scholarly journals A szájüregi szűrés költséghatékonysága Magyarországon

2016 ◽  
Vol 157 (29) ◽  
pp. 1161-1170
Author(s):  
Zoltán Vokó ◽  
Gergő Túri ◽  
Adriána Zsólyom
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Oral Cancer ◽  
Time Course ◽  
Precancerous Lesions ◽  
Participation Rate ◽  
Cost Effective ◽  
Health State ◽  
Opportunistic Screening ◽  
Life Years

Introduction: The burden of oral cancer is high in Hungary. Aim: To study the cost-effectiveness of potential oral cancer screening in Hungary. Method: Three strategies were compared: no introduction of screening, organized yearly screening for 40-year-old males in general medical practise, and opportunistic screening of high risk 40-year-old males in primary care. Local estimates of health utilities and costs of each health state and of the screening programmes were identified. The main outcomes were total costs, quality adjusted life years, and incremental cost-effectiveness ratios. Results: Depending on the efficacy of the treatments of precancerous lesions and the participation rate, screening strategies are cost-effective over a 15–20 year time course. The opportunistic screening of high risk people is more cost-effective than the other strategies. Conclusions: Opportunistic screening of high risk people would be cost-effective in Hungary. The uncertainty about the efficacy of the treatments of precancerous lesions requires more research to support evidence based health policy making. Orv. Hetil., 2016, 157(29), 1161–1170.

scholarly journals Cost-effectiveness of an insertable cardiac monitor in a high-risk population in the UK

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001037 ◽  
Author(s):  
Claudia I Rinciog ◽  
Laura M Sawyer ◽  
Alexander Diamantopoulos ◽  
Mitchell S V Elkind ◽  
Matthew Reynolds ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Oral Anticoagulants ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
High Risk Population ◽  
Risk Population ◽  
Life Years ◽  
The Uk ◽  
The Cost

ObjectiveTo evaluate the cost-effectiveness of insertable cardiac monitors (ICMs) compared with standard of care (SoC) for detecting atrial fibrillation (AF) in patients at high risk of stroke (CHADS2 >2), using a UK National Health Service (NHS) perspective.MethodsUsing patient characteristics and clinical data from the REVEAL AF trial, a Markov model assessed the cost-effectiveness of detecting AF with an ICM compared with SoC. Costs and benefits were extrapolated across modelled patient lifetime. Ischaemic and haemorrhagic strokes, intracranial and extracranial haemorrhages and minor bleeds were modelled. Diagnostic and device costs were included, plus costs of treating stroke and bleeding events and costs of oral anticoagulants (OACs). Costs and health outcomes, measured as quality-adjusted life years (QALYs), were discounted at 3.5% per annum. One-way deterministic and probabilistic sensitivity analyses (PSA) were undertaken.ResultsThe total per-patient cost for ICM was £13 360 versus £11 936 for SoC (namely, annual 24 hours Holter monitoring). ICMs generated a total of 6.50 QALYs versus 6.30 for SoC. The incremental cost-effectiveness ratio (ICER) was £7140/QALY gained, below the £20 000/QALY acceptability threshold. ICMs were cost-effective in 77.4% of PSA simulations. The number of ICMs needed to prevent one stroke was 21 and to cause a major bleed was 37. ICERs were sensitive to assumed proportions of patients initiating or discontinuing OAC after AF diagnosis, type of OAC used and how intense the traditional monitoring was assumed to be under SoC.ConclusionsThe use of ICMs to identify AF in a high-risk population is cost-effective for the UK NHS.

scholarly journals Cost-Effectiveness Analysis of Fourth- or Further-Line Ripretinib in Advanced Gastrointestinal Stromal Tumors

2021 ◽  
Vol 11 ◽  
Author(s):  
Weiting Liao ◽  
Huiqiong Xu ◽  
David Hutton ◽  
Qiuji Wu ◽  
Kexun Zhou ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cost Effectiveness ◽  
Gastrointestinal Stromal Tumors ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Health State ◽  
Lifetime Horizon ◽  
Stromal Tumors ◽  
Life Years ◽  
Health State Utilities

