scholarly journals Comparative clinical and economic evaluation of pharmacogenetic testing application for dabigatran in patients with atrial fibrillation

2019 ◽  
Vol 91 (8) ◽  
pp. 22-27
Author(s):  
Sh P Abdullaev ◽  
K B Mirzaev ◽  
D A Sychev
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Reactions ◽  
Standard Treatment ◽  
Cost Effective ◽  
Economic Feasibility ◽  
Pharmacogenetic Testing ◽  
Pharmacoeconomic Model ◽  
The Difference ◽  
The Cost ◽  
Ces1 Gene

Aim. To evaluate the clinical and economic feasibility of pharmacogenetic testing (PGT) for dabigataran etexilate administration in the treatment of atrial fibrillation (AF) without valve in comparison with tactics without pharmacogenetic testing. Materials and methods. The pharmacoeconomic model was done using generalized data from published clinical, epidemiological and clinical - economic studies. Results and discussion. Application of PGT on the carrier of allelic variant rs2244613 of CES1 gene for adjustment of dabigatrane etexilate dosage in patients with non - valve AF may be more cost - effective strategy for prevention of thromboembolic complications in patients with non - valve AF. Thus, due to the decrease in the number of undesirable drug reactions in the form of minor and major bleedings, the difference in treatment costs in the group with PGT compared to the group with standard pharmacotherapy tactics per 100 patients was 11 827.65 rubles. The expected cost per patient per year for standard treatment was 36 051.35 rubles, while in the group with PGT it was 35 933.07 rubles. The difference was 1182.76 rubles in favor of the pharmacogenetic approach Conclusion. A PGT approach to correct dabigatrane dosage can reduce the cost of pharmacotherapy by reducing the risk of adverse reactions of minor and major bleeding.

Are SSRIs a Cost-Effective Alternative to Tricyclics?

1996 ◽  
Vol 168 (4) ◽  
pp. 404-409 ◽  
Author(s):  
Matthew Hotopf ◽  
Glyn Lewis ◽  
Charles Normand
Keyword(s):  
Cost Effectiveness ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Cost Effective ◽  
Drop Out ◽  
Attrition Rates ◽  
The Difference ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
The Cost ◽  
Effectiveness Studies

BackgroundSelective serotonin reuptake inhibitors (SSRIs) are more expensive than tricyclics. Reports have suggested that SSRIs are cost-effective because they are better tolerated and safer in overdose.MethodA systematic review of all randomised controlled trials (RCTs), meta-analyses, and cost-effectiveness studies comparing SSRIs and tricyclic antidepressants (TCAs).ResultsNone of the RCTs provided an economic analysis and there were methodological problems in the majority which would preclude this approach. Meta-analyses suggest that clinical efficacy is equivalent but slightly fewer patients prescribed SSRIs drop out of RCTs. Cost-effectiveness studies have been based on crude ‘modelling’ approaches and over-estimate the difference in attrition rates and the cost of treatment failure. It appears impossible to evaluate the economic aspects of suicide because of its rarity.ConclusionsThere is no evidence to suggest that SSRIs are more cost-effective than TCAs. The debate will only be concluded when a prospective cost-effectiveness study is done in the setting of a large primary care based RCT.

Abstract 200: Cost-Effectiveness of Newer Anticoagulants for Stroke Prevention in Atrial Fibrillation

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Brendan L Limone ◽  
William L Baker ◽  
Craig I Coleman
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Stroke Prevention ◽  
Indirect Comparison ◽  
Cost Effective ◽  
The United States ◽  
Base Case ◽  
Treatment Comparison ◽  
Newer Anticoagulants ◽  
The Cost

