Cost-Effectiveness Analysis of Combination Statin/Ezetimibe Therapy for the Treatment of Elevated Low-Density Lipoprotein Cholesterol

2005 ◽  
Vol 40 (8) ◽  
pp. 687-692 ◽  
Author(s):  
Kristen A. Gryskiewicz ◽  
Craig I. Coleman ◽  
Effie L. Gillespie ◽  
C. Michael White
Keyword(s):  
Cost Effectiveness ◽  
Drug Cost ◽  
Disease Risk ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Lipid Lowering ◽  
Hospital Perspective ◽  
Effectiveness Analysis

Purpose Although statins have been shown to reduce LDL-C and coronary heart disease risk, it is not uncommon for patients to fail to reach NCEP ATP III goals. Some statins cannot lower LDL-C sufficiently; others cannot be titrated optimally due to drug interactions and adverse effects. Concomitant ezetimibe administration can augment LDL-C reduction over statin monotherapy; however, multidrug therapy may result in additional expense. Methods We conducted a cost-effectiveness analysis (CEA) from the hospital perspective including all FDA approved statins alone (fluvastatin, lovastatin, pravastatin, simvastatin, rosuvastatin, or atorvastatin) or the following statins plus ezetimibe: lovastatin, pravastatin, simvastatin, or atorvastatin. LDL-C lowering efficacy was determined from clinical trials. Our institution's actual acquisition cost was used to approximate drug cost (US $2,004) for each statin dose alone and with ezetimibe. To test the robustness of our results a Monte Carlo simulation was conducted varying both the cost of drug and percent LDL-C reduction efficacy. Results For patients requiring less than or equal to 40% reduction from baseline in LDL-C, lovastatin 10, 20, or 40 mg, or fluvastatin 80 mg would appear to be reasonable choices based upon both efficacy and cost data. For reductions in LDL-C in the range of greater than 40%; simvastatin 40 mg plus ezetimibe 10 mg was found to be most cost effective; although, simvastatin 80 mg, rosuvastatin 20 or 40 mg, or simvastatin 80 mg plus ezetimibe 10 mg appear to be reasonably cost-effective as well. These results were not found to be robust to variations in drug cost and LDL-C reduction. Conclusion When smaller reductions in LDL-C are required (less than 40%), drug cost is the variable that most significantly drives cost effectiveness; however, when larger LDL-C reductions are required, LDL-C lowering capacity is the single most important factor in determining cost-effectiveness of the lipid-lowering therapies. The addition of ezetimibe becomes most cost-effective when larger reductions are required.

scholarly journals Interpreting cost-effectiveness ratios in a cost-effectiveness analysis of risk-tailored prostate screening: A critique of Callender et al.

2020 ◽  
Vol 3 ◽  
pp. 23
Author(s):  
James F. O'Mahony
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Disease Risk ◽  
Prostate Cancer Screening ◽  
Absolute Risk ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
The Cost

Callender et al. recently published a model-based cost-effectiveness analysis of a risk-tailored approach to prostate cancer screening. It considers the costs and effects of prostate cancer screening offered to all men aged 55-69 without any risk selection and, alternatively, over a range of risk-tailored strategies in which screen eligibility is determined by a varying threshold of disease risk. The analysis finds that the strategy of screening men once they reach a 10-year absolute risk of disease of 5% or more is cost-effective in a UK context. I believe there are several problems with the study, mostly stemming from an incorrect interpretation of the cost-effectiveness estimates. I show that one reinterpretation of their results indicates that screening is much less cost-effective than the original analysis suggests, indicating that screening should be restricted to a much smaller group of higher risk men. More broadly, I explain the challenges of attempting to meaningfully reinterpret the originally published results due to the simulation of non-mutually exclusive intervention strategies. Finally, I consider the relevance of considering sufficient alternative screening intensities. This critique highlights the need for appropriate interpretation of cost-effectiveness results for policymakers, especially as risk stratification within screening becomes increasingly feasible.

scholarly journals Interpreting cost-effectiveness ratios in a cost-effectiveness analysis of risk-tailored prostate screening: A critique of Callender et al.

