Use of clinical history (CH) for Lynch syndrome (LS) risk assessment: An economic decision analysis.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1514-1514
Author(s):  
Sarmad Sadeghi ◽  
Afsaneh Barzi ◽  
Michael W. Kattan ◽  
Neal J. Meropol
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Clinical History ◽  
Effective Strategies ◽  
Effectiveness Measure ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Screening Strategies ◽  
Highly Sensitive ◽  
Comprehensive Comparison

1514 Background: Previous studies comparing screening strategies (STs) for LS concluded that immunohistochemistry (IHC)-based STs are most cost effective. However, these analyses generally exclude clinical history (CH)-based criteria due to concerns for reliability, e.g. Amsterdam (Ams), Bethesda (Beth), MMRpro (Mpro), MMRpredict (Mpre) and PREMM (PRE). We conducted a comprehensive comparison of all STs. Methods: Using assumptions from published reports we performed a cost effectiveness analysis (CEA) with a societal viewpoint using TreeAge software. 20 STs for proband (Pd) and general population (GP) screening in a cohort of 100,000 assumed a 3% LS prevalence (Prev) in Pd and 0.23% in GP, 5 first degree relatives (FDRs) per LS diagnosis (Dx), 50% LS Prev in FDRs, and 90% genetic testing (GT) compliance in Pds and GP and 52% in FDRs. We used the number of LS Dxs as effectiveness measure (EM). Sensitivity, accuracy, and incremental cost effectiveness ratios (ICERs) were calculated. Results: The ST of Mpro followed by GT is highly sensitive and has an accuracy of .997. Assuming 1-1.4 life years saved per Dx based on prior studies, this strategy is also cost effective. Strategies with greater sensitivity were dominated or not cost effective. Table shows results in order of increasing cost per Dx. Conclusions: This comprehensive comparison suggests that Mpro is an appropriate first step in screening for LS in Pds, and its routine use may be considered as a quality measure in the management of colorectal cancer. IHC + BRAF, GT should be reserved for Pds where CH is incomplete. [Table: see text]

Use of predictive models (PMs) in colorectal cancer (CRC) for diagnosis of Lynch syndrome (LS): A process measure for quality of care.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 116-116
Author(s):  
Sarmad Sadeghi ◽  
Afsaneh Barzi ◽  
Michael W. Kattan ◽  
Neal J. Meropol
Keyword(s):  
Quality Of Care ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Community Centers ◽  
Clinical Criteria ◽  
Process Measure ◽  
Life Years ◽  
Screening Strategies ◽  
Comprehensive Comparison

116 Background: LS diagnosis (Dx) in CRC patients (probands or Pds) and their first degree relatives (FDRs) impacts the management, outcomes and quality of care. Lack of a uniform approach to screening in academic and community centers is an impediment. Recent studies advocate universal immunohistochemistry (IHC) testing for Pds; however, these analyses exclude clinical criteria e.g., Amsterdam (Ams), Bethesda (Beth), and PMs, e.g., MMRpro (Mpro), MMRpredict (Mpre), and PREMM (PRE) due to concerns for reliability. This comprehensive comparison of all LS screening strategies (STs) aims to identify a cost effective process measure that addresses this need. Methods: We performed a cost effectiveness analysis with a societal viewpoint using TreeAge software. 21 STs for Pd and general population (GP) screening in a population of 100,000 were examined assuming a 3% LS prevalence (Prev) in Pd and 0.23% in GP, 5 FDRs per LS (Dx), 50% LS Prev in FDRs, and 90% germline testing (GT) compliance in Pds and GP and 52% in FDRs. Sensitivity, life years gained (LYG), and incremental cost effectiveness ratios (ICERs) were calculated. Results: See table. Conclusions: This study suggests that Mpro is a cost-effective first step in screening for LS in Pds, and its routine use may be considered as a possible process measure for quality of care in CRC patients. Up-front IHC +/- BRAF, GT could be reserved for Pds where history is incomplete. [Table: see text]

