DPD deficiency: Medicoeconomic evaluation of pretreatment screening of 5-FU toxicity.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 410-410 ◽  
Author(s):  
Sory Traoré ◽  
Michele Boisdron-Celle ◽  
Gilles Hunault ◽  
Thierry Andre ◽  
Alain Morel ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Screening Test ◽  
Screening Strategy ◽  
Cost Of Care ◽  
Point Of View ◽  
Severe Toxicity ◽  
Net Benefit ◽  
Pre Treatment ◽  
Society Perspective ◽  
The Cost

410 Background: Deficiency of DPD activity is associated with severe toxicity or even death after the first two cycles 5-fluorouracil (5-FU) based of chemotherapy. The objective of this study was to assess the cost-effectiveness of a screening test before treatment of the deficiency of DPD activity combining two approaches (genetic and phenotype (UH2 / U)). The main measure of effectiveness was the number of avoided severe toxicities (grade 3-4), but the number of quality adjusted life days was the secondary endpoint. Methods: The analysis was based on retrospective data from a population of patients treated for colorectal cancer. 856 patients were screened (5-FUODPM Tox, ODPM, France) before being treated with adjusted doses (5-FUODPM Protocol, ODPM, France) versus a population of 886 patients treated according to standard doses (2400 mg/m²). The main point of view was society perspective and the time horizon was 2 cycles of chemotherapy. A multi-state Markov-type was used to estimate the mean cost and results for each of the two strategies. The cost of the strategy with screening was composed of the cost of the screening test and the cost of remaining toxicities, the cost of the standard strategy was just the cost of toxicities. The incremental cost-effectiveness ratio (ICER) was calculated: (COSTStandard - COSTWithScreening)/(EffStandard - EffWithScreening) COSTA : Cost of the strategy A, EffA : Effectiveness of the strategy A. Results: In the screened and adapted arm, the prevalence of severe toxicities at 1 cycle of chemotherapy was 0.5%, at 2 cycles was 0.9%. In the arm with standard doses, they were 5.80% and 6.90%, respectively. Any toxicity associated death was observed in the screened arm versus 1 death in the standard arm. The screening strategy was dominant, it allowed avoiding toxicities and saving money. The avoided cost per patient screened was 313 € for two cycles of treatment and a saving of 2780 € per toxicity avoided. The incremental net benefit (INB) per patient screened is 426 €. Conclusions: Pre-treatment screening test combining genetic and phenotype reduced the incidence of toxicities associated with 5-FU, it avoided deaths due to 5-FU and its additional cost was less than the cost of care of toxicity that it avoided.

scholarly journals Cost-effectiveness of two long-lasting insecticidal nets delivery models in mass campaign in rural Mozambique

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Jorge A. H. Arroz ◽  
Baltazar Candrinho ◽  
Chandana Mendis ◽  
Melanie Lopez ◽  
Maria do Rosário O. Martins
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Universal Coverage ◽  
Cost Effectiveness Ratio ◽  
Net Benefit ◽  
Incremental Net Benefit ◽  
The Cost ◽  
And Control ◽  
Delivery Models ◽  
Long Lasting Insecticidal Nets

Abstract Objective The aim is to compare the cost-effectiveness of two long-lasting insecticidal nets (LLINs) delivery models (standard vs. new) in universal coverage (UC) campaigns in rural Mozambique. Results The total financial cost of delivering LLINs was US$ 231,237.30 and US$ 174,790.14 in the intervention (302,648 LLINs were delivered) and control districts (219,613 LLINs were delivered), respectively. The average cost-effectiveness ratio (ACER) per LLIN delivered and ACER per household (HH) achieving UC was lower in the intervention districts. The incremental cost-effectiveness ratio (ICER) per LLIN and ICER per HH reaching UC were US$ 0.68 and US$ 2.24, respectively. Both incremental net benefit (for delivered LLIN and for HHs reaching UC) were positive (intervention deemed cost-effective). Overall, the newer delivery model was the more cost-effective intervention. However, the long-term sustainability of either delivery models is far from guaranteed in Mozambique’s current economic context.

