, a decision-tree model with lifetable estimates of outcomes was built. Model structure and parameterisation were informed by systematic review and expert clinical judgment. A public service perspective was used and lifetime costs and quality-adjusted life years (QALYs) were discounted at 3.5%. Probabilistic, one-way sensitivity analyses and an exploratory disbenefit analysis for the identification of non-SCID patients were conducted. Screening for SCID was estimated to result in an incremental cost-effectiveness ratio (ICER) of £18,222 with a reduction in SCID mortality from 8.1 (5–12) to 1.7 (0.6–4.0) cases per year of screening. Results were sensitive to a number of parameters, including the cost of the screening test, the incidence of SCID and the disbenefit to the healthy at birth and false-positive cases. Screening for SCID is likely to be cost-effective at £20,000 per QALY, key uncertainties relate to the impact on false positives and the impact on the identification of children with non-SCID T Cell lymphopenia.

scholarly journals Cost-effectiveness analysis of radiotherapy techniques for whole breast irradiation

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248220
Author(s):  
Yibo Xie ◽  
Beibei Guo ◽  
Rui Zhang
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Advanced Technology ◽  
Sensitivity Analyses ◽  
Tumor Control ◽  
Life Years ◽  
Whole Breast Radiotherapy ◽  
The Cost ◽  
The Impact

Background The current standard of care (SOC) for whole breast radiotherapy (WBRT) in the US is conventional tangential photon fields. Advanced WBRT techniques may provide similar tumor control and better normal tissue sparing, but it is controversial whether the medical benefits of an advanced technology are significant enough to justify its higher cost. Objective To analyze the cost-effectiveness of six advanced WBRT techniques compared with SOC. Methods We developed a Markov model to simulate health states for one cohort of women (65-year-old) with early-stage breast cancer over 15 years after WBRT. The cost effectiveness analyses of field-in-field (FIF), hybrid intensity modulated radiotherapy (IMRT), full IMRT, standard volumetric modulated arc therapy (STD-VMAT), multiple arc VMAT (MA-VMAT), non-coplanar VMAT (NC-VMAT) compared with SOC were performed with both tumor control and radiogenic side effects considered. Transition probabilities and utilities for each health state were obtained from literature. Costs incurred by payers were adopted from literature and Medicare data. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. One-way sensitivity analyses and probabilistic sensitivity analyses (PSA) were performed to evaluate the impact of uncertainties on the final results. Results FIF has the lowest ICER value of 1,511 $/QALY. The one-way analyses show that the cost-effectiveness of advanced WBRT techniques is most sensitive to the probability of developing contralateral breast cancer. PSAs show that SOC is more cost effective than almost all advanced WBRT techniques at a willingness-to-pay (WTP) threshold of 50,000 $/QALY, while FIF, hybrid IMRT and MA-VMAT are more cost-effective than SOC with a probability of 59.2%, 72.3% and 72.6% at a WTP threshold of 100,000 $/QALY, respectively. Conclusions FIF might be the most cost-effective option for WBRT patients at a WTP threshold of 50,000 $/QALY, while hybrid IMRT and MA-VMAT might be the most cost-effective options at a WTP threshold of 100,000 $/QALY.

scholarly journals The economic impact and cost-effectiveness of combined vector-control and dengue vaccination strategies in Thailand: results from a dynamic transmission model

2020 ◽  
Vol 14 (10) ◽  
pp. e0008805
Author(s):  
Gerhart Knerer ◽  
Christine S. M. Currie ◽  
Sally C. Brailsford
Keyword(s):  
Public Health ◽  
Cost Effectiveness ◽  
Vector Control ◽  
Dengue Fever ◽  
Control Strategies ◽  
Cost Effective ◽  
Scenario Analyses ◽  
Life Years ◽  
The Cost ◽  
The Impact

