scholarly journals Cost-effectiveness of eltrombopag versus intravenous immunoglobulin for the perioperative management of immune thrombocytopenia

2021 ◽  
Author(s):  
Manraj N. Kaur ◽  
Donald M. Arnold ◽  
Nancy M. Heddle ◽  
Richard John Cook ◽  
Cyrus C Hsia ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Randomized Trial ◽  
Intravenous Immunoglobulin ◽  
Immune Thrombocytopenia ◽  
Cost Effective ◽  
Public Healthcare ◽  
Secondary Sources ◽  
Level Data ◽  
Utilization Data ◽  
Mean Cost

Eltrombopag has been shown to be non-inferior to intravenous immunoglobulin (IVIG) for improving perioperative platelet counts in patients with immune thrombocytopenia (ITP) in a randomized trial; thus, cost is an important factor for treatment and policy decisions. We used patient-level data from the trial to conduct a cost-effectiveness analysis comparing perioperative eltrombopag 50mg daily starting dose, with IVIG 1 or 2g/kg (according to local practice) from a Canadian public healthcare payer's perspective over the observation period, from preoperative day 21 to postoperative day 28. Resource utilization data were obtained from the trial data (eltrombopag, n=38; IVIG, n=36) and unit costs were collected from the Ontario Schedule of Benefits, Ontario Drug Formulary, and secondary sources. All costs were adjusted to 2020 Canadian dollars. We calculated the incremental cost per patient for all patients randomized. Uncertainty was addressed using non-parametric bootstrapping. The use of perioperative eltrombopag for patients with ITP resulted in a cost-saving of $413 Canadian dollars per patient. Compared with IVIG, the probability of eltrombopag being cost-effective was 70% even with zero willingness to pay. In a sensitivity analysis based on IVIG dose, we found that with the higher dose of IVIG (2g/kg), eltrombopag saved $2,714 per patient; whereas with the lower dose of IVIG (1g/kg), eltrombopag had a higher mean cost of $562 per patient. In summary, based on data from the randomized trial that demonstrated non-inferiority, the use of eltrombopag for the management of ITP in the perioperative setting was less costly than IVIG.

Cost-effective analysis of the use of EGFR inhibitors (E) for wild-type (WT) KRAS unresectable metastatic colorectal cancer (mCRC).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6552-6552 ◽  
Author(s):  
Maria C. Riesco Martinez ◽  
Scott R. Berry ◽  
Yoo-Joung Ko ◽  
Nicole Mittmann ◽  
Kelly Lien ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Progression Free Survival ◽  
Cost Effective ◽  
Similar Efficacy ◽  
Best Supportive Care ◽  
Sensitivity Analyses ◽  
Public Healthcare ◽  
Term Care ◽  
System Perspective ◽  
Utilization Data

6552 Background: Patients (pts) with unresectable WT KRAS mCRC benefit from fluoropyrimidines (FP), oxaliplatin (O), irinotecan (I), bevacizumab (Bev) and E. The most cost-effective strategy to combine them remains unclear. Methods: A Markov model was constructed for a hypothetical cohort of pts with mCRC to examine the costs and outcomes of 3 treatment strategies: (A): 1st line (1L) Bev+FP+O/I, 2nd line (2L) FP+I/O, 3rd line (3L) E, (B): 1L Bev+FP+O/I, 2L FP+I/O, 3L E+I, and (C): 1L E+FP+O/I, 2L Bev+FP+I/O, 3L best supportive care (BSC). Efficacy and probability data of the treatments were obtained from clinical trials identified through a systematic review of the literature. Resource utilization data were derived from a chart review of 65 consecutive pts treated at Odette Cancer Centre (OCC) since 2009 and from the literature. Utilities were obtained by surveying oncologists (n= 24) across Canada using EQ-5D. Costs were obtained from the Ontario Ministry of Health and Long/Term Care, Ontario Case Costing Initiative, OCC and the literature. The analysis was conducted from the Canadian public healthcare system perspective over a 5 year time horizon with a 5% discount in 2012 Canadian dollars (CAD$) for cost and outcome. Incremental cost-effectiveness analyses were conducted comparing costs and outcomes of the 3 strategies. One way and probabilistic sensitivity analyses (SA) were conducted (n=10,000). Results: All 3 strategies appeared to be of relatively similar efficacy clinically, but C is more expensive than A or B by >45% (see Table). The model is primarily driven by the acquisition cost of drugs. B is most cost-effective when the willingness-to-pay (WTP) threshold >$120,000/QALY. SA showed that C would be cost-effective only when the progression-free survival of E is better than Bev in 1L with hazard ratio <0.24 at WTP of $150,000/QALY. Conclusions: 1L use of E followed by 2L Bev in mCRC is not cost-effective at the current pricing of E relative to Bev. [Table: see text]

