Treatment for Severe Lupus Nephritis: A Cost-Effectiveness Analysis in China

Background: Lupus nephritis (LN) is the most common secondary glomerular diseases that will cause end-stage renal disease (ESRD) and renal-related death. The cost-effectiveness of various treatments for LN recommended by official guidelines has not been investigated in China. Our study is to evaluate clinical prognosis and cost-effectiveness of the current treatments for severe LN.Methods: A Markov model was simulated for 1,000 LN patients of 30 years old, over a 3-years and 30-years lifetime horizon respectively. We assessed the cost-effectiveness of six therapeutic strategies from a societal perspective, with cyclophosphamide (CYC) or mycophenolate mofetil (MMF) induction therapy followed by CYC, MMF or azathioprine (AZA) maintenance therapy. Main outcomes included quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER) and clinical prognosis. One and three times gross domestic product (GDP) per capita were used as the willingness-to-pay (WTP) thresholds. We also carried out sensitivity analysis under a lifetime horizon.Results: Compared with the baseline strategy of CYC induction and maintenance, for a 3-years horizon the most cost-effective strategy was CYC induction and AZA maintenance with $448 per QALY gained, followed by MMF induction and AZA maintenance which however was not cost-effective under the one times GDP per capita WTP threshold. For a lifetime horizon, CYC induction and AZA maintenance remained the most cost-effective strategy but MMF induction and maintenance became cost-effective under the one times GDP per capita WTP threshold and achieved a higher complete remission rate (57.2 versus 48.9%) and lower risks of ESRD (3.3 versus 5.8%) and all-cause mortality (36.0 versus 40.8%). The risk of developing ESRD during maintenance was the most influential parameter affecting ICER.Conclusions: The strategy of CYC induction followed by AZA maintenance was the most cost-effective strategy in China for short-term treatment, while the strategy of MMF in both induction and maintenance became cost-effective and yielded more desirable clinical outcomes for lifetime treatment. The uncertainty analysis supported the need for monitoring the progression to ESRD.

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Accurate diagnosis of latent tuberculosis in children, people who are immunocompromised or at risk from immunosuppression and recent arrivals from countries with a high incidence of tuberculosis: systematic review and economic evaluation

Health Technology Assessment ◽

10.3310/hta20380 ◽

2016 ◽

Vol 20 (38) ◽

pp. 1-678 ◽

Cited By ~ 9

Author(s):

Peter Auguste ◽

Alexander Tsertsvadze ◽

Joshua Pink ◽

Rachel Court ◽

Farah Seedat ◽

...

Keyword(s):

