scholarly journals Sunitinib for the treatment of gastrointestinal stromal tumours: a critique of the submission from Pfizer

2009 ◽  
Vol 13 (Suppl 2) ◽  
pp. 69-74
Author(s):  
M Bond ◽  
M Hoyle ◽  
T Moxham ◽  
M Napier ◽  
R Anderson
Keyword(s):  
Sensitivity Analysis ◽  
Overall Survival ◽  
Cohort Study ◽  
Cost Effectiveness ◽  
Hazard Ratio ◽  
Base Case ◽  
Gastrointestinal Stromal Tumours ◽  
Entire Study ◽  
Significant Difference ◽  
The Cost

The submission’s evidence for the clinical effectiveness and cost-effectiveness of sunitinib for the treatment of gastrointestinal stromal tumours (GISTs) is based on a randomised controlled trial (RCT) comparing sunitinib with placebo for people with unresectable and/or metastatic GIST after failure of imatinib and with Eastern Cooperative Oncology Group (ECOG) progression status 0–1, and an ongoing, non-comparative cohort study of a similar population but with ECOG progression status 0–4. The searches are appropriate and include all relevant studies and the RCT is of high quality. In the RCT sunitinib arm overall survival was 73 median weeks [95% confidence interval (CI) 61 to 83] versus 75 median weeks (95% CI 68 to 84) for the cohort study. However, time to tumour progression in the cohort study was different from that in the RCT sunitinib arm [41 (95% CI 36 to 47) versus 29 (95% CI 22 to 41) median weeks respectively]. Median progression-free survival with sunitinib was 24.6 weeks (95% CI 12.1 to 28.4) versus 6.4 weeks (95% CI 4.4 to 10.0) on placebo (hazard ratio 0.333, 95% CI 0.238 to 0.467, p < 0.001). The manufacturer used a three-state Markov model to model the cost-effectiveness of sunitinib compared with best supportive care for GIST patients; the modelling approach and sources and justification of estimates are reasonable. The base-case incremental cost-effectiveness ratio (ICER) was £27,365 per quality-adjusted life-year (QALY) with the first cycle of sunitinib treatment not costed; when we included the cost of the first treatment cycle we estimated a base-case ICER of £32,636 per QALY. Pfizer’s sensitivity analysis produced a range of ICERs from £15,536 per QALY to £59,002 per QALY. Weaknesses of the manufacturer’s submission include that the evidence is based on only one published RCT; that 84% of the RCT control population crossed over to the intervention group, giving rise to the use of unusual rank preserved structural failure time (RPSFT) analysis to correct for possible bias; and that a number of errors and omissions were made in the probabilistic sensitivity analysis, meaning that it is not possible to come to firm conclusions about the cost-effectiveness of sunitinib for GIST in this patient population. In conclusion, during the blinded phase of the RCT, overall survival was significantly longer in the sunitinib arm than in the placebo arm (hazard ratio 0.491, 95% CI 0.290 to 0.831, p <0.007). However, intention-to-treat analysis of the entire study showed no statistically significant difference in overall survival for those who received sunitinib (73 weeks) versus those who received placebo (65 weeks) (hazard ratio 0.876, 95% CI 0.679 to 1.129, p = 0.306).

scholarly journals Sustained acoustic medicine as a non-surgical and non-opioid knee osteoarthritis treatment option: a health economic cost-effectiveness analysis for symptom management

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Thomas M. Best ◽  
Stephanie Petterson ◽  
Kevin Plancher
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Symptom Management ◽  
Treatment Options ◽  
Base Case ◽  
Treatment Pathways ◽  
Knee Oa ◽  
Cost Effective Treatment ◽  
The Cost

