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Frye CC, Sullivan J, Sanka SA, Smith ER, Goetz B, Brunt LM, Gillanders W, Brown TC, Olson JA, Hall B, Pandian TK. Cost-Effectiveness of Parathyroid Cryopreservation and Autotransplantation. JAMA Surg 2024:2816727. [PMID: 38506884 PMCID: PMC10955396 DOI: 10.1001/jamasurg.2024.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Importance Delayed autotransplantation of cryopreserved parathyroid tissue (DACP) is the only surgical treatment for permanent postoperative hypoparathyroidism. Studies suggest that only a small minority of cryopreserved samples are ultimately autotransplanted with highly variable outcomes. For these reasons, many have questioned the economic utility of the process, although, to the authors' knowledge, this has never been formally studied. Objective To report the clinical outcomes of parathyroid cryopreservation and DACP at a large academic institution and to determine the cost-effectiveness of this treatment. Design, Setting, and Participants An institutional review board-approved, retrospective review of patients at a single institution who underwent DACP over a 17-year period was conducted with a median follow-up of 48.2 months. A forward-looking cost-utility analysis was then performed to determine the economic utility of cryopreservation/DACP vs usual care (monitoring and supplementation). Patients who had parathyroid tissue in cryopreserved storage between August 2005 to September 2022 at a single-center, academic, quaternary care center were identified. Exposure Parathyroid cryopreservation and DACP. Main Outcomes and Measures Graft functionality, clinical outcomes, and cost utility using a willingness-to-pay threshold of $100 000 per quality-adjusted life-year (QALY). Results A total of 591 patients underwent cryopreservation. Of these, 10 patients (1.7%; mean [SD] age, 45.6 [17.9] years; 6 male [60%]) underwent DACP. A minority of autografts (2 [20%]) were subsequently fully functional, one-half (5 [50%]) were partially functional, and 3 (30%) were not functional. The cost-utility model estimated that at a large academic center over 10 years, the additional cost of 591 patients undergoing cryopreservation and 10 patients undergoing autotransplantation would be $618 791.64 (2022 dollars) and would add 8.75 QALYs, resulting in a cost per marginal QALY of $70 719.04, which is less than the common willingness-to-pay threshold of $100 000/QALY. Conclusions and Relevance The reimplantation rate of cryopreserved tissue was low (<2%), but when implanted, autografts were at least partially functional 70% of the time. In the first-ever, to the authors' knowledge, formal cost analysis for this treatment, results of the current model suggest that cryopreservation and autotransplantation were cost-effective compared with the usual care for hypoparathyroidism at a large, academic institution. It is recommended that each surgical center consider whether the economic and logistical commitments necessary for cryopreservation are worthwhile for their individual needs.
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Affiliation(s)
- C Corbin Frye
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Janessa Sullivan
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Sai Anusha Sanka
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Eileen R Smith
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Brian Goetz
- Siteman Cancer Center, Washington University School of Medicine, Barnes Jewish Hospital, St Louis, Missouri
| | - L Michael Brunt
- Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St Louis, Missouri
| | - William Gillanders
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Taylor C Brown
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - John A Olson
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
| | - Bruce Hall
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
- BJC HealthCare, St Louis, Missouri
| | - T K Pandian
- Department of Surgery, Section of Surgical Oncology, Washington University School of Medicine, St Louis, Missouri
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Sarnaik KS, Hoenig SM, Bakir NH, Hammoud MS, Mahboubi R, Vervoort D, McCrindle BW, Welke KF, Karamlou T. Ross procedure or mechanical aortic valve, which is the best lifetime option for an 18-year-old? A decision analysis. JTCVS Open 2024; 17:185-214. [PMID: 38420529 PMCID: PMC10897596 DOI: 10.1016/j.xjon.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/22/2023] [Accepted: 10/23/2023] [Indexed: 03/02/2024]
Abstract
