1
|
James K, Lisk S, Payne-Cook C, Farishta Z, Farrelly M, Sheikh A, Slusarczyk M, Byford S, Day C, Deighton J, Evans C, Fonagy P, Saunders D, Sclare I, Shearer J, Stallard P, Weaver T, Yarrum J, Carter B, Brown JSL. Brief Educational Workshops in Secondary Schools Trial (BESST trial), a school-based cluster randomised controlled trial of the DISCOVER workshop for 16-18-year-olds: recruitment and baseline characteristics. Trials 2024; 25:302. [PMID: 38702825 PMCID: PMC11069277 DOI: 10.1186/s13063-024-08116-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/15/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The Brief Educational Workshops in Secondary Schools Trial (BESST) is an England-wide school-based cluster randomised controlled trial assessing the clinical and cost-effectiveness of an open-access psychological workshop programme (DISCOVER) for 16-18-year-olds. This baseline paper describes the self-referral and other recruitment processes used in this study and the baseline characteristics of the enrolled schools and participants. METHOD We enrolled 900 participants from 57 Secondary schools across England from 4th October 2021 to 10th November 2022. Schools were randomised to receive either the DISCOVER day-long Stress workshop or treatment as usual which included signposting information. Participants will be followed up for 6 months with outcome data collection at baseline, 3-month, and 6-month post randomisation. RESULTS Schools were recruited from a geographically and ethnically diverse sample across England. To reduce stigma, students were invited to self-refer into the study if they wanted help for stress. Their mean age was 17.2 (SD = 0.6), 641 (71%) were female and 411 (45.6%) were from ethnic minority groups. The general wellbeing of our sample measured using the Mood and Feelings Questionnaire (MFQ) found 314 (35%) of students exhibited symptoms of depression at baseline. Eighty percent of students reported low wellbeing on the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) suggesting that although the overall sample mean is below the cut-off for depression, the self-referral approach used in this study supports distressed students in coming forward. CONCLUSION The BESST study will continue to follow up participants to collect outcome data and results will be analysed once all the data have been collected. TRIAL REGISTRATION ISRCTN registry ISRCTN90912799. Registered on 28 May 2020.
Collapse
Affiliation(s)
- Kirsty James
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- Department of Biostatistics and Health Informatics, & King's Clinical Trials Unit (KCTU), Institute of Psychiatry Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK
| | - Stephen Lisk
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | | | | | - Maria Farrelly
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Ayesha Sheikh
- Anna Freud Centre for Children and Families, London, UK
| | - Monika Slusarczyk
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Sarah Byford
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Crispin Day
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
- Southwark CAMHS Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Claire Evans
- Anna Freud Centre for Children and Families, London, UK
| | - Peter Fonagy
- Anna Freud Centre for Children and Families, London, UK
- Department of Clinical Educational and Health Psychology, University College London, London, UK
| | | | - Irene Sclare
- Southwark CAMHS Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - James Shearer
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | | | | | | | - Ben Carter
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
- Department of Biostatistics and Health Informatics, & King's Clinical Trials Unit (KCTU), Institute of Psychiatry Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK.
| | - June S L Brown
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| |
Collapse
|
2
|
Walter E, Dawoud C, Hütterer E, Stift A, Harpain F. Cost-effectiveness of teduglutide in adult patients with short bowel syndrome - a European socioeconomic perspective. Am J Clin Nutr 2024; 119:1187-1199. [PMID: 38431119 PMCID: PMC11130673 DOI: 10.1016/j.ajcnut.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Short bowel syndrome with intestinal failure (SBS-IF) is a rare but devastating medical condition. An absolute loss of bowel length forces the patients into parenteral support dependency and a variety of medical sequelae, resulting in increased morbidity and mortality. Interdisciplinary treatment may include therapy with the effective but expensive intestinotrophic peptide teduglutide. OBJECTIVES A time-discrete Markov model was developed to simulate the treatment effect [lifetime costs, quality-adjusted life years (QALYs), and life years (LYs)] of teduglutide plus best supportive care compared with best supportive care alone in patients with SBS-IF. METHODS The health status of the model was structured around the number of days on PS. Clinical data from 3 data sets were used: 1) an Austrian observational study (base case), 2) pooled observational cohort studies, and 3) a prospective study of teduglutide effectiveness in parenteral nutrition-dependent short bowel syndrome subjects. Direct and indirect costs were derived from published sources. QALYs, LYs, and costs were discounted (3% per annum). RESULTS Under the base case assumption, teduglutide is associated with costs of 2,296,311 € per patient and 10.78 QALYs (13.74 LYs) over a lifetime horizon. No teduglutide is associated with 1,236,816 € and 2.24 QALYs (8.57 LYs). The incremental cost-utility ratio (ICUR) amounts to 123,945 €. In case of the pooled clinical data set, the ICUR increases to 184,961 €. If clinical data based on the study of teduglutide effectiveness in parenteral nutrition-dependent short bowel syndrome subjects were used, the ICUR increased to 235,612 €. CONCLUSIONS Teduglutide in treating patients with SBS-IF meets the traditional cost-effectiveness criteria from a European societal perspective. Nevertheless, the varying concentrations of teduglutide efficacy leave a degree of uncertainty in the calculations.
Collapse
Affiliation(s)
- Evelyn Walter
- IPF Institute for Pharmaeconomic Research, Vienna, Austria
| | - Christopher Dawoud
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Hütterer
- Division of Oncology, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Anton Stift
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Felix Harpain
- Division of Visceral Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
3
|
Dixon P, Martin RM, Harrison S. Causal Estimation of Long-term Intervention Cost-effectiveness Using Genetic Instrumental Variables: An Application to Cancer. Med Decis Making 2024; 44:283-295. [PMID: 38426435 PMCID: PMC10988994 DOI: 10.1177/0272989x241232607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND This article demonstrates a means of assessing long-term intervention cost-effectiveness in the absence of data from randomized controlled trials and without recourse to Markov simulation or similar types of cohort simulation. METHODS Using a Mendelian randomization study design, we developed causal estimates of the genetically predicted effect of bladder, breast, colorectal, lung, multiple myeloma, ovarian, prostate, and thyroid cancers on health care costs and quality-adjusted life-years (QALYs) using outcome data drawn from the UK Biobank cohort. We then used these estimates in a simulation model to estimate the cost-effectiveness of a hypothetical population-wide preventative intervention based on a repurposed class of antidiabetic drugs known as sodium-glucose cotransporter-2 (SGLT2) inhibitors very recently shown to reduce the odds of incident prostate cancer. RESULTS Genetic liability to prostate cancer and breast cancer had material causal impacts on either or both health care costs and QALYs. Mendelian randomization results for the less common cancers were associated with considerable uncertainty. SGLT2 inhibition was unlikely to be a cost-effective preventative intervention for prostate cancer, although this conclusion depended on the price at which these drugs would be offered for a novel anticancer indication. IMPLICATIONS Our new causal estimates of cancer exposures on health economic outcomes may be used as inputs into decision-analytic models of cancer interventions such as screening programs or simulations of longer-term outcomes associated with therapies investigated in randomized controlled trials with short follow-ups. Our method allowed us to rapidly and efficiently estimate the cost-effectiveness of a hypothetical population-scale anticancer intervention to inform and complement other means of assessing long-term intervention value. HIGHLIGHTS The article demonstrates a novel method of assessing long-term intervention cost-effectiveness without relying on randomized controlled trials or cohort simulations.Mendelian randomization was used to estimate the causal effects of certain cancers on health care costs and quality-adjusted life-years (QALYs) using data from the UK Biobank cohort.Given causal data on the association of different cancer exposures on costs and QALYs, it was possible to simulate the cost-effectiveness of an anticancer intervention.Genetic liability to prostate cancer and breast cancer significantly affected health care costs and QALYs, but the hypothetical intervention using SGLT2 inhibitors for prostate cancer may not be cost-effective, depending on the drug's price for the new anticancer indication. The methods we propose and implement can be used to efficiently estimate intervention cost-effectiveness and to inform decision making in all manner of preventative and therapeutic contexts.
Collapse
Affiliation(s)
- Padraig Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Richard M. Martin
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Sean Harrison
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- UK Health Security Agency
| |
Collapse
|
4
|
Ansaripour A, Moloney E, Branagan-Harris M, Patrone L, Javanbakht M. Digital variance angiography in patients undergoing lower limb arterial recanalization: cost-effectiveness analysis within the English healthcare setting. J Comp Eff Res 2024; 13:e230068. [PMID: 38517149 PMCID: PMC11044957 DOI: 10.57264/cer-2023-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/14/2024] [Indexed: 03/23/2024] Open
Abstract
Aim: Digital variance angiography (DVA) is a recently developed image processing method capable of improving image quality compared with the traditionally used digital subtraction angiography (DSA), among patients undergoing lower limb x-ray angiography. This study aims to explore the potential cost-effectiveness of DVA from an English National Health Service perspective. Materials & methods: A two-part economic model, consisting of a decision tree and a Markov model, was developed to consider the costs and health outcomes associated with the use of DVA as part of current practice imaging, compared with x-ray angiography using standard DSA. The model explored the impact of DVA on the development of acute kidney injury (AKI), chronic kidney disease and radiation-induced cancer over a lifetime horizon. Both deterministic and probabilistic analyses were performed to assess the cost per quality-adjusted life-year (QALY). Results: Base-case results indicate that DVA results in cost savings of £309 per patient, with QALYs also improving (+0.025) over a lifetime. As shown in sensitivity analysis, a key driver of model results is the relative risk (RR) reduction of contrast-associated acute kidney injury associated with use of DVA. The intervention also decreases the risk of carcinoma over a lifetime. Scenario analyses show that cost savings range from £310 to £553, with QALY gains ranging from 0.048 to 0.109 per patient. Conclusion: The use of DVA could result in a decrease in costs and an increase in QALYs over a lifetime, compared with existing imaging practice. The potential for this technology to offer an economically viable alternative to existing image processing methods, through a reduction in contrast media volume and radiation exposure, has been demonstrated.
Collapse
Affiliation(s)
- Amir Ansaripour
- Optimax Access Ltd, Hofplein, Rotterdam, 3032AC, The Netherlands
| | - Eoin Moloney
- Optimax Access Ltd, Kenneth Dibben House, Enterprise Rd, Chilworth, Southampton Science Park, Southampton, SO16 7NS, UK
| | - Michael Branagan-Harris
- Device Access Ltd, Market Access Consultancy, University of Southampton Science Park, Southampton, SO16 7NS, UK
| | - Lorenzo Patrone
- West London Vascular & Interventional Centre, London North West University Healthcare NHS Trust, Harrow, HA1 3UJ, UK
| | - Mehdi Javanbakht
- Optimax Access Ltd, Kenneth Dibben House, Enterprise Rd, Chilworth, Southampton Science Park, Southampton, SO16 7NS, UK
| |
Collapse
|
5
|
Höhn A, Lomax N, Rice H, Angus C, Brennan A, Brown D, Cunningham A, Elsenbroich C, Hughes C, Katikireddi SV, McCartney G, Seaman R, Tsuchia A, Meier P. Estimating quality-adjusted life expectancy (QALE) for local authorities in Great Britain and its association with indicators of the inclusive economy: a cross-sectional study. BMJ Open 2024; 14:e076704. [PMID: 38431294 PMCID: PMC10910677 DOI: 10.1136/bmjopen-2023-076704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVES Quantifying area-level inequalities in population health can help to inform policy responses. We describe an approach for estimating quality-adjusted life expectancy (QALE), a comprehensive health expectancy measure, for local authorities (LAs) in Great Britain (GB). To identify potential factors accounting for LA-level QALE inequalities, we examined the association between inclusive economy indicators and QALE. SETTING 361/363 LAs in GB (lower tier/district level) within the period 2018-2020. DATA AND METHODS We estimated life tables for LAs using official statistics and utility scores from an area-level linkage of the Understanding Society survey. Using the Sullivan method, we estimated QALE at birth in years with corresponding 80% CIs. To examine the association between inclusive economy indicators and QALE, we used an open access data set operationalising the inclusive economy, created by the System Science in Public Health and Health Economics Research consortium. RESULTS Population-weighted QALE estimates across LAs in GB were lowest in Scotland (females/males: 65.1 years/64.9 years) and Wales (65.0 years/65.2 years), while they were highest in England (67.5 years/67.6 years). The range across LAs for females was from 56.3 years (80% CI 45.6 to 67.1) in Mansfield to 77.7 years (80% CI 65.11 to 90.2) in Runnymede. QALE for males ranged from 57.5 years (80% CI 40.2 to 74.7) in Merthyr Tydfil to 77.2 years (80% CI 65.4 to 89.1) in Runnymede. Indicators of the inclusive economy accounted for more than half of the variation in QALE at the LA level (adjusted R2 females/males: 50%/57%). Although more inclusivity was generally associated with higher levels of QALE at the LA level, this association was not consistent across all 13 inclusive economy indicators. CONCLUSIONS QALE can be estimated for LAs in GB, enabling further research into area-level health inequalities. The associations we identified between inclusive economy indicators and QALE highlight potential policy priorities for improving population health and reducing health inequalities.
Collapse
Affiliation(s)
- Andreas Höhn
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Nik Lomax
- School of Geography, University of Leeds, Leeds, UK
| | - Hugh Rice
- School of Geography, University of Leeds, Leeds, UK
| | - Colin Angus
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Denise Brown
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anne Cunningham
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Corinna Elsenbroich
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ceri Hughes
- Manchester Institute of Education, The University of Manchester, Manchester, UK
| | | | - Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Rosie Seaman
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Aki Tsuchia
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| |
Collapse
|
6
|
Shinkins B, Allen AJ, Karichu J, Garrison LP, Monz BU. Evidence Synthesis and Linkage for Modelling the Cost-Effectiveness of Diagnostic Tests: Preliminary Good Practice Recommendations. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:131-144. [PMID: 38316713 PMCID: PMC10864520 DOI: 10.1007/s40258-023-00855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To develop preliminary good practice recommendations for synthesising and linking evidence of treatment effectiveness when modelling the cost-effectiveness of diagnostic tests. METHODS We conducted a targeted review of guidance from key Health Technology Assessment (HTA) bodies to summarise current recommendations on synthesis and linkage of treatment effectiveness evidence within economic evaluations of diagnostic tests. We then focused on a specific case study, the cost-effectiveness of troponin for the diagnosis of myocardial infarction, and reviewed the approach taken to synthesise and link treatment effectiveness evidence in different modelling studies. RESULTS The Australian and UK HTA bodies provided advice for synthesising and linking treatment effectiveness in diagnostic models, acknowledging that linking test results to treatment options and their outcomes is common. Across all reviewed models for the case study, uniform test-directed treatment decision making was assumed, i.e., all those who tested positive were treated. Treatment outcome data from a variety of sources, including expert opinion, were utilised for linked clinical outcomes. Preliminary good practice recommendations for data identification, integration and description are proposed. CONCLUSION Modelling the cost-effectiveness of diagnostic tests poses unique challenges in linking evidence on test accuracy to treatment effectiveness data to understand how a test impacts patient outcomes and costs. Upfront consideration of how a test and its results will likely be incorporated into patient diagnostic pathways is key to exploring the optimal design of such models. We propose some preliminary good practice recommendations to improve the quality of cost-effectiveness evaluations of diagnostics tests going forward.
Collapse
Affiliation(s)
- Bethany Shinkins
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
- Leeds Institute for Health Sciences, University of Leeds, Clarendon Way, Leeds, UK.
