scholarly journals Lifetime incremental cost–utility ratios for minimally invasive surgery for degenerative lumbar spondylolisthesis relative to failed medical management compared with total hip and knee arthroplasty for osteoarthritis

2021 ◽  
Vol 64 (4) ◽  
pp. E391-E402
Author(s):  
Eric J. Crawford ◽  
Robert A. Ravinsky ◽  
Peter C. Coyte ◽  
Y. Raja Rampersaud
Keyword(s):  
Minimally Invasive Surgery ◽  
Total Joint Replacement ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Knee Oa ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Hip And Knee Arthroplasty ◽  
Lumbar Spondylolisthesis ◽  
The Cost

Background: The objective of this study was to compare the cost-effectiveness of minimally invasive surgery (MIS) for patients with degenerative lumbar spondylolisthesis (DLS) relative to failed medical management with the cost-effectiveness of hip and knee arthroplasty for matched cohorts of patients with osteoarthritis. Methods: A cohort of patients with DLS undergoing MIS procedures with decompression alone or decompression and instrumented fusion between 2008 and 2014 was matched to cohorts of patients with hip osteoarthritis (OA) and knee OA undergoing total joint replacement. Incremental cost–utility ratios (ICURs) were calculated from the perspective of the Ontario Ministry of Health, using prospectively collected Short Form–6 Dimension utility data. Costs and quality-adjusted life years (QALYs) were discounted at 3% and sensitivity analyses were performed. Results: Sixty-six patients met the inclusion criteria for the DLS cohort (n = 35 for decompression alone), with a minimum follow-up time of 1 year (mean 1.7 yr). The mean age of patients in the DLS cohort was 64.76 years, and 45 patients (68.2%) were female. For each cohort, utility scores improved from baseline to follow-up and the magnitude of the gain did not differ by group. Lifetime ICURs comparing surgical with nonsurgical care were Can$7946/QALY, Can$7104/QALY and Can$5098/QALY for the DLS, knee OA and hip OA cohorts, respectively. Subgroup analysis yielded an increased ICUR for the patients with DLS who underwent decompression and fusion (Can$9870/QALY) compared with that for the patients with DLS who underwent decompression alone (Can$5045/QALY). The rank order of the ICURs by group did not change with deterministic or probabilistic sensitivity analyses. Conclusion: Lifetime ICURs for MIS procedures for DLS are similar to those for total joint replacement. Future research should adopt a societal perspective and potentially capture further economic benefits of MIS procedures.

Cost-Utility Of Bortezomib In Induction Treatment Prior To Autologous Stem-Cell Transplantation (ASCT) In Previously Untreated Multiple Myeloma Patients In Canada

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1735-1735 ◽  
Author(s):  
Tom Kouroukis ◽  
Darrell White ◽  
Morgan Kruse ◽  
Donna Lawrence ◽  
Cristina Trambitas ◽  
...  
Keyword(s):  
Transition Probabilities ◽  
Cost Effective ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Induction Treatment ◽  
Health State ◽  
Health States ◽  
Induction Regimen ◽  
The Cost

