1
|
Krishnamoorthy Y, Govindan D, Kannan N, Majella MG, Hariharan VS, Valliappan V. Budget impact and cost-utility analysis of prophylactic emicizumab versus on-demand bypassing agents for adolescent severe haemophilia A patients with inhibitors in India. Heliyon 2024; 10:e27089. [PMID: 38468938 PMCID: PMC10926073 DOI: 10.1016/j.heliyon.2024.e27089] [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: 06/07/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/13/2024] Open
Abstract
Introduction Severe Haemophilia A patients with inhibitors are currently being treated with bypassing agents like activated prothrombin complex concentrates (aPCC) and recombinant factor VIIa. Emicizumab is a recombinant humanized monoclonal antibody, introduced to reduce the bleeding events, improve treatment adherence, and quality of life. However, cost-effectiveness and long-term sustainability of the intervention is not studied in a low middle income setting like India. Aim The primary objective of this study was to evaluate the cost-utility of Emicizumab compared to traditional bypassing agents in the treatment of severe haemophilia A patients with inhibitors in India. Secondary objective was to analyze the budgetary impact of introducing Emicizumab for this patient population from the perspective of public health system in India. Methods Markov model was created to compare the prophylactic emicizumab therapy against bypassing agents for a hypothetical cohort of 10-year-old adolescents in India. The time horizon was 10 years and model built based on health system perspective. Cost utility was expressed as costs per quality-adjusted life-years (QALYs) gained. All costs were expressed as 2021 US dollars. Probabilistic sensitivity analysis was performed to check the robustness of the estimates. Results Prophylactic emicizumab was a cost saving intervention with negative Incremental Cost Utility Ratio (ICUR) against recombinant factor VIIa of -853,573 USD (INR -63,109,773), and negative ICUR of -211,675 USD (INR -15,650,403) against APCC. The estimated total budget for treating all the severe Haemophilia A patients with inhibitors in India was USD 59,042,000 (INR 4,365,329,312) for 10 years' time horizon (per patient cost of USD 295,210 [INR 21,826,646.56]). Conclusion Prophylactic emicizumab therapy is a cost saving intervention when compared to both the bypassing agents as it is less costly and more effective for severe Haemophilia A patients with inhibitors in India.
Collapse
Affiliation(s)
- Yuvaraj Krishnamoorthy
- PROPUL Evidence Synthesis Unit (PROPUL ESU), PROPUL (Partnership for Research Opportunity Planning Upskilling and Leadership) Evidence, Chennai, Tamilnadu, India
| | - Dhanajayan Govindan
- PROPUL Evidence Synthesis Unit (PROPUL ESU), PROPUL (Partnership for Research Opportunity Planning Upskilling and Leadership) Evidence, Chennai, Tamilnadu, India
| | - Narasimhapriyan Kannan
- Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Marie Gilbert Majella
- PROPUL Evidence Synthesis Unit (PROPUL ESU), PROPUL (Partnership for Research Opportunity Planning Upskilling and Leadership) Evidence, Chennai, Tamilnadu, India
| | | | - Vivek Valliappan
- Department of Pharmacology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Chengalpattu District, 603103, Tamilnadu, India
| |
Collapse
|
2
|
Shi HY, Li CH, Chen YC, Chiu CC, Lee HH, Hou MF. Quality of life and cost-effectiveness of different breast cancer surgery procedures: a Markov decision tree-based approach in the framework of Predictive, Preventive, and Personalized Medicine. EPMA J 2023; 14:457-475. [PMID: 37605647 PMCID: PMC10439868 DOI: 10.1007/s13167-023-00326-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/14/2023] [Indexed: 08/23/2023]
Abstract
Purpose Breast cancer is a complex disease with heterogeneous outcomes that may benefit from the implementation of Predictive, Preventive, and Personalized Medicine (PPPM/3PM) strategies. In this study, we aimed to explore the potential of PPPM approaches by investigating the 10-year trends in quality of life (QOL) and the cost-effectiveness of different types of surgeries for patients with breast cancer. Methods This prospective cohort study recruited 144 patients undergoing breast conserving surgery (BCS), 199 undergoing modified radical mastectomy (MRM), and 44 undergoing total mastectomy with transverse rectus abdominis myocutaneous flap (TRAMF) from three medical centers in Taiwan between June 2007 and June 2010. Results All patients exhibited a significant decrease in most QOL dimension scores from before surgery to 6 months postoperatively (p < 0.05); however, from postoperative year 1 to 2, improvement in most QOL dimension scores was significantly better in the TRAMF group than in the BCS and MRM groups (p < 0.05). At 2, 5, and 10 years after surgery, the patients' QOL remained stable. In the Markov decision tree model, the TRAMF group had higher total direct medical costs than the MRM and BCS groups (US$ 32,426, US$ 29,487, and US$ 28,561, respectively) and higher average QALYs gained (7.771, 6.773, and 7.385, respectively), with an incremental cost-utility ratio (ICUR) of US$ 2,944.39 and US$ 10,013.86 per QALY gained. Conclusions TRAMF appeared cost effective compared with BCS and MRM, and it has been proved with considerable QOL improvements in the framework of PPPM. Future studies should continue to explore the potential of PPPM approaches in breast cancer care. By incorporating predictive models, personalized treatment plans, and preventive strategies into routine clinical practice, we can further optimize patient outcomes and reduce healthcare costs associated with breast cancer treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-023-00326-4.
Collapse
Affiliation(s)
- Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, 80420 Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, 80708 Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, 40402 Taiwan
| | - Chiu-Hui Li
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan
- Superintendent Office Secretary Admission Service Center, Health Management and Occupational Safety and Health Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, 81267 Taiwan
| | - Yen-Chen Chen
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 82445 Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, 82445 Taiwan
- Department of Medical Education and Research, E-Da Cancer Hospital, I-Shou University, Kaohsiung, 82445 Taiwan
| | - Hao-Hsien Lee
- Department of Surgery, Chi Mei Medical Center, Liouying, Tainan 73658 Taiwan
| | - Ming-Feng Hou
- Division of Breast Oncology and Surgery, Department of Surgery, Kaohsiung Medical University Chung-Ho Memorial Hospital, No. 100, Shih-Chuan 1St Road, Kaohsiung, 80708 Taiwan
- Department of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Kaohsiung, 80708 Taiwan
| |
Collapse
|
3
|
Putri S, Saldi SRF, Khoe LC, Setiawan E, Megraini A, Santatiwongchai B, Nugraha RR, Permanasari VY, Nadjib M, Sastroasmoro S, Armansyah A. Cetuximab as first-line treatment for metastatic colorectal cancer (mCRC): a model-based economic evaluation in Indonesia setting. BMC Cancer 2023; 23:731. [PMID: 37553566 PMCID: PMC10408081 DOI: 10.1186/s12885-023-11253-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES To assess the cost-effectiveness of cetuximab in combination with chemotherapy fluorouracil, oxaliplatin, and leucovorin (FOLFOX) or fluorouracil, irinotecan and leucovorin (FOLFIRI) compared to standard chemotherapy alone as a first-line treatment for metastatic colorectal cancer (mCRC) with positive KRAS wild type patients in Indonesia. METHODS A cost-utility analysis applying Markov model was constructed, with a societal perspective. Clinical evidence was derived from published clinical trials. Direct medical costs were gathered from hospital billings. Meanwhile, direct non-medical costs, indirect costs, and utility data were collected by directly interviewing patients. We applied 3% discount rate for both costs and outcomes. Probabilistic sensitivity analysis was performed to explore the model's uncertainty. Additionally, using payer perspective, budget impact analysis was estimated to project the financial impact of treatment coverage. RESULTS There was no significant difference in life years gained (LYG) between cetuximab plus FOLFOX/FOLFIRI and chemotherapy alone. The incremental QALY was only one month, and the incremental cost-effectiveness ratio (ICER) was approximately IDR 3 billion/QALY for cetuximab plus chemotherapy. Using 1-3 GDP per capita (IDR 215 million or USD 14,350) as the current threshold, the cetuximab plus chemotherapy was not cost-effective. The budget impact analysis resulted that if cetuximab plus chemotherapy remain included in the benefits package under the Indonesian national health insurance (NHI) system, the payer would need more than IDR 1 trillion for five years. CONCLUSIONS The combination of cetuximab and chemotherapy for mCRC is unlikely cost-effective and has a substantial financial impact on the system.
Collapse
Affiliation(s)
- Septiara Putri
- Health Policy and Administration Department, Faculty of Public Health, University of Indonesia, Depok, West Java, 16424, Indonesia.
