scholarly journals Modeling the Cost-effectiveness of Esophageal Cancer Screening in China

2020 ◽  
Author(s):  
Yuanyuan LI ◽  
Lingbin Du ◽  
Youqing Wang ◽  
Yuxuan Gu ◽  
Xuemei Zhen ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Low Grade ◽  
Decision Analysis Model ◽  
Endoscopic Screening ◽  
Lugol’S Iodine ◽  
Iodine Staining ◽  
Life Years ◽  
The Cost

Abstract Background This study aimed to examine the cost-effectiveness of the standard endoscopic screening with Lugol’s iodine staining in EC screening in China. Methods The Markov decision analysis model with eleven states was built. Separate cohorts were conducted consisting of those aged 40 to 69 years, classified as six age groups with five years interval. Three different strategies assumed for each cohort:(1) no screening; (2) endoscopic screening with Lugol’s iodine staining with annual follow-up for Low-grade intraepithelial neoplasia; (3) endoscopic screening with Lugol’s iodine staining without follow-up. Quality-adjusted life-years (QALYs) served as effectiveness. The incremental cost-effectiveness ratio (ICER) was identified as the evaluating indicators. Sensitivity analysis was introduced to assess the robustness of the model. Results For aged 40-49 years, the non-screening strategies were absolutely dominated with both more costs and less QALY, while for aged 50-69 years, the screening scenarios were absolutely dominated. Screening with follow-up was the preferred strategy. Compared to non-screening, screening with follow-up saved USD 10942.57 and USD 611.73 per QALY gained for aged 40-44 and 45-49 years separately. One-way sensitivity analysis addressed that the risk ratio of the EC incidence in population after screening compared to people without screening and the utility of precancerous lesion could affect the cost-effectiveness of the screening strategy. However, the probabilistic sensitivity analysis supported the results of the base case analysis. Conclusions EC screening with follow-up targeting aged 40-49 years was the most cost-effective strategy.

scholarly journals Modeling the Cost-effectiveness of Esophageal Cancer Screening in China

2020 ◽  
Author(s):  
Yuanyuan LI ◽  
Lingbin Du ◽  
Youqing Wang ◽  
Yuxuan Gu ◽  
Xuemei Zhen ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Esophageal Cancer ◽  
Cost Effectiveness ◽  
Cancer Screening ◽  
Cost Effective ◽  
Endoscopic Screening ◽  
Lugol’S Iodine ◽  
Iodine Staining ◽  
The Cost

Abstract Background : This study aimed to examine the cost-effectiveness of standard endoscopic screening with Lugol’s iodine staining for EC (esophageal cancer) screening in China. Methods : A Markov decision analysis model with eleven states was built. Individuals aged 40 to 69 years were classified into six age groups according to five-year intervals. Three different strategies were adopted for each cohort: (1) no screening; (2) endoscopic screening with Lugol’s iodine staining with annual follow-up for low-grade intraepithelial neoplasia; and (3) endoscopic screening with Lugol’s iodine staining without follow-up. Quality-adjusted life-years (QALYs) indicated the effectiveness . The incremental cost-effectiveness ratio (ICER) was used as the evaluating indicator. Sensitivity analysis was performed to assess the robustness of the model. Results : Screening with follow-up was the undominated strategy, which saved USD 10942.57 and USD 6611.73 for individuals aged 40-44 and 45-49 years, respectively, per QALY gained. For those aged 50-69 years, the nonscreening scenarios were undominated. Screening without follow-up were extended dominated strategies. Compared to screening strategies without follow-up, all the follow-up strategies were found to be cost effective, with the ICER increasing from 299.57 USD/QALY for individuals 40-44 years to 1617.72 USD/QALY for individuals 65-69 years. Probabilistic sensitivity analysis supported the results of the base case analysis. Conclusions : EC screening with follow-up targeting individuals aged 40-49 years was the most cost-effective strategy.

scholarly journals Modeling the Cost-effectiveness of Esophageal Cancer Screening in China

