scholarly journals Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257494
Author(s):  
Carmen Selva-Sevilla ◽  
F. Dámaso Fernández-Ginés ◽  
Manuel Cortiñas-Sáenz ◽  
Manuel Gerónimo-Pardo
Keyword(s):  
Cost Effectiveness ◽  
Regression Model ◽  
Scenario Analysis ◽  
Cost Effectiveness Analysis ◽  
Pain Clinic ◽  
Sensitivity Analyses ◽  
Intensity Difference ◽  
Leg Ulcers ◽  
Effectiveness Analysis ◽  
Extreme Scenario

Objectives The general anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds. We conducted a Bayesian cost-effectiveness analysis (CEA) comparing the addition of domiciliary topical sevoflurane to conventional analgesics (SEVOFLURANE, n = 38) versus conventional analgesics alone (CONVENTIONAL, n = 26) for the treatment of nonrevascularizable painful leg ulcers in an outpatient Pain Clinic of a Spanish tertiary hospital. Methods We used real-world data collected from charts to conduct this CEA from a public healthcare perspective and with a one-year time horizon. Costs of analgesics, visits and admissions were considered, expressed in €2016. Analgesic effectiveness was measured with SPID (Sum of Pain Intensity Difference). A Bayesian regression model was constructed, including “treatment” and baseline characteristics for patients (“arterial hypertension”) and ulcers (“duration”, “number”, “depth”, “pain”) as covariates. The findings were summarized as a cost-effectiveness plane and a cost-effectiveness acceptability curve. One-way sensitivity analyses, a re-analysis excluding those patients who died or suffered from leg amputation, and an extreme scenario analysis were conducted to reduce uncertainty. Results Compared to CONVENTIONAL, SEVOFLURANE was associated with a 46% reduction in costs, and the mean incremental effectiveness (28.15±3.70 effectiveness units) was favorable to SEVOFLURANE. The estimated probability for SEVOFLURANE being dominant was 99%. The regression model showed that costs were barely influenced by any covariate, whereas effectiveness was noticeably influenced by “treatment”. All sensitivity analyses showed the robustness of the model, even in the extreme scenario analysis against SEVOFLURANE. Conclusions SEVOFLURANE was dominant over CONVENTIONAL as it was less expensive and much more effective.

scholarly journals Cost-effectiveness analysis of guideline-based optimal care for venous leg ulcers in Australia

2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Qinglu Cheng ◽  
Michelle Gibb ◽  
Nicholas Graves ◽  
Kathleen Finlayson ◽  
Rosana E. Pacella
Keyword(s):  
Cost Effectiveness ◽  
Cost Effectiveness Analysis ◽  
Leg Ulcers ◽  
Optimal Care ◽  
Venous Leg Ulcers ◽  
Effectiveness Analysis

Ixazomib (IXA), carfilzomib (CAR), elotuzumab (ELO) or daratumumab (DAR) with lenalidomide and dexamethasone (LEN+DEX) versus LEN+DEX only in relapsed/refractory multiple myeloma (R/R MM): A comparative cost-effectiveness analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 8043-8043
Author(s):  
Mavis Obeng-Kusi ◽  
Daniel Arku ◽  
Neda Alrawashdh ◽  
Briana Choi ◽  
Nimer S. Alkhatib ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Effectiveness Analysis ◽  
The Other ◽  
Sensitivity Analyses ◽  
Treatment Comparison ◽  
Comparative Cost ◽  
Effectiveness Analysis ◽  
Life Years

8043 Background: IXA, CAR, ELO and DARin combination with LEN+DEXhave been found superior in efficacy compared to LEN+DEX in the management of R/R MM. Applying indirect treatment comparisons from a network meta-analysis (NMA), this economic evaluation aimed to estimate the comparative cost-effectiveness and cost-utility of these four triplet regimens in terms of progression-free survival (PFS). Methods: In the absence of direct treatment comparison from a single clinical trial, NMA was used to indirectly estimate the comparative PFS benefit of each regimen. A 2-state Markov model simulating the health outcomes and costs was used to evaluate PFS life years (LY) and quality-adjusted life years (QALY) with the triplet regimens over LEN+DEX and expressed as the incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR). Probability sensitivity analyses were conducted to assess the influence of parameter uncertainty on the model. Results: The NMA revealed that DAR+LEN+DEX was superior to the other triplet therapies, which did not differ statistically amongst them. As detailed in the Table, in our cost-effectiveness analysis, all 4 triplet regimens were associated with increased PFSLY and PFSQALY gained (g) over LEN+DEX at an additional cost. DAR+LEN+DEX emerged the most cost-effective with ICER and ICUR of $667,652/PFSLYg and $813,322/PFSQALYg, respectively. The highest probability of cost-effectiveness occurred at a willingness-to-pay threshold of $1,040,000/QALYg. Conclusions: Our economic analysis shows that all the triplet regimens were more expensive than LEN +DEX only but were also more effective with respect to PFSLY and PFSQALY gained. Relative to the other regimens, the daratumumab regimen was the most cost-effective.[Table: see text]

Cost-effectiveness analysis of neoadjuvant immune checkpoint inhibition (ICI) versus cisplatin-based chemotherapy (CBC) in muscle-invasive bladder cancer (MIBC).

