Utilization and Cost Effectiveness of a Risk Stratified Diagnostic Approach to Patients with Suspected Thrombotic Thrombocytopenic Purpura

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1456-1456
Author(s):  
Vivek Upadhyay ◽  
Benjamin Geisler ◽  
Lova Sun ◽  
Robert S Makar ◽  
Pavan Bendapudi
Keyword(s):  
Cost Effectiveness ◽  
Cost Savings ◽  
Low Risk ◽  
Diagnostic Approach ◽  
Expert Consultation ◽  
Number Of Patients ◽  
Clinical Scoring ◽  
Adamts13 Deficiency ◽  
The Cost ◽  
Over Time

Abstract Background:Thrombotic thrombocytopenic purpura (TTP) is a rare but deadly thrombotic microangiopathy (TMA) that is caused by an acquired deficiency in the ADAMTS13 enzyme. The PLASMIC clinical scoring system was developed and validated in 2014 by the Harvard TMA Research Collaborative in order to determine the pretest probability of severe ADAMTS13 deficiency in cases of suspected TTP. We studied the role of the PLASMIC score in guiding use of the ADAMTS13 activity assay and assessed the cost effectiveness of a score-based diagnostic approach to patients with TMA compared to two strategies currently in use within our consortium. Methods:We utilized an expanded dataset from the Harvard TMA Research Collaborative consisting of all consecutive cases of TMA at three large academic medical centers for which an ADAMTS13 assay was sent between 2004-2015 (n=647). To investigate trends in ADAMTS13 testing over time, we compared the experience at two centers (A and B) with a liberal ADAMTS13 testing policy against a third center in our consortium (C) that carries a more restrictive policy requiring pre-approval by the blood transfusion service. Cost savings analysis was subsequently performed to assess the potential impact of an algorithm incorporating the PLASMIC score for clinical decision support in the workup of these patients. Results:At Sites A and B, we observed after adjusting for changes in inpatient volume that the quantity of ADAMTS13 tests increased greater than eight-fold during the study period (from 11 per 100,000 admissions in 2004 to 94 per 100,000 admissions in 2015, P <0.05). Despite this increase in testing, the average number of patients diagnosed with severe ADAMTS13 deficiency remained steady (5.48 cases per 100,000 admissions per year from 2004-2009 versus 4.67 cases per 100,000 admissions per year from 2010-2015, P=0.93). Furthermore, stratification of patients by PLASMIC score revealed that low-risk cases (score 0-4) have accounted for the majority of ADAMTS13 testing over time, comprising an average of 59% (range: 39-72%) of tests sent each year (see Figure). By contrast, over the same period of time, Site C did not show a significant increase in ADAMTS13 testing (24 per 100,000 admissions in 2004 to 22 per 100,000 admissions in 2015, P=0.82) and had a steady number of patients with severe ADAMTS13 deficiency (7.96 cases per 100,000 admissions per year from 2004-2009 compared to 5.53 cases per 100,000 admissions per year from 2010-2015, P=0.83). Site C also had a lower average proportion of patients with low-risk PLASMIC scores who received ADAMTS13 testing each year (39%, range: 0-70%, P=0.004 for comparison with Sites A and B). No patient with a low risk score in our registry was found to have severe ADAMTS13 deficiencybetween 2004-2015,and we have previously shown that therapeutic plasma exchange (TPE) does not improve mortality or hospital length of stay in the subgroup of TMA cases without severe ADAMTS13 deficiency. Under the score-driven diagnostic approach, patients with a low-risk PLASMIC score would not receive upfront ADAMTS13 testing, expert consultation, or TPE and instead be closely observed while worked up for alternative causes of TMA. Consortium-wide cost savings analysis demonstrates that risk stratification of patients by PLASMIC score to guide use of both testing and therapy would have decreased total costs by 30% ($208,800) in the most recent year studied (2015, n=100 cases of suspected TTP) without any projected change in outcomes by preventing unnecessary testing ($5,500), hematology and transfusion medicine consultations ($5,900), and TPE treatments ($199,600) (see Table). Conclusions:Taken together, our results demonstrate that a significant number of patients in our consortium who are at minimal risk for TTP nevertheless undergo ADAMTS13 testing and receive expert consultation and/or TPE. An approach incorporating upfront application of the PLASMIC clinical scoring system to risk stratify patients with suspected TTP may help enhance the cost effectiveness of diagnosing and managing these cases. Figure Figure. Table Table. Disclosures No relevant conflicts of interest to declare.

