scholarly journals Th e clinical-economic analysis of Dupilumab in severe asthma

2021 ◽  
pp. 15-26
Author(s):  
I. S. Krysanov ◽  
V. S. Krysanova ◽  
V. Yu. Ermakova
Keyword(s):  
Sensitivity Analysis ◽  
Severe Asthma ◽  
Weighted Average ◽  
Indirect Costs ◽  
Cost Effective ◽  
Annual Number ◽  
Treatment Technology ◽  
Biologic Drugs ◽  
Exacerbation Rate ◽  
Treatment Comparison

Background. Severe Asthma is a most social important chronic illness due to highest expenditures of Health Care System for control and treatment of exacerbations and decreasing of GDP. Situation with modern treatment is better now because biologic drugs have introduced into real practice. Biologic drugs — dupilumab, mepolizumab, reslizumab and benralizumab — decrease annual exacerbation rate of severe asthma as well as improve a lung function. Comparison of clinical-economic analyses of biologic drugs usage can help choose an optimal treatment technology of severe asthma. Materials and methods. Calculation of direct and indirect costs of treatment based of indirect treatment comparison of biologic drugs in severe asthma has been performed. Weighted average annual number of exacerbations prevention was chosen as efficacy criteria and their were for dupilumab 200 mg — 0,41, 0,26 for mepolizumab, 0,22 for reslizumab, 0,16 — for benralizumab. Cost-effective ratios were calculated, and sensitivity analysis has been performed for results confirmation. Results. Direct annual costs were less for dupilumab treatment — 834 970 RUR/ patient/year. Same costs for others biologicals were: for mepolizumab — 935 931 RUR, for reslizumab — 1 582 577 RUR/patient/ year, for benralizumab — 1 224 786 RUR/patient/year. Dupilumab has demonstrated less indirect costs in severe asthma patients. Disability is a major contributor of GDP loss. Total expenditures were higher in mepolizumab (on 11,3 %), in reslizumab (on 82,9 %), in benralizumab (on 43,4 %) in compare with the same parameter for dupilumab. Sensitivity analysis has confirmed a stability results calculated in different scenariois. Conclusion. Dupilumab 200 mg in severe asthma is an preference alternative in the treatment compare with other biologics because it has better efficacy and less annual costs.

A social-economic burden of rhinosinusitis with nasal polyps with comorbid asthma and influence of dupilumab

2021 ◽  
pp. 16-30
Author(s):  
I. S. Krysanov ◽  
V. S. Krysanova ◽  
V. Yu. Ermakova
Keyword(s):  
Medical Cost ◽  
Economic Burden ◽  
Nasal Polyps ◽  
Social Economic ◽  
Weighted Average ◽  
Indirect Costs ◽  
Biologic Drugs ◽  
State Position ◽  
The Russian Federation ◽  
Regions Of Russia

Rhinosinusitis with nasal polyps (RwNP) is a one of most common comorbidities in asthma and contrariwise and can lead to exacerbation of severe asthma (SA). Dupilumab is a perspective medicine for treatment of both, because it decreases exacerbations and prevents of a necessity of surgeon. Economics aspects of dupilumab treatment in RwNP + SA are not examined yet. Thus aim of this study was evaluation of social-economic burden of RwNP + SA in the Russian Federation and dupilumab influence on it. Materials and methods. Direct medical (cost of medicines, treatment in outpatients department and in hospital, including surgery and rate of exacerbations per year) and non-medical (payment for temporary and stable disability) and indirect costs (GDP loses) in RwNP + SA patients have been evaluated. Medical cure of a patient with RwNP + SA was created according to survey of experts from different regions of Russia. Modelling of expenditures was prepared on all calculated cohort of potential patients with RwNP + SA from “State” position and growing approach. Results. Expenditures for cure of one patient with RwNP were as 234 217,71 RUR/year. Weighted average costs for one patient with RwNP + SA were 1 881 883,39 RUR, and mostly were associated with indirect costs. Dupilumab can decrease expenditures for one patient with RwNP + SA till 1 593 162,87 RUR (on 15,3 %) annually. Potential cohort with RwNP + SA has been estimated above 39 thousand patients. Total economic burden of RwNP + SA in Russia were estimated as 1,7 bln RUR. Dupilumab usage in patients with RwNP + SA fixed in Register can help decrease economic burden on 259 mln RUR annually. Hidden economic burden of comorbidity can reach 73,4 bln RUR (for all calculated / modelled cohort of patients with RwNP + SA), dupilumab saves 11,3 bln RUR annually in this scenario. Conclusion. Comorbid pathology — RwNP+SA has a sufficient social-economic burden in Russia, that could be decreased by modern biologic drugs, in particular, with dupilumab.

