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Altawalbeh SM, Wateska AR, Nowalk MP, Lin CJ, Harrison LH, Schaffner W, Zimmerman RK, Smith KJ. Cost-effectiveness of an in-development adult-formulated 21-valent pneumococcal conjugate vaccine in US adults aged 50 years or older. Vaccine 2024; 42:3024-3032. [PMID: 38580515 DOI: 10.1016/j.vaccine.2024.04.002] [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: 01/17/2024] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
Indirect effects of childhood pneumococcal conjugate vaccines (PCV) have diminished the cost-effectiveness of current adult vaccine recommendations. An in-development adult-formulated 21-valent pneumococcal conjugate vaccine (PCV21) may play a critical role in reducing pneumococcal illness by targeting a larger number of serotypes responsible for adult pneumococcal infections. This study assesses the cost-effectiveness of PCV21 in US adults aged 50 years or older compared with currently recommended pneumococcal vaccines, from both the societal and healthcare perspectives. A Markov model evaluated the lifetime cost-effectiveness of PCV21 (given at age 50 years only, at ages 50/65 years, and risk-based at ages < 65 years plus age-based at age 65 years) compared to no vaccination and to currently recommended pneumococcal vaccines given either as currently recommended or routinely at ages 50/65 years. The analysis was conducted in hypothetical Black and non-Black cohorts aged 50 years or older, with and without considering childhood pneumococcal vaccination indirect effects. Model parameters were based on US data. Parameter uncertainty was assessed using 1-way and probabilistic sensitivity analyses. From the societal perspective, PCV21 at ages 50/65 years compared to PCV21 at age 50 years cost $7,410 per quality adjusted life year (QALY) gained in Black cohort analyses and $85,696/QALY gained in the non-Black cohort; PCV21 at ages 50/65 years had the most favorable public health outcomes. From the healthcare perspective, compared to no vaccination, PCV21 at age 50 years cost $46,213/QALY gained in the Black cohort and $86,629/QALY in non-Blacks. All other strategies were dominated in both cohorts and from both perspectives. When considering childhood pneumococcal vaccination indirect effects, costs of PCV21 at ages 50/65 years remained less than $140,000/QALY gained from the societal perspective in both populations. PCV21 is potentially cost-effective compared to currently approved pneumococcal vaccines in adults aged 50 years or older from both the societal and healthcare perspectives.
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Affiliation(s)
- Shoroq M Altawalbeh
- Jordan University of Science and Technology, Faculty of Pharmacy, Irbid, Jordan.
| | - Angela R Wateska
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | | | - Chyongchiou J Lin
- The Ohio State University College of Nursing, Columbus, OH, United States.
| | - Lee H Harrison
- Center for Genomic Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - William Schaffner
- Vanderbilt University School of Medicine, Nashville, TN, United States.
| | | | - Kenneth J Smith
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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van den Boom NAC, van den Hurk AA, Evers SMAA, Poeze M. Societal burden and quality of life in patients with Lisfranc Injuries. Injury 2023; 54:110913. [PMID: 37536004 DOI: 10.1016/j.injury.2023.110913] [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: 05/04/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The incidence of Lisfranc fractures is rising, along with the incidence of foot fractures in general. These injuries can lead to long-term healthcare use and societal costs. Current economic evaluation studies are scarce in Lisfranc fracture research, and only investigate the healthcare costs. The aim of the present study was to accurately measure the monetary societal burden of disease and quality of life in the first 6 months after the injury in patients with Lisfranc fractures in the Netherlands. MATERIALS AND METHODS This study used a prevalence-based, bottom-up approach. Patients were included through thirteen medical centres in the Netherlands. Both stable and unstable injuries were included. The societal perspective was used. The costs were measured at baseline, 12 weeks and 6 months using the iMTA MCQ and PCQ questionnaires. Reference prices were used for valuation. Quality-of-life was measured using the EQ-5D-5 L and VAS scores. RESULTS 214 patients were included. The mean age was 45.9 years, and 24.3% of patients had comorbidities. The baseline questionnaires yielded approximately €2023 as the total societal costs in the 3 months prior to injury. The follow-up questionnaires and surgery costs assessment yielded approximately €17,083 as the total costs in the first 6 months after injury. Of these costs, approximately two thirds could be attributed to productivity losses. The EQ-5D-5 L found a mean index value of 0.449 at baseline and an index value of 0.737 at the 6-month follow-up. CONCLUSION The total monetary societal costs in the first 6 months after injury are approximately €17,083. Approximately two thirds of these costs can be attributed to productivity losses. These costs appear to be somewhat higher than those found in other studies. However, these studies only included the healthcare costs. Furthermore, the baseline costs indicate relatively low healthcare usage before the injury compared to the average Dutch patient. The mean QoL index was 0.462 at baseline and 0.737 at 6 months, indicating a rise in QoL after treatment as well as a long-lasting impact on QoL. To our knowledge, this is only the first study investigating the societal costs of Lisfranc injuries, so more research is needed.
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Affiliation(s)
- N A C van den Boom
- Maastricht University Medical Centre, Dept. of Trauma Surgery, P. Debyelaan 25, 6229, HX Maastricht, The Netherlands; Maastricht University, Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands.
| | - A A van den Hurk
- Maastricht University, Faculty of Health, Medicine, and Life Sciences (FHML), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - S M A A Evers
- Maastricht University, Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Maastricht University, Faculty of Health, Medicine, and Life Sciences (FHML), Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health, and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands
| | - M Poeze
- Maastricht University Medical Centre, Dept. of Trauma Surgery, P. Debyelaan 25, 6229, HX Maastricht, The Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
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Yanagi Y, Takahashi K, Iida T, Gomi F, Morii J, Kunikane E, Sakamoto T. Cost-Effectiveness Analysis of Ranibizumab Biosimilar for Neovascular Age-Related Macular Degeneration in Japan. Ophthalmol Ther 2023; 12:2005-2021. [PMID: 37171557 PMCID: PMC10287869 DOI: 10.1007/s40123-023-00715-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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION Neovascular age-related macular degeneration (nAMD) is the world's leading cause of blindness in elderly people. While anti-vascular endothelial growth factor (VEGF) treatments are used as the first option for patients with nAMD, they are generally expensive and need repeated injections. This study aimed to evaluate the cost-effectiveness of anti-VEGF therapies, focusing on the newly launched ranibizumab biosimilar (RBZ BS) in patients with nAMD from a Japanese societal perspective. METHODS A Markov model was developed to simulate the lifetime transitions of a cohort of treatment-naïve patients with nAMD through health states that were based on the involvement of nAMD (single eye vs. both eyes), the treatment status of the patients, and decimal best-corrected visual acuity. The model compared RBZ BS with branded RBZ, aflibercept (AFL), and AFL as loading dose switched to RBZ BS in maintenance in the treat-and-extend (TAE) regimen (RBZ TAE, AFL TAE, and AFL to RBZ BS TAE, respectively), and with branded RBZ in the pro re nata (PRN) regimen, as well as best supportive care (BSC). All processes were validated by five clinical experts. RESULTS When TAE regimens were compared, RBZ BS was dominant (higher quality-adjusted life-years (QALYs) and lower total cost) to AFL TAE and AFL to RBZ TAE. The result was robust regardless of whether the clinical data were taken from the direct head-to-head clinical trial or from indirect treatment comparison. RBZ BS TAE was cost-saving compared to RBZ TAE. RBZ BS TAE was estimated to be dominant to BSC owing to a lower societal cost. Like TAE regimens, RBZ BS was cost-saving compared to RBZ PRN and was dominant to BSC in PRN regimens. CONCLUSION This study suggests that RBZ BS is dominant to other anti-VEGF treatments in patients with nAMD in both TAE and PRN regimens and BSC from a Japanese societal perspective.