Cost-effectiveness of adjuvant chemotherapy for stage III colon cancer in the South African public healthcare setting.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18849-e18849
Author(s):  
Yoanna S Pumpalova ◽  
Alexandra M. Rogers ◽  
Sarah Xinhui Tan ◽  
Candice-Lee Herbst ◽  
Paul Ruff ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Cost Effectiveness ◽  
Adjuvant Chemotherapy ◽  
Healthcare System ◽  
Cost Effective ◽  
Stage Iii ◽  
Public Healthcare ◽  
Administration Cost ◽  
Public Healthcare System ◽  
Stage Iii Colon Cancer

e18849 Background: Colon cancer incidence and mortality rates are increasing in low- and middle-income countries, such as South Africa (SA). Adjuvant chemotherapy after curative resection for stage III colon cancer prolongs overall survival, but it is unclear which regimen is most cost-effective in resource-constrained settings, such as the SA public healthcare system. Methods: A decision-analytic Markov model was developed to compare lifetime costs and health outcomes for 60-year-old stage III colon cancer patients treated with six adjuvant chemotherapy regimens in a public hospital in SA: fluorouracil, leucovorin, and oxaliplatin (FOLFOX) for 3 and 6 months, capecitabine and oxaliplatin (CAPOX) for 3 and 6 months, capecitabine for 6 months, and fluorouracil/leucovorin (5-FU/LV; Mayo regimen) for 6 months. Transition probabilities were derived from clinical trials to estimate risks of toxicity, disease recurrence, and survival. Costs from a SA societal perspective and utility estimates were obtained from literature and local expert opinion. The primary outcome was the incremental cost-effectiveness ratio (ICER) in international dollars (I$) per disability-adjusted life year (DALY) averted, with a willingness-to-pay (WTP) threshold of one times the 2020 GDP per capita of SA (I$13,006.57; ZAR89,225). Results: Our model found CAPOX for 3 months to be the most cost-effective strategy, at a lifetime cost below the local WTP threshold (I$5,380.82; ZAR36,912.44) and 5.74 DALYs averted, compared to no chemotherapy. FOLFOX for 6 months was also on the efficiency frontier, with a higher total cost (I$22,747.47; ZAR156,047.64) and 0.18 additional DALYs averted (ICER = I$99,021.35/DALY averted). All other strategies were absolutely dominated. One-way sensitivity analyses found that FOLFOX for 6 months is optimal when the administration cost (i.e.: port and pump) falls to 20% of the base case price. Conclusions: In the SA public healthcare system, CAPOX for 3 months is the most cost-effective adjuvant treatment for stage III colon cancer. FOLFOX for 6 months, with a greater effectiveness, may be cost-effective if the administration cost decreases significantly. The optimal strategy in other settings may vary according to the local WTP threshold.[Table: see text]

Cost Effectiveness of Post-Remission Intensive Therapy in Patients with Acute Leukemia.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5522-5522
Author(s):  
Hui-Chi Hsu ◽  
Jyh-Pyng Gau ◽  
Hsiouh-Hsiang Chern ◽  
Wing-Keung Chau ◽  
Cheng-Hwai Tzeng ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Acute Leukemia ◽  
Intensive Therapy ◽  
Young Patients ◽  
Cost Effective ◽  
Prospective Clinical Study ◽  
High Dose ◽  
Total Cost ◽  
Cost Effective Approach ◽  
Mean Cost