- Center for Health Economics and Policy Studies (CHEPS), University of Indonesia, Depok, West Java, 16424, Indonesia.
| | - Siti Rizny F Saldi
- Center for Clinical Epidemiology and Evidence-Based Medicine (CEEBM), Cipto Mangunkusomo Hospital, Jakarta, 10430, Indonesia
| | - Levina Chandra Khoe
- Department of Community Medicine, Faculty of Medicine, University of Indonesia, Jakarta, 10430, Indonesia
| | - Ery Setiawan
- Center for Health Economics and Policy Studies (CHEPS), University of Indonesia, Depok, West Java, 16424, Indonesia
| | - Amila Megraini
- Center for Health Economics and Policy Studies (CHEPS), University of Indonesia, Depok, West Java, 16424, Indonesia
| | - Benjarin Santatiwongchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, 11000, Thailand
| | - Ryan R Nugraha
- Center for Population, Family, and Health, Department of Family Medicine and Population Health, University of Antwerp, Antwerp, 2610, Belgium
| | - Vetty Y Permanasari
- Health Policy and Administration Department, Faculty of Public Health, University of Indonesia, Depok, West Java, 16424, Indonesia
| | - Mardiati Nadjib
- Health Policy and Administration Department, Faculty of Public Health, University of Indonesia, Depok, West Java, 16424, Indonesia
- Indonesian Health Technology Assessment Committee, Jakarta, 12950, Indonesia
| | - Sudigdo Sastroasmoro
- Indonesian Health Technology Assessment Committee, Jakarta, 12950, Indonesia
- Department of Pediatrics, Faculty of Medicine, University of Indonesia, Jakarta, 10430, Indonesia
| | - Armansyah Armansyah
- Center for Health Financing and Insurance, Ministry of Health Republic of Indonesia, Jakarta, 12950, Indonesia
| |
Collapse
|
4
|
Morii Y, Abiko K, Osanai T, Takami J, Tanikawa T, Fujiwara K, Houkin K, Ogasawara K. Cost-effectiveness of seven-days-per-week rehabilitation schedule for acute stroke patients. Cost Eff Resour Alloc 2023; 21:12. [PMID: 36726117 PMCID: PMC9893661 DOI: 10.1186/s12962-023-00421-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 01/23/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Rehabilitation is an essential medical service for patients who have suffered acute stroke. Although the effectiveness of 7-days-per-week rehabilitation schedule has been studied in comparison with 5- or 6-days-per-week rehabilitation schedule, its cost-effectiveness has not been analyzed. In this research, to help formulate more cost-effective medical treatments for acute stroke patients, we analyzed the cost-effectiveness of 7-days-per-week rehabilitation for acute stroke from public health payer's perspective, and public healthcare and long-term care payer's perspective in Japan. METHODS Cost-effectiveness of 7-days-per-week rehabilitation for acute stroke patients was analyzed based on the result from a previous study using a Japanese database examining the efficacy of 7-days-per-week rehabilitation. Cost utility analysis was conducted by comparing 7-days-per-week rehabilitation with 5- or 6-days-per-week rehabilitation, with its main outcome incremental cost-effectiveness ratio (ICER) calculated by dividing estimated incremental medical and long-term care costs by incremental quality-adjusted life years (QALY). The costs were estimated using the Japanese fee table and from published sources. The time horizon was 5 years, and Markov modeling was used for the analysis. RESULTS The ICER was $6339/QALY from public health payer's perspective, lower than 5,000,000 Yen/QALY (approximately US$37,913), which was the willingness-to-pay used for the cost-effectiveness evaluation in Japan. The 7-day-per-week rehabilitation was dominant from public healthcare and long-term care payer's perspective. The result of sensitivity analysis confirmed the results. CONCLUSION The results indicated that 7-days-per-week rehabilitation for acute stroke rehabilitation was likely to be cost-effective.
Collapse
Affiliation(s)
- Yasuhiro Morii
- grid.415776.60000 0001 2037 6433Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama Japan ,grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-Ku, Sapporo, Hokkaido Japan
| | - Kagari Abiko
- grid.415260.40000 0004 1769 060XDepartment of Rehabilitation Medicine, Sapporo Azabu Neurosurgical Hospital, N22-E1, Higashi-Ku, Sapporo, Hokkaido Japan ,grid.412167.70000 0004 0378 6088Department of Rehabilitation Medicine, Hokkaido University Hospital, N15-W7, Kita-Ku, Sapporo, Hokkaido Japan
| | - Toshiya Osanai
- grid.39158.360000 0001 2173 7691Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, N15-W7, Kita-Ku, Sapporo, Hokkaido Japan
| | - Jiro Takami
- Department of Rehabilitation, Nishi Sapporo Hospital, 5-1, Yamanote 3-2, Nishi-Ku, Sapporo, Hokkaido Japan
| | - Takumi Tanikawa
- grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-Ku, Sapporo, Hokkaido Japan ,grid.444700.30000 0001 2176 3638Faculty of Health Sciences, Hokkaido University of Science, 4-1, Maeda 7-15, Teine-Ku, Sapporo, Hokkaido Japan
| | - Kensuke Fujiwara
- grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-Ku, Sapporo, Hokkaido Japan ,grid.444620.00000 0001 0666 3591Graduate School of Commerce, Otaru University of Commerce, 5-21, Midori 3, Otaru, Hokkaido Japan
| | - Kiyohiro Houkin
- grid.39158.360000 0001 2173 7691Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, N15-W7, Kita-Ku, Sapporo, Hokkaido Japan
| | - Katsuhiko Ogasawara
- grid.39158.360000 0001 2173 7691Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-Ku, Sapporo, Hokkaido Japan
| |
Collapse
|
5
|
Zoratti MJ, Pickard AS, Stalmeier PFM, Ollendorf D, Lloyd A, Chan KKW, Husereau D, Brazier JE, Krahn M, Levine M, Thabane L, Xie F. Evaluating the conduct and application of health utility studies: a review of critical appraisal tools and reporting checklists. Eur J Health Econ 2021; 22:723-733. [PMID: 33839968 DOI: 10.1007/s10198-021-01286-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/12/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND Published health utility studies are increasingly cited in cost-utility analyses to inform reimbursement decision-making. However, there is limited guidance for investigators looking to systematically evaluate the methodological quality of health utility studies or their applicability to decision contexts. OBJECTIVE To describe how health utility concepts are reflected in tools intended for use with the health economic literature, particularly with respect to the evaluation of methodological quality and context applicability. METHODS We reviewed the critical appraisal and reporting tools described in a 2012 report published by the Agency for Healthcare Research and Quality (AHRQ), supplemented with a keyword search of MEDLINE and EMBASE, to identify existing tools which include health utility constructs. From these tools, a list of relevant items was compiled and grouped into domain categories based on the methodological or applicability aspect they were directed toward. RESULTS Of the 24 tools we identified, 12 contained items relevant to the evaluation of health utilities. Sixty-five items were considered relevant to the evaluation of quality, while 44 were relevant to the evaluation of applicability. Items were arranged into four domains: health state descriptions; selection and description of respondents; elicitation and measurement methods; and other considerations. CONCLUSION As key inputs to cost-utility analyses, health utilities have the potential to significantly impact estimates of cost-effectiveness. Existing tools contain only general items related to the conduct or use of health utility studies. There is a need to develop tools that systematically evaluate the methodological quality and applicability of health utility studies.
