scholarly journals Economic Evaluation of Regular Transfusions for Cerebral Infarct Recurrence in the Silent Cerebral Infarct Transfusion Trial

2021 ◽  
Author(s):  
Peter Hsu ◽  
James C Gay ◽  
Chyongchiou J Lin ◽  
Mark Rodeghier ◽  
Michael R DeBaun ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Blood Transfusion ◽  
Standard Care ◽  
Indirect Costs ◽  
Incremental Cost Effectiveness Ratio ◽  
Cerebral Infarct ◽  
Cost Effectiveness Ratio ◽  
Cerebral Infarcts ◽  
Transfusion Therapy ◽  
Effectiveness Analysis

In 2020, the American Society of Hematology published evidence-based guidelines for cerebrovascular disease in individuals with sickle cell anemia (SCA). While guidelines were based on NIH-sponsored randomized controlled trials, no cost-effectiveness analysis was completed for children with SCA and silent cerebral infarcts. We conducted a cost-effectiveness analysis comparing regular blood transfusion versus standard care using Silent Cerebral Infarct Transfusion (SIT) Trial participants. This analysis included a modified societal perspective with direct costs (hospitalization, emergency room visit, transfusion, outpatient care, iron chelation) and indirect costs (special education). Direct medical costs were estimated from hospitalizations from SIT hospitals and unlinked aggregated hospital and outpatient costs from SIT sites using the Pediatric Health Information System. Indirect costs were estimated from published literature. Effectiveness was prevention of infarct recurrence. Incremental cost-effectiveness ratio using a 3-year time horizon (mean SIT trial participant follow-up) compared transfusion versus standard care. A total of 196 participants received transfusions (N=90) or standard care (N=106), with a mean age of 10.0 years. Annual hospitalization costs were reduced by 54% for transfusions than standard care ($4,929 vs. $10,802), but transfusion group outpatient costs added $22,454 to $137,022 per year. Special education costs savings was $2,634 over three years for every infarct prevented. Transfusion therapy had an incremental cost-effectiveness ratio of $22,025 per infarct prevented. Children with pre-existing silent cerebral infarcts receiving blood transfusions have lower hospitalization but higher outpatient costs, primarily associated with oral iron chelator deferasirox. Regular blood transfusion therapy is cost-effective for infarct recurrence in children with SCA. This trial is registered at www.clinicaltrials.gov as NCT00072761.

scholarly journals Atrial Fibrillation Screen, Management, and Guideline‐Recommended Therapy in the Rural Primary Care Setting: A Cross‐Sectional Study and Cost‐Effectiveness Analysis of eHealth Tools to Support All Stages of Screening

2020 ◽  
Vol 9 (18) ◽  
Author(s):  
Jessica Orchard ◽  
Jialin Li ◽  
Ben Freedman ◽  
Ruth Webster ◽  
Glenn Salkeld ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Oral Anticoagulant ◽  
Population Based ◽  
Incremental Cost Effectiveness Ratio ◽  
Anticoagulant Treatment ◽  
Cost Effectiveness Ratio ◽  
Oral Anticoagulant Treatment ◽  
Effectiveness Analysis

BACKGROUND Internationally, most atrial fibrillation (AF) management guidelines recommend opportunistic screening for AF in people ≥65 years of age and oral anticoagulant treatment for those at high stroke risk (CHA₂DS₂‐VA≥2). However, gaps remain in screening and treatment. METHODS AND RESULTS General practitioners/nurses at practices in rural Australia (n=8) screened eligible patients (≥65 years of age without AF) using a smartphone ECG during practice visits. eHealth tools included electronic prompts, guideline‐based electronic decision support, and regular data reports. Clinical audit tools extracted de‐identified data. Results were compared with an earlier study in metropolitan practices (n=8) and nonrandomized control practices (n=69). Cost‐effectiveness analysis compared population‐based screening with no screening and included screening, treatment, and hospitalization costs for stroke and serious bleeding events. Patients (n=3103, 34%) were screened (mean age, 75.1±6.8 years; 47% men) and 36 (1.2%) new AF cases were confirmed (mean age, 77.0 years; 64% men; mean CHA₂DS₂‐VA, 3.2). Oral anticoagulant treatment rates for patients with CHA₂DS₂‐VA≥2 were 82% (screen detected) versus 74% (preexisting AF)( P =NS), similar to metropolitan and nonrandomized control practices. The incremental cost‐effectiveness ratio for population‐based screening was AU$16 578 per quality‐adjusted life year gained and AU$84 383 per stroke prevented compared with no screening. National implementation would prevent 147 strokes per year. Increasing the proportion screened to 75% would prevent 177 additional strokes per year. CONCLUSIONS An AF screening program in rural practices, supported by eHealth tools, screened 34% of eligible patients and was cost‐effective. Oral anticoagulant treatment rates were relatively high at baseline, trending upward during the study. Increasing the proportion screened would prevent many more strokes with minimal incremental cost‐effectiveness ratio change. eHealth tools, including data reports, may be a valuable addition to future programs. REGISTRATION URL: https://www.anzctr.org.au . Unique identifier: ACTRN12618000004268.

