scholarly journals Cost-Effectiveness of an Obesity Management Program for 6- to 15-Year-Old Children in Poland: Data from Over Three Thousand Participants

Obesity Facts ◽  
2020 ◽  
Vol 13 (5) ◽  
pp. 487-498
Author(s):  
Ewa Bandurska ◽  
Michał Brzeziński ◽  
Paulina Metelska ◽  
Marzena Zarzeczna-Baran
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Management Program ◽  
Obesity And Overweight ◽  
School Programs ◽  
Overweight Group ◽  
Research Findings ◽  
Public Health Challenge ◽  
The Cost

<b><i>Background:</i></b> Obesity and overweight, including childhood obesity and overweight, pose a public health challenge worldwide. According to the available research findings, long-term interventions focusing on dietary behavior, physical activity, and psychological support are the most effective in reducing obesity in children aged 6–18 years. There are limited studies showing the financial effectiveness of such interventions. <b><i>Objective:</i></b> The objective of the present study was to evaluate cost-effectiveness of the 6-10-14 for Health weight management program using pharmacoeconomic indicators, i.e., cost-effectiveness analysis using the incremental cost-effectiveness ratio. <b><i>Methods:</i></b> We used anthropometric data of 3,081 children included in a 1-year-long intervention with a full financial cost assessment. <b><i>Results:</i></b> The cost of removing a child from the overweight group (BMI &#x3e;85th percentile) was PLN 27,758 (EUR 6,463), and the cost of removing a child from the obese group (BMI &#x3e;95th percentile) was slightly lower, i.e., PLN 23,601 (EUR 5,495). Given the obesity-related medical costs calculated in the life-long perspective, these results can be considered encouraging. At the same time, when comparing the total costs per participant with the costs of other interventions, it can be noted that they are similar to the costs of school programs containing more than 1 type of intervention. <b><i>Conclusions:</i></b> The 6-10-14 for Health program can be considered cost-effective. As a result of committing financial resources in the approximate amount of EUR 1,790 per child, around half of the children participating in the program have improved their weight indicators.

The Cost-Effectiveness of an RCT to Establish Whether 5 or 10 Years of Bisphosphonate Treatment Is the Better Duration for Women With a Prior Fracture

2009 ◽  
Vol 29 (6) ◽  
pp. 678-689 ◽  
Author(s):  
Matt D. Stevenson ◽  
Jeremy E. Oakley ◽  
Myfawny Lloyd Jones ◽  
Alan Brennan ◽  
Juliet E. Compston ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Fracture Prevention ◽  
Published Data ◽  
Bisphosphonate Treatment ◽  
Net Benefit ◽  
England And Wales ◽  
Term Efficacy ◽  
The Cost

Purpose. Five years of bisphosphonate treatment have proven efficacy in reducing fractures. Concerns exist that long-term bisphosphonate treatment may actually result in an increased number of fractures. This study evaluates, in the context of England and Wales, whether it is cost-effective to conduct a randomized controlled trial (RCT) and what sample size may be optimal to estimate the efficacy of bisphosphonates in fracture prevention beyond 5 years. Method. An osteoporosis model was constructed to evaluate the cost-effectiveness of extending bisphosphonate treatment from 5 years to 10 years. Two scenarios were run. The 1st uses long-term efficacy data from published literature, and the 2nd uses distributions elicited from clinical experts. Results of a proposed RCT were simulated. The expected value of sample information technique was applied to calculate the expected net benefit of sampling from conducting such an RCT at varying levels of participants per arm and to compare this with proposed trial costs. Results. Without further information, the better duration of bisphosphonate treatment was estimated to be 5 years using the published data but 10 years using the elicited expert opinions, although in both cases uncertainty was substantial. The net benefit of sampling was consistently high when between 2000 and 5000 participants per arm were recruited. Conclusions. An RCT to evaluate the long-term efficacy of bisphosphonates in fracture prevention appears to be cost-effective for informing decision making in England and Wales.

scholarly journals Cost-effective Analysis of Proton Pump Inhibitors in Long-term Management of Gastroesophageal Reflux Disease: A Narrative Review