2020 ◽  
Vol 3 ◽  
pp. 23
Author(s):  
James F. O'Mahony
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Disease Risk ◽  
Prostate Cancer Screening ◽  
Absolute Risk ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
The Cost

Callender et al. recently published a model-based cost-effectiveness analysis of a risk-tailored approach to prostate cancer screening. It considers the costs and effects of prostate cancer screening offered to all men aged 55-69 without any risk selection and, alternatively, over a range of risk-tailored strategies in which screen eligibility is determined by a varying threshold of disease risk. The analysis finds that the strategy of screening men once they reach a 10-year absolute risk of disease of 5% or more is cost-effective in a UK context. I believe there are several problems with the study, mostly stemming from an incorrect interpretation of the cost-effectiveness estimates. I show that one reinterpretation of their results indicates that screening is much less cost-effective than the original analysis suggests, indicating that screening should be restricted to a much smaller group of higher risk men. More broadly, I explain the challenges of attempting to meaningfully reinterpret the originally published results due to the simulation of non-mutually exclusive intervention strategies. Finally, I consider the relevance of considering sufficient alternative screening intensities. This critique highlights the need for appropriate interpretation of cost-effectiveness results for policymakers, especially as risk stratification within screening becomes increasingly feasible.

Cost-effectiveness Analysis of Submandibular Gland Preservation With Sialendoscopy for the Management of Sialolithiasis

2021 ◽  
pp. 019459982110268
Author(s):  
Joseph R. Acevedo ◽  
Ashley C. Hsu ◽  
Jeffrey C. Yu ◽  
Dale H. Rice ◽  
Daniel I. Kwon ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Submandibular Gland ◽  
Average Cost ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Probability Of Success ◽  
Markov Decision Model ◽  
The Cost

Objective To compare the cost-effectiveness of sialendoscopy with gland excision for the management of submandibular gland sialolithiasis. Study Design Cost-effectiveness analysis. Setting Outpatient surgery centers. Methods A Markov decision model compared the cost-effectiveness of sialendoscopy versus gland excision for managing submandibular gland sialolithiasis. Surgical outcome probabilities were found in the primary literature. The quality of life of patients was represented by health utilities, and costs were estimated from a third-party payer’s perspective. The effectiveness of each intervention was measured in quality-adjusted life-years (QALYs). The incremental costs and effectiveness of each intervention were compared, and a willingness-to-pay ratio of $150,000 per QALY was considered cost-effective. One-way, multivariate, and probabilistic sensitivity analyses were performed to challenge model conclusions. Results Over 10 years, sialendoscopy yielded 9.00 QALYs at an average cost of $8306, while gland excision produced 8.94 QALYs at an average cost of $6103. The ICER for sialendoscopy was $36,717 per QALY gained, making sialendoscopy cost-effective by our best estimates. The model was sensitive to the probability of success and the cost of sialendoscopy. Sialendoscopy must meet a probability-of-success threshold of 0.61 (61%) and cost ≤$11,996 to remain cost-effective. A Monte Carlo simulation revealed sialendoscopy to be cost-effective 60% of the time. Conclusion Sialendoscopy appears to be a cost-effective management strategy for sialolithiasis of the submandibular gland when certain thresholds are maintained. Further studies elucidating the clinical factors that determine successful sialendoscopy may be aided by these thresholds as well as future comparisons of novel technology.

scholarly journals Very-low-dose aspirin and surveillance colonoscopy is cost-effective in secondary prevention of colorectal cancer in individuals with advanced adenomas: network meta-analysis and cost-effectiveness analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sajesh K. Veettil ◽  
Siang Tong Kew ◽  
Kean Ghee Lim ◽  
Pochamana Phisalprapa ◽  
Suresh Kumar ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cost Effectiveness ◽  
Secondary Prevention ◽  
Low Dose ◽  
Meta Analysis ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Surveillance Colonoscopy ◽  
Combination Strategy ◽  
Effectiveness Analysis

