Economic evaluation of extended electrocardiogram monitoring for atrial fibrillation in patients with cryptogenic stroke

2020 ◽  
pp. 174749302097456
Author(s):  
Derek S Chew ◽  
Elissa Rennert-May ◽  
F Russell Quinn ◽  
Brian Buck ◽  
Michael D Hill ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cryptogenic Stroke ◽  
Holter Monitoring ◽  
Quality Adjusted Life Year ◽  
Implantable Loop Recorder ◽  
Quality Adjusted Life Years ◽  
Loop Recorder ◽  
Monitoring Strategies ◽  
Life Years ◽  
Quality Adjusted Life

Background Timely identification of occult atrial fibrillation following cryptogenic stroke facilitates consideration of oral anticoagulation therapy. Extended electrocardiography monitoring beyond 24 to 48 h Holter monitoring improves atrial fibrillation detection rates, yet uncertainty remains due to upfront costs and the projected long-term benefit. We sought to determine the cost-effectiveness of three electrocardiography monitoring strategies in detecting atrial fibrillation after cryptogenic stroke. Methods A decision-analytic Markov model was used to project the costs and outcomes of three different electrocardiography monitoring strategies (i.e. 30-day electrocardiography monitoring, three-year implantable loop recorder monitoring, and conventional Holter monitoring) in acute stroke survivors without previously documented atrial fibrillation. Results The lifetime discounted costs and quality-adjusted life years were $206,385 and 7.77 quality-adjusted life years for conventional monitoring, $207,080 and 7.79 quality-adjusted life years for 30-day extended electrocardiography monitoring, and $210,728 and 7.88 quality-adjusted life years for the implantable loop recorder strategy. Additional quality-adjusted life years could be attained at a more favorable incremental cost per quality-adjusted life year with the implantable loop recorder strategy, compared with the 30-day electrocardiography monitoring strategy, thereby eliminating the 30-day strategy by extended dominance. The implantable loop recorder strategy was associated with an incremental cost per quality-adjusted life year gained of $40,796 compared with conventional monitoring. One-way sensitivity analyses indicated that the model was most sensitive to the rate of recurrent ischemic stroke. Conclusions An implantable loop recorder strategy for detection of occult atrial fibrillation in patients with cryptogenic stroke is more economically attractive than 30-day electrocardiography monitoring compared to conventional monitoring and is associated with a cost per quality-adjusted life year gained in the range of other publicly funded therapies. The value proposition is improved when considering patients at the highest risk of recurrent ischemic stroke. However, the implantable loop recorder strategy is associated with increased health care costs, and the opportunity cost of wide scale implementation must be considered.

scholarly journals The Costs and Benefits of Covid-19 Lockdowns in New Zealand

2021 ◽  
Author(s):  
Martin Lally
Keyword(s):  
New Zealand ◽  
Vaccination Campaign ◽  
Quality Adjusted Life Year ◽  
Mitigation Strategy ◽  
Health Interventions ◽  
Costs And Benefits ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Using Data ◽  
Quality Adjusted Life

This paper considers the costs and benefits of New Zealand's Covid-19 nation-wide lockdown strategy relative to pursuit of a mitigation strategy in March 2020. Using data available up to 28 June 2021, the estimated additional deaths from a mitigation strategy are 1,750 to 4,600, implying a Cost per Quality Adjusted Life Year saved by locking down in March 2020 of at least 13 times the generally employed threshold figure of $62,000 for health interventions in New Zealand; the lockdowns do not then seem to have been justified by reference to the standard benchmark. Using only data available to the New Zealand government in March 2020, the ratio is similar and therefore the same conclusion holds that the nation-wide lockdown strategy was not warranted. Looking forwards from 28 June 2021, if a new outbreak occurs that cannot be suppressed without a nation-wide lockdown, the death toll from adopting a mitigation strategy at this point would be even less than had it done so in March 2020, due to the vaccination campaign and because the period over which the virus would then inflict casualties would now be much less than the period from March 2020; this would favour a mitigation policy even more strongly than in March 2020. This approach of assessing the savings in quality adjusted life years and comparing them to a standard benchmark figure ensures that all quality adjusted life years saved by various health interventions are treated equally, which accords with the ethical principle of equity across people.

scholarly journals Cost-Effectiveness Evaluation of Etoricoxib versus Celecoxib and Nonselective NSAIDs in the Treatment of Ankylosing Spondylitis in Norway

2011 ◽  
Vol 2011 ◽  
pp. 1-14 ◽  
Author(s):  
Jeroen P. Jansen ◽  
Stephanie D. Taylor
Keyword(s):  
Cost Effectiveness ◽  
Ankylosing Spondylitis ◽  
Time Horizon ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Cost Effective Treatment ◽  
Ceiling Ratio ◽  
Quality Adjusted Life