Abstract Introduction The effectiveness of bortezomib for induction treatment prior to ASCT in multiple myeloma (MM) patients has been demonstrated in a number of randomized, open-label phase III trials, including the IFM 2005-01 trial (Harousseau et al., J Clin Oncol 2010;28(30):4621-9). This trial showed that the addition of bortezomib as part of an induction treatment prior to ASCT resulted in statistically significant improvements in post-induction response rates and longer progression-free survival (PFS) compared to a non-bortezomib containing regimen (NBCR). The objective of this study was to assess the cost-utility of a bortezomib-containing regimen (BCR) vs. a NBCR for induction treatment in previously untreated MM patients prior to ASCT from a Canadian public payer perspective, based on the results of the IFM 2005-01 study. Methods A Markov model was developed to estimate the cost-utility over a lifetime horizon (50 years) in previously untreated MM patients undergoing induction and ASCT. The model simulated disease progression of patients with previously untreated MM through three health states: “progression-free”, “progression” and “death”, with all patients beginning in the progression-free state. The PFS and overall survival (OS) curves from the IFM 2005-01 trial were extrapolated beyond the study follow-up period to estimate the timeframe spent in each health state. Each health state was associated with a utility value and direct medical costs. Utilities for the progression-free and progression health states were derived from a previous cost-utility analysis for bortezomib and were 0.81 and 0.645, respectively (Hornberger et al., Eur J Haematol 2010;85(6):484-91). Transition probabilities between health states were estimated by calibrating the model to the PFS and OS curves from the IFM 2005-01 trial. In the base case, transition probabilities beyond the trial follow-up period were conservatively assumed to be equal for both treatment groups. Medical resource utilization was estimated using the IFM 2005-01 trial, and supplemented by published literature and clinical advisors. Clinical advisors also provided input on management of adverse events (> grade 3) and treatment of patients who progressed after induction and ASCT. Resource costs were estimated using Canadian sources ($CAN 2012) and costs and outcomes were discounted at 5% annually. Because patients in each group incurred similar costs (i.e. cost of an ASCT), only incremental costs between the two arms were included in the analysis. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to test the robustness of the model. Results The mean total MM-related cost over the lifetime analysis in the model was $68,800 per patient treated with a BCR and $47,000 per patient treated with a NBCR. Addition of bortezomib to the induction regimen increased costs by $21,700 (see table). Over the model lifetime, a delay in progression with a BCR led to 0.25 years of additional survival compared to a NBCR and a quality-adjusted life-year (QALY) gain of 0.22 years. The incremental cost-utility ratio for induction using a BCR compared to a NBCR approach was $99,200/QALY. Sensitivity analyses identified the major factors impacting the cost-utility ratio as: transition probabilities beyond the trial follow-up period, discounting, utilities and bortezomib costs. The probability of a BCR being cost-effective compared to a NBCR was 43.9% at a threshold of $100,000/QALY. Conclusions A number of phase 3 trials have demonstrated the effectiveness of bortezomib as part of an induction regimen prior to ASCT. This analysis indicates that, from a Canadian perspective, induction treatment with a BCR in previously untreated MM patients prior to ASCT can be cost-effective at conventional decision thresholds with a cost-utility ratio of $99,200/QALY. Disclosures: Kouroukis: Janssen Inc.: Honoraria. White:Janssen Inc.: Consultancy, Honoraria. Kruse:OptumInsight: Employment. Lawrence:OptumInsight: Employment. Trambitas:Janssen Inc.: Employment.

scholarly journals OP0198-HPR A STRUCTURED MODEL FOR OA CARE IN PRIMARY HEALTHCARE IS A COST-EFFECTIVE ALTERNATIVE COMPARED TO USUAL CARE FOR PEOPLE WITH HIP AND KNEE OA

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 119-120
Author(s):  
N. Østerås ◽  
E. Aas ◽  
T. Moseng ◽  
L. Van Bodegom-Vos ◽  
K. Dziedzic ◽  
...  
Keyword(s):  
Usual Care ◽  
Primary Healthcare ◽  
Intervention Group ◽  
Cost Effective ◽  
Cost Utility ◽  
Control Group ◽  
Structured Model ◽  
Knee Oa ◽  
Cost Effective Alternative ◽  
The Cost

