Cost-Effectiveness and Value-Based Pricing of Aducanumab for Patients With Early Alzheimer Disease

Introduction:Aducanumab was granted accelerated approval with a conflicting evidence base, near-unanimous FDA Advisory Committee vote to reject approval, and a widely criticized launch price of $56,000 per year. The objective of this analysis was to estimate its cost-effectiveness.Methods:We developed a Markov model to compare aducanumab in addition to supportive care to supportive care alone over a lifetime horizon. Results were presented from both the health system and modified societal perspective. The model tracked the severity of disease and the care setting. Incremental cost-effectiveness ratios were calculated, and a threshold analysis was conducted to estimate at what price aducanumab would meet commonly used cost-effectiveness thresholds.Results:Using estimates of effectiveness based on pooling of data from both pivotal trials, patients treated with aducanumab spent four more months in earlier stages of AD. Over the lifetime time horizon, treating a patient with aducanumab results in 0.154 more QALYs gained per patient and 0.201 evLYGs per patient from the health care system perspective, with additional costs of approximately $204,000 per patient. The incremental outcomes were similar for the modified societal perspective. At the list price of $56,000 per year, the cost-effectiveness ranged from $1.02 million per evLYG to $1.33 million per QALY gained from the health care system perspective; and from $938,000 per evLYG to $1.27 million per QALY gained in the modified societal perspective. The annual price to meet commonly used cost-effectiveness thresholds ranged from $2,950 to $8,360, which represents a discount of 85-95% off from the annual launch price set by the manufacturer. Using estimates of effectiveness based only on the trial that suggested a benefit, the mean incremental cost was greater than $400,000 per QALY gained.Discussion:Patients treated with aducanumab received minimal improvements in health outcomes at considerable cost. This resulted in incremental cost-effectiveness ratios that far exceeded commonly used value thresholds, even under optimistic treatment effectiveness assumptions. These findings are subject to the substantial uncertainty regarding whether aducanumab provides any true net health benefit, but evidence available currently suggests that an annual price of aducanumab of $56,000 is not in reasonable alignment with its clinical benefits.

Universal Dental Adhesives: Cost-Effectiveness and Duration of Use

The purpose of this study was to conduct a cost-effectiveness analysis (CEA) of different brands of universal dental adhesives used for composite restorations. Four adhesive brands were included: Single-Bond Universal (SB), Tetric N-Bond Universal VivaPen (TN), OptiBond All-In-One (OB), and G-Premio Bond (GP). Adhesives were applied 5 times daily in a standardized class II cavity onto a plastic tooth. A precision-analysis scale was used to measure all of the following parameters before and after use: adhesive bottle, applicator, dosing plate, and plastic tooth. CEA was done by measuring the amount of material utilized/day, waste/day, efficacy, efficiency, average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER). Data were analyzed using Kruskal–Wallis and Dunn’s tests with Bonferroni correction at 0.05 significance level. CEA tested parameters were significantly different between groups (p < 0.001) except for ICER (p = 0.112). GP was the least effective (median = 0.062), and SB was the least efficient (median = 0.366). The highest and lowest ACER values were associated with TN (median cost ≈ USD 317) and SB (median cost ≈ USD 317), respectively. ICER analysis reported an incremental cost for extra material utilized per milliliter of ≈USD 208 for TN, USD 3.8 for GP, and USD −38 for OB, compared to SB. TN seems to be the most efficient and cost-effective dental adhesive.

COVID-19 Vaccines Cost-Effectiveness Analysis: A Scenario for Iran

COVID-19 vaccines are supposed to be critical measure for ending the pandemic. Governments had to decide on the type of vaccine to provide for their population. In this decision-making process, cost-effectiveness analysis is considered a helpful tool. This study is a cost-effectiveness analysis utilized to calculate the incremental cost per averted disability-adjusted life year (DALY) by vaccination compared to no vaccination for different COVID-19 vaccines. The incremental cost-effectiveness ratio (ICER) for a vaccination with COVID-19 vaccines was estimated at 6.2 to 121.2 USD to avert one DALY and 566.8 to 10,957.7 USD per one death. The lowest and highest ICERs belong to Ad26.COV2.S and CoronaVac, respectively. Considering the scenario of Iran, vaccines that are recommended include ad26.cov2.s, chadox1-S, rAd26-S + rAd5-S, and BNT162b2 in the order of recommendation.

