scholarly journals Cost Recommendations in the Second Edition of Cost-Effectiveness in Health and Medicine: A Review

2018 ◽  
Vol 3 (1) ◽  
pp. 238146831876516 ◽  
Author(s):  
John A. Nyman
Keyword(s):  
Cost Effectiveness ◽  
Medical Decision Making ◽  
Steering Committee ◽  
Cost Effectiveness Analysis ◽  
Medical Decision ◽  
Quality Adjusted Life Years ◽  
Cost Effectiveness Ratio ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Quality Adjusted Life

A 2nd edition of Cost-Effectiveness in Health and Medicine has now been published by a group of medical decision-making experts known collectively as the 2nd Panel. This is a critical review of the recommendations for how to deal with costs in cost-effectiveness analysis, recommendations that are contained in Chapter 8 of that edition, titled “Estimating Costs and Valuations of Non-Health Benefits in Cost-Effectiveness Analysis,” authored primarily but not exclusively by Anirban Basu. This review focuses on the correspondence between the costs in the numerator of the incremental cost-effectiveness ratio (ICER) and what is measured in the denominator of the ICER by the quality-adjusted life years (QALYs). Although it raises a number of issues regarding what is actually being measured in the numerator and denominator of the ICER, it primarily challenges the 2nd Panel’s recommendation that the costs of non-health consumption in any additional years of life generated by the intervention in question be accounted for in the numerator, even though no measures of the benefits are included in the QALYs in the denominator. This review is adapted from a review of the entire 2nd edition that was sent to the 2nd Panel steering committee on January 8, 2016.

scholarly journals Cost-Effectiveness Analysis (CEA) of Preventive COVID-19 Vaccines by Quality-Adjusted Life Years (QALYs)

2021 ◽  
Author(s):  
Rabnawaz Khan
Keyword(s):  
Cost Effectiveness ◽  
Economic Cost ◽  
Maximum Level ◽  
Cost Effectiveness Analysis ◽  
Quality Adjusted Life Years ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Intensive Approach ◽  
The Cost ◽  
Quality Adjusted Life

Abstract This paper merely presents the dynamic boost of the COVID-19 vaccines. The intensive approach is indicating how the effective COVID-19 vaccine promotes and distributes into various official channels. It enables the exclusive authority to devise a possible way to reduce the economic cost of COVID-19 vaccines and facilitate to a maximum level. The Cost-effectiveness analysis (CEA) method approached with Quality-Adjusted Life Years (QALYs). The key findings are revealing the length of life improves the quality of life of the middle family. The results of QALYs show that Utility Value (UV) by health and the value of statistics in countries in the term of coexistent causation of vaccines. The Pfizer (BNT162b2) and Moderna (mRNA-1273) have instantly created favorable and significant effects probably on many patients, comparatively SARS-CoV-2, AstraZeneca (AZD1222), Russia’s Sputnik (AstraZeneca), and Sinopharm Sinovac Biotech. The opportunity cost provides a valuable benefit in the future.

Lenvatinib versus sorafenib for unresectable hepatocellular carcinoma: a cost–effectiveness analysis

2020 ◽  
Vol 9 (8) ◽  
pp. 553-562
Author(s):  
Hongfu Cai ◽  
Longfeng Zhang ◽  
Na Li ◽  
Bin Zheng ◽  
Maobai Liu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Years ◽  
Cost Effectiveness Ratio ◽  
Phase 3 ◽  
Sorafenib Treatment ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Aim: To investigate the cost–effectiveness of lenvatinib and sorafenib in the treatment of patients with nonresected hepatocellular carcinoma in China. Materials & methods: Markov model was used to simulate the direct medical cost and quality-adjusted life years (QALY) of patients with hepatocellular carcinoma. Clinical data were derived from the Phase 3 randomized clinical trial in a Chinese population. Results: Sorafenib treatment resulted in 1.794 QALYs at a cost of $43,780.73. Lenvatinib treatment resulted in 2.916 QALYs for patients weighing <60 and ≥60 kg at a cost of $57,049.43 and $75,900.36, The incremental cost–effectiveness ratio to the sorafenib treatment group was $11,825.94/QALY and $28,627.12/QALY, respectively. Conclusion: According to WHO’s triple GDP per capita, the use of lenvatinib by providing drugs is a cost-effective strategy.