Abstract Background: We assessed the cost-effectiveness of high dose arabinoside (HiDAC)-based and allogeneic stem cell transplantation (alloSCT)-based therapy in patients with acute leukemia. Patients and Methods: We analyzed the outcome, cost and cost-effectiveness of 106 patients treated between 01/94 and 01/02 (94 AML/12 ALL). Forty-two young patients at either intermediate or unknown cytogenetic risk received post-remission intensive therapy (24 HiDAC-based / 18 alloSCT-based therapy). Results: After a median follow-up of 50 months, the estimated 7 year overall survival for the HiDAC-based group showed a tendency to be higher than the alloSCT-based group (48% versus 28%; p=0.1452). HiDAC-base group spent a significantly lower total cost (USD 51,857 versus 75,474; p=0.004) than the alloSCT-based group. Cost-effectiveness analysis showed that the mean cost per year of life saved for the HiDAC-based group is considerably less expensive than the alloSCT-based group (USD 11,224 versus 21,564). The reduced total cost for the HiDAC-based group originated from lower cost in room fees, medication, laboratory and procedure, but not in blood transfusion and professional man-power fees. Conclusion: HiDAC therapy as initial post-remission intensive therapy is a cost-effective approach in AML patients at either intermediate or unknown cytogenetic risk, which deserves further prospective clinical study to address this issue.

scholarly journals P424 Economic evaluation of vedolizumab SC for the treatment of moderate-to-severe ulcerative colitis in Canada

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S387-S387
Author(s):  
A FISCHER ◽  
M Oppe ◽  
S Stypa ◽  
V Lukyanov ◽  
I Petrakis
Keyword(s):  
Ulcerative Colitis ◽  
Cost Effectiveness ◽  
Meta Analysis ◽  
Cost Effective ◽  
Future Research ◽  
Base Case ◽  
Public Healthcare ◽  
Payer Perspective ◽  
Life Years ◽  
Public Payer

Abstract Background Vedolizumab intravenous (IV), a gut selective humanised monoclonal antibody, is indicated for the management of moderately to severely active Ulcerative Colitis (UC) and has been shown in the only head-to-head clinical trial within UC to be superior to adalimumab (NCT02497469). Furthermore, the novel vedolizumab subcutaneous (SC) has recently been proven to be an effective treatment of UC (NCT02611830). The objective of this study is to estimate the comparative cost-effectiveness of vedolizumab IV with updated efficacy data, and vedolizumab SC for the first time. Both vedolizumab IV and SC have been compared with other publicly reimbursed biologics for the treatment of patients with moderate-to-severe UC from a Canadian public healthcare payer perspective. Methods A hybrid decision tree/Markov model was developed to simulate the clinical course of UC, translating the disease course into costs and quality-adjusted life-years (QALYs). Comparative efficacy of vedolizumab SC, vedolizumab IV, adalimumab, infliximab IV, and golimumab were sourced from a network meta-analysis. Drug and disease management costs (2019 $CAD) were sourced from Ontario public payer schedules of benefits. Utilities were sourced from the literature. Clinical and economic outcomes were projected over a lifetime and discounted at 1.5% annually. Results Within a mixed bio-naïve/experienced population, vedolizumab SC resulted in slightly more QALYs than vedolizumab IV and dominated adalimumab (Table 1); vedolizumab SC yielded an incremental cost-effectiveness ratio (ICER) of $CAD 6,727 per QALY and $CAD 52,673 per QALY relative to golimumab and to infliximab (for which the price of a biosimilar was used), respectively. Further scenario analysis within bio-naïve populations supported the robustness of the base-case results, demonstrating that vedolizumab SC or vedolizumab IV were either dominant or cost-effective across all scenarios. Conclusion Our analysis suggests that vedolizumab SC and vedolizumab IV are a cost-effective therapeutic alternative relative to other biologics for moderate-to-severe UC in Canada. Future research will expand the analysis across all biologic comparators as they are used in the real world.

Community or patient preferences for cost-effectiveness of cardiac rehabilitation: does it matter?

2008 ◽  
Vol 15 (5) ◽  
pp. 608-615 ◽  
Author(s):  
Neil Oldridge ◽  
William Furlong ◽  
Anthony Perkins ◽  
David Feeny ◽  
George W. Torrance
Keyword(s):  
Cost Effectiveness ◽  
Cardiac Rehabilitation ◽  
Incremental Cost ◽  
Usual Care ◽  
Randomized Trial ◽  
Patient Preferences ◽  
Secondary Analysis ◽  
Cost Effective ◽  
Economic Evaluations ◽  
Life Years