Cost-effectiveness Analysis of Submandibular Gland Preservation With Sialendoscopy for the Management of Sialolithiasis

2021 ◽  
pp. 019459982110268
Author(s):  
Joseph R. Acevedo ◽  
Ashley C. Hsu ◽  
Jeffrey C. Yu ◽  
Dale H. Rice ◽  
Daniel I. Kwon ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Submandibular Gland ◽  
Average Cost ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Probability Of Success ◽  
Markov Decision Model ◽  
The Cost

Objective To compare the cost-effectiveness of sialendoscopy with gland excision for the management of submandibular gland sialolithiasis. Study Design Cost-effectiveness analysis. Setting Outpatient surgery centers. Methods A Markov decision model compared the cost-effectiveness of sialendoscopy versus gland excision for managing submandibular gland sialolithiasis. Surgical outcome probabilities were found in the primary literature. The quality of life of patients was represented by health utilities, and costs were estimated from a third-party payer’s perspective. The effectiveness of each intervention was measured in quality-adjusted life-years (QALYs). The incremental costs and effectiveness of each intervention were compared, and a willingness-to-pay ratio of $150,000 per QALY was considered cost-effective. One-way, multivariate, and probabilistic sensitivity analyses were performed to challenge model conclusions. Results Over 10 years, sialendoscopy yielded 9.00 QALYs at an average cost of $8306, while gland excision produced 8.94 QALYs at an average cost of $6103. The ICER for sialendoscopy was $36,717 per QALY gained, making sialendoscopy cost-effective by our best estimates. The model was sensitive to the probability of success and the cost of sialendoscopy. Sialendoscopy must meet a probability-of-success threshold of 0.61 (61%) and cost ≤$11,996 to remain cost-effective. A Monte Carlo simulation revealed sialendoscopy to be cost-effective 60% of the time. Conclusion Sialendoscopy appears to be a cost-effective management strategy for sialolithiasis of the submandibular gland when certain thresholds are maintained. Further studies elucidating the clinical factors that determine successful sialendoscopy may be aided by these thresholds as well as future comparisons of novel technology.

Ixazomib (IXA), carfilzomib (CAR), elotuzumab (ELO) or daratumumab (DAR) with lenalidomide and dexamethasone (LEN+DEX) versus LEN+DEX only in relapsed/refractory multiple myeloma (R/R MM): A comparative cost-effectiveness analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 8043-8043
Author(s):  
Mavis Obeng-Kusi ◽  
Daniel Arku ◽  
Neda Alrawashdh ◽  
Briana Choi ◽  
Nimer S. Alkhatib ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Effectiveness Analysis ◽  
The Other ◽  
Sensitivity Analyses ◽  
Treatment Comparison ◽  
Comparative Cost ◽  
Effectiveness Analysis ◽  
Life Years

8043 Background: IXA, CAR, ELO and DARin combination with LEN+DEXhave been found superior in efficacy compared to LEN+DEX in the management of R/R MM. Applying indirect treatment comparisons from a network meta-analysis (NMA), this economic evaluation aimed to estimate the comparative cost-effectiveness and cost-utility of these four triplet regimens in terms of progression-free survival (PFS). Methods: In the absence of direct treatment comparison from a single clinical trial, NMA was used to indirectly estimate the comparative PFS benefit of each regimen. A 2-state Markov model simulating the health outcomes and costs was used to evaluate PFS life years (LY) and quality-adjusted life years (QALY) with the triplet regimens over LEN+DEX and expressed as the incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR). Probability sensitivity analyses were conducted to assess the influence of parameter uncertainty on the model. Results: The NMA revealed that DAR+LEN+DEX was superior to the other triplet therapies, which did not differ statistically amongst them. As detailed in the Table, in our cost-effectiveness analysis, all 4 triplet regimens were associated with increased PFSLY and PFSQALY gained (g) over LEN+DEX at an additional cost. DAR+LEN+DEX emerged the most cost-effective with ICER and ICUR of $667,652/PFSLYg and $813,322/PFSQALYg, respectively. The highest probability of cost-effectiveness occurred at a willingness-to-pay threshold of $1,040,000/QALYg. Conclusions: Our economic analysis shows that all the triplet regimens were more expensive than LEN +DEX only but were also more effective with respect to PFSLY and PFSQALY gained. Relative to the other regimens, the daratumumab regimen was the most cost-effective.[Table: see text]

scholarly journals Cost-effectiveness of Stockholm3 test and magnetic resonance imaging in prostate cancer screening: a microsimulation study