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Affiliation(s)
- Yasuo Yanagi
- Department of Ophthalmology and Microtechnology, Yokohama City University, Kanagawa, Japan.
| | - Kanji Takahashi
- Department of Ophthalmology, Kansai Medical University, Osaka, Japan
| | - Tomohiro Iida
- Department of Ophthalmology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo Medical University, Hyogo, Japan
| | | | | | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Huynh TNP, Nguyen TM, Povero M, Pradelli L. Economic Analysis of a Ketoanalogue-supplemented Very Low-protein Diet in Patients With Chronic Kidney Disease in Vietnam. Clin Ther 2023; 45:649-654. [PMID: 37365045 DOI: 10.1016/j.clinthera.2023.05.008] [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: 03/08/2023] [Accepted: 05/21/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE The aim of this study was to estimate the cost-effectiveness of a very low-protein diet (VLPD) supplemented with ketoanalogues of essential amino acids compared with a conventional low-protein diet (LPD) in Vietnam. METHODS The study was conducted from payer (base case), patient, and societal perspectives. A Markov model simulated costs and quality-adjusted life-years (QALYs) for patients with chronic kidney disease stage 4 or 5 (CKD4+) who were followed up during their lifetimes. Patients received a VLPD (0.3- to 0.4-g/kg/d diet) supplemented with ketoanalogues (5 kg/d [1 tablet]) versus LPD (0.6 g/kg/d, mixed proteins). In each model cycle, patient transitions among the health states-CKD4+ (nondialysis), dialysis, and death-were based on transition probabilities taken from the published literature. The time horizon covered the cohort's lifetime. Utilities and costs were estimated from literature review and projected for the lifespan considered in the model. Probabilistic and deterministic sensitivity analyses were performed. FINDINGS The ketoanalogue-supplemented VLPD increased survival and QALYs compared with the LPD. From a payer's perspective, total cost of care in Vietnam was ₫216,854,268 (€8684/$9242) per patient with LPD versus ₫200,928,819 (€8046/$8563) per patient with a supplemented VLPD (sVLPD) (difference, -₫15,925,449 [-€638/-$679]). From a patient's perspective, total cost of care in Vietnam was ₫217,872,043 (€8724/$9285) per patient with LPD versus ₫116,015,672 (€4646/$4944) per patient with sVLPD (difference, -₫101,856,371 [-€4,079/ -$4341]). From a societal perspective, total cost of care in Vietnam was ₫434,726,312 (€17,408/-$18,527) per patient with LPD versus ₫316,944,491 (€12,692/ $13,508) per patient with sVLPD (difference, -₫117,781,820 [-€4716 €/$5020). IMPLICATIONS Ketoanalogue-supplemented VLPD lowered costs compared with LPD in all 3 perspectives considered.
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Affiliation(s)
- Thao Ngoc Phuong Huynh
- Medicine Faculty, University of Medicine and Pharmacy at Ho Chi Minh City, Ho chi Minh City, Vietnam; Nephrology and Hemodialysis Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam.
| | - Tuan Minh Nguyen
- Department of Dialysis, Cho Ray Hospital, Hochiminh City, Vietnam
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Hoelen TCA, Willems PC, Arts JJ, van Mastrigt G, Evers S. The economic and societal burden associated with adolescent idiopathic scoliosis: A burden-of-disease study protocol. N Am Spine Soc J 2023; 14:100231. [PMID: 37440982 PMCID: PMC10333714 DOI: 10.1016/j.xnsj.2023.100231] [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: 03/27/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 07/15/2023]
Abstract
Background Adolescent idiopathic scoliosis (AIS) has an estimated general population prevalence of 2% to 3%. The impact of adolescent idiopathic scoliosis (AIS) on the patients' experienced quality of life and psychological well-being and the resulting societal burden are increasingly recognized. However, there is limited knowledge on the economic burden of AIS. This cross-sectional, prevalence-based, bottom-up approach burden of disease study aims to determine the impact associated with adolescent idiopathic scoliosis in terms of the cost-of-illness and health-related quality of life from a societal perspective in the Netherlands. Methods Persons diagnosed with AIS or parents of a child with AIS that are willing and able to answer the questionnaires will be eligible to participate. Patients will be included consecutively between June until January 2023. Costs and self-perceived health-related quality of life will be estimated using 3 steps: identification, measurement and valuation. To assess the costs associated with AIS the institute for Medical Technology Assessment - Medical Consumption Questionnaire and the institute for Medical Technology Assessment - Productivity Cost Questionnaire will be used. To assess the HRQoL of adult AIS patients the EuroQol 5-dimensions or EuroQol 5-dimensions Youth questionnaire for children under the age of 12 and the Scoliosis Research Society-22 revised questionnaire will be considered. Discussion This is the first study in this field. It will help raise awareness for AIS and wider support for both the patient community and informal care takers among healthcare professionals and policymakers. Major strengths of this study will be the use of mostly validated, standardized questionnaires. Limitations include the cross-sectional and retrospective nature of the study design.
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Affiliation(s)
- Thomáy-Claire Ayala Hoelen
- Department of Orthopedic Surgery and CAPHRI Research School, Maastricht University Medical Center (MUMC+), P.Debyelaan 25, Maastricht, 6202AZ, The Netherlands
| | - Paul C. Willems
- Department of Orthopedic Surgery and CAPHRI Research School, Maastricht University Medical Center (MUMC+), P.Debyelaan 25, Maastricht, 6202AZ, The Netherlands
| | - Jacobus J. Arts
- Department of Orthopedic Surgery and CAPHRI Research School, Maastricht University Medical Center (MUMC+), P.Debyelaan 25, Maastricht, 6202AZ, The Netherlands
| | - Ghislaine van Mastrigt
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI, Maastricht University, , Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
| | - Silvia Evers
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, CAPHRI, Maastricht University, , Universiteitssingel 40, Maastricht, 6229 ER, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction Utrecht, 3521 VS Utrecht, The Netherlands
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Caillon M, Brethon B, van Beurden-Tan C, Supiot R, Le Mezo A, Chauny JV, Majer I, Petit A. Cost-Effectiveness of Blinatumomab in Pediatric Patients with High-Risk First-Relapse B-Cell Precursor Acute Lymphoblastic Leukemia in France. Pharmacoecon Open 2023:10.1007/s41669-023-00411-4. [PMID: 37071263 DOI: 10.1007/s41669-023-00411-4] [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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Based on the results of the phase III randomized 20120215 trial, the European Medicines Agency granted the approval of blinatumomab for the treatment of pediatric patients with high-risk first-relapsed Philadelphia chromosome-negative B-cell precursor acute lymphoblastic leukemia (ALL). In France, blinatumomab received reimbursement for this indication in May 2022. This analysis assessed the cost effectiveness of blinatumomab compared with high-risk consolidation chemotherapy (HC3) in this indication from a French healthcare and societal perspective. METHODS A partitioned survival model with three health states (event-free, post-event and death) was developed to estimate life-years (LYs), quality-adjusted life-years (QALYs) and costs over a lifetime horizon. Patients who were alive after 5 years were considered to be cured. An excess mortality rate was applied to capture the late effects of cancer therapy. Utility values were based on the TOWER trial using French tariffs, and cost input data were identified from French national public health sources. The model was validated by clinical experts. RESULTS Treatment with blinatumomab over HC3 was estimated to provide gains of 8.39 LYs and 7.16 QALYs. Total healthcare costs for blinatumomab and HC3 were estimated to be €154,326 and €102,028, respectively, resulting in an increment of €52,298. The incremental cost-effectiveness ratio was estimated to be €7308 per QALY gained from a healthcare perspective. Results were robust to sensitivity analyses, including analysis from the societal perspective. CONCLUSIONS Blinatumomab administered as part of consolidation therapy in pediatric patients with high-risk first-relapsed ALL is cost effective compared with HC3 from the French healthcare and societal perspective.
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Affiliation(s)
- Megane Caillon
- Amgen (France) SAS, Arcs de Seine, 18-20 Quai du Point du Jour, 92100, Boulogne-Billancourt, France.
| | - Benoit Brethon
- Pediatric Hematology and Immunology Department, Robert-Debré Hospital, AP-HP, Paris, France
| | | | | | - Antoine Le Mezo
- Amgen (France) SAS, Arcs de Seine, 18-20 Quai du Point du Jour, 92100, Boulogne-Billancourt, France
| | - Jean-Vannak Chauny
- Amgen (France) SAS, Arcs de Seine, 18-20 Quai du Point du Jour, 92100, Boulogne-Billancourt, France
| | | | - Arnaud Petit
- Department of Pediatric Hematology-Oncology, Armand Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
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Rodríguez-Sánchez B, Daugbjerg S, Peña-Longobardo LM, Oliva-Moreno J, Aranda-Reneo I, Cicchetti A, López-Bastida J. Does the inclusion of societal costs change the economic evaluations recommendations? A systematic review for multiple sclerosis disease. Eur J Health Econ 2023; 24:247-277. [PMID: 35596098 PMCID: PMC9985586 DOI: 10.1007/s10198-022-01471-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 04/19/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND Multiple sclerosis imposes a heavy burden on the person who suffers from it and on the relatives, due to the caregiving load involved. The objective was to analyse whether the inclusion of social costs in economic evaluations of multiple sclerosis-related interventions changed results and/or conclusions. METHODS A systematic review was launched using Medline and the Cost-Effectiveness Analysis Registry of Tufts University (2000-2019). Included studies should: (1) be an original study published in a scientific journal, (2) be an economic evaluation of any multiple sclerosis-related intervention, (3) include productivity losses and/or informal care costs (social costs), (4) be written in English, (5) use quality-adjusted life years as outcome, and (6) separate the results according to the perspective applied. RESULTS Twenty-nine articles were selected, resulting in 67 economic evaluation estimations. Social costs were included in 47% of the studies. Productivity losses were assessed in 90% of the estimations (the human capital approach was the most frequently used method), whereas informal care costs were included in nearly two-thirds of the estimations (applying the opportunity and the replacement-cost methods equally). The inclusion of social costs modified the figures for incremental costs in 15 estimations, leading to a change in the conclusions in 10 estimations, 6 of them changing from not recommended from the healthcare perspective to implemented from the societal perspective. The inclusion of social costs also altered the results from cost-effective to dominant in five additional estimations. CONCLUSIONS The inclusion of social costs affected the results/conclusions in multiple sclerosis-related interventions, helping to identify the most appropriate interventions for reducing its economic burden from a broader perspective.
