COST ANALYSIS OF EXPANDED PROGRAM ON IMMUNIZATION AT BASIS HEALTH LEVEL IN THUA THIEN HUE PROVINCE, VIETNAM

2016 ◽  
pp. 128-136
Author(s):  
Hoang Lan Nguyen ◽  
Thi Tinh Nguyen
Keyword(s):  
Average Cost ◽  
Service Providers ◽  
Vaccine Delivery ◽  
Sensitivity Analyses ◽  
District Health ◽  
Total Cost ◽  
Health Level ◽  
Expanded Program On Immunization ◽  
The Cost ◽  
The Impact

Background: In Vietnam, expanded program on immunization (EPI) has vaccinated freely 8 vaccines to children under one year old to protect from tuberculosis, diphtheria, pertussis, tetanus, hepatitis B, polio, measles and pneumonia/ meningitis caused by Hib. The study aims to 1) identify total cost and cost items of EPI at basis health level of Thua Thien Hue province within the first 6 months of the year 2014 and 2) estimate average cost of vaccine delivery per dose and cost per fully vaccinated child (FVC). Materials and method: This is a descriptive cross sectional study. Costs were analyzed on the basis of perspective of health service providers. A direct allocation method was used to estimate average cost of vaccine delivery per dose and cost per FVC. Data of the program within the first 6 months of the year 2014 was collected in provincial preventive medicine center, 3 district health centers and 9 CHCs in TT Hue province to estimate cost. The price of capital assets was adjusted by inflation with time and was annualized using a discount rate of 3%. One-way sensitivity analyses investigated the impact of cost items and wastage ratio on cost of vaccine delivery. Results: The total cost of EPI within 6 months in 9 CHCs was 452.947.417 VND (US$ 21.532) in which vaccine price shared the largest component cost (41.3%). The average cost per FVC was 456.059VND (US$ 21.68) that is higher than of US$ 15 per FVC only for 6 vaccines as recommendation of WHO. The cost was sensitive to wastage ratio of vaccines. Conclusion: The cost of US$ 21.68 per FVC preventing from 8 dangerous infected diseases found in this study is higher than that of threshold of WHO per FVC only for 6 vaccines of EPI in some developing countries. Key words: Expanded program on immunization, vaccine, cost items, basis health level

scholarly journals Cost-Effectiveness Analysis of Obinutuzumab Versus Ofatumumab for Previously Untreated Chronic Lymphocytic Leukemia (CLL)

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1324-1324 ◽  
Author(s):  
Carolina Reyes ◽  
Gregory Gazauskas ◽  
Ursula Becker ◽  
Santiago Moreno ◽  
David L. Veenstra
Keyword(s):  
Cost Effectiveness ◽  
Chronic Lymphocytic Leukemia ◽  
Cost Effective ◽  
Lymphocytic Leukemia ◽  
Sensitivity Analyses ◽  
Age Difference ◽  
Total Cost ◽  
Life Years ◽  
The Cost ◽  
The Impact

Abstract Background Two recently approved therapies for previously untreated chronic lymphocytic leukemia (CLL), (1) obinutuzumab (GA101) in combination with chlorambucil (G+Clb) and (2) ofatumumab in combination with Clb (O+Clb), have shown improved progression-free survival (PFS) versus Clb alone in two separate trials. However, their relative value has not been formally assessed. The objective of this study was to compare the cost-effectiveness of G+Clb versus O+Clb in previously untreated CLL patients, as well as conduct exploratory analyses versus other comparators. Methods Patient outcomes were simulated using a 3-state Markov model that included PFS, progression, and death. PFS parameters for G+Clb were fitted to the observed G+Clb trial (CLL-11 study) data, and a network meta-analysis incorporating the results of the O+Clb (COMPLEMENT 1 study) was used to estimate the relative treatment effect of G+Clb compared to O+Clb (progression HR = 0.34). Patient populations in these two trials were similar. Drug utilization, dosing and adverse events were incorporated based on trial data, and costs were based on Medicare reimbursements and drug wholesale acquisition costs. One-way and probabilistic sensitivity analyses were conducted to assess the impact of data uncertainty on the results. In an exploratory scenario analyses, we used similar methodology to estimate the cost-effectiveness of G+Clb versus rituximab plus bendamustine (R+B, progression HR = 0.41). A meta-regression on age was used to adjust for the age difference among the patient populations and indirectly taking into account different levels of comorbidities. Results Treatment with G+Clb led to an increase of 0.83 life years and 0.79 quality-adjusted life years (QALYs) relative to O+Clb. The total cost of O+Clb was higher by $3600 per patient relative to G+Clb. Higher G+Clb drug, administration, and adverse event costs were largely offset by lower progression costs compared to O+Clb. The incremental cost per QALY gained with G+Clb vs. O+Clb was $4,500. Based on probabilistic sensitivity analyses, there was a 99% probability that G+Clb was cost-effective compared to O+Clb at a societal willingness-to-pay threshold of $100,000 per QALY saved. Table.OutcomeG+ClbO+ClbDifferenceAverage life years5.744.910.83Average QALYs3.953.160.79Total drug cost$37,192$34,260$2,932Drug administration$1,977$991$985Supportive care$141$73$68Adverse events$9,542$2,660$6,882Cost of progression$46,861$54,147$(7,286)Average total cost$95,713 $92,132 $3,581 In the exploratory scenario analysis, G+Clb was $37,700 less expensive than R+B, and led to an increase of 0.67 QALY. Conclusions Our analysis suggests treatment with G+Clb compared to O+Clb is highly cost-effective based on indirect treatment comparison data. These results are driven by the improved PFS of G+Clb vs. O+Clb, as well as lower disease progression cost. Future direct comparisons of G+Clb versus other treatment options will further clarify the cost-effectiveness of G+Clb, and inform coverage and reimbursement policy decisions. Disclosures Reyes: Genentech: Employment, Equity Ownership. Off Label Use: Rituximab + Bendamustine in CLL. Gazauskas:Genentech: Consultancy. Becker:Roche: Employment. Moreno:Roche: Employment. Veenstra:Roche: Consultancy.