Abstract Background Individuals with advanced colorectal adenomas (ACAs) are at high risk for colorectal cancer (CRC), and it is unclear which chemopreventive agent (CPA) is safe and cost-effective for secondary prevention. We aimed to determine, firstly, the most suitable CPA using network meta-analysis (NMA) and secondly, cost-effectiveness of CPA with or without surveillance colonoscopy (SC). Methods Systematic review and NMA of randomised controlled trials were performed, and the most suitable CPA was chosen based on efficacy and the most favourable risk–benefit profile. The economic benefits of CPA alone, 3 yearly SC alone, and a combination of CPA and SC were determined using the cost-effectiveness analysis (CEA) in the Malaysian health-care perspective. Outcomes were reported as incremental cost-effectiveness ratios (ICERs) in 2018 US Dollars ($) per quality-adjusted life-year (QALY), and life-years (LYs) gained. Results According to NMA, the risk–benefit profile favours the use of aspirin at very-low-dose (ASAVLD, ≤ 100 mg/day) for secondary prevention in individuals with previous ACAs. Celecoxib is the most effective CPA but the cardiovascular adverse events are of concern. According to CEA, the combination strategy (ASAVLD with 3-yearly SC) was cost-saving and dominates its competitors as the best buy option. The probability of being cost-effective for ASAVLD alone, 3-yearly SC alone, and combination strategy were 22%, 26%, and 53%, respectively. Extending the SC interval to five years in combination strategy was more cost-effective when compared to 3-yearly SC alone (ICER of $484/LY gain and $1875/QALY). However, extending to ten years in combination strategy was not cost-effective. Conclusion ASAVLD combined with 3-yearly SC in individuals with ACAs may be a cost-effective strategy for CRC prevention. An extension of SC intervals to five years can be considered in resource-limited countries.

Ixazomib (IXA), carfilzomib (CAR), elotuzumab (ELO) or daratumumab (DAR) with lenalidomide and dexamethasone (LEN+DEX) versus LEN+DEX only in relapsed/refractory multiple myeloma (R/R MM): A comparative cost-effectiveness analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 8043-8043
Author(s):  
Mavis Obeng-Kusi ◽  
Daniel Arku ◽  
Neda Alrawashdh ◽  
Briana Choi ◽  
Nimer S. Alkhatib ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Effectiveness Analysis ◽  
The Other ◽  
Sensitivity Analyses ◽  
Treatment Comparison ◽  
Comparative Cost ◽  
Effectiveness Analysis ◽  
Life Years

8043 Background: IXA, CAR, ELO and DARin combination with LEN+DEXhave been found superior in efficacy compared to LEN+DEX in the management of R/R MM. Applying indirect treatment comparisons from a network meta-analysis (NMA), this economic evaluation aimed to estimate the comparative cost-effectiveness and cost-utility of these four triplet regimens in terms of progression-free survival (PFS). Methods: In the absence of direct treatment comparison from a single clinical trial, NMA was used to indirectly estimate the comparative PFS benefit of each regimen. A 2-state Markov model simulating the health outcomes and costs was used to evaluate PFS life years (LY) and quality-adjusted life years (QALY) with the triplet regimens over LEN+DEX and expressed as the incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR). Probability sensitivity analyses were conducted to assess the influence of parameter uncertainty on the model. Results: The NMA revealed that DAR+LEN+DEX was superior to the other triplet therapies, which did not differ statistically amongst them. As detailed in the Table, in our cost-effectiveness analysis, all 4 triplet regimens were associated with increased PFSLY and PFSQALY gained (g) over LEN+DEX at an additional cost. DAR+LEN+DEX emerged the most cost-effective with ICER and ICUR of $667,652/PFSLYg and $813,322/PFSQALYg, respectively. The highest probability of cost-effectiveness occurred at a willingness-to-pay threshold of $1,040,000/QALYg. Conclusions: Our economic analysis shows that all the triplet regimens were more expensive than LEN +DEX only but were also more effective with respect to PFSLY and PFSQALY gained. Relative to the other regimens, the daratumumab regimen was the most cost-effective.[Table: see text]

Cost-Effectiveness Analysis of Non-Mydriatic Ultrawide- Field Fundus Photography versus Pharmacological Pupil Dilatation in Diabetic Retinopathy Screening Program