Background: A number of new anticoagulants for stroke prevention in atrial fibrillation (SPAF) have gained regulatory approval or are in late-stage development. We sought to conduct a systematic review of economic models of dabigatran, rivaroxaban and apixaban for SPAF. Methods: We searched the Medline, Embase, National Health Service Economic Evaluation Database and Health Technology Assessment database along with the Tuft’s Registry through October 10, 2012. Included models assessed the cost-effectiveness of dabigatran (150mg, 110mg, sequential), rivaroxaban or apixaban for SPAF using a Markov model or discrete event simulation and were published in English. Results: Eighteen models were identified. All models utilized a lone randomized trial (or an indirect comparison utilizing a single study for any given direct comparison), and these trials were clinically and methodologically heterogeneous. Dabigatran 150mg was assessed in 9 of models, dabigatran 110mg in 8, sequential dabigatran in 9, rivaroxaban in 4 and apixaban in 4. Adjusted-dose warfarin (either trial-like, real-world prescribing or genotype-dosed) was a potential first-line therapy in 94% of models. Models were conducted from the perspective of the United States (44%), European countries (39%) and Canada (17%). In base-case analyses, patients typically were at moderate-risk of ischemic stroke, initiated anticoagulation between 65 and 73 years of age, and were followed for or near a lifetime. All models reported cost/quality-adjusted life-year (QALY) gained, and while 22% of models reported using a societal perspective, no model included costs of lost productivity. Four models reported an incremental cost-effectiveness ratio (ICER) for a newer anticoagulant (dabigatran 110mg (n=4)/150mg (n=2); rivaroxaban (n=1)) vs. warfarin above commonly reported willingness-to-pay thresholds. ICERs (in 2012US$) vs. warfarin ranged from $3,547-$86,000 for dabigatran 150mg, $20,713-$150,000 for dabigatran 110mg, $4,084-$21,466 for sequentially-dosed dabigatran and $23,065-$57,470 for rivaroxaban. In addition, apixaban was demonstrated to be an economically dominant strategy compared to aspirin and to be dominant or cost-effective ($11,400-$25,059) vs. warfarin. Based on separate indirect treatment comparison meta-analyses, 3 models compared the cost-effectiveness of these new agents and reported conflicting results. Conclusions: Cost-effectiveness models of newer anticoagulants for SPAF have been extensively published. Models have frequently found newer anticoagulants to be cost-effective, but due to the lack of head-to-head trial comparisons and heterogeneity in clinical characteristic of underlying trials and modeling methods, it is currently unclear which of these newer agents is most cost-effective.

scholarly journals Clinically Useful and Cost-Effective of Recombinant Human Thrombopoietin in Treatment of Chemotherapy Induced Thrombocytopenia

2020 ◽  
Author(s):  
Wenxian Wang ◽  
Yibing Xu ◽  
Lan Shao ◽  
Zhengbo Song ◽  
Yiping Zhang
Keyword(s):  
Malignant Tumors ◽  
Treatment Plan ◽  
Cost Effective ◽  
Blood Platelet ◽  
Chemotherapy Drugs ◽  
Hospitalization Period ◽  
Critical Organ ◽  
The Difference ◽  
The Cost ◽  
Recombinant Human Thrombopoietin

Abstract BackgroundThe bone marrow suppression during chemotherapy will cause severe platelet decline in the human body, resulting in critical organ hemorrhage and intracranial hemorrhage. Therefore, the efficacy and economics of recombinant human thrombopoietin (rhTPO) in treating different degrees of thrombocytopenia caused by chemotherapy were analyzed. MethodsFrom January 2018 to July 2019, 233 with diagnosed lung cancer treated with the course of chemotherapy or chemoradiotherapy were enrolled. After treatment with chemotherapy or chemoradiotherapy, they all happened thrombocytopenia and received rhTPO. We divided patients into three groups according to the level of platelet decline. Changes in blood platelet count, treatment plan and cost performance between them were analyzed. ResultsOf all the included patients, 39.5% was undergoing concurrent radiotherapy or chemotherapy; 42.9% had thrombocytopenia of grade II; 40.3% had thrombocytopenia of grade III; 16.7% had thrombocytopenia of grade IV; 52.8% postponed the next cycle of chemotherapy or radiotherapy due to platelet decline; 12.0% changed the treatment plan for malignant tumors due to severe platelet decline; 15.5% reduced the dose of chemotherapy drugs due to thrombocytopenia; 23.6% had platelet transfusions during this period. During the extended hospitalization period caused by thrombocytopenia, the medical expenses of patients would increase significantly, which was dominated by the cost of rhTPO. ConclusionsFor different degrees of thrombocytopenia, the treatment of rhTPO could increase platelet counts effectively. During the treatment, patients might have varying degrees of economic and the difference between the treatment duration of different patients.

