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Jülicher P, Makarova N, Ojeda F, Giusepi I, Peters A, Thorand B, Cesana G, Jørgensen T, Linneberg A, Salomaa V, Iacoviello L, Costanzo S, Söderberg S, Kee F, Giampaoli S, Palmieri L, Donfrancesco C, Zeller T, Kuulasmaa K, Tuovinen T, Lamrock F, Conrads-Frank A, Brambilla P, Blankenberg S, Siebert U. Cost-effectiveness of applying high-sensitivity troponin I to a score for cardiovascular risk prediction in asymptomatic population. PLoS One 2024; 19:e0307468. [PMID: 39028718 PMCID: PMC11259308 DOI: 10.1371/journal.pone.0307468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 07/05/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION Risk stratification scores such as the European Systematic COronary Risk Evaluation (SCORE) are used to guide individuals on cardiovascular disease (CVD) prevention. Adding high-sensitivity troponin I (hsTnI) to such risk scores has the potential to improve accuracy of CVD prediction. We investigated how applying hsTnI in addition to SCORE may impact management, outcome, and cost-effectiveness. METHODS Characteristics of 72,190 apparently healthy individuals from the Biomarker for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project were included into a discrete-event simulation comparing two strategies for assessing CVD risk. The standard strategy reflecting current practice employed SCORE (SCORE); the alternative strategy involved adding hsTnI information for further stratifying SCORE risk categories (S-SCORE). Individuals were followed over ten years from baseline examination to CVD event, death or end of follow-up. The model tracked the occurrence of events and calculated direct costs of screening, prevention, and treatment from a European health system perspective. Cost-effectiveness was expressed as incremental cost-effectiveness ratio (ICER) in € per quality-adjusted life year (QALYs) gained during 10 years of follow-up. Outputs were validated against observed rates, and results were tested in deterministic and probabilistic sensitivity analyses. RESULTS S-SCORE yielded a change in management for 10.0% of individuals, and a reduction in CVD events (4.85% vs. 5.38%, p<0.001) and mortality (6.80% vs. 7.04%, p<0.001). S-SCORE led to 23 (95%CI: 20-26) additional event-free years and 7 (95%CI: 5-9) additional QALYs per 1,000 subjects screened, and resulted in a relative risk reduction for CVD of 9.9% (95%CI: 7.3-13.5%) with a number needed to screen to prevent one event of 183 (95%CI: 172 to 203). S-SCORE increased costs per subject by 187€ (95%CI: 177 € to 196 €), leading to an ICER of 27,440€/QALY gained. Sensitivity analysis was performed with eligibility for treatment being the most sensitive. CONCLUSION Adding a person's hsTnI value to SCORE can impact clinical decision making and eventually improves QALYs and is cost-effective compared to CVD prevention strategies using SCORE alone. Stratifying SCORE risk classes for hsTnI would likely offer cost-effective alternatives, particularly when targeting higher risk groups.
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Affiliation(s)
- Paul Jülicher
- Medical Affairs, Core Diagnostics, Abbott, Abbott Park, IL, United States of America
| | - Nataliya Makarova
- Midwifery Science—Health Care Research and Prevention, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Isabella Giusepi
- Medical Affairs, Core Diagnostics, Abbott, Abbott Park, IL, United States of America
| | - Annette Peters
- Institute of Epidemiology, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, München, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, Faculty of Medicine, Ludwig-Maximilians-Universität in Munich, Munich, Germany
| | - Barbara Thorand
- Institute of Epidemiology, German Research Center for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, Faculty of Medicine, Ludwig-Maximilians-Universität in Munich, Munich, Germany
| | - Giancarlo Cesana
- Centro Studi Sanità Pubblica, Università Milano Bicocca, Milan, Italy
| | - Torben Jørgensen
- Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Allan Linneberg
- Center for Clinical Research and Prevention, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
- Department of Medicine and Surgery, LUM University “Giuseppe Degennaro”, Casamassima, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS Neuromed, Pozzilli, Italy
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Frank Kee
- Centre for Public Health, Queen’s University of Belfast, Belfast, Northern Ireland
| | - Simona Giampaoli
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Luigi Palmieri
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Chiara Donfrancesco
- Department of Cardiovascular, Endocrine-metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Tanja Zeller
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Kari Kuulasmaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tarja Tuovinen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Felicity Lamrock
- Mathematical Science Research Centre, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Annette Conrads-Frank
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL—University for Health Sciences and Technology, Hall in Tirol, Austria
| | - Paolo Brambilla
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Stefan Blankenberg
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT TIROL—University for Health Sciences and Technology, Hall in Tirol, Austria
- Center for Health Decision Science, Depts. of Epidemiology and Health Policy & Management, Harvard Chan School of Public Health, Boston, MA, United States of America
- Program on Cardiovascular Research, Institute for Technology Assessment and Dept. of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
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Ochenduszko S, Puskulluoglu M, Pacholczak-Madej R, Ruiz-Millo O. Adjuvant anti-PD1 immunotherapy of resected skin melanoma: an example of non-personalized medicine with no overall survival benefit. Crit Rev Oncol Hematol 2024; 202:104443. [PMID: 39025250 DOI: 10.1016/j.critrevonc.2024.104443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/02/2024] [Accepted: 07/06/2024] [Indexed: 07/20/2024] Open
Abstract
Randomized clinical trials demonstrated a recurrence-free survival benefit with adjuvant anti-programmed death-1 (anti-PD1) inhibitors of resected stage IIB-IV melanoma. However, no improvement in overall survival has been observed thus far. Furthermore, there are no predictive markers for immunotherapy response in melanoma, therefore adjuvant treatment is offered to all comers based exclusively on the pathological and clinical stages. Additionally, one year of treatment duration and the risk of chronic immune-related adverse effects may negatively impact patients´ quality of life. In this review, we will try to answer whether the currently available data on adjuvant anti-PD1 therapy of stage IIB-IV resected melanoma is sufficient to make this strategy available to all patients. We will also discuss the economic impact of this therapy on healthcare system budgets. Recent studies suggest that the high cost of cancer drugs may affect access to these agents globally by raising questions of sustainability for patients and society.
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Affiliation(s)
| | - Miroslawa Puskulluoglu
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, Krakow, Poland
| | - Renata Pacholczak-Madej
- Department of Gynaecological Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, Krakow, Poland; Department of Anatomy, Jagiellonian University, Medical College, Krakow, Poland
| | - Oreto Ruiz-Millo
- Department of Pharmacy, Dr. Peset University Hospital, Valencia, Spain
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3
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Kerba M, Lourenco RDA, Sahgal A, Cardet RDF, Siva S, Ding K, Myrehaug SD, Masucci GL, Brundage M, Parulekar WR. An Economic Analysis of SC24 in Canada: A Randomized Study of SBRT Compared With Conventional Palliative RT for Spinal Metastases. Int J Radiat Oncol Biol Phys 2024; 119:1061-1068. [PMID: 38218455 DOI: 10.1016/j.ijrobp.2023.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/19/2023] [Accepted: 12/31/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE The Canadian Cancer Trials Group (CCTG) Symptom Control 24 protocol (SC.24) was a multicenter randomized controlled phase 2/3 trial conducted in Canada and Australia. Patients with painful spinal metastases were randomized to either 24 Gy/2 stereotactic body radiation therapy (SBRT) or 20 Gy/5 conventional external beam radiation therapy (CRT). The study met its primary endpoint and demonstrated superior complete pain response rates at 3 months following SBRT (35%) versus CRT (14%). SBRT planning and delivery is resource intensive. Given its benefits in SC.24, we performed an economic analysis to determine the incremental cost-effectiveness of SBRT compared with CRT. METHODS AND MATERIALS The trial recruited 229 patients. Cost-effectiveness was assessed using a Markov model taking into account observed survival, treatments costs, retreatment, and quality of life over the lifetime of the patient. The EORTC-QLU-C10D was used to determine quality of life values. Transition probabilities for outcomes were from available patient data. Health system costs were from the Canadian health care perspective and were based on 2021 Canadian dollars (CAD). The incremental cost-effectiveness ratio (ICER) was expressed as the ratio of incremental cost to quality-adjusted life years (QALY). The impact of parameter uncertainty was investigated using deterministic and probabilistic sensitivity analyses. RESULTS The base case for SBRT compared with CRT had an ICER of $9,040CAD per QALY gained. Sensitivity analyses demonstrated that the ICER was most sensitive to variations in the utility assigned to "No local failure" ($5,457CAD to $241,051CAD per QALY), adopting low and high estimates of utility and the cost of the SBRT (ICERs ranging from $7345-$123,361CAD per QALY). It was more robust to variations in assumptions around survival and response rate. CONCLUSIONS SBRT is associated with higher upfront costs than CRT. The ICER shows that, within the Canadian health care system, SBRT with 2 fractions is likely to be more cost-effective than CRT.
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Affiliation(s)
- Marc Kerba
- Department of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada.
| | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rafael De Feria Cardet
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Victoria, Australia
| | - Keyue Ding
- Canadian Clinical Trials Group, Queen's University, Kingston, Ontario, Canada.
| | - Sten D Myrehaug
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Giuseppina L Masucci
- Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Michael Brundage
- Department of Cancer Care and Epidemiology, Queens's University, Kingston, Ontario, Canada
| | - Wendy R Parulekar
- Canadian Clinical Trials Group, Queen's University, Kingston, Ontario, Canada
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Espinosa O, Rodríguez-Lesmes P, Romano G, Orozco E, Basto S, Ávila D, Mesa L, Enríquez H. Use of Cost-Effectiveness Thresholds in Healthcare Public Policy: Progress and Challenges. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024:10.1007/s40258-024-00900-5. [PMID: 38995492 DOI: 10.1007/s40258-024-00900-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/13/2024]
Abstract
The article offers a comparative analysis of the influence of cost-effectiveness thresholds in the decision-making processes in financing policies, coverage, and price regulation of health technologies in nine countries. We investigated whether countries used cost-effectiveness thresholds for public health policy decision making and found that few countries have adopted the cost-effectiveness threshold as an official criterion for financing, reimbursement, or pricing. However, in countries where it is applied, such as Thailand, the results have been very favorable in terms of minimizing health technology prices and ensuring the financial sustainability of the health system. Although the cost-effectiveness threshold has opportunities for improvement, particularly in certain institutional contexts and with adequate participation of the different strategic actors in the formulation of public policy, its potential use and added value are significant in various aspects.
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Affiliation(s)
- Oscar Espinosa
- Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia and Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, DC, Colombia
| | | | - Giancarlo Romano
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, DC, Colombia
| | - Esteban Orozco
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, DC, Colombia
- School of Economics, Universidad de Antioquia, Bogotá, DC, Colombia
| | - Sergio Basto
- Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, DC, Colombia
| | - Diego Ávila
- Economic Models and Quantitative Methods Research Group, Centro de Investigaciones para el Desarrollo, Universidad Nacional de Colombia and Directorate of Analytical, Economic and Actuarial Studies in Health, Instituto de Evaluación Tecnológica en Salud (IETS), Bogotá, DC, Colombia
| | - Lorena Mesa
- Directorate of Qualitative Methods and Social Research, Instituto de Evaluación Tecnológica en Salud (IETS), Duitama, Colombia
| | - Hernán Enríquez
- School of Economics, Universidad del Rosario, Bogotá, DC, Colombia
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Fasseeh AN, Korra N, Elezbawy B, Sedrak AS, Gamal M, Eldessouki R, Eldebeiky M, George M, Seyam A, Abourawash A, Khalifa AY, Shaheen M, Abaza S, Kaló Z. Framework for developing cost-effectiveness analysis threshold: the case of Egypt. J Egypt Public Health Assoc 2024; 99:12. [PMID: 38825614 PMCID: PMC11144683 DOI: 10.1186/s42506-024-00159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/01/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Cost-effectiveness analyses rarely offer useful insights to policy decisions unless their results are compared against a benchmark threshold. The cost-effectiveness threshold (CET) represents the maximum acceptable monetary value for achieving a unit of health gain. This study aimed to identify CET values on a global scale, provide an overview of using multiple CETs, and propose a country-specific CET framework specifically tailored for Egypt. The proposed framework aims to consider the globally identified CETs, analyze global trends, and consider the local structure of Egypt's healthcare system. METHODS We conducted a literature review to identify CET values, with a particular focus on understanding the basis of differentiation when multiple thresholds are present. CETs of different countries were reviewed from secondary sources. Additionally, we assembled an expert panel to develop a national CET framework in Egypt and propose an initial design. This was followed by a multistakeholder workshop, bringing together representatives of different governmental bodies to vote on the threshold value and finalize the recommended framework. RESULTS The average CET, expressed as a percentage of the gross domestic product (GDP) per capita across all countries, was 135%, with a range of 21 to 300%. Interestingly, while the absolute value of CET increased with a country's income level, the average CET/GDP per capita showed an inverse relationship. Some countries applied multiple thresholds based on disease severity or rarity. In the case of Egypt, the consensus workshop recommended a threshold ranging from one to three times the GDP per capita, taking into account the incremental relative quality-adjusted life years (QALY) gain. For orphan medicines, a CET multiplier between 1.5 and 3.0, based on the disease rarity, was recommended. A two-times multiplier was proposed for the private reimbursement threshold compared to the public threshold. CONCLUSION The CET values in most countries appear to be closely related to the GDP per capita. Higher-income countries tend to use a lower threshold as a percentage of their GDP per capita, contrasted with lower-income countries. In Egypt, experts opted for a multiple CET framework to assess the value of health technologies in terms of reimbursement and pricing.
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Affiliation(s)
- Ahmad N Fasseeh
- Faculty of Pharmacy Alexandria University, Alexandria, Egypt
- Syreon Middle East, Alexandria, Egypt
| | | | | | - Amal S Sedrak
- Department of Public Health, Cairo University, Cairo, Egypt
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Mary Gamal
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | - Randa Eldessouki
- Department of Community Health, Fayoum University, Fayoum, Egypt
| | - Mariam Eldebeiky
- Egyptian Authority for Unified Procurement, Medical Supply and Technology Management, Cairo, Egypt
| | | | - Ahmed Seyam
- Universal Health Insurance Authority, Cairo, Egypt
| | | | - Ahmed Y Khalifa
- World Health Organization Representative Office, Cairo, Egypt
| | | | | | - Zoltán Kaló
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
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Thema M, Beretzky Z, Brodszky V. Monetary valuation of one year in full capability and health based on demographics, health status, income and well-being. Expert Rev Pharmacoecon Outcomes Res 2024; 24:679-686. [PMID: 38656228 DOI: 10.1080/14737167.2024.2347647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Budget constraints in health-care systems have led to the popularity of Cost Effectiveness Thresholds (CET) to achieve efficient allocation of resources. The capability approach has been hailed for its potentially richer evaluative capabilities compared to the QALY in terms of thresholds. Extensive research, however, is still limited. RESEARCH DESIGN AND METHODS This study estimated the monetary value of a year in full capability (YFC) and compared it to monetary value of a QALY for the Hungarian population. Data was collected from a large, cross sectional, representative online survey on the adult Hungarian population. Applying the wellbeing valuation method, health, capability, and income were then regressed against wellbeing to estimate 'shadow prices' for one QALY and YFC controlling for gender, age, employment, education, marital and social support. To examine 'core' regression coefficients, a robustness check was conducted. RESULTS Health (VAS) and capability (ICECAP-A) had a positive and significant effect on Subjective Well-Being. The monetary values of one QALY and one YFC were 39 459 EUR and 58 148 EUR respectively. CONCLUSIONS These tools provide a systematic approach to determining 'compensating income' for certain illnesses, disabilities and levels of pain. The capability approach shown to be broader than the QALY.