scholarly journals The Development of Patient Scheduling Groups for an Effective Appointment System

2016 ◽  
Vol 07 (01) ◽  
pp. 43-58 ◽  
Author(s):  
Yu Li Huang
Keyword(s):  
Access To Care ◽  
Treatment Time ◽  
Optimization Technique ◽  
Urgent Care ◽  
Patient Scheduling ◽  
Total Cost ◽  
Patient Type ◽  
Clinic Efficiency ◽  
The Cost ◽  
The Impact

SummaryPatient access to care and long wait times has been identified as major problems in outpatient delivery systems. These aspects impact medical staff productivity, service quality, clinic efficiency, and health-care cost.This study proposed to redesign existing patient types into scheduling groups so that the total cost of clinic flow and scheduling flexibility was minimized. The optimal scheduling group aimed to improve clinic efficiency and accessibility.The proposed approach used the simulation optimization technique and was demonstrated in a Primary Care physician clinic. Patient type included, emergency/urgent care (ER/UC), follow-up (FU), new patient (NP), office visit (OV), physical exam (PE), and well child care (WCC). One scheduling group was designed for this physician. The approach steps were to collect physician treatment time data for each patient type, form the possible scheduling groups, simulate daily clinic flow and patient appointment requests, calculate costs of clinic flow as well as appointment flexibility, and find the scheduling group that minimized the total cost.The cost of clinic flow was minimized at the scheduling group of four, an 8.3% reduction from the group of one. The four groups were: 1. WCC, 2. OV, 3. FU and ER/UC, and 4. PE and NP. The cost of flexibility was always minimized at the group of one. The total cost was minimized at the group of two. WCC was considered separate and the others were grouped together. The total cost reduction was 1.3% from the group of one.This study provided an alternative method of redesigning patient scheduling groups to address the impact on both clinic flow and appointment accessibility. Balance between them ensured the feasibility to the recognized issues of patient service and access to care. The robustness of the proposed method on the changes of clinic conditions was also discussed.

Cost Comparison of Panel Level and Wafer Level Fan-out Packaging

2019 ◽  
Vol 2019 (DPC) ◽  
pp. 000141-000164
Author(s):  
Amy Lujan
Keyword(s):  
Cost Reduction ◽  
Cost Comparison ◽  
Cost Modeling ◽  
Cost Models ◽  
Wafer Level ◽  
Process Flow ◽  
Total Cost ◽  
Large Panels ◽  
The Cost ◽  
The Impact

In recent years, the possibility of panels replacing wafers in some fan-out applications has been a topic of interest. Questions of cost and yield continue to arise even as the industry appears to be full steam ahead. While large panels allow for more packages to be produced at once, the cost does not scale simply based on how many more packages can be generated from a panel over a wafer. This analysis begins by breaking down the types of cost and will discuss how those types of cost are impacted (or not) by the shift from wafer to panel. Activity based cost modeling is used; this is a detailed, bottom-up approach that takes into account each type of cost for each activity in a process flow. Two complete cost models were constructed for this analysis. A variety of package sizes are analyzed, and multiple panel sizes are included as well. For each set of activities in the fan-out process flow, there is an explanation of how the process changes with the move to panel, including assumptions related to throughput, equipment price, and materials. The cost reduction that may be achieved at each package and panel size will be presented for each processing segment. The focus of this analysis is on the details of each segment of the process flow, but results for the total cost of various packages will also be presented. There is also a section of analysis related to the impact of yield on the competitiveness of panel processing.