Objectives Identifying the optimal solution for young adults requiring aortic valve replacement (AVR) is challenging, given the variety of options and their lifetime complication risks, impacts on quality of life, and costs. Decision analytic techniques make comparisons incorporating these measures. We evaluated lifetime valve-related outcomes of mechanical aortic valve replacement (mAVR) versus the Ross procedure (Ross) using decision tree microsimulations modeling. Methods Transition probabilities, utilities, and costs derived from published reports were entered into a Markov model decision tree to explore progression between health states for hypothetical 18-year-old patients. In total, 20,000 Monte Carlo microsimulations were performed to model mortality, quality-adjusted-life-years (QALYs), and health care costs. The incremental cost-effectiveness ratio (ICER) was calculated. Sensitivity analyses was performed to identify transition probabilities at which the preferred strategy switched from baseline. Results From modeling, average 20-year mortality was 16.3% and 23.2% for Ross and mAVR, respectively. Average 20-year freedom from stroke and major bleeding was 98.6% and 94.6% for Ross, and 90.0% and 82.2% for mAVR, respectively. Average individual lifetime (60 postoperative years) utility (28.3 vs 23.5 QALYs) and cost ($54,233 vs $507,240) favored Ross over mAVR. The average ICER demonstrated that each QALY would cost $95,345 more for mAVR. Sensitivity analysis revealed late annual probabilities of autograft/left ventricular outflow tract disease and homograft/right ventricular outflow tract disease after Ross, and late death after mAVR, to be important ICER determinants. Conclusions Our modeling suggests that Ross is preferred to mAVR, with superior freedom from valve-related morbidity and mortality, and improved cost-utility for young adults requiring aortic valve surgery.
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Affiliation(s)
- Kunaal S Sarnaik
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Samuel M Hoenig
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nadia H Bakir
- Department of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Miza Salim Hammoud
- Department of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Rashed Mahboubi
- Department of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karl F Welke
- Division of Pediatric Cardiothoracic Surgery, Atrium Health Levine Children's Hospital, Charlotte, NC
| | - Tara Karamlou
- Department of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
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Wu C, Li W, Tao H, Zhang X, Xin Y, Song R, Wang K, Zuo L, Cai Y, Wu H, Hui W. Cost-effectiveness of first-line immunotherapy for advanced non-small cell lung cancer with different PD-L1 expression levels: A comprehensive overview. Crit Rev Oncol Hematol 2024; 193:104195. [PMID: 37931769 DOI: 10.1016/j.critrevonc.2023.104195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/15/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Immunotherapies can substantially improve treatment efficacy, despite their high cost. A comprehensive overview of the cost-effectiveness analysis (CEA) of immune checkpoint inhibitors (ICIs) in patients with non-small cell lung cancer based on different tumor proportion scores (TPSs) was conducted. METHODS PubMed, Embase, Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, and NHS Economic Evaluation databases were searched from their inception until August 24, 2022. Data relevant to the CEA results were recorded, and quality assessments conducted based on the Quality of Health Economic Studies (QHES) process. FINDINGS Fifty-one original studies from seven countries were included. The mean QHES score was 77.0 (range: 53-95). Twenty-seven studies were classified as high-quality, and the rest as fair quality. Pembrolizumab, nivolumab, ipilimumab, atezolizumab, camrelizumab, cemiplimab, sintilimab, tislelizumab, and durvalumab were identified using three TPS categories. While nivolumab plus ipilimumab and pembrolizumab plus chemotherapy were unlikely to be cost-effective in China, the results for the US were uncertain. Atezolizumab combinations were not cost-effective in China or the US, and tislelizumab and sintilimab were cost-effective in China. For TPSs ≥ 50%, the pembrolizumab monotherapy could be cost-effective in some developed countries. Cemiplimab was more cost-effective than chemotherapy, pembrolizumab, and atezolizumab in the US. For TPSs ≥ 1%, the cost-effectiveness of pembrolizumab was controversial due to the different willingness-to-pay thresholds. CONCLUSIONS None of the atezolizumab combination regimens were found to be cost-effective in any perspective of evaluations. Camrelizumab, tislelizumab, and sintilimab have lower ICERs compared to atezolizumab, pembrolizumab, and nivolumab in China. Cemiplimab may be a more affordable alternative to pembrolizumab or atezolizumab. However, it remains unclear which ICIs are the best choices for each country. Future CEAs are required to select comprehensive regimens alongside randomized trials and real-world studies to help verify the economics of ICIs in specific decision-making settings.