scholarly journals ANALISIS EFEKTIVITAS BIAYA PADA PASIEN ANAK DEMAM TIFOID DI RUMAH SAKIT BHAYANGKARA MANADO

PHARMACON ◽  
2019 ◽  
Vol 8 (2) ◽  
pp. 335
Author(s):  
Agatha Agnes ◽  
Gayatri Citraningtyas ◽  
Sri Sudewi
Keyword(s):  
Cost Effectiveness ◽  
Typhoid Fever ◽  
Incremental Cost ◽  
Pediatric Patients ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Effectiveness Analysis ◽  
Record Data

ABSTRACT Typhoid fever is an endemic disease which it incidence rate is still high in Indonesian. Administering antibiotic therapy can do treatment of typhoid fever. This study was conducted since there are several pediatric patients diagnosed with typhoid fever but have different antibiotic therapies, namely cefotaxime and ceftriaxone therapy, so it is necessary to do calculations to determine the comparison and determine which treatment is more efficient in cost and effectiveness. The method used in this study is CEA (Cost-Effectiveness Analysis) with the design of retrieving medical record data of children with typhoid fever in Bhayangkara Manado Hospital retrospectively from January to December 2018. The samples  obtained were 28 pediatric patients, cinsisting of 12 patients using cefotaxime therapy and 16 patients using ceftriaxone therapy. The result of ACER (An Avarage Cost Effective Ratio) obtained by ceftriaxone were Rp. 526.609,-/day and cefotaxime Rp. 484.789,-/day. In this study, if patients under cefotaxime therapy want to swich treatment to ceftriaxone therapy, ICER calculation (Incremental Cost-Effectiveness Ratio) is carried out the result are Rp.340.528,-. Keyword: Typhoid fever, Antibiotics, CEA (Cost-Effectiveness Analysis) ABSTRAK Demam tifoid merupakan penyakit endemik yang angka kejadiannya masih tinggi di Indonesia. Pengobatan demam tifoid dapat diobati dengan cara pemberian terapi antibiotik. Penelitian ini dilakukan karena ada beberapa pasien anak yang di diagnosa demam tifoid tetapi memiliki terapi antibiotik yang berbeda, yaitu terapi sefotaksim dan seftriakson  sehingga perlu dilakukan perhitungan untuk mengetahui perbandingan dan menentukan pemilihan pengobatan mana yang lebih efisien dalam biaya maupun efektivitas. Metode yang digunakan dalam penelitian ini adalah CEA (Cost-Effectiveness Analysis) dengan rancangan pengambilan data rekam medik pasien anak demam tifoid di RS. Bhayangkara Manado secara retrospektif pada periode Januari – Desember 2018. Sampel yang didapat sebanyak 28 pasien anak, yang terdiri dari 12 pasien pengguna terapi sefotaksim dan 16 pasien pengguna terapi seftriakson. Hasil ACER (An Avarage Cost Effective Ratio) yang diperoleh sefotaksim Rp.526.609,-/hari dan seftriakson Rp.484.789,-/hari. Pada penelitian ini jika pasien terapi sefotaksim ingin berpindah pengobatan ke terapi seftriakson maka dilakukan perhitungan ICER (Incremental Cost-Effectiveness Ratio) dan didapat hasil Rp.340.582,-, sehingga jika ingin berpindah pengobatan maka perlu penambahan biaya sesuai nilaI ICER.Kata Kunci : Demam Tifoid, Antibiotik, CEA (Cost-Effectiveness Analysis).

