scholarly journals Cost-Utility Analysis of Oxybutynin vs. OnabotulinumtoxinA (Botox) in the Treatment of Overactive Bladder Syndrome

2021 ◽  
Vol 18 (16) ◽  
pp. 8743
Author(s):  
Habiba Shabir ◽  
Sana Hashemi ◽  
Moussa Al-Rufayie ◽  
Tayo Adelowo ◽  
Umar Riaz ◽  
...  
Keyword(s):  
Overactive Bladder ◽  
Cost Effective ◽  
Time Frame ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Overactive Bladder Syndrome ◽  
Utility Analysis ◽  
Net Benefit ◽  
First Line ◽  
Life Years

Background: The UK National Health Service (NHS) propose the use of oxybutynin prior to onabotulinumtoxinA (Botox) in the management of overactive bladder syndrome (OAB). Oxybutynin is costly and associated with poor adherence, which may not occur with Botox. We conducted a cost-utility analysis (CUA) to compare the medications. Methods: we compared the two treatments in quality-adjusted life years (QALYS), through the NHS’s perspective. Costs were obtained from UK-based sources and were discounted. Total costs were determined by adding the treatment cost and management cost for complications on each branch. A 12-month time frame was used to model the data into a decision tree. Results: Our results found that using Botox first-line had greater cost utility than oxybutynin. The health net benefit calculation showed an increase in 0.22 QALYs when Botox was used first-line. Botox also had greater cost-effectiveness, with the exception of pediatric patients with an ICER of £42,272.14, which is above the NICE threshold of £30,000. Conclusion: Botox was found to be more cost-effective than antimuscarinics in the management of OAB in adults, however less cost-effective in younger patients. This predicates the need for further research to ascertain the age at which Botox becomes cost-effective in the management of OAB.

scholarly journals Economic Evaluation of an Internet-Based Stress Management Intervention Alongside a Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Fanny Kählke ◽  
Claudia Buntrock ◽  
Filip Smit ◽  
Matthias Berking ◽  
Dirk Lehr ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Stress Management ◽  
Perceived Stress ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Management Interventions ◽  
Life Years ◽  
The Cost

BACKGROUND Work-related stress is widespread among employees and associated with high costs for German society. Internet-based stress management interventions (iSMIs) are effective in reducing such stress. However, evidence for their cost-effectiveness is scant. OBJECTIVE The aim of this study was to assess the cost-effectiveness of a guided iSMI for employees. METHODS A sample of 264 employees with elevated symptoms of perceived stress (Perceived Stress Scale≥22) was assigned to either the iSMI or a waitlist control condition (WLC) with unrestricted access to treatment as usual. Participants were recruited in Germany in 2013 and followed through 2014, and data were analyzed in 2017. The iSMI consisted of 7 sessions plus 1 booster session. It was based on problem-solving therapy and emotion regulation techniques. Costs were measured from the societal perspective, including all direct and indirect medical costs. We performed a cost-effectiveness analysis and a cost-utility analysis relating costs to a symptom-free person and quality-adjusted life years (QALYs) gained, respectively. Sampling uncertainty was handled using nonparametric bootstrapping (N=5000). RESULTS When the society is not willing to pay anything to get an additional symptom-free person (eg, willingness-to-pay [WTP]=€0), there was a 70% probability that the intervention is more cost-effective than WLC. This probability rose to 85% and 93% when the society is willing to pay €1000 and €2000, respectively, for achieving an additional symptom-free person. The cost-utility analysis yielded a 76% probability that the intervention is more cost-effective than WLC at a conservative WTP threshold of €20,000 (US $25,800) per QALY gained. CONCLUSIONS Offering an iSMI to stressed employees has an acceptable likelihood of being cost-effective compared with WLC. CLINICALTRIAL German Clinical Trials Register DRKS00004749; https://www.drks.de/DRKS00004749 INTERNATIONAL REGISTERED REPOR RR2-10.1186/1471-2458-13-655

scholarly journals Cost-utility analysis of mechanical thrombectomy between 6 and 24 hours in acute ischemic stroke

