scholarly journals Cost-effectiveness of exercise therapy in patients with coronary heart disease, chronic heart failure and associated risk factors: A systematic review of economic evaluations of randomized clinical trials

2019 ◽  
Vol 27 (10) ◽  
pp. 1045-1055 ◽  
Author(s):  
Neil Oldridge ◽  
Rod S Taylor
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Intermittent Claudication ◽  
Exercise Therapy ◽  
Cost Effective ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Value For Money ◽  
The Cost

Aims Prescribed exercise is effective in adults with coronary heart disease (CHD), chronic heart failure (CHF), intermittent claudication, body mass index (BMI) ≥25 kg/m2, hypertension or type 2 diabetes mellitus (T2DM), but the evidence for its cost-effectiveness is limited, shows large variations and is partly contradictory. Using World Health Organization and American Heart Association/American College of Cardiology value for money thresholds, we report the cost-effectiveness of exercise therapy, exercise training and exercise-based cardiac rehabilitation. Methods Electronic databases were searched for incremental cost-effectiveness and incremental cost–utility ratios and/or the probability of cost-effectiveness of exercise prescribed as therapy in economic evaluations conducted alongside randomized controlled trials (RCTs) published between 1 July 2008 and 28 October 2018. Results Of 19 incremental cost–utility ratios reported in 15 RCTs in patients with CHD, CHF, intermittent claudication or BMI ≥25 kg/m2, 63% met both value for money thresholds as ‘highly cost-effective’ or ‘high value’, with 26% ‘not cost-effective’ or of ‘low value’. The probability of intervention cost-effectiveness ranged from 23 to 100%, probably due to the different populations, interventions and comparators reported in the individual RCTs. Confirmation with the Consolidated Health Economic Evaluation Reporting checklist varied widely across the included studies. Conclusions The findings of this review support the cost-effectiveness of exercise therapy in patients with CHD, CHF, BMI ≥25 kg/m2 or intermittent claudication, but, with concerns about reporting standards, need further confirmation. No eligible economic evaluation based on RCTs was identified in patients with hypertension or T2DM.

Economic evaluation of drug-eluting stents: A systematic literature review and model-based cost–utility analysis

2007 ◽  
Vol 23 (4) ◽  
pp. 473-479 ◽  
Author(s):  
Pekka Kuukasjärvi ◽  
Pirjo Räsänen ◽  
Antti Malmivaara ◽  
Pasi Aronen ◽  
Harri Sintonen
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effective ◽  
Cost Utility ◽  
Drug Eluting Stents ◽  
Economic Evaluations ◽  
Model Based ◽  
Drug Eluting ◽  
The Cost

Objectives:The aim of this study was to systematically review economic analyses comparing drug-eluting stents (DES) to bare metal stents (BMS) in patients who undergo percutaneous coronary intervention to form an overall view about cost-effectiveness of DES and to construct a simple decision analysis model to evaluate the cost–utility of DES.Methods:Electronic databases searched from January 2004 to January 2006 were Cochrane Database of Systematic Reviews; DARE, HTA, EED (NHS CRD); MEDLINE(R) In-Process, Other Non-Indexed Citations, MEDLINE(R). References of the papers identified were checked. We included randomized controlled trials (RCT) or model-based cost-effectiveness analyses comparing DES to BMS in patients with coronary artery disease. The methodological quality of the papers was assessed by Drummond's criteria. Baseline characteristics and results of the studies were extracted and data synthesized descriptively. A decision tree model was constructed to evaluate the cost–utility of DES in comparison to BMS, where health-related quality of life was measured by the 15D.Results:We identified thirteen good-quality economic evaluations. In two of these based on RCTs, DES was found cost-effective. In six studies, it was concluded that DES might probably be a cost-effective strategy in some circumstances, but not as a single strategy, and four studies concluded that DES is not cost-effective. One study did not draw a clear conclusion. In our analysis, the overall incremental cost-effectiveness ratio was €98,827 per quality-adjusted life-years gained. Avoiding one revascularization with DES would cost €4,794, when revascularization with BMS costs €3,260.Conclusions:The evidence is inconsistent of whether DES would be a cost-effective treatment compared with BMS in any healthcare system where evaluated. A marked restenosis risk reduction should be achieved before use of DES is justifiable at present prices. When considering adoption of a new health technology with a high incremental cost within a fixed budget, opportunity cost in terms of untreated patients should be seriously considered as a question of collective ethics.

