scholarly journals Economic analysis of service and delivery interventions in health care

2018 ◽  
Vol 6 (5) ◽  
pp. 1-16 ◽  
Author(s):  
Matt Sutton ◽  
Steph Garfield-Birkbeck ◽  
Graham Martin ◽  
Rachel Meacock ◽  
Stephen Morris ◽  
...  
Keyword(s):  
Health Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Economic Analysis ◽  
Clinical Interventions ◽  
Before And After ◽  
Implementation Costs ◽  
The Cost ◽  
Care System ◽  
Professional Preferences

There are well-developed guidelines for economic evaluation of clearly defined clinical interventions, but no such guidelines for economic analysis of service interventions. Distinctive challenges for analysis of service interventions include diffuse effects, wider system impacts, and variability in implementation, costs and effects. Cost-effectiveness evidence is as important for service interventions as for clinical interventions. There is also an important role for wider forms of economic analysis to increase our general understanding of context, processes and behaviours in the care system. Methods exist to estimate the cost-effectiveness of service interventions before and after introduction, to measure patient and professional preferences, to reflect the value of resources used by service interventions, and to capture wider system effects, but these are not widely applied. Future priorities for economic analysis should be to produce cost-effectiveness evidence and to increase our understanding of how service interventions affect, and are affected by, the care system.

scholarly journals Economic evaluation alongside a randomised controlled trial to assess the effectiveness and cost-effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy

2020 ◽  
pp. 096452842092028
Author(s):  
Alex Molassiotis ◽  
Bryony Dawkins ◽  
Roberta Longo ◽  
Lorna KP Suen ◽  
Hui Lin Cheng ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Peripheral Neuropathy ◽  
Usual Care ◽  
Base Case ◽  
Cost Effective Treatment ◽  
The Cost

Objective To assess the cost-effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy (CIPN) in Hong Kong. Methods A within trial cost-utility analysis with the primary endpoint for the economic evaluation being the Quality Adjusted Life Year (QALY) and associated Incremental Cost Effectiveness Ratio (ICER) over 14 weeks of treatment. A secondary cost-effectiveness analysis was undertaken with the endpoint being change in pain as measured on the Brief Pain Inventory (BPI). Results Eighty-seven patients were randomised to acupuncture or usual care. Acupuncture resulted in significant improvements in pain intensity (8- and 14-week mean changes compared to usual care of −1.8 and −1.8, respectively), pain interference (8- and 14-week mean changes compared to usual care of −1.5 and −0.9, respectively) and indicators of quality of life and neurotoxicity-related symptoms. However, in the economic evaluation there was little difference in QALYs between the two arms (mean change 0.209 and 0.200 in the acupuncture and usual care arms, respectively). Also, costs yielded deterministic ICERs of HK$616,965.62, HK$824,083.44 and HK$540,727.56 per QALY gained from the health care provider perspective, the societal perspective and the patient perspective, respectively. These costs are significantly higher than the cost-effectiveness threshold of HK$180,450 that was used for the base case analysis. Conclusion While acupuncture can improve symptoms and quality of life indicators related to CIPN, it is unlikely to be a cost-effective treatment for CIPN-related pain in health care systems with limited resources. Trial registration number NCT02553863 (ClinicalTrials.gov) post-results.

scholarly journals Determination of a willingness-to-pay threshold and decision-making in financing the healthcare technologies

2018 ◽  
Vol 11 (3) ◽  
pp. 13-22 ◽  
Author(s):  
T. S. Teptsova ◽  
T. P. Bezdenezhnyh ◽  
V. K. Fedyaeva ◽  
N. Z Musina ◽  
G. R. Hachatryan ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Health Care System ◽  
Russian Federation ◽  
Threshold Value ◽  
Medical Technologies ◽  
The Russian Federation ◽  
The Cost ◽  
Care System

