scholarly journals Managing female urinary incontinence: A regional prospective analysis of cost-utility ratios (curs) and effectiveness

2014 ◽  
Vol 86 (2) ◽  
pp. 112 ◽  
Author(s):  
Elisabetta Costantini ◽  
Massimo Lazzeri ◽  
Vittorio Bini ◽  
Alessandro Zucchi ◽  
Emanuele Scarponi ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Floor Muscle ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Group A ◽  
Grade Ii ◽  
Group B ◽  
The Cost ◽  
Quality Adjusted Life

Introduction: To evaluate the cost-utility of incontinence treatments, particularly anticholinergic therapy, by examining costs and quality-adjusted life years. Materials and methods: A prospective cohort study of women who were consecutively referred by general practitioners (GPs) to the Urology Department because of urinary incontinence. The primary outcome was evaluation of the cost-utility of incontinence treatments (surgery, medical therapy and physiotherapy) for stress and/or urgency incontinence by examining costs and quality-adjusted life years. Results: 137 consecutive female patients (mean age 60.6 ± 11.6; range 36-81) were enrolled and stratified according to pathologies: SUI and UUI. Group A: SUI grade II-III: 43 patients who underwent mid-urethral sling (MUS); Group B: SUI grade I-II 57 patients who underwent pelvic floor muscle exercise and Group C: UUI: 37 patients who underwent antimuscarinic treatment with 5 mg solifenacin daily. The cost utility ratio (CUR) was estimated as saving more than €1200 per QALY for surgery and physiotherapy and as costing under € 100 per QALY for drug therapy. Conclusions: This study shows that appropriate diagnosis and treatment of a patient with incontinence lowers National Health Service costs and improves the benefits of treatment and quality of life.

scholarly journals Cost-utility of venoarterial extracorporeal membrane oxygenation in cardiogenic shock and cardiac arrest

2020 ◽  
Vol 9 (4) ◽  
pp. 333-341
Author(s):  
Salla Jäämaa-Holmberg ◽  
Birgitta Salmela ◽  
Raili Suojaranta ◽  
Karl B Lemström ◽  
Jyri Lommi
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Background: The use of venoarterial extracorporeal membrane oxygenation in cardiogenic shock keeps increasing, but its cost-utility is unknown. Methods: We studied retrospectively the cost-utility of venoarterial extracorporeal membrane oxygenation in a five-year cohort of consequent patients treated due to refractory cardiogenic shock or cardiac arrest in a transplant centre in 2013–2017. In our centre, venoarterial extracorporeal membrane oxygenation is considered for all cardiogenic shock patients potentially eligible for heart transplantation, and for selected postcardiotomy patients. We assessed the costs of the index hospitalization and of the one-year hospital costs, and the patients’ health-related quality of life (response rate 71.7%). Based on the data and the population-based life expectancies, we calculated the amount and the costs of quality-adjusted life years gained both without discount and with an annual discount of 3.5%. Results: The cohort included 102 patients (78 cardiogenic shock; 24 cardiac arrest) of whom 67 (65.7%) survived to discharge and 66 (64.7%) to one year. The effective costs per one hospital survivor were 242,303€. Median in-hospital costs of the index hospitalization per patient were 129,967€ (interquartile range 150,340€). Mean predicted number of quality-adjusted life years gained by the treatment was 20.9 (standard deviation 9.7) without discount, and the median cost per quality-adjusted life year was 7474€ (interquartile range 10,973€). With the annual discount of 3.5%, 13.0 (standard deviation 4.8) quality-adjusted life years were gained with the cost of 12,642€ per quality-adjusted life year (interquartile range 15,059€). Conclusions: We found the use of venoarterial extracorporeal membrane oxygenation in refractory cardiogenic shock and cardiac arrest justified from the cost-utility point of view in a transplant centre setting.

scholarly journals Cost–Utility of Mindfulness-Based Stress Reduction for Fibromyalgia versus a Multicomponent Intervention and Usual Care: A 12-Month Randomized Controlled Trial (EUDAIMON Study)

