scholarly journals Cost-effectiveness of implant-supported dental prosthesis compared to conventional dental prosthesis

2019 ◽  
Vol 53 ◽  
pp. 69 ◽  
Author(s):  
Livia Fernandes Probst ◽  
Tazio Vanni ◽  
Denise De Fátima Barros Cavalcante ◽  
Erica Tatiane da Silva ◽  
Yuri Wanderley Cavalcanti ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Cost Effective ◽  
Dental Prosthesis ◽  
Unified Health System ◽  
Dental Prostheses ◽  
Proposed Model ◽  
Analysis Of Alternatives ◽  
Edentulous Patients ◽  
The Cost

OBJECTIVE: To conduct a cost-effectiveness analysis of alternatives for rehabilitation treatment of mandibular edentulism in the context of the Brazilian Unified Health System (implantsupported total dental prosthesis versus conventional total dental prosthesis). METHODS: A Markov model was developed to capture long-term clinical and economic outcomes. The model’s population was comprised of a hypothetical cohort of 1,000,000 patients, aged 55 years, with total mandibular edentulism and without medical contraindications for performing surgical procedures. The adopted analysis perspective was that of the Brazilian Unified Health System. Based on the proposed model, we calculated cost – in BRL, and effectiveness – measured by quality-adjusted prosthesis year (QAPY). The time horizon of the analysis was 20 years. RESULTS: Considering a 5% discount in costs and effects, the incremental cost-effectiveness ratio of implant-supported total dental prostheses compared to conventional total dental prosthesis (BRL 464.22/QAPY) was lower than the willingness to pay threshold adopted in the model (BRL 3,050.00/QAPY). CONCLUSIONS: The results of this economic analysis showed that the rehabilitation of mandibular edentulous patients by implant-supported total prosthesis is very cost-effective when compared to conventional complete prosthesis, considering the cost-effectiveness limits employed.

scholarly journals Evaluating the Cost-Effectiveness of Early Compared with Late or No Biologic Treatment to Manage Crohn’s Disease using Real-World Data

2019 ◽  
Vol 14 (4) ◽  
pp. 490-500 ◽  
Author(s):  
Nadia Pillai ◽  
Judith E Lupatsch ◽  
Mark Dusheiko ◽  
Matthias Schwenkglenks ◽  
Michel Maillard ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Cost Effectiveness ◽  
Crohn's Disease ◽  
Health System ◽  
Real World ◽  
Transition Probabilities ◽  
Cost Effective ◽  
Real World Data ◽  
World Data ◽  
The Cost

Abstract Background and Aims We evaluated the cost-effectiveness of early [≤2 years after diagnosis] compared with late or no biologic initiation [starting biologics >2 years after diagnosis or no biologic use] for adults with Crohn’s disease in Switzerland. Methods We developed a Markov cohort model over the patient’s lifetime, from the health system and societal perspectives. Transition probabilities, quality of life, and costs were estimated using real-world data. Propensity score matching was used to ensure comparability between patients in the early [intervention] and late/no [comparator] biologic initiation strategies. The incremental cost-effectiveness ratio [ICER] per quality-adjusted life year [QALY] gained is reported in Swiss francs [CHF]. Sensitivity and scenario analyses were performed. Results Total costs and QALYs were higher for the intervention [CHF384 607; 16.84 QALYs] compared with the comparator [CHF340 800; 16.75 QALYs] strategy, resulting in high ICERs [health system: CHF887 450 per QALY; societal: CHF449 130 per QALY]. In probabilistic sensitivity analysis, assuming a threshold of CHF100 000 per QALY, the probability that the intervention strategy was cost-effective was 0.1 and 0.25 from the health system and societal perspectives, respectively. In addition, ICERs improved when we assumed a 30% reduction in biologic prices [health system: CHF134 502 per QALY; societal: intervention dominant]. Conclusions Early biologic use was not cost-effective, considering a threshold of CHF100 000 per QALY compared with late/no biologic use. However, early identification of patients likely to need biologics and future drug price reductions through increased availability of biosimilars may improve the cost-effectiveness of an early treatment approach.