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Affiliation(s)
- Mabore Thema
- Doctoral School of Business and Management, Corvinus University of Budapest, Budapest, Hungary
| | - Zsuzsanna Beretzky
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
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Boespflug N, Wittwer J, Bénard A. Factors associated with the author-reported cost-effectiveness threshold in high-income countries: systematic review and multivariable modelling. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:631-639. [PMID: 37433889 DOI: 10.1007/s10198-023-01613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE The cost-effectiveness threshold (CET) is a key parameter to guide objective reimbursement decisions, yet very few countries have defined a reference CET, and there is no reference method for defining it. Our objective was to determine the factors explaining the author-reported CETs in the literature. METHODS Our systematic review targeted original articles referenced in EMBASE and published between 2010 and 2021. Selected studies had to use Quality-Adjusted Life-Year (QALY), and being conducted in high-income countries. Our explanatory variables were: estimated cost-effectiveness ratio (ICER), region of the world, source of funding, type of intervention, disease, year of publication, justification of the author-reported Cost-Effectiveness Threshold (ar-CET), economic perspective, and declaration of interest. Multivariable linear regression models implemented on R software were used, guided by a Directed Acyclic Graph. RESULTS Two hundred and fifty four studies were included. The mean ar-CET was €63,338/QALY (standard deviation (SD) 34,965) overall, and €37,748/QALY (SD 20,750) in studies conducted in the British Commonwealth. The ar-CET increased slightly with the ICER (+ 66€/QALY for each additional 10,000€/QALY in the ICER, 95% confidence interval (IC) [31-102], p < 0.001), was higher in the United States (+ 36,225€/QALY; IC [25,582; 46,869]) and Europe (+ 10,352€/QALY; IC [72; 20,631]) compared to the British Commonwealth (p < 0.001), and was higher when the ar-CET was not defined a priori (+ 22,393€/QALY; [5809; 38,876]) compared to state recommendations defined ar-CET (p < 0.001). CONCLUSIONS Our results underline the virtuous role of state recommendations in the choice of a low and homogeneous CET. We also highlight the need to integrate the a priori justification of the CET into good publishing guidelines.
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Affiliation(s)
- Nicolas Boespflug
- CHU Bordeaux, Service d'information Médicale, USMR & CIC-EC 1401, 33000, Bordeaux, France
| | - Jérôme Wittwer
- INSERM, Bordeaux Population Health, UMR 1219, 33000, Bordeaux, France
| | - Antoine Bénard
- CHU Bordeaux, Service d'information Médicale, USMR & CIC-EC 1401, 33000, Bordeaux, France.
- INSERM, Bordeaux Population Health, UMR 1219, 33000, Bordeaux, France.
- Université de Bordeaux, Case 75, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France.
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Vancoppenolle JM, Franzen N, Koole SN, Retèl VP, van Harten WH. Differences in time to patient access to innovative cancer medicines in six European countries. Int J Cancer 2024; 154:886-894. [PMID: 37864395 DOI: 10.1002/ijc.34753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 10/22/2023]
Abstract
Patients across Europe face inequity regarding access to anticancer medicines. While access is typically evaluated through reimbursement status or sales data, patients can receive first access through early access programs (EAPs) or off-label use. This study aims to assess the time to patient access at the hospital level, considering different indications and countries. (Pre-)registered access to six innovative medicines (Olaparib, Niraparib, Ipilimumab, Osimeritinib, Nivolumab and Ibritunib) was measured using a cross-sectional survey. First patient access to medicines and indications were collected using the hospital databases. Nineteen hospitals from Hungary, Italy, the Netherlands, Belgium, Switzerland and France participated. Analysis showed that some hospitals achieved patient access before national reimbursement, primarily through EAPs. The average time from EMA-approval to patient access for these medicines was 2.1 years (Range: -0.9-7.1 years). Hospitals in Italy and France had faster access compared to Hungary and Belgium. Variation was also found within countries, with specialized hospitals (x̄: -0.9 years; SD: 2.0) more likely to provide patient access prior to national reimbursement than general hospitals (x̄: 0.4 years; SD: 2.9). Contextual differences were observed, with EAPs or off-label use being more prevalent in Switzerland than Hungary. Recent EMA-approved indications and drug combinations reached patients at a later stage. Substantial variation in patient access time was observed between and within countries. Improving pricing and reimbursement timelines, fostering collaboration between national health authorities and market authorization holders, and implementing nationally harmonized, data-generating EAPs can enhance timely and equitable patient access to innovative cancer treatments in Europe.
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Affiliation(s)
- Julie M Vancoppenolle
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department Health Technology and Services Research Technical Medical Centre, University of Twente, Enschede, The Netherlands
- The European Fair Pricing Network, Amsterdam, The Netherlands
| | - Nora Franzen
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department Health Technology and Services Research Technical Medical Centre, University of Twente, Enschede, The Netherlands
- The European Fair Pricing Network, Amsterdam, The Netherlands
| | - Simone N Koole
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Valesca P Retèl
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Erasmus School of Health Policy & Management Health Technology Assessment (HTA), Erasmus University Rotterdam, The Netherlands
| | - Wim H van Harten
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department Health Technology and Services Research Technical Medical Centre, University of Twente, Enschede, The Netherlands
- The European Fair Pricing Network, Amsterdam, The Netherlands
- Organization of European Cancer Institutes (OECI), Brussels, Belgium
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Nu Vu A, Hoang MV, Lindholm L, Sahlen KG, Nguyen CTT, Sun S. A systematic review on the direct approach to elicit the demand-side cost-effectiveness threshold: Implications for low- and middle-income countries. PLoS One 2024; 19:e0297450. [PMID: 38329955 PMCID: PMC10852300 DOI: 10.1371/journal.pone.0297450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Several literature review studies have been conducted on cost-effectiveness threshold values. However, only a few are systematic literature reviews, and most did not investigate the different methods, especially in-depth reviews of directly eliciting WTP per QALY. Our study aimed to 1) describe the different direct approach methods to elicit WTP/QALY; 2) investigate factors that contribute the most to the level of WTP/QALY value; and 3) investigate the relation between the value of WTP/QALY and GDP per capita and give some recommendations on feasible methods for eliciting WTP/QALY in low- and middle-income countries (LMICs). A systematic review concerning select studies estimating WTP/QALY from a direct approach was carried out in seven databases, with a cut off date of 03/2022. The conversion of monetary values into 2021 international dollars (i$) was performed via CPI and PPP indexes. The influential factors were evaluated with Bayesian model averaging. Criteria for recommendation for feasible methods in LMICs are made based on empirical evidence from the systematic review and given the resource limitation in LMICs. A total of 12,196 records were identified; 64 articles were included for full-text review. The WTP/QALY method and values varied widely across countries with a median WTP/QALY value of i$16,647.6 and WTP/QALY per GDP per capita of 0.53. A total of 11 factors were most influential, in which the discrete-choice experiment method had a posterior probability of 100%. Methods for deriving WTP/QALY vary largely across studies. Eleven influential factors contribute most to the level of values of WTP/QALY, in which the discrete-choice experiment method was the greatest affected. We also found that in most countries, values for WTP/QALY were below 1 x GDP per capita. Some important principles are addressed related to what LMICs may be concerned with when conducting studies to estimate WTP/QALY.
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Affiliation(s)
- Anh Nu Vu
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Minh Van Hoang
- Department of Health Economics, Hanoi University of Public Health, Hanoi City, Vietnam
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Klas Göran Sahlen
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Cuc Thi Thu Nguyen
- Department of Pharmaceutical Management and Economics, Faculty of Pharmaceutical Management and Economics, Hanoi University of Pharmacy, Hanoi City, Vietnam
| | - Sun Sun
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
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Drake T, Chi YL, Morton A, Pitt C. Why cost-effectiveness thresholds for global health donors should differ from thresholds for Ministries of Health (and why it matters). F1000Res 2024; 12:214. [PMID: 38434665 PMCID: PMC10905028 DOI: 10.12688/f1000research.131230.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 03/05/2024] Open
Abstract
Healthcare cost-effectiveness analysis is increasingly used to inform priority-setting in low- and middle-income countries and by global health donors. As part of such analyses, cost-effectiveness thresholds are commonly used to determine what is, or is not, cost-effective. Recent years have seen a shift in best practice from a rule-of-thumb 1x or 3x per capita GDP threshold towards using thresholds that, in theory, reflect the opportunity cost of new investments within a given country. In this paper, we observe that international donors face both different resource constraints and opportunity costs compared to national decision-makers. Hence, their perspective on cost-effectiveness thresholds must be different. We discuss the potential implications of distinguishing between national and donor thresholds and outline broad options for how to approach setting a donor-perspective threshold. Further work is needed to clarify healthcare cost-effectiveness threshold theory in the context of international aid and to develop practical policy frameworks for implementation.
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Affiliation(s)
- Tom Drake
- Department of Global Health, Centre for Global Development, London, UK
| | - Y-Ling Chi
- Department of Global Health, Centre for Global Development, London, UK
| | - Alec Morton
- Strathclyde Business School, University of Strathclyde, Strathclyde, UK
| | - Catherine Pitt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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11
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Xu L, Chen M, Angell B, Jiang Y, Howard K, Jan S, Si L. Establishing cost-effectiveness threshold in China: a community survey of willingness to pay for a healthylife year. BMJ Glob Health 2024; 9:e013070. [PMID: 38195152 PMCID: PMC10806867 DOI: 10.1136/bmjgh-2023-013070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION The willingness to pay per quality-adjusted life year gained (WTP/Q) is commonly used to determine whether an intervention is cost-effective in health technology assessment. This study aimed to evaluate the WTP/Q for different disease scenarios in a Chinese population. METHODS The study employed a quadruple-bounded dichotomous choice contingent valuation method to estimate the WTP/Q in the general public. The estimation was conducted across chronic, terminal and rare disease scenarios. Face-to-face interviews were conducted in a Chinese general population recruited from Jiangsu province using a convenience sampling method. Interval regression analysis was performed to determine the relationship between respondents' demographic and socioeconomic conditions and WTP/Q. Sensitivity analyses of removing protest responses and open question analyses were conducted. RESULTS A total of 896 individuals participated in the study. The WTP/Q thresholds were 128 000 Chinese renminbi (RMB) ($36 364) for chronic diseases, 149 500 RMB ($42 472) for rare diseases and 140 800 RMB ($40 000) for terminal diseases, equivalent to 1.76, 2.06 and 1.94 times the gross domestic product per capita in China, respectively. The starting bid value had a positive influence on participants' WTP/Q. Additionally, residing in an urban area (p<0.01), and higher household expenditure (p<0.01), educational attainment (p<0.02) and quality of life (p<0.02) were significantly associated with higher WTP/Q. Sensitivity analyses demonstrated the robustness of the results. CONCLUSION This study implies that tailored or varied rather than a single cost-effectiveness threshold could better reflect community preferences for the value of a healthy year. Our estimates hold significance in informing reimbursement decision-making in health technology assessment in China.
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Affiliation(s)
- Lizheng Xu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Blake Angell
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yawen Jiang
- Sun Yat-Sen University School of Public Health Shenzhen, Shenzhen, Guangdong, China
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Stephen Jan
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lei Si
- School of Health Science, Western Sydney University, Penrith South, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith South, New South Wales, Australia
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12
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Tshomba AO, Mukadi-Bamuleka D, De Weggheleire A, Tshiani OM, Kayembe CT, Mbala-Kingebeni P, Muyembe-Tamfum JJ, Ahuka-Mundeke S, Chenge FM, Jacobs BKM, Mumba DN, Tshala-Katumbay DD, Mulangu S. Cost-effectiveness of incorporating Ebola prediction score tools and rapid diagnostic tests into a screening algorithm: A decision analytic model. PLoS One 2023; 18:e0293077. [PMID: 37847703 PMCID: PMC10581462 DOI: 10.1371/journal.pone.0293077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND No distinctive clinical signs of Ebola virus disease (EVD) have prompted the development of rapid screening tools or called for a new approach to screening suspected Ebola cases. New screening approaches require evidence of clinical benefit and economic efficiency. As of now, no evidence or defined algorithm exists. OBJECTIVE To evaluate, from a healthcare perspective, the efficiency of incorporating Ebola prediction scores and rapid diagnostic tests into the EVD screening algorithm during an outbreak. METHODS We collected data on rapid diagnostic tests (RDTs) and prediction scores' accuracy measurements, e.g., sensitivity and specificity, and the cost of case management and RDT screening in EVD suspect cases. The overall cost of healthcare services (PPE, procedure time, and standard-of-care (SOC) costs) per suspected patient and diagnostic confirmation of EVD were calculated. We also collected the EVD prevalence among suspects from the literature. We created an analytical decision model to assess the efficiency of eight screening strategies: 1) Screening suspect cases with the WHO case definition for Ebola suspects, 2) Screening suspect cases with the ECPS at -3 points of cut-off, 3) Screening suspect cases with the ECPS as a joint test, 4) Screening suspect cases with the ECPS as a conditional test, 5) Screening suspect cases with the WHO case definition, then QuickNavi™-Ebola RDT, 6) Screening suspect cases with the ECPS at -3 points of cut-off and QuickNavi™-Ebola RDT, 7) Screening suspect cases with the ECPS as a conditional test and QuickNavi™-Ebola RDT, and 8) Screening suspect cases with the ECPS as a joint test and QuickNavi™-Ebola RDT. We performed a cost-effectiveness analysis to identify an algorithm that minimizes the cost per patient correctly classified. We performed a one-way and probabilistic sensitivity analysis to test the robustness of our findings. RESULTS Our analysis found dual ECPS as a conditional test with the QuickNavi™-Ebola RDT algorithm to be the most cost-effective screening algorithm for EVD, with an effectiveness of 0.86. The cost-effectiveness ratio was 106.7 USD per patient correctly classified. The following algorithms, the ECPS as a conditional test with an effectiveness of 0.80 and an efficiency of 111.5 USD per patient correctly classified and the ECPS as a joint test with the QuickNavi™-Ebola RDT algorithm with an effectiveness of 0.81 and a cost-effectiveness ratio of 131.5 USD per patient correctly classified. These findings were sensitive to variations in the prevalence of EVD in suspected population and the sensitivity of the QuickNavi™-Ebola RDT. CONCLUSIONS Findings from this study showed that prediction scores and RDT could improve Ebola screening. The use of the ECPS as a conditional test algorithm and the dual ECPS as a conditional test and then the QuickNavi™-Ebola RDT algorithm are the best screening choices because they are more efficient and lower the number of confirmation tests and overall care costs during an EBOV epidemic.