Abstract Background Patients diagnosed with osteoarthritis (OA) and presenting with symptoms are seeking conservative treatment options to reduce pain, improve function, and avoid surgery. Sustained acoustic medicine (SAM), a multi-hour treatment has demonstrated improved clinical outcomes for patients with knee OA. The purpose of this analysis was to compare the costs and effectiveness of multi-hour SAM treatment versus the standard of care (SOC) over a 6-month timeframe for OA symptom management. Methods A decision tree analysis was used to compare the costs and effectiveness of SAM treatment versus SOC in patients with OA. Probabilities of success for OA treatment and effectiveness were derived from the literature using systematic reviews and meta-analyses. Costs were derived from Medicare payment rates and manufacturer prices. Functional effectiveness was measured as the effect size of a therapy and treatment pathways compared to a SOC treatment pathway. A sensitivity analysis was performed to determine which cost variables had the greatest effect on deciding which option was the least costly. An incremental cost-effectiveness plot comparing SAM treatment vs. SOC was also generated using 1000 iterations of the model. Lastly, the incremental cost-effectiveness ratio (ICER) was calculated as the (cost of SAM minus cost of SOC) divided by (functional effectiveness of SAM minus functional effectiveness of SOC). Results Base case demonstrated that over 6 months, the cost and functional effectiveness of SAM was $8641 and 0.52 versus SOC at: $6281 and 0.39, respectively. Sensitivity analysis demonstrated that in order for SAM to be the less expensive option, the cost per 15-min session of PT would need to be greater than $88, or SAM would need to be priced at less than or equal to $2276. Incremental cost-effectiveness demonstrated that most of the time (84%) SAM treatment resulted in improved functional effectiveness but at a higher cost than SOC. Conclusion In patients with osteoarthritis, SAM treatment demonstrated improved pain and functional gains compared to SOC but at an increased cost. Based on the SAM treatment ICER score being ≤ $50,000, it appears that SAM is a cost-effective treatment for knee OA.

scholarly journals Cost-Effectiveness Analysis of Direct Oral Anticoagulants Versus Vitamin K Antagonists for Venous Thromboembolism in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Ke-Xin Sun ◽  
Bin Cui ◽  
Shan-Shan Cao ◽  
Qi-Xiang Huang ◽  
Ru-Yi Xia ◽  
...  
Keyword(s):  
Decision Making ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Markov Model ◽  
Clinical Decision Making ◽  
Cost Effective ◽  
Clinical Decision ◽  
Base Case ◽  
Effectiveness Analysis ◽  
The Cost

Background: The drug therapy of venous thromboembolism (VTE) presents a significant economic burden to the health-care system in low- and middle-income countries. To understand which anticoagulation therapy is most cost-effective for clinical decision-making , the cost-effectiveness of apixaban (API) versus rivaroxaban (RIV), dabigatran (DAB), and low molecular weight heparin (LMWH), followed by vitamin K antagonist (VKA), in the treatment of VTE in China was assessed.Methods: To access the quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs), a long-term cost-effectiveness analysis was constructed using a Markov model with 5 health states. The Markov model was developed using patient data collected from the Xijing Hospital from January 1, 2016 to January 1, 2021. The time horizon was set at 30 years, and a 6-month cycle length was used in the model. Costs and ICERs were reported in 2020 U.S. dollars. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were used to test the uncertainties. A Chinese health-care system perspective was used.Results: In the base case, the data of 231 VTE patients were calculated in the base case analysis retrospectively. The RIV group resulted in a mean VTE attributable to 95% effective treatment. API, DAB, and VKA have a negative ICER (−187017.543, −284,674.922, and −9,283.339, respectively) and were absolutely dominated. The Markov model results confirmed this observation. The ICER of the API and RIV was negative (−216176.977), which belongs to the absolute inferiority scheme, and the ICER value of the DAB and VKA versus RIV was positive (110,577.872 and 836,846.343). Since the ICER of DAB and VKA exceeds the threshold, RIV therapy was likely to be the best choice for the treatment of VTE within the acceptable threshold range. The results of the sensitivity analysis revealed that the model output varied mostly with the cost in the DAB on-treatment therapy. In a probabilistic sensitivity analysis of 1,000 patients for 30 years, RIV has 100% probability of being cost-effective compared with other regimens when the WTP is $10973 per QALY. When WTP exceeded $148,000, DAB was more cost-effective than RIV.Conclusions: Compared with LMWH + VKA and API, the results proved that RIV may be the most cost-effective treatment for VTE patients in China. Our findings could be helpful for physicians in clinical decision-making to select the appropriate treatment option for VTE.