Cost-effectiveness of meningococcal vaccination of infants in the Russian Federation

Generalized forms of invasive meningococcal desease (IMD) are very dangerous because they have a high mortality rate.The aim of the work was to assess the cost-effectiveness of meningococcal vaccination of infants with the 4-valent MenACWY-D conjugate vaccine in the Russian Federation.Material and methods. Cost-effectiveness analysis based on epidemiological data for the Russian Federation was carried out by a modeling method with a horizon of 80 years from the position of the healthcare system and taking into account the social perspective. Vaccination costs were calculated on the basis of the registered price of the vaccine, including VAT, the costs of GFMI therapy and patient rehabilitation – based on the compulsory medical insurance tariffs in St. Petersburg for 2021. Indirect costs due to temporary disability of patients’ parents, disability of patients and premature death were estimated by the lost GDP. In the base case, costs were discounted by 3,5% per year, life expectancy – by 1,5% per year.Results. Given the assumptions made, the average lifetime burden of a child’s illness is 17,556 million rubles. (no discounting). In the base case, the incremental cost per LYG from the payer perspective – 7,821 million rubles, and from the social perspective – 3,328 million rubles. Incremental cost per QALY – 5,350 million rubles and 2,277 million rubles, respectively. The most important factors that have a significant impact on the cost-effectiveness of vaccination are the incidence of IMD, the price of the vaccine, and the value of the discounting of costs and life expectancy.Conclusions. Given the assumptions made, meningococcal vaccination of infants with 4-valent meningococcal vaccine can be considered as a viable option.

Clinical and economic impact of an alert system in primary care for the detection of patients with chronic hepatitis C

Introduction Prevalence of chronic hepatitis C (CHC) is higher in patients born between 1955–1975. The aim was to perform an economic evaluation of an age-based electronic health record (EHR) alert in primary care to detect patients with undiagnosed CHC and its treatment in comparison with non-use of the alert system, in Valencian Community, Spain. Materials and methods Decision trees and Markov model were used to evaluate the diagnosis and progression of the disease, respectively. CHC was diagnosed by serology and viral load in seropositive subjects. Epidemiological data and diagnostic costs were extracted from public sources of the Valencian Community. Probabilities, utilities and costs of model states were obtained from the literature. The impact on mortality and hepatic complications avoided by the implementation of the alert were estimated, and efficiency was measured as an incremental cost-utility ratio (ICUR) based on quality-adjusted life years (QALYs) and the costs of both alternatives. Results The EHR alert detected 269,548 patients, of whom 1,331 had CHC (vs. 23 patients with non-alert). Over the patients’ lifetime, the alert would prevent 93% of decompensated cirrhosis cases, 87% of hepatocellular carcinomas, 90% of liver transplants, and 89% of liver related deaths compared to non-use of the alert system. In addition, it would obtain an additional 3.3 QALY per patient, with an incremental cost of €10,880 and an ICUR of €3,321. Conclusions The implementation of an age-based EHR alert in primary care to detect patients with CHC reduces hepatic complications and mortality and is an efficient strategy.

Cost-effectiveness analysis of COVID-19 vaccination in Poland

IntroductionTo assess the potential value of the Comirnaty COVID-19 vaccination in Poland.Material and methodsMarkov model with 1-week cycles was used to estimate patient events, direct medical costs, utilities and cost-effectiveness for one year with and without implementing the Comirnaty vaccine in Poland. The incremental cost per quality-adjusted life-year (QALY) gained vs. no vaccine was calculated for the general population as well as for selected age-groups.ResultsIn the base case analysis the incremental cost per QALY gained associated with vaccinating the whole population amounted 6,249 PLN. For individuals aged 60-69 and >80 vaccination proved to be less costly and more effective than no vaccination. The incremental cost per QALY gained when vaccinating individuals aged 40-49 and 30-39 amounted 28,135 PLN and 67,823 PLN, respectively. In the general population and in younger subpopulations the incremental cost-effectiveness ratio was most sensitive to the vaccine effectiveness, vaccine price and SARS-CoV-2 infection rates.ConclusionsWhen prioritization is required due to supply constraints, vaccination of elderly is justified as it allows to achieve highest number of QALY gained and generates savings to the health care system. Continual update of the model concerning vaccine real-life effectiveness and epidemic course is required to refine the prioritisation scheme in the future.