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Affiliation(s)
- Antoine Oloma Tshomba
- Department of Public Health, University of Kisangani, Kisangani, Democratic Republic of Congo (DRC)
- National Institute for Biomedical Research, Kinshasa, DRC
| | - Daniel Mukadi-Bamuleka
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | | | - Olivier M. Tshiani
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Charles T. Kayembe
- Department of Internal Medicine, University of Kisangani, Kisangani, DRC
| | - Placide Mbala-Kingebeni
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Jean-Jacques Muyembe-Tamfum
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Steve Ahuka-Mundeke
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
| | - Faustin M. Chenge
- Department of Public Health, University of Kisangani, Kisangani, Democratic Republic of Congo (DRC)
- School of Public Health, University of Lubumbashi, Lubumbashi, RDC
| | - Bart Karl M. Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dieudonné N. Mumba
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Tropical Medicine, University of Kinshasa, Kinshasa, DRC
| | - Désiré D. Tshala-Katumbay
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Neurology and School of Public Health, Oregon Health & Science University, Portland, Oregon, United States of America
- Department of Neurology, University of Kinshasa, Kinshasa, DRC
| | - Sabue Mulangu
- National Institute for Biomedical Research, Kinshasa, DRC
- Department of Medical Biology, University of Kinshasa, Kinshasa, DRC
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13
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Sun L, Peng X, Li S, Huang Z. Cost-effectiveness thresholds or decision-making threshold: a novel perspective. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:72. [PMID: 37789326 PMCID: PMC10548628 DOI: 10.1186/s12962-023-00472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/28/2023] [Indexed: 10/05/2023] Open
Abstract
The use of multiple cost-effectiveness thresholds in pharmacoeconomic evaluation is a hotly debated topic in the international academic community. This study analyzed and discussed thresholds in the context of pharmacoeconomic evaluation and reimbursement decision-making. We suggest that the thresholds inferred from reimbursement decisions should be distinguished from cost-effectiveness threshold in pharmacoeconomic evaluation. Pharmacoeconomic evaluations should adopt a fixed threshold, which should not vary with the subjects evaluated. This would help avoid the invitation of numerous cost-effectiveness thresholds for a specific drug, an exceptional disease, a type of innovation, or a certain level of malignancy, which misleads economic evaluation adopting restless changing standards and making pharmacoeconomic evaluation and decision-making more complex and contradictory.
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Affiliation(s)
- Lihua Sun
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, Liaoning, China.
| | - Xiaochen Peng
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
- Shanghai Health Development Research Center, Shanghai, 201199, China
| | - Shiqi Li
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
| | - Zhe Huang
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, Liaoning, China
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14
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Sanghvi R, Cant A, de Almeida Neves A, Hosey MT, Banerjee A, Pennington M. Should compromised first permanent molar teeth in children be routinely removed? A health economics analysis. Community Dent Oral Epidemiol 2023; 51:755-766. [PMID: 35638700 DOI: 10.1111/cdoe.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 02/14/2022] [Accepted: 04/24/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of retaining one or more compromised first permanent molars (cFPMs) affected by dental caries or enamel hypomineralization, compared to timely extraction, in children aged 8 years. METHODS A Markov model was developed to simulate the lifetime of a cFPM. Two management strategies were compared: extraction facilitating spontaneous space closure or maintenance of teeth with restorations. Ten health states were utilized to capture long-term outcomes including various tooth restorations, prostheses or a retained gap at the cFPM site. Outcomes were expressed as Quality Adjusted Tooth-Years (QATYs). The model was informed by survey data on patient preferences for treatment outcomes and UK data on costs. Discounted costs and QATYs were calculated over 62 years. RESULTS Regardless of the number of cFPMs, retaining cFPMs was more effective than early removal, generating an additional 2.3 QATYs per cFPM. Early removal of one or two cFPM under general anaesthetic (GA) was more expensive than retention and hence never cost-effective. Retaining a cFPM was more expensive than early removal under local anaesthesia or where four cFPMs were extracted under GA. In these cases, retaining cFPMs was cost-effective if a QATY was valued at £100 or £35, respectively. Results were robust to sensitivity analysis. CONCLUSION Preserving a cFPM was more cost-effective than the early loss of one, or two cFPMs under GA. Preservation of four cFPMs was cost-effective if sufficient value was placed on a QATY. These findings can guide clinical practice on management of cFPMs alongside patient/payer values on maintaining teeth.
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Affiliation(s)
- Risha Sanghvi
- Centre of Oral, Clinical and Translational Science, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Aisling Cant
- Centre of Oral, Clinical and Translational Science, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Aline de Almeida Neves
- Centre of Oral, Clinical and Translational Science, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marie Therese Hosey
- Centre of Oral, Clinical and Translational Science, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Avijit Banerjee
- Centre of Oral, Clinical and Translational Science, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark Pennington
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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15
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Lamy A, Eikelboom J, Tong W, Yuan F, Bangdiwala SI, Bosch J, Connolly S, Lonn E, Dagenais GR, Branch KRH, Wang WJ, Bhatt DL, Probstfield J, Ertl G, Störk S, Steg PG, Aboyans V, Durand-Zaleski I, Ryden L, Yusuf S. The cost-effectiveness of rivaroxaban with or without aspirin in the COMPASS trial. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:502-510. [PMID: 36001989 DOI: 10.1093/ehjqcco/qcac054] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 05/23/2023]
Abstract
AIMS The Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial demonstrated that rivaroxaban 2.5 mg BID with aspirin 100 mg was more effective than aspirin 100 mg daily alone for the prevention of cardiovascular (CV) death, stroke, or myocardial infarction in patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD). We aimed to examine the cost-effectiveness of rivaroxaban using patient-level data from the COMPASS trial. METHODS AND RESULTS We performed an in-trial analysis and extrapolated our results for 33 years using a two-state Markov model with a 1-year cycle length. Hospitalization events, procedures, and study drugs were documented for patients. We applied country-specific (Canada, France, and Germany) direct healthcare system costs (in USD) to healthcare resources consumed by patients. Average cost per patient during the trial (mean follow-up of 23 months), quality-adjusted life years (QALYs), and lifetime cost-effectiveness were calculated. Costs of events and procedures were reduced with rivaroxaban 2.5 mg BID with aspirin. The addition of rivaroxaban 2.5 mg BID increased total costs for the combination group. Over a lifetime horizon (in trial +33 years), rivaroxaban plus aspirin was associated with 1.17 QALYs gained, yielding an incremental cost-effectiveness ratio (ICER) of $3946/QALY, $9962/QALY, and $10 264/QALY in Canada, France, and Germany, respectively. PAD and polyvascular disease subgroups had lower ICERs. CONCLUSION Rivaroxaban 2.5 mg twice daily plus aspirin compared with aspirin alone reduces direct healthcare costs. After acquisition costs of rivaroxaban, the lifetime cost-effectiveness of 2.5 mg twice daily plus aspirin is highly cost-effective in Canada, France, and Germany.(COMPASS ClinicalTrials.gov identifier: NCT01776424).
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Affiliation(s)
- Andre Lamy
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- CADENCE Research Group, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - John Eikelboom
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Wesley Tong
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- CADENCE Research Group, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Fei Yuan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jackie Bosch
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stuart Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Eva Lonn
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec, Canada
| | | | - Wei-Jhih Wang
- Comparative Health Outcomes, Policy and Economics Institute, School of Pharmacy, University of Washington, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Jeff Probstfield
- Division of Cardiology, University of Washinton, Seattle, WA, USA
| | - Georg Ertl
- Department of Medicine I, University of Würzburg, WürzburgGermany
- Comprehensive Heart Failure Center, University Hospital, Würzburg, Germany
| | - Stefan Störk
- Department of Medicine I, University of Würzburg, WürzburgGermany
- Comprehensive Heart Failure Center, University Hospital, Würzburg, Germany
| | - P Gabriel Steg
- Department of Cardiology, Université Paris Diderot, Paris, France
- Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, and Inserm 1094 & IRD, NET, Limoges University, Limoges, France
| | - Isabelle Durand-Zaleski
- Assistance Publique Hôpitaux de Paris, URC Eco and Santé Publique, Hôpital Henri Mondor, Créteil, France
- Health Economics Research Unit, Université Paris Est Créteil, Créteil, France
- INSERM ECEVE UMR 1123, ParisFrance
| | - Lars Ryden
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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16
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Franklin M, Angus C, Welte T, Joos G. How Much Should be Invested in Lung Care Across the WHO European Region? Applying a Monetary Value to Disability-Adjusted Life-Years Within the International Respiratory Coalition's Lung Facts. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:547-558. [PMID: 37039953 DOI: 10.1007/s40258-023-00802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The International Respiratory Coalition's Lung Facts web resource provides the latest data on a range of lung conditions covering the World Health Organization's European Region, informed by the Global Burden of Disease studies: https://international-respiratory-coalition.org/lung-facts/ . Within Lung Facts, disability-adjusted life-years (DALYs) are monetised based on gross domestic product (GDP) per capita. We describe the conceptual and empirical basis for using monetised DALYs to inform negotiations with policymakers to invest in lung care across the World Health Organization European region. METHODS We reflect on the existing debate and research evidence regarding the X value in an X*GDP per capita framework to monetise DALYs, with a focus on if 1*GDP per capita is conceptually and practically appropriate. Using an asthma case study, Global Burden of Disease study 2019 DALY estimates per country are presented. Gross domestic product per capita are converted to international dollars using purchasing power parity (Int$2019). RESULTS Using 1*GDP per capita, the estimated monetised asthma DALY burden, for example, in Kyrgyzstan or Germany is: across the whole population, $44,860,483 or $9,264,767,882, respectively; per 100,000 people, $731,600 or $10,208,317, respectively. CONCLUSIONS Our indicative monetised DALY estimates can enable informed discussions with policy and decision makers, to guide financial investment in alleviating the burden of lung conditions. We suggest 1*GDP per capita as a benchmarked value forms a starting point for negotiation with policymakers for investing in lung care, by scaling the estimated lung condition DALY burden to the resource available in each country to tackle the burden.
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Affiliation(s)
- Matthew Franklin
- Health Economics and Decision Science (HEDS), School of Health and Related Research ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Colin Angus
- Health Economics and Decision Science (HEDS), School of Health and Related Research ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Tobias Welte
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Hannover, Germany
| | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
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17
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Lotan M, Zwilling M, Romano A. Psychometric Values of a New Scale: The Rett Syndrome Fear of Movement Scale (RSFMS). Diagnostics (Basel) 2023; 13:2148. [PMID: 37443542 PMCID: PMC10502954 DOI: 10.3390/diagnostics13132148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/04/2023] [Accepted: 06/15/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: One of the characteristics associated with Rett syndrome (RTT) is a fear of movement (FOM). Despite the grave consequences on health, function, and the caregiver's burden associated with bradykinesia accompanying FOM, there is no specific FOM assessment tool for RTT. (2) Objective: To construct and assess the psychometric values of a scale evaluating FOM in RTT (Rett syndrome fear of movement scale-RSFMS). (3) Methods: Twenty-five girls aged 5-33, including a research group (N = 12 individuals with RTT) and control group (N = 13 typically developing girls at equivalent ages). The Pain and Discomfort Scale (PADS) and Facial Action Coding System (FACS) assessed the participants' behavior and facial expressions in rest and movement situations. (4) Results: Significant behavioral differences were recorded in these rest and movement situations within the research groups using the RSFMS (p = 0.003), FACS (p = 0.002) and PADS (p = 0.002). No differences in reactions were found within the control group. The new scale, RSFMS, was found to show a high inter- and intra-rater reliability (r = 0.993, p < 0.001; r = 0.958, p < 0.001; respectively), good internal consistency (α = 0.77), and high accuracy (94.4%). (5) Conclusions: The new scale for measuring FOM in RTT, the RSFMS, was validated using the FACS and PADS. The RSFMS was found to be a tool that holds excellent psychometric values. The new scale can help clinicians working with individuals with RTT to plan appropriate management strategies for this population.
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Affiliation(s)
- Meir Lotan
- Department of Physiotherapy, Ariel University, Ariel 4070000, Israel
- Israeli Rett Syndrome National Evaluation Team, Ramat Gan 5200100, Israel
| | - Moti Zwilling
- Department of Economics and Business Administration, Ariel University, Ariel 4070000, Israel
| | - Alberto Romano
- Department of Health System Management, Ariel University, Ariel 4070000, Israel
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Fischer B, Telser H, Zweifel P, von Wyl V, Beck K, Weber A. The value of a QALY towards the end of life and its determinants: Experimental evidence. Soc Sci Med 2023; 326:115909. [PMID: 37121067 DOI: 10.1016/j.socscimed.2023.115909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/18/2023] [Accepted: 04/13/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Individual and societal willingness to pay (WTP) for end-of-life medical interventions continue to be subject to considerable uncertainty. This study aims at deriving both types of WTP estimates for an extension of survival time and an improvement of quality of life amounting to a QALY. METHODS A discrete choice experiment (DCE) involving a hypothetical novel drug for the treatment of terminal cancer involving 1529 Swiss residents was performed in 2014. In its individual setting, respondents choose between the status quo and a hypothetical drug with varying characteristics and out-of-pocket payments, adopting the perspective of a terminal cancer patient. In the societal setting, participants are asked to choose between the status quo and a social health insurance contract with and without coverage of the novel drug and a varying insurance contribution. RESULTS In the individual setting, respondents put a higher value on their quality of life than on their survival time whereas in the societal setting, they put a higher value on extra survival time. The combination of the two extensions results in a mean individual WTP per QALY of CHF 96,150 (1 CHF = 1 USD as of 2014). Mean societal WTP for a QALY even amounts to CHF 213,500 in favor of an adult patient, CHF 255,600 for a child, and CHF 153,600 for a person aged over 70 years, respectively. While estimated societal values consistently exceed their individual counterparts, they vary considerably with respondents' socioeconomic characteristics in both settings. CONCLUSIONS This research finds that individual WTP for an extension of survival time to one year is dominated by WTP for health-related quality of life whereas for societal WTP, it is the other way round. Both individual and societal WTP values exhibit a great deal of heterogeneity, with the latter depending on the type of beneficiary.