Collapse
Affiliation(s)
- Michael J Zoratti
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, The University of Illinois at Chicago, Chicago, IL, USA
| | - Peep F M Stalmeier
- Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Daniel Ollendorf
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | | | - Kelvin K W Chan
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
- Canadian Centre for Applied Research in Cancer Control, Toronto, Canada
| | - Don Husereau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - John E Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Murray Krahn
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Mitchell Levine
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Clinical Pharmacology and Toxicology, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- St Joseph's Healthcare, Hamilton, ON, Canada
| | - Feng Xie
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
6
|
Hashempour R, Raei B, Safaei Lari M, Abolhasanbeigi Gallezan N, AkbariSari A. QALY league table of Iran: a practical method for better resource allocation. Cost Eff Resour Alloc 2021; 19:3. [PMID: 33441153 PMCID: PMC7807517 DOI: 10.1186/s12962-020-00256-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/11/2020] [Revised: 11/24/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The limited health care resources cannot meet all the demands of the society. Thus, decision makers have to choose feasible interventions and reject the others. We aimed to collect and summarize the results of all cost utility analysis studies that were conducted in Iran and develop a Quality Adjusted Life Year (QALY) league table. METHODS A systematic mapping review was conducted to identify all cost utility analysis studies done in Iran and then map them in a table. PubMed, Embase, Cochrane library, Web of Science, as well as Iranian databases like Iran Medex, SID, Magiran, and Barakat Knowledge Network System were all searched for articles published from the inception of the databases to January 2020. Additionally, Cost per QALY or Incremental Cost Utility Ratio (ICUR) were collected from all studies. The Joanna Briggs checklist was used to assess quality appraisal. RESULTS In total, 51 cost-utility studies were included in the final analysis, out of which 14 studies were on cancer, six studies on coronary heart diseases. Two studies, each on hemophilia, multiple sclerosis and rheumatoid arthritis. The rest were on various other diseases. Markov model was the commonest one which has been applied to in 45% of the reviewed studies. Discount rates ranged from zero to 7.2%. The cost per QALY ranged from $ 0.144 in radiography costs for patients with some orthopedic problems to $ 4,551,521 for immune tolerance induction (ITI) therapy in hemophilia patients. High heterogeneity was revealed; therefore, it would be biased to rank interventions based on reported cost per QALY or ICUR. CONCLUSIONS However, it is instructive and informative to collect all economic evaluation studies and summarize them in a table. The information on the table would in turn be used to redirect resources for efficient allocation. in general, it was revealed that preventive programs are cost effective interventions from different perspectives in Iran.
Collapse
Affiliation(s)
- Reza Hashempour
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, 0000-0002-2043-8451, Tehran, Iran
| | - Behzad Raei
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, 0000-0002-2043-8451, Tehran, Iran
| | - Majid Safaei Lari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, 0000-0002-2043-8451, Tehran, Iran
| | - Nasrin Abolhasanbeigi Gallezan
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali AkbariSari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, 0000-0002-2043-8451, Tehran, Iran.
| |
Collapse
|
7
|
Senanayake S, Graves N, Healy H, Baboolal K, Barnett A, Sypek MP, Kularatna S. Deceased donor kidney allocation: an economic evaluation of contemporary longevity matching practices. BMC Health Serv Res 2020; 20:931. [PMID: 33036621 PMCID: PMC7547436 DOI: 10.1186/s12913-020-05736-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Matching survival of a donor kidney with that of the recipient (longevity matching), is used in some kidney allocation systems to maximize graft-life years. It is not part of the allocation algorithm for Australia. Given the growing evidence of survival benefit due to longevity matching based allocation algorithms, development of a similar kidney allocation system for Australia is currently underway. The aim of this research is to estimate the impact that changes to costs and health outcomes arising from 'longevity matching' on the Australian healthcare system. METHODS A decision analytic model to estimate cost-effectiveness was developed using a Markov process. Four plausible competing allocation options were compared to the current kidney allocation practice. Models were simulated in one-year cycles for a 20-year time horizon, with transitions through distinct health states relevant to the kidney recipient. Willingness to pay was considered as AUD 28000. RESULTS Base case analysis indicated that allocating the worst 20% of Kidney Donor Risk Index (KDRI) donor kidneys to the worst 20% of estimated post-transplant survival (EPTS) recipients (option 2) and allocating the oldest 25% of donor kidneys to the oldest 25% of recipients are both cost saving and more effective compared to the current Australian allocation practice. Option 2, returned the lowest costs, greatest health benefits and largest gain to net monetary benefits (NMB). Allocating the best 20% of KDRI donor kidneys to the best 20% of EPTS recipients had the lowest expected incremental NMB. CONCLUSION Of the four longevity-based kidney allocation practices considered, transplanting the lowest quality kidneys to the worst kidney recipients (option 2), was estimated to return the best value for money for the Australian health system.
Collapse
Affiliation(s)
- Sameera Senanayake
- Australian Center for Health Service Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia.
| | - Nicholas Graves
- Australian Center for Health Service Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Helen Healy
- Royal Brisbane Hospital for Women, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Keshwar Baboolal
- Royal Brisbane Hospital for Women, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Adrian Barnett
- Australian Center for Health Service Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Matthew P Sypek
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, SA, Australia
| | - Sanjeewa Kularatna
- Australian Center for Health Service Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| |
Collapse
|
8
|
Abdali ZI, Roberts TE, Barton P, Hawkey PM. Economic evaluation of Faecal microbiota transplantation compared to antibiotics for the treatment of recurrent Clostridioides difficile infection. EClinicalMedicine 2020; 24:100420. [PMID: 32637898 PMCID: PMC7327885 DOI: 10.1016/j.eclinm.2020.100420] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Received: 03/06/2020] [Revised: 05/23/2020] [Accepted: 05/29/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is a hospital acquired disease associated with significant morbidity, hospitalisation and mortality. Almost 30% of treated patients experience at least one recurrence after treatment of their first episode. Treatment of recurrent CDI (rCDI) utilises vancomycin or fidaxomicin, however, a newer treatment option is faecal microbial transplantation (FMT) administered by nasogastric tube (NGT) or colonoscopy. It is associated with higher cure and lower recurrence rates than fidaxomicin or vancomycin. The aim of this analysis is to evaluate the cost effectiveness of FMT for rCDI using the latest and best evidence. METHOD A cost utility analysis was conducted using a decision model representing the cost per additional Quality Adjusted Life Year (QALY) from a National Health Service (NHS) perspective. A Markov model was constructed to compare FMT NGT and colonoscopy to antibiotic treatment (fidaxomicin or vancomycin). The model was informed by a literature review of clinical evidence, specifically focussing on hospitalised patients with rCDI over 65 years. Both deterministic and probabilistic sensitivity analyses were performed to assess uncertainties around the model inputs and assumptions. FINDINGS The base case analysis showed that FMT is a less costly and more effective treatment than either fidaxomicin or vancomycin. FMT colonoscopy was slightly more effective than FMT NGT leading to an additional 0.012 QALYs but more expensive and the incremental cost effectiveness ratio (ICER) was £242,514/QALY. The Probabilistic sensitivity analysis based on 10,000 simulations suggested the probability of FMT NGT being cost effective was almost 78% at £20,000/QALY Willingness-To-Pay (WTP) threshold. INTERPRETATION FMT is both more effective and less costly option than antimicrobial therapy. FMT NGT was the preferred route of administration and is likely to be considered the most cost-effective strategy by decision makers given current acceptable thresholds.
Collapse
Affiliation(s)
- Zainab I Abdali
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Tracy E Roberts
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Pelham Barton
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Peter M Hawkey
- Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
- Queen Elizabeth Hospital, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, United Kingdom
| |
Collapse
|
9
|
Rankin J, Rowen D, Howe A, Cleland JGF, Whitty JA. Valuing health-related quality of life in heart failure: a systematic review of methods to derive quality-adjusted life years (QALYs) in trial-based cost-utility analyses. Heart Fail Rev 2019; 24:549-63. [PMID: 30903357 DOI: 10.1007/s10741-019-09780-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The accurate measurement of health-related quality of life (HRQoL) and the value of improving it for patients are essential for deriving quality-adjusted life years (QALYs) to inform treatment choice and resource allocation. The objective of this review was to identify and describe the approaches used to measure and value change in HRQoL in trial-based economic evaluations of heart failure interventions which derive QALYs as an outcome. Three databases (PubMed, CINAHL, Cochrane) were systematically searched. Twenty studies reporting economic evaluations based on 18 individual trials were identified. Most studies (n = 17) utilised generic preference-based measures to describe HRQoL and derive QALYs, commonly the EQ-5D-3L. Of these, three studies (from the same trial) also used mapping from a condition-specific to a generic measure. The remaining three studies used patients’ direct valuation of their own health or physician-reported outcomes to derive QALYs. Only 7 of the 20 studies reported significant incremental QALY gains. Most interventions were reported as being likely to be cost-effective at specified willingness to pay thresholds. The substantial variation in the approach applied to derive QALYs in the measurement of and value attributed to HRQoL in heart failure requires further investigation.
