scholarly journals Cost-Effectiveness of Stroke Unit Compared With Routine Treatment For Stroke Patients In Iran

2021 ◽  
Author(s):  
Mohammad Tasavon Gholamhoseini ◽  
Reza Goudarzi ◽  
Mahdiye Zarein ◽  
Mohammadreza Amiresmaili ◽  
Masoud Mehrpour
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Health System ◽  
Stroke Unit ◽  
Cost Effective ◽  
Stroke Patients ◽  
System Perspective ◽  
Routine Treatment ◽  
Use Of Resources ◽  
Life Years

Abstract Background: Two approaches including stroke unit and routine treatment, are used to address stroke patients. Although stroke unit is a new intervention in Iran and its effectiveness has been proven, but there is little information on its costs. It is necessary to utilize the results of the studies of economic evaluation in order to choose the better treatment option between two alternatives. Due to the lack of studies in this field in Iran, the current study was conducted to assess the cost-effectiveness of stroke unit and routine treatment. Methods: A Markov model incorporating three health states of independent, dependent and death for a time horizon of 10 years with a 3-month cycle length was applied. Direct medical and non-medical costs, including pharmaceutical and hospital expenses, were calculated based on 2018 data from a health system perspective. Quality-adjusted life-years (QALYs) were taken as the outcome measure. The analysis of cost-effectiveness and sensitivity for uncertain parameters was carried out using TreeAge 2020. Results: The stroke unit had more costs and QALYs gain in comparison with routine treatment, and it was cost-effective with an ICER of 551 PPP dollars per QALY. Probabilistic sensitivity analysis showed that stroke unit cost-effectiveness probability is 78 percent, in the threshold of willingness to pay three times GDP per capita. Conclusion: Incremental cost-effectiveness ratio of stroke unit is far less than the threshold of willingness to pay, indicating the strategy is cost-effective. Therefore, implementing stroke unit in Iran health system leads to optimal use of resources.

scholarly journals Cost-Effectiveness of Stroke Unit Compared with Routine Treatment for Stroke Patients in Iran

2021 ◽  
Author(s):  
Mohammad Tasavon Gholamhoseini ◽  
Mahdiye Zarein ◽  
Reza Goodarzi ◽  
Mohammadreza Amiresmaili ◽  
Masoud Mehrpour
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Health System ◽  
Stroke Unit ◽  
Unit Cost ◽  
Stroke Patients ◽  
System Perspective ◽  
Routine Treatment ◽  
Use Of Resources ◽  
Life Years

Abstract Background: Two approaches including stroke unit and routine treatment, are used to address stroke patients. Although stroke unit is a new intervention in Iran and its effectiveness has been proven, but there is little information on its costs. It is necessary to utilize the results of the studies of economic evaluation in order to choose the better treatment option between two alternatives. Due to the lack of studies in this field in Iran, the current study was done to compare the cost-effectiveness of stroke unit and routine treatment. Methods: The present study investigated cost-effectiveness of stroke unit compared with routine treatment from health system perspective. Markov model incorporating three health states of independent, dependent and death for a time horizon of 10 years with a 3-month cycle length was applied. Direct medical and non-medical costs including pharmaceutical and hospital expenses, were calculated based on 2018 data. Quality-adjusted life-years (QALYs) were taken as the outcome measure. The analysis of cost-effectiveness and sensitivity for uncertain parameters was carried out using TreeAge 2020. Results: Stroke unit had more costs and QALYs gain in comparison with routine treatment with $1926 per QALY. Probabilistic sensitivity analysis showed that stroke unit cost-effectiveness probability is 77 percent, in the threshold of willingness to pay three times GDP per capita. Conclusion: Incremental cost-effectiveness ratio of stroke unit is far less than the threshold of willingness to pay, indicating the strategy is cost-effective. Therefore, implementing stroke unit in Iran health system leads to optimal use of resources.

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.

scholarly journals Value of willingness to pay for a QALY gained in Iran; a modified chained-approach

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Seyedeh-Fariba Jahanbin ◽  
Hasan Yusefzadeh ◽  
Bahram Nabilou ◽  
Cyrus Alinia
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Health System ◽  
Health Resources ◽  
Cost Effective ◽  
Health Utility ◽  
Income Quintile ◽  
Health State ◽  
Mean Values ◽  
Life Years