Background and aims Dengue fever is a major public health problem in tropical/subtropical regions. Prior economic analyses have predominantly evaluated either vaccination or vector-control programmes in isolation and do not really consider the incremental benefits and cost-effectiveness of mixed strategies and combination control. We estimated the cost-effectiveness of single and combined approaches in Thailand. Methods The impacts of different control interventions were analysed using a previously published mathematical model of dengue epidemiology and control incorporating seasonality, age structure, consecutive infection, cross protection, immune enhancement and combined vector-host transmission. An economic model was applied to simulation results to estimate the cost-effectiveness of 4 interventions and their various combinations (6 strategies): i) routine vaccination of 1-year olds; ii) chemical vector control strategies targeting adult and larval stages separately; iii) environmental management/ public health education and awareness [EM/ PHEA]). Payer and societal perspectives were considered. The health burden of dengue fever was assessed using disability-adjusted life-years (DALYs) lost. Costs and effects were assessed for 10 years. Costs were discounted at 3% annually and updated to 2013 United States Dollars. Incremental cost-effectiveness analysis was carried out after strategies were rank-ordered by cost, with results presented in a table of incremental analysis. Sensitivity and scenario analyses were undertaken; and the impact and cost-effectiveness of Wolbachia was evaluated in exploratory scenario analyses. Results From the payer and societal perspectives, 2 combination strategies were considered optimal, as all other control strategies were dominated. Vaccination plus adulticide plus EM/ PHEA was deemed cost-effective according to multiple cost-effectiveness criteria. From the societal perspective, incremental differences vs. adulticide and EM/ PHEA resulted in costs of $157.6 million and DALYs lost of 12,599, giving an expected ICER of $12,508 per DALY averted. Exploratory scenario analyses showed Wolbachia to be highly cost-effective ($343 per DALY averted) vs. other single control measures. Conclusions Our model shows that individual interventions can be cost-effective, but that important epidemiological reductions and economic impacts are demonstrated when interventions are combined as part of an integrated approach to combating dengue fever. Exploratory scenario analyses demonstrated the potential epidemiological and cost-effective impact of Wolbachia when deployed at scale on a nationwide basis. Our findings were robust in the face of sensitivity analyses.

Disease Management Programmes for Major Depression: Making the Financial Case

2009 ◽  
Vol 15 (3) ◽  
pp. 679-725
Author(s):  
J. Buckle
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Disease Management ◽  
Sickness Absence ◽  
Public Healthcare ◽  
Life Years ◽  
Disease Management Programmes ◽  
The Cost ◽  
The Impact

ABSTRACTDepression is a significant burden for the United Kingdom economy and despite conclusive evidence on the clinical efficacy of treatments and acknowledgements of the impact on quality of life, a high proportion still goes undiagnosed and untreated. The purpose of this paper is to present the economic case for a more structured approach to depression management, using techniques from the disciplines of health economics and actuarial science to demonstrate cost-effectiveness and return on investment. The results are presented first as an economic cost-effectiveness analysis, comparing the benefits of additional quality-adjusted life years (QALYs) with the costs, and secondly as a financial projection model of costs and savings, familiar to actuaries.The results of the model show that from a societal perspective, disease management programmes for depression are likely to both reduce costs and increase quality of life for patients in the overall adult population. This is also true from the perspective of an employer who has the cost burden of direct medical costs and sickness absence. For a healthcare payer who is not bearing the cost of sickness absence, such as a primary care trust (PCT) or private insurer, disease management programmes are likely to improve quality of life, but increase direct healthcare costs. However, the additional cost per QALY is well below the commonly used threshold in the U.K. of £30,000; therefore, most health economists would deem disease management programmes for severe and moderate depression to be a good use of public healthcare funds. The actuarial calculations, which show an internal rate of return for 45% to 50%, validate this conclusion.

scholarly journals Cost-Effectiveness Analysis of Obinutuzumab Versus Ofatumumab for Previously Untreated Chronic Lymphocytic Leukemia (CLL)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1324-1324 ◽  
Author(s):  
Carolina Reyes ◽  
Gregory Gazauskas ◽  
Ursula Becker ◽  
Santiago Moreno ◽  
David L. Veenstra
Keyword(s):  
Cost Effectiveness ◽  
Chronic Lymphocytic Leukemia ◽  
Cost Effective ◽  
Lymphocytic Leukemia ◽  
Sensitivity Analyses ◽  
Age Difference ◽  
Total Cost ◽  
Life Years ◽  
The Cost ◽  
The Impact