2020 ◽  
Author(s):  
Yuanyuan LI ◽  
Lingbin Du ◽  
Youqing Wang ◽  
Yuxuan Gu ◽  
Xuemei Zhen ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Esophageal Cancer ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Endoscopic Screening ◽  
Lugol’S Iodine ◽  
Iodine Staining ◽  
Screening Strategies ◽  
The Cost

Abstract Background: This study aimed to examine the cost-effectiveness of one-time standard endoscopic screening with Lugol’s iodine staining for esophageal cancer (EC) in China. Methods: A Markov decision analysis model with eleven states was built. Individuals aged 40 to 69 years were classified into six age groups in five-year intervals. Three different strategies were adopted for each cohort: (1) no screening; (2) one-time endoscopic screening with Lugol’s iodine staining with an annual follow-up for low-grade intraepithelial neoplasia (LGIN); and (3) one-time endoscopic screening with Lugol’s iodine staining without follow-up. Quality-adjusted life-years (QALYs) indicated the effectiveness of the model. The incremental cost-effectiveness ratio (ICER) was used as the evaluation indicator. Sensitivity analysis was performed to assess the robustness of the model. Results: One-time screening with follow-up was the undominated strategy for individuals aged 40-44 and 45-49 years, which saved USD 10,942.57 and USD 6,611.73 per QALY gained compared to nonscreening strategy. For those aged 50-69 years, the nonscreening scenarios were undominated. One-time screening without follow-up was the extended dominated strategy. Compared to screening strategies without follow-up, all the screening strategies with follow-up were more cost-effective, with the ICER increasing from 299.57 USD/QALY for individuals aged 40-44 years to 1617.72 USD/QALY for individuals aged 65-69 years. Probabilistic sensitivity analysis (PSA) supported the results of the base case analysis. Conclusions: One-time EC screening with follow-up targeting individuals aged 40-49 years was the most cost-effective strategy.

scholarly journals Modeling the Cost-effectiveness of Esophageal Cancer Screening in China

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Yuanyuan Li ◽  
Lingbin Du ◽  
Youqing Wang ◽  
Yuxuan Gu ◽  
Xuemei Zhen ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Esophageal Cancer ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Endoscopic Screening ◽  
Lugol’S Iodine ◽  
Iodine Staining ◽  
Screening Strategies ◽  
The Cost

Abstract Background This study aimed to examine the cost-effectiveness of one-time standard endoscopic screening with Lugol’s iodine staining for esophageal cancer (EC) in China. Methods A Markov decision analysis model with eleven states was built. Individuals aged 40 to 69 years were classified into six age groups in five-year intervals. Three different strategies were adopted for each cohort: (1) no screening; (2) one-time endoscopic screening with Lugol’s iodine staining with an annual follow-up for low-grade intraepithelial neoplasia (LGIN); and (3) one-time endoscopic screening with Lugol’s iodine staining without follow-up. Quality-adjusted life-years (QALYs) indicated the effectiveness of the model. The incremental cost-effectiveness ratio (ICER) was used as the evaluation indicator. Sensitivity analysis was performed to assess the robustness of the model. Results One-time screening with follow-up was the undominated strategy for individuals aged 40–44 and 45–49 years, which saved USD 10,942.57 and USD 6611.73 per QALY gained compared to nonscreening strategy. For those aged 50–69 years, the nonscreening scenarios were undominated. One-time screening without follow-up was the extended dominated strategy. Compared to screening strategies without follow-up, all the screening strategies with follow-up were more cost-effective, with the ICER increasing from 299.57 USD/QALY for individuals aged 40–44 years to 1617.72 USD/QALY for individuals aged 65–69 years. Probabilistic sensitivity analysis (PSA) supported the results of the base case analysis. Conclusions One-time EC screening with follow-up targeting individuals aged 40–49 years was the most cost-effective strategy.

scholarly journals Analysis of Cost-Effectiveness of Trametinib Plus Dabrafenib as First-Line Therapy for Metastatic BRAF V600-Mutated Melanoma in China