- NIHR Leeds In Vitro Diagnostics Co-operative (MIC), Leeds, UK.
| | - A Joy Allen
- Access and Innovation, Roche Diagnostics UK and Ireland, Burgess Hill, UK
| | - James Karichu
- Global Access & Policy, Roche Diagnostics Solutions, Pleasanton, California, USA
| | - Louis P Garrison
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, USA
| | - Brigitta U Monz
- Global Access & Policy, Roche Diagnostics International AG, Forrenstrasse 2, 6343, Rotkreuz, Switzerland
| |
Collapse
|
7
|
Galekop MMJ, Uyl-de Groot C, Redekop WK. Economic Evaluation of a Personalized Nutrition Plan Based on Omic Sciences Versus a General Nutrition Plan in Adults with Overweight and Obesity: A Modeling Study Based on Trial Data in Denmark. PHARMACOECONOMICS - OPEN 2024; 8:313-331. [PMID: 38113009 PMCID: PMC10883904 DOI: 10.1007/s41669-023-00461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Since there is no diet that is perfect for everyone, personalized nutrition approaches are gaining popularity to achieve goals such as the prevention of obesity-related diseases. However, appropriate choices about funding and encouraging personalized nutrition approaches should be based on sufficient evidence of their effectiveness and cost-effectiveness. In this study, we assessed whether a newly developed personalized plan (PP) could be cost-effective relative to a non-personalized plan in Denmark. METHODS Results of a 10-week randomized controlled trial were combined with a validated obesity economic model to estimate lifetime cost-effectiveness. In the trial, the intervention group (PP) received personalized home-delivered meals based on metabolic biomarkers and personalized behavioral change messages. In the control group these meals and messages were not personalized. Effects were measured in body mass index (BMI) and quality of life (EQ-5D-5L). Costs [euros (€), 2020] were considered from a societal perspective. Lifetime cost-effectiveness was assessed using a multi-state Markov model. Univariate, probabilistic sensitivity, and scenario analyses were performed. RESULTS In the trial, no significant differences were found in the effectiveness of PP compared with control, but wide confidence intervals (CIs) were seen [e.g., BMI (-0.07, 95% CI -0.51, 0.38)]. Lifetime estimates showed that PP increased costs (€520,102 versus €518,366, difference: €1736) and quality-adjusted life years (QALYs) (15.117 versus 15.106, difference: 0.011); the incremental cost-utility ratio (ICUR) was therefore high (€158,798 to gain one QALY). However, a 20% decrease in intervention costs would reduce the ICUR (€23,668 per QALY gained) below an unofficial gross domestic product (GDP)-based willingness-to-pay threshold (€47,817 per QALY gained). CONCLUSION On the basis of the willingness-to-pay threshold and the non-significant differences in short-term effectiveness, PP may not be cost-effective. However, scaling up the intervention would reduce the intervention costs. Future studies should be larger and/or longer to reduce uncertainty about short-term effectiveness. TRIAL REGISTRATION NUMBER ClinicalTrials.gov registry (NCT04590989).
Collapse
Affiliation(s)
| | - Carin Uyl-de Groot
- Erasmus Universiteit Rotterdam, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
| | - William Ken Redekop
- Erasmus Universiteit Rotterdam, Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
| |
Collapse
|
8
|
Cobiac LJ, Rogers NT, Adams J, Cummins S, Smith R, Mytton O, White M, Scarborough P. Impact of the UK soft drinks industry levy on health and health inequalities in children and adolescents in England: An interrupted time series analysis and population health modelling study. PLoS Med 2024; 21:e1004371. [PMID: 38547319 PMCID: PMC11008889 DOI: 10.1371/journal.pmed.1004371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 04/11/2024] [Accepted: 03/06/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND The soft drinks industry levy (SDIL) in the United Kingdom has led to a significant reduction in household purchasing of sugar in drinks. In this study, we examined the potential medium- and long-term implications for health and health inequalities among children and adolescents in England. METHODS AND FINDINGS We conducted a controlled interrupted time series analysis to measure the effects of the SDIL on the amount of sugar per household per week from soft drinks purchased, 19 months post implementation and by index of multiple deprivation (IMD) quintile in England. We modelled the effect of observed sugar reduction on body mass index (BMI), dental caries, and quality-adjusted life years (QALYs) in children and adolescents (0 to 17 years) by IMD quintile over the first 10 years following announcement (March 2016) and implementation (April 2018) of the SDIL. Using a lifetable model, we simulated the potential long-term impact of these changes on life expectancy for the current birth cohort and, using regression models with results from the IMD-specific lifetable models, we calculated the impact of the SDIL on the slope index of inequality (SII) in life expectancy. The SDIL was found to have reduced sugar from purchased drinks in England by 15 g/household/week (95% confidence interval: -10.3 to -19.7). The model predicts these reductions in sugar will lead to 3,600 (95% uncertainty interval: 946 to 6,330) fewer dental caries and 64,100 (54,400 to 73,400) fewer children and adolescents classified as overweight or obese, in the first 10 years after implementation. The changes in sugar purchasing and predicted impacts on health are largest for children and adolescents in the most deprived areas (Q1: 11,000 QALYs [8,370 to 14,100] and Q2: 7,760 QALYs [5,730 to 9,970]), while children and adolescents in less deprived areas will likely experience much smaller simulated effects (Q3: -1,830 QALYs [-3,260 to -501], Q4: 652 QALYs [-336 to 1,680], Q5: 1,860 QALYs [929 to 2,890]). If the simulated effects of the SDIL are sustained over the life course, it is predicted there will be a small but significant reduction in slope index of inequality: 0.76% (95% uncertainty interval: -0.9 to -0.62) for females and 0.94% (-1.1 to -0.76) for males. CONCLUSIONS We predict that the SDIL will lead to medium-term reductions in dental caries and overweight/obesity, and long-term improvements in life expectancy, with the greatest benefits projected for children and adolescents from more deprived areas. This study provides evidence that the SDIL could narrow health inequalities for children and adolescents in England.
Collapse
Affiliation(s)
- Linda J. Cobiac
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Nina T. Rogers
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Steven Cummins
- Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Richard Smith
- Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Oliver Mytton
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, United Kingdom
| | - Peter Scarborough
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK & NIHR Oxford Health Biomedical Research Centre at Oxford, Oxford, United Kingdom
| |
Collapse
|
9
|
Ochoa-Moreno I, Taheem R, Woods-Townsend K, Chase D, Godfrey KM, Modi N, Hanson M. Projected health and economic effects of the increase in childhood obesity during the COVID-19 pandemic in England: The potential cost of inaction. PLoS One 2024; 19:e0296013. [PMID: 38265978 PMCID: PMC10807834 DOI: 10.1371/journal.pone.0296013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND The prevalence of overweight and obesity in young children rose sharply during the COVID-19 pandemic. Here we estimate the potential future health and economic effects of these trends in England. METHODS Using publicly available annual Body Mass Index (BMI) data from 2006-2022, we calculated the increase in overweight/obesity prevalence (BMI ≥85th reference percentile) during the COVID-19 pandemic among children aged 4-5 and 10-11, and variation by deprivation and ethnicity. We projected the impact of child BMI trends on adult health measures to estimate added lifelong medical and social costs. RESULTS During 2020-2021 there were steep increases in overweight and obesity prevalence in children. By 2022, overweight and obesity prevalence in children aged 4-5 returned to expected levels based on pre-pandemic trends. However, overweight and obesity prevalence in children aged 10-11 persisted and was 4 percentage points (p<0.001) higher than expected, representing almost 56,000 additional children. The increase was twice as high in the most compared with the least deprived areas. The additional lifelong healthcare cost in this cohort will amount to £800 million with a cost to society of £8.7 billion. We did not find an increase in maternal obesity associated with the COVID-19 pandemic, however, prevalence grew faster in the post pandemic period. DISCUSSION The return of overweight and obesity prevalence to pre-pandemic trends in children aged 4-5 provides a clear policy target for effective intervention to tackle this growing and serious population health concern.
Collapse
Affiliation(s)
- Iván Ochoa-Moreno
- School of Human Development and Health, University of Southampton, Southampton, United Kingdom
- Centre for Health Economics, University of York, Heslington, United Kingdom
| | - Ravita Taheem
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, United Kingdom
- Southampton City Council, Civic Centre, Southampton, United Kingdom
| | - Kathryn Woods-Townsend
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, United Kingdom
- Southampton Education School, University of Southampton, Southampton, United Kingdom
| | - Debbie Chase
- Southampton City Council, Civic Centre, Southampton, United Kingdom
| | - Keith M. Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, United Kingdom
| | - Neena Modi
- Section of Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Mark Hanson
- School of Human Development and Health, University of Southampton, Southampton, United Kingdom
- Partnership for Maternal, Newborn and Child Health, WHO, Geneva, Switzerland
| |
Collapse
|
10
|
Choi W, Shim E. Evaluating the cost-effectiveness of HPV vaccination for adolescent girls in Japan: A comparison of 2-valent, 4-valent, and 9-valent HPV vaccines with consideration of cross-protection. Prev Med 2024; 178:107743. [PMID: 37866695 DOI: 10.1016/j.ypmed.2023.107743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE In April 2023, the Japanese Health Ministry panel approved the inclusion of the 9-valent human papillomavirus (9vHPV) vaccine in the National Immunization Program, alongside the 2-valent (2vHPV) and 4-valent HPV (4vHPV) vaccines. In response to this, we evaluated the cost-effectiveness of these three vaccines for routine immunization of girls aged 12-16 in Japan, considering the cross-protection of 2vHPV and 4vHPV vaccines. METHODS We constructed an age-structured mathematical model for HPV transmission, aiming to quantify the economic and epidemiological effects of various HPV vaccination strategies over a 70-year period in Japan. We determined incremental costs and quality-adjusted life years (QALYs) for each strategy, applying a 3% annual discount. Univariate and probabilistic sensitivity analyses were conducted to assess the uncertainty of our model results, with all evaluations done in 2023. RESULTS Our projections indicate that the HPV vaccination program in Japan will significantly reduce the incidence of HPV-related diseases. All HPV vaccination strategies, using the 2vHPV, 4vHPV, and 9vHPV vaccines, were found to be cost-effective compared to no vaccination, with incremental cost-effectiveness ratios of ¥971,447/QALY, ¥1,237,297/QALY, and ¥742,084/QALY, respectively. Direct comparisons between vaccines demonstrated that the 9vHPV vaccination was more cost-effective than the 2vHPV vaccination, whereas 4vHPV vaccination was dominated by 2vHPV vaccination. CONCLUSIONS Our study validates the cost-effectiveness of implementing the 9vHPV vaccine as the primary option over the 2vHPV or 4vHPV vaccine for girls in Japan. These findings underscore the need to improve the acceptance rate and coverage of HPV vaccinations in the country.
Collapse
Affiliation(s)
- Wongyeong Choi
- Department of Mathematics, Soongsil University, 369 Sangdoro, Dongjak-gu, Seoul 06978, Republic of Korea.
| | - Eunha Shim
- Department of Mathematics, Soongsil University, 369 Sangdoro, Dongjak-gu, Seoul 06978, Republic of Korea.
| |
Collapse
|
11
|
Fauchier L, Lamblin N, Tardu J, Bellier L, Groyer H, Ittah D, Chollet J, Linden S, Levy P. Public Health Impact and Cost-Effectiveness of Empagliflozin (JARDIANCE ®) in the Treatment of Patients with Heart Failure with Preserved Ejection Fraction in France, Based on the EMPEROR-Preserved Clinical Trial. PHARMACOECONOMICS - OPEN 2024; 8:19-30. [PMID: 37606866 PMCID: PMC10781654 DOI: 10.1007/s41669-023-00432-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION The efficacy and safety of empagliflozin in the treatment of heart failure with preserved ejection fraction (HFpEF) were demonstrated in the EMPEROR-Preserved trial, which showed a 21% reduction in combined risks of cardiovascular death or HF hospitalization [hazard ratio (HR) 0.79; 95% confidence interval (CI) 0.69-0.90, p < 0.001] and a 27% reduction in the total number of HF hospitalizations (HR 0.73; 95% CI 0.61-0.88, p < 0.001) compared with placebo. On the basis of these results, the present study aimed to assess the cost-effectiveness of empagliflozin + standard of care (SoC) compared with SoC alone in the treatment of HFpEF. METHODS A published Markov model was adapted to compare the health and economic outcomes in France, considering a collective perspective, in patients treated with empagliflozin in addition to SoC versus patients treated by SoC alone. The model simulated the intention-to-treat (ITT) population of the trial, transitioning between four mutually exclusive health states representing the quartiles of the Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS). For each arm, the model estimated (over a lifetime time horizon) the economics and the health outcomes (HF hospitalizations avoided, and life years and quality-adjusted life years (QALYs) gained) to calculate the incremental cost-effectiveness ratios (ICERs). The resources used were derived by pairing the FREnch Survey on HF (FRESH) cohort data to French health insurance claims data, and the utilities were derived on the basis of the EQ-5D-5L questionnaire valued on the French tariff. Both economic and health outcomes were discounted at a 2.5% annual rate. RESULTS The model predicted that treatment of HFpEF patients with empagliflozin would prevent, for 1000 patients treated, 74 HF hospitalizations and 15 deaths attributable to cardiovascular events, resulting on average in a gain of 1 month in overall survival (7.24 versus 7.16 years with placebo) and 0.11 QALYs (6.14 versus 6.03 with placebo). Empagliflozin costs were partially offset by the cost savings from avoided hospitalizations. The ICERs were €18,597 per life year gained and €13,980 per QALY gained. The sensitivity analyses conducted showed that empagliflozin has a 65% probability to be cost-effective under the €25,000/QALY threshold. CONCLUSIONS The base-case results showed that empagliflozin is a cost-effective strategy for management of HFpEF, in addition to the impact on public health by preventing HF-hospitalizations and deaths in France. Sensitivity analyses suggest that 65% of simulations are under the €25,000/QALY threshold.
Collapse
Affiliation(s)
- Laurent Fauchier
- Cardiology Department, CHU de Tours, Université de Tours, Tours, France
| | - Nicolas Lamblin
- Cardiology Department, CHU de Lille, Université de Lille, Lille, France
| | | | | | | | | | | | | | - Pierre Levy
- Université Paris Dauphine, Université PSL, LEDA [LEGOS], Paris, France
| |
Collapse
|
12
|
Elsisi GH, Mahmoud MMI, Al-Humood K, Al-Yousef A. Cost-effectiveness analysis of sodium zirconium cyclosilicate for hyperkalemia among patients with chronic kidney disease or heart failure in Kuwait. J Med Econ 2024; 27:253-265. [PMID: 38318718 DOI: 10.1080/13696998.2024.2314930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/02/2024] [Indexed: 02/07/2024]
Abstract
INTRODUCTION Our model was conducted from Kuwaiti payer's perspective to provide evidence on the cost-effectiveness of Sodium zirconium cyclosilicate (SZC) versus patiromer to correct and maintain serum potassium (K+) in combination with renin-angiotensin-aldosterone system inhibitors (RAASis) with different dose titration in patients with chronic kidney disease/heart failure (CKD/HF) with/without renal replacement therapy (RRT). METHODOLOGY The model was developed as a patient-level, fixed-time increment stochastic simulation to simulate the complexity of disease, including multiple coexisting and competing conditional risks. This model was established to compare SZC versus patiromer as a treatment for hyperkalemia (HK) among adult populations with underlying conditions of advanced CKD stages 3a-5 or HF to correct and maintain serum K + over a lifetime horizon. The clinical outcomes of SZC and patiromer were demonstrated through arm-specific K + trajectories extracted from the HARMONIZE trial and OPAL-HK trial, respectively. The utility data was captured from different studies. Direct medical cost was captured from local data from Kuwaiti hospitals. Sensitivity analyses were conducted to assess the uncertainty in the model. RESULTS Within different scenarios of CKD/HF, SZC was a cost-saving option, with/without RRT, whether one-off administration or repeated administration, except for one-off treatment administration among the HF cohort, which generated an incremental cost effectiveness ratio of KWD 331/quality adjusted life year (QALY). The incremental QALY of SZC ranged from 0.007 to 0.202. In addition, the savings observed with SZC fall within a range of KWD -60 to KWD -1,235 at serum K+ ≥ 5.1 mmol/L. CONCLUSION The evidence generated by our model recommends the inclusion of SZC as a treatment option to correct HK and maintain normal serum K + level for CKD/HF patients within the Kuwaiti healthcare system. The costs saved from reducing frequent HK episodes, RAASis discontinuation/down titration, major cardiovascular events, and hospitalization offset the drug acquisition cost of SZC.