Cost Effectiveness ◽

Latent Tuberculosis ◽

Cost Effective ◽

Skin Tests ◽

Effective Strategy ◽

Nice Guideline ◽

Cost Effective Strategy ◽

High Incidence ◽

The Uk ◽

The Cost

BackgroundTuberculosis (TB), caused byMycobacterium tuberculosis(MTB) [(Zopf 1883) Lehmann and Neumann 1896], is a major cause of morbidity and mortality. Nearly one-third of the world’s population is infected with MTB; TB has an annual incidence of 9 million new cases and each year causes 2 million deaths worldwide.ObjectivesTo investigate the clinical effectiveness and cost-effectiveness of screening tests [interferon-gamma release assays (IGRAs) and tuberculin skin tests (TSTs)] in latent tuberculosis infection (LTBI) diagnosis to support National Institute for Health and Care Excellence (NICE) guideline development for three population groups: children, immunocompromised people and those who have recently arrived in the UK from high-incidence countries. All of these groups are at higher risk of progression from LTBI to active TB.Data sourcesElectronic databases including MEDLINE, EMBASE, The Cochrane Library and Current Controlled Trials were searched from December 2009 up to December 2014.Review methodsEnglish-language studies evaluating the comparative effectiveness of commercially available tests used for identifying LTBI in children, immunocompromised people and recent arrivals to the UK were eligible. Interventions were IGRAs [QuantiFERON®-TB Gold (QFT-G), QuantiFERON®-TB Gold-In-Tube (QFT-GIT) (Cellestis/Qiagen, Carnegie, VA, Australia) and T-SPOT.TB(Oxford Immunotec, Abingdon, UK)]. The comparator was TST 5 mm or 10 mm alone or with an IGRA. Two independent reviewers screened all identified records and undertook a quality assessment and data synthesis. A de novo model, structured in two stages, was developed to compare the cost-effectiveness of diagnostic strategies.ResultsIn total, 6687 records were screened, of which 53 unique studies were included (a further 37 studies were identified from a previous NICE guideline). The majority of the included studies compared the strength of association for the QFT-GIT/G IGRA with the TST (5 mm or 10 mm) in relation to the incidence of active TB or previous TB exposure. Ten studies reported evidence on decision-analytic models to determine the cost-effectiveness of IGRAs compared with the TST for LTBI diagnosis. In children, TST (≥ 5 mm) negative followed by QFT-GIT was the most cost-effective strategy, with an incremental cost-effectiveness ratio (ICER) of £18,900 per quality-adjusted life-year (QALY) gained. In immunocompromised people, QFT-GIT negative followed by the TST (≥ 5 mm) was the most cost-effective strategy, with an ICER of approximately £18,700 per QALY gained. In those recently arrived from high TB incidence countries, the TST (≥ 5 mm) alone was less costly and more effective than TST (≥ 5 mm) positive followed by QFT-GIT or T-SPOT.TBor QFT-GIT alone.LimitationsThe limitations and scarcity of the evidence, variation in the exposure-based definitions of LTBI and heterogeneity in IGRA performance relative to TST limit the applicability of the review findings.ConclusionsGiven the current evidence, TST (≥ 5 mm) negative followed by QFT-GIT for children, QFT-GIT negative followed by TST (≥ 5 mm) for the immunocompromised population and TST (≥ 5 mm) for recent arrivals were the most cost-effective strategies for diagnosing LTBI that progresses to active TB. These results should be interpreted with caution given the limitations identified. The evidence available is limited and more high-quality research in this area is needed including studies on the inconsistent performance of tests in high-compared with low-incidence TB settings; the prospective assessment of progression to active TB for those at high risk; the relative benefits of two-compared with one-step testing with different tests; and improved classification of people at high and low risk for LTBI.Study registrationThis study is registered as PROSPERO CRD42014009033.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Is Albumin-based Resuscitation in Severe Sepsis and Septic Shock Justifiable? An Evidence from a Cost-effectiveness Evaluation

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v29i1.8 ◽

1970 ◽

Vol 29 (1) ◽

Author(s):

Bereket Tigabu ◽

Majid Davari ◽

Abbas Kebriaeezadeh ◽

Mojtaba Mojtahedzadeh ◽

Kourosh Sadeghi ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Cost Effectiveness ◽

Cost Effective ◽

Tree Age ◽

Gdp Per Capita ◽

Life Years ◽

Per Capita ◽

Sepsis And Septic Shock ◽

The Cost

BACKGROUND: Fluid and antimicrobial therapy are the essential parts of sepsis management. The type of fluid to resuscitate with is an unsettled issue in the treatment of severe sepsis and septic shock. The objective of this study was to evaluate the cost effectiveness of albumin-based resuscitation over crystalloids.METHODS: A cost-effectiveness analysis was conducted by extracting data from a database of Sina Hospital, Islamic Republic of Iran. A decision tree was constructed by using Tree Age Pro2011. The patients were grouped based on the types of fluids used for resuscitation into crystalloid alone or crystalloid + albumin groups at the initial decision node. The patients were followed from the onset of severe sepsis and septic shock upto 28 days. The healthcare payers’ perspective was considered in constructing the model. The cost was measured in US dollars and the effectiveness was measured by life years gained.RESULTS: The addition of albumin during resuscitation of patients with severe sepsis and septic shock has an effectiveness gain of 0.09 life years and cost increment of 495.00 USD. The estimated ICER for this analysis was 5500.00 USD per life year gained. The probability that albumin is cost-effective at one GDP per capita is 49.5%.CONCLUSION: Albumin-based resuscitation is not cost-effective in Iran when a GDP per capita was considered for a life year gain. The cost-effectiveness was insensitive to the cost of standard care. We recomend the caustious use albumin as per the Surviving Sepsis Campaign guideline.