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 419-419
Author(s):  
Ali Raza Khaki ◽  
Yong Shan ◽  
Richard Nelson ◽  
Sapna Kaul ◽  
John L. Gore ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Randomized Clinical Trials ◽  
Pathologic Complete Response ◽  
Weighted Average ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Effectiveness Analysis

419 Background: Multiple single-arm clinical trials have shown promising pathologic complete response (pCR) rates with neoadjuvant ICIs in MIBC. However, ICIs remain costly. We conducted a cost-effectiveness analysis comparing neoadjuvant ICIs with CBC. Methods: We applied a decision analytic simulation model with a health care payer perspective and two-year time horizon to compare neoadjuvant ICIs vs CBC. For the primary analysis we compared pembrolizumab with dose dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC). We performed a secondary analysis with gemcitabine/cisplatin (GC) as CBC and exploratory analyses with atezolizumab or nivolumab/ipilimumab as ICIs (vs both ddMVAC and GC). We input pCR rates from trials (ICIs) or a weighted average of prior studies (CBC) and costs from average sales price. Outcomes of interest included costs, 2-year recurrence-free survival (RFS), and incremental cost-effectiveness ratio (ICER) of cost per 2-year RFS. A threshold analysis estimated a pCR rate or price reduction for ICI to be cost-effective and one-way and probabilistic sensitivity analyses were performed. Results: Results of the cost effectiveness analysis are shown in the table. The incremental cost of pembrolizumab compared with ddMVAC was $8,042 resulting in an incremental improvement of 0.66% in 2-year RFS for an ICER of $1,218,485 per 2-year RFS. A pCR of 71% or a 26% reduction in cost of pembrolizumab would render it more cost-effective with an ICER of $100,000 per 2-year RFS. GC required a 96% pembrolizumab cost reduction to achieve an ICER of $100,000 per 2-year RFS. Atezolizumab appeared to be more cost-effective than ddMVAC, even though the 2yr RFS was 0.66% worse. Conclusions: ICIs were not cost-effective as neoadjuvant therapies, except when atezolizumab was compared with ddMVAC. Pembrolizumab would approach cost-effective thresholds with 26% or 96% reduction in cost when compared to ddMVAC and GC, respectively. Randomized clinical trials, larger sample sizes and longer follow-up are required to better understand the value of ICIs as neoadjuvant treatments. [Table: see text]

scholarly journals A cost-effectiveness analysis of two community models of care for patients with venous leg ulcers

2006 ◽  
Vol 15 (8) ◽  
pp. 348-353 ◽  
Author(s):  
L. Gordon ◽  
H. Edwards ◽  
M. Courtney ◽  
K. Finlayson ◽  
P. Shuter ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Models Of Care ◽  
Cost Effectiveness Analysis ◽  
Leg Ulcers ◽  
Venous Leg Ulcers ◽  
Effectiveness Analysis

scholarly journals The Impact of Outliers on Net-Benefit Regression Model in Cost-Effectiveness Analysis

PLoS ONE ◽  
2013 ◽  
Vol 8 (6) ◽  
pp. e65930 ◽  
Author(s):  
Yu-Wen Wen ◽  
Yi-Wen Tsai ◽  
David Bin-Chia Wu ◽  
Pei-Fen Chen
Keyword(s):  
Cost Effectiveness ◽  
Regression Model ◽  
Cost Effectiveness Analysis ◽  
Net Benefit ◽  
Effectiveness Analysis ◽  
The Impact

scholarly journals Evaluating the Cost-effectiveness Analysis of Rehabilitation Methods for Patients with Stroke

2021 ◽  
Author(s):  
Farzaneh Miri ◽  
Nader Jahanmehr ◽  
Reza Goudarzi
Keyword(s):  
Cost Effectiveness ◽  
Stroke Unit ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Rehabilitation Service ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Rehabilitation Strategy ◽  
At Home

Abstract Aims: This study evaluated and compared the cost-effectiveness of rehabilitation interventions in patients with stroke in the three alternatives of hospitals, units and homes due to the fact that one of the stroke management challenges is how to provide a rehabilitation service to these patients in Iran. Methods: This is a cost-effectiveness analysis from the perspective of a health system. A Markov model with a 20-year time horizon in 3-month cycles was used to analyze the costs and outcomes. Cost data were collected from the 210 patients undergoing rehabilitation in the hospital, home and unit. Utility data were extracted from previously published literature with the same setting. The cost-effectiveness analysis was conducted by calculating ICER using TreeAge Software. Basic and probabilistic sensitivity analyses were also conducted at the end. Results: The average cost of rehabilitation in home strategy ($ 2306) was less than hospital ($2955) and unit ($3485) strategies. Furthermore, the utility of home strategy (26.03) was 8 units higher than hospital utility (17.99) and 19 units higher than utility of the stroke unit (7.03). The Acer values of hospital, stroke unit and home groups were $11424, $33159 and $7233 per utility, respectively. According to the results, the home-based rehabilitation strategy is cost effective compared to hospital and unit rehabilitation strategy. The results of the probabilistic sensitivity analysis also showed that the ICER of home strategy is always cost-effective than the other strategies. Limitation: : limitation of the present study was the reliance on utility values of other studies. Conclusion: Rehabilitation at home is the most cost-effective strategy for stroke patients. Given the high rates of this disease in Iran and the high cost of it, it is suggested that policy makers lay the groundwork for providing these services at home.