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Affiliation(s)
- Changjin Wu
- School of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Wentan Li
- School of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Hongyu Tao
- Laboratory of Oncology, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiyan Zhang
- School of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Yu Xin
- Department of Science and Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruomeng Song
- School of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Kaige Wang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling Zuo
- Department of Pulmonary and Critical Care Medicine, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China; Integrated Care Management Center, Outpatient Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuanyi Cai
- School of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Huazhang Wu
- School of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Wen Hui
- Department of Science and Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Walter N, Hierl K, Rupp M, Alt V. Basics of health economics for clinical trials in orthopaedic trauma. Injury 2023; 54 Suppl 5:110878. [PMID: 37923505 DOI: 10.1016/j.injury.2023.110878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 11/07/2023]
Abstract
With the rise in global healthcare spending, medical decision-making is increasingly based on health economics outcomes. This narrative review aims to provide an overview of cost-effectiveness analysis (CEA) and cost-utility analysis (CUA), including their advantages and limitations, and outline practical aspects for implementing health economics in clinical trials for orthopaedic trauma. Both CEA and CUA offer several advantages. Firstly, they consider the costs as well as benefits of an intervention, providing a more comprehensive picture of its economic impact. Secondly, they provide a clear and straightforward metric for comparing interventions, which can help decision-makers make informed choices. However, there are methodological shortcomings that must be acknowledged, such as the lack of standardized instruments for assessing health utility measures, which can result in a wide range of cost-benefit ratios. In addition, a consensus on the willingness-to-pay threshold still needs to be reached to develop decision rules for cost-effectiveness similar to clinical effectiveness. Methods such as CEA and CUA should be incorporated into clinical trials in orthopaedic trauma research. Practical aspects for this include planning in advance, preferably in cooperation with a health economist. Selecting appropriate outcome measures is crucial, and both the medical effects of interventions and quality of life instruments should be carefully chosen to ensure comparability with previous studies. Additionally, the potential impact on clinical practice and healthcare policies should be considered. Direct as well as indirect costs should be assessed, and quality assurance with well-established checklists should be confirmed.
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Affiliation(s)
- Nike Walter
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, Regensburg 93053, Germany; Department of Psychosomatic Medicine, University Hospital Regensburg, Germany.
| | - Katja Hierl
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, Regensburg 93053, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, Regensburg 93053, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, Regensburg 93053, Germany
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Boespflug N, Wittwer J, Bénard A. Factors associated with the author-reported cost-effectiveness threshold in high-income countries: systematic review and multivariable modelling. Eur J Health Econ 2023:10.1007/s10198-023-01613-7. [PMID: 37433889 DOI: 10.1007/s10198-023-01613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE The cost-effectiveness threshold (CET) is a key parameter to guide objective reimbursement decisions, yet very few countries have defined a reference CET, and there is no reference method for defining it. Our objective was to determine the factors explaining the author-reported CETs in the literature. METHODS Our systematic review targeted original articles referenced in EMBASE and published between 2010 and 2021. Selected studies had to use Quality-Adjusted Life-Year (QALY), and being conducted in high-income countries. Our explanatory variables were: estimated cost-effectiveness ratio (ICER), region of the world, source of funding, type of intervention, disease, year of publication, justification of the author-reported Cost-Effectiveness Threshold (ar-CET), economic perspective, and declaration of interest. Multivariable linear regression models implemented on R software were used, guided by a Directed Acyclic Graph. RESULTS Two hundred and fifty four studies were included. The mean ar-CET was €63,338/QALY (standard deviation (SD) 34,965) overall, and €37,748/QALY (SD 20,750) in studies conducted in the British Commonwealth. The ar-CET increased slightly with the ICER (+ 66€/QALY for each additional 10,000€/QALY in the ICER, 95% confidence interval (IC) [31-102], p < 0.001), was higher in the United States (+ 36,225€/QALY; IC [25,582; 46,869]) and Europe (+ 10,352€/QALY; IC [72; 20,631]) compared to the British Commonwealth (p < 0.001), and was higher when the ar-CET was not defined a priori (+ 22,393€/QALY; [5809; 38,876]) compared to state recommendations defined ar-CET (p < 0.001). CONCLUSIONS Our results underline the virtuous role of state recommendations in the choice of a low and homogeneous CET. We also highlight the need to integrate the a priori justification of the CET into good publishing guidelines.
