PERFORMANCE-ADJUSTED LIFE YEARS MAY SUBSTITUTE FOR QUALITY-ADJUSTED LIFE YEARS IN COST-EFFECTIVENESS ANALYSIS FOR ELDERLY PATIENTS WITH ADVANCED LUNG CANCER

A 2nd edition of Cost-Effectiveness in Health and Medicine has now been published by a group of medical decision-making experts known collectively as the 2nd Panel. This is a critical review of the recommendations for how to deal with costs in cost-effectiveness analysis, recommendations that are contained in Chapter 8 of that edition, titled “Estimating Costs and Valuations of Non-Health Benefits in Cost-Effectiveness Analysis,” authored primarily but not exclusively by Anirban Basu. This review focuses on the correspondence between the costs in the numerator of the incremental cost-effectiveness ratio (ICER) and what is measured in the denominator of the ICER by the quality-adjusted life years (QALYs). Although it raises a number of issues regarding what is actually being measured in the numerator and denominator of the ICER, it primarily challenges the 2nd Panel’s recommendation that the costs of non-health consumption in any additional years of life generated by the intervention in question be accounted for in the numerator, even though no measures of the benefits are included in the QALYs in the denominator. This review is adapted from a review of the entire 2nd edition that was sent to the 2nd Panel steering committee on January 8, 2016.

Download Full-text

Cost-Effectiveness Analysis (CEA) of Preventive COVID-19 Vaccines by Quality-Adjusted Life Years (QALYs)

10.21203/rs.3.rs-837252/v1 ◽

2021 ◽

Author(s):

Rabnawaz Khan

Keyword(s):

Cost Effectiveness ◽

Economic Cost ◽

Maximum Level ◽

Cost Effectiveness Analysis ◽

Quality Adjusted Life Years ◽

Effectiveness Analysis ◽

Life Years ◽

Intensive Approach ◽

The Cost ◽

Quality Adjusted Life

Abstract This paper merely presents the dynamic boost of the COVID-19 vaccines. The intensive approach is indicating how the effective COVID-19 vaccine promotes and distributes into various official channels. It enables the exclusive authority to devise a possible way to reduce the economic cost of COVID-19 vaccines and facilitate to a maximum level. The Cost-effectiveness analysis (CEA) method approached with Quality-Adjusted Life Years (QALYs). The key findings are revealing the length of life improves the quality of life of the middle family. The results of QALYs show that Utility Value (UV) by health and the value of statistics in countries in the term of coexistent causation of vaccines. The Pfizer (BNT162b2) and Moderna (mRNA-1273) have instantly created favorable and significant effects probably on many patients, comparatively SARS-CoV-2, AstraZeneca (AZD1222), Russia’s Sputnik (AstraZeneca), and Sinopharm Sinovac Biotech. The opportunity cost provides a valuable benefit in the future.

Download Full-text

Using QALYs versus DALYs to measure cost-effectiveness: How much does it matter?

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462320000124 ◽

2020 ◽

Vol 36 (2) ◽

pp. 96-103 ◽

Cited By ~ 2

Author(s):

Xue Feng ◽

David D. Kim ◽

Joshua T. Cohen ◽

Peter J. Neumann ◽

Daniel A. Ollendorf

Keyword(s):

Cost Effectiveness ◽

Medical Center ◽

Disability Adjusted Life Years ◽

Quality Adjusted Life Years ◽

Effectiveness Analysis ◽

Disability Weights ◽

Disability Adjusted Life ◽

Life Years ◽

Relative Differences ◽

Quality Adjusted Life

ObjectivesQuality-adjusted life-years (QALYs) and disability-adjusted life-years (DALYs) are commonly used in cost-effectiveness analysis (CEA) to measure health benefits. We sought to quantify and explain differences between QALY- and DALY-based cost-effectiveness ratios, and explore whether using one versus the other would materially affect conclusions about an intervention's cost-effectiveness.MethodsWe identified CEAs using both QALYs and DALYs from the Tufts Medical Center CEA Registry and Global Health CEA Registry, with a supplemental search to ensure comprehensive literature coverage. We calculated absolute and relative differences between the QALY- and DALY-based ratios, and compared ratios to common benchmarks (e.g., 1× gross domestic product per capita). We converted reported costs into US dollars.ResultsAmong eleven published CEAs reporting both QALYs and DALYs, seven focused on pharmaceuticals and infectious disease, and five were conducted in high-income countries. Four studies concluded that the intervention was “dominant” (cost-saving). Among the QALY- and DALY-based ratios reported from the remaining seven studies, absolute differences ranged from approximately $2 to $15,000 per unit of benefit, and relative differences from 6–120 percent, but most differences were modest in comparison with the ratio value itself. The values assigned to utility and disability weights explained most observed differences. In comparison with cost-effectiveness thresholds, conclusions were consistent regardless of the ratio type in ten of eleven cases.ConclusionsOur results suggest that although QALY- and DALY-based ratios for the same intervention can differ, differences tend to be modest and do not materially affect comparisons to common cost-effectiveness thresholds.

