Health impact and economic analysis of NGO-supported neurosurgery in Bolivia

2014 ◽  
Vol 20 (4) ◽  
pp. 436-442 ◽  
Author(s):  
Jared D. Ament ◽  
Kevin R. Greene ◽  
Ivan Flores ◽  
Fernando Capobianco ◽  
Gueider Salas ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Spinal Instrumentation ◽  
Cost Effective ◽  
Health Impact ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Direct Care ◽  
Health Concern ◽  
Discounted Cost

Object Bolivia, one of the poorest countries in the world, ranks 108th on the 2013 Human Development Index. With approximately 1 neurosurgeon per 200,000 people, access to neurosurgery in Bolivia is a growing health concern. Furthermore, neurosurgery in nonindustrialized countries has been considered both cost-prohibitive and lacking in outcomes evaluation. A non-governmental organization (NGO) supports spinal procedures in Bolivia (Solidarity Bridge), and the authors sought to determine its impact and cost-effectiveness. Methods In a retrospective review of prospectively collected data, 19 patients were identified prior to spinal instrumentation and followed over 12 months. For inclusion, patients required interviewing prior to surgery and during at least 2 follow-up visits. All causes of spinal pathology were included. Sixteen patients met inclusion criteria and were therefore part of the analysis. Outcomes measured included assessment of activities of daily living, pain, ambulation, return to work/school, and satisfaction. Cost-effectiveness was determined by cost-utility analysis. Utilities were derived using the Health Utilities Index. Complications were incorporated into an expected value decision tree. Results Median (± SD) preoperative satisfaction was 2.0 ± 0.3 (on a scale of 0–10), while 6-month postoperative satisfaction was 7 ± 1.4 (p < 0.0001). Ambulation, pain, and emotional disability data suggested marked improvement (56%, 69%, and 63%, respectively; p = 0.035, 0.003, and 0.006). Total discounted incremental quality-adjusted life year (QALY) gain was 0.771. The total discounted cost equaled $9036 (95% CI $8561–$10,740) at 2 years. Computing the incremental cost-effectiveness ratio resulted in a value of $11,720/QALY, ranging from $9220 to $15,473/QALY in a univariate sensitivity analysis. Conclusions This NGO-supported spinal instrumentation program in Bolivia appears to be cost-effective, especially when compared with the conventional $50,000/QALY benchmark and the WHO endorsed country-specific threshold of $16,026/QALY. However, with a gross domestic product per capita in Bolivia equaling $4800 per year and 30.3% of the population living on less than $2 per day, this cost continues to appear unrealistic. Additionally, the study has several significant limitations, namely its limited sample size, follow-up period, the assumption that patients not receiving surgical intervention would not make any clinical improvement, the reliance on the NGO for patient selection and sustainable practices such as follow-up care and ancillary services, and the lack of a randomized prospective design. These limitations, as well as an unclear understanding of Bolivian willingness-to-pay data, affect the generalizability of the study findings and impede widespread economic policy reform. Because cost-effectiveness research may inevitably direct care decisions and prove that an effort such as this can be cost saving, a prospective, properly controlled investigation is now warranted.

scholarly journals A one-year cost–utility analysis of REBOA versus RTACC for non-compressible torso haemorrhage

Trauma ◽  
2017 ◽  
Vol 21 (1) ◽  
pp. 45-54 ◽  
Author(s):  
Maxwell S Renna ◽  
Cristiano van Zeller ◽  
Farah Abu-Hijleh ◽  
Cherlyn Tong ◽  
Jasmine Gambini ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Cost Effectiveness Ratio ◽  
One Year ◽  
Quality Adjusted Life

