scholarly journals Comparing Health Gains, Costs and Cost-Effectiveness of 100s of Interventions in Australia and New Zealand: An Online Interactive League Table

2022 ◽  
Author(s):  
Natalie Carvalho ◽  
Tanara Sousa ◽  
Anja Mizdrak ◽  
Amanda Jones ◽  
Nick Wilson ◽  
...  
Keyword(s):  
New Zealand ◽  
Cost Effectiveness ◽  
Communicable Disease ◽  
Health Gain ◽  
Overweight And Obesity ◽  
League Table ◽  
Disease Epidemiology ◽  
Health Gains ◽  
Diabetes Diet ◽  
Life Years

Abstract Background This study compares the health gains, costs, and cost-effectiveness of hundreds of Australian and New Zealand (NZ) health interventions conducted with comparable methods in an online interactive league table designed to inform policy. Methods A literature review was conducted to identify peer-reviewed evaluations (2010 to 2018) arising from the Australia Cost-Effectiveness (ACE) research and NZ Burden of Disease Epidemiology, Equity and Cost-Effectiveness (BODE3) Programmes, or using similar methodology, with: health gains quantified as health-adjusted life years (HALYs); net health system costs and/or incremental cost-effectiveness ratio; time horizon of at least 10 years; and 3–5% discount rates. Results We identified 384 evaluations that met the inclusion criteria, covering 14 intervention domains: alcohol; cancer; cannabis; communicable disease; cardiovascular disease; diabetes; diet; injury; mental illness; other non-communicable disease; overweight and obesity; physical inactivity; salt; tobacco. There were large variations in health gain across evaluations: 33.9% gained less than 0.1 HALYs per 1000 people in the total population over the remainder of their lifespan, through to 13.0% gaining >10 HALYs per 1000 people. Over a third (38.8%) of evaluations were cost-saving. Conclusions League tables of comparably conducted evaluations illustrate the large health gain (and cost) variations per capita between interventions, in addition to cost-effectiveness. Further work can test the utility of this league table with policy makers and researchers.

scholarly journals Exercise programmes to prevent falls among older adults: modelling health gain, cost-utility and equity impacts

2018 ◽  
Vol 25 (4) ◽  
pp. 258-263 ◽  
Author(s):  
Eamonn Deverall ◽  
Giorgi Kvizhinadze ◽  
Frank Pega ◽  
Tony Blakely ◽  
Nick Wilson
Keyword(s):  
Cost Effectiveness ◽  
Cochrane Review ◽  
Health Gain ◽  
Cost Effective ◽  
Exercise Programme ◽  
Falls Prevention ◽  
System Perspective ◽  
Home Based ◽  
Health Gains ◽  
Life Years

BackgroundSome falls prevention interventions for the older population appear cost-effective, but there is uncertainty about others. Therefore, we aimed to model three types of exercise programme each running for 25 years among 65+ year olds: (i) a peer-led group-based one; (ii) a home-based one and (iii) a commercial one.MethodsAn established Markov model for studying falls prevention in New Zealand (NZ) was adapted to estimate incremental cost-effectiveness ratios (ICERs) in cost per quality-adjusted life-years (QALYs) gained. Detailed NZ experimental, epidemiological and cost data were used for the base year 2011. A health system perspective was taken and a discount rate of 3% applied. Intervention effectiveness estimates came from a Cochrane Review.ResultsThe intervention generating the greatest health gain and costing the least was the home-based exercise programme intervention. Lifetime health gains were estimated at 47 100 QALYs (95%uncertainty interval (UI) 22 300 to 74 400). Cost-effectiveness was high (ICER: US$4640 per QALY gained; (95% UI US$996 to 10 500)), and probably more so than a home safety assessment and modification intervention using the same basic model (ICER: US$6060). The peer-led group-based exercise programme was estimated to generate 42 000 QALYs with an ICER of US$9490. The commercially provided group programme was more expensive and less cost-effective (ICER: US$34 500). Further analyses by sex, age group and ethnicity (Indigenous Māori and non-Māori) for the peer-led group-intervention showed similar health gains and cost-effectiveness.ConclusionsImplementing any of these three types of exercise programme for falls prevention in older people could produce considerable health gain, but with the home-based version being likely to be the most cost-effective.

