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Bailey C, Skouteris H, Harrison CL, Boyle J, Bartlett R, Hill B, Thangaratinam S, Teede H, Ademi Z. Cost Effectiveness of Antenatal Lifestyle Interventions for Preventing Gestational Diabetes and Hypertensive Disease in Pregnancy. PHARMACOECONOMICS - OPEN 2020; 4:499-510. [PMID: 32026397 PMCID: PMC7426355 DOI: 10.1007/s41669-020-00197-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Lifestyle interventions (diet, physical activity and/or behavioural) to optimise gestational weight gain can prevent adverse maternal outcomes such as gestational diabetes, pre-eclampsia and caesarean section. OBJECTIVE We aimed to model the cost effectiveness of lifestyle interventions during pregnancy on reducing adverse maternal outcomes. METHODS Decision tree modelling was used to determine the cost effectiveness of lifestyle interventions compared with usual care on preventing cases of gestational diabetes and hypertensive disease in pregnancy. Participants were pregnant women receiving routine antenatal care in secondary and tertiary care hospitals. The main outcome measures were cases of gestational diabetes and/or hypertensive disease in pregnancy prevented, costs, and incremental cost-effectiveness ratios. Analysis was conducted from the perspective of the Australian healthcare system, with a time horizon of early pregnancy to discharge after birth. RESULTS Women in the intervention group were 2.25% less likely to have gestational diabetes and/or hypertensive disease in pregnancy (9.53%) compared with the control group (11.78%). Intervention costs were Australian dollars (AUD) 228 per person. Costs were AUD33 per person higher in the intervention group (AUD8281) than the control group (AUD8248). The incremental cost-effectiveness ratio was AUD1470 per case prevented. Sensitivity analysis showed that base-case results were robust. In the probabilistic sensitivity analysis, 44.8% of data points fell within the north-east quadrant, and 52.2% in the south-east quadrant (cost saving), with a 95% confidence interval ranging from AUD - 50,018 to 32,779 per case prevented. CONCLUSIONS While there is no formally accepted cost-effectiveness threshold for willingness-to-pay to prevent an adverse maternal event, the cost per person receiving a lifestyle intervention compared with controls was close to neutral, and therefore likely to be cost effective. Exploration of the cost effectiveness of different lifestyle delivery modes across various models of antenatal care is now required. Future cost-effectiveness studies should investigate longer time horizons, quality-adjusted life-years and productivity loss. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Cate Bailey
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rebeccah Bartlett
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Briony Hill
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London, School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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102
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Kam N, Perera K, Zomer E, Liew D, Ademi Z. Inclisiran as Adjunct Lipid-Lowering Therapy for Patients with Cardiovascular Disease: A Cost-Effectiveness Analysis. PHARMACOECONOMICS 2020; 38:1007-1020. [PMID: 32789593 DOI: 10.1007/s40273-020-00948-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Inclisiran inhibits hepatic synthesis of proprotein convertase subtilisin-kexin type 9 (PCSK9). The comparison of inclisiran with statin versus statin alone in the ORION-10 trial demonstrated significant reductions in low-density lipoprotein cholesterol (LDL-C). Our study explored whether the use of inclisiran with statin versus statin alone for secondary prevention of cardiovascular events is cost effective from the Australian healthcare perspective, based on the price of currently available PCSK9 inhibitors. METHODS A Markov model was developed based on the ORION-10 trial to model outcomes and costs incurred by patients over a lifetime analysis. The three health states were 'alive with cardiovascular disease (CVD)', 'alive with recurrent CVD', and 'dead'. Cost and utilities were estimated from published sources. The cost of inclisiran was estimated from the annual cost of evolocumab, a PCSK9 inhibitor currently available in Australia (AU$6334, based on 2020 data). Outcomes of interest were incremental cost-effectiveness ratios (ICERs) in terms of cost per quality-adjusted life-year (QALY) and cost per year of life saved (YoLS). All costs, QALYs and YoLS were discounted at 5% per annum in line with Australian standards. RESULTS Among 1000 subjects followed-up over a lifetime analysis, inclisiran with statin compared with statin alone prevented 235 non-fatal myocardial infarctions (NFMIs; 151 NFMI and 84 repeat NFMI cases) and 114 coronary revascularisation cases, and increased years of life by 0.549 (discounted) and QALYs by 0.468 (discounted). At an annual price of AU$6334, the net marginal cost was AU$58,965 per person. The above values equated to ICERs of AU$107,402 per YoLS and AU$125,732 per QALY gained. Assuming a willingness-to-pay threshold of AU$50,000, inclisiran would have to be priced 60% lower than other available PCSK9 inhibitors to be considered cost effective. CONCLUSIONS As an adjunct therapy to statin treatment in those who have persistently elevated LDL-C despite optimal statin therapy, inclisiran is effective in reducing cardiovascular events in patients with atherosclerotic CVD. Inclisiran is not cost effective from the Australian healthcare perspective, assuming acquisition costs of current PCSK9 inhibitors. The cost of inclisiran would have to be 60% lower than that of evolocumab.
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Affiliation(s)
- Ning Kam
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Kanila Perera
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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Orchard J, Li J, Freedman B, Webster R, Salkeld G, Hespe C, Gallagher R, Patel A, Kamel B, Neubeck L, Lowres N. Atrial Fibrillation Screen, Management, and Guideline-Recommended Therapy in the Rural Primary Care Setting: A Cross-Sectional Study and Cost-Effectiveness Analysis of eHealth Tools to Support All Stages of Screening. J Am Heart Assoc 2020; 9:e017080. [PMID: 32865129 PMCID: PMC7726973 DOI: 10.1161/jaha.120.017080] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Internationally, most atrial fibrillation (AF) management guidelines recommend opportunistic screening for AF in people ≥65 years of age and oral anticoagulant treatment for those at high stroke risk (CHA₂DS₂‐VA≥2). However, gaps remain in screening and treatment. METHODS AND RESULTS General practitioners/nurses at practices in rural Australia (n=8) screened eligible patients (≥65 years of age without AF) using a smartphone ECG during practice visits. eHealth tools included electronic prompts, guideline‐based electronic decision support, and regular data reports. Clinical audit tools extracted de‐identified data. Results were compared with an earlier study in metropolitan practices (n=8) and nonrandomized control practices (n=69). Cost‐effectiveness analysis compared population‐based screening with no screening and included screening, treatment, and hospitalization costs for stroke and serious bleeding events. Patients (n=3103, 34%) were screened (mean age, 75.1±6.8 years; 47% men) and 36 (1.2%) new AF cases were confirmed (mean age, 77.0 years; 64% men; mean CHA₂DS₂‐VA, 3.2). Oral anticoagulant treatment rates for patients with CHA₂DS₂‐VA≥2 were 82% (screen detected) versus 74% (preexisting AF)(P=NS), similar to metropolitan and nonrandomized control practices. The incremental cost‐effectiveness ratio for population‐based screening was AU$16 578 per quality‐adjusted life year gained and AU$84 383 per stroke prevented compared with no screening. National implementation would prevent 147 strokes per year. Increasing the proportion screened to 75% would prevent 177 additional strokes per year. CONCLUSIONS An AF screening program in rural practices, supported by eHealth tools, screened 34% of eligible patients and was cost‐effective. Oral anticoagulant treatment rates were relatively high at baseline, trending upward during the study. Increasing the proportion screened would prevent many more strokes with minimal incremental cost‐effectiveness ratio change. eHealth tools, including data reports, may be a valuable addition to future programs. REGISTRATION URL: https://www.anzctr.org.au. Unique identifier: ACTRN12618000004268.
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Affiliation(s)
- Jessica Orchard
- Heart Research Institute Charles Perkins Centre University of Sydney Australia
| | - Jialin Li
- Heart Research Institute Charles Perkins Centre University of Sydney Australia
| | - Ben Freedman
- Heart Research Institute Charles Perkins Centre University of Sydney Australia
| | - Ruth Webster
- The George Institute for Global Health University of New South Wales Sydney Australia
| | - Glenn Salkeld
- Faculty of Social Sciences University of Wollongong Australia
| | - Charlotte Hespe
- School of Medicine University of Notre Dame Australia Sydney Australia
| | - Robyn Gallagher
- Susan Wakil School of Nursing, Faculty of Medicine and Health Charles Perkins Centre University of Sydney Sydney Australia
| | - Anushka Patel
- The George Institute for Global Health University of New South Wales Sydney Australia
| | - Bishoy Kamel
- The George Institute for Global Health University of New South Wales Sydney Australia
| | - Lis Neubeck
- School of Health and Social Care Edinburgh Napier University Edinburgh UK
| | - Nicole Lowres
- Heart Research Institute Charles Perkins Centre University of Sydney Australia
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104
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Kozor R, Walker S, Parkinson B, Younger J, Hamilton-Craig C, Selvanayagam JB, Greenwood JP, Taylor AJ. Cost-Effectiveness of Cardiovascular Magnetic Resonance in Diagnosing Coronary Artery Disease in the Australian Health Care System. Heart Lung Circ 2020; 30:380-387. [PMID: 32863111 DOI: 10.1016/j.hlc.2020.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 06/20/2020] [Accepted: 07/06/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) remains a major public health problem in Australia and globally. A variety of imaging techniques allow for both anatomical and functional assessment of CAD and selection of the optimal investigation pathway is challenging. Cardiovascular magnetic resonance (CMR) is not widely used in Australia, partly due to perceived cost and lack of Federal Government reimbursement compared to the alternative techniques. The aim of this study was to estimate the cost-effectiveness of different diagnostic strategies in identifying significant CAD in patients with chest pain suggestive of angina using the evidence gathered in the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease 2 (CE-MARC trial), analysed from the Australian health care perspective. METHODS A decision analytic model coupled with three distinct Markov models allowed eight potential clinical investigation strategies to be considered; combinations of exercise electrocardiogram stress testing (EST), single-photon emission computed tomography (SPECT), stress CMR, and invasive coronary angiography (ICA). Costs were from the Australian health care system in Australian dollars, and outcomes were measured in terms of quality-adjusted life-years. Parameter estimates were derived from the CE-MARC and EUropean trial on Reduction Of cardiac events with Perindopril in patients with stable coronary Artery disease (EUROPA) trials, and from reviews of the published literature. RESULTS The most cost-effective diagnostic strategy, based on a cost-effectiveness threshold of $45,000 to $75,000 per QALY gained, was EST, followed by stress CMR if the EST was positive or inconclusive, followed by ICA if the stress CMR was positive or inconclusive; this held true in the base case and the majority of scenario analyses. CONCLUSIONS This economic evaluation shows that an investigative strategy of stress CMR if EST is inconclusive or positive is the most cost-effective approach for diagnosing significant coronary disease in chest pain patients within the Australian health care system.