scholarly journals Cost-effectiveness analysis and budgetary impact of antipsychotics available in the Brazilian Unified Health System

2020 ◽  
Vol 12 (3) ◽  
pp. 195-205
Author(s):  
Cid Manso de Mello Vianna ◽  
◽  
Ricardo Ribeiro Alves Fernandes ◽  
Gabriela Bittencourt Gonzalez Mosegui ◽  
Valéria Queiroz Pagnin ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Impact Analysis ◽  
Cost Effective ◽  
Lifetime Horizon ◽  
Budgetary Impact ◽  
Unified Health System ◽  
Cost Strategy ◽  
Schizophrenic Patients ◽  
Effective Choice

Objective: To carry out a cost-effectiveness and budget impact analysis of antipsychotic use in adults to treat schizophrenia from the perspective of the Unified Health System (SUS). Methods: A Markov model simulated the treatment of schizophrenic patients with an initial average age of 25 years and a lifetime horizon. The possibility of combining drugs resulted in 20 pharmacotherapeutic strategies. Results: The lowest-cost strategy, risperidone/olanzapine, obtained values of $45,092.77 with effectiveness of 15.97 QALY. The incremental cost-effectiveness ratio in dollars/QALY of olanzapine/risperidone was 2,470.24, and risperidone/ziprasidone was 352,671.90, compared to the first option. All other therapeutic combinations were dominated. The budgetary impact assessment indicated that the most cost-effective choice could generate savings of US$ 1,555.00 on average, per patient, over five years. Conclusion: The therapeutic proposal with the lowest cost per patient was risperidone combined with olanzapine, revealing these two drugs as a strategy with lower budgetary impact and better cost-effectiveness.

scholarly journals Priority Setting in HIV, Tuberculosis, and Malaria – New Cost-Effectiveness Results From WHO-CHOICE

2021 ◽  
Author(s):  
Ambinintsoa H. Ralaidovy ◽  
Jeremy Addison Lauer ◽  
Carel Pretorius ◽  
Olivier JT Briët ◽  
Edith Patouillard
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
21St Century ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
World Health ◽  
Global Community ◽  
Development Goal ◽  
Life Years ◽  
The Cost

Background: This paper forms part of an update of the World Health Organization Choosing Interventions that are Cost-Effective (WHO-CHOICE) programmes. It provides an assessment of global health system performance during the first decade of the 21st century (2000-2010) with respect to allocative efficiency in HIV, tuberculosis (TB) and malaria control, thereby shining a spotlight on programme development and scale up in these Millennium Development Goal (MDG) priority areas; and examining the cost-effectiveness of selected best-practice interventions and intervention packages commonly in use during that period. Methods: Generalized cost-effectiveness analysis (GCEA) was used to determine the cost-effectiveness of the selected interventions. Impact modelling was performed using the OpenMalaria platform for malaria and using the Goals and TIME (TB Impact Model and Estimates) models in Spectrum for HIV and TB. All health system costs, regardless of payer, were included and reported in international dollars. Health outcomes are estimated and reported as the gain in healthy life years (HLYs) due to the specific intervention or combination. Analysis was restricted to eastern sub-Saharan Africa and Southeast Asia. Results: At the reference year of 2010, commonly used interventions for HIV, TB and malaria were cost-effective, with cost-effectiveness ratios less than I$ 100/HLY saved for virtually all interventions included. HIV, TB and malaria prevention and treatment interventions are highly cost-effective and can be implemented through a phased approach to full coverage to achieve maximum health benefits and contribute to the progressive elimination of these diseases. Conclusion: During the first decade of the 21st century (2000-2010), the global community has done well overall for HIV, TB, and malaria programmes as regards both economic efficiency and programmatic selection criteria. The role of international assistance, financial and technical, arguably was critical to these successes. As the global community now tackles the challenge of universal health coverage, this analysis can reinforce commitment to Sustainable Development Goal targets but also the importance of continued focus on these critical programme areas.

scholarly journals Cost-effectiveness of a lifestyle intervention in high-risk individuals for diabetes in a low- and middle-income setting: Trial-based analysis of the Kerala Diabetes Prevention Program