Collapse
|
10
|
McMeekin N, Chrysos AE, Vale L, Fisher AJ. Incorporating ex-vivo lung perfusion into the UK adult lung transplant service: an economic evaluation and decision analytic model. BMC Health Serv Res 2019; 19:326. [PMID: 31117992 PMCID: PMC6532206 DOI: 10.1186/s12913-019-4154-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/24/2018] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background An estimated 20–30% of end-stage lung disease patients awaiting lung transplant die whilst on the waiting list due to a shortage of suitable donor lungs. Ex-Vivo Lung Perfusion is a technique that reconditions donor lungs initially not deemed usable in order to make them suitable for transplantation, thereby increasing the donor pool. In this study, an economic evaluation was conducted as part of DEVELOP-UK, a multi-centre study assessing the clinical and cost-effectiveness of the Ex-Vivo Lung Perfusion technique in the United Kingdom. Methods We estimated the cost-effectiveness of a UK adult lung transplant service combining both standard and Ex-Vivo Lung Perfusion transplants compared to a service including only standard lung transplants. A Markov model was developed and populated with a combination of DEVELOP-UK, published and clinical routine data, and extrapolated to a lifetime horizon. Probabilistic sensitivity and scenario analyses were used to explore uncertainty in the final outcomes. Results Base-case model results estimated life years gained of 0.040, quality-adjusted life-years (QALYs) gained of 0.045 and an incremental cost per QALY of £90,000 for Ex-Vivo Lung Perfusion. Scenario analyses carried out suggest that an improved rate of converting unusable donor lungs using Ex-Vivo Lung Perfusion, similar resource use post-transplant for both standard and EVLP lung transplant and applying increased waiting list costs would reduce ICERs to approximately £30,000 or below. Conclusion DEVELOP-UK base-case results suggest that incorporating Ex-Vivo Lung Perfusion into the UK adult lung transplant service is more effective, increasing the number of donor lungs available for transplant, but would not currently be considered cost-effective in the UK using the present NICE threshold. However, results were sensitive to change in some model parameters and in several plausible scenario analyses results indicate that a service incorporating Ex-vivo lung perfusion would be considered cost-effective . Trial registration ISRCTN registry number: ISRCTN44922411. Date of registration: 06/02/2012. Retrospectively registered.
Collapse
Affiliation(s)
- N McMeekin
- HEHTA, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - A E Chrysos
- Health Economics Group, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, UK
| | - L Vale
- Health Economics Group, Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - A J Fisher
- Institute of Transplantation, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
11
|
Mulhern B, Norman R, De Abreu Lourenco R, Malley J, Street D, Viney R. Investigating the relative value of health and social care related quality of life using a discrete choice experiment. Soc Sci Med 2019; 233:28-37. [PMID: 31153085 DOI: 10.1016/j.socscimed.2019.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 10/08/2018] [Revised: 05/02/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
A key outcome in the evaluation of health technologies is the quality adjusted life year (QALY) which is often estimated using health measures such as the EuroQol instruments (EQ-5D-3L and EQ-5D-5L). The impacts of many interventions extend beyond a narrow definition of health to include non-health impacts such as social care related dimensions of quality of life (QoL). This means that there are circumstances where the QALY does not capture the full value of an intervention. In response to this, instruments with a wider measurement framework, such as the Adult Social Care Outcomes Toolkit (ASCOT), which measures social care related QoL, have been developed. Given the range of instruments available, it is important that decision-makers have tools to assess value for money comprehensively and consistently. To date, preference elicitation of different aspects of QoL combined within the same valuation procedure has not been tested. We investigate the relationship between health and social care aspects of QoL when assessed jointly by combining EQ-5D-5L and ASCOT in an online discrete choice experiment (DCE). In July 2016, 975 respondents recruited from internet panels completed 15 choice sets from an underlying design of 300. Conditional logit regression was used to estimate coefficient decrements for each attribute and examine their relative magnitude. Latent class and mixed logit modelling were used to understand preference heterogeneity. The results suggest trading across health and social care aspects indicated by coefficient estimates of differing magnitude. Dimensions with the largest disutility include four from EQ-5D-5L and one from ASCOT. There is evidence of preference heterogeneity at more severe dimension levels. We have used an established method to test the joint valuation of concepts measuring different aspects of QoL. The results have implications for the aspects of QoL that are included in QALY estimation and used in resource allocation decision-making.
Collapse
Affiliation(s)
- Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, 1 - 59 Quay St, Haymarket, Sydney, NSW, 2000, Australia.
| | - Richard Norman
- School of Public Health, Curtin University, Kent Street, Bentley, WA, 6102, Australia
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, 1 - 59 Quay St, Haymarket, Sydney, NSW, 2000, Australia
| | - Juliette Malley
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, WC2A 2AE, UK
| | - Deborah Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, 1 - 59 Quay St, Haymarket, Sydney, NSW, 2000, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, 1 - 59 Quay St, Haymarket, Sydney, NSW, 2000, Australia
| |
Collapse
|
12
|
Cochrane M, Watson PM, Timpson H, Haycox A, Collins B, Jones L, Martin A, Graves LEF. Systematic review of the methods used in economic evaluations of targeted physical activity and sedentary behaviour interventions. Soc Sci Med 2019; 232:156-167. [PMID: 31100696 DOI: 10.1016/j.socscimed.2019.04.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/22/2018] [Revised: 04/04/2019] [Accepted: 04/26/2019] [Indexed: 01/22/2023]
Abstract
The burden of noncommunicable diseases (NCD) on health systems worldwide is substantial. Physical inactivity and sedentary behaviour are major risk factors for NCD. Previous attempts to understand the value for money of preventative interventions targeting physically inactive individuals have proved to be challenging due to key methodological challenges associated with the conduct of economic evaluations in public health. A systematic review was carried out across six databases (Medline, SPORTSDiscus, EconLit, PsychINFO, NHS EED, HTA) along with supplementary searches. The review examines how economic evaluations published between 2009-March 2017 have addressed methodological challenges with the aim of bringing to light examples of good practice for future studies. Fifteen economic evaluations from four high-income countries were retrieved; there is a dearth of studies targeting sedentary behaviour as an independent risk factor from physical activity. Comparability of studies from the healthcare and societal perspectives were limited due to analysts' choice in cost categories, valuation technique and time horizon differing substantially. The scarcity of and inconsistencies across economic evaluations for these two behaviours have exposed a mismatch between calls for more preventative action to tackle NCD and the lack of information available on how resources may be optimally allocated in practice. Consequently, this paper offers a table of recommendations on how future studies can be improved.
Collapse
Affiliation(s)
- M Cochrane
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 5 Primrose Hill, Liverpool, L3 2EX, UK.
| | - P M Watson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 5 Primrose Hill, Liverpool, L3 2EX, UK
| | - H Timpson
- Public Health Institute, Faculty of Health, Education and Community, Liverpool John Moores University, 3rd Floor, Exchange Station, Tithebarn Street, Liverpool, L2 2QP, UK
| | - A Haycox
- (c)Management School, University of Liverpool, Chatham Street, Liverpool, L69 7ZH, UK
| | - B Collins
- Department of Public Health and Policy, University of Liverpool, Waterhouse Building, Block B, 2nd Floor Liverpool, L69 3BX, UK
| | - L Jones
- (c)Management School, University of Liverpool, Chatham Street, Liverpool, L69 7ZH, UK
| | - A Martin
- Department of Public Health and Policy, University of Liverpool, Waterhouse Building, Block B, 2nd Floor Liverpool, L69 3BX, UK; HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, WA4 4FS, UK
| | - L E F Graves
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, 5 Primrose Hill, Liverpool, L3 2EX, UK
| |
Collapse
|
13
|
Efthymiadou O, Mossman J, Kanavos P. Health related quality of life aspects not captured by EQ-5D-5L: Results from an international survey of patients. Health Policy 2018; 123:159-165. [PMID: 30598239 DOI: 10.1016/j.healthpol.2018.12.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/08/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this paper we discuss and present evidence on whether a generic Health Related Quality of Life (HRQoL) measurement tool, the EQ-5D-5L, captures the dimensions of quality of life (QoL) which patients consider significant. METHODS An online survey, of individuals with a chronic condition, mainly breast cancer (BC), blood cancers (BLC), rheumatoid arthritis (RA), asthma, and rare diseases (RD) was conducted to collect data on HRQoL and important QoL aspects that respondents thought were not captured by the EQ-5D-5L. Patient organisations across 47 countries were invited to voluntarily share the survey tool with their membership network. RESULTS 767 responses from 38 countries showed that important QoL aspects were not captured by EQ-5D-5L for 51% of respondents, including fatigue (19%) and medication side effects (12%), among others. Fatigue (17%) was also the most commonly reported QoL aspect that changed over the course of patients' illness, suggesting that the current version of the EQ-5D-5L might miss capturing significant clinical changes in important QoL domains. CONCLUSIONS Utilisation of the EQ-5D-5L in HRQoL measurement raises inconsistencies in capturing QoL attributes and changes in disease-specific patient populations. Further research is needed to clarify the extent to which other generic HRQoL measurement tools capture the aspects of health that really matter for patients.