scholarly journals Influence of dupilumab on the economic burden of severe asthma and atopic dermatitis

2020 ◽  
pp. 15-26
Author(s):  
I. S. Krysanov ◽  
V. S. Krysanova ◽  
O. I. Karpov ◽  
V. Yu. Ermakova
Keyword(s):  
Atopic Dermatitis ◽  
Severe Asthma ◽  
Economic Burden ◽  
Weighted Average ◽  
Indirect Costs ◽  
Current Treatment ◽  
Severe Atopic Dermatitis ◽  
Local Conditions ◽  
Economic Burden Of Disease

The prevalence of comorbidity — asthma and atopic dermatitis — is not understood well yet. More severe processes decreasing quality of life and increasing a social-economic burden of disease are occurred in such kind comorbidity.Aim: an evaluation of economic burden of non-control severe asthma in combination with severe atopic dermatitis in the local conditions.Materials and methods. Analysis has been performed for adult patients; the bottom-up approach of costs evaluation was used. Direct medical and non-medical as well as indirect costs were calculated for two models: Model 1 — current practice of the treatment, Model 2 — treatment with Dupilumab. Results. Model 1 — Weighted average expenditures for one patient were 3,1 mln RUR, indirect costs were dominated (76 % from the total), severe atopic dermatitis had 15 % of total. Model 2 (with Dupilumab) — Dupilumab has decreased the total weighted average cost on 903 905 RUR. The total economic burden of comorbidity was 17,6 bln RUR in the current treatment option, and 12,4 bln RUR in Dupilumab hand (different is 5,2 bln RUR, or burden decrease is expected on 29,2 %).Conclusion. The wider introduction of Dupilumab into clinical practice, which allows achieving control in the treatment of severe asthma and severe atopic dermatitis, should reduce treatment costs and reduce the socio-economic burden of these diseases as a result.

Expanding Access: Cost-effectiveness of Cochlear Implantation and Deaf Education in Asia

2019 ◽  
Vol 161 (4) ◽  
pp. 672-682 ◽  
Author(s):  
Susan D. Emmett ◽  
Chad K. Sudoko ◽  
Debara L. Tucci ◽  
Wenfeng Gong ◽  
James E. Saunders ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cochlear Implantation ◽  
Deaf Education ◽  
Cost Effective ◽  
World Health ◽  
Annual Number ◽  
Published Data ◽  
Middle Income ◽  
Life Years

Objective To determine the cost-effectiveness of cochlear implantation (CI) with mainstream education and deaf education with sign language for treatment of children with profound sensorineural hearing loss in low- and lower-middle income countries in Asia. Study Design Cost-effectiveness analysis. Setting Bangladesh, Cambodia, India, Indonesia, Nepal, Pakistan, Philippines, and Sri Lanka participated in the study. Subjects and Methods Costs were obtained from experts in each country with known costs and published data, with estimation when necessary. A disability-adjusted life-years model was applied with 3% discounting and 10-year length of analysis. A sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost-effectiveness was determined with the World Health Organization standard of cost-effectiveness ratio per gross domestic product (CER/GDP) per capita <3. Results Deaf education was cost-effective in all countries except Nepal (CER/GDP, 3.59). CI was cost-effective in all countries except Nepal (CER/GDP, 6.38) and Pakistan (CER/GDP, 3.14)—the latter of which reached borderline cost-effectiveness in the sensitivity analysis (minimum, maximum: 2.94, 3.39). Conclusion Deaf education and CI are largely cost-effective in participating Asian countries. Variation in CI maintenance and education-related costs may contribute to the range of cost-effectiveness ratios observed in this study.