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Affiliation(s)
- B Rodríguez-Sánchez
- Department of Applied Economics, Public Economics and Political Economy, University Complutense of Madrid, Pl. Menéndez Pelayo 4, 28040, Madrid, Spain
| | - S Daugbjerg
- Graduate School of Health Economics and Management (Alta Scuola Di Economia E Management Dei Sistemi Sanitari), Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - L M Peña-Longobardo
- Economic Analysis and Finance Department, Faculty of Law and Social Sciences, University of Castilla-La Mancha, 45071, Toledo, Spain
| | - J Oliva-Moreno
- Economic Analysis and Finance Department, Faculty of Law and Social Sciences, University of Castilla-La Mancha, 45071, Toledo, Spain
| | - I Aranda-Reneo
- Economic Analysis and Finance Department, Faculty of Social Sciences, University of Castilla-La Mancha, Avda. Real Fábrica de Seda s/n, 45600, Talavera de la Reina, Toledo, Spain.
| | - A Cicchetti
- Graduate School of Health Economics and Management (Alta Scuola Di Economia E Management Dei Sistemi Sanitari), Universitá Cattolica del Sacro Cuore, Rome, Italy
| | - J López-Bastida
- Faculty of Health Sciences, Universidad Castilla-La Mancha, 45600, Talavera de la Reina, Toledo, Spain
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Fischer C, Mayer S, Perić N, Simon J. Harmonization issues in unit costing of service use for multi-country, multi-sectoral health economic evaluations: a scoping review. Health Econ Rev 2022; 12:42. [PMID: 35920934 PMCID: PMC9347135 DOI: 10.1186/s13561-022-00390-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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Valuation is a critical part of the costing process in health economic evaluations. However, an overview of specific issues relevant to the European context on harmonizing methodological requirements for the valuation of costs to be used in health economic evaluation is lacking. We aimed to inform the development of an international, harmonized and multi-sectoral costing framework, as sought in the European PECUNIA (ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions) project. METHODS We conducted a scoping review (information extraction 2008-2021) to a) to demonstrate the degree of heterogeneity that currently exists in the literature regarding central terminology, b) to generate an overview of the most relevant areas for harmonization in multi-sectoral and multi-national costing processes for health economic evaluations, and c) to provide insights into country level variation regarding economic evaluation guidance. A complex search strategy was applied covering key publications on costing methods, glossaries, and international costing recommendations augmented by a targeted author and reference search as well as snowballing. Six European countries served as case studies to describe country-specific harmonization issues. Identified information was qualitatively synthesized and cross-checked using a newly developed, pilot-tested data extraction form. RESULTS Costing methods for services were found to be heterogeneous between sectors and country guidelines and may, in practice, be often driven by data availability and reimbursement systems in place. The lack of detailed guidance regarding specific costing methods, recommended data sources, double-counting of costs between sectors, adjustment of unit costs for inflation, transparent handling of overhead costs as well as the unavailability of standardized unit costing estimates in most countries were identified as main drivers of country specific differences in costing methods with a major impact on valuation and cost-effectiveness evidence. CONCLUSION This review provides a basic summary of existing costing practices for evaluative purposes across sectors and countries and highlights several common methodological factors influencing divergence in cost valuation methods that would need to be systematically incorporated and addressed in future costing practices to achieve more comparable, harmonized health economic evaluation evidence.
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Affiliation(s)
- Claudia Fischer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
| | - Nataša Perić
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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Aoun M, Helou E, Sleilaty G, Zeenny RM, Chelala D. Cost of illness of chronic kidney disease in Lebanon: from the societal and third-party payer perspectives. BMC Health Serv Res 2022; 22:586. [PMID: 35501814 PMCID: PMC9063193 DOI: 10.1186/s12913-022-07936-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 09/16/2021] [Accepted: 04/11/2022] [Indexed: 01/10/2023] Open
Abstract
Background Chronic kidney disease (CKD) is the 12th leading cause of death worldwide. Cost-of-illness studies of CKD are scarce in developing countries. This study aims to estimate the cost of illness of all stages of CKD in Lebanon, from early stages until dialysis and kidney transplantation. The secondary objective is to identify factors related to the highest financial burden. Methods This is a cross-sectional study of CKD patients who presented to two nephrology clinics during November 2020. Their medical and administrative records were reviewed for collection of demographics, CKD characteristics, direct medical costs (medications, diagnostic tests, hospitalizations, inpatient care, outpatient care), direct non-medical costs (transportation) and indirect costs (productivity losses) for one year. Kruskal Wallis test was used to compare the costs between different CKD stages and categories. Logistic regression analysis was used to evaluate risk factors associated with costs. Results The sample included 102 non-dialysis CKD patients, 40 hemodialysis, 8 peritoneal dialysis and 10 transplant patients. Their mean age was 66.74 ± 15.36 years, 57.5% were males and 42.5% diabetics. The total median cost per year of CKD across all categories was assessed to be 7,217,500 Lebanese Pounds (3,750,000–35,535,250; 1 $USD = 1515 LBP in 2019) from the societal perspective and 5,685,500 LBP (2,281,750- 32,386,500) from the third-party payer perspective. Statistical analysis showed a higher total cost in hemodialysis (p < 0.001), higher cost of medications in transplant (p < 0.001) and higher cost in technique modality in peritoneal dialysis (p < 0.001). In a sub-analysis of hemodialysis patients, dialysis vintage negatively correlated with total societal cost (r = -0.391, p = 0.013); the regression analysis found diabetes as a risk factor for higher cost (OR = 2.3; 95%CI: 0.638,8.538; p = 0.201). In the subcategory of CKD-ND patients, age correlated with total societal cost (r = 0.323, p = 0.001); diabetes and coronary artery disease were significantly associated with higher total cost (OR = 2.4; 95%CI: 1.083,5.396; p = 0.031; OR = 3.7; 95%CI: 1.535,8.938; p = 0.004). Conclusions This cost of illness study showed a high burden of hemodialysis and peritoneal dialysis cost compared to transplant and non-dialysis CKD patients. It revealed a significantly higher cost of medications in transplant patients. Health policies should target interventions that prevent end-stage kidney disease and encourage kidney transplantation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07936-0.
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Affiliation(s)
- Mabel Aoun
- Department of Nephrology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon. .,Department of Nephrology, Saint-George Hospital, Ajaltoun, Lebanon.
| | - Elie Helou
- Department of Urology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Ghassan Sleilaty
- Unit of biostatistics, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
| | - Rony M Zeenny
- Pharmacy Director, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dania Chelala
- Department of Nephrology, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.,Department of Nephrology at Hotel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
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Schwander B, Feldstein J, Sulo S, Gonzalez L, ElShishiney G, Hassany M. Pursuing Elimination of Hepatitis C in Egypt: Cost-Effectiveness and Economic Evaluation of a Country-Wide Program. Infect Dis Ther 2022. [PMID: 35451742 DOI: 10.1007/s40121-022-00631-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/28/2021] [Accepted: 03/24/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Hepatitis C virus (HCV) is a global public health crisis. Egypt presents the highest HCV global prevalence. Recently, three different HCV screening/testing/therapy programs were implemented: In 2014 (wave 1), major decisions on HCV therapy were enacted, accompanied by a 99% discount for the HCV therapy sofosbuvir. In 2016 (wave 2), a first testing program was launched to identify patients for free treatment. In 2018 (wave 3), population-wide screening was conducted using a WHO-prequalified finger prick rapid diagnostic test (RDT) to identify/treat all Egyptians with HCV. The financial advantages of HCV screening programs (wave 1–3 results) were estimated vs a baseline period of limited Egyptian HCV testing/therapeutic intervention (2008–2014). Methods Using published evidence and model-based estimates from real-world data, we evaluated the direct costs of the different HCV programs, accompanied by a conservative simulation of major HCV health consequences (i.e., liver-related deaths/life years lost) and related indirect costs. Total economic consequences of each HCV program were compared to each other and baseline from a societal perspective. Future costs and health effects were discounted by 3.5% per year. Results Discounted total costs (in US dollars) were $1,057 billion (baseline), $913 million (wave 1), $457 million (wave 2), and $396 million (wave 3). Discounted HCV-related life years lost were 418,000 (baseline), 377,000 (wave 1), 142,000 (wave 2), and 62,000 (wave 3). With each successive Egyptian HCV screening/testing/therapy wave, total costs and HCV-related mortality were reduced. Conclusion Use of the community-applied, WHO-prequalified RDT was the most dominant approach to cost-effectiveness. These results provide rationale for worldwide scalability of similar HCV elimination programs.
