scholarly journals Cost-Utility Analysis of Mycophenolate Mofetil versus Azathioprine Based Regimens for Maintenance Therapy of Proliferative Lupus Nephritis

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Robert Nee ◽  
Ian Rivera ◽  
Dustin J. Little ◽  
Christina M. Yuan ◽  
Kevin C. Abbott
Keyword(s):  
Mycophenolate Mofetil ◽  
Cost Effectiveness ◽  
Lupus Nephritis ◽  
Maintenance Therapy ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Base Case ◽  
Utility Analysis ◽  
Lifetime Horizon ◽  
Life Years

Background/Aims. We aimed to examine the cost-effectiveness of mycophenolate mofetil (MMF) and azathioprine (AZA) as maintenance therapy for patients with Class III and Class IV lupus nephritis (LN), from a United States (US) perspective.Methods. Using a Markov model, we conducted a cost-utility analysis from a societal perspective over a lifetime horizon. The modeled population comprised patients with proliferative LN who received maintenance therapy with MMF (2 gm/day) versus AZA (150 mg/day) for 3 years. Risk estimates of clinical events were based on a Cochrane meta-analysis while costs and utilities were retrieved from other published sources. Outcome measures included costs, quality-adjusted life-years (QALY), incremental cost-effectiveness ratios (ICER), and net monetary benefit.Results. The base-case model showed that, compared with AZA strategy, the ICER for MMF was $2,630,592/QALY at 3 years. Over the patients’ lifetime, however, the ICER of MMF compared to AZA was $6,454/QALY. Overall, the ICER results from various sensitivity and subgroup analyses did not alter the conclusions of the model simulation.Conclusions. In the short term, an AZA-based regimen confers greater value than MMF for the maintenance therapy of proliferative LN. From a lifelong perspective, however, MMF is cost-effective compared to AZA.

A cost-utility analysis of apalutamide for the treatment of patients with metastatic castration-sensitive prostate cancer (mCSPC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19369-e19369
Author(s):  
Ambika Parmar ◽  
Narhari Timilshina ◽  
Urban Emmenegger ◽  
Shabbir M.H. Alibhai ◽  
Martin Smoragiewicz ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Scenario Analysis ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Base Case ◽  
Utility Analysis ◽  
Lifetime Horizon ◽  
Healthcare Perspective ◽  
Canadian Healthcare ◽  
Titan Trial

e19369 Background: The therapeutic landscape for patients with mCSPC has evolved over the last decade given the growing body of evidence demonstrating efficacy for the earlier application of oral androgen receptor signaling inhibitors, such as with abiraterone and enzalutamide. Recently the success of the TITAN trial established the superior efficacy of apalutamide combined with androgen deprivation therapy (ADT), with a 33% reduction in mortality versus ADT alone, and a tolerable toxicity profile. However, with substantially higher costs than ADT alone, the cost-effectiveness of this combination is critical to evaluate. Methods: A cost-utility analysis of apalutamide+ADT versus ADT alone was conducted from the Canadian healthcare perspective. A state-transition model with probabilistic analysis was used to compare the two strategies over a lifetime horizon. Model inputs were informed by the TITAN trial (transition probabilities, adverse events [AE], subsequent therapy), published literature (utilities) and Canadian costing resources (systemic therapy [initial and subsequent], routine care [physician visits, imaging], AE, end-of-life care costs). Primary outcomes included expected life-year gains (LYG), quality-adjusted life-years (QALY), lifetime cost (in 2018 Canadian dollars), and the incremental cost-effectiveness ratio (ICER). Multiple scenario analyses were conducted to assess parameter and model uncertainty. Cost and effectiveness were discounted at 1.5% as per Canadian guidelines. Results: From the base-case analysis expected LYG and QALY for ADT and apalutamide+ADT were 4.11, 5.57 and 3.50, 4.85, respectively. Expected cost over a lifetime horizon was $37,553 and $254,205, respectively. The ICER for apalutamide+ADT as compared to ADT alone was $160,483/QALY. Through scenario analysis, cost-effectiveness of apaluatmide+ADT was achieved with apalutamide price reductions of >50%, relative to a cost-effectiveness threshold (CET) of $100,000/QALY. Scenario analysis of alternative long-term survival expectations with apalutamide+ADT demonstrated cost-effectiveness (relative to CET $100,000/QALY) with expected improvements in the 5-year survival rate of 29% as compared to ADT (versus base-case expected improvement in 5-year survival of 15%). Conclusions: Apalutamide+ADT is unlikely to be cost-effective from the Canadian healthcare perspective at current list prices. Improvement in cost-effectiveness is most likely to be achieved through price reductions in apalutamide drug costs.

