Abstract 13636: Evolocumab Shows No Significant Cost-effectiveness for Myocardial Infarction in China

Introduction: The proprotein convertase subtilisin/kexin type 9 inhibitor evolocumab has been demonstrated to reduce the incidence of cardiovascular events. This study sought to evaluate the value of evolocumab in the healthcare perspective by conducting a long-term cost-effectiveness analysis in Chinese patients with myocardial infarction (MI). Hypothesis: We assessed the hypothesis that evolocumab was inefficient for the secondary prevention of MI. Methods: A Markov cohort state-transition model was developed in decision analysis software. The model subjects could have non-fatal MI and/or stroke events, as well as die from cardiovascular disease or other causes. We integrated Chinese population specific demographics and event rates with the risk reduction of evolocumab based on large trials and meta-analysis. Age-related change, event costs and utilities were included from published sources. The model had 1-year cycle and the time horizon was 25 years. The primary outcome was the incremental cost-effectiveness ratio (ICER), defined as cost per quality-adjusted life-year (QALY) saved. Results: At its current list price (33,748 CNY annually per person), the ICER was 927,713 CNY per QALY gained. In one-way deterministic sensitivity analyses, the ICER was closely associated with the utility of cardiovascular disease event free and the cost of cardiovascular death. Probabilistic sensitivity analyses demonstrated that the probability of the cost-effectiveness of evolocumab was 1.96% at the present willingness-to-pay threshold of 212,676 CNY per QALY gained. To achieve the cost-effectiveness threshold, a net value-based price of 10,255 CNY annually would be required, which is 70% lower than the present price. Alternative scenarios analyses of treatment benefit showed in MI patients with poorly controlled familial hypercholesterolemia (FH), the ICER for evolocumab was 187,736 CNY per QALY gained, which achieved the accepted cost-effectiveness threshold. Conclusions: In conclusion, the cost-effectiveness ratio of evolocumab is less favorable in MI; However, it showed good cost-effectiveness in MI patients with poorly controlled FH in China.

Download Full-text

Cost Effectiveness of Universal Hepatitis B Virus Screening in Patients Beginning Chemotherapy for Sarcomas or GI Stromal Tumors

Journal of Global Oncology ◽

10.1200/jgo.2015.001669 ◽

2016 ◽

Vol 2 (4) ◽

pp. 186-199 ◽

Cited By ~ 3

Author(s):

Glorijoy Tan ◽

Ke Zhou ◽

Chee Hian Tan ◽

David B. Matchar ◽

Mohamad Farid ◽

...

Keyword(s):

Cost Effectiveness ◽

Incremental Cost Effectiveness Ratio ◽

Hbv Reactivation ◽

Cost Effectiveness Ratio ◽

Stromal Tumors ◽

B Virus ◽

The Cost ◽

Hbv Screening ◽

Cost Effectiveness Threshold ◽

Effectiveness Threshold

Purpose The value of screening for hepatitis B virus (HBV) infection before chemotherapy for nonhematopoietic solid tumors remains unsettled. We evaluated the cost effectiveness of universal screening before systemic therapy for sarcomas, including GI stromal tumors (GISTs). Patients and Methods Drawing from the National Cancer Centre Singapore database of 1,039 patients with sarcomas, we analyzed the clinical records of 485 patients who received systemic therapy. Using a Markov model, we compared the cost effectiveness of a screen-all versus screen-none strategy in this population. Results A total of 237 patients were screened for HBV infection. No patients developed HBV reactivation during chemotherapy. The incremental cost-effectiveness ratio per quality-adjusted life-year (QALY) of offering HBV screening to all patients with sarcomas and patients with GISTs exceeded the cost-effectiveness threshold of SG$100,000 per QALY. This result was robust in one-way sensitivity analysis. Our results show that only changes in mortality rate secondary to HBV reactivation could make the incremental cost-effectiveness ratio cross the cost-effectiveness threshold. Conclusion Universal HBV screening in patients with sarcomas or GISTs undergoing chemotherapy is not cost effective at a willingness to pay of SG$100,000 per QALY and may not be required.

Download Full-text

Does Medicare Have an Implicit Cost-Effectiveness Threshold?