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

2019 ◽  
Vol 5 (3) ◽  
pp. 28 ◽  
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.

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

Complexity ◽  
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.

COST-EFFECTIVENESS OF ALEMTUZUMAB FOR T-CELL PROLYMPHOCYTIC LEUKEMIA

2012 ◽  
Vol 28 (3) ◽  
pp. 241-248 ◽  
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.

scholarly journals Discounted costs and obsolescence with the Joint replenishment problem

2022 ◽  
Vol 13 (1) ◽  
pp. 51-66 ◽  
Author(s):  
Ricardo Afonso ◽  
Pedro Godinho ◽  
João Paulo Costa
Keyword(s):  
Lot Sizing ◽  
Real Life ◽  
Progressive Increase ◽  
Sensitivity Analyses ◽  
Joint Replenishment ◽  
Total Cost ◽  
Joint Replenishment Problem ◽  
Ordering Policy ◽  
The Impact ◽  
Item Types

Real life inventory lot sizing problems are frequently challenged with the need to order different types of items within the same batch. The Joint Replenishment Problem (JRP) addresses this setting of coordinated ordering by minimizing the total cost, composed of ordering (or setup) costs and holding costs, while satisfying the demand. The complexity of this problem increases when some or all item types are prone to obsolescence. In fact, the items may experience an abrupt decline in demand because they are no longer needed, due to rapid advancements in technology, going out of fashion, or ceasing to be economically viable. This article proposes an extension of the Joint Replenishment Problem (JRP) where the items may suddenly become obsolete at some time in the future. The model assumes constant demand and the items’ lifetimes follow independent negative exponential distributions. The optimization process considers the time value of money by using the expected discounted total cost as the minimization criterion. The proposed model was applied to some test cases, and sensitivity analyses were performed, in order to assess the impact of obsolescence on the ordering policy. The increase in the obsolescence risk, through the progressive increase of the obsolescence rates of the item types, determines smaller lot sizes on the ordering policy. The increase in the discount rate causes smaller quantities to be ordered as well.

scholarly journals The Impact of Chronic Myeloid Leukemia Therapy Management on the Oncology Care Model

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2265-2265
Author(s):  
Elias J. Jabbour ◽  
Martin F Mendiola ◽  
Melissa Lingohr-Smith ◽  
Brandy Menges ◽  
Jay Lin ◽  
...  
Keyword(s):  
Market Share ◽  
Myeloid Leukemia ◽  
Research Funding ◽  
Risk Model ◽  
Cost Savings ◽  
Total Cost ◽  
Episode Of Care ◽  
Oncology Care ◽  
The Cost ◽  
The Impact