Introduction Major trauma is a leading cause of death and disability in young adults, especially from massive non-compressible torso haemorrhage. The standard technique to control distal haemorrhage and maximise central perfusion is resuscitative thoracotomy with aortic cross-clamping (RTACC). More recently, the minimally invasive technique of resuscitative endovascular balloon occlusion of the aorta (REBOA) has been developed to similarly limit distal haemorrhage without the morbidity of thoracotomy; cost–utility studies on this intervention, however, are still lacking. The aim of this study was to perform a one-year cost–utility analysis of REBOA as an intervention for patients with major traumatic non-compressible abdominal haemorrhage, compared to RTACC within the U.K.’s National Health Service. Methods A retrospective analysis of the outcomes following REBOA and RTACC was conducted based on the published literature of survival and complication rates after intervention. Utility was obtained from studies that used the EQ-5D index and from self-conducted surveys. Costs were calculated using 2016/2017 National Health Service tariff data and supplemented from further literature. A cost–utility analysis was then conducted. Results A total of 12 studies for REBOA and 20 studies for RTACC were included. The mean injury severity scores for RTACC and REBOA were 34 and 39, and mean probability of death was 9.7 and 54%, respectively. The incremental cost-effectiveness ratio of REBOA when compared to RTACC was £44,617.44 per quality-adjusted life year. The incremental cost-effectiveness ratio, by exceeding the National Institute for Health and Clinical Effectiveness’s willingness-to-pay threshold of £30,000/quality-adjusted life year, suggests that this intervention is not cost-effective in comparison to RTACC. However, REBOA yielded a 157% improvement in utility with a comparatively small cost increase of 31.5%. Conclusion Although REBOA has not been found to be cost-effective when compared to RTACC, ultimately, clinical experience and expertise should be the main factor in driving the decision over which intervention to prioritise in the emergency context.

scholarly journals Cost-Effectiveness in Adult Spinal Deformity Surgery

Neurosurgery ◽  
2018 ◽  
Vol 83 (4) ◽  
pp. 597-601 ◽  
Author(s):  
Grigoriy G Arutyunyan ◽  
Peter D Angevine ◽  
Sigurd Berven
Keyword(s):  
Cost Effectiveness ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Cost Effective ◽  
Treatment Method ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Spine Deformity ◽  
Healthcare Provision ◽  
Economic Analyses

Abstract The complexity and heterogeneity of adult spinal deformity (ASD) creates significant difficulties in performing high-quality, complete economic analyses. For the same reasons, however, such studies are immensely valuable to clinicians and health policy experts. There has been a paradigm shift towards value-based healthcare provision and as such, there is an increasing focus on demonstrating not just the value ASD surgery, but the provision of care at large. Health-related quality of life measures are an important tool for assessing value of an intervention and its effect on a quality-adjusted life year (QALY). Currently, there are no definitive criteria in regard to assigning the appropriate value to a QALY. A general accepted threshold discussed in literature is $100 000 per QALY gained. However, this figure may be variable across populations, and may not necessarily be applicable in today's economy, or in all healthcare economies. Fundamentally, an effective treatment method may be associated with a high upfront cost, however, if durable, will be cost-effective over time. The emphasis on cost-effectiveness and cost-utility analysis in the field of adult spine deformity is relatively recent; therefore, there is a limited amount of data on cost-effectiveness analyses. Continued efforts with emphasis on value-based outcomes are needed with long-term follow-up studies.

scholarly journals 1-year cost-utility analysis of prostate artery embolization (PAE) versus transurethral resection of the prostate (TURP) in benign prostatic hyperplasia (BPH)

2021 ◽  
Vol 3 (1) ◽  
pp. e000071
Author(s):  
Nikisha Patel ◽  
Nathan Yung ◽  
Ganesh Vigneswaran ◽  
Laure de Preux ◽  
Drew Maclean ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Artery Embolization ◽  
Prostate Artery Embolization ◽  
Cost Effective Alternative ◽  
The Cost

