A cost-utility analysis of gemcitabine plus nab-paclitaxel in metastatic pancreatic cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17569-e17569 ◽  
Author(s):  
Yoo-Joung Ko ◽  
Vincent Channing Tam ◽  
Nicole Mittmann ◽  
Mark Pasteka ◽  
Kelvin K. Chan
Keyword(s):  
Pancreatic Cancer ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
The United States ◽  
Phase Iii ◽  
Sensitivity Analyses ◽  
Metastatic Pancreatic Cancer ◽  
Base Case ◽  
Public Healthcare ◽  
Term Care

e17569 Background: FOLFIRINOX has been shown to be superior to gemcitabine (gem) alone for metastatic pancreatic cancer (MPC) and has been established as the standard of care. A recent study (von Hoff et al, GI ASCO 2013) showed that gem + nab-paclitaxel (gem+nab-p) was superior to gem alone. The cost-effectiveness of gem+nab-p relative to gem or FOLFIRINOX has not been studied. Methods: A Markov cohort model was constructed for patients with MPC to examine the costs and outcomes of gem alone, gem+nab-p and FOLFIRINOX. Efficacy and side-effect data were obtained from pivotal phase III trials. Resource utilization data, unit costs and utilities were obtained from Ontario Ministry of Health and Long-Term Care, Sunnybrook Health Sciences Centre and the literature. The primary outcome was the incremental cost-effectiveness ratio (ICER) defined as cost per quality-adjusted life year (QALY). The analysis was conducted from the perspective of the Canadian public healthcare system over a 2-year time horizon adjusted to 2012 Canadian dollars (CAD$). Both cost and effectiveness were discounted at 5%. One way and probabilistic sensitivity analyses were performed. Results: Using gem as the base case, gem+nab-p had better outcomes but higher costs (see Table). The ICER was higher than conventional willingness-to-pay (WTP) threshold. Gem+nab-p was less effective but less costly when compared with FOLFIRINOX. It was dominated by combinations of gem and FOLFIRINOX (i.e. extended dominance), and therefore not cost-effective regardless of WTP threshold. If the price of nab-p was 20% lower, then gem+nab-p and FOLFORINOX would have similar cost-effectiveness. Conclusions: Gem+nab-p is not cost-effective, from the Canadian perspective, for the treatment of MPC based on the current price when compared with FOLFIRINOX. A lower-priced generic oxaliplatin, which is available in some jurisdictions including the United States, may affect the outcome of this analysis in further favor of FOLFIRINOX. [Table: see text]

Cost-effectiveness of nab-paclitaxel plus gemcitabine versus erlotinib plus gemcitabine in metastatic pancreatic cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 353-353 ◽  
Author(s):  
E. Gabriela Chiorean ◽  
Scott Whiting ◽  
Gary Binder ◽  
George Dranitsaris ◽  
Victoria Manax
Keyword(s):  
Pancreatic Cancer ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Phase Iii ◽  
Metastatic Pancreatic Cancer ◽  
Payer Perspective ◽  
The Us ◽  
Recent Phase ◽  
Cost Effective Alternative ◽  
The Cost

