Cost-effectiveness of neoadjuvant FOLFIRINOX versus gemcitabine plus nab-paclitaxel in locally advanced/borderline resectable pancreatic cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16793-e16793
Author(s):  
Myles Ingram ◽  
Brianna N Lauren ◽  
Yoanna S Pumpalova ◽  
Gulam Abbas Manji ◽  
Susan Elaine Bates ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Clinical Decision Making ◽  
Locally Advanced ◽  
Cost Effective ◽  
Cost Of Care ◽  
Trial Data ◽  
Borderline Resectable ◽  
Total Cost ◽  
Cost Effective Treatment ◽  
The Cost

e16793 Background: The 2019 NCCN guidelines recommend neoadjuvant FOLFIRINOX or neoadjuvant gemcitabine plus nab-paclitaxel (G-nP) for locally advanced and borderline resectable pancreatic ductal adenocarcinoma (BR/LA PDAC). Neoadjuvant FOLFIRINOX and G-nP have yet to be directly compared in a prospective, randomized trial with BR/LA PDAC patients. The purpose of our study was to incorporate treatment outcomes, toxicity profiles, costs, and quality-of-life measures to further inform clinical decision-making. Methods: We developed a decision-analytic mathematical model to compare the total cost and health outcomes of neoadjuvant FOLFIRINOX against G-nP over twelve years. Adjuvant gemcitabine (GEM) was used as a comparator. The inputs for the model were estimated using clinical trial data and published literature. We used single-institution retrospective studies to estimate our survival data in the absence of a prospective trial. The primary endpoint was incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay (WTP) threshold of $100,000 per quality-adjusted-life-year (QALY). Secondary endpoints included overall (OS) and progression-free survival (PFS), total cost of care (USD), QALYs, patient resection rate, and monthly treatment-related adverse events (TRAE) costs (USD). Results: FOLFIRINOX was the cost-effective strategy, totaling incremental QALYs of 0.21 at a cost of $52,845.96 per QALY when compared to G-nP. G-nP was also on the efficiency frontier with an ICER of $46,430.73 compared to GEM. More patients received resection with FOLFIRINOX (82.15% vs. 72.40%), but had higher TRAE costs than G-nP ($12,051.26 vs. $4,666.97). A one-way sensitivity analysis found that the FOLFIRINOX ICER exceeds the WTP threshold when TRAE costs are higher and resection rates are lower. Conclusions: Our modeling analysis finds FOLFIRNOX is the cost-effective treatment compared to G-nP for BR/LA PDAC despite having a higher cost of total care due to TRAE costs. Trial data with sufficient follow-up are needed to confirm our findings. [Table: see text]

Cost-effectiveness analysis of platinum-based chemotherapy treatment options for germline BRCA-mutated locally advanced/borderline resectable pancreatic cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16246-e16246
Author(s):  
Myles Ingram ◽  
Yoanna S Pumpalova ◽  
Jiheum Park ◽  
Francesca Lim ◽  
Gulam Abbas Manji ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Clinical Trial Data ◽  
Cost Effective ◽  
Trial Data ◽  
Effective Strategy ◽  
Borderline Resectable ◽  
Total Cost ◽  
Life Years ◽  
Platinum Based Chemotherapy ◽  
The Cost