scholarly journals Cost effectiveness analysis of anti-hypertensive drugs used for chronic kidney disease patients

2019 ◽  
Vol 10 (4) ◽  
pp. 2820-2825
Author(s):  
Mohamed Saleem TS ◽  
Sreeja N ◽  
Kiran Karthik J ◽  
Bhanu Sree K
Keyword(s):  
Chronic Kidney Disease ◽  
Cost Effectiveness ◽  
Calcium Channel ◽  
Calcium Channel Blockers ◽  
Antihypertensive Drugs ◽  
Incremental Cost Effectiveness Ratio ◽  
Channel Blockers ◽  
Cost Effectiveness Ratio ◽  
Effectiveness Analysis ◽  
Β Blockers

Cost effectiveness analysis branch of pharmacoeconomics is a technique used to aid in decision making between alternatives. A prospective observational study would be conducted in the nephrology department at O.P, Patients with CKD with hypertension, with or deprived of diabetes are included in the study. Patients with drug-induced renal disease or unknown cause. Pregnant women with chronic kidney disease are excluded from the study. The research was conducted in150 patients in which common are men. The mean age of the research people was found to be 51.2 ±7. 02. .It was observed that calcium channel blockers 127 (84.6%), diuretics 51 (34%), α agonists 33 (22%), β blockers 21 (14%), α blockers 17 (11.3%), α+β blockers 10 (6.6%), Angiotensin receptor blockers 3 (2%) and angiotensin-converting enzyme inhibitors 1 (0.6%) were the numerous antihypertensive drugs given to the study people. Incremental Cost-Effectiveness Ratio was assessed, and it was observed that Rs.31.80 was extra required while using diuretics than Calcium Channel Blockers for achieving respective maintenance value. The major classes of antihypertensive drugs prescribed in all of them are CCB+α agonist was found most effective CCB+ Diuretics were the second most effective. Incremental Cost-Effectiveness Ratio was calculated, and it was found that  Rs.4.40 was Extra needed to attaining essential upkeep of blood pressure. Pharmacoeconomic study shows that Calcium channel blockers were the utmost cost-effective antihypertensive in CKD patients when linked to other antihypertensive drugs. In two-drug combination therapy, CCB+α agonist was found most effective.

Abstract WP50: Cost-Effectiveness of Mechanical Thrombectomy for Acute Ischemic Stroke: An Analysis From RESILIENT Trial

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ana Claudia de Souza ◽  
Sheila Martins ◽  
Carisi Polanczyk ◽  
Denizar Vianna ◽  
Leonardo Carbonera ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Healthcare System ◽  
Standard Care ◽  
Mechanical Thrombectomy ◽  
Medical Costs ◽  
Incremental Cost Effectiveness Ratio ◽  
Mortality Data ◽  
Cost Effectiveness Ratio ◽  
Direct Medical Costs

Background and purpose: RESILIENT Trial was the first study in a developing country to demonstrate the benefit of mechanical thrombectomy (MT) in acute stroke patients. This economic evaluation aimed to access the cost-utility of MT under the perspective of the Brazilian Public Healthcare System. Methods: Analysis was based on a subset sample of the original study (151 of 221 patients) from 4 hospitals. We compared costs and utilities between MT plus standard care (n=78) vs. standard care alone (n=73). Direct medical costs were considered, and utilities were inputted according to each patient’s Utility-Weighted modified Rankin Score (UW-mRS). First-year survival was obtained from trial follow-up and modelled for a life-time horizon adjusted by National Mortality Data. Direct medical costs were converted to I$ using Purchasing Power Parity (PPP). A discount rate of 5% was used. Incremental cost-effectiveness ratio (ICER) is expressed in cost (I$) per Quality-Adjusted Life Year (QALY). Results: RESILIENT trial was stopped on its first interim analysis because of early efficacy. The incremental costs and QALYs gained with MT were estimated at I$ 8,369 and 0.75, respectively, compared with standard medical care, yielding an incremental cost-effectiveness ratio (ICER) of I$ 7,256 per QALY. Conclusion: The initially higher costs of MT were offset by the clear benefit of the intervention. RESILIENT trial demonstrated that such therapy is likely to be cost-effective despite the economical constraints in the Brazilian healthcare system.

