Cost-Effectiveness of Adherence-Enhancing Interventions: A Quality Assessment of the Evidence

2005 ◽  
Vol 39 (3) ◽  
pp. 508-515 ◽  
Author(s):  
Rachel A Elliott ◽  
Nick Barber ◽  
Rob Horne
Keyword(s):  
Cost Effectiveness ◽  
English Language ◽  
Cost Minimization ◽  
Data Extraction ◽  
Cost Benefit ◽  
Quality Criteria ◽  
Cost Utility ◽  
Outcome Data ◽  
Study Selection ◽  
The Cost

OBJECTIVE: To determine whether the current cost-effectiveness evidence on adherence-enhancing interventions (AEIs) was of sufficient quality to aid in decision-making regarding medication adherence policies. DATA SOURCES: A computerized search of Embase, MEDLINE, Cinahl, Econlit, NHSEED, Psychlit, EPIC, and Cochrane databases (1980–April 2004) was performed. English-language human subject articles were identified using the key words compliance, adherence, concordance, patient assistance, therapeutic alliance, costs, economics, efficiency, resource use/utilization, cost-of illness, cost-effectiveness, cost-minimization, cost-utility, and cost-benefit. STUDY SELECTION AND DATA EXTRACTION: Studies that appeared to assess the cost-effectiveness of medication AEIs were included. Methodologic rigor was assessed using 15 minimum quality criteria. DATA SYNTHESIS: We found 45 comparative studies in 43 publications. Asthma (14 studies) and psychiatric illness (12 studies) were most commonly investigated. In 33 studies, interventions were educational, 18 had multiple components, and 23 did not appear to be linked to proven reasons for nonadherence. Reporting of adherence and outcome results was often unclear. Cost data were poorer quality than outcome data, using average or estimated costs and omitting some cost elements. Nine studies carried out incremental economic analysis. No study met all quality criteria. CONCLUSIONS: We were not able to make definitive conclusions about the cost-effectiveness of AEIs due to the heterogeneity of the studies found and incomplete reporting of results. Important policy decisions need to be made about nonadherence; however, they are currently being made in a vacuum of adequate information. AEIs must be based on reasons for nonadherence and be evaluated using accepted clinical and economic quality criteria.

Health economics and health promotion

2018 ◽  
pp. 113-140
Author(s):  
Colin Palfrey
Keyword(s):  
Health Promotion ◽  
Cost Effectiveness ◽  
Health Economics ◽  
Conjoint Analysis ◽  
Cost Benefit ◽  
Cost Utility ◽  
Value For Money ◽  
Cost Minimisation ◽  
The Cost

This chapter examines the techniques used by health economists to evaluate the value for money of health promotion initiatives. It first provides an overview of concepts related to economics and health economics, including efficiency, equality, equity and accessibility. Efficiency can be evaluated in terms of cost-minimisation, cost-effectiveness, cost-benefit and cost-utility. The chapter then considers the various rationing strategies by which the NHS can try to reduce expenditure, the use of QALYs to compare the cost-effectiveness of health promotion projects, and conjoint analysis. It also explains how health economists calculate the cost to society of unhealthy lifestyles such as obesity and smoking, and goes on to tackle the question of prevention vs cure in health promotion, the expenditure on the NHS, and the limitations of health economics in evaluation of health promotion endeavours. The chapter concludes with an assessment of how to estimate the costs of health promotion.

Costs and cost-effectiveness in critical care

2016 ◽  
Author(s):  
David J. Wallace ◽  
Derek C. Angus
Keyword(s):  
Critical Care ◽  
Cost Effectiveness ◽  
Cost Minimization ◽  
Cost Benefit ◽  
Cost Utility ◽  
Cost Effectiveness Analysis ◽  
Policy Implications ◽  
Funding Policy ◽  
Cost Study ◽  
Effectiveness Analysis

