Inference for the Cost-Effectiveness Acceptability Curve and Cost-Effectiveness Ratio

When exceptional situations, such as the COVID-19 pandemic, arise and reliable data is not available at decision-making times, estimation using mathematical models can provide a reasonable reckoning for health planning. We present a simplified model (static but with two-time references) for estimating the cost-effectiveness of the COVID-19 vaccine. A simplified model provides a quick assessment of the upper bound of cost-effectiveness, as we illustrate with data from Spain, and allows for easy comparisons between countries. It may also provide useful comparisons among different vaccines at the marketplace, from the perspective of the buyer. From the analysis of this information, key epidemiological figures, and costs of the disease for Spain have been estimated, based on mortality. The fatality rate is robust data that can alternatively be obtained from death registers, funeral homes, cemeteries, and crematoria. Our model estimates the incremental cost-effectiveness ratio (ICER) to be 5132 € (4926–5276) as of 17 February 2021, based on the following assumptions/inputs: An estimated cost of 30 euros per dose (plus transport, storing, and administration), two doses per person, efficacy of 70% and coverage of 70% of the population. Even considering the possibility of some bias, this simplified model provides confirmation that vaccination against COVID-19 is highly cost-effective.

Download Full-text

Cost–effectiveness analysis of ribociclib plus fulvestrant for hormone receptor-positive/human EGF receptor 2-negative breast cancer

Immunotherapy ◽

10.2217/imt-2020-0237 ◽

2021 ◽

Author(s):

Wei Jiang ◽

Zhichao He ◽

Tiantian Zhang ◽

Chongchong Guo ◽

Jianli Zhao ◽

...

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Hormone Receptor ◽

Egf Receptor ◽

Cost Effective ◽

Quality Adjusted Life Year ◽

Cost Effectiveness Ratio ◽

Hormone Receptor Positive ◽

The Cost ◽

Quality Adjusted Life

Aim: To evaluate the cost–effectiveness of ribociclib plus fulvestrant versus fulvestrant in hormone receptor-positive/human EGF receptor 2-negative advanced breast cancer. Materials & methods: A three-state Markov model was developed to evaluate the costs and effectiveness over 10 years. Direct costs and utility values were obtained from previously published studies. We calculated incremental cost–effectiveness ratio to evaluate the cost–effectiveness at a willingness-to-pay threshold of $150,000 per additional quality-adjusted life year. Results: The incremental cost–effectiveness ratio was $1,073,526 per quality-adjusted life year of ribociclib plus fulvestrant versus fulvestrant. Conclusions: Ribociclib plus fulvestrant is not cost-effective versus fulvestrant in the treatment of advanced hormone receptor-positive/human EGF receptor 2-negative breast cancer. When ribociclib is at 10% of the full price, ribociclib plus fulvestrant could be cost-effective.

Download Full-text

Cost-effectiveness of two long-lasting insecticidal nets delivery models in mass campaign in rural Mozambique

BMC Research Notes ◽

10.1186/s13104-019-4620-6 ◽

2019 ◽

Vol 12 (1) ◽

Author(s):

Jorge A. H. Arroz ◽

Baltazar Candrinho ◽

Chandana Mendis ◽

Melanie Lopez ◽

Maria do Rosário O. Martins

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Universal Coverage ◽

Cost Effectiveness Ratio ◽

Net Benefit ◽

Incremental Net Benefit ◽

The Cost ◽

And Control ◽

Delivery Models ◽

Long Lasting Insecticidal Nets

Abstract Objective The aim is to compare the cost-effectiveness of two long-lasting insecticidal nets (LLINs) delivery models (standard vs. new) in universal coverage (UC) campaigns in rural Mozambique. Results The total financial cost of delivering LLINs was US$ 231,237.30 and US$ 174,790.14 in the intervention (302,648 LLINs were delivered) and control districts (219,613 LLINs were delivered), respectively. The average cost-effectiveness ratio (ACER) per LLIN delivered and ACER per household (HH) achieving UC was lower in the intervention districts. The incremental cost-effectiveness ratio (ICER) per LLIN and ICER per HH reaching UC were US$ 0.68 and US$ 2.24, respectively. Both incremental net benefit (for delivered LLIN and for HHs reaching UC) were positive (intervention deemed cost-effective). Overall, the newer delivery model was the more cost-effective intervention. However, the long-term sustainability of either delivery models is far from guaranteed in Mozambique’s current economic context.

