Cost-effectiveness analysis with direct-acting antivirals in a cohort of HCV-infected inmates in Italy

Objective: To evaluate the cost-effectiveness of a strategy based on direct-acting antivirals (DAAs) versus no drug strategy in HCV-infected inmates, from the perspective of the Italian National Health System (iNHS). Methods: A previous Markov model was adapted to the Italian setting to evaluate the direct medical costs and health outcomes (quality-adjusted life years, QALY) throughout the life of HCV-infected inmates. Epidemiological data, patient characteristics (genotype, METAVIR classification), DAAs sustained virological response (SVR), annual likelihood of transition, treatment costs and utilities were gathered from the literature. The DAAs strategy included the administration of elbasvir/grazoprevir or sofosbuvir/velpatasvir or glecaprevir/pibrentasvir. Direct medical costs and QALYs were discounted at a 3.0% annual rate. Cost-effectiveness was evaluated as incremental cost-effectiveness ratio (€, 2019) per QALY gained. A deterministic sensitivity analysis (DSA) was performed. Results: Over a lifetime horizon, the DAAs strategy showed higher health costs per patient compared to no drugs strategy in the base-case analysis (€ 42,571 vs. € 26,119). However, it was associated with an increase of QALYs gained (21.14 vs. 15.67), showing an incremental cost-effectiveness ratio of € 3,010 per QALY. The sensitivity analysis confirmed the base-case results. Conclusions: Extending the DAAs treatment to HCV-infected inmates was estimated to be cost effective from the perspective of the Italian NHS, regardless genotype and METAVIR classification.

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Abstract WP50: Cost-Effectiveness of Mechanical Thrombectomy for Acute Ischemic Stroke: An Analysis From RESILIENT Trial

Stroke ◽

10.1161/str.51.suppl_1.wp50 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Ana Claudia de Souza ◽

Sheila Martins ◽

Carisi Polanczyk ◽

Denizar Vianna ◽

Leonardo Carbonera ◽

...

Keyword(s):

Cost Effectiveness ◽

Incremental Cost ◽

Healthcare System ◽

Standard Care ◽

Mechanical Thrombectomy ◽

Medical Costs ◽

Incremental Cost Effectiveness Ratio ◽

Mortality Data ◽

Cost Effectiveness Ratio ◽

Direct Medical Costs

Background and purpose: RESILIENT Trial was the first study in a developing country to demonstrate the benefit of mechanical thrombectomy (MT) in acute stroke patients. This economic evaluation aimed to access the cost-utility of MT under the perspective of the Brazilian Public Healthcare System. Methods: Analysis was based on a subset sample of the original study (151 of 221 patients) from 4 hospitals. We compared costs and utilities between MT plus standard care (n=78) vs. standard care alone (n=73). Direct medical costs were considered, and utilities were inputted according to each patient’s Utility-Weighted modified Rankin Score (UW-mRS). First-year survival was obtained from trial follow-up and modelled for a life-time horizon adjusted by National Mortality Data. Direct medical costs were converted to I$ using Purchasing Power Parity (PPP). A discount rate of 5% was used. Incremental cost-effectiveness ratio (ICER) is expressed in cost (I$) per Quality-Adjusted Life Year (QALY). Results: RESILIENT trial was stopped on its first interim analysis because of early efficacy. The incremental costs and QALYs gained with MT were estimated at I$ 8,369 and 0.75, respectively, compared with standard medical care, yielding an incremental cost-effectiveness ratio (ICER) of I$ 7,256 per QALY. Conclusion: The initially higher costs of MT were offset by the clear benefit of the intervention. RESILIENT trial demonstrated that such therapy is likely to be cost-effective despite the economical constraints in the Brazilian healthcare system.