The pharmacoeconomic comparison of the fixed insulin glargine and lixisenatide combination with insulin degludec family in type 2 diabetes mellitus

2021 ◽  
pp. 4-14
Author(s):  
I. N. Dyakov ◽  
S. K. Zyryanov
Keyword(s):  
Diabetes Mellitus ◽  
Sensitivity Analysis ◽  
Insulin Glargine ◽  
Indirect Costs ◽  
Economic Benefits ◽  
Insulin Degludec ◽  
Naive Patient ◽  
Direct And Indirect Costs ◽  
Treatment Comparison

Insulin glargine 100 U/ml (iGla) is gradually giving way to a fixed combination of insulin glargine 100 U/ml+ lixisenatide (iGlaLixi) — an effective and safe drug for Diabetes Mellitus Type 2 (DM2T) control. It has demonstrated the economic benefits in naïve patients as well as for treatment intensification aft er failure of insulins. Economic aspects of iGlaLixi in DM2T in comparison with another effective drugs — insulin degludec (iDeg) and insulin degludec + insulin aspart (iDegAsp) were not evaluated before.Materials and methods. Indirect treatment comparison (ITC) for iGlaLixi with others EDL drugs — iDeg and iDegAsp — has been performed through common comparator — iGla based on published results of efficacy in naïve and insulinized DM2T patients separately. Patients reached target HbA1c level (%) were chosen as a criterion of drugs efficacy. Odds ratio (OR) of efficacy has been calculated, modelling has been performed for direct and indirect costs. Sensitivity analysis was done for validation of results.Results. Efficacy of iGlaLixi were higher as well in naïve as in insulinized patients in comparison with iDeg family: with iDeg comparison OR 2.23 (95 % CI 1.40; 3.53); 3.34 (2.06; 5.40), with iDegAsp OR 1.90 (1.23; 2.95) и 2.49 (1.54; 4.04) accordingly. Direct costs in sum for iGlaLixi were less for iDeg on 22.1, and on 18.3 % for iDegAsp in naïve patient group, and on 35.9 % and 7.0 % for insulinized patients respectively. In total expenditures (direct and indirect costs) for iGlaLixi were less vs iDeg and iDegAsp for naïve patients on 18.9 % and 28 %, and on 15.5 % and 8.9 % for insulinized patients accordingly for 26 weeks treatment. Sensitivity analysis has confirmed of results.Conclusion. iGlaLixi has economic benefits vs iDeg and iGedAsp for DM2T treatment. 

scholarly journals Telemammography for breast cancer screening: a cost-effective approach in Argentina

2021 ◽  
Vol 28 (1) ◽  
pp. e100351
Author(s):  
Victoria Alba Malek Pascha ◽  
Li Sun ◽  
Ramiro Gilardino ◽  
Rosa Legood
Keyword(s):  
Breast Cancer ◽  
Sensitivity Analysis ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Probabilistic Sensitivity Analysis ◽  
Mammography Screening ◽  
Cost Effective ◽  
Access To Healthcare ◽  
Over 40 Years ◽  
Improve Access