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Kalmet P, Andriessen MT, Maduro CV, van den Boom N, Moens-Oyen C, Hiligsmann M, Janzing H, van der Veen A, Jaspars C, Sintenie JB, Seelen H, Brink P, Poeze M, Evers S. The economic burden of the postoperative management in surgically treated trauma patients with peri- and/or intra-articular fractures of the lower extremities: A prospective multicenter cohort study. Injury 2022; 53:713-718. [PMID: 34809922 DOI: 10.1016/j.injury.2021.11.012] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/29/2021] [Accepted: 11/07/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To estimate the economic burden expressed in costs and quality of life of the post-surgical treatment of peri‑ and/or intra-articular fractures in the lower extremity from a societal perspective. DESIGN This is a quantitative study as it aims to find averages and generalize results to wider populations. The design is a cost-of-illness and quality of life study focusing on costs (in euros), Activities of Daily Living (ADL) and Quality of Life (Qol) in patients with peri‑ and/or intra-articular fractures of the lower extremities. SETTING Surgically treated trauma patients with peri‑ and/or intra-articular fractures of the lower extremities during 26 weeks follow-up. Patients were included from 4 hospitals in the Netherlands. MAIN OUTCOME MEASURES Costs, ADL and Quality Adjusted Life Years (QALY). METHODS Cost of illness was estimated through a bottom-up method. The Dutch Eq-5D-5 L questionnaire was used to calculate utilities while Lower Extremity Functional Scale (LEFS) scores were used as a measure of ADL. Non-parametric bootstrapping was used to test for statistical differences in costs. Subgroup analyses were performed to determine the influence of work status and further sensitivity analyses were performed to test the robustness of the results. RESULTS Total average societal costs were € 9836.96 over six months. Unexpectedly, total societal and healthcare costs were lower for patients with a paid job relative to patients without. Sensitivity analyses showed that our choice of a societal perspective and the EuroQol as our primary utility measurement tool had a significant effect on the outcomes. The ADL at baseline was respectively; 10.4 and at 26 weeks post-surgery treatment 49.5. The QoL was at baseline respectively; 0.3 and at 26 weeks post-surgery treatment 0.7. These findings are indicative of a significantly improved ADL and QoL (p ≤ 0.05) over time. CONCLUSIONS This study reveal a substantial economic burden in monetary terms and effect on QoL of patients with peri‑ and/or intra-articular fractures of the lower extremities during 26 weeks follow-up. REGISTRATION This study was registered in the Dutch Trial Register (NTR6077). Date of registration: 01-09-2016.
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Affiliation(s)
- Phs Kalmet
- Maastricht University Medical Center+, Maastricht, the Netherlands
| | | | - C V Maduro
- Maastricht University Medical Center+, Maastricht, the Netherlands; Maastricht University, Maastricht, the Netherlands.
| | - N van den Boom
- Maastricht University Medical Center+, Maastricht, the Netherlands
| | | | - M Hiligsmann
- Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands
| | - H Janzing
- Viecuri Medical Center, Venlo, the Netherlands
| | | | - C Jaspars
- Maxima Medical Center, Veldhoven, the Netherlands
| | | | - Ham Seelen
- Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands; Adelante Rehabilitation Center, Hoensbroek, the Netherlands
| | - Prg Brink
- Maastricht University Medical Center+, Maastricht, the Netherlands
| | - M Poeze
- Maastricht University Medical Center+, Maastricht, the Netherlands; Nutrim School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Smaa Evers
- Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, the Netherlands
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12
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Schnitzler L, Janssen LMM, Evers SMAA, Jackson LJ, Paulus ATG, Roberts TE, Pokhilenko I. The broader societal impacts of COVID-19 and the growing importance of capturing these in health economic analyses. Int J Technol Assess Health Care 2021; 37:e43. [PMID: 33686927 DOI: 10.1017/S0266462321000155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe rapid spread of the current COVID-19 pandemic has affected societies worldwide, leading to excess mortality, long-lasting health consequences, strained healthcare systems, and additional strains and spillover effects on other sectors outside health (i.e., intersectoral costs and benefits). In this perspective piece, we demonstrate the broader societal impacts of COVID-19 on other sectors outside the health sector and the growing importance of capturing these in health economic analyses. These broader impacts include, for instance, the effects on the labor market and productivity, education, criminal justice, housing, consumption, and environment. The current pandemic highlights the importance of adopting a societal perspective to consider these broader impacts of public health issues and interventions and only omit these where it can be clearly justified as appropriate to do so. Furthermore, we explain how the COVID-19 pandemic exposed and exacerbated existing deep-rooted structural inequalities that contribute to the wider societal impacts of the pandemic.
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13
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Simon J, Mayer S, Łaszewska A, Rugkåsa J, Yeeles K, Burns T, Gray A. Cost and quality-of-life impacts of community treatment orders (CTOs) for patients with psychosis: economic evaluation of the OCTET trial. Soc Psychiatry Psychiatr Epidemiol 2021; 56:85-95. [PMID: 32719905 PMCID: PMC7847440 DOI: 10.1007/s00127-020-01919-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 07/02/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE Current RCT and meta-analyses have not found any effect of community treatment orders (CTOs) on hospital or social outcomes. Assumed positive impacts of CTOs on quality-of-life outcomes and reduced hospital costs are potentially in conflict with patient autonomy. Therefore, an analysis of the cost and quality-of-life consequences of CTOs was conducted within the OCTET trial. METHODS The economic evaluation was carried out comparing patients (n = 328) with psychosis discharged from involuntary hospitalisation either to treatment under a CTO (CTO group) or voluntary status via Section 17 leave (non-CTO group) from the health and social care and broader societal perspectives (including cost implication of informal family care and legal procedures). Differences in costs and outcomes defined as quality-adjusted life years (QALYs) based on the EQ-5D-3L or capability-weighted life years (CWLYs) based on the OxCAP-MH were assessed over 12 months (£, 2012/13 tariffs). RESULTS Mean total costs from the health and social care perspective [CTO: £35,595 (SD: £44,886); non-CTO: £36,003 (SD: £41,406)] were not statistically significantly different in any of the analyses or cost categories. Mental health hospitalisation costs contributed to more than 85% of annual health and social care costs. Informal care costs were significantly higher in the CTO group, in which there were also significantly more manager hearings and tribunals. No difference in health-related quality of life or capability wellbeing was found between the groups. CONCLUSION CTOs are unlikely to be cost-effective. No evidence supports the hypothesis that CTOs decrease hospitalisation costs or improve quality of life. Future decisions should consider impacts outside the healthcare sector such as higher informal care costs and legal procedure burden of CTOs.
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Affiliation(s)
- Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria. .,Department of Psychiatry, Warneford Hospital, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK. .,Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Susanne Mayer
- grid.22937.3d0000 0000 9259 8492Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria
| | - Agata Łaszewska
- grid.22937.3d0000 0000 9259 8492Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria
| | - Jorun Rugkåsa
- grid.411279.80000 0000 9637 455XHealth Services Research Unit, Akershus University Hospital, 1478 Lørenskog, Norway ,grid.463530.70000 0004 7417 509XCentre for Care Research, University of South-Eastern Norway, 3900 Porsgrunn, Norway
| | - Ksenija Yeeles
- grid.451190.80000 0004 0573 576XDepartment of Psychiatry, Warneford Hospital, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, OX3 7JX UK
| | - Tom Burns
- grid.451190.80000 0004 0573 576XDepartment of Psychiatry, Warneford Hospital, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, OX3 7JX UK
| | - Alastair Gray
- grid.4991.50000 0004 1936 8948Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF UK
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14
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Duevel JA, Hasemann L, Peña-Longobardo LM, Rodríguez-Sánchez B, Aranda-Reneo I, Oliva-Moreno J, López-Bastida J, Greiner W. Considering the societal perspective in economic evaluations: a systematic review in the case of depression. Health Econ Rev 2020; 10:32. [PMID: 32964372 PMCID: PMC7510122 DOI: 10.1186/s13561-020-00288-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/07/2020] [Indexed: 05/27/2023]
Abstract
BACKGROUND Depressive disorders are associated with a high burden of disease. However, due to the burden posed by the disease on not only the sufferers, but also on their relatives, there is an ongoing debate about which costs to include and, hence, which perspective should be applied. Therefore, the aim of this paper was to examine whether the change between healthcare payer and societal perspective leads to different conclusions of cost-utility analyses in the case of depression. METHODS A systematic literature search was conducted to identify economic evaluations of interventions in depression, launched on Medline and the Cost-Effectiveness Registry of the Tufts University using a ten-year time horizon (2008-2018). In a two-stepped screening process, cost-utility studies were selected by means of specified inclusion and exclusion criteria. Subsequently, relevant findings was extracted and, if not fully stated, calculated by the authors of this work. RESULTS Overall, 53 articles with 92 complete economic evaluations, reporting costs from healthcare payer/provider and societal perspective, were identified. More precisely, 22 estimations (24%) changed their results regarding the cost-effectiveness quadrant when the societal perspective was included. Furthermore, 5% of the ICURs resulted in cost-effectiveness regarding the chosen threshold (2% of them became dominant) when societal costs were included. However, another four estimations (4%) showed the opposite result: these interventions were no longer cost-effective after the inclusion of societal costs. CONCLUSIONS Summarising the disparities in results and applied methods, the results show that societal costs might alter the conclusions in cost-utility analyses. Hence, the relevance of the perspectives chosen should be taken into account when carrying out an economic evaluation. This systematic review demonstrates that the results of economic evaluations can be affected by different methods available for estimating non-healthcare costs.