2021 ◽  
Author(s):  
Guojun Sun ◽  
Jingwen Wang ◽  
Xiaoying Zhou ◽  
Zhichao Hu ◽  
Zuojun Dong
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Transition Probabilities ◽  
Unit Cost ◽  
Cost Effective ◽  
First Line Therapy ◽  
Life Years ◽  
Melanoma Patients ◽  
The Cost

Abstract Background: Treatment with trametinib plus dabrafenib for patients exhibiting metastatic BRAF V600-mutated melanoma has been approved in China.Method: We developed a Markov model to evaluate and compare the cost-effectiveness of trametinib plus dabrafenib against vemurafenib. Information on clinical situations, the rate of adverse reactions, follow-up treatments, and estimated transition probabilities were derived from the results of a clinical trial that compared treatment with trametinib plus dabrafenib against vemurafenib alone. A one-way sensitivity analysis and a probabilistic sensitivity analysis were conducted to assess the influence of uncertainty on the key model.Result: Treatment with trametinib plus dabrafenib for one patient in the treatment period was estimated to cost CNY 332 294, and yield a total gain of 16.6 quality-adjusted life years (QALYs). Compared with vemurafenib, treatment involving trametinib plus dabrafenib yielded additional 3.96 QALYs, resulting in a unit cost-effectiveness of CNY 27 460 per QALY. Sensitivity analysis shows that the results are reliable.Conclusion：From the perspective of China's health system, applying China's per-capita GDP in 2020 as the threshold of willingness-to-pay, it is cost-effective to treat metastatic melanoma patients exhibiting BRAF V600 mutation with dabrafenib plus trametinib.

PP64 Economic Evaluation For Esophageal Cancer Screening In China

2019 ◽  
Vol 35 (S1) ◽  
pp. 49-49
Author(s):  
Yuanyuan Li ◽  
Lingbin Du ◽  
Xiaoqian Hu ◽  
Shuyan Gu ◽  
Xuemei Zhen ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Esophageal Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cohort Analysis ◽  
Cost Utility ◽  
Low Grade ◽  
Age Group ◽  
Life Years

IntroductionThe aim of the study was to estimate the cost-effectiveness of esophageal cancer (EC) screening compared to non-screening in China.MethodsA Markov model was conducted that followed the history of EC. Screening strategies targeted a population aged 40-69 years, classified into six age groups. Each age group had three cohorts: screening without follow-up, screening with yearly follow-up for low-grade intraepithelial neoplasia (LGIN), and non-screening. Life years (LYs) and quality-adjusted life years (QALYs) presented the effectiveness and utility. The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were evaluating indicators. Eighteen cohorts from 100,000 hypothetical individuals were used to run the model, until aged 79 years or death. Costs were changed into USD using the purchasing power parity of 3.506 in 2017. The willingness-to-pay was set as three times the gross domestic product per capita (USD 51,340.6) in 2017. A sensitivity analysis was introduced to assess model robustness.ResultsScreening with follow-up compared to non-screening, ages 40-44, 45-49, and 50-54 years, showed cost-effectiveness, with one LY gained costing USD 6,875.0, USD 9,204.6, and USD 25,278.6, respectively. Ages 40-44 and 45-49 years explained cost-utility, with ICURs of USD 6,709.4/QALY and USD 13,991.4/QALY, respectively. Screening without follow-up compared to non-screening, ages 40-54 years, addressed cost-effectiveness, with one LY gained costing USD 6,934.8, USD 9,760.0, and USD 35,126.0 in ages 40-44, 45-49, and 50-54 years, respectively; the 40-44 years age group demonstrated cost-utility with an ICUR of USD 8,512.3/QALY. Screening with follow-up compared to screening without follow-up, all ages, explained cost-effectiveness and cost-utility. The probabilistic sensitivity analysis supported the outcome of the base cohort analysis.ConclusionsCompared to non-screening, screening with follow-up targeting ages 40-54 years was highly recommended with the ICER as the evaluated indicator, whereas it targeting ages 40-49 years was suggested with the ICUR as indicator.