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Affiliation(s)
- Rebecca Kozor
- University of Sydney School of Medicine, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Bonny Parkinson
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - John Younger
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Christian Hamilton-Craig
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia; Centre for Advanced Imaging, University of Queensland, Qld, Australia
| | - Joseph B Selvanayagam
- Flinders University, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - John P Greenwood
- University of Leeds, and Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Andrew J Taylor
- Department of Cardiology, The Alfred Hospital, Melbourne, Vic, Australia
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105
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Kwasnicka D, Ntoumanis N, Hunt K, Gray CM, Newton RU, Gucciardi DF, Thøgersen-Ntoumani C, Olson JL, McVeigh J, Kerr DA, Wyke S, Morgan PJ, Robinson S, Makate M, Quested E. A gender-sensitised weight-loss and healthy living program for men with overweight and obesity in Australian Football League settings (Aussie-FIT): A pilot randomised controlled trial. PLoS Med 2020; 17:e1003136. [PMID: 32760144 PMCID: PMC7410214 DOI: 10.1371/journal.pmed.1003136] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 06/16/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Recent evidence shows that sport settings can act as a powerful draw to engage men in weight loss. The primary objective of this pilot study was to test the feasibility of delivering and to evaluate preliminary efficacy of Aussie-FIT, a weight-loss program for men with overweight/obesity delivered in Australian Football League (AFL) settings, in preparation for a future definitive trial. METHODS AND FINDINGS This 6-month pilot trial took place in Perth, Australia. Participants were overweight/obese (Body Mass Index [BMI] ≥ 28 kg/m2), middle-aged (35-65 years old) men. Participants were recruited in May 2018, and the intervention took place between June and December 2018. The intervention involved 12 weekly 90-min face-to-face sessions, incorporating physical activity, nutrition, and behaviour change information and practical activities delivered by coaches at 2 clubs. Data were collected at baseline and immediately postintervention. For trial feasibility purposes, 6-month follow-ups were completed. Outcomes were differences in weight loss (primary outcome) and recruitment and retention rates, self-reported measures (for example, psychological well-being), device-measured physical activity, waist size, and blood pressure at 3 months. Within 3 days of advertising at each club, 426 men registered interest; 306 (72%) were eligible. Men were selected on a first-come first-served basis (n = 130; M age = 45.8, SD = 8; M BMI = 34.48 kg/m2, SD = 4.87) and randomised by a blinded researcher. Trial retention was 86% and 63% at 3- and 6-month follow-ups (respectively). No adverse events were reported. At 3 months, mean difference in weight between groups, adjusted for baseline weight and group, was 3.3 kg (95% CI 1.9, 4.8) in favour of the intervention group (p < 0.001). The intervention group's moderate-to-vigorous physical activity (MVPA) was higher than the control group by 8.54 min/day (95% CI 1.37, 15.71, p = 0.02). MVPA among men attracted to Aussie-FIT was high at baseline (intervention arm 35.61 min/day, control arm 38.38 min/day), which may have limited the scope for improvement. CONCLUSIONS Aussie-FIT was feasible to deliver; participants increased physical activity, decreased weight, and reported improvements in other outcomes. Issues with retention were a limitation of this trial. In a future, fully powered randomised controlled trial (RCT), retention could be improved by conducting assessments outside of holiday seasons. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12617000515392.
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Affiliation(s)
- Dominika Kwasnicka
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Psychology, Curtin University, Perth, Australia
- SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Nikos Ntoumanis
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Psychology, Curtin University, Perth, Australia
| | - Kate Hunt
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Cindy M. Gray
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Robert U. Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Daniel F. Gucciardi
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Cecilie Thøgersen-Ntoumani
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Psychology, Curtin University, Perth, Australia
| | - Jenny L. Olson
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Psychology, Curtin University, Perth, Australia
| | - Joanne McVeigh
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Occupational Therapy, Speech Therapy & Social Work, Curtin University, Perth, Australia
- Movement Physiology Laboratory, School of Physiology, University of Witwatersrand, Johannesburg, South Africa
| | - Deborah A. Kerr
- School of Public Health, Curtin University, Perth, Australia
| | - Sally Wyke
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Philip J. Morgan
- Priority Research Centre in Physical Activity and Nutrition, School of Education, University of Newcastle, Newcastle, Australia
| | | | - Marshall Makate
- School of Public Health, Curtin University, Perth, Australia
| | - Eleanor Quested
- Physical Activity and Well-being Research Group, Curtin University, Perth, Australia
- School of Psychology, Curtin University, Perth, Australia
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106
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Karnon J, Pekarsky B. Should Health Economic Evaluations Undertaken from a Societal Perspective Include Net Government Spending Multiplier Effects? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:467-475. [PMID: 32020537 DOI: 10.1007/s40258-020-00556-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The fiscal multiplier represents the ratio of the change in national income to an associated increase in government spending. Fiscal multiplier effects are commonly estimated to justify options for government spending. Multiplier effects are not considered in economic evaluations of healthcare, but alternate forms of healthcare spending are expected to have varying multiplier effects. This paper describes the estimation and application of net government spending multiplier effects to two published economic evaluations. Negative net multiplier effects are estimated for an evaluated pharmaceutical for the treatment of stable cardiovascular disease, with a resulting increase in the published incremental cost per quality-adjusted life-year (QALY) gained from AU$31,244 to 47,311. Positive net multiplier effects are estimated for an evaluated healthcare delivery model for frail older people, with a resulting decrease in the published incremental cost per QALY gained from AU$8129 to 7669. The inclusion of net multiplier effects in economic evaluations undertaken from a societal perspective can have important effects on the estimated value of evaluated health technologies and services. The potential for government spending on healthcare to crowd out existing spending is considered low, but further investigation of crowding-out effects is warranted.
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Affiliation(s)
- Jonathan Karnon
- Flinders Health and Medical Research Institute, Adelaide, SA, Australia.
| | - Brita Pekarsky
- South Australian Ambulance Service, Adelaide, SA, Australia
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107
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Dineen-Griffin S, Vargas C, Williams KA, Benrimoj SI, Garcia-Cardenas V. Cost utility of a pharmacist-led minor ailment service compared with usual pharmacist care. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:24. [PMID: 32742199 PMCID: PMC7388462 DOI: 10.1186/s12962-020-00220-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/17/2020] [Indexed: 01/16/2023] Open
Abstract
Background A cluster randomised controlled trial (cRCT) performed from July 2018 to March 2019 demonstrated the clinical impact of a community pharmacist delivered minor ailment service (MAS) compared with usual pharmacist care (UC). MAS consisted of a technology-based face-to-face consultation delivered by trained community pharmacists. The consultation was guided by clinical pathways for assessment and management, and communication systems, collaboratively agreed with general practitioners. MAS pharmacists were trained and provided monthly practice support by a practice change facilitator. The objective of this study was to assess the cost utility of MAS, compared to UC. Methods Participants recruited were adult patients with symptoms suggestive of a minor ailment condition, from community pharmacies located in Western Sydney. Patients received MAS (intervention) or UC (control) and were followed-up by telephone 14-days following consultation with the pharmacist. A cost utility analysis was conducted alongside the cRCT. Transition probabilities and costs were directly derived from cRCT study data. Utility values were not available from the cRCT, hence we relied on utility values reported in the published literature which were used to calculate quality adjusted life years (QALYs), using the area under the curve method. A decision tree model was used to capture the decision problem, considering a societal perspective and a 14-day time horizon. Deterministic and probabilistic sensitivity analyses assessed robustness and uncertainty of results, respectively. Results Patients (n = 894) were recruited from 30 pharmacies and 82% (n = 732) responded to follow-up. On average, MAS was more costly but also more effective (in terms of symptom resolution and QALY gains) compared to UC. MAS patients (n = 524) gained an additional 0.003 QALYs at an incremental cost of $7.14 (Australian dollars), compared to UC (n = 370) which resulted in an ICER of $2277 (95% CI $681.49–3811.22) per QALY. Conclusion Economic findings suggest that implementation of MAS within the Australian context is cost effective. Trial registration Registered with Australian New Zealand Clinical Trials Registry (ANZCTR) and allocated the ACTRN: ACTRN12618000286246. Registered on 23 February 2018.