scholarly journals 992. Rethinking the 28-day HIV nPEP Dispensing Practice: A Pediatric ID Clinic Analysis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S524-S525
Author(s):  
David Zhang ◽  
Julia Rosebush ◽  
Palak Bhagat ◽  
Allison Nelson ◽  
Veena Ramaiah ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Wholesale Price ◽  
Cost Savings ◽  
Patient Characteristics ◽  
Post Exposure Prophylaxis ◽  
Exposure Prophylaxis ◽  
The Cost ◽  
The University ◽  
Lost To Follow Up

Abstract Background In July 2017, The University of Chicago Comer Children’s Hospital Emergency Department (ED) transitioned from a 5-day to a 28-day HIV nPEP (non-occupational post-exposure prophylaxis) dispensation model in an effort to increase adherence. Anecdotal reports of patients lost to follow-up after ED discharge called into question the utility and cost-effectiveness of this practice. We analyzed HIV nPEP follow-up rates in our clinic, explored reasons for nonadherence, and performed basic cost-savings analyses to inform potential changes to our dispensation model. Methods A retrospective review of both electronic health and pharmacy records was conducted for patients prescribed 28-days of HIV nPEP in the ED and scheduled for outpatient follow-up in Pediatric ID clinic from July 2017-June 2019. Clinic provider documentation of nPEP adherence and reasons for nonadherence were examined. Patients were given an initial dose of nPEP regimen in the ED and provided all subsequent doses to complete at home. Using average wholesale price (AWP), we calculated the total cost of each regimen and potential savings if a shorter duration of HIV nPEP supply was dispensed. Results 50 patients received a 28-day supply of HIV nPEP. Please refer to Table 1 regarding baseline patient characteristics. Of these, only 19 (38%) patients had documented outpatient follow-up after nPEP initiation. Median time to follow-up was 6 days (IQR: 3.0-9.0 days). Of the 19 patients with follow-up, 3 admitted to medication non-adherence. Although side effects were elicited in a total of 9 patients (18%), only 1 cited medication intolerance as the reason for discontinuing their nPEP. Given the relatively short time to follow-up, a potential savings of $1720-2211/patient could be achieved if a 10-14 day supply was dispensed. Conclusion Outpatient follow-up after 28-day HIV nPEP dispensation in our ED was &lt; 40%, calling into question the cost-effectiveness of this dispensation model. While our current practice alleviates nPEP interruption due to potential insurance issues and pick-up delays, follow-up and adherence are not assured. The significant cost-savings with a shorter supply at the outset may encourage more robust follow-up and adherence. Disclosures All Authors: No reported disclosures

scholarly journals Economic evaluations of health care interventions in Oropharyngeal Dysphagia after Stroke: Protocol for a Systematic Review.

2021 ◽  
Author(s):  
Sergio Marin ◽  
Mateu Serra-Prat ◽  
Omar Ortega ◽  
Pere Clavé
Keyword(s):  
Systematic Review ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Oropharyngeal Dysphagia ◽  
Cost Savings ◽  
Economic Evaluations ◽  
Stroke Patients ◽  
Post Stroke ◽  
Healthcare Interventions ◽  
The Cost

Abstract Background and purpose: Oropharyngeal Dysphagia (OD) affects 40-81% of patients after stroke. A recent systematic review on the costs of OD and it’s main complications showed higher acute and long-term costs for those patients who developed OD, malnutrition and pneumonia after stroke. These results suggest that appropriate management of post-stroke OD could lead to reduction of clinical complications and significant cost savings. The purpose of this systematic review is to assess the available literature exploring the efficiency or cost-effectiveness of available healthcare interventions on the appropriate management of OD. Methods: A systematic review on economic evaluations of health care interventions on post-stroke patients with OD following PRISMA recommendations will be performed. MEDLINE, Embase, the National Health Service Economic Evaluation Database and the Cost-Effectiveness Analysis Registry Database will be searched and a subsequent reference check will be done. English and Spanish literature will be included without date restrictions. Studies will be included if they refer to economic evaluations or studies in which cost savings were reported in post-stroke patients suffering OD. Studies will be excluded if they are partial economic evaluation studies, if they refer to esophageal dysphagia, or if OD is caused by causes different from stroke. Evidence will be presented and synthetized with a narrative method and using tables. Quality evaluation will be done using Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement. Discussion: The protocol for this systematic review is the first step to assess the cost-effectiveness of the healthcare interventions that have been described as potential treatments for post-stroke OD. This systematic review will summarize the current evidence on the relation between cost and benefits associated with the appropriate management of OD in post-stroke patients. Systematic review registration: PROSPERO CRD42020136245

scholarly journals Cost-effectiveness of an Environmental Cleaning Bundle for Reducing Healthcare-associated Infections