Collapse
Affiliation(s)
- Gihan Hamdy Elsisi
- HTA Office, LLC, Cairo, Egypt
- Health Economics, American University in Cairo, Cairo, Egypt
| | | | | | - Anas Al-Yousef
- Head of Cardiology Department, Adan Hospital - MOH, Kuwait
| |
Collapse
|
13
|
Werbrouck A, Schmidt M, Putman K, Simoens S, Verhaeghe N, Annemans L. Cost-Utility of an Exercise Referral Scheme Versus Doing Nothing in Flemish Adults: Exploring the Impact of Key Assumptions. J Phys Act Health 2024; 21:59-67. [PMID: 37879617 DOI: 10.1123/jpah.2023-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/30/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND This health-economic evaluation assessed the cost-effectiveness of an exercise referral scheme (ERS) versus doing nothing in the Flemish region (Belgium), with a particular focus on the impact of several scenarios. METHODS A 14-state Markov model was applied to compare the expected costs and quality-adjusted life years (QALYs) of 2 alternatives: the Flemish ERS (2019 data, mean age 52 y, 69.1% women) and doing nothing. A health care payer perspective was adopted and a lifetime time horizon was applied. A set of 18 scenario analyses is presented. In addition, univariate and probabilistic sensitivity analyses were performed. RESULTS Under the assumptions selected for the base-case analysis, the Flemish ERS is moderately cost-effective compared with doing nothing, with an incremental cost-utility ratio of €28,609/QALY. Based on the scenario analyses, the results largely depend on the assumptions regarding the continuation of the intervention effect and the frequency with which the intervention is repeated. The greatest health gains can be made when a sustainable behavioral change is achieved among participants. The probabilistic sensitivity analysis confirmed that the cost-effectiveness results were not robust. CONCLUSIONS If it is possible to induce a sustainable behavioral change with an intervention delivered at 2- or 5-year intervals, then the Flemish ERS is potentially cost-effective compared with doing nothing (given a €40,000/QALY threshold). These results suggest the importance of repeated implementation of the program together with careful monitoring of the adherence and the sustainability of the observed effects in a real-world setting.
Collapse
Affiliation(s)
- Amber Werbrouck
- Interuniversity Centre for Health Economics Research, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
- Interuniversity Centre for Health Economics Research, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Masja Schmidt
- Interuniversity Centre for Health Economics Research, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Koen Putman
- Interuniversity Centre for Health Economics Research, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Nick Verhaeghe
- Interuniversity Centre for Health Economics Research, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
- Interuniversity Centre for Health Economics Research, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieven Annemans
- Interuniversity Centre for Health Economics Research, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| |
Collapse
|
14
|
Croghan SM, Malcolm R, Flood HD, Mealing S, Avey B, Leonard G, Wright J, Davis NF, Walsh MT. Cost-effectiveness of a novel urethral catheter safety device in preventing catheterization injuries in the UK. J Med Econ 2024; 27:154-164. [PMID: 38126355 DOI: 10.1080/13696998.2023.2298121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
AIMS Intraurethral catheter balloon inflation is a substantial contributor to significant catheter-related urethral injury. A novel safety valve has been designed to prevent these balloon-inflation injuries. The purpose of this evaluation was to assess the cost-effectiveness of urethral catheterisation with the safety valve added to a Foley catheter versus the current standard of care (Foley catheter alone). MATERIALS AND METHODS The analysis was conducted from the UK public payer perspective on a hypothetical cohort of adults requiring transurethral catheterization. A decision tree was used to capture outcomes in the first 30 days following transurethral catheterization, followed by a Markov model to estimate outcomes over a person's remaining lifetime. Clinical outcomes included catheter balloon injuries [CBIs], associated short-term complications, urethral stricture disease, life years and QALYs. Health-economic outcomes included total costs, incremental cost-effectiveness ratio, net monetary benefit (NMB) and net health benefit. RESULTS Over a person's lifetime, the safety valve was predicted to reduce CBIs by 0.04 per person and CBI-related short-term complications by 0.03 per person, and nearly halve total costs. The safety valve was dominant, resulting in 0.02 QALYs gained and relative cost savings of £93.19 per person. Probabilistic sensitivity analysis indicated that the safety valve would be cost-saving in 97% of simulations run versus standard of care. CONCLUSIONS The addition of a novel safety valve aiming to prevent CBIs during transurethral catheterization to current standard of care was estimated to bring both clinical benefits and cost savings.
Collapse
Affiliation(s)
- Stefanie M Croghan
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | | | | | | | - Brooke Avey
- York Health Economics Consortium, Heslington, UK
| | | | | | - Niall F Davis
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Michael T Walsh
- Bernal Institute and Health Research Institute, University of Limerick, Limerick, Ireland
| |
Collapse
|
15
|
Abdelhameed F, Pearson E, Parsons N, Barber TM, Panesar A, Summers C, de la Fosse M, Hanson P. Health Outcomes Following Engagement With a Digital Health Tool Among People With Prediabetes and Type 2 Diabetes: Prospective Evaluation Study. JMIR Diabetes 2023; 8:e47224. [PMID: 38016426 PMCID: PMC10784975 DOI: 10.2196/47224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Diabetes is a worldwide chronic condition causing morbidity and mortality, with a growing economic burden on health care systems. Complications from poorly controlled diabetes are associated with increased socioeconomic costs and reduced quality of life. Smartphones have become an influential platform, providing feasible tools such as health apps to deliver tailored support to enhance the ability of patients with diabetes for self-management. Gro Health is a National Health Service division X-certified digital health tool used to deliver educational and monitoring support to facilitate the development of skills and practices for maintaining good health. OBJECTIVE This study aims to assess self-reported outcomes of the Gro Health app among users with diabetes and prediabetes and identify the factors that determine engagement with the digital health tool. METHODS This was a service evaluation of self-reported data collected prospectively by the developers of the Gro Health app. The EQ-5D questionnaire is a standardized tool used to measure health status for clinical and economic appraisal. Gro Health users completed the EQ-5D at baseline and 6 months after using the app. Users provided informed consent for the use of their anonymized data for research purposes. EQ-5D index scores and visual analogue scale (VAS) scores were calculated at baseline and 6 months for individuals with prediabetes and type 2 diabetes. Descriptive statistics and multiple-regression models were used to assess changes in the outcome measures and determine factors that affected engagement with the digital tool. RESULTS A total of 84% (1767/2114) of Gro Health participants completed EQ-5D at baseline and 6 months. EQ-5D index scores are average values that reflect people's preferences about their health state (1=full health and 0=moribund). There was a significant and clinically meaningful increase in mean EQ-5D index scores among app users between baseline (0.746, SD 0.23) and follow-up (0.792, SD 0.22; P<.001). The greatest change was observed in the mean VAS score, with a percentage change of 18.3% improvement (61.7, SD 18.1 at baseline; 73.0, SD 18.8 at follow-up; P<.001). Baseline EQ-5D index scores, age, and completion of educational modules were associated with significant changes in the follow-up EQ-5D index scores, with baseline EQ-5D index scores, race and ethnicity, and completion of educational modules being significantly associated with app engagement (P<.001). CONCLUSIONS This study provides evidence of a significant positive effect on self-reported quality of life among people living with type 2 diabetes engaging with a digital health intervention. The improvements, as demonstrated by the EQ-5D questionnaire, are facilitated through access to education and monitoring support tools within the app. This provides an opportunity for health care professionals to incorporate National Health Service-certified digital tools, such as Gro Health, as part of the holistic management of people living with diabetes.
Collapse
Affiliation(s)
- Farah Abdelhameed
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Eilish Pearson
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Nick Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Thomas M Barber
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Arjun Panesar
- Diabetes Digital Media Health, Coventry, United Kingdom
| | | | | | - Petra Hanson
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| |
Collapse
|
16
|
Söderpalm AC, Montgomery F, Helander KN, Cöster MC. Hallux valgus; An observational study on patient characteristics, surgical treatment and pre-operative HRQoL from the Swedish foot and ankle register (Swefoot). Foot (Edinb) 2023; 57:102060. [PMID: 37922633 DOI: 10.1016/j.foot.2023.102060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/21/2023] [Accepted: 10/29/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Hallux valgus (HV) is a common condition with impact on pain, function and HrQoL. International consensus does not exist on operative treatment of HV and population-level data regarding surgical treatment of HV is lacking. In this study we aimed to present base-line data from surgically treated HV patients reported to the Swedish register for foot and ankle surgery (Swefoot) during the period 2014-2021. MATERIAL AND METHODS In total, 7543 feet in 6770 patients were analyzed regarding patient characteristics, grading of HV, surgical procedures and pre-operative PROMs Euroqol-5 Dimension-3 L (EQ-5D-3 L) and Self-reported Foot and Ankle Score (SEFAS). RESULTS Median age was 55 years (range 15-91) and 87% were women. The surgeon classified 63% of the cases as moderate HV, 15% as mild and 22% as severe. The Chevron osteotomy was the preferred surgical method and was used in 74% of all cases. Out of these, 58% were fixated with a screw. The Offset-V osteotomy was the most performed shaft osteotomy. Proximal osteotomies and lateral releases were less common. The pre-operative mean EQ-5D-3 L index and SEFAS summary score were low and HV patients with overweight and rheumatoid arthritis had significantly lower scores. CONCLUSION This is the first report from Swefoot describing surgeon- and patient reported pre-operative data in patients with surgical treated HV.
Collapse
Affiliation(s)
- Ann-Charlott Söderpalm
- Capio Orthocenter, Gothenburg, Sweden; Department of Orthopedics and Clinical Sciences in Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
| | - Fredrik Montgomery
- Department of Orthopedics and Clinical Sciences in Malmö, Lund University, Sweden
| | - Katarina Nilsson Helander
- Department of Orthopedics and Clinical Sciences in Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Maria C Cöster
- Department of Orthopedics and Clinical Sciences in Malmö, Lund University, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Capio Movement, Halmstad, Sweden
| |
Collapse
|
17
|
Kolovos S, Bellanca L, Groyer H, Rosano GM, Solé A, Gaultney J, Linden S. Multinational cost-effectiveness analysis of empagliflozin for heart failure patients with ejection fraction >40. ESC Heart Fail 2023; 10:3385-3397. [PMID: 37670496 PMCID: PMC10682900 DOI: 10.1002/ehf2.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/02/2023] [Accepted: 06/21/2023] [Indexed: 09/07/2023] Open
Abstract
AIMS Heart failure is a chronic progressive condition, with considerable burden on patients' quality of life and economic burden for the healthcare systems. Before the approval of empagliflozin, there were no proven effective treatments for patients with heart failure with left ventricular ejection fraction (HF LVEF) > 40%. The aim of this study was to evaluate the cost-effectiveness of empagliflozin + standard of care (SoC) compared with SoC alone for patients with HF LVEF > 40%, from the perspective of the healthcare systems of the United Kingdom (UK), Spain, and France, and to quantify the healthcare costs for these patients. METHODS AND RESULTS A lifetime Markov cohort state-transition model was developed based on discrete health states defined by Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score quartiles to track disease severity. Model inputs relied primarily on the EMPEROR-Preserved trial data or obtained from published literature or country-specific databases, as well as local guidelines for the requirements for the conduct of the economic evaluation of healthcare technologies. The total lifetime cost of receiving SoC per patient was £10 092, €15 765, and €14 958 in the UK, Spain, and France, respectively, which increased by £1407, €1148, and €1485, respectively, with the addition of empagliflozin to the SoC. Empagliflozin + SoC was associated with significantly reduced number of hospitalization for HF or cardiovascular death compared with SoC alone, which was a key driver offsetting its drug acquisition costs. The incremental cost-effectiveness ratio per quality-adjusted life year (QALY) gained was consistently favourable at £14 851, €11 706, and €15 447 in the UK, Spain, and France, respectively. Scenario analysis using the New York Heart Association functional class showed similar results. Probabilistic sensitivity analyses showed more than 50% probability for cost-effectiveness for a willingness-to-pay (WTP) threshold of £/€20 000/QALY for the three countries. CONCLUSIONS Empagliflozin was found to be the first targeted treatment option that is clinically effective and cost-effective for patients with HF LVEF > 40%. Prescribing empagliflozin with SoC to patients with HF LVEF > 40% is expected to improve clinical outcomes and patients' quality of life and substantially below accepted WTP threshold for the healthcare systems in the UK, Spain, and France.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Stephan Linden
- Boehringer Ingelheim International GmbHIngelheim am RheinGermany
| |
Collapse
|
18
|
Fariman S, Momeni Nasab F, Faraji H, Afzali M. Cost-Effectiveness of Ibrutinib as First-line Treatment for Older Patients With Chronic Lymphocytic Leukemia in Iran. Value Health Reg Issues 2023; 38:93-100. [PMID: 37806264 DOI: 10.1016/j.vhri.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/11/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES We aimed to evaluate the cost-effectiveness of ibrutinib versus chemoimmunotherapy for frontline treatment of elderly patients with chronic lymphocytic leukemia in Iran. METHODS We developed a partitioned survival model with 3 health states (progression-free survival, post-progression survival, and death) and a lifetime horizon. State memberships were determined by parametric survival analysis of the ALLIANCE (A041202) randomized controlled trial's results, comparing first-line ibrutinib with bendamustine plus rituximab. Direct medical costs were calculated from an Iranian health system perspective. Utility values were extracted from the literature to calculate the incremental costs and quality-adjusted life-years (QALYs) associated with each strategy. To address parameter uncertainties, deterministic and probabilistic sensitivity analyses were also performed. RESULTS In the base-case analysis, ibrutinib and bendamustine plus rituximab were associated with $3739.72 and $3991.20 costs per patient as the first-line treatment strategy, respectively. They resulted in an average of 2.86 and 2.66 QALYs per patient. Thus, first-line ibrutinib was associated with 0.20 incremental QALY and $251.48 cost-saving per patient and was therefore the "dominant" strategy. In deterministic sensitivity analysis, drug prices were the key drivers of model outputs. However, none of the resulting incremental cost-effectiveness ratios exceeded the currently accepted threshold by the Iranian Food and Drug Administration ($1550 per QALY). In probabilistic sensitivity analysis, 63.3% of iterations were cost-saving and 77.4% were cost-effective. CONCLUSIONS Our findings suggest that ibrutinib as a first-line treatment appears to be the dominant strategy, compared with the standard of care, for unselected older adults with chronic lymphocytic leukemia in Iran.
Collapse
Affiliation(s)
- Soroush Fariman
- Department of Pharmacoeconomics and Pharmaceutical administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Pharmaceutical Strategic Analysis and Research (PASAR), Tehran, Iran; Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina Chapel Hill, NC, USA
| | - Fatemeh Momeni Nasab
- Department of Pharmacoeconomics and Pharmaceutical administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Pharmaceutical Strategic Analysis and Research (PASAR), Tehran, Iran
| | - Hoda Faraji
- Department of Pharmacoeconomics and Pharmaceutical administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Pharmaceutical Strategic Analysis and Research (PASAR), Tehran, Iran
| | - Monireh Afzali
- Pharmaceutical Strategic Analysis and Research (PASAR), Tehran, Iran.
| |
Collapse
|
19
|
Kelly J, Menon V, O'Neill F, Elliot L, Combe E, Drinkwater W, Abbott S, Hayee B. UK cost-effectiveness analysis of endoscopic sleeve gastroplasty versus lifestyle modification alone for adults with class II obesity. Int J Obes (Lond) 2023; 47:1161-1170. [PMID: 37674032 PMCID: PMC10599990 DOI: 10.1038/s41366-023-01374-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/08/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is a minimally invasive procedure that has been demonstrated in the MERIT randomised, controlled trial to result in substantial and durable additional weight loss in adults with obesity compared with lifestyle modification (LM) alone. We sought to conduct the first cost-effectiveness analysis of ESG versus LM alone in adults with class II obesity (BMI 35.0-39.9 kg/m2) from a national healthcare system perspective in England based on results from this study. METHODS A 6-state Markov model was developed comprising 5 BMI-based health states and an absorbing death state. Baseline characteristics, utilities, and transition probabilities were informed by patient-level data from the subset of patients with class II obesity in MERIT. Adverse events (AEs) were based on the MERIT safety population. Mortality was estimated by applying BMI-specific hazard ratios from the published literature to UK general population mortality rates. Utilities for the healthy weight and overweight health states were informed from the literature; disutility associated with increasing BMI in the class I-III obesity health states was estimated using MERIT utility data. Disutility due to AEs and the prevalence of obesity-related comorbidities were based on the literature. Costs included intervention costs, AE costs, and comorbidity costs. RESULTS ESG resulted in higher overall costs than LM alone but led to an increase in quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) for ESG vs LM alone was £2453/QALY gained. ESG was consistently cost effective across a wide range of sensitivity analyses, with no ICER estimate exceeding £10,000/QALY gained. In probabilistic sensitivity analysis, the mean ICER was £2502/QALY gained and ESG remained cost effective in 98.25% of iterations at a willingness-to-pay threshold of £20,000/QALY. CONCLUSION Our study indicates that ESG is highly cost effective versus LM alone for the treatment of adults with class II obesity in England.
