scholarly journals Economic Evaluation of Carbetocin as Prophylaxis for Postpartum Hemorrhage in the Philippines

2020 ◽  
Author(s):  
Jamaica Roanne Briones ◽  
Pattarawalai Talungchit ◽  
Montarat Thavorncharoensap ◽  
Usa Chaikledkaew
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Postpartum Hemorrhage ◽  
Budget Impact ◽  
Hospital Setting ◽  
Cost Effective ◽  
The Philippines ◽  
Cost Utility ◽  
Third Party ◽  
Additional Costs

Abstract Background: Cost-effectiveness and budget impact of carbetocin was evaluated as an alternative to oxytocin for postpartum hemorrhage (PPH) prophylaxis in the Philippines.Methods: A model-based economic evaluation was employed to assess cost-effectiveness of carbetocin compared to oxytocin for PPH. Population of interest were women undergoing either vaginal delivery (VD) or cesarean section (CS) in a public hospital setting with costs and outcomes evaluated in six weeks. Cost-utility was analyzed using a government and societal perspectives while the budget impact was determined using a third party payer’s perspective. Incremental Cost Effectiveness Ratio (ICER) was evaluated using the set threshold in the country of 150,000 PhP per QALY gained.Results: Carbetocin was not cost-effective in the Philippines. Deterministic results in a government perspective for CS was at 724,081 PhP while for VD was over 2 million PhP. Deterministic and probabilistic results in the societal perspective for CS and VD were near these respective ICER values and did not also favor carbetocin use. Moreover, the treatment effects of carbetocin in reference to oxytocin were identified as the most sensitive parameter used. On budget impact, if 50% of deliveries would switch to carbetocin for the fiscal years assessed, additional incremental cumulative costs of 1.08 billion PhP for VD and 1.86 billion PhP for CS would be needed.Conclusion: The incremental benefit of carbetocin does not justify the additional costs incurred from purchasing the drug given a Philippine context. Price reduction of carbetocin is recommended if the drug would be publicly reimbursed in the country.

scholarly journals Economic evaluation of carbetocin as prophylaxis for postpartum hemorrhage in the Philippines

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jamaica Roanne Briones ◽  
Pattarawalai Talungchit ◽  
Montarat Thavorncharoensap ◽  
Usa Chaikledkaew
Keyword(s):  
Cost Effectiveness ◽  
Societal Perspective ◽  
Postpartum Hemorrhage ◽  
Budget Impact ◽  
Cost Effective ◽  
The Philippines ◽  
World Health ◽  
Sensitivity Analyses ◽  
Parameter Uncertainties ◽  
Effective Choice

Abstract Background The World Health Organization (WHO) recommends oxytocin as the drug of choice for postpartum hemorrhage (PPH) prevention. However, the WHO has also recently considered carbetocin for PPH prevention, but only if carbetocin were a cost-effective choice in the country. Consequently, we determined the cost-effectiveness and budgetary impact of carbetocin against oxytocin in the Philippines. Methods A cost-utility analysis using a decision tree was done to compare the costs and outcomes of carbetocin with oxytocin for PPH prophylaxis among women undergoing either vaginal delivery (VD) or cesarean section (CS) in a six-week time horizon using a societal perspective. One-way and probabilistic sensitivity analyses were applied to investigate parameter uncertainties. Additionally, budget impact analysis was conducted using a governmental perspective. Results were presented as incremental cost-effectiveness ratio (ICER) using a 2895 United States dollar (USD) per quality adjusted life year (QALY) gained as the ceiling threshold in the Philippines. Results Carbetocin was not cost-effective given the listed price of carbetocin at 18 USD. Given a societal perspective, the ICER values of 13,187 USD and over 40,000 USD per QALY gained were derived for CS and VD, respectively. Moreover, the ICER values were sensitive to the risk ratio of carbetocin versus oxytocin and carbetocin price. On budget impact, the five-year total budget impact of a drug mix of carbetocin and oxytocin was 25.54 million USD (4.23 million USD for CS and 21.31 million USD for VD) compared with ‘only oxytocin’ scenario. Conclusion Carbetocin is not a cost-effective choice in PPH prevention for both modes of delivery in the Philippines, unless price reduction is made. Our findings can be used for evidence-informed policies to guide coverage decisions on carbetocin not only in the Philippines but also in other low and middle-income countries.