Collapse
Affiliation(s)
- Olina Efthymiadou
- Department of Health Policy, Medical Technology Research Group, London School of Economics, Houghton Street, WC2A 2AE, England, United Kingdom.
| | - Jean Mossman
- Department of Health Policy, Medical Technology Research Group, London School of Economics, Houghton Street, WC2A 2AE, England, United Kingdom.
| | - Panos Kanavos
- Department of Health Policy, Medical Technology Research Group, London School of Economics, Houghton Street, WC2A 2AE, England, United Kingdom.
| |
Collapse
|
14
|
Kinchin I, Jacups S, Mann J, Quigley R, Harvey D, Doran CM, Strivens E. Efficacy and cost-effectiveness of a community-based model of care for older patients with complex needs: a study protocol for a multicentre randomised controlled trial using a stepped wedge cluster design. Trials 2018; 19:668. [PMID: 30514378 PMCID: PMC6280415 DOI: 10.1186/s13063-018-3038-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 11/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Community-dwelling older persons with complex care needs may deteriorate rapidly and require hospitalisation if they receive inadequate support for their conditions in the community. INTERVENTION A comprehensive, multidimensional geriatric assessment with care coordination was performed in a community setting-Older Persons ENablement And Rehabilitation for Complex Health conditions (OPEN ARCH). OBJECTIVES This study will assess the acceptability and determine the impact of the OPEN ARCH intervention on the health and quality of life outcomes, health and social services utilisation of older people with multiple chronic conditions and emerging complex care needs. An economic evaluation will determine whether OPEN ARCH is cost-effective when compared to the standard care. METHODS/DESIGN This multicentre randomised controlled trial uses a stepped wedge cluster design with repeated cross-sectional samples. General practitioners (GPs; n ≥ 10) will be randomised as 'clusters' at baseline using simple randomisation. Each GP cluster will recruit 10-12 participants. Data will be collected on each participant at 3-month intervals (- 3, 0, 3, 6 and 9 months). The primary outcome is health and social service utilisation as measured by Emergency Department presentations, hospital admissions, in-patient bed days, allied health and community support services. Secondary outcomes include functional status, quality of life and participants' satisfaction. Cost-effectiveness of the intervention will be assessed as the change to cost outcomes, including the cost of implementing the intervention and subsequent use of services, and the change to health benefits represented by quality adjusted life years. DISCUSSION The results will have direct implications for the design and wider implementation of this new model of care for community-dwelling older persons with complex care needs. Additionally, it will contribute to the evidence base on acceptability, efficacy and cost-effectiveness of the intervention for this high-risk group of older people. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12617000198325p . Registered on 6 February 2017.
Collapse
Affiliation(s)
- Irina Kinchin
- Centre for Indigenous Health Equity Research and School of Health, Medical and Applied Sciences, CQUniversity, Cairns, QLD Australia
- The Cairns Institute, James Cook University, Cairns, QLD Australia
| | - Susan Jacups
- Centre for Indigenous Health Equity Research and School of Health, Medical and Applied Sciences, CQUniversity, Cairns, QLD Australia
- The Cairns Institute, James Cook University, Cairns, QLD Australia
- Medical Services, Torres and Cape Hospital and Health Service, Cairns, QLD Australia
| | - Jennifer Mann
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD Australia
| | - Rachel Quigley
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD Australia
| | - Desley Harvey
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD Australia
- Division of Tropical Health and Medicine, James Cook University, Cairns, QLD Australia
| | - Christopher M. Doran
- Centre for Indigenous Health Equity Research and School of Health, Medical and Applied Sciences, CQUniversity, Cairns, QLD Australia
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, Cairns, QLD Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD Australia
| |
Collapse
|
15
|
Poder TG, Carrier N, Mead H, Stevens KJ. Canadian French translation and linguistic validation of the child health utility 9D (CHU9D). Health Qual Life Outcomes 2018; 16:168. [PMID: 30157857 PMCID: PMC6114803 DOI: 10.1186/s12955-018-0998-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several preference based measures are validated for adults in cost utility analysis, but less are available for children and many researchers have criticized the quality of pediatric economic studies. The objective of this study was to perform a Canadian French translation and linguistic validation of the Child Health Utility 9D (CHU9D) that was conceptually equivalent to the original English version for use in Canada. METHODS The translation and linguistic validation were realized by ICON Clinical Research (UK) Limited in association with the developer of the CHU9D and Canadian collaborators. This was done in accordance with industry standards and the guidance of the Food and Drug Administration (FDA) for patient-reported outcome (PRO) instruments. Five steps were considered: concept elaboration; forward translation; back translation; linguistic validation; proofreading and final verification. RESULTS The CHU9D Canadian French translation and linguistic validation were realized without any major difficulties. Only 3 changes were made after the forward translation and 5 after the back translation. The result of back translation was very similar to the original English version. Six additional changes suggested by the developer team were accepted and the linguistic validation with five children led to 2 additional changes. Most changes were generally to change one word to better sounding Canadian French. CONCLUSION We produced a Canadian French translation and cross-cultural adaptation of the Child Health Utility 9D (CHU9D). Before being used in clinical settings and research projects, the final Canadian French translation needs to be validated for metrological qualities of reliability and validity.
Collapse
Affiliation(s)
- Thomas G Poder
- UETMIS and CRCHUS, CIUSSS de l'Estrie - CHUS, Sherbrooke, Canada.
| | | | | | | |
Collapse
|
16
|
Richardson J, Iezzi A, Maxwell A, Chen G. Does the use of the proportional shortfall help align the prioritisation of health services with public preferences? Eur J Health Econ 2018; 19:797-806. [PMID: 28801762 DOI: 10.1007/s10198-017-0923-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 07/27/2017] [Indexed: 06/07/2023]
Abstract
It has been proposed that equity may be included in the economic evaluation of health services using the 'proportional shortfall' (PS)-the proportion of a person's QALY expectation that they would lose because of an illness. The present paper reports the results of a population survey designed to test whether PS helped to explain people's preferences for health services and whether it did this better than the absolute shortfall or the equity related variables that PS seeks to replace. Survey respondents were asked to allocate 100 votes between 13 scenarios and a standard scenario. Variation in the allocation of votes was explained by health gain and different combinations of the equity variables. Differences in votes for the comparisons were significantly related to differences in PS but the relationship was weaker than between votes and the age related variables. Cases were identified where PS suggested a priority ordering of services which was strongly rejected by respondents. It is concluded that the use of PS is unlikely to improve the alignment of priorities with public preferences.
Collapse
Affiliation(s)
- Jeff Richardson
- Centre for Health Economics, Level 2, 15 Innovation Walk, Monash Business School, Monash University, Clayton, VIC, 3800, Australia.
| | - Angelo Iezzi
- Centre for Health Economics, Level 2, 15 Innovation Walk, Monash Business School, Monash University, Clayton, VIC, 3800, Australia
| | - Aimee Maxwell
- Centre for Health Economics, Level 2, 15 Innovation Walk, Monash Business School, Monash University, Clayton, VIC, 3800, Australia
| | - Gang Chen
- Centre for Health Economics, Level 2, 15 Innovation Walk, Monash Business School, Monash University, Clayton, VIC, 3800, Australia
| |
Collapse
|
17
|
Jing Z, Dong J, Li Z, Nan F. Single balloon versus double balloon bipedicular kyphoplasty: a systematic review and meta-analysis. Eur Spine J 2018; 27:2550-2564. [PMID: 29923019 DOI: 10.1007/s00586-018-5631-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/06/2018] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Kyphoplasty has been widely used to treat vertebral compression fractures (VCFs). In standard procedure of kyphoplasty, two balloons were inserted into the vertebral body through bipedicular and inflated simultaneously, while using a single balloon two times is also a common method in clinic to lessen the financial burden of patients. However, the effect and safety of single balloon versus double balloon bipedicular kyphoplasty are still controversy. METHODS In this systematic review and meta-analysis, eligible studies were identified through a comprehensive literature search of PubMed, Cochrane library EMBASE, Web of Science, Wanfang, CNKI, VIP and CBM until January 1, 2018. Results from individual studies were pooled using a random or fixed effects model. RESULTS Seven articles were included in the systematic review and five studies were consisted in meta-analysis. We observed no significant difference between single balloon and double balloon bipedicular kyphoplasty in visual analog scale (VAS), angle (kyphotic angle and Cobb angle), consumption (operation time, cement volume and volume of bleeding), vertebral height (anterior height, medium height and posterior height) and complications (cement leakage and new VCFs), while the cost of single balloon bipedicular kyphoplasty is lower than that of double balloon bipedicular kyphoplasty. The results of our meta-analysis also demonstrated that single balloon can significantly improve the VAS, angle and vertebral height of patients suffering from VCFs. CONCLUSION This systematic review and meta-analysis collectively concludes that single balloon bipedicular kyphoplasty is as effective as double balloon bipedicular kyphoplasty in improving clinical symptoms, deformity and complications of VCFs but not so expensive. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- Zehao Jing
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning, China
| | - Jianli Dong
- Department of Joint Surgery, Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning, China
| | - Zhengwei Li
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning, China.