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Affiliation(s)
- Sarah Dineen-Griffin
- Graduate School of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Constanza Vargas
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW Australia
| | - Kylie A Williams
- Graduate School of Health, University of Technology Sydney, Sydney, NSW Australia
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Health economic evaluation of screening and treating children with familial hypercholesterolemia early in life: Many happy returns on investment? Atherosclerosis 2020; 304:1-8. [DOI: 10.1016/j.atherosclerosis.2020.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/25/2020] [Accepted: 05/08/2020] [Indexed: 11/20/2022]
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109
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Brain D, Mitchell J, O’Beirne J. Cost-effectiveness analysis of an outreach model of Hepatitis C Virus (HCV) assessment to facilitate HCV treatment in primary care. PLoS One 2020; 15:e0234577. [PMID: 32555696 PMCID: PMC7299404 DOI: 10.1371/journal.pone.0234577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/27/2020] [Indexed: 12/27/2022] Open
Abstract
The effects of hepatitis C virus (HCV), such as morbidity and mortality associated with cirrhosis and liver cancer, is a major public health issue in Australia. Highly effective treatment has recently been made available to all Australians living with HCV. A decision-analytic model was developed to evaluate the cost-effectiveness of the hepatology partnership, compared to usual care. A Markov model was chosen, as it is state-based and able to include recursive events, which accurately reflects the natural history of the chronic and repetitive nature of HCV. Cost-effectiveness of the new model of care is indicated by the incremental cost-effectiveness ratio (ICER), where the mean change to costs associated with the new model of care is divided by the mean change in quality adjusted life-years (QALYs). Ten thousand iterations of the model were run, with the majority (73%) of ICERs representing cost-savings. In comparison to usual care, the intervention improves health outcomes (22.38 QALYs gained) and reduces costs by $42,122 per patient. When compared to usual care, a partnership approach to management of HCV is cost-effective and good value for money, even when key model parameters are changed in scenario analyses. Reduction in costs is driven by improved efficiency of the new model of care, where more patients are treated in a timely manner, away from the expensive tertiary setting. From an economic perspective, a reduction in hospital-based care is a positive outcome and represents a good investment for decision-makers who wish to maximise health gain per dollar spent.
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Affiliation(s)
- David Brain
- Australian Centre for Health Services Innovation, Melbourne, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
- * E-mail:
| | - Jonathan Mitchell
- Sunshine Coast University Hospital, Britinya, Australia
- Sunshine Coast Health Institute, University of the Sunshine Coast, Britinya, Australia
| | - James O’Beirne
- Sunshine Coast University Hospital, Britinya, Australia
- Sunshine Coast Health Institute, University of the Sunshine Coast, Britinya, Australia
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White NM, Barnett AG, Hall L, Mitchell BG, Farrington A, Halton K, Paterson DL, Riley TV, Gardner A, Page K, Gericke CA, Graves N. Cost-effectiveness of an Environmental Cleaning Bundle for Reducing Healthcare-associated Infections. Clin Infect Dis 2020; 70:2461-2468. [PMID: 31359053 PMCID: PMC7286366 DOI: 10.1093/cid/ciz717] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/29/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) remain a significant patient safety issue, with point prevalence estimates being ~5% in high-income countries. In 2016-2017, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study implemented an environmental cleaning bundle targeting communication, staff training, improved cleaning technique, product use, and audit of frequent touch-point cleaning. This study evaluates the cost-effectiveness of the environmental cleaning bundle for reducing the incidence of HAIs. METHODS A stepped-wedge, cluster-randomized trial was conducted in 11 hospitals recruited from 6 Australian states and territories. Bundle effectiveness was measured by the numbers of Staphylococcus aureus bacteremia, Clostridium difficile infection, and vancomycin-resistant enterococci infections prevented in the intervention phase based on estimated reductions in the relative risk of infection. Changes to costs were defined as the cost of implementing the bundle minus cost savings from fewer infections. Health benefits gained from fewer infections were measured in quality-adjusted life-years (QALYs). Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefit of adopting the cleaning bundle over existing hospital cleaning practices. RESULTS Implementing the cleaning bundle cost $349 000 Australian dollars (AUD) and generated AUD$147 500 in cost savings. Infections prevented under the cleaning bundle returned a net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4684 per QALY gained. There was an 86% chance that the bundle was cost-effective compared with existing hospital cleaning practices. CONCLUSIONS A bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs.
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Affiliation(s)
- Nicole M White
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Adrian G Barnett
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Lisa Hall
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
- School of Public Health, University of Queensland, Brisbane, Western Australia
| | - Brett G Mitchell
- Discipline of Nursing, Avondale College of Higher Education, Wahroonga, New South Wales, Western Australia
- School of Nursing and Midwifery, University of Newcastle, New South Wales, Western Australia
| | - Alison Farrington
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Kate Halton
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Crawley, Western Australia
| | - Thomas V Riley
- School of Biomedical Sciences, The University of Western Australia, Crawley, Western Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia
- School of Veterinary and Life Sciences, Murdoch University, Western Australia,, Cairns, Queensland, Australia
| | - Anne Gardner
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Katie Page
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Christian A Gericke
- School of Clinical Medicine, University of Queensland, Cairns, Queensland, Brisbane, Australia
- College of Public Health, Medical and Veterinary Sciences, and College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
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111
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Blythe R, O'Gorman PM, Crawford RW, Feenan R, Hatton A, Whitehouse SL, Graves N. Fixation Method for Hip Arthroplasty Stem Following Hip Fracture: A Population-Level Cost-Effectiveness Analysis. J Arthroplasty 2020; 35:1614-1621. [PMID: 32197963 DOI: 10.1016/j.arth.2020.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/22/2020] [Accepted: 02/03/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hip arthroplasty is increasing in Australia. The number of procedures for fractured neck of femur was 7500 in 2017. Best practices for fixation method and procedure type require scrutiny. This paper is about the costs and health outcomes of cemented and uncemented hemiarthroplasty and total hip arthroplasty at a national level. METHODS We created a Markov model for patients <75, aged 75-85, and over 85. Expected costs and health outcomes over 5 years from a decision to change from existing practice to a best practice policy in which all patients with fractured neck of femur received the same fixation method based on age and type of arthroplasty are estimated. The model was populated using prevalence and incidence data from the Australian Orthopedic Association National Joint Replacement Registry, costs from Metro North Hospital and Health Service in Queensland, and probabilities and utilities from the literature. We simulated the uncertainties in outcomes with probabilistic sensitivity analysis. RESULTS We found that uncemented stem procedures were more costly and provided worse health outcomes compared to cemented stem fixation for hemiarthroplasty and total hip arthroplasty for all age groups. Moving from existing practice to cemented stem arthroplasty could save the Australian health system $2.0 million over 5 years with a gain of 203 quality-adjusted life years. CONCLUSION We suggest that consideration be given to cemented fixation of the femoral stem for patients receiving both hemiarthroplasty and total hip arthroplasty for fractured neck of femur. Best practice guidelines focused on cost-effectiveness should recommend cemented stem fixation to both save costs and improve patient quality of life.
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Affiliation(s)
- Robin Blythe
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Patricia M O'Gorman
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; Gold Coast University Hospital, Queensland Health, Brisbane, Queensland, Australia; Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Ross W Crawford
- School of Mechanical, Medical and Process Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rachel Feenan
- Strategic Procurement, Health Support Queensland, Queensland Health, Brisbane, Queensland, Australia
| | - Alesha Hatton
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia; Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia
| | - Sarah L Whitehouse
- School of Mechanical, Medical and Process Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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112
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Chalkidou K, Claxton K, Silverman R, Yadav P. Value-based tiered pricing for universal health coverage: an idea worth revisiting. Gates Open Res 2020; 4:16. [PMID: 32185365 PMCID: PMC7059551 DOI: 10.12688/gatesopenres.13110.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 10/03/2023] Open
Abstract
The pricing of medicines and health products ranks among the most hotly debated topics in health policy, generating controversy in richer and poorer markets alike. Creating the right pricing structure for pharmaceuticals and other healthcare products is particularly important for low- and middle-income countries, where pharmaceuticals account for a significant portion of total health expenditure; high medicine prices therefore threaten the feasibility and sustainability of nascent schemes for universal health coverage (UHC). We argue that a strategic system of value-based tiered pricing (VBTP), wherein each country would pay a price for each health product commensurate with the local value it provides, could improve access, enhance efficiency, and empower countries to negotiate with product manufacturers. This paper attempts to further understanding on the potential value of tiered pricing, barriers to its implementation, and potential strategies to overcome those.