PP137 Colorectal Cancer Screening In The Philippines: Cost-Utility Analysis

2018 ◽  
Vol 34 (S1) ◽  
pp. 120-120
Author(s):  
John Wong ◽  
Stephanie Anne Co ◽  
Joy Bagas ◽  
Ma. Sophia Graciela Reyes ◽  
Hadrian Lim ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Budget Impact ◽  
Discrete Event ◽  
Cost Effective ◽  
The Philippines ◽  
Cost Utility ◽  
World Health ◽  
Rapid Review ◽  
Primary Data ◽  
Screening Parameter

Introduction:Colorectal cancer (CRC) is the fourth leading cause of cancer deaths in the Philippines. In 2014, the Philippine Health Insurance Corporation (PhilHealth) created a CRC treatment package. The study aimed to determine the cost-utility and budget impact of CRC screening strategies.Methods:A discrete-event microsimulation model was used to simulate four screening modalities: (i) guaiac-fecal occult blood test (gFOBT) followed by colonoscopy every 10 years; (ii) fecal immunochemical test (FIT) followed by colonoscopy every 10 years; (iii) FIT followed by flexible sigmoidoscopy; and (iv) colonoscopy screening every 10 years. These interventions were all compared to no screening. Parameter values were taken from a rapid review of the medical literature and primary data collection from a nationally representative sample of tertiary hospitals.Results:All screening modalities were very cost effective considering that the incremental cost-effective ratios (ICERs) were lower than the gross domestic product per capita threshold suggested by the World Health Organization. Sensitivity analysis showed that the ICERs of all screening modalities evaluated remained below this threshold. The strategy of using FIT followed by colonoscopy every 10 years had an ICER of USD 6,025, with an annual budget impact of USD 6.5 million, assuming low compliance. With moderate compliance this could increase to USD 18.7 million annually.Conclusions:PhilHealth may introduce a benefit package for outpatient screening of colorectal cancer using the screening modality of annual FIT followed by colonoscopy every 10 years.

scholarly journals Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants

BJPsych Open ◽  
2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Nicola S. Klein ◽  
Ben F. M. Wijnen ◽  
Joran Lokkerbol ◽  
Erik Buskens ◽  
Hermien J. Elgersma ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cognitive Therapy ◽  
Clinical Training ◽  
Impact Analysis ◽  
Budget Impact ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cost Utility ◽  
The European Union ◽  
Life Years

BackgroundAs depression has a recurrent course, relapse and recurrence prevention is essential.AimsIn our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT) to maintenance antidepressants (PCT+AD) yielded substantial protective effects versus antidepressants only in individuals with recurrent depression. Antidepressants were not superior to PCT while tapering antidepressants (PCT/−AD). To inform decision-makers on treatment allocation, we present the corresponding cost-effectiveness, cost-utility and budget impact.MethodData were analysed (n = 289) using a societal perspective with 24-months of follow-up, with depression-free days and quality-adjusted life years (QALYs) as health outcomes. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were derived to provide information about cost-effectiveness. The budget impact was examined with a health economic simulation model.ResultsMean total costs over 24 months were €6814, €10 264 and €13 282 for AD+PCT, antidepressants only and PCT/−AD, respectively. Compared with antidepressants only, PCT+AD resulted in significant improvements in depression-free days but not QALYs. Health gains did not significantly favour antidepressants only versus PCT/−AD. High probabilities were found that PCT+AD versus antidepressants only and antidepressants only versus PCT/−AD were dominant with low willingness-to-pay thresholds. The budget impact analysis showed decreased societal costs for PCT+AD versus antidepressants only and for antidepressants only versus PCT/−AD.ConclusionsAdding PCT to antidepressants is cost-effective over 24 months and PCT with guided tapering of antidepressants in long-term users might result in extra costs. Future studies examining costs and effects of antidepressants versus psychological interventions over a longer period may identify a break-even point where PCT/−AD will become cost-effective.Declaration of interestC.L.H.B. is co-editor ofPLOS Oneand receives no honorarium for this role. She is also co-developer of the Dutch multidisciplinary clinical guideline for anxiety and depression, for which she receives no remuneration. She is a member of the scientific advisory board of the National Insure Institute, for which she receives an honorarium, although this role has no direct relation to this study. C.L.H.B. has presented keynote addresses at conferences, such as the European Psychiatry Association and the European Conference Association, for which she sometimes receives an honorarium. She has presented clinical training workshops, some including a fee. She receives royalties from her books and co-edited books and she developed preventive cognitive therapy on the basis of the cognitive model of A. T. Beck. W.A.N. has received grants from the Netherlands Organisation for Health Research and Development and the European Union and honoraria and speakers' fees from Lundbeck and Aristo Pharma, and has served as a consultant for Daleco Pharma.