scholarly journals An Economic Evaluation of a Comprehensive School-Based Caries Prevention Program

2019 ◽  
Vol 4 (4) ◽  
pp. 378-387 ◽  
Author(s):  
S.S. Huang ◽  
R.R. Ruff ◽  
R. Niederman
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effective ◽  
Prevention Programs ◽  
Caries Prevention ◽  
Health Impacts ◽  
Economic Evaluations ◽  
Posterior Teeth ◽  
School Based ◽  
The Cost

Introduction: Current economic evaluations of school-based caries prevention programs (SCPPs) do not compare multiple types of SCPPs against each other and do not consider teeth beyond permanent first molars. Objectives: To assess the cost-effectiveness of a comprehensive SCPP relative to an SCPP focused on delivering sealants for permanent first molars only and to a default of no SCPP. Based on a societal perspective, a simulation model was used that compared the health and cost impacts on 1) permanent first molars only and 2) all posterior teeth. Methods: To calibrate the model, we used data from CariedAway, a comprehensive SCPP that used glass ionomer to prevent and arrest active decay among children. We then evaluated the incremental cost-effectiveness of implementing 3 alternate school-based approaches (comprehensive, sealant only, and no program) on only first molars and all posterior teeth. Probabilistic, 1-, and 2-way sensitivity analyses are included for robustness. Cost-effectiveness is assessed with a threshold of $54,639 per averted disability-adjusted life year (DALY). Results: We first compared the 3 programs under the assumption of treating only first molars. This assessment indicated that CariedAway was less cost-effective than school-based sealant programs (SSPs): the resulting incremental cost-effectiveness ratio (ICER) for CariedAway versus SSPs was $283,455 per averted DALY. However, when the model was extended to include CariedAway’s treatment of all posterior teeth, CariedAway was not only cost-effective but also cost-saving relative to SSPs (ICER, –$943,460.88 per averted DALY; net cost, –$261.45) and no SCPP (ICER, –$400,645.52 per averted DALY; net cost, –$239.77). Conclusions: This study finds that economic evaluations assessing only cost and health impacts on permanent first molars may underestimate the cost-effectiveness of comprehensive SCPPs 1) preventing and arresting decay and 2) treating all teeth. Hence, there is an urgent need for economic evaluations of SCPPs to assess cost and health impacts across teeth beyond only permanent first molars. Knowledge Transfer Statement: The results of this study can be used by policy makers to understand how to evaluate economic evaluations of school-based caries prevention programs and what factors to consider when deciding on what types of programs to implement.

scholarly journals Cost-effectiveness analysis of different methods of treatment of tubal ectopic pregnancy in the south of Iran

2020 ◽  
Author(s):  
Bahia Namavar Jahromi ◽  
Elahe esmaili ◽  
Mozhgan Fardid ◽  
Jafari Abdosaleh ◽  
Zahra Kavosi ◽  
...  
Keyword(s):  
Single Dose ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Ectopic Pregnancy ◽  
Cost Effective ◽  
Cost Utility ◽  
Double Dose ◽  
Tubal Ectopic Pregnancy ◽  
Dose Methotrexate ◽  
The Cost