scholarly journals Cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of complex phalangeal fractures: economic simulation

2020 ◽  
Author(s):  
N. Faccioli ◽  
E. Santi ◽  
G. Foti ◽  
G. Mansueto ◽  
M. Corain
Keyword(s):  
Computed Tomography ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Incremental Cost Effectiveness Ratio ◽  
Quality Adjusted Life Years ◽  
Cost Effectiveness Ratio ◽  
Monetary Benefit ◽  
Life Years ◽  
Net Monetary Benefit ◽  
Quality Adjusted Life

Abstract Purpose The purpose of this study was to evaluate the cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of the complex finger fractures with articular involvement. Methods We created a decision tree model simulating the diagnostic pathway of complex finger fractures, suggesting the use of CBCT as alternative to multi-slice computed tomography (MSCT), and we compared their clinical outcomes, costs, and cost-effectiveness for a hypothetical cohort of 10,000 patients. Measures of effectiveness are analysed by using quality-adjusted life years, incremental cost-effectiveness ratio, and net monetary benefit. Results Diagnosis of a complex finger fracture performed with CBCT costed 67.33€ per patient, yielded 9.08 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 29.94€ and a net monetary benefit of 9.07 € at 30,000€ threshold. Using MSCT for diagnosis costed 106.23 €, yielded 8.18 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 371.15 € and a net monetary benefit of 8.09 €. CBCT strategy dominated the MSCT strategy. The acceptability curve shows that there is 98% probability of CBCT being the optimal strategy at 30,000€ threshold (1 EUR equal to 1.11 USD; updated on 02/02/2020). Conclusion CBCT in complex finger fractures management is cost saving compared with MSCT and may be considered a valuable imaging tool in preoperative assessment, allowing early detection and appropriate treatment. It shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life, and may reduce costs in a societal perspective.

scholarly journals Using QALYs versus DALYs to measure cost-effectiveness: How much does it matter?

2020 ◽  
Vol 36 (2) ◽  
pp. 96-103 ◽  
Author(s):  
Xue Feng ◽  
David D. Kim ◽  
Joshua T. Cohen ◽  
Peter J. Neumann ◽  
Daniel A. Ollendorf
Keyword(s):  
Cost Effectiveness ◽  
Medical Center ◽  
Disability Adjusted Life Years ◽  
Quality Adjusted Life Years ◽  
Effectiveness Analysis ◽  
Disability Weights ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Relative Differences ◽  
Quality Adjusted Life

ObjectivesQuality-adjusted life-years (QALYs) and disability-adjusted life-years (DALYs) are commonly used in cost-effectiveness analysis (CEA) to measure health benefits. We sought to quantify and explain differences between QALY- and DALY-based cost-effectiveness ratios, and explore whether using one versus the other would materially affect conclusions about an intervention's cost-effectiveness.MethodsWe identified CEAs using both QALYs and DALYs from the Tufts Medical Center CEA Registry and Global Health CEA Registry, with a supplemental search to ensure comprehensive literature coverage. We calculated absolute and relative differences between the QALY- and DALY-based ratios, and compared ratios to common benchmarks (e.g., 1× gross domestic product per capita). We converted reported costs into US dollars.ResultsAmong eleven published CEAs reporting both QALYs and DALYs, seven focused on pharmaceuticals and infectious disease, and five were conducted in high-income countries. Four studies concluded that the intervention was “dominant” (cost-saving). Among the QALY- and DALY-based ratios reported from the remaining seven studies, absolute differences ranged from approximately $2 to $15,000 per unit of benefit, and relative differences from 6–120 percent, but most differences were modest in comparison with the ratio value itself. The values assigned to utility and disability weights explained most observed differences. In comparison with cost-effectiveness thresholds, conclusions were consistent regardless of the ratio type in ten of eleven cases.ConclusionsOur results suggest that although QALY- and DALY-based ratios for the same intervention can differ, differences tend to be modest and do not materially affect comparisons to common cost-effectiveness thresholds.