Download Full-text

Cost effectiveness analysis of a randomised trial of acupuncture for chronic headache in primary care

BMJ ◽

10.1136/bmj.38033.896505.eb ◽

2004 ◽

Vol 328 (7442) ◽

pp. 747 ◽

Cited By ~ 106

Author(s):

David Wonderling ◽

Andrew J Vickers ◽

Richard Grieve ◽

Rob McCarney

Keyword(s):

Cost Effectiveness ◽

Chronic Headache ◽

Randomised Trial ◽

Cost Effectiveness Analysis ◽

Base Case ◽

Effectiveness Analysis ◽

Life Years ◽

One Year ◽

The One ◽

Quality Adjusted Life

AbstractObjective To evaluate the cost effectiveness of acupuncture in the management of chronic headache.Design Cost effectiveness analysis of a randomised controlled trial.Setting General practices in England and Wales.Participants 401 patients with chronic headache, predominantly migraine.Interventions Patients were randomly allocated to receive up to 12 acupuncture treatments over three months from appropriately trained physiotherapists, or to usual care alone.Main outcome measure Incremental cost per quality adjusted life year (QALY) gained.Results Total costs during the one year period of the study were on average higher for the acupuncture group (£403; $768;€598) than for controls (£217) because of the acupuncture practitioners' costs. The mean health gain from acupuncture during the one year of the trial was 0.021 quality adjusted life years (QALYs), leading to a base case estimate of £9180 per QALY gained. This result was robust to sensitivity analysis. Cost per QALY dropped substantially when the analysis incorporated likely QALY differences for the years after the trial.Conclusions Acupuncture for chronic headache improves health related quality of life at a small additional cost; it is relatively cost effective compared with a number of other interventions provided by the NHS.

Download Full-text

The Adoption of Cost-Effectiveness Acceptability Curves in Cost-Utility Analyses

Medical Decision Making ◽

10.1177/0272989x09344749 ◽

2009 ◽

Vol 30 (3) ◽

pp. 314-319 ◽

Cited By ~ 8

Author(s):

Lisa M. Meckley ◽

Dan Greenberg ◽

Joshua T. Cohen ◽

Peter J. Neumann

Keyword(s):

Cost Effectiveness ◽

Medical Center ◽

Cost Effective ◽

Cost Utility ◽

Quality Adjusted Life Years ◽

Effectiveness Analysis ◽

Life Years ◽

Study Methodology ◽

The Uk ◽

Quality Adjusted Life

Background. Cost-effectiveness acceptability curves (CEACs) plot the probability that one health intervention is more cost-effective than alternatives, as a function of societal willingness to pay for additional units of health (e.g., life-years or quality-adjusted life-years gained). Objectives. To quantify the adoption of CEACs in published cost-utility analyses (CUAs), and to identify factors associated with CEAC use. Methods. Data from the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org), a database with detailed information on approximately 1,400 CUAs published in the peer reviewed literature through 2006, was analyzed. The registry includes data on study origin, study methodology, reporting of results, whether CEACs were presented, and a subjective quality score. Univariate and multivariate logistic regression analyses were used to identify factors predicting CEAC use, from their introduction in 1994 through 2006. Results. Approximately 15% of CUAs published since 1994 present a CEAC. The use of CEACs has increased rapidly in recent years, from 2.1% of published CUAs in 2001 to 32.6% in 2006 (P < 0.0001). The most significant predictors of CEAC use were study quality (odds ratio [OR]: 2.26; 95% confidence interval [CI]: 1.80, 2.85), recent publication (OR: 1.99; 95% CI: 1.73, 2.29), and whether studies pertain to the UK (OR: 5.66; 95% CI: 3.67, 8.72) or Sweden (OR: 3.76; 95% CI: 1.67, 8.44). Conclusions. CEAC use is increasing in the published cost-effectiveness literature, especially in UK-based studies.