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Bendamustine and Rituximab Versus Conventional Chemoimmunotherapy As a Frontline Treatment for Patients with Indolent B-Cell Lymphoma: A Cost-Effectiveness Analysis

Blood ◽

10.1182/blood.v128.22.1186.1186 ◽

2016 ◽

Vol 128 (22) ◽

pp. 1186-1186 ◽

Cited By ~ 2

Author(s):

Andrew Aw ◽

Kathryn Coyle ◽

Isabelle Bence-Bruckler ◽

Christopher N. Bredeson ◽

Doug Coyle

Keyword(s):

Cost Effectiveness ◽

Incremental Cost ◽

Cost Effective ◽

Effective Strategy ◽

Health States ◽

Cost Effective Strategy ◽

Subgroup Analyses ◽

Frontline Treatment ◽

Cost Effectiveness Acceptability Curve ◽

The Cost

Abstract Background: Indolent lymphomas are characterized by a chronic relapsing-remitting course. Bendamustine-Rituximab (BR) has been shown to improve overall response rate and progression free survival (PFS) in the upfront treatment of patients with indolent B-cell non-Hodgkin lymphoma (iNHL), as compared with conventional chemoimmunotherapy (Rummel et al., 2013; Flinn et al., 2014). The pan-Canadian Oncology Drug Review has recommended publicly funding BR, but concluded there is substantial uncertainty regarding the regimen's cost-effectiveness. The objective of our study was to assess the cost-effectiveness of BR as compared with Rituximab-Cyclophosphamide, Doxorubicin, Vincristine, Prednisone (RCHOP) as frontline treatment for patients with advanced iNHL from a Canadian perspective. Methods: A Markov model was developed to estimate the costs, life expectancy and quality-adjusted life-years (QALYs) associated with the two regimen options allowing determination of the incremental cost-utility ratio (ICUR). Model parameters were derived from peer-reviewed studies. Key health states included FT (frontline therapy), MR (2-year state of maintenance R), PF1 (1st progression-free state), PD1/2/3 (subsequent progressive disease states requiring salvage), PF2/3/4 (subsequent progression-free states post-salvage), palliation and death. To determine progression after FT, individual data elements were derived from the published literature, and transition probabilities were determined through parametric survival analysis. Age-related mortality was obtained from Statistics Canada. Cost data (in 2016 Canadian dollars) were obtained from current funding arrangements under the New Drug Funding Program of Cancer Care Ontario, the Ontario Health Insurance Plan Schedule of Benefits and Fees, and the published literature. Utility values for health states and utility decrements associated with treatment related adverse events (AEs) were derived from peer-reviewed studies. The analysis was performed from the health care provider perspective, with a lifetime time horizon (equivalent to 24 years) and cycle lengths of 6 months. Patients were treated with a maximum of 3 lines of salvage therapy (3rd salvage permitted in age-appropriate patients achieving at least 1 year remission from 2nd line salvage). In order to address uncertainty of model input variables, a probabilistic analysis in which model inputs were represented by probability distributions was utilized, permitting a Monte Carlo simulation with 5000 replications. Costs and utilities were discounted at a rate of 5% per annum. Subgroup analyses for the following iNHL histologies were performed using individualized parametric survival curves: follicular lymphoma (FL), mantle cell lymphoma (MCL), marginal zone lymphoma (MZL), lymphoplasmacytic lymphoma (LPL). Results: The average costs and QALYs for the two treatment strategies were as follows: $116,811 and 5.86 QALYs for RCHOP; $121,364 and 6.38 QALYs for BR. The incremental cost per QALY gained for using BR with respect to RCHOP was $8,812 (Figure 1). Subgroup analyses revealed robust ICUR results: $27,398 (FL), $8,924 (MCL), $10,012 (MZL), $6,565 (LPL). For the commonly accepted willingness to pay threshold (WTP) of $50,000 per QALY, BR was the more cost-effective strategy 92% of the time in the entire cohort (Figure 2). In the subgroup analyses, BR was the more cost-effective strategy 66%, 82%, 64%, 86% of the time in FL, MCL, MZL, LPL respectively. ICUR results were robust to sensitivity analyses of key variables including age at study entry, maximum allowable age for therapy, duration of AEs, probability of death from palliation state and discount rate. Conclusion: Our model suggests that BR is a cost-effective strategy for the frontline treatment of patients with iNHL as compared with RCHOP. The cost-effectiveness of BR may be driven by the upfront PFS advantage despite higher acquisition costs and is consistent in various iNHL histology subgroups. Our analysis supports the use of frontline BR for iNHL in the Canadian setting. Figure 1 Cost-effectiveness acceptability curve Figure 1. Cost-effectiveness acceptability curve Figure 2 Incremental cost-effectiveness of BR relative to RCHOP with WTP threshold of $50,000 per QALY Figure 2. Incremental cost-effectiveness of BR relative to RCHOP with WTP threshold of $50,000 per QALY Disclosures Bence-Bruckler: Lundbeck: Membership on an entity's Board of Directors or advisory committees.