e16246 Background: Patients with germline BRCA1/2 mutations (gBRCAm) have an increased risk for pancreatic ductal adenocarcinoma (PDAC). The NCCN 2020 guidelines recommend platinum-based chemotherapy (FOLFIRINOX or gemcitabine plus cisplatin) in patients with gBRCAm diagnosed with borderline resectable or locally advanced (BR/LA) PDAC; for patients without progression on chemotherapy, maintenance therapy with a PAPR inhibitor (PARPi) can be considered. FOLFIRINOX and gemcitabine plus cisplatin (GemCis), with or without maintenance PARPi, have not been directly compared in this patient population. The purpose of our study was to compare treatment outcomes, toxicity, costs, and quality-of-life of the two recommended platinum-based regimens, with or without maintenance PARPi (olaparib or veliparib), in patients with gBRCAm and BR/LA PDAC. Methods: We developed a decision-analytic mathematical model comparing the total cost and health outcomes of FOLFIRINOX, FOLFIRINOX + olaparib (FOLFIRNOX-O), GemCis, and GemCis + veliparib (GCV) over twelve years. The inputs for the model were estimated using clinical trial data and published literature. Natural history was used as a comparator. The primary endpoint was incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay (WTP) threshold of $100,000 per quality-adjusted-life-year (QALY). Secondary endpoints included overall survival (OS), progression-free survival (PFS), life-years (LYs) and total cost of care (USD). Results: Both FOLFIRINOX strategies were dominated by the GemCis strategies and thus eliminated from the efficiency frontier. GCV was the strategy that yielded the most life-years (2.05 LYs) but the ICER of $629,697.46 for this regimen far exceeded the WTP threshold. Therefore, GemCis was the cost-effective strategy, totaling incremental QALYs of 1.31 at a cost of $61,228.40 per QALY when compared to natural history. A one-way sensitivity analysis found that the GCV becomes the cost-effective strategy when the cost of maintenance PARPi is lowered to 4% of the base case. Conclusions: Our model found that GemCis is the cost-effective option for patients with gBRCAm and BR/LA PDAC. Neither of the strategies with maintenance PARPi were cost-effective. Additional clinical trial data with adequate follow-up are needed to confirm our findings.[Table: see text]

scholarly journals Economic evaluation of the Good School Toolkit: an intervention for reducing violence in primary schools in Uganda

2018 ◽  
Vol 3 (2) ◽  
pp. e000526 ◽  
Author(s):  
Giulia Greco ◽  
Louise Knight ◽  
Willington Ssekadde ◽  
Sophie Namy ◽  
Dipak Naker ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Primary Schools ◽  
Physical Violence ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cluster Randomised Controlled Trial ◽  
Total Cost ◽  
Good School ◽  
Randomised Controlled ◽  
The Cost

IntroductionThis paper presents the cost and cost-effectiveness of the Good School Toolkit (GST), a programme aimed at reducing physical violence perpetrated by school staff to students in Uganda.MethodsThe effectiveness of the Toolkit was tested with a cluster randomised controlled trial in 42 primary schools in Luwero District, Uganda. A full economic costing evaluation and cost-effectiveness analysis were conducted alongside the trial. Both financial and economic costs were collected retrospectively from the provider’s perspective to estimate total and unit costs.ResultsThe total cost of setting up and running the Toolkit over the 18-month trial period is estimated at US$397 233, excluding process monitor (M&E) activities. The cost to run the intervention is US$7429 per school annually, or US$15 per primary school pupil annually, in the trial intervention schools. It is estimated that the intervention has averted 1620 cases of past-week physical violence during the 18-month implementation period. The total cost per case of violence averted is US$244, and the annual implementation cost is US$96 per case averted during the trial.ConclusionsThe GST is a cost-effective intervention for reducing violence against pupils in primary schools in Uganda. It compares favourably against other violence reduction interventions in the region.

Cost-effectiveness analysis of first-line treatment for metastatic renal cell carcinoma (mRCC) in Colombia (ONCOLGroup study)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16150-e16150
Author(s):  
J. Godoy ◽  
A. F. Cardona ◽  
H. Cáceres ◽  
J. M. Otero ◽  
M. Lujan ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cost Effectiveness ◽  
Renal Cell ◽  
Cost Effective ◽  
Average Total Cost ◽  
Line Treatment ◽  
First Line ◽  
Total Cost ◽  
The Cost ◽  
First Line Treatment

