When Is Carotid Angioplasty and Stenting the Cost-Effective Alternative for Revascularization of Symptomatic Carotid Stenosis? A Canadian Health System Perspective

Aim: Concerns for fatal severe cutaneous adverse reactions (SCARs) hamper allopurinol use. Methods and material: We adopted a health system perspective to evaluate the cost–effectiveness of HLA-B*58:01 genotyping before allopurinol initiation. A decision tree compared three treatment strategies in gout patients with chronic kidney disease who have higher risk for SCAR. They were standard allopurinol treatment followed by febuxostat in nonresponders, test-positive patients receive febuxostat while test-negative receive allopurinol and universal use of febuxostat. Results: The first strategy was the most cost effective. Genotyping dominated universal febuxostat use. Time horizon and SCAR incidence were the most influential factors on the incremental cost–effectiveness ratio. Conclusion: HLA-B*58:01 genotyping compared with standard allopurinol–febuxostat sequential treatment does not provide good value for money in gout with chronic kidney disease.

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Carotid Angioplasty and Stenting in High-Risk Patients With Severe Symptomatic Carotid Stenosis

Stroke ◽

10.1161/01.str.0000065106.12772.29 ◽

2003 ◽

Vol 34 (4) ◽

pp. 834-835 ◽

Cited By ~ 3

Author(s):

Enzo Ballotta ◽

Giuseppe Da Giau ◽

Claudio Baracchini

Keyword(s):

High Risk ◽

Carotid Stenosis ◽

Carotid Angioplasty ◽

Symptomatic Carotid ◽

High Risk Patients ◽

Symptomatic Carotid Stenosis ◽

Risk Patients ◽

Angioplasty And Stenting ◽

Carotid Angioplasty And Stenting

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OP0198-HPR A STRUCTURED MODEL FOR OA CARE IN PRIMARY HEALTHCARE IS A COST-EFFECTIVE ALTERNATIVE COMPARED TO USUAL CARE FOR PEOPLE WITH HIP AND KNEE OA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.950 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 119-120

Author(s):

N. Østerås ◽

E. Aas ◽

T. Moseng ◽

L. Van Bodegom-Vos ◽

K. Dziedzic ◽

...

Keyword(s):