BackgroundThe INVICTUS trial assessed the efficacy and safety of ripretinib compared with placebo in the management of advanced gastrointestinal stromal tumors.MethodWe used a Markov model with three health states: progression-free disease, progression disease and death. We parameterized the model from time-to-event data (progression-free survival, overall survival) of ripretinib and placebo arms in the INVICTUS trial and extrapolated to a patient’s lifetime horizon. Estimates of health state utilities and costs were based on clinical trial data and the published literature. The outcomes of this model were measured in quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs). Uncertainty was tested via univariate and probabilistic sensitivity analyses.ResultsThe base-case model projected improved outcomes (by 0.29 QALYs) and additional costs (by $70,251) and yielded an ICER of $244,010/QALY gained for ripretinib versus placebo. The results were most sensitive to progression rates, the price of ripretinib, and health state utilities. The ICER was most sensitive to overall survival. When overall survival in the placebo group was lower, the ICER dropped to $127,399/QALY. The ICER dropped to $150,000/QALY when the monthly cost of ripretinib decreased to $14,057. Probabilistic sensitivity analyses revealed that ripretinib was the cost-effective therapy in 41.1% of simulations at the willingness-to-pay (WTP) threshold of $150,000.ConclusionAs the fourth- or further-line therapy in advanced gastrointestinal stromal tumors, ripretinib is not cost-effective in the US. Ripretinib would achieve its cost-effectiveness with a price discount of 56% given the present effectiveness.

scholarly journals Estimating the Relative Treatment Effect and Corresponding Cost-Effectiveness Estimates of Inotuzumab Ozogamicin Vs. Blinatumomab for Adults with Philadelphia Chromosome-Negative (Ph-) Relapsed/Refractory (R/R) B-Cell Acute Lymphoblastic Leukaemia (B-ALL) in the United Kingdom (UK)

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3427-3427 ◽  
Author(s):  
Simone Critchlow ◽  
Miranda Cooper ◽  
Ilse van Oostrum ◽  
Verna L Welch ◽  
T. Alexander Russell-Smith
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Complete Response ◽  
Health State ◽  
Health States ◽  
Term Survival ◽  
Long Term Survival ◽  
Treatment Comparison ◽  
Life Years

Introduction: Inotuzumab ozogamicin (InO), is a novel anti-CD22 antibody-calicheamicin conjugate approved in R/R B-ALL due to its high hematologic remission rate (81%) based on the phase 3 INO-VATE trial comparing to investigators choice (IC). The TOWER trial demonstrated the efficacy and safety of blinatumomab (Blina) for treatment of Ph- B-ALL versus IC. The relative effectiveness of InO versus Blina was investigated by applying indirect treatment comparison (ITC) methods. A UK-based cost-effectiveness model (CEM) submitted to the Scottish Medicines Consortium (SMC) explored the impact of treatment differences with regard to mean life years (LY) gained and quality-adjusted life years (QALY). Methods: As R/R ALL is a terminal disease if left untreated, achievement of complete response/complete response with incomplete count recovery (CR/CRi) in conjunction with stem cell transplant (SCT) is essential for long-term survival. The three most important outcomes related to treatment are thus the level of response determined by CR/CRi, the rate of SCT, and overall survival (OS). Without potentially curative therapy such as SCT, there is no evidence to suggest long-term survival is possible. Therefore, to compare InO to Blina, comparisons of these outcomes were explored using patient-level data from the INO-VATE ALL trial and aggregate data from the TOWER trial. The CEM structure contained four health states categorising patients based on 'No CR/CRi & no SCT', 'CR/CRi and no SCT' and patients receiving SCT ('SCT/Post SCT') - with progression-free survival (PFS) and OS modelled within these states. States were clinically validated as relevant to treatment of the disease. Death was the fourth health state. Different methods were incorporated to allocate Blina patients to the respective health-states. For levels of response (CR/CRi) and SCT a matching-adjusted indirect comparison (MAIC) and a Bucher ITC were explored. As CR/CRi and SCT rates are not mutually exclusive, a multinomial ITC was also conducted. Once allocated into respective health states, OS and PFS were modelled. Three ITC methods were used to compare OS; a simulated treatment comparison (STC), MAIC and a standard network meta-analysis. In the absence of PFS data for Blina, PFS was assumed to have the same relative treatment effect as OS. Quality of life data within the model for the 'No CR/CRi & no SCT' and 'CR/CRi and no SCT' were informed from InO trial data, while SCT quality of life was informed from the literature with time-varying utilities. Costs were incorporated from a UK perspective using 2017 sources and were those submitted to the SMC. Results were annually discounted at 3.5%. Results: Health state proportions for Ph- InO patients were used as the basis to estimate corresponding Blina proportions and show 49.3% of patients treated with InO reach SCT. With higher odds for CR/CRi and SCT for InO, the ITC results consistently indicate Blina leads to lower proportions of patients receiving SCT (19.1-22.5%) and CR/CRi (25.2-33.3%). ITCs comparing OS outcomes for InO versus blinatumomab show negligible differences between treatments, consistently across the three methods. All combinations of the various methods were explored using the list price for both treatments. The results of the CEM ranged from 0.91-1.14 incremental QALYs for InO versus Blina, while LYs ranged from 2.03-2.59 resulting from higher rates of SCT. The incremental cost-effectiveness ratio (ICER) ranged from £3,700 to £7,010 for InO versus Blina. Extensive scenario analysis indicates that InO is a cost-effective option compared to Blina at a willingness to pay threshold of £20,000 per QALY. The SMC recommended InO as a cost-effective use of resources citing an ICER of £6,754 in the CEM when using the MAIC; InO was associated with a mean survival gain of >29 months over Blina corresponding to this ICER. Conclusions: Outcomes from the ITC indicate that InO provides patients with a greater probability of achieving CR/CRi and/or receiving a subsequent SCT versus Blina. As CR/CRi followed by SCT are essential for long-term survival and potential cure, the mean OS gain in the model cited in the SMC recommendation is intuitive as it aligns with the superior CR/CRi and SCT odds ratios associated with InO. Further research is required to determine the long-term PFS and OS following SCT in R/R B-ALL, beyond what can be reliably captured within clinical trials. Disclosures Critchlow: BresMed Health Solutions Ltd.: Consultancy. Cooper:BresMed Health Solutions Ltd.: Consultancy. van Oostrum:Ingress Health: Employment; Pfizer: Consultancy; Merck: Consultancy; Janssen: Consultancy; AstraZeneca: Consultancy. Welch:Pfizer Inc: Employment, Equity Ownership. Russell-Smith:Pfizer: Employment, Equity Ownership.

