Reality Check 2: The Cost-Effectiveness of Policy Disallowing Body Checking in Non-Elite 13- to 14-Year-Old Ice Hockey Players

Sport-related injuries are the leading cause of injury in youth and are costly to the healthcare system. When body checking is disallowed in non-elite levels of Bantam (ages 13–14 years) ice hockey, the injury rate is reduced, but the impact on costs is unknown. This study compared rates of game injuries and costs among non-elite Bantam ice hockey leagues that disallow body checking to those that did not. Methods: An economic evaluation was conducted alongside a prospective cohort study comparing 608 players from leagues where body checking was allowed in games (Calgary/Edmonton 2014–2015, Edmonton 2015–2016) with 396 players from leagues where it was not allowed in games (Vancouver, Kelowna 2014–2015, Calgary in 2015–2016). The effectiveness measure was rate of game injuries per 1000 player-hours. Costs were estimated based on associated healthcare use within the publicly funded healthcare system as well as privately paid healthcare costs. Probabilistic sensitivity analysis was conducted using bootstrapping. Results: Disallowing body checking reduced the rate of injuries by 4.32 per 1000 player-hours (95% CI −6.92, −1.56) and reduced public and total healthcare system costs by $1556 (95% CI −$2478, −$559) and $1577 (95% CI −$2629, −$500) per 1000 player-hours, respectively. These finding were robust in over 99% of iterations in sensitivity analyses in the public healthcare and the total healthcare system perspectives. There was no statistically significant difference in privately paid healthcare costs (−$65 per 1000 player-hours (95% CI −$220, $99)). Interpretation: Disallowing body checking in non-elite 13–14-year-old ice hockey nationally would prevent injuries and reduce public healthcare costs.

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PP329 An Australian Cost-Effectiveness Analysis Of The EluviaTM Drug-Eluting Stent For Treatment Of Symptomatic Lower-Limb Peripheral Artery Disease

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462320001592 ◽

2020 ◽

Vol 36 (S1) ◽

pp. 28-29

Author(s):

William A. Gray ◽

Thathya V. Ariyaratne ◽

Robert I. Griffiths ◽

Peter W.M. Elroy ◽

Stacey L. Amorosi ◽

...

Keyword(s):

Cost Effectiveness ◽

Healthcare System ◽

Lower Limb ◽

Sensitivity Analyses ◽

Public Healthcare ◽

System Perspective ◽

Healthcare System Perspective ◽

Drug Eluting ◽

Zilver Ptx ◽

Cost Parameters

IntroductionDespite advances in endovascular interventions, including the introduction of drug-eluting stents (DES), high target lesion revascularization (TLR) rates still burden the treatment of symptomatic lower-limb peripheral arterial disease (PAD). EluviaTM, a novel, sustained-release, paclitaxel-eluting DES, was shown to further reduce TLRs when compared with the paclitaxel-coated Zilver® PTX® stent, in the IMPERIAL randomized controlled trial. This evaluation estimated the cost-effectiveness of Eluvia when compared with Zilver PTX in Australia, based on 12-month clinical outcomes from the IMPERIAL trial.MethodsA state-transition, decision-analytic model with a 12-month time horizon was developed from an Australian public healthcare system perspective. Cost parameters were obtained from the Australian National Hospital Cost Data Collection Cost Report (2016–17). All costs were captured in Australian dollars (AUD), where AUD 1 = USD 0.69 (June 2020). Complete sets of clinical parameters (primary patency loss, TLR, amputation, and death) and cost parameters from their respective distributions were bootstrapped in samples of 1,000 patients, for each intervention arm of the model. One-way and probabilistic sensitivity analyses were performed.ResultsAt 12 months, modeled TLR rates were 4.5 percent for Eluvia and 8.9 percent for Zilver PTX, and mean total direct costs were AUD 6,537 [USD 4,511] and AUD 6,908 [USD 4,767], respectively (Eluvia average per patient savings; overall cohort=AUD 371 [USD 256]; diabetic cohort=AUD 625 [USD 431]). In probabilistic sensitivity analyses, Eluvia was cost-effective relative to Zilver PTX in 92.0 percent of all simulations at a threshold of $10,000 per TLR avoided. Eluvia was more effective and less costly (dominant) than Zilver PTX in 76.0 percent of simulations.ConclusionsIn the first year after the intervention, Eluvia was more effective and less costly than Zilver PTX, making Eluvia the dominant treatment strategy for treatment of symptomatic lower-limb PAD, from an Australian public healthcare system perspective. These findings should be considered when formulating policy and practice guidelines in the context of priority setting and making evidence-based resource allocation decisions for treatment of PAD in Australia.