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Thirunavukkarasu Sathish ◽  
Brian Oldenburg ◽  
Kavumpurathu R. Thankappan ◽  
Pilvikki Absetz ◽  
Jonathan E. Shaw ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Lifestyle Intervention ◽  
Diabetes Prevention ◽  
Intervention Group ◽  
Diabetes Prevention Program ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Control Group ◽  
The Cost

Abstract Background Data on the cost-effectiveness of lifestyle-based diabetes prevention programs are mostly from high-income countries, which cannot be extrapolated to low- and middle-income countries. We performed a trial-based cost-effectiveness analysis of a lifestyle intervention targeted at preventing diabetes in India. Methods The Kerala Diabetes Prevention Program was a cluster-randomized controlled trial of 1007 individuals conducted in 60 polling areas (electoral divisions) in Kerala state. Participants (30–60 years) were those with a high diabetes risk score and without diabetes on an oral glucose tolerance test. The intervention group received a 12-month peer-support lifestyle intervention involving 15 group sessions delivered in community settings by trained lay peer leaders. There were also linked community activities to sustain behavior change. The control group received a booklet on lifestyle change. Costs were estimated from the health system and societal perspectives, with 2018 as the reference year. Effectiveness was measured in terms of the number of diabetes cases prevented and quality-adjusted life years (QALYs). Three times India’s gross domestic product per capita (US$6108) was used as the cost-effectiveness threshold. The analyses were conducted with a 2-year time horizon. Costs and effects were discounted at 3% per annum. One-way and multi-way sensitivity analyses were performed. Results Baseline characteristics were similar in the two study groups. Over 2 years, the intervention resulted in an incremental health system cost of US$2.0 (intervention group: US$303.6; control group: US$301.6), incremental societal cost of US$6.2 (intervention group: US$367.8; control group: US$361.5), absolute risk reduction of 2.1%, and incremental QALYs of 0.04 per person. From a health system perspective, the cost per diabetes case prevented was US$95.2, and the cost per QALY gained was US$50.0. From a societal perspective, the corresponding figures were US$295.1 and US$155.0. For the number of diabetes cases prevented, the probability for the intervention to be cost-effective was 84.0% and 83.1% from the health system and societal perspectives, respectively. The corresponding figures for QALY gained were 99.1% and 97.8%. The results were robust to discounting and sensitivity analyses. Conclusions A community-based peer-support lifestyle intervention was cost-effective in individuals at high risk of developing diabetes in India over 2 years. Trial registration The trial was registered with Australia and New Zealand Clinical Trials Registry (ACTRN12611000262909). Registered 10 March 2011.

scholarly journals Cost-effectiveness analysis of influenza A (H1N1) chemoprophylaxis in unified health system in Brazil

2019 ◽  
Author(s):  
Luisa Von Zuben Vecoso ◽  
Tais Freire Galvao ◽  
Marcus Silva ◽  
Everton Silva ◽  
Mariangela Resende
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Influenza A ◽  
Cost Effective ◽  
Cost Effectiveness Ratio ◽  
Tree Model ◽  
Unified Health System ◽  
Effectiveness Analysis ◽  
Influenza A H1n1 ◽  
Effectiveness Data

BACKGROUND: Oseltamivir and zanamivir have indication for treating symptomatic flu and in prophylaxis in epidemics for groups with high risk of complications. METHODS: Effectiveness data was identified in literature review, and costs were obtained from official systems and micro-costing. RESULTS: We adopted a decision-tree model to assess the effectiveness of chemoprophylaxis in Brazilian Unified Health System (SUS) perspective with willingness to pay BRL 30,000.00/QALY. The incremental cost-effectiveness ratio for chemoprophylaxis compared to no prophylaxis was - 2,921.14/QALY. CONCLUSION: Chemoprophylaxis is cost-effective in Brazilian scenario.

scholarly journals Modelling the cost-effectiveness of essential and advanced critical care for COVID-19 patients in Kenya