2021 ◽  
Author(s):  
Shuang Hao ◽  
Emelie Heintz ◽  
Ellinor Östensson ◽  
Andrea Discacciati ◽  
Fredrik Jäderling ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Magnetic Resonance ◽  
Cost Effective ◽  
Resonance Imaging ◽  
Life Years ◽  
Incidence And Mortality ◽  
Screening Strategies ◽  
Reflex Threshold

AbstractObjectiveAssess the cost-effectiveness of no screening and quadrennial magnetic resonance imaging (MRI)-based screening for prostate cancer using either Stockholm3 or prostate-specific antigen (PSA) test as a reflex test.MethodsTest characteristics were estimated from the STHLM3-MR study (NCT03377881). A cost-utility analysis was conducted from a lifetime societal perspective using a microsimulation model for men aged 55-69 in Sweden for no screening and three quadrennial screening strategies, including: PSA≥3ng/mL; and Stockholm3 with reflex test thresholds of PSA≥1.5 and 2ng/mL. Men with a positive test had an MRI, and those MRI positive had combined targeted and systematic biopsies. Predictions included the number of tests, cancer incidence and mortality, costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Uncertainties in key parameters were assessed using sensitivity analyses.ResultsCompared with no screening, the screening strategies were predicted to reduce prostate cancer deaths by 7-9% across a lifetime and were considered to be moderate costs per QALY gained in Sweden. Using Stockholm3 with a reflex threshold of PSA≥2ng/mL resulted in a 60% reduction in MRI compared with screening using PSA. This Stockholm3 strategy was cost-effective with a probability of 70% at a cost-effectiveness threshold of €47,218 (500,000 SEK).ConclusionsAll screening strategies were considered to be moderate costs per QALY gained compared with no screening. Screening with Stockholm3 test at a reflex threshold of PSA≥2ng/mL and MRI was predicted to be cost-effective in Sweden. Use of the Stockholm3 test may reduce screening-related harms and costs while maintaining the health benefits from early detection.

scholarly journals The Cost-Effectiveness of Hepatitis C Virus Screening Strategies among Recently Arrived Migrants in the Netherlands

2020 ◽  
Vol 17 (17) ◽  
pp. 6091
Author(s):  
Mohamed N.M.T. Al Khayat ◽  
Job F.H. Eijsink ◽  
Maarten J. Postma ◽  
Jan C. Wilschut ◽  
Marinus van Hulst
Keyword(s):  
Hepatitis C Virus ◽  
Cost Effectiveness ◽  
Hepatitis C ◽  
The Netherlands ◽  
Budget Impact ◽  
Cost Effective ◽  
Life Years ◽  
Screening Strategies ◽  
Hcv Screening ◽  
The Cost

Objective: We aimed to assess the cost-effectiveness of hepatitis C virus (HCV) screening strategies among recently arrived migrants in the Netherlands. Methods: A Markov model was used to estimate the health effects and costs of HCV screening from the healthcare perspective. A cohort of 50,000 recently arrived migrants was used. In this cohort, three HCV screening strategies were evaluated: (i) no screening, (ii) screening of migrants from HCV-endemic countries and (iii) screening of all migrants. Results: Strategy (ii) screening of migrants from HCV-endemic countries compared to strategy (i) no screening, yielded an incremental cost-effectiveness ratio (ICER) of €971 per quality-adjusted life-years (QALYs) gained. Strategy (iii) screening of all migrants compared with strategy (ii) screening of migrants from HCV-endemic countries yielded an ICER of €1005 per QALY gained. The budget impact of strategy (ii) screening of migrants from HCV-endemic countries and strategy (iii) screening of all migrants was €13,752,039 and €20,786,683, respectively. Conclusion: HCV screening is cost-effective. However, the budget impact may have a strong influence on decision making.