Objectives. To evaluate the cost-effectiveness of etoricoxib (90 mg) relative to celecoxib (200/400 mg), and the nonselective NSAIDs naproxen (1000 mg) and diclofenac (150 mg) in the initial treatment of ankylosing spondylitis in Norway.Methods. A previously developed Markov state-transition model was used to estimate costs and benefits associated with initiating treatment with the different competing NSAIDs. Efficacy, gastrointestinal and cardiovascular safety, and resource use data were obtained from the literature. Data from different studies were synthesized and translated into direct costs and quality adjusted life years by means of a Bayesian comprehensive decision modeling approach.Results. Over a 30-year time horizon, etoricoxib is associated with about 0.4 more quality adjusted life years than the other interventions. At 1 year, naproxen is the most cost-saving strategy. However, etoricoxib is cost and quality adjusted life year saving relative to celecoxib, as well as diclofenac and naproxen after 5 years of follow-up. For a willingness-to-pay ceiling ratio of 200,000 Norwegian krones per quality adjusted life year, there is a >95% probability that etoricoxib is the most-cost-effective treatment when a time horizon of 5 or more years is considered.Conclusions. Etoricoxib is the most cost-effective NSAID for initiating treatment of ankylosing spondylitis in Norway.

scholarly journals A Markov Analysis of Screening for Late-Onset Cytomegalovirus Disease in Cytomegalovirus High-Risk Kidney Transplant Recipients

2017 ◽  
Vol 13 (2) ◽  
pp. 290-298
Author(s):  
Chethan M. Puttarajappa ◽  
Sundaram Hariharan ◽  
Kenneth J. Smith
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Cytomegalovirus Infection ◽  
Late Onset ◽  
Quality Adjusted Life Year ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Quality Adjusted Life

Background and objectivesManagement strategies are unclear for late-onset cytomegalovirus infection occurring beyond 6 months of antiviral prophylaxis in cytomegalovirus high-risk (cytomegalovirus IgG positive to cytomegalovirus IgG negative) kidney transplant recipients. Hybrid strategies (prophylaxis followed by screening) have been investigated but with inconclusive results. There are clinical and potential cost benefits of preventing cytomegalovirus-related hospitalizations and associated increased risks of patient and graft failure. We used decision analysis to evaluate the utility of postprophylaxis screening for late-onset cytomegalovirus infection.Design, setting, participants, & measurementsWe used the Markov decision analysis model incorporating costs and utilities for various cytomegalovirus clinical states (asymptomatic cytomegalovirus, mild cytomegalovirus infection, and cytomegalovirus infection necessitating hospitalization) to estimate cost-effectiveness of postprophylaxis cytomegalovirus screening strategies. Five strategies were compared: no screening and screening at 1-, 2-, 3-, or 4-week intervals. Progression to severe cytomegalovirus infection was modeled on cytomegalovirus replication kinetics. Incremental cost-effectiveness ratios were calculated as a ratio of cost difference between two strategies to difference in quality-adjusted life-years starting with the low-cost strategy. One-way and probabilistic sensitivity analyses were performed to test model’s robustness.ResultsThere was an incremental gain in quality-adjusted life-years with increasing screening frequency. Incremental cost-effectiveness ratios were $783 per quality-adjusted life-year (every 4 weeks over no screening), $1861 per quality-adjusted life-year (every 3 weeks over every 4 weeks), $10,947 per quality-adjusted life-year (every 2 weeks over every 3 weeks), and $197,086 per quality-adjusted life-year (weekly over every 2 weeks). Findings were sensitive to screening cost, cost of hospitalization, postprophylaxis cytomegalovirus incidence, and graft loss after cytomegalovirus infection. No screening was favored when willingness to pay threshold was <$14,000 per quality-adjusted life-year, whereas screening weekly was favored when willingness to pay threshold was >$185,000 per quality-adjusted life-year. Screening every 2 weeks was the dominant strategy between willingness to pay range of $14,000–$185,000 per quality-adjusted life-year.ConclusionsIn cytomegalovirus high-risk kidney transplant recipients, compared with no screening, screening for postprophylactic cytomegalovirus viremia is associated with gains in quality-adjusted life-years and seems to be cost effective. A strategy of screening every 2 weeks was the most cost-effective strategy across a wide range of willingness to pay thresholds.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_12_18_CJASNPodcast_18_2_P.mp3

scholarly journals ANALISIS NILAI WILLINGNESS TO PAY PER QUALITY ADJUSTED LIFE YEAR TERAPI PENYAKIT MODERATE MASYARAKAT DI KOTA BANJARMASIN TAHUN 2019

2020 ◽  
Vol 4 (1) ◽  
pp. 1-11
Author(s):  
Melviani ◽  
Setia Budi
Keyword(s):  
Willingness To Pay ◽  
Stated Preference ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Cross Sectional ◽  
Bivariate Correlation ◽  
Life Years ◽  
Quality Adjusted Life