COST-EFFECTIVENESS ANALYSIS OF IVABRADINE IN TREATMENT OF PATIENTS WITH HEART FAILURE IN IRAN

2018 ◽  
Vol 34 (6) ◽  
pp. 576-583 ◽  
Author(s):  
Saeed Taheri ◽  
Elham Heidari ◽  
Mohammad Ali Aivazi ◽  
Mehran Shams-Beyranvand ◽  
Mehdi Varmaghani
Keyword(s):  
Heart Failure ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Transition Probabilities ◽  
Drug Acquisition ◽  
Sensitivity Analyses ◽  
Baseline Heart Rate ◽  
Life Years ◽  
The Cost

Objectives:This study aimed to assess the cost-effectiveness of ivabradine plus standard of care (SoC) in comparison with current SoC alone from the Iranian payer perspective.Methods:A cohort-based Markov model was developed to assess the incremental cost-effectiveness ratio (ICER) over a 10-year time horizon in a cohort of 1,000 patients. The baseline transition probabilities between New York Heart Association (NYHA), mortality rate, and hospitalization rate were extracted from the literature. The effect of ivabradine on mortality, hospitalization, and NYHA improvement or worsening were retrieved from the SHIFT study. The effectiveness was measured as quality-adjusted life-years (QALYs) using the utility values derived from Iranian Heart Failure Quality of Life study. Direct medical costs were obtained from hospital records and national tariffs. Deterministic and probabilistic sensitivity analyses were conducted to show the robustness of the model.Results:Ivabradine therapy was associated with an incremental cost per QALY of USD $5,437 (incremental cost of USD $2,207 and QALYs gained 0.41) versus SoC. The probabilistic sensitivity analysis showed that ivabradine is expected to have a 60 percent chance of being cost-effective accepting a threshold of USD $6,550 per QALY. Furthermore, deterministic sensitivity analysis indicated that the model is sensitive to the ivabradine drug acquisition cost.Conclusions:The cost-effectiveness model suggested that the addition of ivabradine to SoC therapy was associated with improved clinical outcomes along with increased costs. The analysis indicates that the clinical benefit of ivabradine can be achieved at a reasonable cost in eligible heart failure patients with sinus rhythm and a baseline heart rate ≥ 75 beats per minute (bpm).

Is Banning Texturized Implants to Prevent Breast Implant-Associated Anaplastic Large Cell Lymphoma a Rational Decision? A Meta-Analysis and Cost-Effectiveness Study

2019 ◽  
Vol 40 (7) ◽  
pp. 721-731 ◽  
Author(s):  
Stefan V Danilla ◽  
Rocio P Jara ◽  
Felipe Miranda ◽  
Francisco Bencina ◽  
Marcela Aguirre ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cell Lymphoma ◽  
Meta Analysis ◽  
Breast Implant ◽  
Cost Effective ◽  
Large Cell ◽  
Life Years ◽  
Large Cell Lymphoma ◽  
The Cost

Abstract Background Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emergent disease that threatens patients with texturized breast implants. Major concerns about the safety of these implants are leading to global changes to restrict the utilization of this product. The principal alternative is to perform breast augmentation utilizing smooth implants, given the lack of association with BIA-ALCL. The implications and costs of this intervention are unknown. Objectives The authors of this study determined the cost-effectiveness of smooth implants compared with texturized implants for breast augmentation surgery. Methods A tree decision model was utilized to analyze the cost-effectiveness. Model input parameters were derived from published sources. The capsular contracture (CC) rate was calculated from a meta-analysis. Effectiveness measures were life years, avoided BIA-ALCL, avoided deaths, and avoided reoperations. A sensitivity analysis was performed to test the robustness of the model. Results For avoided BIA-ALCL, the incremental cost was $18,562,003 for smooth implants over texturized implants. The incremental cost-effectiveness ratio was negative for life years, and avoided death and avoided reoperations were negative. The sensitivity analysis revealed that to avoid 1 case of BIA-ALCL, the utilization of smooth implants would be cost-effective for a risk of developing BIA-ALCL equal to or greater than 1:196, and there is a probability of CC with smooth implants equal to or less than 0.096. Conclusions The utilization of smooth implants to prevent BIA-ALCL is not cost-effective. Banning texturized implants to prevent BIA-ALCL may involve additional consequences, which should be considered in light of higher CC rates and more reoperations associated with smooth implants than with texturized implants.