Cost-Effectiveness of a School-Based Chlamydia Screening Program, Duval County, FL

2019 ◽  
pp. 105984051989002 ◽  
Author(s):  
Li Yan Wang ◽  
Kwame Owusu-Edusei ◽  
J. Terry Parker ◽  
Kristina Wilson
Keyword(s):  
Cost Effectiveness ◽  
Screening Program ◽  
Student Participation ◽  
Participation Rate ◽  
Cost Effective ◽  
Base Case ◽  
Chlamydia Screening ◽  
Program Cost ◽  
Life Years ◽  
The Cost

During the 2015–2016 school year, the Florida Department of Health in Duval County hosted Teen Health Centers (TeenHC) at five high schools of Jacksonville providing HIV/STD screening and pregnancy testing. The purpose of this study was to assess the cost-effectiveness of the TeenHC chlamydia screening program and determine at what student participation level, the program can be cost-effective. We assessed the costs and effectiveness of the chlamydia screening program compared with “no TeenHC”. Cost-effectiveness was measured as cost per quality-adjusted life years (QALY) gained. At a program cost of US$61,001 and 3% participation rate, the cost/QALY gained was $124,328 in the base-case analysis and $81,014–$264,271 in 95% of the simulation trials, all greater than the frequently citied $50,000/QALY benchmark. The cost/QALY gained could be <$50,000/QALY if student participation rate was >7%. The TeenHC chlamydia screening has the potential to be cost-effective. Future program efforts should focus on improving student participation.

Cost-effectiveness of nodal observation versus completion lymphadenectomy in patients with melanoma and sentinel lymph node metastases.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e22076-e22076
Author(s):  
Elena Parvez ◽  
Teodora Dumitra ◽  
Dimitra Panagiotoglou ◽  
Sarkis H. Meterissian ◽  
Sinziana Dumitra
Keyword(s):  
Cost Effectiveness ◽  
Transition Probabilities ◽  
Treatment Strategies ◽  
Cost Savings ◽  
Cost Effective ◽  
Health State ◽  
Complication Rates ◽  
Disease States ◽  
Payer Perspective ◽  
Life Years

