scholarly journals Cost-effectiveness of rapid diagnostic tests, compared to microscopic tests, for the diagnosis and treatment of gestational malaria in Colombia from an institutional perspective

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Deisy Cristina Restrepo-Posada ◽  
Jaime Carmona-Fonseca ◽  
Jaiberth Antonio Cardona-Arias
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Tests ◽  
Cost Effective ◽  
Rapid Diagnostic Tests ◽  
Diagnosis And Treatment ◽  
Thick Blood Smear ◽  
Institutional Perspective ◽  
Monetary Benefit ◽  
The Cost ◽  
Net Monetary Benefit

Abstract Background Gestational malaria is associated with negative outcomes in maternal and gestational health; timely diagnosis is crucial to avoid complications. However, the limited infrastructure, equipment, test reagents, and trained staff make it difficult to use thick blood smear tests in rural areas, where rapid testing could be a viable alternative. The purpose of this study was to estimate the cost-effectiveness of rapid tests type III (Plasmodium falciparum/Plasmodium spp P.f/pan) versus microscopic tests for the diagnosis and treatment of gestational malaria in Colombia. Methods Cost-effectiveness analyses of gestational malaria diagnosis from an institutional perspective using a decision tree. Standard costing was performed for the identification, measurement and assessment phases, with data from Colombian tariff manuals. The data was collected from Health Situation Analysis, SIVIGILA and meta-analysis. Average and incremental cost-effectiveness ratio were estimated. The uncertainty was assessed through probabilistic sensitivity analysis. Results The cost of rapid diagnostic tests in 3,000 pregnant women with malaria was US$66,936 and 1,182 disability adjusted life years (DALYs) were estimated. The cost using thick blood smear tests was US$50,838 and 1,023 DALYs, for an incremental cost-effectiveness of US$ 101.2. The probabilistic sensitivity analysis of rapid diagnostic tests determined that they are highly cost-effective in 70% of the cases, even below the US$1,200 threshold; also, they showed an incremental net monetary benefit of $150,000 when payer’s willingness is US$1,000. Conclusion The use of rapid diagnostic tests for timely diagnosis and treatment of gestational malaria is a highly cost-effective strategy in Colombia, with uncertainty analyses supporting the robustness of this conclusion and the increased net monetary benefit that the health system would obtain. This strategy may help in preventing the negative effects on maternal health and the neonate at a low cost.

scholarly journals Correction to: Cost-effectiveness of rapid diagnostic tests, compared to microscopic tests, for the diagnosis and treatment of gestational malaria in Colombia from an institutional perspective

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Deisy Cristina Restrepo-Posada ◽  
Jaime Carmona-Fonseca ◽  
Jaiberth Antonio Cardona-Arias
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Tests ◽  
Rapid Diagnostic Tests ◽  
Diagnosis And Treatment ◽  
Institutional Perspective

An amendment to this paper has been published and can be accessed via the original article.

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.

scholarly journals Modelling the cost-effectiveness of introducing subsidised malaria rapid diagnostic tests in the private retail sector in sub-Saharan Africa

2020 ◽  
Vol 5 (5) ◽  
pp. e002138
Author(s):  
David Bath ◽  
Catherine Goodman ◽  
Shunmay Yeung
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Tests ◽  
Cost Effective ◽  
Rapid Diagnostic Tests ◽  
Sub Saharan Africa ◽  
Small Scale ◽  
Retail Sector ◽  
First Line ◽  
Sub Saharan ◽  
The Cost

BackgroundOver the last 10 years, there has been a huge shift in malaria diagnosis in public health facilities, due to widespread deployment of rapid diagnostic tests (RDTs), which are accurate, quick and easy to use and inexpensive. There are calls for RDTs to be made available at-scale in the private retail sector where many people with suspected malaria seek care. Retail sector RDT use in sub-Saharan Africa (SSA) is limited to small-scale studies, and robust evidence on value-for-money is not yet available. We modelled the cost-effectiveness of introducing subsidised RDTs and supporting interventions in the SSA retail sector, in a context of a subsidy programme for first-line antimalarials.MethodsWe developed a decision tree following febrile patients through presentation, diagnosis, treatment, disease progression and further care, to final health outcomes. We modelled results for three ‘treatment scenarios’, based on parameters from three small-scale studies in Nigeria (TS-N), Tanzania (TS-T) and Uganda (TS-U), under low and medium/high transmission (5% and 50% Plasmodium falciparum (parasite) positivity rates (PfPR), respectively).ResultsCost-effectiveness varied considerably between treatment scenarios. Cost per disability-adjusted life year averted at 5% PfPR was US$482 (TS-N) and US$115 (TS-T) and at 50% PfPR US$44 (TS-N) and US$45 (TS-T), from a health service perspective. TS-U was dominated in both transmission settings.ConclusionThe cost-effectiveness of subsidised RDTs is strongly influenced by treatment practices, for which further evidence is required from larger-scale operational settings. However, subsidised RDTs could promote increased use of first-line antimalarials in patients with malaria. RDTs may, therefore, be more cost-effective in higher transmission settings, where a greater proportion of patients have malaria and benefit from increased antimalarial use. This is contrary to previous public sector models, where RDTs were most cost-effective in lower transmission settings as they reduced unnecessary antimalarial use in patients without malaria.