Abstract Background Due to the lack of a constant Willingness to Pay per one additional Quality Adjusted Life Years gained based on the preferences of Iran’s general public, the cost-effectiveness of health system interventions is unclear and making it challenging to apply economic evaluation to health resources priority setting. Methods We have measured this cost-effectiveness threshold with the participation of 2854 individuals from five provinces, each representing an income quintile, using a modified Time Trade-Off-based Chained-Approach. In this online-based empirical survey, to extract the health utility value, participants were randomly assigned to one of two green (21121) and yellow (22222) health scenarios designed based on the earlier validated EQ-5D-3L questionnaire. Results Across the two health state versions, mean values for one QALY gain (rounded) ranged from $6740-$7400 and $6480-$7120, respectively, for aggregate and trimmed models, which are equivalent to 1.35-1.18 times of the GDP per capita. Log-linear Multivariate OLS regression analysis confirmed that respondents were more likely to pay if their income, disutility, and education level were higher than their counterparts. Conclusions In the health system of Iran, any intervention that is with the incremental cost-effectiveness ratio, equal to and less than 7402.12 USD, will be considered cost-effective.

COST-EFFECTIVENESS OF EXERCISE PROGRAMS IN TYPE 2 DIABETES

2012 ◽  
Vol 28 (3) ◽  
pp. 228-234 ◽  
Author(s):  
Doug Coyle ◽  
Kathryn Coyle ◽  
Glen P. Kenny ◽  
Normand G. Boulé ◽  
George A. Wells ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Exercise Training ◽  
Exercise Program ◽  
Cost Effective ◽  
Exercise Programs ◽  
Combined Exercise ◽  
Use Of Resources ◽  
Life Years

Background: A randomized controlled trial has shown that supervised, facility-based exercise training is effective in improving glycemic control in type 2 diabetes. However, these programs are associated with additional costs. This analysis assessed the cost-effectiveness of such programs.Methods: Analysis used data from the Diabetes Aerobic and Resistance Exercise (DARE) clinical trial which compared three different exercise programs (resistance, aerobic or a combination of both) of 6 months duration with a control group (no exercise program). Clinical outcomes at 6 months were entered for individual patients into the UKPDS economic model for type 2 diabetes adapted for the Canadian context. From this, expected life-years, quality-adjusted life-years (QALYs) and costs were estimated for all patients within the trial.Results: The combined exercise program was the most expensive ($40,050) followed by the aerobic program ($39,250), the resistance program ($38,300) and no program ($31,075). QALYs were highest for combined (8.94), followed by aerobic (8.77), resistance (8.73) and no program (8.70). The incremental cost per QALY gained for the combined exercise program was $4,792 compared with aerobic alone, $8,570 compared with resistance alone, and $37,872 compared with no program. The combined exercise program remained cost-effective for all scenarios considered within sensitivity analysis.Conclusions: A program providing training in both resistance and aerobic exercise was the most cost-effective of the alternatives compared. Based on previous funding decisions, exercise training for individuals with diabetes can be considered an efficient use of resources.

scholarly journals Cost Utility Analysis of the Cervical Artificial Disc vs Fusion for the Treatment of 2-Level Symptomatic Degenerative Disc Disease:

Neurosurgery ◽  
2016 ◽  
Vol 79 (1) ◽  
pp. 135-145 ◽  
Author(s):  
Jared D. Ament ◽  
Zhuo Yang ◽  
Pierce Nunley ◽  
Marcus B. Stone ◽  
Darrin Lee ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Degenerative Disc Disease ◽  
Short Form ◽  
Sensitivity Analyses ◽  
Disc Disease ◽  
System Perspective ◽  
Degenerative Disc ◽  
Life Years ◽  
Significant Difference

Abstract BACKGROUND: The cervical total disc replacement (cTDR) was developed to treat cervical degenerative disc disease while preserving motion. OBJECTIVE: Cost-effectiveness of this intervention was established by looking at 2-year follow-up, and this update reevaluates our analysis over 5 years. METHODS: Data were derived from a randomized trial of 330 patients. Data from the 12-Item Short Form Health Survey were transformed into utilities by using the SF-6D algorithm. Costs were calculated by extracting diagnosis-related group codes and then applying 2014 Medicare reimbursement rates. A Markov model evaluated quality-adjusted life years (QALYs) for both treatment groups. Univariate and multivariate sensitivity analyses were conducted to test the stability of the model. The model adopted both societal and health system perspectives and applied a 3% annual discount rate. RESULTS: The cTDR costs $1687 more than anterior cervical discectomy and fusion (ACDF) over 5 years. In contrast, cTDR had $34 377 less productivity loss compared with ACDF. There was a significant difference in the return-to-work rate (81.6% compared with 65.4% for cTDR and ACDF, respectively; P = .029). From a societal perspective, the incremental cost-effective ratio (ICER) for cTDR was −$165 103 per QALY. From a health system perspective, the ICER for cTDR was $8518 per QALY. In the sensitivity analysis, the ICER for cTDR remained below the US willingness-to-pay threshold of $50 000 per QALY in all scenarios (−$225 816 per QALY to $22 071 per QALY). CONCLUSION: This study is the first to report the comparative cost-effectiveness of cTDR vs ACDF for 2-level degenerative disc disease at 5 years. The authors conclude that, because of the negative ICER, cTDR is the dominant modality.

