scholarly journals A comparison of three strategies to reduce the burden of osteoarthritis: A population-based microsimulation study

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261017
Author(s):  
Jacek A. Kopec ◽  
Eric C. Sayre ◽  
Anya Okhmatovskaia ◽  
Jolanda Cibere ◽  
Linda C. Li ◽  
...  
Keyword(s):  
Joint Replacement ◽  
Time Horizon ◽  
Population Based ◽  
Base Case ◽  
Model Parameters ◽  
Surgical Interventions ◽  
Joint Replacement Surgery ◽  
Open Population ◽  
Life Years ◽  
Wide Range

Objectives The purpose of this study was to compare three strategies for reducing population health burden of osteoarthritis (OA): improved pharmacological treatment of OA-related pain, improved access to joint replacement surgery, and prevention of OA by reducing obesity and overweight. Methods We applied a validated computer microsimulation model of OA in Canada. The model simulated a Canadian-representative open population aged 20 years and older. Variables in the model included demographics, body mass index, OA diagnosis, OA treatment, mortality, and health-related quality of life. Model parameters were derived from analyses of national surveys, population-based administrative data, a hospital-based cohort study, and the literature. We compared 8 what-if intervention scenarios in terms of disability-adjusted life years (DALYs) relative to base-case, over a wide range of time horizons. Results Reductions in DALYs depended on the type of intervention, magnitude of the intervention, and the time horizon. Medical interventions (a targeted increase in the use of painkillers) tended to produce effects quickly and were, therefore, most effective over a short time horizon (a decade). Surgical interventions (increased access to joint replacement) were most effective over a medium time horizon (two decades or longer). Preventive interventions required a substantial change in BMI to generate a significant impact, but produced more reduction in DALYs than treatment strategies over a very long time horizon (several decades). Conclusions In this population-based modeling study we assessed the potential impact of three different burden reduction strategies in OA. Data generated by our model may help inform the implementation of strategies to reduce the burden of OA in Canada and elsewhere.

scholarly journals Economic evaluation of robot-assisted radical prostatectomy compared to open radical prostatectomy for prostate cancer treatment in Ontario, Canada

2020 ◽  
Vol 14 (8) ◽  
Author(s):  
Anna Parackal ◽  
Jean-Eric Tarride ◽  
Feng Xie ◽  
Gord Blackhouse ◽  
Jennifer Hoogenes ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Radical Prostatectomy ◽  
Time Horizon ◽  
Cost Effective ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Base Case ◽  
Robot Assisted ◽  
Open Radical Prostatectomy ◽  
Life Years

Introduction: Recent health technology assessments (HTAs) of robot-assisted radical prostatectomy (RARP) in Ontario and Alberta, Canada, resulted in opposite recommendations, calling into question whether benefits of RARP offset the upfront investment. Therefore, the study objectives were to conduct a cost-utility analysis from a Canadian public payer perspective to determine the cost-effectiveness of RARP. Methods: Using a 10-year time horizon, a five-state Markov model was developed to compare RARP to open radical prostatectomy (ORP). Clinical parameters were derived from Canadian observational studies and a recently published systematic review. Costs, resource utilization, and utility values from recent Canadian sources were used to populate the model. Results were presented in terms of increment costs per quality-adjusted life years (QALYs) gained. A probabilistic analysis was conducted, and uncertainty was represented using cost-effectiveness acceptability curves (CEACs). One-way sensitivity analyses were also conducted. Future costs and QALYs were discounted at 1.5%. Results: Total cost of RARP and ORP were $47 033 and $45 332, respectively. Total estimated QALYs were 7.2047 and 7.1385 for RARP and ORP, respectively. The estimated incremental cost-utility ratio (ICUR) was $25 704 in the base-case analysis. At a willingness-to-pay threshold of $50 000 and $100 000 per QALY gained, the probability of RARP being cost-effective was 0.65 and 0.85, respectively. The model was most sensitive to the time horizon. Conclusions: The results of this analysis suggest that RARP is likely to be cost-effective in this Canadian patient population. The results are consistent with Alberta’s HTA recommendation and other economic evaluations, but challenges Ontario’s reimbursement decision.