Background Few healthcare economic evaluations, and none in cardiac rehabilitation, report results based on both community and patient preferences for health outcomes. We published the results of a randomized trial of cardiac rehabilitation after myocardial infarction in 1994 in which preferences were measured using both perspectives but only patient preferences were reported. This secondary analysis uses both types of preference measurements. Methods We collected community Quality of Well-Being (QWB) and patient Time Trade-off (TTO) preference scores from 188 patients (rehabilitation, n = 93; usual care, n = 95) on entry into the trial, at 2 months (end of the intervention) and again at 4, 8, and 12 months. Mean preference scores over the 12-month follow-up study period, estimates of quality-adjusted life years (QALYs) gained per patient, incremental cost-effectiveness ratios [costs inflated to 2006 US dollars] and probabilities of the cost-effectiveness of rehabilitation for costs per QALY up to US$100 000 are reported. Results Mean QWB preference scores were lower ( P < 0.01) than the corresponding mean TTO preference scores at each assessment point. The 12-month changes in mean QWB and TTO preference scores were large and positive ( P < 0.001) with rehabilitation patients gaining a mean of 0.011 (95% confidence interval, –0.030 to +0.052) more QWB-derived QALYs, and 0.040 (–0.026, 0.107) more TTO-derived QALYs, per patient than usual care patients. The incremental cost-effectiveness ratio for QWB-derived QALYs was estimated at $60270/QALY (about €50 600/QALY) and at $16580/QALY (about €13 900/QALY) with TTO-derived QALYs. With a willingness to spend $100 000/QALY, the probability of rehabilitation being cost-effective is 0.58 for QWB-derived QALYs and 0.83 for TTO-derived QALYs. Conclusion This secondary analysis of data from a randomized trial indicates that cardiac rehabilitation is cost-effective from a community perspective and highly cost-effective from the perspective of patients.

scholarly journals Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047072
Author(s):  
Kathy W Tannous ◽  
Ajesh George ◽  
Moin Uddin Ahmed ◽  
Anthony Blinkhorn ◽  
Hannah G Dahlen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Oral Health ◽  
Health Benefit ◽  
Cost Effective ◽  
Economic Benefits ◽  
Dental Service ◽  
Public Healthcare ◽  
Life Years ◽  
The Cost

ObjectivesTo critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.Design and settingThe evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.ParticipantsData were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.Cost measuresData included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.Outcome measuresUtility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.ResultsCompared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only ‘cost-effective’ in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was ‘cost-effective’ in all scenarios except at 3 months scenario.ConclusionsThe midwives’ only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives’ and dentists’ combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.Trial registration numberACTRN12612001271897; Post-results.

Cost-effectiveness analysis of Helicobacter pylori screening in prevention of gastric cancer in Chinese

2008 ◽  
Vol 24 (01) ◽  
pp. 87-95 ◽  
Author(s):  
Feng Xie ◽  
Nan Luo ◽  
Gord Blackhouse ◽  
Ron Goeree ◽  
Hin-Peng Lee
Keyword(s):  
Gastric Cancer ◽  
Helicobacter Pylori ◽  
Cost Effectiveness ◽  
Model Simulation ◽  
Healthcare Providers ◽  
Cost Effective ◽  
Public Healthcare ◽  
Effective Strategy ◽  
Cost Effective Strategy ◽  
Life Years

Objectives:The aim of this study was to evaluate the costs and effectiveness associated with no screening,Helicobacter pyloriserology screening, and the13C-urea breath test (UBT) for gastric cancer in the Chinese population.Methods:A Markov model simulation was carried out in Singaporean Chinese at 40 years of age (n= 478,500) from the perspective of public healthcare providers. The main outcome measures were costs, number of gastric cancer cases prevented, life-years saved, quality-adjusted life-years (QALYs) gained from the screening age to death, and incremental cost-effectiveness ratios (ICERs), which were compared among the three strategies. The uncertainty surrounding ICERs was addressed by scenario analyses and probabilistic sensitivity analysis using Monte Carlo simulation.Results: The ICER of serology screening versus no screening was $25,881 per QALY gained (95 percent confidence interval (95 percent CI), $5,700 to $120,000). The ICER of UBT versus no screening was $53,602 per QALY gained (95 percent CI, $16,000 to $230,000). ICER of UBT versus serology screening was $470,000 per QALY gained, for which almost all random samples of the ICERs distributed above $50,000 per QALY.Conclusions: It cannot be confidently concluded that eitherH pyloriscreening was a cost-effective strategy compared with no screening in all Chinese at the age of 40 years. Nevertheless, serology screening has demonstrated much more potential to be a cost-effective strategy, especially in the population with higher gastric cancer prevalence.