The Cost-Effectiveness of an RCT to Establish Whether 5 or 10 Years of Bisphosphonate Treatment Is the Better Duration for Women With a Prior Fracture

2009 ◽  
Vol 29 (6) ◽  
pp. 678-689 ◽  
Author(s):  
Matt D. Stevenson ◽  
Jeremy E. Oakley ◽  
Myfawny Lloyd Jones ◽  
Alan Brennan ◽  
Juliet E. Compston ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Fracture Prevention ◽  
Published Data ◽  
Bisphosphonate Treatment ◽  
Net Benefit ◽  
England And Wales ◽  
Term Efficacy ◽  
The Cost

Purpose. Five years of bisphosphonate treatment have proven efficacy in reducing fractures. Concerns exist that long-term bisphosphonate treatment may actually result in an increased number of fractures. This study evaluates, in the context of England and Wales, whether it is cost-effective to conduct a randomized controlled trial (RCT) and what sample size may be optimal to estimate the efficacy of bisphosphonates in fracture prevention beyond 5 years. Method. An osteoporosis model was constructed to evaluate the cost-effectiveness of extending bisphosphonate treatment from 5 years to 10 years. Two scenarios were run. The 1st uses long-term efficacy data from published literature, and the 2nd uses distributions elicited from clinical experts. Results of a proposed RCT were simulated. The expected value of sample information technique was applied to calculate the expected net benefit of sampling from conducting such an RCT at varying levels of participants per arm and to compare this with proposed trial costs. Results. Without further information, the better duration of bisphosphonate treatment was estimated to be 5 years using the published data but 10 years using the elicited expert opinions, although in both cases uncertainty was substantial. The net benefit of sampling was consistently high when between 2000 and 5000 participants per arm were recruited. Conclusions. An RCT to evaluate the long-term efficacy of bisphosphonates in fracture prevention appears to be cost-effective for informing decision making in England and Wales.

scholarly journals Assessment of the Clinical and Economic Impact of Different Immunization Protocols of Measles, Mumps, Rubella and Varicella in Internationally Adopted Children

Vaccines ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 60 ◽  
Author(s):  
Sara Boccalini ◽  
Angela Bechini ◽  
Cecilia Maria Alimenti ◽  
Paolo Bonanni ◽  
Luisa Galli ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Economic Impact ◽  
Minimum Cost ◽  
Point Of View ◽  
Decision Analysis Model ◽  
Adopted Children ◽  
Analysis Model ◽  
Internationally Adopted Children ◽  
The Cost ◽  
Internationally Adopted

The appropriate immunization of internationally adopted children (IAC) is currently under debate and different approaches have been suggested. The aim of this study is to evaluate the clinical and economic impact of different strategies of measles, mumps, rubella, and varicella (MMRV) immunization in IAC in Italy. A decision analysis model was developed to compare three strategies: presumptive immunization, pre-vaccination serotesting and vaccination based on documentation of previous immunization. Main outcomes were the cost of strategy, number of protected IAC, and cost per child protected against MMRV. Moreover, the incremental cost-effectiveness ratio (ICER) was calculated. The strategy currently recommended in Italy (immunize based on documentation) is less expensive. On the other hand, the pre-vaccination serotesting strategy against MMRV together, improves outcomes with a minimum cost increase, compared with the presumptive immunization strategy and compared with the comparator strategy. From a cost-effectiveness point of view, vaccination based on serotesting results in being the most advantageous strategy compared to presumptive vaccination. By applying a chemiluminescent immunoassay test, the serology strategy resulted to be clinically and economically advantageous. Similar results were obtained excluding children aged <1 year for both serology methods. In conclusion, based on our analyses, considering MMRV vaccine, serotesting strategy appears to be the preferred option in IAC.