scholarly journals Cost-Effectiveness Analysis of Imaging Modalities for Breast Cancer Surveillance Among BRCA1/2 Mutation Carriers: A Systematic Review

2022 ◽  
Vol 11 ◽  
Author(s):  
Jiaxin Li ◽  
Ziqi Jia ◽  
Menglu Zhang ◽  
Gang Liu ◽  
Zeyu Xing ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Cancer Surveillance ◽  
Cochrane Library ◽  
Mutation Carriers ◽  
Life Years ◽  
Screening Strategies ◽  
The Impact

BackgroundBRCA1/2 mutation carriers are suggested with regular breast cancer surveillance screening strategies using mammography with supplementary MRI as an adjunct tool in Western countries. From a cost-effectiveness perspective, however, the benefits of screening modalities remain controversial among different mutated genes and screening schedules.MethodsWe searched the MEDLINE/PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases to collect and compare the results of different cost-effectiveness analyses. A simulated model was used to predict the impact of screening strategies in the target group on cost, life-year gained, quality-adjusted life years, and incremental cost-effectiveness ratio (ICER).ResultsNine cost-effectiveness studies were included. Combined mammography and MRI strategy is cost-effective in BRCA1 mutation carriers for the middle-aged group (age 35 to 54). BRCA2 mutation carriers are less likely to benefit from adjunct MRI screening, which implies that mammography alone would be sufficient from a cost-effectiveness perspective, regardless of dense breast cancer.ConclusionsPrecision screening strategies among BRCA1/2 mutation carriers should be conducted according to the acceptable ICER, i.e., a combination of mammography and MRI for BRCA1 mutation carriers and mammography alone for BRCA2 mutation carriers.Systematic Review RegistrationPROSPERO, identifier CRD42020205471.

scholarly journals Cost-effectiveness analysis of a physician deployment program to improve access to healthcare in rural and underserved areas in the Philippines

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033455
Author(s):  
Anton L.V. Avanceña ◽  
Kim Patrick S Tejano ◽  
David W. Hutton
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
The Philippines ◽  
Cost Effectiveness Analysis ◽  
Base Case ◽  
Rural Municipality ◽  
Healthcare Perspective ◽  
Effectiveness Analysis ◽  
Life Years ◽  
The Cost

ObjectivesThe objective of this study is to explore the cost-effectiveness of Doctor to the Barrios (DTTB), a physician deployment program in the Philippines.DesignCost-effectiveness analysis using decision tree models with a lifetime time horizon and probabilistic sensitivity analysis.SettingSocietal and healthcare perspectives.PopulationHypothetical cohort of children under 5 years in two provinces (Aklan and Nueva Ecija) and in a representative rural municipality.ParticipantsNone.InterventionsDTTB’s impact on paediatric pneumonia and diarrhoea outcomes compared with a scenario without DTTB.Main outcome measuresCosts, effectiveness (in terms of lives saved and quality-adjusted life years (QALYs) gained) and incremental cost-effectiveness ratio (ICER).ResultsDTTB is cost-effective in the two provinces that were included in the study from societal and healthcare perspectives. Looking at a representative rural municipality, base case analysis and probabilistic sensitivity analyses suggest that DTTB has an ICER of 27 192 per QALY gained from a societal perspective. From a healthcare perspective, the base case ICER of DTTB is Philippine pesos (PHP) 71 839 per QALY gained and PHP 2 064 167 per life saved, and 10 000 Monte Carlo simulations produced similar average estimates. The cost per QALY of DTTB from a healthcare perspective is lower than the WHO recommended willingness-to-pay threshold of 100% of the country’s per-capita gross domestic product.ConclusionsDTTB can be a cost-effective intervention, but its value varies by setting and the conditions of the municipality where it is implemented. By focusing on a narrow set of paediatric outcomes, this study has likely underestimated the health benefits of DTTB. Additional research is needed to understand the full extent of DTTB’s impact on the health of communities in rural and remote areas. Future cost-effectiveness analysis should empirically estimate various parameters and include other health conditions in addition to pneumonia and diarrhoea in children.