353 Background: In a recent phase III trial nab-paclitaxel (albumin-bound paclitaxel) + gemcitabine (nab-P/G) demonstrated a 1.8 month, or 27%, improvement in median overall survival (OS) (HR = 0.72, P < 0.001) vs gemcitabine (G) in first-line metastatic pancreatic cancer (mPC). nab-P/G had higher 1 year OS (35% vs 22%) and improved PFS by 1.8 months (HR = 0.69, P < 0.01). nab-P/G is the first taxane based therapy to show a significant OS improvement in a phase III mPC trial. Erlotinib + gemcitabine (E/G) has also demonstrated activity in mPC, with a 0.3 month OS benefit vs G (HR = 0.82, P = 0.04), a 1 year OS of 23% vs 17%, and 0.2 months PFS benefit (HR = 0.77, P = 0.004) vs G. A cost-effectiveness analysis measuring the cost per life year (LY) gained for nab-P/G and E/G was conducted from the US payer perspective. Methods: Costs and clinical outcomes were evaluated fromnab-P/G vs G and E/G vs G trials of mPC. Health care resource use and the management of grade III/IV adverse events (AE) were collected from a large multisite US oncology clinic, expert opinion, and literature (2012 US dollars). Drug cost per cycle was multiplied by the median cycles delivered from the trials for nab-P/G and E/G. Results: Duration of therapy was 4 months for nab-P/G vs 3.9 months for E/G. Total cost for nab-P/G was $24,984 vs $23,044 for E/G, including drug, administration and AE management. AE costs were similar between the two therapies (Table). Differences of > 5% were noted in neutropenia (rates: nab-P/G = 33%; E/G = 24%), neuropathy (nab-P/G = 17%; E/G = 1%), and rash (nab-P/G = 0%; E/G = 6%). The net survival advantage for nab-P/G vs E/G was 1.5 incremental life months gained. Nab-P/G was cost-effective relative to E/G, at a cost of $15,522 per incremental life year gained. Conclusions: nab-P/G is a cost-effective alternative to E/G in mPC, bringing more months of OS at < $16,000 cost per incremental life year gained. [Table: see text]

scholarly journals Cost-effectiveness of sequential daily teriparatide/weekly alendronate compared with alendronate monotherapy for older osteoporotic women with prior vertebral fracture in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Mori ◽  
Carolyn J. Crandall ◽  
Tomoko Fujii ◽  
David A. Ganz
Keyword(s):  
Cost Effectiveness ◽  
Vertebral Fracture ◽  
Cost Effective ◽  
Community Dwelling ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Microsimulation Model ◽  
Term Care ◽  
Lifetime Horizon ◽  
The Cost

Abstract Summary Using a Markov microsimulation model among hypothetical cohorts of community-dwelling older osteoporotic Japanese women with prior vertebral fracture over a lifetime horizon, we found that daily subcutaneous teriparatide for 2 years followed by weekly oral alendronate for 8 years was not cost-effective compared with alendronate monotherapy for 10 years. Purpose Teriparatide has proven efficacy in reducing osteoporotic fractures, but with substantial cost. We examined the cost-effectiveness of sequential teriparatide/alendronate (i.e., daily subcutaneous teriparatide for 2 years followed by weekly oral alendronate for 8 years) compared with alendronate monotherapy for 10 years among community-dwelling older osteoporotic women with prior clinical or morphometric vertebral fracture in Japan. 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 perspective of a single payer responsible for both public healthcare and long-term care. We assumed a lifetime horizon with a willingness-to-pay of ¥5million (or $47,500) per QALY in the base case. We modeled the cost of biosimilar teriparatide, which has been available since November 2019 in Japan, assuming the efficacy was the same as that of the brand version. Results In the base case, sequential teriparatide/alendronate was not cost-effective compared with alendronate monotherapy. In deterministic sensitivity analyses, sequential teriparatide/alendronate would become cost-effective with 85%, 50%, and 15% price discounts to teriparatide at ages 70, 75, and 80, respectively, compared to the current biosimilar cost. Otherwise, results were especially sensitive to changes that affected efficacy of teriparatide or alendronate. In probabilistic sensitivity analyses, the probabilities of sequential teriparatide/alendronate being cost-effective were 0%, 1%, and 37% at ages 70, 75, and 80, respectively. Conclusions Among high-risk osteoporotic women in Japan, sequential teriparatide/alendronate was not cost-effective compared with alendronate monotherapy, even with the availability of biosimilar teriparatide.

scholarly journals Additional MRI for initial M-staging in pancreatic cancer: a cost-effectiveness analysis

2021 ◽  
Author(s):  
Felix G. Gassert ◽  
Sebastian Ziegelmayer ◽  
Johanna Luitjens ◽  
Florian T. Gassert ◽  
Fabian Tollens ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cost Effectiveness ◽  
Tnm Classification ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Contrast Enhanced ◽  
Life Years ◽  
Input Parameters ◽  
Initial Staging

