QALY-time: experts’ view on the use of the quality-adjusted life year in cost-effectiveness analysis in palliative care

Introduction: Hepatocellular carcinoma (HCC) is the most common form of liver cancer worldwide and carries a poor prognosis. Historically, sorafenib was the only available systemic treatment for advanced HCC. However, in recent years, 6 new treatments have been approved by the US Food and Drug Administration (FDA): regorafenib, lenvatinib, cabozantinib, pembrolizumab, ramucirumab, and nivolumab. Data are lacking regarding the most appropriate sequencing pathway for these agents. Our objective was to conduct a comprehensive cost effectiveness analysis (CEA) of different 1st- and 2nd-line treatment pathways for HCC reflecting all new drug approvals, and then use our data to provide guidance for clinicians on which pathway is the most cost-effective. Materials and Methods: Markov models were used to evaluate the cost effectiveness of 8 different 1st- and 2nd-line treatment sequences. The model allowed for 9 possible states. Cost effectiveness ratios (CER) and incremental CER (ICER) were calculated to compare costs between different pathways and against a willingness-to-pay (WTP) threshold. Efficacy and toxicity data were extracted from the landmark trials for each agent. All agents except ramucirumab were included. The cost of each agent was based on the wholesale acquisition cost (WAC) in USD as of June 2019. Monte-Carlo methods were used to simulate the experience of 1,000,000 patients per treatment sequence for a 12-month period. Results: The pathway with the lowest CER was sorafenib, followed by pembrolizumab (USD 227,741.03/quality-adjusted life year [QALY]). ICER analysis supported implementing 2nd-line pembrolizumab-based pathways at a higher WTP threshold of 300,000/quality-adjusted life year. Sensitivity analysis did not substantially change these results. Conclusions: The most cost-effective strategy was 1st-line tyrosine kinase inhibitor therapy followed by 2nd-line immunotherapy. All pathways exceeded a commonly accepted WTP of USD 100–150,000/QALY. Our preliminary results warrant further studies to best inform real-world practices.

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Cost-Effectiveness Analysis of the Spanish Renal Replacement Therapy Program

Peritoneal Dialysis International ◽

10.3747/pdi.2011.00037 ◽

2012 ◽

Vol 32 (2) ◽

pp. 192-199 ◽

Cited By ~ 19

Author(s):

Guillermo Villa ◽

Lucía Fernández–Ortiz ◽

Jesús Cuervo ◽

Pablo Rebollo ◽

Rafael Selgas ◽

...

Keyword(s):

Cost Effectiveness ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Markov Chain Model ◽

Cost Savings ◽

Quality Adjusted Life Year ◽

Cost Effectiveness Analysis ◽

Chain Model ◽

Therapy Program ◽

Effectiveness Analysis

♦BackgroundWe undertook a cost-effectiveness analysis of the Spanish Renal Replacement Therapy (RRT) program for end-stage renal disease patients from a societal perspective. The current Spanish situation was compared with several hypothetical scenarios.♦MethodsA Markov chain model was used as a foundation for simulations of the Spanish RRT program in three temporal horizons (5, 10, and 15 years). The current situation (scenario 1) was compared with three different scenarios: increased proportion of overall scheduled (planned) incident patients (scenario 2); constant proportion of overall scheduled incident patients, but increased proportion of scheduled incident patients on peritoneal dialysis (PD), resulting in a lower proportion of scheduled incident patients on hemodialysis (HD) (scenario 3); and increased overall proportion of scheduled incident patients together with increased scheduled incidence of patients on PD (scenario 4).♦ResultsThe incremental cost-effectiveness ratios (ICERs) of scenarios 2, 3, and 4, when compared with scenario 1, were estimated to be, respectively, -€83 150, -€354 977, and -€235 886 per incremental quality-adjusted life year (ΔQALY), evidencing both moderate cost savings and slight effectiveness gains. The net health benefits that would accrue to society were estimated to be, respectively, 0.0045, 0.0211, and 0.0219 ΔQALYs considering a willingness-to-pay threshold of €35 000/ΔQALY.♦ConclusionsScenario 1, the current Spanish situation, was dominated by all the proposed scenarios. Interestingly, scenarios 3 and 4 showed the best results in terms of cost-effectiveness. From a cost-effectiveness perspective, an increase in the overall scheduled incidence of RRT, and particularly that of PD, should be promoted.

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

BMJ ◽

10.1136/bmj.38033.896505.eb ◽

2004 ◽

Vol 328 (7442) ◽

pp. 747 ◽

Cited By ~ 106

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.