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Meta-Analytic Findings in the Self-Controlled Motor Learning Literature: Underpowered, Biased, and Lacking Evidential Value

10.31234/osf.io/8d3nb ◽

2021 ◽

Author(s):

Brad McKay ◽

Zachary Yantha ◽

Julia Hussien ◽

Michael J Carter ◽

Diane M. Ste-Marie

Keyword(s):

Motor Learning ◽

Weight Function ◽

Selection Bias ◽

The Self ◽

Sensitivity Analyses ◽

P Value ◽

Function Model ◽

Evidential Value ◽

Significant Difference ◽

The Impact

The self-controlled motor learning literature consists of experiments that compare a group of learners who are provided with a choice over an aspect of their practice environment to a group who are yoked to those choices. A qualitative review of the literature suggests an unambiguous benefit from self-controlled practice. A meta-analysis was conducted on the effects of self-controlled practice on retention test performance measures with a focus on assessing and potentially correcting for selection bias in the literature, such as publication bias and p-hacking. First, a naïve random effects model was fit to the data and a moderate benefit of self-controlled practice, g=.44 (k= 52,N= 3134,95%CI[.31, .56]), was found. Second, publication status was added to the model as a potential moderator, revealing a significant difference between published and unpublished findings, with only the former reporting a benefit of self-controlled practice. Third, to investigate and adjust for the impact of selectively reporting statistically significant results, a weight-function model was fit to the data with a one-tailed p-value cutpoint of .025. The weight-function model revealed substantial selection bias and estimated the true average effect of self-controlled practice as g=.107 (95%CI[.047, .18]). P-curve analyses were conducted on the statistically significant results published in the literature and the outcome suggested a lack of evidential value. Fourth, a suite of sensitivity analyses were conducted to evaluate the robustness of these results, all of which converged on trivially small effect estimates. Overall, our results suggest the benefit of self-controlled practice on motor learning is small and not currently distinguishable from zero.

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Economic evaluation of the randomised, double-blind, placebo-controlled study of subcutaneous ketamine in the management of chronic cancer pain

Palliative Medicine ◽

10.1177/0269216318801754 ◽

2018 ◽

Vol 33 (1) ◽

pp. 74-81 ◽

Cited By ~ 1

Author(s):

Nikki McCaffrey ◽

Thomas Flint ◽

Billingsley Kaambwa ◽

Belinda Fazekas ◽

Debra Rowett ◽

...

Keyword(s):

