Infliximab for the treatment of acute exacerbations of ulcerative colitis

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of infliximab for the treatment of acute exacerbations of ulcerative colitis, in accordance with the licensed indication, based upon the manufacturer’s submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process. The submitted clinical evidence included four randomised controlled trials (RCTs), two comparing infliximab with placebo in patients not responsive to initial treatment with intravenous corticosteroids and one comparing ciclosporin with placebo. A fourth RCT compared ciclosporin with intravenous corticosteroids as the initial treatment after hospitalisation. The manufacturer’s submission concluded that infliximab provides clinical benefit to patients with acute severe, steroid-refractory ulcerative colitis and is well tolerated; it also provides additional clinical benefits over ciclosporin, particularly avoidance of colectomy. A decision tree model was built to compare infliximab with strategies involving ciclosporin, standard care and surgery. After correcting a small number of errors in the model, the revised base-case incremental cost-effectiveness ratio (ICER) for infliximab compared with standard care was £20,000. However, sensitivity analyses revealed considerable uncertainty emanating from the weight of the patient, the timeframe considered and, most importantly, the colectomy rates used. When a more appropriate mix of trials were included in the estimation of colectomy rates, the ICER for infliximab rose to £48,000. The guidance issued by NICE on 31 October 2008 states that infliximab is recommended as an option for the treatment of acute exacerbations of severely active ulcerative colitis only in patients in whom ciclosporin is contraindicated or clinically inappropriate, based on a careful assessment of the risks and benefits of treatment in the individual patient; for people who do not meet this criterion, infliximab should only be used for the treatment of acute exacerbations of severely active ulcerative colitis in clinical trials.

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Romiplostim for the treatment of chronic immune or idiopathic thrombocytopenic purpura: a single technology appraisal

Health Technology Assessment ◽

10.3310/hta13suppl2-09 ◽

2009 ◽

Vol 13 (Suppl 2) ◽

pp. 63-68

Author(s):

G Mowatt ◽

C Boachie ◽

M Crowther ◽

C Fraser ◽

R Hernández ◽

...

Keyword(s):

Cost Effectiveness ◽

Idiopathic Thrombocytopenic Purpura ◽

Economic Model ◽

Clinical Excellence ◽

Sensitivity Analyses ◽

Base Case ◽

Technology Appraisal ◽

Platelet Response ◽

Single Technology Appraisal ◽

Thrombocytopenic Purpura

This paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of romiplostim for the treatment of adults with chronic immune or idiopathic thrombocytopenic purpura (ITP) 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 submission’s evidence came from two relatively high-quality randomised controlled trials (RCTs). The ERG found no evidence that any important data were missed or that data extraction was inaccurate. In both RCTs more patients in the romiplostim than in the placebo group achieved a durable platelet response [non-splenectomised patients: romiplostim 25/41 (61%), placebo 1/21 (5%), odds ratio (OR) 24.45, 95% confidence interval (CI) 3.34 to 179.18; splenectomised patients: romiplostim 16/42 (38%), placebo 0/21 (0%), OR 8.5 (95% CI 1.15 to 372)] and an overall platelet response [non-splenectomised patients: romiplostim 36/41 (88%), placebo 3/21 (14%), OR 34.74, 95% CI 7.77 to 155.38; splenectomised patients: romiplostim 33/42 (79%), placebo 0/21 (0%), OR 16.6 (95% CI 2.37 to 706]. The difference in mean period with a platelet response was 13.9 weeks (95% CI 10.5 to 17.4) in favour of romiplostim in the RCT of non-splectomised patients and 12.1 weeks (95% CI 8.7 to 15.6) in favour of romiplostim in the RCT of splectomised patients. The manufacturer’s economic model evaluated the cost-effectiveness of romiplostim compared with standard care. The ERG had concerns about the way the decision problem was addressed in the economic model and about the non-adjustment of findings for confounding factors. In non-splenectomised patients, using romiplostim as a first option treatment, the base-case incremental cost-effectiveness ratio (ICER) was £14,840 per quality-adjusted life-year (QALY). In splenectomised patients the ICER was £14,655 per QALY. Additional sensitivity analyses performed by the ERG identified two issues of importance: whether individuals entered the model on watch and rescue or on active therapy in the comparator arm (ICER £21,674 per QALY for non-splenectomised patients, £29,771 per QALY for splenectomised patients); whether it was assumed that any unused medicine would be wasted. Combining all of the separate sensitivity analyses, and assuming that watch and rescue was not the first-line treatment, increased the ICERs further (non-splenectomised £37,290 per QALY; splenectomised £131,017 per QALY). In conclusion, the manufacturer’s submission and additional work conducted by the ERG suggest that romiplostim has short-term efficacy for the treatment of ITP, but there is no robust evidence on long-term effectiveness or cost-effectiveness of romiplostim compared with relevant comparators.