Critical care accounts for a large and growing part of national health expenditures. Cost-effectiveness analyses are one way to identify therapies that maximize society’s return on investment. This chapter provides a broad overview of four cost study designs—cost-minimization, cost-benefit, cost-effectiveness, and cost-utility. Cost -effectiveness analysis allows the costs and benefits of different therapies to be directly compared. Within a constrained budget, cost-effectiveness analysis can identify the optimal therapies for funding. Policy informed by cost effectiveness should improve public health. The reader is introduced to the concepts of cost perspective, included costs and cost discounting. We conclude by describing policy implications of cost effectiveness evaluations and highlight their relevance to the Patient-Centered Outcomes Research Institute.

scholarly journals The study of Pharmacoeconomics analysis on anti tuberculosis drugs Rifampicin & Ethambutol

2018 ◽  
Vol 1 (1) ◽  
pp. 31-40
Author(s):  
Arsalan Sarmad ◽  
B. Syed Salman ◽  
Syed Sharfuddin Ibrahim
Keyword(s):  
Cost Effectiveness ◽  
Cost Benefit Analysis ◽  
Cost Minimization ◽  
Cost Benefit ◽  
Minimum Cost ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Effective Therapy ◽  
Benefit Analysis ◽  
Utility Analysis

Cost-benefit analysis can be used to quantify the value of clinical pharmacy services. Providing Effective Therapy and Minimum cost, Quantify costs of care, Quantify outcomes, Assess whether and by how much average costs and outcomes differ among treatment groups, Compare magnitude of difference in costs and outcomes and evaluate “value for costs” by reporting a cost-effectiveness ratio, net monetary benefit, or probability that ratio is acceptable – Potential hypothesis: Cost per quality-adjusted life year saved significantly less than Rs.75,000, To Perform sensitivity analysis. For providing good effective therapy with less adverse drug reaction at affordable price, Cost-Identification, Cost-Effectiveness Analysis, Cost-Utility Analysis, Cost-Benefit Analysis, Clinical outcomes: Cure, comfort and survival, Humanistic outcomes: Physical, emotional, social function, role performance, Economic outcomes, Economic Evaluation, Cost of Illness Evaluation (COI), Cost Benefit Analysis (CBA), Cost Minimization Analysis, Cost Effective Analysis: Cost Utility Analysis.

Cost-effectiveness of primary prophylaxis (PP) with colony-simulating factor (CSF) when compared with secondary prophylaxis (SP) in elderly patients with diffuse aggressive lymphoma undergoing curative chemotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6558-6558
Author(s):  
K. K. Chan ◽  
K. R. Imrie ◽  
S. M. Alibhai
Keyword(s):  
Cost Effectiveness ◽  
Elderly Patients ◽  
Cost Minimization ◽  
Cost Effective ◽  
Primary Prophylaxis ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Aggressive Lymphoma ◽  
Base Case ◽  
The Cost

6558 Background: The 2006 ASCO guideline recommends PP with CSF for elderly patients with diffuse aggressive lymphoma, partially based on previous cost-minimization analyses showing that CSF saved costs when compared with no CSF by reducing hospitalization from febrile neutropenia (FN) when the risk of FN was > 20%. However, these studies examined only one cycle of chemotherapy and did not account for costs of CSF in subsequent cycles, did not consider SP, and did not consider patients’ preferences. Methods: We conducted a cost-utility analysis to compare PP with SP in this setting using a Markov model for a time horizon of 8 cycles of chemotherapy with a government payer perspective. Costs were adjusted to 2006 $CAD. Ontario health economic data were used. The cost of hospitalization for FN was obtained from Ontario Case Costing Initiative. Data for efficacies of CSF, probabilities and utilities were obtained from published literature. Sensitivity analyses were conducted using a threshold of $100,000/QALY. Results: The base case costs for PP and SP were $22,077 and $17,641. The QALYs of PP and SP were 0.254 and 0.248. The incremental cost effectiveness ratio of PP to SP was $739,999/QALY. One-way sensitivity analyses showed that in order for PP to be cost-effective, the cost of hospitalization per episode of FN had to be > $31,138 (i.e. 2.5 times > base case), the cost of CSF per cycle had to be < $896 (base case = $1,960), the risk of FN in the 1st cycle had to be > 48% (base case = 24%), or the relative risk reduction of FN with CSF had to be > 97% (base case = 41%). Our result was robust to all other cost, probability and utility variables. First order microsimulation showed that < 17% of simulations were cost-effective. Conclusions: PP is not cost-effective when compared with SP for this population under most assumptions. PP only becomes attractive in places where the cost of hospitalization for FN is much more than that of Ontario, or the cost of CSF is under $896 per cycle. The costs of CSF and hospitalization in all cycles (instead of just one cycle) should be accounted for in any economic evaluation of CSF. Current guidelines recommending PP in this population should be revisited. No significant financial relationships to disclose.