Abstract Background: Ectopic pregnancy is one of the most important causes of maternal mortality and infertility that may impose many costs on patients. Today, Surgery and pharmaceutical treatments are the common methods of treating the disease. The aim of this study was to evaluate the cost-effectiveness of different methods of treating tubal ectopic pregnancy in the south of Iran.Methods: This study was an economic evaluation which analysed and compared the cost-effectiveness and cost-utility of three treatment methods, including single-dose methotrexate, double-dose methotrexate, and surgery in patients with tubal ectopic pregnancy. In this study, a decision tree model was used. The outcomes included in the model were the percentage of successful treatment and the average utility score of each treatment method. The study was conducted from the social perspective and a one-way and probabilistic sensitivity analysis was performed to measure the effects of uncertainty. The analysis of the collected data was performed using Excel and TreeAge software.Results: The incremental cost-effectiveness ratio of the surgery versus single-dose methotrexate was positive and equal to $5812 PPP; since it was less than the threshold, surgery was considered as a cost-effective method. The incremental cost-utility ratio also identified surgery as the best option. Moreover, the results of one-way showed the highest sensitivity to the effectiveness of single-dose methotrexate. Scatter plots also revealed that surgery in 82% and 96% of simulations was at the acceptable region compared with a single dose and double-dose methotrexate, respectively and below the threshold. It was identified as a more cost-effective strategy. Furthermore, the acceptability curves showed that in 81.4% of simulations, surgery was the most cost-effective treatment for thresholds less than 21011 PPP dollars.Conclusions: Based on the results of the present study, it is recommended that surgery can be used as the first line of treatment for ectopic. Also, the best drug strategy was single-dose methotrexate. Since these strategies reduce costs and increase treatment success and QALYs compared to double-dose methotrexate.

scholarly journals Economic evaluation of sacubitril/valsartan versus enalapril in the treatment of heart failure with reduced ejection fraction

2020 ◽  
Author(s):  
Haiqiang SANG ◽  
Yaohui JIANG ◽  
Zhe WANG ◽  
Rujie ZHENG
Keyword(s):  
Heart Failure ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Ejection Fraction ◽  
Incremental Cost ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Reduced Ejection Fraction ◽  
The Cost

Abstract Background: In 2020, sacubitril/valsartan(formerly LCZ696) will implement the new negotiated price of medical insurance in China, and the cost of treatment will be significantly reduced. The aim of study is to evaluate the economy of sacubitril/valsartan(SAC/VAL) compared with an angiotensin converting enzyme inhibitor (ACEI) (enalapril) in the treatment of heart failure with reduced ejection fraction (HFrEF) in China.Method: A Markov model was developed to project clinical and economic outcomes of SAC/VAL versus enalapril for 64-year-old patients with HFrEF over 10 years from the Chinese medical and health system perspective. A cost-utility analysis was performed mostly based on data from the PARADIGM trial. Other transition probability, costs, and utilities were obtained from published literature and public databases. The primary outcome were total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for SAC/VAL relative to enalapril. The model was verified the uncertainty using the sensitivity analysis furtherly.Results: Compared with enalapril, SAC/VAL cost more than enalapril (¥96532 vs. ¥34560) and was more cost-effective (4.6 QALYs vs. 4.3 QALYs), resulting in an incremental cost-effectiveness ratio of ¥185720 per QALY gained for patients with HFrEF at a WTP threshold of ¥212676 per QALY. Sensitivity analysis demonstrated the robustness of the model, identifying the death on the SAC/VAL group as a significant drivers of the cost-effectiveness. At the national negotiation price (¥9.95 per 100mg), probability of SAC/VAL being cost-effective was about 53% at a WTP threshold of ¥212676 per QALY.Conclusion: SAC/VAL was associated with clinical benefit and may be cost-effective compared with an ACEI (the current standard of care) in patients with HFrEF.

scholarly journals A Telemonitoring Programme in Patients with Heart Failure in France: A Cost-Utility Analysis

2021 ◽  
Author(s):  
Mégane Caillon ◽  
Rémi Sabatier ◽  
Damien Legallois ◽  
Laurène Courouve ◽  
Valérie Donio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Standard Care ◽  
Care Setting ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Life Years