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Affiliation(s)
- Juliane Andrea Duevel
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany.
| | - Lena Hasemann
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
| | - Luz María Peña-Longobardo
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
| | - Beatriz Rodríguez-Sánchez
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
- Faculty of Technology and Science, University Camilo José Cela, Urb. Villafranca del Castillo, Calle Castillo de Alarcón, 49, 28692 Villanueva de la Cañada, Madrid, Spain
| | - Isaac Aranda-Reneo
- Faculty of Social Science, Economic Analysis and Finance Department, Research Group in Economics and Health, University of Castilla-La Mancha, Avda. Real Fábrica s/n, Talavera de la Reina, 45600, Toledo, Spain
| | - Juan Oliva-Moreno
- Faculty of Law and Social Sciences, Economic Analysis Department, Research Group in Economics and Health, University of Castilla-La Mancha, Cobertizo San Pedro Mártir, S/N, 45002, Toledo, Spain
| | - Julio López-Bastida
- Faculty of Health Science, Research Group in Economics and Health, University of Castilla-La Mancha, Av. Real Fábrica de Sedas, s/n, Talavera de la Reina, 45600, Toledo, Spain
| | - Wolfgang Greiner
- AG 5 - Department of Health Economics and Health Care Management, Bielefeld University, School of Public Health, Universitaetsstrasse 25, 33615, Bielefeld, Germany
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15
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Janssen LMM, Pokhilenko I, Evers SMAA, Paulus ATG, Simon J, König HH, Brodszky V, Salvador-Carulla L, Park AL, Hollingworth W, Drost RMWA. Exploring the identification, validation, and categorization of the cost and benefits of criminal justice in mental health: the PECUNIA project. Int J Technol Assess Health Care 2020; 36:1-8. [PMID: 32715991 DOI: 10.1017/s0266462320000471] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/07/2022]
Abstract
BACKGROUND Mental health disorders and their treatments produce significant costs and benefits in both healthcare and non-healthcare sectors. The latter are often referred to as intersectoral costs and benefits (ICBs). Little is known about healthcare-related ICBs in the criminal justice sector and how to include these in health economics research. OBJECTIVES The triple aim of this study is (i) to identify healthcare-related ICBs in the criminal justice sector, (ii) to validate the list of healthcare-related ICBs in the criminal justice sector on a European level by sector-specific experts, and (iii) to classify the identified ICBs. METHODS A scientific literature search in PubMed and an additional grey literature search, carried out in six European countries, were used to retrieve ICBs. In order to validate the international applicability of the ICBs, a survey was conducted with an international group of experts from the criminal justice sector. The list of criminal justice ICBs was categorized according to the PECUNIA conceptual framework. RESULTS The full-text analysis of forty-five peer-reviewed journal articles and eleven grey literature sources resulted in a draft list of items. Input from the expert survey resulted in a final list of fourteen unique criminal justice ICBs, categorized according to the care atom. CONCLUSION This study laid further foundations for the inclusion of important societal costs of mental health-related interventions within the criminal justice sector. More research is needed to facilitate the further and increased inclusion of ICBs in health economics research.
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Affiliation(s)
- Luca M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Irina Pokhilenko
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Trimbos Institute Centre of Economic Evaluation & Machine Learning, Utrecht, The Netherlands
| | - Aggie T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Judit Simon
- Department of Health Economics, Centre for Public Health, Medical University of Vienna, Vienna, Austria
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg, Hamburg, Germany
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia
| | - A-La Park
- London School of Economics (LSE), Department of Health Policy, London School of Economics and Political Science, London, UK
| | - W Hollingworth
- Health Economics, Bristol Medical School: Population Health Sciences, Bristol, UK
| | - Ruben M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
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16
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Basu A. A welfare-theoretic model consistent with the practice of cost-effectiveness analysis and its implications. J Health Econ 2020; 70:102287. [PMID: 31972535 DOI: 10.1016/j.jhealeco.2020.102287] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 07/30/2019] [Revised: 10/25/2019] [Accepted: 01/03/2020] [Indexed: 05/19/2023]
Abstract
I look at three debates in the health economics literature in the context of cost-effectiveness analysis (CEA): 1) inclusion of future costs, 2) discounting, and 3) consistency with a welfare-economic perspective. These debates thus far have been studied in isolation leading to confusion and lingering questions. I look at these three debates holistically and present a welfare theoretic model that is consistent with the practice of CEA and can help inform all of these three debates. It shows rationales for the recommendations of the Second Panel and clarifies some nuanced implications for the practice of CEA when taking a societal perspective in the context of distributional CEA and multi-sectorial budgets.
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Affiliation(s)
- Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle WA, United States; The National Bureau of Economic Research, Cambridge MA, United States.
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17
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Chuvarayan Y, Finger RP, Köberlein-Neu J. Economic burden of blindness and visual impairment in Germany from a societal perspective: a cost-of-illness study. Eur J Health Econ 2020; 21:115-127. [PMID: 31493181 DOI: 10.1007/s10198-019-01115-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 01/14/2019] [Accepted: 08/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Visual impairment and blindness cause a considerable and increasing economic burden affecting not only persons with vision loss and their families, but also societies. For the majority of countries, there is no solid database that would allow a comprehensive assessment of costs from a societal perspective. The present study was conducted to fill this gap. OBJECTIVES To investigate resource utilization of blind or visually impaired people and to assess the economic burden of blindness and visual impairment in Germany. METHODS This cross-sectional cost-of-illness study measures the economic burden of blindness and visual impairment bottom-up and from a societal perspective. Therefore, blind and visually impaired persons were recruited via national self-help organizations (prevalence-based approach) and interviewed regarding their utilized resources using various survey modes (mixed-mode approach). The observation period was 6 months retrospectively. Utilized resources were valued applying standardized unit costs (macro-costing). Calculations for the study population provided direct and indirect costs per person for a period of 6 months. Further cost per category was extrapolated to 1 year for the general population of Germany. Uncertainty of results was addressed applying univariate deterministic sensitivity analyses. RESULTS Complete data were collected from 683 participants (54.84% women; average age: 60.28 ± 17.02 years). Decreasing vision was associated with increasing costs (p < 0.001). Most costs were incurred by informal support from relatives, which was the most important resource for coping with everyday life for people with visual loss. Together with assistive/medical devices and loss of productivity due to disability, informal support accounted for 80% of total costs. Extrapolated to Germany, the annual costs of blindness and visual impairment from a societal perspective amounted to € 49.6 billion. Results of the sensitivity analyses and 95% confidence intervals showed a considerable degree of uncertainty. CONCLUSION Visual impairment and blindness may cause enormous overall costs from a societal point of view, as shown here for Germany. Our findings on the costs of blindness and visual impairment in Germany add in a number of different ways to the international evidence. In particular, results show that a large proportion of the costs are not obvious per se as it is caused by self-paid deductibles, productivity loss, early retirement and informal support/care by relatives. Further research should make special efforts to investigate these costs precisely as well as their influence factors.
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Affiliation(s)
- Yuliya Chuvarayan
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Rainer-Gruenter-Str. 21, 42119, Wuppertal, Germany
| | - Robert P Finger
- Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Rainer-Gruenter-Str. 21, 42119, Wuppertal, Germany.
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Abstract
In economic evaluation, the healthcare perspective has gradually given way to use of the societal perspective, as this perspective is often advocated for support in making optimal societal decisions. In practice, economic evaluations conducted from the societal perspective ignore, fail to measure and/or fail to monetize many of the costs that fall outside of the healthcare sector. To limit bias and increase decision-supportive power, researchers could strengthen their evaluations by adhering to a few basic principles. Five "pillars for the societal perspective" are proposed. First, who bears the cost and who does not is irrelevant. Second, it is imperative to consider including costs for sectors outside the healthcare sector. Third, both high frequent costs and costs with high unit prices should be considered. Fourth, double counting should be avoided. And fifth, researchers should reflect on choices related to costs, i.e. cost omission and problems with identifying, measuring, and valuing costs.