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Affiliation(s)
- Kalipso Chalkidou
- Global Health Policy, Center for Global Development, London, UK
- Medicine, School of Public Health, Imperial College London, London, UK
| | - Karl Claxton
- Department of Economics, University of York, UK, York, UK
| | | | - Prashant Yadav
- Global Health Policy, Center for Global Development, London, UK
- Technology and Operations Management, INSEAD, Fontainebleau, France
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113
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Chalkidou K, Claxton K, Silverman R, Yadav P. Value-based tiered pricing for universal health coverage: an idea worth revisiting. Gates Open Res 2020; 4:16. [PMID: 32185365 PMCID: PMC7059551 DOI: 10.12688/gatesopenres.13110.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 01/29/2023] Open
Abstract
The pricing of medicines and health products ranks among the most hotly debated topics in health policy, generating controversy in richer and poorer markets alike. Creating the right pricing structure for pharmaceuticals and other healthcare products is particularly important for low- and middle-income countries, where pharmaceuticals account for a significant portion of total health expenditure; high medicine prices therefore threaten the feasibility and sustainability of nascent schemes for universal health coverage (UHC). We argue that a strategic system of value-based tiered pricing (VBTP), wherein each country would pay a price for each health product commensurate with the local value it provides, could improve access, enhance efficiency, and empower countries to negotiate with product manufacturers. This paper attempts to further understanding on the potential value of tiered pricing, barriers to its implementation, and potential strategies to overcome those.
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Affiliation(s)
- Kalipso Chalkidou
- Global Health Policy, Center for Global Development, London, UK.,Medicine, School of Public Health, Imperial College London, London, UK
| | - Karl Claxton
- Department of Economics, University of York, UK, York, UK
| | | | - Prashant Yadav
- Global Health Policy, Center for Global Development, London, UK.,Technology and Operations Management, INSEAD, Fontainebleau, France
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114
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Gandjour A. Willingness to pay for new medicines: a step towards narrowing the gap between NICE and IQWiG. BMC Health Serv Res 2020; 20:343. [PMID: 32321496 PMCID: PMC7178559 DOI: 10.1186/s12913-020-5050-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The question of how to set the cost-effectiveness threshold for new, innovative medicines is a matter of ongoing controversy. One prominent proposal suggests that the cost-effectiveness threshold adopted by the U.K. National Institute for Health and Care Excellence (NICE) should represent the opportunity cost for the U.K. National Health Service resulting from the adoption of new medicines. The purpose of this article is to compare this proposal for the U.K. with the approach chosen by the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany, which relies on indication-specific cost-effectiveness thresholds. MAIN TEXT The 'ideal' NICE and IQWiG surprisingly share the fundamental principle of inferring the willingness to pay from existing care. For this and other reasons, indication-specific thresholds based on IQWiG's methodology do not lead to more inefficiency at the health system's level than a generic threshold based on the 'ideal' NICE (keeping other conditions the same). Also, applying either decision rule to one country will yield a similar long-term growth in population spending. Assuming that everything else is equal, both decision rules are predicted to decrease long-term expenditure growth. Convergence of the two decision rules would require, among others, ruling out waste in the 'ideal' NICE's approach and, for IQWiG's approach, using the same relative weights for life expectancy and health-related quality of life as the quality-adjusted-life-year model. CONCLUSION This article shows that both decision rules have notable commonalities in terms of inferring the willingness to pay from existing care and the projected impact on long-term growth in population spending.
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Affiliation(s)
- Afschin Gandjour
- Frankfurt School of Finance and Management, Adickesallee 32-34, 60322, Frankfurt am Main, Germany.
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115
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Affiliation(s)
- Jonathan Siverskog
- Centre for Medical Technology Assessment, Linköping University, Linköping, Sweden
| | - Martin Henriksson
- Centre for Medical Technology Assessment, Linköping University, Linköping, Sweden
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116
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Chatterton ML, Bayer JK, Engel L, Rapee RM, Beatson R, Hiscock H, Bretherton L, Wake M, Mihalopoulos C. Cost-effectiveness of preventing child internalising problems: Results from the translational trial of Cool Little Kids at school entry. J Anxiety Disord 2020; 70:102191. [PMID: 32014832 DOI: 10.1016/j.janxdis.2020.102191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/11/2019] [Accepted: 01/15/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE A translational trial evaluated the effectiveness of screening for inhibited childhood temperament, followed by a preventive parenting program -Cool Little Kids. This study determined the cost-effectiveness from societal and health sector perspectives using trial data. METHOD Resources to deliver the screening and parenting sessions were determined from study records. Parents completed a questionnaire reporting resources used at one-year follow-up. Standard Australian unit costs were applied. Clinical outcomes for children and parental quality adjusted life-years (QALYs) were used to calculate incremental cost-effectiveness ratios (ICERs). RESULTS Total societal costs were lower, but non-significant for the intervention compared to the control group (mean difference -$500 p = 0.937). Total health sector costs were significantly greater (mean difference $1,956; p = 0.015). The intervention led to significantly fewer internalising symptoms (Strengths and Difficulties Questionnaire (SDQ)-emotional difficulties adjusted mean difference -0.5; p = 0.006), fewer children with SDQ-emotional symptoms in the abnormal range (24.2 % vs. 33.0 % p = .014) and fewer with diagnosed anxiety (44.2 % vs. 50.2 % p = 0.427). From the societal perspective, the intervention would likely be cost-effective. Health sector ICERs were $1,171/SDQ-emotional symptom decrease, $51/abnormal SDQ avoided and $77/anxiety case avoided. CONCLUSIONS This economic analysis alongside an implementation study provides an early indication that Cool Little Kids may be cost-effective.
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Affiliation(s)
- Mary Lou Chatterton
- Deakin University, Deakin Health Economics, Institute for Health Transformation, Geelong, VIC, Australia.
| | - Jordana K Bayer
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Lidia Engel
- Deakin University, Deakin Health Economics, Institute for Health Transformation, Geelong, VIC, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Ruth Beatson
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Harriet Hiscock
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Lesley Bretherton
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin University, Deakin Health Economics, Institute for Health Transformation, Geelong, VIC, Australia
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Chalkidou K, Claxton K, Silverman R, Yadav P. Value-based tiered pricing for universal health coverage: an idea worth revisiting. Gates Open Res 2020; 4:16. [DOI: 10.12688/gatesopenres.13110.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 11/20/2022] Open
Abstract
The pricing of medicines and health products ranks among the most hotly debated topics in health policy, generating controversy in richer and poorer markets alike. Creating the right pricing structure for pharmaceuticals and other healthcare products is particularly important for low- and middle-income countries, where pharmaceuticals account for a significant portion of total health expenditure; high medicine prices therefore threaten the feasibility and sustainability of nascent schemes for universal health coverage (UHC). We argue that a strategic system of value-based tiered pricing (VBTP), wherein each country would pay a price for each health product commensurate with the local value it provides, could improve access, enhance efficiency, and empower countries to negotiate with product manufacturers. This paper attempts to further understanding on the potential value of tiered pricing, barriers to its implementation, and potential strategies to overcome those.
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118
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Love-Koh J, Cookson R, Claxton K, Griffin S. Estimating Social Variation in the Health Effects of Changes in Health Care Expenditure. Med Decis Making 2020; 40:170-182. [PMID: 32065026 PMCID: PMC7430104 DOI: 10.1177/0272989x20904360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/01/2020] [Indexed: 11/17/2022]
Abstract
Background. A common aim of health expenditure is to reduce unfair inequalities in health. Although previous research has attempted to estimate the total health effects of changes in health expenditure, little is known about how changes affect different groups in the population. Methods. We propose a general framework for disaggregating the total health effects of changes in health expenditure by social groups. This can be performed indirectly when the estimate of the total health effect has first been disaggregated by a secondary factor (e.g., disease area) that can be linked to social characteristics. This is illustrated with an application to the English National Health Service. Evidence on the health effects of expenditure across 23 disease areas is combined with data on the distribution of disease-specific hospital utilization by age, sex, and area-level deprivation. Results. We find that the health effects from NHS expenditure changes are produced largely through disease areas in which individuals from more deprived areas account for a large share of health care utilization, namely, respiratory and neurologic disease and mental health. We estimate that 26% of the total health effect from a change in expenditure would accrue to the fifth of the population living in the most deprived areas, compared with 14% to the fifth living in the least deprived areas. Conclusions. Our approach can be useful for evaluating the health inequality impacts of changing health budgets or funding alternative health programs. However, it requires robust estimates of how health expenditure affects health outcomes. Our example analysis also relied on strong assumptions about the relationship between health care utilization and health effects across population groups.