Medical Decision Making ◽

10.1177/0272989x10371134 ◽

2010 ◽

Vol 30 (4) ◽

pp. E14-E27 ◽

Cited By ~ 46

Author(s):

James D. Chambers ◽

Peter J. Neumann ◽

Martin J. Buxton

Keyword(s):

Economic Evaluation ◽

Cost Effectiveness ◽

Cost Effective ◽

Incremental Cost Effectiveness Ratio ◽

Cost Effectiveness Ratio ◽

Medical Interventions ◽

Coverage Decision ◽

The Cost ◽

Cost Effectiveness Threshold ◽

Effectiveness Threshold

Background. Despite the huge cost of the program, the Centers for Medicare and Medicaid Services (CMS) has maintained a policy that cost-effectiveness is not considered in national coverage determinations (NCDs). Objective. To assess whether an implicit cost-effectiveness threshold exists and to determine if economic evidence has been considered in previous NCDs. Methods. A literature search was conducted to identify estimates of cost-effectiveness relevant to each NCD from 1999—2007 (n = 103). The economic evaluation that best represented each coverage decision was included in a review of the cost-effectiveness of medical interventions considered in NCDs. Results. Of the 64 coverage decisions determined to have a corresponding cost-effectiveness estimate, 49 were associated with a positive coverage decision and 15 with a noncoverage decision. Of the positive decisions, 20 were associated with an economic evaluation that estimated the intervention to be dominant (costs less and was more effective than the alternative), 12 with an incremental cost-effectiveness ratio (ICER) of less than $50,000, 8 with an ICER greater than $50,000 but less than $100,000, and 9 with an ICER greater than $100,000. Fourteen of the sample of 64 decision memos cited or discussed cost-effectiveness information. Conclusions. CMS is covering a number of interventions that do not appear to be cost-effective, suggesting that resources could be allocated more efficiently. Although the authors identified several instances where cost-effectiveness evidence was cited in NCDs, they found no clear evidence of an implicit threshold.

Download Full-text

The cost-effectiveness threshold for medical interventions may depend on the context of the circumstances

PsycEXTRA Dataset ◽

10.1037/e556142006-025 ◽

2006 ◽

Keyword(s):

Cost Effectiveness ◽

Medical Interventions ◽

The Cost ◽

Cost Effectiveness Threshold ◽

Effectiveness Threshold

Download Full-text

Cost Needed to Treat (CNT) and Number Needed to Treat (NNT) analysis of drugs for treatment of heart failure in India

European Heart Journal ◽

10.1093/ehjci/ehaa946.3539 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Mullavelil ◽

V George ◽

A Thannikkal ◽

R Aravindakshan ◽

D John ◽

...

Keyword(s):

Heart Failure ◽

Cost Effectiveness ◽

Treatment Strategies ◽

Future Research ◽

Number Needed To Treat ◽

Neprilysin Inhibitor ◽

Long Term Treatment ◽

The Cost ◽

Cost Effectiveness Threshold ◽

Effectiveness Threshold

Abstract Background Only little attention has been paid to treatment strategies of chronic disease conditions that require long term treatment and repeated hospitalizations Purpose Our aim was to review cost-effectiveness of guideline directed medical therapy of heart failure in India and identify drugs that can be made available free of cost or at subsidized rates to the patient population. Methods Data extracted from ten landmark trials in heart failure was used to compute Number Needed to Treat (NNT) and Cost Needed to Treat (CNT) of drugs used in heart failure, to prevent cardiovascular mortality and heart failure re-hospitalization using HDS Plotter- Incremental Cost Effectiveness Calculator. Since various brands (i.e. trade names) with wide cost range are available in Indian market, the average retail price in Indian Rupees for year 2019 was considered and converted to US dollars and used for the analysis.NNT and CNT of each drug was computed and the cost-effectiveness was analyzed. WHO recommendation of three times per capita GDP was used as the cost effectiveness threshold. Results Medications that were labeled as class I for the treatment of heart failure, were included in our analysis. Ivabradine, Valsartan and Angiotensin Receptor Neprilysin inhibitor (ARNi) did not meet the cost effectiveness criteria for preventing cardio-vascular mortality. For prevention of heart failure re-hospitalization, all drugs except ARNi, met the cost effectiveness threshold. Conclusion Any future research would need to consider compliance factor along with Willingness to Pay (WTP) to understand the real acceptance of these drugs on the ground in India. Log prices (in US$) of various HF drugs Funding Acknowledgement Type of funding source: None

Download Full-text

Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold

Health Technology Assessment ◽

10.3310/hta19140 ◽

2015 ◽

Vol 19 (14) ◽

pp. 1-504 ◽

Cited By ~ 311

Author(s):

Karl Claxton ◽

Steve Martin ◽

Marta Soares ◽

Nigel Rice ◽

Eldon Spackman ◽

...