Abstract Background Two recently approved therapies for previously untreated chronic lymphocytic leukemia (CLL), (1) obinutuzumab (GA101) in combination with chlorambucil (G+Clb) and (2) ofatumumab in combination with Clb (O+Clb), have shown improved progression-free survival (PFS) versus Clb alone in two separate trials. However, their relative value has not been formally assessed. The objective of this study was to compare the cost-effectiveness of G+Clb versus O+Clb in previously untreated CLL patients, as well as conduct exploratory analyses versus other comparators. Methods Patient outcomes were simulated using a 3-state Markov model that included PFS, progression, and death. PFS parameters for G+Clb were fitted to the observed G+Clb trial (CLL-11 study) data, and a network meta-analysis incorporating the results of the O+Clb (COMPLEMENT 1 study) was used to estimate the relative treatment effect of G+Clb compared to O+Clb (progression HR = 0.34). Patient populations in these two trials were similar. Drug utilization, dosing and adverse events were incorporated based on trial data, and costs were based on Medicare reimbursements and drug wholesale acquisition costs. One-way and probabilistic sensitivity analyses were conducted to assess the impact of data uncertainty on the results. In an exploratory scenario analyses, we used similar methodology to estimate the cost-effectiveness of G+Clb versus rituximab plus bendamustine (R+B, progression HR = 0.41). A meta-regression on age was used to adjust for the age difference among the patient populations and indirectly taking into account different levels of comorbidities. Results Treatment with G+Clb led to an increase of 0.83 life years and 0.79 quality-adjusted life years (QALYs) relative to O+Clb. The total cost of O+Clb was higher by $3600 per patient relative to G+Clb. Higher G+Clb drug, administration, and adverse event costs were largely offset by lower progression costs compared to O+Clb. The incremental cost per QALY gained with G+Clb vs. O+Clb was $4,500. Based on probabilistic sensitivity analyses, there was a 99% probability that G+Clb was cost-effective compared to O+Clb at a societal willingness-to-pay threshold of $100,000 per QALY saved. Table.OutcomeG+ClbO+ClbDifferenceAverage life years5.744.910.83Average QALYs3.953.160.79Total drug cost$37,192$34,260$2,932Drug administration$1,977$991$985Supportive care$141$73$68Adverse events$9,542$2,660$6,882Cost of progression$46,861$54,147$(7,286)Average total cost$95,713 $92,132 $3,581 In the exploratory scenario analysis, G+Clb was $37,700 less expensive than R+B, and led to an increase of 0.67 QALY. Conclusions Our analysis suggests treatment with G+Clb compared to O+Clb is highly cost-effective based on indirect treatment comparison data. These results are driven by the improved PFS of G+Clb vs. O+Clb, as well as lower disease progression cost. Future direct comparisons of G+Clb versus other treatment options will further clarify the cost-effectiveness of G+Clb, and inform coverage and reimbursement policy decisions. Disclosures Reyes: Genentech: Employment, Equity Ownership. Off Label Use: Rituximab + Bendamustine in CLL. Gazauskas:Genentech: Consultancy. Becker:Roche: Employment. Moreno:Roche: Employment. Veenstra:Roche: Consultancy.

Different Strategies for First-Line Treatment of Chronic Myeloid Leukaemia: An Economic Analysis

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4696-4696
Author(s):  
Bin Wu ◽  
Hua Zhong ◽  
Giuseppe Saglio ◽  
Fangyuan Chen
Keyword(s):  
Cost Effectiveness ◽  
Conflicts Of Interest ◽  
Myelogenous Leukemia ◽  
Economic Outcome ◽  
Sensitivity Analyses ◽  
Newly Diagnosed ◽  
Assistance Program ◽  
Life Years ◽  
The Cost ◽  
The Impact

Abstract Abstract 4696 Purpose: To evaluate the economic outcome of conventional and targeted therapies of patients with chronic myelogenous leukemia (CML). Methods: Two Markov simulation models were designed to measure the cost and quality-adjusted life years (QALYs) for newly diagnosed CML patients whether to be administered conventional therapy or six tyrosine kinase inhibitors (TKIs) based strategies. Clinical and utility data were taken mostly from the literature by a MEDLINE search. Costs were based on local charges. The primary output was reported in terms of incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to examine the robustness of the model output. The impact of patient assistance program (PAP) was assessed. Results: The imatinib plus peginterferon-Á switch 2nd TKIs strategy yielded the most health benefits for newly diagnosed CML patients when compared with the conventional, imatinib switch 2nd TKIs, imatinib switch conventional, imatinib plus IFN-Á switch conventional, nilotinib switch conventional and dasatinib switch conventional strategies (figure 1). Marginal cost-effectiveness was $79,134 or $17,600 per QALY gained relative to conventional strategy without or with PAP (figure 2). Both the nilotinib and dasatinib based strategies were more expensive yet less effective than the alternative strategies and were therefore dominated. Model outputs were sensitive to the cost of TKIs. Conclusion: Imatinib and imatinib plus peginterferon-Á based strategies are potentially more cost-effective and 2nd-generation TKIs may be preferred in the setting of imatinib failure. Patient assistant program in health resource limited setting might notably improve the economic outcome of TKIs based therapies. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial

2013 ◽  
Vol 202 (2) ◽  
pp. 121-128 ◽  
Author(s):  
Renee Romeo ◽  
Martin Knapp ◽  
Jennifer Hellier ◽  
Michael Dewey ◽  
Clive Ballard ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
People With Dementia ◽  
Life Years ◽  
The Cost ◽  
The Impact

BackgroundDepression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes.AimsTo evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia.MethodA pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0–13 weeks and 0–39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods.ResultsThere were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively.ConclusionsIn terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety. Given the priority and the potential value of supporting family carers of people with dementia, further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers.