ObjectiveTo determine whether prostate artery embolization (PAE) is a cost-effective alternative to transurethral resection of the prostate (TURP) in the management of benign prostate hyperplasia (BPH) after 1-year follow-up.Design, setting and main outcome measuresA retrospective cost-utility analysis over a 12-month time period was conducted to compare the two interventions from a National Health Service perspective. Effectiveness was measured as quality-adjusted life years (QALYs) derived from data collected during the observational UK Register of Prostate Embolisation (UK-ROPE) Study. Costs for both PAE and TURP were derived from University Hospital Southampton, a tertiary referral centre for BPH and the largest contributor to the UK-ROPE. An incremental cost-effectiveness ratio (ICER) was derived from cost and QALY values associated with both interventions to assess the cost-effectiveness of PAE versus TURP. Further sensitivity analyses involved a decision tree model to account for the impact of patient-reported complications on the cost-effectiveness of the interventions.ResultsThe mean patient age for TURP (n=31) and PAE (n=133) was 69 and 65.6 years, respectively. In comparison to TURP, PAE was cheaper due to shorter patient stays and the lack of necessity for an operating theatre. Analysis revealed an ICER of £64 798.10 saved per QALY lost when comparing PAE to TURP after 1-year follow-up.ConclusionOur findings suggest that PAE is initially a cost-effective alternative to TURP for the management of BPH after 1-year follow-up. Due to a higher reintervention rate in the PAE group, this benefit may be lost in subsequent years.Trial registration numberNCT02434575.

scholarly journals The impact and cost-effectiveness of 9-valent human papillomavirus vaccine in adolescent females in Hong Kong

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Tak Hong Cheung ◽  
Sally Shuk Yee Cheng ◽  
Danny C. Hsu ◽  
Queenie Wing-Lei Wong ◽  
Andrew Pavelyev ◽  
...  
Keyword(s):  
Hong Kong ◽  
Human Papillomavirus ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effective ◽  
Health Impact ◽  
Quality Adjusted Life Year ◽  
Catch Up ◽  
Coverage Rates ◽  
Quality Adjusted Life

Abstract Introduction In Hong Kong (HK), a single-cohort vaccination program for 10–12-year-old girls with the 9-valent human papillomavirus (HPV) vaccine (9vHPV; types 6/11/16/18/31/33/45/52/58) has been launched. This study assessed the public health impact and cost-effectiveness of implementing routine 9vHPV vaccination (12-year-olds) with or without catch-up 9vHPV vaccination (13–18-year-olds) in HK. Methods The health impact and costs of implementing routine 9vHPV vaccination with or without catch-up vaccination over a 100-year time horizon were evaluated using a validated HPV-type transmission dynamic model adapted to the HK population; analyses were performed from a healthcare payer perspective. Routine vaccination (12-year-old girls) and catch-up vaccination (13–18 years) assumed vaccine coverage rates of 70% (base case) and 30%, respectively. The model also assumed herd immunity, lifelong vaccine protection, a discount rate of 3%, and a cost per dose of HK dollars (HKD) 858 [United States dollars (USD) 110] and HKD 1390 (USD 179) for the 2-valent HPV (2vHPV) and 9vHPV vaccines, respectively. HPV disease-related incidence and the incremental cost-effectiveness ratio (ICER) per quality-adjusted-life-year (QALY) were estimated. Cost-effectiveness was determined at a ceiling threshold of HK dollars (HKD) 382,046 (USD 49,142) or 1.0 times the gross domestic product per capita of HK. Results Compared with routine 9vHPV alone, routine plus catch-up 9vHPV is projected to reduce cervical cancer incidence by 3.4%. Routine plus catch-up 9vHPV will also reduce genital warts incident cases for males/females by 2.6%/5.4%. The incremental cost-effectiveness ratios were HKD 29,911 (USD 3847)/quality-adjusted life-year (QALY) for routine plus catch-up 9vHPV versus routine 9vHPV alone and HKD 25,524 (USD 3283)/QALY for routine 9vHPV alone versus screening only. Sensitivity analyses indicated that routine plus catch-up 9vHPV compared with routine 9vHPV alone remained cost-effective at coverage rates of 30% and 90%. Conclusions This analysis predicts that the current HK vaccination strategy can be considered cost-effective and will provide maximum health benefit. These results support addition of the routine 9vHPV vaccine with or without catch-up 9vHPV vaccination to the regional vaccination program in HK.