Cost–Utility Analysis of Wide-Field Imaging as an Auxiliary Technology for Retinopathy of Prematurity Care in Brazil

Purpose: To evaluate the cost–utility of wide-field imaging (WFI) as a complementary technology for retinopathy of prematurity (ROP) screening from the Brazilian Unified Health System's perspective.Introduction: ROP is one of the leading causes of avoidable childhood blindness worldwide, especially in middle-income countries. The current ROP screening involves indirect binocular ophthalmoscopy (IBO) by ROP expert ophthalmologists. However, there is still insufficient ROP screening coverage. An alternative screening strategy is the combination of WFI with IBO.Methods: A cost–utility analysis was performed using a deterministic decision-tree simulation model to estimate incremental cost–utility for ROP care. Two screening strategies were compared: (1) IBO and (2) combination of WFI of all eligible preterm infants and IBO for type 2 ROP or worse and for non-readable images. Eligible population included preterm infants &lt;32 weeks of gestational age or birth weight equal to or &lt;1,500 g. The temporal horizon was lifetime. Visual outcome data was converted to utility, and the health benefits were estimated on quality-adjusted life-years (QALY). Incremental cost per QALY gained was calculated from the health system perspective. Costs were estimated considering equipment, maintenance, consumables, and staff. A micro-costing approach was used for WFI. Two technician nurses were trained for imaging execution and had their time evaluated. Two ROP expert ophthalmologists had their time evaluated for imaging reading. One-way sensitivity analysis and probabilistic sensitivity analysis were performed.Results: Combined screening strategy resulted in a cost-effective program considering 90% ROP screening coverage. Costs per examination: (1) screening with IBO: US dollar (US $) 34.36; (2) screening with combination: US $58.20; (3) laser treatment: US $642.09; (4) long-term follow-up: ranged from US $69.33 to 286.91, based on the infant's visual function. Incremental cost per QALY gained was US $1,746.99/QALY per infant screened with the combination strategy. One-way sensitivity analysis resulted in cost-effectiveness for all parameters. Probabilistic sensitivity analyses yielded a 100% probability of combination being cost-effective in a willingness-to-pay threshold of US $1,800/QALY.Conclusion: The combined strategy for ROP screening was cost-effective. It enhances access for appropriate ROP care in middle-income countries and dminishes opportunity costs for ophthalmologists.

Use of the Ring Wound Protector in Open Appendectomy: A Model-Based Cost-Utility Analysis

Objective: To evaluate cost-effectiveness of ring wound protector (RWP) used in open appendectomy. Materials and Methods: The present study was a decision-tree-based analysis. Model inputs, including costs, utilities, and probabilities of surgical site infection (SSI), were retrieved from the previous studies. The incremental cost-effectiveness ratio (ICER) represented the cost of one additional quality-adjusted life day (QALD). This ratio was calculated by dividing the incremental cost [Thai Baht (THB)] by the incremental QALD. One-way sensitivity analyses were performed by varying each input parameter to see how ICER change. Monte-Carlo simulation with 5,000 replications was used to estimate probabilistic ICER and construct the acceptability curve, demonstrating how the probability of being cost-effective changed when the willingness-to-pay (WTP) threshold was shifted. Results: The deterministic ICER of 64,630.78 THB/QALD did not favor RWP use compared with the WTP threshold of 10,000 THB/QALD. However, if the threshold was shifted to 100,000 THB/QALD, it would yield approximately 75% probability of being cost-effective from RWP. Threshold analysis indicated that RWP should cost 281, 301, and 661 THB to be cost-effective at the threshold of 500, 1,000, and 10,000 THB/QALD, respectively. Conclusion: Routine RWP use might not be cost-effective when QALD is the outcome of interest. Based on the results from the present study, policy-makers could be informed that the adoption of this health technology might not be suitable. Keywords: Ring wound protector; Appendectomy; Cost-utility analysis; Decision tree model