scholarly journals Cost-effectiveness of docetaxel in high-volume hormone-sensitive metastatic prostate cancer

2019 ◽  
Vol 13 (12) ◽  
Author(s):  
Jaclyn Beca ◽  
Habeeb Majeed ◽  
Kelvin K.W. Chan ◽  
Sebastian J. Hotte ◽  
Andrew Loblaw ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Survival Data ◽  
High Volume ◽  
Base Case ◽  
Castration Resistant Prostate Cancer ◽  
Life Years ◽  
Hormone Sensitive ◽  
The Cost

Introduction: Three pivotal trials have considered the addition of docetaxel (D) chemotherapy to conventional androgen-deprivation therapy (ADT) for the treatment of metastatic hormone-sensitive prostate cancer (HSPC). While an initial small trial was inconclusive, two larger trials demonstrated significant clinical benefit, including pronounced survival benefits (added 17 months) among patients with high-volume metastatic disease. Given the evolving clinical evidence, the cost-effectiveness of this approach warrants exploration. Methods: The cost-effectiveness of six cycles of ADT+D compared to ADT alone to treat patients with high-volume metastatic HSPC was assessed from a Canadian public payer perspective. We included three health states: HSPC, metastatic castration-resistant prostate cancer (CRPC), and death. Survival data were obtained from the CHAARTED trial, which reported outcomes specifically for high-volume disease. We used Ontario costs data and utilities from the literature. Results: In the base case analysis, ADT+D cost an additional $25 757 and produced an extra 1.06 quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of $24 226/QALY gained. Results from one-way sensitivity analysis across wide ranges of estimates and a range of scenarios, including an alternate model structure, produced ICERs below $35 000/QALY gained in all cases. Conclusions: The use of D with ADT in high-volume metastatic HSPC appears to be an economically attractive treatment approach. The findings were consistent with other studies and robust in sensitivity analysis across a variety of scenarios.

scholarly journals Cost Effectiveness Analysis of Fecal Transplant Delivery Methods for Recurrent Clostridium difficile Infections in Outpatients

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S386-S386 ◽  
Author(s):  
Jeremey Walker ◽  
Nathan Gundacker ◽  
Martin Rodriguez ◽  
Ellen Eaton
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Clostridium Difficile ◽  
Medical Center ◽  
Cost Effective ◽  
Third Party ◽  
Base Case ◽  
Delivery Methods ◽  
The Cost ◽  
Cure Rates