e16150 Background: Renal cell carcinoma has increased its incidence by 126% since 1950. A local study developed a complete economic evaluation of sunitinib versus IFN in first-line treatment of mRCC in Colombia, finding that sunitinib was more cost-useful and cost-effective. Methods: A Markov model was developed using 6-week cycles for evaluating the cost-effectiveness of four interventions (IFN, sunitinib, bevacizumab+IFN, sorafenib) approved as first-line treatment for mRCC in Colombia. The model used the third-party payer perspective and a 5-year time-line; it also presumed that all the patients (pts) continued with active treatment until progression when it became acceptable to continue with a second-line treatment or BSC. Overall survival (OS) and progression-free survival (PFS) curves of IFN were used as reference framework; they were obtained form a published clinical trial. The hazard ratios (HR) for PFS and OS were estimated for comparing new generation medicaments with IFN. The information about frequency of use and health service cost units consumed in Colombia was taken from a series of 24 pts treated in Manizales, Pereira, Medellín and Bogotá. Service costs were requested from an external consultant and corresponded to the average value billed by the EPSs, calculated from 33 sources of information which were representative of the country's market. The cost of the medicaments was obtained from LCLC. The costs and benefits were discounted annually at 3%. (all cost are presented in Colombian pesos Col$ 2008 with an exchange rate 1 USD = 1836.20 Col$). Results: Incremental analysis indicated a difference of 41.1 million Col$ in the average total cost of treatment when Sunitinib was compared to IFN; in contrast, comparing sorafenib and Bevacizumab+INF to sunitinib demonstrated that the average total cost was less for the sunitinib by 8.3 and 104.2 million Col$, respectively. Additionally, the ratios of incremental cost-effectiveness by life years (LY) gained demonstrated sunitinib's simple dominance over sorafenib and the combination of bevacizumab+IFN, and an average by LY gained of 100.5 million Col$ compared to IFN. Conclusions: Sunitinib is the most cost-effective option as first-line treatment for mRCC pts in Colombia. [Table: see text]

Cost-Effectiveness of Migraine Prevention: The Case of Topiramate in the UK

Cephalalgia ◽  
2006 ◽  
Vol 26 (12) ◽  
pp. 1473-1482 ◽  
Author(s):  
JS Brown ◽  
G Papadopoulos ◽  
PJ Neumann ◽  
M Price ◽  
M Friedman ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Preventive Treatment ◽  
Cost Effective ◽  
Health Utility ◽  
Quality Adjusted Life Year ◽  
Migraine Prevention ◽  
Migraine Frequency ◽  
Cost Effective Treatment ◽  
The Uk ◽  
The Cost

The aim of this study was to assess the cost-effectiveness of topiramate vs. no preventive treatment in the UK. Model inputs included baseline migraine frequency, treatment discontinuation and response, preventive and acute medical cost per attack [2005 GBP (£)] and gain in health utility. Outcomes included monthly migraines averted, acute and preventive treatment costs and cost per quality-adjusted life year (QALY). Topiramate was associated with 1.8 fewer monthly migraines and a QALY gain of 0.0384. The incremental cost of topiramate vs. no preventive treatment was about £10 per migraine averted and £5700 per QALY. Results are sensitive to baseline monthly migraine frequency, triptan use rate and the gain in utility. Incorporating savings from reduced work loss (about £36 per month) suggests that topiramate would be cost saving compared with no preventive treatment. This analysis suggests that topiramate is a cost-effective treatment for migraine prevention compared with no preventive treatment.

scholarly journals Cost-Effectiveness Analysis of Direct Oral Anticoagulants Versus Vitamin K Antagonists for Venous Thromboembolism in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Ke-Xin Sun ◽  
Bin Cui ◽  
Shan-Shan Cao ◽  
Qi-Xiang Huang ◽  
Ru-Yi Xia ◽  
...  
Keyword(s):  
Decision Making ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Clinical Decision Making ◽  
Cost Effective ◽  
Clinical Decision ◽  
Base Case ◽  
Effectiveness Analysis ◽  
The Cost