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Cost-Effectiveness Analysis of Vedolizumab Compared With Infliximab in Anti-TNF-α-Naïve Patients With Moderate-to-Severe Ulcerative Colitis in China

Frontiers in Public Health ◽

10.3389/fpubh.2021.704889 ◽

2021 ◽

Vol 9 ◽

Author(s):

Ting Zhou ◽

Yanan Sheng ◽

Haijing Guan ◽

Rui Meng ◽

Zijing Wang

Keyword(s):

Ulcerative Colitis ◽

Cost Effectiveness ◽

Discount Rate ◽

Sensitivity Analyses ◽

Base Case ◽

Parameter Estimates ◽

Annual Discount Rate ◽

Life Years ◽

Tnf Α ◽

The Cost

Objective: To evaluate the cost effectiveness of vedolizumab vs. infliximab in the treatment of anti-tumor necrosis factor-alpha (TNF-α)-naïve patients with moderate-to-severe active ulcerative colitis (UC) in China.Methods: The costs and effectiveness of vedolizumab and infliximab in the treatment of anti-TNF-α naïve patients with moderate-to-severe active UC were compared using a hybrid decision tree model and a Markov model. From the perspective of the Chinese healthcare system, this study simulated the lifetime health benefits [quality-adjusted life-years (QALYs)] and costs (USD) for patients with UC from the induction phase to the maintenance phase, with an annual discount rate of 5%. The clinical efficacy and transition probability data were based on a previously published network meta-analysis. The health utility, surgical risk, biologic drug discontinuation rate, and mortality were derived from previous literature and the Chinese statistical yearbook. The cost data were based on China's drug purchase and biding platform and the results of a survey sent to clinicians in 18 tertiary hospitals. One-way and probabilistic sensitivity analyses (PSAs) were performed to validate the robustness of the models' assumptions and specific parameter estimates.Results: The results of the base-case analyses showed that compared with infliximab, vedolizumab led to a gain of 0.25 QALYs (9.56 vs. 9.31 QALYs) and was less expensive by $7,349 ($180,138 vs. 187,487), indicating that the use of vedolizumab was a dominant strategy. The results of one-way sensitivity analyses suggested that the annual discount rate and health-state costs had the greatest impact, but the results were otherwise consistent with those of the base-case analyses. The PSAs suggested that vedolizumab had a 98.6% probability of being effective at a threshold of 3 times the gross domestic product (GDP) per capita in China in 2020.Conclusion: Compared with infliximab, vedolizumab appears to be a more cost-effective option in the treatment of anti-TNF-α naïve adult patients with moderate-to-severe, active UC in China.

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Omalizumab for the treatment of severe persistent allergic asthma

Health Technology Assessment ◽

10.3310/hta13suppl2-05 ◽

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.

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Use of Impulse oscillometry for Diagnostic of Asthma in Preschoolers: A Cost-effectiveness Analysis

10.21203/rs.3.rs-832251/v1 ◽

2021 ◽

Author(s):

Jefferson Antonio Buendía ◽

Diana Guerrero_Patiño

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Sensitivity Analyses ◽

Base Case ◽

Impulse Oscillometry ◽

Tree Model ◽

Health Technologies ◽

Patient Cooperation ◽

The One ◽

The Cost

Abstract BackgroundImpulse oscillometry is an alternative to measure lung function in preschoolers because is much simpler and can be performed in tidal breathing with minimal patient cooperation. The introduction of new health technologies such as impulse oscillometry raises concerns as if the extra benefit offered outweighs the additional cost compared to spirometry This study aimed to evaluate the cost-effectiveness of impulse oscillometry in preschoolers in Colombia.Methods We conducted a decision tree model to estimate the cost and proportion of correctly diagnosed cases of asthma of impulse oscillometry compared to spirometry in preschooler’s children between 3-6 years old . The analysis was carried out from a societal perspective. Multiple sensitivity analyses were conducted. Cost-effectiveness was evaluated at a willingness-to-pay value of $19,000. ResultsWith impulse oscillometry, the proportion of correctly diagnosed cases was 42%, while with spirometry was 39%. The expected cost estimated by the model for a patient diagnosed with IOS was U$ 174 while with spirometry was U$ 99. The incremental cost-effectiveness ratio estimated in the probabilistic model was US$ 6881. The one-way and probabilistic sensitivity analyses, our base‐case results were robust to variations of all assumptions and parameters Conclusion Impulse oscillometry was found to be cost-effective for the diagnosis of asthma in preschoolers. Our results should stimulate further research to expand the use of this diagnostic test in developing countries.