scholarly journals Cost-Effectiveness Analysis of Direct Oral Anticoagulants Vs. Vitamin K Antagonists in the Elderly With Atrial Fibrillation: Insights From the Evidence in a Real-World Setting

2021 ◽  
Vol 8 ◽  
Author(s):  
Yue Wu ◽  
Chi Zhang ◽  
Zhi-Chun Gu
Keyword(s):  
Atrial Fibrillation ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Real World ◽  
Treatment Strategy ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cost Effective ◽  
The Cost

Background: In the clinical setting, the economic benefits of direct oral anticoagulants (DOACs) in elderly patients with atrial fibrillation (AF) remain unclear. This study aimed to estimate and compare the cost-effectiveness of DOACs (dabigatran, rivaroxaban, apixaban, and edoxaban) and vitamin K antagonists (VKAs; warfarin) in preventing stroke among AF patients aged >75 years in real-world practice.Methods: A Markov model with a 10-year span was constructed to estimate the long-term clinical and economic outcomes among AF patients aged >75 years treated with DOACs and warfarin. The study was populated with a hypothetical cohort of 10,000 AF patients aged >75 years. Probabilities of clinical outcomes were obtained from the pooled observational studies (OSs), comparing DOACs (dabigatran, rivaroxaban, apixaban, and edoxaban) with VKAs. Other model inputs, including the utilities and the costs, were all estimated from public sources and the published literature. The costs, quality-adjusted life-years (QAYLs), and incremental cost-effectiveness ratios (ICER) were estimated for each treatment strategy. Subgroup analyses of individual DOACs and the scenario analysis were performed. Uncertainty was evaluated by deterministic sensitivity analysis and probabilistic sensitivity analysis (PSA).Results: Compared to warfarin, DOACs were associated with a gain of 0.36 QALY at an additional cost of $15,234.65, resulting in an ICER of $42,318.47 per QALY. Sensitivity analysis revealed that the ICER was sensitive to the cost of DOACs. Direct oral anticoagulants also shifted from dominating to dominated status When their annual costs of DOACs were over $3,802.84 or the risk ratio of death compared to warfarin was over 1.077%/year. Probabilistic sensitivity analysis (PSA) suggested that DOACs had a 53.83 and 90.7% probability of being cost-effective when the willingness-to-pay threshold was set at $50,000 and $100,000, respectively. Among all the four individual DOACs, edoxaban treatment was revealed as the preferred treatment strategy for the AF patients aged over 75 years by yielding the most significant health gain with the relatively low total cost.Conclusions: Despite the high risk for major bleeding in elderly patients with AF, DOACs are more cost-effective treatment options than warfarin in real-world practice. Edoxaban was the preferred treatment strategy among four kinds of DOACs for AF patients aged over 75 years. Furthermore, beyond their safety profiles, the treatment benefits of DOACs assumed greater relevance and importance in older adults.

Home-based versus hospital-based care for serious mental illness

1998 ◽  
Vol 172 (6) ◽  
pp. 506-512 ◽  
Author(s):  
Martin R. J. Knapp ◽  
Isaac M. Marks ◽  
Jane Wolstenholme ◽  
Jennifer K. Beecham ◽  
Jack Astin ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Standard Care ◽  
Cost Effective ◽  
Controlled Study ◽  
Sample Attrition ◽  
Home Based ◽  
The Difference ◽  
Randomised Controlled ◽  
The Cost ◽  
Home Based Care

BackgroundThe Daily Living Programme (DLP) offered intensive home-based care with problem-centred case management for seriously mentally ill people facing crisis admission to the Maudsley Hospital, London. The cost-effectiveness of the DLP was examined over four years.MethodA randomised controlled study examined cost-effectiveness of DLP versus standard in/out-patient hospital care over 20 months, followed by a randomised controlled withdrawal of half the DLP patients into standard care. Three patient groups were compared over 45 months: DLP throughout the period, DLP for 20 months followed by standard care, and standard care throughout. Bivariate and multivariate analyses were conducted (the latter to standardise for possible inter-sample differences stemming from sample attrition and to explore sources of within-sample variation).ResultsThe DLP was more cost-effective than control care over months 1–20, and also over the full 45-month period, but the difference between groups may have disappeared by the end of month 45.ConclusionsThe reduction of the cost-effectiveness advantage for home-based care was perhaps partly due to the attenuation of DLP care, although sample attrition left some comparisons under-powered.