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Affiliation(s)
- James Love-Koh
- Centre for Health Economics, University of York, York, North Yorkshire, UK
| | - Richard Cookson
- Centre for Health Economics, University of York, York, North Yorkshire, UK
| | - Karl Claxton
- />Centre for Health Economics, University of York, York, North Yorkshire, UK
- />Department of Economics and Related Studies, University of York, York, North Yorkshire, UK
| | - Susan Griffin
- Centre for Health Economics, University of York, York, North Yorkshire, UK
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119
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Bailey C, Skouteris H, Teede H, Hill B, De Courten B, Walker R, Liew D, Thangaratinam S, Ademi Z. Are Lifestyle Interventions to Reduce Excessive Gestational Weight Gain Cost Effective? A Systematic Review. Curr Diab Rep 2020; 20:6. [PMID: 32008111 DOI: 10.1007/s11892-020-1288-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Lifestyle interventions (such as diet and physical activity) successfully limit excessive gestational weight gain and can reduce some adverse maternal events; however, benefit is variable and cost-effectiveness remains unclear. We aimed to review published cost-effectiveness analyses of lifestyle interventions compared with usual care on clinically relevant outcome measures. Five international and six grey-literature databases were searched from 2007 to 2018. Articles were assessed for quality of reporting. Data were extracted from healthcare and societal perspectives. Costs were adapted to the common currencies of Australia and the United Kingdom by adjusting for resource utilization, healthcare purchase price and changes in costs over time. Included studies were economic analyses of lifestyle interventions aiming to limit weight-gain during pregnancy and/or reduce risk of gestational diabetes, for women with a BMI of 25 or greater in pre- or early-pregnancy. RECENT FINDINGS Of the 538 articles identified, six were retained for review: one modelling study and five studies in which an economic analysis was performed alongside a randomized-controlled trial. Outcome measures included infant birth-weight, fasting glucose, insulin resistance, gestational weight-gain, infant respiratory distress syndrome, perceived health, cost per case of adverse outcome avoided and quality-adjusted life years (QALYs). Interventions were cost-effective in only one study. Although many studies have investigated the efficacy of lifestyle interventions in pregnancy, few have included cost-effectiveness analyses. Where cost-effectiveness studies were undertaken, results were inconsistent. Secondary meta-analysis, taxonomy and framework research is now required to determine the effective components of lifestyle interventions and to guide future cost-effectiveness analyses.
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Affiliation(s)
- Cate Bailey
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
- Monash Centre for Health Research and Implementation, Monash University, Level 1 42-51 Kanooka Grove, Clayton, VIC, 3168, Australia.
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Briony Hill
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Barbora De Courten
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ruth Walker
- Monash Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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120
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Ochalek J, Lomas J. Reflecting the Health Opportunity Costs of Funding Decisions Within Value Frameworks: Initial Estimates and the Need for Further Research. Clin Ther 2020; 42:44-59.e2. [PMID: 31955967 DOI: 10.1016/j.clinthera.2019.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/30/2019] [Accepted: 12/03/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE Evaluating whether a new health technology provides good value for money requires an assessment of its opportunity cost. If the opportunity cost of the new health technology exceeds the benefits, however measured, a net loss is produced. Value frameworks using economic evaluation methods have been developed to guide the assessment of the value of new technologies within health care in response to rising spending. However, few explicitly consider health opportunity costs and fewer still base health opportunity costs on empirical estimates. This may partly be due to the dearth of estimates available, with only a handful of countries having estimates based on within-country data. To fill this gap, this study provides estimates of cost per disability-adjusted life year (DALY) averted for 33 high-income countries and the remaining Organization for Economic Cooperation and Development (OECD) and BRIICS countries (Brazil, Russia, India, Indonesia, China and South Africa). METHODS Cost per DALY averted for each country was based on estimated elasticities of the health effects of changes in expenditure on health outcomes from applying an existing published econometric model that uses cross-country data to an expanded dataset and other existing elasticities drawn from selected UK within-country studies to country-level data on health expenditure, demographic characteristics, and burden of ill health. To provide a comprehensive picture of the state of research around empirical estimates of health opportunity costs for these countries, results from this study are reported against previously published estimates of cost per quality-adjusted life year (QALY) gained for the same countries. FINDINGS All but one of the ranges estimated fall below 3× the gross domestic product (GDP) per capita, the upper end of the widely applied range of 1-3× GDP per capita. The range of estimates based on applying an existing published econometric model that uses cross-country data to an expanded dataset are higher than when cost per DALY averted is calculated from other existing elasticities of the health effects of changes in expenditure drawn from selected UK within-country studies. They also tend to be higher than published estimates of cost per QALY gained. IMPLICATIONS This study provides placeholder cost per DALY averted estimates that reflect health opportunity costs for 33 high-income countries and the remaining OECD and BRIICS countries. These estimates can be used to estimate the health opportunity costs of government health care expenditure until country-specific health opportunity cost are estimated using within-country data.
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Affiliation(s)
- Jessica Ochalek
- Centre for Health Economics, University of York, Heslington, York, United Kingdom.
| | - James Lomas
- Centre for Health Economics, University of York, Heslington, York, United Kingdom
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121
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Stadhouders N, Koolman X, van Dijk C, Jeurissen P, Adang E. The marginal benefits of healthcare spending in the Netherlands: Estimating cost-effectiveness thresholds using a translog production function. HEALTH ECONOMICS 2019; 28:1331-1344. [PMID: 31469510 PMCID: PMC6851736 DOI: 10.1002/hec.3946] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/12/2019] [Accepted: 06/29/2019] [Indexed: 05/19/2023]
Abstract
New technologies may displace existing, higher-value care under a fixed budget. Countries aim to curtail adoption of low-value technologies, for example, by installing cost-effectiveness thresholds. Our objective is to estimate the opportunity cost of hospital care to identify a threshold value for the Netherlands. To this aim, we combine claims data, mortality data and quality of life questionnaires from 2012 to 2014 for 11,000 patient groups to obtain quality-adjusted life-year (QALY) outcomes and spending. Using a fixed effects translog model, we estimate that a 1% increase in hospital spending on average increases QALY outcomes by 0.2%. This implies a threshold of €73,600 per QALY, with 95% confidence intervals ranging from €53,000 to €94,000 per QALY. The results stipulate that new technologies with incremental cost effectiveness ratios exceeding the Dutch upper reference value of €80,000 may indeed displace more valuable care.
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Affiliation(s)
- Niek Stadhouders
- Scientific Institute for Quality of HealthcareRadboud University Medical CenterNijmegenNetherlands
| | - Xander Koolman
- Talma Institute, Department of Health SciencesVU University AmsterdamAmsterdamNetherlands
| | | | - Patrick Jeurissen
- Scientific Institute for Quality of HealthcareRadboud University Medical CenterNijmegenNetherlands
| | - Eddy Adang
- Radboud Institute for Health SciencesRadboud University Medical CenterNijmegenNetherlands
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122
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Stiles JA, Chatterton ML, Le LKD, Lee YY, Whiteford H, Mihalopoulos C. The cost-effectiveness of stepped care for the treatment of anxiety disorders in adults: A model-based economic analysis for the Australian setting. J Psychosom Res 2019; 125:109812. [PMID: 31442844 DOI: 10.1016/j.jpsychores.2019.109812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/10/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of stepped care compared to care as usual (CAU) for the treatment of adults with mild-to-moderate anxiety disorders from a health sector perspective in the Australian setting. METHOD A decision tree model was constructed to estimate the cost per disability adjusted life year (DALY) averted over a 12-month time horizon. The model compared a three-step stepped care intervention to CAU. Stepped care included an initial phase of guided self-help, followed by face-to-face cognitive behavioural therapy, and pharmacotherapy as the final step. The model adopted a health sector perspective, used epidemiological parameters and disability weights obtained from the Global Burden of Disease Study 2013. Effect sizes were derived from a randomized trial of stepped care and a longitudinal cohort study. Costs were expressed in 2013 Australian dollars (A$). Multivariate probabilistic and univariate sensitivity analyses were performed. RESULTS Stepped care was found to be cost-effective compared to CAU with an incremental cost-effective ratio of A$3093 per DALY averted. One-hundred percent of the uncertainty iterations fell below the A$50,000 per DALY averted willingness-to-pay threshold commonly used in Australia. The evaluation was most sensitive to changes in diagnosis rates and effect sizes. CONCLUSION A three-step model of stepped care appears to be cost-effective for the treatment of adults with mild to moderate anxiety disorders from the Australian health sector perspective. These results can provide some assurance to decision-makers that stepped care represents an efficient use of health care resources.
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Affiliation(s)
- Jay A Stiles
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Australia; National Ageing Research Institute, Parkville, Australia.
| | | | - Long Khanh-Dao Le
- Deakin Health Economics, Deakin University, Geelong, Victoria, Australia
| | - Yong Yi Lee
- School of Public Health, The University of Queensland, Herston, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
| | - Harvey Whiteford
- School of Public Health, The University of Queensland, Herston, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Walker S, Griffin S, Asaria M, Tsuchiya A, Sculpher M. Striving for a Societal Perspective: A Framework for Economic Evaluations When Costs and Effects Fall on Multiple Sectors and Decision Makers. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:577-590. [PMID: 31098947 PMCID: PMC6748888 DOI: 10.1007/s40258-019-00481-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
In most societies, resources are distributed by individuals acting in markets and by governments through some form of collective decision-making process. Economic evaluation offers a set of tools to inform collective decisions by examining the resource requirements and outcomes of alternative policies. The 'societal perspective' has been advocated, but less consideration has been given to what this should include and its practical implementation. This paper presents a framework for economic evaluation of policies with costs and outcomes falling on different sectors (e.g. health, criminal justice, education) and involving different decision makers. It extends the 'impact inventory' developed by the Second Panel on Cost-Effectiveness in Health and Medicine by considering all affected individuals and reflecting how outcomes attributed to an intervention can be compared with outcomes forgone as a result of resources not being available for other purposes. The framework sets out the series of assessments to be made, distinguishing points at which value judgements feed into the evaluation, and the implications of alternative judgements. These assessments reflect the institutional arrangements of public bodies, for example, their funding, the outcomes they consider important and their relative valuations of these outcomes. By avoiding the use of an abstract 'societal perspective', the contribution of the framework is to inform multiple decision makers with different objectives and provide practical guidance on overall societal impact.