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Affiliation(s)
- Nicolas Boespflug
- CHU Bordeaux, Service d'information Médicale, USMR & CIC-EC 1401, 33000, Bordeaux, France
| | - Jérôme Wittwer
- INSERM, Bordeaux Population Health, UMR 1219, 33000, Bordeaux, France
| | - Antoine Bénard
- CHU Bordeaux, Service d'information Médicale, USMR & CIC-EC 1401, 33000, Bordeaux, France.
- INSERM, Bordeaux Population Health, UMR 1219, 33000, Bordeaux, France.
- Université de Bordeaux, Case 75, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.
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Vallejo-Torres L, García-Lorenzo B, Edney LC, Stadhouders N, Edoka I, Castilla-Rodríguez I, García-Pérez L, Linertová R, Valcárcel-Nazco C, Karnon J. Are Estimates of the Health Opportunity Cost Being Used to Draw Conclusions in Published Cost-Effectiveness Analyses? A Scoping Review in Four Countries. Appl Health Econ Health Policy 2022; 20:337-349. [PMID: 34964092 PMCID: PMC9021093 DOI: 10.1007/s40258-021-00707-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND When healthcare budgets are exogenous, cost-effectiveness thresholds (CETs) used to inform funding decisions should represent the health opportunity cost (HOC) of such funding decisions, but HOC-based CET estimates have not been available until recently. In recent years, empirical HOC-based CETs for multiple countries have been published, but the use of these CETs in the cost-effectiveness analysis (CEA) literature has not been investigated. Analysis of the use of HOC-based CETs by researchers undertaking CEAs in countries with different decision-making contexts will provide valuable insights to further understand barriers and facilitators to the acceptance and use of HOC-based CETs. OBJECTIVES We aimed to identify the CET values used to interpret the results of CEAs published in the scientific literature before and after the publication of jurisdiction-specific empirical HOC-based CETs in four countries. METHODS We undertook a scoping review of CEAs published in Spain, Australia, the Netherlands and South Africa between 2016 (2014 in Spain) and 2020. CETs used before and after publication of HOC estimates were recorded. We conducted logit regressions exploring factors explaining the use of HOC values in identified studies and linear models exploring the association of the reported CET value with study characteristics and results. RESULTS 1171 studies were included in this review (870 CEAs and 301 study protocols). HOC values were cited in 28% of CEAs in Spain and in 11% of studies conducted in Australia, but they were not referred to in CEAs undertaken in the Netherlands and South Africa. Regression analyses on Spanish and Australian studies indicate that more recent studies, studies without a conflict of interest and studies estimating an incremental cost-effectiveness ratio (ICER) below the HOC value were more likely to use the HOC as a threshold reference. In addition, we found a small but significant impact indicating that for every dollar increase in the estimated ICER, the reported CET increased by US$0.015. Based on the findings of our review, we discuss the potential factors that might explain the lack of adoption of HOC-based CETs in the empirical CEA literature. CONCLUSIONS The adoption of HOC-based CETs by identified published CEAs has been uneven across the four analysed countries, most likely due to underlying differences in their decision-making processes. Our results also reinforce a previous finding indicating that CETs might be endogenously selected to fit authors' conclusions.