2021 ◽  
Vol 104 (5) ◽  
pp. 818-824
Keyword(s):  
Diabetic Retinopathy ◽  
Cost Effectiveness ◽  
Screening Program ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Fundus Photography ◽  
Diabetic Retinopathy Screening ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Retinopathy Screening

Background: Diabetic retinopathy (DR) causes blindness of the population in many countries worldwide. Early detection and treatment of this disease via a DR screening program is the best way to secure the vision. An annual screening program using pharmacological pupil dilatation becomes the standard method. Recently, non-mydriatic ultrawide-field fundus photography (UWF) has been proposed as a choice for DR screening. However, there was no cost-effectiveness study between the standard DR screening and this UWF approach. Objective: To compare the cost-effectiveness between UWF and pharmacological pupil dilatation in terms of hospital and societal perspectives. Materials and Methods: Patients with type 2 diabetes mellitus that visited the ophthalmology clinic at Chulabhorn Hospital for DR screening were randomized using simple randomization method. The patients were interviewed by a trained interviewer for general and economic information. The clinical characteristics of DR and staging were recorded. Direct medical costs, direct non-medical costs, and informal care costs due to DR screening were recorded. Cost analyses were calculated for the hospital and societal perspectives. Results: The present study presented the cost-effectiveness analyses of UWF versus pharmacological pupil dilatation. Cost-effectiveness analysis from the hospital perspective showed the incremental cost-effectiveness ratio (ICER) of UWF to be –13.87. UWF was a cost-effective mean in DR screening in the societal perspective when compared with pharmacologically pupil dilatation with the ICER of 76.46, under the threshold of willingness to pay. Conclusion: The UWF was a cost-effective mean in DR screening. It can reduce screening duration and bypass post-screening blurred vision. The results suggested that UWF could be a viable option for DR screening. Keywords: Diabetic retinopathy, Diabetic retinopathy screening, Non-mydriatic ultrawide-field fundus photography, Cost-effectiveness analysis

scholarly journals Cost-Effectiveness Analysis Kloramfenikol Dan Seftriakson Untuk Pengobatan Demam Tifoid Pada Pasien Dewasa Di Rumah Sakit Sanglah Denpasar

2019 ◽  
Vol 2 (2) ◽  
pp. 105-112
Author(s):  
Amelia Lorensia ◽  
Doddy De Queljoe ◽  
Made Dwike Swari Santi
Keyword(s):  
Cost Effectiveness ◽  
Length Of Stay ◽  
Typhoid Fever ◽  
Medical Records ◽  
Cost Effective ◽  
Cost Effectiveness Ratio ◽  
Hospital Perspective ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Two Alternatives

The number of typhoid fever patient in Indonesia is still high. Typhoid fever can be treated by antibiotic therapy such as chloramphenicol and ceftriaxone. The purpose of this study was to compare the cost-effectiveness of chloramphenicol and ceftriaxone which was given to adult patients who were diagnosed with typhoid fever in Sanglah Denpasar Hospital. A comparative study between two alternatives was conducted using the hospital perspective. Retrospective method was used to collect data from patient medical records, who was diagnosed and hospitalized in Sanglah Denpasar Hospital during January 2017 until July 2018. The cost analysis was perform using cost-effectiveness grid and cost-effectiveness ratio (ACER) methods. Cost-effectiveness grid showed that dominant of ceftriaxone for patient with typhoid fever. ACER analysis for ceftriaxone was IDR 2,097,170.88 with effectivenes (length of stay) 4.27 days, and was IDR 2,097,170.88 with effectiveness (the time of reaching normal temperature) 2.42 days. ACER analysis for chloramphenicol was IDR 2,555,464.22        with effectivenes (length of stay) 10.22 days, and was IDR 2,555,464.22 with effectiveness (the time of reaching normal temperature) 3.44 days. ACER analysis showed lower degree of ceftriaxone and higher effectiveness based on length of stay and the time of reaching normal temperature. The conclusion of this study is that ceftriaxone is more cost-effective than chloramphenicol.

scholarly journals Cost-effectiveness analysis of acupuncture compared with usual care for acute non-specific low back pain: secondary analysis of a randomised controlled trial