Economic Analysis of Tirilazad Mesylate for Aneurysmal Subarachnoid Hemorrhage: Economic Evaluation of a Phase III Clinical Trial in Europe and Australia

1998 ◽  
Vol 14 (1) ◽  
pp. 145-160 ◽  
Author(s):  
Henry Glick ◽  
Richard Willke ◽  
Daniel Polsky ◽  
Ted Llana ◽  
Wayne M. Alves ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cost Effectiveness ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Controlled Trial ◽  
Cost Of Care ◽  
Phase Iii ◽  
Double Blind ◽  
Additional Information ◽  
Tirilazad Mesylate ◽  
The Cost

AbstractThis study used data from a multinational phase III randomized, double-blind, vehicle-controlled trial to evaluate the cost-effectiveness of tirilazad mesylate (Freedox®) in the treatment of aneurysmal subarachnoid hemorrhage. In men, therapy with 6 mg/kg per day of tirilazad mesylate was associated with significantly increased survival, increased cost of care, and ratios of cost per death averted that compare favorably with the ratios of other life and death interventions. In women, it appeared to have no effects on costs or survival. Further clinical studies may provide additional information about the cost-effectiveness of this intervention.

scholarly journals The cost-effectiveness of physician assistants/associates: A systematic review of international evidence

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259183
Author(s):  
G. T. W. J. van den Brink ◽  
R. S. Hooker ◽  
A. J. Van Vught ◽  
H. Vermeulen ◽  
M. G. H. Laurant
Keyword(s):  
Systematic Review ◽  
Quality Of Care ◽  
Cost Effectiveness ◽  
Physician Assistants ◽  
Labor Cost ◽  
Cost Of Care ◽  
Complementary Role ◽  
Care Outcomes ◽  
The Cost

Background The global utilization of the physician assistant/associate (PA) is growing. Their increasing presence is in response to the rising demands of demographic changes, new developments in healthcare, and physician shortages. While PAs are present on four continents, the evidence of whether their employment contributes to more efficient healthcare has not been assessed in the aggregate. We undertook a systematic review of the literature on PA cost-effectiveness as compared to physicians. Cost-effectiveness was operationalized as quality, accessibility, and the cost of care. Methods and findings Literature to June 2021 was searched across five biomedical databases and filtered for eligibility. Publications that met the inclusion criteria were categorized by date, country, design, and results by three researchers independently. All studies were screened with the Risk of Bias in Non-randomised Studies—of Interventions (ROBIN-I) tool. The literature search produced 4,855 titles, and after applying criteria, 39 studies met inclusion (34 North America, 4 Europe, 1 Africa). Ten studies had a prospective design, and 29 were retrospective. Four studies were assessed as biased in results reporting. While most studies included a small number of PAs, five studies were national in origin and assessed the employment of a few hundred PAs and their care of thousands of patients. In 34 studies, the PA was employed as a substitute for traditional physician services, and in five studies, the PA was employed in a complementary role. The quality of care delivered by a PA was comparable to a physician’s care in 15 studies, and in 18 studies, the quality of care exceeded that of a physician. In total, 29 studies showed that both labor and resource costs were lower when the PA delivered the care than when the physician delivered the care. Conclusions Most of the studies were of good methodological quality, and the results point in the same direction; PAs delivered the same or better care outcomes as physicians with the same or less cost of care. Sometimes this efficiency was due to their reduced labor cost and sometimes because they were more effective as producers of care and activity.