2019 ◽  
Vol 15 (1) ◽  
pp. 75-84 ◽  
Author(s):  
Elena Pizzo ◽  
Maureen Dumba ◽  
Kyriakos Lobotesis
Keyword(s):  
Ischemic Stroke ◽  
Medical Treatment ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Life Years ◽  
The Uk

Background Recently, two randomized controlled trials demonstrated the benefit of mechanical thrombectomy performed between 6 and 24 h in acute ischemic stroke. The current economic evidence is supporting the intervention only within 6 h, but extended thrombectomy treatment times may result in better long-term outcomes for a larger cohort of patients. Aims We compared the cost-utility of mechanical thrombectomy in addition to medical treatment versus medical treatment alone performed beyond 6 h from stroke onset in the UK National Health Service (NHS). Methods A cost-utility analysis of mechanical thrombectomy compared to medical treatment was performed using a Markov model that estimates expected costs and quality-adjusted life years (QALYs) over a 20-year time horizon. We present the results of three models using the data from the DEFUSE 3 and DAWN trials and evidence from published sources. Results Over a 20-year period, the incremental cost per QALY of mechanical thrombectomy was $1564 (£1219) when performed after 12 h from onset, $5253 (£4096) after 16 h and $3712 (£2894) after 24 h. The probabilistic sensitivity analysis demonstrated that thrombectomy had a 99.9% probability of being cost-effective at the minimum willingness to pay for a QALY commonly used in the UK. Conclusions The results of this study demonstrate that performing mechanical thrombectomy up to 24 h from acute ischemic stroke symptom onset is still cost-effective, suggesting that this intervention should be implemented by the NHS on the basis of improvement in quality of life as well as economic grounds.

Economic evaluation of compression stockings for the prevention of venous leg ulcer recurrence in Ontario

2020 ◽  
Vol 29 (3) ◽  
pp. 141-151 ◽  
Author(s):  
Sandjar Djalalov ◽  
Shayan Sehatzadeh ◽  
David H Keast ◽  
William WL Wong
Keyword(s):  
Cost Effectiveness ◽  
Usual Care ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Ulcer Recurrence ◽  
Utility Analysis ◽  
Compression Stockings ◽  
Old Patients ◽  
Life Years

Objective: Approximately between 1.5 and 3.0 per 1000 people are affected by venous leg ulcers (VLUs). The treatment and management of VLUs is costly and recurrence is a major concern. There is evidence that compression stockings can reduce the rate of re-ulceration compared with no compression. We present the first cost-effective analysis of compression stockings in preventing recurrence of VLUs from the perspective of the Ontario healthcare system. Method: A cost-utility analysis with a five-year time horizon was conducted. Use of compression stockings was compared with usual care (no compression stockings). We simulated a hypothetical cohort of 65-year-old patients with healed VLUs, using a state-transition model. Model input parameters were obtained mainly from the published literature. We estimated quality-adjusted life years (QALYs) gained and direct medical costs. We conducted various sensitivity analyses. Results: Compared with usual care, compression stockings were associated with higher costs and increased QALYs. Cost-utility analysis showed that the incremental cost-effectiveness ratio of compression stockings was $23,864 per QALY gained compared with no compression stockings. The most influential drivers of cost-effectiveness were the utility value of healed VLUs, cost of stockings, number of stocking replacements, monthly prevention cost and the risk of VLU recurrence. Conclusion: Compared with usual care, compression stockings were cost-effective in preventing VLUs, using a willingness-to-pay threshold of $50,000. These observations were consistent even when uncertainty in model inputs and parameters were considered.

scholarly journals A Telemonitoring Programme in Patients with Heart Failure in France: A Cost-Utility Analysis

2021 ◽  
Author(s):  
Mégane Caillon ◽  
Rémi Sabatier ◽  
Damien Legallois ◽  
Laurène Courouve ◽  
Valérie Donio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Standard Care ◽  
Care Setting ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Life Years