| | - Feng Nan
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, No. 467, Zhongshan Road, Shahekou District, Dalian, Liaoning, China.
| |
Collapse
|
18
|
Coyle S, Kinsella S, Lenehan B, Queally JM. Cost-utility analysis in orthopaedic trauma; what pays? A systematic review. Injury 2018; 49:575-584. [PMID: 29428222 DOI: 10.1016/j.injury.2018.01.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/31/2017] [Accepted: 01/17/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND As healthcare systems come under ever-increasing pressure to provide more care with fewer resources, emphasis is being placed on value-based systems that maximise quality and minimize cost. The aim of this study was to determine which interventions in fracture care have been demonstrated to be cost effective. METHODS A systemic review of cost-utility studies on the management of fractures from 1976 to 2015 was carried out using a search of the Cost-Effectiveness Analysis Registry, National Health Service Economic Evaluation Database (NHS EED) and MEDLINE. RESULTS 20 studies were included with 15 (75%) studies assessing interventions in lower limb trauma and 8 (25%) studies assessing interventions in upper limb trauma. 50% of studies used a decision tree model and 50% used collected data alongside a randomised clinical trial. Interventions which were shown to be cost effective in lower limb trauma were total hip replacement in displaced femoral neck fractures, the SHS in stable (A1 and A2) fractures and IM nailing for unstable (A3) fractures, salvage treatment for grade IIIB and IIIC open tibial fractures and operative treatment of ankle and calcaneal fractures. For systems-based strategies, there is evidence demonstrating cost effectiveness to treating hip fractures in high volume centres and to having resources in place to facilitate fractures being treated within 48 h of injury. In upper limb trauma there was evidence showing operative treatment of displaced proximal humerus fractures to be neither clinically nor cost effective. There was evidence supporting the operative treatment of non-displaced scaphoid fractures. Overall the quality of the studies was poor with only 50% (10) of studies able to make a treatment recommendation. Reasons for this included poor quality primary source data and poor reporting methodological practices. CONCLUSION Certain aspects of fracture management have been shown to be cost effective. However, there is a paucity of evidence in this area and further research is required so that value-based interventions are chosen by healthcare providers engaged in orthopaedic trauma care.
Collapse
Affiliation(s)
- S Coyle
- Department of Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| | - S Kinsella
- Kemmy Business School, University of Limerick, Limerick, Ireland; School of Government, University of Melbourne, Australia
| | - B Lenehan
- Department of Orthopaedic Surgery, University Hospital Limerick, Limerick, Ireland
| | - J M Queally
- Department of Orthopaedic Surgey, Addenbrooke's Hospital, Cambridge, UK.
| |
Collapse
|
19
|
Tullberg M, Persson J, Petersen J, Hellström P, Wikkelsø C, Lundgren-Nilsson Å. Shunt surgery in idiopathic normal pressure hydrocephalus is cost-effective-a cost utility analysis. Acta Neurochir (Wien) 2018; 160:509-18. [PMID: 29150794 DOI: 10.1007/s00701-017-3394-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 11/03/2017] [Indexed: 12/03/2022]
Abstract
Background The objective was to evaluate the cost-effectiveness of shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). Methods Health-related quality of life was evaluated before and 6 months after surgery using the EQ-5D-3 L (EuroQOL group five-dimensions health survey) in 30 patients (median age, 71 years; range, 65–89 years) diagnosed with iNPH. The costs associated with shunt surgery were assessed by a detailed survey with interviews and extraction of register data concerning the cost of hospital care, primary care, residential care, home-care service and informal care. The cost of untreated patients was derived from the cost of dementia disorders in Sweden in 2012, as reported by the National Board of Health and Welfare. The cost effectiveness analysis used a decision-analytic Markov model. We used a societal perspective and a lifelong time horizon to estimate costs and effects. One-way sensitivity analysis and probabilistic sensitivity analysis were carried out to test the robustness of the model. Results The shunt surgery model as the standard treatment in iNPH resulted in a gain of 2.2 life years and 1.7 quality-adjusted life years (QALY), along with an incremental cost per patient of €7,500/QALY. The sensitivity analysis showed that the results were not sensitive to changes in uncertain parameters or assumptions. Conclusions Shunt surgery in iNPH, an underdiagnosed condition severely impairing elderly patients, is not only an effective medical treatment, it is also cost-effective, adding 2.2 additional life years and 1.7 QALYs at a low cost, a remarkable gain for an individual aged around 70 years.
Collapse
|
20
|
Verstraete J, Ramma L, Jelsma J. Influence of the child's perceived general health on the primary caregiver's health status. Health Qual Life Outcomes 2018; 16:8. [PMID: 29321017 PMCID: PMC5763523 DOI: 10.1186/s12955-018-0840-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In estimating the impact of an intervention, ignoring the effect of improving the health of one member of the caregiver/child dyad on the Health Related Quality of Life (HRQoL) of the other member may lead to an underestimation of the utility gained. This may be particularly true for infants/young children and their caregivers. The aim of this study was to quantify the interaction between the child's perceived general health as assessed by the newly developed Toddler and Infant Questionnaire (TANDI) on the reporting of the caregiver's own HRQoL as assessed by the EQ-5D-3 L. METHODS A sample of 187 caregivers participated. A total of 60 caregivers of acutely-ill (AI) and 60 caregivers of chronically-ill (CI) children were recruited from a children's hospital. The 67 caregivers of general population (GP) children were recruited at a pre-school. Each caregiver completed the proxy rating of their child's HRQoL on the TANDI (The TANDI is an experimental HRQoL instrument, modelled on the EQ-5D-Y proxy, for children aged 1-36 months), which comprises of six dimensions of health and a rating of general health on a Visual Analogue Scale (VAS). The caregiver completed the EQ-5D-3 L, a self-report measure of their own HRQoL. Forward stepwise regression models were developed with 1) the VAS score of the caregiver and 2) the VAS score of the child as dependent variables. The independent variables for the caregiver included dummy variables for the presence or absence of problems on the EQ-5D-3 L and the VAS score of the child. The independent variables for the child included dummy variables for each TANDI dimension and the VAS of the caregiver. RESULTS The TANDI results indicated that in five of the six dimensions AI children had more problems than the other two groups and the GP children were reported to have a significantly higher VAS than the other two groups. The child's VAS was significantly correlated with the caregiver's VAS in all groups, but most strongly in the AI group. The preference based scores (using the UK TTO tariff) were only correlated in the AI group. The inclusion of the child's VAS increased the variance accounted for 11% of the VAS score of the caregiver. Anxiety and depression was the only dimension which accounted for more variance (18%). Similarly the perceived health state, VAS of the caregiver accounted for 14% of the variance in the child's VAS, second only to problems with play (25%). CONCLUSION There does indeed appear to be a strong relationship between the VAS scores of the children and their caregivers. The perceived general health of the child influences the caregivers reporting of their general health, more than their own report of experiencing pain or discomfort or problems with mobility. Thus, improving the HRQoL of the very young child may improve the caregiver's HRQoL as well. Conversely, if the caregiver has a lower perceived HRQoL this may result in a decrement in the reported VAS of the child, independent of the presence or absence of problems in the different dimensions. This improvement is not currently captured by Cost Utility Analysis (CUA). It is recommended that future research investigates this effect with regards to CUA calculations.