A cost-utility analysis of combined durvalumab and tremelimumab in patients with refractory metastatic colorectal cancer (mCRC) and high plasma tumour mutation burden (pTMB): A Canadian Cancer Trials Group (CCTG) study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e15581-e15581
Author(s):  
Monish Ahluwalia ◽  
Ambika Parmar ◽  
Eric Xueyu Chen ◽  
Derek J. Jonker ◽  
Jonathan M. Loree ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Treatment Strategies ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Trial Data ◽  
Base Case ◽  
Utility Analysis ◽  
Life Years ◽  
Lifetime Costs ◽  
Event Rates

e15581 Background: The randomized phase II CCTG CO.26 clinical trial investigated the use of combined durvalumab and tremelimumab vs. best supportive care (BSC) for patients with mCRC and suggested an increase in overall survival (OS). The largest benefit was seen in patients who were microsatellite stable (MSS) with a pTMB ≥ 28 variants per megabase. Considering significantly higher adverse event rates and costs associated with durvalumab and tremelimumab, it is important to evaluate its cost-effectiveness. Accordingly, we performed a cost-utility analysis of durvalumab and tremelimumab compared to BSC in the intention-to-treat (ITT) and biomarker-enriched populations using CO.26 trial data. Methods: We developed a 4-state microsimulation model to evaluate the expected health outcomes in life-years (LYs), quality-adjusted life-years (QALYs) and costs of the treatment group compared to BSC over a lifetime horizon (5 years). The incremental cost-utility ratio (ICUR) was used to compare treatment strategies. Direct trial data from CO.26 were used to inform model inputs, including OS curves, progression-free survival (PFS) curves, and adverse event rates. As health state utilities were not collected in CO.26, values from the CORRECT trial, a multi-centre randomized placebo-controlled phase III study for regorafenib in mCRC, were used. Costs of therapy, hospitalization due to adverse events, end-of-life care, and physician costs were derived from the literature and publicly available sources (in 2020 Canadian dollars). Since the monthly price of tremelimumab was unavailable, it was approximated with the price of another CTLA-4 inhibitor, ipilimumab. The base-case analysis evaluated these treatment strategies in the ITT population. Scenario analyses evaluated the cost-effectiveness in biomarker-enriched populations. Costs and effects were discounted at 1.5% as per Canadian guidelines. Results: In the base-case, expected LYs for combined durvalumab and tremelimumab and BSC were 0.75 and 0.51 (incremental (Δ) 0.24) respectively. Expected QALYs were 0.47 and 0.33 (Δ 0.14). Expected lifetime costs were $60 500 and $15 500 (Δ $45 000) for an ICUR of $320 000/QALY. In the biomarker-enriched subgroup, the expected LYs were 0.67 and 0.33 (Δ 0.34), expected QALYs were 0.43 and 0.22 (Δ 0.21), and expected lifetime costs were $62 000 and $15 200 (Δ $47 000). This represents an increase in the incremental QALYs by 50% and costs by 5% for an ICUR 30% lower than the base case at $220 000/QALY. Conclusions: Combined durvalumab and tremelimumab is not considered cost-effective in refractory mCRC under conventional willingness-to-pay thresholds. Cost-effectiveness is improved with biomarker enrichment for high pTMB, driven by the greater derived health outcomes in this subgroup.