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QALY-Time: Experts’ view on the use of the quality-adjusted life year in cost-effectiveness analysis in palliative care

10.21203/rs.2.13292/v1 ◽

2019 ◽

Author(s):

Anne B. Wichmann ◽

Lia C.M.J. Goltstein ◽

Ndidi J. Obihara ◽

Madeleine R. Berendsen ◽

Mark van Houdenhoven ◽

...

Keyword(s):

Decision Making ◽

Palliative Care ◽

Cost Effectiveness ◽

Quality Adjusted Life Year ◽

Capabilities Approach ◽

Nominal Group ◽

Future Research ◽

Measurement Tool ◽

Suitable Alternative ◽

Quality Adjusted Life

Abstract Background. The Quality-Adjusted Life Year (QALY) is internationally recognized as standard metric of health outcomes in cost-effectiveness analyses (CEAs) in healthcare. The ongoing debate concerning the appropriateness of its use for decision-making in palliative care has been recently mapped in a review. Aim. To report on and draw conclusions from two expert meetings that reflected on earlier mapped issues in order to reach consensus, and to advise on the QALY’s future use in palliative care. Methods. A nominal group approach was used. In order to facilitate group decision making, three statements regarding the use of the QALY in palliative care were discussed in a structured way. Two groups of international policymakers, healthcare professionals and researchers participated. Data were analysed qualitatively using inductive coding. Findings. 1) Most experts agreed that the recommended measurement tool for the QALYs ‘Q’ component, the EuroQol-5D (EQ-5D), is inappropriate for palliative care. A more sensitive tool, which might be based on the capabilities approach, could be used or developed. 2) Valuation of time should be incorporated in the ‘Q’ part, leaving the linear clock time in the ‘LY’ component. 3) Most experts agreed that the QALY, in its current shape, is not suitable for palliative care. Discussion. 1) Although the EQ-5D does not suffice, a generic tool is needed for the QALY. As long as no suitable alternative is available, other tools can be used besides or serve as basis for the EQ-5D because of issues in conceptual overlap. 2) Future research should further investigate the valuation of time issue, and how best to integrate it in the ‘Q’ component. 3) A generic outcome measure of effectiveness is essential to justly allocate healthcare resources. However, experts emphasized, the QALY is and should be one of multiple criteria for choices in the healthcare insurance package.

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Cost-Effectiveness Analysis of Hospice-Palliative Care for Adults with Terminal Cancer in South Korea

Korean Journal of Medicine ◽

10.3904/kjm.2019.94.3.273 ◽

2019 ◽

Vol 94 (3) ◽

pp. 273-280

Author(s):

Yeong Jun Ju ◽

Woorim Kim ◽

Yoon Soo Choy ◽

Joo Eun Lee ◽

Sang Ah Lee ◽

...

Keyword(s):

Palliative Care ◽

Cost Effectiveness ◽

South Korea ◽

Cost Effectiveness Analysis ◽

Terminal Cancer ◽

Effectiveness Analysis ◽

Hospice Palliative Care

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Comparing the cost-per-QALYs gained and cost-per-DALYs averted literatures

Gates Open Research ◽

10.12688/gatesopenres.12786.2 ◽

2018 ◽

Vol 2 ◽

pp. 5 ◽

Cited By ~ 1

Author(s):

Peter J. Neumann ◽

Jordan E. Anderson ◽

Ari D. Panzer ◽

Elle F. Pope ◽

Brittany N. D'Cruz ◽

...

Keyword(s):

Cost Effectiveness ◽

English Language ◽

Medical Center ◽

Quality Adjusted Life Year ◽

Cost Effectiveness Analysis ◽

Middle Income ◽

Effectiveness Analysis ◽

Global Cost ◽

Study Characteristics ◽

The Cost

Background: We examined the similarities and differences between studies using two common metrics used in cost-effectiveness analyses (CEAs): cost per quality-adjusted life year (QALY) gained and cost per disability-adjusted life year (DALY) averted. Methods: We used the Tufts Medical Center CEA Registry, which contains English-language cost-per-QALY gained studies, and the Global Cost-Effectiveness Analysis (GHCEA) Registry, which contains cost-per-DALY averted studies. We examined study characteristics, including intervention type, sponsor, country, and primary disease, and also compared the number of published CEAs to disease burden for major diseases and conditions across geographic regions. Results: We identified 6,438 cost-per-QALY and 543 cost-per-DALY studies published through 2016 and observed rapid growth for both literatures. Cost-per-QALY studies most often examined pharmaceuticals and interventions in high-income countries. Cost-per-DALY studies predominantly focused on infectious disease interventions and interventions in low and lower-middle income countries. We found that while diseases imposing a larger burden tend to receive more attention in the cost-effectiveness analysis literature, the number of publications for some diseases and conditions deviates from this pattern, suggesting “under-studied” conditions (e.g., neonatal disorders) and “over-studied” conditions (e.g., HIV and TB). Conclusions: The CEA literature has grown rapidly, with applications to diverse interventions and diseases. The publication of fewer studies than expected for some diseases given their imposed burden suggests funding opportunities for future cost-effectiveness research.