scholarly journals Cost-utility analysis of standard dressing compared with incisional negative-pressure wound therapy among patients with closed surgical wounds following major trauma to the lower limb

2020 ◽  
Vol 102-B (8) ◽  
pp. 1072-1081
Author(s):  
May E. Png ◽  
Jason J. Madan ◽  
Melina Dritsaki ◽  
Juul Achten ◽  
Nick Parsons ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Negative Pressure Wound Therapy ◽  
Major Trauma ◽  
Cost Effective ◽  
Cost Utility ◽  
Lower Limbs ◽  
Wound Therapy ◽  
Surgical Wounds

Aims To compare the cost-utility of standard dressing with incisional negative-pressure wound therapy (iNPWT) in adults with closed surgical wounds associated with major trauma to the lower limbs. Methods A within-trial economic evaluation was conducted from the UK NHS and personal social services (PSS) perspective based on data collected from the Wound Healing in Surgery for Trauma (WHiST) multicentre randomized clinical trial. Health resource utilization was collected over a six-month post-randomization period using trial case report forms and participant-completed questionnaires. Cost-utility was reported in terms of incremental cost per quality-adjusted life year (QALY) gained. Sensitivity analysis was conducted to test the robustness of cost-effectiveness estimates while uncertainty was handled using confidence ellipses and cost-effectiveness acceptability curves. Results The incremental cost of standard dressing versus iNPWT over six months was £2,037 (95% confidence interval (CI) £349 to £3,724). There was an insignificant increment in QALYs gained in the iNPWT group (0.005, 95% CI -0.018 to 0.028). The probability of iNPWT being cost-effective at £20,000 per QALY was 1.9%. The results remained robust in the sensitivity analysis. Conclusion The within-trial economic evaluation suggests that iNPWT is unlikely to be a cost-effective alternative to standard dressing in adults with closed surgical wounds to their lower limbs. Cite this article: Bone Joint J 2020;102-B(8):1072–1081.

scholarly journals A guided and unguided internet- and mobile-based intervention for chronic pain: health economic evaluation alongside a randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e023390 ◽  
Author(s):  
Sarah Paganini ◽  
Jiaxi Lin ◽  
Fanny Kählke ◽  
Claudia Buntrock ◽  
Delia Leiding ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Treatment Response ◽  
Controlled Trial ◽  
Health Economic Evaluation ◽  
Cost Effective ◽  
Cost Utility ◽  
Randomised Controlled ◽  
The Cost

ObjectiveThis study aims at evaluating the cost-effectiveness and cost-utility of a guided and unguided internet-based intervention for chronic pain patients (ACTonPainguidedand ACTonPainunguided) compared with a waitlist control group (CG) as well as the comparative cost-effectiveness of the guided and the unguided version.DesignThis is a health economic evaluation alongside a three-arm randomised controlled trial from a societal perspective. Assessments were conducted at baseline, 9 weeks and 6 months after randomisation.SettingParticipants were recruited through online and offline strategies and in collaboration with a health insurance company.Participants302 adults (≥18 years, pain for at least 6 months) were randomly allocated to one of the three groups (ACTonPainguided, ACTonPainunguided, CG).InterventionsACTonPain consists of seven modules and is based on Acceptance and Commitment Therapy. ACTonPainguidedand ACTonPainunguidedonly differ in provision of human support.Primary and secondary outcome measuresMain outcomes of the cost-effectiveness and the cost-utility analyses were meaningful change in pain interference (treatment response) and quality-adjusted life years (QALYs), respectively. Economic evaluation estimates were the incremental cost-effectiveness and cost-utility ratio (ICER/ICUR).ResultsAt 6-month follow-up, treatment response and QALYs were highest in ACTonPainguided(44% and 0.280; mean costs = €6,945), followed by ACTonPainunguided(28% and 0.266; mean costs = €6,560) and the CG (16% and 0.244; mean costs = €6,908). ACTonPainguidedvs CG revealed an ICER of €45 and an ICUR of €604.ACTonPainunguideddominated CG. At a willingness-to-pay of €0 the probability of being cost-effective was 50% for ACTonPainguided(vs CG, for both treatment response and QALY gained) and 67% for ACTonPainunguided(vs CG, for both treatment response and QALY gained). These probabilities rose to 95% when society’s willingness-to-pay is €91,000 (ACTonPainguided) and €127,000 (ACTonPainunguided) per QALY gained. ACTonPainguidedvs ACTonPainunguidedrevealed an ICER of €2,374 and an ICUR of €45,993.ConclusionsDepending on society’s willingness-to-pay, ACTonPain is a potentially cost-effective adjunct to established pain treatment. ACTonPainunguided(vs CG) revealed lower costs at better health outcomes. However, uncertainty has to be considered. Direct comparison of the two interventions does not indicate a preference for ACTonPainguided.Trial registration numberDRKS00006183.