ECONOMIC EVALUATION OF DIAGNOSTIC LOCALIZATION FOLLOWING BIOCHEMICAL PROSTATE CANCER RECURRENCE

2014 ◽  
Vol 30 (4) ◽  
pp. 345-353 ◽  
Author(s):  
Daniel A. Barocas ◽  
Mark E. Bensink ◽  
Kristin Berry ◽  
Zahra Musa ◽  
Carolyn Bodnar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Radical Prostatectomy ◽  
Metastatic Disease ◽  
Specific Antigen ◽  
Base Case ◽  
Diagnostic Strategy ◽  
Potential Cost ◽  
Life Years ◽  
Wide Range

Objectives: The aim of this study was to assess potential cost-effectiveness of using a prostate cancer specific functional imaging technology capable of identifying residual localized disease versus small volume metastatic disease for asymptomatic men with low but detectable prostate specific antigen (PSA) elevation following radical prostatectomy.Methods: Markov modeling was used to estimate the incremental impact on healthcare system costs (2012 USD) and quality-adjusted life-years (QALYs) of two alternative strategies: (i) using the new diagnostic to guide therapy versus (ii) current usual care—using a combination of computed tomography, magnetic resonance imaging, and bone scan to guide therapy. Costs were based on estimates from literature and Medicare reimbursement. Prostate cancer progression, survival, utilities, and background risk of all-cause mortality were obtained from literature. Base-case diagnostic sensitivity (75 percent), specificity (90 percent), and cost (USD 2,500) were provided by our industry partner GE Healthcare.Results: The new diagnostic strategy provided an average gain of 1.83 (95 percent uncertainty interval [UI]: 1.24–2.64) QALYs with added costs of USD 15,595 (95 percent UI: USD -6,330–44,402) over 35 years. The resulting incremental cost-effectiveness ratio was USD 8,516/QALY (95 percent UI: USD -2,947–22,372). Results were most influenced by the utility discounting rate and test performance characteristics; however, the new diagnostic provided clinical benefits over a wide range of sensitivity and specificity.Conclusion: This analysis suggests a diagnostic technology capable of identifying whether men with biochemical recurrence after radical prostatectomy have localized versus metastatic disease would be a cost-effective alternative to current standard work-up. The results support additional investment in development and validation of such a diagnostic.

OP535 Cost-Effectiveness Of Internet-Based HIV Screening In Men Who Have Sex With Men in Vancouver, British Columbia, Canada

2020 ◽  
Vol 36 (S1) ◽  
pp. 13-14
Author(s):  
Wei Zhang ◽  
José de Anda ◽  
Michael Irvine ◽  
Hsiu-Ju Chang ◽  
Mark Gilbert
Keyword(s):  
British Columbia ◽  
Cost Effectiveness ◽  
Time Horizon ◽  
Cost Effective ◽  
Cost Utility ◽  
Sexual History ◽  
Base Case ◽  
Hiv Screening ◽  
Life Years ◽  
Sex With Men

IntroductionIn Canada, individuals test for HIV commonly through clinic-based screening services (CBSS). However, gay, bisexual and other men who have sex with men (GBMSM) may face barriers accessing such services due to, for example, feeling discomfort disclosing their sexual history or fearing judgment from healthcare providers. To reduce barriers and increase uptake and frequency of screening for sexually-transmitted infections (STIs) including HIV, the British Columbia Centre for Disease Control implemented an internet-based screening service, GetCheckedOnline.com (GCO), in September 2014 in Vancouver, Canada. We assessed the cost-effectiveness of GCO at different uptake scenarios compared to CBSS in Vancouver GBMSM.MethodsCost-utility analyses were conducted from a healthcare payer's perspective using an established dynamic GBMSM HIV compartmental model. The model estimated the probability of becoming infected with HIV, progressing through diagnosis, disease stages, and treatment over a 30-year time horizon. The base case assumed 4.7 percent uptake of GCO, and 74 percent of high-risk and 44 percent of low-risk infrequent testers becoming regular testers in five years. Scenario analyses tested GCO 10 and 15 percent uptakes.ResultsCompared with the conventional CBSS alone, a 4.7 percent GCO uptake increased the costs by CAD90,059 (USD75,680; 95% confidence interval (CI): -CAD420,836, CAD273,987) and gained 3 (95% CI: 0, 6) quality-adjusted life years (QALYs) in a 30-year time horizon. There was a 71 percent probability that GCO was cost-effective at a cost-effectiveness threshold of CAD50,000 (USD42,000) per QALY. The results were consistent in other two uptake scenarios.ConclusionsExpanding HIV screening for GBMSM through increasing uptake of GCO is a cost-effective alternative to expanding the conventional CBSS. We noted that difference in total costs might be smaller if a battery of STI tests is considered, which in turn may affect our cost-effectiveness estimate. For the next phase of cost-utility analysis, we will expand our model to include testing for other STIs.

