scholarly journals Cost-effectiveness analysis for HbA1c test intervals to screen patients with type 2 diabetes based on risk stratification.

2021 ◽  
Author(s):  
Sachiko Ohde ◽  
Kensuke Moriwaki ◽  
Osamu Takahashi
Keyword(s):  
Cost Effectiveness ◽  
Risk Stratification ◽  
Age Groups ◽  
Cost Effective ◽  
Healthy Population ◽  
Test Interval ◽  
Screening Interval ◽  
Hba1c Test ◽  
Younger Age ◽  
Low Bmi

Abstract Background: To determine the best HbA1c test interval strategy for detecting new type 2 diabetes mellitus (T2DM) cases in a healthy population, HbA1c test characteristics, risk stratification towards T2DM and cost effectiveness were considered.Methods: State transition models were built to study the optimal screening interval for new cases of T2DM among each age- and BMI-stratified health population. Age was stratified into 30-44-, 45-59-, and 60-74-year-old age groups, and BMI was also stratified into underweight (<18.5 kg/m2), normal (18.5-25 kg/m2), overweight (25-30 kg/m2) and obesity (≥30 kg/m2). In each model, different HbA1c test intervals were compared to evaluate costs per quality-adjusted life year (QALY) and the incremental cost-effectiveness ratio (ICER). We compared intervals annually (current Japanese strategy), every three years (US and UK recommendations) and tailored to each risk stratification group, based on our previous work. All model parameters, including screening and treatment costs, complications and mortality rates and utilities, were applied from published studies. The willingness-to-pay threshold in the cost-effectiveness analysis was set to US $50,000/QALY.Results: The HbA1c test interval for detecting T2DM in a healthy population varies by age and BMI. Three-year intervals were the most cost effective in obesity at all ages—30-44: $15,034/QALY, 45-59: $11,849/QALY, 60-74: $8,685/QALY—compared with the other two interval strategies. The three-year interval was also the most cost effective in the 60-74-year-old age groups—underweight: $11,377/QALY, normal: $18,123/QALY, overweight: $12,537/QALY—and in the overweight 45-59-year-old group; $18,918/QALY. In other groups, the screening interval for detecting T2DM was found to be longer than three years, as previously reported. Annual screenings were dominated in many groups with low BMI and in younger age groups. Based on the probability distribution of the ICER, QALY does not show much difference among any groups.Conclusions: Annual screening to detect T2DM was not cost effective and should not apply to any population. The three-year screening interval was optimal among all elderly populations, the obesity at all ages and the overweight 45-59-year-old group. For the low BMI and younger age groups, the optimal HbA1c test interval can be longer than three years.

scholarly journals Cost-effectiveness analysis for HbA1c test intervals to screen patients with type 2 diabetes based on risk stratification.

2020 ◽  
Author(s):  
Sachiko Ohde ◽  
Kensuke Moriwaki ◽  
Osamu Takahashi
Keyword(s):  
Cost Effectiveness ◽  
Risk Stratification ◽  
Age Groups ◽  
Cost Effective ◽  
Healthy Population ◽  
Test Interval ◽  
Screening Interval ◽  
Hba1c Test ◽  
Younger Age ◽  
Low Bmi