Collapse
Affiliation(s)
- Jamie Kelly
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Vinod Menon
- University Hospitals Coventry & Warwickshire NHS Foundation Trust, Coventry, UK
- University of Warwick, Coventry, UK
| | | | | | | | | | - Sally Abbott
- University Hospitals Coventry & Warwickshire NHS Foundation Trust, Coventry, UK
- Research Centre for Healthcare and Communities, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | | |
Collapse
|
20
|
Collins B, Downing J, Head A, Comerford T, Nathan R, Barr B. Investigating the impact of undiagnosed anxiety and depression on health and social care costs and quality of life: cross-sectional study using household health survey data. BJPsych Open 2023; 9:e201. [PMID: 37886809 PMCID: PMC10753950 DOI: 10.1192/bjo.2023.596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/18/2023] [Accepted: 09/28/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND There is uncertainty around the costs and health impacts of undiagnosed mental health problems. AIMS Using survey data, we aim to understand the costs and health-related quality-of-life decrements from undiagnosed anxiety/depression. METHOD We analysed survey data from two waves of the North West Coast Household Health Survey, which included questions on disease, medications, and Patient Health Questionnaire 9 (PHQ-9) and Generalised Anxiety Disorder 7 (GAD-7) scores (depression and anxiety scales). People were judged as having undiagnosed anxiety/depression problems if they scored ≥5 on the PHQ-9 or GAD-7, and did not declare a mental health issue or antidepressant prescription. Linear regression for EuroQol 5-Dimension 3-Level (EQ-5D-3L) index scores, and Tweedie regression for health and social care costs, were used to estimate the impact of undiagnosed mental health problems, controlling for age, gender, deprivation and other health conditions. RESULTS Around 26.5% of participants had undiagnosed anxiety/depression. The presence of undiagnosed anxiety/depression was associated with reduced EQ-5D-3L index scores (0.040 lower on average) and increased costs (£250 ($310) per year on average). Using a higher cut-off score of 10 on the PHQ-9 and GAD-7 for undiagnosed anxiety/depression had similar increased costs but a greater reduction in EQ-5D-3L index scores (0.076 on average), indicating a larger impact on health-related quality of life. CONCLUSIONS Having undiagnosed anxiety or depression increases costs and reduces health-related quality of life. Reducing stigma and increasing access to cost-effective treatments will have population health benefits.
Collapse
Affiliation(s)
- Brendan Collins
- Department of Public Health, Policy and Systems, University of Liverpool, UK
| | - Jennifer Downing
- Department of Public Health, Policy and Systems, University of Liverpool, UK
| | - Anna Head
- Department of Public Health, Policy and Systems, University of Liverpool, UK
| | - Terence Comerford
- Department of Public Health, Policy and Systems, University of Liverpool, UK
| | - Rajan Nathan
- Forensic Psychiatry, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Benjamin Barr
- Department of Public Health, Policy and Systems, University of Liverpool, UK
| |
Collapse
|
21
|
Falk Hvidberg M, Hernández Alava M. Catalogues of EQ-5D-3L Health-Related Quality of Life Scores for 199 Chronic Conditions and Health Risks for Use in the UK and the USA. PHARMACOECONOMICS 2023; 41:1287-1388. [PMID: 37330973 PMCID: PMC10492737 DOI: 10.1007/s40273-023-01285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Health-related quality of life (HRQoL) measures are essential in economic evaluation, but sometimes primary sources are unavailable, and information from secondary sources is required. Existing HRQoL UK/US catalogues are based on earlier diagnosis classification systems, amongst other issues. A recently published Danish catalogue merged EQ-5D-3L data from national health surveys with national registers containing patient information on ICD-10 diagnoses, healthcare activities and socio-demographics. AIMS To provide (1) UK/US EQ-5D-3L-based HRQoL utility population catalogues for 199 chronic conditions on the basis of ICD-10 codes and health risks and (2) regression models controlling for age, sex, comorbidities and health risks to enable predictions in other populations. METHODS UK and US EQ-5D-3L value sets were applied to the EQ-5D-3L responses of the Danish dataset and modelled using adjusted limited dependent variable mixture models (ALDVMMs). RESULTS Unadjusted mean utilities, percentiles and adjusted disutilities based on two ALDVMMs with different control variables were provided for both countries. Diseases from groups M, G, and F consistently had the smallest utilities and the largest negative disutilities: fibromyalgia (M797), sclerosis (G35), rheumatism (M790), dorsalgia (M54), cerebral palsy (G80-G83), post-traumatic stress disorder (F431), dementia (F00-2), and depression (F32, etc.). Risk factors, including stress, loneliness, and BMI30+, were also associated with lower HRQoL. CONCLUSIONS This study provides comprehensive catalogues of UK/US EQ-5D-3L HRQoL utilities. Results are relevant in cost-effectiveness analysis, for NICE submissions, and for comparing and identifying facets of disease burden.
Collapse
Affiliation(s)
- Michael Falk Hvidberg
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Region Zealand, Denmark.
- Department of Psychology, University of York, York, UK.
| | | |
Collapse
|
22
|
Vincken L, van der Broeck L, Geurts J, Qiu Shao SS, Poeze M, Blokhuis TJ. The effect of post-traumatic long bone non-unions on health-related quality of life. Injury 2023; 54 Suppl 5:110929. [PMID: 37923507 DOI: 10.1016/j.injury.2023.110929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/08/2023] [Accepted: 07/06/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Fracture non-unions have a detrimental effect on patients due to reduced mobility and severe pain. Current literature on the quality of life in non-unions is limited, hence the purpose of this study, to quantify the health-related quality of life (HRQoL) among patients with post-traumatic long bone non-unions. It was hypothesized that the HRQoL of these patients is lower than the Dutch population standard as well as for multiple chronic diseases and musculoskeletal disorders. PATIENTS AND METHODS From January 2020 to December 2021, this study included consecutive patients who were referred to a multidisciplinary (trauma, orthopedic and plastic surgery), non-union clinic at the Maastricht UMC+. All non-unions were evaluated using the Non-Union Scoring System (NUSS) questionnaire. Patient reported HRQoL outcomes were acquired using the EQ-5D-5L questionnaire and the Lower Extremity Functional Scale (LEFS). RESULTS 50 patients were included, 18 females and 32 males, with a mean age of 55 years (± 15.5 SD). Eighteen patients presented with an open fracture, nine non-unions were infected and 39 patients had a lower extremity non-union. The mean NUSS score was 39.61 (± 14.6 SD). The mean EQ-5D-5L index score was 0.490 (± 0.261 SD), where patients experienced most problems with mobility. The mean EQ-5D-5L VAS was 61.4 (± 19.6 SD). The patients had a mean LEFS score of 28.7 (± 16.4 SD). The health-related quality of life was well below the age-corrected normative score of the Dutch population (EQ-5D-5L 0.857(p < 0.001); LEFS 77(p < 0.001)). This cohort's HRQoL was significantly lower than the HRQoL of multiple chronic and musculoskeletal disorders, including different forms of cancer and osteoarthritis. CONCLUSIONS This study has quantified the detrimental effect of post-traumatic long bone non-unions on patient's health-related quality of life, being significantly lower than the HRQoL of the Dutch population as well as for multiple chronic and musculoskeletal medical conditions. This cohort demonstrates a patient population in need of more specialized care with a low health-related quality of life.
Collapse
Affiliation(s)
- L Vincken
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - L van der Broeck
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - J Geurts
- Department of Orthopaedics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - S S Qiu Shao
- Department of Plastic, Hand and Reconstructive Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - M Poeze
- Department of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - T J Blokhuis
- Department of Trauma Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands; Department of Surgery, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands.
| |
Collapse
|
23
|
Garfield K, Thorn JC, Noble S, Husbands S, Hollingworth W. Development of a brief, generic, modular resource-use measure (ModRUM): piloting with patients. BMC Health Serv Res 2023; 23:994. [PMID: 37710265 PMCID: PMC10503201 DOI: 10.1186/s12913-023-10011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 09/08/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Bespoke self-report resource-use measures (RUMs) are commonly developed or adapted for each new randomised controlled trial. Consequently, RUMs lack standardisation and validation is rarely conducted. A new generic RUM, ModRUM, has been developed using a rigorous process, including consultation with health economists and patients. ModRUM includes a concise core healthcare module, designed to be included in all trials, and depth-adding questions, which can replace or be added to core questions as needed. Modules covering other sectors are under development. The aim of this study was to test the acceptability, feasibility, and criterion and construct validity of the healthcare module of ModRUM. METHODS Patients who had a recent appointment at their GP practice were invited to complete ModRUM (core module or core module with depth questions), a characteristics form and the EQ-5D-5L. Acceptability was assessed via response rates and questionnaire completion time. Feasibility was assessed by reviewing issues observed in participants' responses and question completion rates. Construct validity was tested via hypothesis testing and known-group analyses, using Wilcoxon rank-sum and Kruskal-Wallis tests, and a generalised linear model. Criterion validity was tested by comparing ModRUM results with primary care medical records. Sensitivity, specificity, and agreement using Lin's concordance correlation coefficient (pc) were estimated. RESULTS One hundred patients participated from five GP practices in the South-West of England. Acceptability was higher for the core module (20% versus 10% response rate). Question completion rates were high across both versions (> 90%). Some support was observed for construct validity, with results suggesting that healthcare costs differ dependent on the number of long-term conditions (p < 0.05) and are negatively associated with health-related quality of life (p < 0.01). Sensitivity was high for all questions (> 0.83), while specificity varied (0.33-0.88). There was a good level of agreement for GP contacts and costs, and prescribed medication costs (pc > 0.6). CONCLUSION This study provided preliminary evidence of the acceptability, feasibility, and criterion and construct validity of ModRUM. Further testing is required within trials and with groups that were less well represented in this study.
Collapse
Affiliation(s)
- Kirsty Garfield
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whitladies Road, Bristol, BS8 1NU, UK.
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK.
| | - Joanna C Thorn
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whitladies Road, Bristol, BS8 1NU, UK
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - Sian Noble
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whitladies Road, Bristol, BS8 1NU, UK
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - Samantha Husbands
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whitladies Road, Bristol, BS8 1NU, UK
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| | - Will Hollingworth
- Health Economics Bristol, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whitladies Road, Bristol, BS8 1NU, UK
- Bristol Trials Centre, Population Health Sciences, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, UK
| |
Collapse
|
24
|
Slot M, Niemann CU, Ehlers LH, Rotbain EC. Cost-effectiveness of targeted treatment vs chemoimmunotherapy in treatment-naive unfit CLL without TP53 aberrations. Blood Adv 2023; 7:4186-4196. [PMID: 37184985 PMCID: PMC10415699 DOI: 10.1182/bloodadvances.2023010108] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/31/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
Several targeted treatments, such as venetoclax + obinutuzumab (VenO) and ibrutinib, have been developed to treat patients with treatment-naive chronic lymphocytic leukemia (CLL) and have been shown to improve progression-free survival compared with chlorambucil + obinutuzumab (ClbO). However, novel targeted agents are associated with a significant cost investment. The objective of this study was to investigate the cost-effectiveness of VenO compared with ClbO and ibrutinib in treatment-naive CLL without del17p/TP53 mutation in Denmark. We used a decision-analytic modeling approach to simulate hypothetical cohorts of patients with CLL from the initiation of first-line treatment to death, including the full treatment pathway and second-line therapy. VenO, ClbO, or ibrutinib was included as first-line therapy followed by either Ven + rituximab or ibrutinib. Model outcomes were expected quality-adjusted life years (QALYs), life years (LYs), and cost per patient, which were used to calculate incremental cost-effectiveness ratios (ICERs) with a willingness to pay from €23 600 to €35 600 per QALY. Compared with ClbO, VenO was associated with a QALY gain of 1.30 (1.42 LYs) over a lifetime. The incremental cost was €12 360, resulting in an ICER of €9491 per QALY gained, indicating that VenO is cost-effective. Compared with VenO, ibrutinib was associated with a QALY gain of 0.82 (1.74 LYs) but at a substantially increased incremental cost of €247 488 over a lifetime horizon. The ICER was €302 156 per QALY, indicating that ibrutinib in first-line treatment would not be considered cost-effective in Danish health care, compared with VenO. Future analyses in fit patients with CLL are needed to determine the cost-effectiveness of VenO.
Collapse
Affiliation(s)
- Matilde Slot
- Nordic Institute of Health Economics, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Carsten Utoft Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Emelie Curovic Rotbain
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Hematology Research Group, Danish Cancer Society Research Center, Copenhagen, Denmark
| |
Collapse
|
25
|
Malcolm R, Buckley C, Shore J, Stainthorpe A, Marti B, White A, Deckert J, Vernia M, Carapinha JL, López-Marco A, Nikolaidis N, Wendler O. An exploratory cost-effectiveness analysis of a novel tissue valve compared with mechanical valves for surgical aortic valve replacement in subgroups of people aged 55-64 and 65+ with aortic stenosis in the UK. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1087-1099. [PMID: 37638585 DOI: 10.1080/14737167.2023.2249611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE Exploratory analysis to conceptualize and evaluate the potential cost-effectiveness and economic drivers of using a novel tissue valve compared with mechanical heart valves for surgical aortic valve replacement (SAVR) in people aged 55-64 and 65+ with aortic stenosis (AS) from a National Health Service (NHS) UK perspective. METHODS A decision-analytic model was developed using a partitioned survival model. Parameter inputs were obtained from published literature. Deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted to explore the uncertainty around the parameters. RESULTS The novel tissue valve was potentially associated with higher quality-adjusted life years (QALYs) of 0.01 per person. Potential cost savings were greatest for those aged 55-64 (£408) versus those aged 65+(£53). DSA indicated the results to be most dependent on relative differences in general mortality, procedure costs, and reoperation rates. PSA estimated around 75% of the iterations to be cost-effective at £20,000 per QALY for those aged 55-64, and 57% for those aged 65+. CONCLUSIONS The exploratory analysis suggests that the novel tissue valve could be a cost-effective intervention for people over the age of 55 with AS who are suitable for SAVR in the UK.
Collapse
Affiliation(s)
- Robert Malcolm
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, UK
| | - Ciara Buckley
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, UK
| | - Judith Shore
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, UK
| | - Angela Stainthorpe
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, York, UK
| | - Belen Marti
- Market Access & Public Affairs, Edwards Lifesciences SA, Nyon, Switzerland
| | - Andrea White
- Market Access & Public Affairs, Edwards Lifesciences SA, Nyon, Switzerland
| | - Jens Deckert
- Market Access & Public Affairs, Edwards Lifesciences SA, Nyon, Switzerland
| | - Matteo Vernia
- Market Access & Public Affairs, Edwards Lifesciences SA, Nyon, Switzerland
| | - João L Carapinha
- Director, Syenza, Anaheim, CA, USA
- School of Pharmacy, Northeastern University, Boston, Massachusetts, USA
| | - Ana López-Marco
- Cardiothoracic Surgery, St Bartholomew's Hospital London, London, UK
| | | | - Olaf Wendler
- Chair of Heart, Vascular & Thoracic Institute, Cleveland Clinic London Hospital, London, UK
| |
Collapse
|
26
|
McKenzie GAG, Johnson MJ, Lind MJ, Kelly C, Parrott S. Geriatric assessment prior to cancer treatment: A health economic evaluation. J Geriatr Oncol 2023; 14:101504. [PMID: 37320931 DOI: 10.1016/j.jgo.2023.101504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/16/2022] [Accepted: 04/12/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION To address uncertainty regarding the cost-effectiveness of implementing geriatric assessment (GA) in oncology practice, we undertook a synthetic, model-based economic evaluation. MATERIALS AND METHODS A decision-analytic model with embedded Markov chains was developed to simulate a cost-effectiveness analysis of implementing GA within standard oncological care compared to current practice. This was for patients aged 77 years (the mean age in included trials) receiving chemotherapy or surgery as first-line treatment. Assumptions were made about model parameters, based on available literature, to calculate the incremental net health benefit (INHB) of GA, using a data synthesis. RESULTS GA has additional costs over standard care alone of between £390 and £576, depending upon implementation configuration. When major assumptions about the effectiveness of GA were modelled, INHB was marginally positive (0.09-0.12) at all cost-effectiveness thresholds (CETs). If no reduction in postoperative complications was assumed, the intervention was shown not to be cost-effective (INHB negative at all CETs). When used before chemotherapy, with minimal healthcare staffing inputs and technological assistance, GA is cost-effective (INHB positive between 0.06 and 0.07 at all CETs). DISCUSSION Considering emerging evidence that GA improves outcomes in oncology, GA may not be a cost-effective intervention when used for all older adults with cancer. However, with judicious selection of implementation models, GA has the potential to be cost-effective. Due to significant heterogeneity and centre dependent success in implementation and effectiveness, GA is difficult to study in oncology settings. Stakeholders could take a pragmatic approach towards GA introduction with local evaluation favoured over generalisable research. Because GA tends towards utilitarianism and has no safety issues, it is a suitable intervention for more widespread implementation.