Abstract Objective Pancreatic cancer is portrayed to become the second leading cause of cancer-related death within the next years. Potentially complicating surgical resection emphasizes the importance of an accurate TNM classification. In particular, the failure to detect features for non-resectability has profound consequences on patient outcomes and economic costs due to incorrect indication for resection. In the detection of liver metastases, contrast-enhanced MRI showed high sensitivity and specificity; however, the cost-effectiveness compared to the standard of care imaging remains unclear. The aim of this study was to analyze whether additional MRI of the liver is a cost-effective approach compared to routinely acquired contrast-enhanced computed tomography (CE-CT) in the initial staging of pancreatic cancer. Methods A decision model based on Markov simulation was developed to estimate the quality-adjusted life-years (QALYs) and lifetime costs of the diagnostic modalities. Model input parameters were assessed based on evidence from recent literature. The willingness-to-pay (WTP) was set to $100,000/QALY. To evaluate model uncertainty, deterministic and probabilistic sensitivity analyses were performed. Results In the base-case analysis, the model yielded a total cost of $185,597 and an effectiveness of 2.347 QALYs for CE-MR/CT and $187,601 and 2.337 QALYs for CE-CT respectively. With a net monetary benefit (NMB) of $49,133, CE-MR/CT is shown to be dominant over CE-CT with a NMB of $46,117. Deterministic and probabilistic survival analysis showed model robustness for varying input parameters. Conclusion Based on our results, combined CE-MR/CT can be regarded as a cost-effective imaging strategy for the staging of pancreatic cancer. Key Points • Additional MRI of the liver for initial staging of pancreatic cancer results in lower total costs and higher effectiveness. • The economic model showed high robustness for varying input parameters.

scholarly journals Cost-Effectiveness of Short-Course Radiation Plus Temozolomide for the Treatment of Newly Diagnosed Glioblastoma Among Elderly Patients in China and the United States

2021 ◽  
Vol 12 ◽  
Author(s):  
Jigang Chen ◽  
Xin Tong ◽  
Mingyang Han ◽  
Songfeng Zhao ◽  
Linjin Ji ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Elderly People ◽  
Cost Effective ◽  
The United States ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Newly Diagnosed ◽  
Life Years ◽  
The Us

Background: Glioblastoma multiforme (GBM) is a fatal type of brain tumor with a high incidence among elderly people. Temozolomide (TMZ) has proven to be an effective chemotherapeutic agent with significant survival benefits. This study aimed to evaluate the economic outcomes of radiotherapy (RT) and TMZ for the treatment of newly diagnosed GBM in elderly people in the United States (US) and China.Methods: A partitioned survival model was constructed for RT plus TMZ and RT alone among patients with methylated and unmethylated tumor status. Base case calculations and one-way and probabilistic sensitivity analyses were performed. Life-years, quality-adjusted life-years (QALYs), costs (in 2021 US dollars [$] and Chinese Yuan Renminbi [¥]), and incremental cost-effectiveness ratios (ICERs) were calculated.Results: RT plus TMZ was found to be associated with significantly higher costs and QALYs in all groups. Only US patients with methylated status receiving RT plus TMZ had an ICER ($89358.51) less than the willingness-to-pay (WTP) threshold of $100000 per QALY gained when compared with receiving RT alone. When the WTP threshold ranged from $100000 to $150000 from the US perspective, the probability of RT plus TMZ being cost-effective increased from 80.5 to 99.8%. The cost of TMZ must be lower than ¥120 per 20 mg for RT plus TMZ to be cost-effective among patients with methylated tumor status in China.Conclusion: RT plus TMZ was not cost-effective in China, and a reduction in the TMZ price was justified. However, it is highly likely to be cost-effective for patients with methylated tumor status in the US.