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Affiliation(s)
| | - Harry Telser
- Polynomics AG, Baslerstrasse 44, 4600, Olten, Switzerland; Center for Health, Policy and Economics, University of Lucerne, Lucerne, Switzerland
| | - Peter Zweifel
- Emeritus, University of Zurich, Wulfensiedlung 24, 9530, Bad Bleiberg, Austria.
| | - Viktor von Wyl
- Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Konstantin Beck
- Faculty of Economics and Management, University of Lucerne, Lucerne, Switzerland
| | - Andreas Weber
- Palliative Care Unit, Dept. of Internal Medicine, GZO Hospital Wetzikon, Wetzikon, Switzerland
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Russo P, Zanuzzi M, Carletto A, Sammarco A, Romano F, Manca A. Role of Economic Evaluations on Pricing of Medicines Reimbursed by the Italian National Health Service. PHARMACOECONOMICS 2023; 41:107-117. [PMID: 36434415 PMCID: PMC9813158 DOI: 10.1007/s40273-022-01215-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The main objective of this study was to explore the extent to which the incremental cost-effectiveness ratio (ICER), alongside other factors, predicts the final outcome of medicine price negotiation in Italy. The second objective was to depict the mean ICER of medicines obtained after negotiation. METHODS Data were extracted from company dossiers submitted to the Italian Medicines Agency (AIFA) from October 2016 to January 2021 and AIFA's internal database. Beta-based regression analyses were used to test the effect of ICER and other variables on the outcome of price negotiation (ΔP), defined as the percentage difference between the list price requested by manufacturers and the final price paid by the Italian National Health Service (INHS). RESULTS In our dataset of 48 pricing and reimbursement procedures, the ICER before negotiation was one of the variables with a major impact on the outcome of negotiation when ≥ 40,000€/QALY. As resulting from multiple regression analyses, the effect of the ICER on ΔP seemed driven by medicines for non-onco-immunological and non-rare diseases. Overall, the negotiation process granted mean incremental costs of €64,688 and mean incremental QALYs of 1.96, yielding an average ICER of €33,004/QALY. CONCLUSIONS This study provides support on the influence of cost-effectiveness analysis on price negotiation in the Italian context, providing an estimate of the mean ICER of reimbursed medicines, calculated using net confidential prices charged by the INHS. The role and use of economic evaluations in medicines pricing should be further improved to get the best value for money.
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Affiliation(s)
| | - Matteo Zanuzzi
- Italian Medicines Agency, Via del Tritone 181, Rome, Italy
| | | | | | | | - Andrea Manca
- Centre for Health Economics, University of York, Heslington, York, UK
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20
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Mistry H, Enderby J, Court R, Al-Khudairy L, Nduka C, Melendez-Torres GJ, Taylor-Phillips S, Clarke A, Uthman OA. Determining optimal strategies for primary prevention of cardiovascular disease: systematic review of cost-effectiveness analyses in the United Kingdom. Health Technol Assess 2022:10.3310/QOVK6659. [PMID: 36562488 PMCID: PMC10068585 DOI: 10.3310/qovk6659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. The aim of the study was to guide researchers and commissioners of cardiovascular disease preventative services towards possible cost-effective interventions by reviewing published economic analyses of interventions for the primary prevention of cardiovascular disease, conducted for or within the UK NHS. METHODS In January 2021, electronic searches of MEDLINE and Embase were carried out to find economic evaluations of cardiovascular disease preventative services. We included fully published economic evaluations (including economic models) conducted alongside randomised controlled trials of any form of intervention that was aimed at the primary prevention of cardiovascular disease, including, but not limited to, drugs, diet, physical activity and public health. Full systematic review methods were used with predetermined inclusion/exclusion criteria, data extraction and formal quality appraisal [using the Consolidated Health Economic Evaluation Reporting Standards checklist and the framework for the quality assessment of decision analytic modelling by Philips et al. (Philips Z, Ginnelly L, Sculpher M, Claxton K, Golder S, Riemsma R, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess 2004;8(36)]. RESULTS Of 4351 non-duplicate citations, eight articles met the review's inclusion criteria. The eight articles focused on health promotion (n = 3), lipid-lowering medicine (n = 4) and blood pressure-lowering medication (n = 1). The majority of the populations in each study had at least one risk factor for cardiovascular disease or were at high risk of cardiovascular disease. For the primary prevention of cardiovascular disease, all strategies were cost-effective at a threshold of £25,000 per quality-adjusted life-year, except increasing motivational interviewing in addition to other behaviour change strategies. Where the cost per quality-adjusted life-year gained was reported, interventions varied from dominant (i.e. less expensive and more effective than the comparator intervention) to £55,000 per quality-adjusted life-year gained. FUTURE WORK AND LIMITATIONS We found few health economic analyses of interventions for primary cardiovascular disease prevention conducted within the last decade. Future economic assessments should be undertaken and presented in accordance with best practices so that future reviews may make clear recommendations to improve health policy. CONCLUSIONS It is difficult to establish direct comparisons or draw firm conclusions because of the uncertainty and heterogeneity among studies. However, interventions conducted for or within the UK NHS were likely to be cost-effective in people at increased risk of cardiovascular disease when compared with usual care or no intervention. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in Health Technology Assessment. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hema Mistry
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jodie Enderby
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Chidozie Nduka
- Warwick Medical School, University of Warwick, Coventry, UK
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Aileen Clarke
- Warwick Medical School, University of Warwick, Coventry, UK
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Isaranuwatchai W, Nakamura R, Wee HL, Sarajan MH, Wang Y, Soboon B, Lou J, Chai JH, Theantawee W, Laoharuangchaiyot J, Mongkolchaipak T, Thathong T, Kingkaew P, Tungsanga K, Teerawattananon Y. What are the impacts of increasing cost-effectiveness Threshold? a protocol on an empirical study based on economic evaluations conducted in Thailand. PLoS One 2022; 17:e0274944. [PMID: 36191016 PMCID: PMC9529087 DOI: 10.1371/journal.pone.0274944] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/07/2022] [Indexed: 11/07/2022] Open
Abstract
Background Economic evaluations have been widely used to inform and guide policy-making process in healthcare resources allocation as a part of an evidence package. An intervention is considered cost-effective if an ICER is less than a cost-effectiveness threshold (CET), where a CET represents the acceptable price for a unit of additional health gain which a decision-maker is willing to pay. There has been discussion to increase a CET in many settings such as the United Kingdom and Thailand. To the best of our knowledge, Thailand is the only country that has an explicit CET and has revised their CET, not once but twice. Hence, the situation in Thailand provides a unique opportunity for evaluating the impact of changing CET on healthcare expenditure and manufacturers’ behaviours in the real-world setting. Before we decide whether a CET should be increased, information on what happened after the CET was increased in the past could be informative and helpful. Objectives This study protocol describes a proposed plan to investigate the impact of increased cost-effectiveness threshold using Thailand as a case study. Specifically, we will examine the impact of increasing CET on the drug prices submitted by pharmaceutical companies to the National List of Essential Medicine (NLEM), the decision to include or exclude medications in the NLEM, and the overall budget impact. Materials and designs Retrospective data analysis of the impact of increased CET on national drug committee decisions in Thailand (an upper middle-income country) will be conducted and included data from various sources such as literature, local organizations (e.g. Thai Food and Drug Administration), and inputs from stakeholder consultation meetings. The outcomes include: (1) drug price submitted by the manufacturers and final drug price included in the NLEM if available; (2) decisions about whether the drug was included in the NLEM for reimbursement; and (3) budget impact. The independent variables include a CET, the variable of interest, which can take values of THB100,000, THB120,000, or THB160,000, and potential confounders such as whether this drug was for a chronic disease, market size, and primary endpoint. We will conduct separate multivariable regression analysis for each outcome specified above. Discussion Understanding the impact of increasing the CET would be helpful in assisting the decision to use and develop an appropriate threshold for one’s own setting. Due to the nature of the study design, the findings will be prone to confounding effect and biases; therefore, the analyses will be adjusted for potential confounders and statistical methods will be explored to minimize biases. Knowledge gained from the study will be conveyed to the public through various disseminations such as reports, policy briefs, academic journals, and presentations.
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Affiliation(s)
- Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- * E-mail:
| | - Ryota Nakamura
- Hitotsubashi Institute for Advanced Study and Graduate School of Economics, Hitotsubashi University, Tokyo, Japan
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Myka Harun Sarajan
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Budsadee Soboon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Jing Lou
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jia Hui Chai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Wannisa Theantawee
- Food and Drug Administration (FDA), Ministry of Public Health, Nonthaburi, Thailand
- Subcommittee for Development of the National List of Essential Medicines (NLEM), Bangkok, Thailand
| | - Jutatip Laoharuangchaiyot
- Food and Drug Administration (FDA), Ministry of Public Health, Nonthaburi, Thailand
- Subcommittee for Development of the National List of Essential Medicines (NLEM), Bangkok, Thailand
| | - Thanakrit Mongkolchaipak
- Food and Drug Administration (FDA), Ministry of Public Health, Nonthaburi, Thailand
- Subcommittee for Development of the National List of Essential Medicines (NLEM), Bangkok, Thailand
| | - Thanisa Thathong
- Food and Drug Administration (FDA), Ministry of Public Health, Nonthaburi, Thailand
- Subcommittee for Development of the National List of Essential Medicines (NLEM), Bangkok, Thailand
| | - Pritaporn Kingkaew
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
| | - Kriang Tungsanga
- Subcommittee for Development of the National List of Essential Medicines (NLEM), Bangkok, Thailand
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Bernard L, Valsecchi V, Mura T, Aouinti S, Padern G, Ferreira R, Pastor J, Jorgensen C, Mercier G, Pers YM. Management of patients with rheumatoid arthritis by telemedicine: connected monitoring. A randomized controlled trial. Joint Bone Spine 2022; 89:105368. [PMID: 35248737 DOI: 10.1016/j.jbspin.2022.105368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a prevalent and disabling disease that is the source of significant direct and indirect costs. The current recommended therapeutic strategy is based on the rapid introduction of therapy with conventional Disease-Modifying Anti-Rheumatic Drugs (DMARDs) combined with regular disease monitoring by the rheumatologist. The onerous nature of such intense monitoring has motivated the development of new, less demanding strategies such as telemedicine. This study aimed to estimate the cost-effectiveness of the connected monitoring of RA patients initiating a new DMARD therapy versus conventional monitoring. METHODS An economic evaluation based on a randomized controlled trial of 89 patients was conducted. The patients in the intervention group (n=45) were monitored using a connected monitoring interface on a smartphone, while patients in the control group (n=44) were conventionally monitored. Health outcomes were measured as the gain in quality-adjusted life-years (QALYs), assessed using the EuroQol-5D questionnaire. Resource use and health outcomes were collected alongside the trial and at the six-month follow-up using application data and the related clinical case manager time, visits, hospitalisations, and transport records. These outcomes were valued using externally collected data on unit costs and QALY weights. RESULTS Compared to conventionally monitored patients, patients receiving connected monitoring had a slightly greater but not significant gain in the average QALY of 0.07. The economic analysis found that connected monitoring resulted in a significant cost reduction of 72€ (2927€ vs. 2999€, P<0.01). The incremental cost-utility ratio of the intervention was equal to -1,029€ per QALY (95% CI: -32,033; +24,625) with a 97.8% chance of being cost-effective at a threshold of 30,000€ per QALY gained. CONCLUSION Implementing EULAR recommendations for RA patients initiating a DMARD treatment using connected monitoring is more efficient and less expensive than conventional care. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT03005925).
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Affiliation(s)
- Laurene Bernard
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Verushka Valsecchi
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Thibault Mura
- Clinical Research and Epidemiology Unit (URCE), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Safa Aouinti
- Clinical Research and Epidemiology Unit (URCE), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Guillaume Padern
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Rosanna Ferreira
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Jenica Pastor
- Clinical Research and Medico economic Unit (URME), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Christian Jorgensen
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Grégoire Mercier
- Clinical Research and Medico economic Unit (URME), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Yves-Marie Pers
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France.
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Mitchell E, Ahern E, Saha S, McGettrick G, Trépel D. Value of Nonpharmacological Interventions for People With an Acquired Brain Injury: A Systematic Review of Economic Evaluations. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1778-1790. [PMID: 35525832 DOI: 10.1016/j.jval.2022.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/10/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Acquired brain injury (ABI) has long-lasting effects, and patients and their families require continued care and support, often for the rest of their lives. For many individuals living with an ABI disorder, nonpharmacological rehabilitation treatment care has become increasingly important care component and relevant for informed healthcare decision making. Our study aimed to appraise economic evidence on the cost-effectiveness of nonpharmacological interventions for individuals living with an ABI. METHODS This systematic review was registered in PROSPERO (CRD42020187469), and a protocol article was subject to peer review. Searches were conducted across several databases for articles published from inception to 2021. Study quality was assessed according the Consolidated Health Economic Evaluation Reporting Standards checklist and Population, Intervention, Control, and Outcomes criteria. RESULTS Of the 3772 articles reviewed 41 publications met the inclusion criteria. There was a considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives and comparators used. Keeping these issues in mind, we find that 4 multidisciplinary interventions studies concluded that fast-track specialized services were cheaper and more cost-effective than usual care, with cost savings ranging from £253 to £6063. In 3 neuropsychological studies, findings suggested that meditated therapy was more effective and saved money than usual care. In 4 early supported discharge studies, interventions were dominant over usual care, with cost savings ranging from £142 to £1760. CONCLUSIONS The cost-effectiveness evidence of different nonpharmacological rehabilitation treatments is scant. More robust evidence is needed to determine the value of these and other interventions across the ABI care pathway.
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Affiliation(s)
- Eileen Mitchell
- Centre for Public Health, Queen's University, Belfast, Northern Ireland, UK; Trinity College Institute for Neuroscience, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
| | - Elayne Ahern
- Trinity College Institute for Neuroscience, Trinity College Dublin, Dublin, Ireland; Department of Psychology, University of Limerick, Castletroy, Limerick, Ireland
| | - Sanjib Saha
- Trinity College Institute for Neuroscience, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland; School of Medicine, Dentistry and Biomedical Sciences, University of California, San Francisco, CA, USA; Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden
| | | | - Dominic Trépel
- Trinity College Institute for Neuroscience, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland; School of Medicine, Dentistry and Biomedical Sciences, University of California, San Francisco, CA, USA; School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
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24
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Boettiger DC, Chattranukulchai P. Considering Whether Countries Participating in Clinical Trials can Afford the Intervention. Health Policy Plan 2022; 37:1064-1065. [PMID: 35674252 DOI: 10.1093/heapol/czac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/11/2022] [Accepted: 06/07/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- D C Boettiger
- Kirby Institute, UNSW Sydney, Australia.,Institute for Health and Aging, University of California, San Francisco, USA.,Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - P Chattranukulchai
- Cardiac Center, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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25
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Jahn B, Santamaria J, Dieplinger H, Binder CJ, Ebenbichler C, Scholl-Bürgi S, Conrads-Frank A, Rochau U, Kühne F, Stojkov I, Todorovic J, James L, Siebert U. Familial hypercholesterolemia: A systematic review of modeling studies on screening interventions. Atherosclerosis 2022; 355:15-29. [DOI: 10.1016/j.atherosclerosis.2022.06.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/26/2022]
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Perry-Duxbury M, Lomas J, Asaria M, van Baal P. The Relevance of Including Future Healthcare Costs in Cost-Effectiveness Threshold Calculations for the UK NHS. PHARMACOECONOMICS 2022; 40:233-239. [PMID: 34697717 PMCID: PMC8545559 DOI: 10.1007/s40273-021-01090-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND AND OBJECTIVE The supply-side threshold for the UK National Health Service has been empirically estimated as the marginal returns to healthcare spending on health outcomes. These estimates implicitly exclude future healthcare costs, which is inconsistent with the objective of making the most efficient use of healthcare resources. This paper illustrates how empirical estimates of the threshold within healthcare can be adjusted to account for future healthcare costs. METHODS Using cause-deleted life tables and previous work on future costs in England and Wales, we illustrate how such estimates can be adjusted. RESULTS While the effect of including future healthcare costs can have substantial effects on incremental cost-effectiveness ratios of specific life-extending interventions, we find that including future costs has relatively little impact (an increase of £743 per quality-adjusted life-year) on the threshold estimate. CONCLUSIONS For some life-extending interventions the impact of including future costs on whether an intervention is deemed cost effective may be considerable.