scholarly journals Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care

BMJ ◽  
2004 ◽  
Vol 328 (7442) ◽  
pp. 747 ◽  
Author(s):  
David Wonderling ◽  
Andrew J Vickers ◽  
Richard Grieve ◽  
Rob McCarney
Keyword(s):  
Cost Effectiveness ◽  
Chronic Headache ◽  
Randomised Trial ◽  
Cost Effectiveness Analysis ◽  
Base Case ◽  
Effectiveness Analysis ◽  
Life Years ◽  
One Year ◽  
The One ◽  
Quality Adjusted Life

AbstractObjective To evaluate the cost effectiveness of acupuncture in the management of chronic headache.Design Cost effectiveness analysis of a randomised controlled trial.Setting General practices in England and Wales.Participants 401 patients with chronic headache, predominantly migraine.Interventions Patients were randomly allocated to receive up to 12 acupuncture treatments over three months from appropriately trained physiotherapists, or to usual care alone.Main outcome measure Incremental cost per quality adjusted life year (QALY) gained.Results Total costs during the one year period of the study were on average higher for the acupuncture group (£403; $768;€598) than for controls (£217) because of the acupuncture practitioners' costs. The mean health gain from acupuncture during the one year of the trial was 0.021 quality adjusted life years (QALYs), leading to a base case estimate of £9180 per QALY gained. This result was robust to sensitivity analysis. Cost per QALY dropped substantially when the analysis incorporated likely QALY differences for the years after the trial.Conclusions Acupuncture for chronic headache improves health related quality of life at a small additional cost; it is relatively cost effective compared with a number of other interventions provided by the NHS.

scholarly journals Incorporating Extrinsic Goals Into Decision and Cost-Effectiveness Analyses

2009 ◽  
Vol 29 (5) ◽  
pp. 580-589 ◽  
Author(s):  
Gordon B. Hazen ◽  
Alan Schwartz
Keyword(s):  
Cost Effectiveness ◽  
Arteriovenous Malformations ◽  
Medical Decision ◽  
Preventive Strategies ◽  
Medical Patients ◽  
Quality Adjusted Life Years ◽  
Intracranial Arteriovenous Malformations ◽  
Extrinsic Goals ◽  
Life Years ◽  
Quality Adjusted Life

It has not been widely recognized that medical patients as individuals may have goals that are not easily expressed in terms of quality-adjusted life years (QALYs). The QALY model deals with ongoing goals such as reducing pain or maintaining mobility, but goals such as completing an important project or seeing a child graduate from college occur at unique points in time and do not lend themselves to easy expression in terms of QALYs. Such extrinsic goals have been posited as explanations for preferences inconsistent with the QALY model, such as unwillingness to trade away time or accept gambles. In this article, the authors examine methods for including extrinsic goals in medical decision and cost-effectiveness analyses. As illustrations, they revisit 2 previously published analyses, the management of unruptured intracranial arteriovenous malformations (AVMs) and the evaluation of preventive strategies for BRCA + women.