Cataract surgery for falls prevention and improving vision: modelling the health gain, health system costs and cost-effectiveness in a high-income country

2019 ◽  
Vol 26 (4) ◽  
pp. 302-309 ◽  
Author(s):  
Matt Boyd ◽  
Giorgi Kvizhinadze ◽  
Adeline Kho ◽  
Graham Wilson ◽  
Nick Wilson
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Cataract Surgery ◽  
Health Gain ◽  
Cost Effective ◽  
Falls Prevention ◽  
Age Group ◽  
System Perspective ◽  
Life Years ◽  
Incident Cases

AimTo estimate the health gain, health system costs and cost-effectiveness of cataract surgery when expedited as a falls prevention strategy (reducing the waiting time for surgery by 12 months) and as a routine procedure.MethodsAn established injurious falls model designed for the New Zealand (NZ) population (aged 65+ years) was adapted. Key parameters relating to cataracts were sourced from the literature and the NZ Ministry of Health. A health system perspective with discounting at 3% was used.ResultsExpedited cataract surgery for 1 year of incident cases was found to generate a total 240 quality-adjusted life years (QALYs) (95% uncertainty interval (UI) 161 to 360) at net health system costs of NZ$2.43 million (95% UI 2.02 to 2.82 million) over the remaining lifetimes of the surgery group. This intervention was cost-effective by widely accepted standards with an incremental cost-effectiveness ratio (ICER) of NZ$10 600 (US$7540) (95% UI NZ$6030 to NZ$15 700) per QALY gained. The level of cost-effectiveness did not vary greatly by sex, ethnicity and previous fall history, but was higher for the 65–69 age group compared with the oldest age group of 85–89 years (NZ$7000 vs NZ$14 200 per QALY gained). Comparing cataract surgery with no surgery, the ICER was even more favourable at NZ$4380 (95% UI 2410 to 7210) per QALY. Considering only the benefits for vision improvement and excluding the benefits of falls prevention, it was still favourable at NZ$9870 per QALY.ConclusionsExpedited cataract surgery appears very cost-effective. Routine cataract surgery is itself very cost-effective, and its value appears largely driven by the falls prevention benefits.

Cost-effectiveness of a two-gene urine biomarker assay in MRI strategies for the initial detection of prostate cancer.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 91-91 ◽  
Author(s):  
Tim Govers ◽  
Matthew J. Resnick ◽  
Geert Trooskens ◽  
Wim Van Criekinge ◽  
Jack A. Schalken
Keyword(s):  
Prostate Cancer ◽  
Cost Effectiveness ◽  
Health Gain ◽  
Cost Savings ◽  
Decision Analytic Model ◽  
Model Parameters ◽  
Life Years ◽  
Clinically Significant ◽  
Using Data ◽  
Systematic Biopsy

91 Background: MRI is increasingly used in men with a suspicion for prostate cancer (PCa) to target abnormal areas next to systematic biopsy. Although, MRI increases the detection of clinically significant PCa compared to systematic biopsy alone, overdiagnosis and overtreatment of insignificant disease still exists. The 2-gene mRNA PCR urine test combined with traditional risk factors SelectMDx (MDxhealth Irvine Ca) predicts clinically significant PCa, and can be used to reduce overdiagnosis and overtreatment. We assessed the cost-effectiveness of SelectMDx in a population of U.S. men who in the current situation undergo initial MRI and biopsies. Methods: We developed a decision-analytic model to simulate the downstream outcomes in the current MRI strategy, i.e. systematic biopsy plus targeted biopsy in case of a positive MRI. SelectMDx was assessed in two different diagnostic pathways: 1) before MRI to select patients for MRI and biopsy, 2) after a negative MRI to select patients for systematic biopsy. Outcomes were quality-adjusted life years (QALYs) and costs. Model parameters were informed by literature. Two scenarios regarding the mortality of missed PCa were used, using SPCG trial data and using data from the PIVOT trial. Results: Using SelectMDx before MRI (1) resulted in a health gain of 0.003 and 0.030 QALY per patient compared to the current MRI strategy, using the SPCG and PIVOT data, respectively. Cost savings were $1590 per patient and about $496 million for the yearly population of men at risk in the U.S. (n = 311,879). SelectMDx after negative MRI (2) resulted in a health gain of 0.008 and 0,011 QALY per patient using the SPCG and PIVOT data.. Cost savings were $436 per patient and about $136 million for the yearly population. Conclusions: The use of SelectMDx to guide prostate biopsy decision-making can improve health outcomes and lower costs. Cost savings were highest when SelectMDx was used before MRI to select patients for MRI and biopsy. With respect to health gain, the use of SelectMDx after negative MRI was most beneficial when assuming higher mortality for missed PCa (SPCG). When the mortality was assumed to be lower (PIVOT) SelectMDx should be used before MRI to result in the highest health gain.