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Affiliation(s)
- Megan Perry-Duxbury
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, The Netherlands.
| | - James Lomas
- Centre for Health Economics, University of York, York, UK
| | | | - Pieter van Baal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, The Netherlands
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Vicente G, Calnan M, Rech N, Leite S. Pharmaceutical policies for gaining access to high-priced medicines: a comparative analysis between England and Brazil. SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-1104202213422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT Although the National Health Service (NHS) and the Unified Health System (SUS) are systems with similar universal principles, they can show different political measure patterns in the pharmaceutical field. This paper aimed to provide a comparative analysis of pharmaceutical policies highlighting strategies to guarantee access and sustainability to High-Price Medicines (HPMs) in Brazil and England. We performed an integrative literature review in electronic databases, supplemented by grey literature searched on governmental platforms (laws, decrees, ordinances, and resolutions). A total of Forty-seven articles and seven policies were selected and categorized for analysis. The results showed that both countries apply distinct policies to ensure access to HPMs, among them, policies to define price and reimbursement and actions to regulate the use inside the system. Also, these countries apply distinct policies to their sustainability as local partnerships for product development in Brazil and confidential managed agreements with multinational industries in the England. In conclusion, despite similarities in principles, these countries have been proposing and applying distinct pharmaceutical policies to maintain access and ensure the sustainability of their health systems.
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Wettstein DJ, Boes S. How value-based policy interventions influence price negotiations for new medicines: An experimental approach and initial evidence. Health Policy 2021; 126:112-121. [PMID: 35000803 DOI: 10.1016/j.healthpol.2021.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Various forms of value-based pricing policies for new medicines have recently been introduced in OECD countries. While these initiatives are expected to have a positive impact on societal outcomes such as availability, affordability and value for money, scientific evidence on this impact is scarce due to confidential agreements. OBJECTIVE We aimed to assess the impact of value-based policy interventions in price negotiations on patient benefit in an experimental setting. METHODS An online experiment was conducted (n = 269). Participants were randomly assigned into the active role of either a buyer or seller in two intervention groups (cost-benefit, risk-sharing) and one control group. Decisions had real monetary consequences on other participants and through donations to a patient association. RESULTS Patient access, benefit and value for money were higher in the cost-benefit group than in the risk-sharing group. An available alternative to the agreement led to higher price offers. This effect was weaker in the cost-benefit group. CONCLUSIONS Outcomes of price negotiations on patient benefit depend on the alternatives available for failed or delayed negotiations. A shared but voluntary valuation framework might increase patient access, benefit, and value for money. The cost containment effect of risk-sharing agreements may be offset by the negative impact on overall patient benefit. Further development of the approach could provide support for policy design of pharmaceutical pricing regulations.
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Affiliation(s)
- Dominik J Wettstein
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, CH-6002 Lucerne, Switzerland.
| | - Stefan Boes
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, P.O. Box 4466, CH-6002 Lucerne, Switzerland.
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Nathalie LM, Mulligen VE, Maria WAEA, Wilhelmina HJM, Pieter DJPH. Comparing cost-utility of DMARDs in autoantibody-negative rheumatoid arthritis patients. Rheumatology (Oxford) 2021; 60:5765-5774. [PMID: 33725091 PMCID: PMC8645278 DOI: 10.1093/rheumatology/keab251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/28/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives To evaluate the 1-year cost-effectiveness between three different initial treatment strategies in autoantibody-negative RA patients, according to 2010 criteria. Methods For this analysis we selected all RA patients within the intermediate probability stratum of the treatment in the Rotterdam Early Arthritis Cohort (tREACH) trial. The tREACH had a treat-to-target approach, aiming for low DAS <2.4, and treatment adjustments could occur every 3 months. Initial treatment strategies consisted of MTX 25 mg/week (initial MTX, iMTX), iHCQ 400 mg/day or an oral glucocorticoids tapering scheme without DMARDs (iGCs). Data on quality-adjusted life-years, measured with the European Quality of Life 5-Dimensions 3 Levels (EQ-5D-3L), healthcare and productivity costs were used. Results Average quality-adjusted life-years (s.d.), for iMTX, iHCQ and iGCs were respectively 0.71 (0.14), 0.73 (0.14) and 0.71 (0.15). The average total costs (s.d.) for iMTX, iHCQ and iGCs were, respectively, €10 832 (14.763), €11 208 (12.801) and €10 502 (11.973). Healthcare costs were mainly determined by biological costs, which were significantly lower in the iHCQ group compared with iGCs (P < 0.05). However, costs due to presenteeism were the highest in the iHCQ group (55%) followed by iMTX (27%) and iGCs (18%). The incremental cost-effectiveness ratios did not differ between treatment strategies. At a willingness-to-pay level of €50 000, the Dutch threshold for reimbursement of medical care, iHCQ had the highest probability (38.7%) of being cost-effective, followed by iGCs (31.1%) and iMTX (30.2%). Conclusion iHCQ had the lowest healthcare and highest productivity costs, resulting in a non-significant incremental cost-effectiveness ratio. However, iHCQ had the highest chance of being cost-effective at the Dutch willingness-to-pay threshold for healthcare reimbursement. Therefore, we believe that iHCQ is a good alternative to iMTX in autoantibody-negative RA patients, but validation is needed. Clinical trial registration number ISRCTN26791028
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Affiliation(s)
| | | | - Weel Angelique Elisabeth Adriana Maria
- Department of Rheumatology, Erasmus Medical Center.,Department of Rheumatology, Maasstad Hospital.,Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
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Gaskin J, Whyte J, Zhou LG, Coyle D. Regional cost effectiveness analyses for increasing radon protection strategies in housing in Canada. JOURNAL OF ENVIRONMENTAL RADIOACTIVITY 2021; 240:106752. [PMID: 34628245 DOI: 10.1016/j.jenvrad.2021.106752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 06/13/2023]
Abstract
The incremental cost effectiveness ratios for implementing a recent recommendation to install a more radon resistant foundation barrier were modelled for new and existing housing in 2016, for each province and territory in Canada. Cost-utility analyses were conducted, in which the health benefit of an intervention was quantified in quality-adjusted life years, to help guide policymakers considering increasing investment in radon reduction in housing to reduce the associated lung cancer burden shouldered by the health care system. Lung cancer morbidity was modelled using a lifetable analysis that incorporated lung cancer incidence and survival time for localized, regional, and distant stages of diagnoses for both non-small cell and small cell lung cancer. The model accounted for surgical or advanced lung cancer treatment costs avoided, and average health care costs incurred for radon-attributable lung cancer cases prevented by the intervention. The incremental implementation of radon interventions in the housing stock was modelled over a lifetime horizon, and a discount rate of 1.5% was adopted. This radon intervention in new housing was cost effective in all but one region, ranging from $18,075/QALY (15,704; 20,178) for the Yukon to $58,454/QALY (52,045; 65,795) for British Columbia. A sequential analysis was conducted to compare intervention in existing housing for mitigation thresholds of 200 and 100 Bq/m3. This intervention in existing housing was cost effective at a mitigation threshold of 200 Bq/m3 in regions with higher radon levels, ranging from $33,247/QALY (27,699; 39,377) for the Yukon to $61,960/QALY (46,932; 113,737) for Newfoundland, and more cost effective at a threshold of 200 than 100 Bq/m3. More lung cancer deaths can be prevented by intervention in new housing than in existing housing; it was estimated that the proposed intervention in new housing would prevent a mean of 446 (416; 477) lung cancer cases annually. The cost effectiveness of increased radon resistance in foundation barriers in housing varied widely, and would support adopting this intervention in new housing across Canada and in existing housing in higher radon regions. This study provides further evidence that the most cost effective way of responding to the geographically variable radon burden is by implementing specific regional radon reduction policies.
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Affiliation(s)
- Janet Gaskin
- Construction Research Centre, National Research Council, 1200 Montreal Road, Ottawa, Canada; Radiation Protection Bureau, Health Canada, 775 Brookfield Rd, Ottawa, Canada.
| | - Jeff Whyte
- Construction Research Centre, National Research Council, 1200 Montreal Road, Ottawa, Canada
| | - Liang Grace Zhou
- Construction Research Centre, National Research Council, 1200 Montreal Road, Ottawa, Canada
| | - Doug Coyle
- School of Epidemiology and Public Health, 600 Peter Morand Crescent, University of Ottawa, Ottawa, Canada
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Mühlberger N, Sroczynski G, Gogollari A, Jahn B, Pashayan N, Steyerberg E, Widschwendter M, Siebert U. Cost effectiveness of breast cancer screening and prevention: a systematic review with a focus on risk-adapted strategies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1311-1344. [PMID: 34342797 DOI: 10.1007/s10198-021-01338-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Benefit and cost effectiveness of breast cancer screening are still matters of controversy. Risk-adapted strategies are proposed to improve its benefit-harm and cost-benefit relations. Our objective was to perform a systematic review on economic breast cancer models evaluating primary and secondary prevention strategies in the European health care setting, with specific focus on model results, model characteristics, and risk-adapted strategies. METHODS Literature databases were systematically searched for economic breast cancer models evaluating the cost effectiveness of breast cancer screening and prevention strategies in the European health care context. Characteristics, methodological details and results of the identified studies are reported in evidence tables. Economic model outputs are standardized to achieve comparable cost-effectiveness ratios. RESULTS Thirty-two economic evaluations of breast cancer screening and seven evaluations of primary breast cancer prevention were included. Five screening studies and none of the prevention studies considered risk-adapted strategies. Studies differed in methodologic features. Only about half of the screening studies modeled overdiagnosis-related harms, most often indirectly and without reporting their magnitude. All models predict gains in life expectancy and/or quality-adjusted life expectancy at acceptable costs. However, risk-adapted screening was shown to be more effective and efficient than conventional screening. CONCLUSIONS Economic models suggest that breast cancer screening and prevention are cost effective in the European setting. All screening models predict gains in life expectancy, which has not yet been confirmed by trials. European models evaluating risk-adapted screening strategies are rare, but suggest that risk-adapted screening is more effective and efficient than conventional screening.
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Affiliation(s)
- Nikolai Mühlberger
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Artemisa Gogollari
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Beate Jahn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Nora Pashayan
- Institute of Epidemiology and Healthcare, Department of Applied Health Research, UCL-University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Ewout Steyerberg
- Department of Public Health, Erasmus MC, PO Box 9600, 3000 CA, Rotterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Widschwendter
- Department of Women's Cancer, EGA Institute for Women's Health, UCL - University College London, 74 Huntley St, Rm 340, London, WC1E 6AU, UK
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria.
- Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria.
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA.
- Harvard Medical School, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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Gloria MAJ, Thavorncharoensap M, Chaikledkaew U, Youngkong S, Thakkinstian A, Culyer AJ. A Systematic Review of Demand-Side Methods of Estimating the Societal Monetary Value of Health Gain. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1423-1434. [PMID: 34593165 DOI: 10.1016/j.jval.2021.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Although many reviews of the literature on cost-effectiveness thresholds (CETs) exist, the availability of new studies and the absence of a fully comprehensive analysis warrant a new review. This study systematically reviews demand-side methods for estimating the societal monetary value of health gain. METHODS Several electronic databases were searched from inception to October 2019. To be included, a study had to be an original article in any language, with a clearly described method for estimating the societal monetary values of health gain and with all estimated values reported. Estimates were converted to US dollars ($), using purchasing power parity (PPP) exchange rates and the gross domestic product (GDP) per capita (2019). RESULTS We included 53 studies; 45 used direct approach and 8 used indirect approach. Median estimates from the direct approach were PPP$ 24 942 (range 554-1 301 912) per quality-adjusted life-year (QALY), which were typically 0.53 (range 0.02-24.08) GDP per capita. Median estimates using the indirect approach were PPP$ 310 051 (range 36 402-7 574 870) per QALY, which accounted for 7.87 (range 0.68-116.95) GDP per capita. CONCLUSIONS Our review found that the societal values of health gain or CETs were less than GDP per capita. The great variety in methods and estimates suggests that a more standardized and internationally agreed methodology for estimating CET is warranted. Multiple CETs may have a role when QALYs are not equally valued from a societal perspective (eg, QALYs accruing to people near death compared with equivalent QALYs to others).
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Affiliation(s)
- Mac Ardy Junio Gloria
- Mahidol University Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand; Department of Pharmacy, College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | - Montarat Thavorncharoensap
- Mahidol University Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand; Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
| | - Usa Chaikledkaew
- Mahidol University Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand; Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Sitaporn Youngkong
- Mahidol University Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand; Social and Administrative Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Mahidol University Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand; Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anthony J Culyer
- Centre for Health Economics, University of York, York, England, UK
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Turner HC, Archer RA, Downey LE, Isaranuwatchai W, Chalkidou K, Jit M, Teerawattananon Y. An Introduction to the Main Types of Economic Evaluations Used for Informing Priority Setting and Resource Allocation in Healthcare: Key Features, Uses, and Limitations. Front Public Health 2021; 9:722927. [PMID: 34513790 PMCID: PMC8424074 DOI: 10.3389/fpubh.2021.722927] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
Economic evidence is increasingly being used for informing health policies. However, the underlining principles of health economic analyses are not always fully understood by non-health economists, and inappropriate types of analyses, as well as inconsistent methodologies, may be being used for informing health policy decisions. In addition, there is a lack of open access information and methodological guidance targeted to public health professionals, particularly those based in low- and middle-income country (LMIC) settings. The objective of this review is to provide a comprehensive and accessible introduction to economic evaluations for public health professionals with a focus on LMIC settings. We cover the main principles underlining the most common types of full economic evaluations used in healthcare decision making in the context of priority setting (namely cost-effectiveness/cost-utility analyses, cost-benefit analyses), and outline their key features, strengths and weaknesses. It is envisioned that this will help those conducting such analyses, as well as stakeholders that need to interpret their output, gain a greater understanding of these methods and help them select/distinguish between the different approaches. In particular, we highlight the need for greater awareness of the methods used to place a monetary value on the health benefits of interventions, and the potential for such estimates to be misinterpreted. Specifically, the economic benefits reported are typically an approximation, summarising the health benefits experienced by a population monetarily in terms of individual preferences or potential productivity gains, rather than actual realisable or fiscal monetary benefits to payers or society.
