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Kim DD, Cohen JT, Wong JB, Mohit B, Fendrick AM, Kent DM, Neumann PJ. Targeted Incentive Programs For Lung Cancer Screening Can Improve Population Health And Economic Efficiency. Health Aff (Millwood) 2019; 38:60-67. [PMID: 30615528 DOI: 10.1377/hlthaff.2018.05148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Because an intervention's clinical benefit depends on who receives it, a key to improving the efficiency of lung cancer screening with low-dose computed tomography (LDCT) is to incentivize its use among the current or former smokers who are most likely to benefit from it. Despite its clinical advantages and cost-effectiveness, only 3.9 percent of the eligible population underwent LDCT screening in 2015. Using individual lung cancer mortality risk, we developed a policy simulation model to explore the potential impact of implementing risk-targeted incentive programs, compared to either implementing untargeted incentive programs or doing nothing. We found that compared to the status quo, an untargeted incentive program that increased overall LDCT screening from 3,900 (baseline) to 10,000 per 100,000 eligible people would save 12,300 life-years and accrue a net monetary benefit (NMB) of $771 million over a lifetime horizon. Increasing screening by the same amount but targeting higher-risk people would yield an additional 2,470-6,600 life-years and an additional $210-$560 million NMB, depending on the extent of the risk-targeting. Risk-targeted incentive programs could include provider-level bonuses, health plan premium subsidies, and smoking cessation programs to maximize their impact. As clinical medicine becomes more personalized, targeting and incentivizing higher-risk people will help enhance population health and economic efficiency.
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Affiliation(s)
- David D Kim
- David D. Kim ( ) is an assistant professor of medicine in the School of Medicine, Tufts University, and an investigator in the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center, in Boston, Massachusetts
| | - Joshua T Cohen
- Joshua T. Cohen is a research associate professor of medicine in the School of Medicine, Tufts University, and deputy director of the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center
| | - John B Wong
- John B. Wong is a professor of medicine in the School of Medicine, Tufts University, and chief of the Division of Clinical Decision Making, Tufts Medical Center
| | - Babak Mohit
- Babak Mohit is a postdoctoral research fellow in the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center
| | - A Mark Fendrick
- A. Mark Fendrick is a professor in the Department of Internal Medicine, University of Michigan, in Ann Arbor
| | - David M Kent
- David M. Kent is a professor of medicine in the School of Medicine, Tufts University, and director of the Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center
| | - Peter J Neumann
- Peter J. Neumann is a professor of medicine in the School of Medicine, Tufts University, and director of the Center for the Evaluation of Value and Risk in Health, Tufts Medical Center
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Shields GE, Buck D, Elvidge J, Hayhurst KP, Davies LM. Cost-Effectiveness Evaluations of Psychological Therapies for Schizophrenia and Bipolar Disorder: A Systematic Review. Int J Technol Assess Health Care 2019; 35:317-326. [PMID: 31328702 PMCID: PMC6707812 DOI: 10.1017/s0266462319000448] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This review aims to assess the cost-effectiveness of psychological interventions for schizophrenia/bipolar disorder (BD), to determine the robustness of current evidence and identify gaps in the available evidence. METHODS Electronic searches (PsycINFO, MEDLINE, Embase) identified economic evaluations relating incremental cost to outcomes in the form of an incremental cost-effectiveness ratio published in English since 2000. Searches were concluded in November 2018. Inclusion criteria were: adults with schizophrenia/BD; any psychological/psychosocial intervention (e.g., psychological therapy and integrated/collaborative care); probability of cost-effectiveness at explicitly defined thresholds reported. Comparators could be routine practice, no intervention, or alternative psychological therapies. Screening, data extraction, and critical appraisal were performed using pre-specified criteria and forms. Results were summarized qualitatively. The protocol was registered on the PROSPERO database (CRD42017056579). RESULTS Of 3,864 studies identified, 12 met the criteria for data extraction. All were integrated clinical and economic randomized controlled trials. The most common intervention was cognitive behavioral therapy (CBT, 6/12 studies). The most common measure of health benefit was the quality-adjusted life-year (6/12). Follow-up ranged from 6 months to 5 years. Interventions were found to be cost-effective in most studies (9/12): the probability of cost-effectiveness ranged from 35-99.5 percent. All studies had limitations and demonstrated uncertainty (particularly related to incremental costs). CONCLUSIONS Most studies concluded psychological interventions for schizophrenia/BD are cost-effective, including CBT, although there was notable uncertainty. Heterogeneity across studies makes it difficult to reach strong conclusions. There is a particular need for more evidence in the population with BD and for longer-term evidence across both populations.
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Affiliation(s)
| | - Deborah Buck
- Personal and Social Services Research Unit, University of Manchester
| | - Jamie Elvidge
- National Institute for Health and Care Excellence, United Kingdom
| | | | - Linda Mary Davies
- Centre for Health Economics, Division of Population Health, University of Manchester
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Pu H, Doig GS, Heighes PT, Allingstrup MJ, Wang A, Brereton J, Pollock C, Chesher D, Bellomo R. Intravenous amino acid therapy for kidney protection in cardiac surgery patients: A pilot randomized controlled trial. J Thorac Cardiovasc Surg 2019; 157:2356-2366. [DOI: 10.1016/j.jtcvs.2018.11.097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 01/21/2023]
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Windegger TM, Nghiem S, Nguyen KH, Fung YL, Scuffham PA. Cost-utility analysis comparing hospital-based intravenous immunoglobulin with home-based subcutaneous immunoglobulin in patients with secondary immunodeficiency. Vox Sang 2019; 114:237-246. [PMID: 30883804 DOI: 10.1111/vox.12760] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVE Immunoglobulin replacement therapy (IRT) is often used to support patients with primary immunodeficiency disease (PID) and secondary immunodeficiency disease (SID). Home-based subcutaneous immunoglobulin (SCIg) is reported to be a cheaper and more efficient option compared to hospital-based intravenous immunoglobulin (IVIg) for PID. In contrast, there is little information on the cost-effectiveness of IRT in SID. However, patients who develop hypogammaglobulinaemia secondary to other conditions (SID) have different clinical aetiology compared to PID. This study assesses whether SCIg provides a good value-for-money treatment option in patients with secondary immunodeficiency disease (SID). METHODS A Markov cohort simulation model with six health states was used to compare cost-effectiveness of IVIg with SCIg from a healthcare system perspective. The costs of treatment, infection and quality-adjusted life years (QALYs) for IVIg and SCIg treatment options were modelled with a time horizon of 10 years and weekly cycles. Deterministic and probabilistic sensitivity analyses were performed around key parameters. RESULTS The cumulative cost for IVIg was A$151 511 and for SCIg A$144 296. The QALYs with IVIg were 3·07 and with SCIg 3·51. Based on the means, SCIg is the dominant strategy with better outcomes and at lower cost. The probabilistic sensitivity analysis shows that 88·3% of the 50 000 iterations fall below the nominated willingness to pay threshold of A$50 000 per QALY. Therefore, SCIg is a cost-effective treatment option. CONCLUSION For SID patients in Queensland (Australia), the home-based SCIg treatment option provides better health outcomes and cost savings.