Collapse
Affiliation(s)
- Janine Verstraete
- Department of Physiotherapy, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700 South Africa
- Faculty of Health and Rehabilitation Sciences, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Lebogang Ramma
- Faculty of Health and Rehabilitation Sciences, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Jennifer Jelsma
- Faculty of Health and Rehabilitation Sciences, Anzio Road, Observatory, Cape Town, 7925 South Africa
| |
Collapse
|
21
|
Abstract
Purpose Urinary incontinence (UI) is a common chronic health condition, a problem specifically among elderly women that impacts quality of life negatively. However, UI is usually viewed as likely result of old age, and as such is generally not evaluated or even managed appropriately. Many treatments are available to manage incontinence, such as bladder training and numerous surgical procedures such as Burch colposuspension and Sling for UI which have high success rates. The purpose of this paper is to analyze which of these popular surgical procedures for UI is effective. Design/methodology/approach This research employs randomized, prospective studies to obtain robust cost and utility data used in the Markov chain decision model for examining which of these surgical interventions is more effective in treating women with stress UI based on two measures: number of quality adjusted life years (QALY) and cost per QALY. Treeage Pro Healthcare software was employed in Markov decision analysis. Findings Results showed the Sling procedure is a more effective surgical intervention than the Burch. However, if a utility greater than certain utility value, for which both procedures are equally effective, is assigned to persistent incontinence, the Burch procedure is more effective than the Sling procedure. Originality/value This paper demonstrates the efficacy of a Markov chain decision modeling approach to study the comparative effectiveness analysis of available treatments for patients with UI, an important public health issue, widely prevalent among elderly women in developed and developing countries. This research also improves upon other analyses using a Markov chain decision modeling process to analyze various strategies for treating UI.
Collapse
Affiliation(s)
- Sameer Kumar
- Department of Operations and Supply Chain Management, University of St. Thomas , Minneapolis, Minnesota, USA
| | - Nidhi Ghildayal
- Division of Health Policy and Management, School of Public Health, University of Minnesota - Twin Cities , Minneapolis, Minnesota, USA
| | - Neha Ghildayal
- Division of Health Policy and Management, School of Public Health, University of Minnesota - Twin Cities , Minneapolis, Minnesota, USA
| |
Collapse
|
22
|
Newhall K, Albright B, Tosteson A, Ozanne E, Trus T, Goodney PP. Cost-effectiveness of prophylactic appendectomy: a Markov model. Surg Endosc 2017; 31:3596-3604. [PMID: 28078461 DOI: 10.1007/s00464-016-5391-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 03/17/2016] [Accepted: 12/15/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Appendectomy is the most common emergency surgery performed in the USA. Removal of a non-inflamed appendix during unrelated abdominal surgery (prophylactic or incidental appendectomy) can prevent the downstream risks and costs of appendicitis. It is unknown whether such a strategy could be cost saving for the health system. METHODS We considered hypothetical patient cohorts of varying ages from 18 to 80, undergoing elective laparoscopic abdominal and pelvic procedures. A Markov decision model using cost per life-year as the main outcome measure was constructed to simulate the trade-off between cost and risk of prophylactic appendectomy and the ongoing risk of developing appendicitis, with downstream costs and risks. Rates, probabilities, and costs of disease, treatment, and outcomes by patient age and gender were extracted from the literature. Sensitivity analyses were conducted using complications and costs of prophylactic appendectomy. RESULTS With our base-case assumptions, including added cost of prophylactic appendectomy of $660, we find that prophylactic removal of the appendix is cost saving for males aged 18-27 and females aged 18-28 undergoing elective surgery. The margin of cost savings depends on remaining life-years and increases exponentially with age: a 20-year-old female undergoing elective surgery could save $130 over a lifetime by undergoing prophylactic appendectomy, while a 40-year-old female would lose $130 over a lifetime. When the risk of the prophylactic appendectomy exceeds the risk of laparoscopic appendectomy for appendicitis or the cost exceeds $1080, it becomes more cost saving to forego the prophylactic procedure. CONCLUSIONS Prophylactic appendectomy can be cost saving for patients younger than age thirty undergoing elective laparoscopic abdominal and pelvic procedures.
Collapse
Affiliation(s)
- Karina Newhall
- VA Outcomes Group, White River Junction Veterans Affairs Hospital, White River Junction, VT, USA. .,Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, USA.
| | | | - Anna Tosteson
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Elissa Ozanne
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Thadeus Trus
- Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, USA
| | - Philip P Goodney
- VA Outcomes Group, White River Junction Veterans Affairs Hospital, White River Junction, VT, USA.,Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
23
|
Jenks M, Taylor M, Shore J. Cost-utility analysis of the insufflation of warmed humidified carbon dioxide during open and laparoscopic colorectal surgery. Expert Rev Pharmacoecon Outcomes Res 2016; 17:99-107. [PMID: 27935333 DOI: 10.1080/14737167.2017.1270759] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND An evaluation was conducted to estimate the cost-effectiveness of insufflation of warmed humidified CO2 during open and laparoscopic colorectal surgery compared with usual care from a UK NHS perspective. METHODS Decision analytic models were developed for open and laparoscopic surgery. Incremental costs per quality-adjusted life year (QALY) were estimated. The open surgery model used data on the incidence of intra-operative hypothermia and applied risks of complications for hypothermia and normothermia. The laparoscopic surgery model utilised data describing complications directly. Sensitivity analyses were conducted. RESULTS Compared with usual care, insufflation of warmed humidified CO2 dominated. For open surgery, savings of £20 and incremental QALYs of 0.013 were estimated per patient. For laparoscopic surgery, savings of £345 and incremental QALYs of 0.001 per patient were estimated. Results were robust to most sensitivity analyses. CONCLUSIONS Considering the current evidence base, the intervention is likely to be cost-effective compared with usual care in patients undergoing colorectal surgery.
Collapse
Affiliation(s)
- Michelle Jenks
- a York Health Economics Consortium, Enterprise House, Innovation Way , University of York , York , UK
| | - Matthew Taylor
- a York Health Economics Consortium, Enterprise House, Innovation Way , University of York , York , UK
| | - Judith Shore
- a York Health Economics Consortium, Enterprise House, Innovation Way , University of York , York , UK
| |
Collapse
|
24
|
Versteegh MM, Brouwer WBF. Patient and general public preferences for health states: A call to reconsider current guidelines. Soc Sci Med 2016; 165:66-74. [PMID: 27497260 DOI: 10.1016/j.socscimed.2016.07.043] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [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: 01/30/2016] [Revised: 07/20/2016] [Accepted: 07/29/2016] [Indexed: 11/29/2022]
Abstract
In economic evaluations of health care interventions, benefits are often expressed in terms of Quality-Adjusted Life-Years (QALYs). The QALY comprises length and quality of life into one measure which allows cross-disease comparability. The quality adjustment of the QALY is based on preferences for health states. An important normative choice is the question whose preferences for states of health we wish to capture. The answer to this question is directly related to the normative question regarding the appropriate maximand in health care decisions. Currently, preferences are commonly derived from the general public, rather than from actual patients. This choice, which can have large consequences on final outcomes of economic evaluations, has always been a topic of debate. This paper clarifies and furthers the discussion regarding the appropriate source of preferences for health state valuations, acknowledges the plurality of different perspectives, and argues that health economic guidelines could require analysis of benefit in terms of QALYs based on both patient and general public preferences.
Collapse
Affiliation(s)
- M M Versteegh
- Institute for Medical Technology Assessment (iMTA), Erasmus University of Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - W B F Brouwer
- Institute of Health Policy & Management, Erasmus University of Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| |
Collapse
|
25
|
Wallbillich JJ, Forde B, Havrilesky LJ, Cohn DE. A personalized paradigm in the treatment of platinum-resistant ovarian cancer - A cost utility analysis of genomic-based versus cytotoxic therapy. Gynecol Oncol 2016; 142:144-149. [PMID: 27106017 DOI: 10.1016/j.ygyno.2016.04.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 03/13/2016] [Revised: 04/17/2016] [Accepted: 04/18/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess the cost-effectiveness of a strategy employing genomic-based tumor testing to guide therapy for platinum-resistant ovarian cancer. METHODS A decision model was created to compare standard of care (SOC) cytotoxic chemotherapy to a genomic-based treatment strategy. The genomic arm included tumor testing with treatment directed at targets identified. Overall survival was assumed to be similar between strategies; quality of life (QOL) was assumed superior during targeted therapy compared to chemotherapy. Pertinent uncertainties (cost of targeted therapy and genomic testing, response to targeted therapy, probability of a tumor having a targetable alteration, and impact on QOL) were evaluated in a series of one-and two-way sensitivity analyses. RESULTS The genomic testing strategy was more expensive ($90,271 vs. $74,926) per patient than SOC. The incremental cost-effectiveness ratio (ICER) of the genomic strategy was $479,303 per quality-adjusted life year saved (QALY). Model results were insensitive to the cost of genomic testing, differences in QOL, and the probability of identifying a targetable alteration. However, the model was sensitive to the cost of targeted therapy. For example, when the cost of targeted therapy was reduced to 56% of its current cost (or $6400/cycle), the genomic strategy became more cost-effective with an ICER of $96,612/QALY. CONCLUSIONS Genomic-based tumor testing and targeted therapy in patients with platinum-resistant ovarian cancer is not cost-effective compared with SOC. However, reducing the cost of targeted therapy (independently, or in combination with reducing the cost of the genomic test) provides opportunities for improved value in cancer care.