scholarly journals The cost-effectiveness of azithromycin in reducing exacerbations in uncontrolled asthma

2020 ◽  
pp. 2002436 ◽  
Author(s):  
Ciaran O'Neill ◽  
Peter G Gibson ◽  
Liam G Heaney ◽  
John W Upham ◽  
Ian A Yang ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Healthcare Use ◽  
Uncontrolled Asthma ◽  
Societal Costs ◽  
Monetary Benefit ◽  
Lost Productivity ◽  
Therapy Costs ◽  
The Cost ◽  
Net Monetary Benefit

Add-on azithromycin (AZM) results in a significant reduction in exacerbations among adults with persistent uncontrolled asthma. The aim of this study was to assess the cost-effectiveness of add-on AZM in terms of healthcare and societal costs.The AMAZES trial randomly assigned 420 participants to AZM or placebo. Healthcare use and asthma exacerbations were measured during the treatment period. Healthcare use included all prescribed medicine and healthcare contacts. Costs of antimicrobial resistance (AMR) were estimated based on overall consumption and published estimates of costs. The value of an avoided exacerbation was based on published references. Differences in cost between the two groups were related to differences in exacerbations in a series of net monetary benefit estimates. Societal costs included lost productivity, over the counter medicines, steroid induced morbidity and AMR costs.Add-on AZM resulted in a reduction in healthcare costs (mean (95% CI)) including nights in hospital (AUD$433.70 ($48.59–$818.81) or €260.22(€29.15–€491.29)), unplanned healthcare visits (AUD$20.25 ($5.23–$35.27) or €12.15 (€3.14–€21.16)), antibiotic costs (AUD$14.88 ($7.55–$22.21) or €8.93(€4.53–€13.33)) and oral corticosteroid costs (AUD$4.73 ($0.82–$8.64) or €2.84(€0.49–€5.18)), all p<0.05. Overall healthcare and societal costs were lower (AUD$77.30 (€46.38) and AUD$256.22 (€153.73) respectively) albeit not statistically significant. The net monetary benefit of add-on AZM was estimated to be AUD$2072.30 (95% CI $1348.55–$2805.23) or (€1243.38 (€809.13–€1683.14) assuming a willingness to pay per exacerbation avoided of AUD$2651 (€1590.60). Irrespective of the sensitivity analysis applied, the net monetary benefit for total, moderate and severe exacerbations remained positive and significant.Add-on AZM therapy in poorly controlled asthma was a cost-effective therapy. Costs associated with AMR did not influence estimated cost-effectiveness.

scholarly journals Cost-effectiveness of treatment optimisation with biomarkers for immunotherapy in solid tumours: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e048141
Author(s):  
Sara Mucherino ◽  
Valentina Lorenzoni ◽  
Valentina Orlando ◽  
Isotta Triulzi ◽  
Marzia Del Re ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cost Effectiveness ◽  
Immune Checkpoint ◽  
Cost Utility ◽  
Solid Tumours ◽  
Economic Evaluations ◽  
Monetary Benefit ◽  
The Cost ◽  
Net Monetary Benefit

IntroductionThe combination of biomarkers and drugs is the subject of growing interest both from regulators, physicians and companies. This study protocol of a systematic review is aimed to describe available literature evidences about the cost-effectiveness, cost-utility or net-monetary benefit of the use of biomarkers in solid tumour as tools for customising immunotherapy to identify what further research needs.Methods and analysisA systematic review of the literature will be carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. PubMed and Embase will be queried from June 2010 to June 2021. The PICOS model will be applied: target population (P) will be patients with solid tumours treated with immune checkpoint inhibitors (ICIs); the interventions (I) will be test of the immune checkpoint predictive biomarkers; the comparator (C) will be any other targeted or non-targeted therapy; outcomes (O) evaluated will be health economic and clinical implications assessed in terms of incremental cost-effectiveness ratio, net health benefit, net monetary benefit, life years gained, quality of life, etc; study (S) considered will be economic evaluations reporting cost-effectiveness analysis, cost-utility analysis, net-monetary benefit. The quality of the evidence will be graded according to Grading of Recommendations Assessment, Development and Evaluation.Ethics and disseminationThis systematic review will assess the cost-effectiveness implications of using biomarkers in the immunotherapy with ICIs, which may help to understand whether this approach is widespread in real clinical practice. This research is exempt from ethics approval because the work is carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal.PROSPERO registration numberCRD42020201549.