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Affiliation(s)
- Laura Vallejo-Torres
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Borja García-Lorenzo
- Kronikgune Institute for Health Services Research, Barakaldo, Basque Country, Spain
- Assessment of Innovations and New Technologies Unit, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Laura Catherine Edney
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Niek Stadhouders
- IQ Healthcare, Radboud University and Medical Center, Nijmegen, The Netherlands
| | - Ijeoma Edoka
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Iván Castilla-Rodríguez
- Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna, La Laguna, Spain
| | - Lidia García-Pérez
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS), Madrid, Spain
| | - Renata Linertová
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS), Madrid, Spain
| | - Cristina Valcárcel-Nazco
- Canary Islands Health Research Institute Foundation (FIISC), Santa Cruz de Tenerife, Spain
- Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Santa Cruz de Tenerife, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
- Red Española de Agencias de Evaluación de Tecnologías Sanitarias y Prestaciones del Sistema Nacional de Salud (RedETS), Madrid, Spain
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
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Sharma M, John R, Afrin S, Zhang X, Wang T, Tian M, Sahu KS, Mash R, Praveen D, Saif-Ur-Rahman KM. Cost-Effectiveness of Population Screening Programs for Cardiovascular Diseases and Diabetes in Low- and Middle-Income Countries: A Systematic Review. Front Public Health 2022; 10:820750. [PMID: 35345509 PMCID: PMC8957212 DOI: 10.3389/fpubh.2022.820750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/11/2022] [Indexed: 11/29/2022] Open
Abstract
Almost all low- and middle-income countries (LMICs) have instated a program to control and manage non-communicable diseases (NCDs). Population screening is an integral component of this strategy and requires a substantial chunk of investment. Therefore, testing the screening program for economic along with clinical effectiveness is essential. There is significant proof of the benefits of incorporating economic evidence in health decision-making globally, although evidence from LMICs in NCD prevention is scanty. This systematic review aims to consolidate and synthesize economic evidence of screening programs for cardiovascular diseases (CVD) and diabetes from LMICs. The study protocol is registered on PROSPERO (CRD42021275806). The review includes articles from English and Chinese languages. An initial search retrieved a total of 2,644 potentially relevant publications. Finally, 15 articles (13 English and 2 Chinese reports) were included and scrutinized in detail. We found 6 economic evaluations of interventions targeting cardiovascular diseases, 5 evaluations of diabetes interventions, and 4 were combined interventions, i.e., screening of diabetes and cardiovascular diseases. The study showcases numerous innovative screening programs that have been piloted, such as using mobile technology for screening, integrating non-communicable disease screening with existing communicable disease screening programs, and using community health workers for screening. Our review reveals that context is of utmost importance while considering any intervention, i.e., depending on the available resources, cost-effectiveness may vary—screening programs can be made universal or targeted just for the high-risk population.
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Affiliation(s)
- Manushi Sharma
- The George Institute for Global Health, New Delhi, India
| | - Renu John
- The George Institute for Global Health, New Delhi, India
| | - Sadia Afrin
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh
| | - Xinyi Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Tengyi Wang
- School of Public Health, Harbin Medical University, Harbin, China
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, Harbin, China.,Faculty of Medicine and Health, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Kirti Sundar Sahu
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Robert Mash
- Department of Family and Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Devarsetty Praveen
- The George Institute for Global Health, New Delhi, India.,Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - K M Saif-Ur-Rahman
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh.,Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Abstract
Every public health expenditure, including the one that saves lives or extends life expectancy of particular persons (target population), bears a cost. Although cost-effectiveness analysis (CEA) is routinely performed in health policy, ethical justification of CEA is rarely discussed. Also, there is neither consensus value nor even consensus method for determining cost-effectiveness threshold (CET) for life-extending measures. In this study, we performed ethical analysis of CEA by policy impact assessment based on connection of health and wealth (poorer people have statistically shorter life expectancies) and concluded that CEA is not only a practical but also an ethical necessity. To quantify CET, we used three independent methods: (1) literature survey of analyzing salaries in risky occupations, (2) utilizing Prospect Theory suggesting that people value their lives in monetary terms twice more than their lifetime earnings, and (3) literature survey of the U.S. current legal practice. To the best of our knowledge, nobody applied method (2) to determine CET. The three methods yielded rather similar results with CET about 1.0 ± 0.4 gross domestic product per capita (GDPpc) per quality-adjusted life-year. Therefore, a sum of not higher than 140% GDPpc is statistically sufficient to “purchase” an additional year of life—or, alternatively, to “rob” one year of life if taken away. Therefore, 140% GDP per capita per quality-adjusted life-year should be considered as the upper limit of prudent and ethically justified expenditure on life extension programs.