scholarly journals Economic Evaluation of an Internet-Based Stress Management Intervention Alongside a Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Fanny Kählke ◽  
Claudia Buntrock ◽  
Filip Smit ◽  
Matthias Berking ◽  
Dirk Lehr ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Stress Management ◽  
Perceived Stress ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Management Interventions ◽  
Life Years ◽  
The Cost

BACKGROUND Work-related stress is widespread among employees and associated with high costs for German society. Internet-based stress management interventions (iSMIs) are effective in reducing such stress. However, evidence for their cost-effectiveness is scant. OBJECTIVE The aim of this study was to assess the cost-effectiveness of a guided iSMI for employees. METHODS A sample of 264 employees with elevated symptoms of perceived stress (Perceived Stress Scale≥22) was assigned to either the iSMI or a waitlist control condition (WLC) with unrestricted access to treatment as usual. Participants were recruited in Germany in 2013 and followed through 2014, and data were analyzed in 2017. The iSMI consisted of 7 sessions plus 1 booster session. It was based on problem-solving therapy and emotion regulation techniques. Costs were measured from the societal perspective, including all direct and indirect medical costs. We performed a cost-effectiveness analysis and a cost-utility analysis relating costs to a symptom-free person and quality-adjusted life years (QALYs) gained, respectively. Sampling uncertainty was handled using nonparametric bootstrapping (N=5000). RESULTS When the society is not willing to pay anything to get an additional symptom-free person (eg, willingness-to-pay [WTP]=€0), there was a 70% probability that the intervention is more cost-effective than WLC. This probability rose to 85% and 93% when the society is willing to pay €1000 and €2000, respectively, for achieving an additional symptom-free person. The cost-utility analysis yielded a 76% probability that the intervention is more cost-effective than WLC at a conservative WTP threshold of €20,000 (US $25,800) per QALY gained. CONCLUSIONS Offering an iSMI to stressed employees has an acceptable likelihood of being cost-effective compared with WLC. CLINICALTRIAL German Clinical Trials Register DRKS00004749; https://www.drks.de/DRKS00004749 INTERNATIONAL REGISTERED REPOR RR2-10.1186/1471-2458-13-655

Economic evaluation of compression stockings for the prevention of venous leg ulcer recurrence in Ontario

2020 ◽  
Vol 29 (3) ◽  
pp. 141-151 ◽  
Author(s):  
Sandjar Djalalov ◽  
Shayan Sehatzadeh ◽  
David H Keast ◽  
William WL Wong
Keyword(s):  
Cost Effectiveness ◽  
Usual Care ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Ulcer Recurrence ◽  
Utility Analysis ◽  
Compression Stockings ◽  
Old Patients ◽  
Life Years

Objective: Approximately between 1.5 and 3.0 per 1000 people are affected by venous leg ulcers (VLUs). The treatment and management of VLUs is costly and recurrence is a major concern. There is evidence that compression stockings can reduce the rate of re-ulceration compared with no compression. We present the first cost-effective analysis of compression stockings in preventing recurrence of VLUs from the perspective of the Ontario healthcare system. Method: A cost-utility analysis with a five-year time horizon was conducted. Use of compression stockings was compared with usual care (no compression stockings). We simulated a hypothetical cohort of 65-year-old patients with healed VLUs, using a state-transition model. Model input parameters were obtained mainly from the published literature. We estimated quality-adjusted life years (QALYs) gained and direct medical costs. We conducted various sensitivity analyses. Results: Compared with usual care, compression stockings were associated with higher costs and increased QALYs. Cost-utility analysis showed that the incremental cost-effectiveness ratio of compression stockings was $23,864 per QALY gained compared with no compression stockings. The most influential drivers of cost-effectiveness were the utility value of healed VLUs, cost of stockings, number of stocking replacements, monthly prevention cost and the risk of VLU recurrence. Conclusion: Compared with usual care, compression stockings were cost-effective in preventing VLUs, using a willingness-to-pay threshold of $50,000. These observations were consistent even when uncertainty in model inputs and parameters were considered.