2019 ◽  
Vol 70 (12) ◽  
pp. 2461-2468 ◽  
Author(s):  
Nicole M White ◽  
Adrian G Barnett ◽  
Lisa Hall ◽  
Brett G Mitchell ◽  
Alison Farrington ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Savings ◽  
Cost Effective ◽  
Cost Effectiveness Ratio ◽  
Environmental Cleaning ◽  
Monetary Benefit ◽  
Healthcare Associated ◽  
The Cost ◽  
Net Monetary Benefit ◽  
Hospital Cleaning

Abstract Background Healthcare-associated infections (HAIs) remain a significant patient safety issue, with point prevalence estimates being ~5% in high-income countries. In 2016–2017, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study implemented an environmental cleaning bundle targeting communication, staff training, improved cleaning technique, product use, and audit of frequent touch-point cleaning. This study evaluates the cost-effectiveness of the environmental cleaning bundle for reducing the incidence of HAIs. Methods A stepped-wedge, cluster-randomized trial was conducted in 11 hospitals recruited from 6 Australian states and territories. Bundle effectiveness was measured by the numbers of Staphylococcus aureus bacteremia, Clostridium difficile infection, and vancomycin-resistant enterococci infections prevented in the intervention phase based on estimated reductions in the relative risk of infection. Changes to costs were defined as the cost of implementing the bundle minus cost savings from fewer infections. Health benefits gained from fewer infections were measured in quality-adjusted life-years (QALYs). Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefit of adopting the cleaning bundle over existing hospital cleaning practices. Results Implementing the cleaning bundle cost $349 000 Australian dollars (AUD) and generated AUD$147 500 in cost savings. Infections prevented under the cleaning bundle returned a net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4684 per QALY gained. There was an 86% chance that the bundle was cost-effective compared with existing hospital cleaning practices. Conclusions A bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs.

Cost-Effectiveness Analysis for Integral Treatment of Chronic Myeloid Leukemia in Chronic Phase at the Instituto Mexicano del Seguro Social (IMSS) Mexico.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4789-4789
Author(s):  
Luisa Tenorio ◽  
Juan Vargas E ◽  
Enrique Baez ◽  
Carolina Afanador ◽  
Leon Zapata ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Chronic Myeloid Leukemia ◽  
Medical Care ◽  
Imatinib Mesylate ◽  
Myeloid Leukemia ◽  
Chronic Phase ◽  
Number Of Patients ◽  
Health Institutions ◽  
Clinical Records ◽  
The Cost

Abstract The economic analysis has become a priority for health institutions as a result of the increase in medical care costs. Therefore, an analysis model was developed integrating clinical and economic outcomes for the Medical care of chronic myeloid leukemia (CML) in chronic pahse. Objective: To perform a cost-effectiveness assessment of the therapeutic alternatives for CML at UMAE No.25 IMSS. Methodology: Economic evaluation of the use of imatinib mesylate (IM) vs. interferon + citarabine (INF/AraC), using as an effectiveness indicator, the number needed for treatment (NNT), to achieve a complete cytogenetic response (CCR) at 24 and 30 months was used. The integral care was obtained from the revision of clinical records in the UMAE 25, and from disease related-costs published by the IMSS. Results: The NNT reveals the amount of patients that need to be treated with one or the other of the therapies to obtain the desired result (CCR), which means that for every 1.15 patients IC 95% (1.06–1.25) treated with IM for 24 months, one will reach the CCR, with a cost of $867,729 mexican pesos (mx), in comparison to the care cost for 7.14 patients IC 95 % (5.75–8.88) patients that are required to be treated with IFN/AraC for 24 months to obtain the same result, with a cost of mx $4,454,565. This difference is higher when results are assessed at 30 months: A cost of NNT care of 1.27 patients IC 95% (1.07–1.50) of mx $1,178,848 for IM vs. mx $10,182,116 for NNT care of the 13.5 patients, CI 95% (9.40–19.43) required to achieve a CCR with IFN/AraC. Discussion: Comparing these results with the cost of the main treatment used during the same time, the expense effectiveness is evident. In other words, for each peso spent on IM at 24 months, mx $0.63 are effective, whilst for each peso spent on IFN/AraC, only mx $0.02 are beneficial for the patient. When this same reasoning is applied to the success cost at 30 months, we see that for each peso spent on IM, $0.58 are effective vs mx $0.01 per peso effectiveness spent on IFN/AraC. Conclusions: The superiority of IM is evident compared to INF/AraC in regards to the effectiveness of achieving CCR at 24 and 30 months. This positive difference in favor of imatinib mesylate is reflected on the cost that Health Institutions have to spend, in order to obtain a successful CCR, due to the decreased number of patients necessary to treat with IM, in order to achieve this success.