scholarly journals Economic Evaluation of Severe Anaemia: Review-Based Recommendations and a Conceptual Framework

2020 ◽  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Blood Cell ◽  
Conceptual Framework ◽  
Red Blood Cell ◽  
Budget Impact ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Economic Analyses ◽  
Impact Models

Objective: Novel anaemia treatments have greatly improved patient outcomes in the last decade and have also undergone economic evaluations in various settings using heterogenous model structures, costs, and inputs. The objectives were to review published economic evaluation studies in major red blood cell disorders, identify limitations in the applied methodology, provide a set of recommendations, and produce a conceptual framework for future economic research in this disease area. Methods: A targeted search was conducted for economic literature evaluating treatments in major red blood cell disorders related to anaemia. Disorders included autoimmune haemolytic anaemia, β-thalassaemia, chemotherapy-induced anaemia, anaemia in chronic kidney disease, and severe aplastic anaemia. Budget impact models and cost-effectiveness and cost-utility analyses were considered. Modelling assumptions regarding the model structure, time horizon, perspective, and type of costs were reviewed and recommendations and a conceptual framework for future economic analyses were created. Results: A total of four budget impact models, nine cost-utility analyses, and four cost-effectiveness analyses were investigated. A major limitation was that the included costs varied significantly across studies. Costs which were rarely included, and generally should be considered, were related to adverse events, mortality, and productivity. Additionally, relationships between levels of serum ferritin, hepatic or total body iron, and haemoglobin with long-term complications and mortality were rarely included. Conclusion: Published economic analyses evaluating treatments for major red blood cell disorders frequently exclude vital costs. A set of recommendations and a conceptual framework will aid researchers in applying a more comprehensive approach for economic evaluations in major red blood cell disorders.

scholarly journals Adding Rituximab to Chemotherapy for Diffuse Large B-Cell Lymphoma Patients in Indonesia: A Cost Utility and Budget Impact Analysis

2022 ◽  
Author(s):  
Septiara Putri ◽  
Ery Setiawan ◽  
Siti Rizny F. Saldi ◽  
Levina Chandra ◽  
Euis Ratna Sari ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Impact Analysis ◽  
Budget Impact ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Cost Effective ◽  
Cost Utility ◽  
Budget Impact Analysis ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract Background This study aims to estimate the cost-effectiveness and budget impact of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) compared to CHOP for the treatment of patients with diffuse large B-cell lymphoma (DLBCL) in Indonesia. Methods We conducted a cost utility analysis using Markov model over a lifetime horizon, from a societal perspective. Clinical evidence was derived from published clinical trials. Direct medical costs were gathered from hospital data. Direct non-medical costs, indirect costs, and utility data were primarily gathered by interviewing the patients. We applied 3% discount rate for both costs and effect. All monetary data are converted into USD (1 USD = IDR 14,000, 2019). Probabilistic sensitivity analysis was performed. In addition, from a payer perspective, budget impact analysis was estimated using price reduction scenarios. Results The incremental cost-effectiveness ratio (ICER) of R-CHOP was USD 4,674/LYG and 9,280/QALY. If we refer to the threshold three times the GDP per capita (USD 11,538), R-CHOP could thus be determined as a cost-effective therapy. Its significant health benefit has contributed to the considerable ICER result. Although the R-CHOP has been considered a cost-effective intervention, the financial consequence of R-CHOP if remain in benefit package under National Health Insurance (NHI) system in Indonesia is considerably substantial, approximately USD 66 million with 75% price reduction scenario. Conclusions As a favorable treatment for DLBCL, R-CHOP ensures value for money in Indonesia. Budget impact analysis provides results which can be used as further consideration for decision-makers in matters related to benefit packages.