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.

A cost-utility analysis of atezolizumab in the second-line treatment of metastatic urothelial carcinoma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6639-6639
Author(s):  
Ambika Parmar ◽  
Marina Richardson ◽  
Beate Sander ◽  
Susanna Y. Cheng ◽  
Kelvin K. Chan
Keyword(s):  
Cost Effectiveness ◽  
Urothelial Carcinoma ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Line Treatment ◽  
Second Line ◽  
Utility Analysis ◽  
Lifetime Horizon ◽  
Metastatic Urothelial Carcinoma

6639 Background: Despite early promising results, IMvigor211 failed to demonstrate an overall survival benefit for atezolizumab, compared to chemotherapy, in the second-line treatment of metastatic urothelial carcinoma. However, given improvements in adverse events (AE) and quality of life with atezolizumab, there may still be investment value. We conducted a cost-utility analysis (CUA) of atezolizumab compared to chemotherapy from a public-payer healthcare perspective. Methods: We developed a partitioned survival model to evaluate atezolizumab versus chemotherapy (i.e. docetaxel, paclitaxel or vinflunine). IMvigor211 informed rates of treatment receipt (initial and subsequent), AE, effectiveness and utility estimates. Cost for treatment, AE and death were based on published literature (adjusted to 2018 Canadian dollars). Per health state, cost of treatment (initial and subsequent) and AE were incorporated. Outcomes included quality-adjusted life-years (QALY), cost per treatment, and incremental cost-effectiveness ratio (ICER). QALY and cost were discounted at 1.5% (Canadian guidelines). Parameter uncertainty was assessed through one-way and scenario analyses. Time horizons of 2 (within trial) and 5 years (extrapolated lifetime) were evaluated. Results: QALY of atezolizumab and chemotherapy over 2 years (lifetime) were 0.65 (0.93) and 0.58 (0.64), respectively. Cost of atezolizumab and chemotherapy over 2 years (lifetime) was $77,614.64, ($92,484.34), and $62,212.35 ($67,606.65), respectively. ICER over 2 years and lifetime was $220,032.71/QALY and $85,785.14/QALY. Scenario analysis from a North American perspective with only taxane chemotherapy with and without third line immunotherapy (IO) revealed an ICER of $80,144.90/QALY, $125,332.76/QALY over a lifetime horizon, respectively. Conclusions: The difference in ICER dependent on time horizon, driven by extrapolated survival benefits, highlights the importance of long-term follow-up to examine whether early evidence for durable response translates into long-term survival and improvements in cost-effectiveness. Thus, CUA of IO require careful interpretation and warrant dynamic assessment as new data becomes available.

scholarly journals Economic Evaluation of an Internet-Based Stress Management Intervention Alongside a Randomized Controlled Trial

10.2196/10866 ◽  
2019 ◽  
Vol 6 (5) ◽  
pp. e10866 ◽  
Author(s):  
Fanny Kählke ◽  
Claudia Buntrock ◽  
Filip Smit ◽  
Matthias Berking ◽  
Dirk Lehr ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Stress Management ◽  
Perceived Stress ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Management Interventions ◽  
Life Years ◽  
The Cost

