scholarly journals Simplified Mathematical Modelling of Uncertainty: Cost-Effectiveness of COVID-19 Vaccines in Spain

Mathematics ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 566
Author(s):  
Julio Emilio Marco-Franco ◽  
Pedro Pita-Barros ◽  
Silvia González-de-Julián ◽  
Iryna Sabat ◽  
David Vivas-Consuelo
Keyword(s):  
Cost Effectiveness ◽  
Health Planning ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Reliable Data ◽  
Simplified Model ◽  
Fatality Rate ◽  
Cost Effectiveness Ratio ◽  
Funeral Homes ◽  
The Cost

When exceptional situations, such as the COVID-19 pandemic, arise and reliable data is not available at decision-making times, estimation using mathematical models can provide a reasonable reckoning for health planning. We present a simplified model (static but with two-time references) for estimating the cost-effectiveness of the COVID-19 vaccine. A simplified model provides a quick assessment of the upper bound of cost-effectiveness, as we illustrate with data from Spain, and allows for easy comparisons between countries. It may also provide useful comparisons among different vaccines at the marketplace, from the perspective of the buyer. From the analysis of this information, key epidemiological figures, and costs of the disease for Spain have been estimated, based on mortality. The fatality rate is robust data that can alternatively be obtained from death registers, funeral homes, cemeteries, and crematoria. Our model estimates the incremental cost-effectiveness ratio (ICER) to be 5132 € (4926–5276) as of 17 February 2021, based on the following assumptions/inputs: An estimated cost of 30 euros per dose (plus transport, storing, and administration), two doses per person, efficacy of 70% and coverage of 70% of the population. Even considering the possibility of some bias, this simplified model provides confirmation that vaccination against COVID-19 is highly cost-effective.

Comparing the cost-effectiveness of three diagnostic test strategies for angle closure in a developing country

2021 ◽  
Vol 27 (4) ◽  
pp. 1-7
Author(s):  
Mariana Y Miyamoto ◽  
Ralph Cohen ◽  
Niro Kasahara
Keyword(s):  
Cost Effectiveness ◽  
Developing Country ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Angle Closure ◽  
Cost Effectiveness Ratio ◽  
Primary Angle Closure ◽  
Scheimpflug Camera ◽  
Camera Imaging ◽  
The Cost

Background/Aims The appropriate roles for alternative diagnostic tests in detecting primary angle closure of the eye are uncertain. This study evaluated the cost-effectiveness of Scheimpflug camera imaging, the van Herick technique and gonioscopy to identify primary angle in a developing country. Methods This cross-sectional diagnostic study included participants aged >40 years with suspected primary angle closure in the developing country of Brazil. All participants underwent Scheimpflug camera imaging, a van Herick test and gonioscopy. The diagnostic ability of these tests was evaluated using a receiver operating characteristic curve. Costs of interventions were derived using the Brazilian Hierarchical Classification of Medical Procedures. The cost-effectiveness of the tests were compared using an incremental cost-effectiveness ratio. Results Gonioscopy was confirmed to be the most accurate diagnostic test for primary angle closure, closely followed by the van Herick test. The accuracy of Scheimpflug camera imaging was considerably lower, largely because of its low sensitivity. The incremental cost-effectiveness ratio demonstrated that Scheimpflug camera imaging was also the least cost-effective, as it was considerably more expensive but with less clinical benefits. Conclusions Because of its relatively low accuracy and high costs, Scheimpflug camera imaging is not as cost-effective as gonioscopy nor the van Herick test as a means of diagnosing primary angle closure in a developing country.

Societal and Economic Effect of Meniscus Scaffold Procedures for Irreparable Meniscus Injuries

2016 ◽  
Vol 44 (7) ◽  
pp. 1724-1734 ◽  
Author(s):  
Jan J. Rongen ◽  
Tim M. Govers ◽  
Pieter Buma ◽  
Janneke P.C. Grutters ◽  
Gerjon Hannink
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Incremental Cost ◽  
Medial Meniscus ◽  
Relative Risk Reduction ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
The Cost ◽  
Meniscus Scaffolds