2021 ◽  
Author(s):  
Angela Kairu ◽  
Vincent Were ◽  
Lynda Isaaka ◽  
Ambrose Agweyu ◽  
Samuel Aketch ◽  
...  
Keyword(s):  
Critical Care ◽  
Cost Effectiveness ◽  
Health System ◽  
Incremental Cost ◽  
Cost Effective ◽  
Resource Scarcity ◽  
Status Quo ◽  
Tree Model ◽  
System Perspective ◽  
The Cost

Background: Case management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care needed for the management of severe and critical COVID-19. However, given scarce resources, gaps in both essential and advanced critical care persist. This study assessed the cost-effectiveness of investments in essential and advanced critical care to inform the prioritization of investment decisions. Methods: We employed a decision tree model to assess the incremental cost-effectiveness of investment in essential care (EC) and investment in both essential and advanced critical care (EC+ACC) compared to current health care provision capacity (status quo) for COVID-19 patients in Kenya. We used a health system perspective, and an inpatient care episode time horizon. Cost data was obtained from primary empirical analysis while outcomes data was obtained from epidemiological model estimates. We used univariate and probabilistic sensitivity analysis (PSA) to assess the robustness of the results. Results: The status quo option is more costly and less effective compared to investment in essential care and is thus dominated by the later. The incremental cost effectiveness ratio (ICER) of Investment in essential and advanced critical care (EC+ACC) was US $1,378.21 per DALY averted and hence not a cost-effective strategy when compared to the Kenyan cost-effectiveness threshold (USD 908). Conclusion: When the criterion of cost-effectiveness is considered, and within the context of resource scarcity, Kenya will achieve better value for money if it prioritizes investments in essential care before investments in advanced critical care. This information on cost-effectiveness will however need to be considered as part of a multi-criteria decision-making framework that uses a range of criteria that reflect societal values of the Kenyan society. Keywords: COVID-19, cost-effectiveness, essential care, advanced critical care, Kenya

Oral rehabilitation with complete implant-supported dental prosthesis: a budget impact analysis from the unified health system perspective

2020 ◽  
Author(s):  
Livia Fernandes Probst ◽  
Denise de Fátima Barros Cavalcante ◽  
Tazio Vanni ◽  
Erica Tatiane da Silva ◽  
Yuri Wanderley Cavalcanti ◽  
...  
Keyword(s):  
Health System ◽  
Impact Analysis ◽  
Budget Impact ◽  
Dental Prosthesis ◽  
Budget Impact Analysis ◽  
Oral Rehabilitation ◽  
System Perspective ◽  
Unified Health System ◽  
Dental Prostheses ◽  
Methodological Guidelines

Abstract Background Tooth loss is an important measure of a population's health condition and has a significant impact on people's quality of life. Oral rehabilitation is an important means for functional and social recovery of edentulous patThe aim of the study was to estimate the budget impact of complete implant-supported dental prostheses in the rehabilitation of mandibular edentulism in patients within the context of the Unified Health System (Sistema Único de Saúde – SUS).Methods Treatment with complete implant-supported dentures was compared with the technology most frequently used - Conventional Complete Dental Prosthesis. For analysis we adopted the Methodology proposed by the Methodological Guidelines for Budget Impact Analysis of the Brazilian Network for Health Technology Assessment (REBRATS). Sensitivity analysis was performed per scenarios and a temporal horizon of 5 years was used.Results Implementation of treatment by complete implant-supported dental prostheses would demand an amount of US$ 970,253,019.00 in 5 years in the reference scenario, US$ 545,767,323.40 in the most optimistic scenario, and US$ 1,516,020,342.40 in the worst scenario.Conclusions These results could support the Brazilian managers in planning the Federal budget destined to Medium to High Complexity (treatments), making it possible to disseminate rehabilitative treatment performed with complete implant-supported dentures in SUS, and serve as reference for health systems in other countries.

scholarly journals Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study

Vaccines ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 707
Author(s):  
Afifah Machlaurin ◽  
Franklin Christiaan Karel Dolk ◽  
Didik Setiawan ◽  
Tjipke Sytse van der Werf ◽  
Maarten J. Postma
Keyword(s):  
Cost Effectiveness ◽  
Univariate Analysis ◽  
Cost Effective ◽  
Epidemiological Data ◽  
Control Programme ◽  
Detection Rates ◽  
Middle Income ◽  
Bcg Vaccination ◽  
Life Years ◽  
The Cost