2019 ◽  
Vol 8 (7) ◽  
pp. 1068 ◽  
Author(s):  
Adrián Pérez-Aranda ◽  
Francesco D’Amico ◽  
Albert Feliu-Soler ◽  
Lance M. McCracken ◽  
María T. Peñarrubia-María ◽  
...  
Keyword(s):  
Stress Reduction ◽  
Controlled Trial ◽  
Indirect Costs ◽  
Cost Utility ◽  
Public Healthcare ◽  
Quality Adjusted Life Years ◽  
Randomized Controlled ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost–utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to treatment-as-usual (TAU) for patients with FM compared to an adjuvant multicomponent intervention (“FibroQoL”) and to TAU. We performed an economic evaluation alongside a 12 month, randomized, controlled trial; data from 204 (68 per study arm) of the 225 patients (90.1%) were included in the cost–utility analyses, which were conducted both under the government and the public healthcare system perspectives. The main outcome measures were the EuroQol (EQ-5D-5L) for assessing Quality-Adjusted Life Years (QALYs) and improvements in health-related quality of life, and the Client Service Receipt Inventory (CSRI) for estimating direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were also calculated. Two sensitivity analyses (intention-to-treat, ITT, and per protocol, PPA) were conducted. The results indicated that MBSR achieved a significant reduction in costs compared to the other study arms (p < 0.05 in the completers sample), especially in terms of indirect costs and primary healthcare services. It also produced a significant incremental effect compared to TAU in the ITT sample (ΔQALYs = 0.053, p < 0.05, where QALYs represents quality-adjusted life years). Overall, our findings support the efficiency of MBSR over FibroQoL and TAU specifically within a Spanish public healthcare context.

scholarly journals An Economic Evaluation of Thread Embedding Acupuncture for the Treatment of Lumbar Herniated Intervertebral Disc in a Randomized Controlled Clinical Trial

2021 ◽  
Vol 38 (4) ◽  
pp. 312-319
Author(s):  
Ha-Na Kim ◽  
Jun-Yeon Kim ◽  
Kyeong-Ju Park ◽  
Ji-Min Hwang ◽  
Jun-Yeong Jang ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Visual Analog Scale Score ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Randomized Controlled ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Background: Lumbar herniated intervertebral disc (LHIVD) is a frequently presented condition/disease in Korean medical institutions. In this study, the economics of thread embedding acupuncture (TEA) was evaluated in a randomized controlled trial comparing TEA with sham TEA (STEA).Methods: This economic evaluation was analyzed from a limited social perspective, and the per-protocol set was from a basic analysis perspective. The cost-effectiveness analysis was based on the change in visual analog scale score, and the cost-utility analysis was based on the quality-adjusted life years. The final results were expressed as the average cost-effectiveness ratio and incremental cost-effectiveness ratio, and furthermore sensitivity analysis was performed to confirm the robustness of the results observed.Results: The cost-effectiveness analysis showed that TEA was 9,908 won lower than STEA, while the decrease in 100 mm visual analog scale score was 8.5 mm greater in the TEA group compared with the STEA group (p > 0.05). The cost-utility analysis showed that TEA was 9,908 won lower than STEA, while the quality-adjusted life years of TEA was 0.0026 years higher than STEA (p > 0.05). These results were robust in the sensitivity analysis, but were not statistically significant.Conclusion: In treating LHIVD, TEA appeared to have cost-effectiveness and cost-utility compared with STEA. However, there were no significant differences between the groups in terms of cost, effectiveness, and utility indicators. Therefore, results must be interpreted prudently; this study was the 1st to conduct an economic evaluation of TEA for LHIVD.

scholarly journals Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: multicentre randomised controlled trial