Impact of five tobacco endgame strategies on future smoking prevalence, population health and health system costs: two modelling studies to inform the tobacco endgame

2017 ◽  
Vol 27 (3) ◽  
pp. 278-286 ◽  
Author(s):  
Frederieke S van der Deen ◽  
Nick Wilson ◽  
Christine L Cleghorn ◽  
Giorgi Kvizhinadze ◽  
Linda J Cobiac ◽  
...  
Keyword(s):  
Smoking Prevalence ◽  
Health Gain ◽  
Cost Savings ◽  
Uncertainty Interval ◽  
Health Gains ◽  
Life Years ◽  
Tobacco Tax ◽  
Population Forecasting ◽  
Modelling Studies ◽  
Tobacco Endgame

ObjectiveThere is growing international interest in advancing ‘the tobacco endgame’. We use New Zealand (Smokefree goal for 2025) as a case study to model the impacts on smoking prevalence (SP), health gains (quality-adjusted life-years (QALYs)) and cost savings of (1) 10% annual tobacco tax increases, (2) a tobacco-free generation (TFG), (3) a substantial outlet reduction strategy, (4) a sinking lid on tobacco supply and (5) a combination of 1, 2 and 3.MethodsTwo models were used: (1) a dynamic population forecasting model for SP and (2) a closed cohort (population alive in 2011) multistate life table model (including 16 tobacco-related diseases) for health gains and costs.ResultsAll selected tobacco endgame strategies were associated with reductions in SP by 2025, down from 34.7%/14.1% for Māori (indigenous population)/non-Māori in 2011 to 16.0%/6.8% for tax increases; 11.2%/5.6% for the TFG; 17.8%/7.3% for the outlet reduction; 0% for the sinking lid; and 9.3%/4.8% for the combined strategy. Major health gains accrued over the remainder of the 2011 population’s lives ranging from 28 900 QALYs (95% Uncertainty Interval (UI)): 16 500 to 48 200; outlet reduction) to 282 000 QALYs (95%UI: 189 000 to 405 000; sinking lid) compared with business-as-usual (3% discounting). The timing of health gain and cost savings greatly differed for the various strategies (with accumulated health gain peaking in 2040 for the sinking lid and 2070 for the TFG).ConclusionsImplementing endgame strategies is needed to achieve tobacco endgame targets and reduce inequalities in smoking. Given such strategies are new, modelling studies provide provisional information on what approaches may be best.

scholarly journals 1243Quantitative risk-benefit assessment of fish and seafood consumption scenarios to support recommendations

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Catarina Carvalho ◽  
Daniela Correia ◽  
Milton Severo ◽  
Cláudia Afonso ◽  
Narcisa M. Bandarra ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Health Gain ◽  
Benefit Assessment ◽  
Mercury Species ◽  
Seafood Consumption ◽  
Tolerable Weekly Intake ◽  
Health Gains ◽  
Life Years ◽  
Risk Benefit Assessment ◽  
Alternative Scenarios