Pelayanan kesehatan di Indonesia belum maksimal dalam memenuhi kebutuhan pasien dengan penyakit moderate. Pendekatan farmakoekonomi yang paling direkomendasikan dalam rangka kendali mutu dan biaya adalah cost utility analysis. Interpretasi terhadap nilai rasio efektivitas biaya tersebut membutuhkan cost effectiveness threshold untuk menentukan suatu teknologi kesehatan bersifat costeffective atau tidak. Salah satu pendekatan yang dapat dilakukan adalah dengan estimasi nilai willingness to pay per quality adjusted life years. Tujuan penelitian adalah menganalisis nilai estimasi willingness to pay per quality adjusted life year pada penyakit moderate di masyarakat di Kota Banjarmasin dan faktor-faktor yang mempengaruhi WTP per QALY. Metode penelitian menggunakan pendekatan cross-sectional. Survei dilakukan pada masyarakat di Kota Banjarmasin tahun 2019 menggunakan metode stated preference dengan pendekatan contingent valuation. Jumlah sampel sebanyak 100 responden. Instrumen penelitian ini berupa kuesioner yang terdiri dari pengukuran nilai WTP menggunakan metode dichotomous bidding game, pengukuran utility menggunakan EQ-5D berdasarkan skenario hipotetik nilai utility penyakit moderate. Analisis mengunakan bivariate correlation analysis spearman.  Hasil penelitian menunjukan Rata-rata WTP per QALY EQ-5D-5L Rp19.538.910 dan analisis variabel karakteristik responden terhadap WTP per QALY di dapatkan R square 0,397(p=0,026) yang artinya bahwa 39% secara bersama-sama variabel dependen akan mempengaruhi WTP per QALY. Penelitian ini diharapkan dapat memberi masukan terhadap CE-Threshold berdasarkan preferensi masyarakat

scholarly journals The use of Quality-Adjusted Life Years in cost-effectiveness analyses in palliative care: Mapping the debate through an integrative review

2017 ◽  
Vol 31 (4) ◽  
pp. 306-322 ◽  
Author(s):  
Anne B Wichmann ◽  
Eddy MM Adang ◽  
Peep FM Stalmeier ◽  
Sinta Kristanti ◽  
Lieve Van den Block ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cost Effectiveness ◽  
Quality Adjusted Life Year ◽  
Integrative Review ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Pros And Cons ◽  
Quality Adjusted Life

Background: In cost-effectiveness analyses in healthcare, Quality-Adjusted Life Years are often used as outcome measure of effectiveness. However, there is an ongoing debate concerning the appropriateness of its use for decision-making in palliative care. Aim: To systematically map pros and cons of using the Quality-Adjusted Life Year to inform decisions on resource allocation among palliative care interventions, as brought forward in the debate, and to discuss the Quality-Adjusted Life Year’s value for palliative care. Design: The integrative review method of Whittemore and Knafl was followed. Theoretical arguments and empirical findings were mapped. Data sources: A literature search was conducted in PubMed, EMBASE, and CINAHL, in which MeSH (Medical Subject Headings) terms were Palliative Care, Cost-Benefit Analysis, Quality of Life, and Quality-Adjusted Life Years. Findings: Three themes regarding the pros and cons were identified: (1) restrictions in life years gained, (2) conceptualization of quality of life and its measurement, including suggestions to adapt this, and (3) valuation and additivity of time, referring to changing valuation of time. The debate is recognized in empirical studies, but alternatives not yet applied. Conclusion: The Quality-Adjusted Life Year might be more valuable for palliative care if specific issues are taken into account. Despite restrictions in life years gained, Quality-Adjusted Life Years can be achieved in palliative care. However, in measuring quality of life, we recommend to—in addition to the EQ-5D— make use of quality of life or capability instruments specifically for palliative care. Also, we suggest exploring the possibility of integrating valuation of time in a non-linear way in the Quality-Adjusted Life Year.

scholarly journals Quality adjusted life years in the time of COVID-19

2021 ◽  
Vol 45 (1) ◽  
pp. 12
Author(s):  
Jane Hall ◽  
Rosalie Viney
Keyword(s):  
Economic Evaluation ◽  
Economic Activity ◽  
Economic Recession ◽  
Quality Adjusted Life Year ◽  
Economic Losses ◽  
Quality Adjusted Life Years ◽  
Trade Offs ◽  
Life Years ◽  
The Face ◽  
Quality Adjusted Life

The quality adjusted life year (QALY) as a basis of valuing additional expenditure on health is widely accepted. Although early in the COVID-19 pandemic, several commentators called for a similar approach in resolving trade-offs between economic activity and reducing the burden of COVID-19, this has not occurred. The value of a QALY has not been used to deny all intervention, as the rule of rescue attests. Further, while there was no other way of managing the pandemic, there were other means available to mitigate the economic losses. Now that vaccine programs have commenced in several countries, it is interesting to consider whether economic evaluation should now be applied. However, the recognised complexities of the evaluation of vaccines, plus the challenge of measuring opportunity costs in the face of an economic recession and the severity of the consequences of an outbreak even though the probability of transmission is exceedingly low, mean its use will be restricted. COVID-19 has changed everything, even the way we should think about economic evaluation.

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