Background: Meniscus scaffolds are currently evaluated clinically for their efficacy in preventing the development of osteoarthritis as well as for their efficacy in treating patients with chronic symptoms. Procedural costs, therapeutic consequences, clinical efficacy, and future events should all be considered to maximize the monetary value of this intervention. Purpose: To examine the socioeconomic effect of treating patients with irreparable medial meniscus injuries with a meniscus scaffold. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: Two Markov simulation models for patients with an irreparable medial meniscus injury were developed. Model 1 was used to investigate the lifetime cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by the possibility of preventing the development of osteoarthritis. Model 2 was used to investigate the short-term (5-year) cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by alleviating clinical symptoms, specifically in chronic patients with previous meniscus surgery. For both models, probabilistic Monte Carlo simulations were applied. Treatment effectiveness was expressed as quality-adjusted life-years (QALYs), while costs (estimated in euros) were assessed from a societal perspective. We assumed €20,000 as a reference value for the willingness to pay per QALY. Next, comprehensive sensitivity analyses were performed to identify the most influential variables on the cost-effectiveness of meniscus scaffolds. Results: Model 1 demonstrated an incremental cost-effectiveness ratio of a meniscus scaffold treatment of €54,463 per QALY (€5991/0.112). A threshold analysis demonstrated that a meniscus scaffold should offer a relative risk reduction of at least 0.34 to become cost-effective, assuming a willingness to pay of €20,000. Decreasing the costs of the meniscus scaffold procedure by 33% (€10,160 instead of €15,233; an absolute change of €5073) resulted in an incremental cost-effectiveness ratio of €7876 per QALY. Model 2 demonstrated an incremental cost-effectiveness ratio of a meniscus scaffold treatment of €297,727 per QALY (€9825/0.033). On the basis of the current efficacy data, a meniscus scaffold provides a relative risk reduction of “limited benefit” postoperatively of 0.37 compared with standard treatment. A threshold analysis revealed that assuming a willingness to pay of €20,000, a meniscus scaffold would not be cost-effective within a period of 5 years. Most influential variables on the cost-effectiveness of meniscus scaffolds were the cost of the scaffold procedure, cost associated with osteoarthritis, and quality of life before and after the scaffold procedure. Conclusion: Results of the current health technology assessment emphasize that the monetary value of meniscus scaffold procedures is very much dependent on a number of influential variables. Therefore, before implementing the technology in the health care system, it is important to critically assess these variables in a relevant context. The models can be improved as additional clinical data regarding the efficacy of the meniscus scaffold become available.

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

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.

Cost-effectiveness and safety of ramucirumab plus paclitaxel chemotherapy in the treatment of advanced and recurrent gastric cancer

2017 ◽  
Vol 24 (6) ◽  
pp. 403-411
Author(s):  
Michio Kimura ◽  
Eiseki Usami ◽  
Hitomi Teramachi ◽  
Tomoaki Yoshimura
Keyword(s):  
Gastric Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Clinical Information ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Chemotherapy Agent ◽  
Recurrent Gastric Cancer ◽  
The Cost

Introduction Weekly paclitaxel (PTX), irinotecan (CPT-11) and ramucirumab plus paclitaxel (Ram + PTX) are currently recommended as the standard second-line or later chemotherapies for advanced and recurrent gastric cancer. This study aims to compare the cost-effectiveness of using Ram + PTX vs. PTX or CPT-11. Furthermore, we investigated the safety and treatment continuity of Ram + PTX in Japan. Methods Expected costs were calculated based on data from patients with advanced and recurrent gastric cancer who were treated with PTX, CPT-11 and Ram + PTX. A literature review was performed to obtain clinical information so that the probability of the efficacy of each chemotherapy could be calculated. The cost-effectiveness ratio of each chemotherapy agent was calculated by dividing the expected cost by the median survival time (MST). Results The cost-effectiveness ratio per month was JPY 85,395.8/MST for the PTX regimen, JPY 132,735.4/MST for the CPT-11 regimen and JPY 657,175.4/MST for the Ram + PTX regimen (p < 0.001). The incremental cost-effectiveness ratio per month of the Ram + PTX regimen to the PTX regimen was JPY 2,780,432.4/MST. The incremental cost-effectiveness ratio of the Ram + PTX regimen to the CPT-11 regimen was JPY 2,185,179.0/MST. With regard to the reasons for discontinuation of treatment, the Ram + PTX regimen had only one case of being discontinued owing to adverse events, and had a profile similar to that of the PTX and CPT-11 regimens. Conclusion These findings show that the Ram + PTX regimen is less cost-effective compared to both the PTX and CPT-11 regimen, but the Ram + PTX regimen is a well-tolerated regimen with sufficient efficacy.