Abstract Background Fish/seafood consumption has health benefits, namely due to its omega-3 fatty acids levels and risks due to methylmercury contamination. This study aims to quantify the health impact of hypothetical scenarios of fish/seafood consumption through a risk-benefit assessment and provide support for recommendations, using Portuguese food consumption data. Methods We used data from the National Food, Nutrition and Physical Activity Survey 2015-2016 (n = 5811) to estimate the mean exposure to methylmercury and EPA+DHA in the current and alternative scenarios. Alternative scenarios were modelled using probabilistic approaches to reflect substitutions from the current consumption in the type of fish/seafood (predatory vs low-mercury species) or its frequency (1-7x/week). The overall scenarios’ impact was quantified using Disability-Adjusted Life Years (DALYs). Results About 14% of the Portuguese population exceeds the methylmercury tolerable weekly intake, and this prevalence is higher among small children (36.6%). Nevertheless, if the fish/seafood consumption increased to once a day, ≈11450 DALYs could be prevented each year. However, such a scenario would result in higher risk for pregnant women (1398 extra DALYs). Moreover, excluding predatory species consumption resulted in small but significant health gains (-1078 DALYs). Conclusions For the general population, the maximum health gains are obtained by consuming fish/seafood up to 7x/week, but among children and pregnant women, the frequency should be limited to 3-5x/week. All population should preferably choose non-predatory species. Key messages Daily fish consumption results in the highest overall populational health gain, but children and pregnant women need to limit it to 3-5x/week, due to methylmercury exposure.

Health Impact and Cost-Effectiveness of Achieving the National Salt and Sugar Reduction Initiative Voluntary Sugar Reduction Targets in the United States: A Micro-Simulation Study

Circulation ◽  
2021 ◽  
Author(s):  
Siyi Shangguan ◽  
Dariush Mozaffarian ◽  
Stephen Sy ◽  
Yujin Lee ◽  
Junxiu Liu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Savings ◽  
Cost Effective ◽  
The United States ◽  
Sensitivity Analyses ◽  
Potential Health ◽  
Added Sugar ◽  
Health Gains ◽  
Life Years ◽  
Sugar Reduction

Background: High intake of added sugar is linked to weight gain and cardiometabolic risk. In 2018, the US National Salt and Sugar Reduction Initiative (NSSRI) proposed government supported voluntary national sugar reduction targets. This intervention's potential health and equity impacts, and cost-effectiveness are unclear. Methods: A validated microsimulation model, CVD-PREDICT, coded in C++, was used to estimate incremental changes in type 2 diabetes, cardiovascular disease (CVD), quality-adjusted life-years (QALYs), costs and cost-effectiveness of the NSSRI policy. The model was run at the individual-level, incorporating the annual probability of each person's transition between health status based on their risk factors. The model incorporated national demographic and dietary data from the National Health and Nutrition Examination Survey across 3 cycles (2011-2016), added sugar-related diseases from meta-analyses, and policy costs and health-related costs from established sources. A simulated nationally representative US population was created and followed until age 100 years or death, with 2019 as the year of intervention start. Findings were evaluated over 10 years and a lifetime from healthcare and societal perspectives. Uncertainty was evaluated in a one-way analysis by assuming 50% industry compliance, and probabilistic sensitivity analyses via a second-order Monte Carlo approach. Model outputs included averted diabetes cases, CVD events and CVD deaths, QALYs gained, and formal healthcare cost savings, stratified by age, race, income and education. Results: Achieving the NSSRI sugar reduction targets could prevent 2.48 million CVD events, 0.49 million CVD deaths, and 0.75 million diabetes cases; gain 6.67 million QALYs; and save $160.88 billion net costs from a societal perspective over a lifetime. The policy became cost-effective (<150K/QALYs) at 6 years, highly cost-effective (< 50K/QALYs) at 7 years, and cost-saving at 9 years. Results were robust from a healthcare perspective, with lower (50%) industry compliance, and in probabilistic sensitivity analyses. The policy could also reduce disparities, with greatest estimated health gains per million adults among Black and Hispanic, lower income, and less educated Americans. Conclusions: Implementing and achieving the NSSRI sugar reformation targets could generate substantial health gains, equity gains and cost-savings.

