Modeling the cost-effectiveness and budgetary impact for subpopulations

Modelling the cost effectiveness of treatments for Parkinson's disease: a methodological review

The objective of this review was to assess models of cost effectiveness for Parkinson's disease (PD) published after July 2002 and to derive recommendations for future modelling. A systematic literature search was performed in the databases PubMed, Current Contents, EMBASE, EconLit, the Cochrane Database of Systematic Reviews, and DARE (Database of Abstracts of Reviews of Effectiveness), NHS EED (Economic Evaluation Database) and HTA (Health Technology Assessment) of the UK NHS Centre for Review and Dissemination (July 2002 to March 2010). Only fully published studies using decision trees, Markov models, individual simulation models or sets of mathematical equations were included. Most of the 11 studies identified used Markov models (n = 9) and two employed were based on decision trees. Based on the Hoehn & Yahr (HY) scale, authors evaluated the cost effectiveness of drug treatments (n = 6), surgical approaches such as deep brain stimulation (n = 1) or striatal cell grafting (n = 1), and diagnostic procedures such as single photon emission computed tomography (SPECT) testing (n = 3) over a time horizon of 1 year to lifetime. Costs were adapted to address a societal and/or healthcare provider/third-party payer perspective. All but one of the interventions investigated were considered cost effective or cost saving. Cost-effectiveness modelling in PD between 2003 and 2010 showed only minor improvement when compared with our earlier review of models published from 1998 up to 2003. Cost-effectiveness modelling recommendations were complied with to only a limited extent, leaving room for quality improvement. More advanced modelling approaches may, so far, be under-represented, but may be used in the future, driven by the research question. Adverse events of treatment, co-morbidities or disease complications are not yet sufficiently included in the models to adequately represent clinical reality.

[Budget impact analysis of the treatment of chronic hepatitis C in a hospital]

OBJECTIVE

To perform a budget impact analysis (BIA) of the treatment with pegylated interferon (pegIFN), alfa-2a or alfa-2b, plus ribavirin in patients with chronic hepatitis C (CHC).

METHOD

An interactive model has been designed from the inputs obtained from hospital databases. Prices for pegIFN and RIB have been taken from the hospitals considering their respective discounts. Only pharmacological costs (euros 2005 values) for the options have been considered. Both strategies have been considered as therapeutic equivalents.

RESULTS

The number of patients with CHC evaluated in the model has been of 117, with an average age of 42 years and an average weight of 75 kg. The genotypes of the patients were: G1/4, 85% and; G2/3, 15%. Discontinuation of the treatment at week 12 took place in 26% of the patients. The average duration of treatment has been of 37 weeks. Total cost of the 117 evaluated patients ranged between 942,632-952,109 and 861,646-880,751 euros for the treatment with pegIFN alfa-2a + RIB and pegIFN alfa-2b + RIB, respectively.

CONCLUSIONS

BIA models can be useful for the inclusion or reassessment of drugs in formularies. In this case, the treatment with pegIFN alfa-2b + RIB (in comparison with pegIFN alfa-2a + RIB) is an efficient strategy although it depends on acquisition prices, and so, it would be rarely useful in other centres. In our hospital it would produce a budgetary saving that would range from 71,358 to 80,986 euros, which would represent a 7.5-8.6% of the total cost of the pharmacological treatment of the CHC.