Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies

Background: Evidence on costs and health benefits of pneumococcal conjugate vaccine (PCV) for children in Asian countries is limited but growing. As a region with a considerably high burden of pneumococcal disease, it is prominent to have a comprehensive overview on the cost-effectiveness of implementing and adopting a PCV vaccination program. Methods: We conducted a systematic review from Pubmed and Embase to identify economic evaluation studies of PCV for children in Asian countries up to May 2020. Data extraction included specific characteristics of the study, input parameters, cost elements, cost-effectiveness results, and key drivers of uncertainty. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement was followed for this systematic review. The reporting quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Results: After the screening process on both the title and abstract and full text of 518 records, a total of 25 studies fulfilled the inclusion criteria, and were included in the review. The majority of included studies demonstrates that PCV for children is cost-effective in most of the Asian region, and even cost-saving in some countries. Most of the included studies implemented cost utility analysis (CUA) using either quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). Overall, the main drivers affecting the cost effectiveness were vaccine price, burden regarding pneumonia-related parameters, and the inclusion of herd effects. Conclusion: The children pneumococcal vaccination program appears to be a cost-effective intervention in Asia, and even cost-saving in certain conditions. Vaccine price, pneumonia-related disease burden, and the inclusion of the herd effect are observed as important key drivers in estimating cost-effectiveness in this region. Incorporating PCV in vaccination programs in this region was found to be highly favorable.

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Economic Evaluation of Home Care for Stroke Patients Compared to Hospital Care: A Systematic Review

Health Scope ◽

10.5812/ealthscope.112833 ◽

2021 ◽

Vol 10 (2) ◽

Author(s):

Maryam Khoramrooz ◽

Asra Asgharzadeh ◽

Saeide Alidoost ◽

Zeynab Foroughi ◽

Saber Azami ◽

...

Keyword(s):

Systematic Review ◽

Economic Evaluation ◽

Home Care ◽

Hospital Care ◽

Cost Effective ◽

Stroke Patients ◽

Life Years ◽

Effective Option ◽

The Cost

Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (mRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.

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Systematic review of health economic studies in cranial neurosurgery

Neurosurgical FOCUS ◽

10.3171/2018.2.focus17792 ◽

2018 ◽

Vol 44 (5) ◽

pp. E2 ◽

Cited By ~ 1

Author(s):

Won Hyung A. Ryu ◽

Michael M. H. Yang ◽

Sandeep Muram ◽

W. Bradley Jacobs ◽

Steven Casha ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Cost Effectiveness ◽

Acute Ischemic Stroke ◽

Cost Effective ◽

Current Evidence ◽

Cochrane Library ◽

Endovascular Thrombectomy ◽

Life Years ◽

The Cost

OBJECTIVEAs the cost of health care continues to increase, there is a growing emphasis on evaluating the relative economic value of treatment options to guide resource allocation. The objective of this systematic review was to evaluate the current evidence regarding the cost-effectiveness of cranial neurosurgery procedures.METHODSThe authors performed a systematic review of the literature using PubMed, EMBASE, and the Cochrane Library, focusing on themes of economic evaluation and cranial neurosurgery following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Included studies were publications of cost-effectiveness analysis or cost-utility analysis between 1995 and 2017 in which health utility outcomes in life years (LYs), quality-adjusted life years (QALYs), or disability-adjusted life years (DALYs) were used. Three independent reviewers conducted the study appraisal, data abstraction, and quality assessment, with differences resolved by consensus discussion.RESULTSIn total, 3485 citations were reviewed, with 53 studies meeting the inclusion criteria. Of those, 34 studies were published in the last 5 years. The most common subspecialty focus was cerebrovascular (32%), followed by neurooncology (26%) and functional neurosurgery (24%). Twenty-eight (53%) studies, using a willingness to pay threshold of US$50,000 per QALY or LY, found a specific surgical treatment to be cost-effective. In addition, there were 11 (21%) studies that found a specific surgical option to be economically dominant (both cost saving and having superior outcome), including endovascular thrombectomy for acute ischemic stroke, epilepsy surgery for drug-refractory epilepsy, and endoscopic pituitary tumor resection.CONCLUSIONSThere is an increasing number of cost-effectiveness studies in cranial neurosurgery, especially within the last 5 years. Although there are numerous procedures, such as endovascular thrombectomy for acute ischemic stroke, that have been conclusively proven to be cost-effective, there remain promising interventions in current practice that have yet to meet cost-effectiveness thresholds.