Preventive Antibiotics in Stroke Study (PASS)

Neurology ◽  
2018 ◽  
Vol 90 (18) ◽  
pp. e1553-e1560 ◽  
Author(s):  
Willeke F. Westendorp ◽  
Elles Zock ◽  
Jan-Dirk Vermeij ◽  
Henk Kerkhoff ◽  
Paul J. Nederkoorn ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Acute Stroke ◽  
Resource Use ◽  
Institutional Care ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Control Group ◽  
Open Label ◽  
The Cost

ObjectiveTo evaluate the cost-effectiveness of preventive ceftriaxone vs standard stroke unit care without preventive antimicrobial therapy in acute stroke patients.MethodsIn this multicenter, randomized, open-label trial with masked endpoint assessment, 2,550 patients with acute stroke were included between 2010 and 2014. Economic evaluation was performed from a societal perspective with a time horizon of 3 months. Volumes and costs of direct, indirect, medical, and nonmedical care were assessed. Primary outcome was cost per unit of the modified Rankin Scale (mRS) and per quality-adjusted life year (QALY) for cost-effectiveness and cost-utility analysis. Incremental cost-effectiveness analyses were performed.ResultsA total of 2,538 patients were available for the intention-to-treat analysis. For the cost-effectiveness analysis, 2,538 patients were available for in-hospital resource use and 1,453 for other resource use. Use of institutional care resources, out-of-pocket expenses, and productivity losses was comparable between treatment groups. The mean score on mRS was 2.38 (95% confidence interval [CI] 2.31–2.44) vs 2.44 (95% CI 2.37–2.51) in the ceftriaxone vs control group, the decrease by 0.06 (95% CI −0.04 to 0.16) in favor of ceftriaxone treatment being nonsignificant. However, the number of QALYs was 0.163 (95% CI 0.159–0.166) vs 0.155 (95% CI 0.152–0.158) in the ceftriaxone vs control group, with the difference of 0.008 (95% CI 0.003–0.012) in favor of ceftriaxone (p = 0.006) at 3 months. The probability of ceftriaxone being cost-effective ranged between 0.67 and 0.89. Probability of 0.75 was attained at a willing-to-pay level of €2,290 per unit decrease in the mRS score and of €12,200 per QALY.ConclusionsPreventive ceftriaxone has a probability of 0.7 of being less costly than standard treatment per unit decrease in mRS and per QALY gained.

The cost-utility of a care coordination/home telehealth programme for veterans with diabetes

2007 ◽  
Vol 13 (6) ◽  
pp. 318-321 ◽  
Author(s):  
Tracey E Barnett ◽  
Neale R Chumbler ◽  
W Bruce Vogel ◽  
Rebecca J Beyth ◽  
Patricia Ryan ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Care Coordination ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Home Telehealth ◽  
Before And After ◽  
Related Quality ◽  
Health Related ◽  
The Cost

We examined the cost-effectiveness of a care coordination/home telehealth (CCHT) programme for veterans with diabetes. We conducted a retrospective, pre-post study which compared data for a cohort of veterans ( n=370) before and after the introduction of the CCHT programme for two periods of 12 months. To assess the cost-effectiveness, we converted the patients' health-related quality of life data into Quality Adjusted Life Year (QALY) utility scores and used costs to construct incremental cost-effectiveness ratios (ICERs). The overall mean ICER for the programme at one-year was &dollar;60,941, a value within the commonly-cited range of cost-effectiveness of &dollar;50,000&ndash;100,000. The programme was cost-effective for one-third of the participants. Characteristics that contributed to cost-effectiveness were marital status, location and clinically relevant co-morbidities. By targeting the intervention differently in future work, it may become cost-effective for a greater proportion of patients.