Abstract 171: Endovascular Thrombectomy May Be Cost-Effective for Patients With Large Core Ischemic Strokes: A Cost-Utility Analysis From the SELECT Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Elena Pizzo ◽  
Kyriakos Lobotesis ◽  
Gregory W Albers ◽  
Sheryl Martin-Schild ◽  
Ameer Hassan ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Utility ◽  
Large Core ◽  
Multicenter Cohort Study ◽  
Endovascular Thrombectomy ◽  
Monetary Benefit ◽  
Life Years ◽  
Ischemic Core ◽  
Net Monetary Benefit

Background: Whether Endovascular Thrombectomy (EVT) is cost-effective in large ischemic core infarcts is unknown. Methods: In the prospective multicenter cohort study of imaging selection study (SELECT), large core was defined as CT ASPECTS < 6 or CTP ischemic core volume (rCBF<30%) ≥ 50 cc. A Markov model estimated costs, quality-adjusted life years (QALYs) and the Incremental Cost-effectiveness Ratio (ICER) of EVT compared to Medical Management (MM) over 20 years life expectancy. The lower and upper willingness to pay (WTP) per QALY were set at $50000 and $100000 and the Net Monetary Benefit (NMB) for EVT were calculated. A probabilistic sensitivity analysis (PSA) and cost-effectiveness acceptability curves (CEAC) assessed EVT cost-effective probability at WTP range values. Results: Of 361 enrolled, 105 had large core on CT or CTP (EVT 62, MM 43). 19 (31%) EVT patients achieved mRS 0-2 vs 6 (14%) MM (aOR: 3.27, 95% CI: 1.11-9.62; P = .03) with a shift towards better mRS (adj cOR: 2.12, 95% CI: 1.05-4.31, P = .04). Over 20 years EVT was associated with $26589 (C.I. $8672- $43978) incremental costs and a gain of 1.18 QALYs (C.I. 0.091- 2.2) per patient. EVT could avert 75 deaths over a theoretical cohort of 1000 patients (MM 861 vs EVT 786) thus the ICER of EVT compared to MM was $22400 per QALY (CI. $10109 - $66140), which is <$50000/QALY, Tab 1. EVT has a higher NMB compared to MM at the lower and upper WTP thresholds (EVT $86,3 and 271,4 million vs MM $53,6-$179,3 million), Tab 2. The PSA confirmed the results (fig 1). The CEAC showed 94% and 97% cost-effectiveness probability of EVT at the lower and upper values respectively of the maximum WTP, fig 2. EVT ICER in SELECT large core ($22400/QALY) was higher but still comparable to those in HERMES ($16882/QALY), DAWN ($7335/QALY) and DEFUSE3 ($14673/QALY), Tab 3. Conclusion: EVT may result in better outcomes and more lives saved in large core patients with higher QALYs, NMB and an acceptable ICER. The results were comparable to other EVT RCTs.

Impact and Cost Effectiveness of Videonystagmography

2020 ◽  
pp. 000348942096887
Author(s):  
Garrett Ni ◽  
Christine Kim ◽  
Lakshmi Nair ◽  
Alexander G. Bien ◽  
Daohai Yu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Treatment Plan ◽  
Cost Effective ◽  
Diagnosis And Treatment ◽  
Medicare Reimbursement ◽  
Treatment Plans ◽  
Vestibular Symptoms ◽  
The Cost ◽  
Evidence Based Guidelines ◽  
The Impact

Objective: Videonystagmography (VNG) is a commonly ordered test to evaluate patients with vestibular complaints. To date, there are no evidence-based guidelines for evaluating patients presenting with vestibular symptoms. This study evaluates the cost effectiveness of VNG and the impact of VNG findings on patient management. Methods: Patient charts were reviewed from 3 institutions to collect the pre- and post-VNG ICD-9/10 diagnosis and treatment plan. VNG findings were recorded to calculate the incidence of abnormal findings and the incidence of change in diagnosis and/or treatment plan. The cost effectiveness of VNG was estimated based on these calculations. Results: A total of 120 patient charts were reviewed. 69/120 (57.5%; 95% CI: 48.2%-66.5%) patients had abnormal findings on their VNG. A change in diagnosis was noted in 24/120 (20.0%; 95% CI: 13.3%-28.3%) patients. A change in treatment plan was noted in 62/120 (51.7%; 95% CI: 42.4%-60.9%) patients, and 11/120 (9.2%; 95% CI: 4.7%-15.8%) had a change in diagnosis that led to change in treatment plan. Using the average Medicare reimbursement for VNG, the cost effectiveness analysis showed a cost of $869.57 per VNG with abnormal findings and a cost of $5454.55 per VNG that lead to a change in diagnosis and treatment plan. Conclusions: VNG findings may not result in changes in clinical diagnosis. However, VNG is impactful at influencing treatment plan changes. VNG results are beneficial for counseling patients, guiding treatment plans, and managing patient expectations. When there is a clear indication, VNG testing can be cost effective in managing patients presenting with vestibular symptoms.

