scholarly journals Pharmacoeconomic Study on the Application of Magnetic Resonance Imaging with Gadoxetic Acid in Addition to Contrast-Enhanced Computed Tomography in Diagnosis of Hepatocellular Carcinoma

2021 ◽  
Vol 102 (5) ◽  
pp. 284-295
Author(s):  
G. G. Kаrmаzаnovsky ◽  
A. A. Volobueva
Keyword(s):  
Cost Effectiveness ◽  
Pharmacoeconomic Study ◽  
Gadoxetic Acid ◽  
Effectiveness Analysis ◽  
Contrast Enhanced Ct ◽  
Disability Adjusted Life ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
The Cost ◽  
Disability Adjusted Life Year

Objective: to evaluate pharmacoeconomic advantages of the application of magnetic resonance imaging (MRI) with hepatobiliary-specific contrast agent – gadoxetic acid in addition to contrast-enhanced computed tomography (CT) in the diagnosis of hepatocellular carcinoma (HCC).Material and methods. We performed the modeling and obtained the results of the pharmacoeconomic study: effectiveness analysis, cost analysis, and cost-effectiveness analysis. The cost analysis included only direct medical costs (the cost of contrast-enhanced CT, gadolinium-based contrast agent (GBCA) for MRI, and therapy per a patient with verified HCC diagnosis after diagnostic procedures). The financing was performed from the Compulsary Health Insurance Fund. The calculations were made per 1 patient.Results. The effectiveness analysis showed that the diagnostic scheme CT + MRI with gadoxetic acid was the most effective complex for the diagnosis of HCC because its application provided 50% of patients with 5-year overall survival (4.8 years), which was significantly higher than in patients who were diagnosed HCC with CT + MRI with extracellular GBCA (2.3 years) or CT (3.7 years). The cost-effectiveness analysis showed that the diagnostic scheme with gadoxetic acid was dominant because each disability-adjusted life year required fewer costs (14 862 rubles) in comparison with CT + MRI with extracellular GBCA (25 293 rubles) or CT (46 540 rubles). According to the results of the incremental cost-effectiveness ratio analysis, the application of the diagnostic complex with gadoxetic acid was characterized by the lowest rate of additional costs per 1 disability-adjusted life year.Conclusion. The pharmacoeconomic study showed that the application of MRI with a hepatospecific contrasting agent – gadoxetic acid in addition to contrast-enhanced CT was an effective and economically beneficial method of early HCC diagnosis.

scholarly journals Reassessing the Cost-Effectiveness of High-Provitamin A Bananas to Reduce Vitamin A Deficiency in Uganda

2021 ◽  
Vol 5 ◽  
Author(s):  
Marta Kozicka ◽  
Julia Elsey ◽  
Beatrice Ekesa ◽  
Susan Ajambo ◽  
Enoch Kikulwe ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Vitamin A Deficiency ◽  
Cost Effective ◽  
Provitamin A ◽  
Disability Adjusted Life ◽  
Alternative Scenarios ◽  
And Shifts ◽  
The Cost ◽  
Disability Adjusted Life Year ◽  
Promotion Campaigns

There are two high-provitamin A (pVA) banana-based interventions potentially available in Uganda—biofortified genetically modified (GM) banana and fast-tracked banana landraces from outside Uganda that are naturally high in provitamin A (nHpVA). Based on the newest country statistics and using adoption scenarios obtained through focus group discussions and expert interviews, we assess obstacles and opportunities for adoption as well as cost-effectiveness of these interventions. In two alternative scenarios for the GM banana (M9 matooke), we assume 40% and 64% adoption rates, which would result in US$29,374,151 and US$63,259,415 in income saved, respectively. As an alternative, for the symmetrical scenarios, we calculate that if the nHpVA banana (Apantu plantain, native of Ghana) were to be adopted, US$46,100,148 and US$76,364,988 in income would be saved. Taking into account the full cost of R&D, we estimate that the M9 matooke could save one disability-adjusted life year (DALY) at a cost of US$67.37 at best and US$145.09 at worst. We estimate that the Apantu plantain could save one DALY at a cost of US$50.54 at best and US$83.72 at worst. Our DALY analysis estimates that all assessed HpVA banana interventions are extremely cost-effective in all scenarios, following both the World Bank's and the WHO criteria. Nevertheless, successful interventions would require extensive promotion campaigns and shifts in agricultural value chains.

