Cost-effectiveness of prophylactic antibiotics to prevent pneumonia in patients treated with chemoradiotherapy (CRT) for locally advanced head and neck carcinoma (LAHNC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6075-6075 ◽  
Author(s):  
Janneke Ham ◽  
Chantal Driessen ◽  
Mathijs P Hendriks ◽  
W. Edward Fiets ◽  
Bas Kreike ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Locally Advanced ◽  
Intervention Group ◽  
Pain Medication ◽  
Cost Effectiveness Analysis ◽  
Prophylactic Antibiotics ◽  
Clinical Effects ◽  
Effectiveness Analysis ◽  
The Cost ◽  
The Impact

6075 Background: Recently, we reported about a prospective randomized study (PANTAP-study) investigating the effect of prophylactic antibiotics in LAHNC pts treated with CRT. We did not show a reduction in pneumonias, but did find a significant decrease in the number of hospitalizations. Detailed quality of life (QoL) results have been reported elsewhere. Now we present the results of the cost-effectiveness analysis. Methods: A multicenter study was performed in LAHNC pts treated with CRT, i.e.cisplatin weekly or 3-weekly combined with radiotherapy for 42 or 49 days. The standard treatment group (STG) received no prophylactic antibiotics; the intervention group (IG) received prophylactic antibiotics, i.e. amoxicillin/clavulanic acid, from day 29 until 14 days after completion of CRT. QoL questionnaires, including EQ-5D, QLQ-C30, EORTC Head&Neck35 and PSSHN, were taken before start of CRT, before start of antibiotics, at the end of CRT and at the end of follow up. Costs of hospitalization, prophylactic antibiotics, pain medication and anti-emetics were taken into account for the cost-effectiveness analysis. Results: A total of 94 pts were randomized; 48 pts to the STG and 47 pts to the IG. Between the STG and IG we found a difference per patient in costs of hospitalization of €2076 and €682 (p = 0.03), respectively, but not in the costs for pain medication per patient €78 and €46, respectively, (p = 0.382). The total costs of hospitalization in combination with prophylactic antibiotics, pain medication and anti-emetics were €2462 and €1037 (p = 0.046) in the STG and IG respectively, leading to a difference in total costs per patient of €1425 in favor of the IG. There were no significant differences in QoL between the groups. Conclusions: Prophylactic antibiotics during CRT for LAHNC did not reduce the rate of pneumonias, but reduced the number of hospitalizations in the IG, which led to a significant reduction in costs. Given the lack of adverse clinical effects, the same QoL, the cost savings and the impact of costs of hospitalization on health care globally, we recommend the use of prophylactic antibiotics in LAHNC pts receiving CRT. Clinical trial information: NCT01598402.

scholarly journals Comparison of the ‘11+ Kids’ injury prevention programme and a regular warmup in children’s football (soccer): a cost effectiveness analysis

2018 ◽  
Vol 53 (5) ◽  
pp. 309-314 ◽  
Author(s):  
Roland Rössler ◽  
Evert Verhagen ◽  
Nikki Rommers ◽  
Jiri Dvorak ◽  
Astrid Junge ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Injury Prevention ◽  
Healthcare Costs ◽  
Intervention Group ◽  
Cost Effectiveness Analysis ◽  
Prevention Programme ◽  
Control Group ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Injury Prevention Programme