scholarly journals Cost-effectiveness of whole area testing of asymptomatic SARS-CoV-2 infections in Merthyr Tydfil, 2020: A Modelling and economic analysis

2021 ◽  
Author(s):  
Mark Drakesmith ◽  
Brendan Collins ◽  
Kelechi Nnoaham ◽  
Angela Jones ◽  
Daniel Rhys Thomas
Keyword(s):  
Cost Effectiveness ◽  
Health Benefit ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Cost Ratio ◽  
Case Scenario ◽  
Monetary Benefit ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Net Monetary Benefit

Objectives: To evaluate the cost effectiveness of an asymptomatic SARS-CoV-2 whole area testing pilot. Design: Epidemiological modelling and cost effectiveness analysis. Setting: The community of Merthyr Tydfil County Borough between20 Nov and 21 Dec 2020. Participants: A total of 33,822 people tested as part of the pilot in Merthyr Tydfil County Borough, 712 of whom tested positive by lateral flow test and reported being asymptomatic. Main outcome measures: Estimated number of cases, hospitalisations, ICU admissions and deaths prevented, and associated costs per quality-adjusted life years (QALYs) gained and monitory cost to the healthcare system. Results: An initial conservative estimate of 360 (95% CI: 311 - 418) cases were prevented by the mass testing, representing a would-be reduction of 11% of all cases diagnosed in Merthyr Tydfil residents during the same period. Modelling healthcare burden estimates that 24 (16 - 36) hospitalizations, 5 (3 - 6) ICU admissions and 15 (11 - 20) deaths were prevented, representing 6.37%, 11.1% and 8.19%, respectively of the actual counts during the same period. A less conservative, best-case scenario predicts a much higher number of cases prevented of 2328 (1761 - 3107), representing 80% reduction in would-be cases. Cost effectiveness analysis indicates 108 (80 - 143) QALYs gained, an incremental cost ratio of &#163 2,143 (&#163 860-&#163 4,175) per QALY gained and net monetary benefit of &#163 6.2m (&#163 4.5m-&#163 8.4m). In the less conservative scenario, the net monetary benefit increases to &#163 15.9m (&#163 12.3m-&#163 20.5m). Conclusions: A significant number of cases, hospitalisations and deaths were prevented by the mass testing pilot. Considering QALYs lost and healthcare costs avoided, the pilot was cost-effective. These findings suggest mass testing with LFDs in areas of high prevalence (>2%) is likely to provide significant public health benefit. It is not yet clear whether similar benefits will be obtained in low prevalence settings.

scholarly journals Cost-Effectiveness of Three Poliovirus Immunization Schedules in Shanghai, China

Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1062
Author(s):  
Jia Ren ◽  
Hairenguli Maimaiti ◽  
Xiaodong Sun ◽  
Zhuoying Huang ◽  
Jiechen Liu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Polio Eradication ◽  
Paralytic Poliomyelitis ◽  
Tree Model ◽  
Monetary Benefit ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Polio Immunization ◽  
The Cost

In Shanghai, China, a polio immunization schedule of four inactivated polio vaccines (IPV) has been implemented since 2020, replacing the schedules of a combination of two IPVs and two bivalent live attenuated oral polio vaccines (bOPV), and four trivalent live attenuated oral polio vaccines (tOPV). This study aimed to assess the cost-effectiveness of these three schedules in infants born in 2016, in preventing vaccine-associated paralytic poliomyelitis (VAPP). We performed a decision tree model and estimated incremental cost-effectiveness ratio (ICER). Compared to the four-tOPV schedule, the two-IPV-two-bOPV schedule averted 1.2 VAPP cases and 16.83 disability-adjusted life years (DALY) annually; while the four-IPV schedule averted 1.35 VAPP cases and 18.96 DALY annually. Consequently, ICERVAPP and ICERDALY were substantially high for two-IPV-two-bOPV (CNY 12.96 million and 0.93 million), and four-IPV (CNY 21.24 million and 1.52 million). Moreover, net monetary benefit of the two-IPV-two-bOPV and four-IPV schedules was highest when the cost of IPV was hypothesized to be less than CNY 23.75 or CNY 9.11, respectively, and willingness-to-pay was hypothesized as CNY 0.6 million in averting one VAPP-induced DALY. IPV-containing schedules are currently cost-ineffective in Shanghai. They may be cost-effective by reducing the prices of IPV, which may accelerate polio eradication in Chinese settings.

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