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Affiliation(s)
- Tanja M Windegger
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Son Nghiem
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Kim-Huong Nguyen
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Qld, 4072, Australia.,Health Service Strategy and Planning, Metro North Hospital and Health Services, Brisbane, Qld, 4029, Australia
| | - Yoke-Lin Fung
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
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Huang SJ, Galárraga O, Smith KA, Fuimaono S, McGarvey ST. Cost-effectiveness analysis of a cluster-randomized, culturally tailored, community health worker home-visiting diabetes intervention versus standard care in American Samoa. HUMAN RESOURCES FOR HEALTH 2019; 17:17. [PMID: 30836964 PMCID: PMC6402127 DOI: 10.1186/s12960-019-0356-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/17/2019] [Indexed: 05/27/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is highly prevalent in American Samoa. Community health worker (CHW) interventions may improve T2DM care and be cost-effective. Current cost-effectiveness analyses (CEA) of CHW interventions have either overlooked important cost considerations or not been based on randomized clinical trials (RCTs). The Diabetes Care in American Samoa (DCAS) intervention which occurred in 2009-2010 was a cluster-randomized, culturally tailored, home-visiting CHW intervention and improved HbA1c levels. OBJECTIVE To analyze the cost-effectiveness of the DCAS intervention against standard care using a RCT in a low-resource setting. METHODS We collected clinical, utilization, and cost data over 2 years and modeled quality-adjusted life years (QALYs) gained based on the RCT glycated hemoglobin (HbA1c) improvements. We calculated an incremental cost-effectiveness ratio (ICER) from the societal perspective over a 2-year time horizon and reported all costs in 2012 USD ($). RESULTS Two hundred sixty-eight American Samoans diagnosed with T2DM were cluster randomized into the CHW (n = 104) or standard care control (n = 164) arms. The CHW arm had a mean reduction of 0.53% in HbA1c, an increase of $594 in cost, and an increase of 0.05 QALYs. The ICER for the CHW arm compared to the control arm was $1121 per percentage point HbA1c reduced and $13 191 per QALY gained. CONCLUSIONS Compared to a variety of willingness-to-pay thresholds from $39 000 to $154 353 per QALY gained, this ICER shows that the CHW intervention is highly cost-effective. Future studies of the cost-effectiveness of CHW T2DM interventions in similar settings should model lifetime costs and QALYs gained to better assess long-term cost-effectiveness. TRIAL REGISTRATION ClinicalTrials.gov , ID NCT00850824. Registered 9 February 2009, https://clinicaltrials.gov/ct2/show/NCT00850824 .
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Affiliation(s)
- Shuo J. Huang
- Department of Epidemiology, International Health Institute, Brown University School of Public Health, Box G-S -121-2, Providence, RI 02912 United States of America
- Department of Health Services Administration, University of Maryland School of Public Health, College Park, MD United States of America
| | - Omar Galárraga
- Department of Health Services, Policy, and Practice, International Health Institute, Brown University School of Public Health, Providence, RI United States of America
| | - Kelley A. Smith
- Department of Epidemiology, International Health Institute, Brown University School of Public Health, Box G-S -121-2, Providence, RI 02912 United States of America
| | | | - Stephen T. McGarvey
- Department of Epidemiology, International Health Institute, Brown University School of Public Health, Box G-S -121-2, Providence, RI 02912 United States of America
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Moradi N, Rashidian A, Nosratnejad S, Olyaeemanesh A, Zanganeh M, Zarei L. Willingness to pay for one quality-adjusted life year in Iran. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:4. [PMID: 30867654 PMCID: PMC6396529 DOI: 10.1186/s12962-019-0172-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 02/12/2019] [Indexed: 02/27/2024] Open
Abstract
Background Recent years have witnessed a strong tendency to apply economic evidence as a guide for making health resource allocation decisions, especially those related to reimbursement policies. One such measure is the use of the cost-effectiveness threshold as a benchmark. This study explored the threshold for use in the health system of Iran by determining society’s preferences. Methods A cross-sectional household survey based on the contingent valuation method was administered to a representative general population of 1002 in Tehran, Iran from April to June 2015. The survey was intended to estimate the respondents’ willingness-to-pay (WTP) preferences for one quality-adjusted life year (QALY) gained. The valuation scenarios featured 12 vignettes on mild to severe diseases that can change people’s quality of life. The mean of WTP for QALY was estimated using different health instruments, and the determinants of such willingness were analyzed using the Heckman selection model. Results WTP for QALY varied depending on the severity of a disease and the instrument used to determine health preferences. Mean low health state value were associated with high valuation. The best estimated WTP values ranged from US$1032 to US$2666 and 0.22–0.56 of Iran’s local gross domestic product (GDP) per capita in 2014. Except for educational level, significant variables differed across different disease scenarios. Generally, a high health state valuation for target diseases, high income, high educational level, and being married were associated with high WTP for QALY. Conclusion From the general public’s perspective, the monetary value of QALY for mild to severe diseases with no risk of death was less than one GDP per capita. Therefore, the obtained valuation range is recommended as reference only for the adoption of interventions designed to improve quality of life. Future studies should estimate the threshold of interventions for life-threatening diseases or formulate transparent policies in such contexts. Electronic supplementary material The online version of this article (10.1186/s12962-019-0172-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Najmeh Moradi
- 1Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- 2School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Nosratnejad
- 3Iranian Center of Excellence in Health Service Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Olyaeemanesh
- 4Health Economics Department, National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Marzieh Zanganeh
- 5Health Insurance Office, Ministry of Health and Medical Education, Tehran, Iran
| | - Leila Zarei
- 6Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Kanis JA, Cooper C, Rizzoli R, Reginster JY. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2019; 30:3-44. [PMID: 30324412 PMCID: PMC7026233 DOI: 10.1007/s00198-018-4704-5] [Citation(s) in RCA: 904] [Impact Index Per Article: 180.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/12/2018] [Indexed: 12/25/2022]
Abstract
Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis. INTRODUCTION The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2013. This manuscript updates these in a European setting. METHODS Systematic reviews were updated. RESULTS The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; monitoring of treatment; assessment of fracture risk; case-finding strategies; investigation of patients; health economics of treatment. The update includes new information on the evaluation of bone microstructure evaluation in facture risk assessment, the role of FRAX® and Fracture Liaison Services in secondary fracture prevention, long-term effects on fracture risk of dietary intakes, and increased fracture risk on stopping drug treatment. CONCLUSIONS A platform is provided on which specific guidelines can be developed for national use.