CRUCIAL FACTORS THAT INFLUENCE COST-EFFECTIVENESS OF UNIVERSAL HEPATITIS B IMMUNIZATION IN INDIA

2003 ◽  
Vol 19 (1) ◽  
pp. 28-40 ◽  
Author(s):  
Charu Prakash
Keyword(s):  
Cost Effectiveness ◽  
Hepatitis B ◽  
Latin Hypercube Sampling ◽  
Hypothetical Cohort ◽  
Disability Adjusted Life Years ◽  
Effectiveness Analysis ◽  
Disability Adjusted Life ◽  
Life Years ◽  
The Cost

This study examines the parameters crucial to cost-effectiveness of universal hepatitis B immunization in India. An incremental cost-effectiveness analysis was done using a decision tree (Markov model) to follow up a hypothetical cohort of 100,000 newborns for the effects of hepatitis B acquired vertically at birth. The measure of effectiveness was disability-adjusted life-years gained. Uncertainty analysis and Scenario analysis were done using Latin hypercube sampling. Hepatitis B endemicity is the most important factor, followed by the cost of vaccine. Other factors of some influence are vaccination coverage, vaccine efficacy, HBeAg positivity, and vaccine wastage.

scholarly journals The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242170
Author(s):  
Stephanie Bogdewic ◽  
Rohit Ramaswamy ◽  
David M. Goodman ◽  
Emmanuel K. Srofenyoh ◽  
Sebnem Ucer ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Neonatal Mortality ◽  
Clinical Skills ◽  
Cost Effective ◽  
Regional Hospital ◽  
Sensitivity Analyses ◽  
Neonatal Deaths ◽  
Disability Adjusted Life ◽  
The Cost ◽  
Disability Adjusted Life Year

Objective To evaluate the cost-effectiveness of a program intended to reduce intrapartum and neonatal mortality in Accra, Ghana. Design Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis. Methods A program integrating leadership development, clinical skills and quality improvement training was piloted at the Greater Accra Regional Hospital from 2013 to 2016. The number of intrapartum and neonatal deaths prevented were estimated using the hospital’s 2012 stillbirth and neonatal mortality rates as a steady-state assumption. The cost-effectiveness of the intervention was calculated as cost per disability-adjusted life year (DALY) averted. In order to test the assumptions included in this analysis, it was subjected to probabilistic and one-way sensitivity analyses. Main outcome measures Incremental cost-effectiveness ratio (ICER), which measures the cost per disability-adjusted life-year averted by the intervention compared to status quo. Results From 2012 to 2016, there were 45,495 births at the Greater Accra Regional Hospital, of whom 5,734 were admitted to the newborn intensive care unit. The budget for the systems strengthening program was US $1,716,976. Based on program estimates, 307 (±82) neonatal deaths and 84 (±35) stillbirths were prevented, amounting to 12,342 DALYs averted. The systems strengthening intervention was found to be highly cost effective with an ICER of US $139 (±$44), an amount significantly lower than the established threshold of cost-effectiveness of the per capita gross domestic product, which averaged US $1,649 between 2012–2016. The results were found to be sensitive to the following parameters: DALYs averted, number of neonatal deaths, and number of stillbirths. Conclusion An integrated approach to system strengthening in referral hospitals has the potential to reduce neonatal and intrapartum mortality in low resource settings and is likely to be cost-effective. Sustained change can be achieved by building organizational capacity through leadership and clinical training.

Cost-Effectiveness of Cognitive–Behavioural Therapy and Drug Interventions for Major Depression

2005 ◽  
Vol 39 (8) ◽  
pp. 683-692 ◽  
Author(s):  
Theo Vos ◽  
Justine Corry ◽  
Michelle M. Haby ◽  
Rob Carter ◽  
Gavin Andrews
Keyword(s):  
Cost Effectiveness ◽  
Major Depression ◽  
Maintenance Treatment ◽  
Treatment Options ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
Disability Adjusted Life ◽  
The Cost ◽  
Disability Adjusted Life Year

Objective: Antidepressant drugs and cognitive–behavioural therapy (CBT) are effective treatment options for depression and are recommended by clinical practice guidelines. As part of the Assessing Cost-effectiveness – Mental Health project we evaluate the available evidence on costs and benefits of CBT and drugs in the episodic and maintenance treatment of major depression. Method: The cost-effectiveness is modelled from a health-care perspective as the cost per disability-adjusted life year. Interventions are targeted at people with major depression who currently seek care but receive non-evidence based treatment. Uncertainty in model inputs is tested using Monte Carlo simulation methods. Results: All interventions for major depression examined have a favourable incremental cost-effectiveness ratio under Australian health service conditions. Bibliotherapy, group CBT, individual CBT by a psychologist on a public salary and tricyclic antidepressants (TCAs) are very cost-effective treatment options falling below $A10 000 per disability-adjusted life year (DALY) even when taking the upper limit of the uncertainty interval into account. Maintenance treatment with selective serotonin re-uptake inhibitors (SSRIs) is the most expensive option (ranging from $A17 000 to $A20 000 per DALY) but still well below $A50 000, which is considered the affordable threshold. Conclusions: A range of cost-effective interventions for episodes of major depression exists and is currently underutilized. Maintenance treatment strategies are required to significantly reduce the burden of depression, but the cost of long-term drug treatment for the large number of depressed people is high if SSRIs are the drug of choice. Key policy issues with regard to expanded provision of CBT concern the availability of suitably trained providers and the funding mechanisms for therapy in primary care.