The aim was to develop a methodology for determining the willingness to pay threshold (WTPT) and its upper limit value within the Russian health care system.Materials and methods. WTPT was calculated based on the shadow budget price (i. e. determining the WTPT by the suppling party). This method is an empirical assessment of the cost-effectiveness threshold that reflects the utmost productivity of the health care system, as determined from the relationship between changes in healthcare expenditure and health outcomes achieved. The state’s willingness to pay for improving their citizens’ healthcare was evaluated considering the population of the Russian Federation, mortality and life expectancy in different age and gender groups, as well as the volume of government spending. The cost of disability-adjusted life-year prevented (DALY) and the cost of quality-adjusted life-year saved (QALY) were determined by the suppling party, that is, they reflect the cost the state is willing to pay for improving the health of their population under conditions of limited budget. The described approach considers the performance of the country’s healthcare system over a certain period and the costs incurred in functioning of the system.Results. As part of this study, it was found that the cost of one additionally prevented DALY would be 313,878.21 rubles, and the cost of one additionally saved QALY – 365,060.31 rubles.Conclusion. The WTPT for medical technologies in the Russian Federation, determined by estimating the shadow budget price will amount to 313,878.21 rubles for one prevented DALY and 365 060,31 rubles for one saved QALY. With regard to clinical and economic analysis, medical technologies with the incremental cost-effectiveness indicator not exceeding the one calculated in this study can be seen as cost-effective. The obtained threshold value is a recommendation. A medical technology can be approved even with a WTPT higher than the recommended level, because this specific technology may have additional  advantages other than WTPT when compared with the reference technologies. 

PP34 A Cost-Utility Analysis Of The Syncope: Pacing Or Recording Trial

2018 ◽  
Vol 34 (S1) ◽  
pp. 78-79
Author(s):  
Mark Hofmeister ◽  
Robert Sheldon ◽  
Eldon Spackman ◽  
Satish Raj ◽  
Mario Talajic ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Health Care System ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Additional Qaly ◽  
Life Years ◽  
The Cost ◽  
Care System

Introduction:For patients with bifascicular block and syncope of unknown origin, different American Heart Association guidelines give Class 2A recommendations for two treatments: the implantable loop recorder (ILR) and empiric pacemaker insertion (PM). Equipoise reflected in guidelines may contribute to uncertainty in management and inefficient resource use. The objective of this analysis is to determine the cost-effectiveness of ILR compared to PM in the management of older adults (age>50 years) with bifascicular block and syncope over two years, from the perspective of a Canadian publicly funded health care system, in the Syncope: Pacing or Recording In ThE Later Years (SPRITELY) trial.Methods:Resource utilization data was collected throughout the trial, and unit costs were assigned (2017 Canadian dollars). Utility was measured at baseline and annually with the EQ-5D-3L. Quality adjusted life years (QALYs) were calculated as area-under-the-curve, and adjusted for baseline imbalances in utility. Confidence intervals for the incremental cost effectiveness ratio were generated with non-parametric bootstrapping.Results:Mean cost in participants randomized to PM was CAD 9,759 (USD 7,400), compared to CAD 13,453 (USD 10,200) in participants randomized to ILR. The ILR strategy resulted in 0.020 QALYs more than the PM strategy. The incremental cost effectiveness ratio was CAD 186,553 (95% CI: −831,950–1,191,816) (USD 141,900, 95% CI: −632,740–906,440) per additional QALY. In 1,000 bootstrapped replicates, the cost of the ILR strategy was always greater than that of the PM strategy. At the threshold of CAD 50,000 (USD 38,000) per additional QALY, the probability that the ILR strategy is the cost effective option is 0.504.Conclusions:ILR costs were greater than PM costs, with little difference in QALY outcomes over two-years. Findings are generalizable to patients similar to SPRITELY participants, from the perspective of the Canadian health care system. However, practice pattern variation and payment systems inhibit generalizability to other countries. Future analysis will explore cost and QALY outcomes in countries that participated in the SPRITELY trial.

scholarly journals The cost-effectiveness of early goaldirected therapy: an economic evaluation alongside the ARISE trial

2021 ◽  
Vol 23 (3) ◽  
pp. 329-336
Author(s):  
Alisa M Higgins ◽  
◽  
Sandra L Peake ◽  
Rinaldo Bellomo AO ◽  
D Jamie Cooper AO ◽  
...  
Keyword(s):  
Health Care ◽  
Septic Shock ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Resource Use ◽  
Cost Effective ◽  
Evaluation Study ◽  
Life Years ◽  
The Cost

