scholarly journals Calculation of the cost-effectiveness of subcutaneous administration of trastuzumab

2020 ◽  
Vol 55 (1) ◽  
pp. 11-13
Author(s):  
I. M. Omarova ◽  
J. O. Nurketaeva ◽  
D. D. Dorogan
Keyword(s):  
Cost Effectiveness ◽  
Cost Minimization ◽  
Subcutaneous Administration ◽  
Comparable Efficacy ◽  
Trastuzumab Emtansine ◽  
Minimization Method ◽  
Efficient Treatment ◽  
Outpatient Chemotherapy ◽  
The Cost ◽  
Selection Of

Rational selection of medicines with an assessment of their pharmacoeconomic effectiveness is the most effective way to ensure safe and efficient treatment and economical use of budget funds allocated for drug therapy, as well as to reduce the time of hospitalization and treatment of patients. The purpose of the research was to evaluate the pharmacoeconomic effectiveness of using the subcutaneous and intravenous forms of drug Trastuzumab. Research tasks: 1. Estimate costs when using subcutaneous trastuzumab in an outpatient chemotherapy room (OCR). 2. Estimate costs when using intravenous trastuzumab in a day patient department (DPD) 3. Estimate costs when using intravenous trastuzumab in a round-the-clock hospital Results: The paper presents the pharmacoeconomic analysis of targeted therapy with trastuzumab in two forms for intravenous (IV) administration and trastuzumab emtansine for subcutaneous (SC) administration in breast cancer by cost minimization method. The costs include the cost of used drugs according to the price-list of the unified national distributor SK Pharmacia as of January 1, 2018. At comparable efficacy and toxicity, the estimated cost-effectiveness of trastuzumab per 100 patients per year is KZT16,939,600 ($50,972) for SC administration in OCR and IV administration in DPD vs. KZT41,783,200 ($125,728) for SC administration in OCR and IV administration in a round-theclock hospital.

scholarly journals Calculation of the cost-effectiveness of subcutaneous administration of trastuzumab

2020 ◽  
Vol 55 (1) ◽  
pp. 9-11
Author(s):  
I. M. OMAROVA ◽  
J. O. NURKETAEVA ◽  
D. D. DOROGAN
Keyword(s):  
Targeted Therapy ◽  
Cost Effectiveness ◽  
Cost Minimization ◽  
Pharmacoeconomic Analysis ◽  
Subcutaneous Administration ◽  
Comparable Efficacy ◽  
Minimization Method ◽  
Efficient Treatment ◽  
Outpatient Chemotherapy ◽  
The Cost

Rational selection of medicines with an assessment of their pharmacoeconomic effectiveness is the most effective way to ensure safe and efficient treatment and economical use of budget funds allocated for drug therapy, as well as to reduce the time of hospitalization and treatment of patients. The purpose of the research was to evaluate the pharmacoeconomic effectiveness of using the subcutaneous and intravenous forms of drug Trastuzumab. Research tasks: 1. Estimate costs when using subcutaneous trastuzumab in an outpatient chemotherapy room (OCR). 2. Estimate costs when using intravenous trastuzumab in a day patient department (DPD). 3. Estimate costs when using intravenous trastuzumab in a round-the-clock hospital. Results: The paper presents the pharmacoeconomic analysis of targeted therapy with trastuzumab in two forms for intravenous administration (IV) and trastuzumab emtansine for subcutaneous administration (SC) in breast cancer by cost minimization method. The costs of used drugs are according to the price-list of the unified national distributor SK Pharmacia as of January 1, 2018. At comparable efficacy and toxicity, the estimated cost-effectiveness of trastuzumab per 100 patients per year is KZT 16,939,600 ($ 50,972) for SC administration in OCR and IV administration in DPD vs. KZT 41,783,200 ($ 125,728) for SC administration in OCR and IV administration in a round-the-clock hospital. Conclusions: Based on the above, the subcutaneous form is economically feasible for conducting targeted therapy with trastuzumab.

scholarly journals Economic evaluation of online computerised cognitive–behavioural therapy without support for depression in primary care: randomised trial