Dynamic Cost-Effectiveness: A More Efficient Reimbursement Criterion

2008 ◽  
Vol 11 (2) ◽  
Author(s):  
Douglas Lundin ◽  
Joakim Ramsberg
Keyword(s):  
Life Cycle ◽  
Cost Effectiveness ◽  
Theoretical Model ◽  
Patent Protection ◽  
Decision Makers ◽  
Value For Money ◽  
Entire Life ◽  
Entire Life Cycle ◽  
The Cost ◽  
Over Time

Basing drug reimbursement on cost-effectiveness provides too little incentives for R&D. The reason for this is that cost-effectiveness is concerned with immediate value for money. But since the price of a drug usually declines over time, the drug might well provide value for money as seen over its entire life cycle, even though its price during patent protection is too high to warrant reimbursement according to the cost-effectiveness decision rule. We show in a theoretical model that welfare could be improved if decision-makers took a longer perspective and initially allowed higher prices than immediate value for money can motivate. We also discuss the real world relevance of applying dynamic cost-effectiveness.

A cost analysis of inpatient compared with outpatient prostaglandin E2 cervical priming for induction of labour: results from the OPRA trial

2013 ◽  
Vol 37 (4) ◽  
pp. 467 ◽  
Author(s):  
Pamela L. Adelson ◽  
Garry R. Wedlock ◽  
Chris S. Wilkinson ◽  
Kirsten Howard ◽  
Robert L. Bryce ◽  
...  
Keyword(s):  
Outpatient Care ◽  
Inpatient Care ◽  
Controlled Trial ◽  
Hospital Costs ◽  
Cost Savings ◽  
Low Risk ◽  
Induction Of Labour ◽  
Cervical Priming ◽  
Randomised Controlled ◽  
The Cost

Objective To compare the costs of inpatient (usual care) with outpatient (intervention) care for cervical priming for induction of labour in women with healthy, low-risk pregnancies who are being induced for prolonged pregnancies or for social reasons. Methods Data from a randomised controlled trial at two hospitals in South Australia were matched with hospital financial data. A cost analysis comparing women randomised to inpatient care with those randomised to outpatient care was performed, with an additional analysis focusing on those who received the intervention. Results Overall, 48% of women randomised into the trial did not receive the intervention. Women randomised to outpatient care had an overall cost saving of $319 per woman (95% CI −$104 to $742) as compared with women randomised to usual care. When restricted to women who actually received the intervention, in-hospital cost savings of $433 (95% CI −$282 to $1148) were demonstrated in the outpatient group. However, these savings were partially offset by the cost of an outpatient priming clinic, reducing the overall cost savings to $156 per woman. Conclusions Overall cost savings were not statistically significant in women who were randomised to or received the intervention. However, the trend in cost savings favoured outpatient priming. What is known about the topic? Induction of labour is a common obstetric intervention. For women with low-risk, prolonged pregnancies who require cervical priming there has been increased interest in whether this period of waiting for the cervix to ‘ripen’ can be achieved at home. Outpatient priming has been reported to reduce hospital costs and improve maternal satisfaction. However, few studies have actually examined the cost of outpatient priming for induction of labour. What does this paper add? This is the first paper in Australia to both assess the full cost of outpatient cervical priming and to compare it with usual (inpatient) care. This is the first costing paper from a randomised controlled trial directly comparing inpatient and outpatient priming with prostaglandin E2. What are the implications for practitioners? For women with prolonged, low-risk pregnancies, a program of outpatient cervical priming can potentially reduce in-hospital costs and free up labour ward beds by avoiding an additional overnight hospitalisation.

scholarly journals The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam

2020 ◽  
Author(s):  
Colman Taylor ◽  
Annet C Hoek ◽  
Irene Deltetto ◽  
Adrian Peacock ◽  
Do Thi Phuong Ha ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Sodium Intake ◽  
Intervention Strategy ◽  
Cost Savings ◽  
Cost Effective ◽  
Dietary Sodium ◽  
Fish Sauce ◽  
Regulatory Strategies ◽  
Life Years ◽  
The Cost

Abstract Background Dietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.Methods The three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and IHD events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (-3,445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (-43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (-243,530 ₫ US$ -10.49; 0.074 QALYs gained). Conclusion This research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment, however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.

scholarly journals Cost-effectiveness of household contact investigation for detection of tuberculosis in Pakistan