scholarly journals Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina

2013 ◽  
Vol 29 (12) ◽  
pp. 2459-2472 ◽  
Author(s):  
Pablo Wenceslao Orellano ◽  
Nestor Vazquez ◽  
Oscar Daniel Salomon
Keyword(s):  
Cost Effectiveness ◽  
Early Diagnosis ◽  
Incremental Cost ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Sensitivity Analyses ◽  
Cost Effectiveness Ratio ◽  
Tegumentary Leishmaniasis ◽  
Life Years ◽  
The Cost

The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.

scholarly journals COVID-19 Vaccination Scenarios: A Cost-Effectiveness Analysis for Turkey

Vaccines ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 399
Author(s):  
Arnold Hagens ◽  
Ahmet Çağkan İnkaya ◽  
Kasirga Yildirak ◽  
Mesut Sancar ◽  
Jurjen van der Schans ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Savings ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Vaccine Uptake ◽  
First Year ◽  
Cost Effectiveness Ratio ◽  
Scenario Analyses ◽  
Effectiveness Analysis ◽  
The Cost

As of March 2021, COVID-19 has claimed the lives of more than 2.7 million people worldwide. Vaccination has started in most countries around the world. In this study, we estimated the cost-effectiveness of strategies for COVID-19 vaccination for Turkey compared to a baseline in the absence of vaccination and imposed measures by using an enhanced SIRD (Susceptible, Infectious, Recovered, Death) model and various scenarios for the first year after vaccination. The results showed that vaccination is cost-effective from a health care perspective, with an incremental cost-effectiveness ratio (ICER) of 511 USD/QALY and 1045 USD/QALY if vaccine effectiveness on transmission is equal or reduced to only 50% of effectiveness on disease, respectively, at the 90% baseline effectiveness of the vaccine. From a societal perspective, cost savings were estimated for both scenarios. Other results further showed that the minimum required vaccine uptake to be cost-effective would be at least 30%. Sensitivity and scenario analyses, as well as the iso-ICER curves, showed that the results were quite robust and that major changes in cost-effectiveness outcomes cannot be expected. We can conclude that COVID-19 vaccination in Turkey is highly cost-effective or even cost-saving.

Does Medicare Have an Implicit Cost-Effectiveness Threshold?

2010 ◽  
Vol 30 (4) ◽  
pp. E14-E27 ◽  
Author(s):  
James D. Chambers ◽  
Peter J. Neumann ◽  
Martin J. Buxton
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Medical Interventions ◽  
Coverage Decision ◽  
The Cost ◽  
Cost Effectiveness Threshold ◽  
Effectiveness Threshold

Background. Despite the huge cost of the program, the Centers for Medicare and Medicaid Services (CMS) has maintained a policy that cost-effectiveness is not considered in national coverage determinations (NCDs). Objective. To assess whether an implicit cost-effectiveness threshold exists and to determine if economic evidence has been considered in previous NCDs. Methods. A literature search was conducted to identify estimates of cost-effectiveness relevant to each NCD from 1999—2007 (n = 103). The economic evaluation that best represented each coverage decision was included in a review of the cost-effectiveness of medical interventions considered in NCDs. Results. Of the 64 coverage decisions determined to have a corresponding cost-effectiveness estimate, 49 were associated with a positive coverage decision and 15 with a noncoverage decision. Of the positive decisions, 20 were associated with an economic evaluation that estimated the intervention to be dominant (costs less and was more effective than the alternative), 12 with an incremental cost-effectiveness ratio (ICER) of less than $50,000, 8 with an ICER greater than $50,000 but less than $100,000, and 9 with an ICER greater than $100,000. Fourteen of the sample of 64 decision memos cited or discussed cost-effectiveness information. Conclusions. CMS is covering a number of interventions that do not appear to be cost-effective, suggesting that resources could be allocated more efficiently. Although the authors identified several instances where cost-effectiveness evidence was cited in NCDs, they found no clear evidence of an implicit threshold.

scholarly journals Cost effectiveness of the cancer prevention program for carriers of the BRCA1/2 mutation

2018 ◽  
Vol 52 ◽  
pp. 94 ◽  
Author(s):  
Marcelo Cristiano de Azevedo Ramos ◽  
Maria Aparecida Azevedo Koike Folgueira ◽  
Simone Maistro ◽  
Alessandro Gonçalves Campolina ◽  
Patricia Coelho de Soárez ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Impact Analysis ◽  
National Health System ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Prophylactic Measures ◽  
The Cost