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 A cost-effectiveness analysis of front-line treatment strategies in early stage follicular lymphoma

2021 ◽  
Author(s):  
Joshua W.D. Tobin ◽  
Anna Crothers ◽  
Ti Eric Ma ◽  
Peter Mollee ◽  
Maher K. Gandhi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Follicular Lymphoma ◽  
Early Stage ◽  
Combined Modality Therapy ◽  
Treatment Strategies ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Minimal Improvement

AbstractRecent data suggests the use of radiotherapy alone (RT) in Early-Stage Follicular Lymphoma is declining. Cost-effectiveness analysis of treatments has not been performed. We constructed a partitioning model (15-year horizon) to compare RT, combined-modality therapy (CMT) and immunochemotherapy with rituximab maintenance (ICT+RM) from a PET-staged cohort from the Australian Lymphoma Alliance. Lifetime direct health care costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. AUD $75,000 was defined as the willingness-to-pay threshold (WTP). The direct healthcare costs were: RT $12,791, CMT $29,391 and ICT+RM $42,644. Compared with RT, CMT demonstrated minimal improvement in QALYs (+0.01) and an ICER well above the WTP threshold ($1,535,488). Compared with RT, ICT+RM demonstrated an improvement in QALYs (+0.41) with an ICER of $73,319. Modelling a 25% cost reduction with a rituximab biosimilar led to further ICER reductions with ICT+RM ($52,476). ICT+RM is cost-effective in early stage FL from the Australian taxpayer perspective.

scholarly journals Cost-effectiveness analysis of caplacizumab in the new standard of care for immune Thrombotic Thrombocytopenic Purpura in Italy

2021 ◽  
Vol 8 ◽  
pp. 43-52
Author(s):  
Giovanni Di Minno ◽  
Roberto Ravasio
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Standard Of Care ◽  
Cost Effectiveness Analysis ◽  
Lifetime Horizon ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Life Threatening ◽  
The Cost

Objectives: To evaluate the cost-effectiveness analysis (CEA) of caplacizumab in combination with plasmapheresis (PEX) and immunosuppression compared to PEX and immunosuppression in the treatment of acute episodes of iTTP. Methods: A Markov model was used to conduct the CEA from the perspective of the hospital, over a lifetime horizon. Clinical data derived from HERCULES trial and a systematic literature review. Economic input included direct costs only. Utility and disutility values were obtained from literature. Data on healthcare resources and costs were retrieved from HERCULES trial, literature, TTP guidelines and Italian tariffs. A sensitivity analysis was conducted. The cost-effectiveness probability was tested for several options of discount levels considering a suggested willingness to pay (WTP) threshold of € 60,000 in Italy. Results: The use of caplacizumab in combination with PEX and immunosuppression is associated with a positive difference in survival of 3.27 life years (24.53 vs 21.26) and in quality of life of 3.06 QALY (22.01 vs 18.96) when compared to PEX and immunosuppression. Caplacizumab leads to an ICER per life years of € 41,653 and an ICER per QALY of € 44,572. For the suggested WTP threshold, the probability of caplacizumab being cost-effective is 82.4% (no discount), 92.8% (15% discount), 95.3% (20% discount), 96.9% (25% discount) and 98.2% (30% discount). Conclusions: Caplacizumab in addition to PEX and immunosuppression is cost-effective, allowing the hospital to achieve greater efficiency in managing the burden of a life-threatening disease such as iTTP.

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