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 Long-term efficacy and safety of omalizumab in patients with persistent uncontrolled allergic asthma: a systematic review and meta-analysis

2015 ◽  
Vol 5 (1) ◽  
Author(s):  
Tianwen Lai ◽  
Shaobin Wang ◽  
Zhiwei Xu ◽  
Chao Zhang ◽  
Yun Zhao ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Allergic Asthma ◽  
Treatment Effectiveness ◽  
Meta Analysis ◽  
Cost Effective ◽  
Global Evaluation ◽  
Limited Information ◽  
Term Efficacy ◽  
The Cost

Abstract Currently, limited information is available to clinicians regarding the long-term efficacy of omalizumab treatment for allergic asthma. In this report, we aimed to (i) systematically review the evidence regarding the long-term efficacy of omalizumab in patients with persistent uncontrolled allergic asthma and to (ii) discuss the cost-effectiveness evidence published for omalizumab in this patient population. A comprehensive search for randomized controlled trials (RCTs; ≥52 weeks) was performed and six studies met our final inclusion criteria (n = 2,749). Omalizumab was associated with significant improvements in quality of life and the Global Evaluation of Treatment Effectiveness. Omalizumab also allowed patients to completely withdraw from inhaled corticosteroid therapy and did not increase the overall incidence of adverse events. However, there was insufficient evidence that omalizumab reduced the incidence of exacerbations and the cost-effectiveness of omalizumab varied across studies. Our data indicated that omalizumab use for at least 52 weeks in patients with persistent uncontrolled allergic asthma was accompanied by an acceptable safety profile, but it lacked effect on the asthma exacerbations. Use of omalizumab was associated with a higher cost than conventional therapy, but these increases may be cost-effective if the medication is used in patients with severe allergic asthma.

scholarly journals Cost-effectiveness of two long-lasting insecticidal nets delivery models in mass campaign in rural Mozambique

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Jorge A. H. Arroz ◽  
Baltazar Candrinho ◽  
Chandana Mendis ◽  
Melanie Lopez ◽  
Maria do Rosário O. Martins
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Universal Coverage ◽  
Cost Effectiveness Ratio ◽  
Net Benefit ◽  
Incremental Net Benefit ◽  
The Cost ◽  
And Control ◽  
Delivery Models ◽  
Long Lasting Insecticidal Nets

Abstract Objective The aim is to compare the cost-effectiveness of two long-lasting insecticidal nets (LLINs) delivery models (standard vs. new) in universal coverage (UC) campaigns in rural Mozambique. Results The total financial cost of delivering LLINs was US$ 231,237.30 and US$ 174,790.14 in the intervention (302,648 LLINs were delivered) and control districts (219,613 LLINs were delivered), respectively. The average cost-effectiveness ratio (ACER) per LLIN delivered and ACER per household (HH) achieving UC was lower in the intervention districts. The incremental cost-effectiveness ratio (ICER) per LLIN and ICER per HH reaching UC were US$ 0.68 and US$ 2.24, respectively. Both incremental net benefit (for delivered LLIN and for HHs reaching UC) were positive (intervention deemed cost-effective). Overall, the newer delivery model was the more cost-effective intervention. However, the long-term sustainability of either delivery models is far from guaranteed in Mozambique’s current economic context.

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 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.

Cost-effectiveness of hydrotherapy versus land-based therapy in patients with musculoskeletal disorders in Singapore

2018 ◽  
Vol 41 (2) ◽  
pp. 391-398
Author(s):  
Monica Teng ◽  
Hui Jun Zhou ◽  
Liang Lin ◽  
Pang Hung Lim ◽  
Doreen Yeo ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Musculoskeletal Disorders ◽  
Cost Effective ◽  
Target Population ◽  
Quality Adjusted Life Year ◽  
Decision Analytic Model ◽  
Published Data ◽  
Total Knee ◽  
The Cost ◽  
Quality Adjusted Life