Abstract Background Clostridium difficile infection (CDI) accounts for more than $1 billion annually in US health care costs. Recurrent CDI (RCDI, recurrence within 8 weeks of initial treatment) contributes substantially to this cost. The objective of the study was to compare the cost effectiveness of FMT delivered via colonoscopy vs. blind nasogastric tube (NGT) in outpatients. We hypothesized that FMT by NGT would be cost-effective given its low risk and simplicity. Methods A decision-analytic simulation model compared the cost effectiveness of FMT by colonoscopy vs. NGT from a third-party payer perspective. Our base case cure rates were derived from a cohort receiving outpatient RCDI treatment at our institution. Cure was defined as resolution of symptoms for ≥ 90 days. Procedural cost and consultation was defined by average reimbursement to a large southeastern medical center in 2016 USD based on current procedural terminology (CPT) codes, and cost of disease states were derived from published literature. Health utilities were defined by quality of life year (QALY) based on published literature. Incremental Cost Effectiveness ratio (ICER) was defined as the cost per additional QALY gained. We assumed a 90 day time horizon. One-way sensitivity analysis was performed on all variables using ranges defined by published literature. We used TreeAge Software (Williamstown, MA). Results In the base case, FMT by colonoscopy was dominant (more effective and less costly) than NGT, with cost of $1,568/QALY vs. $1,910/QALY respectively. Cure rates of FMT by colonoscopy vs. NGT (100% vs. 87%) had the largest impact on ICER based on one-way sensitivity analysis. Therefore, a subsequent two-way sensitivity analysis was conducted to compare cure rates of both delivery methods and found that NGT delivery is cost effective as cure rates approach colonoscopy delivery cure rates within 5 percentage points. Conclusion Contrary to our hypothesis, our decision model supports FMT by colonoscopy as the preferred delivery method in outpatients with RCDI relative to NGT delivery. Additional costs of colonoscopy delivery are off-set by the improved cure rate leading to lower overall costs. As cure rates from NGT delivery are optimized, NGT may become the preferred method for FMT delivery. Disclosures All authors: No reported disclosures.

scholarly journals Test-and-Treat Strategies forHelicobacter pyloriin Uninvestigated Dyspepsia: A Canadian Economic Anaylsis

2000 ◽  
Vol 14 (5) ◽  
pp. 379-388 ◽  
Author(s):  
John K Marshall ◽  
David Armstrong ◽  
Bernie J O’Brien
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Third Party ◽  
Base Case ◽  
Model Parameters ◽  
Local Conditions ◽  
Ulcer Disease ◽  
Test And Treat ◽  
H Pylori ◽  
The Cost

BACKGROUND: Recognition of the pivotal role ofHelicobacter pyloriin the pathogenesis of peptic ulcer disease has revolutionized primary care approaches to dyspepsia. Decision analysis was used to compare the cost effectiveness of empirical ranitidine with a test and treat strategy using eitherH pyloriserology or the13carbon-urea breath test (13C-UBT).PATIENTS AND METHODS: A cohort of patients under age 50 years presenting with uninvestigated dyspepsia was evaluated. Three initial strategies were compared with respect to direct medical costs and effectiveness in curingH pylori-related ulcers - empirical ranitidine,H pyloriserology and UBT. A one-year time horizon and third-party payer perspective were adopted in a Canadian health care setting.RESULTS: UBT was more costly than either serology or ranitidine but was the most effective strategy and required the fewest endoscopies. No strategy demonstrated dominance over another in the base case. The incremental cost effectiveness ratio (ICER) of serology versus ranitidine was $118/cure, and sensitivity analysis induced dominance of serology in several plausible scenarios. The baseline ICER of UBT versus serology was $885/cure but showed substantial variation in sensitivity analysis. Each ICER was highly sensitive to variation in the cost of the tests themselves. At a serology cost of $25, UBT became dominant when its cost fell to $39.CONCLUSIONS: In low risk patients with uninvestigated dyspepsia, testing forH pyloriusing serology appears to be economically attractive.13C-UBT may be a cost effective alternative to serology if local conditions closely approximate the model parameters. Future changes in the costs of serology and13C-UBT may determine the optimal approach.

scholarly journals Lapatinib for the treatment of HER2-overexpressing breast cancer

2009 ◽  
Vol 13 (Suppl 3) ◽  
pp. 1-6
Author(s):  
J Jones ◽  
A Takeda ◽  
J Picot ◽  
C von Keyserlingk ◽  
A Clegg
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Cost Effectiveness ◽  
Progression Free Survival ◽  
Cost Effective ◽  
Hazard Ratio ◽  
Sensitivity Analyses ◽  
Time To Progression ◽  
Free Survival ◽  
Significant Difference

