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]

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]

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 Quality of Life and Cost-Effectiveness Assessment of Radioiodine Ablation Strategies in Patients With Thyroid Cancer: Results From the Randomized Phase III ESTIMABL Trial

2015 ◽  
Vol 33 (26) ◽  
pp. 2885-2892 ◽  
Author(s):  
Isabelle Borget ◽  
Julia Bonastre ◽  
Bogdan Catargi ◽  
Désirée Déandréis ◽  
Slimane Zerdoud ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Thyroid Cancer ◽  
Cost Effectiveness ◽  
Short Form ◽  
Cost Effective ◽  
Phase Iii ◽  
Sensitivity Analyses ◽  
Life Years ◽  
Tsh Stimulation

Purpose In the ESTIMABL phase III trial, the thyroid ablation rate was equivalent for the two thyroid-stimulating hormone (TSH) stimulation methods (thyroid hormone withdrawal [THW] and recombinant human TSH [rhTSH]) and the two iodine-131 (131I) activities (1.1 or 3.7 GBq). The objectives of this article were to present health-related quality-of-life (HRQoL) results and a cost-effectiveness evaluation performed alongside this trial. Patients and Methods HRQoL and utility were longitudinally assessed, from random assignment to the follow-up visit at 8 ± 2 months for the 752 patients with thyroid cancer, using the Short Form-36 and the EuroQoL-5D questionnaires, respectively. A cost-effectiveness analysis was performed from the societal perspective in the French context. Resource use (hospitalization for 131I administration, rhTSH, sick leaves, and transportation) was collected prospectively. We used the net monetary benefit approach and computed cost-effectiveness acceptability curves for both TSH stimulation methods and 131I activities. Sensitivity analyses of the costs of rhTSH were performed. Results At 131I administration, THW caused a clinically significant deterioration of HRQoL, whereas HRQoL remained stable with rhTSH. This deterioration was transient with no difference 3 months later. rhTSH was more effective than THW in terms of quality-adjusted life-years (QALYs; +0.013 QALY/patient) but more expensive (+€474/patient). The probability that rhTSH would be cost effective at a €50,000/QALY threshold was 47% in France. The use of 1.1 GBq of 131I instead of 3.7 GBq reduced per-patient costs by €955 (US$1,018) but with slightly decreased efficacy (−0.007 QALY/patient). Conclusion rhTSH avoids the transient THW-induced deterioration of HRQoL but is unlikely to be cost effective at its current price.

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.

Evaluating the cost-effectiveness of the hospital-based palliative care program at The Johns Hopkins Hospital.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 23-23
Author(s):  
Sarina Isenberg ◽  
David R Holtgrave ◽  
Chunhua Lu ◽  
John P McQuade ◽  
Brian Weir ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Of Care ◽  
Palliative Care Unit ◽  
Hospital Perspective ◽  
Life Years ◽  
The Cost

23 Background: The objectives of the study were to determine whether a Palliative Care Unit (PCU) provides benefits not just from a cost perspective, but from a patient and caregiver quality of life (QOL) perspective. Methods: (1) Calculate the total costs of the PCU; (2) Leverage a threshold analysis to estimate the Quality-Adjusted Life Years (QALYs) required for the PCU to be cost effective; and (3) Determine whether it is feasible for the program to yield the required number of QALYs. Setting was the Johns Hopkins Health System Palliative Care Unit (PCU) in Baltimore, MD. Analysis was based on patient volume from March 2013-2014. Results: There were 209 palliative patients. The costs for the societal perspective was $2,044,364 and the required number of QALYs to deem it cost effective were 11.36. The net costs for the hospital perspective was $625,777 (gross cost was $993,528; however, the program generated $367,751 in savings for the hospital through treating patients in the PCU as opposed to other functional units), and the required number of QALYs to deem it cost effective were 3.48. To determine whether the program is able to achieve the number of QALYs required, the study team generated aggregated QALYs based on other studies’ evidence for palliative care’s improvement of quality of life for patients and their caregivers. Combining the QALYs generated from the aggregated calculations for patients (0.12) and caregivers (4.60), the program had the potential to yield a total of 4.73 QALYs. Conclusions: This analysis suggests that the PCU is cost effective from the hospital perspective in the sense that the benefits it provides to patients’ and caregivers’ quality of life outweighs the cost of care. Future studies should continue to evaluate palliative care from a cost effectiveness perspective that incorporates a consideration of the quality of life improvements, rather than just cost-reduction.

scholarly journals Immunoglobulin Replacement Therapy is critical and cost-effective in increasing life expectancy and quality of life in patients suffering from Common Variable Immunodeficiency Disorders (CVID): A health-economic assessment

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247941
Author(s):  
Philippe van Wilder ◽  
Irina Odnoletkova ◽  
Mehdi Mouline ◽  
Esther de Vries
Keyword(s):  
Health Economic ◽  
Cost Effectiveness ◽  
Diagnostic Delay ◽  
Cost Effective ◽  
Cost Utility ◽  
Life Years ◽  
Health Economic Model ◽  
Simulated Cohort ◽  
Common Variable