Collapse
Affiliation(s)
- J J Wallbillich
- The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - B Forde
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - L J Havrilesky
- Duke University Medical Center, Durham, NC, United States
| | - D E Cohn
- The Ohio State University Wexner Medical Center, Columbus, OH, United States.
| |
Collapse
|
26
|
Jain KM, Zulliger R, Maulsby C, Kim JJ, Charles V, Riordan M, Holtgrave D. Cost-Utility Analysis of Three U.S. HIV Linkage and Re-engagement in Care Programs from Positive Charge. AIDS Behav 2016; 20:973-6. [PMID: 26563760 DOI: 10.1007/s10461-015-1243-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Linking and retaining people living with HIV in ongoing, HIV medical care is vital for ending the U.S. HIV epidemic. Yet, 41-44 % of HIV+ individuals are out of care. In response, AIDS United initiated Positive Charge, a series of five HIV linkage and re-engagement projects around the U.S. This paper investigates whether three Positive Charge programs were cost effective and calculates a return on investment for each program. It uses standard methods of cost utility analysis and WHO-CHOICE thresholds. All three projects were found to be cost effective, and two were highly cost effective. Cost utility ratios ranged from $4439 to $137,271. These results suggest that HIV linkage to care programs are a productive and efficient use of public health funds.
Collapse
Affiliation(s)
- Kriti M Jain
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA.
| | - Rose Zulliger
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Cathy Maulsby
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Jeeyon Janet Kim
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| | | | | | - David Holtgrave
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
| |
Collapse
|
27
|
Murphy A, McCarthy FP, McElroy B, Khashan AS, Spillane N, Marchocki Z, Sarkar RK, Higgins JR. Day care versus inpatient management of nausea and vomiting of pregnancy: cost utility analysis of a randomised controlled trial. Eur J Obstet Gynecol Reprod Biol 2016; 197:78-82. [PMID: 26708475 DOI: 10.1016/j.ejogrb.2015.10.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 08/04/2015] [Accepted: 10/28/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the comparative cost effectiveness of day care over inpatient management of nausea and vomiting of pregnancy (NVP). STUDY DESIGN A cost utility analysis was performed using a decision analytical model in which a Markov model was constructed. The Markov model was primarily populated with data from a recently published randomised controlled trial. Which included pregnant women presenting to Cork University Maternity Hospital, a tertiary referral maternity hospital, seeking treatment for NVP. Costs and outcomes were estimated from the perspective of the Irish health service (HSE) and patients. A probabilistic sensitivity analysis, using a Monte Carlo simulation, was also performed. A Bayesian Value of Information analysis was used to estimate the value of collecting additional information. RESULTS When both the healthcare provider and patient's perspective was considered, day care management of NVP remained less costly (mean €985; 95% C.I. 705-1456 vs. €3837 (2124-8466)) and more effective (9.42; 4.19-12.25 vs. 9.49; 4.32-12.39 quality adjusted life years) compared with inpatient management. The Cost Effectiveness Acceptability Curve indicates the probability that day care management is 70% more cost effective compared to inpatient management at a ceiling ratio of €45,000 per QALY, indicating little decision uncertainty. The Bayesian Value of Information analysis indicates there is value in collecting further information; the Expected Value of Perfect Information (EVPI) is estimated to be €5.4 million. CONCLUSION Day care management of NVP is cost effective compared to inpatient management.
Collapse
|
28
|
Watson CH, Edmunds WJ. A review of typhoid fever transmission dynamic models and economic evaluations of vaccination. Vaccine 2015; 33 Suppl 3:C42-54. [PMID: 25921288 PMCID: PMC4504000 DOI: 10.1016/j.vaccine.2015.04.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 03/03/2015] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 01/22/2023]
Abstract
There are relatively few dynamic models or economic analyses of typhoid vaccination. The relative contribution of carriage to transmission is a key uncertainty. Published economic analyses use static models that omit indirect protection of vaccines. Nevertheless, vaccines appear highly cost-effective against WHO criteria in high-incidence settings. No economic model was found to compare vaccine and sanitation.
Despite a recommendation by the World Health Organization (WHO) that typhoid vaccines be considered for the control of endemic disease and outbreaks, programmatic use remains limited. Transmission models and economic evaluation may be informative in decision making about vaccine programme introductions and their role alongside other control measures. A literature search found few typhoid transmission models or economic evaluations relative to analyses of other infectious diseases of similar or lower health burden. Modelling suggests vaccines alone are unlikely to eliminate endemic disease in the short to medium term without measures to reduce transmission from asymptomatic carriage. The single identified data-fitted transmission model of typhoid vaccination suggests vaccines can reduce disease burden substantially when introduced programmatically but that indirect protection depends on the relative contribution of carriage to transmission in a given setting. This is an important source of epidemiological uncertainty, alongside the extent and nature of natural immunity. Economic evaluations suggest that typhoid vaccination can be cost-saving to health services if incidence is extremely high and cost-effective in other high-incidence situations, when compared to WHO norms. Targeting vaccination to the highest incidence age-groups is likely to improve cost-effectiveness substantially. Economic perspective and vaccine costs substantially affect estimates, with disease incidence, case-fatality rates, and vaccine efficacy over time also important determinants of cost-effectiveness and sources of uncertainty. Static economic models may under-estimate benefits of typhoid vaccination by omitting indirect protection. Typhoid fever transmission models currently require per-setting epidemiological parameterisation to inform their use in economic evaluation, which may limit their generalisability. We found no economic evaluation based on transmission dynamic modelling, and no economic evaluation of typhoid vaccination against interventions such as improvements in sanitation or hygiene.
Collapse
Affiliation(s)
- Conall H Watson
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, United Kingdom.
| | - W John Edmunds
- Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, United Kingdom
| |
Collapse
|
29
|
Westerhout K, Treur M, Mehnert A, Pascoe K, Ladha I, Belsey J. A cost utility analysis of simeprevir used with peginterferon + ribavirin in the management of genotype 1 hepatitis C virus infection, from the perspective of the UK National Health Service. J Med Econ 2015; 18:838-49. [PMID: 25903830 DOI: 10.3111/13696998.2015.1044457] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Triple therapy using a protease inhibitor (PI) with peginterferon and ribavirin (PR) is increasingly used in patients with chronic hepatitis C virus (HCV) infection. The most recently introduced PI, simeprevir (SMV), offers high levels of viral eradication combined with a reduced overall duration of therapy. The objective of this study was to compare the cost-effectiveness of SMV + PR vs PR alone or in combination with telaprevir (TVR) or boceprevir (BOC) in patients infected with genotype 1 HCV Method: A cost-utility model was constructed, incorporating two phases, capturing the efficacy of therapy in an initial treatment phase, followed by a long-term post-treatment Markov phase, capturing lifetime outcomes according to whether a sustained viral response (SVR) had been achieved on treatment. Dosage regimens were based on the EMA approved label for each treatment. SVR estimates and adverse event rates were derived from a mixed treatment comparison. Baseline characteristics were drawn from an analysis of a UK HCV data-set and clinician opinion. Health state transition probabilities, utilities, and health state costs were drawn from previously published economic analyses. The model considered direct health costs only, and the perspective was that of the UK National Health Service. RESULTS The model yielded an ICER for SMV + PR vs PR alone of £9725/QALY for treatment-naïve and £7819/QALY for treatment-experienced. Benefit was driven by increased likelihood of achieving SVR, with consequent long-term utility gains. SMV + PR dominated TVR + PR and BOC + PR in both patient groups. This principally reflected the QALY benefit of an increased likelihood of SVR with SMV, combined with lower overall drug costs, due to reduced mean treatment duration. CONCLUSION Compared to other currently licensed treatment options, SMV + PR represents a cost effective treatment option for patients with chronic genotype 1 HCV infection.
Collapse
|