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Tenofovir disoproxil fumarate in pregnancy for prevention of mother to child transmission of hepatitis B in a rural setting on the Thailand-Myanmar border: a cost-effectiveness analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03612-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Marieke Bierhoff ◽

Chaisiri Angkurawaranon ◽

Marcus J. Rijken ◽

Kanlaya Sriprawa ◽

Pachinee Kobphan ◽

...

Keyword(s):

Cost Effectiveness ◽

Hepatitis B ◽

Cost Effective ◽

Hbv Dna ◽

Gdp Per Capita ◽

Per Capita ◽

The Cost ◽

Mother To Child ◽

Hbv Transmission

Abstract Background Hepatitis B Virus (HBV) is transmitted from mother to child which can be prevented via birth dose vaccine combined with three follow up hepatitis B vaccines, hepatitis B immunoglobulins (HBIG), and maternal antiviral treatment with Tenofovir Disoproxil Fumarate (TDF). This study evaluates the cost effectiveness of six strategies to prevent perinatal HBV transmission in a resource limited setting (RLS) on the Thailand-Myanmar border. Methods The cost effectiveness of six strategies was tested by a decision tree model in R. All strategies included birth and follow up vaccinations and compared cost per infection averted against two willingness to pay thresholds: one-half and one gross domestic product (GDP) per capita. Strategies were: 1) Vaccine only, 2) HBIG after rapid diagnostic test (RDT): infants born to HBsAg+ are given HBIG, 3) TDF after RDT: HBsAg+ women are given TDF, 4) TDF after HBeAg test: HBeAg+ women are given TDF, 5) TDF after high HBV DNA: women with HBV DNA > 200,000 are given TDF, 6) HBIG & TDF after high HBV DNA: women with HBV DNA > 200,000 are given TDF and their infants are given HBIG. One-way and probabilistic sensitivity analyses were conducted on the cost-effective strategies. Results Vaccine only was the least costly option with TDF after HBeAg test strategy as the only cost-effective alternative. TDF after HBeAg test had an incremental cost-effectiveness ratio of US$1062; which would not be considered cost-effective with the lower threshold of one-half GDP per capita. The one-way sensitivity analysis demonstrated that the results were reasonably robust to changes in single parameter values. The PSA showed that TDF after HBeAg test had an 84% likelihood of being cost effective at a willingness to pay threshold of one GDP per capita per infection averted. Conclusions We found that TDF after HBeAg test has the potential to be cost-effective if TDF proves effective locally to prevent perinatal HBV transmission. The cost of TDF treatment and reliability of the RDT could be barriers to implementing this strategy. While TDF after RDT may be a more feasible strategy to implement in RLS, TDF after HBeAg test is a less costly option.