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19
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Peña-Longobardo LM, Rodríguez-Sánchez B, Oliva-Moreno J, Aranda-Reneo I, López-Bastida J. How relevant are social costs in economic evaluations? The case of Alzheimer's disease. Eur J Health Econ 2019; 20:1207-1236. [PMID: 31342208 PMCID: PMC8149344 DOI: 10.1007/s10198-019-01087-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/09/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND The main objective of this study was to analyse how the inclusion (exclusion) of social costs can alter the results and conclusions of economic evaluations in the field of Alzheimer's disease interventions. METHODS We designed a systematic review that included economic evaluations in Alzheimer's disease. The search strategy was launched in 2000 and ran until November 2018. The inclusion criteria were: being an original study published in a scientific journal, being an economic evaluation of any intervention related to Alzheimer's disease, including social costs (informal care costs and/or productivity losses), being written in English, using QALYs as an outcome for the incremental cost-utility analysis, and separating the results according to the perspective applied. RESULTS It was finally included 27 studies and 55 economic evaluations. Around 11% of economic evaluations changed their main conclusions. More precisely, three of them concluded that the new intervention became cost-effective when the societal perspective was considered, whereas when using just the health care payer perspective, the new intervention did not result in a cost-utility ratio below the threshold considered. Nevertheless, the inclusion of social cost can also influence the results, as 37% of the economic evaluations included became the dominant strategy after including social costs when they were already cost-effective in the health care perspective. CONCLUSIONS Social costs can substantially modify the results of the economic evaluations. Therefore, taking into account social costs in diseases such as Alzheimer's can be a key element in making decisions about public financing and pricing of health interventions.
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Affiliation(s)
- L M Peña-Longobardo
- Faculty of Social Science and Law, University of Castilla-La Mancha, Talavera de la Reina, Spain.
| | - B Rodríguez-Sánchez
- Faculty of Social Science and Law, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - J Oliva-Moreno
- Faculty of Social Science and Law, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - I Aranda-Reneo
- Faculty of Social Science and Law, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - J López-Bastida
- Faculty of Health Science, University of Castilla-La Mancha, Talavera de la Reina, Spain
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Spanò R, Di Paola N, Bova M, Barbarino A. Value co-creation in healthcare: evidence from innovative therapeutic alternatives for hereditary angioedema. BMC Health Serv Res 2018; 18:571. [PMID: 30029666 PMCID: PMC6053759 DOI: 10.1186/s12913-018-3389-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 03/20/2017] [Accepted: 07/13/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Our research focuses on the co-creation of value in healthcare with reference to a case of hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE). Our work is mainly based on the concept of value co-creation in healthcare. The aim of this study is to assess the impact of an alternative treatment strategy - self-administration - by focusing on treatment outcomes and costs to understand if innovative therapeutic solutions can create value for patients and healthcare systems. METHODS This paper compares home-based and hospital-based therapeutic strategies (independent of treatment type) with a cost minimization analysis. It encompasses compliance issues and focuses on both payer and societal perspectives, also benefiting from an operationalization of the service-dominant logic model for healthcare delivery. Data were collected over a 6-month period (August 2014-January 2015) through monthly patient interviews. Archival data were used for variable measurement. RESULTS Thirty-nine out of 62 patients enrolled in the study, experienced at least one HAE attacks, equally distributed between home and hospital-based strategies. No evidence of correlation between therapeutic strategy and disease severity score (p = 0.351), compliance (p = 0.399), and quality of life (p = 0.971), were found. Total direct cost per attack amounts to € 1224 for home-based strategy with respect to € 1454 for hospital-based strategy, with a savings of € 230. The economic advantage of the home-based strategy almost doubles if the societal perspective was considered due to a further savings of €169 (less missed work/school days and no travel expenses). CONCLUSIONS Our study suggests that home-based therapies represent a feasible strategy for managing C1-INH-HAE and may result in lower costs and increased value for both patients and the healthcare systems. The findings are relevant to the debate on and extend the extant literature to provide a broader view of value co-creation dynamics for home-based therapies in healthcare and their positive effects. The insights are relevant to practitioners and policy makers.
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Affiliation(s)
- Rosanna Spanò
- Department of Economics, Management, Institutions, University of Naples Federico II, Campus Universitario di Monte S. Angelo, Via Cintia 24, 80126 Naples, Italy
| | - Nadia Di Paola
- Department of Economics, Management, Institutions, University of Naples Federico II, Campus Universitario di Monte S. Angelo, Via Cintia 24, 80126 Naples, Italy
| | - Maria Bova
- Department of Translational Medical Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Alessandro Barbarino
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
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Abstract
The economic burden of chronic hepatitis C might exceed $10 billion annually in the United States alone. This disease has a worldwide prevalence of up to 3%, making the global burden of the disease comparably tremendous. The cost of the disease includes direct medical expenses for its hepatic and extrahepatic manifestations, and also indirect costs incurred from impaired quality of life and the loss of work productivity. Recent emergence of treatment options that are not only highly effective and safe but also costly has emphasized the need to study the disease from the economic point of view.
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Affiliation(s)
- Maria Stepanova
- Center for Outcomes Research in Liver Diseases, 2411 I Street NW, Washington, DC 20037, USA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Zobair M Younossi
- Center for Outcomes Research in Liver Diseases, 2411 I Street NW, Washington, DC 20037, USA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, 3300 Gallows Road, Falls Church, VA 22042, USA; Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA.
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Drost RMWA, van der Putten IM, Ruwaard D, Evers SMAA, Paulus ATG. CONCEPTUALIZATIONS OF THE SOCIETAL PERSPECTIVE WITHIN ECONOMIC EVALUATIONS: A SYSTEMATIC REVIEW. Int J Technol Assess Health Care 2017; 33:251-60. [PMID: 28641592 DOI: 10.1017/S0266462317000526] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The aim of this study was to investigate how the societal perspective is conceptualized in economic evaluations and to assess how intersectoral costs and benefits (ICBs), that is, the costs and benefits pertaining to sectors outside the healthcare sector, impact their results. METHODS Based on a search in July 2015 using PubMed, Embase, CINAHL, and PsychINFO, a systematic literature review was performed for economic evaluations which were conducted from a societal perspective. Conceptualizations were assessed in NVivo version 11 using conventional and directed content analysis. Trial-based evaluations in the fields of musculoskeletal and mental disorders were analyzed further, focusing on the way ICBs impact the results of economic evaluations. RESULTS A total of 107 studies were assessed, of which 74 (69.1 percent) provided conceptualizations of the societal perspective. These varied in types of costs included and in descriptions of cost bearers. Labor productivity costs were included in seventy-two studies (67.3 percent), while only thirty-eight studies (35.5 percent) included other ICBs, most of which entailed informal care and/or social care costs. ICBs within the educational and criminal justice sectors were each included five times. Most of the trial-based evaluations analyzed further (n = 21 of 28) reported productivity costs. In nine, these took up more than 50 percent of total costs. In several studies, criminal justice and informal care costs were also important. CONCLUSIONS There is great variety in the way the societal perspective is conceptualized and interpreted within economic evaluations. Use of the term "societal perspective" is often related to including merely productivity costs, while other ICBs could be relevant as well.
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Jakubczyk M, Koń B. The impact of firms' adjustments on the indirect cost of illness. Int J Health Econ Manag 2017; 17:10.1007/s10754-017-9212-1. [PMID: 28154961 DOI: 10.1007/s10754-017-9212-1] [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: 12/12/2015] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Abstract
Illness-related absenteeism reduces firms' output, an effect referred to as indirect cost (IC) and often included in cost-of-illness or cost-effectiveness (of health technologies) studies. The companies may foresee this effect and modify hiring or contracting policies. We present a model allowing the estimation of IC with such adjustments. We show that the risk of illness does not change the general shape and properties of the (expected) marginal productivity function. We apply our model to several illustrative examples and show that firm's adjustments impact IC in an ambiguous way, depending on detailed company/market characteristics: in some cases the company reduces the employment (further increasing IC), in another-the opposite happens. Contrary to previous findings, teamwork and shortfall penalties may reduce IC in some settings. Our analysis highlights that IC should be split into the result of companies preparing for and actually experiencing sick leaves.