Financial implications of dialysis modalities in the developing world: A Chinese perspective

2020 ◽  
Vol 40 (2) ◽  
pp. 193-201
Author(s):  
Jing Liu ◽  
David W Hutton ◽  
Yonghong Gu ◽  
Yao Hu ◽  
Yi Li ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Direct Cost ◽  
Cost Effective ◽  
The United States ◽  
Direct Costs ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Published Data ◽  
Life Years ◽  
The Cost

Background: End-stage renal disease has been imposing a heavy economic burden on public health; however, few studies have been performed on the cost-effectiveness of dialysis modalities. We aim to estimate the cost-effectiveness of different dialysis modalities in China. Methods: Cost-effectiveness analyses were performed using Markov models based on published data of hemodialysis (HD) and peritoneal dialysis (PD) modalities in China. Sensitivity analyses were conducted to identify key variables influencing the results. Results: Over a 10-year time horizon, the base-case cost-effectiveness analysis indicated that PD-first absolutely dominated the HD-first option by gaining 0.13 more quality-adjusted life years (QALYs) and costing RMB ¥81,081 less. When using reported mortality of HD and PD from the United States, the PD-first option still dominated HD-first with higher QALYs and lower costs. Sensitivity analyses revealed that the results were more sensitive to the direct cost of HD, utility of HD, utility of PD, direct cost of PD, PD mortality, and HD mortality, while less sensitive to the indirect costs and transition probabilities. The HD utility needed to be at least 0.148 higher than PD utility for HD to be cost-effective. PD was about 72% likely to be considered cost-effective compared with HD, regardless of the willingness-to-pay for QALYs. Conclusion: PD appears to be more cost-effective than HD in China, and the major influential factors on the cost-effectiveness are the direct costs of HD, utility of HD, utility of PD, direct costs of PD, PD mortality, and HD mortality.

Abstract WP330: Unreliable Long-term Cost Data Introduces Substantial Uncertainty Into Stroke Cost-Effectiveness Models

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Michelle Leppert ◽  
James Burke ◽  
Jennifer Simpson ◽  
Jonathan Campbell
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Tissue Type ◽  
Base Case ◽  
Decision Analytic Model ◽  
Term Care ◽  
Cost Estimates ◽  
The Cost

Background: Cost effectiveness analysis (CEA) models evaluate the value of stroke care methods. Estimates of long-term costs of stroke, a key input, vary substantially. We explored the effect of long-term cost variation on the interpretation of stroke CEA models. Methods: We estimated the lifetime costs and outcomes associated with intravenous tissue-type plasminogen treatment in acute ischemic stroke within the 0-3 hr and 3-4.5 hr windows. Decision analytic model inputs were from previously published literature, and clinical trials. We varied annual long term care costs, using cost groupings (i.e. cost per year at a given level of function) from published CEA models. Low estimates were from the Stroke Treatment Economic Model based on cost in the United Kingdom. High estimates were from the Rochester Stroke Registry from 1987 to1989. Split estimate took cost of minor disability from the low estimate and cost of major disability from the high estimate. We estimated incremental cost effectiveness ratio (ICER) for the base-case and conducted probabilistic sensitivity analyses. Results: The split estimate resulted in the lowest ICERs and was the dominant strategy (improved efficacy, cost savings) in all three conditions (0-3hr, 3-4.5hr, ECASS III) with ICERS -$67,530, -$223,294, and -$39,517 respectively. The low estimate, while still cost effective, increased ICERS substantially to $809, $144, and $18,549 respectively. When low cost estimates were substituted for split cost estimates, the percentage of dominant stimulations dropped by more than half (figure 1). Conclusion: Varying cost estimates led to considerably different conclusions regarding the cost effectiveness of tPA . For a highly cost-effective therapy, these differences do not affect the overall judgement of cost-effectiveness. However, this uncertainty could alter the cost effectiveness of more marginally effective or costly treatments. More reliable long term stroke cost estimates are needed.

scholarly journals Cost-effectiveness analysis of ranibizumab for retinal vein occlusion patients in China from the societal perspective

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Weiyi Ni ◽  
Jia Liu ◽  
Yawen Jiang ◽  
Jing Wu
Keyword(s):  
Cost Effectiveness ◽  
Retinal Vein Occlusion ◽  
Societal Perspective ◽  
Laser Photocoagulation ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Gdp Per Capita ◽  
Base Case ◽  
Vein Occlusion ◽  
Per Capita