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Cost-Effectiveness Analysis of Ceftazidime-Avibactam Versus Colistin-Meropenem in the Treatment of Infections Due to Carbapenem-Resistant Enterobacteriaceae in Colombia

10.21203/rs.3.rs-40162/v1 ◽

2020 ◽

Author(s):

FA Varón-Vega ◽

N Castaño ◽

E Lemos ◽

Juan Manuel Reyes

Keyword(s):

Cost Effectiveness ◽

Length Of Hospital Stay ◽

Cost Effective ◽

Sensitivity Analyses ◽

Significant Advance ◽

Base Case ◽

Tree Model ◽

System Perspective ◽

Carbapenem Resistant ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Background: Ceftazidime-Avibactam (CAZ-AVI) may offer a significant advance over previously antimicrobials against carbapenem-resistant Enterobacteriaceae (CRE). We evaluate the cost-effectiveness of CAZ-AVI compared to colistin-meropenem (COL+MEM) in the treatment of CRE infections in ColombiaMethods: A decision tree model was developed from healthcare system perspective assuming a 30-day time horizon. Inputs were derived from a published observational study. The clinical course was simulated based on treatment response between 48-72 hours, and the duration of the treatment was 7-14 days. The clinical failure was assumed as the addition of an antibiotic. The model considered that combination therapy of COL+MEM was not superior to monotherapy to reflect real clinical behavior. Cost inputs were extracted from a published Colombian manual tariffs and official databases, expressed in 2019 dollars (USD). Utility values were from published literature. The sensitivity analyses were performed.Results: In the base case analysis, CAZ-AVI was associated with reduced mortality, length of hospital stay and fewer add-on antibiotics, resulting in an increase of 1.76 QALYs per patient versus COL+MEM. and incremental costs associated in CAZ-AVI were $2,521 higher per patient compared to COL+MEM ($755 versus $3,276). The incremental costs were partially increased due to the lower mortality rate observed with CAZ-AVI. The incremental cost-effectiveness ratio was estimated to be $3,317 per QALY. In the probabilistic sensitivity analysis, with a willingness to pay above $2,438, CAZ-AVI has a higher probability of being cost-effective.Discussion: CAZ-AVI demonstrates cost-effectiveness as a treatment for CRE infections by reducing the number of deaths and increasing QALYs.

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Economic evaluation of enhanced staff contact for the promotion of breastfeeding for low birth weight infants

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462310000115 ◽

2010 ◽

Vol 26 (2) ◽

pp. 133-140 ◽

Cited By ~ 14

Author(s):

Stephen J. C. Rice ◽

Dawn Craig ◽

Felicia McCormick ◽

Mary J. Renfrew ◽

Anthony F. Williams

Keyword(s):

Economic Evaluation ◽

Birth Weight ◽

Cost Effectiveness ◽

Sensitivity Analyses ◽

Future Research ◽

Base Case ◽

Tree Model ◽

Low Birth Weight Infants ◽

Life Years

Objectives: There is evidence that breastmilk feeding reduces mortality and short and long-term morbidity among infants born too soon or too small. The aim of this study was to evaluate the cost-effectiveness of enhanced staff contact for mothers with infants in a neonatal unit with a birth weight of 500–2,500 g from the perspective of the UK National Health Service.Methods: A decision-tree model linked clinical outcomes with long-term health outcomes. The study population was divided into three weight bands: 500–999 g, 1000–1,749 g, and 1,750–2,500 g. Clinical and resource use data were obtained from literature reviews. The measure of benefit was quality-adjusted life-years. Uncertainty was evaluated using cost-effectiveness acceptability curves and sensitivity analyses.Results: The intervention was less costly and more effective than the comparator in the base–case analysis for each birth weight group. The results were quite robust to the sensitivity analyses performed.Conclusions: This is the first economic evaluation in this complex field and offers a model to be developed in future research. The results provide preliminary indications that enhanced staff contact may be cost-effective. However, the limited evidence available, and the limited UK data in particular, suggest that further research is required to provide results with confidence.