Cost-effectiveness of tositumomab and iodine I-131 tositumomab (Bexxar therapeutic regimen (BTR)), in treatment of non- Hodgkin lymphoma (NHL)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8089-8089 ◽  
Author(s):  
C. R. Flowers ◽  
J. C. Sambrook ◽  
A. Briggs ◽  
K. Osenenko ◽  
H. Wang ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Alternative Therapies ◽  
Cost Of Care ◽  
Low Grade ◽  
Life Years ◽  
Weibull Models ◽  
Third Line ◽  
The Cost

8089 Background: BTR has demonstrated efficacy in NHL patients and it has potential to prolong time to progression (TTP) in relapsed/refractory, low grade, follicular, or transformed NHL. This study assessed effectiveness and cost-effectiveness of BTR compared to alternative therapies in first, second, and third line NHL therapy. Methods: Time-to-event models were constructed with 2 events: progression and death. Patient data from 8 BTR clinical trials were combined to fit Weibull models for TTP and overall survival (OS) by including FLIPI covariates. Estimates for BTR were compared with estimates for alternatives from Weibull models fitted to published TTP and BTR OS data by lines of therapy and measured in life-years (LY). Estimated pre-progression costs included drug costs, lab tests, monitoring, and adverse events; post progression costs included NHL costs until death, all valued in 2006 $US and discounted at 3%. Indirect comparisons yielded incremental cost-effectiveness ratios (ICER=Δ cost/Δ LYs) in each line of therapy. Results: As observed in the table , cost of care estimates in BTR were often comparable with alternative therapies, but typically LY gain favored BTR. Mostly in first and third line, a BTR strategy had an ICER less than the cost-effectiveness threshold of $50,000 per LY gained. Conclusion: Overall, a BTR strategy has a favorable cost-effectiveness profile to alternative strategies including rituximab maintenance (RXM) in first, second, and third line NHL therapy. Results imply both a possible survival gain with early BTR use, and the cost-effectiveness of BTR. This modeling approach can aid in clinical decision making regarding the sequence and timing of therapy for patients with follicular NHL. No significant financial relationships to disclose. [Table: see text]

A cost-benefit analysis for sonographic screening for renal tumors.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 665-665
Author(s):  
Shmuel Roizman ◽  
Moshe Leshno ◽  
Miki Haifler ◽  
Yishai Hode Rappaport ◽  
Amnon Zisman
Keyword(s):  
Targeted Therapy ◽  
Cost Effectiveness ◽  
Cost Benefit ◽  
Cost Effective ◽  
Screening Strategy ◽  
Renal Tumors ◽  
Stage Migration ◽  
Mathematical Framework ◽  
Abdominal Ultrasonography ◽  
The Cost

665 Background: In the last 2 decades, the rates of metastatic Renal Cell Carcinoma (RCC) at diagnosis declined from 33% to 17%This fact is attributed to massive penetration of cross sectional imaging leading to a marked stage migration. The cost of targeted therapy for metastatic RCC patients is very high. These trends led us to hypothesize that screening for RCC with ultrasound may be cost effective. Objective: To assess the cost effectiveness of screening with ultrasound for renal tumors in the general population over 60 years of age. Methods: Using the Markov model, a mathematical framework was set up describing the course of disease with and without screening for RCC using abdominal ultrasonography. Quality Adjusted Life Year (QALY) and financial costs were the outputs of the model. Results: Average costs for the screening strategy was 137.4 U$ and for non-screening was 31.4 U$. Screening and non-screening strategy would add an average of 21.7396 and 21.7385 QALY, respectively. An increase of 0.001 QALY equates to Incremental Cost Effectiveness Ratio (ICER) of 86,4 U$ per QALY, Currently, the cost which is considered cost effective for 1 QALY point is approximately 27,548.21 U$. The two variables most influential on the model output were prevalence of RCC and US cost. Conclusions: To our knowledge, this is the sole cost benefit screening study performed for RCC in the targeted therapy era. Screening for renal tumors using abdominal ultrasonography at a cost of 35.81 U$ per exam is cost effective. Our findings are highly suggestive that early screening for RCC may be cost effective for preventing RCC metastatic disease and nevertheless will save lives.