Health Outcomes and Costs of Rituximab in Combination with Cyclophosphamide, Vincristine and Prednisolone in the Treatment of Patients with Advanced Follicular Lymphoma in Portugal.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2481-2481
Author(s):  
Paula Braga ◽  
Susana Carvalho ◽  
Marília Gomes ◽  
Lurdes Guerra ◽  
Paulo Lúcio ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Life Expectancy ◽  
Probabilistic Sensitivity Analysis ◽  
Time Horizon ◽  
Case Analysis ◽  
Base Case ◽  
Base Case Analysis ◽  
Non Hodgkin Lymphoma ◽  
Life Years ◽  
Quality Adjusted Life

Abstract Abstract 2481 Poster Board II-458 Objective: With the pressure on healthcare budgets, it has become increasingly important for healthcare decision makers to consider the value for money of the treatments they reimburse. The objective of this analysis was to evaluate the long term outcomes and costs of rituximab in combination with cyclophosphamide/vincristine/prednisolone chemotherapy regimen (R-CVP) versus CVP alone, in previously untreated patients with indolent Non-Hodgkin Lymphoma (NHL) from the Portuguese National Health System (NHS) perspective. Methods: Cost-effectiveness (Life Years Gained - LYG) and cost-utility analysis (Quality Adjusted Life years – QALYs) were performed for a time horizon of 10 years, according to a Markov economic model with three health states (“progression free survival”, “progression” and “death”) and monthly cycles for a population of previously untreated patients with indolent NHL. Data from a phase III clinical trial (Marcus 2007) was used and expanded to include unpublished 53-month median follow-up data. Survival after first-line therapy was estimated from the Scotland and Newcastle Lymphoma Group registry data and utilities were derived from a study in the UK performed in patients with follicular lymphoma. Resource consumption was estimated by a Portuguese expert panel (Delbecq Panel). Costs were calculated from the Portuguese NHS perspective through official data with prices updated to 2008. Only direct medical costs were considered. Costs and clinical outcomes were discounted at 5% per annum. Deterministic and probabilistic sensitivity analysis were performed around assumptions on the time horizon, costs, utilities and excess mortality rate due to progression applied in the base-case analysis. Results: The 10-year base-case analysis showed a lower total cost per patient with CVP alone (€ 85,838) in comparison with R-CVP (€ 87,774). Life expectancy and quality-adjusted life expectancy per patient were higher with R-CVP (6.361 and 4.166, respectively) than with CVP alone (5.557 and 3.438, respectively), representing increases of 0.804 in LYG and 0.728 (8.7 months) in QALYs gained. The incremental cost per LYG was € 2,407 and the incremental cost per QALY gained was € 2,661. The probabilistic sensitivity analysis confirmed the robustness of the base-case analysis results. Conclusions: This study demonstrates that the combination R-CVP in previously untreated non-Hodgkin lymphoma patients improves life expectancy and is a cost-effective alternative to CVP in Portugal. Disclosures: Braga: Roche Farmacêutica Química, Lda: Employment. Pereira:Roche Farmacêutica Química, Lda.: Employment.

Abstract 15622: Cost-Effectiveness of Pediatric Heart Transplantation Across a Positive Crossmatch

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Brian Feingold ◽  
Steven A Webber ◽  
Cindy L Bryce ◽  
Heather E Tomko ◽  
Seo Y Park ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Heart Transplantation ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Lower Probability ◽  
Base Case ◽  
Model Parameters ◽  
Risk Of Death ◽  
Life Years ◽  
Pediatric Heart Transplantation