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Affiliation(s)
- Hugo C Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Rachel A Archer
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Laura E Downey
- School of Public Health, Imperial College London, London, United Kingdom
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Kalipso Chalkidou
- School of Public Health, Imperial College London, London, United Kingdom
| | - Mark Jit
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Modelling and Economics Unit, Public Health England, London, United Kingdom
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Atherosclerotic cardiovascular disease thresholds for statin initiation among people living with HIV in Thailand: A cost-effectiveness analysis. PLoS One 2021; 16:e0256926. [PMID: 34499685 PMCID: PMC8428548 DOI: 10.1371/journal.pone.0256926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background People living with HIV (PLHIV) have an elevated risk of atherosclerotic cardiovascular disease (ASCVD) compared to their uninfected peers. Expanding statin use may help alleviate this burden. We evaluated the cost-effectiveness of reducing the recommend statin initiation threshold for primary ASCVD prevention among PLHIV in Thailand. Methods Our decision analytic microsimulation model randomly selected (with replacement) individuals from the TREAT Asia HIV Observational Database (data collected between 1/January/2013 and 1/September/2019). Direct medical costs and quality-adjusted life-years were assigned in annual cycles over a lifetime horizon and discounted at 3% per year. We assumed the Thai healthcare sector perspective. The study population included PLHIV aged 35–75 years, without ASCVD, and receiving antiretroviral therapy. Statin initiation thresholds evaluated were 10-year ASCVD risk ≥10% (control), ≥7.5% and ≥5%. Results A statin initiation threshold of ASCVD risk ≥7.5% resulted in accumulation of 0.015 additional quality-adjusted life-years compared with an ASCVD risk threshold ≥10%, at an extra cost of 3,539 Baht ($US113), giving an incremental cost-effectiveness ratio of 239,000 Baht ($US7,670)/quality-adjusted life-year gained. The incremental cost-effectiveness ratio comparing ASCVD risk ≥5% to ≥7.5% was 349,000 Baht ($US11,200)/quality-adjusted life-year gained. At a willingness-to-pay threshold of 160,000 Baht ($US5,135)/quality-adjusted life-year gained, a 30.8% reduction in the average cost of low/moderate statin therapy led to the ASCVD risk threshold ≥7.5% becoming cost-effective compared with current practice. Conclusions Reducing the recommended 10-year ASCVD risk threshold for statin initiation among PLHIV in Thailand would not currently be cost-effective. However, a lower threshold could become cost-effective with greater preference for cheaper statins.
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Seebacher J, Muigg F, Kühn H, Weichbold V, Galvan O, Zorowka P, Schmutzhard J. Cost-utility Analysis of Cochlear Implantation in Adults With Single-sided Deafness: Austrian and German Perspective. Otol Neurotol 2021; 42:799-805. [PMID: 33625194 DOI: 10.1097/mao.0000000000003103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Single-sided deafness (SSD) is associated with a loss of binaural hearing. Major limitations of such patients are poor speech understanding in noisy environments and a lack of spatial hearing. To date, cochlear implantation is the most promising approach to overcome these deficits in this group of patients. OBJECTIVE Cost-effectiveness analyses of cochlear implantation in patients with unilateral deafness. The model targets Austrian and German SSD patients who can either opt for treatment with a cochlear implant (CI) or decide against a CI and stay without any treatment. METHODS A Markov model analyzed as microsimulation was developed using TreeAge Pro 2019 software. Pre- and postoperative utility values generated with HUI-3 were used to populate the model. Costs covered by the national insurance were considered. Costs and utilities were discounted by 3%. A model time horizon of 20 years was set. RESULTS According to Austrian base-case analysis, the incremental cost-utility ratio (ICUR) was €34845.2 per quality-adjusted life year gained when comparing the "CI strategy" to the "no treatment strategy." The ICUR is marginally lower when adapting a German cost perspective-it was €31601.25 per quality-adjusted life year gained. Sensitivity analyses showed that the cost-effectiveness results are stable. Analyses also showed that the longer the time horizon is set, the more favorable the cost-effectiveness result is. CONCLUSIONS Based on currently available data, the Markov microsimulation model suggests that cochlear implantation is cost-effective in Austrian and German patients with SSD if no other treatment option is considered within the model.
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Affiliation(s)
- Josef Seebacher
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck
| | | | - Heike Kühn
- Comprehensive Hearing Center, ENT University Clinic, Würzburg, Germany
| | - Viktor Weichbold
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck
| | | | - Patrick Zorowka
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology, Medical University of Innsbruck, Innsbruck, Austria
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Skarzynski PH, Ciesla K, Lorens A, Wojcik J, Skarzynski H. Cost-Utility Analysis of Bilateral Cochlear Implantation in Adults With Severe to Profound Sensorineural Hearing Loss in Poland. Otol Neurotol 2021; 42:706-712. [PMID: 33967247 DOI: 10.1097/mao.0000000000003040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to develop a Markov model and apply it for the evaluation of three different treatment scenarios for adult patients with severe to profound bilateral sensorineural hearing loss. STUDY DESIGN Prospective Observational Study. SETTINGS Hospital. PATIENTS A clinical group of 22 adult patients (59.1% men, 40.9% women) aged from 59.13 ± 8.9 years were included in the study. The study comprised two arms: patients in group 1 received the second cochlear implant one to three months after the first implant; while patients in group 2 got the second cochlear implant approximately one year after the first implant. MAIN OUTCOME MEASURES All participants were first asked to complete an AQoL-8D questionnaire. For the cost-effectiveness analyses, a Markov model analyzed as microsimulation was developed to compare the different treatment options. RESULTS The analyses show that bilateral cochlear implantation strategies are cost-effective compared to the 'no treatment' alternative when having a 10-year model time horizon. When all three model scenarios are compared, the bilateral simultaneous cochlear implantation strategy (Scenario 3) compared to the 'no treatment' option is even more cost-effective than the Scenarios 1 and 2, compared with the 'no treatment' alternative. CONCLUSIONS The model results summarize that bilateral (sequential and simultaneous) cochlear implantation that are represented in the model scenarios, are cost-effective strategies for Polish adult patients with bilateral severe to profound sensorineural hearing loss.
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Affiliation(s)
- Piotr Henryk Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw
- Department of Teleaudiology and Screening, World Hearing Center, Institute of Physiology and Pathology of Hearing
- Heart Failure and Cardiac Rehabilitation Department, Faculty of Medicine, Medical University of Warsaw, Warsaw
- Institute of Sensory Organs, Nadarzyn/Warsaw
- Center of Hearing and Speech Medincus, Kajetany, Poland
| | - Katarzyna Ciesla
- Bioimaging Research Center, World Hearing Center of the Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany
| | - Artur Lorens
- World Hearing Center, Institute of Physiology and Pathology of Hearing, Kajetany/Warsaw
| | - Joanna Wojcik
- Bioimaging Research Center, World Hearing Center of the Institute of Physiology and Pathology of Hearing, Warsaw/Kajetany
| | - Henryk Skarzynski
- World Hearing Center, Institute of Physiology and Pathology of Hearing
- Oto-Rhino-Laryngology Surgery Clinic, World Hearing Center
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Jülicher P, O'Kane M, Price CP, Christenson R, John AS. Health economic evaluations of medical tests: Translating laboratory information into value - A case study example. Ann Clin Biochem 2021; 59:23-36. [PMID: 33874738 DOI: 10.1177/00045632211013852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health-care providers and funders are focused on identifying value in all their services and that includes laboratories. This means that in order to gain a share of scarce resources, laboratory professionals must also understand and assess the value of tests and that includes their economic impact. This can be assessed using health economic modelling tools which, when used in conjunction with a detailed value proposition for the test, can translate laboratory information into value. While a variety of health economic assessment tools are available, this review will focus on the use of decision analytic models which essentially compare the outcomes from pathways with and without the new test, the value of which is being assessed. A step-by-step framework is provided to guide laboratory professionals through the essential steps of conducting the evaluation. Initial steps include mapping the clinical pathway, understanding the goal of the evaluation, identifying the key stakeholders and their needs and determining a suitable analytical model. Following collection of the actual data, the validity of the model must be checked, and the robustness of the outcomes tested through sensitivity analysis. The last step is to translate the findings into measures of value which can then inform appropriate decisions by the stakeholders. This review of basic health economic modelling should enable laboratory professionals to have an understanding of how modelling can be applied to tests in their own environment and help deliver their potential value.
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Affiliation(s)
- Paul Jülicher
- Health Economics and Outcomes Research, Medical Affairs, Abbott Laboratories, Wiesbaden, Germany
| | - Maurice O'Kane
- Clinical Chemistry Laboratory, Altnagelvin Hospital, Londonderry, UK
- Centre for Personalised Medicine: Clinical Decision Making and Patient Safety, C-TRIC, Altnagelvin Hospital, Londonderry, UK
| | - Christopher P Price
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Robert Christenson
- Laboratories of Pathology, University of Maryland Medical Centre, Baltimore, MD, USA
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Tammemägi MC, Darling GE, Schmidt H, Llovet D, Buchanan DN, Leung Y, Miller B, Rabeneck L. Selection of individuals for lung cancer screening based on risk prediction model performance and economic factors - The Ontario experience. Lung Cancer 2021; 156:31-40. [PMID: 33887677 DOI: 10.1016/j.lungcan.2021.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/29/2021] [Accepted: 04/06/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Randomized controlled trials have shown that screening with computed tomography reduces lung cancer mortality but is most effective when applied to high-risk individuals. Accurate lung cancer risk prediction models effectively select individuals for screening. Few pilots or programs have implemented risk models for enrolling individuals for screening in real-world, population-based settings. This report describes implementation of the PLCOm2012 risk prediction model in the Ontario Health (Cancer Care Ontario) lung cancer screening Pilot. METHODS In the Pilot's Health Technology Assessment, 576 categorical age/pack-years/quit-years scenarios were evaluated using MISCAN microsimulation modeling and cost-effectiveness analyses. A preferred model was selected which provided the most life-years gained per cost. The PLCOm2012 was compared to the preferred MISCAN scenario at a threshold that yielded the same number eligible (risk ≥2.0 %/6-years). RESULTS The PLCOm2012 had significantly higher sensitivity and predictive value (68.1 % vs 59.6 %, p < 0.0001; 4.90 % vs 4.29 %, p = 0.044), and an Expert Panel selected it for use in the Pilot. The Pilot cancer detection rate was significantly higher than in the NLST (p = 0.009) or NELSON (p = 0.003) and there was a significant shift to early stage compared to historical Ontario Cancer Registry statistics (p < 0.0001). Pre- and post-Pilot evaluations found that conducting quality risk assessments were not excessively time consuming or difficult, and participants' satisfaction was high. CONCLUSIONS The PLCOm2012 was efficiently implemented in the Pilot in a real-world setting and is being used to transition into a provincial program. Compared to categorical age/pack-years/quit-years criteria, risk assessment using the PLCOm2012 can lead to effective and efficient screening.
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Affiliation(s)
- Martin C Tammemägi
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada.
| | - Gail E Darling
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Heidi Schmidt
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Joint Department of Medical Imaging (JDMI) at University Health Network, Sinai Health, and Women's College Hospital, Toronto, Ontario, Canada; Division of Cardiothoracic Imaging, Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Diego Llovet
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Daniel N Buchanan
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Yvonne Leung
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Beth Miller
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada
| | - Linda Rabeneck
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Tonin FS, Aznar-Lou I, Pontinha VM, Pontarolo R, Fernandez-Llimos F. Principles of pharmacoeconomic analysis: the case of pharmacist-led interventions. Pharm Pract (Granada) 2021; 19:2302. [PMID: 33727994 PMCID: PMC7939117 DOI: 10.18549/pharmpract.2021.1.2302] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In the past years, several factors such as evidence-based healthcare culture, quality-linked incentives, and patient-centered actions, associated with an important increase of financial constraints and pressures on healthcare budgets, resulted in a growing interest by policy-makers in enlarging pharmacists' roles in care. Numerous studies have demonstrated positive therapeutic outcomes associated with pharmaceutical services in a wide array of diseases. Yet, the evidence of the economic impact of the pharmacist in decreasing total health expenditures, unnecessary care, and societal costs relies on well-performed, reliable, and transparent economic evaluations, which are scarce. Pharmacoeconomics is a branch of health economics that usually focuses on balancing the costs and benefits of an intervention towards the use of limited resources, aiming at maximizing value to patients, healthcare payers and society through data driven decision making. These decisions can be guide by a health technology assessment (HTA) process that inform governmental players about medical, social, and economic implications of development, diffusion, and use of health technologies - including clinical pharmacy interventions. This paper aims to provide an overview of the important concepts in costing in healthcare, including studies classification according to the type of analysis method (e.g. budget-impact analysis, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis), types of costs (e.g. direct, indirect and intangible costs) and outcomes (e.g. events prevented, quality adjusted life year - QALY, disability adjusted life year - DALY). Other key components of an economic evaluation such as the models' perspective, time horizon, modelling approaches (e.g. decision trees or simulation models as the Markov model) and sensitivity analysis are also briefly covered. Finally, we discuss the methodological issues for the identification, measurement and valuation of costs and benefits of pharmacy services, and suggest some recommendations for future studies, including the use of Value of Assessment Frameworks.
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Affiliation(s)
- Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Program, Federal University of Paraná . Curitiba ( Brazil ).
| | - Ignacio Aznar-Lou
- Research and Development Unit, Sant Joan de Déu Research Institute . Barcelona, ( Spain ).
| | - Vasco M Pontinha
- Department of Pharmacotherapy and Outcomes Science, Center for Pharmacy Practice Innovation, School of Pharmacy, Virginia Commonwealth University . Richmond, VA ( United States ).
| | - Roberto Pontarolo
- Department of Pharmacy, Federal University of Paraná . Curitiba ( Brazil ).
| | - Fernando Fernandez-Llimos
- Center for Health Technology and Services Research (CINTESIS), Laboratory of Pharmacology, Faculty of Pharmacy, University of Porto . Porto ( Portugal ).
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Hashempour R, Raei B, Safaei Lari M, Abolhasanbeigi Gallezan N, AkbariSari A. QALY league table of Iran: a practical method for better resource allocation. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:3. [PMID: 33441153 PMCID: PMC7807517 DOI: 10.1186/s12962-020-00256-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 11/24/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The limited health care resources cannot meet all the demands of the society. Thus, decision makers have to choose feasible interventions and reject the others. We aimed to collect and summarize the results of all cost utility analysis studies that were conducted in Iran and develop a Quality Adjusted Life Year (QALY) league table. METHODS A systematic mapping review was conducted to identify all cost utility analysis studies done in Iran and then map them in a table. PubMed, Embase, Cochrane library, Web of Science, as well as Iranian databases like Iran Medex, SID, Magiran, and Barakat Knowledge Network System were all searched for articles published from the inception of the databases to January 2020. Additionally, Cost per QALY or Incremental Cost Utility Ratio (ICUR) were collected from all studies. The Joanna Briggs checklist was used to assess quality appraisal. RESULTS In total, 51 cost-utility studies were included in the final analysis, out of which 14 studies were on cancer, six studies on coronary heart diseases. Two studies, each on hemophilia, multiple sclerosis and rheumatoid arthritis. The rest were on various other diseases. Markov model was the commonest one which has been applied to in 45% of the reviewed studies. Discount rates ranged from zero to 7.2%. The cost per QALY ranged from $ 0.144 in radiography costs for patients with some orthopedic problems to $ 4,551,521 for immune tolerance induction (ITI) therapy in hemophilia patients. High heterogeneity was revealed; therefore, it would be biased to rank interventions based on reported cost per QALY or ICUR. CONCLUSIONS However, it is instructive and informative to collect all economic evaluation studies and summarize them in a table. The information on the table would in turn be used to redirect resources for efficient allocation. in general, it was revealed that preventive programs are cost effective interventions from different perspectives in Iran.