Abstract Introduction: In an Oncology Care Model (OCM) setting, practices may earn a Performance-Based Payment (PBP) for a reduction in the costs of treating participating Medicare patients during a 6-month episode of care. An Excel-based decision analytics model was developed to evaluate the cost-savings associated with implementing changes in the usage of tyrosine kinase inhibitors (TKIs) among patients with chronic myeloid leukemia (CML) within a typical OCM practice and the impact it could have on a practice potentially receiving a PBP. Methods: The default scenario is based on an OCM practice that treats 1,000 cancer patients during a 6-month episode of care. The types of cancers treated and the proportions of patients treated in the OCM practice were estimated from an OCM baseline report; all-cause healthcare costs for each cancer type were obtained from published literature. CML patients were stratified into newly-diagnosed and established TKI-treated patients. The percentages of CML patients on each of the TKIs (branded and generic imatinib [1st-gen TKIs], as well as dasatinib and nilotinib [2nd-gen TKIs]) within each stratum were estimated using market share data from April 2018. The 2018 Wholesales Acquisition Costs for the TKIs were obtained from RedBook. It was assumed that, if a practice implements the policy of restricting utilization of branded TKIs as a cost-cutting measure, 80% of the current market share of branded imatinib would shift to the generic and 50% of the current market shares of 2nd-gen TKIs would shift to generic imatinib. Among established TKI-treated patients, it was assumed that 80% of the current market share of branded imatinib would shift to the generic, whereas no patients treated with 2nd-gen TKIs would be switched to generic imatinib due to the lack of supporting evidence, physician and patient apprehension, some patients already having used imatinib, among other reasons. The relationship between the savings achieved from restricting utilization of 2nd-gen TKIs and the savings required for the OCM practice to receive a PBP using either a one-sided or two-sided risk model was evaluated. Results: The total healthcare costs of an OCM practice that treats 1,000 cancer patients for 6 months were estimated at $51,345,812. It was estimated that there would only be 4 CML patients in a 1,000-patient OCM practice, 1 newly-diagnosed and 3 established TKI-treated patients. Implementing the policy of restricting utilization of 2nd-gen TKIs for patients with CML would save a practice $12,970 during the 6-month episode of care, while $25,250 would be saved through a branded to generic imatinib shift (Table). For a 1,000-patient OCM practice participating in a one-sided risk model, a total cost-savings of $3,013,832 is required for it to be eligible for a PBP. In this scenario, the cost reduction associated with a shift from 2nd-gen TKIs to generic imatinib amounts to only 0.4% of the required total cost-savings threshold before the practice is eligible for a PBP. For a 1,000-patient OCM practice participating in a two-sided risk model, a total cost-savings of $2,372,010 is required for it to be eligible for a PBP. In this case, the cost reduction associated with a shift from 2nd-gen TKIs to generic imatinib amounts to only 0.5% of the required total cost-savings threshold before the practice is eligible for a PBP. Conclusions: This economic model indicates that the cost-savings associated with restricting branded TKI utilization among CML patients in an OCM setting will represent only a very small portion of the cost-savings required before an OCM practice is eligible for a PBP. Of the reduction in TKI costs, approximately two-thirds was attributed to the shift from branded to generic imatinib. Restricting utilization of the 2nd-gen TKIs contributed a negligible amount of savings required for a PBP. The cost-savings opportunities in CML in the OCM setting are limited by how few CML patients would be affected by restrictions. Disclosures Jabbour: Pfizer: Consultancy, Research Funding; Novartis: Research Funding; Takeda: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Abbvie: Research Funding. Mendiola:Bristol-Myers Squibb: Employment. Lingohr-Smith:Novosys Health: Employment. Menges:Novosys Health: Employment. Lin:Bristol-Myers Squibb: Consultancy; Novosys Health: Employment. Makenbaeva:Bristol-Myers Squibb: Employment.

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

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

OP37 Impact On Uncertainty Of Disaggregating Cost Data

2019 ◽  
Vol 35 (S1) ◽  
pp. 8-9
Author(s):  
Conor Teljeur ◽  
Paul Carty ◽  
Máirín Ryan
Keyword(s):  
Cost Utility ◽  
Cost Data ◽  
Model Parameters ◽  
Robot Assisted ◽  
Total Cost ◽  
Uncertainty Set ◽  
The Cost ◽  
The Impact ◽  
Cost Components

IntroductionEconomic models contain several parameters ordinarily subject to uncertainty. Unlike most other model parameters, costs can constitute numerous distinct components. For example, a surgical intervention can require a variety of disposables and reusable equipment. A micro-costing output may be disaggregated or presented as a total cost. Uncertainty could be applied to individual cost components or to total cost. We aimed to explore how disaggregation of cost data may impact on uncertainty using a case study.MethodsA set of simulations using hypothetical scenarios were developed with uncertainty set at ± 20 percent. The simulations investigated the impact of number of cost components, balance between components, and correlation between them. A cost-utility model from an assessment of robot-assisted radical prostatectomy was analyzed; procedure cost was divided into 32 individual cost components or treated as a total cost.ResultsBased on five equal cost components, uncertainty reduces from ± 20 percent for correlated variables to ± 9 percent for uncorrelated variables. With increasing numbers of uncorrelated cost components, the uncertainty in the total cost decreases markedly. The uncertainty around total robot-assisted surgery procedure equipment costs was ± 19.7 percent when components were correlated and ± 9.4 percent when uncorrelated. The impact on uncertainty in the incremental cost effectiveness ratio (ICER) was negligible but the ranking of parameters in the univariate sensitivity analysis changed.ConclusionsAnalyzing uncertainty by aggregated or disaggregated costs can have implications for presenting uncertainty in costs to decision makers. Applying uncertainty to aggregated costs essentially implies that variation in the cost of individual components is perfectly correlated. By disaggregating cost components they are being treated as uncorrelated, which can substantially reduce uncertainty in the total cost. In this case study we found that although the reduction in uncertainty could be clearly seen in the cost parameter, it had a negligible impact on uncertainty in the ICER.

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