Collapse
Affiliation(s)
- Gordon A G McKenzie
- Cancer Research Group, Hull York Medical School, University of Hull, Hull, UK.
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Michael J Lind
- Cancer Research Group, Hull York Medical School, University of Hull, Hull, UK
| | - Charlotte Kelly
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| |
Collapse
|
27
|
Peng K, Li Y, Chan EW, Wong IC, Li X. Cost-Effectiveness of Direct Oral Anticoagulants in Patients With Nonvalvular Atrial Fibrillation in Hong Kong. Value Health Reg Issues 2023; 36:51-57. [PMID: 37030031 DOI: 10.1016/j.vhri.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/18/2023] [Accepted: 02/22/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES The emergence of direct oral anticoagulants (DOACs) has revolutionized the prevention of stroke related to nonvalvular atrial fibrillation (NVAF). Several DOACs are available on the market, while the cost-effectiveness comparison among DOACs and vitamin K antagonist (warfarin) in NVAF management in Hong Kong market remains scarce. The objective of this study was to assess the cost-effectiveness of DOACs and warfarin from a Hong Kong public institutional perspective to inform formulary listing decisions. METHODS A previously developed Markov model was adapted to simulate the lifetime disease progression of a hypothetical cohort of 1000 patients. Net monetary costs, quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio were computed for the following competing alternatives: warfarin, apixaban (5 mg twice daily), dabigatran (110 mg or 150 mg twice daily), and rivaroxaban (20 mg once daily). Probabilistic sensitivity analyses were conducted to address study uncertainties. RESULTS In base-case results, all DOACs were associated with greater QALYs improvements and lower costs than warfarin. Rivaroxaban, apixaban, dabigatran 150 mg, dabigatran 110 mg, and warfarin resulted in net costs US dollar (USD) 8088, USD 8240, USD 8566, USD 8653, and USD 16 363 and net QALY 5.87, 6.017, 6.022, 5.98, and 5.829, respectively. In probabilistic sensitivity analysis, the probabilities of warfarin, rivaroxaban 20 mg, dabigatran 110 mg, dabigatran 150 mg, and apixaban 5 mg being cost-effective of 2000 iterations were 0%, 0%, 29.4%, 33.2%, and 37.4%, respectively. CONCLUSION Apixaban was the most cost-effective option compared with other DOACs and warfarin in the management of NVAF; this conclusion is consistent under all the tested uncertainty scenarios.
Collapse
|
28
|
López-Mínguez JR, Martín de Francisco AL, Soler MJ, Hernández F, Moreno R, Pinar E, Sampedro A, Mareque M, Oyagüez I. Cost-effectiveness analysis of dyevert™ Power XT in patients with chronic kidney disease undergoing percutaneous coronary intervention procedures in Spain. Catheter Cardiovasc Interv 2023. [PMID: 37300893 DOI: 10.1002/ccd.30744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the efficiency of Dyevert™ Power XT compared to the standard clinical practice when used for percutaneous coronary interventions (PCI). METHODS A Markov model was developed to estimate, over 3-month cycles and a lifetime time horizon, the cumulative costs and health outcomes (life years gained [LYG] and quality-adjusted life years [QALY]) in a hypothetical cohort of 1,000 patients with chronic kidney disease (CKD) 3b-4 and an average age of 72 years. The incidence of contrast-induced acute kidney injury for these patients is 18.89% in routine practice and 7.78% with Dyevert. QALYs were estimated by applying utilities by health state. Transitions between states and utilities were obtained from the literature. Overall all-cause and state-specific mortality were considered. The total cost (€2,022) estimated with the National Health System perspective included cost of the procedure and of CKD management. The parameters were validated by a panel of experts. A discount rate (3% per year) was applied to costs and outcomes. RESULTS The use of Dyevert yielded more health benefits (34.60 LYG and 5.69 QALYs) compared to the current standard practice (33.11 LYG and 5.38 QALYs). Lifetime cost accumulated at the end of the simulation resulted €30,211/patient with Dyevert and €33,895/patient with current standard clinical practice. CONCLUSIONS The use of Dyevert™ Power XT resulted dominant option, due to its higher effectiveness and lower cost as compared to standard clinical practice and, therefore, a preferred option in patients with CKD stages 3b-4 undergoing PCI in Spain.
Collapse
Affiliation(s)
- Jose R López-Mínguez
- Sección de Hemodinámica y Cardiología Intervencionista, Hospital Universitario de Badajoz, Badajoz, España
| | | | - M J Soler
- Servicio de Nefrología, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Felipe Hernández
- Unidad de Hemodinámica y Cardiología Intervencionista, Clínica Universidad de Navarra, Madrid, España
| | - Raul Moreno
- Unidad de Cardiología Intervencionista, Hospital Universitario La Paz, Madrid, España
| | - Eduardo Pinar
- Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | | | - M Mareque
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| | - I Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Pozuelo de Alarcón, Madrid, España
| |
Collapse
|
29
|
Jones DA, Candio P, Shakir R, Ramroth J, Wolstenholme J, Gray AM, Cutter DJ, Ntentas G. Individualised Estimation of Quality-adjusted Survival Benefit and Cost-effectiveness of Proton Beam Therapy in Intermediate-stage Hodgkin Lymphoma. Clin Oncol (R Coll Radiol) 2023; 35:301-310. [PMID: 36732121 DOI: 10.1016/j.clon.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/02/2022] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
AIMS Radiotherapy for Hodgkin lymphoma leads to the irradiation of organs at risk (OAR), which may confer excess risks of late effects. Comparative dosimetry studies show that proton beam therapy (PBT) may reduce OAR irradiation compared with photon radiotherapy, but PBT is more expensive and treatment capacity is limited. The purpose of this study is to inform the appropriateness of PBT for intermediate-stage Hodgkin lymphoma (ISHL). MATERIALS AND METHODS A microsimulation model simulating the course of ISHL, background mortality and late effects was used to estimate comparative quality-adjusted life years (QALYs) lived and healthcare costs after consolidative pencil beam scanning PBT or volumetric modulated arc therapy (VMAT), both in deep-inspiration breath-hold. Outcomes were compared for 606 illustrative patients covering a spectrum of clinical presentations, varying by two age strata (20 and 40 years), both sexes, three smoking statuses (never, former and current) and 61 pairs of OAR radiation doses from a comparative planning study. Both undiscounted and discounted outcomes at 3.5% yearly discount were estimated. The maximum excess cost of PBT that might be considered cost-effective by the UK's National Institute for Health and Care Excellence was calculated. RESULTS OAR doses, smoking status and discount rate had large impacts on QALYs gained with PBT. Current smokers benefited the most, averaging 0.605 undiscounted QALYs (range -0.341 to 2.171) and 0.146 discounted QALYs (range -0.067 to 0.686), whereas never smokers benefited the least, averaging 0.074 undiscounted QALYs (range -0.196 to 0.491) and 0.017 discounted QALYs (range -0.030 to 0.086). For the gain in discounted QALYs to be considered cost-effective, PBT would have to cost at most £4812 more than VMAT for current smokers and £645 more for never smokers. This is below preliminary National Health Service cost estimates of PBT over photon radiotherapy. CONCLUSION In a UK setting, PBT for ISHL may not be considered cost-effective. However, the degree of unquantifiable uncertainty is substantial.
Collapse
Affiliation(s)
- D A Jones
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK.
| | - P Candio
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK; Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Department of Economics and Management, University of Trento, Trento, Italy
| | - R Shakir
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - J Ramroth
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - J Wolstenholme
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - A M Gray
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK
| | - D J Cutter
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK; Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - G Ntentas
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, UK; Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| |
Collapse
|
30
|
Hvidberg MF, Petersen KD, Davidsen M, Witt Udsen F, Frølich A, Ehlers L, Alava MH. Catalog of EQ-5D-3L Health-Related Quality-of-Life Scores for 199 Chronic Conditions and Health Risks in Denmark. MDM Policy Pract 2023; 8:23814683231159023. [PMID: 37056295 PMCID: PMC10088414 DOI: 10.1177/23814683231159023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/27/2023] [Indexed: 04/15/2023] Open
Abstract
Background. Assessments of health-related quality of life (HRQoL) are essential in estimating quality-adjusted life-years. It is sometimes not feasible to collect primary HRQoL data, and reliable secondary sources are necessary. Current "off-the-shelf" HRQoL catalogs are based on older diagnosis classifications and include a limited number of diseases. This article aims to provide 1) a Danish EQ-5D-3L-based HRQoL catalog for 199 nationally representative chronic conditions based on ICD-10 codes and 2) a complementary model-based catalog controlling for age, sex, comorbidities, lifestyle, and health risks. Design. A total of 55,616 respondents from 3 national health survey samples were pooled and combined with 7 national registers containing patient-level information on diagnoses, health care activity, and sociodemographics. EQ-5D-3L data were converted to utility scores using the Danish EQ-5D-3L value set to estimate the mean utility for each chronic disease population. Adjusted limited dependent variable mixture models were estimated and used to provide a regression-based catalog of utilities/disutilities. Results. Diseases with the lowest mean EQ-5D score in the Danish population were systemic sclerosis (M34; score = 0.432), fibromyalgia (M797; score = 0.490), rheumatism (M790; score = 0.515), dementia (F00, G30; score = 0.546), posttraumatic stress syndrome (F431; score = 0.557), and systemic atrophies (G10-G14; score = 0.583. Based on the estimated models, the largest estimated disutilities were cystic fibrosis, cerebral palsy, depression, dorsalgia, sclerosis, and fibromyalgia. Lifestyle factors, including perceived stress, loneliness, and body mass index, were also significantly associated with low HRQoL. Conclusions. This study provides a comprehensive nationally representative catalog and a model-based catalog of EQ-5D-3L-based HRQoL scores for Denmark that can be used to describe aspects of disease burden and allocate resources within health care. Additional Stata programs are also provided to facilitate predictions in other populations. Highlights A Danish national representative catalog of health-related quality-of-life scores for 199 chronic conditions is presented, which provides population estimates for chronic conditions subgroups that can be used for health economic evaluation.Two separate regression models of EQ-5D-3L utility scores with different sets of control variables are estimated to allow researchers to adjust for differences in the composition of the subgroups and provide a tool that can be used in other settings.Results indicate that health-related quality of life varies across disease groups but is lowest for renal disease, mental and behavioral disorders, benign neoplasms and diseases of the blood, digestive systems, and nervous systems.Health risks and lifestyle factors such as perceived stress, loneliness, and a large body mass index are highly correlated with health-related quality of life, and, in many cases, the correlation is higher than with individual diseases.
Collapse
Affiliation(s)
- Michael Falk Hvidberg
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
- Department of Psychology, University of York, UK
| | | | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | | | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
- Institute of Public Health, University of Copenhagen, Denmark
| | - Lars Ehlers
- Department of Clinical Medicine, Aalborg University, Denmark
| | | |
Collapse
|
31
|
Hvidberg MF, Petersen KD, Davidsen M, Witt Udsen F, Frølich A, Ehlers L, Alava MH. Catalog of EQ-5D-3L Health-Related Quality-of-Life Scores for 199 Chronic Conditions and Health Risks in Denmark. MDM Policy Pract 2023; 8:23814683231159023. [PMID: 37056295 PMCID: PMC10088414 DOI: 10.1177/23814683231159023#supplementary-materials] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/27/2023] [Indexed: 06/20/2023] Open
Abstract
UNLABELLED Background. Assessments of health-related quality of life (HRQoL) are essential in estimating quality-adjusted life-years. It is sometimes not feasible to collect primary HRQoL data, and reliable secondary sources are necessary. Current "off-the-shelf" HRQoL catalogs are based on older diagnosis classifications and include a limited number of diseases. This article aims to provide 1) a Danish EQ-5D-3L-based HRQoL catalog for 199 nationally representative chronic conditions based on ICD-10 codes and 2) a complementary model-based catalog controlling for age, sex, comorbidities, lifestyle, and health risks. Design. A total of 55,616 respondents from 3 national health survey samples were pooled and combined with 7 national registers containing patient-level information on diagnoses, health care activity, and sociodemographics. EQ-5D-3L data were converted to utility scores using the Danish EQ-5D-3L value set to estimate the mean utility for each chronic disease population. Adjusted limited dependent variable mixture models were estimated and used to provide a regression-based catalog of utilities/disutilities. Results. Diseases with the lowest mean EQ-5D score in the Danish population were systemic sclerosis (M34; score = 0.432), fibromyalgia (M797; score = 0.490), rheumatism (M790; score = 0.515), dementia (F00, G30; score = 0.546), posttraumatic stress syndrome (F431; score = 0.557), and systemic atrophies (G10-G14; score = 0.583. Based on the estimated models, the largest estimated disutilities were cystic fibrosis, cerebral palsy, depression, dorsalgia, sclerosis, and fibromyalgia. Lifestyle factors, including perceived stress, loneliness, and body mass index, were also significantly associated with low HRQoL. Conclusions. This study provides a comprehensive nationally representative catalog and a model-based catalog of EQ-5D-3L-based HRQoL scores for Denmark that can be used to describe aspects of disease burden and allocate resources within health care. Additional Stata programs are also provided to facilitate predictions in other populations. HIGHLIGHTS A Danish national representative catalog of health-related quality-of-life scores for 199 chronic conditions is presented, which provides population estimates for chronic conditions subgroups that can be used for health economic evaluation.Two separate regression models of EQ-5D-3L utility scores with different sets of control variables are estimated to allow researchers to adjust for differences in the composition of the subgroups and provide a tool that can be used in other settings.Results indicate that health-related quality of life varies across disease groups but is lowest for renal disease, mental and behavioral disorders, benign neoplasms and diseases of the blood, digestive systems, and nervous systems.Health risks and lifestyle factors such as perceived stress, loneliness, and a large body mass index are highly correlated with health-related quality of life, and, in many cases, the correlation is higher than with individual diseases.