ObjectivesArgentina is a low and middle-income country (LMIC) with a highly fragmented healthcare system that conflicts with access to healthcare stated by the country’s Universal Health Coverage plan. A tele-mammography network could improve access to breast cancer screening decreasing its mortality. This research aims to conduct an economic evaluation of the implementation of a tele-mammography program to improve access to healthcare.MethodsA cost-utility analysis was performed to explore the incremental benefit of annual tele-mammography screening for at-risk Argentinian women over 40 years old. A Markov model was developed to simulate annual mammography or tele-mammography screening in two hypothetical population-based cohorts of asymptomatic women. Parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analysis. Model structure uncertainty was also explored to test the robustness of the results.ResultsIt was estimated that 31 out of 100 new cases of breast cancer would be detected by mammography and 39/100 by tele-mammography. The model returned an incremental cost-effectiveness ratio (ICER) of £26 051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended threshold of £26 288/QALY for Argentina. Deterministic sensitivity analysis showed the ICER is most sensitive to the uptake and sensitivity of the screening tests. Probabilistic sensitivity analysis showed tele-mammography is cost-effective in 59% of simulations.DiscussionTele-mammography should be considered for adoption as it could improve access to expertise in underserved areas where adherence to screening protocols is poor. Disaggregated data by province is needed for a better- informed policy decision. Telemedicine could also be beneficial in ensuring the continuity of care when health systems are under stress like in the current COVID-19 pandemic.ConclusionThere is a 59% chance that tele-mammography is cost-effective compared to mammography for at-risk Argentinian women over 40- years old, and should be adopted to improve access to healthcare in underserved areas of the country.

scholarly journals Cost-effectiveness of pembrolizumab for treatment of platinum-resistant recurrent or metastatic head and neck squamous cell carcinoma in China: an economic analysis based on a randomised, open-label, phase III trial

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e038867 ◽  
Author(s):  
Wenxiu Xin ◽  
Haiying Ding ◽  
Qilu Fang ◽  
Xiaowei Zheng ◽  
Yinghui Tong ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Squamous Cell Carcinoma ◽  
Cost Effectiveness ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Effective ◽  
Platinum Resistant ◽  
The Cost

BackgroundPembrolizumab was recently demonstrated to have survival benefit in patients with recurrent or metastatic head and neck squamous cell carcinoma (r/mHNSCC). However, the cost-effectiveness of pembrolizumab versus chemotherapy in China remains uncertain.ObjectiveThis analysis aimed to describe the cost-effectiveness of pembrolizumab versus standard-of-care (SOC) therapy in r/mHNSCC in China.DesignA Markov model consisting of three health states (stable, progressive and dead) was developed to compare the cost and effectiveness of pembrolizumab with SOC in platinum-resistant r/mHNSCC. Model inputs for transition probabilities and toxicity were collected from the KEYNOTE-040 trial, while health utilities were estimated from a literature review. Cost data were acquired for the payer’s perspective in China. Costs and outcomes were discounted at an annual rate of 3.0%. Sensitivity analyses were conducted to test the uncertainties surrounding model parameters.Outcome measuresThe primary outcome was incremental cost-effectiveness ratios (ICERs), which were calculated as the cost per quality-adjusted life years (QALYs).ResultsThe total mean cost of pembrolizumab and SOC was US$45 861 and US$41 950, respectively. As for effectiveness, pembrolizumab yielded 0.31 QALYs compared with 0.25 QALYs for SOC therapy. The ICER for pembrolizumab versus SOC was US$65 186/QALY, which was higher than the willingness-to-pay threshold (WTP) of US$28 130/QALY in China. The univariate sensitivity analysis indicated that utility values for progressive state, probability from stable to progressive in the SOC group, as well as cost of pembrolizumab were the three most influential variables on ICER. The probabilistic sensitivity analysis demonstrated that standard therapy was more likely to be cost-effective compared with pembrolizumab at a WTP value of US$28 130/QALY. Results were robust across both univariate analysis and probabilistic sensitivity analysis.ConclusionsPembrolizumab is not likely to be a cost-effective strategy compared with SOC therapy in patients with platinum-resistant r/mHNSCC in China.Trial registration numberNCT02252042; Post-results.