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Affiliation(s)
- Reza Hashempour
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, 0000-0002-2043-8451, Tehran, Iran
| | - Behzad Raei
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, 0000-0002-2043-8451, Tehran, Iran
| | - Majid Safaei Lari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, 0000-0002-2043-8451, Tehran, Iran
| | - Nasrin Abolhasanbeigi Gallezan
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali AkbariSari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, 0000-0002-2043-8451, Tehran, Iran.
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McGlone ER, Carey I, Veličković V, Chana P, Mahawar K, Batterham RL, Hopkins J, Walton P, Kinsman R, Byrne J, Somers S, Kerrigan D, Menon V, Borg C, Ahmed A, Sgromo B, Cheruvu C, Bano G, Leonard C, Thom H, le Roux CW, Reddy M, Welbourn R, Small P, Khan OA. Bariatric surgery for patients with type 2 diabetes mellitus requiring insulin: Clinical outcome and cost-effectiveness analyses. PLoS Med 2020; 17:e1003228. [PMID: 33285553 PMCID: PMC7721482 DOI: 10.1371/journal.pmed.1003228] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 10/16/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Although bariatric surgery is well established as an effective treatment for patients with obesity and type 2 diabetes mellitus (T2DM), there exists reluctance to increase its availability for patients with severe T2DM. The aims of this study were to examine the impact of bariatric surgery on T2DM resolution in patients with obesity and T2DM requiring insulin (T2DM-Ins) using data from a national database and to develop a health economic model to evaluate the cost-effectiveness of surgery in this cohort when compared to best medical treatment (BMT). METHODS AND FINDINGS Clinical data from the National Bariatric Surgical Registry (NBSR), a comprehensive database of bariatric surgery in the United Kingdom, were extracted to analyse outcomes of patients with obesity and T2DM-Ins who underwent primary bariatric surgery between 2009 and 2017. Outcomes for this group were combined with data sourced from a comprehensive literature review in order to develop a state-transition microsimulation model to evaluate cost-effectiveness of bariatric surgery versus BMT for patients over a 5-year time horizon. The main outcome measure for the clinical study was insulin cessation at 1-year post-surgery: relative risks (RR) summarising predictive factors were determined, unadjusted, and after adjusting for variables including age, initial body mass index (BMI), duration of T2DM, and weight loss. Main outcome measures for the economic evaluation were total costs, total quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) at willingness-to-pay threshold of GBP£20,000. A total of 2,484 patients were eligible for inclusion, of which 1,847 had 1-year follow-up data (mean age of 51 years, mean initial BMI 47.2 kg/m2, and 64% female). 67% of patients no longer required insulin at 1-year postoperatively: these rates persisted for 4 years. Roux-en-Y gastric bypass (RYGB) was associated with a higher rate of insulin cessation (71.7%) than sleeve gastrectomy (SG; 64.5%; RR 0.92, confidence interval (CI) 0.86-0.99) and adjustable gastric band (AGB; 33.6%; RR 0.45, CI 0.34-0.60; p < 0.001). When adjusted for percentage total weight loss and demographic variables, insulin cessation following surgery was comparable for RYGB and SG (RR 0.97, CI 0.90-1.04), with AGB having the lowest cessation rates (RR 0.55, CI 0.40-0.74; p < 0.001). Over 5 years, bariatric surgery was cost saving compared to BMT (total cost GBP£22,057 versus GBP£26,286 respectively, incremental difference GBP£4,229). This was due to lower treatment costs as well as reduced diabetes-related complications costs and increased health benefits. Limitations of this study include loss to follow-up of patients within the NBSR dataset and that the time horizon for the economic analysis is limited to 5 years. In addition, the study reflects current medical and surgical treatment regimens for this cohort of patients, which may change. CONCLUSIONS In this study, we observed that in patients with obesity and T2DM-Ins, bariatric surgery was associated with high rates of postoperative cessation of insulin therapy, which is, in turn, a major driver of overall reductions in direct healthcare cost. Our findings suggest that a strategy utilising bariatric surgery for patients with obesity and T2DM-Ins is cost saving to the national healthcare provider (National Health Service (NHS)) over a 5-year time horizon.
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Affiliation(s)
- Emma Rose McGlone
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Iain Carey
- Population Health Research Institute, St George’s Hospital, University of London, London, United Kingdom
| | - Vladica Veličković
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT, Hall in Tirol, Austria
| | - Prem Chana
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Kamal Mahawar
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Rachel L. Batterham
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
- UCL Centre for Obesity Research, Division of Medicine, Rayne Building, University College London, London, United Kingdom
- National Institute of Health Research, UCLH Biomedical Research Centre, London, United Kingdom
| | - James Hopkins
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Peter Walton
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Robin Kinsman
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - James Byrne
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Shaw Somers
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - David Kerrigan
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Vinod Menon
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Cynthia Borg
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Ahmed Ahmed
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Bruno Sgromo
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Chandra Cheruvu
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Gul Bano
- St George’s Hospital, London, United Kingdom
| | - Catherine Leonard
- Medtronic Ltd, Croxley Green Business Park, Hatters Lane, Watford, United Kingdom
| | - Howard Thom
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Carel W le Roux
- Diabetes Complications Research Centre, University College Dublin, Dublin, Ireland
| | - Marcus Reddy
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Richard Welbourn
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Peter Small
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
| | - Omar A. Khan
- National Bariatric Surgical Registry (NBSR)/British Obesity and Metabolic Surgical Society (BOMSS), Royal College of Surgeons of England, London, United Kingdom
- Population Health Research Institute, St George’s Hospital, University of London, London, United Kingdom
- St George’s Hospital, London, United Kingdom
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Conte TM, Haddad LBDP, Ribeiro IB, de Moura ETH, DʼAlbuquerque LAC, de Moura EGH. Peroral endoscopic myotomy (POEM) is more cost-effective than laparoscopic Heller myotomy in the short term for achalasia: economic evaluation from a randomized controlled trial. Endosc Int Open 2020; 8:E1673-E1680. [PMID: 33140023 PMCID: PMC7584466 DOI: 10.1055/a-1261-3417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/18/2020] [Indexed: 12/11/2022] Open
Abstract
Background and study aims We aimed to perform an economic evaluation of peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) for the treatment of achalasia. Materials and methods An economic cost-utility analysis was carried out over a time horizon of 1 year. Patients with achalasia who were admitted to the gastroenterology outpatient clinic of a public tertiary referral hospital were assigned to undergo POEM or LHM. The monetary amounts were extracted from the intranet of the institution using microcosting. All costs associated with the procedure, hospitalization, clinical follow-up and resolution of therapeutic complications were included. The utility data were measured in quality-adjusted life years (QALYs), which were estimated from the scores of a quality-of-life questionnaire. Results Forty patients (20 POEM patients and 20 LHM patients) were included. The final cost associated with POEM and LHM was US$ 2,619.19 ± 399.53 and US$ 1,696.44 ± 412.21, respectively ( P < 0.001). However, the QALYs in the POEM group (0.434 ± 0.215 vs 0.332 ± 0.222, P = 0.397) were slightly higher than those in the LHM group. The incremental cost-utility ratio (ICUR) suggested that an additional US$ 9,046.41/QALY gained was required when using POEM. Conclusion For the treatment of achalasia in the public health system, POEM appears to be more cost-effective than LHM in the short term.
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Affiliation(s)
| | - Luciana Bertocco de Paiva Haddad
- Department of Transplantation, Gastroenterology Division, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Igor Braga Ribeiro
- Endoscopy, Gastroenterology Division, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | | | - Luiz Augusto Carneiro DʼAlbuquerque
- Department of Transplantation, Gastroenterology Division, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
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Zampirolli Dias C, Godman B, Gargano LP, Azevedo PS, Garcia MM, Souza Cazarim M, Pantuzza LLN, Ribeiro-Junior NG, Pereira AL, Borin MC, de Figueiredo Zuppo I, Iunes R, Pippo T, Hauegen RC, Vassalo C, Laba TL, Simoens S, Márquez S, Gomez C, Voncina L, Selke GW, Garattini L, Kwon HY, Gulbinovic J, Lipinska A, Pomorski M, McClure L, Fürst J, Gambogi R, Ortiz CH, Canuto Santos VC, Araújo DV, Araujo VE, Acurcio FDA, Alvares-Teodoro J, Guerra-Junior AA. Integrative Review of Managed Entry Agreements: Chances and Limitations. PHARMACOECONOMICS 2020; 38:1165-1185. [PMID: 32734573 DOI: 10.1007/s40273-020-00943-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Managed entry agreements (MEAs) consist of a set of instruments to reduce the uncertainty and the budget impact of new high-priced medicines; however, there are concerns. There is a need to critically appraise MEAs with their planned introduction in Brazil. Accordingly, the objective of this article is to identify and appraise key attributes and concerns with MEAs among payers and their advisers, with the findings providing critical considerations for Brazil and other high- and middle-income countries. METHODS An integrative review approach was adopted. This involved a review of MEAs across countries. The review question was 'What are the health technology MEAs that have been applied around the world?' This review was supplemented with studies not retrieved in the search known to the senior-level co-authors including key South American markets. It also involved senior-level decision makers and advisers providing guidance on the potential advantages and disadvantages of MEAs and ways forward. RESULTS Twenty-five studies were included in the review. Most MEAs included medicines (96.8%), focused on financial arrangements (43%) and included mostly antineoplastic medicines. Most countries kept key information confidential including discounts or had not published such data. Few details were found in the literature regarding South America. Our findings and inputs resulted in both advantages including reimbursement and disadvantages including concerns with data collection for outcome-based schemes. CONCLUSIONS We are likely to see a growth in MEAs with the continual launch of new high-priced and often complex treatments, coupled with increasing demands on resources. Whilst outcome-based MEAs could be an important tool to improve access to new innovative medicines, there are critical issues to address. Comparing knowledge, experiences, and practices across countries is crucial to guide high- and middle-income countries when designing their future MEAs.
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Affiliation(s)
- Carolina Zampirolli Dias
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Ludmila Peres Gargano
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Pâmela Santos Azevedo
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Marina Morgado Garcia
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Maurílio Souza Cazarim
- Department of Pharmaceutical Sciences, Pharmacy School, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
| | - Laís Lessa Neiva Pantuzza
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
| | - Nelio Gomes Ribeiro-Junior
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - André Luiz Pereira
- Gerência de Planejamento, Monitoramento e Avaliação Assistenciais Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcus Carvalho Borin
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Isabella de Figueiredo Zuppo
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | | | - Tomas Pippo
- Pan American Health Organization (PAHO), Brasília, Brazil
| | - Renata Curi Hauegen
- National Institute of Science and Technology for Innovation on Diseases of Neglected Populations (INCT-IDPN), Center for Technological Development in Health (CDTS), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Carlos Vassalo
- Facultad de Ciencias Médicas, Universidad Nacional del Litoral, Santa Fe, Argentina
| | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, Sydney, NSW, Australia
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Louvain, Belgium
| | - Sergio Márquez
- Economista, Administradora de los Recursos del Sistema General de Seguridad Social en Salud (ADRES), Bogotá, Colombia
| | - Carolina Gomez
- Think Tank "Medicines, Information and Power", National University of Colombia, Bogotá, Colombia
| | | | | | - Livio Garattini
- CESAV, Centre for Health Economics, IRCCS Institute for Pharmacological Research 'Mario Negri', Ranica, Bergamo, Italy
| | - Hye-Young Kwon
- Division of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Jolanta Gulbinovic
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Institute of Biomedical Sciences, Vilnius University, Vilnius, Lithuania
| | - Aneta Lipinska
- Agency for Health Technology Assessment and Tariff System (AOTMiT), Warsaw, Poland
| | - Maciej Pomorski
- Agency for Health Technology Assessment and Tariff System (AOTMiT), Warsaw, Poland
| | - Lindsay McClure
- Procurement, Commissioning and Facilities, NHS National Services Scotland, Edinburgh, UK
| | - Jurij Fürst
- Health Insurance Institute, Ljubljana, Slovenia
| | | | | | | | - Denizar Vianna Araújo
- Secretariat of Science, Technology and Strategic Inputs, Ministry of Health, Brasília, Brazil
| | - Vânia Eloisa Araujo
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Francisco de Assis Acurcio
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Alvares-Teodoro
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil
| | - Augusto Afonso Guerra-Junior
- Graduate Program in Medicines and Pharmaceutical Services, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627. Pampulha, Belo Horizonte, 31270-901, Minas Gerais, Brazil.
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Minas Gerais, Brazil.
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Cost-Effectiveness of Early Detection and Prevention Strategies for Endometrial Cancer-A Systematic Review. Cancers (Basel) 2020; 12:cancers12071874. [PMID: 32664613 PMCID: PMC7408795 DOI: 10.3390/cancers12071874] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 12/24/2022] Open
Abstract
Endometrial cancer is the most common female genital tract cancer in developed countries. We systematically reviewed the current health-economic evidence on early detection and prevention strategies for endometrial cancer based on a search in relevant databases (Medline/Embase/Cochrane Library/CRD/EconLit). Study characteristics and results including life-years gained (LYG), quality-adjusted life-years (QALY) gained, and incremental cost-effectiveness ratios (ICERs) were summarized in standardized evidence tables. Economic results were transformed into 2019 euros using standard conversion methods (GDP-PPP, CPI). Seven studies were included, evaluating (1) screening for endometrial cancer in women with different risk profiles, (2) risk-reducing interventions for women at increased or high risk for endometrial cancer, and (3) genetic testing for germline mutations followed by risk-reducing interventions for diagnosed mutation carriers. Compared to no screening, screening with transvaginal sonography (TVS), biomarker CA-125, and endometrial biopsy yielded an ICER of 43,600 EUR/LYG (95,800 EUR/QALY) in women with Lynch syndrome at high endometrial cancer risk. For women considering prophylactic surgery, surgery was more effective and less costly than screening. In obese women, prevention using Levonorgestrel as of age 30 for five years had an ICER of 72,000 EUR/LYG; the ICER for using oral contraceptives for five years as of age 50 was 450,000 EUR/LYG. Genetic testing for mutations in women at increased risk for carrying a mutation followed by risk-reducing surgery yielded ICERs below 40,000 EUR/QALY. Based on study results, preventive surgery in mutation carriers and genetic testing in women at increased risk for mutations are cost-effective. Except for high-risk women, screening using TVS and endometrial biopsy is not cost-effective and may lead to overtreatment. Model-based analyses indicate that future biomarker screening in women at increased risk for cancer may be cost-effective, dependent on high test accuracy and moderate test costs. Future research should reveal risk-adapted early detection and prevention strategies for endometrial cancer.