Background Work-related stress is widespread among employees and associated with high costs for German society. Internet-based stress management interventions (iSMIs) are effective in reducing such stress. However, evidence for their cost-effectiveness is scant. Objective The aim of this study was to assess the cost-effectiveness of a guided iSMI for employees. Methods A sample of 264 employees with elevated symptoms of perceived stress (Perceived Stress Scale≥22) was assigned to either the iSMI or a waitlist control condition (WLC) with unrestricted access to treatment as usual. Participants were recruited in Germany in 2013 and followed through 2014, and data were analyzed in 2017. The iSMI consisted of 7 sessions plus 1 booster session. It was based on problem-solving therapy and emotion regulation techniques. Costs were measured from the societal perspective, including all direct and indirect medical costs. We performed a cost-effectiveness analysis and a cost-utility analysis relating costs to a symptom-free person and quality-adjusted life years (QALYs) gained, respectively. Sampling uncertainty was handled using nonparametric bootstrapping (N=5000). Results When the society is not willing to pay anything to get an additional symptom-free person (eg, willingness-to-pay [WTP]=€0), there was a 70% probability that the intervention is more cost-effective than WLC. This probability rose to 85% and 93% when the society is willing to pay €1000 and €2000, respectively, for achieving an additional symptom-free person. The cost-utility analysis yielded a 76% probability that the intervention is more cost-effective than WLC at a conservative WTP threshold of €20,000 (US $25,800) per QALY gained. Conclusions Offering an iSMI to stressed employees has an acceptable likelihood of being cost-effective compared with WLC. Trial Registration German Clinical Trials Register DRKS00004749; https://www.drks.de/DRKS00004749 International Registered Report Identifier (IRRID) RR2-10.1186/1471-2458-13-655

scholarly journals Cost-Utility Analysis of Hearing Aid Device for Older Adults in the Community: A Delayed Start Study

2020 ◽  
Author(s):  
Palvinder Kaur ◽  
Sheue Lih Chong ◽  
Palvannan Kannapiran ◽  
Kelvin WS Teo ◽  
Charis Ng Wei Ling ◽  
...  
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Cost Effectiveness ◽  
Healthcare Costs ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Index Visit ◽  
Life Years ◽  
The Cost

Abstract BackgroundHearing aids (HA) is the primary medical intervention aimed to reduce hearing handicap. This study assessed the cost-effectiveness of HA for older adults who were volunteered to be screened for hearing loss in a community based mobile hearing clinic (MHC).MethodsParticipants with (1) at least moderate hearing loss (≥40 dB HL) in at least one ear, (2) no prior usage of HA, (3) no ear related medical complications, and (4) had a Mini-Mental State Examination score ≥18 were eligible for this study. Using a delayed-start study design, participants were randomized into the immediate-start (Fitted) group where HA was fitted immediately or the delayed-start (Not Fitted) group where HA fitting was delayed for three months. Cost utility analysis was used to compare the cost-effectiveness of being fitted with HA combined with short-term, aural rehabilitation with the routine care group who were not fitted with HA. Incremental cost effectiveness ration (ICER) was computed. Health Utility Index (HUI-3) was used to measure utility gain, a component required to derive the quality adjusted life years (QALY). Total costs included direct healthcare costs, direct non-healthcare costs and indirect costs (productivity loss of participant and caregiver). Demographic data was collected during the index visit to MHC. Cost and utility data were collected three months after index visit and projected to five years.ResultsThere were 264 participants in the Fitted group and 163 participants in the Not Fitted group. No between-group differences in age, gender, ethnicity, housing type and degree of hearing loss were observed at baseline. At 3 months, HA fitting led to a mean utility increase of 0.12 and an ICER gain of S$42,790/QALY (95% CI: S$32, 793/QALY to S$62,221/QALY). At five years, the ICER was estimated to be at S$11,964/QALY (95% CI: S$8,996/QALY to S$17,080/QALY) assuming 70% of the participants continued using the HA. As fewer individuals continued using their fitted HA, the ICER increased.ConclusionsHA fitting can be cost-effective and could improve the quality of life of hearing-impaired older individuals within a brief period of device fitting. Long term cost-effectiveness of HA fitting is dependent on its continued usage.

scholarly journals Cost-utility analysis of hearing aid device for older adults in the community: a delayed start study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Palvinder Kaur ◽  
Sheue Lih Chong ◽  
Palvannan Kannapiran ◽  
W.-S. Kelvin Teo ◽  
Charis Ng Wei Ling ◽  
...  
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Cost Effectiveness ◽  
Healthcare Costs ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Index Visit ◽  
Life Years ◽  
The Cost