Background:To improve quality of care for patients with hip and knee osteoarthritis (OA), a structured model for integrated OA care was developed based on international treatment recommendations. A previous analysis of a cluster RCT (cRCT) showed that compared to usual care, the intervention group reported higher quality of care and greater satisfaction with care. Also, more patients were treated according to international guidelines and fulfilled recommendations for physical activity at the 6-month follow-up.Objectives:To assess the cost-utility of a structured model for hip or knee OA care.Methods:A cRCT with stepped-wedge cohort design was conducted in 6 Norwegian municipalities (clusters) in 2015-17. The OA care model was implemented in one cluster at the time by switching from “usual care” to the structured model. The implementation of the model was facilitated by interactive workshops for general practitioners (GPs) and physiotherapists (PTs) with an update on OA treatment recommendations. The GPs explained the OA diagnosis and treatment alternatives, provided pharmacological treatment when appropriate, and suggested referral to physiotherapy. The PT-led patient OA education programme was group-based and lasted 3 hours followed by an 8–12-week individually tailored resistance exercise programme with twice weekly 1-hour supervised group sessions (5–10 patients per PT). An optional 10-hours Healthy Eating Program was available. Participants were ≥45 years with symptomatic hip or knee OA.Costs were measured from the healthcare perspective and collected from several sources. Patients self-reported visits in primary healthcare at 3, 6, 9 and 12 months. Secondary healthcare visits and joint surgery data were extracted from the Norwegian Patient Register. The health outcome, quality-adjusted life-year (QALY), was estimated based on the EQ-5D-5L scores at baseline, 3, 6, 9 and 12 months. The result of the cost-utility analysis was reported using the incremental cost-effectiveness ratio (ICER), defined as the incremental costs relative to incremental QALYs (QALYs gained). Based on Norwegian guidelines, the threshold is €27500. Sensitivity analyses were performed using bootstrapping to assess the robustness of reported results and presented in a cost-effectiveness plane (Figure 1).Results:The 393 patients’ mean age was 63 years (SD 9.6) and 74% were women. 109 patients were recruited during control periods (control group), and 284 patients were recruited during interventions periods (intervention group). Only the intervention group had a significant increase in EQ-5D-5L utility scores from baseline to 12 months follow-up (mean change 0.03; 95% CI 0.01, 0.05) with QALYs gained: 0.02 (95% CI -0.08, 0.12). The structured OA model cost approx. €301 p.p. with an additional €50 for the Healthy Eating Program. Total 12 months healthcare cost p.p. was €1281 in the intervention and €3147 in the control group, resulting in an incremental cost of -€1866 (95% CI -3147, -584) p.p. Costs related to surgical procedures had the largest impact on total healthcare costs in both groups. During the 12-months follow-up period, 5% (n=14) in the intervention compared to 12% (n=13) in the control group underwent joint surgery; resulting in a mean surgical procedure cost of €553 p.p. in the intervention as compared to €1624 p.p. in the control group. The ICER was -€93300, indicating that the OA care model resulted in QALYs gained and cost-savings. At a threshold of €27500, it is 99% likely that the OA care model is a cost-effective alternative.Conclusion:The results of the cost-utility analysis show that implementing a structured model for OA care in primary healthcare based on international guidelines is highly likely a cost-effective alternative compared to usual care for people with hip and knee OA. More studies are needed to confirm this finding, but this study results indicate that implementing structured OA care models in primary healthcare may be beneficial for the individual as well as for the society.Disclosure of Interests:None declared

scholarly journals Funding the New Biologics – CCOHTA Report on the Cost Effectiveness of Infliximab for Crohn’s Disease: Pearls and Pitfalls

2002 ◽  
Vol 16 (12) ◽  
pp. 877-879 ◽  
Author(s):  
John K Marshall
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Economic Analysis ◽  
Safety Data ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
State Transitions ◽  
Health State ◽  
Life Years ◽  
The Cost