Palliative Care ◽

Cost Effectiveness ◽

Cancer Pain ◽

Sensitivity Analyses ◽

Controlled Study ◽

Double Blind ◽

Double Blind Placebo ◽

Cost Effective Treatment ◽

Significant Difference ◽

The Cost

Background: Treating chronic, uncontrolled, cancer pain with subcutaneous ketamine in patients unresponsive to opioids and co-analgesics remains controversial, especially in light of recent evidence demonstrating ketamine does not have net clinical benefit in this setting. Aim: To evaluate the cost-effectiveness of subcutaneous ketamine versus placebo in this patient population. Design and setting: A within-trial cost-effectiveness analysis of the Australian Palliative Care Clinical Studies Collaborative’s randomised, double-blind, placebo-controlled trial of ketamine was conducted from a healthcare provider perspective. Mean costs and outcomes were estimated from participant-level data over 5 days including positive response, health-related quality of life (HrQOL) measured with the Functional Assessment of Chronic Illness Therapy–Palliative Care (FACIT-Pal), ketamine costs, medication usage and in-patient stays. Results: There was no statistically significant difference in responder rates, but higher toxicity and worse HrQOL for ketamine participants (mean change −3.10 (standard error (SE) 1.76), ketamine n = 93; 4.53 (SE 1.38), placebo n = 92). Estimated total mean costs were AU$706 higher per ketamine participant (AU$6608) compared with placebo (AU$5902), attributable to the cost of higher in-patient costs as well as costs of ketamine administration. The results were robust to sensitivity analyses accounting for different medication use costing methods and removal of cost outliers. Conclusion: The findings suggest subcutaneous ketamine in conjunction with opioids and standard adjuvant therapy is neither an effective nor cost-effective treatment for refractory pain in advanced cancer patients.

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A Cost-Effectiveness Analysis of Newborn Screening for Severe Combined Immunodeficiency in the UK

International Journal of Neonatal Screening ◽

10.3390/ijns5030028 ◽

2019 ◽

Vol 5 (3) ◽

pp. 28 ◽

Cited By ~ 2

Author(s):

Alice Bessey ◽

James Chilcott ◽

Joanna Leaviss ◽

Carmen de la Cruz ◽

Ruth Wong

Keyword(s):

Cost Effectiveness ◽

Severe Combined Immunodeficiency ◽

Cost Effective ◽

Sensitivity Analyses ◽

Combined Immunodeficiency ◽

Tree Model ◽

Life Years ◽

The Uk ◽

The Cost ◽

The Impact

Severe combined immunodeficiency (SCID) can be detected through newborn bloodspot screening. In the UK, the National Screening Committee (NSC) requires screening programmes to be cost-effective at standard UK thresholds. To assess the cost-effectiveness of SCID screening for the NSC, a decision-tree model with lifetable estimates of outcomes was built. Model structure and parameterisation were informed by systematic review and expert clinical judgment. A public service perspective was used and lifetime costs and quality-adjusted life years (QALYs) were discounted at 3.5%. Probabilistic, one-way sensitivity analyses and an exploratory disbenefit analysis for the identification of non-SCID patients were conducted. Screening for SCID was estimated to result in an incremental cost-effectiveness ratio (ICER) of £18,222 with a reduction in SCID mortality from 8.1 (5–12) to 1.7 (0.6–4.0) cases per year of screening. Results were sensitive to a number of parameters, including the cost of the screening test, the incidence of SCID and the disbenefit to the healthy at birth and false-positive cases. Screening for SCID is likely to be cost-effective at £20,000 per QALY, key uncertainties relate to the impact on false positives and the impact on the identification of children with non-SCID T Cell lymphopenia.

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A Two-Echelon Agricultural Product Supply Chain with Freshness and Greenness Concerns: A Cost-Sharing Contract Perspective

Complexity ◽

10.1155/2020/8560102 ◽

2020 ◽

Vol 2020 ◽

pp. 1-13

Author(s):

Manyi Tan ◽

Manli Tu ◽

Bin Wang ◽

Tianyue Zou ◽

Hong Cheng

Keyword(s):