Usual Care ◽

Primary Healthcare ◽

Intervention Group ◽

Cost Effective ◽

Cost Utility ◽

Control Group ◽

Structured Model ◽

Knee Oa ◽

Cost Effective Alternative ◽

The Cost

Background:To improve quality of care for patients with hip and knee osteoarthritis (OA), a structured model for integrated OA care was developed based on international treatment recommendations. A previous analysis of a cluster RCT (cRCT) showed that compared to usual care, the intervention group reported higher quality of care and greater satisfaction with care. Also, more patients were treated according to international guidelines and fulfilled recommendations for physical activity at the 6-month follow-up.Objectives:To assess the cost-utility of a structured model for hip or knee OA care.Methods:A cRCT with stepped-wedge cohort design was conducted in 6 Norwegian municipalities (clusters) in 2015-17. The OA care model was implemented in one cluster at the time by switching from “usual care” to the structured model. The implementation of the model was facilitated by interactive workshops for general practitioners (GPs) and physiotherapists (PTs) with an update on OA treatment recommendations. The GPs explained the OA diagnosis and treatment alternatives, provided pharmacological treatment when appropriate, and suggested referral to physiotherapy. The PT-led patient OA education programme was group-based and lasted 3 hours followed by an 8–12-week individually tailored resistance exercise programme with twice weekly 1-hour supervised group sessions (5–10 patients per PT). An optional 10-hours Healthy Eating Program was available. Participants were ≥45 years with symptomatic hip or knee OA.Costs were measured from the healthcare perspective and collected from several sources. Patients self-reported visits in primary healthcare at 3, 6, 9 and 12 months. Secondary healthcare visits and joint surgery data were extracted from the Norwegian Patient Register. The health outcome, quality-adjusted life-year (QALY), was estimated based on the EQ-5D-5L scores at baseline, 3, 6, 9 and 12 months. The result of the cost-utility analysis was reported using the incremental cost-effectiveness ratio (ICER), defined as the incremental costs relative to incremental QALYs (QALYs gained). Based on Norwegian guidelines, the threshold is €27500. Sensitivity analyses were performed using bootstrapping to assess the robustness of reported results and presented in a cost-effectiveness plane (Figure 1).Results:The 393 patients’ mean age was 63 years (SD 9.6) and 74% were women. 109 patients were recruited during control periods (control group), and 284 patients were recruited during interventions periods (intervention group). Only the intervention group had a significant increase in EQ-5D-5L utility scores from baseline to 12 months follow-up (mean change 0.03; 95% CI 0.01, 0.05) with QALYs gained: 0.02 (95% CI -0.08, 0.12). The structured OA model cost approx. €301 p.p. with an additional €50 for the Healthy Eating Program. Total 12 months healthcare cost p.p. was €1281 in the intervention and €3147 in the control group, resulting in an incremental cost of -€1866 (95% CI -3147, -584) p.p. Costs related to surgical procedures had the largest impact on total healthcare costs in both groups. During the 12-months follow-up period, 5% (n=14) in the intervention compared to 12% (n=13) in the control group underwent joint surgery; resulting in a mean surgical procedure cost of €553 p.p. in the intervention as compared to €1624 p.p. in the control group. The ICER was -€93300, indicating that the OA care model resulted in QALYs gained and cost-savings. At a threshold of €27500, it is 99% likely that the OA care model is a cost-effective alternative.Conclusion:The results of the cost-utility analysis show that implementing a structured model for OA care in primary healthcare based on international guidelines is highly likely a cost-effective alternative compared to usual care for people with hip and knee OA. More studies are needed to confirm this finding, but this study results indicate that implementing structured OA care models in primary healthcare may be beneficial for the individual as well as for the society.Disclosure of Interests:None declared

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Optical spin-symmetry breaking for high-efficiency directional helicity-multiplexed metaholograms

Microsystems & Nanoengineering ◽

10.1038/s41378-020-00226-x ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Muhammad Ashar Naveed ◽

Muhammad Afnan Ansari ◽

Inki Kim ◽

Trevon Badloe ◽

Joohoon Kim ◽

...

Keyword(s):

High Efficiency ◽

Spin Symmetry ◽

Cost Effective ◽

Dielectric Materials ◽

Additional Degree ◽

Cost Effective Alternative ◽

Spin Orbit Interactions ◽

Smart Mobile ◽

The Cost ◽

Hydrogenated Amorphous

AbstractHelicity-multiplexed metasurfaces based on symmetric spin–orbit interactions (SOIs) have practical limits because they cannot provide central-symmetric holographic imaging. Asymmetric SOIs can effectively address such limitations, with several exciting applications in various fields ranging from asymmetric data inscription in communications to dual side displays in smart mobile devices. Low-loss dielectric materials provide an excellent platform for realizing such exotic phenomena efficiently. In this paper, we demonstrate an asymmetric SOI-dependent transmission-type metasurface in the visible domain using hydrogenated amorphous silicon (a-Si:H) nanoresonators. The proposed design approach is equipped with an additional degree of freedom in designing bi-directional helicity-multiplexed metasurfaces by breaking the conventional limit imposed by the symmetric SOI in half employment of metasurfaces for one circular handedness. Two on-axis, distinct wavefronts are produced with high transmission efficiencies, demonstrating the concept of asymmetric wavefront generation in two antiparallel directions. Additionally, the CMOS compatibility of a-Si:H makes it a cost-effective alternative to gallium nitride (GaN) and titanium dioxide (TiO2) for visible light. The cost-effective fabrication and simplicity of the proposed design technique provide an excellent candidate for high-efficiency, multifunctional, and chip-integrated demonstration of various phenomena.