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Affiliation(s)
- J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK.
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia.
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - R Rizzoli
- University Hospitals and Faculty of Medicine of Geneva, Geneva, Switzerland
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Prince Mutaib Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Poder TG. Challenges to make cost-effectiveness studies usable by decision makers. J Thorac Cardiovasc Surg 2018; 156:1931-1932. [DOI: 10.1016/j.jtcvs.2018.05.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 11/17/2022]
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Moayeri F, Dunt D, Hsueh YSA, Doyle C. Cost-utility analysis of telephone-based cognitive behavior therapy in chronic obstructive pulmonary disease (COPD) patients with anxiety and depression comorbidities: an application for willingness to accept concept. Expert Rev Pharmacoecon Outcomes Res 2018; 19:331-340. [PMID: 30324818 DOI: 10.1080/14737167.2019.1536550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND This study evaluated the cost-utility of telephone-based cognitive behavioral therapy (TB-CBT) (experimental arm) in comparison with a placebo-befriending (control arm) program in COPD participants with mild to severe depression and/or anxiety. METHODS The decision rule was based on willingness-to-pay if there is an increased unit of effectiveness (a quality-adjusted life year [QALY] gain) and an increase in cost, and willingness-to-accept (WTA) if there is a reduced unit of effectiveness (a QALY loss) and decrease in cost (a cost-saving). RESULTS TB-CBT group was associated with a reduction in the incremental cost of AUS-$407.3 (p < 0.001, SE:34.1) plus a negative, nonsignificant incremental QALY gain of -0.008 (SE:0.011) per patient compared to control group. The point estimate of the mean incremental cost-utility ratio was AUS$50,284.0 cost saving per QALY sacrificed (the high value associated with small QALY value in the denominator). Ninety-five percent CI was AUS$13,426 cost sacrificed to AUS$32,018 cost gain (lower values associated with larger QALY values in the denominator). If the societal's minimum (flooring threshold) WTA is AUS$64,000 per QALY forgone, the probability of TB-CBT being cost-effective was 42% Conclusions: This study showed that TB-CBT can be recommended as a cost-saving and preventive approach over usual care plus befriending program.
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Affiliation(s)
- Foruhar Moayeri
- a Centre for Health Policy, Melbourne School of Population and Global Health , The University of Melbourne , Carlton Victoria , Australia
| | - David Dunt
- a Centre for Health Policy, Melbourne School of Population and Global Health , The University of Melbourne , Carlton Victoria , Australia
| | - Ya-Seng Arthur Hsueh
- a Centre for Health Policy, Melbourne School of Population and Global Health , The University of Melbourne , Carlton Victoria , Australia
| | - Colleen Doyle
- b Australian Catholic University, Faculty of Health Sciences , School of Behavioural and Health Sciences (VIC), Villa Maria Catholic Homes , Kew Victoria , Australia
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Shafrin J, Skornicki M, Brauer M, Villeneuve J, Lees M, Hertel N, Penrod JR, Jansen J. An exploratory case study of the impact of expanding cost-effectiveness analysis for second-line nivolumab for patients with squamous non-small cell lung cancer in Canada: Does it make a difference? Health Policy 2018; 122:607-613. [DOI: 10.1016/j.healthpol.2018.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 04/05/2018] [Accepted: 04/19/2018] [Indexed: 12/31/2022]
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Ryu WHA, Yang MMH, Muram S, Jacobs WB, Casha S, Riva-Cambrin J. Systematic review of health economic studies in cranial neurosurgery. Neurosurg Focus 2018; 44:E2. [PMID: 29712519 DOI: 10.3171/2018.2.focus17792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE As the cost of health care continues to increase, there is a growing emphasis on evaluating the relative economic value of treatment options to guide resource allocation. The objective of this systematic review was to evaluate the current evidence regarding the cost-effectiveness of cranial neurosurgery procedures. METHODS The authors performed a systematic review of the literature using PubMed, EMBASE, and the Cochrane Library, focusing on themes of economic evaluation and cranial neurosurgery following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Included studies were publications of cost-effectiveness analysis or cost-utility analysis between 1995 and 2017 in which health utility outcomes in life years (LYs), quality-adjusted life years (QALYs), or disability-adjusted life years (DALYs) were used. Three independent reviewers conducted the study appraisal, data abstraction, and quality assessment, with differences resolved by consensus discussion. RESULTS In total, 3485 citations were reviewed, with 53 studies meeting the inclusion criteria. Of those, 34 studies were published in the last 5 years. The most common subspecialty focus was cerebrovascular (32%), followed by neurooncology (26%) and functional neurosurgery (24%). Twenty-eight (53%) studies, using a willingness to pay threshold of US$50,000 per QALY or LY, found a specific surgical treatment to be cost-effective. In addition, there were 11 (21%) studies that found a specific surgical option to be economically dominant (both cost saving and having superior outcome), including endovascular thrombectomy for acute ischemic stroke, epilepsy surgery for drug-refractory epilepsy, and endoscopic pituitary tumor resection. CONCLUSIONS There is an increasing number of cost-effectiveness studies in cranial neurosurgery, especially within the last 5 years. Although there are numerous procedures, such as endovascular thrombectomy for acute ischemic stroke, that have been conclusively proven to be cost-effective, there remain promising interventions in current practice that have yet to meet cost-effectiveness thresholds.
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Affiliation(s)
- Won Hyung A Ryu
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - Michael M H Yang
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - Sandeep Muram
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - W Bradley Jacobs
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - Steven Casha
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
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Thokala P, Ochalek J, Leech AA, Tong T. Cost-Effectiveness Thresholds: the Past, the Present and the Future. PHARMACOECONOMICS 2018; 36:509-522. [PMID: 29427072 DOI: 10.1007/s40273-017-0606-1] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Cost-effectiveness (CE) thresholds are being discussed more frequently and there have been many new developments in this area; however, there is a lack of understanding about what thresholds mean and their implications. This paper provides an overview of the CE threshold literature. First, the meaning of a CE threshold and the key assumptions involved (perfect divisibility, marginal increments in budget, etc.) are highlighted using a hypothetical example, and the use of historic/heuristic estimates of the threshold is noted along with their limitations. Recent endeavours to estimate the empirical value of the thresholds, both from the supply side and the demand side, are then presented. The impact on CE thresholds of future directions for the field, such as thresholds across sectors and the incorporation of multiple criteria beyond quality-adjusted life-years as a measure of 'value', are highlighted. Finally, a number of common issues and misconceptions associated with CE thresholds are addressed.