The Canadian Coordinating Office for Health Technology Assessment (CCOHTA) published an economic analysis, using a Markov model, of infliximab therapy for Crohn’s disease that is refractory to other treatments. This was the first fully published economic analysis that addresses this treatment option. Health state transitions were based on data from Olmsted County, Minnesota, health state resource profiles were created using expert opinion and a number of assumptions were made when designing the model. The analysis was rigorous, the best available efficacy and safety data were used, state-of-the art sensitivity analyses were undertaken and an ‘acceptability curve‘ was constructed. The model found that infliximab was effective in increasing quality-adjusted life years when offered in a variety of protocols, but it was associated with high incremental cost utility ratios compared with usual care. The results should be interpreted, however, in view of a number of limitations. The time horizon for the analysis was short (one year), because of a lack of longer-term efficacy data, and might have led to an underestimation of the benefits from averting surgery. Because the analysis was performed from the perspective of a Canadian provincial ministry of health, only direct medical costs were considered. Patients with active Crohn’s disease are likely to incur significant indirect costs, which could be mitigated by this medication. The analysis should be updated as new data become available. Moreover, small changes in the cost of the medication could make the treatment cost effective, according to this model. Economic analyses, such as the one undertaken by the CCOHTA, cannot by themselves solve dilemmas in the allocation of limited health care resources, and other considerations must be included when formulating policy. This is especially important for patients with severe Crohn’s disease, who have significant disability and for whom few therapeutic options exist.

scholarly journals Corrigendum: Brief alcohol intervention for risky drinking in young people aged 14–15 years in secondary schools: the SIPS JR-HIGH RCT

2020 ◽  
Vol 7 (9) ◽  
pp. 135-142
Author(s):  
Emma L Giles ◽  
Grant J McGeechan ◽  
Simon Coulton ◽  
Paolo Deluca ◽  
Colin Drummond ◽  
...  
Keyword(s):  
Young People ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Alcohol Intervention ◽  
Risky Drinking ◽  
Brief Alcohol Intervention ◽  
Utility Evaluation ◽  
The Cost ◽  
Phd Thesis ◽  
And Control

Abstract During independent re-analysis of the cost data for a PhD thesis, a coding error was identified in one of the sensitivity analyses of the cost-utility evaluation of the trial looking at the effect of excluding from the intervention and control costs the cost of missed school days.

scholarly journals Sexual Dysfunction: Prevalence and Prognosis in Patients Operated for Degenerative Lumbar Spondylolisthesis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Andrew Kai-Hong Chan ◽  
Erica F Bisson ◽  
Kai-Ming G Fu ◽  
Paul Park ◽  
Leslie Robinson ◽  
...  
Keyword(s):  
Sexual Function ◽  
Sexual Life ◽  
Quality Outcomes ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Negative Effect ◽  
American Society ◽  
Lumbar Spondylolisthesis ◽  
American Society Of Anesthesiologists ◽  
The Impact

Abstract INTRODUCTION There is a paucity of investigation on the impact of spondylolisthesis surgery on back-pain related sexual inactivity. To this end, we utilized the prospective Quality Outcomes Database (QOD) registry to investigate factors predictive of improved sex life following surgery. METHODS This was an analysis of a prospective registry of 608 patients who underwent surgery for grade 1 degenerative lumbar spondylolisthesis at 12 high-enrolling sites. Of these, 218 patients were included who were sexually active and had both baseline and 24-mo sexual function follow-up. Baseline variables were collected. Outcomes were collected at 24 mo. Sexual function was assessed by the associated question in the Oswestry Disability Index, “With regards to pain, how would you say your sex life is?” Outcomes were dichotomized into patients who had improved sexual function and those who had same or worse sexual function. RESULTS Mean age was 58.0 ± 11.0 yr and 108 (49.5%) patients were women. At baseline, 178 patients (81.7%) had an impaired sex life. At final follow-up, 130 patients (73.0% of the 178 impaired) had an improved sex life. In univariate comparisons, those with improved sexual life had lower body mass index (BMI) (29.6 ± 5.5 vs 34.4 ± 6.0; P < .001) and a lower proportion of American Society of Anesthesiologists' grades 3 or 4 (33.1%% vs 54.2%; P = .01). Following surgery, those with improved sex lives noted higher satisfaction following surgery (84.5% vs 64.6% would undergo surgery again, P = .002). In adjusted analyses, lower BMI was associated with an improved sex life at 24 mo (OR = 1.14; 95% CI [1.05-1.20]; P < .001). CONCLUSION Over 80% of patients who present for surgery for degenerative lumbar spondylolisthesis report a negative effect of the disease on sex life. However, most patients (73%) report an improvement in sex life postoperatively. Improvement in sex life was associated with significantly greater satisfaction with surgery. Lower BMI was predictive of improved sex life postoperatively.