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An Innovative Cost-Effective Approach for Characterization of Removable Prosthesis - Case Series

Journal of Dentistry and Oral Sciences ◽

10.37191/mapsci-2582-3736-3(2)-091 ◽

2021 ◽

Author(s):

Tushar

Keyword(s):

Case Series ◽

Cost Effective ◽

Functional Rehabilitation ◽

Denture Base ◽

Cost Effective Approach ◽

Removable Denture ◽

Removable Prosthesis ◽

Cost Effective Alternative ◽

The Aesthetic ◽

The Cost

Esthetics plays a crucial role in rehabilitation of removable dentures to achieve a pleasant smile. Denture esthetics is the effect produced, which improves the beauty and attractiveness of a person. With the advances of implants and ceramics, the conventional removable denture needs to be updated. denture characterization is a must in avoiding denture look and giving natural look. Giving the prosthesis as close as possible to the natural apparatus before the tooth loss is the key to a successful prosthetic, esthetic and functional rehabilitation. As a prosthodontist dealing in fulfilling the aesthetic challenges an economical alternative to high-end costly procedures is a must considering the Indian scenario, keeping in mind the biocompatibility and longevity of the treatment. As per literature light cure, gum staining is one of the techniques for masking denture base color and imparting natural color to mucosa but considering the cost involved many patients requiring aesthetic enhancement of prosthesis avoid going for such treatment thereby compromising their aesthetic. the present case series describe an innovative cost-effective alternative to the previously describe technique for masking the denture base color by using composite mixed with stains to replicate the natural apparatus.

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Cost–effectiveness and cost-benefit analysis of oliceridine in the treatment of acute pain

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2021-0107 ◽

2021 ◽

Author(s):

Kit N Simpson ◽

Michael J Fossler ◽

Linda Wase ◽

Mark A Demitrack

Keyword(s):

Cost Benefit Analysis ◽

Cost Savings ◽

Cost Benefit ◽

Cost Effective ◽

Adverse Outcomes ◽

Protein Signaling ◽

Opioid Receptor Agonist ◽

Cost Effective Alternative ◽

Μ Opioid Receptor ◽

The Cost

Aim: Oliceridine, a new class of μ-opioid receptor agonist, is selective for G-protein signaling (analgesia) with limited recruitment of β-arrestin (associated with adverse outcomes) and may provide a cost-effective alternative versus conventional opioid morphine for postoperative pain. Patients & methods: Using a decision tree with a 24-h time horizon, we calculated costs for medication and management of three most common adverse events (AEs; oxygen saturation <90%, vomiting and somnolence) following postoperative oliceridine or morphine use. Results: Using oliceridine, the cost for managing AEs was US$528,424 versus $852,429 for morphine, with a net cost savings of $324,005. Conclusion: Oliceridine has a favorable overall impact on the total cost of postoperative care compared with the use of the conventional opioid morphine.

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Cost of a new method of active screening for human African trypanosomiasis in the Democratic Republic of the Congo

10.1101/2020.06.25.20139717 ◽

2020 ◽

Author(s):

Rian Snijders ◽

Alain Fukinsia ◽

Yves Claeys ◽

Alain Mpanya ◽

Epco Hasker ◽

...

Keyword(s):