Download Full-text

Lutetium oxodotreotide (177Lu-Dotatate) for the treatment of unresectable or metastatic progressive gastroenteropancreatic neuroendocrine tumors: a cost-effectiveness analysis for Scotland

BMC Cancer ◽

10.1186/s12885-020-07710-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

J. Smith-Palmer ◽

O. R. Leeuwenkamp ◽

J. Virk ◽

N. Reed

Keyword(s):

Cost Effectiveness ◽

Neuroendocrine Tumors ◽

Cost Effectiveness Analysis ◽

Phase Iii ◽

Base Case ◽

Gastroenteropancreatic Neuroendocrine Tumors ◽

Effectiveness Analysis ◽

Payer Perspective ◽

Life Years ◽

Quality Adjusted Life

Abstract Background Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) represent a heterogenous group of tumors. Findings from the phase III NETTER-1 trial showed that treatment of unresectable/metastatic progressive gastrointestinal (GI) NETs with 177Lu-Dotatate resulted in a significant improvement in progression-free survival (PFS) and overall survival (OS) compared with best supportive care (BSC) with high dose octreotide long-acting repeatable (LAR) 60 mg. A health economic analysis was performed using input data from clinical studies and data derived from an indirect comparison to determine the cost-effectiveness of 177Lu-Dotatate in the treatment of GI-NETs and pancreatic NETs (P-NETs) in Scotland. Methods Cost-effectiveness analysis was performed from the payer perspective using a three-state partitioned survival model. In the base case 177Lu-Dotatate was compared with BSC in gastrointestinal (GI)-NETs using clinical data from the NETTER-1 trial. A secondary analysis comparing 177Lu-Dotatate with BSC, everolimus or sunitinib in patients with P-NETs was also performed using hazard ratios inferred from indirect comparisons. The base case analysis was performed over a 20-year time horizon with an annual discount rate of 3.5% for both costs and clinical outcomes. Results For unresectable/metastatic progressive GI-NETs treatment with 177Lu-Dotatate led to a gain in quality-adjusted life expectancy of 1.33 quality-adjusted life years (QALYs) compared with BSC due to extended PFS and OS. Mean total lifetime costs were GBP 35,701 higher with 177Lu-Dotatate, leading to an incremental cost-effectiveness ratio (ICER) of GBP 26,830 per QALY gained. In analyses in patients with P-NETs 177Lu-Dotatate was associated with ICERs below GBP 30,000 per QALY gained in comparisons with BSC, sunitinib and everolimus. Conclusions Cost-effectiveness analyses demonstrated that, in Scotland, from the payer perspective, 177Lu-Dotatate at the set acquisition cost is a cost-effective treatment option for patients with unresectable or metastatic progressive GI-NETs or P-NETs.

Download Full-text

Cost-Effectiveness Analysis of Adding Daratumumab to Bortezomib, Melphalan, and Prednisone for Untreated Multiple Myeloma

Frontiers in Pharmacology ◽

10.3389/fphar.2021.608685 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yaohua Cao ◽

Lina Zhao ◽

Tiantian Zhang ◽

Weiling Cao

Keyword(s):

Multiple Myeloma ◽

Cost Effectiveness ◽

Life Time ◽

Cost Effective ◽

Base Case ◽

Quality Adjusted Life Years ◽

Effectiveness Analysis ◽

Life Years ◽

The Cost ◽

Quality Adjusted Life

Background: To evaluate the cost-effectiveness of adding daratumumab to bortezomib, melphalan, and prednisone for transplant-ineligible newly diagnosed multiple myeloma patients.Methods: A three-state Markov model was developed from the perspective of US payers to simulate the disease development of patient’s life time for daratumumab plus bortezomib, melphalan, and prednisone (D-VMP) and bortezomib, melphalan, and prednisone (VMP) regimens. The primary outputs were total costs, expected life-years (LYs), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs).Results: The base case results showed that adding daratumumab to VMP provided an additional 3.00 Lys or 2.03 QALYs, at a cost of $262,526 per LY or $388,364 per QALY. Sensitivity analysis indicated that the results were most sensitive to utility of progression disease of D-VMP regimens, but no matter how these parameters changed, ICERs remained higher than $150,000 per QALY.Conclusion: In the case that the upper limit of willingness to pay threshold was $150,000 per QALY from the perspective of US payers, D-VMP was not a cost-effective regimen compared to VMP.