Background: The drug therapy of venous thromboembolism (VTE) presents a significant economic burden to the health-care system in low- and middle-income countries. To understand which anticoagulation therapy is most cost-effective for clinical decision-making , the cost-effectiveness of apixaban (API) versus rivaroxaban (RIV), dabigatran (DAB), and low molecular weight heparin (LMWH), followed by vitamin K antagonist (VKA), in the treatment of VTE in China was assessed.Methods: To access the quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs), a long-term cost-effectiveness analysis was constructed using a Markov model with 5 health states. The Markov model was developed using patient data collected from the Xijing Hospital from January 1, 2016 to January 1, 2021. The time horizon was set at 30 years, and a 6-month cycle length was used in the model. Costs and ICERs were reported in 2020 U.S. dollars. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were used to test the uncertainties. A Chinese health-care system perspective was used.Results: In the base case, the data of 231 VTE patients were calculated in the base case analysis retrospectively. The RIV group resulted in a mean VTE attributable to 95% effective treatment. API, DAB, and VKA have a negative ICER (−187017.543, −284,674.922, and −9,283.339, respectively) and were absolutely dominated. The Markov model results confirmed this observation. The ICER of the API and RIV was negative (−216176.977), which belongs to the absolute inferiority scheme, and the ICER value of the DAB and VKA versus RIV was positive (110,577.872 and 836,846.343). Since the ICER of DAB and VKA exceeds the threshold, RIV therapy was likely to be the best choice for the treatment of VTE within the acceptable threshold range. The results of the sensitivity analysis revealed that the model output varied mostly with the cost in the DAB on-treatment therapy. In a probabilistic sensitivity analysis of 1,000 patients for 30 years, RIV has 100% probability of being cost-effective compared with other regimens when the WTP is $10973 per QALY. When WTP exceeded $148,000, DAB was more cost-effective than RIV.Conclusions: Compared with LMWH + VKA and API, the results proved that RIV may be the most cost-effective treatment for VTE patients in China. Our findings could be helpful for physicians in clinical decision-making to select the appropriate treatment option for VTE.

scholarly journals ANALISIS EFEKTIVITAS BIAYA PASIEN PNEUMONIA BALITA RAWAT INAP DI RUMAH SAKIT BHAYANGKARA MANADO

PHARMACON ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. 968
Author(s):  
Monica D. Lestari ◽  
Gayatri Citraningtyas ◽  
Hosea Jaya Edi
Keyword(s):  
Cost Effectiveness ◽  
Effective Treatment ◽  
Treatment Options ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Cost Effective Treatment ◽  
Retrospective Data Collection ◽  
Keywords Antibiotics ◽  
The Cost

ABSTRACTPneumonia is an infectious disease in the lower respiratory tract that affects the lung tissue. Ceftriaxone and Gentamicin antibiotics are the most numerous and good for use in the treatment of pneumonia, but of the two antibiotics is not yet known the options for more cost effective treatment, so it needs to be done the cost effectiveness analysis in order to facilitate the selection of more cost-effective treatment options especially in toddler. This study aims to determine which therapies are more cost-effective than the use of antibiotics Ceftriaxone and Gentamicin in pneumonia patients in the January-December 2018 period in the Bhayangkara Manado Hospital using descriptive research methods with retrospective data collection. The sample in this study were 22 patients, 12 patients using ceftriaxone antibiotics and 10 patients using gentamicin antibiotics. The results showed that pneumonia treatment in infants using Ceftriaxone antibiotics was more cost-effective with ACER ceftriaxone value of Rp. 503,872 / day and ICER value of Rp. 145,588 / day. Keywords : Antibiotics, CEA (Cost-Effectiveness Analysis), Pharmacoeconomy, Toddler Pneumonia. ABSTRAKPneumonia merupakan penyakit infeksi pada saluran pernapasan bagian bawah yang mengenai jaringan paru. Antibiotik Seftriakson dan Gentamisim yang paling banyak dan baik untuk digunakan dalam pengobatan pneumonia, namun dari kedua antibiotik tersebut belum diketahui pilihan terapi yang lebih cost-effective, sehingga perlu dilakukan analisis efektivitas biaya agar dapat mempermudah dalam pemilihan alternatif pengobatan yang lebih cost-effective khususnya pada balita. Penelitian ini bertujuan untuk menentukan terapi yang lebih cost-effective dari penggunaan antibiotik Seftriakson dan Gentamisin pada pasien pneumonia rawat inap periode Januari-Desember 2018 di Rumah Sakit Bhayangkara Manado dengan menggunakan metode penelitian deskriptif dengan pengambilan data secara retrospektif. Sampel pada penelitian ini sebanyak 22 pasien yaitu 12 pasien menggunakan antibiotik Seftriakson dan 10 pasien menggunakan antibiotik Gentamisin. Hasil penelitian menunjukkan pengobatan pneumonia pada balita menggunakan antibiotik Seftriakson lebih cost-effective dengan nilai ACER seftriakson sebesar Rp. 503,872/hari dan nilai ICER sebesar Rp. 145.588/hari. Kata Kunci : Pneumonia Balita, Antibiotik, CEA (Cost-Effectiveness Analysis), Farmakoekonomi