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Cost-effectiveness of endovascular thrombectomy in patients with low Alberta Stroke Program Early CT Scores (< 6) at presentation

Journal of Neurosurgery ◽

10.3171/2020.9.jns202965 ◽

2021 ◽

pp. 1-11

Author(s):

Xiao Wu ◽

Sam Payabvash ◽

Charles C. Matouk ◽

Michael H. Lev ◽

Max Wintermark ◽

...

Keyword(s):

Cost Effectiveness ◽

Medical Management ◽

Cost Effective ◽

Effective Strategy ◽

Lifetime Horizon ◽

Old Patients ◽

Endovascular Thrombectomy ◽

Good Outcome ◽

Cost Effective Strategy

OBJECTIVE The utility of endovascular thrombectomy (EVT) in patients with acute ischemic stroke, large vessel occlusion (LVO), and low Alberta Stroke Program Early CT Scores (ASPECTS) remains uncertain. The objective of this study was to determine the health outcomes and cost-effectiveness of EVT versus medical management in patients with ASPECTS < 6. METHODS A decision-analytical study was performed with Markov modeling to estimate the lifetime quality-adjusted life-years (QALYs) and associated costs of EVT-treated patients compared to medical management. The study was performed over a lifetime horizon with a societal perspective in the US setting. RESULTS The incremental cost-effectiveness ratios were $412,411/QALY and $1,022,985/QALY for 55- and 65-year-old groups in the short-term model. EVT was the long-term cost-effective strategy in 96.16% of the iterations and resulted in differences in health benefit of 2.21 QALYs and 0.79 QALYs in the 55- and 65-year-old age groups, respectively, equivalent to 807 days and 288 days in perfect health. EVT remained the more cost-effective strategy when the probability of good outcome with EVT was above 16.8% or as long as the good outcome associated with the procedure was at least 1.6% higher in absolute value than that of medical management. EVT remained cost-effective even when its cost exceeded $100,000 (threshold was $108,036). Although the cost-effectiveness decreased with age, EVT was cost-effective for 75-year-old patients as well. CONCLUSIONS This study suggests that EVT is the more cost-effective approach compared to medical management in patients with ASPECTS < 6 in the long term (lifetime horizon), considering the poor outcomes and significant disability associated with nonreperfusion.

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Detecting Germline PTEN Mutations Among At-Risk Patients With Cancer: An Age- and Sex-Specific Cost-Effectiveness Analysis

Journal of Clinical Oncology ◽

10.1200/jco.2014.60.3456 ◽

2015 ◽

Vol 33 (23) ◽

pp. 2537-2544 ◽

Cited By ~ 11

Author(s):

Joanne Ngeow ◽

Chang Liu ◽

Ke Zhou ◽

Kevin D. Frick ◽

David B. Matchar ◽

...

Keyword(s):

Cost Effectiveness ◽

Cleveland Clinic ◽

Cost Effective ◽

Cancer Surveillance ◽

Sensitivity Analyses ◽

Base Case ◽

Effective Strategy ◽

Female Patients ◽

Cost Effective Strategy ◽

The Cost

Purpose Cowden syndrome (CS) is an autosomal dominant disorder characterized by benign and malignant tumors. One-quarter of patients who are diagnosed with CS have pathogenic germline PTEN mutations, which increase the risk of the development of breast, thyroid, uterine, renal, and other cancers. PTEN testing and regular, intensive cancer surveillance allow for early detection and treatment of these cancers for mutation-positive patients and their relatives. Individual CS-related features, however, occur commonly in the general population, making it challenging for clinicians to identify CS-like patients to offer PTEN testing. Patients and Methods We calculated the cost per mutation detected and analyzed the cost-effectiveness of performing selected PTEN testing among CS-like patients using a semi-quantitative score (the PTEN Cleveland Clinic [CC] score) compared with existing diagnostic criteria. In our model, first-degree relatives of the patients with detected PTEN mutations are offered PTEN testing. All individuals with detected PTEN mutations are offered cancer surveillance. Results CC score at a threshold of 15 (CC15) costs from $3,720 to $4,573 to detect one PTEN mutation, which is the most inexpensive among the different strategies. At base-case, CC10 is the most cost-effective strategy for female patients who are younger than 40 years, and CC15 is the most cost-effective strategy for female patients who are between 40 and 60 years of age and male patients of all ages. In sensitivity analyses, CC15 is robustly the most cost-effective strategy for probands who are younger than 60 years. Conclusion Use of the CC score as a clinical risk calculator is a cost-effective prescreening method to identify CS-like patients for PTEN germline testing.