Predictors of the Best Outcomes Following Minimally Invasive Surgery for Grade 1 Lumbar Spondylolisthesis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Andrew Kai-Hong Chan ◽  
Erica F Bisson ◽  
Mohamad Bydon ◽  
Steven D Glassman ◽  
Kevin T Foley ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Back Pain ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Rating Scale ◽  
College Education ◽  
Leg Pain ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Patient Reported ◽  
Lumbar Spondylolisthesis

Abstract INTRODUCTION The factors driving the best outcomes following minimally invasive surgery (MIS) for degenerative lumbar spondylolisthesis (DLS) are not clearly elucidated. This study investigates the factors that drive the best patient reported outcomes (PRO) following MIS for DLS. METHODS A total of 608 patients from the prospective Quality Outcomes Database (QOD) Lumbar Spondylolisthesis Registry underwent surgery for grade 1 DLS of whom 259 underwent surgery with MIS techniques [187 fusions (72.2%)]. Surgeries were classified as MIS if any of the following were involved: MIS laminectomy, MIS pedicle screws, MIS interbody grafts, or percutaneous screws. Outcomes were assessed at 24 mo postoperatively. PROs included the Oswestry Disability Index (ODI), numeric rating scale (NRS) Back Pain, NRS Leg Pain, EuroQoL-5D (EQ-5D) Questionnaire, and North American Spine Society (NASS) Satisfaction Questionnaire. Multivariate models were constructed adjusting for patient characteristics, presentation characteristics, surgical variables, socioeconomic characteristics, and baseline PRO values. RESULTS The mean age of the MIS cohort was 64.2 ± 11.5 yr [148 (57.1%) women and 111 (42.9%) men]. In multivariate analyses, aside from baseline PRO values, only 3 factors were significantly associated with multiple 24-mo PRO change scores: employment, age, and the addition of fusion to surgery. Employment was associated with superior postoperative ODI (ß-7.8; 95% CI [−12.9- −2.6]; P = .003), NRS back pain (ß-1.2; 95% CI [−2.1- −0.4]; P = 0.004), EQ-5D (ß0.1; 95% CI [0.01-0.1]; P = .03), and NASS satisfaction (OR = 0.27; 95% CI [0.12-0.58]; P < .001). Increasing age was associated with superior NRS leg pain (ß-0.1; 95% CI [minus;0.1- minus;0.01]; P = .03) and NASS satisfaction (OR = 0.95; 95% CI [0.92-0.99]; P = .02). The addition of a fusion was associated with superior ODI (ß-6.7; 95% CI [minus;12.7- minus;0.7]; P = .03), NRS back pain (ß-1.1; 95% CI [minus;2.1- minus;0.2]; P = .02), and NASS satisfaction (OR = 0.28; 95% CI [0.12-0.62]; P = .002). CONCLUSION Preoperative active employment, at least 4 yr of college education, and surgeries including a fusion were significant predictors of superior outcomes across the domains of disease-specific disability, back pain, leg pain, quality of life, and patient satisfaction. Increasing age was predictive of superior outcomes for leg pain and satisfaction.