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286. Exploratory Cost-Effectiveness Analysis for Treatment of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections: Are Daptomycin and Linezolid Favored over Vancomycin and Other Antibiotics?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.330 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S143-S144

Author(s):

Michelle Vu ◽

Kenneth Smith ◽

Sherrie L Aspinall ◽

Cornelius J Clancy ◽

Deanna Buehrle

Keyword(s):

Staphylococcus Aureus ◽

Cost Effectiveness ◽

Methicillin Resistant Staphylococcus Aureus ◽

Bloodstream Infections ◽

Sensitivity Analyses ◽

Drug Event ◽

Base Case ◽

Health Administration ◽

Research Support ◽

Methicillin Resistant

Abstract Background Methicillin-resistant Staphylococcus aureus bloodstream infections (MRSAB) cause significant mortality and often require extended antibiotic therapy. Vancomycin, the most common initial MRSAB treatment, carries significant monitoring burden and nephrotoxicity risks. We compared cost-effectiveness of vancomycin and other antibiotic regimens as MRSAB treatment. Methods We estimated cost-effectiveness of intravenous antibiotics (vancomycin, daptomycin, linezolid, ceftaroline/daptomycin, dalbavancin) for Veterans Health Administration (VA) patients with MRSAB using an exploratory decision-tree model. Primary effectiveness outcome was composite of microbiological failure and adverse drug event (ADE)-related discontinuation at 7-days. Results In base-case analyses, linezolid and daptomycin were less expensive and had fewer treatment failures than other regimens at 4 and 6-weeks. Compared to linezolid, daptomycin incremental cost-effectiveness ratios were ~$45,000 (4-weeks) and ~$61,000 (6-weeks) per composite failure avoided, respectively. In one-way sensitivity analyses, daptomycin (4-weeks) was favored over linezolid if linezolid microbiological failure or ADE-related discontinuation rates were >14.8% (base case: 14.0%) or >14.3% (base case: 14.0%), respectively, assuming a willingness to pay (WTP) threshold of $40,000/ composite treatment failure avoided. Vancomycin was favored if its microbiological failure risk was < 16.4% (base case: 27.2%). In two-way sensitivity analyses, daptomycin was favored if linezolid microbiological failure and ADE-related discontinuation rates were >19% and > 16%, respectively. Linezolid, daptomycin and vancomycin were favored in 47%, 39%, and 11% of 4-week probabilistic iterations, respectively, at $40,000 WTP. Conclusion Daptomycin or linezolid are likely less expensive and more effective than vancomycin or other initial regimens for MRSAB. More data are needed to support safety of linezolid in MRSAB patients. Disclosures Cornelius J. Clancy, MD, Astellas (Consultant, Grant/Research Support)Cidara (Consultant, Research Grant or Support)Melinta (Grant/Research Support)Merck (Consultant, Grant/Research Support)Needham Associates (Consultant)Qpex (Consultant)Scynexis (Consultant)Shionogi (Consultant)

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Cost-effectiveness analysis of ranibizumab for retinal vein occlusion patients in China from the societal perspective

BMC Ophthalmology ◽

10.1186/s12886-021-01997-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Weiyi Ni ◽

Jia Liu ◽

Yawen Jiang ◽

Jing Wu

Keyword(s):

Cost Effectiveness ◽

Retinal Vein Occlusion ◽

Societal Perspective ◽

Laser Photocoagulation ◽

Cost Effective ◽

Sensitivity Analyses ◽

Gdp Per Capita ◽

Base Case ◽

Vein Occlusion ◽

Per Capita

Abstract Background Clinical trials in China have demonstrated that ranibizumab can improve the clinical outcomes of branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). However, no economic evaluation of ranibizumab has been conducted among Chinese patient population. Methods To provide insights into the economic profile of ranibizumab among Chinese RVO population, a Markov state-transition model was used to predict the outcomes of ranibizumab comparing to laser photocoagulation and observational-only care from the societal perspective. This model simulated changes in patient visuality, quality-adjusted of life years (QALY), medical costs, and direct non-medical costs of individuals with visual impairment due to BRVO or CRVO in lifetime. The base-case analysis used an annual discount rate of 5% for costs and benefits following the China Guidelines for Pharmacoeconomic Evaluations. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of the model. Results The base-case incremental cost-effectiveness ratio (ICER) comparing ranibizumab to laser photocoagulation was ¥65,008/QALY among BRVO patients and was ¥65,815/QALY among CRVO patients, respectively. Comparing to the 2019 gross domestic product (GDP) per capita of ¥71,000, both two ICERs were far below the cost-effective threshold at three times of GDP per capita (¥213,000). The deterministic and probabilistic sensitivity analyses demonstrated the base-case results were robust in most of the simulation scenarios. Conclusion The current Markov model demonstrated that ranibizumab may be cost-effective compared with laser photocoagulation to treat BRVO and cost-effective compared to observation-only care to treat CRVO in China from the societal perspective.