Introduction: Allosensitized children listed with a requirement for a negative prospective crossmatch (XM) have a high risk of death awaiting heart transplantation (HTx). Previously we found that acceptance of the first suitable organ offer for these patients, regardless of the possibility of a +XM, results in a survival benefit at all times after listing, including post-HTx. The cost-effectiveness of this strategy is unknown. Methods: We used a Markov-state transition model with a 10 yr time horizon to compare survival, costs, and utility (i.e. quality of life) for 2 waitlist strategies for sensitized candidates: requiring a negative prospective XM (WAIT) vs. accepting the first suitable organ offer (TAKE). Model data were derived from OPTN status 1A pediatric HTx listings from 1999-2009, the PHTS and HCUP KIDS databases, and other published sources. We assumed no possibility of a +XM in the wait strategy and that the probability of a +XM in the take strategy was equal to the pre-transplant PRA. Results: At base case, TAKE was dominant; it cost less ($122,856) and gained more (1.04) quality-adjusted life-years (QALYs) than WAIT. In sensitivity analyses varying all model parameters individually over clinically plausible ranges, TAKE remained dominant or favored (using a $100,000/QALY cost-effectiveness threshold) except when the probability of HTx for TAKE was <55% over 2 years (base case value 67%). After adjustment of the model so that waitlist probabilities of death and delisting were equal in both strategies (while maintaining the lower probability of HTx associated with WAIT), TAKE remained dominant. WAIT was no longer dominated if mortality after HTx across a +XM was >30%/year (equivalent to median post-HTx survival of <3 yrs); yet even at the extreme assumption of 100% 1-year mortality after HTx across a +XM for TAKE, the wait strategy was not cost effective ($350,097/QALY). CONCLUSIONS: Among sensitized status 1A pediatric HTx candidates, we found that taking the first suitable organ offer is less costly and results in greater survival than awaiting HTx across a negative prospective XM. This suggests that HTx should not be denied based on sensitization status alone.

The Longterm Effect of Early Intensive Treatment of Seniors with Rheumatoid Arthritis: A Comparison of 2 Population-based Cohort Studies on Time to Joint Replacement Surgery

2016 ◽  
Vol 43 (5) ◽  
pp. 861-868 ◽  
Author(s):  
Jessica Widdifield ◽  
Cristiano S. Moura ◽  
Yishu Wang ◽  
Michal Abrahamowicz ◽  
J. Michael Paterson ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Studies ◽  
Joint Replacement ◽  
Population Based ◽  
Intensive Treatment ◽  
Cumulative Exposure ◽  
First Year ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Independent Population

Objective.Disease-modifying antirheumatic drugs (DMARD) have the greatest effect when initiated early. We evaluated the influence of early exposure to DMARD on time to joint replacement surgery among patients with incident rheumatoid arthritis (RA).Method.Using a common protocol, we undertook 2 independent population-based cohort studies of patients with incident RA aged 66 years or older in Ontario (ON) and Quebec (QC) covering the period 2000–2013. We used Cox proportional hazards regression with time-dependent variables measuring duration of drug use in the first year, separately for methotrexate (MTX) and other DMARD, adjusting for baseline demographics, clinical factors, and other potentially confounding drug exposures. Our outcome measure was any joint replacement derived from standardized procedure codes. Adjusted HR and 95% CI were estimated.Results.Among 20,918 ON and 6754 QC patients with RA followed for a median of 4.5 years, 2201 and 494 patients underwent joint replacement surgery for crude event rates of 2.0 and 1.4 per 100 person-years, respectively. Greater cumulative exposure to MTX (HR 0.97, 95% CI 0.95–0.98) and other DMARD (HR 0.98, 95% CI 0.97–0.99) in the first year after diagnosis was associated with longer times to joint replacement in ON, corresponding to a 2–3% decrease in the hazard of surgery with each additional month of early use. Similar results were observed in QC.Conclusion.Greater duration of exposure to DMARD soon after RA diagnosis was associated with delays to joint replacement surgery in both provinces. Early intensive treatment of RA may ultimately reduce demand for joint replacement surgery.

scholarly journals Blinatumomab Is Cost-Effective Compared to Standard Chemotherapy for Children with High Risk Relapses of Acute Lymphoblastic Leukemia: A Cost-Effectiveness Analysis Using Population-Based Healthcare Data

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 565-565
Author(s):  
Petros Pechlivanoglou ◽  
Linda Luu ◽  
Qing Li ◽  
Paul J. Gibson ◽  
Uma H. Athale ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Lymphoblastic Leukemia ◽  
Cost Effective ◽  
Population Based ◽  
Model Parameters ◽  
Cell Transplant ◽  
Childhood All ◽  
Life Years ◽  
Relapsed Disease