Economic evaluations of videoconference and telephone consultations in primary care: A systematic review

2021 ◽  
pp. 1357633X2110433
Author(s):  
Keshia R De Guzman ◽  
Centaine L Snoswell ◽  
Liam J Caffery ◽  
Anthony C Smith
Keyword(s):  
Primary Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Cost Minimization ◽  
Health Economic Evaluation ◽  
Reporting Quality ◽  
Cost Effective ◽  
Cost Utility ◽  
Economic Evaluations ◽  
Published Evidence

Introduction Telehealth services using videoconference and telephone modalities have been increasing exponentially in primary care since the coronavirus pandemic. The challenge now is ensuring that these services remain sustainable. This review investigates the cost-effectiveness of videoconference and telephone consultations in primary care settings, by summarizing the available published evidence. Methods A systematic search of PubMed, Embase, Scopus, and CINAHL databases was used to identify articles published from January 2000 to July 2020, using keyword synonyms for telehealth, primary care, and economic evaluation. Databases were searched, and title, abstract, and full-text reviews were conducted. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. Results Twenty articles were selected for inclusion, with 12 describing telephone triage services, seven describing telehealth substitution services, and one describing another telehealth service in primary care. These services were delivered by nurses, doctors, and allied health clinicians. Of the 20 included studies, 11 used cost analyses, five used cost-minimization analyses, and four used one or more methods, including either a cost–consequence analysis, a cost–utility analysis, or a cost-effectiveness analysis. Conclusions Telephone and videoconference consultations in primary care were cost-effective to the health system when deemed clinically appropriate, clinician when time was used efficiently, and when overall demand on health services was reduced. The societal benefits of telehealth consultations should be considered an important part of telehealth planning and should influence funding reform decisions for telehealth services in primary care.

scholarly journals Cost-utility analysis of adjuvant trastuzumab therapy for HER2-positive early-stage breast cancer in the Philippines

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Anne Julienne Genuino ◽  
Usa Chaikledkaew ◽  
Anna Melissa Guerrero ◽  
Thanyanan Reungwetwattana ◽  
Ammarin Thakkinstian
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Budget Impact ◽  
Early Stage ◽  
The Philippines ◽  
Cost Utility ◽  
Standard Chemotherapy ◽  
Her2 Positive ◽  
Adjuvant Trastuzumab ◽  
Trastuzumab Therapy

Abstract Background Breast cancer is the leading malignancy among Filipino women, with about 23.50% of cases characterized by human epidermal growth factor receptor-2 (HER2) overexpression. Trastuzumab, in addition to standard chemotherapy, is currently recommended as primary treatment for HER2-positive early-stage breast cancer (EBC) in the adjuvant settings, and has been listed in the Philippine National Formulary (PNF) since 2008, but with no current evidence yet on its value for money, to date. Hence, despite several policy enablers, its accessibility remains to be limited in the Philippines. We performed an economic evaluation to assess the cost-effectiveness and budget impact of adjuvant trastuzumab therapy for HER2-positive EBC in the Philippines, using healthcare system and societal perspectives, in aid of guiding coverage decisions. Methods A Markov model-based cost-utility and budget impact analyses were conducted to estimate the total costs incurred and outcomes gained in using 1 year of adjuvant trastuzumab added to standard chemotherapy versus standard chemotherapy alone, over a lifetime horizon. We discounted both costs and outcomes at 3.5% per annum. Parameters were estimated using country survival data, systematic review and meta-analysis of the relative treatment effect, local and international cost data, and published utility data. Univariate and probabilistic sensitivity analyses were used to account for parameter uncertainty. Results Trastuzumab therapy was dominated with an incremental cost-effectiveness ratio (ICER) at PHP 453,505 per QALY gained from a healthcare system perspective or PHP 458,686 per QALY gained from a societal perspective, with 10% cost-effectiveness probability at the country cost-effectiveness threshold of PHP 120,000 per QALY gained. National implementation will cost an additional amount of PHP 13,909 million in year one alone, plus about PHP 2000 to 3000 million annually for the succeeding fiscal years. Conclusion At its current cost, 1 year of adjuvant trastuzumab therapy compared to standard chemotherapy alone for HER2-positive EBC does not represent value for money in the Philippines. Its current cost will have to significantly lower down by one-half to achieve cost-effectiveness.

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