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Affiliation(s)
- Praveen Thokala
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Jessica Ochalek
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
| | - Ashley A Leech
- Center for the Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, Boston, MA, 02111, USA
| | - Thaison Tong
- Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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Andronis L, Goranitis I, Bayliss S, Duarte R. Cost-Effectiveness of Treatments for the Management of Bone Metastases: A Systematic Literature Review. PHARMACOECONOMICS 2018; 36:301-322. [PMID: 29224174 DOI: 10.1007/s40273-017-0595-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Metastatic cancers occur when cancer cells break away from the primary tumour. One of the most common sites of metastasis is the bone, with several therapeutic options currently available for managing bone metastases. In a resource-constrained environment, policy makers and practitioners need to know which options are cost effective. OBJECTIVE The aim of this systematic review was to review and appraise published economic evaluations on treatments for the management of bone metastases. METHODS We searched eight bibliographic databases (MEDLINE, MEDLINE in Process, EMBASE, CSDR, DARE, HTA, EED and CPCI) for relevant economic evaluations published from each database's inception date until March 2017. Study selection, quality assessment and data extraction were carried out according to published guidelines. RESULTS Twenty-four relevant economic analyses were identified. Seventeen of these studies focused on bone metastases resulting from a particular type of cancer, i.e. prostate (n = 8), breast (n = 7), lung (n = 1) or renal (n = 1), while seven report results for various primary tumours. Across types of cancer, evidence suggests that bisphosphonates result in lower morbidity and improved quality of life, for an additional cost, which is typically below conventional cost-effectiveness thresholds. While denosumab leads to health gains compared with zoledronic acid, it also results in substantial additional costs and is unlikely to represent value for money. The limited literature on the radiopharmaceutical strontium-89 (Sr89) and external beam radiotherapy (EBR) suggest that these treatments are cost effective compared with no treatment. CONCLUSIONS The reviewed evidence suggests that bisphosphonate treatments are cost-effective options for bone metastases, while denosumab is unlikely to represent value for money. Evidence on EBR and Sr89 is limited and less conclusive.
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Affiliation(s)
- Lazaros Andronis
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- Office A.103, Populations, Evidence and Technologies Group, Division of Health Sciences, University of Warwick, Coventry, CV4 7AL, UK.
| | - Ilias Goranitis
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sue Bayliss
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rui Duarte
- Liverpool Reviews and Implementation Group, Department of Health Services Research, University of Liverpool, Liverpool, UK
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Cameron D, Ubels J, Norström F. On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review. Glob Health Action 2018; 11:1447828. [PMID: 29564962 PMCID: PMC5930346 DOI: 10.1080/16549716.2018.1447828] [Citation(s) in RCA: 198] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/26/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The amount a government should be willing to invest in adopting new medical treatments has long been under debate. With many countries using formal cost-effectiveness (C/E) thresholds when examining potential new treatments and ever-growing medical costs, accurately setting the level of a C/E threshold can be essential for an efficient healthcare system. OBJECTIVES The aim of this systematic review is to describe the prominent approaches to setting a C/E threshold, compile available national-level C/E threshold data and willingness-to-pay (WTP) data, and to discern whether associations exist between these values, gross domestic product (GDP) and health-adjusted life expectancy (HALE). This review further examines current obstacles faced with the presently available data. METHODS A systematic review was performed to collect articles which have studied national C/E thresholds and willingness-to-pay (WTP) per quality-adjusted life year (QALY) in the general population. Associations between GDP, HALE, WTP, and C/E thresholds were analyzed with correlations. RESULTS Seventeen countries were identified from nine unique sources to have formal C/E thresholds within our inclusion criteria. Thirteen countries from nine sources were identified to have WTP per QALY data within our inclusion criteria. Two possible associations were identified: C/E thresholds with HALE (quadratic correlation of 0.63), and C/E thresholds with GDP per capita (polynomial correlation of 0.84). However, these results are based on few observations and therefore firm conclusions cannot be made. CONCLUSIONS Most national C/E thresholds identified in our review fall within the WHO's recommended range of one-to-three times GDP per capita. However, the quality and quantity of data available regarding national average WTP per QALY, opportunity costs, and C/E thresholds is poor in comparison to the importance of adequate investment in healthcare. There exists an obvious risk that countries might either over- or underinvest in healthcare if they base their decision-making process on erroneous presumptions or non-evidence-based methodologies. The commonly referred to value of 100,000$ USD per QALY may potentially have some basis.
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Affiliation(s)
- David Cameron
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jasper Ubels
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Fredrik Norström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Mavrodi A, Aletras V, Spanou A, Niakas D. Eliciting the Monetary Value of a Quality-Adjusted Life Year in a Greek Outpatient Department in Times of Economic Austerity. PHARMACOECONOMICS - OPEN 2017; 1:291-300. [PMID: 29441505 PMCID: PMC5711751 DOI: 10.1007/s41669-017-0033-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND OBJECTIVE Contingent valuation is widely used to determine individuals' willingness to pay (WTP) for a health gain. Our study aimed to elicit an empirical estimate of the monetary value of a quality-adjusted life year (QALY) in a Greek outpatient setting in times of economic austerity and assess the impact of patients' characteristics on their valuations. METHODS We used a questionnaire as a survey tool to determine the maximum WTP for a health gain of a hypothetical therapy and to evaluate patients' health-related quality of life (EuroQoL-5D-3L) and demographic and socioeconomic characteristics. EuroQoL tariffs were used to estimate health utilities. Mean WTP values were computed and ordinary least squares regressions performed on transformed Box-Cox and logarithmic dependent WTP per QALY variables to remedy observed skewness problems. RESULTS Analyses were performed for 167 patients with utility values less than unity. Mean WTP per QALY reported was similar for both payment vehicles examined: payments made out-of-pocket (€2629) and payments made through new tax imposition (€2407). Regression results showed that higher net monthly family income was associated with higher WTP per QALY for both payment vehicles. Moreover, the presence of a chronic condition and higher level of education were associated with higher out-of-pocket WTP per QALY and WTP per QALY through taxes, respectively. CONCLUSION The very low WTP per QALY estimates could be explained by the recent severe economic depression and austerity in Greece. In fact, family income was found to be a significant predictor of WTP per QALY. Since these estimates deviate significantly from the cost-effectiveness thresholds still employed in economic evaluations in this country, research should be undertaken promptly to further examine this important issue using a nationwide representative sample of the general population along with WTP and other methodologies.
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Affiliation(s)
- A Mavrodi
- Department of Business Administration, University of Macedonia, 156 Egnatia Str., Thessaloniki, 54636, Greece
| | - V Aletras
- Department of Business Administration, University of Macedonia, 156 Egnatia Str., Thessaloniki, 54636, Greece.