ObjectiveTo evaluate a potential reduction in injury related healthcare costs when using the ‘11+ Kids’ injury prevention programme compared with a usual warmup in children’s football.MethodsThis cost effectiveness analysis was based on data collected in a cluster randomised controlled trial over one season from football teams (under-9 to under-13 age groups) in Switzerland. The intervention group (INT) replaced their usual warmup with ‘11+ Kids’, while the control group (CON) warmed up as usual. Injuries, healthcare resource use and football exposure (in hours) were collected prospectively. We calculated the mean injury related costs in Swiss Francs (CHF) per 1000 hours of football. We calculated the cost effectiveness (the direct net healthcare costs divided by the net health effects of the ‘11+ Kids’ intervention) based on the actual data in our study (trial based) and for a countrywide implementation scenario (model based).ResultsCosts per 1000 hours of exposure were CHF228.34 (95% CI 137.45, 335.77) in the INT group and CHF469.00 (95% CI 273.30, 691.11) in the CON group. The cost difference per 1000 hours of exposure was CHF−240.66 (95%CI −406.89, −74.32). A countrywide implementation would reduce healthcare costs in Switzerland by CHF1.48 million per year. 1002 players with a mean age of 10.9 (SD 1.2) years participated. During 76 373 hours of football, 99 injuries occurred.ConclusionThe ‘11+ Kids’ programme reduced the healthcare costs by 51% and was dominant (ie, the INT group had lower costs and a lower injury risk) compared with a usual warmup. This provides a compelling case for widespread implementation.

scholarly journals The Impact of the Cost of Existing Treatment on the Results of Cost-Effectiveness Analysis Studies for Japan

2018 ◽  
Vol 21 ◽  
pp. S87
Author(s):  
M LoPresti ◽  
D Mazumder ◽  
H Bhandari ◽  
S Ranjan ◽  
M Smulders
Keyword(s):  
Cost Effectiveness ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
The Cost ◽  
The Impact

scholarly journals Cost-effectiveness analysis of branded and authorized generic celecoxib for patients with chronic pain in Japan

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253547
Author(s):  
Yusuke Karasawa ◽  
Isao Kamae ◽  
Kazutaka Nozawa ◽  
Shigeki Zeniya ◽  
Tatsunori Murata ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cost Effectiveness ◽  
Real World ◽  
Cost Effectiveness Analysis ◽  
Public Healthcare ◽  
Cost Information ◽  
Lifetime Horizon ◽  
Effectiveness Analysis ◽  
The Cost ◽  
The Impact

Objectives The aim of this study was to examine the cost-effectiveness of branded and authorized generic (AG) celecoxib for chronic pain patients with osteoarthritis (OA), rheumatoid arthritis (RA), and low back pain (LBP), using real-world cost information for loxoprofen and pharmacotherapy for gastrointestinal bleeding. Methods This cost-effectiveness analysis was performed as a long-term simulation using the Markov model from the Japanese public healthcare payer’s perspective. The analysis was conducted using loxoprofen with real-world weighted price by branded/generic distribution (hereinafter, loxoprofen with weighted price) as a comparator. In the model, we simulated the prognosis of patients with chronic pain by OA, RA, and LBP treated with loxoprofen or celecoxib, over a lifetime period. Results A cost-increase of 129,688 JPY (1,245.00 USD) for branded celecoxib and a cost-reduction of 6,268 JPY (60.17 USD) for AG celecoxib were recognized per patient in lifetime horizon, compared to loxoprofen with weighted price. No case was recognized to reverse the results of cost-saving by AG celecoxib in one-way sensitivity analysis. The incremental cost-effectiveness ratio of branded celecoxib attained 5,403,667 JPY/QALY (51,875.20 USD/QALY), compared to loxoprofen with the weighted price. Conclusion The current cost-effectiveness analysis for AG celecoxib revealed its good value for costs, considering the patients’ future risk of gastrointestinal injury; also, the impact on costs due to AG celecoxib against loxoprofen will be small. It implies that the disadvantage of AG celecoxib being slightly more expensive than generic loxoprofen could be offset by the good cost-effectiveness during the prognosis.

scholarly journals Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial

2013 ◽  
Vol 202 (2) ◽  
pp. 121-128 ◽  
Author(s):  
Renee Romeo ◽  
Martin Knapp ◽  
Jennifer Hellier ◽  
Michael Dewey ◽  
Clive Ballard ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
People With Dementia ◽  
Life Years ◽  
The Cost ◽  
The Impact

