scholarly journals Major Thalassemia, Screening or Treatment: An Economic Evaluation Study in Iran

2021 ◽  
Author(s):  
Firooz Esmaeilzadeh ◽  
Batoul Ahmadi ◽  
Sajad Vahedi ◽  
Saeed Barzegari ◽  
Abdolhalim Rajabi
Keyword(s):  
Thalassemia Major ◽  
Economic Benefits ◽  
Thalassaemia Major ◽  
Screening Techniques ◽  
Screening Programs ◽  
Life Years ◽  
Thalassemia Minor ◽  
The Cost ◽  
Thalassemia Screening

Background: Beta-thalassemia minor and thalassemia major are an autosomal recessive disease with hypochromic, microcytic anemia, and morbidities, Today, therapeutic advances have significantly improved the life expectancy of thalassemia major patients, but at the cost of financial toxicity. The present study aimed to investigate the possibility of increasing the funding for thalassemia screening programs and comparing the cost-effectiveness of screening for thalassemia in the treatment of the patients. Methods: In this study, screening for thalassemia minor was compared with the treatment of thalassemia major patients. A decision tree model was used for analysis. A hospital database, supplemented with a review of published literature, was used to derive input parameters for the model. A lifetime study horizon was used and future costs and consequences were discounted at 3%. The approach of purchases of services was used to evaluate the screening test costs for patients with thalassemia major. Also, a bottom-up method was applied to estimate other screening and treatment costs. All the costs were calculated over one year. The number of gained quality-adjusted life years (QALYs) was calculated using the EQ-5D questionnaire in the evaluated patients. Results: In this study, 26.97 births of patients with thalassemia major were prevented by screening techniques. On the other hand, total screening costs for patients with thalassemia major were estimated equal to US$ 879879, while the costs of preventing the birth of each thalassaemia major patient was US$ 32 624 by screening techniques. In comparison, the cost of managing a patient with thalassemia major is about US$ 136 532 per year. The life time QALYs for this is 11.8 QALYs. Results are presented using a societal perspective. Incremental cost per QALY gained with screening as compared with managing thalassaemia major was US$ 11 571. Conclusion: Screening is a long-term value for money intervention that is highly cost effective and its long-term clinical and economic benefits outweigh those of managing thalassaemia major patients.

scholarly journals Economic evaluation of the Midwifery Initiated Oral Health-Dental Service programme in Australia

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e047072
Author(s):  
Kathy W Tannous ◽  
Ajesh George ◽  
Moin Uddin Ahmed ◽  
Anthony Blinkhorn ◽  
Hannah G Dahlen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Oral Health ◽  
Health Benefit ◽  
Cost Effective ◽  
Economic Benefits ◽  
Dental Service ◽  
Public Healthcare ◽  
Life Years ◽  
The Cost

ObjectivesTo critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.Design and settingThe evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.ParticipantsData were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.Cost measuresData included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.Outcome measuresUtility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.ResultsCompared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only ‘cost-effective’ in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was ‘cost-effective’ in all scenarios except at 3 months scenario.ConclusionsThe midwives’ only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives’ and dentists’ combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.Trial registration numberACTRN12612001271897; Post-results.

scholarly journals Cost-Effectiveness Analysis of a Large-Scale Crèche Intervention to Prevent Child Drowning in Rural Bangladesh

2021 ◽  
Author(s):  
Y. Natalia Alfonso ◽  
Adnan A Hyder ◽  
Olakunle Alonge ◽  
Shumona Sharmin Salam ◽  
Kamran Baset ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Societal Perspective ◽  
Large Scale ◽  
Operating Cost ◽  
Cost Effective ◽  
Economic Benefits ◽  
Program Cost ◽  
Rural Bangladesh ◽  
Life Years ◽  
The Cost