A cost-utility analysis of gemcitabine plus nab-paclitaxel in metastatic pancreatic cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17569-e17569 ◽  
Author(s):  
Yoo-Joung Ko ◽  
Vincent Channing Tam ◽  
Nicole Mittmann ◽  
Mark Pasteka ◽  
Kelvin K. Chan
Keyword(s):  
Pancreatic Cancer ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
The United States ◽  
Phase Iii ◽  
Sensitivity Analyses ◽  
Metastatic Pancreatic Cancer ◽  
Base Case ◽  
Public Healthcare ◽  
Term Care

e17569 Background: FOLFIRINOX has been shown to be superior to gemcitabine (gem) alone for metastatic pancreatic cancer (MPC) and has been established as the standard of care. A recent study (von Hoff et al, GI ASCO 2013) showed that gem + nab-paclitaxel (gem+nab-p) was superior to gem alone. The cost-effectiveness of gem+nab-p relative to gem or FOLFIRINOX has not been studied. Methods: A Markov cohort model was constructed for patients with MPC to examine the costs and outcomes of gem alone, gem+nab-p and FOLFIRINOX. Efficacy and side-effect data were obtained from pivotal phase III trials. Resource utilization data, unit costs and utilities were obtained from Ontario Ministry of Health and Long-Term Care, Sunnybrook Health Sciences Centre and the literature. The primary outcome was the incremental cost-effectiveness ratio (ICER) defined as cost per quality-adjusted life year (QALY). The analysis was conducted from the perspective of the Canadian public healthcare system over a 2-year time horizon adjusted to 2012 Canadian dollars (CAD$). Both cost and effectiveness were discounted at 5%. One way and probabilistic sensitivity analyses were performed. Results: Using gem as the base case, gem+nab-p had better outcomes but higher costs (see Table). The ICER was higher than conventional willingness-to-pay (WTP) threshold. Gem+nab-p was less effective but less costly when compared with FOLFIRINOX. It was dominated by combinations of gem and FOLFIRINOX (i.e. extended dominance), and therefore not cost-effective regardless of WTP threshold. If the price of nab-p was 20% lower, then gem+nab-p and FOLFORINOX would have similar cost-effectiveness. Conclusions: Gem+nab-p is not cost-effective, from the Canadian perspective, for the treatment of MPC based on the current price when compared with FOLFIRINOX. A lower-priced generic oxaliplatin, which is available in some jurisdictions including the United States, may affect the outcome of this analysis in further favor of FOLFIRINOX. [Table: see text]

Cost-effectiveness of mechanical thrombectomy for acute ischemic stroke in Brazil: Results from the RESILIENT trial

2021 ◽  
pp. 174749302110559
Author(s):  
Ana Claudia de Souza ◽  
Sheila O Martins ◽  
Carisi Anne Polanczyk ◽  
Denizar Vianna Araújo ◽  
Ana Paula BS Etges ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Medical Care ◽  
Mechanical Thrombectomy ◽  
Cost Effective ◽  
Cost Utility ◽  
Public Healthcare ◽  
Cost Effectiveness Ratio ◽  
Standard Medical Care ◽  
The Cost ◽  
Quality Adjusted Life

Background The RESILIENT trial demonstrated the clinical benefit of mechanical thrombectomy in patients presenting acute ischemic stroke secondary to anterior circulation large vessel occlusion in Brazil. Aims This economic evaluation aims to assess the cost-utility of mechanical thrombectomy in the RESILIENT trial from a public healthcare perspective. Methods A cost-utility analysis was applied to compare mechanical thrombectomy plus standard medical care (n = 78) vs. standard medical care alone (n = 73), from a subset sample of the RESILIENT trial (151 of 221 patients). Real-world direct costs were considered, and utilities were imputed according to the Utility-Weighted modified Rankin Score. A Markov model was structured, and probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of results. Results The incremental costs and quality-adjusted life years gained with mechanical thrombectomy plus standard medical care were estimated at Int$ 7440 and 1.04, respectively, compared to standard medical care alone, yielding an incremental cost-effectiveness ratio of Int$ 7153 per quality-adjusted life year. The deterministic sensitivity analysis demonstrated that mRS-6 costs of the first year most affected the incremental cost-effectiveness ratio. After 1000 simulations, most of results were below the cost-effective threshold. Conclusions The intervention's clear long-term benefits offset the initially higher costs of mechanical thrombectomy in the Brazilian public healthcare system. Such therapy is likely to be cost-effective and these results were crucial to incorporate mechanical thrombectomy in the Brazilian public stroke centers.

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