BackgroundDepression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes.AimsTo evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia.MethodA pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0–13 weeks and 0–39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods.ResultsThere were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively.ConclusionsIn terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety. Given the priority and the potential value of supporting family carers of people with dementia, further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers.

scholarly journals Pharmacoeconomic analysis of the anidulafungin (EraxisR) in adult patients with invasive candidiasis

2019 ◽  
Vol 14 (3) ◽  
pp. 98-108
Author(s):  
S. V. Nedogoda ◽  
A. S. Salasyuk ◽  
I. N. Barykina ◽  
V. O. Smirnova
Keyword(s):  
Cost Effectiveness ◽  
Invasive Candidiasis ◽  
Budget Impact ◽  
Cost Effectiveness Analysis ◽  
Adult Patients ◽  
Complete Replacement ◽  
Treatment Regimens ◽  
Effectiveness Analysis ◽  
The Cost ◽  
The Impact

Objective: to assess the economic outcomes of using anidulafungin (Eraxis®) in comparison with the recommended treatment regimens in adult patients with invasive candidiasis.Materials and methods. The economic impact assessment was carried out using “cost–effectiveness” analysis and “budget impact” analysis. “Cost–effectiveness” and “budget impact” analyses were performed in Microsoft Excel model.Results. An analysis of the effectiveness showed that the use of anidulafungin is characterized by higher survival (79.25 % vs 66.17 % for caspofungin and 60.84 % for mikafungin). The cost of anidulafungin was 377.7 thousand rubles, which is comparable with the course of caspofungin and 61 % lower than the cost of micafungin therapy. “Cost–effectiveness” analysis showed that the use of the anidulafungin in the treatment of invasive candidiasis is pharmacoeconomically effective and has a “cost–effectiveness” ratio comparable to caspofungin in terms of the effectiveness of therapy for 7 days and exceeds it in terms of the cost of preserving the patient»s life by 14.5 %. Compared to micafungin, anidulafungin is both more economical and more effective in terms of preserving the patient's life, reaching an advantage of up to 45 %. An analysis of the impact on the budget showed that with the complete replacement of the currently used treatment regimens in the target population of 11,840 patients with invasive candidiasis with anidulafungin, it is possible to reduce the burden on the budget of the healthcare system to 17 % or 1458.6 million rubles in year. The average savings in the 3‑year study horizon, taking into account the gradual switching of 25, 50 and 75 % of the target patient population, amounted to 1277.9 million rubles per year or 14.4 %. A sensitivity analysis confirmed the results.Conclusion. Based on results, it can be concluded that the use of the drug anidulafungin (Eraxis®) in patients with invasive candidiasis is economically the preferred option compared to the use of current antibiotic therapy regimens.

scholarly journals Pregabalin versus gabapentin nel trattamento dei pazienti con neuropatia periferica: adattamento di un modello internazionale per la valutazione di costo/efficacia e costo/utilità alla realtà nazionale

2005 ◽  
Vol 6 (3) ◽  
pp. 243-250 ◽  
Author(s):  
Paolo Marchettini ◽  
Lisa Da Deppo ◽  
Lorenzo Pradelli
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effectiveness Analysis ◽  
Delphi Panel ◽  
Pain Experience ◽  
Mild Pain ◽  
Effectiveness Analysis ◽  
The Cost ◽  
The Impact ◽  
Daily Pain