2021 ◽  
pp. 096452842110557
Author(s):  
Trygve Skonnord ◽  
Arne Fetveit ◽  
Holgeir Skjeie ◽  
Mette Brekke ◽  
Margreth Grotle ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Randomised Controlled ◽  
Care Costs

Objective: To assess the cost-effectiveness of a single treatment session of acupuncture, when applied in addition to usual care for acute low back pain (ALBP). Methods: Secondary analysis of a multicentre randomised controlled trial in Norwegian general practice. In total, 171 participants with ALBP ⩽14 days were randomised to a control group (CG) receiving usual care or to an acupuncture group (AG) receiving one additional session of Western medical acupuncture alongside usual care. Primary outcome measures for this cost-effectiveness analysis were quality-adjusted life years (QALYs), health care costs and societal costs at days 28 and 365, the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). The NMB was calculated on the basis of the Norwegian cost-effectiveness threshold of NOK 275,000 (USD 35,628) per QALY gained. Missing data were replaced by multiple chained imputation. Results: Eighty-six participants in the CG and 81 in the AG were included in the analysis. We found no QALY gain at day 28. At day 365, the incremental QALY of 0.035 was statistically significant. The differences in health care costs and societal costs were not statistically significant. Three out of four calculations led to negative ICERs (cost saving) and positive NMBs. For the health care perspective at day 365, the ICER was USD –568 per QALY and the NMB was USD 1265, with 95.9% probability of acupuncture being cost-effective. Conclusion: To our knowledge, this is the first cost-effectiveness analysis of acupuncture for ALBP. The findings indicate that acupuncture may be cost-effective from a 1-year perspective, but more studies are needed. Trial registration number: NCT01439412 (ClinicalTrials.gov).

Cost-effectiveness analysis of neoadjuvant immune checkpoint inhibition (ICI) versus cisplatin-based chemotherapy (CBC) in muscle-invasive bladder cancer (MIBC).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 419-419
Author(s):  
Ali Raza Khaki ◽  
Yong Shan ◽  
Richard Nelson ◽  
Sapna Kaul ◽  
John L. Gore ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Randomized Clinical Trials ◽  
Pathologic Complete Response ◽  
Weighted Average ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Effectiveness Analysis

419 Background: Multiple single-arm clinical trials have shown promising pathologic complete response (pCR) rates with neoadjuvant ICIs in MIBC. However, ICIs remain costly. We conducted a cost-effectiveness analysis comparing neoadjuvant ICIs with CBC. Methods: We applied a decision analytic simulation model with a health care payer perspective and two-year time horizon to compare neoadjuvant ICIs vs CBC. For the primary analysis we compared pembrolizumab with dose dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC). We performed a secondary analysis with gemcitabine/cisplatin (GC) as CBC and exploratory analyses with atezolizumab or nivolumab/ipilimumab as ICIs (vs both ddMVAC and GC). We input pCR rates from trials (ICIs) or a weighted average of prior studies (CBC) and costs from average sales price. Outcomes of interest included costs, 2-year recurrence-free survival (RFS), and incremental cost-effectiveness ratio (ICER) of cost per 2-year RFS. A threshold analysis estimated a pCR rate or price reduction for ICI to be cost-effective and one-way and probabilistic sensitivity analyses were performed. Results: Results of the cost effectiveness analysis are shown in the table. The incremental cost of pembrolizumab compared with ddMVAC was $8,042 resulting in an incremental improvement of 0.66% in 2-year RFS for an ICER of $1,218,485 per 2-year RFS. A pCR of 71% or a 26% reduction in cost of pembrolizumab would render it more cost-effective with an ICER of $100,000 per 2-year RFS. GC required a 96% pembrolizumab cost reduction to achieve an ICER of $100,000 per 2-year RFS. Atezolizumab appeared to be more cost-effective than ddMVAC, even though the 2yr RFS was 0.66% worse. Conclusions: ICIs were not cost-effective as neoadjuvant therapies, except when atezolizumab was compared with ddMVAC. Pembrolizumab would approach cost-effective thresholds with 26% or 96% reduction in cost when compared to ddMVAC and GC, respectively. Randomized clinical trials, larger sample sizes and longer follow-up are required to better understand the value of ICIs as neoadjuvant treatments. [Table: see text]

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