Abstract Background Certain telemedicine programmes for heart failure (HF) have been shown to reduce all-cause mortality and heart failure-related hospitalisations, but their cost-effectiveness remains controversial. The SCAD programme is a home-based interactive telemonitoring service for HF, which is one of the longest-running and largest telemonitoring programmes for HF in France. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD programme with respect to standard hospital-based care in patients with HF. Methods A Markov model simulating hospitalisations and mortality in patients with HF was constructed to estimate outcomes and costs. The model included six distinct health states (three ‘not hospitalised’ states, two ‘hospitalisation for heart failure’ states, both depending on the number of previous hospitalisations, and one death state. The model lifetime in the base case was ten years. Model inputs were based on published literature. Outputs (costs and QALYs) were compared between SCAD participants and standard care. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the input parameters of the model. Results The number of quality-adjusted life years (QALYs) was 3.75 in the standard care setting and 4.41 in the SCAD setting. This corresponds to a gain in QALYs provided by the SCAD programme of 0.65 over the ten-year lifetime of the model. The estimated total cost was €30,932 in the standard care setting and €35,177 in the SCAD setting, with an incremental cost of €4,245. The incremental cost-effectiveness ratio for the SCAD programme over standard care was estimated at €4,579/QALY. In the deterministic sensitivity analysis, the variables that had the most impact on the ICER were HF management costs. The likelihood of the SCAD programme being considered cost-effective was 90% at a willingness-to-pay threshold of €11,800. Conclusions Enrolment of patients into the SCAD programme is highly cost-effective. Extension of the programme to other hospitals and more patients would have a limited budget impact but provide important clinical benefits. This finding should also be taken into account in new public health policies aimed at encouraging a shift from inpatient to ambulatory care.

scholarly journals Cost-effectiveness analysis of different methods of treatment of tubal ectopic pregnancy in the south of Iran

2020 ◽  
Author(s):  
Bahia Namavar Jahromi ◽  
Elahe esmaili ◽  
Mozhgan Fardid ◽  
Jafari Abdosaleh ◽  
Zahra Kavosi ◽  
...  
Keyword(s):  
Single Dose ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Ectopic Pregnancy ◽  
Cost Effective ◽  
Cost Utility ◽  
Double Dose ◽  
Tubal Ectopic Pregnancy ◽  
Dose Methotrexate ◽  
The Cost

Abstract Background: Ectopic pregnancy is one of the most important causes of maternal mortality and infertility that may impose many costs on patients. Today, Surgery and pharmaceutical treatments are the common methods of treating the disease. The aim of this study was to evaluate the cost-effectiveness of different methods of treating tubal ectopic pregnancy in the south of Iran.Methods: This study was an economic evaluation which analysed and compared the cost-effectiveness and cost-utility of three treatment methods, including single-dose methotrexate, double-dose methotrexate, and surgery in patients with tubal ectopic pregnancy. In this study, a decision tree model was used. The outcomes included in the model were the percentage of successful treatment and the average utility score of each treatment method. The study was conducted from the social perspective and a one-way and probabilistic sensitivity analysis was performed to measure the effects of uncertainty. The analysis of the collected data was performed using Excel and TreeAge software.Results: The incremental cost-effectiveness ratio of the surgery versus single-dose methotrexate was positive and equal to $5812 PPP; since it was less than threshold, surgery was considered as a cost-effective method. The incremental cost-utility ratio also identified surgery as the best option. Moreover, the results of one-way showed the highest sensitivity to the effectiveness of single-dose methotrexate. Scatter plots also revealed that surgery in 82% and 96% of simulations was at the acceptable region compared with single dose and double-dose methotrexate, respectively and below the threshold. It was identified as the more cost effective strategy. Furthermore, the acceptability curves showed that in 81.4% of simulations, surgery was the most cost effective treatment for thresholds less than 21011 PPP dollars.Conclusions: Based on the results of the present study, it is recommended that surgery can be used as the first line of treatment for ectopic. Also, the best drug strategy was single dose methotrexate. Since these strategies reduce costs and increase treatment success and QALYs compared to double-dose methotrexate.

OP151 Cost-Utility Of Gender-Neutral HPV Vaccination In Ireland

2019 ◽  
Vol 35 (S1) ◽  
pp. 34-34
Author(s):  
Conor Teljeur ◽  
Eamon O Murchu ◽  
Patricia Harrington ◽  
Mairin Ryan
Keyword(s):  
Cost Effectiveness ◽  
Uptake Rate ◽  
Hpv Vaccination ◽  
Cost Effective ◽  
Cost Utility ◽  
Vaccine Uptake ◽  
Economic Evaluations ◽  
Uptake Rates ◽  
Gender Neutral ◽  
The Cost