OBJECTIVE: To determine the cost-effectiveness of early goal-directed therapy (EGDT) for patients with early septic shock. DESIGN: Within-trial cost-effectiveness evaluation. SETTING: Nineteen hospitals in Australia and New Zealand. PARTICIPANTS AND INTERVENTIONS: Patients with early septic shock enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial were randomly assigned to EGDT versus usual care. A subgroup of patients participated in a nested economic evaluation study in which detailed resource use data were collected until 12 months after randomisation. OUTCOME MEASURES: Clinical outcomes included lives saved, life-years gained and quality-adjusted life-years (QALYs), with mortality collected until 12 months and health-related quality of life assessed at baseline, 6 and 12 months using the 3-level EuroQol five dimensions questionnaire (EQ-5D-3L). Economic outcomes included health care resource use, costs and cost-effectiveness from the Australian health care payer perspective. RESULTS: A total of 205 patients (100 EGDT, 105 usual care) participated in the nested economic evaluation study, of which 203 had complete resource use data. Unadjusted mean health care costs to 12 months were $67 223 (standard deviation [SD], $72 397) in the EGDT group and $54 179 (SD, $61 980) in the usual care group, with a mean difference of $13 044 (95% CI, −$5791 to $31 878). There was no difference between groups with regards to lives saved (EGDT, 69.4% v usual care, 68.6%; P = 1.0), life-years gained (mean EGDT, 0.746 [SD, 0.406] v usual care, 0.725 [SD, 0.417]; P = 0.72) or QALYs (mean EGDT, 0.318 [SD, 0.291] v usual care, 0.367 [SD, 0.295]; P = 0.24). EGDT was dominated (higher costs, lower effectiveness) by usual care in 80.4% of bootstrap replications. For a willingness-to-pay threshold of $50 000 per QALY, the probability of EGDT being cost-effective was only 6.4%. CONCLUSIONS: In patients presenting to the emergency department with early septic shock, EGDT compared with usual care was not cost-effective. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number NCT00975793.

scholarly journals Cost Effectiveness of Infant Vaccination for Rotavirus in Canada

2012 ◽  
Vol 23 (2) ◽  
pp. 71-77 ◽  
Author(s):  
Doug Coyle ◽  
Kathryn Coyle ◽  
Julie A Bettinger ◽  
Scott A Halperin ◽  
Wendy Vaudry ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Health Care System ◽  
Societal Perspective ◽  
Emergency Department Visits ◽  
System Perspective ◽  
The Cost ◽  
Care System

INTRODUCTION: Rotavirus is the main cause of gastroenteritis in Canadian children younger than five years of age, resulting in significant morbidity and cost. The present study provides evidence on the cost effectiveness of two alternative rotavirus vaccinations (RotaTeq [Merck Frosst Canada Ltd, Canada] and Rotarix [GlaxoSmithKline, Canada]) available in Canada.METHODS: Analysis was conducted through a Markov model that followed a cohort of children from birth to five years of age. Analysis used pertinent data on the natural history of rotavirus and the effects of vaccination. Estimates of heath care costs for children requiring hospitalizations and emergency department visits were derived from the Canadian Immunization Monitoring Program, Active (IMPACT) surveillance, emergency department studies, as well as other Canadian studies. The model estimated the effect of vaccination on costs and quality-adjusted life years (QALYs).RESULTS: The incremental cost per QALY gained from the health care system perspective was $122,000 for RotaTeq and $108,000 for Rotarix. From the societal perspective, both vaccination strategies were dominant – both cost saving and more effective. The cost-effectiveness of vaccination is dependent on the mode of administration, the perspective adopted and the cost of the vaccine.CONCLUSIONS: From a societal perspective, a universal vaccination program against rotavirus will be both cost saving and more effective than no vaccination. Becasue the majority of rotavirus infections do not require emergency department visits or hospital admission, from a health care system perspective, a program would not be considered cost effective.

scholarly journals Systematic Review of Cost-Effectiveness of Injury Prevention Interventions in Soccer—Evidence Why Health Agencies Should Address It

2021 ◽  
Vol 18 (22) ◽  
pp. 11901
Author(s):  
Monika Grygorowicz ◽  
Martyna Wiernicka ◽  
Marzena Wiernicka
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Injury Prevention ◽  
Health Care System ◽  
Peer Review Process ◽  
Cost Effective ◽  
Prevention Interventions ◽  
The Cost ◽  
Care System

Soccer injuries are a recognized problem worldwide. Several injury prevention programs have been confirmed to reduce the number of injuries in female and male players. Unfortunately, there is a lack of data about their cost, burden, and benefit for the health care system. In this paper we aim to systematically review the literature and critically evaluate the economic quality of injury prevention interventions implemented across different populations of soccer players. Web of Science, Medline, SPORTDiscus, Ovid, and other databases were searched from January 2011 through July 2021. Research articles were only selected for analysis if they focused on the cost-effectiveness of injury prevention, were experimental papers written in English, and were published following the peer-review process. Three cluster RCT and one retrospective study met the criteria. Cost data on incremental cost-effectiveness ratios (ICERs) were extracted. The included studies had a good/average quality of economic evaluation. Based on ICERs, injury prevention interventions were cost-effective in three out of the three comparisons. One study did not report the ICER value. However, since economic analyses were reported with varying methodological approaches and results, more data are required to recognize the cost-effectiveness of soccer-specific injury prevention interventions and their benefit for the health care system.

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