OBJECTIVE: To analyze the cost effectiveness of the diagnostic program for the germline mutation in BRCA1/2 genes and of preventative strategies for the relatives of patients diagnosed with ovarian cancer associated with this mutation. METHODS: The study analyzed the cost effectiveness by developing an analysis of the Markov decision process from the perspective of the National Health System. The strategies compared reflect upon the adoption of genetic testing and preventative strategies for relatives or the usual care currently proposed. The incremental cost-effectiveness ratio was expressed in terms of cost per case avoided. The sensitivity analysis was performed in a univariate and deterministic manner. RESULTS: The study showed increments for effectiveness and for costs when performing genetic testing and adopting prophylactic measures for family members. The incremental cost-effectiveness ratio was estimated at R$908.58 per case of cancer avoided, a figure considered lower than the study’s cost-effectiveness threshold (R$7,543.50). CONCLUSIONS: The program analyzed should be considered a cost-effective strategy for the national situation. Studies in various other countries have reached similar conclusions. One possible ramification of this research might the need to perform a budgetary-impact analysis of making the program one of the country’s health policies

scholarly journals Optimal Control of Shigellosis with Cost-Effective Strategies

2020 ◽  
Vol 2020 ◽  
pp. 1-15
Author(s):  
Stephen Edward ◽  
Nyimvua Shaban ◽  
Eunice Mureithi
Keyword(s):  
Optimal Control ◽  
Cost Effectiveness ◽  
Optimal Control Theory ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Effective Strategies ◽  
Education Campaign ◽  
Effectiveness Analysis ◽  
The Cost

In this paper, we apply optimal control theory to the model for shigellosis. It is assumed that education campaign, sanitation, and treatment are the main controls for this disease. The aim is to minimize the number of infections resulting from contact with careers, infectious population, and contaminated environments while keeping the cost of associated controls minimum. We achieve this aim through the application of Pontryagin’s Maximum Principle. Numerical simulations are carried out by using both forward and backward in time fourth-order Runge-Kutta schemes. We simulate the model under different strategies to investigate which option could yield the best results. The findings show that the strategy combining all three control efforts (treatment, sanitation, and education campaign) proves to be more beneficial in containing shigellosis than the rest. On the other hand, cost-effectiveness analysis is performed via incremental cost-effectiveness ratio (ICER). The findings from the ICER show that a strategy incorporating all three controls (treatment, sanitation, and education campaign) is the most cost-effective of all strategies considered in the study.

scholarly journals A study on rapid diagnosis (by PCR) and cost-effective treatment of pulmonary mycosis

2018 ◽  
Vol 6 (6) ◽  
pp. 1938
Author(s):  
Saurabh Kumar ◽  
Iram Shaifali ◽  
Shalini Chandra
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Molecular Method ◽  
Chain Reaction ◽  
Pulmonary Mycosis ◽  
Cost Effective Treatment ◽  
Polymerase Chain ◽  
The Cost

Background: Incidence of Pulmonary Mycosis is rampantly growing in critically ill patients. This study was designed to comparatively evaluate conventional and molecular method-Polymerase Chain Reaction (PCR) for detecting Candida and Aspergillus species in Brocho-Alveolar Lavage (BAL) samples and secondarily to find out the Cost-Effective treatment for Pulmonary Mycosis.Methods: In this study 100 BAL-specimens were collected from patients suspected of Pulmonary Mycosis. These samples were examined for Aspergillus and Candida species by preparation of wet smear using potassium hydroxide, Gram staining, Culture media and Polymerase Chain Reaction (PCR). For Cost-Effectiveness analysis(CEA), a decision tree model was constructed for Anidulafungin and Fluconazole The probability of treatment success and mortality rate were extracted from published Randomized Control Trials. Incremental Cost Effectiveness Ratio (ICER) was calculated.Results: Out of 100 samples, 22 were found to be positive for mycotic infections, 9 were detected as Candida and 13 as Aspergillus. On comparing with KOH and Culture, it was observed that all KOH positive and all Culture positive fungal infections were PCR positive. In no cases PCR negative was identified either culture or KOH positive. This establishes the superiority of PCR over conventional diagnostic methods. Anidulafungin was associated with an Incremental Cost Effectiveness Ratio (ICER) of INR 1,13,217 per LY saved, which was below the implicit ICER threshold for India.Conclusions: PCR is a novel molecular method for early and definitive diagnosis of fungal infection and Aidulafungin appears to be the cost-effective drug for treatment of Pulmonary Mycosis.

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