scholarly journals The cost‑effectiveness of hypertonic saline inhalations for infant bronchiolitis.

2020 ◽  
Author(s):  
jefferson buendia ◽  
Ranniery Acuña-Cordero
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Decision Makers ◽  
Hypertonic Solution ◽  
Cost Effectiveness Ratio ◽  
Tropical Country ◽  
Total Cost ◽  
Use Of Resources ◽  
Lower Total Cost ◽  
The Cost

Abstract BackgroundPharmacological treatment for bronchiolitis is primarily supportive because bronchodilators, steroids, and antibiotics, show little benefit. Clinical studies have suggested that nebulized 3% hypertonic solution is useful for infants with bronchiolitis. This study aims to evaluate the cost-effectiveness of the HS inhalations in infant bronchiolitis in a tropical country Methods Decision tree analysis was used to calculate the expected costs and QALYs. All cost and use of resources were collected directly from medical invoices of 193 patient hospitalized with diagnosis of bronchiolitis in tertiary centers, of Rionegro, Colombia. The utility values applied to QALYs calculations were collected from the literature. The economic analysis was carried out from a societal perspective.ResultsThe model showed that nebulized 3% hypertonic solution, was associated with lower total cost than controls (US $200vs US $240 average cost per patient), and higher QALYs ( 0.92 vs 0.91 average per patient); showing dominance. A position of dominance negates the need to calculate an incremental cost-effectiveness ratio.Conclusion The nebulized 3% hypertonic solution was cost-effective in the inpatient treatment of infant bronchiolitis. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other tropical countries.

scholarly journals Pegylated versus non-pegylated interferon beta 1a in patients with relapsing-remitting multiple sclerosis: A cost-effectiveness analysis

2019 ◽  
Author(s):  
Amir Hashemi-Meshkini ◽  
Hedieh Sadat Zekri ◽  
Hasan Karimi-Yazdi ◽  
Pardis Zaboli ◽  
Mohammad Ali Sahraian ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cost Effectiveness ◽  
Interferon Beta ◽  
Cost Effective ◽  
Pegylated Interferon ◽  
The United States ◽  
Health States ◽  
Payer Perspective ◽  
Cost Effective Treatment ◽  
The Cost

Background: Pegylated (PEG) interferon beta 1a has been approved by the United States Food and Drug Administration (USFDA) as an alternative to interferon beta 1a for multiple sclerosis (MS). Due to its higher price, this study aimed to evaluate the cost-effectiveness of PEG-interferon beta 1-a compared with interferon beta 1a from an Iranian payer perspective. Methods: A Markov model was designed according to health states based on Expanded Disability Status Scale (EDSS) and one-month cycles over a 10-year time horizon. Direct medical and non-medical costs were included from a payer perspective. Results: The incremental cost-effectiveness ratio (ICER) was estimated around 11111 US dollars (USD) per quality-adjusted life-year (QALY) gained for the PEG-interferon versus interferon regimen [with currency rate of 29,000 Iranian Rial (IRR) to 1 USD in 2016]. Conclusion: Considering the cost-effectiveness  threshold in Iran [three times of gross domestic product (GDP) per capita or 15,945 USD], PEG-interferon beta 1-a could be considered as a cost effective treatment for Iranian patients with MS.