Abstract Introduction: Though cure rates for childhood acute lymphoblastic leukemia (ALL) have improved significantly, outcomes for children with relapsed ALL remain poor. Novel immunotherapies have proved effective in relapsed disease. Blinatumomab, a bispecific T-cell engager targeting CD19, was recently shown to improve disease-free and overall survival among children with high-risk relapsed disease (Brown et al, 2021) prior to proceeding to stem cell transplant. Blinatumomab however also represents a significant cost burden to institutions and healthcare systems. Our objective was thus to determine the cost-effectiveness of blinatumomab vs. standard of care therapy among children with high-risk relapsed ALL. Methods: We used a childhood ALL-specific policy simulation model previously developed using real world clinical, healthcare utilization, and cost population-based data from Ontario, Canada, and restricted it to children with B-lineage ALL who relapsed with 18 months of their original diagnosis to capture a population of patients with high-risk relapse who survived their original month of re-induction chemotherapy. This model was combined with published data from the Children's Oncology Group randomized control study AALL1331 to estimate the long-term survival, healthcare costs and quality adjusted life years associated with two courses of blinatumomab vs. two courses of standard intensive chemotherapy, followed by stem cell transplant. Combining these two sources allowed for the creation of a multi-state survival model and the estimation of the impact of blinatumomab upon relapse and survival. Healthcare costs for the administration of blinatumomab or chemotherapy were sourced from administrative data, provincial formularies, and published sources. Lifetime costs and quality-adjusted life years were calculated while Monte Carlo simulation was used to propagate parameter uncertainty in the cost-effectiveness outcomes. All costs were calculated in Canadian dollars (CAD). Results: Blinatumomab was associated with on average higher life expectancy (43.4 years vs. 36.8 years) and a higher number of quality adjust life years [2.75 QALYs gained, 95 th confidence interval (95CI) -0.44 to 5.99] but higher costs (60,420 CAD, 95CI 26,794 - 94,047) compared to standard intensive chemotherapy. The incremental cost effectiveness ratio (ICER) associated with blinatumomab was 21,970 CAD/QALY gained. However, substantial uncertainty around model parameters resulted in wide confidence intervals around cost-effectiveness outcomes. Discussion: Initial evidence indicates that the use of blinatumomab in high-risk relapse of childhood ALL as compared to standard chemotherapy is associated with a cost-effectiveness ratio that is comparable to or lower than that associated with other interventions recently introduced in pediatric ALL, and represents a cost-effective intervention for this population. However, estimates are based on limited evidence; further research is necessary to better inform several model parameters and thereby decrease uncertainty in cost-effectiveness outcomes. Disclosures Gupta: Jazz Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees.

EXPRESS: Drip-and-Ship versus Mothership for Endovascular Treatment of Acute Stroke: A Comparative Effectiveness Analysis

2021 ◽  
pp. 174749302110087
Author(s):  
Xiao Wu ◽  
Charles Wira ◽  
Charles Matouk ◽  
Howard Forman ◽  
Dheeraj Gandhi ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Health Benefit ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Decision Analytic Model ◽  
Model Parameters ◽  
Stroke Patients ◽  
Case Scenario ◽  
Life Years ◽  
Stroke Center

Background Triage for suspected acute stroke has two main options (1) transport to the closest primary stroke center (PSC) and then to the nearest comprehensive stroke center (CSC) (Drip-and-Ship) or (2) transport the patient to the nearest CSC, bypassing a closer PSC (mothership). The purpose was to evaluate the effectiveness of drip-and-ship versus mothership models for acute stroke patients. Methods A Markov decision-analytic model was constructed. All model parameters were derived from recent medical literature. Our target population is adult patient with sudden onset of acute stroke over a one-year horizon. The primary outcome is quantified in term of quality-adjusted-life-years (QALYs). Results The base-case scenario shows the Drip-and-Ship strategy has a slightly higher expected health benefit, 0.591 QALY, as compared to 0.586 QALY in the Mothership strategy when the time to PSC is 30 minutes and to CSC is 65 minutes, although the difference in health benefit becomes minimal as the time to PSC increases towards 60 min. Multiple sensitivity analyses show that when both PSC and CSC are far from place of onset (>1.5 hours away), Drip-and-Ship becomes the better strategy. Mothership strategy is favored by smaller difference between distances to PSC and CSC, shorter transfer time from PSC to CSC, and longer delay in reperfusion in CSC for transferred patients. Drip-and-Ship is favored by the reverse. Conclusion Drip-and-ship has a slightly higher utility than mothership. This study assesses the complex issue of prehospital triage of acute stroke patients, and can provide a framework for real-world data input.

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