Download Full-text

Cost-Effectiveness Analysis Kloramfenikol Dan Seftriakson Untuk Pengobatan Demam Tifoid Pada Pasien Dewasa Di Rumah Sakit Sanglah Denpasar

Media Pharmaceutica Indonesiana (MPI) ◽

10.24123/mpi.v2i2.1391 ◽

2019 ◽

Vol 2 (2) ◽

pp. 105-112

Author(s):

Amelia Lorensia ◽

Doddy De Queljoe ◽

Made Dwike Swari Santi

Keyword(s):

Cost Effectiveness ◽

Length Of Stay ◽

Typhoid Fever ◽

Medical Records ◽

Cost Effective ◽

Cost Effectiveness Ratio ◽

Hospital Perspective ◽

Effectiveness Analysis ◽

The Cost ◽

Two Alternatives

The number of typhoid fever patient in Indonesia is still high. Typhoid fever can be treated by antibiotic therapy such as chloramphenicol and ceftriaxone. The purpose of this study was to compare the cost-effectiveness of chloramphenicol and ceftriaxone which was given to adult patients who were diagnosed with typhoid fever in Sanglah Denpasar Hospital. A comparative study between two alternatives was conducted using the hospital perspective. Retrospective method was used to collect data from patient medical records, who was diagnosed and hospitalized in Sanglah Denpasar Hospital during January 2017 until July 2018. The cost analysis was perform using cost-effectiveness grid and cost-effectiveness ratio (ACER) methods. Cost-effectiveness grid showed that dominant of ceftriaxone for patient with typhoid fever. ACER analysis for ceftriaxone was IDR 2,097,170.88 with effectivenes (length of stay) 4.27 days, and was IDR 2,097,170.88 with effectiveness (the time of reaching normal temperature) 2.42 days. ACER analysis for chloramphenicol was IDR 2,555,464.22 with effectivenes (length of stay) 10.22 days, and was IDR 2,555,464.22 with effectiveness (the time of reaching normal temperature) 3.44 days. ACER analysis showed lower degree of ceftriaxone and higher effectiveness based on length of stay and the time of reaching normal temperature. The conclusion of this study is that ceftriaxone is more cost-effective than chloramphenicol.

Download Full-text

Comparing the cost-effectiveness of three diagnostic test strategies for angle closure in a developing country

British Journal of Healthcare Management ◽

10.12968/bjhc.2019.0083 ◽

2021 ◽

Vol 27 (4) ◽

pp. 1-7

Author(s):

Mariana Y Miyamoto ◽

Ralph Cohen ◽

Niro Kasahara

Keyword(s):

Cost Effectiveness ◽

Developing Country ◽

Cost Effective ◽

Incremental Cost Effectiveness Ratio ◽

Angle Closure ◽

Cost Effectiveness Ratio ◽

Primary Angle Closure ◽

Scheimpflug Camera ◽

Camera Imaging ◽

The Cost

Background/Aims The appropriate roles for alternative diagnostic tests in detecting primary angle closure of the eye are uncertain. This study evaluated the cost-effectiveness of Scheimpflug camera imaging, the van Herick technique and gonioscopy to identify primary angle in a developing country. Methods This cross-sectional diagnostic study included participants aged >40 years with suspected primary angle closure in the developing country of Brazil. All participants underwent Scheimpflug camera imaging, a van Herick test and gonioscopy. The diagnostic ability of these tests was evaluated using a receiver operating characteristic curve. Costs of interventions were derived using the Brazilian Hierarchical Classification of Medical Procedures. The cost-effectiveness of the tests were compared using an incremental cost-effectiveness ratio. Results Gonioscopy was confirmed to be the most accurate diagnostic test for primary angle closure, closely followed by the van Herick test. The accuracy of Scheimpflug camera imaging was considerably lower, largely because of its low sensitivity. The incremental cost-effectiveness ratio demonstrated that Scheimpflug camera imaging was also the least cost-effective, as it was considerably more expensive but with less clinical benefits. Conclusions Because of its relatively low accuracy and high costs, Scheimpflug camera imaging is not as cost-effective as gonioscopy nor the van Herick test as a means of diagnosing primary angle closure in a developing country.

Download Full-text

Dacomitinib in first-line treatment of advanced EGFR-mutated non-small-cell lung cancer: a cost–effectiveness analysis

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2020-0233 ◽

2021 ◽

Author(s):

Javier Aguilar-Serra ◽

Vicente Gimeno-Ballester ◽

Alfonso Pastor-Clerigues ◽

Javier Milara ◽

Ezequiel Marti-Bonmati ◽

...

