scholarly journals Corrigendum: Brief alcohol intervention for risky drinking in young people aged 14–15 years in secondary schools: the SIPS JR-HIGH RCT

2020 ◽  
Vol 7 (9) ◽  
pp. 135-142
Author(s):  
Emma L Giles ◽  
Grant J McGeechan ◽  
Simon Coulton ◽  
Paolo Deluca ◽  
Colin Drummond ◽  
...  
Keyword(s):  
Young People ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Alcohol Intervention ◽  
Risky Drinking ◽  
Brief Alcohol Intervention ◽  
Utility Evaluation ◽  
The Cost ◽  
Phd Thesis ◽  
And Control

Abstract During independent re-analysis of the cost data for a PhD thesis, a coding error was identified in one of the sensitivity analyses of the cost-utility evaluation of the trial looking at the effect of excluding from the intervention and control costs the cost of missed school days.

scholarly journals Funding the New Biologics – CCOHTA Report on the Cost Effectiveness of Infliximab for Crohn’s Disease: Pearls and Pitfalls

2002 ◽  
Vol 16 (12) ◽  
pp. 877-879 ◽  
Author(s):  
John K Marshall
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Economic Analysis ◽  
Safety Data ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
State Transitions ◽  
Health State ◽  
Life Years ◽  
The Cost

The Canadian Coordinating Office for Health Technology Assessment (CCOHTA) published an economic analysis, using a Markov model, of infliximab therapy for Crohn’s disease that is refractory to other treatments. This was the first fully published economic analysis that addresses this treatment option. Health state transitions were based on data from Olmsted County, Minnesota, health state resource profiles were created using expert opinion and a number of assumptions were made when designing the model. The analysis was rigorous, the best available efficacy and safety data were used, state-of-the art sensitivity analyses were undertaken and an ‘acceptability curve‘ was constructed. The model found that infliximab was effective in increasing quality-adjusted life years when offered in a variety of protocols, but it was associated with high incremental cost utility ratios compared with usual care. The results should be interpreted, however, in view of a number of limitations. The time horizon for the analysis was short (one year), because of a lack of longer-term efficacy data, and might have led to an underestimation of the benefits from averting surgery. Because the analysis was performed from the perspective of a Canadian provincial ministry of health, only direct medical costs were considered. Patients with active Crohn’s disease are likely to incur significant indirect costs, which could be mitigated by this medication. The analysis should be updated as new data become available. Moreover, small changes in the cost of the medication could make the treatment cost effective, according to this model. Economic analyses, such as the one undertaken by the CCOHTA, cannot by themselves solve dilemmas in the allocation of limited health care resources, and other considerations must be included when formulating policy. This is especially important for patients with severe Crohn’s disease, who have significant disability and for whom few therapeutic options exist.

Health economic analysis of breast cancer index in patients with ER+, LN- breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11504-e11504
Author(s):  
Gary Gustavsen ◽  
Brock Schroeder ◽  
Patrick Kennedy ◽  
Kristin Ciriello Pothier ◽  
Catherine A. Schnabel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Gene Expression ◽  
Adjuvant Chemotherapy ◽  
Endocrine Therapy ◽  
Cost Savings ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Breast Cancer Index ◽  
Extended Endocrine Therapy ◽  
The Cost

e11504 Background: Numerous studies have demonstrated the cost utility of gene expression-based assessment of recurrence risk in breast cancer. Cost savings rely primarily on decreased use of adjuvant chemotherapy in patients predicted to be low-risk. Breast Cancer Index (BCI) is a gene expression-based test that significantly predicts overall risk of recurrence, late (≥5y) recurrence and likelihood of benefit from extended (≥5y) endocrine therapy in patients with ER+, LN- breast cancer. This study evaluated the potential cost utility of BCI from a US third-party payer perspective. Methods: A fact-based economic model was developed which projected the cost and effectiveness of BCI in a hypothetical population of patients with ER+, LN- breast cancer compared to standard clinicopathologic diagnostic modalities. Patients flowed through the model based on patterns of care and BCI data. Costs associated with adjuvant chemotherapy, toxicity, follow-up, endocrine therapy, and recurrence were modeled over 10 yrs. Model inputs were based primarily on published literature, and supplemented by interviews with disease experts and payers. Sensitivity analyses were performed around key inputs to estimate effects on the model. Results: Use of BCI is projected to be cost saving in this patient population, with a net cost savings of $4,005 per patient tested after accounting for BCI cost. Gross cost savings were projected to be achieved through targeted use of adjuvant chemotherapy ($5,785), reduced recurrence in patients receiving extended endocrine therapy based on BCI ($2,350), and reduced recurrence in previously non-compliant patients ($370). Sensitivity analyses demonstrated that results were most sensitive to chemotherapy utilization in low- and intermediate-risk patients, cost of adjuvant chemotherapy, cost of recurrence, and percentage of patients classified as low risk. Conclusions: BCI is projected to be cost saving in an ER+, LN-, breast cancer patient population. Cost savings are achieved through projected impact on adjuvant chemotherapy use, extended endocrine therapy use, and endocrine therapy compliance. These findings require validation in additional cohorts, including studies of real-world clinical practice.