scholarly journals Cost-effectiveness of relapse-prevention cognitive therapy for bipolar disorder: 30-month study

2005 ◽  
Vol 186 (6) ◽  
pp. 500-506 ◽  
Author(s):  
Dominic H. Lam ◽  
Paul McCrone ◽  
Kim Wright ◽  
Natalie Kerr
Keyword(s):  
Bipolar Disorder ◽  
Cost Effectiveness ◽  
Clinical Outcome ◽  
Cognitive Therapy ◽  
Service Use ◽  
Standard Treatment ◽  
Cost Effective ◽  
Net Benefit ◽  
Frequent Relapses ◽  
The Cost

BackgroundWe have reported the advantageous clinical outcome of adding cognitive therapy to medication in the prevention of relapse of bipolar disorder.AimsThis 30-month study compares the cost-effectiveness of cognitive therapy with standard care.MethodWe randomly allocated 103 individuals with bipolar 1 disorder to standard treatment and cognitive therapy plus standard treatment. Service use and costs were measured at 3-month intervals and cost-effectiveness was assessed using the net-benefit approach.ResultsThe group receiving cognitive therapy had significantly better clinical outcomes. The extra costs were offset by reduced service use elsewhere. The probability of cognitive therapy being cost-effective was high and robust to different therapy prices.ConclusionsCombination of cognitive therapy and mood stabilisers was superior to mood stabilisers alone in terms of clinical outcome and cost-effectiveness for those with frequent relapses of bipolar disorder.

Cost-effective analysis of conventional and nurse-led clinics for common otological procedures

2004 ◽  
Vol 118 (3) ◽  
pp. 189-192 ◽  
Author(s):  
S. Uppal ◽  
J. Jose ◽  
P. Banks ◽  
E. Mackay ◽  
A. P. Coatesworth
Keyword(s):  
Cost Effective ◽  
Access Time ◽  
Patient Visit ◽  
Complex Patients ◽  
The Difference ◽  
The Cost ◽  
Mean Cost ◽  
Effective Health Care ◽  
Effective Analysis

The need to reduce costs while providing a first-class service has led to the expansion in the role of nurses in recent years. We present results of a comparison of the cost-effectiveness of conventional and nurse-led out-patient ear clinics. Our results indicate that cost-effective health care is a distinct competitive advantage for nurses taking up some roles conventionally performed by doctors. The difference in mean cost of out-patient visit per patient between the two groups is £75.28. This is equivalent to a reduction in cost to the hospital of more than £47000 for the 626 patients seen in a nurse-led ear clinic in a year. The nurse-led service is thus more cost-effective and presents an opportunity by freeing up otolaryngologists’ time to see more complex patients and has the potential for reducing out-patient access time in the NHS.

Abstract 16741: The Cost-Effectiveness of Apixaban versus Warfarin in Patients With Atrial Fibrillation: Insights From the ARISTOTLE Study Group

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Patricia A Cowper ◽  
Shubin Sheng ◽  
Kevin J Anstrom ◽  
Judith A Stafford ◽  
Renato D Lopes ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Life Expectancy ◽  
Linear Models ◽  
Cox Model ◽  
Study Drug ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
The Us ◽  
The Cost