2019 ◽  
Vol 55 (5) ◽  
pp. 292-305
Author(s):  
Shazia Jamshed ◽  
Akshaya Srikanth Bhagavathula ◽  
Sheikh Muhammad Zeeshan Qadar ◽  
Umaira Alauddin ◽  
Sana Shamim ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Gastroesophageal Reflux Disease ◽  
Cost Effective ◽  
The Other ◽  
Cost Effectiveness Ratio ◽  
On Demand ◽  
Step Down ◽  
The Cost ◽  
Term Management

Background: Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder that results from regurgitation of acid from the stomach into the esophagus. Treatment available for GERD includes lifestyle changes, antacids, histamine-2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), and anti-reflux surgery. Aim: The aim of this review is to assess the cost-effectiveness of the use of PPIs in the long-term management of patients with GERD. Method: We searched in PubMed to identify related original articles with close consideration based on inclusion and exclusion criteria to choose the best studies for this narrative review. The first section compares the cost-effectiveness of PPIs with H2RAs in long-term heartburn management. The other sections shall only discuss the cost-effectiveness of PPIs in 5 different strategies, namely, continuous (step-up, step-down, and maintenance), on-demand, and intermittent therapies. Results: Of 55 articles published, 10 studies published from 2000 to 2015 were included. Overall, PPIs are more effective in relieving heartburn in comparison with ranitidine. The use of PPIs in managing heartburn in long-term consumption of nonsteroidal anti-inflammatory drug (NSAID) has higher cost compared with H2RA. However, if the decision-maker is willing to pay more than US$174 788.60 per extra quality-adjusted life year (QALY), then the optimal strategy is traditional NSAID (tNSAID) and PPIs. The probability of being cost-effective was also highest for NSAID and PPI co-therapy users. On-demand PPI treatment strategy showed dominant with an incremental cost-effectiveness ratio of US$2197 per QALY gained and was most effective and cost saving compared with all the other treatments. The average cost-effectiveness ratio was lower for rabeprazole therapy than for ranitidine therapy. Conclusion: Our review revealed that long-term treatment with PPIs is effective but costly. To achieve long-term cost-effective approach, we recommend on-demand approach to treat heartburn symptoms, but if the symptoms persist, treatment with continuous step-down therapy should be applied.

scholarly journals Cost-Effectiveness of a Problem-Solving Intervention Aimed to Prevent Sickness Absence among Employees with Common Mental Disorders or Occupational Stress

2020 ◽  
Vol 17 (14) ◽  
pp. 5234
Author(s):  
Marijke Keus Van De Poll ◽  
Gunnar Bergström ◽  
Irene Jensen ◽  
Lotta Nybergh ◽  
Lydia Kwak ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Problem Solving ◽  
Mental Disorders ◽  
Sickness Absence ◽  
Common Mental Disorders ◽  
Cost Benefit ◽  
Cost Effective ◽  
Production Loss ◽  
The Cost

The cost-benefit and cost-effectiveness of a work-directed intervention implemented by the occupational health service (OHS) for employees with common mental disorders (CMD) or stress related problems at work were investigated. The economic evaluation was conducted in a two-armed clustered RCT. Employees received either a problem-solving based intervention (PSI; n = 41) or care as usual (CAU; n = 59). Both were work-directed interventions. Data regarding sickness absence and production loss at work was gathered during a one-year follow-up. Bootstrap techniques were used to conduct a Cost-Benefit Analysis (CBA) and a Cost-Effectiveness Analysis (CEA) from both an employer and societal perspective. Intervention costs were lower for PSI than CAU. Costs for long-term sickness absence were higher for CAU, whereas costs for short-term sickness absence and production loss at work were higher for PSI. Mainly due to these costs, PSI was not cost-effective from the employer’s perspective. However, PSI was cost-beneficial from a societal perspective. CEA showed that a one-day reduction of long-term sickness absence costed on average €101 for PSI, a cost that primarily was borne by the employer. PSI reduced the socio-economic burden compared to CAU and could be recommended to policy makers. However, reduced long-term sickness absence, i.e., increased work attendance, was accompanied by employees perceiving higher levels of production loss at work and thus increased the cost for employers. This partly explains why an effective intervention was not cost-effective from the employer’s perspective. Hence, additional adjustments and/or support at the workplace might be needed for reducing the loss of production at work.

scholarly journals Cost Effectiveness Analysis of Candesartan Therapy in Comparison to Candesartan-Amlodipine Therapy on Hypertensive Outpatients