scholarly journals Cost-Utility of Acromegaly Pharmacological Treatments in a French Context

2021 ◽  
Vol 12 ◽  
Author(s):  
Thierry Brue ◽  
Philippe Chanson ◽  
Patrice Rodien ◽  
Brigitte Delemer ◽  
Delphine Drui ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Meta Analysis ◽  
Cost Effective ◽  
Somatostatin Analogues ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Pharmacological Treatments ◽  
Lifetime Horizon ◽  
Efficient Treatment ◽  
The Cost

ObjectiveEfficacy of pharmacological treatments for acromegaly has been assessed in many clinical or real-world studies but no study was interested in economics evaluation of these treatments in France. Therefore, the objective of this study was to estimate the cost-utility of second-line pharmacological treatments in acromegaly patients.MethodsA Markov model was developed to follow a cohort of 1,000 patients for a lifetime horizon. First-generation somatostatin analogues (FGSA), pegvisomant, pasireotide and pegvisomant combined with FGSA (off label) were compared. Efficacy was defined as the normalization of insulin-like growth factor-1 (IGF-1) concentration and was obtained from pivotal trials and adjusted by a network meta-analysis. Costs data were obtained from French databases and literature. Utilities from the literature were used to estimate quality-adjusted life year (QALY).ResultsThe incremental cost-utility ratios (ICUR) of treatments compared to FGSA were estimated to be 562,463 € per QALY gained for pasireotide, 171,332 € per QALY gained for pegvisomant, and 186,242 € per QALY gained for pegvisomant + FGSA. Pasireotide seems to be the least cost-efficient treatment. Sensitivity analyses showed the robustness of the results.ConclusionFGSA, pegvisomant and pegvisomant + FGSA were on the cost-effective frontier, therefore, depending on the willingness-to-pay for an additional QALY, they are the most cost-effective treatments. This medico-economic analysis highlighted the consistency of the efficiency results with the efficacy results assessed in the pivotal trials. However, most recent treatment guidelines recommend an individualized treatment strategy based on the patient and disease profile.

scholarly journals Cost-utility Analysis of Trabecular Micro-bypass Stents (TBS) in Patients With Mild-to-moderate Open-angle Glaucoma in Italy

2021 ◽  
Author(s):  
Antonio Maria Fea ◽  
Francesco Cattel ◽  
Stefano Gandolfi ◽  
Giorgio Buseghin ◽  
Gianluca Furneri ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cataract Surgery ◽  
Open Angle Glaucoma ◽  
Cost Effective ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Utility Analysis ◽  
Istent Inject ◽  
The Cost

Abstract BackgroundGlaucoma is a disease characterized by progressive damage of the optic nerve. Several therapeutic options are available to lower intraocular pressure (IOP). In primary open-angle glaucoma (POAG) patients with inadequate IOP control (or controlled with multiple medical therapies or for whom medical therapy is contraindicated), the implantation of micro-invasive glaucoma surgery devices (MIGS) and concomitant cataract surgery has proved to be more effective in reducing intraocular pressure (IOP), as compared to cataract surgery alone. The objective of this study is to assess the cost-effectiveness of iStent inject® device with concurrent cataract surgery vs. cataract surgery alone, in patients with mild-to-moderate POAG, adopting the Italian National Health Service (NHS) perspective.MethodsSimulation of outcomes and costs was undertaken using a Markov model with 4 health states and one-month cycles, that is used to simulate the prognosis of these patients. Efficacy data were obtained from the randomized clinical trial (RCT). A lifetime horizon was adopted in the analysis. A discount rate of 3.5% was applied to both costs and effects. The Italian National Healthcare Service (NHS) perspective was considered, therefore only healthcare direct costs (acquisition of main interventions and subsequent procedures; medications; monitoring and follow-up; adverse events). Model robustness was tested through sensitivity analyses. ResultsResults of the base-case analysis showed that the total lifetime costs were higher in the iStent inject® + concurrent cataract surgery, compared with the cataract surgery alone group (€8,368.51 vs. €7,134.71 respectively). iStent inject® + concurrent cataract surgery was cost-effective vs. cataract surgery alone, with an incremental cost-effectiveness ratio of €13,037.01 per quality-adjusted life year (QALY) gained. Both one-way deterministic and probabilistic sensitivity analyses confirmed robustness of base-case results. The acceptability curve of cost-effectiveness (CEAC) analysis showed that iStent inject® + cataract surgery would have a 98% probability of being cost-effective, compared to cataract surgery alone, when the willingness to pay (WTP) is equal to €50,000 per QALY gained.ConclusionsThe results of the cost-utility analysis confirm that iStent inject® + cataract surgery is a cost-effective option for the treatment of patients affected by mild-to-moderate POAG, compared with cataract surgery alone, when evaluated from the Italian NHS perspective. Trial registration: Not applicable

scholarly journals 80. Pharmacoeconomic Analysis Comparing the Empiric Utilization of Cefepime Versus Piperacillin/tazobactam