scholarly journals The cost-effectiveness of conducting three versus two reverse transcription-polymerase chain reaction tests for diagnosing and discharging people with COVID-19: evidence from the epidemic in Wuhan, China

2020 ◽  
Vol 5 (7) ◽  
pp. e002690 ◽  
Author(s):  
Yawen Jiang ◽  
Dan Cai ◽  
Daqin Chen ◽  
Shan Jiang
Keyword(s):  
Cost Effectiveness ◽  
Reverse Transcription ◽  
Health Gain ◽  
Medical Costs ◽  
Rt Pcr ◽  
Reverse Transcription Pcr ◽  
Life Years ◽  
Moderate Sensitivity ◽  
The Cost ◽  
Quality Adjusted Life

ObjectivesThe objectives were to evaluate the effectiveness of conducting three versus two reverse transcription-PCR (RT-PCR) tests for diagnosing and discharging people with COVID-19 with regard to public health and clinical impacts by incorporating asymptomatic and presymptomatic infection and to compare the medical costs associated with the two strategies.MethodsA model that consisted of six compartments was built. The compartments were the susceptible (S), the asymptomatic infective (A), the presymptomatic infective (L), the symptomatic infective (I), the recovered (R), and the deceased (D). The A, L and I classes were infective states. To construct the model, several parameters were set as fixed using existing evidence and the rest of the parameters were estimated by fitting the model to a smoothed curve of the cumulative confirmed cases in Wuhan from 24 January 2020 to 6 March 2020. Input data about the cost-effectiveness analysis were retrieved from the literature.ResultsConducting RT-PCR tests three times for diagnosing and discharging people with COVID-19 reduced the estimated total number of symptomatic cases to 45‌ 013 from 51 144 in the two-test strategy over 43 days. The former strategy also led to 850.1 quality-adjusted life years (QALYs) of health gain and a net healthcare expenditure saving of CN¥49.1 million. About 100.7 QALYs of the health gain were attributable to quality-adjusted life day difference between the strategies during the analytic period and 749.4 QALYs were attributable to years of life saved.ConclusionsMore accurate strategies and methods of testing for the control of COVID-19 may reduce both the number of infections and the total medical costs. Increasing the number of tests should be considered in regions with relatively severe epidemics when existing tests have moderate sensitivity.

scholarly journals International experience in determining the cost-effectiveness thresholds

2019 ◽  
Vol 11 (4) ◽  
pp. 73-80
Author(s):  
T. P. Bezdenezhnykh ◽  
N. Z. Musina ◽  
V. K. Fedyaeva ◽  
T. S. Tepcova ◽  
V. A. Lemeshko ◽  
...  
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Cost Effectiveness ◽  
South Korea ◽  
Health Benefit ◽  
Threshold Value ◽  
Quality Adjusted Life Year ◽  
Life Years ◽  
The Usa ◽  
Methodological Guidelines

The article reviews international methodological guidelines, regulatory documents and existing approaches to the determination of the costeffectiveness threshold (CeT), also known as the willingness-to-pay threshold (WTP), the threshold value of the incremental cost-effectiveness ratio (ICeR), in europe (england and Wales, Scotland, Ireland, France, Belgium, Denmark, the netherlands, Germany, Sweden, Finland, norway, Poland), America (the USA, Canada, Brazil), Asia (Japan, South korea, Taiwan, Thailand), in Australia and new Zealand. The CeT is commonly used to rationalize decision-making in health cost reimbursement. The present review demonstrates that just a few countries (englandandWales,Thailand,Poland,USA) have introduced the explicit value of CeT into their decision making. Some countries (Australia,Canada,new Zealand, thenetherlands,Sweden, andBrazil) use CeT in an implicit manner implying that no specific CeT value is defined by law. In other countries (Finland,Sweden,norway,France,Germany,Denmark,Japan,South korea,Taiwan), the role of the threshold in health reimbursement remains uncertain despite the presence of HTA systems. The CeT is expressed as additional cost per unit of incremental health benefit, which is represented by quality-adjusted life year (QALY) in most counties. However,PolandandBrazilallow using life years gained (LYG) as a measure of additional benefit neglecting the quality of life. In thenetherlandsandengland, different CeT values are applied to the health technology under assessment depending on the severity or rareness of the disease and some other factors.