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Affiliation(s)
- Simon Walker
- Centre for Health Economics, Alcuin a Block, University of York, York, YO10 5DD, UK.
| | - Susan Griffin
- Centre for Health Economics, Alcuin a Block, University of York, York, YO10 5DD, UK
| | | | - Aki Tsuchiya
- School of Health and Related Research (ScHARR) and the Department of Economics, University of Sheffield, Sheffield, UK
| | - Mark Sculpher
- Centre for Health Economics, Alcuin a Block, University of York, York, YO10 5DD, UK
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124
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Lomas J, Martin S, Claxton K. Estimating the Marginal Productivity of the English National Health Service From 2003 to 2012. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:995-1002. [PMID: 31511189 DOI: 10.1016/j.jval.2019.04.1926] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 03/26/2019] [Accepted: 04/18/2019] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Estimates of the marginal productivity of the health sector are required for a wide range of resource allocation decisions. Founding these estimates on robust empirical analysis can inform these decisions and improve allocative efficiency. This article estimates the annual marginal productivity of the English NHS over a 10-year period (between 2003 and 2012). METHODS Data on expenditure and mortality by program budget category are used in conjunction with socioeconomic and demographic variables from the censuses for 2001 and 2011. This article applies an econometric strategy that employs an established instrumental variable approach, which is then subjected to a number of sensitivity analyses. The results of the econometric analysis, along with additional data on the burden of disease, are used to generate an estimate of the marginal productivity for each of the study years. RESULTS We find that an additional unit of health benefit has cost between £5000 and £15 000 per quality-adjusted life-year from 2003 to 2012. Over this period these estimates (all in current prices) have increased at a faster rate than NHS price inflation, suggesting an increase in real terms. CONCLUSIONS These results are discussed in the context of the existing literature, and the potential policy implications for decisions about resource allocation are explored.
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Affiliation(s)
- James Lomas
- Centre for Health Economics, University of York, York, UK.
| | - Stephen Martin
- Department of Economics and Related Studies, University of York, York, UK
| | - Karl Claxton
- Centre for Health Economics, University of York, York, UK; Department of Economics and Related Studies, University of York, York, UK
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125
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Carter HE, Knowles D, Moroney T, Holtmann G, Rahman T, Appleyard M, Steele N, Zanco M, Graves N. The use of modelling studies to inform planning of health services: case study of rapidly increasing endoscopy services in Australia. BMC Health Serv Res 2019; 19:608. [PMID: 31464609 PMCID: PMC6716875 DOI: 10.1186/s12913-019-4438-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background Demand for gastrointestinal endoscopy in Australia is increasing as a result of the expanding national bowel cancer screening program and a growing, ageing population. More services are required to meet demand and ensure patients are seen within clinically recommended timeframes. Methods A discrete event simulation model was developed to project endoscopy waiting list outcomes for two large metropolitan health services encompassing 8 public hospitals in Australia. The model applied routinely collected health service data to forecast the impacts of future endoscopic demand over 5 years and to identify the level of service activity required to address patient waiting times and meet key policy targets. The approach incorporated evidence from the literature to produce estimates of cost-effectiveness by showing longer term costs and Quality Adjusted Life Years (QALYs) associated with service expansion. Results The modelling revealed that doing nothing would lead to the number of patients waiting longer than clinically recommended doubling across each health service within 5 years. A 38% overall increase in the number of monthly procedures available was required to meet and maintain a target of 95–98% of patients being seen within clinically recommended timeframes to the year 2021. This was projected to cost the funder approximately $140 million in additional activity over a 5 year period. Due to improved patient outcomes associated with timely intervention, it was estimated that the increased activity would generate over 22,000 additional QALYs across the two health services. This translated to an incremental cost-effectiveness ratio of $6467 and $5974 per QALY for each health service respectively. Conclusions Discrete event simulation modelling provided a rational, data based approach that allowed decision makers to quantify the future demand for endoscopy services and identify cost-effective strategies to meet community needs. Electronic supplementary material The online version of this article (10.1186/s12913-019-4438-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hannah E Carter
- Australian Centre for Health Services Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia.
| | - Dylan Knowles
- Anthrodynamics Simulation Services Australia, Homebush, NSW, 2140, Australia
| | - Timothy Moroney
- Healthcare Purchasing and System Performance, Queensland Health, 33 Charlotte St, Brisbane, QLD, 4001, Australia
| | - Gerald Holtmann
- Faculty of Medicine & Faculty of Health & Behavioural Sciences, University of Queensland, 288 Herston Rd, Herston, QLD, 4006, Australia.,Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
| | - Tony Rahman
- The Prince Charles Hospital, Rode Road, Chermside, QLD, 4032, Australia
| | - Mark Appleyard
- Royal Brisbane and Women's Hospital, Butterfield St, Herston, QLD, 4029, Australia
| | - Nick Steele
- Healthcare Purchasing and System Performance, Queensland Health, 33 Charlotte St, Brisbane, QLD, 4001, Australia
| | - Michael Zanco
- Health systems innovation branch, Queensland Health, 33 Charlotte St, Brisbane, QLD, 4001, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
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126
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Nguyen TM, Tonmukayakul U, Warren E, Cartwright S, Liew D. A Markov cost-effective analysis of biannual fluoride varnish for preventing dental caries in permanent teeth over a 70-year time horizon. Health Promot J Austr 2019; 31:177-183. [PMID: 31373066 PMCID: PMC7187475 DOI: 10.1002/hpja.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/27/2019] [Accepted: 07/28/2019] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Biannual application of fluoride varnish is effective for dental caries prevention, but its cost-effectiveness using quality-adjusted life years (QALY) is unknown. This study performed a cost-effectiveness analysis, from the Australian health care system perspective of biannual application of fluoride varnish versus current practice (non-routine application) for an individual aged 15 years and older over a 70-year time horizon. METHODS Health outcomes measured were the number of prevented decayed, missing, and filled teeth (prevented-DMFT) and QALY gained. The calculated incremental cost-effectiveness ratio (ICER) was compared against the reference cost-effectiveness ICER threshold of AUD$28 033 per QALY gained. A published Markov model capturing dental caries progression of eight permanent molars was used. This 6-monthly cycle model represented ten possible health states for an individual tooth. A 5% discount rate was applied with relevant sensitivity analysis. RESULTS In the base-case scenario, the net cost for the intervention was $3600 compared to $2303 in the current practice arm. The intervention arm yielded 13.99 DMFT and 15.44 QALY gained, whereas the current practice arm yielded 15.52 DMFT and 14.74 QALY gained. The estimated ICER was $849 per prevented-DMFT and $1851 per QALY gained. Sensitivity analysis shows the ICER ranged from $424-$1807 per prevented-DMFT and $1851-$3941 per QALY gained. CONCLUSION Biannual professional application of fluoride varnish appears to be a highly cost-effective strategy and should be considered for universal funding in Australia's health care system.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, Vic., Australia.,Melbourne Dental School, The University of Melbourne, Melbourne, Vic., Australia
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, Vic., Australia
| | | | | | - Danny Liew
- Nursing and Health Sciences, School of Public Health & Preventive Medicine, Faculty of Medicine, Monash University, Clayton, Vic., Australia
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127
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Streatfeild J, Hillman D, Adams R, Mitchell S, Pezzullo L. Cost-effectiveness of continuous positive airway pressure therapy for obstructive sleep apnea: health care system and societal perspectives. Sleep 2019; 42:5546946. [DOI: 10.1093/sleep/zsz181] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/12/2019] [Indexed: 12/20/2022] Open
Abstract
AbstractStudy ObjectivesTo determine cost-effectiveness of continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) in Australia for 2017–2018 to facilitate public health decision-making.MethodsAnalysis was undertaken of direct per-person costs of CPAP therapy (according to 5-year care pathways), health system and other costs of OSA and its comorbidities averted by CPAP treatment (5-year adherence rate 56.7%) and incremental benefit of therapy (in terms of disability-adjusted life years [DALYs] averted) to determine cost-effectiveness of CPAP. This was expressed as the incremental cost-effectiveness ratio (= dollars per DALY averted). Direct costs of CPAP were estimated from government reimbursements for services and advertised equipment costs. Costs averted were calculated from both the health care system perspective (health system costs only) and societal perspective (health system plus other financial costs including informal care, productivity losses, nonmedical accident costs, deadweight taxation and welfare losses). These estimates of costs (expressed in US dollars) and DALYs averted were based on our recent analyses of costs of untreated OSA.ResultsFrom the health care system perspective, estimated cost of CPAP therapy to treat OSA was $12 495 per DALY averted while from a societal perspective the effect was dominant (−$10 688 per DALY averted) meaning it costs more not to treat the problem than to treat it.ConclusionsThese estimates suggest substantial community investment in measures to more systematically identify and treat OSA is justified. Apart from potential health and well-being benefits, it is financially prudent to do so.