BMJ ◽  
2020 ◽  
pp. m3719 ◽  
Author(s):  
Suzanne Hagen ◽  
Andrew Elders ◽  
Susan Stratton ◽  
Nicole Sergenson ◽  
Carol Bugge ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Floor ◽  
Pelvic Floor Muscle Training ◽  
Pelvic Floor Muscle ◽  
Controlled Trial ◽  
Quality Adjusted Life Years ◽  
Electromyographic Biofeedback ◽  
Life Years ◽  
Randomised Controlled ◽  
Quality Adjusted Life

AbstractObjectiveTo assess the effectiveness of pelvic floor muscle training (PFMT) plus electromyographic biofeedback or PFMT alone for stress or mixed urinary incontinence in women.DesignParallel group randomised controlled trial.Setting23 community and secondary care centres providing continence care in Scotland and England.Participants600 women aged 18 and older, newly presenting with stress or mixed urinary incontinence between February 2014 and July 2016: 300 were randomised to PFMT plus electromyographic biofeedback and 300 to PFMT alone.InterventionsParticipants in both groups were offered six appointments with a continence therapist over 16 weeks. Participants in the biofeedback PFMT group received supervised PFMT and a home PFMT programme, incorporating electromyographic biofeedback during clinic appointments and at home. The PFMT group received supervised PFMT and a home PFMT programme. PFMT programmes were progressed over the appointments.Main outcome measuresThe primary outcome was self-reported severity of urinary incontinence (International Consultation on Incontinence Questionnaire-urinary incontinence short form (ICIQ-UI SF), range 0 to 21, higher scores indicating greater severity) at 24 months. Secondary outcomes were cure or improvement, other pelvic floor symptoms, condition specific quality of life, women’s perception of improvement, pelvic floor muscle function, uptake of other urinary incontinence treatment, PFMT self-efficacy, adherence, intervention costs, and quality adjusted life years.ResultsMean ICIQ-UI SF scores at 24 months were 8.2 (SD 5.1, n=225) in the biofeedback PFMT group and 8.5 (SD 4.9, n=235) in the PFMT group (mean difference −0.09, 95% confidence interval −0.92 to 0.75, P=0.84). Biofeedback PFMT had similar costs (mean difference £121 ($154; €133), −£409 to £651, P=0.64) and quality adjusted life years (−0.04, −0.12 to 0.04, P=0.28) to PFMT. 48 participants reported an adverse event: for 23 this was related or possibly related to the interventions.ConclusionsAt 24 months no evidence was found of any important difference in severity of urinary incontinence between PFMT plus electromyographic biofeedback and PFMT alone groups. Routine use of electromyographic biofeedback with PFMT should not be recommended. Other ways of maximising the effects of PFMT should be investigated.Trial registrationISRCTN57756448.

scholarly journals The clinical and economic efficiency of treatment in patients with chronic heart failure