Cost-Effectiveness of Interventions To Control Campylobacter in the New Zealand Poultry Meat Food Supply

2013 ◽  
Vol 76 (7) ◽  
pp. 1161-1167 ◽  
Author(s):  
ROBIN J. LAKE ◽  
BEVERLEY J. HORN ◽  
ALEX H. DUNN ◽  
RUTH PARRIS ◽  
F. TERRI GREEN ◽  
...  
Keyword(s):  
New Zealand ◽  
Cost Effectiveness ◽  
Risk Model ◽  
Cost Effective ◽  
Poultry Meat ◽  
Processing Stage ◽  
Primary Processing ◽  
Effective Interventions ◽  
Disability Adjusted Life ◽  
Life Years

An analysis of the cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry supply examined a series of interventions. Effectiveness was evaluated in terms of reduced health burden measured by disability-adjusted life years (DALYs). Costs of implementation were estimated from the value of cost elements, determined by discussions with industry. Benefits were estimated by changing the inputs to a poultry food chain quantitative risk model. Proportional reductions in the number of predicted Campylobacter infections were converted into reductions in the burden of disease measured in DALYs. Cost-effectiveness ratios were calculated for each intervention, as cost per DALY reduction and the ratios compared. The results suggest that the most cost-effective interventions (lowest ratios) are at the primary processing stage. Potential phage-based controls in broiler houses were also highly cost-effective. This study is limited by the ability to quantify costs of implementation and assumptions required to estimate health benefits, but it supports the implementation of interventions at the primary processing stage as providing the greatest quantum of benefit and lowest cost-effectiveness ratios.

scholarly journals Cost effectiveness of cardiovascular disease prevention strategies: a perspective on EU food based dietary guidelines

2001 ◽  
Vol 4 (2b) ◽  
pp. 711-715 ◽  
Author(s):  
Eric Brunner ◽  
David Cohen ◽  
Lynn Toon
Keyword(s):  
Cardiovascular Disease ◽  
Cost Effectiveness ◽  
Healthy Eating ◽  
Health Gain ◽  
Cost Effective ◽  
Dietary Guidelines ◽  
Member States ◽  
Eu Member States ◽  
Health Gains ◽  
Prevention Of Cardiovascular Disease

AbstractFor policymakers considering strategy options for the prevention of cardiovascular disease (CVD) the distinction between effectiveness and cost effectiveness is critical. When cost limitations apply, an evaluation of cost effectiveness is essential if a rational decision is to be made. Policy changes and resource reallocation have opportunity costs, and therefore it is necessary to compare the cost of health gains achievable by means of different policies. Here the broad question is: How cost effective are diet change strategies compared to other measures aimed at reducing cardiovascular disease in EU member states?An overview of published studies of cost effectiveness in the primary and secondary prevention of cardiovascular disease was conducted. Few comprehensive studies were available.Estimated costs per life year gained were as follows: population-based healthy eating £14–560; smoking cessation £300–790; nurse screening and life style advice £900 (minimum); simvastatin (HMGCoA reductase inhibitor) £6200–11 300. Cost effectiveness is dependent on the underlying level of CVD risk in the target population, and the duration of the achieved alterations in behaviours and risk factors.The limited evidence from these studies tends to support the view that health protection strategies which promote healthy eating are likely to be more cost-effective than strategies involving modern cholesterol-lowering drugs, screening and advice in primary care, and are comparable to or less expensive per year of life saved than anti-smoking strategies. Given the considerable diversity in food habits, health care and public health systems among current and prospective EU member states, careful appraisal of the policy options within each member state is desirable to ensure that health gain is maximised. EU wide food based dietary guidelines are potentially the basis of large health gains in Europe, and cost-effectiveness studies tend to support their adoption.

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