Cost-effectiveness of three different strategies for the treatment of first recurrent Clostridium difficile infection diagnosed in a community setting

2018 ◽  
Vol 39 (8) ◽  
pp. 924-930 ◽  
Author(s):  
Simon W. Lam ◽  
Elizabeth A. Neuner ◽  
Thomas G. Fraser ◽  
David Delgado ◽  
Donald B. Chalfin
Keyword(s):  
Cost Effectiveness ◽  
Clostridium Difficile ◽  
Incremental Cost ◽  
Community Setting ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Effective Regimen ◽  
Use Of Resources ◽  
Life Years ◽  
First Recurrence

AbstractObjectiveA significant portion of patients with Clostridium difficile infections (CDI) experience recurrence, and there is little consensus on its treatment. With the availability of newer agents for CDI and the added burdens of recurrent disease, a cost-effectiveness analysis may provide insight on the most efficient use of resources.DesignA decision-tree analysis was created to compare the cost-effectiveness of 3 possible treatments for patients with first CDI recurrence: oral vancomycin, fidaxomicin, or bezlotoxumab plus vancomycin. The model was performed from a payer’s perspective with direct cost inputs and a timeline of 1 year. A systematic review of literature was performed to identify clinical, utility, and cost data. Quality-adjusted life years (QALY) and incremental cost-effectiveness ratios were calculated. The willingness-to-pay (WTP) threshold was set at $100,000 per QALY gained. The robustness of the model was tested using one-way sensitivity analyses and probabilistic sensitivity analysis.ResultsVancomycin had the lowest cost ($15,692) and was associated with a QALY gain of 0.8019 years. Bezlotoxumab plus vancomycin was a dominated strategy. Fidaxomicin led to a higher QALY compared to vancomycin, at an incremental cost of $500,975 per QALY gained. Based on our WTP threshold, vancomycin alone was the most cost-effective regimen for treating the first recurrence of CDI. Sensitivity analyses demonstrated the model’s robustness.ConclusionsVancomycin alone appears to be the most cost-effective regimen for the treatment of first recurrence of CDI. Fidaxomicin alone led to the highest QALY gained, but at a cost beyond what is considered cost-effective.

scholarly journals Priority Setting in HIV, Tuberculosis, and Malaria – New Cost-Effectiveness Results From WHO-CHOICE

2021 ◽  
Author(s):  
Ambinintsoa H. Ralaidovy ◽  
Jeremy Addison Lauer ◽  
Carel Pretorius ◽  
Olivier JT Briët ◽  
Edith Patouillard
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
21St Century ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
World Health ◽  
Global Community ◽  
Development Goal ◽  
Life Years ◽  
The Cost

Background: This paper forms part of an update of the World Health Organization Choosing Interventions that are Cost-Effective (WHO-CHOICE) programmes. It provides an assessment of global health system performance during the first decade of the 21st century (2000-2010) with respect to allocative efficiency in HIV, tuberculosis (TB) and malaria control, thereby shining a spotlight on programme development and scale up in these Millennium Development Goal (MDG) priority areas; and examining the cost-effectiveness of selected best-practice interventions and intervention packages commonly in use during that period. Methods: Generalized cost-effectiveness analysis (GCEA) was used to determine the cost-effectiveness of the selected interventions. Impact modelling was performed using the OpenMalaria platform for malaria and using the Goals and TIME (TB Impact Model and Estimates) models in Spectrum for HIV and TB. All health system costs, regardless of payer, were included and reported in international dollars. Health outcomes are estimated and reported as the gain in healthy life years (HLYs) due to the specific intervention or combination. Analysis was restricted to eastern sub-Saharan Africa and Southeast Asia. Results: At the reference year of 2010, commonly used interventions for HIV, TB and malaria were cost-effective, with cost-effectiveness ratios less than I$ 100/HLY saved for virtually all interventions included. HIV, TB and malaria prevention and treatment interventions are highly cost-effective and can be implemented through a phased approach to full coverage to achieve maximum health benefits and contribute to the progressive elimination of these diseases. Conclusion: During the first decade of the 21st century (2000-2010), the global community has done well overall for HIV, TB, and malaria programmes as regards both economic efficiency and programmatic selection criteria. The role of international assistance, financial and technical, arguably was critical to these successes. As the global community now tackles the challenge of universal health coverage, this analysis can reinforce commitment to Sustainable Development Goal targets but also the importance of continued focus on these critical programme areas.