- School of Social Sciences, Hellenic Open University, 18 Parodos Aristotelous Str.,, 26335, Patra, Greece.
| | - A Spanou
- School of Social Sciences, Hellenic Open University, 18 Parodos Aristotelous Str.,, 26335, Patra, Greece
| | - D Niakas
- School of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, Athens, 11527, Greece
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Asgeirsdottir TL, Birgisdottir KH, Ólafsdóttir T, Olafsson SP. A compensating income variation approach to valuing 34 health conditions in Iceland. ECONOMICS AND HUMAN BIOLOGY 2017; 27:167-183. [PMID: 28709119 DOI: 10.1016/j.ehb.2017.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 06/06/2017] [Accepted: 06/06/2017] [Indexed: 06/07/2023]
Abstract
Using data from an Icelandic health-and-lifestyle survey carried out in 2007, 2009, and 2012, we employ a compensating income variation (CIV) approach to estimate the monetary value sufficient to compensate individuals for the presence of various sub-optimal health conditions. This method is inexpensive and easy on subjects and has been applied to several desiderata that do not have revealed market prices. The CIV literature is, however, still limited in its application to health and thus information about its suitability is limited. With the aim of shedding light on the method́s appropriateness we thus provide a broad-view analysis including a spectrum of diseases and conditions that can be held up against more traditionally used methods. CIV for physical conditions vary greatly, but paralysis, fibromyalgia, chronic back pain, rheumatoid arthritis, urinary incontinence, severe headache and thyroid disease were among those consistently associated with substantial well-being reductions. Mental-health results using this method should be read with caution. The societal value of health interventions is multidimensional, including for example increased productivity in the population. However, one of the main positive aspects of increased health is undoubtedly the increased well-being of the treated subjects. Such quality-of-life effects should thus preferably be taken into account. For this reason, information on the value individuals place on recovery from various sub-optimal health conditions is useful when it comes to prioritizing scarce capital in the health sector. It is therefore vital to estimate the importance individuals place on various health states and hold them up against each other. Furthermore, this paper has scientific value as it sheds light on attributes of a potentially useful method in health evaluations.
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Affiliation(s)
| | | | - Thorhildur Ólafsdóttir
- Faculty of Economics, University of Iceland, Oddi v/Sturlugotu, 101 Reykjavik, Iceland; Faculty of Business Administration, University of Iceland, Gimli v/Sturlugotu, 101 Reykjavik, Iceland
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67
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Schwendicke F, Stolpe M, Müller F. Professional oral health care for preventing nursing home-acquired pneumonia: A cost-effectiveness and value of information analysis. J Clin Periodontol 2017; 44:1236-1244. [DOI: 10.1111/jcpe.12775] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry; Charité - Universitätsmedizin Berlin; Berlin Germany
| | | | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics; University Clinics of Dental Medicine; Geneva Switzerland
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Parker SL, Chotai S, Devin CJ, Tetreault L, Mroz TE, Brodke DS, Fehlings MG, McGirt MJ. Bending the Cost Curve-Establishing Value in Spine Surgery. Neurosurgery 2017; 80:S61-S69. [PMID: 28350948 DOI: 10.1093/neuros/nyw081] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/31/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As publically promoted by all stakeholders in health care reform, prospective outcomes registry platforms lie at the center of all current evidence-driven value-based models. OBJECTIVE To demonstrate the variability in outcomes and cost at population level and individual patient level for patients undergoing spine surgery for degenerative diseases. METHODS Retrospective analysis of prospective longitudinal spine registry data was conducted. Baseline and postoperative 1-year patient-reported outcomes were recorded. Previously published minimal clinically important difference for Oswestry Disability Index (14.9) was used. Back-related resource utilization and quality-adjusted life years (QALYs) were assessed. Variations in outcomes and cost were analyzed at population level and at the individual patient level. RESULTS A total of 1454 patients were analyzed. There was significant improvement in patient-reported outcomes at postoperative 1 year ( P < .0001). For patients demonstrating health benefit at population level, 12.5%, n = 182 of patients experienced no gain from surgery and 38%, n = 554 failed to achieve minimal clinically important difference. Mean 1-year QALY-gained was 0.29; 18% of patients failed to report gain in QALY. For patients with 2-year follow-up, surgery resulted in 0.62 QALY-gained at average direct cost of $28 953. A wide variation in both QALY-gained and cost was observed. CONCLUSION Spine treatments that on average are cost-effective may have wide variability in value at the individual patient level. The variability demonstrated here represents an opportunity, through registries, to identify specific care that may be less effective, and refine patient-specific care delivery and indications to drive overall group-level treatment value. Understanding value of spine care at an individualized as well as population level will allow clinicians, and eventually payers, to better target resources for improving care for nonresponders, ultimately driving up the average health for the whole population.
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Affiliation(s)
- Scott L Parker
- Department of Orthopedics Surgery and Neurological surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Silky Chotai
- Department of Orthopedics Surgery and Neurological surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Clinton J Devin
- Department of Orthopedics Surgery and Neurological surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lindsay Tetreault
- Spinal Cord Injury Clinical Research Unit, Krembil Neuroscience Centre, University Health Network, Toronto, Canada
| | - Thomas E Mroz
- Center for Spine Health, Department of Neurosurgery and Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Darrel S Brodke
- Department of Orthopedics, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
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69
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Chew DS, Manns B, Miller RJ, Sharma N, Exner DV. Economic Evaluation of Left Ventricular Assist Devices for Patients With End Stage Heart Failure Who Are Ineligible for Cardiac Transplantation. Can J Cardiol 2017; 33:1283-1291. [DOI: 10.1016/j.cjca.2017.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/18/2017] [Accepted: 07/14/2017] [Indexed: 10/19/2022] Open
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Tan SHX, Vernazza CR, Nair R. Critical review of willingness to pay for clinical oral health interventions. J Dent 2017; 64:1-12. [PMID: 28662842 PMCID: PMC5558873 DOI: 10.1016/j.jdent.2017.06.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES This critical review aimed to identify, consolidate and evaluate the quality of Willingness to Pay (WTP) studies applied to clinical contexts in the field of dentistry. METHODS PubMed and Web of Science databases were systematically searched for relevant publications. Screening and data extraction was then performed. Primary literature in English-language were included to assess the WTP for oral health interventions, when the valuations were applied to a clinical measure. Twenty-six publications met the inclusion criteria. RESULTS WTP was elicited mainly via face-to-face interviews (13 publications) and questionnaires (12 publications). The majority (24) of publications selected an out-of-pocket payment vehicle. Eleven publications adopted a bidding method, nine publications adopted an open-ended format, and the remaining six studies adopted a payment card or choice method. Pre-testing was reported in only nine publications, and few studies accounted for starting point bias. Eight of 11 publications found that higher incomes were associated with higher WTP values. The female gender, a younger age and higher education levels were associated with a higher WTP in select studies. CONCLUSIONS Only a small minority of the studies used strategies to avoid well documented biases related to WTP elicitation. Cost versus benefit of many clinical scenarios remain uninvestigated. CLINICAL SIGNIFICANCE WTP studies in dentistry may benefit from pre-testing and the inclusion of a script to minimise hypothetical bias. They may also be better conducted face-to-face and via a shuffled payment card method. Income levels, and potentially education levels, gender and age, should be assessed for their influence on WTP values.