2010 ◽  
Vol 196 (4) ◽  
pp. 310-318 ◽  
Author(s):  
S. A. H. Gerhards ◽  
L. E. de Graaf ◽  
L. E. Jacobs ◽  
J. L. Severens ◽  
M. J. H. Huibers ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Cost Utility ◽  
Significant Group ◽  
Efficient Treatment ◽  
Cognitive Behavioural ◽  
The Cost

BackgroundEvidence about the cost-effectiveness and cost utility of computerised cognitive–behavioural therapy (CCBT) is still limited. Recently, we compared the clinical effectiveness of unsupported, online CCBT with treatment as usual (TAU) and a combination of CCBT and TAU (CCBT plus TAU) for depression. The study is registered at the Netherlands Trial Register, part of the Dutch Cochrane Centre (ISRCTN47481236).AimsTo assess the cost-effectiveness of CCBT compared with TAU and CCBT plus TAU.MethodCosts, depression severity and quality of life were measured for 12 months. Cost-effectiveness and cost-utility analyses were performed from a societal perspective. Uncertainty was dealt with by bootstrap replications and sensitivity analyses.ResultsCosts were lowest for the CCBT group. There are no significant group differences in effectiveness or quality of life. Cost-utility and cost-effectiveness analyses tend to be in favour of CCBT.ConclusionsOn balance, CCBT constitutes the most efficient treatment strategy, although all treatments showed low adherence rates and modest improvements in depression and quality of life.

Cost-Effectiveness Analysis: Discount the Placebo at Your Peril

2010 ◽  
Vol 30 (5) ◽  
pp. 536-543 ◽  
Author(s):  
Neil Hawkins ◽  
David A. Scott
Keyword(s):  
Clinical Practice ◽  
Cost Effectiveness ◽  
Placebo Effect ◽  
Severe Disease ◽  
Quality Adjusted Life Year ◽  
Routine Clinical Practice ◽  
Regression To The Mean ◽  
Expectancy Effect ◽  
The Cost ◽  
Selection Of

Introduction: The authors consider alternative mechanisms that might explain placebo responses and their implications for cost-effectiveness modeling. Three alternative placebo mechanisms are examined: a ‘‘regression to the mean’’ effect arising from natural variation and the preferential selection of patients with acutely severe disease into clinical trials, a patient expectancy effect specific to the clinical trial setting (Hawthorne effect), and a patient expectancy effect generalizable to routine clinical practice (true placebo effect). Methods: To estimate cost-effectiveness, the authors needed to generalize from trial data to estimate responses to treatment that they would see in routine clinical practice. They use an example analysis of the cost-effectiveness of adjunct epilepsy treatments to illustrate the potential effects of these different placebo mechanisms on this generalization and subsequent cost-effectiveness estimates and adoption decisions. Results: If an acceptable willingness-to-pay threshold of 30,000 per quality-adjusted life year (QALY) is assumed, then each of the placebo effect scenarios identifies a different treatment alternative as being optimum. Discussion: Estimated cost-effectiveness ratios and associated policy decisions may be sensitive to assumptions regarding the mechanism underlying placebo responses. These assumptions should, if possible, be investigated through analysis of trial or observational data and, in the absence of other evidence, sensitivity analysis.

scholarly journals Cost-Effectiveness Analysis of Trastuzumab Emtansine as Second-Line Therapy for HER2 Positive Breast Cancer in China

2020 ◽  
Author(s):  
Huahua Zhang ◽  
Yandong Zhang ◽  
Chaonan Huang ◽  
Jiangfeng Wang
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Trastuzumab Emtansine ◽  
Second Line ◽  
Her2 Positive ◽  
Second Line Therapy ◽  
Her2 Positive Breast Cancer ◽  
Line Therapy ◽  
The Cost ◽  
Positive Breast Cancer