The Adoption of Cost-Effectiveness Acceptability Curves in Cost-Utility Analyses

2009 ◽  
Vol 30 (3) ◽  
pp. 314-319 ◽  
Author(s):  
Lisa M. Meckley ◽  
Dan Greenberg ◽  
Joshua T. Cohen ◽  
Peter J. Neumann
Keyword(s):  
Cost Effectiveness ◽  
Medical Center ◽  
Cost Effective ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Study Methodology ◽  
The Uk ◽  
Quality Adjusted Life

Background. Cost-effectiveness acceptability curves (CEACs) plot the probability that one health intervention is more cost-effective than alternatives, as a function of societal willingness to pay for additional units of health (e.g., life-years or quality-adjusted life-years gained). Objectives. To quantify the adoption of CEACs in published cost-utility analyses (CUAs), and to identify factors associated with CEAC use. Methods. Data from the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org), a database with detailed information on approximately 1,400 CUAs published in the peer reviewed literature through 2006, was analyzed. The registry includes data on study origin, study methodology, reporting of results, whether CEACs were presented, and a subjective quality score. Univariate and multivariate logistic regression analyses were used to identify factors predicting CEAC use, from their introduction in 1994 through 2006. Results. Approximately 15% of CUAs published since 1994 present a CEAC. The use of CEACs has increased rapidly in recent years, from 2.1% of published CUAs in 2001 to 32.6% in 2006 (P < 0.0001). The most significant predictors of CEAC use were study quality (odds ratio [OR]: 2.26; 95% confidence interval [CI]: 1.80, 2.85), recent publication (OR: 1.99; 95% CI: 1.73, 2.29), and whether studies pertain to the UK (OR: 5.66; 95% CI: 3.67, 8.72) or Sweden (OR: 3.76; 95% CI: 1.67, 8.44). Conclusions. CEAC use is increasing in the published cost-effectiveness literature, especially in UK-based studies.

scholarly journals Lutetium oxodotreotide (177Lu-Dotatate) for the treatment of unresectable or metastatic progressive gastroenteropancreatic neuroendocrine tumors: a cost-effectiveness analysis for Scotland

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. Smith-Palmer ◽  
O. R. Leeuwenkamp ◽  
J. Virk ◽  
N. Reed
Keyword(s):  
Cost Effectiveness ◽  
Neuroendocrine Tumors ◽  
Cost Effectiveness Analysis ◽  
Phase Iii ◽  
Base Case ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Effectiveness Analysis ◽  
Payer Perspective ◽  
Life Years ◽  
Quality Adjusted Life

Abstract Background Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) represent a heterogenous group of tumors. Findings from the phase III NETTER-1 trial showed that treatment of unresectable/metastatic progressive gastrointestinal (GI) NETs with 177Lu-Dotatate resulted in a significant improvement in progression-free survival (PFS) and overall survival (OS) compared with best supportive care (BSC) with high dose octreotide long-acting repeatable (LAR) 60 mg. A health economic analysis was performed using input data from clinical studies and data derived from an indirect comparison to determine the cost-effectiveness of 177Lu-Dotatate in the treatment of GI-NETs and pancreatic NETs (P-NETs) in Scotland. Methods Cost-effectiveness analysis was performed from the payer perspective using a three-state partitioned survival model. In the base case 177Lu-Dotatate was compared with BSC in gastrointestinal (GI)-NETs using clinical data from the NETTER-1 trial. A secondary analysis comparing 177Lu-Dotatate with BSC, everolimus or sunitinib in patients with P-NETs was also performed using hazard ratios inferred from indirect comparisons. The base case analysis was performed over a 20-year time horizon with an annual discount rate of 3.5% for both costs and clinical outcomes. Results For unresectable/metastatic progressive GI-NETs treatment with 177Lu-Dotatate led to a gain in quality-adjusted life expectancy of 1.33 quality-adjusted life years (QALYs) compared with BSC due to extended PFS and OS. Mean total lifetime costs were GBP 35,701 higher with 177Lu-Dotatate, leading to an incremental cost-effectiveness ratio (ICER) of GBP 26,830 per QALY gained. In analyses in patients with P-NETs 177Lu-Dotatate was associated with ICERs below GBP 30,000 per QALY gained in comparisons with BSC, sunitinib and everolimus. Conclusions Cost-effectiveness analyses demonstrated that, in Scotland, from the payer perspective, 177Lu-Dotatate at the set acquisition cost is a cost-effective treatment option for patients with unresectable or metastatic progressive GI-NETs or P-NETs.

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