Supply Chain ◽

Cost Sharing ◽

Agricultural Products ◽

Sensitivity Analyses ◽

Agricultural Product ◽

Human Beings ◽

Optimal Decisions ◽

Game Theoretic ◽

The Cost ◽

The Impact

Agricultural products are basic needs of human beings, and whether they are cultivated in a green (or organic) manner has direct impact on environment and public health. This research incorporates product freshness and greenness into a two-echelon agricultural product supply chain (APSC). Game theoretic analyses are carried out to examine pricing, freshness, and greenness decisions of the supply chain members with and without cost-sharing for greenness investment. Subsequently, we conduct comparative and sensitivity analyses for these optimal decisions and profits of the APSC members under different cases. Numerical experiment is employed to investigate the impact of key parameters on equilibrium decisions and profitability. Analytical and experimental results show that the cost-sharing contract of greenness investment for agricultural products helps to strengthen the supply chain members’ effort in improving the greenness and freshness levels of the agricultural product, thereby enhancing both individual and channel profitability of the APSC under certain conditions. This research also reveals a widened profit gap between the producer and the retailer under the cost-sharing contract.

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COST-EFFECTIVENESS OF ALEMTUZUMAB FOR T-CELL PROLYMPHOCYTIC LEUKEMIA

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462312000244 ◽

2012 ◽

Vol 28 (3) ◽

pp. 241-248 ◽

Cited By ~ 5

Author(s):

Lanting Lu ◽

Jaime Peters ◽

Chris Roome ◽

Ken Stein

Keyword(s):

Cost Effectiveness ◽

T Cell ◽

Cost Effective ◽

Perfect Information ◽

Sensitivity Analyses ◽

Future Research ◽

Decision Analytic Model ◽

Prolymphocytic Leukemia ◽

The Cost ◽

The Impact

Objectives:The aim of this study was to evaluate the cost-effectiveness of alemtuzumab (CAMPATH-1H) compared with conventional chemotherapy in people with T-cell prolymphocytic leukemia (T-PLL).Methods:We developed a decision-analytic model to assess the costs and benefits of alemtuzumab or conventional therapy based on their effects on quality of life of patients. The main outcome was the incremental cost-effectiveness ratio incorporating costs per additional quality-adjusted life-year (QALY) gained over lifetime. Due to the limited data available, a large number of assumptions had to be made to construct the cost-utility model. One-way, multi-way, and probabilistic sensitivity analyses (PSA) were conducted to explore the impact of these uncertainties. Expected values of perfect information were also calculated for four specific scenarios.Results:Depending on different key assumptions made, the PSA suggested distinct conclusions using a willingness-to-pay threshold of 30,000 GBP per QALY gained. Using this threshold, the probability that alemtuzumab would be cost-effective varies from 0 percent to 53 percent for the four modeled scenarios. Population expected value of perfect information analysis suggests that resolving the parameter uncertainty in the analysis for people with T-PLL in the United Kingdom would have considerable value—up to 5.3 million euro.Conclusions:Alemtuzumab appears more likely to be cost-effective if used earlier in the course of T-PLL and where it replaces the use of multiple alternative therapies. However, cost-effectiveness is highly uncertain and future research is clearly justified. Nevertheless, our analysis demonstrates the feasibility of considering the cost-effectiveness of an agent despite the presence of significant uncertainty to provide appropriate assessment information to policy makers.

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The impact of the SARS-CoV-2 pandemic on healthcare provision in Italy to non-COVID patients: a systematic review

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2022.012 ◽

2022 ◽

Vol 14 (1) ◽

pp. e2022012

Author(s):

Annarita Botta ◽

Gianmarco Lugli ◽

Matteo Maria Ottaviani ◽

Guido Ascione ◽

Alessandro Bruschi ◽

...

Keyword(s):

Systematic Review ◽

Healthcare System ◽

Public Healthcare ◽

Healthcare Provision ◽

Hub And Spoke ◽

Medical Specialties ◽

Health Crisis ◽

Outbreak Period ◽

Long Term Impact ◽

The Impact

Background Italy has been one of the countries most affected by the SARS-CoV-2 pandemic and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. We investigated the management of non-COVID-19 patients across all medical specialties in Italy. Methods A PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from 20 February to 22 June, 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialties in combination with our geographical focus (Italy) and COVID-19. Results Of the 4643 potentially eligible studies identified by the search, 247 studies were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialties have been affected by the reorganization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine. Conclusions Our work highlights the changes taking place in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyze future directions for the healthcare system in the case of new pandemic scenarios.