Abstract Background: To determine the best HbA1c test interval strategy for detecting new type 2 diabetes mellitus (T2DM) cases in a healthy population, HbA1c test characteristics, risk stratification towards T2DM and cost effectiveness were considered.Methods: State transition models were built to study the optimal screening interval for new cases of T2DM among each age- and BMI-stratified health population. Age was stratified into 30-44-, 45-59-, and 60-74-year-old age groups, and BMI was also stratified into underweight (<18.5 kg/m2), normal (18.5-25 kg/m2), overweight (25-30 kg/m2) and obese (≥30 kg/m2). In each model, different HbA1c test intervals were compared to evaluate costs per quality-adjusted life year (QALY) and the incremental cost-effectiveness ratio (ICER). We compared intervals annually (current Japanese strategy), every three years (US and UK recommendations) and tailored to each risk stratification group, based on our previous work. All model parameters, including screening and treatment costs, complications and mortality rates and utilities, were applied from published studies. The willingness-to-pay threshold in the cost-effectiveness analysis was set to US $50,000/QALY.Results: The HbA1c test interval for detecting T2DM in a healthy population varies by age and BMI. Three-year intervals were the most cost effective in obese groups at all ages—30-44: $15,034/QALY, 45-59: $11,849/QALY, 60-74: $8,685/QALY—compared with the other two interval strategies. The three-year interval was also the most cost effective in the 60-74-year-old age groups—underweight: $11,377/QALY, normal: $18,123/QALY, overweight: $12,537/QALY—and in the overweight 45-59-year-old group; $18,918/QALY. In other groups, the screening interval for detecting T2DM was found to be longer than three years, as previously reported. Annual screenings were dominated in many groups with low BMI and in younger age groups. Based on the probability distribution of the ICER, QALY does not show much difference among any groups.Conclusions: Annual screening to detect T2DM was not cost effective and should not apply to any population. The three-year screening interval was optimal among all elderly populations, the obese groups of all ages and the overweight 45-59-year-old group. For the low BMI and younger age groups, the optimal HbA1c test interval can be longer than three years.

scholarly journals Cost-effectiveness analysis for HbA1c test intervals to screen patients with type 2 diabetes based on risk stratification

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sachiko Ohde ◽  
Kensuke Moriwaki ◽  
Osamu Takahashi
Keyword(s):  
Cost Effectiveness ◽  
Risk Stratification ◽  
Age Groups ◽  
Cost Effective ◽  
Test Interval ◽  
Screening Interval ◽  
Hba1c Test ◽  
Younger Age ◽  
Low Bmi

Abstract Background The best HbA1c test interval strategy for detecting new type 2 diabetes mellitus (T2DM) cases in healthy individuals should be determined with consideration of HbA1c test characteristics, risk stratification towards T2DM and cost effectiveness. Methods State transition models were constructed to investigate the optimal screening interval for new cases of T2DM among each age- and BMI-stratified health individuals. Age was stratified into 30–44-, 45–59-, and 60–74-year-old age groups, and BMI was also stratified into underweight, normal, overweight and obesity. In each model, different HbA1c test intervals were evaluated with respect to the incremental cost-effectiveness ratio (ICER) and costs per quality-adjusted life year (QALY). Annual intervals (Japanese current strategy), every 3 years (recommendations in US and UK) and intervals which are tailored to each risk stratification group were compared. All model parameters, including costs for screening and treatment, rates for complications and mortality and utilities, were taken from published studies. The willingness-to-pay threshold in the cost-effectiveness analysis was set to US $50,000/QALY. Results The HbA1c test interval for detecting T2DM in healthy individuals varies by age and BMI. Three-year intervals were the most cost effective in obesity at all ages—30-44: $15,034/QALY, 45–59: $11,849/QALY, 60–74: $8685/QALY—compared with the other two interval strategies. The three-year interval was also the most cost effective in the 60–74-year-old age groups—underweight: $11,377/QALY, normal: $18,123/QALY, overweight: $12,537/QALY—and in the overweight 45–59-year-old group; $18,918/QALY. In other groups, the screening interval for detecting T2DM was found to be longer than 3 years, as previously reported. Annual screenings were dominated in many groups with low BMI and in younger age groups. Based on the probability distribution of the ICER, results were consistent among any groups. Conclusions The three-year screening interval was optimal among elderly at all ages, the obesity at all ages and the overweight in 45–59-year-old group. For those sin the low-BMI and younger age groups, the optimal HbA1c test interval could be longer than 3 years. Annual screening to detect T2DM was not cost effective and should not be applied in any population.