Abstract Background Certain telemedicine programmes for heart failure (HF) have been shown to reduce all-cause mortality and heart failure-related hospitalisations, but their cost-effectiveness remains controversial. The SCAD programme is a home-based interactive telemonitoring service for HF, which is one of the longest-running and largest telemonitoring programmes for HF in France. The objective of this cost-utility analysis was to evaluate the cost-effectiveness of the SCAD programme with respect to standard hospital-based care in patients with HF. Methods A Markov model simulating hospitalisations and mortality in patients with HF was constructed to estimate outcomes and costs. The model included six distinct health states (three ‘not hospitalised’ states, two ‘hospitalisation for heart failure’ states, both depending on the number of previous hospitalisations, and one death state. The model lifetime in the base case was ten years. Model inputs were based on published literature. Outputs (costs and QALYs) were compared between SCAD participants and standard care. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty in the input parameters of the model. Results The number of quality-adjusted life years (QALYs) was 3.75 in the standard care setting and 4.41 in the SCAD setting. This corresponds to a gain in QALYs provided by the SCAD programme of 0.65 over the ten-year lifetime of the model. The estimated total cost was €30,932 in the standard care setting and €35,177 in the SCAD setting, with an incremental cost of €4,245. The incremental cost-effectiveness ratio for the SCAD programme over standard care was estimated at €4,579/QALY. In the deterministic sensitivity analysis, the variables that had the most impact on the ICER were HF management costs. The likelihood of the SCAD programme being considered cost-effective was 90% at a willingness-to-pay threshold of €11,800. Conclusions Enrolment of patients into the SCAD programme is highly cost-effective. Extension of the programme to other hospitals and more patients would have a limited budget impact but provide important clinical benefits. This finding should also be taken into account in new public health policies aimed at encouraging a shift from inpatient to ambulatory care.

scholarly journals Economic Evaluation of an Internet-Based Stress Management Intervention Alongside a Randomized Controlled Trial

10.2196/10866 ◽  
2019 ◽  
Vol 6 (5) ◽  
pp. e10866 ◽  
Author(s):  
Fanny Kählke ◽  
Claudia Buntrock ◽  
Filip Smit ◽  
Matthias Berking ◽  
Dirk Lehr ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Stress Management ◽  
Perceived Stress ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Management Interventions ◽  
Life Years ◽  
The Cost

Background Work-related stress is widespread among employees and associated with high costs for German society. Internet-based stress management interventions (iSMIs) are effective in reducing such stress. However, evidence for their cost-effectiveness is scant. Objective The aim of this study was to assess the cost-effectiveness of a guided iSMI for employees. Methods A sample of 264 employees with elevated symptoms of perceived stress (Perceived Stress Scale≥22) was assigned to either the iSMI or a waitlist control condition (WLC) with unrestricted access to treatment as usual. Participants were recruited in Germany in 2013 and followed through 2014, and data were analyzed in 2017. The iSMI consisted of 7 sessions plus 1 booster session. It was based on problem-solving therapy and emotion regulation techniques. Costs were measured from the societal perspective, including all direct and indirect medical costs. We performed a cost-effectiveness analysis and a cost-utility analysis relating costs to a symptom-free person and quality-adjusted life years (QALYs) gained, respectively. Sampling uncertainty was handled using nonparametric bootstrapping (N=5000). Results When the society is not willing to pay anything to get an additional symptom-free person (eg, willingness-to-pay [WTP]=€0), there was a 70% probability that the intervention is more cost-effective than WLC. This probability rose to 85% and 93% when the society is willing to pay €1000 and €2000, respectively, for achieving an additional symptom-free person. The cost-utility analysis yielded a 76% probability that the intervention is more cost-effective than WLC at a conservative WTP threshold of €20,000 (US $25,800) per QALY gained. Conclusions Offering an iSMI to stressed employees has an acceptable likelihood of being cost-effective compared with WLC. Trial Registration German Clinical Trials Register DRKS00004749; https://www.drks.de/DRKS00004749 International Registered Report Identifier (IRRID) RR2-10.1186/1471-2458-13-655

A cost-utility analysis of antenatal screening to prevent congenital rubella syndrome