scholarly journals Repeat screening for syphilis in pregnancy as an alternative screening strategy in the UK: a cost-effectiveness analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038505
Author(s):  
Susie Huntington ◽  
Georgie Weston ◽  
Farah Seedat ◽  
John Marshall ◽  
Heather Bailey ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Pregnant Women ◽  
Neonatal Death ◽  
Cost Effective ◽  
Screening Strategy ◽  
Base Case ◽  
Scenario Analyses ◽  
The Uk ◽  
The Cost ◽  
In Pregnancy

ObjectivesTo assess the cost-effectiveness of universal repeat screening for syphilis in late pregnancy, compared with the current strategy of single screening in early pregnancy with repeat screening offered only to high-risk women.DesignA decision tree model was developed to assess the incremental costs and health benefits of the two screening strategies. The base case analysis considered short-term costs during the pregnancy and the initial weeks after delivery. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted to assess the robustness of the results.SettingUK antenatal screening programme.PopulationHypothetical cohort of pregnant women who access antenatal care and receive a syphilis screen in 1 year.Primary and secondary outcome measuresThe primary outcome was the cost to avoid one case of congenital syphilis (CS). Secondary outcomes were the cost to avoid one case of intrauterine fetal demise (IUFD) or neonatal death and the number of women needing to be screened/treated to avoid one case of CS, IUFD or neonatal death. The cost per quality-adjusted life year gained was assessed in scenario analyses.ResultsBase case results indicated that for pregnant women in the UK (n=725 891), the repeat screening strategy would result in 5.5 fewer cases of CS (from 8.8 to 3.3), 0.1 fewer cases of neonatal death and 0.3 fewer cases of IUFD annually compared with the single screening strategy. This equates to an additional £1.8 million per case of CS prevented. When lifetime horizon was considered, the incremental cost-effectiveness ratio for the repeat screening strategy was £120 494.ConclusionsUniversal repeat screening for syphilis in pregnancy is unlikely to be cost-effective in the current UK setting where syphilis prevalence is low. Repeat screening may be cost-effective in countries with a higher syphilis incidence in pregnancy, particularly if the cost per screen is low.

Cost effectiveness of dengue vaccination following pre-vaccination serological screening in Sri Lanka

2019 ◽  
Vol 35 (6) ◽  
pp. 427-435 ◽  
Author(s):  
Sathira Perera ◽  
Denny John ◽  
Buddhika Senanayaka
Keyword(s):  
Cost Effectiveness ◽  
Sri Lanka ◽  
Test Performance ◽  
Regional Variation ◽  
Disease Incidence ◽  
Vaccination Strategy ◽  
Screening Strategy ◽  
Sensitivity Analyses ◽  
Serological Screening ◽  
The Cost

AbstractObjectiveThis study sets an example of an economic evaluation of a model dengue vaccination strategy for Sri Lanka, following a mandatory pre-vaccination screening strategy.MethodsA decision analytic Markov model was developed to estimate the cost-effectiveness of a predicted dengue vaccination strategy over a time horizon of 10 years. The cost effectiveness of dengue vaccination strategy for seropositive individuals was estimated in terms of incremental cost effectiveness ratio (ICER) (cost per additional quality adjusted life-year [QALY]). District-specific ICER values and the budget impact for dengue vaccine were estimated with appropriate sensitivity analyses, also taking the variability of the pre-vaccination screening test performance into consideration.ResultsThe ICER for the predicted vaccination strategy following pre-vaccination screening was 4,382 USD/QALY for Sri Lanka. There was a significant regional variation in vaccine cost effectiveness. The disaggregated regional incidence of dengue and the need to perform pre-vaccination screening affects the cost effectiveness estimates significantly, where a safer version of the vaccine has the potential to become cost saving in high incidence districts.ConclusionsThe cost effectiveness of the predicted dengue vaccination strategy following pre-vaccination screening showed a significant regional variation across the districts of Sri Lanka. District-wise disease incidence and the need for pre-vaccination screening was found to be the most significant factors affecting the cost effectiveness of the vaccine.

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