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Economic evaluation of sacubitril/valsartan versus enalapril in the treatment of heart failure with reduced ejection fraction

10.21203/rs.3.rs-21177/v1 ◽

2020 ◽

Author(s):

Haiqiang SANG ◽

Yaohui JIANG ◽

Zhe WANG ◽

Rujie ZHENG

Keyword(s):

Heart Failure ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Ejection Fraction ◽

Incremental Cost ◽

Cost Effective ◽

Incremental Cost Effectiveness Ratio ◽

Cost Effectiveness Ratio ◽

Reduced Ejection Fraction ◽

The Cost

Abstract Background: In 2020, sacubitril/valsartan(formerly LCZ696) will implement the new negotiated price of medical insurance in China, and the cost of treatment will be significantly reduced. The aim of study is to evaluate the economy of sacubitril/valsartan(SAC/VAL) compared with an angiotensin converting enzyme inhibitor (ACEI) (enalapril) in the treatment of heart failure with reduced ejection fraction (HFrEF) in China.Method: A Markov model was developed to project clinical and economic outcomes of SAC/VAL versus enalapril for 64-year-old patients with HFrEF over 10 years from the Chinese medical and health system perspective. A cost-utility analysis was performed mostly based on data from the PARADIGM trial. Other transition probability, costs, and utilities were obtained from published literature and public databases. The primary outcome were total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for SAC/VAL relative to enalapril. The model was verified the uncertainty using the sensitivity analysis furtherly.Results: Compared with enalapril, SAC/VAL cost more than enalapril (¥96532 vs. ¥34560) and was more cost-effective (4.6 QALYs vs. 4.3 QALYs), resulting in an incremental cost-effectiveness ratio of ¥185720 per QALY gained for patients with HFrEF at a WTP threshold of ¥212676 per QALY. Sensitivity analysis demonstrated the robustness of the model, identifying the death on the SAC/VAL group as a significant drivers of the cost-effectiveness. At the national negotiation price (¥9.95 per 100mg), probability of SAC/VAL being cost-effective was about 53% at a WTP threshold of ¥212676 per QALY.Conclusion: SAC/VAL was associated with clinical benefit and may be cost-effective compared with an ACEI (the current standard of care) in patients with HFrEF.

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PP452 Impact Of Patient Access Schemes On Health Technology Assessment Agency Guidance For Rare Diseases In England and Scotland

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462321001616 ◽

2021 ◽

Vol 37 (S1) ◽

pp. 38-38

Author(s):

Karen Mark ◽

Prachi Manchanda ◽

Judith Rubinstein ◽

Riza Veronica Inumerable

Keyword(s):

Cost Effectiveness ◽

Health Technology Assessment ◽

Incremental Cost ◽

Rare Diseases ◽

Technology Assessment ◽

Health Technology ◽

Incremental Cost Effectiveness Ratio ◽

Base Case ◽

Patient Access ◽

Cost Effectiveness Ratio

IntroductionPatient access schemes (PAS) are agreements that may enable patients to access drugs or other treatments that may not be cost effective under normal circumstances. The aim of this study was to determine whether the use of PAS by the National Institute for Health and Care Excellence (NICE) and Scottish Medicines Consortium (SMC) for recommended drugs can lead to greater access to medications for rare diseases.MethodsReimbursement data for rare diseases between 2004 and 2021 from health technology assessment (HTA) agencies, namely the SMC (Scotland) and NICE (England), were included. The reviews with positive HTA decisions were considered, while those with negative decisions were excluded. Several observations were made from these data and reported.ResultsAmong the total positive reviews (n = 81), 43 included PAS. The inclusion of PAS in manufacturer submissions was more frequent for NICE than for the SMC (79% and 40% percent, respectively). Most of the drugs with PAS were included in the HTA guidance from both agencies. The positive NICE reviews contingent on PAS consisted of 20 drugs. For the same set of drugs, the SMC recommended 14 with PAS and one without PAS; five drugs were not assessed. Adalimumab was recommended by NICE with a PAS (base-case incremental cost-effectiveness ratio of GBP12,336 [EUR14,256]; GBP13,676 [EUR15,804]) and by the SMC without a PAS (base-case incremental cost-effectiveness ratio of GBP22,519 [EUR26,023]). Hence, without a PAS, the drug was costlier per quality-adjusted life-year for the National Health Service (NHS) Scotland.ConclusionsPAS submissions for rare diseases are more frequent for NICE than for the SMC. With the PAS discounts, the overall cost of the drugs is reduced, resulting in cost effectiveness. The SMC approved some drugs for which NICE required a PAS to improve the economic argument. Hence, the use of PAS for these drugs could lead to potential cost-savings to the NHS Scotland.