IntroductionA number of economic evaluations of gender-neutral human papillomavirus (HPV) vaccination have been published, generally finding that the cost-effectiveness is sensitive to the uptake rate in girls. In Ireland there is a girls-only program in place, but the initial high uptake rate (>85 percent) was substantially impacted by high profile negative publicity concerning perceived vaccine safety issues. Efforts to address perceived safety concerns have recently yielded a partial recovery in uptake rates. The aim of this study was to estimate the cost-utility of extending the program to include boys and explore the impact of fluctuating uptake rates.MethodsA previously published cost-utility model used in the United States of America and Norway was adapted to the Irish setting and populated with Irish epidemiological and cost data. Comparators included no vaccination, and girls-only and gender-neutral vaccination, both with either a 4-valent or 9-valent vaccine. Vaccination is at age 12 years and oropharyngeal and penile cancers were excluded in the base case analysis. Additional analyses were used to incorporate fluctuating uptake rates into the model.ResultsA 9-valent girls-only program dominated the existing girls-only 4-valent program. The incremental cost-effectiveness ratio (ICER) for a gender-neutral 9-valent program was EUR 50,823/quality-adjusted life year (QALY). Gender-neutral vaccination would be cost-effective at a willingness-to-pay threshold of EUR 45,000/QALY when the uptake rate is below 78 percent. The ICER decreased to between EUR 41,000 and EUR 42,000/QALY when the uptake rate was allowed to fluctuate across six to 12 yearly cycles.ConclusionsThe cost-effectiveness of gender-neutral HPV vaccination is highly sensitive to the assumed uptake rate in girls. Large fluctuations in HPV vaccine uptake rates have been observed in a number of countries in the last decade. Incorporating fluctuating uptake rates in the model shows that a gender-neutral program may be more cost-effective than when a stable uptake is assumed.

Abstract 15981: Cost-effectiveness of Dapagliflozin in Heart Failure With Reduced Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nicolas Isaza ◽  
Paola Calvachi ◽  
Inbar Raber ◽  
Changyu Shen ◽  
Michael C Gavin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Ejection Fraction ◽  
Incremental Cost ◽  
Cost Effective ◽  
Healthcare Sector ◽  
Base Case ◽  
Reduced Ejection Fraction ◽  
Life Years ◽  
The Cost

Introduction: In May 2020, the US FDA approved the use of dapagliflozin, an SGLT2 inhibitor, for the reduction of cardiovascular death and heart failure hospitalization in patients with heart failure with reduced ejection fraction (HFrEF). We examined the cost-effectiveness of adding dapagliflozin to guideline-directed medical therapy (GDMT) in patients with or without diabetes. Methods: We developed a state-transition Markov model with inputs from the DAPA-HF trial, FDA review documents, published literature, and nationally representative datasets (Panel A). The model was calibrated to event rates observed in DAPA-HF; survival was extrapolated using non-parametric approaches. The main outcomes were quality-adjusted life years (QALYs) and incremental cost effectiveness ratio (ICER) of dapagliflozin + GDMT compared with GDMT alone, from a healthcare sector perspective and a lifetime analytic horizon. We applied a discount rate of 3% per year for future costs and benefits, and assumed a willingness-to-pay threshold of $100,000 per QALY gained. In sensitivity analyses, we examined subgroups with or without diabetes, and varied the cost of dapagliflozin (base case = $6,188 per year). This analysis was independent of the trial sponsor. Results: Compared with GDMT alone, adding dapagliflozin produced 0.57 additional QALYs at an incremental cost of $56,650, producing an ICER of $98,700 per QALY gained (Panel B). In subgroup analyses, dapagliflozin produced 0.71 additional QALYs in patients with diabetes at an ICER of $89,100 per QALY gained, and 0.48 additional QALYs in patients without diabetes at an ICER of $108,800 per QALY (Panels C and D). A 9% price reduction (to $5,613 per year) would make dapagliflozin cost-effective in patients without diabetes. Conclusions: Adding dapagliflozin to GDMT in patients with HFrEF is cost-effective and has the potential to improve long-term outcomes. Scalable strategies to improve access and uptake are urgently required.

scholarly journals Economic evaluation of robot-assisted radical prostatectomy compared to open radical prostatectomy for prostate cancer treatment in Ontario, Canada