scholarly journals Cost-effectiveness of TAS-102 plus bevacizumab versus TAS-102 monotherapy in patients with metastatic colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kiyoaki Sugiura ◽  
Yuki Seo ◽  
Takayuki Takahashi ◽  
Hideyuki Tokura ◽  
Yasuhiro Ito ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Metastatic Colorectal Cancer ◽  
Cost Effective ◽  
Model Parameters ◽  
Combination Regimen ◽  
The Cost

Abstract Background TAS-102 plus bevacizumab is an anticipated combination regimen for patients who have metastatic colorectal cancer. However, evidence supporting its use for this indication is limited. We compared the cost-effectiveness of TAS-102 plus bevacizumab combination therapy with TAS-102 monotherapy for patients with chemorefractory metastatic colorectal cancer. Method Markov decision modeling using treatment costs, disease-free survival, and overall survival was performed to examine the cost-effectiveness of TAS-102 plus bevacizumab combination therapy and TAS-102 monotherapy. The Japanese health care payer’s perspective was adopted. The outcomes were modeled on the basis of published literature. The incremental cost-effectiveness ratio (ICER) between the two treatment regimens was the primary outcome. Sensitivity analysis was performed and the effect of uncertainty on the model parameters were investigated. Results TAS-102 plus bevacizumab had an ICER of $21,534 per quality-adjusted life-year (QALY) gained compared with TAS-102 monotherapy. Sensitivity analysis demonstrated that TAS-102 monotherapy was more cost-effective than TAS-102 and bevacizumab combination therapy at a willingness-to-pay of under $50,000 per QALY gained. Conclusions TAS-102 and bevacizumab combination therapy is a cost-effective option for patients who have metastatic colorectal cancer in the Japanese health care system.

scholarly journals Cost-of-illness for non-underweight binge-eating disorders

2021 ◽  
Author(s):  
Paul E. Jenkins
Keyword(s):  
Eating Disorders ◽  
Binge Eating ◽  
Economic Impact ◽  
Indirect Costs ◽  
Cost Effective ◽  
Level Of Evidence ◽  
Academic Impairment ◽  
The United Kingdom ◽  
Binge Eating Disorders ◽  
Low Weight

Abstract Purpose This study examined economic costs associated with untreated eating disorders (EDs) characterised by regular binge eating in the absence of low weight. Both direct and indirect costs were assessed, reporting a limited societal perspective of economic impact as some costs were not included. Methods One hundred and twenty six adults seeking treatment for recurrent binge eating were asked to report impairment associated with an ED. Costs were calculated using 2017 prices, including an examination of variables associated with costs. Results Estimated societal costs for the year preceding assessment were £3268.47 (€3758.54) per person. In multivariate analyses, no reliable baseline associates of cost were identified. Conclusion The economic burden of EDs characterised by regular binge eating is significant, and underscores the need for efficacious and cost-effective treatments. Individuals with binge-eating disorders report work impairment and healthcare use that may cost the United Kingdom economy upwards of £3.5 billion (€4bn) per annum. Further studies should consider academic impairment and the economic impact of EDs on families. Level of evidence III: evidence obtained from well-designed cohort or case–control analytic studies.

scholarly journals Addition of Flucytosine to Fluconazole for the Treatment of Cryptococcal Meningitis in Africa: A Multicountry Cost-effectiveness Analysis

2019 ◽  
Vol 70 (1) ◽  
pp. 26-29 ◽  
Author(s):  
Tinevimbo Shiri ◽  
Angela Loyse ◽  
Lawrence Mwenge ◽  
Tao Chen ◽  
Shabir Lakhi ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cryptococcal Meningitis ◽  
Cost Effective ◽  
Immunodeficiency Virus ◽  
The Mean ◽  
The Cost ◽  
The Impact ◽  
Costing Analysis ◽  
Very High