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PERFORMANCE-ADJUSTED LIFE YEARS MAY SUBSTITUTE FOR QUALITY-ADJUSTED LIFE YEARS IN COST-EFFECTIVENESS ANALYSIS FOR ELDERLY PATIENTS WITH ADVANCED LUNG CANCER

10.26226/morressier.5cdbe0aa618793e647b12a0d ◽

2019 ◽

Author(s):

Tateaki Naito ◽

Akifumi Notsu ◽

Taro Okayama ◽

Yusuke Yonenaga ◽

Takahisa Kawamura ◽

...

Keyword(s):

Lung Cancer ◽

Cost Effectiveness ◽

Elderly Patients ◽

Cost Effectiveness Analysis ◽

Advanced Lung Cancer ◽

Quality Adjusted Life Years ◽

Effectiveness Analysis ◽

Life Years ◽

Quality Adjusted Life

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Cost-effectiveness analysis of first-line treatments for early-stage, low-grade follicular lymphoma.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.6619 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 6619-6619 ◽

Cited By ~ 1

Author(s):

Joanna C. Yang ◽

Elena B. Elkin ◽

Rahul Parikh ◽

Joachim Yahalom

Keyword(s):

Cost Effectiveness ◽

Follicular Lymphoma ◽

Early Stage ◽

Complete Response ◽

Cost Effectiveness Analysis ◽

Low Grade ◽

First Line ◽

Effectiveness Analysis ◽

Cost Effective Treatment ◽

Quality Adjusted Life

6619 Background: Low-grade follicular lymphoma (FL) can present as localized stage I to II disease in up to one-third of patients. Upfront involved-site radiation therapy (RT) to 24-30Gy is the preferred first-line management strategy for these patients. However, the National LymphoCare Study found that less than one quarter of patients with early-stage, low-grade FL received upfront RT, while more than half received either chemoimmunotherapy or observation. Methods: We performed a cost-effectiveness analysis using a Markov state-transition model to simulate the progression of early-stage, low-grade FL in a cohort of 60-year-old men. The following first-line treatments were compared: RT, observation, rituximab induction (RI), rituximab and bendamustine (BR), and rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP). Patients who relapsed received second-line therapies that were dependent on their first-line treatment: RT for RI and observation, RCHOP for RT and BR, and BR for RCHOP. Disease-progression probabilities and other model inputs were from published trials. Results: First-line RT followed by RCHOP for relapses had a quality-adjusted life expectancy (QALE) of 11.4 years, superior to first-line observation, RI, BR, and RCHOP strategies. First-line RT strongly dominated observation, BR, and RCHOP. Compared with RI, first-line RT resulted in an incremental cost-effectiveness ratio of $2,740 per quality-adjusted life year. The probability of dying from other causes, the probability of a complete response to RT, and the probability of relapse had the greatest impact on both cost and effectiveness expected values. Conclusions: In contrast to current practice patterns, first-line RT is the most effective upfront treatment for patients with early-stage, low-grade FL. Further, first-line RT paired with RCHOP for relapses is a cost-effective treatment paradigm, relative to other strategies. [Table: see text]

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Health Economics of Vaccination and Immunization Practices

10.33442/vt202121 ◽

2021 ◽

Author(s):

Thomas Szucs

Keyword(s):

Cost Effectiveness ◽

Cost Benefit Analysis ◽

Cost Savings ◽

Cost Benefit ◽

Quality Adjusted Life Year ◽

Cost Utility ◽

Cost Effectiveness Analysis ◽

Vaccination Programs ◽

Effectiveness Analysis ◽

Wide Range

The economic importance of vaccines lies partly in the burden of disease that can be avoided and partly in the competition for resources between vaccines and other interventions. Decision-makers are increasingly demanding hard economic data as a basis for the allocation of limited healthcare resources. The main types of evaluation available are cost-benefit analysis (best use of allocated resources), cost-effectiveness analysis (a tool that helps policy-makers decide on the overall allocation of resources), and cost-utility analysis (quality-adjusted life year [QALY] which allows for a direct comparison of a wide range of medical interventions). The cost per QALY for a range of vaccinations can be compared in order to plan a vaccination program. Public health vaccines warrant a cost-benefit approach, in order to determine if they are worthwhile, whereas recommended vaccines might be more usefully assessed by cost-effectiveness analysis. Although cost-savings do not necessarily equate with cost-effectiveness, cost-savings are achieved in many vaccination programs.

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