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Affiliation(s)
- Sharon Hui Xuan Tan
- Ministry of Health Holdings, Singapore 1 Maritime Square, 099253, Singapore.
| | - Christopher R Vernazza
- Centre for Oral Health Research, Newcastle University Framlington Place, Newcastle Upon Tyne, NE2 4BW, United Kingdom.
| | - Rahul Nair
- University of Adelaide, ARCPOH, Adelaide Dental School, Level 9, AHMS Building, Adelaide, SA 5005, Australia.
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Mbachu C, Okoli C, Onwujekwe O, Enabulele F. Willingness to pay for antiretroviral drugs among HIV and AIDS clients in south-east Nigeria. Health Expect 2017; 21:270-278. [PMID: 28805985 PMCID: PMC5750729 DOI: 10.1111/hex.12612] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The current trend of withdrawal of donor support for HIV/AIDS treatment in Nigeria may require that the cost of antiretroviral drugs be borne in part by infected people and their families. OBJECTIVE This study was conducted to determine the economic value for free antiretroviral drugs (ARVs) expressed by clients receiving treatment for HIV/AIDS in a tertiary hospital. STUDY METHOD The contingent valuation method was used to elicit the values attached to free ARVs from people living with HIV/AIDS that were receiving care in a public tertiary hospital in south-east Nigeria. Exit poll using a pre-tested questionnaire was undertaken with adult clients on treatment. The bidding game technique was used to elicit their willingness to pay (WTP) for ARVs for themselves and members of their households. Ordinary least squares (OLS) multiple regression analysis was used to test the construct validity of elicited WTP amounts. RESULTS About a third of the respondents were willing to pay for a monthly supply of ARVs for themselves and household members. The mean WTP for monthly supply of ARVs for self was US$15.32 and for household member was US$15.26 (1US$=₦160). OLS regression analysis showed that employment status and higher socio-economic status were positively associated with higher WTP. OLS showed that age and transport cost per clinic visit were negatively related to WTP. Knowing the risks of not adhering to treatment protocol was positively related to WTP. CONCLUSION The respondents positively valued the free ARVs. This calls for greater financial support for the sustainable provision of the treatment service. However, holistic financing mechanisms should be explored to ensure sustained funding in the event of complete withdrawal of donor support.
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Affiliation(s)
- Chinyere Mbachu
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.,Department of Community Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Chijioke Okoli
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Fabian Enabulele
- College of Health Sciences, Ebonyi state University, Abakaliki, Nigeria
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Moradi-Lakeh M, Yaghoubi M, Hajebi A, Malakouti SK, Vasfi MG. Cost-effectiveness of aftercare services for people with severe mental disorders: an analysis parallel to a randomised controlled clinical trial in Iran. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:1151-1159. [PMID: 28147433 DOI: 10.1111/hsc.12416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/27/2016] [Indexed: 06/06/2023]
Abstract
Aftercare services are not part of the usual care for people with severe mental disorders in Iran. This study was performed to assess the cost-effectiveness of aftercare services, including telephone follow-up or home visit, in addition to caregivers' education and training of social skills, for all subjects during the 20 months after hospital discharge. An economic evaluation was performed along with a registered randomised controlled trial (IRCT201009052557N2) on two groups of 60 persons recruited between 2010 and 2012. Intervention's effectiveness was measured by psychopathology and quality of life indicators. Cost-effectiveness and cost-utility were analysed from the societal and Ministry of Health (MoH) perspectives. All indicators of psychopathology, quality of life and satisfaction with services in the intervention group were significantly different from the control group. Mean intervention costs was US$674 (95% confidence interval [CI]: 572-776) per subject in the intervention group. Average total direct costs were US$1445 (95% CI: 1086-1804) and US$1640 (95% CI: 1087-2093) per subject in the intervention and control groups respectively. From the societal perspective, intervention had more effects with lower costs. The ratios for incremental cost-effectiveness was US$8399.1 (95% CI: 8178.2-8620.0) per quality-adjusted life year (QALY) gained from the MoH perspective for 20 months of follow-up. This study showed that aftercare services can create opportunities to use hospital beds more efficiently for unmet needs of people with psychiatric disorders. Indirect and intangible costs were not considered in this study, if taken into account, they are likely to further increase the efficiency of intervention.
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Affiliation(s)
- Maziar Moradi-Lakeh
- Institute for Health Metrics and Evaluation, Department of Global Health, University of Washington, Seattle, Washington, USA
- Preventive Medicine and Public Health Research Center, Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Yaghoubi
- Preventive Medicine and Public Health Research Center, Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Hajebi
- Research Center for Addiction & Risky Behavior (ReCARB), Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Kazem Malakouti
- Mental Health Research Center, Tehran Institute of Psychiatry, Faculty of Behavior Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad Ghadiri Vasfi
- Mental Health Research Center, Tehran Institute of Psychiatry, Faculty of Behavior Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
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Leung HWC, Chan ALF. Cost-utility of stereotactic radiation therapy versus proton beam therapy for inoperable advanced hepatocellular carcinoma. Oncotarget 2017; 8:75568-75576. [PMID: 29088891 PMCID: PMC5650446 DOI: 10.18632/oncotarget.17369] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 04/11/2017] [Indexed: 02/07/2023] Open
Abstract
The cost-utility of proton beam therapy was compared to stereotactic body radiation therapy for inoperable advanced hepatocellular carcinoma. A Markov decision-analytic model was performed following time to progression and survival using phase II trial data. Patients transitioned between three health states. Clinical outcomes were estimated for quality of life using utility estimates in the published literature and measured as incremental cost-effectiveness ratios (ICERs) and net monetary benefits (NMBs). Real direct medical costs were extracted from the Bureau of National Health Insurance database. One-way and probabilistic sensitivity analyses assessed the impact of specific variables on the model. In the base-case scenario, the modeled median survival was 16 months for proton beam therapy and 10 months for SBRT. Proton beam therapy resulted in an additional 2.61 quality-adjusted life years (QALYs) at an incremental cost of NT$ 557,907 compared to SBRT. The ICER was NT$ 213,354 per QALY gained. The probabilistic sensitivity analysis predicted a 97 % chance of proton beam therapy being cost-effective at the willingness to pay NT$2,157,024 per QALY gained. Thus, proton beam therapy is a cost-effective therapy for inoperable advanced hepatocellular carcinoma at the willingness-to-pay threshold of Taiwan.