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of lapatinib for the treatment of advanced or metastatic HER2overexpressing breast cancer based upon a review of the manufacturer’s submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The scope included women with advanced, metastatic or recurrent HER2-overexpressing breast cancer who have had previous therapy that includes trastuzumab. Outcomes were time to progression, progression-free survival, response rates, overall survival, health-related quality of life and adverse effects. The submission’s evidence came from one randomised controlled trial (RCT) of reasonable methodological quality, although it was not powered to detect a statistically significant difference in mean overall survival. Median time to progression was longer in the lapatinib plus capecitabine arm than in the capecitabine monotherapy arm {27.1 [95% confidence interval (CI) 17.4 to 49.4] versus 18.6 [95% CI 9.1 to 36.9] weeks; hazard ratio 0.57 [95% CI 0.43 to 0.77; p = 0.00013]}. Median overall survival was very similar between the groups [67.7 (95% CI 58.9 to 91.6) versus 66.6 (95% CI 49.1 to 75.0) weeks; hazard ratio 0.78 (95% CI 0.55 to 1.12; p = 0.177)]. Median progression-free survival was statistically significantly longer in the lapatinib plus capecitabine group than in the capecitabine monotherapy group [27.1 (95% CI 24.1 to 36.9) versus 17.6 (95% CI 13.3 to 20.1) weeks; hazard ratio 0.55 (95% CI 0.41 to 0.74); p = 0.000033]. The manufacturer’s economic model to estimate progression-free and overall survival for patients with HER2-positive advanced/metastatic breast cancer who had relapsed following treatment with an anthracycline, a taxane and trastuzumab was appropriate for the disease area. The base-case incremental cost-effectiveness ratios (ICERs) for lapatinib plus capecitabine compared with capecitabine monotherapy or vinorelbine monotherapy were higher than would conventionally be considered cost-effective. When compared with trastuzumab-containing regimes, lapatinib plus capecitabine dominated. In sensitivity analyses the ICER for lapatinib plus capecitabine compared with capecitabine monotherapy or vinorelbine monotherapy was robust to variation in assumptions. In all sensitivity analyses the ICERs remained higher than would conventionally be considered cost-effective. ICERs for trastuzumab-containing regimes were particularly sensitive to assumptions over the frequency of treatment, which had a large effect on the cost-effectiveness of lapatinib plus capecitabine. In conclusion, there was a general lack of evidence on the effectiveness of comparators included in the model and on key parameters such as dose adjustments and the model outputs need to be interpreted in the light of this uncertainty. At the time of writing, NICE were still considering the available evidence for this appraisal.

scholarly journals Omalizumab for the treatment of severe persistent allergic asthma

2009 ◽  
Vol 13 (Suppl 2) ◽  
pp. 31-39
Author(s):  
J Jones ◽  
J Shepherd ◽  
D Hartwell ◽  
P Harris ◽  
K Cooper ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Allergic Asthma ◽  
Standard Therapy ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Life Questionnaire ◽  
Exacerbation Rate ◽  
Single Technology Appraisal ◽  
Significant Difference

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of omalizumab for the treatment of chronic severe persistent allergic asthma, in accordance with the licensed indication, based upon the evidence submission from Novartis to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The clinical evidence comes from a randomised controlled trial comparing omalizumab as an add-on to standard therapy with placebo and standard therapy over a 28-week treatment period. For the primary outcome of the rate of clinically significant asthma exacerbations, there was no statistically significant difference between treatment groups. However, after making a post hoc adjustment for a suggested ‘clinically relevant’ imbalance between trial arms in baseline exacerbation rate, the difference became marginally statistically significant. In terms of secondary outcomes, there were statistically significant differences favouring omalizumab over placebo in total emergency visits, Asthma Quality of Life Questionnaire scores, total symptom scores and lung function. Adverse events appeared to be similar between the trial arms. Results from three other publications are included in the manufacturer’s submission as supporting evidence for the effectiveness of omalizumab, despite not meeting the inclusion criteria which adhere strictly to the licensed indication. The ERG checked and provided commentary on the manufacturer’s model using standard checklists as well as undertook one-way sensitivity analysis, scenario analysis and a probabilistic sensitivity analysis. The cost-effectiveness analysis estimates the incremental costs and consequences of omalizumab as an add-on to standard therapy. The base-case analysis of the trial’s primary intention-to-treat population estimates a cost per quality-adjusted life-year of £30,647. The ERG conducted one-way sensitivity analyses for parameters omitted from the manufacturer’s submission sensitivity analysis. The results were most sensitive to variation in the utility values for omalizumab responders, and the unit cost of omalizumab. The guidance issued by NICE in November 2007 as a result of the STA states that omalizumab is recommended as a possible treatment for adults and young people over 12 years with severe persistent allergic asthma when their asthma meets certain conditions. Omalizumab treatment should be given along with the person’s current asthma medicines. It should be prescribed by a doctor who is experienced in asthma and allergy medicine at a specialist centre. If omalizumab does not control the asthma after 16 weeks, treatment should be stopped.