Keyword(s):

Cost Effectiveness ◽

Health Effects ◽

The Other ◽

Opportunity Costs ◽

Best Estimate ◽

The Cost ◽

The Impact ◽

The Relationship ◽

Cost Effectiveness Threshold ◽

Effectiveness Threshold

BackgroundCost-effectiveness analysis involves the comparison of the incremental cost-effectiveness ratio of a new technology, which is more costly than existing alternatives, with the cost-effectiveness threshold. This indicates whether or not the health expected to be gained from its use exceeds the health expected to be lost elsewhere as other health-care activities are displaced. The threshold therefore represents the additional cost that has to be imposed on the system to forgo 1 quality-adjusted life-year (QALY) of health through displacement. There are no empirical estimates of the cost-effectiveness threshold used by the National Institute for Health and Care Excellence.Objectives(1) To provide a conceptual framework to define the cost-effectiveness threshold and to provide the basis for its empirical estimation. (2) Using programme budgeting data for the English NHS, to estimate the relationship between changes in overall NHS expenditure and changes in mortality. (3) To extend this mortality measure of the health effects of a change in expenditure to life-years and to QALYs by estimating the quality-of-life (QoL) associated with effects on years of life and the additional direct impact on QoL itself. (4) To present the best estimate of the cost-effectiveness threshold for policy purposes.MethodsEarlier econometric analysis estimated the relationship between differences in primary care trust (PCT) spending, across programme budget categories (PBCs), and associated disease-specific mortality. This research is extended in several ways including estimating the impact of marginal increases or decreases in overall NHS expenditure on spending in each of the 23 PBCs. Further stages of work link the econometrics to broader health effects in terms of QALYs.ResultsThe most relevant ‘central’ threshold is estimated to be £12,936 per QALY (2008 expenditure, 2008–10 mortality). Uncertainty analysis indicates that the probability that the threshold is < £20,000 per QALY is 0.89 and the probability that it is < £30,000 per QALY is 0.97. Additional ‘structural’ uncertainty suggests, on balance, that the central or best estimate is, if anything, likely to be an overestimate. The health effects of changes in expenditure are greater when PCTs are under more financial pressure and are more likely to be disinvesting than investing. This indicates that the central estimate of the threshold is likely to be an overestimate for all technologies which impose net costs on the NHS and the appropriate threshold to apply should be lower for technologies which have a greater impact on NHS costs.LimitationsThe central estimate is based on identifying a preferred analysis at each stage based on the analysis that made the best use of available information, whether or not the assumptions required appeared more reasonable than the other alternatives available, and which provided a more complete picture of the likely health effects of a change in expenditure. However, the limitation of currently available data means that there is substantial uncertainty associated with the estimate of the overall threshold.ConclusionsThe methods go some way to providing an empirical estimate of the scale of opportunity costs the NHS faces when considering whether or not the health benefits associated with new technologies are greater than the health that is likely to be lost elsewhere in the NHS. Priorities for future research include estimating the threshold for subsequent waves of expenditure and outcome data, for example by utilising expenditure and outcomes available at the level of Clinical Commissioning Groups as well as additional data collected on QoL and updated estimates of incidence (by age and gender) and duration of disease. Nonetheless, the study also starts to make the other NHS patients, who ultimately bear the opportunity costs of such decisions, less abstract and more ‘known’ in social decisions.FundingThe National Institute for Health Research-Medical Research Council Methodology Research Programme.

Download Full-text

On the Estimation of the Cost-Effectiveness Threshold: Why, What, How?

Value in Health ◽

10.1016/j.jval.2016.02.020 ◽

2016 ◽

Vol 19 (5) ◽

pp. 558-566 ◽

Cited By ~ 56

Author(s):

Laura Vallejo-Torres ◽

Borja García-Lorenzo ◽

Iván Castilla ◽

Cristina Valcárcel-Nazco ◽

Lidia García-Pérez ◽

...

Keyword(s):

Cost Effectiveness ◽

The Cost ◽

Cost Effectiveness Threshold ◽

Effectiveness Threshold

Download Full-text

Daily Almond Consumption in Cardiovascular Disease Prevention via LDL-C Change in the U.S. Population: a Cost-Effectiveness Analysis

10.21203/rs.2.11042/v2 ◽

2019 ◽

Author(s):

Jifan Wang(New Corresponding Author) ◽

Michelle A. Lee Bravatti ◽

Elizabeth J. Johnson ◽

Gowri Raman(Former Corresponding Author)

Keyword(s):