PROBABILISTIC SENSITIVITY ANALYSIS IN COST-EFFECTIVENESS

1999 ◽  
Vol 15 (3) ◽  
pp. 563-572 ◽  
Author(s):  
William Whang ◽  
Jane E. Sisk ◽  
Daniel F. Heitjan ◽  
Alan J. Moskowitz
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Probabilistic Sensitivity Analysis ◽  
Probabilistic Methods ◽  
Policy Implications ◽  
Sensitivity Analyses ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Worst Case ◽  
The Cost

Objectives: We explore the policy implications of probabilistic sensitivity analysis in cost-effectiveness analysis by applying simulation methods to a decision model.Methods: We present the multiway sensitivity analysis results of a study of the cost-effectiveness of vaccination against pneumococcal bacteremia in the elderly. We then execute a probabilistic sensitivity analysis of the cost-effectiveness ratio by specifying posterior distributions for the uncertain parameters in our decision analysis model. In order to estimate probability intervals, we rank the numerical values of the simulated incremental cost-effectiveness ratios (ICERs) to take into account preferences along the cost-effectiveness plane.Results: The 95% probability intervals for the ICER were generally much narrower than the difference between the best case and worst case results from a multiway sensitivity analysis. Although the multiway sensitivity analysis had indicated that, in the worst case, vaccination in the 85 and older age group was not acceptable from a policy standpoint, probabilistic methods indicated that the cost-effectiveness of vaccination was below $50,000 per quality-adjusted life-year in greater than 92% of the simulations and below $100,000 in greater than 95% of the simulations.Conclusions: Probabilistic methods can supplement multiway sensitivity analyses to provide a more comprehensive picture of the uncertainty associated with cost-effectiveness ratios and thereby inform policy decisions.

scholarly journals Incremental cost-effectiveness of adult spinal deformity surgery: observed quality-adjusted life years with surgery compared with predicted quality-adjusted life years without surgery

2014 ◽  
Vol 36 (5) ◽  
pp. E3 ◽  
Author(s):  
Ian McCarthy ◽  
Michael O'Brien ◽  
Christopher Ames ◽  
Chessie Robinson ◽  
Thomas Errico ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Surgical Treatment ◽  
Incremental Cost ◽  
Adult Spinal Deformity ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Nonsurgical Patients ◽  
The Cost ◽  
Quality Adjusted Life