Health economic analysis of breast cancer index in patients with ER+, LN- breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11504-e11504
Author(s):  
Gary Gustavsen ◽  
Brock Schroeder ◽  
Patrick Kennedy ◽  
Kristin Ciriello Pothier ◽  
Catherine A. Schnabel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gene Expression ◽  
Adjuvant Chemotherapy ◽  
Endocrine Therapy ◽  
Cost Savings ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Breast Cancer Index ◽  
Extended Endocrine Therapy ◽  
The Cost

e11504 Background: Numerous studies have demonstrated the cost utility of gene expression-based assessment of recurrence risk in breast cancer. Cost savings rely primarily on decreased use of adjuvant chemotherapy in patients predicted to be low-risk. Breast Cancer Index (BCI) is a gene expression-based test that significantly predicts overall risk of recurrence, late (≥5y) recurrence and likelihood of benefit from extended (≥5y) endocrine therapy in patients with ER+, LN- breast cancer. This study evaluated the potential cost utility of BCI from a US third-party payer perspective. Methods: A fact-based economic model was developed which projected the cost and effectiveness of BCI in a hypothetical population of patients with ER+, LN- breast cancer compared to standard clinicopathologic diagnostic modalities. Patients flowed through the model based on patterns of care and BCI data. Costs associated with adjuvant chemotherapy, toxicity, follow-up, endocrine therapy, and recurrence were modeled over 10 yrs. Model inputs were based primarily on published literature, and supplemented by interviews with disease experts and payers. Sensitivity analyses were performed around key inputs to estimate effects on the model. Results: Use of BCI is projected to be cost saving in this patient population, with a net cost savings of $4,005 per patient tested after accounting for BCI cost. Gross cost savings were projected to be achieved through targeted use of adjuvant chemotherapy ($5,785), reduced recurrence in patients receiving extended endocrine therapy based on BCI ($2,350), and reduced recurrence in previously non-compliant patients ($370). Sensitivity analyses demonstrated that results were most sensitive to chemotherapy utilization in low- and intermediate-risk patients, cost of adjuvant chemotherapy, cost of recurrence, and percentage of patients classified as low risk. Conclusions: BCI is projected to be cost saving in an ER+, LN-, breast cancer patient population. Cost savings are achieved through projected impact on adjuvant chemotherapy use, extended endocrine therapy use, and endocrine therapy compliance. These findings require validation in additional cohorts, including studies of real-world clinical practice.

SURGICAL MANAGEMENT OF DEGENERATIVE LUMBAR SPONDYLOLISTHESIS: A COMPARATIVE STUDY OF OUTCOMES FOLLOWING DECOMPRESSION WITH FUSION AND MICROENDOSCOPIC DECOMPRESSION

2012 ◽  
Vol 15 (04) ◽  
pp. 1250020 ◽  
Author(s):  
Takato Aihara ◽  
Tomoaki Toyone ◽  
Yasuchika Aoki ◽  
Tomoyuki Ozawa ◽  
Gen Inoue ◽  
...  
Keyword(s):  
Back Pain ◽  
Clinical Outcome ◽  
Japanese Orthopaedic Association ◽  
Neutral Position ◽  
Minimally Invasive Operation ◽  
Surgical Methods ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Functional Scores ◽  
Lumbar Spondylolisthesis

Fifty consecutive patients with degenerative lumbar spondylolisthesis were treated surgically. The first 17 patients (FU group) underwent decompression with fusion, the second 33 patients (MED group) underwent microendoscopic decompression (MED), and the outcomes following the two surgical methods were compared. The duration of follow-up ranged from 27 to 40 months in the FU group and from 25 to 40 months in the MED group. Clinical outcomes were evaluated with use of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Although statistically not significant, the degrees of improvement in all five functional scores were greater in the MED group than in the FU group. There was no influence of instability before MED to the clinical outcome, and a large percentage of slipping in the neutral position could lead to inadequate improvement in low back pain after MED, but MED is a useful, minimally invasive operation and can lead to a good clinical outcome for degenerative lumbar spondylolisthesis. Considering the lower invasiveness of MED, this procedure is recommended in case of degenerative lumbar spondylolisthesis with less than 20% slipping. Posterior decompression and fusion using pedicular screws is recommended in case of degenerative lumbar spondylolisthesis with over 20% slipping.

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