scholarly journals Perspective and Costing in Cost-Effectiveness Analysis, 1974–2018

2020 ◽  
Vol 38 (10) ◽  
pp. 1135-1145 ◽  
Author(s):  
David D. Kim ◽  
Madison C. Silver ◽  
Natalia Kunst ◽  
Joshua T. Cohen ◽  
Daniel A. Ollendorf ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Productivity Loss ◽  
Quality Adjusted Life Year ◽  
Healthcare Sector ◽  
Disability Adjusted Life ◽  
Payer Perspective ◽  
The Cost ◽  
Disability Adjusted Life Year ◽  
The Impact

Abstract Objective Our objective was to examine perspective and costing approaches used in cost-effectiveness analyses (CEAs) and the distribution of reported incremental cost-effectiveness ratios (ICERs). Methods We analyzed the Tufts Medical Center’s CEA and Global Health CEA registries, containing 6907 cost-per-quality-adjusted-life-year (QALY) and 698 cost-per-disability-adjusted-life-year (DALY) studies published through 2018. We examined how often published CEAs included non-health consequences and their impact on ICERs. We also reviewed 45 country-specific guidelines to examine recommended analytic perspectives. Results Study authors often mis-specified or did not clearly state the perspective used. After re-classification by registry reviewers, a healthcare sector or payer perspective was most prevalent (74%). CEAs rarely included unrelated medical costs and impacts on non-healthcare sectors. The most common non-health consequence included was productivity loss in the cost-per-QALY studies (12%) and patient transportation in the cost-per-DALY studies (21%). Of 19,946 cost-per-QALY ratios, the median ICER was $US26,000/QALY (interquartile range [IQR] 2900–110,000), and 18% were cost saving and QALY increasing. Of 5572 cost-per-DALY ratios, the median ICER was $US430/DALY (IQR 67–3400), and 8% were cost saving and DALY averting. Based on 16 cost-per-QALY studies (2017–2018) reporting 68 ICERs from both the healthcare sector and societal perspectives, the median ICER from a societal perspective ($US22,710/QALY [IQR 11,991–49,603]) was more favorable than from a healthcare sector perspective ($US30,402/QALY [IQR 10,486–77,179]). Most governmental guidelines (67%) recommended either a healthcare sector or a payer perspective. Conclusion Researchers should justify and be transparent about their choice of perspective and costing approaches. The use of the impact inventory and reporting of disaggregate outcomes can reduce inconsistencies and confusion.

Measuring and valuing health: an international perspective

2016 ◽  
Author(s):  
John Brazier ◽  
Julie Ratcliffe ◽  
Joshua A. Salomon ◽  
Aki Tsuchiya
Keyword(s):  
Developing Countries ◽  
Cost Effectiveness ◽  
International Perspective ◽  
General Observation ◽  
Middle Income ◽  
Middle Income Countries ◽  
Disability Adjusted Life ◽  
Key Issues ◽  
The Cost ◽  
Disability Adjusted Life Year

The institutionalized demand for cost-effectiveness evidence in low- and middle-income countries—where this sort of information is arguably even more urgently required—has yet to gain traction to the same extent that it has in various countries in the industrialized world. There are several important exceptions to this general observation, and these may signal a rising interest in undertaking and applying cost-effectiveness analysis (CEAs) in developing countries. The disability-adjusted life year (DALY) is an alternative to the QALY that has been favoured in much of the cost-effectiveness work in developing countries; and extends the discussions of key issues in the definition, description, and valuation of health to address some of the added considerations demanded by cross-cultural applications of the methods and tools that are the focus of this book.

scholarly journals Hospital-based evidence on cost-effectiveness of brucellosis diagnostic tests and treatment in Kenyan hospitals

2021 ◽  
Vol 15 (1) ◽  
pp. e0008977
Author(s):  
Lorren Alumasa ◽  
Lian F. Thomas ◽  
Fredrick Amanya ◽  
Samuel M. Njoroge ◽  
Ignacio Moriyón ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
National Level ◽  
Cost Effective ◽  
Human Brucellosis ◽  
Serum Samples ◽  
Therapy Regimen ◽  
Treatment Regimens ◽  
Disability Adjusted Life ◽  
The Cost ◽  
Disability Adjusted Life Year