Human African Trypanosomiasis ◽

Democratic Republic ◽

Public Health Problem ◽

Cost Effective ◽

Active Case Finding ◽

Active Screening ◽

Populations At Risk ◽

Republic Of The Congo ◽

Cost Effective Alternative ◽

The Cost

ABSTRACTBackgroundHuman African trypanosomiases caused by the Trypanosoma brucei gambiense parasite is a lethal disease that killed thousands of people at the start of the 20th century. Today, less than 1,000 cases are reported globally, and the disease is targeted for elimination and eradication. One of the main disease control strategies is active case-finding through outreach campaigns. In 2014, a new method for active screening was developed with mini, motorcycle-based, teams. This study aims to compare the cost of two approaches for active HAT screening, namely the traditional mobile teams and mini mobile teams.MethodsWe estimated annual economic costs for the two active HAT screening approaches from a health care provider perspective. Cost and operational data was collected for 12 months for 1 traditional team and 3 mini teams in the health districts of Yasa Bonga and Mosango in the Kwilu province of the Democratic Republic of the Congo. The cost per person screened and per person diagnosed was calculated. Univariate sensitivity analysis was conducted on important cost drivers.ResultsThe study shows that the cost per person screened is lower for a mini team compared to a traditional team in the study setting (US$1.86 compared to US$2.08) as well as in a simulation analysis assuming both teams would operate in a setting with similar disease prevalence.DiscussionActive HAT screening with mini mobile teams has a lower cost and could be a cost-effective alternative for active screening campaigns. Further research is needed to determine if mini mobile teams have similar or better yields than traditional mobile teams in terms of detections and cases successfully treated.AUTHOR SUMMARYHuman African Trypanosomiasis (HAT) used to be a major public health problem in Sub-Saharan Africa, but the disease is becoming less frequent today as a result of sustained control efforts. Currently, the elimination of sleeping sickness is targeted as a public health problem by 2020 with interruption of transmission by 2030. To achieve these targets, a long-term commitment towards HAT control activities will be necessary with innovative disease control approaches accompanied by economic evaluations to assess their cost and cost-effectiveness in the changing context. Today, active case finding conducted through mass outreach campaigns accounts for approximately half of all identified cases in the Democratic Republic of the Congo. However, this strategy has become less efficient, with a dwindling “yield” in terms of the number of identified cases, translating to a higher cost per diagnosed HAT case. Therefore, different approaches to outreach campaigns need to be evaluated with a focus on reaching populations at risk for HAT.This article presents the costs and outcomes of two approaches to active screening: traditional mobile teams and mini mobile teams.This study shows that mini mobile teams could be a cost-effective alternative for active screening with a cost-per-person screened of US$1.86 compared to US$2.08. This approach could increase the screening coverage of populations at risk for HAT that are currently not being reached through the traditional approach. Future research is needed to evaluate the difference in HAT cases identified and treated by both approaches. This would allow a cost-effectiveness comparison of both strategies based on the cost-per-person diagnosed and treated.

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Long-acting porcine sequence ACTH in the diagnosis of adrenal insufficiency: a cost-effective alternative to the ACTH1–24 test

Acta Endocrinologica ◽

10.1530/eje-19-0923 ◽

2020 ◽

Vol 182 (2) ◽

pp. C5-C7

Author(s):

Warrick J Inder

Keyword(s):

Developing Countries ◽

Adrenal Insufficiency ◽

Diagnostic Performance ◽

Cost Effective ◽

Effective Alternative ◽

Secondary Adrenal Insufficiency ◽

Robust Test ◽

Cost Effective Alternative ◽

Long Acting ◽

The Cost

While the ACTH1–24 test has some well-documented shortcomings, it is the most widely used test to diagnose primary and secondary adrenal insufficiency. However, this synthetic ACTH preparation is not readily available in some countries. Research from India has demonstrated that using a long-acting porcine sequence ACTH has similar diagnostic performance to ACTH1–24 at around 25% of the cost. This may allow access to a robust test for adrenal insufficiency to developing countries and potentially allow thousands of patients to be identified and appropriately treated.