Abstract WMP5: Clinical and Cost Effectiveness of Rapid Recanalization within 6 Hours Performed by Intraarterial Thrombectomy for Acute Ischemic Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Hye Seon Jeong ◽  
Hee Seon Yu ◽  
Na Young Yoon ◽  
Hae Mi Lee ◽  
Jong Wook Shin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cost Effectiveness ◽  
Acute Ischemic Stroke ◽  
Cost Effective ◽  
Medical Costs ◽  
Functional Independence ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Functional Improvement ◽  
Stroke Patients

Introduction: Rapid recanalization using intraarterial thrombectomy (IAT) is recommended to achieve rapid functional improvement and to shorten admission and rehabilitation period for acute ischemic stroke patients. We evaluated clinical and cost effectiveness of rapid recanalization within 6 hours by comparison with recanalization over 6 hours and no-recanalization of the occluded vessels in acute ischemic stroke patients. Methods: We analyzed clinical outcomes and medical costs of 230 acute ischemic stroke patients, who received IAT from October 2010 to May 2015. Patients were classified into rapid- (<6 hrs, n=143) and late- (> 6hrs, n=31) recanalization (≥2b or 3 of Thrombolysis in Cerebral Infarction grade [TICI]), and no-recanalization (TICI ≤2a, n=56) groups by the recanalization status after IAT. Differences of functional independence defined as 0-2 modified Rankin Score and medical costs checked at discharge and 1 year after IAT were compared between three groups. We also evaluated quality-adjusted life year (QALY) using EQ-5D 3 level version at 1 year after IAT and compared mortality and cost-effectiveness differences between the groups using QALY. Results: Functional independence was significantly higher in rapid-recanalization group than others at discharge (rapid-, 57%, vs. late-, 23% vs. no-recanalization, 0%, p <0.001) and after 1 year (70% vs. 40% vs. 6%, p <0.001). QALY (0.71±0.41 vs. 0.52±0.45 vs. 0.15±0.34, p <0.001) checked at 1 year was also higher in rapid-recanalization group than the others. Instead, one year mortality was lower in rapid-group than the others (10% vs. 17% vs. 43%, p <0.001). Medical cost of rapid-recanalization group was lower than other two groups at discharge ($9515 vs. $12711 vs. $12460, p <0.001) and after 1 year ($16753 vs. $21957 vs. $30718, p <0.001). On QALY adjusted cost-utility analysis, rapid-recanalization after IAT was more cost effective than late- ($27389/QALY) and no-recanalization ($51059/QALY) for acute ischemic stroke patients. Conclusions: The present data showed the importance of rapid recanalization within 6 hrs of acute ischemic stroke patients using IAT to reduce economic burden by the enhancement of functional outcomes during admission and after discharge.

Cost-effectiveness of a lifestyle intervention in preventing Type 2 diabetes

2011 ◽  
Vol 27 (4) ◽  
pp. 275-282 ◽  
Author(s):  
Lisa Irvine ◽  
Garry R. Barton ◽  
Amy V. Gasper ◽  
Nikki Murray ◽  
Allan Clark ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effective ◽  
Large Degree ◽  
Quality Adjusted Life Year ◽  
Develop Type ◽  
Intervention Costs

Objectives: Previous research has suggested people with impaired fasting glucose (IFG) are less likely to develop Type 2 diabetes (T2DM) if they receive prolonged structured diet and exercise advice. This study examined the within-trial cost-effectiveness of such lifestyle interventions.Methods: Screen-detected participants with either newly diagnosed T2DM or IFG were randomized 2:1 to intervention versus control (usual care) between February and December 2009, in Norfolk (UK). The intervention consisted of group based education, physiotherapy and peer support sessions, plus telephone contacts from T2DM volunteers. We monitored healthcare resource use, intervention costs, and quality of life (EQ-5D). The incremental cost per quality-adjusted life-year (QALY) gain (incremental cost effectiveness ratio [ICER]), and cost effectiveness acceptability curves (CEAC) were estimated.Results: In total, 177 participants were recruited (118 intervention, 59 controls), with a mean follow-up of 7 months. Excluding screening and recruitment costs, the mean cost was estimated to be £551 per participant in the intervention arm, compared with £325 in the control arm. The QALY gains were –0.001 and –0.004, respectively. The intervention was estimated to have an ICER of £67,184 per QALY (16 percent probability of being cost-effective at the £20,000/QALY threshold). Cost-effectiveness estimates were more favorable for IFG participants and those with longer follow-up (≥4 months) (ICERs of £20,620 and £17,075 per QALY, respectively).Conclusions: Group sessions to prevent T2DM were not estimated to be within current limits of cost-effectiveness. However, there was a large degree of uncertainty surrounding these estimates, suggesting the need for further research.