scholarly journals Systematic Review of the Economic Evaluation of Returning Incidental Findings in Genomic Research

2021 ◽  
Vol 9 ◽  
Author(s):  
Mayara Fontes Marx ◽  
John E. Ataguba ◽  
Jantina de Vries ◽  
Ambroise Wonkam
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Cost Analysis ◽  
Incidental Findings ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Cost Utility ◽  
Genomic Sequencing ◽  
Benefit Analysis ◽  
The Cost

Objectives: Discussions regarding who and how incidental findings (IFs) should be returned and the ethics behind returning IFs have increased dramatically over the years. However, information on the cost and benefits of returning IFs to patients remains scanty.Design: This study systematically reviews the economic evaluation of returning IFs in genomic sequencing. We searched for published articles on the cost-effectiveness, cost-benefit, and cost-utility of IFs in Medline, Scopus, PubMed, and Google Scholar.Results: We found six published articles that met the eligibility criteria of this study. Two articles used cost analysis only, one used cost-benefit analysis only, two used both cost analysis and cost-effectiveness, and one used both cost-benefit analysis and cost-utility to describe the cost of returning IFs in genomic sequencing.Conclusion: While individuals value the IF results and are willing to pay for them, the cost of returning IFs depends on the primary health condition of the patient. Although patients were willing to pay, there was no clear evidence that returning IFs might be cost-effective. More rigorous economic evaluation studies of IFs are needed to determine whether or not the cost of returning IFs is beneficial to the patient.

scholarly journals Outlook of Pharmacoeconomics and its status in Nepal

2018 ◽  
Vol 14 (1) ◽  
pp. 56-58
Author(s):  
Sabita Paudel
Keyword(s):  
Health Services ◽  
Cost Minimization ◽  
Cost Benefit ◽  
Cost Effective ◽  
Cost Utility ◽  
Nonmedical Cost ◽  
Effective Cost ◽  
The Cost ◽  
Benefit Cost ◽  
Effective Analysis

Pharmacoeconomics is a branch of health economics which is derived from latin word “Pharmacon”- and “Economia”- It deals with the economic aspect of health that is the costs of health services. There are different types of costs which is affecting the health services. There is not only the direct medical cost, but also direct nonmedical cost, indirect nonmedical costs and intangible cost. The consequences of therapy are evaluated from economic, clinical and humanistic perspective, also known as the ECHO model. There are partial and full pharmacoeconomic analyses. The partial analyses are cost of illness and cost of consequence. The full analyses are cost effective, cost benefit, cost utility and cost minimization analyses. The cost effective analysis is the most commonly used analysis.

Routine Low-Cost Pathology Tests: Measuring the Value in Use of Bacteriology Tests in Hospital and Primary Care

1992 ◽  
Vol 5 (3) ◽  
pp. 225-237 ◽  
Author(s):  
Ala Szczepura
Keyword(s):  
Cost Effectiveness ◽  
Patient Management ◽  
Cost Minimization ◽  
Low Cost ◽  
Major Effect ◽  
Cost Utility ◽  
Clinical Services ◽  
Antibiotic Susceptibility Test ◽  
Utility Cost ◽  
The Cost