OBJECTIVE: To compare the economic impact of treating neuropathic pain with pregabalin versus gabapentin. DESIGN: A cost effectiveness analysis comparing costs and effects of pregabalin 375 mg/die versus gabapentin 1800 mg/die in the perspective of the Italian National Healthcare Service was developed. The cost effectiveness analysis is examined alternatively in terms of the incremental cost per additional day with no or mild pain, and the incremental cost per quality-adjusted life-year (QALY) gained. Effects were derived from a pregabalin randomised clinical study 1008-155 and gabapentin 645-210 and 945-211 studies. Effects are expressed as reduction score of the VAS pain scale. Pharmacological costs were quantified according to the Italian market price of the drugs; healthcare procedure and hospitalisation costs were quantified on the basis of the National Tariff. Other healthcare services consumption data were derived from a Delphi Panel. To estimate the impact of pregabalin and gabapentin on daily pain experience in patients with neuropatic pain a Markov model is used. The dynamic simulation focuses on a hypothetical cohort of 1000 patients and simulates their daily pain experience over 12 weeks, to estimate clinical and economic outcomes for the group as a whole. MAIN OUTCOME MEASURES AND RESULTS: The cost-effectiveness ratio for the use of pregabalin is less than 1 euro per additional day with no or mild pain and 468 euros per QALY. The sensitivity analysis conducted to examine the effects of decreasing gabapentin dose to 1200 mg/die showes the consistency of the model results. CONCLUSIONS AND RESULTS: Although pregabalin pure costs are higher than gabapentin costs, the analyses prove pregabalin to be more effective with a small additional cost per day with no or mild pain.

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.

scholarly journals STeroids Against Radiculopathy (STAR) trial: a statistical analysis plan

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bastiaan C. ter Meulen ◽  
Johanna M. van Dongen ◽  
Marinus van der Vegt ◽  
Henry C. Weinstein ◽  
Raymond W. J. G. Ostelo
Keyword(s):  
Statistical Analysis ◽  
Cost Effectiveness ◽  
Intervention Group ◽  
Statistical Analysis Plan ◽  
Pain Medication ◽  
Oral Pain ◽  
Oral Pain Medication ◽  
Group 2 ◽  
The Cost ◽  
Star Trial

Abstract Background Transforaminal epidural injections with steroids (TESI) are used increasingly for patients with sciatica. However, their safety, effectiveness, and cost-effectiveness are still a matter of debate. This a priori statistical analysis plan describes the methodology of the analysis for the STAR trial that assesses the (cost-)effectiveness of TESI during the acute stage of sciatica (< 8 weeks). Methods The STAR trial is a multicentre, randomized controlled, prospective trial (RCT) investigating the (cost-)effectiveness of TESI by making a three-group comparison among patients with acute sciatica due to a herniated lumbar disc (< 8 weeks): (1) TESI combined with levobupivacaine added to oral pain medication (intervention group 1) versus oral pain medication alone (control group), (2) intervention group 1 versus transforaminal epidural injection with levobupivacaine and saline solution added to oral pain medication (intervention group 2), and (3) intervention group 2 versus control group. Co-primary outcomes were physical functioning (Roland Morris Disability Questionnaire), pain intensity (10-point numerical rating scale), and global perceived recovery (7-point Likert scale, dichotomized into ‘recovered’ and ‘not recovered’). For all three comparisons, we defined the following minimal clinically relevant between-group differences: two points for pain intensity (range 0–10), four points for physical functioning (range 0–24) and a 20% difference in recovery rate. Secondary outcomes are health-related quality of life (EQ-5D-5L) and patient satisfaction (7-point Likert scale) and surgery rate. We also collected resource use data to perform an economic evaluation. Analyses will be conducted by intention-to-treat with p < 0.05 (two-tailed) for all three comparisons. Effects will be estimated using mixed models by maximum likelihood. For each comparison, mean differences, or difference in proportions, between groups will be tested per time point and an overall mean difference, or difference in proportions, between groups during the complete duration of follow-up (6 months) will be estimated. In the economic evaluation, Multivariate Imputation by Chained Equations will be used to handle missing data. Cost and effect differences will be estimated using seemingly unrelated regression, and uncertainty will be estimated using bootstrapping techniques. Discussion This statistical analysis plan provides detailed information on the intended analysis of the STAR trial, which aims to deliver evidence about the (cost-)effectiveness of TESI during the acute phase of sciatica (< 8 weeks). Trial registration Dutch National trial register NTR4457 (6 March 2014)

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