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A Systematic Review of Methods, Study Quality, and Results of Economic Evaluation for Childhood and Adolescent Obesity Intervention

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16030485 ◽

2019 ◽

Vol 16 (3) ◽

pp. 485 ◽

Cited By ~ 3

Author(s):

Mandana Zanganeh ◽

Peymane Adab ◽

Bai Li ◽

Emma Frew

Keyword(s):

Systematic Review ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Evidence Synthesis ◽

Evaluation Studies ◽

Cost Effective ◽

Adolescent Obesity ◽

Economic Evaluations ◽

Full Economic Evaluation ◽

Childhood And Adolescent Obesity

Many suggested policy interventions for childhood and adolescent obesity have costs and effects that fall outside the health care sector. These cross-sectorial costs and consequences have implications for how economic evaluation is applied and although previous systematic reviews have provided a summary of cost-effectiveness, very few have conducted a review of methods applied. We undertook this comprehensive review of economic evaluations, appraising the methods used, assessing the quality of the economic evaluations, and summarising cost-effectiveness. Nine electronic databases were searched for full-economic evaluation studies published between January 2001 and April 2017 with no language or country restrictions. 39 economic evaluation studies were reviewed and quality assessed. Almost all the studies were from Western countries and methods were found to vary by country, setting and type of intervention. The majority, particularly “behavioural and policy” preventive interventions, were cost-effective, even cost-saving. Only four interventions were not cost effective. This systematic review suggests that economic evaluation of obesity interventions is an expanding area of research. However, methodological heterogeneity makes evidence synthesis challenging. Whilst upstream interventions show promise, an expanded and consistent approach to evaluate cost-effectiveness is needed to capture health and non-health costs and consequences.

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Cost-effectiveness of intrapleural use of tissue plasminogen activator and DNase in pleural infection: evidence from the MIST2 randomised controlled trial

European Respiratory Journal ◽

10.1183/13993003.01550-2018 ◽

2019 ◽

Vol 54 (2) ◽

pp. 1801550 ◽

Cited By ~ 5

Author(s):

Ramon Luengo-Fernandez ◽

Erika Penz ◽

Melissa Dobson ◽

Ioannis Psallidas ◽

Andrew J. Nunn ◽

...

Keyword(s):

Economic Evaluation ◽

Cost Effectiveness ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Controlled Trial ◽

Combined Therapy ◽

Cost Effective ◽

Life Years ◽

Tissue Plasminogen ◽

The Cost

The MIST2 (Second Multicentre Intrapleural Sepsis Trial) trial showed that combined intrapleural use of tissue plasminogen activator (t-PA) and recombinant human DNase was effective when compared with single agents or placebo. However, the treatment costs are significant and overall cost-effectiveness of combined therapy remains unclear.An economic evaluation of the MIST2 trial was performed to assess the cost-effectiveness of combined therapy. Costs included were those related to study medications, initial hospital stay and subsequent hospitalisations. Outcomes were measured in terms of life-years gained. All costs were reported in euro and in 2016 prices.Mean annual costs were lowest in the t-PA–DNase group (EUR 10 605 for t-PA, EUR 17 856 for DNase, EUR 13 483 for placebo and EUR 7248 for t-PA–DNase; p=0.209). Mean 1-year life expectancy was 0.988 for t-PA, 0.923 for DNase, and 0.969 for both placebo and t-PA–DNase (p=0.296). Both DNase and placebo were less effective, in terms of life-years gained, and more costly than t-PA. When placebo was compared with t-PA–DNase, the incremental cost per life-year gained of placebo was EUR 1.6 billion, with a probability of 0.85 of t-PA–DNase being cost-effective.This study demonstrates that combined t-PA–DNase is likely to be highly cost-effective. In light of this evidence, a definitive trial designed to facilitate a thorough economic evaluation is warranted to provide further evidence on the cost-effectiveness of this promising combined intervention.