Abstract Drowning is the leading cause of death among children 12-59 months old in rural Bangladesh. This study evaluated the cost-effectiveness of a large-scale crèche intervention in preventing child drowning. Estimates of the effectiveness of the crèches was based on prior studies and the program cost was assessed using monthly program expenditures captured prospectively throughout the study period from two different implementing agencies. The study evaluated the cost-effectiveness from both a program and societal perspective. Results showed that from the program perspective the annual operating cost of a crèche was $416.35 (95%C.I.: $222 to $576), the annual cost per child was $16 (95%C.I.: $9 to $22) and the incremental-cost-effectiveness ratio (ICER) per life saved with the crèches was $17,803 (95%C.I.: $9,051 to $27,625). From the societal perspective (including parents time valued) the ICER per life saved was -$176,62 (95%C.I.: -$347,091 to -$67,684)—meaning crèches generated net economic benefits per child enrolled. Based on the ICER per disability-adjusted-life years averted from the societal perspective (excluding parents time), $2,020, the crèche intervention was cost-effective even when the societal economic benefits were ignored. Based on the evidence, the creche intervention has great potential for reducing child drowning at a cost that is reasonable.

Cost of Current Iron Chelation Infusion Therapy and Cost-Effectiveness of Once-Daily Oral Deferasirox in Transfusion-Dependent Thalassemia Patients in Canada.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3349-3349
Author(s):  
T.E. Delea ◽  
K. El Ouagari ◽  
O. Sofrygin
Keyword(s):  
Cost Effectiveness ◽  
Iron Overload ◽  
Chelation Therapy ◽  
Thalassemia Major ◽  
Infusion Therapy ◽  
Published Data ◽  
Blood Transfusions ◽  
Once Daily ◽  
Life Years ◽  
The Cost

Abstract Background: Deferasirox (Exjade®) is a recently approved once-daily oral chelator that has been shown to produce reductions in liver iron concentrations and serum ferritin similar to those with infusional deferoxamine (Desferal®), in patients with β-thalassemia major or sickle cell disease (SCD) and chronic iron overload from blood transfusions. The objective of this study was to estimate the cost of deferoxamine administration in Canada and evaluate the cost-effectiveness of deferasirox versus deferoxamine for chronic iron overload from blood transfusions from the Ontario provincial healthcare system. Methods: Cost of chelation therapy with deferoxamine was estimated from five major treatment centers in Canada. Costs comprised the material used and the time spent by hospital pharmacists in preparing deferoxamine infusions. Cost-effectiveness of the new oral iron chelator, deferasirox, which could replace deferoxamine, was estimated using a Markov model. The model estimates and compares the total lifetime costs and quality-adjusted life years (QALYs) related to the use of deferasirox or deferoxamine in patients with β-thalassemia major at risk of chronic iron overload from blood transfusions. Dosages of deferasirox and deferoxamine used in the model were those that have been shown to be similarly effective in such patients. Compliance with deferoxamine was based on analyses of health-insurance claims data from transfusion-dependent thalassemia patients. Probabilities of complications of iron overload and death by compliance with chelation were estimated from published studies. Because data on compliance with deferasirox in typical clinical practice are unavailable, we used published data on compliance with the oral chelator deferiprone versus deferoxamine. Costs of deferasirox, deferoxamine, and drugs used in the treatment of complications of iron overload were based on publicly available data sources. Utilities were based on a study of patient preferences for oral versus infusional chelation therapy, as well as published literature and assumption. Future costs and QALYs were discounted at 5% annually. Costs were adjusted to 2004 Canadian dollars. Results: Cost of yearly infusion therapy in Canada was estimated at $6,000 per patient, excluding deferoxamine drug cost. Cost-effectiveness of deferasirox compared to deferoxamine was estimated at $45,054 per QALY gained resulting mainly from a gain in 2.9 QALYs obtained at an expected lifetime cost of $130,058 per patient. Cost-effectiveness is sensitive to the estimated costs of deferoxamine and infusional therapy, as well as the quality of life benefit associated with oral versus infusional therapy, and is more favorable in younger patients. Conclusion: In patients with transfusion-dependent β-thalassemia, the cost-effectiveness of deferasirox versus deferoxamine is within the range generally considered acceptable in Canada.