Background: In Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE), apixaban (vs. warfarin) significantly reduced stroke, death, and major bleeding in 18,201 patients with atrial fibrillation (AF). We assessed the cost-effectiveness of apixaban vs. warfarin from the perspective of the US health care system. Methods: Resource use (service dates, intensive care days, days on drug) was obtained from ARISTOTLE case report forms. Unit costs for components of hospital-based care of AF patients were estimated with generalized linear models using the national Premier database. Daily cost of anticoagulants was based on current acquisition cost (apixaban=$9.49; warfarin=$0.09) for 10 years, after which time apixaban was valued at projected costs of generic substitutes ($1.89). Physician services and anticoagulant monitoring were valued using Medicare fees. Within-trial costs were estimated using inverse probability weighting for differential follow-up. Survival was modeled with patient-level ARISTOTLE data using a two stage approach that combined a time-based Cox model for the within-trial period and an age-based Cox model for extrapolation. Uncertainty surrounding estimates of cost, life expectancy and cost/per life year gained was characterized with bootstraps and sensitivity analyses. Results: After 2 years, costs in the US cohort (n=3417) excluding study drug and monitoring averaged $306 less with apixaban than warfarin ($6257 vs. $6563). This difference was more than offset by higher apixaban anticoagulation costs ($6160 vs. $1181), resulting in an overall increase of $4673/patient. Over a lifetime, gains in life expectancy with apixaban (9.92 vs. 9.69; p<.001) were achieved at an additional cost of $17,564 ($29,447 vs. $11,883; p<.001), yielding a cost-effectiveness ratio (ICER) of $76,365/life year gained (85% likelihood of meeting $110,000 willingness to pay threshold). Cost-effectiveness was most sensitive to cost of apixaban. Conclusions: Reductions in mortality, stroke, and bleeding observed in ARISTOTLE translate to significant increases in life expectancy. At an estimated ICER of $76,365/life year gained, apixaban is a cost-effective alternative to warfarin.

The Economics of Seismic Isolation in Buildings

1990 ◽  
Vol 6 (2) ◽  
pp. 245-263 ◽  
Author(s):  
Ronald L. Mayes ◽  
Lindsay R. Jones ◽  
Trevor E. Kelly
Keyword(s):  
Seismic Isolation ◽  
Economic Feasibility ◽  
Construction Costs ◽  
Physical Damage ◽  
Earthquake Insurance ◽  
Construction Techniques ◽  
Key Issues ◽  
The Difference ◽  
The Cost ◽  
Cost Studies

Seismic isolation is a design technique that offers significant benefits in appropriate applications, and interest in its application continues to grow. The two key issues that must be addressed early in the design phase of a project are the technical and economic feasibility issues. This paper focuses on the economic issues, and discusses the four principal cost factors that should be evaluated. These being construction costs, earthquake insurance premiums, physical damage that must be repaired and disruption costs, loss of market share and potential liability. The paper includes a summary of first cost studies on both new and existing buildings. It also discusses methods of estimating the difference in the cost of earthquake damage using different construction techniques.

scholarly journals Effectiveness and cost-effectiveness analysis of nimotuzumab for the radiotherapy of locoregionally advanced nasopharyngeal carcinoma

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Zhaodong Fei ◽  
Ting Xu ◽  
Mengying Li ◽  
Taojun Chen ◽  
Li Li ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Nasopharyngeal Carcinoma ◽  
Concurrent Chemoradiotherapy ◽  
Standard Treatment ◽  
Prognostic Significance ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Significant Survival ◽  
The Cost

Abstract Background This study aimed to assess the effectiveness and cost-effectiveness of nimotuzumab in patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC). Methods LA-NPC patients treated between October 2013 and December 2016 were retrospectively reviewed. A well-balanced cohort of patients who received nimotuzumab in addition to standard treatment (n = 50) and patients who did not receive nimotuzumab (n = 100) was selected using propensity score-matching method (1:2 ratio) for the cost-effectiveness analysis. Results Compared with concurrent chemoradiotherapy (CCRT) alone, addition of nimotuzumab to CCRT significantly improved the 3-year overall survival (OS) (98.00% vs. 91.00%, P = 0.032). On multivariate analysis, nimotuzumab (hazard ratio = 0.124, 95% confidence interval: 0.017–0.902, P = 0.039) showed prognostic significance for OS. No serious treatment-related adverse events were observed in the nimotuzumab group (P > 0.05). Cost-effectiveness analysis revealed that addition of nimotuzumab increased the average treatment costs by $14,364.63. The additional cost for every one percent increase in OS rate was $ 2,052.09. Conclusion Addition of nimotuzumab to CCRT for LA-NPC confers significant survival benefits; however, it is not cost-effective.

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