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Assessment of Cost-Effectiveness on Remote Monitoring for Cardiovascular Devices in Japan

Global Journal of Health Science ◽

10.5539/gjhs.v11n11p1 ◽

2019 ◽

Vol 11 (11) ◽

pp. 1

Author(s):

Tomoya Shirane

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Remote Monitoring ◽

Social Insurance ◽

Cost Effective ◽

Flow Diagram ◽

Medical Council ◽

Remote Monitoring System ◽

Life Years ◽

The Cost

BACKGROUND: 2018 revision of the health insurance reimbursement in Japan brought additional fee for Cardiovascular Implantable Electronic Devices (CIEDs) Management by Remote Monitoring. The adaption of CIEDs Remote Monitoring has already been recommended by the societies, but the cost-effectiveness evaluation about the system has not been enough. This research was designed, therefore, to evaluate the cost-effectiveness about CIEDs Remote Monitoring in Japan. METHODS: A systematic review was conducted along with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Certain criteria and search strategy were pre-defined to identify studies that could be included into this research. The process of the quality assessments was planned by Critical Appraisal Skills Programme (CASP). Quality Adjusted Life Years (QALYs) that were extracted from the included studies would be calculated into Incremental Cost-Effectiveness Ratio (ICER) with the reimbursement amount in Japan. RESULTS: Three studies met the systematic review criteria after the selection along with PRISMA flow diagram. The quality of the included studies was assured by CASP Checklists designed for RCT and Cohort Study. ICERs from the selected studies were provided as 569,697 JPY, 1,220,000 JPY, and 311, 111 JPY for the patient groups enrolled with Remote Monitoring system. CONCLUSION: ICERs for CIEDs Remote Monitoring were demonstrated as the cost-effective under the threshold set by Central Social Insurance Medical Council (Chuikyo). As this study put the validity of the cost-effectiveness approach in a certain field in Japan, this kind of evaluation should be performed on more areas along with the guideline by Chuikyo.

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The cost-effectiveness of early goaldirected therapy: an economic evaluation alongside the ARISE trial

Critical Care and Resuscitation ◽

10.51893/2021.3.oa10 ◽

2021 ◽

Vol 23 (3) ◽

pp. 329-336

Author(s):

Alisa M Higgins ◽

◽

Sandra L Peake ◽

Rinaldo Bellomo AO ◽

D Jamie Cooper AO ◽

...

Keyword(s):