Abstract Background Clinical trials in China have demonstrated that ranibizumab can improve the clinical outcomes of branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). However, no economic evaluation of ranibizumab has been conducted among Chinese patient population. Methods To provide insights into the economic profile of ranibizumab among Chinese RVO population, a Markov state-transition model was used to predict the outcomes of ranibizumab comparing to laser photocoagulation and observational-only care from the societal perspective. This model simulated changes in patient visuality, quality-adjusted of life years (QALY), medical costs, and direct non-medical costs of individuals with visual impairment due to BRVO or CRVO in lifetime. The base-case analysis used an annual discount rate of 5% for costs and benefits following the China Guidelines for Pharmacoeconomic Evaluations. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of the model. Results The base-case incremental cost-effectiveness ratio (ICER) comparing ranibizumab to laser photocoagulation was ¥65,008/QALY among BRVO patients and was ¥65,815/QALY among CRVO patients, respectively. Comparing to the 2019 gross domestic product (GDP) per capita of ¥71,000, both two ICERs were far below the cost-effective threshold at three times of GDP per capita (¥213,000). The deterministic and probabilistic sensitivity analyses demonstrated the base-case results were robust in most of the simulation scenarios. Conclusion The current Markov model demonstrated that ranibizumab may be cost-effective compared with laser photocoagulation to treat BRVO and cost-effective compared to observation-only care to treat CRVO in China from the societal perspective.

Abstract 200: Cost-Effectiveness of Newer Anticoagulants for Stroke Prevention in Atrial Fibrillation

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Brendan L Limone ◽  
William L Baker ◽  
Craig I Coleman
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Stroke Prevention ◽  
Indirect Comparison ◽  
Cost Effective ◽  
The United States ◽  
Base Case ◽  
Treatment Comparison ◽  
Newer Anticoagulants ◽  
The Cost

Background: A number of new anticoagulants for stroke prevention in atrial fibrillation (SPAF) have gained regulatory approval or are in late-stage development. We sought to conduct a systematic review of economic models of dabigatran, rivaroxaban and apixaban for SPAF. Methods: We searched the Medline, Embase, National Health Service Economic Evaluation Database and Health Technology Assessment database along with the Tuft’s Registry through October 10, 2012. Included models assessed the cost-effectiveness of dabigatran (150mg, 110mg, sequential), rivaroxaban or apixaban for SPAF using a Markov model or discrete event simulation and were published in English. Results: Eighteen models were identified. All models utilized a lone randomized trial (or an indirect comparison utilizing a single study for any given direct comparison), and these trials were clinically and methodologically heterogeneous. Dabigatran 150mg was assessed in 9 of models, dabigatran 110mg in 8, sequential dabigatran in 9, rivaroxaban in 4 and apixaban in 4. Adjusted-dose warfarin (either trial-like, real-world prescribing or genotype-dosed) was a potential first-line therapy in 94% of models. Models were conducted from the perspective of the United States (44%), European countries (39%) and Canada (17%). In base-case analyses, patients typically were at moderate-risk of ischemic stroke, initiated anticoagulation between 65 and 73 years of age, and were followed for or near a lifetime. All models reported cost/quality-adjusted life-year (QALY) gained, and while 22% of models reported using a societal perspective, no model included costs of lost productivity. Four models reported an incremental cost-effectiveness ratio (ICER) for a newer anticoagulant (dabigatran 110mg (n=4)/150mg (n=2); rivaroxaban (n=1)) vs. warfarin above commonly reported willingness-to-pay thresholds. ICERs (in 2012US$) vs. warfarin ranged from $3,547-$86,000 for dabigatran 150mg, $20,713-$150,000 for dabigatran 110mg, $4,084-$21,466 for sequentially-dosed dabigatran and $23,065-$57,470 for rivaroxaban. In addition, apixaban was demonstrated to be an economically dominant strategy compared to aspirin and to be dominant or cost-effective ($11,400-$25,059) vs. warfarin. Based on separate indirect treatment comparison meta-analyses, 3 models compared the cost-effectiveness of these new agents and reported conflicting results. Conclusions: Cost-effectiveness models of newer anticoagulants for SPAF have been extensively published. Models have frequently found newer anticoagulants to be cost-effective, but due to the lack of head-to-head trial comparisons and heterogeneity in clinical characteristic of underlying trials and modeling methods, it is currently unclear which of these newer agents is most cost-effective.