scholarly journals Cost-effectiveness of TB treatments to Burmese and Laotian patients by Thai hospitals on the border with Myanmar and Laos

2019 ◽  
Vol 34 (1) ◽  
pp. 13-21
Author(s):  
Onn Laingoen ◽  
Tawatchai Apidechkul ◽  
Panupong Upala ◽  
Ratipark Tamornpark ◽  
Chaleerat Foungnual ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Care Program ◽  
Cost Effective ◽  
Cost Effectiveness Ratio ◽  
Content Type ◽  
Total Cost ◽  
Tb Treatment ◽  
Retrospective Data Collection ◽  
The Cost

Purpose The purpose of this paper is to estimate the cost-effectiveness of tuberculosis (TB) treatment and care in two Thai hospitals located on the borders with Myanmar and Laos. Design/methodology/approach A retrospective data collection was conducted to analyze all costs relevant to TB treatment and care from Mae Sai and Chiang Sean Hospitals. The cost related to TB treatment and care and the number of successful TB treatment from January 1 to December 31, 2017 were used for the calculation. The cost-effectiveness ratio (C/E) and the incremental cost-effectiveness ratio (ICER) were the outcomes. Findings In 2017, the total cost of the TB treatment and care program at Mae Sai Hospital was 482,728.94 baht for 57 TB patients. The cast per treated case per year was 8,468.93 baht. The C/E was 10,971.11 baht per successful TB treatment (44 successful cases). The total cost of the TB treatment and care program at Chiang Sean Hospital was 330,578.73 baht for 39 TB patients. The cost per treated case per year was 8,476.38 baht. The C/E was 22,038.58 baht per successful TB treatment (15 successful cases). The ICER was 5,246.56 baht. The Mae Sai Hospital model was more cost-effective in terms of the treatment and care provided to Burmese patients with TB than the Chiang Sean Hospital model for Laotian patients with TB. Originality/value To improve the cost-effectiveness of TB treatment and care programs for foreign patients in hospitals located on the Thai border, focus should be placed on patient follow-up at the community or village level.

scholarly journals The cost-effectiveness of hypertonic saline inhalations for infant bronchiolitis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jefferson Antonio Buendía ◽  
Ranniery Acuña-Cordero
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Decision Makers ◽  
Hypertonic Solution ◽  
Cost Effectiveness Ratio ◽  
Tropical Country ◽  
Total Cost ◽  
Use Of Resources ◽  
Lower Total Cost ◽  
The Cost

Abstract Background Pharmacological treatment for bronchiolitis is primarily supportive because bronchodilators, steroids, and antibiotics, show little benefit. Clinical studies have suggested that nebulized 3% hypertonic solution is useful for infants with bronchiolitis. This study aims to evaluate the cost-effectiveness of the HS inhalations in infant bronchiolitis in a tropical country. Methods Decision tree analysis was used to calculate the expected costs and QALYs. All cost and use of resources were collected directly from medical invoices of 193 patient hospitalized with diagnosis of bronchiolitis in tertiary centers, of Rionegro, Colombia. The utility values applied to QALYs calculations were collected from the literature. The economic analysis was carried out from a societal perspective. Results The model showed that nebulized 3% hypertonic solution, was associated with lower total cost than controls (US $200vs US $240 average cost per patient), and higher QALYs (0.92 vs 0.91 average per patient); showing dominance. A position of dominance negates the need to calculate an incremental cost-effectiveness ratio. Conclusion The nebulized 3% hypertonic solution was cost-effective in the inpatient treatment of infant bronchiolitis. Our study provides evidence that should be used by decision-makers to improve clinical practice guidelines and should be replicated to validate their results in other tropical countries.

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