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Conventional Computed Tomographic Calcium Scoring vs Full Chest CTCS for Lung Cancer Screening: A Cost-Effectiveness Analysis

10.21203/rs.2.11996/v3 ◽

2019 ◽

Author(s):

Boxiang Jiang ◽

Philip A. Linden ◽

Amit Gupta ◽

Craig Jarrett ◽

Stephanie G. Worrell ◽

...

Keyword(s):

Cost Effectiveness ◽

Cancer Screening ◽

Literature Review ◽

Incremental Cost ◽

Pulmonary Nodules ◽

Lung Cancer Screening ◽

Incremental Cost Effectiveness Ratio ◽

Base Case ◽

Lung Field ◽

Cost Effectiveness Ratio

Abstract Background Conventional CTCS images the mid/lower chest for coronary artery disease (CAD). Because many CAD patients are also at risk for lung malignancy, CTCS often discovers incidental pulmonary nodules (IPN). CTCS excludes the upper chest, where malignancy is common. Full-chest CTCS (FCT) may be a cost-effective screening tool for IPN. Methods A decision tree was created to compare a FCT to CTCS in a hypothetical patient cohort with suspected CAD. (Figure) The design compares the effects of missed cancers on CTCS with the cost of working up non-malignant nodules on FCT. The model was informed by results of the National Lung Screening Trial and literature review, including the rate of malignancy among patients receiving CTCS and the rate of malignancy in upper vs lower portions of the lung. The analysis outcomes are Quality-Adjusted Life Year (QALY) and incremental cost-effectiveness ratio (ICER), which is generally considered beneficial when <$50,000/QALY. Results Literature review suggests that rate of IPNs in the upper portion of the lung varied from 47-76%. Our model assumed that IPNs occur in upper and lower portions of the lung with equal frequency. The model also assumes an equal malignancy potential in upper lung IPNs despite data that malignancy occurs 61-66% in upper lung fields. In the base case analysis, a FCT will lead to an increase of 0.03 QALYs comparing to conventional CTCS (14.54 vs 14.51 QALY, respectively), which translates into an QALY increase of 16 days. The associated incremental cost for FCT is $278 ($1,027 vs $748, FCT vs CTCS respectively. The incremental cost-effectiveness ratio (ICER) is $10,289/QALY, suggesting significant benefit. Sensitivity analysis shows this benefit increases proportional to the rate of malignancy in upper lung fields. Conclusion Conventional CTCS may be a missed opportunity to screen for upper lung field cancers in high risk patients. The ICER of FCT is better than screening for breast cancer screening (mammograms $80k/QALY) and colon cancer (colonoscopy $6k/QALY). Prospective studies are appropriate to define protocols for FCT.

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Abstract 216: A Sensitivity Analysis of Incremental Cost-Effectiveness Ratio of the Nationwide Public Access Defibrillation Program in Japan

Circulation ◽

10.1161/circ.130.suppl_2.216 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Hiroshi Kaneko ◽

Tetsuo Hatanaka ◽

Aki Nagase ◽

Seishiro Marukawa ◽

Tetsuya Sakamoto

Keyword(s):

Sensitivity Analysis ◽

Monte Carlo Simulation ◽

Monte Carlo ◽

Cost Effectiveness ◽

Incremental Cost ◽

Incremental Cost Effectiveness Ratio ◽

Public Access ◽

Cost Effectiveness Ratio ◽

Public Access Defibrillation ◽

Incremental Effectiveness

Introduction: We have previously estimated the cost of and quality-adjusted life year (QALY) gained with ~200,000 AEDs placed in Japan between 2004 through 2009, and reported that the maximum likelihood estimate (MLE) of the incremental cost-effectiveness ratio (ICER) to be ~$93,980/QALY. To evaluate the robustness of the estimated ICER, we conducted a sensitivity analysis using Monte Carlo simulation. Methods: Over the study period, 3,927 patients received public access defibrillation (PAD). A control group was created by extracting, from the national database, another group of 3,927 cardiac arrest patients who did not receive PADs but otherwise matched with regard to confounders including age, sex, response time and others. The difference of the total QALY in the 2 groups yielded incremental effectiveness gained by the PAD program. The sum of the total cost for AED purchase and maintenance, cost of BLS training for first responders, and differential cost for medical care yielded the incremental cost. The value for each variable needed to calculate the incremental cost and effectiveness was randomly varied in such a way that followed the pre-defined probability density function (Table). Monte Carlo simulation was repeated 10,000 times to estimate the MLE and its 95% CI for ICER. Results: The MLE (95% CI) for the incremental cost and incremental effectiveness was ~$ 580 million (577- 583 million) and ~7,559 (6,298- 8,858) QALY, yielding ICER of $77,320 ($65,503- 92,017) /QALY (figure). Conclusions: Our estimate of the ICER seemed to be relatively robust to several assumptions. The ICER of the whole Japan PAD program seemed to be higher than desirable but still acceptable.