Health Care ◽

Septic Shock ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Usual Care ◽

Resource Use ◽

Cost Effective ◽

Evaluation Study ◽

Life Years ◽

The Cost

OBJECTIVE: To determine the cost-effectiveness of early goal-directed therapy (EGDT) for patients with early septic shock. DESIGN: Within-trial cost-effectiveness evaluation. SETTING: Nineteen hospitals in Australia and New Zealand. PARTICIPANTS AND INTERVENTIONS: Patients with early septic shock enrolled in the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial were randomly assigned to EGDT versus usual care. A subgroup of patients participated in a nested economic evaluation study in which detailed resource use data were collected until 12 months after randomisation. OUTCOME MEASURES: Clinical outcomes included lives saved, life-years gained and quality-adjusted life-years (QALYs), with mortality collected until 12 months and health-related quality of life assessed at baseline, 6 and 12 months using the 3-level EuroQol five dimensions questionnaire (EQ-5D-3L). Economic outcomes included health care resource use, costs and cost-effectiveness from the Australian health care payer perspective. RESULTS: A total of 205 patients (100 EGDT, 105 usual care) participated in the nested economic evaluation study, of which 203 had complete resource use data. Unadjusted mean health care costs to 12 months were $67 223 (standard deviation [SD], $72 397) in the EGDT group and $54 179 (SD, $61 980) in the usual care group, with a mean difference of $13 044 (95% CI, −$5791 to $31 878). There was no difference between groups with regards to lives saved (EGDT, 69.4% v usual care, 68.6%; P = 1.0), life-years gained (mean EGDT, 0.746 [SD, 0.406] v usual care, 0.725 [SD, 0.417]; P = 0.72) or QALYs (mean EGDT, 0.318 [SD, 0.291] v usual care, 0.367 [SD, 0.295]; P = 0.24). EGDT was dominated (higher costs, lower effectiveness) by usual care in 80.4% of bootstrap replications. For a willingness-to-pay threshold of $50 000 per QALY, the probability of EGDT being cost-effective was only 6.4%. CONCLUSIONS: In patients presenting to the emergency department with early septic shock, EGDT compared with usual care was not cost-effective. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov number NCT00975793.

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Economic Evaluation of Home Care for Stroke Patients Compared to Hospital Care: A Systematic Review

Health Scope ◽

10.5812/jhealthscope.112833 ◽

2021 ◽

Vol 10 (2) ◽

Author(s):

Maryam Khoramrooz ◽

Asra Asgharzadeh ◽

Saeide Alidoost ◽

Zeynab Foroughi ◽

Saber Azami ◽

...

Keyword(s):

Systematic Review ◽

Economic Evaluation ◽

Home Care ◽

Hospital Care ◽

Cost Effective ◽

Stroke Patients ◽

Life Years ◽

Effective Option ◽

The Cost

Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (MRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.

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Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study

Vaccines ◽

10.3390/vaccines8040707 ◽

2020 ◽

Vol 8 (4) ◽

pp. 707

Author(s):

Afifah Machlaurin ◽

Franklin Christiaan Karel Dolk ◽

Didik Setiawan ◽

Tjipke Sytse van der Werf ◽

Maarten J. Postma

Keyword(s):

Cost Effectiveness ◽

Univariate Analysis ◽

Cost Effective ◽

Epidemiological Data ◽

Control Programme ◽

Detection Rates ◽

Middle Income ◽

Bcg Vaccination ◽

Life Years ◽

The Cost

Bacillus Calmette–Guerin (BCG), the only available vaccine for tuberculosis (TB), has been applied for decades. The Indonesian government recently introduced a national TB disease control programme that includes several action plans, notably enhanced vaccination coverage, which can be strengthened through underpinning its favourable cost-effectiveness. We designed a Markov model to assess the cost-effectiveness of Indonesia’s current BCG vaccination programme. Incremental cost-effectiveness ratios (ICERs) were evaluated from the perspectives of both society and healthcare. The robustness of the analysis was confirmed through univariate and probabilistic sensitivity analysis (PSA). Using epidemiological data compiled for Indonesia, BCG vaccination at a price US$14 was estimated to be a cost-effective strategy in controlling TB disease. From societal and healthcare perspectives, ICERs were US$104 and US$112 per quality-adjusted life years (QALYs), respectively. The results were robust for variations of most variables in the univariate analysis. Notably, the vaccine’s effectiveness regarding disease protection, vaccination costs, and case detection rates were key drivers for cost-effectiveness. The PSA results indicated that vaccination was cost-effective even at US$175 threshold in 95% of cases, approximating the monthly GDP per capita. Our findings suggest that this strategy was highly cost-effective and merits prioritization and extension within the national TB programme. Our results may be relevant for other high endemic low- and middle-income countries.