scholarly journals Cost-Effectiveness Analysis of First-Line FOLFIRI Combined With Cetuximab or Bevacizumab in Patients With RAS Wild-Type Left-Sided Metastatic Colorectal Cancer

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482090227
Author(s):  
Jiaqi Han ◽  
Desheng Xiao ◽  
Chongqing Tan ◽  
Xiaohui Zeng ◽  
Huabin Hu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Metastatic Colorectal Cancer ◽  
Phase Iii ◽  
Base Case ◽  
Wild Type ◽  
Lifetime Horizon ◽  
Life Years ◽  
The Cost

Background: The FIRE-3 phase III clinical trial demonstrated the marked advantage of prolonging the median overall survival of patients with final RAS wild-type (WT) left-sided metastatic colorectal cancer (mCRC) by 38.3 months after treatment with irinotecan, fluorouracil, and leucovorin (FOLFIRI) plus cetuximab and by 28.0 months after treatment with FOLFIRI plus bevacizumab. However, the substantial cost increase and economic impact of using cetuximab imposes a considerable burden on patients and society. Methods: A Markov model based on the data collected in the FIRE-3 trial was developed to investigate the cost-effectiveness of treating patients with FOLFIRI plus either cetuximab or bevacizumab from the perspective of the Chinese health-care system. Costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated over a lifetime horizon. One-way and probabilistic sensitivity analyses were performed by varying potentially modifiable parameters. Results: In our analysis, the total treatment costs in the bevacizumab and cetuximab groups were $92 549.31 and $94 987.31, respectively, and the QALYs gained were 1.58 and 2.05. In the base-case analysis, compared with bevacizumab, left-sided RAS WT patients receiving cetuximab gained 0.47 more QALYs at an ICER of $5187.23/QALY ($3166.23/LY). The 1-way sensitivity analysis showed that the most influential parameter was the cost of cetuximab. Probabilistic sensitivity analysis indicated that the cost-effective probability of cetuximab group was 92.8% under the willingness-to-pay threshold of $24 081. Conclusions: Treatment with FOLFIRI plus cetuximab in Chinese patients with left-sided RAS WT mCRC may improve health outcomes and use financial resources more efficiently than FOLFIRI plus bevacizumab.

Should We Use Contrast-Enhanced Ultrasound (CEUS) for the Characterization of Nonpalpable Testicular Lesions? An Analysis from a Cost-Effectiveness Perspective

2019 ◽  
Vol 41 (06) ◽  
pp. 668-674 ◽  
Author(s):  
Johannes Rübenthaler ◽  
Su Hwan Kim ◽  
Wolfgang G. Kunz ◽  
Wieland H. Sommer ◽  
Matthias Trottmann ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Base Case ◽  
Imaging Method ◽  
Contrast Enhanced Ultrasound ◽  
Case Scenario ◽  
Contrast Enhanced ◽  
Testicular Lesions ◽  
The Cost