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Conventional Computed Tomographic Calcium Scoring vs Full Chest CTCS for Lung Cancer Screening: A Cost-Effectiveness Analysis

10.21203/rs.2.11996/v1 ◽

2019 ◽

Author(s):

Boxiang Jiang ◽

Philip A. Linden ◽

Craig Jarrett ◽

Stephanie G. Worrell ◽

Vanessa P. Ho ◽

...

Keyword(s):

Cost Effectiveness ◽

Cancer Screening ◽

Literature Review ◽

Incremental Cost ◽

Pulmonary Nodules ◽

Lung Cancer Screening ◽

Incremental Cost Effectiveness Ratio ◽

Base Case ◽

Lung Field ◽

Cost Effectiveness Ratio

Abstract Background Conventional CTCS images the mid/lower chest for coronary artery disease (CAD). Because many CAD patients are also at risk for lung malignancy, CTCS often discovers incidental pulmonary nodules (IPN). CTCS excludes the upper chest, where malignancy is common. Full-chest CTCS (FCT) may be a cost-effective screening tool for IPN. Methods A decision tree was created to compare a FCT to CTCS in a hypothetical patient cohort with suspected CAD. (Figure) The design compares the effects of missed cancers on CTCS with the cost of working up non-malignant nodules on FCT. The model was informed by results of the National Lung Screening Trial and literature review, including the rate of malignancy among patients receiving CTCS and the rate of malignancy in upper vs lower portions of the lung. The analysis outcomes are Quality-Adjusted Life Year (QALY) and incremental cost-effectiveness ratio (ICER), which is generally considered beneficial when <$50,000/QALY. Results Literature review suggests that rate of IPNs in the upper portion of the lung varied from 47-76%. Our model assumed that IPNs occur in upper and lower portions of the lung with equal frequency. The model also assumes an equal malignancy potential in upper lung IPNs despite data that malignancy occurs 61-66% in upper lung fields. In the base case analysis, a FCT will lead to an increase of 0.03 QALYs comparing to conventional CTCS (14.54 vs 14.51 QALY, respectively), which translates into an QALY increase of 16 days. The associated incremental cost for FCT is $278 ($1,027 vs $748, FCT vs CTCS respectively. The incremental cost-effectiveness ratio (ICER) is $10,289/QALY, suggesting significant benefit. Sensitivity analysis shows this benefit increases proportional to the rate of malignancy in upper lung fields. Conclusion Conventional CTCS may be a missed opportunity to screen for upper lung field cancers in high risk patients. The ICER of FCT is better than screening for breast cancer screening (mammograms $80k/QALY) and colon cancer (colonoscopy $6k/QALY). Prospective studies are appropriate to define protocols for FCT.

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Cost-effectiveness analysis of neoadjuvant chemotherapy with intensive dose of epirubicin and different cycles in patients with locally advanced breast cancer: 4 FE100C versus 6 FE100C.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e11565 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e11565-e11565

Author(s):

Nicolas Ramirez ◽

Jorge Eduardo Herrera ◽

Jose Fortino Chavez ◽

Horacio Astudillo

Keyword(s):

Breast Cancer ◽

Sensitivity Analysis ◽

Cost Effectiveness ◽

Incremental Cost ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Incremental Cost Effectiveness Ratio ◽