Cost-Effectiveness of Posaconazole vs Fluconazole in the Prevention of Invasive Fungal Infections among Patients with Graft-Versus-Host Disease (GVHD) in the US.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3336-3336 ◽  
Author(s):  
Amy K. O’Sullivan ◽  
Milton C. Weinstein ◽  
Ankur Pandya ◽  
David Thompson ◽  
Amelia Langston ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Graft Versus Host Disease ◽  
Fungal Infections ◽  
Cost Effective ◽  
Graft Versus Host ◽  
Life Years ◽  
The Us ◽  
The Cost ◽  
Long Term Mortality

Abstract Trial data suggest that posaconazole is similar to fluconazole in preventing invasive fungal infections (IFIs) among allogeneic progenitor cell transplant recipients with graft-versus-host disease (GVHD). We estimated the cost-effectiveness of posaconazole versus fluconazole in this population in the US. A decision-analytic model was developed to estimate the average per patient treatment costs, IFIs avoided, life-years gained, and incremental cost per life-year gained of prophylaxis (2006 US$). The model extrapolates the trial results to a lifetime horizon to include long-term mortality due to GVHD. In the model, patients are assumed to receive posaconazole or fluconazole; efficacy data were obtained from the clinical trial. Long-term mortality and prophylaxis drug and IFI treatment costs were estimated from secondary sources. One-way and probabilistic sensitivity analyses were conducted. Posaconazole is associated with fewer IFIs (0.05 vs. 0.09), increased life years (7.87 vs. 7.66), and higher IFI-related costs (prophylaxis and IFI treatment) ($8,750 vs. $5,530) per patient relative to fluconazole. Costs for treatment of IFIs comprised 95% of the total cost for fluconazole and 35% for posaconazole. The incremental cost-effectiveness of posaconazole versus fluconazole is estimated to be $15,700 per life-year saved. Results are most sensitive to changes in the cost of treating an IFI and the efficacy of prophylaxis. Results from the probabilistic analysis indicate that there is an 88% probability that posaconazole is cost-effective at a $50,000 per life year saved threshold. We conclude that posaconazole is a cost-effective strategy for the prevention of IFIs in patients with GVHD.

scholarly journals Cost-Effectiveness of Multiple Sclerosis Disease-Modifying Therapies: A Systematic Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-13 ◽  
Author(s):  
David Yamamoto ◽  
Jonathan D. Campbell
Keyword(s):  
Cost Effectiveness ◽  
Simulation Models ◽  
Primary Outcome Measure ◽  
Multiple Sclerosis Disease ◽  
Life Years ◽  
Quality Category ◽  
The Cost ◽  
Effectiveness Studies

Objective. To provide a current and comprehensive understanding of the cost-effectiveness of DMTs for the treatment of MS by quantitatively evaluating the quality of recent cost-effectiveness studies and exploring how the field has progressed from past recommendations.Methods. We assessed the quality of studies that met our systematic literature search criteria using the Quality of Health Economic Studies validated instrument.Results. Of the 82 studies that met our initial search criteria, we included 22 in this review. Four studies (18%) achieved quality category 2, three studies (14%) achieved quality category 3, and 15 studies (68%) achieved the highest quality category 4. 91% of studies were simulation models. 13 studies (59%) had quality-adjusted life years (QALYs) as the primary outcome measure, included a societal perspective in the analysis, and utilized time horizons of 10 years to lifetime.Conclusions. To continue to improve the cost-effectiveness evidence of DMTs, we recommend: lifetime horizons, societal perspectives, and QALYs; supplemental evidence with shorter horizons, payer perspectives, and clinical outcomes to inform multiple decision makers; development of modeling and input standards for comparability; head-to-head RCTs between DMTs and long-term prospective studies; and comprehensive cost-effectiveness studies that compare all appropriate DMTs.

