scholarly journals Cost-Effectiveness of Teriflunomide and Fingolimod in The First-Line Treatment of Relapsing-Remitting Multiple sclerosis：The Chinese Health System Perspective

2021 ◽  
Author(s):  
Zuojun Dong ◽  
Zhichao Hu ◽  
Xiaoying Zhou ◽  
Jingwen Wang ◽  
Jianwei Wang ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
First Line ◽  
Cost Of Treatment ◽  
System Perspective ◽  
Total Cost ◽  
Relapsing Remitting ◽  
The Cost ◽  
First Line Treatment ◽  
Health System Perspective

Abstract Objective The aim of this study is to evaluate the cost-effectiveness of teriflunomide and fingolimod in relapsing-remitting patients in the first-line treatment from the perspective of the Chinese health system perspective.Methods A Markov model was developed to evaluate the cost effectiveness of disease-modifying drugs (DMDs) from the Chinese health system perspective.Cost input includes medication, follow-up, nursing, recurrence treatment and adverse reaction management.Treatment effects, including monthly confrmed disability worsening and annualized relapse rate.The output result was ICER and the threshold of willingness to pay(WTP) was three times per capita GDP.One-way sensitivity analysis and probability sensitivity analysis are carried out to test the stability of the model results.Results In the context of medical insurance with Chinese characteristics.The total cost of treatment with teriflunomide was ¥423,816.61, and the total cost of treatment with fingolimod was ¥656,055.95.The cumulative QALYs of teriflunomide was 5.14, and the cumulative QALYs of fingolimod was 5.25.The ICER value of Fingolimod and Liflunomide is ¥2139444.61/QALY, which is higher than WTP , so teriflunomide has a dominant advantage.Sensitivity analysis proves that the model was stable.Conclusion From the perspective of Chinese health system perspective, teriflunomide is the more cost-effective of the two interventions.

scholarly journals Cost-effectiveness of ribociclib plus letrozole versus palbociclib plus letrozole or letrozole as monotherapy in first-line treatment of postmenopausal women with HR+/HER2− locally advanced or metastatic breast cancer: a Brazilian private payer perspective

2021 ◽  
Vol 13 ◽  
pp. 175883592110005
Author(s):  
Anna Maria Buehler ◽  
Gabriela Castilho ◽  
Pierre-Alexandre Dionne ◽  
Stephen Stefani
Keyword(s):  
Cost Effectiveness ◽  
Postmenopausal Women ◽  
Locally Advanced ◽  
Line Treatment ◽  
First Line ◽  
Cost Of Treatment ◽  
Total Cost ◽  
Private Healthcare ◽  
The Cost ◽  
First Line Treatment

Background: The global burden of breast cancer (BC) is high, especially in advanced stages. CDK 4/6 inhibitors represent a paradigm shift in the treatment of advanced BC HR+/HER2−, given the clinically and statistically significant gain in overall survival associated with this new class of medications. Nevertheless, as an innovation, the incorporation of these drugs impacts healthcare budgets, requiring cost-effectiveness analyses for decision-making. The aim of this study was to evaluate the cost-effectiveness of ribociclib plus letrozole compared with palbociclib plus letrozole or letrozole as monotherapy for first-line treatment of postmenopausal women with HR+/HER2− locally advanced or metastatic BC (aBC) from a Brazilian private healthcare system perspective. Methods: A model including progression-free survival (PFS), progressed disease, and death health states was used to simulate lifetime costs and outcomes. PFS and overall survival were derived from the MONALEESA-2 trial (lifetime horizon). Healthcare costs included drug acquisition and monitoring, subsequent therapies, adverse events, and end-of-life costs. Effectiveness was measured in quality-adjusted life-years (QALYs). Deterministic and probabilistic sensitivity analyses were performed. Results: The total cost of treatment with ribociclib plus letrozole was USD 72,091.82 versus USD 92,749.64 for palbociclib plus letrozole. Total QALYs were 3.30 and 3.16, respectively. Base-case analysis showed ribociclib as dominant over palbociclib in first-line treatment of women with HR+/HER2− aBC, associated with cost savings and QALY gains. The total cost of treatment with ribociclib plus letrozole was USD 83,058.73 versus USD 29,215.10 for letrozole. Total QALYs were 3.84 and 2.61, respectively. Compared with letrozole, ribociclib plus letrozole was associated with an incremental cost of USD 53,843.64 and an incremental QALY gain of 1.23, with incremental cost-effectiveness ratio of USD 43,826.91 per QALY gained. Conclusions: As demonstrated by the cost-effectiveness dominance over palbociclib, ribociclib results in savings when used as first-line treatment in postmenopausal women with HR+/HER2− aBC, warranting incorporation in the private healthcare system.