Abstract Background Mortality from cryptococcal meningitis remains very high in Africa. In the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) trial, 2 weeks of fluconazole (FLU) plus flucytosine (5FC) was as effective and less costly than 2 weeks of amphotericin-based regimens. However, many African settings treat with FLU monotherapy, and the cost-effectiveness of adding 5FC to FLU is uncertain. Methods The effectiveness and costs of FLU+5FC were taken from ACTA, which included a costing analysis at the Zambian site. The effectiveness of FLU was derived from cohorts of consecutively enrolled patients, managed in respects other than drug therapy, as were participants in ACTA. FLU costs were derived from costs of FLU+5FC in ACTA, by subtracting 5FC drug and monitoring costs. The cost-effectiveness of FLU+5FC vs FLU alone was measured as the incremental cost-effectiveness ratio (ICER). A probabilistic sensitivity analysis assessed uncertainties and a bivariate deterministic sensitivity analysis examined the impact of varying mortality and 5FC drug costs on the ICER. Results The mean costs per patient were US $847 (95% confidence interval [CI] $776–927) for FLU+5FC, and US $628 (95% CI $557–709) for FLU. The 10-week mortality rate was 35.1% (95% CI 28.9–41.7%) with FLU+5FC and 53.8% (95% CI 43.1–64.1%) with FLU. At the current 5FC price of US $1.30 per 500 mg tablet, the ICER of 5FC+FLU versus FLU alone was US $65 (95% CI $28–208) per life-year saved. Reducing the 5FC cost to between US $0.80 and US $0.40 per 500 mg resulted in an ICER between US $44 and US $28 per life-year saved. Conclusions The addition of 5FC to FLU is cost-effective for cryptococcal meningitis treatment in Africa and, if made available widely, could substantially reduce mortality rates among human immunodeficiency virus–infected persons in Africa.

Computer Simulation to Estimate the Effectiveness of Carotid Endarterectomy

1998 ◽  
Vol 3 (1) ◽  
pp. 6-11 ◽  
Author(s):  
Michael Lavender ◽  
Neil Craig ◽  
Ron Kerr ◽  
Denise Howel
Keyword(s):  
Sensitivity Analysis ◽  
Computer Simulation ◽  
Medical Treatment ◽  
Carotid Endarterectomy ◽  
Transient Ischaemic Attack ◽  
Cost Effective ◽  
Baseline Scenario ◽  
Cost Information ◽  
Patient Groups ◽  
Ischaemic Attack

Objectives: To investigate the benefit of carotid endarterectomy relative to medical treatment, by comparing the outcome for different groups of patients following transient ischaemic attacks. Methods: A Markov model was used to describe the survival and quality of life of patients treated for a transient ischaemic attack. The benefit is measured in terms of quality adjusted life months (QALMs). The outcome was estimated using a computer simulation with parameters based on published studies on the probability of events following treatment. The benefit of carotid endarterectomy was explored using a baseline set of parameters and a sensitivity analysis. Results: The baseline scenario of a 65-year-old male patient with the model factors set at an intermediate level showed a benefit for surgery of 3 QALMs compared with medical treatment alone. The sensitivity analysis showed that the most favourable combination of factors had a benefit of 13.4 QALMs and the least favourable a loss of 2 QALMs. Of all 128 factor combinations, 79.9% showed a benefit for surgery, 5.5% showed equal benefit, and 15.6% showed a benefit for medical treatment. Conclusions: Computer simulations have the potential for deriving estimates of benefit for different patient groups from the results of clinical trials. Combined with reliable information on costs, the technique could also demonstrate variations in cost-effectiveness for these groups. For patients following a transient ischaemic attack, the results from this simulation and limited cost information suggest that carotid endarterectomy is unlikely to be a cost-effective intervention in the UK for many patient groups despite a reduction in the risk of stroke.

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