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Affiliation(s)
- Jared Streatfeild
- Health Economics and Social Policy, Deloitte Access Economics, Canberra, Australia
| | - David Hillman
- Centre for Sleep Science, University of Western Australia, Perth, Australia
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Robert Adams
- The Health Observatory, University of Adelaide, Adelaide, Australia
| | - Scott Mitchell
- Health Economics and Social Policy, Deloitte Access Economics, Canberra, Australia
| | - Lynne Pezzullo
- Health Economics and Social Policy, Deloitte Access Economics, Canberra, Australia
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128
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Gumbie M, Parkinson B, Cutler H, Gauld N, Mumford V. Is Reclassification of the Oral Contraceptive Pill from Prescription to Pharmacist-Only Cost Effective? Application of an Economic Evaluation Approach to Regulatory Decisions. PHARMACOECONOMICS 2019; 37:1049-1064. [PMID: 31069781 DOI: 10.1007/s40273-019-00804-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Unplanned pregnancies can lead to poorer maternal and child health outcomes. The Australian Therapeutic Goods Administration committee rejected reclassifying a range of oral contraceptive pills (OCPs) from prescription to pharmacist-only medicines in 2015, mainly based on safety concerns. Improving access to OCPs may encourage some women to use contraceptives or switch from other contraceptive methods. However, some adverse events may increase and some women may stop using condoms, increasing their risk of sexually transmitted infections. This study aimed to estimate the cost effectiveness of reclassifying OCPs from prescription to pharmacist-only. PERSPECTIVE Healthcare system. SETTING Australian primary care. METHODS A Markov model was used to synthesise data from a variety of sources. The model included all Australian women aged 15-49 years (N = 5,644,701). The time horizon was 35 years. Contraceptive use before reclassification was estimated using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, while survey data informed use after reclassification. Health outcomes included pregnancies, pregnancy outcomes (live birth, miscarriage, stillbirth, ectopic pregnancy and abortion), sexually transmitted infections, adverse events (venous thromboembolism, depression, myocardial infarction and stroke), ovarian cancer cases and quality-adjusted life-years. Costs included those related to general practitioner and specialist consultations, contraceptives and other medicines, pharmacist time, hospitalisations and adverse events. All costs were reported in 2016 Australian Dollars. A 5% discount rate was applied to health outcomes and costs. RESULTS Reclassifying OCPs resulted in 85.70 million quality-adjusted life-years experienced and costs of $46,910.14 million over 35 years, vs. 85.68 million quality-adjusted life-years experienced and costs of $50,274.95 million with OCPs remaining prescription-only. Thus, reclassifying OCPs was more effective and cost saving. However, a sensitivity analysis found that more research on the probability of pregnancy in women not using contraception and not trying to conceive is needed. CONCLUSION Reclassifying OCPs is likely to be considered cost effective by Australian decision makers.
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Affiliation(s)
- Mutsa Gumbie
- Centre for the Health Economy, Macquarie University, Sydney, NSW, 2109, Australia
| | - Bonny Parkinson
- Centre for the Health Economy, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Henry Cutler
- Centre for the Health Economy, Macquarie University, Sydney, NSW, 2109, Australia
| | - Natalie Gauld
- School of Pharmacy, University of Auckland, Auckland, 1023, New Zealand
| | - Virginia Mumford
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
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129
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Le LKD, Sanci L, Chatterton ML, Kauer S, Buhagiar K, Mihalopoulos C. The Cost-Effectiveness of an Internet Intervention to Facilitate Mental Health Help-Seeking by Young Adults: Randomized Controlled Trial. J Med Internet Res 2019; 21:e13065. [PMID: 31333199 PMCID: PMC6681639 DOI: 10.2196/13065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/10/2019] [Accepted: 05/07/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Little empirical evidence is available to support the effectiveness and cost-effectiveness of internet interventions to increase help-seeking behavior for mental health in young adults. OBJECTIVE The aim of this study was to evaluate the cost-effectiveness of a Web-based mental health help-seeking navigation tool (Link) in comparison with usual help-seeking strategies. METHODS A cost-utility analysis alongside the main randomized trial of Link was conducted from the Australian health care sector perspective. Young adults aged 18 to 25 years were randomized to the Link intervention (n=205) or usual care (n=208) with 1- and 3-month follow-ups. The primary outcome of this study was quality-adjusted life years (QALYs) measured by the assessment of quality of life-4D. Costs were calculated based on the self-reported resource use questionnaire and were reported in 2015 Australian dollars. Primary analyses were conducted as intention-to-treat and reported as incremental cost-effectiveness ratios. Completer analyses were conducted in a sensitivity analysis. RESULTS Significantly more QALYs were gained in the intervention group than the control group (0.15 vs 0.14; P<.001). The intervention was associated with significantly lower health professional consultation costs at 1-month follow-up (mean costs Aus $98 vs Aus $162; P<.05). Costs of hospital services were lower at 3 months in the intervention arm (mean costs Aus $47 vs Aus $101); however, there was insufficient sample size to detect a significant difference between the groups. There were no statistically significant differences in the total costs between the 2 arms. Relative to the control group, those who received the intervention experienced 0.01 more QALYs (0.00-0.02) and had lower total health sector costs of Aus -$81 (Aus -$348 to Aus $186) over 3 months. The intervention was found to be more effective and less costly compared with usual help-seeking strategies. The intervention was 100% likely to be cost-effective below a willingness-to-pay value-for-money threshold of Aus $28,033 per QALY. Results were robust in the sensitivity analysis. CONCLUSIONS Our study found that the online youth mental health help-seeking Web service is a cost-effective intervention for young people aged 18 to 25 years compared with usual search strategies. Further research is required to confirm these results. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=366731.
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Affiliation(s)
- Long Khanh-Dao Le
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Australia
| | - Lena Sanci
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Australia
| | - Sylvia Kauer
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | | | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Australia
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130
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Siverskog J, Henriksson M. Estimating the marginal cost of a life year in Sweden's public healthcare sector. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:751-762. [PMID: 30796552 PMCID: PMC6602994 DOI: 10.1007/s10198-019-01039-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/12/2019] [Indexed: 05/19/2023]
Abstract
Although cost-effectiveness analysis has a long tradition of supporting healthcare decision-making in Sweden, there are no clear criteria for when an intervention is considered too expensive. In particular, the opportunity cost of healthcare resource use in terms of health forgone has not been investigated empirically. In this work, we therefore seek to estimate the marginal cost of a life year in Sweden's public healthcare sector using time series and panel data at the national and regional levels, respectively. We find that estimation using time series is unfeasible due to reversed causality. However, through panel instrumental variable estimation we are able to derive a marginal cost per life year of about SEK 370,000 (EUR 39,000). Although this estimate is in line with emerging evidence from other healthcare systems, it is associated with uncertainty, primarily due to the inherent difficulties of causal inference using aggregate observational data. The implications of these difficulties and related methodological issues are discussed.
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Affiliation(s)
- Jonathan Siverskog
- Centre for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Martin Henriksson
- Centre for Medical Technology Assessment, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden
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131
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O'Mahony JF. Beneluxa: What are the Prospects for Collective Bargaining on Pharmaceutical Prices Given Diverse Health Technology Assessment Processes? PHARMACOECONOMICS 2019; 37:627-630. [PMID: 30847759 DOI: 10.1007/s40273-019-00781-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- James F O'Mahony
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland.
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132
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Mitchell BG, Fasugba O, Cheng AC, Gregory V, Koerner J, Collignon P, Gardner A, Graves N. Chlorhexidine versus saline in reducing the risk of catheter associated urinary tract infection: A cost-effectiveness analysis. Int J Nurs Stud 2019; 97:1-6. [PMID: 31129443 DOI: 10.1016/j.ijnurstu.2019.04.003] [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: 02/11/2019] [Revised: 04/04/2019] [Accepted: 04/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Catheter associated urinary tract infections are one of the most common infections acquired in hospital. A recent randomised control study demonstrated the benefit of using chlorhexidine (0.1%) for meatal cleaning prior to urinary catheter insertion, by reducing both catheter associated asymptomatic bacteriuria and infection. These findings raise the important question of whether a decision to switch from saline to chlorhexidine was likely to be cost-effective. The aim of this paper was to evaluate the cost-effectiveness of adopting routine use of chlorhexidine for meatal cleaning prior to urinary catheter insertion METHODS: The outcomes of this cost-effectiveness study are changes to health service costs in $AUD and changes to quality adjusted life years from a decision to adopt 0.1% chlorhexidine for meatal cleaning prior to urinary catheter insertion as compared to saline. Effectiveness outcomes for this study were taken from a 32 week stepped wedge randomised controlled study conducted in three Australian hospitals. RESULTS The changes in health costs from switching from saline to 0.1% chlorhexidine per 100,000 catheterisations would save hospitals AUD$387,909 per 100,000 catherisations, prevent 70 cases of catheter associated urinary tract infections, release 282 bed days and provide a small improvement in health benefits of 1.43 quality adjusted life years. Using a maximum willingness to pay for a marginal quality adjusted life year threshold of AUD$28,000 per 100,000 catherisations, suggests that adopting chlorhexidine would be cost effective and potentially cost-saving. CONCLUSION The findings from our work provide evidence to health system administrators and those responsible for drafting catheter associated urinary tract infections prevention guidelines that investing in switching from saline to chlorhexidine is not only clinically effective but also a sensible decision in the context of allocating finite healthcare resources.