Cost-effectiveness analysis of first-line treatment for metastatic renal cell carcinoma (mRCC) in Colombia (ONCOLGroup study)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e16150-e16150
Author(s):  
J. Godoy ◽  
A. F. Cardona ◽  
H. Cáceres ◽  
J. M. Otero ◽  
M. Lujan ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cost Effectiveness ◽  
Renal Cell ◽  
Cost Effective ◽  
Average Total Cost ◽  
Line Treatment ◽  
First Line ◽  
Total Cost ◽  
The Cost ◽  
First Line Treatment

e16150 Background: Renal cell carcinoma has increased its incidence by 126% since 1950. A local study developed a complete economic evaluation of sunitinib versus IFN in first-line treatment of mRCC in Colombia, finding that sunitinib was more cost-useful and cost-effective. Methods: A Markov model was developed using 6-week cycles for evaluating the cost-effectiveness of four interventions (IFN, sunitinib, bevacizumab+IFN, sorafenib) approved as first-line treatment for mRCC in Colombia. The model used the third-party payer perspective and a 5-year time-line; it also presumed that all the patients (pts) continued with active treatment until progression when it became acceptable to continue with a second-line treatment or BSC. Overall survival (OS) and progression-free survival (PFS) curves of IFN were used as reference framework; they were obtained form a published clinical trial. The hazard ratios (HR) for PFS and OS were estimated for comparing new generation medicaments with IFN. The information about frequency of use and health service cost units consumed in Colombia was taken from a series of 24 pts treated in Manizales, Pereira, Medellín and Bogotá. Service costs were requested from an external consultant and corresponded to the average value billed by the EPSs, calculated from 33 sources of information which were representative of the country's market. The cost of the medicaments was obtained from LCLC. The costs and benefits were discounted annually at 3%. (all cost are presented in Colombian pesos Col$ 2008 with an exchange rate 1 USD = 1836.20 Col$). Results: Incremental analysis indicated a difference of 41.1 million Col$ in the average total cost of treatment when Sunitinib was compared to IFN; in contrast, comparing sorafenib and Bevacizumab+INF to sunitinib demonstrated that the average total cost was less for the sunitinib by 8.3 and 104.2 million Col$, respectively. Additionally, the ratios of incremental cost-effectiveness by life years (LY) gained demonstrated sunitinib's simple dominance over sorafenib and the combination of bevacizumab+IFN, and an average by LY gained of 100.5 million Col$ compared to IFN. Conclusions: Sunitinib is the most cost-effective option as first-line treatment for mRCC pts in Colombia. [Table: see text]

Cost-effectiveness Analysis of Caspofungin and Fluconazole for Primary Treatment of Invasive Candidiasis and Candidemia in Ethiopia

2022 ◽  
Author(s):  
Gebremedhin Beedemariam Gebretekle ◽  
Atalay Mulu Fentie ◽  
Girma Tekle Gebremariam ◽  
Eskinder Eshetu Ali ◽  
Daniel Asfaw Erku ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Invasive Candidiasis ◽  
Cost Effective ◽  
Primary Treatment ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
System Perspective ◽  
The Cost ◽  
First Line Treatment