e22076 Background: The MSLT-II trial demonstrated no survival benefit of completion lymphadenectomy (CLND) compared to nodal observation (NO) and subsequent therapeutic lymphadenectomy (TLND) in the case of macroscopic nodal relapse in patients with melanoma and SLN metastases. NO avoids the upfront cost and morbidity of CLND. However, patients followed with NO must undergo intensive surveillance and if TLND is required, it is associated with a higher complication rate than CLND. The cost-effectiveness of NO versus CLND in light of data from MSLT-II has not been previously studied. Methods: A Markov model with a 10-year time horizon was constructed to simulate two hypothetical cohorts of patients with SLN metastases undergoing NO and subsequent TLND for nodal recurrence or upfront CLND. Transition probabilities between disease states were derived from the MSLT-II trial. Remaining parameters including complication rates and health state utilities were obtained from an extensive review of the literature. Direct health care system costs were obtained from published US Medicare cost data and the literature. Primary outcomes were cost and quality-adjusted life years (QALYs) saved. Incremental cost-effectiveness ratio (ICER) was used to compare treatment strategies. Sensitivity analysis was performed in order to evaluate model uncertainty. A threshold of acceptance of $100,000/QALY was used. Results: Total projected cost over the study period for CLND was $28,609.87, while that of NO was lower at $20,865.27, resulting in $7,744.60 saved for the NO treatment strategy. Ten-year utility was 4.840 for CLND compared to 5.379 for NO, resulting in a gain of 0.539 QALYs in the NO arm. The NO strategy is dominant in the model as it results in both cost-savings and a gain in health effects, with an average ICER of -$14,368.46/QALY gained. Conclusions: From the payer perspective, the strategy of NO compared to CLND in patients with melanoma and SLN metastases is associated with an improvement in health outcomes and reduction in cost. Taking into account MSLT-II trial data, this study demonstrates NO is more cost-effective than CLND.

scholarly journals Cost-effectiveness Analysis of Evolocumab in Patients With Recent Acute Coronary Syndrome in China

2021 ◽  
Author(s):  
Xiaoyu Xi ◽  
Xin Wang ◽  
Wenwen Xie ◽  
Yu Jia ◽  
Santiago Zuluaga Sanchez ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cost Effectiveness ◽  
Cardiovascular Events ◽  
Health Economic Evaluation ◽  
Cost Effective ◽  
Health State ◽  
Lifetime Horizon ◽  
Coronary Syndrome ◽  
Life Years ◽  
The Cost

Abstract Purpose: To assess the cost-effectiveness of evolocumab, a PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor, added to background statins therapy in patients with a recent acute coronary syndrome (ACS) event (in the past 12 months) and low-density lipoprotein cholesterol (LDL-C) levels ≥100 mg/dL in China.Methods: A health economic evaluation was performed from a Chinese healthcare perspective, using a Markov model over a lifetime horizon based on baseline CV event rate from claims database data and efficacy from the FOURIER trial. The health benefit was reflected in the decrease of LDL-C level, which led to the decrease of cardiovascular events. The cost of cardiovascular events and the utility value of each health state were derived from published literature. Sensitivity analysis were conducted to evaluate the effects of uncertainty in parameters and the robustness of the model. The cost-effectiveness of evolocumab was also explored in patients with recent MI, very high-risk (VHR) ASCVD and homozygous familiar hypercholesterolemia (HoFH).Results: In recent ACS patients, evolocumab was associated with incremental quality adjusted life years (QALYs) of 1.41 and incremental costs of 120,966 yuan vs. ezetimibe, both with background statins therapy, resulting in an ICER of 85,964 yuan per QALY gained. The probability that evolocumab is cost-effective at a threshold of 217,341 yuan (3 times per capita GDP, 2020) was 100% in patients with recent ACS, recent MI, VHR ASCVD and HoFH.Conclusion: Compared with ezetimibe, evolocumab was considered to be cost-effective in patients with a recent ACS event in China.