Keyword(s):

Cost Effectiveness ◽

Incremental Cost ◽

Quality Adjusted Life Year ◽

Incremental Cost Effectiveness Ratio ◽

Line Treatment ◽

Cost Effectiveness Ratio ◽

First Line ◽

Estimate Quality ◽

The Cost ◽

First Line Treatment

Aim: To assess the cost–effectiveness of first-line treatment with dacomitinib compared with gefitinib in patients newly diagnosed with advanced NSCLC EGFR-positive in the context of Spain. Materials & methods: A partitioned survival model was developed including costs, utilities and disutilities to estimate quality-adjusted life-year (QALY) and incremental cost–effectiveness ratio when treating with dacomitinib versus gefitinib. Results: Dacomitinib presented higher QALYs (0.51) compared with gefitinib (0.45). Dacomitinib costs were €33,061 in comparison with €26,692 for gefitinib arm. An incremental cost–effectiveness ratio of €111,048 was obtained for dacomitinib. Conclusion: Dacomitinib was more effective in terms of QALYs gained than gefitinib. However, to obtain a cost–effectiveness alternative, a discount greater than 25% in dacomitinib acquisition cost is required.

Download Full-text

Cost-effective Analysis of Proton Pump Inhibitors in Long-term Management of Gastroesophageal Reflux Disease: A Narrative Review

Hospital Pharmacy ◽

10.1177/0018578719893378 ◽

2019 ◽

Vol 55 (5) ◽

pp. 292-305

Author(s):

Shazia Jamshed ◽

Akshaya Srikanth Bhagavathula ◽

Sheikh Muhammad Zeeshan Qadar ◽

Umaira Alauddin ◽

Sana Shamim ◽

...

Keyword(s):

Cost Effectiveness ◽

Gastroesophageal Reflux Disease ◽

Cost Effective ◽

The Other ◽

Cost Effectiveness Ratio ◽

On Demand ◽

Step Down ◽

The Cost ◽

Term Management

Background: Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder that results from regurgitation of acid from the stomach into the esophagus. Treatment available for GERD includes lifestyle changes, antacids, histamine-2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), and anti-reflux surgery. Aim: The aim of this review is to assess the cost-effectiveness of the use of PPIs in the long-term management of patients with GERD. Method: We searched in PubMed to identify related original articles with close consideration based on inclusion and exclusion criteria to choose the best studies for this narrative review. The first section compares the cost-effectiveness of PPIs with H2RAs in long-term heartburn management. The other sections shall only discuss the cost-effectiveness of PPIs in 5 different strategies, namely, continuous (step-up, step-down, and maintenance), on-demand, and intermittent therapies. Results: Of 55 articles published, 10 studies published from 2000 to 2015 were included. Overall, PPIs are more effective in relieving heartburn in comparison with ranitidine. The use of PPIs in managing heartburn in long-term consumption of nonsteroidal anti-inflammatory drug (NSAID) has higher cost compared with H2RA. However, if the decision-maker is willing to pay more than US$174 788.60 per extra quality-adjusted life year (QALY), then the optimal strategy is traditional NSAID (tNSAID) and PPIs. The probability of being cost-effective was also highest for NSAID and PPI co-therapy users. On-demand PPI treatment strategy showed dominant with an incremental cost-effectiveness ratio of US$2197 per QALY gained and was most effective and cost saving compared with all the other treatments. The average cost-effectiveness ratio was lower for rabeprazole therapy than for ranitidine therapy. Conclusion: Our review revealed that long-term treatment with PPIs is effective but costly. To achieve long-term cost-effective approach, we recommend on-demand approach to treat heartburn symptoms, but if the symptoms persist, treatment with continuous step-down therapy should be applied.

Download Full-text

Cost and outcomes of the ultrasound screening program for birth defects over time: a population-based study in France

BMJ Open ◽

10.1136/bmjopen-2019-036566 ◽

2020 ◽

Vol 10 (7) ◽

pp. e036566

Author(s):

Clément Ferrier ◽

Babak Khoshnood ◽

Ferdinand Dhombres ◽

Hanitra Randrianaivo ◽

Isabelle Perthus ◽

...

Keyword(s):

Health Insurance ◽

Cost Effectiveness ◽

Birth Defects ◽

Screening Programme ◽

Population Based ◽

Ultrasound Screening ◽

Cost Effectiveness Ratio ◽

Population Based Study ◽

Prenatal Detection ◽

The Cost

ObjectiveTo assess trends in the average costs and effectiveness of the French ultrasound screening programme for birth defects.DesignA population-based study.SettingNational Public Health Insurance claim database.ParticipantsAll pregnant women in the ‘Echantillon Généraliste des Bénéficiaires’, a permanent representative sample of 1/97 of the individuals covered by the French Health Insurance System.Main outcomes measuresTrends in the costs and in the average cost-effectiveness ratio (ACER) of the screening programme (in € per case detected antenatally), per year, between 2006 and 2014. incremental cost-effectiveness ratio (ICER) from 1 year to another were also estimated. We assessed costs related to the ultrasound screening programme of birth defects excluding the specific screening of Down’s syndrome. The outcome for effectiveness was the prenatal detection rate of birth defects, assessed in a previous study. Linear and logistic regressions were used to analyse time trends.ResultsDuring the study period, there was a slight decrease in prenatal detection rates (from 58.2% in 2006 to 55.2% in 2014; p=0.015). The cost of ultrasound screening increased from €168 in 2006 to €258 per pregnancy in 2014 (p=0.001). We found a 61% increase in the ACER for ultrasound screening during the study period. ACERs increased from €9050 per case detected in 2006 to €14 580 per case detected in 2014 (p=0.001). ICERs had an erratic pattern, with a strong tendency to show that any increment in the cost of screening was highly cost ineffective.ConclusionEven if the increase in costs may be partly justified, we observed a diminishing returns for costs associated with the prenatal ultrasound screening of birth defects, in France, between 2006 and 2014.

