scholarly journals Is your syringe services program cost-saving to society? A methodological case study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Don C. Des Jarlais ◽  
Jonathan Feelemyer ◽  
Courtney McKnight ◽  
Kelly Knudtson ◽  
Sara N. Glick
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Hiv Infection ◽  
Hiv Transmission ◽  
Hiv Infections ◽  
Effectiveness Study ◽  
Persons Who Inject Drugs ◽  
Annual Budget ◽  
The Cost ◽  
Cost Effectiveness Study

Abstract Background While there is a general acceptance among public health officials and policy-makers that syringe services programs can be effective in reducing HIV transmission among persons who inject drugs, local syringe services programs are often asked to provide economic justifications for their activities. A cost-effectiveness study, estimating the cost of preventing one HIV infection, would be the preferred methods for addressing this economic question, but few local syringe services programs have the needed data, staff and epidemiologic modeling resources needed for a cost–effectiveness study. We present a method for estimating a threshold value for the number of HIV infections prevented above which the program will be cost-saving to society. An intervention is considered “cost-saving” when it leads to a desirable health outcome a lower cost than the alternative. Methods The research literature on the effectiveness of syringe services programs in controlling HIV transmission among persons who inject drugs and guidelines for syringe services program that are “functioning very well” were used to estimate the cost-saving threshold at which a syringe services program becomes cost-saving through preventing HIV infections versus lifetime treatment of HIV. Three steps are involved: (1) determining if HIV transmission in the local persons who inject drugs (PWID) population is being controlled, (2) determining if the local syringe services program is functioning very well, and then (3) dividing the annual budget of the syringe services program by the lifetime cost of treating a single HIV infection. Results A syringe services program in an area with controlled HIV transmission (with HIV incidence of 1/100 person-years or less), functioning very well (with high syringe coverage, linkages to other services, and monitoring the local drug use situation), and an annual budget of $500,000 would need to prevent only 3 new HIV infections per year to be cost-saving. Conclusions Given the high costs of treating HIV infections, syringe services programs that are operating according to very good practices (“functioning very well”) and in communities in which HIV transmission is being controlled among persons who inject drugs, will almost certainly be cost-saving to society.

scholarly journals Strošek In Učinkovitost Zdravljenja Shizofrenije Z Atipičnimi Antipsihotiki V Sloveniji: Raziskava Stroškovne Učinkovitosti / The Cost And Effects Of Atypical Antipsychotic Agents In Patients With Schizophrenia In Slovenia: A Cost Effectiveness Study

2013 ◽  
Vol 52 (1) ◽  
pp. 27-38 ◽  
Author(s):  
Matej Štuhec ◽  
Demetrij Petrica ◽  
Janez Toni
Keyword(s):  
Cost Effectiveness ◽  
Atypical Antipsychotic ◽  
Antipsychotic Agents ◽  
Effectiveness Study ◽  
Atypical Antipsychotic Agents ◽  
The Cost ◽  
Cost Effectiveness Study

Izvleček Uvod: Zdravljenje z atipičnimi antipsihotiki predstavlja najpomembnejši način zdravljenja bolnikov z akutno shizofrenijo in predstavlja veliki strošek. V Sloveniji nam primanjkuje raziskav stroškovne učinkovitosti atipičnih antipsihotikov, ki jih lahko uporabimo v klinični praksi. Namen: Osnovni namen raziskave je bil primerjava stroškov in učinkovitosti petih atipičnih antipsihotikov z največjim tržnim deležem v letu 2011 v Sloveniji. V raziskavo smo vključili aripiprazol, kvetiapin, paliperidon, risperidon in olanzapin. Metode: Ciljna populacija v raziskavi so bili slovenski bolniki z akutno shizofrenijo. Vsak izmed petih antipsihotikov predstavlja glavno vejo odločitvenega drevesa. Terapevtska učinkovitost je bila določena kot verjetnost letne remisije. Ceno dnevnega zdravljenja s posameznim zdravilom smo pridobili iz podatkov tržnega deleža in prometa v letu 2011, stroške mentalnega zdravstvenega varstva v Sloveniji pa smo pridobili iz podatkov Zavoda za zdravstveno zavarovanje Republike Slovenije. Raziskava je bila zasnovana z vidika plačnika, tj. Zavoda za zdravstveno zavarovanje Republike Slovenije. Rezultati: Zdravljenje z risperidonom je najcenejše, najučinkovitejše pa z olanzapinom. Strategija zdravljenja z risperidonom ima najmanjši kvocient med stroški in učinkovitostjo. Strategije zdravljenja z aripiprazolom, s kvetiapinom in paliperidonom so prevladujoče. Cene letnega zdravljenja so: 6.812 EUR za risperidon, 7.509 EUR za kvetiapin, 7.295 EUR za olanzapin, 8.229 EUR za aripiprazol in 8.044 EUR za paliperidon. Učinkovitosti, podane v deležu letne remisije, so: 0,605 - kvetiapin, 0,603 - aripiprazol, 0,671 - risperidon, 0,723 - olanzapin in 0,712 - paliperidon. Sklep: Rezultati študije kažejo, da je najbolj stroškovno učinkovito zdravljenje akutne shizofrenije z risperidonom in olanzapinom

A Comparative Cost-Effectiveness Study of Two Treatment Modalities for Ragweed Hay Fever

1989 ◽  
Vol 3 (2) ◽  
pp. 99-104 ◽  
Author(s):  
Frederick E. Leickly ◽  
Dolores Sears-Ewald ◽  
Dennis R. Ownby
Keyword(s):  
Allergic Rhinitis ◽  
Cost Effectiveness ◽  
Low Dose ◽  
Hay Fever ◽  
Treatment Modalities ◽  
Effectiveness Study ◽  
Cost Of Treatment ◽  
Comparative Cost ◽  
The Cost ◽  
Cost Effectiveness Study