Efficacy and cost-effectiveness of breast cancer (BC) screening in female survivors of childhood Hodgkin lymphoma (HL).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6593-6593
Author(s):  
Florence Lennie Wong ◽  
Janie M. Lee ◽  
Wendy M. Leisenring ◽  
Joseph Philip Neglia ◽  
Rebecca M. Howell ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
De Novo ◽  
Digital Breast Tomosynthesis ◽  
Clinical Breast Examination ◽  
Cost Effective ◽  
Female Survivors ◽  
Life Years ◽  
Clinical Breast ◽  
Magnetic Resonance Imaging Mri

6593 Background: Female childhood HL survivors treated with ≥10 Gy of chest radiation are at high risk of developing BC. The Children’s Oncology Group (COG) guidelines recommend lifetime annual mammography (MAM) and breast Magnetic Resonance Imaging (MRI) starting 8y after chest radiation or age 25, whichever is later, and clinical breast examination (CBE) annually from puberty and semiannually from age 25. Initial model results suggest that CBE adds no survival benefit in this cohort. Digital breast tomosynthesis (DBT) is increasingly replacing digital MAM in clinical practice. Here, we present the efficacy and cost-effectiveness of COG’s imaging-based screening recommendations. Methods: Life-years (LYs), quality-adjusted LYs (QALYs), BC mortality, and costs (2017 U.S.$) were estimated from simulating the lifetimes of 5-million chest-irradiated 25y old HL survivors who underwent BC screening with each of the following strategies: annual digital MAM, MRI, MAM+MRI, annual DBT or DBT+MRI from age 25 onward. Treatment-related BC risk (in-situ and invasive) and non-BC mortality were estimated from female 5y HL survivors in the Childhood Cancer Survivor Study and from U.S. population rates. Test sensitivity was 70-74% for MAM (based on prior HL studies) and 89% for DBT and MRI (based on women at high risk of de novo BC). Costs and quality of life weights were obtained from medical literature. Results: For HL survivors with no screening, lifetime BC risk was 42.7% and BC mortality was 18.1%. BC risk and non-BC mortality were, respectively, 7.4- and 5.2-fold higher at age 50 in HL survivors relative to the general population. Screening at ages 25-74 had similar LY gain and BC mortality reduction compared to lifetime screening; hence, we focused on screening for ages 25-74. For all strategies screening provided LY gain of 0.34-0.47 and reduced BC mortality by 6.7-9.8% compared with no screening; incremental cost-effectiveness ratio (ICER), or cost per QALY gained, for MAM alone was $58,726 and for DBT alone was $62,989. ICER of adding MRI to MAM ($385,285) or to DBT ($513,358) indicated lower cost-effectiveness of supplemental MRI (Table). Conclusions: Annual screening at ages 25-74y in chest-irradiated HL survivors appears beneficial. Using $100K per QALY gained as cost-effectiveness threshold, annual MAM or DBT are more cost-effective, whereas adding MRI to MAM is less cost-effective.[Table: see text]

scholarly journals Cost-effectiveness of CYP2C19 genotyping to guide antiplatelet therapy for acute minor stroke and high-risk transient ischemic attack

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zeling Cai ◽  
De Cai ◽  
Ruiwen Wang ◽  
Heng Wang ◽  
Ze Yu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Cost Effective ◽  
Bleeding Risk ◽  
Sensitivity Analyses ◽  
Minor Stroke ◽  
Loss Of Function ◽  
Life Years ◽  
The Cost

AbstractDual antiplatelet therapy (DAPT) with clopidogrel plus aspirin within 48 h of acute minor strokes and transient ischemic attacks (TIAs) has been indicated to effectively reduce the rate of recurrent strokes. However, the efficacy of clopidogrel has been shown to be affected by cytochrome P450 2C19 (CYP2C19) polymorphisms. Patients carrying loss-of-function alleles (LoFAs) at a low risk of recurrence (ESRS < 3) cannot benefit from clopidogrel plus aspirin at all and may have an increased bleeding risk. In order to optimize antiplatelet therapy for these patients and avoid the waste of medical resources, it is important to identify the subgroups that genuinely benefit from DAPT with clopidogrel plus aspirin through CYP2C19 genotyping. This study sought to assess the cost-effectiveness of CYP2C19 genotyping to guide drug therapy for acute minor strokes or high-risk TIAs in China. A decision tree and Markov model were constructed to evaluate the cost-effectiveness of CYP2C19 genotyping. We used a healthcare payer perspective, and the primary outcomes included quality-adjusted life years (QALYs), costs and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to evaluate the robustness of the results. CYP2C19 genotyping resulted in a lifetime gain of 0.031 QALYs at an additional cost of CNY 420.13 (US$ 59.85), yielding an ICER of CNY 13,552.74 (US$ 1930.59) per QALY gained. Probabilistic sensitivity analysis showed that genetic testing was more cost-effective in 95.7% of the simulations at the willingness-to-pay threshold of CNY 72,100 (GDP per capita, US$ 10,300) per QALY. Therefore, CYP2C19 genotyping to guide antiplatelet therapy for acute minor strokes and high-risk TIAs is highly cost-effective in China.