scholarly journals Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening

2015 ◽  
Vol 19 (74) ◽  
pp. 1-116 ◽  
Author(s):  
Peter H Scanlon ◽  
Stephen J Aldington ◽  
Jose Leal ◽  
Ramon Luengo-Fernandez ◽  
Jason Oke ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Risk Stratification ◽  
Cost Effective ◽  
Risk Groups ◽  
East Anglia ◽  
Effective Screening ◽  
Screening Interval ◽  
Screening Intervals ◽  
Qaly Threshold

BackgroundThe English NHS Diabetic Eye Screening Programme was established in 2003. Eligible people are invited annually for digital retinal photography screening. Those found to have potentially sight-threatening diabetic retinopathy (STDR) are referred to surveillance clinics or to Hospital Eye Services.ObjectivesTo determine whether personalised screening intervals are cost-effective.DesignRisk factors were identified in Gloucestershire, UK using survival modelling. A probabilistic decision hidden (unobserved) Markov model with a misgrading matrix was developed. This informed estimation of lifetime costs and quality-adjusted life-years (QALYs) in patients without STDR. Two personalised risk stratification models were employed: two screening episodes (SEs) (low, medium or high risk) or one SE with clinical information (low, medium–low, medium–high or high risk). The risk factor models were validated in other populations.SettingGloucestershire, Nottinghamshire, South London and East Anglia (all UK).ParticipantsPeople with diabetes in Gloucestershire with risk stratification model validation using data from Nottinghamshire, South London and East Anglia.Main outcome measuresPersonalised risk-based algorithm for screening interval; cost-effectiveness of different screening intervals.ResultsData were obtained in Gloucestershire from 12,790 people with diabetes with known risk factors to derive the risk estimation models, from 15,877 people to inform the uptake of screening and from 17,043 people to inform the health-care resource-usage costs. Two stratification models were developed: one using only results from previous screening events and one using previous screening and some commonly available GP data. Both models were capable of differentiating groups at low and high risk of development of STDR. The rate of progression to STDR was 5 per 1000 person-years (PYs) in the lowest decile of risk and 75 per 1000 PYs in the highest decile. In the absence of personalised risk stratification, the most cost-effective screening interval was to screen all patients every 3 years, with a 46% probability of this being cost-effective at a £30,000 per QALY threshold. Using either risk stratification models, screening patients at low risk every 5 years was the most cost-effective option, with a probability of 99-100% at a £30,000 per QALY threshold. For the medium-risk groups screening every 3 years had a probability of 43 –48% while screening high-risk groups every 2 years was cost-effective with a probability of 55–59%.ConclusionsThe study found that annual screening of all patients for STDR was not cost-effective. Screening this entire cohort every 3 years was most likely to be cost-effective. When personalised intervals are applied, screening those in our low-risk groups every 5 years was found to be cost-effective. Screening high-risk groups every 2 years further improved the cost-effectiveness of the programme. There was considerable uncertainty in the estimated incremental costs and in the incremental QALYs, particularly with regard to implications of an increasing proportion of maculopathy cases receiving intravitreal injection rather than laser treatment. Future work should focus on improving the understanding of risk, validating in further populations and investigating quality issues in imaging and assessment including the potential for automated image grading.Study registrationIntegrated Research Application System project number 118959.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

scholarly journals How effective and cost-effective is water fluoridation for adults? Protocol for a 10-year retrospective cohort study

BDJ Open ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Deborah Moore ◽  
Thomas Allen ◽  
Stephen Birch ◽  
Martin Tickle ◽  
Tanya Walsh ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cost Effectiveness ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Dental Treatment ◽  
Age Groups ◽  
Cost Effective ◽  
Tooth Decay ◽  
Service Utilisation ◽  
Water Fluoridation