2009 ◽  
Vol 138 (8) ◽  
pp. 1172-1184 ◽  
Author(s):  
A. K. LUGNÉR ◽  
L. MOLLEMA ◽  
W. L. M. RUIJS ◽  
S. J. M. HAHNÉ
Keyword(s):  
The Netherlands ◽  
Pregnant Women ◽  
Cost Savings ◽  
Cost Effective ◽  
Risk Groups ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Congenital Rubella ◽  
Life Years

SUMMARYIn low vaccination coverage regions (LVR) in The Netherlands people often reject participation in the National Immunization Programme for religious reasons. During a rubella epidemic in 2004–2005, 32 pregnant women were notified with rubella, and 11 babies were born with defects related to maternal infection. This study presents a cost-utility analysis of a screening and vaccination programme for rubella focusing on three scenarios: (1) screening non-vaccinated pregnant women in LVR; (2) screening all pregnant women in LVR; (3) screening all non-vaccinated pregnant women in The Netherlands (including pregnant first-generation non-Western immigrant women). Cost-utility was estimated over a 16-year period which included two rubella outbreaks. Observed complications from the 2004–2005 epidemic were used to estimate average cost savings and quality-adjusted life-years (QALY) gained. The programme would be cost-effective (€1100/QALY gained) when assuming an acceptability of vaccination of 20% in women belonging to orthodox protestant risk groups.

scholarly journals Cost–Utility Analysis of Mindfulness-Based Cognitive Therapy Versus Antidepressant Pharmacotherapy for Prevention of Depressive Relapse in a Canadian Context: Analyse coût-utilité de la thérapie cognitive basée sur la pleine conscience contre la pharmacothérapie antidépressive pour prévenir la rechute de la dépression en contexte canadien

2020 ◽  
Vol 65 (8) ◽  
pp. 568-576
Author(s):  
Tina Pahlevan ◽  
Christine Ung ◽  
Zindel Segal
Keyword(s):  
Cognitive Therapy ◽  
Time Horizon ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Economic Evaluations ◽  
Utility Analysis ◽  
First Line ◽  
System Perspective ◽  
Antidepressant Pharmacotherapy

Objective: Patients suffering from major depressive disorder (MDD) experience impaired functioning and reduced quality of life, including an elevated risk of episode return. MDD is associated with high societal burden due to increased healthcare utilization, productivity losses, and suicide-related costs, making the long-term management of this illness a priority. The purpose of this study is to evaluate the cost-effectiveness of mindfulness-based cognitive therapy (MBCT), a first-line preventative psychological treatment, compared to maintenance antidepressant medication (ADM), the current standard of care. Method: A cost–utility analysis was conducted over a 24-month time horizon to model differences between MBCT and ADM in cost and quality-adjusted life years (QALY). The analysis was conducted using a decision tree analytic model. Intervention efficacy, utility, and costing data estimates were derived from published sources and expert consultation. Results: MBCT was found to be cost-effective compared to maintenance ADM over a 24-month time horizon. Antidepressant pharmacotherapy resulted in 1.10 QALY and $17,255.37 per patient on average, whereas MBCT resulted in 1.18 QALY and $15,030.70 per patient on average. This resulted in a cost difference of $2,224.67 and a QALY difference of 0.08, in favor of MBCT. Multiple sensitivity analyses supported these findings. Conclusions: From both a societal and health system perspective, utilizing MBCT as a first-line relapse prevention treatment is potentially cost-effective in a Canadian setting. Future economic evaluations should consider combined treatment (e.g., ADM and psychotherapy) as a comparator and longer time horizons as the literature advances.

scholarly journals Hemodialysis or Transplantation for Ethiopia: A Cost Utility Analysis

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Tariku Shimels
Keyword(s):  
Kidney Transplantation ◽  
Incremental Cost ◽  
Addis Ababa ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Medline Search ◽  
Life Years ◽  
End Stage