Collapse
Affiliation(s)
- Michael Falk Hvidberg
- Michael Falk Hvidberg, Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Ingemannsvej 18, St, Region Zealand, Slagelse, 4200, Denmark; ()
| | | | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | | | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
- Institute of Public Health, University of Copenhagen, Denmark
| | - Lars Ehlers
- Department of Clinical Medicine, Aalborg University, Denmark
| | | |
Collapse
|
32
|
Hvidberg MF, Frølich A, Lundstrøm SL. Catalogue of socioeconomic disparities and characteristics of 199+ chronic conditions-A nationwide register-based population study. PLoS One 2022; 17:e0278380. [PMID: 36584039 PMCID: PMC9803180 DOI: 10.1371/journal.pone.0278380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Real-world information on socioeconomic differences within and between chronic conditions represents an important data source for treatments and decision-makers executing and prioritising healthcare resources. AIMS The aim of this study was to estimate the prevalence and mean of socioeconomic disparities from educational, income, and socioeconomic positions of 199 chronic conditions and disease groups, including sex and age group estimates, for use in planning of care services and prioritisation, by healthcare professionals, decision-makers and researchers. METHODS The study population includes all Danish residents 16 years and above, alive on 1 January 2013 (n = 4,555,439). The data was established by linking seven national registers encompassing educational achievements, incomes, socioeconomic positions, hospital- and general practice services, and filled-in out-of-hospital prescriptions. The health register data were used to identify the 199+ chronic conditions. Socioeconomic differences were primarily measured as differences in educational prevalence levels from low to high educational achievements using a ratio. Furthermore, multiple binary logistic regression models were carried out to control for potential confounding and residual correlations of the crude estimates. RESULTS The prevalence of having one or more chronic conditions for patients with no educational achievement was 768 per thousand compared to 601.3 for patients with higher educational achievement (ratio 1.3). Across disease groups, the highest educational differences were found within disease group F-mental and behavioural (ratio 2.5), E-endocrine, nutritional and metabolic disease (ratio 2.4), I-diseases of the circulatory system (ratio 2.1) and, K-diseases of the digestive system (ratio 2.1). The highest educational differences among the 29 common diseases were found among schizophrenia (ratio 5.9), hyperkinetic disorders (ratio 5.2), dementia (ratio 4.9), osteoporosis (ratio 3.9), type 2 diabetes (ratio 3.8), chronic obstructive pulmonary disease COPD (ratio 3.3), heart conditions and stroke (ratios ranging from 2.3-3.1). CONCLUSIONS A nationwide catalogue of socioeconomic disparities for 199+ chronic conditions and disease groups is catalogued and provided. The catalogue findings underline a large scope of socioeconomic disparities that exist across most chronic conditions. The data offer essential information on the socioeconomic disparities to inform future socially differentiated treatments, healthcare planning, etiological, economic, and other research areas.
Collapse
Affiliation(s)
- Michael Falk Hvidberg
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- University of York, York, United Kingdom
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sanne Lykke Lundstrøm
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, The Capital Region of Denmark
| |
Collapse
|
33
|
Wang Y, Gavan SP, Steinke D, Cheung KL, Chen LC. The impact of age on health utility values for older women with early-stage breast cancer: a systematic review and meta-regression. Health Qual Life Outcomes 2022; 20:169. [PMID: 36564800 PMCID: PMC9789668 DOI: 10.1186/s12955-022-02067-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION An increasing number of postmenopausal women are diagnosed with breast cancer at an older age (≥ 70 years). There is a lack of synthesised health utility data to support decision-making for managing breast cancer in this older population. This study aimed to identify the availability of, and the subsequent impact of age on, health state utility values (HSUVs) measured by the EQ-5D for older women with early-stage breast cancer. METHOD This systematic review identified EQ-5D (3L or 5L version) HSUVs for postmenopausal women with early-stage breast cancer. Studies were identified from a previous systematic review (inception to 2009) and an electronic database search (Medline and Embase; 2009 to September 2021). Mean HSUVs were summarised by health state. Quality appraisal was performed on studies reporting HSUVs for older ages (≥ 70 years). Multivariable meta-regression assessed the association between HSUVs and age, health state, treatments received, and time of measuring the utility values (greater or less than one year post-treatment). RESULTS Fifty EQ-5D HSUVs were identified from 13 studies. Mean HSUVs decreased as health state worsened: from the stable (mean=0.83) to progression (mean=0.79) and advanced (mean=0.68) states. Two studies reported six HSUVs estimated from the sample of women with a mean age ≥ 70. Meta-regression model fit improved by including age as an independent variable and attenuated the estimated utility decrements associated with worse health states. Utility decrements for the progression and advanced states were -0.052 (95%CI: -0.097, -0.007) and -0.143 (95%CI: -0.264, -0.022) respectively. The breast cancer-specific utility decrement associated with a one-year increase in age was -0.001 (95%CI: -0.004, 0.002). CONCLUSION Relevant and accurate HSUVs are essential to help support decision-making about the most effective and cost-effective ways to manage early-stage breast cancer in older women. Age has a vital role in determining health utility values in this population. This study provides analysts and decision-makers with HSUVs and utility decrements that reflect the disease process in this older population.
Collapse
Affiliation(s)
- Yubo Wang
- grid.5379.80000000121662407Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Stopford Building, Oxford Road, 1stFloor Stopford Building, Manchester, M13 9PT UK
| | - Sean P. Gavan
- grid.5379.80000000121662407Manchester Centre for Health Economics, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Douglas Steinke
- grid.5379.80000000121662407Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Stopford Building, Oxford Road, 1stFloor Stopford Building, Manchester, M13 9PT UK
| | - Kwok-Leung Cheung
- grid.4563.40000 0004 1936 8868School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby, DE22 3DT UK
| | - Li-Chia Chen
- grid.5379.80000000121662407Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Stopford Building, Oxford Road, 1stFloor Stopford Building, Manchester, M13 9PT UK
| |
Collapse
|
34
|
Tsukamoto K, Inoue M, Mori H, Matsumaru N. [Establishment of Mono-scaled Benefit/Risk Analysis of HPV Vaccine]. YAKUGAKU ZASSHI 2022; 142:1399-1407. [PMID: 36156032 DOI: 10.1248/yakushi.22-00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Decisions concerning approval of human papillomavirus (HPV) vaccines and their use are based on expert evaluation of the vaccines. However, the quantitative differences between vaccine benefits and risks are difficult for non-experts to understand. In this study, we developed a new method to calculate the benefits and risks of the HPV vaccines using disability-adjusted life year (DALY) as the mono-scaled weight for various benefits and risks relevant to the vaccines. We evaluated benefits as a gain of DALY values for cervical cancer and risks as the loss of DALY values for various adverse events by the vaccination. To calculate the loss of DALY values, we integrated all adverse events in the International Classification of Diseases chapters. The novel method reflected the men-women ratio of this epidemiological disease to a certain extent. Among the vaccinated women, 111,372 and 477,190 received a bivalent and quadrivalent vaccine, respectively. The DALY rate of cervical cancer was 148.7. The calculated benefit for the bivalent and quadrivalent vaccines was 149.1 and 638.8, respectively, and set as the theoretical maximum. The risk was calculated as 129.3 and 49.6 in the bivalent and quadrivalent vaccines, respectively. Since HPV vaccines prevent several other cancers, the benefit of the vaccination extends beyond the risk according to this new method.
Collapse
Affiliation(s)
| | - Manami Inoue
- Global Regulatory Science, Gifu Pharmaceutical University
| | - Hirohito Mori
- Global Regulatory Science, Gifu Pharmaceutical University
| | | |
Collapse
|
35
|
Drakesmith M, Collins B, Jones A, Nnoaham K, Thomas DR. Cost-effectiveness of a whole-area testing pilot of asymptomatic SARS-CoV-2 infections with lateral flow devices: a modelling and economic analysis study. BMC Health Serv Res 2022; 22:1190. [PMID: 36138455 PMCID: PMC9502892 DOI: 10.1186/s12913-022-08511-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/04/2022] [Indexed: 02/03/2023] Open
Abstract
Background Mass community testing for SARS-CoV-2 by lateral flow devices (LFDs) aims to reduce prevalence in the community. However its effectiveness as a public heath intervention is disputed. Method Data from a mass testing pilot in the Borough of Merthyr Tydfil in late 2020 was used to model cases, hospitalisations, ICU admissions and deaths prevented. Further economic analysis with a healthcare perspective assessed cost-effectiveness in terms of healthcare costs avoided and QALYs gained. Results An initial conservative estimate of 360 (95% CI: 311–418) cases were prevented by the mass testing, representing a would-be reduction of 11% of all cases diagnosed in Merthyr Tydfil residents during the same period. Modelling healthcare burden estimates that 24 (16—36) hospitalizations, 5 (3–6) ICU admissions and 15 (11–20) deaths were prevented, representing 6.37%, 11.1% and 8.2%, respectively of the actual counts during the same period. A less conservative, best-case scenario predicts 2333 (1764–3115) cases prevented, representing 80% reduction in would-be cases. Cost -effectiveness analysis indicates 108 (80–143) QALYs gained, an incremental cost-effectiveness ratio of £2,143 (£860-£4,175) per QALY gained and net monetary benefit of £6.2 m (£4.5 m-£8.4 m). In the best-case scenario, this increases to £15.9 m (£12.3 m-£20.5 m). Conclusions A non-negligible number of cases, hospitalisations and deaths were prevented by the mass testing pilot. Considering QALYs gained and healthcare costs avoided, the pilot was cost-effective. These findings suggest mass testing with LFDs in areas of high prevalence (> 2%) is likely to provide significant public health benefit. It is not yet clear whether similar benefits will be obtained in low prevalence settings or with vaccination rollout. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08511-3.
Collapse
Affiliation(s)
- Mark Drakesmith
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, Wales, UK.
| | - Brendan Collins
- Health and Social Services Group, Welsh Government, Cardiff, Wales, UK.,Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, England, UK
| | - Angela Jones
- Cwm Taf Morgannwg University Health Board, Abercynon, Rhondda Cynon Taf, Wales, UK
| | - Kelechi Nnoaham
- Cwm Taf Morgannwg University Health Board, Abercynon, Rhondda Cynon Taf, Wales, UK
| | - Daniel Rhys Thomas
- Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, Wales, UK.,School of Health Sciences, Cardiff Metropolitan University, Cardiff, Wales, UK
| |
Collapse
|
36
|
Hvidberg MF, Frølich A, Lundstrøm SL, Kamstrup-Larsen N. Catalogue of multimorbidity mean based severity and associational prevalence rates between 199+ chronic conditions-A nationwide register-based population study. PLoS One 2022; 17:e0273850. [PMID: 36103504 PMCID: PMC9473636 DOI: 10.1371/journal.pone.0273850] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Real-world data on multimorbidity represents an important but underutilised source of evidence for the planning of healthcare services, including prevention, treatments, and health economic modelling. AIMS This study aimed to estimate means of multimorbidity and provide associated prevalence rates and frequencies between 199 x 199 chronic conditions and disease groups based on the total adult Danish population and sex, age, and educational attainment. Thus, this study provides an off-the-shelf catalogue for use in treatments and planning by clinicians, decision-makers and researchers. METHODS The study population contained all Danish residents above 16 years on 1 January 2013 (n = 4,555,439). The data was based on the linkage of six national registers covering hospital contacts, services in general practice, filled-in out-of-hospital prescriptions, and educational attainments. The health registers were used to identify the 199 chronic conditions based on the ICD-10 classification system. RESULTS The mean number of chronic conditions (NCC) was 2.2. The mean increased with age, women had a higher mean than men, and there was a social gradient with the mean increasing with lower educational attainment. The mean NCC varied from 3.3-9.8 among all conditions. Across disease groups, the highest mean NCC were found within disease group N (chronic renal failure, mean = 8.8), D (in situ and benign neoplasms; mean = 6.5), K (diseases of the digestive system; mean = 5.7), and H (diseases of the eye and the ear; mean = 5.6). The highest mean NCC among the 29 common diseases was heart failure, ischemic heart diseases, angina pectoris, stroke, and dementia, with a mean above 6.5. Several prevalent conditions like hypertension, arthritis, chronic lower respiratory diseases, depression, type 2 diabetes, and overweight transcended other conditions regarding the associated prevalence rates. As one of the most frequent, hypertensive diseases were highly associated with arthritis (50.4%), depression (37.4%), type 2 diabetes (75.4%), cancers (49.7%), and being overweight (39.7%)-meaning that 50.4% of people with arthritis, 37.4% of people with depression and so on also had hypertensive diseases. The largest differences in means between individuals with no educational attainment and individuals with high educational attainment were found within disease groups J (diseases of the respiratory system, ratio = 1.8), Q (congenital malformations, deformations, and chromosomal abnormalities, ratio = 1.7), and B (viral hepatitis and human immunodeficiency virus disease, ratio = 1.7). CONCLUSIONS The current study provides a nationwide off-the-shelf catalogue of multimorbidity means and real-world associations estimates of 199+ chronic conditions for future clinical treatments and health care systems planning. The findings described are just one example of numerous results and underline that multimorbidity is highly prevalent in the adult Danish population and that it is a vital condition transcending all future medical treatment. The data offer essential information on the multimorbidity burden of disease in future differentiated treatments, healthcare planning, and economic, aetiological, and other research.
Collapse
Affiliation(s)
- Michael Falk Hvidberg
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- University of York, York, United Kingdom
| | - Anne Frølich
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, København, Denmark
| | - Sanne Lykke Lundstrøm
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, København, Denmark
| | - Nina Kamstrup-Larsen
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, København, Denmark
| |
Collapse
|
37
|
Raunbak SM, Sørensen AS, Hansen L, Skjøth F, Larsen TB, Ehlers LH. Cost Effectiveness of Patient Self-Managed Warfarin Compared with Direct Oral Anticoagulants in Atrial Fibrillation: An Economic Evaluation in a Danish Healthcare Sector Setting. PHARMACOECONOMICS - OPEN 2022; 6:483-494. [PMID: 35665481 PMCID: PMC9283633 DOI: 10.1007/s41669-022-00337-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patient self-managed anticoagulant treatment with warfarin (PSM) has been proposed as an alternative to direct oral anticoagulants (DOACs) in patients with non-valvular atrial fibrillation (NVAF); however, direct evidence on the cost effectiveness of PSM compared with DOACs is lacking. We aimed to evaluate the cost effectiveness of PSM versus DOACs for NVAF patients in the Danish healthcare setting using a model-based cost-utility analysis. METHODS A cost-utility analysis was performed using a decision-analytic model including two treatment alternatives: continuous PSM and DOACs. The analysis was performed from an extended Danish healthcare sector perspective, including patient-paid costs of medication related to the anticoagulant treatment, with a lifetime horizon. Inputs for the model comprised of probabilities of events, costs in Danish estimates, when possible, and effect in utilities. The probabilities of events are primarily based on real-life data from a direct comparison of PSM and DOACs. The results are presented as the incremental cost-effectiveness ratio (ICER) with an assumed cost-effectiveness threshold of £20,000/quality-adjusted life-year (QALY). Both deterministic and probabilistic sensitivity analyses were performed to investigate the robustness of the results. RESULTS The base-analysis showed that PSM was dominant, with a decreased cost of £8495 and an increased QALY accumulation of 0.23 per patient (ICER = -£36,935/QALY). All deterministic sensitivity analyses indicated that PSM was dominant or at least cost effective. The probabilistic sensitivity analysis showed that 95% of the iterations were cost effective. CONCLUSIONS The present study found that PSM is dominant (i.e., both more effective and cost saving) compared with DOACs, adding to the scarce evidence of the comparative cost effectiveness of PSM and DOACs in NVAF.
Collapse
Affiliation(s)
- Sabine Michelsen Raunbak
- Danish Center for Healthcare Improvements, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
| | - Anne Sig Sørensen
- Danish Center for Healthcare Improvements, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Danish Health Technology Council, Aalborg, Denmark
| | - Louise Hansen
- Danish Center for Healthcare Improvements, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Contracts and Trial Nation, Legal Department, North Denmark Region, Aalborg, Denmark
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Torben Bjerregaard Larsen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Lars Holger Ehlers
- Danish Center for Healthcare Improvements, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| |
Collapse
|
38
|
Collins B, Bandosz P, Guzman-Castillo M, Pearson-Stuttard J, Stoye G, McCauley J, Ahmadi-Abhari S, Araghi M, Shipley MJ, Capewell S, French E, Brunner EJ, O’Flaherty M. What will the cardiovascular disease slowdown cost? Modelling the impact of CVD trends on dementia, disability, and economic costs in England and Wales from 2020–2029. PLoS One 2022; 17:e0268766. [PMID: 35767575 PMCID: PMC9242440 DOI: 10.1371/journal.pone.0268766] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background
There is uncertainty around the health impact and economic costs of the recent slowing of the historical decline in cardiovascular disease (CVD) incidence and the future impact on dementia and disability.
Methods
Previously validated IMPACT Better Ageing Markov model for England and Wales, integrating English Longitudinal Study of Ageing (ELSA) data for 17,906 ELSA participants followed from 1998 to 2012, linked to NHS Hospital Episode Statistics. Counterfactual design comparing two scenarios: Scenario 1. CVD Plateau—age-specific CVD incidence remains at 2011 levels, thus continuing recent trends. Scenario 2. CVD Fall—age-specific CVD incidence goes on declining, following longer-term trends. The main outcome measures were age-related healthcare costs, social care costs, opportunity costs of informal care, and quality adjusted life years (valued at £60,000 per QALY).