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Affiliation(s)
- Michał Jakubczyk
- Decision Analysis and Support Unit, SGH Warsaw School of Economics, Al. Niepodległości 162, 02-554, Warsaw, Poland.
| | - Beata Koń
- Decision Analysis and Support Unit, SGH Warsaw School of Economics, Al. Niepodległości 162, 02-554, Warsaw, Poland
- Department of Analysis and Strategy, Ministry of Health, ul. Miodowa 15, 00-952, Warsaw, Poland
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Lammerts L, van Dongen JM, Schaafsma FG, van Mechelen W, Anema JR. A participatory supportive return to work program for workers without an employment contract, sick-listed due to a common mental disorder: an economic evaluation alongside a randomized controlled trial. BMC Public Health 2017; 17:162. [PMID: 28152999 PMCID: PMC5290622 DOI: 10.1186/s12889-017-4079-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 07/12/2016] [Accepted: 01/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental disorders are associated with high costs for productivity loss, sickness absence and unemployment. A participatory supportive return to work (RTW) program was developed in order to improve RTW among workers without an employment contract, sick-listed due to a common mental disorder. The program contained a participatory approach, integrated care and direct placement in a competitive job. The aim of this study was to evaluate the cost-effectiveness and cost-utility of this new program, compared to usual care. In addition, its return on investment was evaluated. METHODS An economic evaluation was conducted alongside a 12-month randomized controlled trial. A total of 186 participants was randomly allocated to the new program (n = 94) or to usual care (n = 92). Effect measures were the duration until sustainable RTW in competitive employment and quality-adjusted life years (QALYs) gained. Costs included intervention costs, medical costs and absenteeism costs. Registered data of the Dutch Social Security Agency were used to assess the duration until sustainable RTW, intervention costs and absenteeism costs. QALYs and medical costs were assessed using three- or six-monthly questionnaires. Missing data were imputed using multiple imputations. Cost-effectiveness analysis and cost-utility analysis were conducted from the societal perspective. A return on investment analysis was conducted from the social insurer's perspective. Various sensitivity analyses were performed to assess the robustness of the results. RESULTS The new program had no significant effect on the duration until sustainable RTW and QALYs gained. Intervention costs and medical costs were significantly higher in the intervention group. From the societal perspective, the maximum probability of cost-effectiveness for duration until sustainable RTW was 0.64 at a willingness to pay of about €10 000/day, and 0.27 for QALYs gained, regardless of the willingness to pay. From the social insurer's perspective, the probability of financial return was 0.18. CONCLUSIONS From the societal perspective, the new program was neither cost-effective in improving sustainable RTW nor in gaining QALYs. From the social insurer's perspective, the program did not result in a positive financial return. Therefore, the present study provided no evidence to support its implementation. TRIAL REGISTRATION The trial was listed at the Dutch Trial Register (NTR) under NTR3563 on August 7, 2012.
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Affiliation(s)
- Lieke Lammerts
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, NL-1081 BT The Netherlands
- Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Johanna M. van Dongen
- Department of Health Sciences, EMGO+ Institute for Health and Care Research, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frederieke G. Schaafsma
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, NL-1081 BT The Netherlands
- Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
| | - Willem van Mechelen
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, NL-1081 BT The Netherlands
| | - Johannes R. Anema
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, NL-1081 BT The Netherlands
- Research Center for Insurance Medicine AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands
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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.
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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
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Rowen D, Dixon S, Hernández-Alava M, Mukuria C. Estimating informal care inputs associated with EQ-5D for use in economic evaluation. Eur J Health Econ 2016; 17:733-744. [PMID: 26276521 DOI: 10.1007/s10198-015-0718-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 07/22/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES This paper estimates informal care need using the health of the patient. The results can be used to predict changes in informal care associated with changes in the health of the patient measured using EQ-5D. METHODS Data was used from a prospective survey of inpatients containing 59,512 complete responses across 44,494 individuals. The number of days a friend or relative has needed to provide care or help with normal activities in the last 6 weeks was estimated using the health of the patient measured by EQ-5D, ICD chapter and other health and sociodemographic data. A variety of different regression models were estimated that are appropriate for the distribution of the informal care dependent variable, which has large spikes at 0 (zero informal care) and 42 days (informal care every day). RESULTS The preferred model that most accurately predicts the distribution of the data is the zero-inflated negative binomial with variable inflation. The results indicate that improving the health of the patient reduces informal care need. The relationship between ICD chapter and informal care need is not as clear. CONCLUSIONS The preferred zero-inflated negative binomial with variable inflation model can be used to predict changes in informal care associated with changes in the health of the patient measured using EQ-5D and these results can be applied to existing datasets to inform economic evaluation. Limitations include recall bias and response bias of the informal care data, and restrictions of the dataset to exclude some patient groups.
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Affiliation(s)
- Donna Rowen
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Simon Dixon
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Mónica Hernández-Alava
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Clara Mukuria
- Health Economics and Decision Science, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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Ngalesoni FN, Ruhago GM, Mori AT, Robberstad B, Norheim OF. Cost-effectiveness of medical primary prevention strategies to reduce absolute risk of cardiovascular disease in Tanzania: a Markov modelling study. BMC Health Serv Res 2016; 16:185. [PMID: 27184802 PMCID: PMC4869389 DOI: 10.1186/s12913-016-1409-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 03/28/2015] [Accepted: 04/18/2016] [Indexed: 11/27/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a growing cause of mortality and morbidity in Tanzania, but contextualized evidence on cost-effective medical strategies to prevent it is scarce. We aim to perform a cost-effectiveness analysis of medical interventions for primary prevention of CVD using the World Health Organization’s (WHO) absolute risk approach for four risk levels. Methods The cost-effectiveness analysis was performed from a societal perspective using two Markov decision models: CVD risk without diabetes and CVD risk with diabetes. Primary provider and patient costs were estimated using the ingredients approach and step-down methodologies. Epidemiological data and efficacy inputs were derived from systematic reviews and meta-analyses. We used disability- adjusted life years (DALYs) averted as the outcome measure. Sensitivity analyses were conducted to evaluate the robustness of the model results. Results For CVD low-risk patients without diabetes, medical management is not cost-effective unless willingness to pay (WTP) is higher than US$1327 per DALY averted. For moderate-risk patients, WTP must exceed US$164 per DALY before a combination of angiotensin converting enzyme inhibitor (ACEI) and diuretic (Diu) becomes cost-effective, while for high-risk and very high-risk patients the thresholds are US$349 (ACEI, calcium channel blocker (CCB) and Diu) and US$498 per DALY (ACEI, CCB, Diu and Aspirin (ASA)) respectively. For patients with CVD risk with diabetes, a combination of sulfonylureas (Sulf), ACEI and CCB for low and moderate risk (incremental cost-effectiveness ratio (ICER) US$608 and US$115 per DALY respectively), is the most cost-effective, while adding biguanide (Big) to this combination yielded the most favourable ICERs of US$309 and US$350 per DALY for high and very high risk respectively. For the latter, ASA is also part of the combination. Conclusions Medical preventive cardiology is very cost-effective for all risk levels except low CVD risk. Budget impact analyses and distributional concerns should be considered further to assess governments’ ability and to whom these benefits will accrue.
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Affiliation(s)
- Frida N Ngalesoni
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania. .,Department of Global Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, Post box 7804, NO-5020, Bergen, Norway.
| | - George M Ruhago
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Global Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, Post box 7804, NO-5020, Bergen, Norway
| | - Amani T Mori
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Centre of International Health, University of Bergen, Bergen, Norway
| | - Bjarne Robberstad
- Centre of International Health, University of Bergen, Bergen, Norway
| | - Ole F Norheim
- Department of Global Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, Post box 7804, NO-5020, Bergen, Norway
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Abstract
OBJECTIVES The aim of this study was to explore whether wealth effects of health interventions, including productivity gains and savings in other sectors, are considered in resource allocations by health technology assessment (HTA) agencies and government departments. To analyze reasons for including, or not including, wealth effects. METHODS Semi-structured interviews with decision makers and academic experts in eight countries (Australia, France, Germany, Italy, Poland, South Korea, Sweden, and the United Kingdom). RESULTS There is evidence suggesting that health interventions can produce economic gains for patients and national economies. However, we found that the link between health and wealth does not influence decision making in any country with the exception of Sweden. This is due to a combination of factors, including system fragmentation, methodological issues, and the economic recession forcing national governments to focus on short-term measures. CONCLUSIONS In countries with established HTA processes and methods allowing, in principle, the inclusion of wider effects in exceptional cases or secondary analyses, it might be possible to overcome the methodological and practical barriers and see a more systematic consideration of wealth effect in decision making. This would be consistent with principles of efficient priority setting. Barriers for the consideration of wealth effects in government decision making are more fundamental, due to an enduring separation of budgets within the public sector and current financial pressures. However, governments should consider all relevant effects from public investments, including healthcare, even when benefits can only be captured in the medium- and long-term. This will ensure that resources are allocated where they bring the best returns.
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Affiliation(s)
| | | | - Priya Sharma
- United States Agency for International Development
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Abraldes MJ, Pareja A, Roura M. Analysis of costs associated with the management and morbidity of diabetic macular oedema and macular oedema secondary to retinal vein occlusion. ACTA ACUST UNITED AC 2016; 91:273-80. [PMID: 26810908 DOI: 10.1016/j.oftal.2015.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 08/14/2015] [Revised: 11/20/2015] [Accepted: 11/28/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To analyse the disease burden in patients with diabetic macular oedema (DMO) or with retinal vein occlusion macular oedema (RVOMO) from a societal perspective. METHODS Observational, cross-sectional, multicentre study conducted on patients >18 years old diagnosed with uni- or bilateral DMO or unilateral RVOMO. Data on the use of health resources from diagnosis was collected, and the impact of disease on work life was assessed. Costs were annualised (euros, January 2014). Differences were contrasted using Chi-squared test (or Fisher Exact test), Mann Whitney-U test or Kruskal-Wallis test (Dunn contrast). RESULTS A total of 448 patients were included (DMO 255; RVOMO 193). There were significant differences in costs of diagnosis: RVOMO €1856, bilateral DMO €1661, and unilateral DMO €1401 (P<.001) and the aggregate medical costs: RVOMO €4639, bilateral DMO 6275€ and unilateral DMO 6269€ (P<.001). Cost by permanent time off work was higher in bilateral DMO €11712, than in unilateral DMO €4284€, and than in RVOMO €1052 (P<.05). Linear regression analysis showed that variables associated with direct health costs were: Diagnosis (bilateral DMO was associated with higher cost), as well as number of days in hospital, number of visits, time of observation, and number of days of time off work. CONCLUSIONS Patients with bilateral DMO are associated with a higher direct health cost, as well as a higher indirect cost by impact of the disease on work life.