Download Full-text

Lenvatinib versus sorafenib for unresectable hepatocellular carcinoma: a cost–effectiveness analysis

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2020-0041 ◽

2020 ◽

Vol 9 (8) ◽

pp. 553-562

Author(s):

Hongfu Cai ◽

Longfeng Zhang ◽

Na Li ◽

Bin Zheng ◽

Maobai Liu

Keyword(s):

Hepatocellular Carcinoma ◽

Cost Effectiveness ◽

Cost Effective ◽

Quality Adjusted Life Years ◽

Cost Effectiveness Ratio ◽

Phase 3 ◽

Sorafenib Treatment ◽

Life Years ◽

The Cost ◽

Quality Adjusted Life

Aim: To investigate the cost–effectiveness of lenvatinib and sorafenib in the treatment of patients with nonresected hepatocellular carcinoma in China. Materials & methods: Markov model was used to simulate the direct medical cost and quality-adjusted life years (QALY) of patients with hepatocellular carcinoma. Clinical data were derived from the Phase 3 randomized clinical trial in a Chinese population. Results: Sorafenib treatment resulted in 1.794 QALYs at a cost of $43,780.73. Lenvatinib treatment resulted in 2.916 QALYs for patients weighing <60 and ≥60 kg at a cost of $57,049.43 and $75,900.36, The incremental cost–effectiveness ratio to the sorafenib treatment group was $11,825.94/QALY and $28,627.12/QALY, respectively. Conclusion: According to WHO’s triple GDP per capita, the use of lenvatinib by providing drugs is a cost-effective strategy.

Download Full-text

Cost Effectiveness of Gene Expression Profile Testing in Community Practice

Journal of Clinical Oncology ◽

10.1200/jco.2017.74.5034 ◽

2018 ◽

Vol 36 (6) ◽

pp. 554-562 ◽

Cited By ~ 17

Author(s):

Young Chandler ◽

Clyde B. Schechter ◽

Jinani Jayasekera ◽

Aimee Near ◽

Suzanne C. O’Neill ◽

...

Keyword(s):

Gene Expression ◽

Cost Effectiveness ◽

Usual Care ◽

Gene Expression Profile ◽

Expression Profile ◽

Test Accuracy ◽

Community Practice ◽

Cost Effectiveness Ratio ◽

Life Years ◽

The Cost

Purpose Gene expression profile (GEP) testing can support chemotherapy decision making for patients with early-stage, estrogen receptor–positive, human epidermal growth factor 2–negative breast cancers. This study evaluated the cost effectiveness of one GEP test, Onco type DX (Genomic Health, Redwood City, CA), in community practice with test-eligible patients age 40 to 79 years. Methods A simulation model compared 25-year societal incremental costs and quality-adjusted life-years (QALYs) of community Onco type DX use from 2005 to 2012 versus usual care in the pretesting era (2000 to 2004). Inputs included Onco type DX and chemotherapy data from an integrated health care system and national and published data on Onco type DX accuracy, chemotherapy effectiveness, utilities, survival and recurrence, and Medicare and patient costs. Sensitivity analyses varied individual parameters; results were also estimated for ideal conditions (ie, 100% testing and adherence to test-suggested treatment, perfect test accuracy, considering test effects on reassurance or worry, and lowest costs). Results Twenty-four percent of test-eligible patients had Onco type DX testing. Testing was higher in younger patients and patients with stage I disease ( v stage IIA), and 75.3% and 10.2% of patients with high and low recurrence risk scores received chemotherapy, respectively. The cost-effectiveness ratio for testing ( v usual care) was $188,125 per QALY. Considering test effects on worry versus reassurance decreased the cost-effectiveness ratio to $58,431 per QALY. With perfect test accuracy, the cost-effectiveness ratio was $28,947 per QALY, and under ideal conditions, it was $39,496 per QALY. Conclusion GEP testing is likely to have a high cost-effectiveness ratio on the basis of community practice patterns. However, realistic variations in assumptions about key variables could result in GEP testing having cost-effectiveness ratios in the range of other accepted interventions. The differences in cost-effectiveness ratios on the basis of community versus ideal conditions underscore the importance of considering real-world implementation when assessing the new technology.

Download Full-text