Findings
The total 10 year cumulative incremental net monetary cost associated with a persistent plateauing of CVD would be approximately £54 billion (95% uncertainty interval £14.3-£96.2 billion), made up of some £13 billion (£8.8-£16.7 billion) healthcare costs, £1.5 billion (-£0.9-£4.0 billion) social care costs, £8 billion (£3.4-£12.8 billion) informal care and £32 billion (£0.3-£67.6 billion) value of lost QALYs.
Interpretation
After previous, dramatic falls, CVD incidence has recently plateaued. That slowdown could substantially increase health and social care costs over the next ten years. Healthcare costs are likely to increase more than social care costs in absolute terms, but social care costs will increase more in relative terms. Given the links between COVID-19 and cardiovascular health, effective cardiovascular prevention policies need to be revitalised urgently.
Collapse
Affiliation(s)
- Brendan Collins
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | | | | | | | - George Stoye
- Institute for Fiscal Studies, London, United Kingdom
| | - Jeremy McCauley
- School of Economics, University of Bristol, Bristol, United Kingdom
| | - Sara Ahmadi-Abhari
- School of Public Health, Imperial College London, London, United Kingdom
| | - Marzieh Araghi
- School of Public Health, Imperial College London, London, United Kingdom
| | - Martin J. Shipley
- Institute of Epidemiology & Health, University College London, London, United Kingdom
| | - Simon Capewell
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Eric French
- Faculty of Economics, University of Cambridge, Cambridge, United Kingdom
| | - Eric J. Brunner
- Institute of Epidemiology & Health, University College London, London, United Kingdom
| | - Martin O’Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
39
|
Shah BD, Smith NJ, Feng C, Jeyakumar S, Castaigne JG, Faghmous I, Masouleh BK, Malone DC, Bishop MR. Cost-Effectiveness of KTE-X19 for Adults with Relapsed/Refractory B-Cell Acute Lymphoblastic Leukemia in the United States. Adv Ther 2022; 39:3678-3695. [PMID: 35727476 PMCID: PMC9309154 DOI: 10.1007/s12325-022-02201-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/19/2022] [Indexed: 12/03/2022]
Abstract
Introduction Despite currently available treatments for adults with relapsed/refractory acute lymphoblastic leukemia (R/R ALL), survival outcomes remain poor, highlighting the need for new therapeutic strategies. This study estimates the cost-effectiveness of KTE-X19 to treat adults with R/R ALL from a US payer perspective. Methods The model had two components: a decision-tree, where pre-infusion costs for patients who ultimately did not receive KTE-X19 are accounted for, followed by a partitioned survival analysis, where all KTE-X19 infused patients would enter the three-state (pre-progression, progressed disease, death) model. Comparators included current standard of care treatments, i.e., blinatumomab (BLIN), inotuzumab ozogamicin (INO), and salvage chemotherapy (CHEMO). Both standard parametric and mixture cure models were used to model survival. Efficacy, safety, healthcare resource utilization, and health state utility inputs were derived from the ZUMA-3 trial (NCT02614066) and literature. Cost inputs were derived from literature or publicly available sources. Outcomes and costs were discounted 3% annually. Results of KTE-X19 versus comparators are reported as total and incremental life-years (LYs), quality-adjusted life-years (QALYs), costs, and resulting incremental cost-effectiveness ratio (ICER). Deterministic and probabilistic sensitivity analyses (PSA) and key scenario analyses were also performed. Results In the base case, incremental QALYs for KTE-X19 were 2.44, 3.26, and 4.61 versus BLIN, INO, and CHEMO, respectively. Incremental costs were $50,913, $251,532, and $432,027, respectively, resulting in ICERs of $20,843/QALY (versus BLIN), $77,271/QALY (versus INO), and $93,768/QALY (versus CHEMO). Deterministic sensitivity analysis results were most sensitive to subsequent allogeneic stem cell transplant rates and post-progression utilities. PSA found that KTE-X19 is 78.4%, 74.0%, and 75.4% likely to be cost-effective versus BLIN, INO, and CHEMO, respectively. Across most scenarios, at a willingness-to-pay (WTP) threshold of $150,000/QALY, KTE-X19 was cost-effective versus all treatments. Conclusions Compared to current options for adults with R/R ALL, KTE-X19 is cost-effective, driven primarily by improved survival. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02201-6. Several treatments for adults with relapsed/refractory B-cell precursor acute lymphoblastic leukemia (R/R B-ALL) have been approved in the past decade in the US, including blinatumomab (BLIN) and inotuzumab ozogamicin (INO). However, despite the high costs associated with these treatments, survival for patients remains poor. KTE-X19, an autologous anti-CD19 chimeric antigen receptor T-cell (CAR-T) therapy, approved by the Food and Drug Administration in October 2021, has potential to improve survival, but its economic value has not yet been determined. This model comprehensively evaluated the long-term clinical and economic value of KTE-X19 versus current treatments, including BLIN, INO, and salvage chemotherapy (CHEMO). Inputs were derived from key clinical trials, the literature, and other publicly available sources. The model used the perspective of a US third party payer over a patient lifetime. Compared to BLIN, INO and CHEMO, KTE-X19 resulted in improved quality of life as measured with incremental quality-adjusted life years (QALYs) of 2.44 (vs BLIN), 3.26 (vs INO), and 4.61 (vs CHEMO). Treatment with KTE-X19 had incremental costs of $50,913 (vs BLIN), $251,532 (vs INO), and $432,027 (vs CHEMO). KTE-X19 was found to provide good value for money based on incremental cost-effectiveness ratios of $20,843/QALY (vs BLIN), $77,271/QALY (vs INO), and $93,768/QALY (vs CHEMO). These values are well below the commonly accepted thresholds to determine economic value. Results were also found to be robust across sensitivity and scenario analyses.
Collapse
Affiliation(s)
| | - Nathaniel J Smith
- Maple Health Group, LLC, 1740 Broadway, 15th Floor, New York, NY, 10019, USA.
| | | | - Sushanth Jeyakumar
- Maple Health Group, LLC, 1740 Broadway, 15th Floor, New York, NY, 10019, USA
| | | | | | | | | | - Michael R Bishop
- The David Etta Jonas Center for Cellular Therapy, University of Chicago, Chicago, IL, USA
| |
Collapse
|
40
|
Heslin M, Jin H, Trevillion K, Ling X, Nath S, Barrett B, Demilew J, Ryan EG, O'Connor S, Sands P, Milgrom J, Bick D, Stanley N, Hunter MS, Howard LM, Byford S. Cost-effectiveness of screening tools for identifying depression in early pregnancy: a decision tree model. BMC Health Serv Res 2022; 22:774. [PMID: 35698125 PMCID: PMC9190075 DOI: 10.1186/s12913-022-08115-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although the effectiveness of screening tools for detecting depression in pregnancy has been investigated, there is limited evidence on the cost-effectiveness. This is vital in providing full information to decision makers. This study aimed to explore the cost-effectiveness of different screening tools to identify depression in early pregnancy compared to no screening. Methods A decision tree was developed to model the identification and treatment pathways of depression from the first antenatal appointment to 3-months postpartum using the Whooley questions, the Edinburgh Postnatal Depression Scale (EPDS) and the Whooley questions followed by the EPDS, compared to no screening. The economic evaluation took an NHS and Personal Social Services perspective. Model parameters were taken from a combination of sources including a cross-sectional survey investigating the diagnostic accuracy of screening tools, and other published literature. Cost-effectiveness was assessed in terms of the incremental cost per quality adjusted life years (QALYs). Cost-effectiveness planes and cost-effectiveness acceptability curves were produced using a net-benefit approach based on Monte Carlo simulations of cost-outcome data. Results In a 4-way comparison, the Whooley, EPDS and Whooley followed by the EPDS each had a similar probability of being cost-effective at around 30% for willingness to pay values from £20,000–30,000 per QALY compared to around 20% for the no screen option. Conclusions All three screening approaches tested had a higher probability of being cost-effective than the no-screen option. In the absence of a clear cost-effectiveness advantage for any one of the three screening options, the choice between the screening approaches could be made on other grounds, such as clinical burden of the screening options. Limitations include data availability and short time horizon, thus further research is needed. Clinical trials registration N/A Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08115-x.
Collapse
Affiliation(s)
- Margaret Heslin
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Huajie Jin
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Kylee Trevillion
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Xiaoxiao Ling
- Department of Statistical Science, University College London, London, UK
| | - Selina Nath
- Population, Policy and Practice Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Barbara Barrett
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Jill Demilew
- King's College Hospital NHS Foundation Trust, London, UK
| | - Elizabeth G Ryan
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | | | - Polly Sands
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jeannette Milgrom
- Parent-Infant Research Institute, Austin Health, Heidelberg West, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Debra Bick
- Warwick Clinical Trials Unit, University of Warwick & University Hospitals Coventry and Warwick NHS Foundation Trust, Coventry, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Myra S Hunter
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience at King's College London, Guy's Campus, London, SE1 9RT, UK
| | - Louise M Howard
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sarah Byford
- Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| |
Collapse
|
41
|
Kato G, Doi T, Arai H, Shimada H. Cost-effectiveness Analysis of Combined Physical and Cognitive Exercises Programs Designed for Preventing Dementia among Community-dwelling Healthy Young-old Adults. Phys Ther Res 2022; 25:56-67. [PMID: 36118786 PMCID: PMC9437929 DOI: 10.1298/ptr.e10153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/28/2022] [Indexed: 09/27/2023]
Abstract
OBJECTIVE This study aims to estimate the cost-effectiveness of combined physical and cognitive programs designed to prevent community-dwelling healthy young-old adults from developing dementia. METHODS The analysis was conducted from a public healthcare and long-term care payer's perspective. Quality-adjusted life years (QALYs) and expenses for health services and long-term care services were described in terms of effectiveness and cost, respectively. A thousand community-dwelling healthy adults aged 65 years were generated through simulation and analyzed. The incremental cost-effectiveness ratio (ICER) of adults with preventive program intervention compared to those with nonintervention was simulated with a 10-year cycle Markov model. The data sources for the parameters to build the Markov models were selected with priority given to higher levels of evidence. The threshold for assessing cost-effectiveness was set as less than 5,000,000 Japanese yen/QALY. RESULTS The ICER was estimated as -5,740,083 Japanese yen (US$-57,400)/QALY. CONCLUSION A program targeting community-dwelling healthy young-old adults could be cost-effective.
Collapse
Affiliation(s)
- Gohei Kato
- Department of Physical Therapy, School of Rehabilitation, Tokyo Professional University of Health Sciences, Japan
| | - Takehiko Doi
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Japan
| |
Collapse
|
42
|
Tužil J, Mlčoch T, Závada J, Svoboda M, Pavelka K, Doležal T. Time in remission as an alternative outcome measure for rheumatoid arthritis: a 10-year prospective study of 2618 new users of anti-TNF. Rheumatology (Oxford) 2022; 61:2295-2306. [PMID: 34599798 DOI: 10.1093/rheumatology/keab737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/20/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Achieving targeted disease activity (DA) is the primary therapeutic strategy in RA. Point measurements of DA are done at out-patient visits, however true DA between visits remains unobserved. This study sought to describe and validate a new outcome measure, i.e. time in remission (TIR). METHODS Patients were enrolled in the Czech ATTRA-RA registry. TIR was calculated using linear interpolation of the DAS28-ESR determined at outpatient visits. Correlation coefficients were computed between TIR and DAS28-CRP, HAQ, Simple Disease Activity Index (SDAI), patient global assessment (PGA) and physician global assessment (PhGA). Using logistic regression, TIR was used as a predictor of remission (SDAI ≤3.3) and non-disability (HAQ <0.5). The predictive value of TIR was compared with point and sustained remission using the cross-validated area under receiver-operating curves. RESULTS Since 2010, 2618 RA patients started anti-TNF therapy and were followed until 2020 or until treatment discontinuation. During the first 6 months of therapy, 56% of patients had no remission (TIR = 0), and 22% of patients reached sustained remission (TIR = 1), while 22% of patients had point remissions with 0 < TIR < 1. EULAR good responders and moderate/non-responders spent 64 ± 42% and 6 ± 18% of time in remission, respectively. The mean TIR grew during the follow-up and was correlated with DAS28-CRP, SDAI, HAQ, PGA, and PhGA (P < 0.0001). TIR at 3 and 6 months predicted remission (SDAI ≤3.3) and non-disability (HAQ <0.5) at 13 and 19 months better than point or sustained remission. CONCLUSIONS TIR is an intuitive way of estimating unobserved DA between scheduled visits; its calculation only requires two consecutive DA values (https://www.medevio.cz/tir-calculator/). TIR is a valid predictor of RA outcomes.
Collapse
Affiliation(s)
- Jan Tužil
- Institute of Health Economics and Technology Assessment.,1st Faculty of Medicine, Charles University in Prague
| | - Tomáš Mlčoch
- Institute of Health Economics and Technology Assessment
| | - Jakub Závada
- 1st Faculty of Medicine, Charles University in Prague.,Institute of Rheumatology, Prague
| | - Michal Svoboda
- Institute of Biostatistics and Analyses, Ltd, Spinoff Company of the Faculty of Medicine of the Masaryk University, Brno
| | - Karel Pavelka
- 1st Faculty of Medicine, Charles University in Prague.,Institute of Rheumatology, Prague
| | - Tomáš Doležal
- Institute of Health Economics and Technology Assessment.,Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| |
Collapse
|
43
|
Wouterse B, Ram F, van Baal P. Quality-Adjusted Life-Years Lost Due to COVID-19 Mortality: Methods and Application for The Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:731-735. [PMID: 35500946 PMCID: PMC8810280 DOI: 10.1016/j.jval.2021.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 05/08/2023]
Abstract
OBJECTIVES The COVID-19 pandemic has increased mortality worldwide considerably in 2020. Nevertheless, it is unknown how the increase in mortality translates into a loss in quality-adjusted life-years (QALYs), which is a function of age and the health condition of the deceased patient at time of death. We estimate the QALYs lost in The Netherlands as a result of deaths because of COVID-19 in 2020. METHODS As a starting point, we use estimates of underlying diseases and the number of COVID-19 deaths in nursing homes as a proxy for underlying health status. In a next step, these are combined with estimates of excess mortality rates and quality of life for different groups to calculate QALYs lost. We compare the results with an alternative scenario, in which COVID-19 deaths occurred randomly across the population regardless of underlying conditions. For this alternative scenario, we use population mortality and average quality of life by age and sex. RESULTS Accounting for underlying health status, we estimate that QALYs lost because of COVID-19 mortality are on average 3.9 per death for men and 3.5 for women. This is approximately 3.5 QALYs less than when not taking selective mortality into account. Given 16 308 excess deaths, this translates into 61 032 QALYs lost because of COVID-19. CONCLUSIONS We conclude that QALYs lost because of COVID-19 mortality are still substantial, even if mortality is strongly concentrated in people with poor health.
Collapse
Affiliation(s)
- Bram Wouterse
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Frederique Ram
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Pieter van Baal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
44
|
Krueger H, Robinson S, Hancock T, Birtwhistle R, Buxton JA, Henry B, Scarr J, Spinelli JJ. Priorities among effective clinical preventive services in British Columbia, Canada. BMC Health Serv Res 2022; 22:564. [PMID: 35473549 PMCID: PMC9044882 DOI: 10.1186/s12913-022-07871-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the long-standing experience of rating the evidence for clinical preventive services, the delivery of effective clinical preventive services in Canada and elsewhere is less than optimal. We outline an approach used in British Columbia to assist in determining which effective clinical preventive services are worth doing. Methods We calculated the clinically preventable burden and cost-effectiveness for 28 clinical preventive services that received a ‘strong or conditional (weak) recommendation for’ by the Canadian Task Force on Preventive Health Care or an ‘A’ or ‘B’ rating by the United States Preventive Services Task Force. Clinically preventable burden is the total quality adjusted life years that could be gained if the clinical preventive services were delivered at recommended intervals to a British Columbia birth cohort of 40,000 individuals over the years of life that the service is recommended. Cost-effectiveness is the net cost per quality adjusted life year gained. Results Clinical preventive services with the highest population impact and best value for money include services that address tobacco use in adolescents and adults, exclusive breastfeeding, and screening for hypertension and other cardiovascular disease risk factors followed by appropriate pharmaceutical treatment. In addition, alcohol misuse screening and brief counseling, one-time screening for hepatitis C virus infection in British Columbia adults born between 1945 and 1965, and screening for type 2 diabetes approach these high-value clinical preventive services. Conclusions These results enable policy makers to say with some confidence what preventive manoeuvres are worth doing but further work is required to determine the best way to deliver these services to all those eligible and to establish what supportive services are required. After all, if a clinical preventive service is worth doing, it is worth doing well.