Abstract Background Tooth decay can cause pain, sleepless nights and loss of productive workdays. Fluoridation of drinking water was identified in the 1940s as a cost-effective method of prevention. In the mid-1970s, fluoride toothpastes became widely available. Since then, in high-income countries the prevalence of tooth decay in children has reduced whilst natural tooth retention in older age groups has increased. Most water fluoridation research was carried out before these dramatic changes in fluoride availability and oral health. Furthermore, there is a paucity of evidence in adults. The aim of this study is to assess the clinical and cost-effectiveness of water fluoridation in preventing invasive dental treatment in adults and adolescents aged over 12. Methods/design Retrospective cohort study using 10 years of routinely available dental treatment data. Individuals exposed to water fluoridation will be identified by sampled water fluoride concentration linked to place of residence. Outcomes will be based on the number of invasive dental treatments received per participant (fillings, extractions, root canal treatments). A generalised linear model with clustering by local authority area will be used for analysis. The model will include area level propensity scores and individual-level covariates. The economic evaluation will focus on (1) cost-effectiveness as assessed by the water fluoridation mean cost per invasive treatment avoided and (2) a return on investment from the public sector perspective, capturing the change in cost of dental service utilisation resulting from investment in water fluoridation. Discussions There is a well-recognised need for contemporary evidence regarding the effectiveness and cost-effectiveness of water fluoridation, particularly for adults. The absence of such evidence for all age groups may lead to an underestimation of the potential benefits of a population-wide, rather than targeted, fluoride delivery programme. This study will utilise a pragmatic design to address the information needs of policy makers in a timely manner.

scholarly journals A Cost-effectiveness Analysis of an Adjuvanted Subunit Vaccine for the Prevention of Herpes Zoster and Post-herpetic Neuralgia

2019 ◽  
Vol 6 (7) ◽  
Author(s):  
Christopher F Carpenter ◽  
Annas Aljassem ◽  
Jerry Stassinopoulos ◽  
Giovanni Pisacreta ◽  
David Hutton
Keyword(s):  
Herpes Zoster ◽  
Cost Effectiveness ◽  
Subunit Vaccine ◽  
Age Groups ◽  
Cost Effective ◽  
The United States ◽  
Quality Adjusted Life Year ◽  
Published Data ◽  
Disease Epidemiology

Abstract Background Herpes zoster (HZ) develops in up to 50% of unvaccinated individuals, accounting for &gt;1 million cases annually in the United States. A live attenuated HZ vaccine (LAV) is Food and Drug Administration approved for those age 50 years or older, though Advisory Committee on Immunization Practices recommendations are only for those age 60 years or older. LAV efficacy is ~70% for persons 50–59 years of age, with lower efficacy in older adults. A new 2-dose adjuvanted subunit vaccine (SUV) has &gt;95% efficacy in persons 50–69 years of age and remains ~90% efficacious in persons vaccinated at age 70 years. Methods To estimate the relative cost-effectiveness of SUV, LAV, and no vaccination (NoV) strategies, a Markov model was developed based on published data on vaccine efficacy, durability of protection, quality of life, resource utilization, costs, and disease epidemiology. The perspective was US societal, and the cycle length was 1 year with a lifelong time horizon. SUV efficacy was estimated to wane at the same rate as LAV. Outcomes evaluated included lifetime costs, discounted life expectancy, and incremental cost-effectiveness ratios (ICERs). Results For individuals vaccinated at age 50 years, the ICER for LAV vs NoV was $118 535 per quality-adjusted life-year (QALY); at age 60 years, the ICER dropped to $42 712/QALY. SUV was more expensive but had better ICERs than LAV. At age 50, the ICER was $91 156/QALY, and it dropped to $19 300/QALY at age 60. Conclusions Vaccination with SUV was more cost-effective than LAV in all age groups studied. Vaccination with SUV at age 50 years appears cost-effective, with an ICER &lt;$100 000/QALY.

scholarly journals Cost Effectiveness and Screening Interval of Lipid Screening in Hodgkin's Lymphoma Survivors