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Analysis of the cost-effectiveness of treatment strategies for CML with incorporation of treatment discontinuation

Blood Advances ◽

10.1182/bloodadvances.2019000745 ◽

2019 ◽

Vol 3 (21) ◽

pp. 3266-3277 ◽

Cited By ~ 7

Author(s):

Chihiro Yamamoto ◽

Hirotomo Nakashima ◽

Takashi Ikeda ◽

Shin-ichiro Kawaguchi ◽

Yumiko Toda ◽

...

Keyword(s):

Cost Effectiveness ◽

Treatment Strategies ◽

Cost Effective ◽

Treatment Discontinuation ◽

Effective Strategy ◽

Cost Effective Strategy ◽

Key Points ◽

The Cost

Key Points The cost of TKI for treatment of CML can be substantially saved by treatment discontinuation in patients who achieved DMR. Starting treatment with imatinib is the most cost-effective strategy even after incorporation of treatment discontinuation.

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Diagnostic yield of genetic tests in epilepsy

Neurology ◽

10.1212/wnl.0000000000006850 ◽

2019 ◽

Vol 92 (5) ◽

pp. e418-e428 ◽

Cited By ~ 24

Author(s):

Iván Sánchez Fernández ◽

Tobias Loddenkemper ◽

Marina Gaínza-Lein ◽

Beth Rosen Sheidley ◽

Annapurna Poduri

Keyword(s):

Genetic Testing ◽

Cost Effectiveness ◽

Publication Bias ◽

Diagnostic Yield ◽

Cost Effective ◽

Effective Strategy ◽

Genetic Tests ◽

Cost Effective Strategy ◽

Testing Strategies ◽

The Cost

ObjectiveTo compare the cost-effectiveness of genetic testing strategies in patients with epilepsy of unknown etiology.MethodsThis meta-analysis and cost-effectiveness study compared strategies involving 3 genetic tests: chromosomal microarray (CMA), epilepsy panel (EP) with deletion/duplication testing, and whole-exome sequencing (WES) in a cost-effectiveness model, using “no genetic testing” as a point of comparison.ResultsTwenty studies provided information on the diagnostic yield of CMA (8 studies), EP (9 studies), and WES (6 studies). The diagnostic yield was highest for WES: 0.45 (95% confidence interval [CI]: 0.33–0.57) (0.32 [95% CI: 0.22–0.44] adjusting for potential publication bias), followed by EP: 0.23 (95% CI: 0.18–0.29), and CMA: 0.08 (95% CI: 0.06–0.12). The most cost-effective test was WES with an incremental cost-effectiveness ratio (ICER) of $15,000/diagnosis. However, after adjusting for potential publication bias, the most cost-effective test was EP (ICER: $15,848/diagnosis) followed by WES (ICER: $34,500/diagnosis). Among combination strategies, the most cost-effective strategy was WES, then if nondiagnostic, EP, then if nondiagnostic, CMA (ICER: $15,336/diagnosis), although adjusting for potential publication bias, the most cost-effective strategy was EP ± CMA ± WES (ICER: $18,385/diagnosis). While the cost-effectiveness of individual tests and testing strategies overlapped, CMA was consistently less cost-effective than WES and EP.ConclusionWES and EP are the most cost-effective genetic tests for epilepsy. Our analyses support, for a broad population of patients with unexplained epilepsy, starting with these tests. Although less expensive, CMA has lower yield, and its use as the first-tier test is thus not supported from a cost-effectiveness perspective.