2019 ◽  
Vol 7 (22) ◽  
pp. 3837-3840
Author(s):  
Faridah Baroroh ◽  
Andriana Sari ◽  
Noviana Masruroh
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Significant Difference ◽  
Hypertension Therapy ◽  
The Mean ◽  
The Cost

BACKGROUND: he achievement of optimal hypertension therapy requires cost-effective medicine. The treatment of hypertensive patients needs for long-term medication have made medical costs a prime issue in health economics. AIM: This study aims to determine the cost effectiveness of candesartan therapy compared to candesartan-amlodipine therapy on hypertensive outpatients. METHODS: This is a prospective cohort study that compares candesartan therapy to candesartan-amlodipine therapy at a public hospital from payers’ perspective. The outcome is the percentage of targeted blood pressure decrease after three months of therapy. The cost effectiveness analysis uses the Incremental Cost Effectiveness Ratio (ICER) based on the ratio of cost difference to the outcome in both therapy groups. RESULTS: As many as 111 patients participated in this research, comprising 40 candesartan therapy patients and 71 patients with the combination of candesartan-amlodipine. Of the participants, 63.96% were female, 57.66% were aged 60 or older, and 56.32% had diabetes mellitus as the most common complication. Results show that the average direct medical cost per patient for a therapy of three months with candesartan was IDR 1,050,536 ± 730,007 and IDR 760,040 ± 614,290 for a candesartan-amlodipine therapy. The mean decline of systolic and diastolic blood pressure under candesartan therapy is less than that of candesartan-amlodipine, although without any significant difference (p > 0.05). It follows that the effectiveness of candesartan (85%) is greater than that of the candesartan-amlodipine combination (84.50%). Candesartan therapy is thereby more cost-effective with an ICER value of IDR 580,993/%. CONCLUSION: Hypertension therapy by candesartan is more cost-effective than candesartan-amlodipine therapy with a cost addition of IDR 580,993.

Cost-Effectiveness of Posaconazole vs Fluconazole in the Prevention of Invasive Fungal Infections among Patients with Graft-Versus-Host Disease (GVHD) in the US.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3336-3336 ◽  
Author(s):  
Amy K. O’Sullivan ◽  
Milton C. Weinstein ◽  
Ankur Pandya ◽  
David Thompson ◽  
Amelia Langston ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Graft Versus Host Disease ◽  
Fungal Infections ◽  
Cost Effective ◽  
Graft Versus Host ◽  
Life Years ◽  
The Us ◽  
The Cost ◽  
Long Term Mortality

Abstract Trial data suggest that posaconazole is similar to fluconazole in preventing invasive fungal infections (IFIs) among allogeneic progenitor cell transplant recipients with graft-versus-host disease (GVHD). We estimated the cost-effectiveness of posaconazole versus fluconazole in this population in the US. A decision-analytic model was developed to estimate the average per patient treatment costs, IFIs avoided, life-years gained, and incremental cost per life-year gained of prophylaxis (2006 US$). The model extrapolates the trial results to a lifetime horizon to include long-term mortality due to GVHD. In the model, patients are assumed to receive posaconazole or fluconazole; efficacy data were obtained from the clinical trial. Long-term mortality and prophylaxis drug and IFI treatment costs were estimated from secondary sources. One-way and probabilistic sensitivity analyses were conducted. Posaconazole is associated with fewer IFIs (0.05 vs. 0.09), increased life years (7.87 vs. 7.66), and higher IFI-related costs (prophylaxis and IFI treatment) ($8,750 vs. $5,530) per patient relative to fluconazole. Costs for treatment of IFIs comprised 95% of the total cost for fluconazole and 35% for posaconazole. The incremental cost-effectiveness of posaconazole versus fluconazole is estimated to be $15,700 per life-year saved. Results are most sensitive to changes in the cost of treating an IFI and the efficacy of prophylaxis. Results from the probabilistic analysis indicate that there is an 88% probability that posaconazole is cost-effective at a $50,000 per life year saved threshold. We conclude that posaconazole is a cost-effective strategy for the prevention of IFIs in patients with GVHD.

scholarly journals Efficient routes to land conservation given risk of covenant failure