2009 ◽  
Vol 27 (32) ◽  
pp. 5383-5389 ◽  
Author(s):  
Aileen B. Chen ◽  
Rinaa S. Punglia ◽  
Karen M. Kuntz ◽  
Peter M. Mauch ◽  
Andrea K. Ng
Keyword(s):  
Cost Effectiveness ◽  
Life Expectancy ◽  
Cost Effective ◽  
Hodgkin's Lymphoma ◽  
Cardiac Events ◽  
Mediastinal Irradiation ◽  
Screening Interval ◽  
Lipid Screening ◽  
Screening Intervals ◽  
Quality Adjusted Life

Purpose Survivors of Hodgkin's lymphoma (HL) who received mediastinal irradiation have an increased risk of coronary heart disease. We evaluated the cost effectiveness of lipid screening in survivors of HL and compared different screening intervals. Methods We developed a decision-analytic model to evaluate lipid screening in a hypothetical cohort of 30-year-old survivors of HL who survived 5 years after mediastinal irradiation. We compared the following strategies: no screening, and screening at 1-, 3-, 5-, or 7-year intervals. Screen-positive patients were treated with statins. Markov models were used to calculate life expectancy, quality-adjusted life expectancy, and lifetime costs. Baseline probabilities, transition probabilities, and utilities were derived from published studies and US population data. Costs were estimated from Medicare fee schedules and the medical literature. Sensitivity analyses were performed. Results Using an incremental cost-effectiveness ratio (ICER) threshold of $100,000 per quality-adjusted life-year (QALY) saved, lipid screening at every interval was cost effective relative to a strategy of no screening. When comparing screening intervals, a 3-year interval was cost effective relative to a 5-year interval, but annual screening, relative to screening every 3 years, had an ICER of more than $100,000/QALY saved. Factors with the most influence on the results included risk of cardiac events/death after HL, efficacy of statins in reducing cardiac events/death, and costs of statins. Conclusion Lipid screening in survivors of HL, with statin therapy for screen-positive patients, improves survival and is cost effective. A screening interval of 3 years seems reasonable in the long-term follow-up of survivors of HL.

scholarly journals Optimizing Age-Structured and Risk-Based Mass Drug Administration Against Soil-Transmitted Helminthiasis in Ghana Using Cost-Effectiveness Analysis

2018 ◽  
Author(s):  
Mugdha Thakur ◽  
Rasheeda Mohammed ◽  
Anuj Mubayi
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Large Fraction ◽  
Age Groups ◽  
Cost Effective ◽  
Major Health Problem ◽  
Age Structured ◽  
Soil Transmitted Helminthiasis

Soil-transmitted helminthiasis (STH), a neglected tropical disease (NTD) remains a major health problem all over the world including Ghana, which has STH prevalence of 25.4%. To control the disease, the government of Ghana currently concentrates on implementing mass drug administration (MDA) efforts focusing only among school-aged children. However, various studies have suggested that focusing on only a specific group for MDA may not be cost-effective. Moreover, some adults such as teachers and school-workers spend large fraction of their time with children, who shed more parasite in environment due to unhygienic behavior, and thus have a higher risk of getting infected as compared to other adults. In this study we use a mathematical model to evaluate age-structured and risk-based policies for implementing MDA while capturing transmission dynamics of STH in Ghana. A cost model was developed that included various costs related to MDA to study cost-effectiveness of current policies of MDA in Ghana against novel policies to control STH in Ghana. We carry out analysis for five different scenarios&mdash; I: no MDA (baseline), II: current MDA policy (focusing children) in Ghana, III: MDA for different age groups (adults and children groups) for unlimited budget, IV: MDA for different age groups with limitations of number of individuals treated, and, V: MDA for different groups based on their risk of getting infected (adults school workers (high-risk group), adults non-school workers and children groups). Our results suggest that it might be more cost-effective to allocate treatment through MDA to at least some proportion of adults along with children. In case of unlimited budget, the best strategy in Scenario IV would be to treat approximately 22% of adults and approximately 45% of children. The most cost-effective among the 5 scenarios is suggested through scenario V, where high-risk adults group and children are provided MDA at higher level than low-risk adults. In conclusion, age-structured and risk-based allocation of treatment and resources is crucial to reducing STH load in developing countries.