PD44 Multi-Comparator Incremental Cost-Effectiveness Ratio: A New Framework For Cost-Effectiveness Analysis

2018 ◽  
Vol 34 (S1) ◽  
pp. 144-145
Author(s):  
Stefano Lucherini ◽  
Robert Hughes ◽  
Paul Okhuoya
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
New Technology ◽  
Standard Of Care ◽  
Cost Effectiveness Analysis ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Second Best ◽  
Effectiveness Analysis ◽  
The Impact

Introduction:Current practice in cost-effectiveness analysis (CEA) involves the estimation of the incremental cost-effectiveness ratio (ICER) between a new intervention and one alternative comparator reflecting the standard of care. As this focuses on pairwise comparisons, rather than considering the whole range of available alternatives at any given time, this method fails to capture the full impact of bringing the new intervention to market.Methods:A multi-comparator ICER (MC-ICER) evaluating the impact of the new technology on patients treated with all comparators used in clinical practice, rather than a theoretical ‘second-best’ alternative only, was estimated. This can be achieved by weighting the incremental costs and benefits for each comparator by its change in market share to generate an MC-ICER. This is shown using a stylized example with three comparators.Results:The traditional ICER against the second-best alternative was USD 200,000 per QALY, while the estimated multi-comparator ICER is USD 133,548 per QALY, corresponding to a 33 percent decrease. This reflects the fact that patients who switch to the new intervention are not only those who had been previously treated with one particular comparator, as is assumed in a traditional CEA. The difference between the traditional ICER and the MC-ICER depends on how the new intervention impacts on the uptake of each comparator.Conclusions:Results show that, when comparator selection was made excluding dominated and extendedly-dominated alternatives, the MC-ICER, produced using the method described above, is lower than the traditional ICER comparing the new intervention to the second-best comparator. This captures the fact that patients may switch to the new intervention not only from the second-best comparator, but from the whole range of alternative treatments. Such patient movements determine the real impact, or opportunity cost, of the new intervention on the healthcare system and, therefore, should be captured in CEA alongside traditional one-way ICERs.

scholarly journals COVID-19 Vaccination Scenarios: A Cost-Effectiveness Analysis for Turkey

Vaccines ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 399
Author(s):  
Arnold Hagens ◽  
Ahmet Çağkan İnkaya ◽  
Kasirga Yildirak ◽  
Mesut Sancar ◽  
Jurjen van der Schans ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Savings ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Vaccine Uptake ◽  
First Year ◽  
Cost Effectiveness Ratio ◽  
Scenario Analyses ◽  
Effectiveness Analysis ◽  
The Cost

As of March 2021, COVID-19 has claimed the lives of more than 2.7 million people worldwide. Vaccination has started in most countries around the world. In this study, we estimated the cost-effectiveness of strategies for COVID-19 vaccination for Turkey compared to a baseline in the absence of vaccination and imposed measures by using an enhanced SIRD (Susceptible, Infectious, Recovered, Death) model and various scenarios for the first year after vaccination. The results showed that vaccination is cost-effective from a health care perspective, with an incremental cost-effectiveness ratio (ICER) of 511 USD/QALY and 1045 USD/QALY if vaccine effectiveness on transmission is equal or reduced to only 50% of effectiveness on disease, respectively, at the 90% baseline effectiveness of the vaccine. From a societal perspective, cost savings were estimated for both scenarios. Other results further showed that the minimum required vaccine uptake to be cost-effective would be at least 30%. Sensitivity and scenario analyses, as well as the iso-ICER curves, showed that the results were quite robust and that major changes in cost-effectiveness outcomes cannot be expected. We can conclude that COVID-19 vaccination in Turkey is highly cost-effective or even cost-saving.

scholarly journals Optimal Control of Shigellosis with Cost-Effective Strategies

2020 ◽  
Vol 2020 ◽  
pp. 1-15
Author(s):  
Stephen Edward ◽  
Nyimvua Shaban ◽  
Eunice Mureithi
Keyword(s):  
Optimal Control ◽  
Cost Effectiveness ◽  
Optimal Control Theory ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Effective Strategies ◽  
Education Campaign ◽  
Effectiveness Analysis ◽  
The Cost