Abstract Background Hearing aids (HA) is the primary medical intervention aimed to reduce hearing handicap. This study assessed the cost-effectiveness of HA for older adults who were volunteered to be screened for hearing loss in a community-based mobile hearing clinic (MHC). Methods Participants with (1) at least moderate hearing loss (≥40 dB HL) in at least one ear, (2) no prior usage of HA, (3) no ear related medical complications, and (4) had a Mini-Mental State Examination score ≥ 18 were eligible for this study. Using a delayed-start study design, participants were randomized into the immediate-start (Fitted) group where HA was fitted immediately or the delayed-start (Not Fitted) group where HA fitting was delayed for three months. Cost utility analysis was used to compare the cost-effectiveness of being fitted with HA combined with short-term, aural rehabilitation with the routine care group who were not fitted with HA. Incremental cost effectiveness ration (ICER) was computed. Health Utility Index (HUI-3) was used to measure utility gain, a component required to derive the quality adjusted life years (QALY). Total costs included direct healthcare costs, direct non-healthcare costs and indirect costs (productivity loss of participant and caregiver). Demographic data was collected during the index visit to MHC. Cost and utility data were collected three months after index visit and projected to five years. Results There were 264 participants in the Fitted group and 163 participants in the Not Fitted group. No between-group differences in age, gender, ethnicity, housing type and degree of hearing loss were observed at baseline. At 3 months, HA fitting led to a mean utility increase of 0.12 and an ICER gain of S$42,790/QALY (95% CI: S$32, 793/QALY to S$62,221/QALY). At five years, the ICER was estimated to be at S$11,964/QALY (95% CI: S$8996/QALY to S$17,080/QALY) assuming 70% of the participants continued using the HA. As fewer individuals continued using their fitted HA, the ICER increased. Conclusions HA fitting can be cost-effective and could improve the quality of life of hearing-impaired older individuals within a brief period of device fitting. Long term cost-effectiveness of HA fitting is dependent on its continued usage.

scholarly journals Long-term cost-utility analysis of remote monitoring of older patients with pacemakers: the PONIENTE study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rafael Jesus Bautista-Mesa ◽  
Antonio Lopez-Villegas ◽  
Salvador Peiro ◽  
Daniel Catalan-Matamoros ◽  
Emilio Robles-Musso ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Remote Monitoring ◽  
Older Patients ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Life Years

Abstract Background Cost-effectiveness studies on pacemakers have increased in the last years. However the number of long-term cost-utility studies is limited. The objective of this study was to perform a cost-utility analysis comparing remote monitoring (RM) versus conventional monitoring (CM) in hospital of older patients with pacemakers, 5 years after implant. Methods Under a controlled, not randomized, nor masked clinical trial, 83 patients with pacemakers were initially selected. After five years of follow-up, a total of 55 patients (CM = 34; RM = 21) completed the study. A cost-utility analysis of RM in terms of costs per gained quality-adjusted life years (QALYs) was conducted. The costs from the Public Health System (PHS) as well as patients and their relatives were taken into account for the study. The robustness of the results was verified by the probabilistic analyses through Monte-Carlo simulations. Results After a five-year follow-up period, total costs were lower in the RM group by 23.02% than in the CM group (€274.52 versus €356.62; p = 0.033) because of a cost saving from patients’ perspective (€59.05 versus €102.98; p = 0.002). However, the reduction of in-hospital visits derived from RM exhibited insignificant impact on the costs from the PHS perspective, with a cost saving of 15.04% (€215.48 vs. €253.64; p = 0.144). Costs/QALYs obtained by the RM group were higher as compared to the CM group, although there were no significant differences. The incremental cost-effectiveness ratio of CM in comparison to RM became positive (€301.16). Conclusions This study confirms RM of older patients with pacemakers appears still as a cost-utility alternative to CM in hospital after 5 years of follow-up. Trial registration ClinicalTrials.gov: (Identifier: NCT02234245). Registered 09 September 2014 - Prospectively registered.

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