scholarly journals Cost-effectiveness of HPV vaccination in 195 countries: A meta-regression analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260808
Author(s):  
Katherine L. Rosettie ◽  
Jonah N. Joffe ◽  
Gianna W. Sparks ◽  
Aleksandr Aravkin ◽  
Shirley Chen ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Regression Analysis ◽  
Cost Effectiveness ◽  
Hpv Vaccination ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Cancer Burden ◽  
Effectiveness Analysis ◽  
Meta Regression ◽  
Meta Regression Analysis

Cost-effectiveness analysis (CEA) is a well-known, but resource intensive, method for comparing the costs and health outcomes of health interventions. To build on available evidence, researchers are developing methods to transfer CEA across settings; previous methods do not use all available results nor quantify differences across settings. We conducted a meta-regression analysis of published CEAs of human papillomavirus (HPV) vaccination to quantify the effects of factors at the country, intervention, and method-level, and predict incremental cost-effectiveness ratios (ICERs) for HPV vaccination in 195 countries. We used 613 ICERs reported in 75 studies from the Tufts University’s Cost-Effectiveness Analysis (CEA) Registry and the Global Health CEA Registry, and extracted an additional 1,215 one-way sensitivity analyses. A five-stage, mixed-effects meta-regression framework was used to predict country-specific ICERs. The probability that HPV vaccination is cost-saving in each country was predicted using a logistic regression model. Covariates for both models included methods and intervention characteristics, and each country’s cervical cancer burden and gross domestic product per capita. ICERs are positively related to vaccine cost, and negatively related to cervical cancer burden. The mean predicted ICER for HPV vaccination is 2017 US$4,217 per DALY averted (95% uncertainty interval (UI): US$773–13,448) globally, and below US$800 per DALY averted in 64 countries. Predicted ICERs are lowest in Sub-Saharan Africa and South Asia, with a population-weighted mean ICER across 46 countries of US$706 per DALY averted (95% UI: $130–2,245), and across five countries of US$489 per DALY averted (95% UI: $90–1,557), respectively. Meta-regression analyses can be conducted on CEA, where one-way sensitivity analyses are used to quantify the effects of factors at the intervention and method-level. Building on all published results, our predictions support introducing and expanding HPV vaccination, especially in countries that are eligible for subsidized vaccines from GAVI, the Vaccine Alliance, and Pan American Health Organization.

scholarly journals Cost-effectiveness analysis of screening for first-degree relatives of patients with bicuspid aortic valve

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Tessler ◽  
M Leshno ◽  
A Shmueli ◽  
S Shpitzen ◽  
R Durst ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Cost Effectiveness Analysis ◽  
Public Institution ◽  
Sensitivity Analyses ◽  
Decision Analytic Model ◽  
First Degree Relatives ◽  
Effectiveness Analysis ◽  
Life Years

Abstract Introduction Bicuspid aortic valve (BAV) is the commonest congenital heart valve defect, found in 1% to 2% of the general population and associated with life-threatening complications. Given the high heritability index of BAV, many experts recommend echocardiography for first-degree relatives (FDRs) of an index patient. However, the cost-effectiveness of such cascade screening for BAV has not been fully evaluated. Materials and methods Using a decision-analytic model, we performed a cost-effectiveness analysis of echocardiographic screening of FDRs of BAV index cases. Data on BAV probabilities and BAV complications among FDRs were derived from our institution's BAV familial cohort and from the relevant literature on population-based BAV cohorts with long-term follow-up. Health gain was measured as quality-adjusted life years (QALYs). Cost inputs were based on list prices and literature data. One-way and probabilistic sensitivity analyses were performed to account for uncertainty in the model's variables. Results and disscusion Screening of FDRs was found to be the dominant strategy, being more effective and less costly than no screening, with savings of €208 and gains of 1.6 QALYs. Results were sensitive to the full range of reported BAV rates among FDRs across the literature, with the benefit gradually decreasing from the screening age of 55 years, with trend shifting at the age of 69. Conclusions This economic evaluation model revealed that echocardiographic screening of FDRs of BAV index case is not only clinically important but also highly cost effective and cost-saving. Health gains could be achieved from initiating screening program, along with costs saving. Sensitivity analysis supported the model's robustness, suggesting its generalization. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Center for Interdisciplinary Data Science Research fellowships grant

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