The introduction of a managed market in health care in the NHS will encourage managers and clinicians to examine clinical services, such as pathology, more closely. However, simple cost-minimization may not be sufficient; the recent Audit Commission report on pathology emphasises a need to measure and monitor cost-effectiveness of clinical services such as pathology. This paper presents the findings of a study to measure the cost-effectiveness of one routine pathology test; the culture and antibiotic susceptibility test performed by all microbiology laboratories. Over 2,900 requests were examined and test results tracked in hospitals and general practices served by three laboratories. The findings show that, although average test costs are low for the three main user groups (£4.3–5.9), the cost of producing an effect on patient management (change to therapy) is high at £54–67. In addition to therapy changes, the one major effect recorded was that of clinician reassurance. If all measured effects are weighted by their reported clinical utility, cost-utility ratios of £27.0 ± £1.0, £45.5 ± £4.5 and £44.5 ± £3.5 per patient management effect are calculated for general practitioner, outpatient and inpatient use respectively. A theoretical model is presented which will allow the comparative cost-effectiveness of a range of routine diagnostic tests to be measured through the use of a test-utility index, similar to the health index which is currently used to measure the outcome of medical interventions (QALYs).

Economic evaluation and priority setting: an overview

2017 ◽  
Author(s):  
Jan Abel Olsen
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Benefit Analysis ◽  
Utility Analysis ◽  
The Cost ◽  
Evaluation Techniques

This chapter provides an overview of the methodologies that come under the umbrella term of economic evaluation in healthcare. Economic evaluations seek to identify, measure, value, and compare alternative programmes. A taxonomy is developed to distinguish economic evaluation techniques depending on whether benefits have been measured in money terms or not, and whether benefits are based on preferences or not. When benefits are measured in money terms, it is referred to as a cost–benefit analysis (CBA). If benefits are measured in health terms, some sort of cost-effectiveness analysis (CEA) is being used. An important class of CEA is what has come to be labelled ‘cost-utility-analysis’ (CUA). The chapter explains the incremental cost-effectiveness ratio (ICER) and illustrates the cost-effectiveness plane. Finally, the idea of discounting health is discussed.

Transdermal Fentanyl

1992 ◽  
Vol 26 (11) ◽  
pp. 1393-1399 ◽  
Author(s):  
Lisa Y. Yee ◽  
Julio R. Lopez
Keyword(s):  
Chronic Pain ◽  
Clinical Trials ◽  
Placebo Group ◽  
Adverse Effects ◽  
English Language ◽  
Data Extraction ◽  
Opioid Analgesia ◽  
Transdermal Fentanyl ◽  
Study Selection ◽  
The Cost

OBJECTIVE: To review the use of transdermal fentanyl for the treatment of moderate to severe chronic pain. The article provides background on the pharmacology and pharmacokinetics of the drug, as well as the properties of the transdermal system. In addition, clinical trials, adverse effects, and therapeutic considerations and recommendations are presented. DATA SOURCES: Clinical trials, review articles, and reference texts. STUDY SELECTION: Comparative clinical trials involving the use of transdermal fentanyl on postoperative and chronic pain patients. DATA EXTRACTION: Data from clinical human trials published in the English language were reviewed. Trials were assessed by sample size, opioid dosage regimen, and therapeutic outcome. DATA SYNTHESIS: Transdermal fentanyl was found to be effective in the control of chronic and postoperative pain. In one trial the overall patient satisfaction with pain control was 79 percent for the transdermal fentanyl group and 44 percent for the placebo group. In another trial, the amount of additional parenteral morphine was significantly lower for the group receiving transdermal fentanyl than for the placebo group (49.9 ± 4.9 vs. 77.0 ± 6.3 mg, respectively, p<0.01). The most common adverse effects recorded were nausea (45–85 percent), pruritus (14–60 percent), and sedation (40–59 percent). The cost of analgesic therapy with this delivery system is higher than that of parenteral opioid analgesia, but less than patient-controlled analgesia. CONCLUSIONS: The transdermal fentanyl formulation offers some minor advantages over other forms of conventional pain management. Results of early clinical trials are promising, but more studies are needed to evaluate its long-term effectiveness and adverse effects. Specifically, comparisons with standard parenteral and patient-controlled opioid analgesia in chronic malignant and nonmalignant pain are necessary for adequate evaluation of transdermal fentanyl.

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