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e049658
Author(s):  
Hamidah Hussain ◽  
Amyn Malik ◽  
Junaid F Ahmed ◽  
Sara Siddiqui ◽  
Farhana Amanullah ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Index Patient ◽  
Household Contact ◽  
Household Contacts ◽  
Contact Investigation ◽  
Number Of Patients ◽  
The Cost ◽  
The Impact ◽  
Household Contact Investigation

ObjectivesDespite WHO guidelines recommending household contact investigation, and studies showing the impact of active screening, most tuberculosis (TB) programmes in resource-limited settings only carry out passive contact investigation. The cost of such strategies is often cited as barriers to their implementation. However, little data are available for the additional costs required to implement this strategy. We aimed to estimate the cost and cost-effectiveness of active contact investigation as compared with passive contact investigation in urban Pakistan.MethodsWe estimated the cost-effectiveness of ‘enhanced’ (passive with follow-up) and ‘active’ (household visit) contact investigations compared with standard ‘passive’ contact investigation from providers and the programme’s perspective using a simple decision tree. Costs were collected in Pakistan from a TB clinic performing passive contact investigation and from studies of active contact tracing interventions conducted. The effectiveness was based on the number of patients with TB identified among household contacts screened.ResultsThe addition of enhanced contact investigation to the existing passive mode detected 3.8 times more cases of TB per index patient compared with passive contact investigation alone. The incremental cost was US$30 per index patient, which yielded an incremental cost of US$120 per incremental patient identified with TB. The active contact investigation was 1.5 times more effective than enhanced contact investigation with an incremental cost of US$238 per incremental patient with TB identified.ConclusionOur results show that enhanced and active approaches to contact investigation effectively identify additional patients with TB among household contacts at a relatively modest cost. These strategies can be added to the passive contact investigation in a high burden setting to find the people with TB who are missed and meet the End TB strategy goals.

scholarly journals The cost-effectiveness of government actions to reduce sodium intake through salt substitutes in Vietnam

2020 ◽  
Author(s):  
Colman Taylor ◽  
Annet C Hoek ◽  
Irene Deltetto ◽  
Adrian Peacock ◽  
Do Thi Phuong Ha ◽  
...  
Keyword(s):  
Heart Disease ◽  
Cost Effectiveness ◽  
Ischaemic Heart Disease ◽  
Sodium Intake ◽  
Cost Savings ◽  
Cost Effective ◽  
Dietary Sodium ◽  
Fish Sauce ◽  
Regulatory Strategies ◽  
The Cost

Abstract BackgroundDietary sodium reduction is recommended to reduce the burden of cardiovascular disease. In Vietnam food products including salt, fish sauce and bot canh contribute to ~70% of dietary sodium intake. Reduced sodium versions of these products can be produced by replacing some of the sodium chloride with potassium chloride. We aimed to assess the cost-effectiveness of three alternative approaches to introducing reduced sodium products onto the market with a view to lowering population sodium intake in Vietnam.MethodsThe three salt substitution strategies included voluntary, subsidised and regulatory approaches targeting salt, fish sauce and bot canh products. Costs were modelled using the WHO-CHOICE methodology. A Markov cohort model was developed to evaluate the cost-effectiveness of each strategy versus no intervention from the government perspective. The model linked each intervention strategy to assumed changes in levels of sodium intake and then to systolic blood pressure. Changes in SBP were linked to a probability of ischaemic heart disease or stroke. The model followed people over their lifetime to assess average costs and quality adjusted life years (QALYs) gained for each strategy. Results The voluntary salt substitution strategy was assumed to require no investment by government. Following ramp up (years 6+), the average annual costs for the subsidised and regulatory strategies were 21,808,968,902 ₫ (US$ 977,354) and 12,949,953,247 ₫ (US$ 580,410) respectively. Relative to no intervention, all three salt substitution strategies were found to be cost-effective. Cost savings were driven by reductions in strokes (32,595; 768,384; 2,366,480) and ischaemic heart disease (IHD) events (22,830; 537,157; 1,648,590) for the voluntary, subsidised & regulatory strategies, respectively. The voluntary strategy was least cost-effective (-3,445 ₫ US$ -0.15; 0.009 QALYs gained) followed by the subsidised strategy (-43,189 ₫ US$ -1.86; 0.022 QALYs gained) and the regulatory strategy delivered the highest cost savings and health gains (-243,530 ₫ US$ -10.49; 0.074 QALYs gained). ConclusionThis research shows that all three modelled salt substitution strategies would be good value for money relative to no intervention in Vietnam. The subsidised alternative would require the highest level of government investment, however the implementation costs will be exceeded by healthcare savings assuming a reasonable time horizon is considered.

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