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Affiliation(s)
- Henry W C Leung
- Department of Radiation Oncology, An Nan Hospital, China Medical University, Tainan, Taiwan.,Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Agnes L F Chan
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan.,Department of Pharmacy, An Nan Hospital, China Medical University, Tainan, Taiwan
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Pennington M, Gomes M, Donaldson C. Handling Protest Responses in Contingent Valuation Surveys. Med Decis Making 2017; 37:623-634. [PMID: 28199176 DOI: 10.1177/0272989x17691771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Protest responses, whereby respondents refuse to state the value they place on the health gain, are commonly encountered in contingent valuation (CV) studies, and they tend to be excluded from analyses. Such an approach will be biased if protesters differ from non-protesters on characteristics that predict their responses. The Heckman selection model has been commonly used to adjust for protesters, but its underlying assumptions may be implausible in this context. We present a multiple imputation (MI) approach to appropriately address protest responses in CV studies, and compare it with the Heckman selection model. METHODS This study exploits data from the multinational EuroVaQ study, which surveyed respondents' willingness-to-pay (WTP) for a Quality Adjusted Life Year (QALY). Here, our simulation study assesses the relative performance of MI and Heckman selection models across different realistic settings grounded in the EuroVaQ study, including scenarios with different proportions of missing data and non-response mechanisms. We then illustrate the methods in the EuroVaQ study for estimating mean WTP for a QALY gain. RESULTS We find that MI provides lower bias and mean squared error compared with the Heckman approach across all considered scenarios. The simulations suggest that the Heckman approach can lead to considerable underestimation or overestimation of mean WTP due to violations in the normality assumption, even after log-transforming the WTP responses. The case study illustrates that protesters are associated with a lower mean WTP for a QALY gain compared with non-protesters, but that the results differ according to method for handling protesters. CONCLUSIONS MI is an appropriate method for addressing protest responses in CV studies.
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Affiliation(s)
- Mark Pennington
- King's Health Economics, King's College London, London, UK (MP)
| | - Manuel Gomes
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK (MG)
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK (CD)
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Moradi N, Rashidian A, Rasekh HR, Olyaeemanesh A, Foroughi M, Mohammadi T. Monetary Value of Quality-Adjusted Life Years (QALY) among Patients with Cardiovascular Disease: a Willingness to Pay Study (WTP). IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2017; 16:823-833. [PMID: 28979338 PMCID: PMC5603894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The aim of this study was to estimate the monetary value of a QALY among patients with heart disease and to identify its determinants. A cross-sectional survey was conducted through face-to-face interview on 196 patients with cardiovascular disease from two heart hospitals in Tehran, Iran, to estimate the value of QALY using disaggregated and aggregated approaches. The EuroQol-5 Dimension (EQ-5D) questionnaire, Visual Analogue Scale (VAS), Time Trade-Off (TTO) and contingent valuation WTP techniques were employed, first to elicit patients' preferences and then, to estimate WTP for QALY. The association of patients' characteristics with WTP for QALY, was assessed through Heckman selection model. The Mean willingness to pay per QALY, estimated by the disaggregated approach ranged from 2,799 to 3599 US dollars. It is higher than the values, estimated from aggregated methods (USD 2,256 to 3,137). However, in both approaches, the values were less than one Gross Domestic Product (GDP) per capita of Iran. Significant variables were: Current health state, education, age, marital status, number of comorbidities, and household's cost group. Our results challenge two major issues: the first, is a policy challenge which concerns the WHO recommendation to use less than 3 GDP per capita as a cost-effectiveness threshold value. The second, is an analytical challenge related to patients with zero QALY gain. More scrutiny is suggested on the issue of how patients with full health state valuation should be dealt with and what arbitrary value could be included in the estimation value of QALY when the disaggregated approach used.
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Affiliation(s)
- Najmeh Moradi
- School of Pharmacy ,Shahid Beheshti University of medical sciences, Tehran, Iran
| | - Arash Rashidian
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Rasekh
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- Health Economics Department, National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnoosh Foroughi
- cardiovascular research center, Shahid Beheshti University of medical sciences, Tehran, Iran
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Chotai S, Parker SL, Sielatycki JA, Sivaganesan A, Kay HF, Wick JB, McGirt MJ, Devin CJ. Impact of old age on patient-report outcomes and cost utility for anterior cervical discectomy and fusion surgery for degenerative spine disease. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1236-1245. [PMID: 27885477 DOI: 10.1007/s00586-016-4835-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 09/21/2016] [Accepted: 10/20/2016] [Indexed: 01/13/2023]
Abstract
PURPOSE With growing older population and increasing rates of cervical spinal surgery, it is vital to understand the value of cervical surgery in this population. We set forth to determine the cost utility following anterior cervical decompression and fusion (ACDF) for degenerative disease in older patients. METHODS Patients undergoing ACDF for degenerative diseases were enrolled into prospective longitudinal registry. Patient-reported outcomes (PROs) were recorded at baseline, 1-year, and 2-year postoperatively. Two-year medical resource utilization, missed work, and health-state values [quality-adjusted life years (QALYs)] were assessed to compute cost per QALY gained. Patients were dichotomized based on age: <65 years (younger) and ≥65 years (older) to compare the cost utility in these age groups. RESULTS Total 218 (87%) younger patients and 33 (13%) older patients who underwent ACDF were analyzed. Both the groups demonstrated a significant improvement in PROs 2-year following surgery. The older patients had a lower mean cumulative gain in QALYs compared to younger patients at 1 year (0.141 vs. 0.28, P = 0.05) and 2 years (0.211 vs. 0.424, P = 0.04). There was no significant difference in the mean total 2-year cost between older [$21,041 (95% CI $18,466-$23,616)] and younger [$22,669 (95% CI $$21,259-$24,079)] patients (P = 0.27). Two-year cost per QALY gained in older vs. younger patients was ($99,720/QALYs gained vs. ($53,464/QALYs gained, P = 0.68). CONCLUSION ACDF surgery provided a significant gain in health-state utility in older patients with degenerative cervical pathology, with a mean cumulative 2-year cost per QALY gained of $99,720/QALY. While older patients have a slightly higher cost utility compared to their younger counterparts, surgery in the older cohort does provide a significant improvement in pain, disability, and quality-of-life outcomes.