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

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.125 ◽

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

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Quality of life and cost consequence of delays in endovascular treatment for acute ischemic stroke in China

Health Economics Review ◽

10.1186/s13561-021-00352-w ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Weiyi Ni ◽

Wolfgang G. Kunz ◽

Mayank Goyal ◽

Lijin Chen ◽

Yawen Jiang

Keyword(s):

Ischemic Stroke ◽

Cost Effectiveness ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Healthcare Costs ◽

Time Window ◽

Time Windows ◽

Sensitivity Analyses ◽

Health State ◽

The Impact

Abstract Background Although endovascular therapy (EVT) improves clinical outcomes in patients with acute ischemic stroke, the time of EVT initiation significantly influences clinical outcomes and healthcare costs. This study evaluated the impact of EVT treatment delay on cost-effectiveness in China. Methods A model combining a short-term decision tree and long-term Markov health state transition matrix was constructed. For each time window of symptom onset to EVT, the probability of receiving EVT or non-EVT treatment was varied, thereby varying clinical outcomes and healthcare costs. Clinical outcomes and cost data were derived from clinical trials and literature. Incremental cost-effectiveness ratio and incremental net monetary benefits were simulated. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the model. The willingness-to-pay threshold per quality-adjusted life-year (QALY) was set to ¥71,000 ($10,281). Results EVT performed between 61 and 120 min after the stroke onset was most cost-effective comparing to other time windows to perform EVT among AIS patients in China, with an ICER of ¥16,409/QALY ($2376) for performing EVT at 61–120 min versus the time window of 301–360 min. Each hour delay in EVT resulted in an average loss of 0.45 QALYs and 165.02 healthy days, with an average net monetary loss of ¥15,105 ($2187). Conclusions Earlier treatment of acute ischemic stroke patients with EVT in China increases lifetime QALYs and the economic value of care without any net increase in lifetime costs. Thus, healthcare policies should aim to improve efficiency of pre-hospital and in-hospital workflow processes to reduce the onset-to-puncture duration in China.

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Impact of Advancing Technology on Nuclear Facility Operation

ASCE-ASME J Risk and Uncert in Engrg Sys Part B Mech Engrg ◽

10.1115/1.4044784 ◽

2019 ◽

Vol 6 (1) ◽

Author(s):

Jonathan K. Corrado ◽

Ronald M. Sega

Keyword(s):

Human Error ◽

New Technologies ◽

Nuclear Industry ◽

Nuclear Facilities ◽

Event Scale ◽

Technological Advances ◽

Significant Difference ◽

The Cost ◽

The Impact ◽

The U.S

Abstract Many unfortunate and unintended adverse industrial incidents occur across the U.S. each year, and the nuclear industry is no exception. Depending on the severity, these incidents can be problematic for people, the facilities, and surrounding environments. These incidents occur for a number of varying reasons, but more often than not, human error is an accomplice. This article explores whether the complexity and changing technologies, which affect the way operators interact within the systems of the nuclear facilities, exacerbate the severity of incidents caused by human error. A review of nuclear incidents in the U.S. from 1955 to 2010 reaching level three or higher on the International Nuclear Event Scale (INES) scale was conducted. The cost of each incident at facilities that had recently undergone technological changes affecting plant operator's jobs was compared to those facilities which had not undergone changes. A t-test was applied and determined a statistically significant difference between the two groups. This affirmed that technological advances at nuclear facilities that affect how operators interact within the plant system increase the severity of resulting incidents. Next, a follow-on study was conducted to determine the impact from the incorporation of new technologies into nuclear facilities. The data indicated that spending more money on upgrades increased the capacity of the facility as well as the number of incidents reported, but the incident severity was minor.

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