Abstract ObjectiveTo evaluate the cost-effectiveness of trastuzumab emtansine (T-DM1) as the second-line treatment for patients with human epidermal growth factor receptor-2 (HER2) positive breast cancer from the Chinese healthcare perspective. Capecitabine (Cap), capecitabine + lapatinib (Cap+Lap), capecitabine + trastuzumab (Cap+Tra), capecitabine + trastuzumab + pertuzumab (Cap+Tra+Pre) were selected as comparators.MethodsA three-state Markov simulation model was performed. The state transition probabilities were estimated based on the results of a published network meta-analysis, and utilities were derived from the published literature. The costs populated in the model were acquired from the local charge or previously published studies. Univariate sensitive analysis and probabilistic sensitivity analyses were performed to test the robustness of the results.ResultsTreatment with T-DM1 was estimated to increase the cost by $109,683.7, $106,003.7, $94,212.2, and $63,214.9, and yield a gain of 0.544 quality-adjusted life years (QALYs), 0.383 QALYs, 0.367 QALYs, 0.087 QALYs in comparison with Cap, Cap+Lap, Cap+Tra, and Cap+Tra+Pre, respectively. Corresponding incremental cost-effectiveness ratios (ICERs) were $201,624.4, $276,772.1, $256,709.0, and $726,608.0 per QALY. The probabilities of T-DM1 as the dominant option were 0% at the WTP threshold of $30,829.3/QALY.ConclusionsT-DM1, as second-line therapy in the treatment of HER2 positive breast cancer, is not a cost-effective option in China. Given the significant clinical efficacy, an appropriate price reduction of T-DM1 is required to benefit more HER2 positive breast cancer patients.

Latest Strategy in Renal Anemia Management in Peritoneal Dialysis Patients

2008 ◽  
Vol 28 (3_suppl) ◽  
pp. 76-80
Author(s):  
Wai Kei Lo
Keyword(s):  
Cost Effectiveness ◽  
Subcutaneous Administration ◽  
Renal Anemia ◽  
Randomized Control Trials ◽  
Dialysis Patients ◽  
Dosing Frequency ◽  
Anemia Management ◽  
Randomized Control ◽  
The Cost ◽  
Esa Therapy

The target of renal anemia correction with erythropoietin stimulating agents (ESAs) has been traditionally set at a hemoglobin (Hb) level of 11 – 12 g/dL. However, a trend has arisen of progressively increasing the Hb level to beyond 12 g/dL. Recent randomized control trials (RCTs) on correction of renal anemia in chronic kidney disease patients found that normalization of anemia to above 13 g/dL was associated with negative outcome parameters, echoing a previous RCT that showed increased death and myocardial infarction risk after normalization of hemoglobin level in hemodialysis patients. The latest consensus is to limit Hb to a level not exceeding 13 g/dL during renal anemia correction with ESAs. Currently, there are three ESAs available commercially. The choice of ESA should consider safety of subcutaneous administration, cost-effectiveness, and dosing frequency, all of which may affect compliance with ESA administration. Early identification of, and an early search for the causes of hyporesponsiveness to, ESAs is needed to avoid unnecessary escalation in the dose of ESAs. These approaches will help to improve the cost-effectiveness of ESA therapy and permit early detection of hidden problems. The current definitions of hyporesponsiveness are far too stringent and should be reviewed.

Cost-effectiveness of primary prophylaxis (PP) with colony-simulating factor (CSF) when compared with secondary prophylaxis (SP) in elderly patients with diffuse aggressive lymphoma undergoing curative chemotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6558-6558
Author(s):  
K. K. Chan ◽  
K. R. Imrie ◽  
S. M. Alibhai
Keyword(s):  
Cost Effectiveness ◽  
Elderly Patients ◽  
Cost Minimization ◽  
Cost Effective ◽  
Primary Prophylaxis ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Aggressive Lymphoma ◽  
Base Case ◽  
The Cost