Bacillus Calmette–Guerin (BCG), the only available vaccine for tuberculosis (TB), has been applied for decades. The Indonesian government recently introduced a national TB disease control programme that includes several action plans, notably enhanced vaccination coverage, which can be strengthened through underpinning its favourable cost-effectiveness. We designed a Markov model to assess the cost-effectiveness of Indonesia’s current BCG vaccination programme. Incremental cost-effectiveness ratios (ICERs) were evaluated from the perspectives of both society and healthcare. The robustness of the analysis was confirmed through univariate and probabilistic sensitivity analysis (PSA). Using epidemiological data compiled for Indonesia, BCG vaccination at a price US$14 was estimated to be a cost-effective strategy in controlling TB disease. From societal and healthcare perspectives, ICERs were US$104 and US$112 per quality-adjusted life years (QALYs), respectively. The results were robust for variations of most variables in the univariate analysis. Notably, the vaccine’s effectiveness regarding disease protection, vaccination costs, and case detection rates were key drivers for cost-effectiveness. The PSA results indicated that vaccination was cost-effective even at US$175 threshold in 95% of cases, approximating the monthly GDP per capita. Our findings suggest that this strategy was highly cost-effective and merits prioritization and extension within the national TB programme. Our results may be relevant for other high endemic low- and middle-income countries.

scholarly journals Cost Effectiveness of Transbronchial Needle Aspiration

1999 ◽  
Vol 6 (4) ◽  
pp. 332-335 ◽  
Author(s):  
Jennifer A Crocket ◽  
Eric YL Wong ◽  
Dale C Lien ◽  
Khanh Gia Nguyen ◽  
Michelle R Chaput ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Benign Disease ◽  
University Hospital ◽  
High Yield ◽  
Transbronchial Needle Aspiration ◽  
Computed Tomographic ◽  
The Cost

OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.DESIGN: Retrospective study.SETTING: A university hospital.POPULATION STUDIED: Ninety-six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy.RESULTS: Ninety-nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented.CONCLUSIONS: TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.

The cost-effectiveness of insulin analogs and regular insulin for diabetes control: a case study in Iran

2020 ◽  
Vol 33 (4/5) ◽  
pp. 323-331
Author(s):  
Mohsen pakdaman ◽  
Raheleh akbari ◽  
Hamid reza Dehghan ◽  
Asra Asgharzadeh ◽  
Mahdieh Namayandeh
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Regular Insulin ◽  
Diabetes Control ◽  
Diabetic Patients ◽  
Insulin Analogs ◽  
Content Type ◽  
Patients With Diabetes ◽  
The Government ◽  
The Cost

PurposeFor years, traditional techniques have been used for diabetes treatment. There are two major types of insulin: insulin analogs and regular insulin. Insulin analogs are similar to regular insulin and lead to changes in pharmacokinetic and pharmacodynamic properties. The purpose of the present research was to determine the cost-effectiveness of insulin analogs versus regular insulin for diabetes control in Yazd Diabetes Center in 2017.Design/methodology/approachIn this descriptive–analytical research, the cost-effectiveness index was used to compare insulin analogs and regular insulin (pen/vial) for treatment of diabetes. Data were analyzed in the TreeAge Software and a decision tree was constructed. A 10% discount rate was used for ICER sensitivity analysis. Cost-effectiveness was examined from a provider's perspective.FindingsQALY was calculated to be 0.2 for diabetic patients using insulin analogs and 0.05 for those using regular insulin. The average cost was $3.228 for analog users and $1.826 for regular insulin users. An ICER of $0.093506/QALY was obtained. The present findings suggest that insulin analogs are more cost-effective than regular insulin.Originality/valueThis study was conducted using a cost-effectiveness analysis to evaluate insulin analogs versus regular insulin in controlling diabetes. The results of study are helpful to the government to allocate more resources to apply the cost-effective method of the treatment and to protect patients with diabetes from the high cost of treatment.

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