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Dickreuter J, Schmoor C, Bengel J, Jähne A, Leifert JA. Efficacy of a short-term residential smoking cessation therapy versus standard outpatient group therapy ('START-Study'): study protocol of a randomized controlled trial. Trials 2020; 21:562. [PMID: 32576275 PMCID: PMC7310333 DOI: 10.1186/s13063-020-04253-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/14/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In Germany, evidence-based outpatient smoking cessation therapies are widely available. Long-term abstinence rates, however, are limited. Studies suggest that short-term residential therapy enables a higher level of environmental control, more intense contact and greater support among patients and from therapists, which could result in higher abstinence rates. The aim of the current START-study is to investigate the long-term efficacy of a short-term residential therapy exclusively for smoking cessation, conducted by a mobile team of expert therapists. METHODS A randomized controlled trial (RCT) is conducted to examine the efficacy of residential behavior therapeutic smoking cessation therapy compared to standard outpatient behavior therapeutic smoking cessation group therapy. Adult smokers consuming 10 or more cigarettes per day, who are willing to stop smoking, are randomized in a ratio of 1:1 between therapy groups. The primary endpoint is sustained abstinence for 6-month and 12-month periods. Secondary endpoints include smoking status after therapy, 7-day point abstinence after the 6-month and 12-month follow-ups, level of physical dependence, cost-effectiveness, use of nicotine replacement products, health-related quality of life, self-efficacy expectation for tobacco abstinence, motivational and volitional determinants of behavior change, self-reported depressive symptom severity, adverse events and possible side effects. Assessments will take place at baseline, post-therapy, and at 6-month and 12-month intervals after smoking cessation. DISCUSSION There is a high demand for long-term effective smoking cessation therapies. This study represents the first prospective RCT to examine the long-term efficacy of a residential smoking cessation therapy program compared to standard outpatient group therapy as an active control condition. The residential therapeutic concept may serve as a new model to substantially enhance future cessation therapies and improve the understanding of therapeutic impact factors on tobacco abstinence. Utilizing a mobile team, the model could be applied efficiently to medical centers that do not have permanent and trained personnel for smoking cessation at their disposal. TRIAL REGISTRATION German Register for Clinical Trials (Deutsches Register für Klinische Studien), DRKS00013466. Retrospectively registered on 1 April 2019. https://www.drks.de/drks_web/navigate.do?navigationId=start.
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Affiliation(s)
- Jonas Dickreuter
- Comprehensive Cancer Center, Prevention Team CMPT, University Medical Center Freiburg, Elsässerstraße 2, 79110, Freiburg, Germany.
| | - Claudia Schmoor
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University Medical Center Freiburg, Elsässerstraße 2, 79110 Freiburg, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Engelberger Straße 41, 79085, Freiburg, Germany
| | - Andreas Jähne
- Rhein-Jura Klinik, Schneckenhalde 13, 79713, Bad Säckingen, Germany
| | - Jens A Leifert
- Comprehensive Cancer Center, Prevention Team CMPT, University Medical Center Freiburg, Elsässerstraße 2, 79110, Freiburg, Germany
- Breisgau-Klinik, Herbert-Hellmann-Allee 37, 79189, Bad Krozingen, Germany
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Boettiger DC, Newall AT, Chattranukulchai P, Chaiwarith R, Khusuwan S, Avihingsanon A, Phillips A, Bendavid E, Law MG, Kahn JG, Ross J, Bautista‐Arredondo S, Kiertiburanakul S. Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost-effectiveness analysis. J Int AIDS Soc 2020; 23 Suppl 1:e25494. [PMID: 32562359 PMCID: PMC7305414 DOI: 10.1002/jia2.25494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/20/2020] [Accepted: 03/31/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION People living with HIV (PLHIV) have an elevated risk of atherosclerotic cardiovascular disease (CVD) compared to their HIV-negative peers. Expanding statin use may help alleviate this burden. However, the choice of statin in the context of antiretroviral therapy is challenging. Pravastatin and pitavastatin improve cholesterol levels in PLHIV without interacting substantially with antiretroviral therapy. They are also more expensive than most statins. We evaluated the cost-effectiveness of pravastatin and pitavastatin for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid-lowering therapy. METHODS We developed a discrete-state microsimulation model that randomly selected (with replacement) individuals from the TREAT Asia HIV Observational Database cohort who were aged 40 to 75 years, receiving antiretroviral therapy in Thailand, and not using lipid-lowering therapy. The model simulated each individual's probability of experiencing CVD. We evaluated: (1) treating no one with statins; (2) treating everyone with pravastatin 20mg/day (drug cost 7568 Thai Baht ($US243)/year) and (3) treating everyone with pitavastatin 2 mg/day (drug cost 8182 Baht ($US263)/year). Direct medical costs and quality-adjusted life-years (QALYs) were assigned in annual cycles over a 20-year time horizon and discounted at 3% per year. We assumed the Thai healthcare sector perspective. RESULTS Pravastatin was estimated to be less effective and less cost-effective than pitavastatin and was therefore dominated (extended) by pitavastatin. Patients receiving pitavastatin accumulated 0.042 additional QALYs compared with those not using a statin, at an extra cost of 96,442 Baht ($US3095), giving an incremental cost-effectiveness ratio of 2,300,000 Baht ($US73,812)/QALY gained. These findings were sensitive to statin costs and statin efficacy, pill burden, and targeting of PLHIV based on CVD risk. At a willingness-to-pay threshold of 160,000 Baht ($US5135)/QALY gained, we estimated that pravastatin would become cost-effective at an annual cost of 415 Baht ($US13.30)/year and pitavastatin would become cost-effective at an annual cost of 600 Baht ($US19.30)/year. CONCLUSIONS Neither pravastatin nor pitavastatin were projected to be cost-effective for the primary prevention of CVD among PLHIV in Thailand who are not currently using lipid-lowering therapy. We do not recommend expanding current use of these drugs among PLHIV in Thailand without substantial price reduction.
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Affiliation(s)
- David C Boettiger
- Kirby InstituteUNSW SydneySydneyNSWAustralia
- Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Anthony T Newall
- The School of Public Health and Community MedicineUNSW SydneySydneyNSWAustralia
| | | | - Romanee Chaiwarith
- Research Institute for Health SciencesChiang Mai UniversityChiang MaiThailand
| | | | - Anchalee Avihingsanon
- The Thai Red Cross AIDS Research Centre and Faculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Andrew Phillips
- Institute for Global HealthUniversity College LondonUnited Kingdom
| | - Eran Bendavid
- Center for Health Policy and the Center for Primary Care and Outcomes ResearchStanford UniversityStanfordCAUSA
| | | | - James G Kahn
- Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoCAUSA
| | - Jeremy Ross
- TREAT Asia/amfAR–Foundation for AIDS ResearchBangkokThailand
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Assumpção RP, Bahia LR, da Rosa MQM, Correia MG, da Silva EN, Zubiaurre PR, Mottin CC, Vianna DA. Cost-Utility of Gastric Bypass Surgery Compared to Clinical Treatment for Severely Obese With and Without Diabetes in the Perspective of the Brazilian Public Health System. Obes Surg 2020; 29:3202-3211. [PMID: 31214966 DOI: 10.1007/s11695-019-03957-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Obesity is associated with increased morbidity and mortality. Weight loss due to gastric bypass (GBP) surgery improves clinical outcomes and may be a cost-effective intervention. To estimate the cost-effectiveness of GBP compared to clinical treatment in severely obese individuals with and without diabetes in the perspective of the Brazilian public health system. MATERIALS AND METHODS A Markov model was developed to compare costs and outcomes of gastric bypass in an open approach to clinical treatment. Health states were living with diabetes, remission of diabetes, non-fatal and fatal myocardial infarction, and death. We also included the occurrence of complications related to surgery and plastic surgery after the gastric bypass surgery. The direct costs were obtained from primary data collection performed in three public reference centers for obesity treatment. Utility values also derived from this cohort, while transition probabilities came from the international literature. A sensitivity analysis was performed to evaluate uncertainties. The model considered a 10-year time horizon and a 5% discount rate. RESULTS Over 10 years, GBP increased quality-adjusted life years (QALY) and costs compared to clinical treatment, resulting in an incremental cost-effectiveness ratio (ICER) of Int$1820.17/QALY and Int$1937.73/QALY in individuals with and without diabetes, respectively. Sensitivity analysis showed that utility values and direct costs of treatments were the parameters that affected the most the ICERs. CONCLUSION The study demonstrated that GBP is a cost-effective intervention for severely obese individuals in the Brazilian public health system perspective, with a better result in individuals with diabetes.
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Affiliation(s)
- Roberto Pereira Assumpção
- Department of Internal Medicine, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 3° andar, Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil.
| | - Luciana Ribeiro Bahia
- Department of Internal Medicine, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 3° andar, Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil
| | - Michelle Quarti Machado da Rosa
- Department of Internal Medicine, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 3° andar, Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil
| | - Marcelo Goulart Correia
- Biostatistics and Bioinformatics Department, National Institute of Cardiology, Rio de Janeiro, Brazil
| | - Everton Nunes da Silva
- Department of Public Health, University of Brasilia,, Centro Metropolitano, conjunto A, lote 01, Brasília, Distrito Federal, 72.220-275, Brazil
| | - Paula Rosales Zubiaurre
- Center of Morbid Obesity, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga 6690/302, Porto Alegre, Rio Grande do Sul, 90610-000, Brazil
| | - Claudio Corá Mottin
- Center of Morbid Obesity, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga 6690/302, Porto Alegre, Rio Grande do Sul, 90610-000, Brazil
| | - Denizar Araujo Vianna
- Department of Internal Medicine, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 3° andar, Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil
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Sroczynski G, Gogollari A, Kuehne F, Hallsson LR, Widschwendter M, Pashayan N, Siebert U. A Systematic Review on Cost-effectiveness Studies Evaluating Ovarian Cancer Early Detection and Prevention Strategies. Cancer Prev Res (Phila) 2020; 13:429-442. [PMID: 32071120 DOI: 10.1158/1940-6207.capr-19-0506] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/01/2020] [Accepted: 02/14/2020] [Indexed: 11/16/2022]
Abstract
Ovarian cancer imposes a substantial health and economic burden. We systematically reviewed current health-economic evidence for ovarian cancer early detection or prevention strategies. Accordingly, we searched relevant databases for cost-effectiveness studies evaluating ovarian cancer early detection or prevention strategies. Study characteristics and results including quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICER) were summarized in standardized evidence tables. Economic results were transformed into 2017 Euros. The included studies (N = 33) evaluated ovarian cancer screening, risk-reducing interventions in women with heterogeneous cancer risks and genetic testing followed by risk-reducing interventions for mutation carriers. Multimodal screening with a risk-adjusted algorithm in postmenopausal women achieved ICERs of 9,800-81,400 Euros/QALY, depending on assumptions on mortality data extrapolation, costs, test performance, and screening frequency. Cost-effectiveness of risk-reducing surgery in mutation carriers ranged from cost-saving to 59,000 Euros/QALY. Genetic testing plus risk-reducing interventions for mutation carriers ranged from cost-saving to 54,000 Euros/QALY in women at increased mutation risk. Our findings suggest that preventive surgery and genetic testing plus preventive surgery in women at high risk for ovarian cancer can be considered effective and cost-effective. In postmenopausal women from the general population, multimodal screening using a risk-adjusted algorithm may be cost-effective.
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Affiliation(s)
- Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Artemisa Gogollari
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Division of Health Technology Assessment, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Felicitas Kuehne
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
| | - Lára R Hallsson
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria
- Division of Health Technology Assessment, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | | | - Nora Pashayan
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall i.T., Austria.
- Division of Health Technology Assessment, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Haddad R, Cohen EEW, Venkatachalam M, Young K, Singh P, Shaw JW, Korytowsky B, Abraham P, Harrington KJ. Cost-effectiveness analysis of nivolumab for the treatment of squamous cell carcinoma of the head and neck in the United States. J Med Econ 2020; 23:442-447. [PMID: 31928375 DOI: 10.1080/13696998.2020.1715414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Aim: To assess the cost-effectiveness of nivolumab monotherapy for recurrent/metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) in the US.Methods: We constructed a cohort-based partitioned survival model for three health states (progression-free, progressed disease, and death). Using overall survival and progression-free survival data from the nivolumab and investigator's choice (IC) arms of the CheckMate 141 study, the proportion of patients in each health state was estimated by parametric modeling over a 25-year period. Cost, utility, adverse event, and disease management data inputs were obtained from relevant literature and applied to patients in each health state. A scenario analysis was conducted assuming increased uptake of subsequent immunotherapies. A one-way deterministic sensitivity analysis assessed the impact of variation in multiple parameters. A probabilistic sensitivity analysis in which probabilistic distributions were applied to each input during 1,000 model iterations was also conducted.Results: Total costs incurred were higher with nivolumab ($101,552) than with IC ($38,067). Nivolumab was associated with a higher number of life-years (LY; 1.21) and quality-adjusted life-years (QALYs; 0.89), compared with IC (0.68 and 0.42, respectively). The incremental cost-effectiveness ratio for nivolumab compared with IC was $134,438 per QALY, and this remained qualitatively similar when increased uptake of subsequent immunotherapies was assumed ($129,603 per QALY). Sensitivity analyses supported these findings.Conclusions: These results suggest that, at a willingness-to-pay threshold of $150,000 per QALY, nivolumab is a cost-effective option for therapy of SCCHN in the US.
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Affiliation(s)
| | - Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | | | | | | | | | | | | | - Kevin J Harrington
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, UK
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van der Vliet N, Suijkerbuijk AW, de Blaeij AT, de Wit GA, van Gils PF, Staatsen BA, Maas R, Polder JJ. Ranking Preventive Interventions from Different Policy Domains: What Are the Most Cost-Effective Ways to Improve Public Health? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062160. [PMID: 32213919 PMCID: PMC7142580 DOI: 10.3390/ijerph17062160] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 12/15/2022]
Abstract
It is widely acknowledged that in order to promote public health and prevent diseases, a wide range of scientific disciplines and sectors beyond the health sector need to be involved. Evidence-based interventions, beyond preventive health interventions targeting disease risk factors and interventions from other sectors, should be developed and implemented. Investing in these preventive health policies is challenging as budgets have to compete with other governmental expenditures. The current study aimed to identify, compare and rank cost-effective preventive interventions targeting metabolic, environmental, occupational and behavioral risk factors. To identify these interventions, a literature search was performed including original full economic evaluations of Western country interventions that had not yet been implemented in the Netherlands. Several workshops were held with experts from different disciplines. In total, 51 different interventions (including 13 cost saving interventions) were identified and ranked based on their incremental cost-effectiveness ratio (ICER) and potential averted disability-adjusted life years (DALYs), resulting in two rankings of the most cost-effective interventions and one ranking of the 13 cost saving interventions. This approach, resulting in an intersectoral ranking, can assist policy makers in implementing cost-effective preventive action that considers not only the health sector, but also other sectors.
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Affiliation(s)
- Nina van der Vliet
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
- Tilburg School of Social and Behavioral Sciences, University of Tilburg, 5000 Tilburg, The Netherlands
- Correspondence: ; Tel.: +3130-274-3816
| | - Anita W.M. Suijkerbuijk
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Adriana T. de Blaeij
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - G. Ardine de Wit
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Paul F. van Gils
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Brigit A.M. Staatsen
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Rob Maas
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
| | - Johan J. Polder
- National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands (A.T.d.B.); (G.A.d.W.); (P.F.v.G.); (R.M.); (J.J.P.)
- Tilburg School of Social and Behavioral Sciences, University of Tilburg, 5000 Tilburg, The Netherlands
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