Cost Effectiveness Ratio ◽

Effectiveness Analysis ◽

The Cost

e11565 Background: There are different combinations of neoadjuvant chemotherapy (NCT) to treat locally advanced breast cancer (LABC); treatment with cytostatics drugs make it a costly concern, by establishing economic differences in the consumption of healthcare resources. To compare the cost-effectiveness of two NCT strategies (4FE100C vs. 6FE100C). Methods: It was made a cost-effectiveness analysis (CEA) of two treatment schemes (4FE100C vs. 6FE100C) in patients with clinical stage III breast cancer, each cohort included 48 patients. Effectiveness parameter: pathologic complete response (pCR). Differential cost: incremental cost-effectiveness ratio (ICER) using a Markov’s model. Results are expressed in terms of incremental cost per extra unit of effectiveness. Costs were expressed in Mexican (MXN) pesos ($) as of 2005; these were calculated under the perspective of public healthcare system (SSP, for its acronym in Spanish) denominated IMSS, with a 3 to 4 years analytical horizon. In order to determine the robustness of the results, a sensitivity analysis was carried out by modifying only the medical direct costs with a 3% discount rate. Results: The use of 6FE100C offered greater effectiveness compared against 4FE100C; the medical direct cost of only the cytostatic drugs for NCT with 6 FE100C and 4 E100C generated a cost per case of $30,467.00 MXN (€ 2,343.61) and $18,004.00 MXN (€ 1,384.92), respectively. The greatest unit price was given by epirubicin. The CEA demonstrated that the cost-effectiveness (C/E) was greater with 6 FE100C and the incremental cost-effectiveness ratio (ICER) showed that it was necessary to pay $11,765,925.42 MXN (€ 905,071.20) because it tells us how much it is paid additionally for every extra unit of effectiveness (pCR) which assumes 6 FE100C in front of 4 FE100C. The sensitivity analysis performed shows the robustness of the results. Conclusions: The6 FE100C scheme is the chemotherapeutic strategy with better cost-effectiveness ratio and is the most efficient in the short run for treating LABC.

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Conventional Computed Tomographic Calcium Scoring vs Full Chest CTCS for Lung Cancer Screening: A Cost-Effectiveness Analysis

10.21203/rs.2.11996/v2 ◽

2019 ◽

Author(s):

Boxiang Jiang ◽

Philip A. Linden ◽

Amit Gupta ◽

Craig Jarrett ◽

Stephanie G. Worrell ◽

...

Keyword(s):

Cost Effectiveness ◽

Cancer Screening ◽

Literature Review ◽

Incremental Cost ◽

Pulmonary Nodules ◽

Lung Cancer Screening ◽

Incremental Cost Effectiveness Ratio ◽

Base Case ◽

Lung Field ◽

Cost Effectiveness Ratio

Abstract Background Conventional CTCS images the mid/lower chest for coronary artery disease (CAD). Because many CAD patients are also at risk for lung malignancy, CTCS often discovers incidental pulmonary nodules (IPN). CTCS excludes the upper chest, where malignancy is common. Full-chest CTCS (FCT) may be a cost-effective screening tool for IPN. Methods A decision tree was created to compare a FCT to CTCS in a hypothetical patient cohort with suspected CAD. (Figure) The design compares the effects of missed cancers on CTCS with the cost of working up non-malignant nodules on FCT. The model was informed by results of the National Lung Screening Trial and literature review, including the rate of malignancy among patients receiving CTCS and the rate of malignancy in upper vs lower portions of the lung. The analysis outcomes are Quality-Adjusted Life Year (QALY) and incremental cost-effectiveness ratio (ICER), which is generally considered beneficial when <$50,000/QALY. Results Literature review suggests that rate of IPNs in the upper portion of the lung varied from 47-76%. Our model assumed that IPNs occur in upper and lower portions of the lung with equal frequency. The model also assumes an equal malignancy potential in upper lung IPNs despite data that malignancy occurs 61-66% in upper lung fields. In the base case analysis, a FCT will lead to an increase of 0.03 QALYs comparing to conventional CTCS (14.54 vs 14.51 QALY, respectively), which translates into an QALY increase of 16 days. The associated incremental cost for FCT is $278 ($1,027 vs $748, FCT vs CTCS respectively. The incremental cost-effectiveness ratio (ICER) is $10,289/QALY, suggesting significant benefit. Sensitivity analysis shows this benefit increases proportional to the rate of malignancy in upper lung fields. Conclusion Conventional CTCS may be a missed opportunity to screen for upper lung field cancers in high risk patients. The ICER of FCT is better than screening for breast cancer screening (mammograms $80k/QALY) and colon cancer (colonoscopy $6k/QALY). Prospective studies are appropriate to define protocols for FCT.

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