scholarly journals Cost-effectiveness of the latent tuberculosis screening program for migrants in Stockholm Region

2021 ◽  
Author(s):  
Jad Shedrawy ◽  
Charlotte Deogan ◽  
Joanna Nederby Öhd ◽  
Maria-Pia Hergens ◽  
Judith Bruchfeld ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Screening Program ◽  
Country Of Origin ◽  
Age Groups ◽  
Latent Tuberculosis ◽  
Cost Effective ◽  
Age Group ◽  
Tuberculosis Screening ◽  
Initiation Rate ◽  
Ltbi Screening

Abstract Introduction The majority of tuberculosis (TB) cases in Sweden occur among migrants from endemic countries through activation of latent tuberculosis infection (LTBI). Sweden has LTBI-screening policies for migrants that have not been previously evaluated. This study aimed to assess the cost-effectiveness of the current screening strategy in Stockholm. Methods A Markov model was developed to predict the costs and effects of the current LTBI-screening program compared to a scenario of no LTBI screening over a 50-year time horizon. Epidemiological and cost data were obtained from local sources when available. The primary outcomes were incremental cost-effectiveness ratio (ICER) in terms of societal cost per quality-adjusted life year (QALY). Results Screening migrants in the age group 13–19 years had the lowest ICER, 300,082 Swedish Kronor (SEK)/QALY, which is considered cost-effective in Sweden. In the age group 20–34, ICER was 714,527 SEK/QALY (moderately cost-effectives) and in all age groups above 34 ICERs were above 1,000,000 SEK/QALY (not cost-effective). ICER decreased with increasing TB incidence in country of origin. Conclusion Screening is cost-effective for young cohorts, mainly between 13 and 19, while cost-effectiveness in age group 20–34 years could be enhanced by focusing on migrants from highest incidence countries and/or by increasing the LTBI treatment initiation rate. Screening is not cost-effective in older cohorts regardless of the country of origin.

Costs and Cost-Effectiveness in Hip and Knee Replacements: A Prospective Study

1997 ◽  
Vol 13 (4) ◽  
pp. 574-588 ◽  
Author(s):  
Pekka Rissanen ◽  
Seppo Aro ◽  
Harri Sintonen ◽  
Kimmo Asikainen ◽  
Pär Slätis ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Total Joint Replacement ◽  
Nottingham Health Profile ◽  
Hospital Costs ◽  
Age Groups ◽  
Cost Effective ◽  
Patient Characteristics ◽  
Related Quality ◽  
Health Related ◽  
A Prospective Study

AbstractThe extensive benefits of the total hip (THA) and knee (TKA) replacements are well documented, but surprisingly little is known about their economics. We assessed costs, cost-effectiveness (C/E), and patient-related C/E variances in THA and TKA from data on 276 THA and 176 TKA patients. Patients with primary arthrosis, primary operation, and total joint replacement were recruited from seven hospitals between March 1991 and June 1992. Their use of health and other welfare services together with health-related quality of life (HRQoL) were measured before the surgery and at 6, 12, and 24 months postoperatively. HRQoL was assessed by the 15D, a 15-dimensional HRQoL instrument, and the Nottingham Health Profile. Costs were assessed from questionnaire responses, the Finnish Hospital Discharge Register, and Finnish Arthroplasty Register. Total hospital costs per patient were 45,000 FIM (US $10,500) for THA and 49,600 FIM (US $11,500) for TKA. Prosthesis costs comprised 21 % of these costs in THA and 24% in TKA. On average, hip patients gained more in terms of HRQoL, and the operations were more cost-effective. The C/E ratio for younger (« 60 years) knee patients did not differ from those in all age groups of hip patients, whereas TKAs in those over 60 years had a worse C/E ratio compared with all other patient subgroups. It was concluded that allocation efficiency can be improved by considering not only the intervention but also patient characteristics such as age. Indeed, the C/E ratio varied more across age groups of knee patients than between average THA and TKA patients.

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