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Cost-effectiveness of Triple Therapy with Telaprevir for Chronic Hepatitis C Virus Patients in Germany

Journal of Health Economics and Outcomes Research ◽

10.36469/9870 ◽

2013 ◽

Vol 1 (3) ◽

pp. 239-253 ◽

Cited By ~ 9

Author(s):

Jona T. Stahmeyer ◽

Svenja Schauer ◽

Siegbert Rossol ◽

Hans Heinrich Wedemeyer ◽

Daniel Wirth ◽

...

Keyword(s):

Cost Effectiveness ◽

Hepatitis C ◽

Triple Therapy ◽

Sensitivity Analyses ◽

Healthcare Sector ◽

Base Case ◽

Life Years ◽

Previously Treated Patients ◽

Previously Treated ◽

The Cost

Background: About 400,000-500,000 people are infected with hepatitis C in Germany. Long-term consequences are the development of liver cirrhosis and hepatocellular carcinoma. The introduction of first generation protease inhibitors has significantly improved the treatment of hepatitis C genotype 1 patients. The aim of the study was to assess the cost-effectiveness of triple therapy with telaprevir in Germany. Methods: We used a Markov model on disease progression and natural history to assess the cost-effectiveness of triple therapy with telaprevir compared to standard treatment with pegylated interferon and ribavirin. Model structure and inputs were discussed with clinical experts. Deterministic and probabilistic sensitivity analyses were performed to verify the robustness of results. Results: The base-case analyses shows that triple therapy results in higher costs (untreated patients: €48,446 vs. €30,691; previously treated patients: €63,228 vs. €48,603) and better outcomes (untreated patients: 16.85 qualily of life years [QALYs] vs. 15.97 QALYs; previously treated patients: 14.16 QALYs vs. 12.89 QALYs). The incremental cost-effectiveness ratio (ICER) was €20,131 per QALY and €30,567 per life year gained (LYG) for previously untreated patients. ICER in treatment experienced patients was €7,664 per QALY for relapse patients, €12,506 per QALY for partial responders and €28,429 per QALY for null responders. Results were robust in sensitivity analyses. Conclusion: Although triple therapy with telaprevir leads to additional costs, there is a high probability of being cost-effective for different thresholds. This health economic analysis makes an important contribution to current debates on cost savings and efficient resource allocation in the German healthcare sector.

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Cost-effectiveness of mobile health-based integrated care for atrial fibrillation: Model development and data analysis (Preprint)

10.2196/preprints.29408 ◽

2021 ◽

Author(s):

Xueyan Luo ◽

Wei Xu ◽

Quan Yuan ◽

Han Lai ◽

Chunji Huang

Keyword(s):

Atrial Fibrillation ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Integrated Care ◽

Mobile Health ◽

Cost Effective ◽

Sensitivity Analyses ◽

Base Case ◽

Life Years ◽

Mhealth Technology

BACKGROUND Mobile health (mhealth) technology is increasingly used in disease management. Using mhealth tools to integrate and streamline care was found to improve atrial fibrillation (AF) patients’ clinical outcomes. OBJECTIVE This study aimed to investigate the potential clinical and health economic outcomes of mhealth-based integrated care for AF from the perspective of a public healthcare provider in China. METHODS A Markov model was designed to compare outcomes of mhealth-based care and usual care in a hypothetical cohort of AF patients in China. The time horizon was 30 years with monthly cycles. Model outcomes measured were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to examine the robustness of base-case results. RESULTS In the base-case analysis, mhealth-based care gained higher QALYs of 0.0818 with an incurred cost of USD1,778. Using USD33,438 per QALY (three times gross domestic product) as the willingness-to-pay threshold, mhealth-based care was cost-effective, with an ICER of USD21,739 per QALY. The one-way sensitivity analysis found compliance to mhealth-based care had the greatest impact on the ICER. In probabilistic sensitivity analysis, mhealth-based care was accepted as cost-effective in 80.91% of 10,000 iterations. CONCLUSIONS This study suggested that the use of mhealth technology in streamlining and integrating care for AF patients was cost-effective in China.

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