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Affiliation(s)
- Silky Chotai
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Parker
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Alex Sielatycki
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ahilan Sivaganesan
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harrison F Kay
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joseph B Wick
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA
| | - Clinton J Devin
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA. .,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Vallejo-Torres L, García-Lorenzo B, Castilla I, Valcárcel-Nazco C, García-Pérez L, Linertová R, Polentinos-Castro E, Serrano-Aguilar P. On the Estimation of the Cost-Effectiveness Threshold: Why, What, How? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2016; 19:558-66. [PMID: 27565273 DOI: 10.1016/j.jval.2016.02.020] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/02/2016] [Accepted: 02/28/2016] [Indexed: 05/19/2023]
Abstract
BACKGROUND Many health care systems claim to incorporate the cost-effectiveness criterion in their investment decisions. Information on the system's willingness to pay per effectiveness unit, normally measured as quality-adjusted life-years (QALYs), however, is not available in most countries. This is partly because of the controversy that remains around the use of a cost-effectiveness threshold, about what the threshold ought to represent, and about the appropriate methodology to arrive at a threshold value. OBJECTIVES The aim of this article was to identify and critically appraise the conceptual perspectives and methodologies used to date to estimate the cost-effectiveness threshold. METHODS We provided an in-depth discussion of different conceptual views and undertook a systematic review of empirical analyses. Identified studies were categorized into the two main conceptual perspectives that argue that the threshold should reflect 1) the value that society places on a QALY and 2) the opportunity cost of investment to the system given budget constraints. RESULTS These studies showed different underpinning assumptions, strengths, and limitations, which are highlighted and discussed. Furthermore, this review allowed us to compare the cost-effectiveness threshold estimates derived from different types of studies. We found that thresholds based on society's valuation of a QALY are generally larger than thresholds resulting from estimating the opportunity cost to the health care system. CONCLUSIONS This implies that some interventions with positive social net benefits, as informed by individuals' preferences, might not be an appropriate use of resources under fixed budget constraints.
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Affiliation(s)
- Laura Vallejo-Torres
- Departamento de Economía Aplicada y Métodos Cuantitativos, Universidad de la Laguna; Centre for Biomedical Research of the Canary Islands (CIBICAN); Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Department of Applied Health Research, University College London, London, UK.
| | | | - Iván Castilla
- Centre for Biomedical Research of the Canary Islands (CIBICAN); Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Departamento de Ingeniería Informática y de Sistemas, Universidad de La Laguna
| | - Cristina Valcárcel-Nazco
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Canary Foundation for Health Care Research (FUNCANIS)
| | - Lidia García-Pérez
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Canary Foundation for Health Care Research (FUNCANIS)
| | - Renata Linertová
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Canary Foundation for Health Care Research (FUNCANIS)
| | - Elena Polentinos-Castro
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Unidad Docente de Atención Familiar y Comunitaria Norte, Gerencia de Atención Primaria, Servicio Madrileño de Salud
| | - Pedro Serrano-Aguilar
- Spanish Network of Health Services Research for Chronic Diseases (REDISSEC); Servicio de Evaluación del Servicio Canario de la Salud (SESCS), Canary Islands, Spain
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Jain S, Kilgore M, Edwards RK, Owen J. Revisiting the cost-effectiveness of universal cervical length screening: importance of progesterone efficacy. Am J Obstet Gynecol 2016; 215:101.e1-7. [PMID: 26821336 DOI: 10.1016/j.ajog.2016.01.165] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/06/2016] [Accepted: 01/19/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Preterm birth (PTB) is a significant cause of neonatal morbidity and mortality. Studies have shown that vaginal progesterone therapy for women diagnosed with shortened cervical length can reduce the risk of PTB. However, published cost-effectiveness analyses of vaginal progesterone for short cervix have not considered an appropriate range of clinically important parameters. OBJECTIVE To evaluate the cost-effectiveness of universal cervical length screening in women without a history of spontaneous PTB, assuming that all women with shortened cervical length receive progesterone to reduce the likelihood of PTB. STUDY DESIGN A decision analysis model was developed to compare universal screening and no-screening strategies. The primary outcome was the cost-effectiveness ratio of both the strategies, defined as the estimated patient cost per quality-adjusted life-year (QALY) realized by the children. One-way sensitivity analyses were performed by varying progesterone efficacy to prevent PTB. A probabilistic sensitivity analysis was performed to address uncertainties in model parameter estimates. RESULTS In our base-case analysis, assuming that progesterone reduces the likelihood of PTB by 11%, the incremental cost-effectiveness ratio for screening was $158,000/QALY. Sensitivity analyses show that these results are highly sensitive to the presumed efficacy of progesterone to prevent PTB. In a 1-way sensitivity analysis, screening results in cost-saving if progesterone can reduce PTB by 36%. Additionally, for screening to be cost-effective at WTP=$60,000 in three clinical scenarios, progesterone therapy has to reduce PTB by 60%, 34% and 93%. Screening is never cost-saving in the worst-case scenario or when serial ultrasounds are employed, but could be cost-saving with a two-day hospitalization only if progesterone were 64% effective. CONCLUSION Cervical length screening and treatment with progesterone is a not a dominant, cost-effective strategy unless progesterone is more effective than has been suggested by available data for US women. Until future trials demonstrate greater progesterone efficacy, and effectiveness studies confirm a benefit from screening and treatment, the cost-effectiveness of universal cervical length screening in the United States remains questionable.
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Affiliation(s)
- Siddharth Jain
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Meredith Kilgore
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rodney K Edwards
- Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - John Owen
- Center for Women's Reproductive Health, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
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Abstract
OBJECTIVE To estimate the willingness to pay (WTP) per quality-adjusted life year (QALY) value for life-saving treatments and to determine factors affecting the WTP per QALY value. DESIGN A cross-sectional survey with multistage sampling and face-to-face interviews. SETTING General population in the southern part of Thailand. PARTICIPANTS A total of 600 individuals were included in the study. Only 554 (92.3%) responses were usable for data analyses. OUTCOME MEASURE Participants were asked for the maximum amount of WTP value for life-saving treatments by an open-ended question. EQ-5D-3L and visual analogue scale (VAS) were used to estimate additional QALY. RESULTS The amount of WTP values varied from 0 to 720,000 Baht/year (approximately 32 Baht=US$1). The averages of additional QALY obtained from VAS and EQ-5D-3L were only slightly different (0.872 and 0.853, respectively). The averages of WTP per QALY obtained from VAS and EQ-5D-3L were 244,720 and 243,120 Baht/QALY, respectively. As compared to male participants, female participants were more likely to pay less for an additional QALY (p=0.007). In addition, participants with higher household incomes tended to have higher WTP per QALY values (p<0.001). CONCLUSIONS Our study added another WTP per QALY value specifically for life-saving treatments, which would complement the current cost-effectiveness threshold used in Thailand and optimise patient access to innovative treatments or technologies.
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Affiliation(s)
- Khachapon Nimdet
- Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hatyai, Songkhla, Thailand
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