Hospitals in Kenya continue to use the Febrile Antigen Brucella Agglutination Test (FBAT) to diagnose brucellosis, despite reports showing its inadequacy. This study generated hospital-based evidence on the performance and cost-effectiveness of the FBAT, compared to the Rose Bengal Test (RBT).Twelve hospitals in western Kenya stored patient serum samples that were tested for brucellosis using the FBAT, and these were later re-tested using the RBT. Data on the running time and cost of the FBAT, and the treatment prescribed for brucellosis, were collected. The cost-effectiveness of the two tests, defined as the cost in US Dollars ($) per Disability Adjusted Life Year (DALY) averted, was determined, and a basic sensitivity analysis was run to identify the most influential parameters. Over a 6-month period, 180 patient serum samples that were tested with FBAT at the hospitals were later re-tested with RBT at the field laboratory. Of these 24 (13.3%) and 3 (1.7%) tested positive with FBAT and RBT, respectively. The agreement between the FBAT and RBT was slight (Kappa = 0.12). Treatment prescribed following FBAT positivity varied between hospitals, and only one hospital prescribed a standardized therapy regimen. The mean $/DALY averted when using the FBAT and RBT were $2,065 (95% CI $481-$6,736) and $304 (95% CI $126-$604), respectively. Brucellosis prevalence was the most influential parameter in the cost-effectiveness of both tests. Extrapolation to the national level suggested that an estimated $338,891 (95% CI $47,000-$1,149,000) per year is currently spent unnecessarily treating those falsely testing positive by FBAT. These findings highlight the potential for misdiagnosis using the FBAT. Furthermore, the RBT is cost-effective, and could be considered as the mainstay screening test for human brucellosis in this setting. Lastly, the treatment regimens must be harmonized to ensure the appropriate use of antibiotics for treatment.

scholarly journals COVID-19 Vaccines Cost-Effectiveness Analysis: A Scenario for Iran

Vaccines ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 37
Author(s):  
Atefeh Vaezi ◽  
Alipasha Meysamie
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effectiveness Analysis ◽  
Incremental Cost Effectiveness Ratio ◽  
Decision Making Process ◽  
Cost Effectiveness Ratio ◽  
Effectiveness Analysis ◽  
Critical Measure ◽  
Disability Adjusted Life ◽  
Disability Adjusted Life Year

COVID-19 vaccines are supposed to be critical measure for ending the pandemic. Governments had to decide on the type of vaccine to provide for their population. In this decision-making process, cost-effectiveness analysis is considered a helpful tool. This study is a cost-effectiveness analysis utilized to calculate the incremental cost per averted disability-adjusted life year (DALY) by vaccination compared to no vaccination for different COVID-19 vaccines. The incremental cost-effectiveness ratio (ICER) for a vaccination with COVID-19 vaccines was estimated at 6.2 to 121.2 USD to avert one DALY and 566.8 to 10,957.7 USD per one death. The lowest and highest ICERs belong to Ad26.COV2.S and CoronaVac, respectively. Considering the scenario of Iran, vaccines that are recommended include ad26.cov2.s, chadox1-S, rAd26-S + rAd5-S, and BNT162b2 in the order of recommendation.

scholarly journals Screening for Melanoma by Primary Health Care Physicians: A Cost—Effectiveness Analysis

1996 ◽  
Vol 3 (1) ◽  
pp. 47-53 ◽  
Author(s):  
Afaf Girgis ◽  
Philip Clarke ◽  
Robert C Burton ◽  
Rob W Sanson—Fisher
Keyword(s):  
Cost Effectiveness ◽  
Screening Programme ◽  
Cost Effective ◽  
Economic Assessment ◽  
Screening Tests ◽  
Family Practitioners ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Primary Health Care Physicians ◽  
Melanoma Screening

Background and design— Australia has the highest rates of skin cancer in the world, and the incidence is estimated to be doubling every 10 years. Despite advances in the early detection and treatment of melanoma about 800 people still die nationally of the disease each year. A possible strategy for further reducing the mortality from melanoma is an organised programme of population screening for unsuspected lesions in asymptomatic people. Arguments against introducing melanoma screening have been based on cost and the lack of reliable data on the efficacy of any screening tests. To date, however, there has been no systematic economic assessment of the cost effectiveness of melanoma screening. The purpose of this research was to determine whether screening may be potentially cost effective and, therefore, warrants further investigation. A computer was used to simulate the effects of a hypothetical melanoma screening programme that was in operation for 20 years, using cohorts of Australians aged 50 at the start of the programme. Based on this simulation, cost—effectiveness estimates of melanoma screening were calculated. Results— Under the standard assumptions used in the model, and setting the sensitivity of the screening test (visual inspection of the skin) at 60%, cost effectiveness ranged from Aust$6853 per life year saved for men if screening was undertaken five yearly to $12137 if screening was two yearly. For women, it ranged from $11 102 for five yearly screening to $20 877 for two yearly screening. Conclusion— The analysis suggests that a melanoma screening programme could be cost effective, particularly if five yearly screening is implemented by family practitioners for men over the age of 50.

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