Background: The burden of end stage kidney disease (ESKD) characterized with a requirement with lifesaving dialysis or kidney transplantation is estimated to be more than 1.4 million whereas the annual incidence exceeds 8% worldwide. In Ethiopia, there is no renal transplant practice whereas hemodialysis is characterized with very limited number of dialysis centers in the capital; Addis Ababa. The objective of this analysis was to evaluate the cost-utility of hemodialysis and renal transplantation in Ethiopia. Method: A cost utility evaluation (CUA) was produced to estimate if kidney transplantation would be a cost-effective alternative to hemodialysis. The decision model was developed as a decision tree that allows for comparisons of costutility evaluation between the two alternatives. While a patient perspective was used in the study, The Probabilities cost of transplant and effects included in this study were derived from the literature following a formal MEDLINE search for studies published in English language. Results: Transplantation resulted in an incremental cost of $42,623.74 and incremental utility of 3.18 quality-adjusted life years (QALYs) compared with conventional hemodialysis presented with an incremental cost of $25,902.08 but very less QALY of 0.36 over a five years’ time horizon. Given its higher incremental costs, transplantation remained more cost effective than hemodialysis (ICUR of 13414.67 vs. 71860.00 $/QALY). The one way ANOVA sensitivity analysis has also confirmed that the result of the CUA is not sensitive to any plausible parameter changes. Conclusion: Our cost utility analysis result demonstrated that the incremental cost utility ratio of a patient’s five year therapy by hemodialysis at end-stage renal disease is significantly higher than by performing therapy of kidney transplantation, by more than a factor of five times.

scholarly journals Risk-benefit and cost-utility analysis for COVID-19 lockdown in Belgium: the impact on mental health and wellbeing.

2020 ◽  
Author(s):  
Frederik Feys ◽  
Sam Brokken ◽  
Steven De Peuter
Keyword(s):  
Mental Health ◽  
Cost Effectiveness ◽  
Time Horizon ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Net Benefit ◽  
Psychological Burden ◽  
Health And Wellbeing ◽  
Life Years

OBJECTIVE The objective of this study was to assess the benefits and risks of a lockdown in Belgium, with focus on mental health. Consequently, projecting the cost effectiveness of remedial measures.METHODS For benefits; in estimating health savings, we compared Belgium (lockdown) and Sweden (lockdown-light) for COVID-19 related deaths, peak intensive care unit load and peak hospitalisations load. We also calculated the years of life lost (YLL). For risks; we assessed the mental health and wellbeing, using the most common dimensions: anxiety and depression. GAD-7 and PHQ-9 scores were extracted from a survey and compared to a similar representative survey in 2018. Disability-adjusted life years (DALYs) were calculated for and we assessed non-COVID-19 related-deaths from excess mortality. Cost-utility analysis was performed with a 1-year time horizon. Hence, considering the Quality-adjusted Life Years (QALYs), Incremental Cost-effectiveness Ratio (ICER) and the potential impact providing adequate treatment compared to standard care.RESULTS Lockdown versus lockdown-light gave no COVID-19 related benefits. COVID-19 related risks during lockdown saw an increase of 4,231 deaths; 667 extra ICU admissions on peak day, 3213 extra hospital admissions on peak day and 140 extra non-COVID-19 related deaths. Additionally, 140 extra deaths occured due to a non-COVID-19 cause. 1,034,365 (9,0%) of Belgian population reported increased anxiety and/or depression. Risk-benefit analysis; COVID-19 related deaths yielded an extra 3,145 YLL, total psychological burden of 104,515 (74,025-139,762) DALYs and the total loss of societal value is considered between €3.0 billion and €5.6 billion. Cost-utility analysis; ICER for psychological treatment for depression was €11,510/QALY gained. In total psychotherapy could create 181,714 (34,134-213,654) QALYs and a 1 year net benefit of € 5.2 billion.CONCLUSION We found no evidence that a lockdown versus lockdown-light results in less COVID-19 related mortality and morbidity. The Belgian lockdown created an obvious +104,515 (74,025-139,762) DALYs psychological burden in Belgium. Adequate investment in psychological help would provide individual relief and may improve a person’s immunological response. Also, within a 1-year time horizon, taking into account the loss of value in healthy functioning people, the net benefit is €0.9 billion.

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