6558 Background: The 2006 ASCO guideline recommends PP with CSF for elderly patients with diffuse aggressive lymphoma, partially based on previous cost-minimization analyses showing that CSF saved costs when compared with no CSF by reducing hospitalization from febrile neutropenia (FN) when the risk of FN was > 20%. However, these studies examined only one cycle of chemotherapy and did not account for costs of CSF in subsequent cycles, did not consider SP, and did not consider patients’ preferences. Methods: We conducted a cost-utility analysis to compare PP with SP in this setting using a Markov model for a time horizon of 8 cycles of chemotherapy with a government payer perspective. Costs were adjusted to 2006 $CAD. Ontario health economic data were used. The cost of hospitalization for FN was obtained from Ontario Case Costing Initiative. Data for efficacies of CSF, probabilities and utilities were obtained from published literature. Sensitivity analyses were conducted using a threshold of $100,000/QALY. Results: The base case costs for PP and SP were $22,077 and $17,641. The QALYs of PP and SP were 0.254 and 0.248. The incremental cost effectiveness ratio of PP to SP was $739,999/QALY. One-way sensitivity analyses showed that in order for PP to be cost-effective, the cost of hospitalization per episode of FN had to be > $31,138 (i.e. 2.5 times > base case), the cost of CSF per cycle had to be < $896 (base case = $1,960), the risk of FN in the 1st cycle had to be > 48% (base case = 24%), or the relative risk reduction of FN with CSF had to be > 97% (base case = 41%). Our result was robust to all other cost, probability and utility variables. First order microsimulation showed that < 17% of simulations were cost-effective. Conclusions: PP is not cost-effective when compared with SP for this population under most assumptions. PP only becomes attractive in places where the cost of hospitalization for FN is much more than that of Ontario, or the cost of CSF is under $896 per cycle. The costs of CSF and hospitalization in all cycles (instead of just one cycle) should be accounted for in any economic evaluation of CSF. Current guidelines recommending PP in this population should be revisited. No significant financial relationships to disclose.

Cost Analysis Comparing Computed Tomographic Pulmonary Angiography (CTPA) and Ventilation-Perfusion (V/Q) Scanning for the Diagnosis of Pulmonary Embolism

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 567-567
Author(s):  
Alastair Dorreen ◽  
Chris Skedgel ◽  
Marc A. Rodger ◽  
Susan R. Kahn ◽  
Michael J. Kovacs ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cost Effectiveness ◽  
Cost Analysis ◽  
Incremental Cost ◽  
Cost Minimization ◽  
Imaging Modality ◽  
Sensitivity Analyses ◽  
Pulmonary Emboli ◽  
Cost Minimization Analysis ◽  
The Cost

Abstract Abstract 567 Background: Accurate diagnosis of a pulmonary embolism remains problematic due to the nonspecific findings of the clinical presentation and the limitations of radiographic imaging. Computed tomography pulmonary angiography (CTPA) has surpassed ventilation-perfusion (V/Q) scanning as the primary imaging modality in the investigation of patients with suspected pulmonary emboli due to its superior diagnostic accuracy. Data from a large randomized controlled trial has indicated that while strategies using both CTPA and V/Q are equally safe at excluding the diagnosis, CTPA detects significantly more pulmonary emboli (1). The purpose of this study was to perform a cost analysis comparing CTPA and V/Q scanning for the investigation of patients with suspected pulmonary emboli based upon this large trial. Methods: A cost analysis was performed using a decision-analysis model. The costs and outcomes of CTPA and V/Q scanning in detecting or ruling out pulmonary embolism over a 90 day analysis horizon were incorporated into a decision tree where the probabilities for each outcome were taken from (1) and a systematic literature review. The decision tree incorporated the thromboembolic and major bleeding complications associated with the diagnosis and treatment of pulmonary embolism in 100,000 patients. Outcomes in the model were measured in terms of quality-adjusted life years (QALYs). The economic model took a direct-payer perspective, considering direct costs to the health care system and patients. All costs were based on 2009 Canadian dollars. The primary economic evaluation was conducted within a deterministic cost-effectiveness analysis framework in terms of incremental cost per QALY. If the clinical benefits were found to be statistically insignificant the primary evaluation would be collapsed to a cost-minimization analysis and a secondary analysis would be performed to using probabilistic methods to estimate the expected incremental costs and outcomes based upon probability distributions around mean point estimates. Sensitivity analyses around key parameters were also performed. Results: The primary deterministic analysis collapsed to a cost-minimization analysis on the grounds that no statistically differences in the proportion of false negative results or mortality were observed in the randomized trial comparing CTPA with VQ scanning for the diagnosis of pulmonary embolism (1). The cost minimization analysis demonstrated a strategy using V/Q scanning as the primary imaging modality was less costly. CTPA was associated with an incremental cost of $11.3 million per 100,000 patients compared to V/Q scanning. CTPA was associated with an additional 3760 additional diagnoses of pulmonary embolism and 111 major bleeding episodes compared to V/Q scanning. The secondary probabilistic cost-effectiveness analysis revealed that CTPA was associated with an incremental cost of $4.8 million per 100,000-person cohort and 3134 QALYs gained relative to V/Q scanning for a cost-effectiveness of $1543 per QALY gained. Furthermore, the cost-effectiveness acceptability curve demonstrated CTPA had an 89% likelihood of being cost-effective relative to the threshold of $50,000 per QALY gained. Sensitivity analyses demonstrated cost-effectiveness ratio was most impacted by varying prevalence of pulmonary embolism and the relative and absolute differences in the proportions of fatal pulmonary embolism from falsely negative scans between the two tests. Conclusions: The results of the cost-minimization analysis imply that V/Q scanning is a less costly alternative to CTPA resulting from less pulmonary emboli diagnosed while maintaining similar 3-month rate of thromboembolic complications relative to CTPA. Secondary analysis, however, concluded that diagnostic algorithms incorporating CTPA may be cost-effective under defined circumstances. (1) Anderson et al. JAMA 2007; 298:2743-2753 Disclosures: No relevant conflicts of interest to declare.