Cost-effectiveness of Diabetes Self-management Programs in Community Primary Care Settings

2009 ◽  
Vol 35 (5) ◽  
pp. 761-769 ◽  
Author(s):  
Carol A. Brownson ◽  
Thomas J. Hoerger ◽  
Edwin B. Fisher ◽  
Kerry E. Kilpatrick
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Simulation Model ◽  
Health Systems ◽  
Self Management ◽  
Systems Perspective ◽  
Primary Care Settings ◽  
Life Years ◽  
The Cost

Purpose The purpose of this study is to estimate the cost-effectiveness of diabetes self-management programs in real-world community primary care settings. Estimates incorporated lifetime reductions in disease progression, costs of adverse events, and increases in quality of life. Methods Clinical results and costs were based on programs of the Diabetes Initiative of the Robert Wood Johnson Foundation, implemented in primary care and community settings in disadvantaged areas with notable health disparities. Program results were used as inputs to a Markov simulation model to estimate the long-term effects of self-management interventions. A health systems perspective was adopted. Results The simulation model estimates that the intervention does reduce discounted lifetime treatment and complication costs by $3385, but this is more than offset by the $15 031 cost of implementing the intervention and maintaining its effects in subsequent years. The intervention is estimated to reduce long-term complications, leading to an increase in remaining life-years and quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio is $39 563/QALY, well below a common benchmark of $50 000/QALY. Sensitivity analyses tested the robustness of the model’s estimates under various alternative assumptions. The model generally predicts acceptable cost-effectiveness ratios. Conclusions Self-management programs for type 2 diabetes are cost-effective from a health systems perspective when the cost savings due to reductions in long-term complications are recognized. These findings may justify increased reimbursement for effective self-management programs in diverse settings.

The long-term cost of multiple sclerosis in France and potential changes with disease-modifying interventions

2009 ◽  
Vol 15 (6) ◽  
pp. 741-751 ◽  
Author(s):  
G Kobelt ◽  
B Texier-Richard ◽  
P Lindgren
Keyword(s):  
Multiple Sclerosis ◽  
Normal Population ◽  
Productivity Losses ◽  
Life Years ◽  
Disability Status ◽  
Disease Modifying ◽  
The Cost ◽  
Different Sources

Objective To evaluate the long-term costs and quality of life (QoL) with and without disease-modifying treatments (DMTs) of patients with multiple sclerosis (MS). Methods Data on resource consumption, productivity losses, QoL (utility), and fatigue were collected from 1355 patients registered with a patient association and descriptive analyses was performed. A Markov model was developed to estimate costs and utility over 20 years using the survey data. Disease progression without DMTs was taken from an epidemiological cohort in France (EDMUS cohort, LYON). Progression under DMTs was estimated from the Stockholm MS registry. Results are presented as cost per quality-adjusted life-years (QALYs), from the societal perspective, in EUR2007, discounted at 3%. Results Mean Expanded Disability Status Scale (EDSS) was 4.4 and mean total annual costs per patient were EUR44,400, of which 47% were productivity losses and 11% informal care. Public payers cover an estimated 48% of costs. Mean utility was 0.52, and the loss compared with the normal population was estimated at 0.28. Costs and utility ranged from EUR16,000 and 0.79 at EDSS 1 to EUR76,000 and 0.11 at EDSS 8–9. Over 20 years, costs were estimated at EUR429,000 and QALYs at 8.96 for patients without DMTs and at EUR433,207 and 9.24 QALYs if all patients were starting treated with DMTs at EDSS 1–3. Conclusion Although the data for this analysis come from different sources, the results indicate that the cost increase with DMTs is moderate.

scholarly journals Fluvoxamina: profilo farmacoeconomico

2001 ◽  
Vol 2 (3) ◽  
pp. 175-184
Author(s):  
Mario Eandi
Keyword(s):  
Cost Minimization ◽  
Economic Benefits ◽  
Pharmacoeconomic Evaluation ◽  
Term Therapy ◽  
Purchase Cost ◽  
Antidepressant Use ◽  
Differential Costs ◽  
Long Term Therapy ◽  
The Cost

In this study we mean to outline a brief pharmacoeconomic review of fluvoxamine, considering only its antidepressant use. Essential objective is to highlight all the variables of cost effectiveness, tolerance and safety that can lead some types of differential costs. This study analyses the epidemiology and the economic burden of depression and a pharmacoeconomic profile of fluvoxamine, with its characteristics of effectiveness, tolerance, safety and handiness. The pharmacoeconomic evaluation is conducted according to the cost minimization analysis (CMA), considering fluvoxamine, Selective Serotonine Reuptake Inhibitors (SSRI) and antidepressant tricycic as native treatments. Fluvoxamine differs from the others SSRI far the purchase cost and it’s more convenient than the antidepressant tricycic treatment, especially for long term therapy. Economic benefits can be distributed in a balanced way between the Italian national healthcare system (NACS), the society and the patients.