scholarly journals Epidemiological impact and cost-effectiveness of varicella vaccination strategies in the United Kingdom (UK)

2020 ◽  
Author(s):  
E I Hervé Akpo ◽  
Olivier Cristeau ◽  
Manjit Hunjan ◽  
Giacomo Casabona
Keyword(s):  
United Kingdom ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Varicella Vaccination ◽  
Lifetime Horizon ◽  
The United Kingdom ◽  
The Uk ◽  
The Impact

Abstract Background Despite the burden of varicella, there is no universal varicella vaccination (UVV) programme in the United Kingdom (UK) due to concerns this could increase herpes zoster (HZ) incidence. This study assessed the cost-utility of a first-dose monovalent (V) or quadrivalent (MMRV) followed by a second-dose quadrivalent (MMRV) UVV programmes. GSK and MSD varicella-containing vaccines (VCVs) were considered. Methods A dynamic transmission and cost-effectiveness models were adapted to the UK. Outcomes measured included varicella and HZ incidences, the incremental cost-utility ratio (ICURs) over a lifetime horizon. The payer and societal perspectives were evaluated. Results The impact of V-MMRV and MMRV-MMRV UVV programmes on varicella incidence was comparable between both VCVs at equilibrium. HZ incidence increased by 1.6%-1.7% over seven years after UVV start, regardless of the strategies, then decreased by &gt;95% at equilibrium. ICURs ranged from £5,665 (100 years) to £18,513 (20 years) per quality-adjusted life year (QALY) gained with V-MMRV; and from £9,220 to £27,101 per QALY gained with MMRV-MMRV (payer perspective). MMRV-MMRV was cost-effective in medium- and long-terms with GSK VCV, and only cost-effective at long-term with MSD VCV at £20,000 per QALY gained threshold. Without the exogenous boosting hypothesis, HZ incidence decreased through UVV implementation. ICURs were most sensitive to discount rates and MMRV price. Conclusions A 2-dose UVV was demonstrated to be a cost-effective alternative to no vaccination. With comparable effectiveness as MSD VCV at lower costs, GSK VCV may offer higher value for money.

scholarly journals Cost utility of behavioural activation delivered by the non-specialist

2011 ◽  
Vol 199 (6) ◽  
pp. 510-511 ◽  
Author(s):  
David Ekers ◽  
Christine Godfrey ◽  
Simon Gilbody ◽  
Steve Parrott ◽  
David A. Richards ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Controlled Trial ◽  
Cost Effective ◽  
Threshold Value ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Behavioural Activation ◽  
Treatment As Usual ◽  
Intention To Treat

SummaryBehavioural activation by non-specialists appears effective in the treatment of depression. We examined incremental cost-effectiveness of behavioural activation (n = 24) v. treatment as usual (n = 23) in a randomised controlled trial. Intention-to-treat analyses indicated a quality-adjusted life-year (QALY) difference in favour of behavioural activation of 0.20 (95% CI 0.01–0.39, P = 0.042), incremental cost-effectiveness ratio of £5756 per QALY and a 97% probability that behavioural activation is more cost-effective at a threshold value of £20 000. Results are promising for dissemination of behavioural activation but require replication in a larger study.

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