scholarly journals Intravascular Ultrasound Versus Angiography-Guided Drug-Eluting Stent Implantation: A Health Economic Analysis

2021 ◽  
Vol 14 (5) ◽  
Author(s):  
Jennifer Zhou ◽  
Danny Liew ◽  
Stephen J. Duffy ◽  
James Shaw ◽  
Antony Walton ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Intravascular Ultrasound ◽  
Stent Implantation ◽  
Cost Effective ◽  
Drug Eluting Stent ◽  
Worst Case ◽  
System Perspective ◽  
Life Years ◽  
Drug Eluting ◽  
The Cost

Background: There is increasing evidence that use of intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) is associated with improved clinical outcomes compared with angiography guidance alone. However, concern regarding the cost-effectiveness of IVUS has limited use of this technology worldwide. In this study, we aimed to evaluate the cost-effectiveness of IVUS-guided PCI compared with angiography-guided PCI in patients undergoing drug-eluting stent implantation. Methods: A decision-analytic Markov model was constructed to compare the cost-effectiveness of IVUS to angiography guidance from the Australian healthcare system perspective. Procedure-related morbidity and mortality were estimated from the literature. Costs were obtained from Australian sources. The population of interest was all-comers undergoing PCI with drug-eluting stent. Outcomes of interest included costs, life-expectancy, and quality-adjusted life years (QALYs) for both treatment groups. Results: In the base case, IVUS guidance was cost-effective compared with angiography guidance alone. With 5% annual discounting, IVUS was associated with increased lifetime costs of Australian dollars (AUD) $823 (USD $597) per person and benefits of 0.04 life years and 0.05 QALYs compared with angiography, yielding an incremental cost-effectiveness ratio of AUD $17 539 (USD $12 730) per QALY gained. Results were robust to sensitivity analyses, with IVUS being cost-effective in 99% of 10 000 Monte Carlo iterations assuming a willingness-to-pay threshold of AUD $50 000 per QALY gained. In a worst-case scenario analysis, IVUS remained the cost-effective option, with an ICER of AUD $36 651 (USD $26 601) per QALY gained. Exploratory subgroup analysis revealed that cost-effectiveness may be greatest among patients with left main and complex coronary lesions. Conclusions: Use of IVUS guidance during PCI is likely to be cost-effective compared with angiography guidance alone among patients undergoing drug-eluting stent implantation.

scholarly journals Innovation in unruptured intracranial aneurysm coiling: At which price or efficacy are new technologies cost-effective?

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255870
Author(s):  
David Ben-Israel ◽  
Brooke L. Belanger ◽  
Amin Adibi ◽  
Muneer Eesa ◽  
Alim P. Mitha ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
New Technologies ◽  
Cost Effective ◽  
The United States ◽  
Baseline Risk ◽  
Endovascular Coiling ◽  
Base Case ◽  
Unruptured Intracranial Aneurysms ◽  
Life Years

Background Unruptured intracranial aneurysms (UIA) are increasingly being treated by endovascular coiling as opposed to open surgical clipping. Unfortunately, endovascular coiling imparts an approximate 25% recanalization rate, leading to additional procedures and increased rupture risk. While a new health technology innovation (HTI) that reduces this recanalization rate would benefit patients, few advancements have been made. We aim to determine whether cost-effectiveness has been a barrier to HTI. Methods A probabilistic Markov model was constructed from the healthcare payer perspective to compare standard endovascular treatment of UIA to standard treatment plus the addition of a HTI adjunct. Costs were measured in 2018 USD and health outcomes were measured in quality-adjusted life-years (QALY). In the base case, the HTI was a theoretical mesenchymal stem cell therapy which reduced the aneurysm recanalization rate by 50% and cost $10,000 per procedure. All other model inputs were derived from the published scientific literature. Results Based on the model results, we found that for a given HTI price (y) and relative risk reduction of aneurysm recanalization (x), the HTI was always cost-effective if the following equation was satisfied: y ≤ 20268 ∙ x, using a willingness-to-pay threshold of $50,000 per QALY. The uncertainty surrounding whether an aneurysm would recanalize was a significant driver within the model. When the uncertainty around the risk of aneurysm recanalization was eliminated, the 10-year projected additional benefit to the United States healthcare system was calculated to be $113,336,994. Conclusion Cost-effectiveness does not appear to be a barrier to innovation in reducing the recanalization rate of UIA treated by endovascular coil embolization. Our model can now be utilized by academia and industry to accentuate economically feasible HTI and by healthcare payers to calculate their maximum willingness-to-pay for a new technology. Our results also indicate that predicting a patient’s baseline risk of aneurysm recanalization is a critical area of future research.

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