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Affiliation(s)
- Moshe Yanovskiy
- Department of Industrial Engineering, Jerusalem College of Technology, Jerusalem, Israel
| | - Ori N. Levy
- Department of Industrial Engineering, Jerusalem College of Technology, Jerusalem, Israel
- Disaster Research Center, IL, Ariel University, Ariel, Israel
| | - Yair Y. Shaki
- Department of Industrial Engineering, Jerusalem College of Technology, Jerusalem, Israel
| | - Avi Zigdon
- Disaster Research Center, IL, Ariel University, Ariel, Israel
- Department of Health Systems Management, School of Health and Medical Sciences, Ariel University, Ariel, Israel
| | - Yehoshua Socol
- Department of Electrical and Electronics Engineering, Jerusalem College of Technology, Jerusalem, Israel
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9
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Kamaraj A, Agarwal N, Seah KTM, Khan W. Understanding cost-utility analysis studies in the trauma and orthopaedic surgery literature. EFORT Open Rev 2021; 6:305-315. [PMID: 34150325 PMCID: PMC8183147 DOI: 10.1302/2058-5241.6.200115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cost-utility analysis (CUA) studies are becoming increasingly important due to the need to reduce healthcare spending, especially in the field of trauma and orthopaedics. There is an increasing need for trauma and orthopaedic surgeons to understand these economic evaluations to ensure informed cost-effective decisions can be made to benefit the patient and funding body. This review discusses the fundamental principles required to understand CUA studies in the literature, including a discussion of the different methods employed to assess the health outcomes associated with different management options and the various approaches used to calculate the costs involved. Different types of model design may be used to conduct a CUA which can be broadly categorized into real-life clinical studies and computer-simulated modelling. We discuss the main types of study designs used within each category. We also cover the different types of sensitivity analysis used to quantify uncertainty in these studies and the commonly employed instruments used to assess the quality of CUAs. Finally, we discuss some of the important limitations of CUAs that need to be considered. This review outlines the main concepts required to understand the CUA literature and provides a basic framework for their future conduct.
Cite this article: EFORT Open Rev 2021;6:305-315. DOI: 10.1302/2058-5241.6.200115
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Affiliation(s)
- Achi Kamaraj
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Nikhil Agarwal
- Department of Surgery, University of Cambridge, Cambridge, UK
| | | | - Wasim Khan
- Department of Surgery, University of Cambridge, Cambridge, UK
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Abstract
BACKGROUND Cost-effectiveness analysis is an important tool for informing treatment coverage and pricing decisions, yet no consensus exists about what threshold for the incremental cost-effectiveness ratio (ICER) in dollars per quality-adjusted life-year (QALY) gained indicates whether treatments are likely to be cost-effective in the United States. OBJECTIVE To estimate a U.S. cost-effectiveness threshold based on health opportunity costs. DESIGN Simulation of short-term mortality and morbidity attributable to persons dropping health insurance due to increased health care expenditures passed though as premium increases. Model inputs came from demographic data and the literature; 95% uncertainty intervals (UIs) were constructed. SETTING Population-based. PARTICIPANTS Simulated cohort of 100 000 individuals from the U.S. population with direct-purchase private health insurance. MEASUREMENTS Number of persons dropping insurance coverage, number of additional deaths, and QALYs lost from increased mortality and morbidity, all per increase of $10 000 000 (2019 U.S. dollars) in population treatment cost. RESULTS Per $10 000 000 increase in health care expenditures, 1860 persons (95% UI, 1080 to 2840 persons) were simulated to become uninsured, causing 5 deaths (UI, 3 to 11 deaths), 81 QALYs (UI, 40 to 170 QALYs) lost due to death, and 15 QALYs (UI, 6 to 32 QALYs) lost due to illness; this implies a cost-effectiveness threshold of $104 000 per QALY (UI, $51 000 to $209 000 per QALY) in 2019 U.S. dollars. Given available evidence, there is about 14% probability that the threshold exceeds $150 000 per QALY and about 48% probability that it lies below $100 000 per QALY. LIMITATIONS Estimates were sensitive to inputs, most notably the effects of losing insurance on mortality and of premium increases on becoming uninsured. Health opportunity costs may vary by population. Nonhealth opportunity costs were excluded. CONCLUSION Given current evidence, treatments with ICERs above the range $100 000 to $150 000 per QALY are unlikely to be cost-effective in the United States. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- David J Vanness
- Pennsylvania State University, University Park, Pennsylvania (D.J.V., H.A.)