Abstract Background: Caspofungin was shown to be more effective than fluconazole in treating patients with invasive candidiasis and/or candidaemia (IC/C). However, cost-effectiveness of caspofungin for treating IC/C in Ethiopia remains unknown. We aimed to assess the cost-effectiveness of caspofungin compared to fluconazole as primary treatment of IC/C in Ethiopia.Methods: A Markov cohort model was developed to compare the cost-utility of caspofungin versus fluconazole antifungal agents as first-line treatment for adult inpatients with IC/C from the Ethiopian health system perspective. Treatment outcome was categorized as either a clinical success or failure, with clinical failure being switched to a different antifungal medication. Liposomal amphotericin B (L-AmB) was used as a rescue agent for patients who had failed caspofungin treatment, while caspofungin or L-AmB were used for patients who had failed fluconazole treatment. Primary outcomes were expected quality-adjusted life years (QALYs), costs (US$2021), and the incremental cost-effectiveness ratio (ICER). QALYs and costs were discounted at 3% annually. Cost data was obtained from Addis Ababa hospitals while locally unavailable data were derived from the literature. Cost-effectiveness was assessed against the recommended threshold of 50% of Ethiopia’s gross domestic product/capita. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the findings.Results: In the base-case analysis, treatment of IC/C with caspofungin as first-line treatment resulted in better health outcomes (12.86 QALYs) but higher costs (US$7,714) compared to fluconazole-initiated treatment followed by caspofungin (12.30 QALYs; US$3,217) or L-AmB (10.92 QALYs; US$2,781) as second-line treatment. Caspofungin as primary treatment for IC/C was not cost-effective when compared to fluconazole-initiated therapies. Fluconazole-initiated treatment followed by caspofungin was cost-effective for the treatment of IC/C compared to fluconazole with L-AmB as second-line treatment, at US$316/QALY gained. Our findings were sensitive to medication costs, drug effectiveness, infection recurrence, and infection-related mortality rates. Probabilistic sensitivity analysis confirmed the stability of our findings.Conclusions: Our study showed that the use of caspofungin as primary treatment for IC/C in Ethiopia was not cost-effective when compared with fluconazole-initiated treatment alternatives. The findings supported the use of fluconazole-initiated therapy with caspofungin as a second-line treatment to treat IC/C in Ethiopia and other low-income countries.

scholarly journals THE COST OF NOT BREASTFEEDING IN NORTH SUMATERA

2019 ◽  
Author(s):  
Estro Dariatno Sihaloho ◽  
Rahma ◽  
Wandira Larasati Senja ◽  
Pipit Pitriyan ◽  
Adiatma Y.M Siregar
Keyword(s):  
Health System ◽  
Economic Impact ◽  
Medical Cost ◽  
Economic Loss ◽  
Primary Data ◽  
System Perspective ◽  
Total Cost ◽  
Health System Cost ◽  
The Cost ◽  
Health System Perspective

Breastfeeding provide many good impacts on health and economics side. This study tries toestimate the economic impact of not breastfeeding due to diarrhea and PRD cases in NorthSumatera. The economic impact elaborated by finds health system medical cost and thepatient/non- medical cost. This paper calculates health system medical cost from publichospital, private hospital, and primary health center while the patient cost calculated from135 patients in 3 kinds of health facilities. This paper combines primary data with CensusData 2010 and IDHS 2012 to get total cost of not breastfeeding in North Sumatera. Thecosting process shows there are economic loss about US$1,290,582 with average cost aboutUS$ 13.48 in North Sumatera. The total cost consist of health system perspective costabout US$ 799,050 and patient costs about 491,532. This show that most of the cost comesfrom the health system cost/medical cost about 61.91% and the 38.09% borne from thepatient costs and non-medical cost

scholarly journals Cost-effectiveness Analysis of Rituximab Associated With Fludarabine and Cyclophosphamide (R-FC) for the First-line Treatment of Chronic Lymphocytic Leukemia Under the Brazilian Public Health System (SUS).