The cost of treatment for ragweed hay fever can vary considerably. The newer classes of antihistamines are purported to be effective and without major side effects, but they are costly. This study compared the cost-effectiveness of terfenadine and chlorpheniramine/pseudoephedrine. We found that the maximum use of a low dose of chlorpheniramine/pseudoephedrine was effective and without major daytime sedation and should be considered when treatment for ragweed-induced allergic rhinitis is begun.

scholarly journals Moving forward: Cost-Effectiveness of PrEP in HIV prevention for Men Who Have Sex with Men in Italy

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M C Nurchis ◽  
M T Riccardi ◽  
M Sapienza ◽  
D Pascucci ◽  
G Damiani
Keyword(s):  
Monte Carlo ◽  
Cost Effectiveness ◽  
Hiv Infection ◽  
Hiv Transmission ◽  
Cost Effective ◽  
Critical Parameters ◽  
Model Parameters ◽  
Susceptible Population ◽  
Sex With Men ◽  
The Cost

Abstract Globally, in 2018 1.7 million people contracted Human Immunodeficiency Virus (HIV) and 770,000 people died from AIDS-related illnesses. Men Who Have Sex with Men (MSM) have one of the highest probabilities of HIV transmission. In Italy, in 2018 2,847 new HIV cases were diagnosed, of which 39% among MSM. The MSM population accounts for 16,690 individuals whereof 50% already underwent the Highly Active Antiretroviral Therapy (HAART). The aim of this study is to evaluate the cost-effectiveness of daily Pre-Exposure Prophylaxis (PrEP) in the Italian MSM susceptible population. A Markov transition model was calibrated to the HIV epidemic among MSM in Italy, comparing PrEP to naïve patients (NP). Model parameters were retrieved by querying scientific databases. Transition probabilities were adjusted for incidence of HIV while costs and benefits were discounted at an annual rate of 3%. The impact on results of critical parameters was explored through a Monte Carlo-based sensitivity analysis. The cost-effectiveness analysis results were reported as Incremental Cost-Effectiveness Ratio (ICER) express as € per Quality Adjusted Life Year (QALY) gained. The introduction of such a PrEP program would result in a total cost of €822,398,199 million and lead to a gain of 70,762 discounted QALYs over an 85-year time horizon. Assuming a 92% efficacy of PrEP therapy, the ICER for the PrEP program is €4,346.16/QALY gained. This value is definitively lower than acceptability NICE threshold (£20,000). PrEP can reduce the infection rate up to 60% in a five-year period. The Monte Carlo simulation confirmed the robustness of the model results. This analysis showed PrEP to be cost-effective when used in a susceptible population. Even if PrEP doesn't protect from other sex-related infectious diseases, it could prevent HIV transmission, thus breaking down HIV-infection incidence rate. Each country should reflect on the real possibility to implement a robust Public Health program pondering the adoption of PrEP. Key messages PrEP is very effective at reducing HIV infection when taken correctly. It is the backbone in the “combination prevention”, necessary to reach the SDG of ending the AIDS epidemic by 2030. This preliminary analysis suggests that the introduction of a daily PrEP program for MSM in Italy is cost-effective and possibly cost saving in the long term.

scholarly journals Cost-effectiveness of zoledronic acid compared with sequential denosumab/alendronate for older osteoporotic women in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Mori ◽  
Carolyn J. Crandall ◽  
Tomoko Fujii ◽  
David A. Ganz
Keyword(s):  
Health Economic ◽  
Cost Effectiveness ◽  
Zoledronic Acid ◽  
Cost Saving ◽  
Fragility Fracture ◽  
Community Dwelling ◽  
Sensitivity Analyses ◽  
Term Care ◽  
Lifetime Horizon ◽  
The Cost

Abstract Summary Among hypothetical cohorts of older osteoporotic women without prior fragility fracture in Japan, we evaluated the cost-effectiveness of two treatment strategies using a simulation model. Annual intravenous zoledronic acid for 3 years was cost-saving compared with biannual subcutaneous denosumab for 3 years followed by weekly oral alendronate for 3 years. Purpose Osteoporosis constitutes a major medical and health economic burden to society worldwide. Injectable treatments for osteoporosis require less frequent administration than oral treatments and therefore have higher persistence and adherence with treatment, which could explain better efficacy for fracture prevention. Although annual intravenous zoledronic acid and biannual subcutaneous denosumab are available, it remains unclear which treatment strategy represents a better value from a health economic perspective. Accordingly, we examined the cost-effectiveness of zoledronic acid for 3 years compared with sequential denosumab/alendronate (i.e., denosumab for 3 years followed by oral weekly alendronate for 3 years, making the total treatment duration 6 years) among hypothetical cohorts of community-dwelling osteoporotic women without prior fragility fracture in Japan at ages 65, 70, 75, or 80 years. Methods Using a previously validated and updated Markov microsimulation model, we obtained incremental cost-effectiveness ratios (Japanese yen [¥] (or US dollars [$]) per quality-adjusted life-year [QALY]) from the public healthcare and long-term care payer’s perspective over a lifetime horizon with a willingness-to-pay of ¥5 million (or $47,500) per QALY. Results In the base case, zoledronic acid was cost-saving (i.e., more effective and less expensive) compared with sequential denosumab/alendronate. In deterministic sensitivity analyses, results were sensitive to changes in the efficacy of zoledronic acid or the cumulative persistence rate with zoledronic acid or denosumab. In probabilistic sensitivity analyses, the probabilities of zoledronic acid being cost-effective were 98–100%. Conclusions Among older osteoporotic women without prior fragility fracture in Japan, zoledronic acid was cost-saving compared with sequential denosumab/alendronate.

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