Cost-effectiveness of mobile health-based integrated care for atrial fibrillation: Model development and data analysis (Preprint)

2021 ◽  
Author(s):  
Xueyan Luo ◽  
Wei Xu ◽  
Quan Yuan ◽  
Han Lai ◽  
Chunji Huang
Keyword(s):  
Atrial Fibrillation ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Integrated Care ◽  
Mobile Health ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Life Years ◽  
Mhealth Technology

BACKGROUND Mobile health (mhealth) technology is increasingly used in disease management. Using mhealth tools to integrate and streamline care was found to improve atrial fibrillation (AF) patients’ clinical outcomes. OBJECTIVE This study aimed to investigate the potential clinical and health economic outcomes of mhealth-based integrated care for AF from the perspective of a public healthcare provider in China. METHODS A Markov model was designed to compare outcomes of mhealth-based care and usual care in a hypothetical cohort of AF patients in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to examine the robustness of base-case results. RESULTS In the base-case analysis, mhealth-based care gained higher QALYs of 0.0818 with an incurred cost of USD1,778. Using USD33,438 per QALY (three times gross domestic product) as the willingness-to-pay threshold, mhealth-based care was cost-effective, with an ICER of USD21,739 per QALY. The one-way sensitivity analysis found compliance to mhealth-based care had the greatest impact on the ICER. In probabilistic sensitivity analysis, mhealth-based care was accepted as cost-effective in 80.91% of 10,000 iterations. CONCLUSIONS This study suggested that the use of mhealth technology in streamlining and integrating care for AF patients was cost-effective in China.

scholarly journals Milk Powder Fortified with Potassium and Phytosterols to Decrease the Risk of Cardiovascular Events among the Adult Population in Malaysia: A Cost-Effectiveness Analysis

Nutrients ◽  
2019 ◽  
Vol 11 (6) ◽  
pp. 1235
Author(s):  
Anita E. Gandola ◽  
Livia Dainelli ◽  
Diane Zimmermann ◽  
Maznah Dahlui ◽  
Patrick Detzel
Keyword(s):  
Cost Effectiveness ◽  
Adult Population ◽  
Grey Literature ◽  
Milk Powder ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Discounted Cost ◽  
Life Years ◽  
The Impact

This study evaluated the cost-effectiveness of the consumption of a milk powder product fortified with potassium (+1050.28 mg/day) and phytosterols (+1200 mg/day) to lower systolic blood pressure and low-density lipoprotein cholesterol, respectively, and, therefore, the risk of myocardial infarction (MI) and stroke among the 35–75-year-old population in Malaysia. A Markov model was created against a do-nothing option, from a governmental perspective, and with a time horizon of 40 years. Different data sources, encompassing clinical studies, practice guidelines, grey literature, and statistical yearbooks, were used. Sensitivity analyses were performed to evaluate the impact of uncertainty on the base case estimates. With an incremental cost-effectiveness ratio equal to international dollars (int$) 22,518.03 per quality-adjusted life-years gained, the intervention can be classified as very cost-effective. If adopted nationwide, it would help prevent at least 13,400 MIs, 30,500 strokes, and more than 10,600 and 17,100 MI- and stroke-related deaths. The discounted cost savings generated for the health care system by those who consume the fortified milk powder would amount to int$8.1 per person, corresponding to 0.7% of the total yearly health expenditure per capita. Sensitivity analyses confirmed the robustness of the results. Together with other preventive interventions, the consumption of milk powder fortified with potassium and phytosterols represents a cost-effective strategy to attenuate the rapid increase in cardiovascular burden in Malaysia.

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