Cardiovascular Disease ◽

Cost Effectiveness ◽

Willingness To Pay ◽

Cost Effective ◽

Dietary Factors ◽

Sensitivity Analyses ◽

Healthcare Sector ◽

Cvd Prevention ◽

The Cost ◽

The U.S

Abstract Objectives Heart disease is the leading cause of death in the United States. The U.S. Food and Drug Administration approved the health claim that 1.5 ounces (42.5 grams) of nut intake may reduce the risk of cardiovascular disease (CVD). Previous studies have focused on the cost-effectiveness of other foods or dietary factors on primary CVD prevention, yet not in almond consumption. This study aimed to examine the cost-effectiveness of almond consumption in CVD primary prevention. Perspective & Setting This study assessed the cost-effectiveness of consuming 42.5 grams of almond from the U.S. healthcare sector perspective. Methods A decision model was developed for 42.5 grams of almond per day versus no almond consumption and CVD in the U.S. population. Parameters in the model were derived from the literature, which included the probabilities of increasing LDL-C, developing acute myocardial infarction (MI) and stroke, treating MI, dying from the disease and surgery, as well as the costs of the disease and procedures in the U.S. population, and the quality-adjusted life years (QALY). The cost of almonds was based on the current price in the U.S. market. Sensitivity analyses were conducted for different levels of willingness-to-pay, the probabilistic sensitivity analysis, ten-year risk prevention, different costs of procedures and almond prices, and patients with or without CVD. Results The almond strategy had $363 lower cost and 0.02 higher QALY gain compared to the non-almond strategy in the base-case model. The annual net monetary benefit (NMB) of almond consumption was $1,421 higher per person than no almond consumption, when the willingness to pay threshold was set at $50,000 for annual health care expenditure. Almond was more cost-effective than non-almond in CVD prevention in all the sensitivity analyses. Conclusion Consuming 42.5 grams of almonds per day is a cost-effective approach to prevent CVD in the short term and potentially in the long term.

Download Full-text

Continuation of Anti-TNF in Patients With Ulcerative Colitis in Remission Is Not Cost-effective Compared With Treatment Withdrawal: A Markov Model

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa219 ◽

2020 ◽

Author(s):

Remi Mahmoud ◽

Chris van Lieshout ◽

Geert W J Frederix ◽

Bindia Jharap ◽

Bas Oldenburg

Keyword(s):

Ulcerative Colitis ◽

Health Care ◽

Cost Effectiveness ◽

Markov Model ◽

Cost Effective ◽

Health Care Expenditures ◽

Increased Risk ◽

The Cost ◽

Cost Effectiveness Threshold ◽

Effectiveness Threshold

Abstract Background and Aims Anti-tumour necrosis factor alpha [anti-TNF] treatment accounts for 31% of health care expenditures associated with ulcerative colitis [UC]. Withdrawal of anti-TNF in patients with UC in remission may decrease side effects and infections, while promoting cost containment. Approximately 36% of patients relapse within 12–24 months of anti-TNF withdrawal, but reintroduction of treatment is successful in 80% of patients. We aimed to evaluate the cost-effectiveness of continuation versus withdrawal of anti-TNF in patients with UC in remission. Methods We developed a Markov model comparing cost-effectiveness of anti-TNF continuation versus withdrawal, from a health care provider perspective. Transition probabilities were calculated from literature, or estimated by an expert panel of 11 gastroenterologists. Deterministic and probabilistic sensitivity analyses were performed to account for assumptions and uncertainty. The cost-effectiveness threshold was set at an incremental cost-effectiveness ratio of €80,000 per quality-adjusted life-year [QALY]. Results At 5 years, anti-TNF withdrawal was less costly [-€10,781 per patient], but also slightly less effective [-0.04 QALY per patient] than continued treatment. Continuation of anti-TNF compared with withdrawal costs €300,390/QALY, exceeding the cost-effectiveness threshold. Continued therapy would become cost-effective if the relapse rate following anti-TNF withdrawal was ≥43% higher, or if adalimumab or infliximab [biosimilar] prices fell below €87/40 mg and €66/100 mg, respectively. Conclusions Continuation of anti-TNF in UC patients in remission is not cost-effective compared with withdrawal. A stop-and-reintroduction strategy is cost-saving but is slightly less effective than continued therapy. This strategy could be improved by identifying patients at increased risk of relapse.

Download Full-text

Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina

Cadernos de Saúde Pública ◽

10.1590/0102-311x00172512 ◽

2013 ◽

Vol 29 (12) ◽

pp. 2459-2472 ◽

Cited By ~ 8

Author(s):

Pablo Wenceslao Orellano ◽

Nestor Vazquez ◽

Oscar Daniel Salomon

Keyword(s):

Cost Effectiveness ◽

Early Diagnosis ◽

Incremental Cost ◽

Cost Effective ◽

Incremental Cost Effectiveness Ratio ◽

Sensitivity Analyses ◽

Cost Effectiveness Ratio ◽

Tegumentary Leishmaniasis ◽

Life Years ◽

The Cost

The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.

Download Full-text