2015 ◽  
Author(s):  
Richard Schuster ◽  
Peter Arcese
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Private Land ◽  
Legal Challenges ◽  
Monitoring And Enforcement ◽  
Cost Effective Alternative ◽  
The Cost ◽  
Conservation Investment ◽  
Term Monitoring

Conservation initiatives to protect valued species communities in human-dominated landscapes face challenges linked to their potential costs. Conservation covenants on private land may represent a cost-effective alternative to land purchase, although many questions on the long-term monitoring and enforcement costs of covenants and the risk of violation or legal challenges remain unquantified. We explore the cost-effectiveness of conservation covenants, defined here as the fraction of the high-biodiversity landscape potentially protected via investment in covenants versus land purchase. We show that covenant violation and dispute rates substantially affect the estimated long-term cost-effectiveness of a covenant versus land purchase strategy. Our results suggest the long-term cost-effectiveness of conservation covenants may outperform land purchase as a strategy to protect biodiversity as long as disputes and legal challenges are low, but point to a critical need for monitoring data to reduce uncertainty and maximize conservation investment cost-effectiveness.

scholarly journals Assessing the Cost-Effectiveness of Contraceptive Methods from a Health Provider Perspective: Case Study of Kiambu County Hospital, Kenya

2020 ◽  
Author(s):  
James Kiragu Ngacha ◽  
Richard Ayah
Keyword(s):  
Cost Effectiveness ◽  
Service Delivery ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
Contraceptive Methods ◽  
Donor Funding ◽  
Contraceptive Prevalence ◽  
Sub Saharan ◽  
The Cost

Abstract Background: Kenya’s Contraceptive Prevalence Rate at 53% is low, with wide disparity among the 47 counties that make up the country (2% - 76%). Significant financial investment is required to maintain this level of contraceptive use and increase it to levels seen in more developed countries. This is in the context of a growing population, declining donor funding, limited fiscal space and competing health challenges. Studies have shown that long-term contraceptive methods are more cost-effective than short-term methods. However, it is unclear if this applies in Sub-Saharan Africa; with limited financial resources, lower social economic status among users, and publicly managed commodity supply chains, in vertical programs largely dependent on donor funding. This study assessed the cost-effectiveness of contraceptive methods used in Kenya.Methods: A cross-sectional study was undertaken in a county referral hospital in mid-2018. Purposive sampling of 5 Family Planning clinic providers and systematic sampling of 15 service delivery sessions per method was done. Questionnaire aided interviews were done to determine inputs required to provide services and direct observation to measure time taken to provide each method. Cost per method was determined using Activity Based Costing, effectiveness via couple year protection conversion factors, and cost-effectiveness was expressed as cost per couple year protection. Results: The Intra-Uterine Copper Device was most cost-effective at 4.87 US dollars per couple year protection followed by the 2-Rod Implant at 6.36, the 1-Rod Implant at 9.50, DMPA at 23.68, while the Combined Oral Contraceptive Pills were least cost-effective at 38.60 US dollars per couple year protection. Long-term methods attracted a higher initial cost of service delivery when compared to short-term methods.Conclusion: Long-term contraceptive methods are more cost-effective. As such, investing in long-term contraceptives would save costs despite higher initial cost of service delivery. It is recommended, therefore, that Sub-Saharan Africa countries allocate more domestic financial resources towards availability of contraceptive services, preferably with multi-year planning and budget commitment. The resources should be invested in a wide range of interventions shown to increase uptake of long-term methods, including reduction of cost barriers for the younger population, thereby increasing Contraceptive Prevalence Rates.

scholarly journals Efficient routes to land conservation given risk of covenant failure

2015 ◽  
Author(s):  
Richard Schuster ◽  
Peter Arcese
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Private Land ◽  
Legal Challenges ◽  
Monitoring And Enforcement ◽  
Cost Effective Alternative ◽  
The Cost ◽  
Conservation Investment ◽  
Term Monitoring

Conservation initiatives to protect valued species communities in human-dominated landscapes face challenges linked to their potential costs. Conservation covenants on private land may represent a cost-effective alternative to land purchase, although many questions on the long-term monitoring and enforcement costs of covenants and the risk of violation or legal challenges remain unquantified. We explore the cost-effectiveness of conservation covenants, defined here as the fraction of the high-biodiversity landscape potentially protected via investment in covenants versus land purchase. We show that covenant violation and dispute rates substantially affect the estimated long-term cost-effectiveness of a covenant versus land purchase strategy. Our results suggest the long-term cost-effectiveness of conservation covenants may outperform land purchase as a strategy to protect biodiversity as long as disputes and legal challenges are low, but point to a critical need for monitoring data to reduce uncertainty and maximize conservation investment cost-effectiveness.