Download Full-text

The Option Value of Innovation

Forum for Health Economics & Policy ◽

10.1515/1558-9544.1306 ◽

2012 ◽

Vol 15 (2) ◽

Cited By ~ 3

Author(s):

Julia Thornton Snider ◽

John A. Romley ◽

William B. Vogt ◽

Tomas J. Philipson

Keyword(s):

Cost Effectiveness ◽

Adjuvant Treatment ◽

Cost Effectiveness Analysis ◽

Technological Advancement ◽

Option Value ◽

Quality Adjusted Life Years ◽

Effectiveness Analysis ◽

Standard Cost ◽

Life Years

Standard techniques of cost effectiveness analysis measure a technology’s benefits in terms of expected life years (or quality-adjusted life years) gained at today’s life expectancies. However, this approach ignores the gains which derive from the possibility that a health technology allows an individual to survive long enough to benefit from other technological innovations which raise life expectancy (and quality of life) in the future. Borrowing a term from the finance literature, we refer to this source of value as the “option value” of innovation. We explain where this value comes from and how to calculate it in a variety of standard cost effectiveness analysis contexts. We provide a proof-of-concept using the example of the drug tamoxifen, which delayed the onset of breast cancer for some patients until more effective adjuvant treatment was available. We find that incorporating option value can increase the conventionally estimated value of tamoxifen with better adjuvant treatment by nearly a quarter (from $200,000 to $248,000 for those who initiated tamoxifen in 1999). We expect similar results for other drugs in therapeutic areas of rapid technological advancement.

Download Full-text

The integrated care pathway for managing post stroke patients (iCaPPS©) in public primary care Healthcentres in Malaysia: impact on quality adjusted life years (QALYs) and cost effectiveness analysis

BMC Geriatrics ◽

10.1186/s12877-020-1453-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Aznida Firzah Abdul Aziz ◽

Nor Azlin Mohd Nordin ◽

Amrizal Muhd Nur ◽

Saperi Sulong ◽

Syed Mohamed Aljunid

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Integrated Care ◽

Care Pathway ◽

Quality Adjusted Life Years ◽

Stroke Patients ◽

Effectiveness Analysis ◽

Life Years ◽

Integrated Care Pathway ◽

Quality Adjusted Life

Download Full-text

Cost-effectiveness Analysis of Submandibular Gland Preservation With Sialendoscopy for the Management of Sialolithiasis

Otolaryngology ◽

10.1177/01945998211026847 ◽

2021 ◽

pp. 019459982110268

Author(s):

Joseph R. Acevedo ◽

Ashley C. Hsu ◽

Jeffrey C. Yu ◽

Dale H. Rice ◽

Daniel I. Kwon ◽

...

Keyword(s):

Cost Effectiveness ◽

Submandibular Gland ◽

Average Cost ◽

Cost Effective ◽

Cost Effectiveness Analysis ◽

Effectiveness Analysis ◽

Life Years ◽

Probability Of Success ◽

Markov Decision Model ◽

The Cost

Objective To compare the cost-effectiveness of sialendoscopy with gland excision for the management of submandibular gland sialolithiasis. Study Design Cost-effectiveness analysis. Setting Outpatient surgery centers. Methods A Markov decision model compared the cost-effectiveness of sialendoscopy versus gland excision for managing submandibular gland sialolithiasis. Surgical outcome probabilities were found in the primary literature. The quality of life of patients was represented by health utilities, and costs were estimated from a third-party payer’s perspective. The effectiveness of each intervention was measured in quality-adjusted life-years (QALYs). The incremental costs and effectiveness of each intervention were compared, and a willingness-to-pay ratio of $150,000 per QALY was considered cost-effective. One-way, multivariate, and probabilistic sensitivity analyses were performed to challenge model conclusions. Results Over 10 years, sialendoscopy yielded 9.00 QALYs at an average cost of $8306, while gland excision produced 8.94 QALYs at an average cost of $6103. The ICER for sialendoscopy was $36,717 per QALY gained, making sialendoscopy cost-effective by our best estimates. The model was sensitive to the probability of success and the cost of sialendoscopy. Sialendoscopy must meet a probability-of-success threshold of 0.61 (61%) and cost ≤$11,996 to remain cost-effective. A Monte Carlo simulation revealed sialendoscopy to be cost-effective 60% of the time. Conclusion Sialendoscopy appears to be a cost-effective management strategy for sialolithiasis of the submandibular gland when certain thresholds are maintained. Further studies elucidating the clinical factors that determine successful sialendoscopy may be aided by these thresholds as well as future comparisons of novel technology.

Download Full-text