| | - James Lomas
- University of York, York, United Kingdom (J.L.)
| | - Hannah Ahn
- Pennsylvania State University, University Park, Pennsylvania (D.J.V., H.A.)
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Patil NR, Dhandapani S, Sahoo SK, Chhabra R, Singh A, Dutta P, Walia R, Verma R, Gupta R, Virk RS, Ahuja CK, Dhandapani M, Chaudhary H, Jangra K, Gupta SK. Differential independent impact of the intraoperative use of navigation and angled endoscopes on the surgical outcome of endonasal endoscopy for pituitary tumors: a prospective study. Neurosurg Rev 2020; 44:2291-2298. [PMID: 33089448 DOI: 10.1007/s10143-020-01416-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/26/2020] [Accepted: 10/07/2020] [Indexed: 02/07/2023]
Abstract
Despite widespread popularity of navigation and angled endoscopes in endonasal endoscopy, there are hardly few studies on their efficacy with the extent of resection or retreatment. This is probably the first study to assess the independent impact of these adjuncts among pituitary tumors. Patients with pituitary tumors undergoing endonasal endoscopy were prospectively studied for their demographics, clinico-radiological features, intraoperative use of navigation, and angled endoscopes, in relation to gross total resection (GTR), near total resection (NTR), endocrine remission, and retreatment. Pertinent statistical analyses were performed. Among a total of 139 patients, navigation and angled endoscopes could be used in 54 and 48 patients, respectively, depending upon their availability rather than chosen as per the case. There was no significant difference in baseline characteristics in relation to their use. The surgeon's perception of immediate benefit was noted among 51.9% while using navigation. The use of angled endoscopes towards the end of resection could help with additional tumor removal in 62.5% of patients. Overall, the use of navigation resulted in a significantly higher GTR (80.8% vs. 59.7%, OR 2.83, p = 0.01), a higher GTR/NTR (86.5% vs. 70.8%, OR 2.65, p = 0.04), and a lower retreatment rate (7.7% vs. 20.8%, OR 3.15, p = 0.05) than the others. In functioning tumors with cavernous sinus invasion, navigation had significantly increased remission rates (69.2% vs. 0%, p = 0.03). The use of angled endoscopes yielded a significantly higher GTR/NTR (91.7% vs. 70.6%, p = 0.04) and a lower retreatment rate (0% vs. 15.7%, p = 0.05) among only non-functioning adenomas. In multivariate analyses, the use of neuronavigation had a significant association with both GTR and retreatment rates (p values 0.005 and 0.02 respectively), independent of other confounding factors. The elective intraoperative use of navigation has a significant independent impact on the extent of resection and retreatment overall. While navigation results in better remission rates among functioning tumors with cavernous sinus invasion, angled endoscopy has a significant association with surgical outcomes in non-functioning tumors.
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Affiliation(s)
- Ninad R Patil
- Dept. of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sivashanmugam Dhandapani
- Dept. of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Sushant K Sahoo
- Dept. of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Chhabra
- Dept. of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Apinderpreet Singh
- Dept. of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pinaki Dutta
- Dept. of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rama Walia
- Dept. of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Roshan Verma
- Dept. of ENT, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rijuneeta Gupta
- Dept. of ENT, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ramandeep S Virk
- Dept. of ENT, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Chirag K Ahuja
- Dept. of Radiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manju Dhandapani
- NINE, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Himanshi Chaudhary
- Dept. of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kiran Jangra
- Dept. of Neuroanesthesia, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sunil K Gupta
- Dept. of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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