Collapse
Affiliation(s)
- Hans Krueger
- H. Krueger & Associates Inc., Delta, Canada. .,School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | | | - Trevor Hancock
- School of Public Health and Social Policy, University of Victoria, Victoria, Canada
| | - Richard Birtwhistle
- Department of Family Medicine and Public Health Sciences, Queen's University, Kingston, Canada.,Canadian Task Force on Preventive Health Care, Ottawa, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,BC Center for Disease Control, Vancouver, Canada
| | - Bonnie Henry
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,BC Ministry of Health, Victoria, Canada
| | - Jennifer Scarr
- Child Health BC, Provincial Health Services Authority, Vancouver, Canada
| | - John J Spinelli
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| |
Collapse
|
45
|
Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain. PLoS One 2022; 17:e0266658. [PMID: 35443000 PMCID: PMC9020681 DOI: 10.1371/journal.pone.0266658] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/24/2022] [Indexed: 01/21/2023] Open
Abstract
Aims A Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban, dabigatran and apixaban. Each of these non-vitamin K antagonist oral anticoagulants was compared with vitamin K antagonist for stroke prevention in patients with non-valvular atrial fibrillation in Spain. Methods All inputs were derived from real-world studies: baseline patient characteristics, clinical event rates, as well as persistence rates for the vitamin K antagonist treatment option. A meta-analysis of real-world studies provided treatment effect and persistence data for rivaroxaban, dabigatran and apixaban, each compared with vitamin K antagonist therapy. The model considered 3-month cycles over a lifetime horizon. The model outcomes included different costs, quality-adjusted life years and life-years gained. Sensitivity analyses were performed to test the robustness of the model. Results When compared with vitamin K antagonist, rivaroxaban incurred incremental costs of €77 and resulted in incremental quality-adjusted life years of 0.08. The incremental cost per quality-adjusted life year was €952. For the same comparison, the incremental cost per quality-adjusted life year for dabigatran was €4,612. Finally, compared with vitamin K antagonist, the incremental cost per quality-adjusted life year for apixaban was €32,015. The sensitivity analyses confirmed the robustness of the base case results. The probabilities to be cost-effective versus vitamin K antagonist were 94%, 86% and 35%, respectively, for rivaroxaban, dabigatran and apixaban, considering a willingness-to-pay threshold of €22,000 per quality-adjusted life year gained, based on a cost-effectiveness study of the Spanish National Health System. Conclusion These results suggest that rivaroxaban and dabigatran are cost-effective versus vitamin K antagonist for stroke prevention in non-valvular atrial fibrillation, from the Spanish National Health System perspective.
Collapse
|
46
|
Postma JD, Kemler MA. The effect of carpal tunnel release on health-related quality of life of 2346 patients over a 5-year period. J Hand Surg Eur Vol 2022; 47:347-352. [PMID: 34525853 DOI: 10.1177/17531934211045634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In this prospective cohort study, the health-related quality of life (HRQoL) from a societal perspective of carpal tunnel syndrome (CTS) patients was determined and compared with other diseases. In addition, the effect of carpal tunnel release (CTR) was analysed 6 weeks postoperatively with regard to mean EQ-5D index value improvement, side-effects of surgery and cost per quality adjusted life year (QALY) gained. We found a baseline mean EQ-5D index value of 0.75 (SD: 0.23), comparable with values seen in other disease like breast cancer, diabetes and asthma. Furthermore, we found that CTR improved HRQoL substantially 6 weeks postoperatively (mean + 0.12, SD: 0.22) and significantly reduced symptom reporting (mean -52%, SD: 53) with a cost per QALY gained of €396.05. In conclusion, CTS has a comparable impact on quality of life as compared with other diseases, and CTR has the potential to substantially improve patient's HRQoL at a fairly modest cost.Level of evidence: III.
Collapse
Affiliation(s)
- Justin D Postma
- Department of Plastic Surgery, Martini Hospital, Groningen, Netherlands
| | - Marius A Kemler
- Department of Plastic Surgery, Martini Hospital, Groningen, Netherlands
| |
Collapse
|
47
|
Gilard M, Eltchaninoff H, Iung B, Lefèvre T, Spaulding C, Dumonteil N, Mutuon P, Roussel C, Candolfi P, de Pouvourville G, Green M, Shore J. Cost-Effectiveness Analysis of SAPIEN 3 Transcatheter Aortic Valve Implantation Procedure Compared With Surgery in Patients With Severe Aortic Stenosis at Low Risk of Surgical Mortality in France. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:605-613. [PMID: 35365304 DOI: 10.1016/j.jval.2021.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/03/2021] [Accepted: 10/05/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The clinical and cost-saving benefits of transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis who are at high or intermediate risk of surgical mortality are supported by a growing evidence base. The PARTNER 3 trial (Placement of AoRTic TraNscathetER Valve Trial) demonstrated clinical benefits with SAPIEN 3 TAVI compared with SAVR in selected patients at low risk of surgical mortality. This study uses PARTNER 3 outcomes in combination with a French national hospital claim database to inform a cost-utility model and examine the cost implications of TAVI over SAVR in a low-risk population. METHODS A 2-stage cost-utility analysis was developed to estimate changes in both direct healthcare costs and health-related quality of life using TAVI with SAPIEN 3 compared with SAVR. Early adverse events associated with TAVI were captured using the PARTNER 3 data set. These data fed into a Markov model that captured longer-term outcomes of patients, after TAVI or SAVR intervention. RESULTS TAVI with SAPIEN 3 offers meaningful benefits over SAVR in providing both cost saving (€12 742 per patient) and generating greater quality-adjusted life-years (0.89 per patient). These results are robust with TAVI with SAPIEN 3 remaining dominant across several scenarios and deterministic and probabilistic sensitivity analyses. CONCLUSIONS This model demonstrated that TAVI with SAPIEN 3 was dominant compared with SAVR in the treatment of patients with severe symptomatic aortic stenosis who are at low risk of surgical mortality. These findings should help policy makers in developing informed approaches to intervention selection for this patient population.
Collapse
Affiliation(s)
- Martine Gilard
- Centre Hospitalier Régional et Universitaire de Brest, Brest, France.
| | - Hélène Eltchaninoff
- Department of Cardiology, CHU Rouen, UNIROUEN, Normandie Univ, Rouen, France
| | - Bernard Iung
- Hôpital Bichat Claude-Bernard (APHP), Paris, France
| | - Thierry Lefèvre
- Hôpital Privé Jacques Cartier, Ramsay-générale de santé, Massy, France
| | | | | | | | | | | | | | - Michelle Green
- York Health Economics Consortium, University of York, York, England, UK
| | - Judith Shore
- York Health Economics Consortium, University of York, York, England, UK
| |
Collapse
|
48
|
Franta G, Hersh AR, Cirino NH, Caughey AB. Prevention of perinatal depression with counseling in adolescents: a cost-effectiveness analysis. J Matern Fetal Neonatal Med 2022; 35:9593-9599. [PMID: 35282745 DOI: 10.1080/14767058.2022.2049746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The US Preventive Services Task Force recently recommended that clinicians refer all pregnant and postpartum individuals at increased risk of perinatal depression to a counseling intervention. Adolescents are considered a high-risk group for perinatal depression. Therefore, we examined whether it is cost effective for all pregnant adolescents to be referred for preventive counseling. STUDY DESIGN We developed a decision-analytic model using TreeAge Pro software to compare outcomes in pregnant adolescents who received versus did not receive counseling interventions. We used a theoretical cohort of 180,000 individuals, which is the estimated annual number of births to persons ≤ 19 years in the US. Outcomes included perinatal depression, chronic depression, maternal suicide attributed to depression, preterm delivery, neonatal death, cerebral palsy, and sudden infant death syndrome (SIDS), in addition to cost and quality-adjusted life years (QALYs). The willingness-to-pay (WTP) threshold was set to $100,000/QALY. We derived model inputs from the literature, and sensitivity analyses were used to assess robustness of the model. RESULTS A strategy of referral to counseling interventions was cost effective in our theoretical cohort, with 8935 fewer cases of perinatal depression, 1606 fewer cases of chronic depression, 166 fewer preterm deliveries, 4 fewer neonatal deaths, 1 fewer case of cerebral palsy, 20 fewer cases of SIDS. In total, there were 21,976 additional QALYs and cost savings of $223,549,872, making it the dominant strategy (better outcomes with lower costs). We found that counseling interventions remained cost saving until the annual direct and indirect cost of chronic, severe depression was set below $30,000, at which point it became cost effective (baseline input: $182,309). CONCLUSION We found it was cost effective to refer all pregnant adolescents for preventive counseling interventions. Clinicians should develop approaches to identify and refer pregnant adolescents for behavioral counseling to prevent perinatal depression.
Collapse
Affiliation(s)
- Gabriel Franta
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Alyssa R Hersh
- Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Nicole H Cirino
- Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Aaron B Caughey
- Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
49
|
Cordingley L, Nelson PA, Davies L, Ashcroft D, Bundy C, Chew-Graham C, Chisholm A, Elvidge J, Hamilton M, Hilton R, Kane K, Keyworth C, Littlewood A, Lovell K, Lunt M, McAteer H, Ntais D, Parisi R, Pearce C, Rutter M, Symmons D, Young H, Griffiths CEM. Identifying and managing psoriasis-associated comorbidities: the IMPACT research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2022. [DOI: 10.3310/lvuq5853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Psoriasis is a common, lifelong inflammatory skin disease, the severity of which can range from limited disease involving a small body surface area to extensive skin involvement. It is associated with high levels of physical and psychosocial disability and a range of comorbidities, including cardiovascular disease, and it is currently incurable.
Objectives
To (1) confirm which patients with psoriasis are at highest risk of developing additional long-term conditions and identify service use and costs to patient, (2) apply knowledge about risk of comorbid disease to the development of targeted screening services to reduce risk of further disease, (3) learn how patients with psoriasis cope with their condition and about their views of service provision, (4) identify the barriers to provision of best care for patients with psoriasis and (5) develop patient self-management resources and staff training packages to improve the lives of people with psoriasis.
Design
Mixed methods including two systematic reviews, one population cohort study, one primary care screening study, one discrete choice study, four qualitative studies and three mixed-methodology studies.
Setting
Primary care, secondary care and online surveys.
Participants
People with psoriasis and health-care professionals who manage patients with psoriasis.
Results
Prevalence rates for psoriasis vary by geographical location. Incidence in the UK was estimated to be between 1.30% and 2.60%. Knowledge about the cost-effectiveness of therapies is limited because high-quality clinical comparisons of interventions have not been done or involve short-term follow-up. After adjusting for known cardiovascular risk factors, psoriasis (including severe forms) was not found to be an independent risk factor for major cardiovascular events; however, co-occurrence of inflammatory arthritis was a risk factor. Traditional risk factors were high in patients with psoriasis. Large numbers of patients with suboptimal management of known risk factors were found by screening patients in primary care. Risk information was seldom discussed with patients as part of screening consultations, meaning that a traditional screening approach may not be effective in reducing comorbidities associated with psoriasis. Gaps in training of health-care practitioners to manage psoriasis effectively were identified, including knowledge about risk factors for comorbidities and methods of facilitating behavioural change. Theory-based, high-design-quality patient materials broadened patient understanding of psoriasis and self-management. A 1-day training course based on motivational interviewing principles was effective in increasing practitioner knowledge and changing consultation styles. The primary economic analysis indicated a high level of uncertainty. Sensitivity analysis indicated some situations when the interventions may be cost-effective. The interventions need to be assessed for long-term (cost-)effectiveness.
Limitations
The duration of patient follow-up in the study of cardiovascular disease was relatively short; as a result, future studies with longer follow-up are recommended.
Conclusions
Recognition of the nature of the psoriasis and its impact, knowledge of best practice and guideline use are all limited in those most likely to provide care for the majority of patients. Patients and practitioners are likely to benefit from the provision of appropriate support and/or training that broadens understanding of psoriasis as a complex condition and incorporates support for appropriate health behaviour change. Both interventions were feasible and acceptable to patients and practitioners. Cost-effectiveness remains to be explored.
Future work
Patient support materials have been created for patients and NHS providers. A 1-day training programme with training materials for dermatologists, specialist nurses and primary care practitioners has been designed. Spin-off research projects include a national study of responses to psoriasis therapy and a global study of the prevalence and incidence of psoriasis. A new clinical service is being developed locally based on the key findings of the Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) programme.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 3. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Lis Cordingley
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
| | - Pauline A Nelson
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Linda Davies
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Darren Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christine Bundy
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Anna Chisholm
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Jamie Elvidge
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Matthew Hamilton
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rachel Hilton
- Bridgewater Community Healthcare NHS Foundation Trust, Wigan, UK
| | - Karen Kane
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | | | - Alison Littlewood
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | | | - Dionysios Ntais
- Centre for Health Economics, University of Manchester, Manchester, UK
| | - Rosa Parisi
- Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester, UK
| | - Christina Pearce
- Dermatology Research Centre, University of Manchester, Manchester, UK
| | - Martin Rutter
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Deborah Symmons
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Helen Young
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Christopher EM Griffiths
- Dermatology Research Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| |
Collapse
|
50
|
Escobar C, Morales C, Capel M, Simón S, Pérez-Alcántara F, Pomares E. Cost-effectiveness analysis of dapagliflozin for the treatment of type 2 diabetes mellitus in Spain: results of the DECLARE-TIMI 58 study. BMC Health Serv Res 2022; 22:217. [PMID: 35177053 PMCID: PMC8851809 DOI: 10.1186/s12913-022-07567-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study was to carry out a cost-effectiveness analysis of dapagliflozin, as an add-on therapy to standard of care (SoC), for the treatment of type 2 diabetes mellitus (T2DM) in Spain, based on the results of the DECLARE-TIMI 58 trial. METHODS A discrete event simulation model (Cardiff T2DM) based on the data observed in the DECLARE-TIMI 58 trial was adapted to the Spanish setting to estimate the costs and health outcomes of treatment with dapagliflozin in patients with T2DM who had or were at risk of atherosclerotic cardiovascular disease. Macrovascular events (hospitalization for heart failure, myocardial infarction, stroke, and unstable angina), end-stage renal disease and cardiovascular and non-cardiovascular mortality were modeled according to the survival equations of the DECLARE-TIMI 58 study. Microvascular events (blindness and ulcers) were estimated based on the risk equations of the UK Prospective Diabetes Study. The analysis was conducted from the Spanish National Health System perspective and the time horizon was 30 years. The results were evaluated in terms of cost per quality-adjusted life year (QALY) gained. Only direct health costs were included, and a 3% discount rate was applied to costs and health outcomes. Univariate and probabilistic sensitivity analyses (PSA) were made to assess the robustness of the results. RESULTS In the main analysis, dapagliflozin was a dominant therapeutic option compared with placebo, with greater effectiveness (0.08 QALYs) and lower associated total costs per patient (€ -2,921). The univariate sensitivity analysis and the PSA confirmed the robustness of the results. The PSA showed the probability that dapagliflozin was a dominant alternative compared with placebo was 84.2% and that it was cost-effective of 92.1%, under a willingness-to-pay of € 20,000/QALY gained. CONCLUSIONS The analysis of data from the DECLARE-TIMI 58 trial shows that dapagliflozin would be a cost-effective option in Spain for the treatment of adult patients with T2DM, as an add-on therapy to SoC, compared with placebo.
Collapse
Affiliation(s)
| | | | | | - Susana Simón
- HEOR & Market Access, AstraZeneca, Madrid, Spain
| | | | | |
Collapse
|