In this paper, we apply optimal control theory to the model for shigellosis. It is assumed that education campaign, sanitation, and treatment are the main controls for this disease. The aim is to minimize the number of infections resulting from contact with careers, infectious population, and contaminated environments while keeping the cost of associated controls minimum. We achieve this aim through the application of Pontryagin’s Maximum Principle. Numerical simulations are carried out by using both forward and backward in time fourth-order Runge-Kutta schemes. We simulate the model under different strategies to investigate which option could yield the best results. The findings show that the strategy combining all three control efforts (treatment, sanitation, and education campaign) proves to be more beneficial in containing shigellosis than the rest. On the other hand, cost-effectiveness analysis is performed via incremental cost-effectiveness ratio (ICER). The findings from the ICER show that a strategy incorporating all three controls (treatment, sanitation, and education campaign) is the most cost-effective of all strategies considered in the study.

scholarly journals COVID-19 Vaccines Cost-Effectiveness Analysis: A Scenario for Iran

Vaccines ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 37
Author(s):  
Atefeh Vaezi ◽  
Alipasha Meysamie
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effectiveness Analysis ◽  
Incremental Cost Effectiveness Ratio ◽  
Decision Making Process ◽  
Cost Effectiveness Ratio ◽  
Effectiveness Analysis ◽  
Critical Measure ◽  
Disability Adjusted Life ◽  
Disability Adjusted Life Year

COVID-19 vaccines are supposed to be critical measure for ending the pandemic. Governments had to decide on the type of vaccine to provide for their population. In this decision-making process, cost-effectiveness analysis is considered a helpful tool. This study is a cost-effectiveness analysis utilized to calculate the incremental cost per averted disability-adjusted life year (DALY) by vaccination compared to no vaccination for different COVID-19 vaccines. The incremental cost-effectiveness ratio (ICER) for a vaccination with COVID-19 vaccines was estimated at 6.2 to 121.2 USD to avert one DALY and 566.8 to 10,957.7 USD per one death. The lowest and highest ICERs belong to Ad26.COV2.S and CoronaVac, respectively. Considering the scenario of Iran, vaccines that are recommended include ad26.cov2.s, chadox1-S, rAd26-S + rAd5-S, and BNT162b2 in the order of recommendation.

scholarly journals Pharmacoeconomic Analysis Of Using Cephalosporin Group In Appendicitis Prophylactic In Rumah Sakit Umum Daerah Subang

2018 ◽  
Vol 16 (2) ◽  
pp. 200
Author(s):  
Yulia Wardati ◽  
Dytha Andri Deswat ◽  
Zainal Muttaqin
Keyword(s):  
Cost Effectiveness ◽  
Pharmacoeconomic Analysis ◽  
Antibiotic Use ◽  
Incremental Cost Effectiveness Ratio ◽  
Analysis Method ◽  
Cost Effectiveness Ratio ◽  
Standard Drug ◽  
Effectiveness Analysis ◽  
The Subject ◽  
The Cost

The administration of cephalosporin group antibiotics in patients with post-surgical appendicitis is necessary to prevent postoperative wounds. This pharmacoeoconomic study was conducted retrospectively in the period of 1 January to 31 December 2015 in RSUD Subang for the purpose of determining the effectiveness of drugs and the cost of antibiotic use of ceftriaxone, cefotaxime, and ceftizoxime injection by Cost Effectiveness Analysis method. The subject of the patient was 78 people. Based on Average Cost Effectiveness Ratio (ACER), the smallest value is ceftriaxone Rp 729.124 / day, while the result of Cost Effectiveness plane with cefotaxime as standard drug, ceftriaxone occupies quadrant IV and ceftizoxime occupies  quadrant I. The result of Incremental Cost Effectiveness Ratio (ICER) calculation obtained by difference of value equal  to Rp 106.347 / day hence can be concluded that antibiotic injection of cefotaxime as standard injection antibiotics used by RSUD Subang can be replaced by antibiotic injection of ceftizoxim by adding cost Rp 106.347 / day but need attention to resource especially funds owned and should be selected if sufficient resources are available.

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