scholarly journals Adaptive Radio Link Framework for Wireless Communications

2019 ◽  
Vol 8 (4) ◽  
pp. 12185-12187
Keyword(s):  
Cognitive Radio ◽  
Wireless Communications ◽  
Cost Minimization ◽  
Radio Link ◽  
Effective Utilization ◽  
Receiving Antenna ◽  
Relative Field ◽  
Reception System ◽  
The Cost ◽  
Selection Of

This paper presents brief record on Adaptive Receiving Antenna (ARA) system for functional remote networking. The selection of acute/adaptable reception system in infinite remote wireless frameworks is required to significantly affect the effective utilization of the dimensions, the cost minimization of creating new remote systems, the optimization of appropriate framework quality and acknowledgment of guileless movement of the nodes over multi innovation remote systems. This paper presents brief record on a keen Radio Link Framework (RLF). ARAs can put nulls toward interferers through adaptable system of load connected to every radio terminal component. ARAs in this way counterbalance the majority of the co-direct obstruction bringing about better cover of cells and lower dropped calls. The paper further clarifies about the radiation scenario of the receiving end and why it is exceptionally favored in its relative field. The capacities of acute/adaptable reception system are effectively employable to Cognitive Radio and OFDMA framework.

scholarly journals Análisis multicriterio de preferencias sociales en gestión hídrica bajo la Directiva Marco del Agua

2011 ◽  
Vol 8 (2) ◽  
pp. 105 ◽  
Author(s):  
P. Mesa ◽  
J. Martín-Ortega ◽  
J. Berbel
Keyword(s):  
Water Management ◽  
Cost Effectiveness ◽  
Analytic Hierarchy ◽  
Effectiveness Analysis ◽  
Management Measures ◽  
The Cost ◽  
Guadalquivir River ◽  
Hierarchy Process ◽  
Multicriteria Decision Support ◽  
Selection Of

This work aims to contribute to the implementation of the WFD with regard to the selection of the measures for a sustainable and socially accepted water management. A multicriteria decision support exercise is applied to the Guadalquivir River Basin in order to test the applicability of the Analytic Hierarchy Process in the new WFD context. A survey was carried out in the context of a future enlargement of La Breña reservoir (Córdoba). This analysis aims to obtain the public’s weight of the criteria in water management, in order to assess the legitimacy of the reservoir enlargement, as well as other management measures. Results suggest that the AHP is an adequate tool for the WFD purposes and a useful complement for the cost-effectiveness analysis.

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