scholarly journals Economic Evaluation of Medical Screening

2019 ◽  
Author(s):  
Eline Aas ◽  
Emily Burger ◽  
Kine Pedersen
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Health Benefits ◽  
Cost Effective ◽  
Population Based ◽  
Preventive Interventions ◽  
Screening Strategies ◽  
The Cost ◽  
Analytic Models

The objective of medical screening is to prevent future disease (secondary prevention) or to improve prognosis by detecting the disease at an earlier stage (early detection). This involves examination of individuals with no symptoms of disease. Introducing a screening program is resource demanding, therefore stakeholders emphasize the need for comprehensive evaluation, where costs and health outcomes are reasonably balanced, prior to population-based implementation. Economic evaluation of population-based screening programs involves quantifying health benefits (e.g., life-years gained) and monetary costs of all relevant screening strategies. The alternative strategies can vary by starting- and stopping-age, frequency of the screening and follow-up regimens after a positive test result. Following evaluation of all strategies, the efficiency frontier displays the efficient strategies and the country-specific cost-effectiveness threshold is used to determine the optimal, i.e., most cost-effective, screening strategy. Similar to other preventive interventions, the costs of screening are immediate, while the health benefits accumulate after several years. Hence, the effect of discounting can be substantial when estimating the net present value (NPV) of each strategy. Reporting both discounting and undiscounted results is recommended. In addition, intermediate outcome measures, such as number of positive tests, cases detected, and events prevented, can be valuable supplemental outcomes to report. Estimating the cost-effectiveness of alternative screening strategies is often based on decision-analytic models, synthesizing evidence from clinical trials, literature, guidelines, and registries. Decision-analytic modeling can include evidence from trials with intermediate or surrogate endpoints and extrapolate to long-term endpoints, such as incidence and mortality, by means of sophisticated calibration methods. Furthermore, decision-analytic models are unique, as a large number of screening alternatives can be evaluated simultaneously, which is not feasible in a randomized controlled trial (RCT). Still, evaluation of screening based on RCT data are valuable as both costs and health benefits are measured for the same individual, enabling more advanced analysis of the interaction of costs and health benefits. Evaluation of screening involves multiple stakeholders and other considerations besides cost-effectiveness, such as distributional concerns, severity of the disease, and capacity influence decision-making. Analysis of harm-benefit trade-offs is a useful tool to supplement cost-effectiveness analyses. Decision-analytic models are often based on 100% participation, which is rarely the case in practice. If those participating are different from those not choosing to participate, with regard to, for instance, risk of the disease or condition, this would result in selection bias, and the result in practice could deviate from the results based on 100% participation. The development of new diagnostics or preventive interventions requires re-evaluation of the cost-effectiveness of screening. For example, if treatment of a disease becomes more efficient, screening becomes less cost-effective. Similarly, the introduction of vaccines (e.g., HPV-vaccination for cervical cancer) may influence the cost-effectiveness of screening. With access to individual level data from registries, there is an opportunity to better represent heterogeneity and long-term consequences of screening on health behavior in the analysis.

scholarly journals Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047072
Author(s):  
Kathy W Tannous ◽  
Ajesh George ◽  
Moin Uddin Ahmed ◽  
Anthony Blinkhorn ◽  
Hannah G Dahlen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Oral Health ◽  
Health Benefit ◽  
Cost Effective ◽  
Economic Benefits ◽  
Dental Service ◽  
Public Healthcare ◽  
Life Years ◽  
The Cost

ObjectivesTo critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.Design and settingThe evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.ParticipantsData were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.Cost measuresData included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.Outcome measuresUtility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.ResultsCompared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only ‘cost-effective’ in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was ‘cost-effective’ in all scenarios except at 3 months scenario.ConclusionsThe midwives’ only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives’ and dentists’ combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.Trial registration numberACTRN12612001271897; Post-results.

Sign in / Sign up

Export Citation Format

Share Document