Object Incremental cost-effectiveness analysis is critical to the efficient allocation of health care resources; however, the incremental cost-effectiveness ratio (ICER) of surgical versus nonsurgical treatment for adult spinal deformity (ASD) has eluded the literature, due in part to inherent empirical difficulties when comparing surgical and nonsurgical patients. Using observed preoperative health-related quality of life (HRQOL) for patients who later underwent surgery, this study builds a statistical model to predict hypothetical quality-adjusted life years (QALYs) without surgical treatment. The analysis compares predicted QALYs to observed postoperative QALYs and forms the resulting ICER. Methods This was a single-center (Baylor Scoliosis Center) retrospective analysis of consecutive patients undergoing primary surgery for ASD. Total costs (expressed in 2010 dollars) incurred by the hospital for each episode of surgical care were collected from administrative data and QALYs were calculated from the 6-dimensional Short-Form Health Survey, each discounted at 3.5% per year. Regression analysis was used to predict hypothetical QALYs without surgery based on preoperative longitudinal data for 124 crossover surgical patients with similar diagnoses, baseline HRQOL, age, and sex compared with the surgical cohort. Results were projected through 10-year follow-up, and the cost-effectiveness acceptability curve (CEAC) was estimated using nonparametric bootstrap methods. Results Three-year follow-up was available for 120 (66%) of 181 eligible patients, who were predominantly female (89%) with average age of 50. With discounting, total costs averaged $125,407, including readmissions, with average QALYs of 1.93 at 3-year follow-up. Average QALYs without surgery were predicted to be 1.6 after 3 years. At 3- and 5-year follow-up, the ICER was $375,000 and $198,000, respectively. Projecting through 10-year follow-up, the ICER was $80,000. The 10-year CEAC revealed a 40% probability that the ICER was $80,000 or less, a 90% probability that the ICER was $90,000 or less, and a 100% probability that the ICER was less than $100,000. Conclusions Based on the WHO's suggested upper threshold for cost-effectiveness (3 times per capita GDP, or $140,000 in 2010 dollars), the analysis reveals that surgical treatment for ASD is cost-effective after a 10-year period based on predicted deterioration in HRQOL without surgery. The ICER well exceeds the WHO threshold at earlier follow-up intervals, highlighting the importance of the durability of surgical treatment in assessing the value of surgical intervention. Due to the study's methodology, the results are dependent on the predicted deterioration in HRQOL without surgery. As such, the results may not extend to patients whose HRQOL would remain steady without surgery. Future research should therefore pursue a direct comparison of QALYs for surgical and nonsurgical patients to better understand the cost-effectiveness of surgery for the average ASD patient.

scholarly journals Cost-effectiveness of Memory Assessment Services for the diagnosis and early support of patients with dementia in England

2017 ◽  
Vol 22 (4) ◽  
pp. 226-235 ◽  
Author(s):  
Manuel Gomes ◽  
Mark Pennington ◽  
Raphael Wittenberg ◽  
Martin Knapp ◽  
Nick Black ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Base Case ◽  
Memory Assessment ◽  
Life Years ◽  
Follow Up Care ◽  
Related Quality ◽  
Mean Differences ◽  
The Cost

Background Policy makers in England advocate referral of patients with suspected dementia to Memory Assessment Services (MAS), but it is unclear how any improvement in patients’ health-related quality of life (HRQL) compares with the associated costs. Aims To evaluate the cost-effectiveness of MAS for the diagnosis and follow-up care of patients with suspected dementia. Method We analysed observational data from 1318 patients referred to 69 MAS, and their lay carers (n = 944), who completed resource use and HRQL questionnaires at baseline, three and six months. We reported mean differences in HRQL (disease-specific DEMQOL and generic EQ-5D-3L), quality-adjusted life years (QALYs) and costs between baseline and six months after referral to MAS. We also assessed the cost-effectiveness of MAS across different patient subgroups and clinic characteristics. Results Referral to MAS was associated with gains in DEMQOL (mean gain: 3.48, 95% confidence interval: 2.84 to 4.12), EQ-5D-3L (0.023, 0.008 to 0.038) and QALYs (0.006, 0.002 to 0.01). Mean total cost over six months, assuming a societal perspective, was £1899 (£1277 to £2539). This yielded a negative incremental net monetary benefit of −£1724 (−£2388 to −£1085), assuming NICE’s recommended willingness-to-pay threshold (£30,000 per QALY). These base case results were relatively robust to alternative assumptions about costs and HRQL. There was some evidence that patients aged 80 or older benefitted more from referral to MAS (p < 0.01 from adjusted mean differences in net benefits) compared to younger patients. MAS with over 75 new patients a month or cost per patient less than £2500 over six months were relatively more cost-effective (p < 0.01) than MAS with fewer new monthly patients or higher cost per patient. Conclusions Diagnosis, treatment and follow-up care provided by MAS to patients with suspected dementia appears to be effective, but not cost-effective, in the six months after diagnosis. Longer term evidence is required before drawing conclusions about the cost-effectiveness of MAS.

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