Abstract Purpose Accurate characterization of testicular lesions is crucial to allow for correct treatment of malignant tumors and to avoid unnecessary procedures in benign ones. In recent years, contrast-enhanced ultrasound (CEUS) proved to be superior in specifying the dignity of small, nonpalpable testicular lesions (< 1.5 cm) compared to native B-mode and color Doppler ultrasound which were previously regarded as the primary imaging method. However, the cost-effectiveness of CEUS has not been evaluated yet. The aim of this study was to analyze the cost-effectiveness of CEUS as compared to unenhanced ultrasound for the characterization of nonpalpable testicular lesions. Methods A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with unenhanced ultrasound and CEUS. Model input parameters were obtained from recent literature. Deterministic sensitivity analysis of diagnostic parameters and costs was performed. Also, probabilistic sensitivity analysis using Monte-Carlo Modelling was applied. The willingness-to-pay (WTP) was set to $100 000/QALY. Results In the base-case scenario, unenhanced ultrasound resulted in total costs of $5113.14 and an expected effectiveness of 8.29 QALYs, whereas CEUS resulted in total costs of $4397.77 with 8.35 QALYs. Therefore, the unenhanced ultrasound strategy was dominated by CEUS in the base-case scenario. Sensitivity analysis showed CEUS to be the cost-effective alternative along a broad range of costs. Conclusion Contrast-enhanced ultrasound is a cost-effective imaging method for the characterization of nonpalpable testicular lesions.

scholarly journals Sustained Acoustic Medicine as a Non-surgical and Non-opioid Knee Osteoarthritis Treatment Option: A Health Economic Cost-effectiveness Analysis for Symptom Management 

2020 ◽  
Author(s):  
Thomas M Best ◽  
Stephanie Petterson ◽  
Kevin Plancher
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Treatment Options ◽  
Economic Cost ◽  
Base Case ◽  
Treatment Pathways ◽  
Knee Oa ◽  
Cost Effective Treatment ◽  
The Cost

Abstract Background: Patients diagnosed with osteoarthritis (OA) and presenting with symptoms are seeking conservative treatment options to reduce pain, improve function, and avoid surgery. Sustained acoustic medicine (SAM), a multi-hour treatment has demonstrated improved clinical outcomes for patients with knee OA. The purpose of this analysis was to compare the costs and effectiveness of multi-hour SAM treatment versus the standard of care (SOC) over a 6-month timeframe for OA symptom management.Methods: A decision tree analysis was used to compare the costs and effectiveness of SAM treatment versus SOC in patients with OA. Probabilities of success for OA treatment and effectiveness were derived from the literature using systematic reviews and meta-analyses. Costs were derived from Medicare payment rates and manufacturer prices. Functional effectiveness was measured as the effect size of a therapy and treatment pathways compared to a SOC treatment pathway. A sensitivity analysis was performed to determine which cost variables had the greatest effect on deciding which option was the least costly. An incremental cost effectiveness plot comparing SAM treatment vs. SOC was also generated using 1,000 iterations of the model. Lastly, the incremental cost effectiveness ratio (ICER) was calculated as the (cost of SAM minus cost of SOC) divided by (functional effectiveness of SAM minus functional effectiveness of SOC). Results: Base case demonstrated that over 6 months, the cost and functional effectiveness of SAM was $8,641 and 0.52 versus SOC at: $6,281 and 0.39, respectively. Sensitivity analysis demonstrated that in order for SAM to be the less expensive option, the cost per 15-minute session of PT would need to be greater than $88, or SAM would need to be priced at less than or equal to $2,276. Incremental cost effectiveness demonstrated that most of the time (84%), SAM treatment resulted in improved functional effectiveness but at a higher cost than SOC.Conclusion: In patients with osteoarthritis, SAM treatment demonstrated improved pain and functional gains compared to SOC but at an increased cost. Based on the SAM treatment ICER score being ≤$50,000, it appears that SAM is a cost-effective treatment for knee OA.

Sign in / Sign up

Export Citation Format

Share Document