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S57-S58
Author(s):  
Kelsey Olmack ◽  
Curtis D Collins
Keyword(s):  
Pharmacoeconomic Analysis ◽  
Hospital Setting ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Decision Analytic Model ◽  
Empiric Treatment ◽  
Life Years ◽  
The Cost ◽  
The Impact

Abstract Background In the hospital setting, cefepime (CFP) and piperacillin/tazobactam (PTZ) are among the most commonly utilized antipseudomonal agents in the empiric treatment of nosocomial and healthcare-associated infections. Institutional preference of CFP or PTZ as the preferred antipseudomonal antibiotic varies. Recent literature suggests each may be associated with increased rates of harmful adverse effects including Clostridiodes difficile infection (CDI) and acute kidney injury (AKI). The objective of this study is to perform a pharmacoeconomic analysis comparing CFP versus PTZ for empiric antibiotic treatment in patients where Pseudomonas aeruginosa is a concern. Methods We performed a cost-utility analysis comparing CFP and PTZ for empiric utilization in the hospital setting by creating a decision analytic model from the hospital perspective. Model variables were populated utilizing published clinical and economic data including incidence of AKI and CDI, their associated costs and mortality, and the cost of antibiotic therapy. Secondary and univariate sensitivity analyses tested the impact of model uncertainties and the robustness of our model. A willingness to pay (WTP) threshold of $0 was utilized. Results Results of our base-case model predicted that the use of CFP dominated PTZ as empiric utilization was less expensive ($7690 vs. $9331) and associated with a higher quality-adjusted life-years (QALY) (0.9193 vs. 0.9191) compared to the use of PTZ. Several variables had the potential to impact base case results. PTZ became cost-effective at our WTP threshold if CFP nephrotoxicity rates increased to 17.3%, the PTZ nephrotoxicity decreased to 28.5%, or if the cost of nephrotoxicity was less than $17,457. No other model variables, including incidence of CDI, impacted base case results. Sensitivity Analysis on Cefepime Clostridioides difficile Infection Incidence and Piperacillin/tazobactam Nephrotoxicity Conclusion Results of our model showed that CFP dominated PTZ for the empiric treatment of nosocomial infections. The model was sensitive to variation in CFP and PTZ nephrotoxicity rates. Disclosures All Authors: No reported disclosures

Cost-effectiveness of primary prophylaxis (PP) with colony-simulating factor (CSF) when compared with secondary prophylaxis (SP) in elderly patients with diffuse aggressive lymphoma undergoing curative chemotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6558-6558
Author(s):  
K. K. Chan ◽  
K. R. Imrie ◽  
S. M. Alibhai
Keyword(s):  
Cost Effectiveness ◽  
Elderly Patients ◽  
Cost Minimization ◽  
Cost Effective ◽  
Primary Prophylaxis ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Aggressive Lymphoma ◽  
Base Case ◽  
The Cost

6558 Background: The 2006 ASCO guideline recommends PP with CSF for elderly patients with diffuse aggressive lymphoma, partially based on previous cost-minimization analyses showing that CSF saved costs when compared with no CSF by reducing hospitalization from febrile neutropenia (FN) when the risk of FN was > 20%. However, these studies examined only one cycle of chemotherapy and did not account for costs of CSF in subsequent cycles, did not consider SP, and did not consider patients’ preferences. Methods: We conducted a cost-utility analysis to compare PP with SP in this setting using a Markov model for a time horizon of 8 cycles of chemotherapy with a government payer perspective. Costs were adjusted to 2006 $CAD. Ontario health economic data were used. The cost of hospitalization for FN was obtained from Ontario Case Costing Initiative. Data for efficacies of CSF, probabilities and utilities were obtained from published literature. Sensitivity analyses were conducted using a threshold of $100,000/QALY. Results: The base case costs for PP and SP were $22,077 and $17,641. The QALYs of PP and SP were 0.254 and 0.248. The incremental cost effectiveness ratio of PP to SP was $739,999/QALY. One-way sensitivity analyses showed that in order for PP to be cost-effective, the cost of hospitalization per episode of FN had to be > $31,138 (i.e. 2.5 times > base case), the cost of CSF per cycle had to be < $896 (base case = $1,960), the risk of FN in the 1st cycle had to be > 48% (base case = 24%), or the relative risk reduction of FN with CSF had to be > 97% (base case = 41%). Our result was robust to all other cost, probability and utility variables. First order microsimulation showed that < 17% of simulations were cost-effective. Conclusions: PP is not cost-effective when compared with SP for this population under most assumptions. PP only becomes attractive in places where the cost of hospitalization for FN is much more than that of Ontario, or the cost of CSF is under $896 per cycle. The costs of CSF and hospitalization in all cycles (instead of just one cycle) should be accounted for in any economic evaluation of CSF. Current guidelines recommending PP in this population should be revisited. No significant financial relationships to disclose.

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