2021 ◽  
Author(s):  
Bruno Azevedo ◽  
Adriana Carvalho ◽  
Andre Deeke Sasse
Keyword(s):  
Public Health ◽  
Cost Effectiveness ◽  
Chronic Lymphocytic Leukemia ◽  
Health System ◽  
Public Health System ◽  
Lymphocytic Leukemia ◽  
Line Treatment ◽  
First Line ◽  
System Perspective ◽  
First Line Treatment

Abstract BACKGROUNDChronic Lymphocytic leukemia is the most common leukemia in the western world. In the last decade, treatment options expanded with an expressive rise in treatment costs. In Brazil the overall cancer treatment costs are rising mainly due to the judicialization law suits. The efficacy and safety of associating rituximab to fludarabine and cyclophosphamide (R-FC) for the treatment of chronic lymphocytic leukemia has been demonstrated by the CLL8 trial, which was conducted in previously untreated patients positioning the immunochemotherapy regimen as the standard choice for physically fit patients. Considering this scenario, the current study has as objective to evaluate the cost-effectiveness of the addition of rituximab to the FC protocol considering the Brazilian public health system perspective. METHODSWe developed a Markov model with three health states to extrapolate the CLL8 trial results. The transition probabilities and adverse events incidence were obtained from the trial published data. The costs were assessed from Brazil’s ministry of health pricing database (public available). A simplified treatment algorithm was developed according to the current available treatment options in the Brazilian public health system and assuming the availability of rituximab. RESULTSThe addition of rituximab to the FC regimen results in an incremental cost-effectiveness ratio (ICER) of 8389 USD (45003,86 BRL) per year life free of progression. The sensititvity analysis conducted shows a From the Brazilian public health system perspective, the combination of rituximab with the FC chemotherapy represents a cost-effective strategic approach for first-line treatment of patients with CLL.CONCLUSIONSconsidering the data described in this study, we cqn conclude that the addition of rituximab to the first-line treatment of CLL is cost-effective strategy for the Brazil public health system. With the advent of new drugs and new treatment regimens that presents positive clinical outcomes in patients refratary to the R-FC regimen (del17p, p53 mutations), new studies must be conducted to evaluate their cost-effectiveness considering this population of patients.

First-Line Pembrolizumab Plus Chemotherapy for Extensive-Stage Small-Cell Lung Cancer: A Cost-Effectiveness Analysis

2021 ◽  
Author(s):  
Youwen Zhu ◽  
Huabin Hu ◽  
Dong Ding ◽  
Shuosha Li ◽  
Mengting Liao ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Small Cell ◽  
Sensitivity Analyses ◽  
Small Cell Lung ◽  
First Line ◽  
The Us ◽  
Extensive Stage ◽  
The Cost ◽  
First Line Treatment

Abstract Background：The phase III clinical trial Keynote-604 indicated that pembrolizumab plus chemotherapy could generate clinical benefits in Extensive-Stage Small-Cell Lung Cancer (ES-SCLC). We aim to evaluate the cost-effectiveness of pembrolizumab plus chemotherapy as the first-line treatment of ES-SCLC from the United States (US) payers’ perspective.Methods: A synthetical Markov model was used to evaluate cost and effectiveness of pembrolizumab plus platinum-etoposide (EP) versus EP in first-line therapy for ES-SCLC from the data of Keynote-604. Lifetime costs life-years (LYs), quality adjusted LYs (QALYs), and incremental cost-effectiveness ratios (ICERs) were estimated. One-way and probabilistic sensitivity analyses were performed. In addition, We also considered subgroup cost-effectiveness.Results: Pembrolizumab plus EP resulted in additional 0.18 QALYs (0.32 LYs) and corresponding incremental costs $113,625, resulting an ICER of $647,509 per QALY versus EP. The most influential factor in this model was the cost of pembrolizumab. Probabilistic sensitivity analysis showed there was 0% probability that pembrolizumab combination chemotherapy was cost-effective at willingness-to-pay (WTP) values of $150,000 per QALY in the US. The results of subgroup probabilistic sensitivity analyses suggested that all subgroups were not cost-effective.Conclusion: From the perspective of the US payer, pembrolizumab plus EP is not a cost-effective option as first-line treatment for patients with ES-SCLC at a WTP threshold of $150,000 per QALY.

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