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Pharmaco Economics Analysis of COVID-19 Vaccines in Ukraine

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i32a31727 ◽

2021 ◽

pp. 140-147

Author(s):

Tsekhmister Yaroslav Volodymyrovych ◽

Stepanenko Viktor Ivanovich ◽

Konovalova Tetiana ◽

Tsekhmister Bogdan Yaroslavovych

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

The Elderly ◽

Transmission Model ◽

Sample Population ◽

Group Model ◽

Effective Strategy ◽

Vaccine Strategy ◽

Cost Effective Strategy ◽

The Cost

Aims: To evaluate pharmacoeconomics for the vaccination of COVID-19 vaccine and analyze the cost-effectiveness for the vaccine in Ukraine. Study design: we have analyzed using models for the economics of coronavirus vaccine. Place and duration of study: Sample: population of Ukraine, data used from the official website of Ministry of Health, Ukraine. April - May 2021 Methodology: We have used the transmission model to analyze the vaccine strategy. Data were collected from official sources. We structured an age group model for evaluating high transmitters. Four strategies were organized and analyzed for analyzing the cost-effective strategy vaccination for everyone, no vaccination, and vaccination for old age only, high transmitters’ vaccination. Results: we have analyzed country specific cost-effective strategy for Ukraine depends upon the pandemic and economics of the country. Vaccinating older people was found to be the economically effective for Ukraine. In these study influences of discount rate analysis on QALY in Ukraine was done. When we vaccinate, high transmitters’ ratio was found to be 8.8% higher than for the elderly. This analysis suggests that vaccinating first the elderly group would not be so cost-effective. While doubling the cost for the vaccine, if the vaccine is available early with the scenario of pre-existing immunity has shifted cost-effectiveness for high transmitters than for the elderly in Ukraine Conclusion: we conclude from our pharmacoeconomic research study that cost effective analysis depends on pandemic and vaccinating elderly would be effective economically.

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Cost-Effectiveness Analysis of High-Risk Groups Tuberculosis Screening in Malaysia

Frontiers in Public Health ◽

10.3389/fpubh.2021.699735 ◽

2021 ◽

Vol 9 ◽

Author(s):

Nor Zam Azihan Mohd Hassan ◽

Asmah Razali ◽

Mohd Ridzwan Shahari ◽

Mohd Shaiful Jefri Mohd Nor Sham Kunusagaran ◽

Juanita Halili ◽

...

Keyword(s):

Cost Effectiveness ◽

High Risk ◽

Incremental Cost ◽

Screening Program ◽

Cost Effective ◽

Risk Groups ◽

Effective Strategy ◽

Tree Model ◽

Cost Effective Strategy ◽

The Cost

Screening of high-risk groups for Tuberculosis (TB) is considered as the cornerstone for TB elimination but the measure of cost-effectiveness is also crucial in deciding the strategy for TB screening. This study aims to measure the cost-effectiveness of TB screening between the various high-risk groups in Malaysia. A decision tree model was developed to assess the cost-effectiveness of TB screening among the high-risk groups from a provider perspective using secondary data from the year 2016 to 2018. The results are presented in terms of an Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per TB case detected. Deterministic and Probabilistic Sensitivity Analysis was also performed to measure the robustness of the model. TB screening among Person Living with Human Immunodeficiency Virus (PL HIV) was the most cost-effective strategy, with MYR 2,597.00 per TB case detected. This was followed by elderly, prisoners and smokers with MYR 2,868.62, MYR 3,065.24, and MYR 4,327.76 per one TB case detected, respectively. There was an incremental cost of MYR 2.49 per screening, and 3.4 TB case detection per 1,000 screening for TB screening among PL HIV in relation to TB screening among prisoners. The probability of symptomatic cases diagnosed as TB was the key driver for increasing cost-effectiveness efficacy among PL HIV. Results of the study suggest prioritization of high-risk group TB screening program by focusing on the most cost-effective strategy such as screening among PL HIV, prisoners and elderly, which has a lower cost per TB case detected.

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