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Affiliation(s)
- M J Abraldes
- Complexo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Santiago de Compostela, (La Coruña), España; Red Temática de Investigación Cooperativa en Salud (RETICS), Instituto de Salud Carlos III, Madrid, España.
| | - A Pareja
- Hospital Universitario de Canarias, Tenerife, España
| | - M Roura
- Novartis Farmacéutica, S. A. , Barcelona, España
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Abstract
OBJECTIVE To evaluate long-run cost-effectiveness in a Swedish setting for liraglutide compared with sulphonylureas (glimepiride) or sitagliptin, all as add-on to metformin for patients with type 2 diabetes insufficiently controlled with metformin in monotherapy. METHODS The IHE Cohort Model of Type 2 Diabetes was used to evaluate clinical and economic outcomes from a societal perspective. Model input data were obtained from two clinical trials, the Swedish National Diabetes Register and the literature. Cost data reflected year 2013 price level. The robustness of results was checked with one-way-sensitivity analysis and probability sensitivity analysis. RESULTS The cost per QALY gained for liraglutide (1.2 mg) compared to SU (glimepiride 4 mg), both as add-on to metformin, ranged from SEK 226,000 to SEK 255,000 in analyzed patient cohorts. The cost per QALY for liraglutide (1.2 mg) vs sitagliptin (100 mg) as second-line treatment was lower, ranging from SEK 149,000 to SEK 161,000. Costs of preventive treatment were driving costs, but there was also a cost offset from reduced costs of complications of ∼ 20%. Notable cost differences were found for nephropathy, stroke, and heart failure. The predicted life expectancy with liraglutide increased the cost of net consumption for liraglutide. LIMITATIONS The analysis was an ex-ante analysis using model input data from clinical trials which may not reflect effectiveness in real-world clinical practice in broader patient populations. This limitation was explored in the sensitivity analysis. The lack of specific data on loss of production due to diabetes complications implied that these costs may be under-estimated. CONCLUSIONS Treatment strategies with liraglutide 1.2 mg improved the expected quality-of-life and increased costs when compared to SU and to sitagliptin for second-line add-on treatments. The cost per QALY for liraglutide was in the range considered medium by Swedish authorities.
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Goorden M, Muntingh A, van Marwijk H, Spinhoven P, Adèr H, van Balkom A, van der Feltz-Cornelis C, Hakkaart-van Roijen L. Cost utility analysis of a collaborative stepped care intervention for panic and generalized anxiety disorders in primary care. J Psychosom Res 2014; 77:57-63. [PMID: 24913343 DOI: 10.1016/j.jpsychores.2014.04.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 02/17/2014] [Revised: 04/11/2014] [Accepted: 04/14/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Generalized anxiety and panic disorders are a burden on the society because they are costly and have a significant adverse effect on quality of life. The aim of this study was to evaluate the cost-utility of a collaborative stepped care intervention for panic disorder and generalized anxiety disorder in primary care compared to care as usual from a societal perspective. METHODS The design of the study was a two armed cluster randomized controlled trial. In total 43 primary care practices in the Netherlands participated in the study. Eventually, 180 patients were included (114 collaborative stepped care, 66 care as usual). Baseline measures and follow-up measures (3, 6, 9 and 12 months) were assessed using questionnaires. We applied the TiC-P, the SF-HQL and the EQ-5D respectively measuring health care utilization, production losses and health related quality of life. RESULTS The average annual direct medical costs in the collaborative stepped care group were 1854 Euro (95% C.I., 1726 to 1986) compared to €1503 (95% C.I., 1374 to 1664) in the care as usual group. The average quality of life years (QALYs) gained was 0.05 higher in the collaborative stepped care group, leading to an incremental cost effectiveness ratio (ICER) of 6965 Euro per QALY. Inclusion of the productivity costs, consequently reflecting the full societal costs, decreased the ratio even more. CONCLUSION The study showed that collaborative stepped care was a cost effective intervention for panic disorder and generalized anxiety disorder and was even dominant when a societal perspective was taken. TRIAL REGISTRATION trialregister.nl, Netherlands Trial Register NTR107.
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Affiliation(s)
- Maartje Goorden
- Institute for Medical Technology Assessment, Institute of Health Policy & Management, PO Box 1783, Rotterdam, The Netherlands.
| | - Anna Muntingh
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), PO Box 725, Utrecht, The Netherlands; Faculty of Social Sciences, Tranzo Department, Tilburg University, PO Box 90153, Tilburg, The Netherlands; Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Harm van Marwijk
- Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research (EMGO+), PO Box 7057, Amsterdam, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, PO Box 9555, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Centre, PO Box 9600, Leiden, The Netherlands
| | - Herman Adèr
- Johannes van Kessel Advising, Huizen, The Netherlands
| | - Anton van Balkom
- Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
| | - Christina van der Feltz-Cornelis
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), PO Box 725, Utrecht, The Netherlands; Clinical Centre for Body, Mind and Health, GGZ Breburg, Tilburg, The Netherlands; Faculty of Social Sciences, Tranzo Department, Tilburg University, PO Box 90153, Tilburg, The Netherlands
| | - Leona Hakkaart-van Roijen
- Institute for Medical Technology Assessment, Institute of Health Policy & Management, PO Box 1783, Rotterdam, The Netherlands
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Osiri M, Sattayasomboon Y. Prevalence and out-patient medical costs of comorbid conditions in patients with rheumatoid arthritis. Joint Bone Spine 2013; 80:608-12. [PMID: 23827409 DOI: 10.1016/j.jbspin.2013.01.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 09/27/2012] [Accepted: 01/24/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the prevalence, types, and out-patient direct medical costs of comorbid conditions in patients with RA in Thailand. METHODS Information of the patients with RA treated by rheumatologists with at least one disease modifying antirheumatic drugs (DMARDs), including demographic data, RA-related medication types and treatment costs, comorbidity-related medication types and treatment costs, and total direct medical costs, was captured from King Chulalongkorn Memorial Hospital databases. RESULTS The data from 684 patients with RA were included for analysis. The majority of the patients were prescribed combined DMARDs, while only 2.5% received biologics. Comorbid conditions were reported in 434 patients (63.5%). The most common comorbid condition was hypertension (51.2%). Advanced age and presence of healthcare coverage was associated with comorbid conditions. The average annual cost of non-RA-related treatments in patients with comorbid diseases was 15 times the cost in those without comorbidities (1546 vs. 104 USD; P < 0.001) while the total direct medical cost in patients with comorbid conditions was twice that in patients without comorbid diseases (4118 vs. 2045 USD; P < 0.001). Parameters that influenced total direct medical costs were RA medications costs, comorbidity, healthcare coverage, patient's age, and types of DMARDs. CONCLUSIONS Comorbid conditions were common in this study. However, the major cost component incurred in RA patients was the costs of RA medications and services, while the out-patient costs of comorbid conditions accounted for approximately 38% of the total costs.
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Affiliation(s)
- Manathip Osiri
- Division of Rheumatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, 1873, Rama IV Road, Pathumwan, 10330 Bangkok, Thailand.
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Abstract
Data from European countries participating in the Generations and Gender Surveys showed that mean loneliness scores of older adults are higher in Eastern than in Western European countries. Although co-residence is considered as one of the fundamental types of social integration, and although co-residence is more common in Eastern Europe, the mean loneliness scores of older co-resident adults in Eastern Europe are still very high. This article investigates mechanisms behind the puzzling between-country differences in social integration and loneliness. Firstly, the theoretical framework of loneliness is discussed starting from the individual's perspective using the deficit and the cognitive discrepancy approach and taking into account older adults' deprived living conditions. Secondly, mechanisms at the societal level are investigated: cultural norms, the demographical composition and differences in societal wealth and welfare. It is argued that an integrated theoretical model, as developed in this article, combining individual and societal level elements, is most relevant for understanding the puzzling reality around social integration and loneliness in country-comparative research. An illustration of the interplay of individual and societal factors in the emergence of loneliness is presented.
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Affiliation(s)
- Jenny de Jong Gierveld
- Netherlands Interdisciplinary Demographic Institute (NIDI), The Hague, The Netherlands
- Faculty of Social Sciences, VU University, Amsterdam, The Netherlands
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