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Abstract 202: Cost-effectiveness Of Carotid Stenting In Canada

Stroke ◽

10.1161/str.44.suppl_1.a202 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Mohammed Almekhlafi ◽

Fiona Clement ◽

Michael D Hill

Keyword(s):

Cost Effectiveness ◽

Incremental Cost ◽

Carotid Stenting ◽

Cost Utility ◽

Sensitivity Analyses ◽

Minor Stroke ◽

System Perspective ◽

Symptomatic Carotid ◽

Symptomatic Carotid Stenosis ◽

Procedural Costs

BACKGROUND To estimate the cost-effectiveness of carotid stenting (CAS) compared to endarterectomy (CEA) in symptomatic patients. METHODS A cost-utility analysis from the Canadian health system perspective was performed using a Markov analytic model. Clinical estimates were based on a recent meta-analysis. Procedural costs for CAS and CEA were derived from a local cohort. The costs for hospitalization and rehabilitation for minor and major strokes were based on the Burden of Ischemic Stroke (BURST) study. Utility scores were based on SAPPHIRE trial. A Monte Carlo simulation using a hypothetical cohort of 10,000 and sensitivity analyses were performed to investigate the model assumptions and uncertainties. RESULTS CAS was more expensive (incremental cost of $6106.84) and had a lower effectiveness (- 0.12 QALYs). The model was sensitive to the risk of annual death. At a threshold odds ratio (OR) of 0.85, CAS was associated with an incremental cost-effectiveness ratio (ICER) of $32,839.04. Using estimates from SAPPHIRE trial, CAS dominated CEA. When estimates from CREST or EVA-3S trials were used, CEA dominated CAS. Only after simultaneously reducing CAS costs and risks of periprocedural and annual minor strokes, CAS had a favorable ICER. This was achieved at a threshold CAS procedural cost of $4350, a threshold OR of periprocedural minor stroke of 1, and a threshold OR of annual minor stroke of 1.15or less; resulting in an ICER of $577.5. The figure shows CAS cost-effectiveness plane. CONCLUSIONS In this analysis, CAS was associated with higher costs and lower effectiveness compared to CEA in symptomatic carotid stenosis patients. The results were driven by the costs of periprocedural major and minor stroke. The costs associated with MI did not impact the results. For CAS to be more effective, it needs to be performed in patients with longer survival, in patients at a high surgical-risk, or at a lower procedural costs plus lower rates of periprocedural and annual minor strokes.

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The COST-UTILITY ANALYSIS OF FOUR CHELATION REGIMENS FOR Β-THALASSEMIA MAJOR: A CHINESE PERSPECTIVE

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2020.029 ◽

2020 ◽

Vol 12 (1) ◽

pp. e2020029

Author(s):

Jialian Li

Keyword(s):

Healthcare System ◽

Cost Effective ◽

Thalassemia Major ◽

Cost Utility ◽

Base Case ◽

Chinese Government ◽

System Perspective ◽

Mortality And Morbidity ◽

Markov Decision Model ◽

The Cost

Background: The four most commonly used chelation regimens for β-thalassemia major patients in China are a combination therapy of deferoxamine and deferiprone (DFO+DFP), deferoxamine(DFO) monotherapy, deferiprone(DFP) monotherapy and deferasirox(DFX) monotherapy. Such patients use iron chelators their whole lives, resulting in enormous treatment costs. This study analyses the cost-utility of these four regimens from the Chinese healthcare system perspective. Methods: A Markov decision model was used over a 70-year time horizon and was populated using clinical data from a systematic literature review. We obtained utility data from local and previous research. Costs were estimated using Chinese national sources. Results: From the base-case analysis results, DFP was the most cost-effective chelation regimen, followed by DFO+DFP, DFO and DFX. DFP had a 99.60%, 78.10% and 64.40% likelihood of being cost-effective versus DFX, DFO and DFO+DFP, respectively, at a payment threshold of 193,932.00 CNY/QALY. Conclusions: DFP was the most cost-effective chelation regimen for β-thalassemia major patients, followed by DFO+DFP, DFO and DFX. Using DFP as the primary treatment regimen may potentially result in cost-savings and QALY gains for the Chinese healthcare system. To increase these benefits, the Chinese government and clinicians should lower drug costs, increase drug utility and reduce mortality and morbidity. Changes in influential parameters easily affect the results of DFO+DFP versus DFP and of DFP versus DFO; clinicians should focus on such parameters and adjust the regimens accordingly.

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