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Cost-effectiveness Analysis of Submandibular Gland Preservation With Sialendoscopy for the Management of Sialolithiasis

Otolaryngology ◽

10.1177/01945998211026847 ◽

2021 ◽

pp. 019459982110268

Author(s):

Joseph R. Acevedo ◽

Ashley C. Hsu ◽

Jeffrey C. Yu ◽

Dale H. Rice ◽

Daniel I. Kwon ◽

...

Keyword(s):

Cost Effectiveness ◽

Submandibular Gland ◽

Average Cost ◽

Cost Effective ◽

Cost Effectiveness Analysis ◽

Effectiveness Analysis ◽

Life Years ◽

Probability Of Success ◽

Markov Decision Model ◽

The Cost

Objective To compare the cost-effectiveness of sialendoscopy with gland excision for the management of submandibular gland sialolithiasis. Study Design Cost-effectiveness analysis. Setting Outpatient surgery centers. Methods A Markov decision model compared the cost-effectiveness of sialendoscopy versus gland excision for managing submandibular gland sialolithiasis. Surgical outcome probabilities were found in the primary literature. The quality of life of patients was represented by health utilities, and costs were estimated from a third-party payer’s perspective. The effectiveness of each intervention was measured in quality-adjusted life-years (QALYs). The incremental costs and effectiveness of each intervention were compared, and a willingness-to-pay ratio of $150,000 per QALY was considered cost-effective. One-way, multivariate, and probabilistic sensitivity analyses were performed to challenge model conclusions. Results Over 10 years, sialendoscopy yielded 9.00 QALYs at an average cost of $8306, while gland excision produced 8.94 QALYs at an average cost of $6103. The ICER for sialendoscopy was $36,717 per QALY gained, making sialendoscopy cost-effective by our best estimates. The model was sensitive to the probability of success and the cost of sialendoscopy. Sialendoscopy must meet a probability-of-success threshold of 0.61 (61%) and cost ≤$11,996 to remain cost-effective. A Monte Carlo simulation revealed sialendoscopy to be cost-effective 60% of the time. Conclusion Sialendoscopy appears to be a cost-effective management strategy for sialolithiasis of the submandibular gland when certain thresholds are maintained. Further studies elucidating the clinical factors that determine successful sialendoscopy may be aided by these thresholds as well as future comparisons of novel technology.

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Incremental Net Monetary Benefit of Bariatric Surgery: Systematic Review and Meta-Analysis of Cost-Effectiveness Evidences

Obesity Surgery ◽

10.1007/s11695-021-05415-9 ◽

2021 ◽

Author(s):

Prapaporn Noparatayaporn ◽

Montarat Thavorncharoensap ◽

Usa Chaikledkaew ◽

Bhavani Shankara Bagepally ◽

Ammarin Thakkinstian

Keyword(s):

Systematic Review ◽

Bariatric Surgery ◽

Cost Effectiveness ◽

Evaluation Studies ◽

Meta Analysis ◽

Cost Effective ◽

Diabetes Group ◽

Lifetime Horizon ◽

Middle Income ◽

Full Economic Evaluation

AbstractThis systematic review aimed to comprehensively synthesize cost-effectiveness evidences of bariatric surgery by pooling incremental net monetary benefits (INB). Twenty-eight full economic evaluation studies comparing bariatric surgery with usual care were identified from five databases. In high-income countries (HICs), bariatric surgery was cost-effective among mixed obesity group (i.e., obesity with/without diabetes) over a 10-year time horizon (pooled INB = $53,063.69; 95% CI $42,647.96, $63,479.43) and lifetime horizon (pooled INB = $101,897.96; 95% CI $79,390.93, $124,404.99). All studies conducted among obese with diabetes reported that bariatric surgery was cost-effective. Also, the pooled INB for obesity with diabetes group over lifetime horizon in HICs was $80,826.28 (95% CI $32,500.75, $129,151.81). Nevertheless, no evidence is available in low- and middle-income countries. Graphical abstract

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