scholarly journals A Cost-Effectiveness Analysis of Atezolizumab and Bevacizumab Verses Sorafenib in Patients With Advanced Hepatocellular Carcinoma

2021 ◽  
Author(s):  
Meiyue Li ◽  
Peili Lin ◽  
Shaohong Luo ◽  
Xiaoting Huang ◽  
Xiaojia Huang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Health Benefit ◽  
Life Time ◽  
Cost Effective ◽  
Health State ◽  
Advanced Hepatocellular Carcinoma ◽  
Life Years

Abstract Background: Several studies have evaluated the cost-effectiveness of treatment for advanced hepatocellular carcinoma (HCC), but the economics of atezolizumab plus bevacizumab (Ate plus Beva) remains unclear. Method: A three-state Markov model was established to simulate the life-time cost and effectiveness of advanced liver cancer, which included costs and health outcomes. Medical costs were sourced from Red Book, Healthcare Cost and Utilization Project (HCUP) and literatures. Also, the utility values of health state were deprived from references. The primary outcomes were measured by life-years (LYs), quality-adjusted life-years (QALYs), incremental cost-benefit ratio (ICER) and incremental net-health benefit (INHB). The robustness of the model was verified by one-way and probabilistic sensitivity analysis.Results: Ate plus Beva generated a gain of 0.84 QALYs (1.17 LYs ), an additional incremental cost of $242,447.40 per patient as compared with sorafenib, which resulted in the ICER of $288,663.09/QALY ($206,906.76/LY) at the willingness-to-pay (WTP) threshold of $150,000/QALY, and the INHB was -0.78/QALY. The sensitivity analysis demonstrated that the ICER was most affected by the price of atezolizumab.Conclusion: From the U.S. health care payer perspective, compare with sorafenib, Ate plus Beva regimen seems unlikely to be cost-effective in advanced HCC patients at a WTP threshold of 150,000 /QALY. If the price of atezolizumab was reduced by 75%, the probability of atezolizumab being cost-effective was over 50% at the WTP threshold.

scholarly journals Cost-effectiveness of an insertable cardiac monitor in a high-risk population in the US

2021 ◽  
Author(s):  
Mitchell Elkind ◽  
Klaus Witte ◽  
Scott Kasner ◽  
Laura Sawyer ◽  
Frank Grimsey Jones ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Oral Anticoagulants ◽  
Effective Means ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
High Risk Population ◽  
Risk Population ◽  
Life Years ◽  
The Us

Objective: To evaluate the cost-effectiveness of insertable cardiac monitors (ICMs) compared to standard of care (SoC) for detecting atrial fibrillation (AF) in patients at high risk of stroke (CHADS2 >2), in the US. Background: ICMs are a clinically effective means of detecting AF in high-risk patients, prompting the initiation of non-vitamin K oral anticoagulants (NOACs). Their cost-effectiveness from a US clinical payer perspective is not yet known. Methods: Using patient data from the REVEAL AF trial (n= 446, average CHADS2 score= 2.9), a Markov model estimated the lifetime costs and benefits of detecting AF with an ICM or with SoC (namely, intermittent use of electrocardiograms [ECGs] and 24-hour Holter monitors). Ischemic and hemorrhagic strokes, intra- and extra-cranial hemorrhages, and minor bleeds were modelled. Diagnostic and device costs were included, plus costs of treating stroke and bleeding events and of NOACs. Costs and health outcomes, measured as quality-adjusted life years (QALYs), were discounted at 3% per annum. One-way deterministic and probabilistic sensitivity analyses (PSA) were undertaken. Results: Lifetime per-patient cost for ICM was $58,132 vs. $52,019 for SoC. ICMs generated a total 7.75 QALYs vs. 7.59 for SoC, with 34 fewer strokes projected per 1,000 patients. The incremental cost-effectiveness ratio (ICER) was $35,452 per QALY gained. ICMs were cost-effective in 72% of PSA simulations, using a $50,000 per QALY threshold. Conclusions: The use of ICMs to identify AF in a high-risk population is likely to be cost-effective in the US healthcare setting.

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