VP136 The Impact Of Hospital Costing Methods On Economic Evaluations

2017 ◽  
Vol 33 (S1) ◽  
pp. 211-212
Author(s):  
Stefania Manetti ◽  
Jose Leal
Keyword(s):  
Cost Effectiveness ◽  
Hip Fracture ◽  
Resource Use ◽  
Models Of Care ◽  
Economic Evaluations ◽  
Hospital Resource ◽  
Unit Costs ◽  
Life Years ◽  
The Cost ◽  
The Impact

INTRODUCTION:There are several methods to cost hospital contacts when estimating the cost effectiveness of a new intervention. In England, the National Insitute for Health and Care Excellence (NICE) recommends the use of diagnosis-related group (DRG)-based costs as a valuable way of costing hospital resource use. There are three main sources of unit costs of a DRG: (i) tariffs as used for reimbursement purposes, (ii) benchmarking finished consultant episode (FCE)-level reference costs and (iii) benchmarking spell-level reference costs.The purpose of this work is to compare the implications of choosing a particular source of DRG-based unit costs when conducting an economic evaluation.METHODS:As a case study, we used a cost-utility model developed to compare secondary fracture prevention models of care for hip fracture patients (1). A Markov model was derived from large primary and hospital care administrative datasets in England. Utilities were informed by a meta-regression of thirty-two studies. Hospital resource use (inpatient, outpatient, critical care and emergency care) was valued using the three different 2014–15 DRG-based unit costs and regression-based costing models were derived from 33,000 hip fracture patients to inform the health states of the model (2). For each source of DRG-based costs, we calculated mean life years, Quality-Adjusted Life Years (QALYs) and costs for a representative male and female associated with three models of care: (i) orthogeriatrician (OG)-led, (ii) nurse-led fracture liaison services and (iii) usual care.RESULTS:Using the benchmarking FCE-level DRG-based costs, the OG-led model was estimated to be the most effective model of care (1.77 QALYs, 95 percent Confidence Interval, CI 1.56-1.98) at a threshold of GBP30,000/QALY. However, it also resulted in the highest costs per patient. We will report the cost-effectiveness results using the two remaining DRG-based costs.CONCLUSIONS:Choosing a particular hospital costing method may have an impact on economic evaluations. We will reflect on the implications for the estimated hospital costs, decision uncertainty and adoption of models of care.

scholarly journals Cost-Effectiveness of Product Reformulation in Response to the Health Star Rating Food Labelling System in Australia

Nutrients ◽  
2018 ◽  
Vol 10 (5) ◽  
pp. 614 ◽  
Author(s):  
Ana Mantilla Herrera ◽  
Michelle Crino ◽  
Holly Erskine ◽  
Gary Sacks ◽  
Jaithri Ananthapavan ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effective ◽  
Cost Effectiveness Ratio ◽  
Star Rating ◽  
Life Years ◽  
Packaged Food ◽  
The Cost ◽  
The Impact ◽  
Labelling System

The Health Star Rating (HSR) system is a voluntary front-of-pack labelling (FoPL) initiative endorsed by the Australian government in 2014. This study examines the impact of the HSR system on pre-packaged food reformulation measured by changes in energy density between products with and without HSR. The cost-effectiveness of the HSR system was modelled using a proportional multi-state life table Markov model for the 2010 Australian population. We evaluated scenarios in which the HSR system was implemented on a voluntary and mandatory basis (i.e., HSR uptake across 6.7% and 100% of applicable products, respectively). The main outcomes were health-adjusted life years (HALYs), net costs, and incremental cost-effectiveness ratios (ICERs). These were calculated with accompanying 95% uncertainty intervals (95% UI). The model predicted that HSR-attributable reformulation leads to small changes in mean population energy intake (voluntary: −0.98 kJ/day; mandatory: −11.81 kJ/day). These are likely to result in changes in mean body weight (voluntary: −0.01 kg [95% UI: −0.012 to −0.006]; mandatory: −0.11 kg [95% UI: −0.14 to −0.07]), and HALYs gained (voluntary: 4207 HALYs gained [95% UI: 2438 to 6081]; mandatory: 49,949 HALYs gained [95% UI: 29,291 to 72,153]). The HSR system could be considered cost-effective relative to a willingness-to-pay threshold of A$50,000 per HALY (incremental cost effectiveness ratio for voluntary: A$1728 per HALY [95% UI: dominant to 10,445] and mandatory: A$4752 per HALY [95% UI: dominant to 16,236]).

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