2020 ◽  
Vol 14 (8) ◽  
Author(s):  
Anna Parackal ◽  
Jean-Eric Tarride ◽  
Feng Xie ◽  
Gord Blackhouse ◽  
Jennifer Hoogenes ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Radical Prostatectomy ◽  
Time Horizon ◽  
Cost Effective ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Base Case ◽  
Robot Assisted ◽  
Open Radical Prostatectomy ◽  
Life Years

Introduction: Recent health technology assessments (HTAs) of robot-assisted radical prostatectomy (RARP) in Ontario and Alberta, Canada, resulted in opposite recommendations, calling into question whether benefits of RARP offset the upfront investment. Therefore, the study objectives were to conduct a cost-utility analysis from a Canadian public payer perspective to determine the cost-effectiveness of RARP. Methods: Using a 10-year time horizon, a five-state Markov model was developed to compare RARP to open radical prostatectomy (ORP). Clinical parameters were derived from Canadian observational studies and a recently published systematic review. Costs, resource utilization, and utility values from recent Canadian sources were used to populate the model. Results were presented in terms of increment costs per quality-adjusted life years (QALYs) gained. A probabilistic analysis was conducted, and uncertainty was represented using cost-effectiveness acceptability curves (CEACs). One-way sensitivity analyses were also conducted. Future costs and QALYs were discounted at 1.5%. Results: Total cost of RARP and ORP were $47 033 and $45 332, respectively. Total estimated QALYs were 7.2047 and 7.1385 for RARP and ORP, respectively. The estimated incremental cost-utility ratio (ICUR) was $25 704 in the base-case analysis. At a willingness-to-pay threshold of $50 000 and $100 000 per QALY gained, the probability of RARP being cost-effective was 0.65 and 0.85, respectively. The model was most sensitive to the time horizon. Conclusions: The results of this analysis suggest that RARP is likely to be cost-effective in this Canadian patient population. The results are consistent with Alberta’s HTA recommendation and other economic evaluations, but challenges Ontario’s reimbursement decision.

COST-EFFECTIVENESS ANALYSIS OF IVABRADINE IN TREATMENT OF PATIENTS WITH HEART FAILURE IN IRAN

2018 ◽  
Vol 34 (6) ◽  
pp. 576-583 ◽  
Author(s):  
Saeed Taheri ◽  
Elham Heidari ◽  
Mohammad Ali Aivazi ◽  
Mehran Shams-Beyranvand ◽  
Mehdi Varmaghani
Keyword(s):  
Heart Failure ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Transition Probabilities ◽  
Drug Acquisition ◽  
Sensitivity Analyses ◽  
Baseline Heart Rate ◽  
Life Years ◽  
The Cost

Objectives:This study aimed to assess the cost-effectiveness of ivabradine plus standard of care (SoC) in comparison with current SoC alone from the Iranian payer perspective.Methods:A cohort-based Markov model was developed to assess the incremental cost-effectiveness ratio (ICER) over a 10-year time horizon in a cohort of 1,000 patients. The baseline transition probabilities between New York Heart Association (NYHA), mortality rate, and hospitalization rate were extracted from the literature. The effect of ivabradine on mortality, hospitalization, and NYHA improvement or worsening were retrieved from the SHIFT study. The effectiveness was measured as quality-adjusted life-years (QALYs) using the utility values derived from Iranian Heart Failure Quality of Life study. Direct medical costs were obtained from hospital records and national tariffs. Deterministic and probabilistic sensitivity analyses were conducted to show the robustness of the model.Results:Ivabradine therapy was associated with an incremental cost per QALY of USD $5,437 (incremental cost of USD $2,207 and QALYs gained 0.41) versus SoC. The probabilistic sensitivity analysis showed that ivabradine is expected to have a 60 percent chance of being cost-effective accepting a threshold of USD $6,550 per QALY. Furthermore, deterministic sensitivity analysis indicated that the model is sensitive to the ivabradine drug acquisition cost.Conclusions:The cost-effectiveness model suggested that the addition of ivabradine to SoC therapy was associated with improved clinical outcomes along with increased costs. The analysis indicates that the clinical benefit of ivabradine can be achieved at a reasonable cost in eligible heart failure patients with sinus rhythm and a baseline heart rate ≥ 75 beats per minute (bpm).

Sign in / Sign up

Export Citation Format

Share Document