2013 ◽  
Vol 4 (1) ◽  
pp. 72-76
Author(s):  
E. I Tarlovskaya ◽  
S. V Malchikova
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Standard Therapy ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Structure ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Objective: to study the clinical and economic benefits of adding ivabradine to standard therapy for chronic heart failure (CHF). Subjects and methods. A clinical and economic analysis of the pharmacoeconomic efficacy of ivabradine (Coraxan Servier, France) in patients with CHF was made using the Markov simulation on the basis of the SHIFT trial. The cost-utility ratio (CUR) was calculated by the formula: CUR=DC/Ut, where DC is the direct cost of treatment; Ut is the cost utility expressed in life-years gained (LYG) and quality-adjusted life years (QALY). While calculating the latter, the model used the utility value derived in the SHIFT-PRO trial, by applying the EQ-5D questionnaire. Results. The monthly cost of standard pharmacotherapy was 799,14 rbl. per person. The treatment involving ivabradine cost 1807,77 rbl. The mean total direct cost for treating one patient was 64 741,09 and 47 647,83 rbl. in the ivabradine and placebo groups, respectively. The costs of hospital stay were ascertained to constitute 60% of all the direct costs in patients receiving standard therapy. On the contrary, addition of ivabradine to standard therapy allows avoidance of 309 admissions for worsening CHF, which permitted 23 709 879 rbl. to be saved. Reducing the costs of hospitalization enables one to spend 67% of the means for pharmacotherapy. Following a 10-year simulation period, the standard therapy remains more inexpensive than therapy involving ivabradine (74 585,31 rbl. per person versus 120 843,30 rbl per person) and ensures the lower cost of one LYG and one QALY. At the same time, the therapy added by ivabradine can prevent 1300 admissions for CHF and about 500 deaths per 10,000 patients over 10 years. This will lead to more life-years gained (4,277 LYGs on ivabradine therapy versus 4,083 LYGs on standard therapy), including quality-adjusted life years (3,031 QALYs on ivabradine therapy versus 2,839 QALYs on standard therapy). When ivabradine was added to standard therapy, the cost of one LYG was 238 443 rbl. and that of QALY was 240 927 rbl. Thus, the estimated medical intervention is a cost-effective investment. Conclusions: 1. To enhance the efficiency of CHF treatment with ivabradine causes a rational change in the cost structure. 2. To reduce the costs of hospitalizations and to change the cost structure provide a possibility of increasing those of qualitative therapy. 3. To incorporate ivabradine in therapy for systolic CHF can gain more additional life years, including quality-adjusted life years. 4. To increase expenses on therapy involving ivabradine per LYG is a cost-effective investment.

Utilities and Quality-Adjusted Life Years

1989 ◽  
Vol 5 (4) ◽  
pp. 559-575 ◽  
Author(s):  
George W. Torrance ◽  
David Feeny
Keyword(s):  
Quality Of Life ◽  
Cost Utility ◽  
Health Improvement ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Quality Adjustment ◽  
Life Years ◽  
Quality Adjusted Life ◽  
Broad Overview

Utilities and quality-adjusted life years (QALYs) are reviewed, with particular focus on their use in technology assessment. This article provides a broad overview and perspective on these two techniques and their interrelationship, with reference to other sources for details of implementation. The historical development, assumptions, strengths/weaknesses, and applications of each are summarized.Utilities are specifically designed for individual decision-making under uncertainty, but, with additional assumptions, utilities can be aggregated across individuals to provide a group utility function. QALYs are designed to aggregate in a single summary measure the total health improvement for a group of individuals, capturing improvements from impacts on both quantity of life and quality of life– with quality of life broadly defined. Utilities can be used as the quality-adjustment weights for QALYs; they are particularly appropriate for that purpose, and this combination provides a powerful and highly useful variation on cost-effectiveness analysis known as cost-utility analysis.

Lenvatinib versus sorafenib for unresectable hepatocellular carcinoma: a cost–effectiveness analysis

2020 ◽  
Vol 9 (8) ◽  
pp. 553-562
Author(s):  
Hongfu Cai ◽  
Longfeng Zhang ◽  
Na Li ◽  
Bin Zheng ◽  
Maobai Liu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Years ◽  
Cost Effectiveness Ratio ◽  
Phase 3 ◽  
Sorafenib Treatment ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Aim: To investigate the cost–effectiveness of lenvatinib and sorafenib in the treatment of patients with nonresected hepatocellular carcinoma in China. Materials & methods: Markov model was used to simulate the direct medical cost and quality-adjusted life years (QALY) of patients with hepatocellular carcinoma. Clinical data were derived from the Phase 3 randomized clinical trial in a Chinese population. Results: Sorafenib treatment resulted in 1.794 QALYs at a cost of $43,780.73. Lenvatinib treatment resulted in 2.916 QALYs for patients weighing <60 and ≥60 kg at a cost of $57,049.43 and $75,900.36, The incremental cost–effectiveness ratio to the sorafenib treatment group was $11,825.94/QALY and $28,627.12/QALY, respectively. Conclusion: According to WHO’s triple GDP per capita, the use of lenvatinib by providing drugs is a cost-effective strategy.

Sign in / Sign up

Export Citation Format

Share Document