Abstract Background The study evaluated the cost-effectiveness of hydrotherapy versus land-based therapy in patients with musculoskeletal disorders (MSDs) in Singapore. Methods A decision-analytic model was constructed to compare the cost-effectiveness of hydrotherapy to land-based therapy over 3 months from societal perspective. Target population comprised patients with low back pain (LBP), osteoarthritis (OA), rheumatoid arthritis (RA), total hip replacement (THR) and total knee replacement (TKR). Subgroup analyses were carried out to determine the cost-effectiveness of hydrotherapy in individual MSDs. Relative treatment effects were obtained through a systematic review of published data. Results Compared to land-based therapy, hydrotherapy was associated with an incremental cost-effectiveness ratio (ICER) of SGD 27 471 per quality-adjusted life-year (QALY) gained, which was below the willingness-to-pay threshold of SGD 70 000 per QALY (one gross domestic product per capita in Singapore in 2015). For the respective MSDs, hydrotherapy were dominant (more effective and less costly) in THR and TKR, cost-effective for LBP and RA, and not cost-effective for OA. Treatment adherence and cost of hydrotherapy were key drivers to the ICER values. Conclusions Hydrotherapy was a cost-effective rehabilitation compared to land-based therapy for a population with MSDs in Singapore. However, the benefit of hydrotherapy was not observed in patients with OA.

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.

Abstract 1: Impact of Predicted Bleeding Risk on the Cost-Effectiveness of Direct Thrombin Inhibition vs. Heparin Monotherapy for Patients Undergoing PCI

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Amit P Amin ◽  
Steven P Marso ◽  
Sunil V Rao ◽  
John Messenger ◽  
John House ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Major Bleeding ◽  
Cost Effective ◽  
Bleeding Risk ◽  
Thrombin Inhibitors ◽  
Published Data ◽  
Life Years ◽  
The Cost ◽  
Predicted Risk

Introduction Direct thrombin inhibitors (DTI) reduce bleeding and are cost-saving in patients (pts) undergoing PCI when compared to unfractionated heparin (UFH) plus routine glycoprotein IIb/IIIa inhibition (GPI). Little is known about the cost-effectiveness of DTI alone vs. UFH alone, however. Methods We combined data on patient-level bleeding risk with several external data sources to estimate the economic impact of substituting DTI for UFH among unselected PCI patients. We used a validated model to predict the risk of major bleeding for 81,628 NCDR® CathPCI Registry® patients who received UFH only in 2004-06. DTI costs were estimated based on current FDA dosing guidelines and acquisition costs. The cost of major bleeding ($8722) was estimated based on data from the Mid America Heart Institute. The benefit of DTI vs. UFH alone was based on bleeding risk reduction from ISAR-REACT 3. A Markov model based on published data was used to estimate the loss in life expectancy associated with major bleeding. Results The overall rate of major bleeding in the reference population was 2.2%, the estimated cost of a major bleed was $8722, projected DTI costs were $641/pt and heparin costs were negligible ($4). Assuming that DTI use reduces the risk of bleeding by 33%, use of DTI for all patients was estimated to increase costs by $573/patient and was cost saving only for patients with a predicted risk of major bleeding >20% (0.16% of the overall population). When life years lost due to bleeding were included, at willingness-to-pay thresholds of $50K and $100K per life year gained, DTI was cost effective for patients with a bleeding risk ≥8% (2.5% patients) and ≥5% (7.9% of patients), respectively. Conclusions For patients undergoing PCI, substitution of DTI for UFH monotherapy is projected to increase costs for virtually all patients, but may be reasonably cost-effective for patients with a high predicted risk (≥5%) of bleeding.

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 Cost-effectiveness of relapse-prevention cognitive therapy for bipolar disorder: 30-month study

2005 ◽  
Vol 186 (6) ◽  
pp. 500-506 ◽  
Author(s):  
Dominic H. Lam ◽  
Paul McCrone ◽  
Kim Wright ◽  
Natalie Kerr
Keyword(s):  
Bipolar Disorder ◽  
Cost Effectiveness ◽  
Clinical Outcome ◽  
Cognitive Therapy ◽  
Service Use ◽  
Standard Treatment ◽  
Cost Effective ◽  
Net Benefit ◽  
Frequent Relapses ◽  
The Cost

BackgroundWe have reported the advantageous clinical outcome of adding cognitive therapy to medication in the prevention of relapse of bipolar disorder.AimsThis 30-month study compares the cost-effectiveness of cognitive therapy with standard care.MethodWe randomly allocated 103 individuals with bipolar 1 disorder to standard treatment and cognitive therapy plus standard treatment. Service use and costs were measured at 3-month intervals and cost-effectiveness was assessed using the net-benefit approach.ResultsThe group receiving cognitive therapy had significantly better clinical outcomes. The extra costs were offset by reduced service use elsewhere. The probability of cognitive therapy being cost-effective was high and robust to different therapy prices.ConclusionsCombination of cognitive therapy and mood stabilisers was superior to mood stabilisers alone in terms of clinical outcome and cost-effectiveness for those with frequent relapses of bipolar disorder.

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