Economic benefit of neurosurgical intervention for infant hydrocephalus in Haiti

2019 ◽  
Vol 24 (3) ◽  
pp. 306-314 ◽  
Author(s):  
Zachary S. Hubbard ◽  
Ashish H. Shah ◽  
Michael Ragheb ◽  
Shelly Wang ◽  
Sarah Jernigan ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Economic Benefit ◽  
Time Frame ◽  
Aqueductal Stenosis ◽  
Economic Benefits ◽  
Economic Modeling ◽  
Life Years ◽  
Hydrocephalus Treatment ◽  
The Cost ◽  
Neurosurgical Intervention

OBJECTIVEPrevious models have been utilized in other low- and middle-income countries (LMICs) to explore and assess the cost, sustainability, and effectiveness of infant hydrocephalus treatment. However, similar models have not been implemented in Haiti due to a paucity of data, epidemiology, and outcomes for hydrocephalus. Therefore, the authors utilized previously described economic modeling to estimate the annual cost and benefit of treating hydrocephalus in infants at a neurosurgery referral center, Hospital Bernard Mevs (HBM), in Port-au-Prince, Haiti.METHODSThe authors conducted a retrospective review of data obtained in all children treated for hydrocephalus at the HBM from 2008 to 2015. The raw data were pooled with previously described surgical outcomes for hydrocephalus in other LMICs. Modeling was performed to determine outcomes, neurosurgical costs, disability-adjusted life years (DALYs), and economic benefits of Haitian hydrocephalus treatment during this time frame. Standard account methodology was employed to calculate cost per procedure. Using these formulas, the net economic benefit and cost/DALY were determined for hydrocephalus treatment at HBM from 2008 to 2015.RESULTSOf the 401 patients treated during the study period, 158 (39.4%) met criteria for postinfectious hydrocephalus, 54 (13.5%) had congenital hydrocephalus, 38 (9.5%) had myelomeningocele, 19 (4.7%) had aqueductal stenosis, and 132 (33%) were not placed into a category. Overall, 317 individuals underwent surgical treatment of their hydrocephalus, averting 3077 DALYs. The total cost of the procedures was $754,000, and the cost per DALY ranged between $86 and $245. The resulting net economic benefit for neurosurgical intervention ranged from $2.5 to $5.5 million.CONCLUSIONSThis work demonstrates the substantial economic benefit of neurosurgical intervention for the treatment of pediatric hydrocephalus at a single hospital in Haiti. Based on DALYs averted, the need for additional centers offering basic neurosurgical services is apparent. A single center offering these services for several days each month was able to generate between $2.5 to $5.5 million in economic benefits, suggesting the need to develop neurosurgical capacity building in Haiti. Ultimately, prevention, screening, and early surgical treatment of these infants represent a public health and socioeconomic requisite for Haiti.

ROLE OF SCREENING IN EPIDEMIOLOGY MANAGEMENT FOR LUNG CANCER IN THE KRASNOYARSK REGION

2017 ◽  
Vol 63 (3) ◽  
pp. 385-393
Author(s):  
Ivan Safontsev ◽  
Ruslan Zukov ◽  
Andrey Modestov ◽  
Yevgeniy Slepov ◽  
Irina Son ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Screening Program ◽  
Target Population ◽  
Screening Programs ◽  
Krasnoyarsk Region ◽  
The Cost ◽  
The City ◽  
Lung Cancer Detection

The paper presents data of multifactorial Cancer Registry analysis of lung cancer incidence in the city of Krasnoyarsk and the Krasnoyarsk Region for the period from 2004 till 2014. The authors show the economic efficiency of the screening programs for the lung cancer risk target group, among the inhabitants of the city of Krasnoyarsk. The group was determined on the base of long-term analysis of register data, as well as international experience. The article shows the economic calculations of the cost and effectiveness of screening program that are proposed for the target population as early lung cancer detection.

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