Background Common variable immunodeficiency disorders (CVID), the most common form of primary antibody deficiency, are rare conditions associated with considerable morbidity and mortality. The clinical benefit of immunoglobulin replacement therapy (IgGRT) is substantial: timely treatment with appropriate doses significantly reduces mortality and the incidence of CVID-complications such as major infections and bronchiectasis. Unfortunately, CVID-patients still face a median diagnostic delay of 4 years. Their disease burden, expressed in annual loss of disability-adjusted life years, is 3-fold higher than in the general population. Hurdles to treatment access and reimbursement by healthcare payers may exist because the value of IgGRT is poorly documented. This paper aims to demonstrate cost-effectiveness and cost-utility (on life expectancy and quality) of IgGRT in CVID. Methods and findings With input from a literature search, we built a health-economic model for cost-effectiveness and cost-utility assessment of IgGRT in CVID. We compared a mean literature-based dose (≥450mg/kg/4wks) to a zero-or-low dose (0 to ≤100 mg/kg/4wks) in a simulated cohort of adult patients from time of diagnosis until death; we also estimated the economic impact of diagnostic delay in this simulated cohort. Compared to no or minimal treatment, IgGRT showed an incremental benefit of 17 life-years (LYs) and 11 quality-adjusted life-years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of €29,296/LY and €46,717/QALY. These results were robust in a sensitivity analysis. Reducing diagnostic delay by 4 years provided an incremental benefit of six LYs and four QALYs compared to simulated patients with delayed IgGRT initiation, resulting in an ICER of €30,374/LY and €47,495/QALY. Conclusions The health-economic model suggests that early initiation of IgGRT compared to no or delayed IgGRT is highly cost-effective. CVID-patients’ access to IgGRT should be facilitated, not only because of proven clinical efficacy, but also due to the now demonstrated cost-effectiveness.

scholarly journals The cost–effectiveness of oral semaglutide versus empagliflozin in Type 2 diabetes in Denmark

2021 ◽  
Author(s):  
Lars H Ehlers ◽  
Mark Lamotte ◽  
Mafalda C Ramos ◽  
Susanne Sandgaard ◽  
Pia Holmgaard ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Duration Of Treatment ◽  
Diabetes Model ◽  
Life Years ◽  
The Cost

Aim: To evaluate the cost–effectiveness of oral semaglutide+metformin versus empagliflozin+metformin in people with Type 2 diabetes uncontrolled on msetformin alone. Materials and methods: The IQVIA Core Diabetes Model was populated with efficacy data from a head-to-head study between oral semaglutide+metformin and empagliflozin+metformin. Danish costs and quality-of-life data were sourced from literature. Price per day was Danish Krone (DKK) 25.53 for oral semaglutide and DKK11.40 for empagliflozin. Discounting was fixed at 4%. Scenario and sensitivity analyses were performed. Results: Over a lifetime, Core Diabetes Model projected 8.78 and 8.75 quality-adjusted life-years and a total cost of DKK 447,633 and DKK 387,786; thereby, generating an incremental cost–effectiveness ratio of DKK 1,930,548 for oral semaglutide+metformin versus empagliflozin+metformin. Scenario and sensitivity analyses showed the robustness of the outcomes. Duration of treatment with oral semaglutide is the key driver of the analyses. Conclusion: Oral semaglutide+metformin seems not cost-effective versus empagliflozin+metformin in patients uncontrolled on metformin in Denmark.

scholarly journals Quality of Life and Cost-Effectiveness of Radiofrequency Ablation versus Open Surgery for Benign Thyroid Nodules: a retrospective cohort study

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Wen-Wen Yue ◽  
Shu-Rong Wang ◽  
Feng Lu ◽  
Xiao-Long Li ◽  
Hui-Xiong Xu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Radiofrequency Ablation ◽  
Thyroid Nodules ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Life Years ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Abstract This study is to compare the health-related quality of life (HRQoL) and cost-effectiveness of radiofrequency ablation (RFA) and open thyroidectomy (OT) for benign thyroid nodules (BTNs) treatment. HRQoL and utility were assessed for 404 BTN patients immediately before treatments (RFA:OT = 137:267) and at 6-month visit. A cost-effectiveness analysis was performed from societal perspective in the China context. Resource use (hospitalization, sick leaves) was collected. We used the net monetary benefit approach and computed cost-effectiveness acceptability curves for RFA and OT. Sensitivity analyses of costs of RFA were performed. At 6-month visit, patients treated with RFA had significantly better HRQoL than patients treated with OT on general health (68.5 versus 66.7, P = 0.029), vitality (71.3 versus 67.5, P < 0.001) and mental health (80.9 versus 79.3, P = 0.038). RFA was more effective than OT in terms of quality-adjusted life-years (QALYs; 0.01QALY/patient) but more expensive (US$823/patient). The probability that RFA would be cost effective at a US$50,000/QALY threshold was 15.5% in China, and it would be increased to 88.4% when price of the RFA device was lowered by 30%. RFA exhibited a significant improvement of HRQoL relative to OT, but is unlikely to be cost effective at its current price in short time.

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