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Affiliation(s)
- Brett G Mitchell
- Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, 185 Fox Valley Road, Wahroonga, New South Wales 2076, Australia; School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia.
| | - Oyebola Fasugba
- Nursing Research Institute, Australian Catholic University & St Vincent's Health Australia Sydney, New South Wales, Australia; Lifestyle Research Centre, Avondale College of Higher Education, Cooranbong, New South Wales, Australia
| | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Infectious Prevention and Healthcare Epidemiology Unit, Alfred Hospital, Melbourne, Australia
| | - Victoria Gregory
- Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, 185 Fox Valley Road, Wahroonga, New South Wales 2076, Australia
| | - Jane Koerner
- School of Nursing, Midwifery and Paramedicine Australian Catholic University, Watson Australia
| | - Peter Collignon
- Australian Capital Territory Pathology, Canberra Hospital and Health Services, Yamba Drive, Garran, Australian Capital Territory 2605, Australia; Medical School, Australian National University, Acton, Australian Capital Territory 2601, Australia
| | - Anne Gardner
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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133
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McCabe C. Expanding the Scope of Costs and Benefits for Economic Evaluations in Health: Some Words of Caution. PHARMACOECONOMICS 2019; 37:457-460. [PMID: 30328562 DOI: 10.1007/s40273-018-0729-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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134
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Caro JJ, Brazier JE, Karnon J, Kolominsky-Rabas P, McGuire AJ, Nord E, Schlander M. Determining Value in Health Technology Assessment: Stay the Course or Tack Away? PHARMACOECONOMICS 2019; 37:293-299. [PMID: 30414074 PMCID: PMC6386014 DOI: 10.1007/s40273-018-0742-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The economic evaluation of new health technologies to assess whether the value of the expected health benefits warrants the proposed additional costs has become an essential step in making novel interventions available to patients. This assessment of value is problematic because there exists no natural means to measure it. One approach is to assume that society wishes to maximize aggregate health, measured in terms of quality-adjusted life-years (QALYs). Commonly, a single 'cost-effectiveness' threshold is used to gauge whether the intervention is sufficiently efficient in doing so. This approach has come under fire for failing to account for societal values that favor treating more severe illness and ensuring equal access to resources, regardless of pre-existing conditions or capacity to benefit. Alternatives involving expansion of the measure of benefit or adjusting the threshold have been proposed and some have advocated tacking away from the cost per QALY entirely to implement therapeutic area-specific efficiency frontiers, multicriteria decision analysis or other approaches that keep the dimensions of benefit distinct and value them separately. In this paper, each of these alternative courses is considered, based on the experiences of the authors, with a view to clarifying their implications.
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Affiliation(s)
- J Jaime Caro
- London School of Economics and Political Science, London, UK.
- Evidera, Waltham, MA, USA.
- , 39 Bypass Road, Lincoln, MA, 01773, USA.
| | - John E Brazier
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jonathan Karnon
- School of Public Health, University of Adelaide, Adelaide, SA, Australia
| | - Peter Kolominsky-Rabas
- Interdisciplinary Centre for Health Technology Assessment and Public Health, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Erik Nord
- Norwegian Institute of Public Health, Oslo, Norway
| | - Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), University of Heidelberg, Heidelberg, Germany
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135
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Brouwer W, van Baal P, van Exel J, Versteegh M. When is it too expensive? Cost-effectiveness thresholds and health care decision-making. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:175-180. [PMID: 30187251 DOI: 10.1007/s10198-018-1000-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Werner Brouwer
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Pieter van Baal
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Matthijs Versteegh
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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136
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Fletcher S, Chondros P, Palmer VJ, Chatterton ML, Spittal MJ, Mihalopoulos C, Wood A, Harris M, Burgess P, Bassilios B, Pirkis J, Gunn J. Link-me: Protocol for a randomised controlled trial of a systematic approach to stepped mental health care in primary care. Contemp Clin Trials 2019; 78:63-75. [PMID: 30593884 DOI: 10.1016/j.cct.2018.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/12/2018] [Accepted: 12/25/2018] [Indexed: 11/16/2022]
Abstract
Primary care in Australia is undergoing significant reform, with a particular focus on cost-effective tailoring of mental health care to individual needs. Link-me is testing whether a patient-completed Decision Support Tool (DST), which predicts future severity of depression and anxiety symptoms and triages individuals into care accordingly, is clinically effective and cost-effective relative to usual care. The trial is set in general practices, with English-speaking patients invited to complete eligibility screening in their general practitioner's waiting room. Eligible and consenting patients will then complete the DST assessment and are randomised and stratified according to predicted symptom severity. Participants allocated to the intervention arm will receive feedback on DST responses, select treatment priorities, assess motivation to change, and receive a severity-matched treatment recommendation (information about and links to low intensity services for those with mild symptoms, or assistance from a specially trained health professional (care navigator) for those with severe symptoms). All patients allocated to the comparison arm will receive usual GP care plus attention control. Primary (psychological distress) and secondary (depression, anxiety, quality of life, days out of role) outcomes will be assessed at 6 and 12 months. Differences in outcome means between trial arms both across and within symptom severity group will be examined using intention-to-treat analyses. Within trial and modelled economic evaluations will be conducted to determine the value for money of credentials of Link-me. Findings will be reported to the Federal Government to inform how mental health services across Australia are funded and delivered in the future.
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Affiliation(s)
- Susan Fletcher
- The Department of General Practice, Melbourne Medical School, University of Melbourne.
| | - Patty Chondros
- The Department of General Practice, Melbourne Medical School, University of Melbourne
| | - Victoria J Palmer
- The Department of General Practice, Melbourne Medical School, University of Melbourne
| | | | - Matthew J Spittal
- Melbourne School of Population and Global Health, University of Melbourne
| | | | - Anna Wood
- The Department of General Practice, Melbourne Medical School, University of Melbourne
| | | | | | - Bridget Bassilios
- Melbourne School of Population and Global Health, University of Melbourne
| | - Jane Pirkis
- Melbourne School of Population and Global Health, University of Melbourne
| | - Jane Gunn
- The Department of General Practice, Melbourne Medical School, University of Melbourne
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137
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Warren E, Morgan K, Toward TJ, Schwenkglenks M, Leadbetter J. Cost Effectiveness of Inhaled Mannitol (Bronchitol ®) in Patients with Cystic Fibrosis. PHARMACOECONOMICS 2019; 37:435-446. [PMID: 30666534 DOI: 10.1007/s40273-019-00767-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Inhaled mannitol (Bronchitol®) is licensed in Australia as a safe and efficacious addition to best supportive care in patients with cystic fibrosis. OBJECTIVE The objective of this study was to assess the cost effectiveness of inhaled mannitol (in addition to best supportive care) in the Australian setting from the perspective of a government-funded national healthcare system. METHODS A probabilistic patient-level simulation Markov model estimated life-time costs and outcomes of mannitol when added to best supportive care, compared with best supportive care alone in patients aged 6 years and older. We estimated treatment-related inputs (initial change in percentage of predicted forced expiratory volume, relative reduction in severe pulmonary exacerbations, and treatment discontinuations) from two phase III trials. Longer term natural history rates of predicted forced expiratory volume decline over time and severe pulmonary exacerbation rates for best supportive care were taken from Australian CF registries. The utility value for the cystic fibrosis health state was as measured in the trials using the Health Utility Index, whereas the impact of pulmonary exacerbations and lung transplantation on utility was ascertained from the published literature. The underlying cost of managing cystic fibrosis, and the cost associated with pulmonary exacerbations and transplantations was taken from published Australian sources. RESULTS The addition of inhaled mannitol to best supportive care resulted in a discounted cost per quality-adjusted life-year of AU$39,165. The result was robust with 77% of probabilistic sensitivity analysis samples below a willingness-to-pay threshold of AU$45,000/quality-adjusted life-year. CONCLUSION Benchmarked against an implicit Australian willingness-to-pay threshold for life-threatening diseases, our model suggests inhaled mannitol provides a cost-effective addition to best supportive care in patients with cystic fibrosis, irrespective of concomitant dornase alfa use.
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Affiliation(s)
- Emma Warren
- HERA Consulting Australia Pty Ltd, 515 Darling Street, Balmain, NSW, 2041, Australia.
| | | | - Toby J Toward
- Pharmaxis Ltd, Frenchs Forest, Australia
- Henley Health Economics, Henley-on-Thames, UK
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138
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Claxton K, Asaria M, Chansa C, Jamison J, Lomas J, Ochalek J, Paulden M. Accounting for Timing when Assessing Health-Related Policies. JOURNAL OF BENEFIT-COST ANALYSIS 2019; 10:73-105. [PMID: 33282628 PMCID: PMC7691758 DOI: 10.1017/bca.2018.29] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The primary focus of this paper is to offer guidance on the analysis of time streams of effects that a project may have so that they can be discounted appropriately. This requires a framework that identifies the common parameters that need to be assessed, whether conducting cost-effectiveness or benefit-cost analysis. The quantification and conversion of the time streams of different effects into their equivalent health, health care cost or consumption effects avoids embedding multiple arguments in discounting policies. This helps to identify where parameters are likely to differ in particular contexts, what type of evidence would be relevant, what is currently known and how this evidence might be strengthened. The current evidence available to support the assessment of the key parameters is discussed and possible estimates and default assumptions are suggested. Reporting the results in an extensive way is recommended. This makes the assessments required explicit so the impact of alternative assumptions can be explored and analysis updated as better estimates evolve. Some projects will have effects across different countries where some or all of these parameters will differ. Therefore, the net present value of a project will be the sum of the country specific net present values rather than the sum of effects across countries discounted at some common rate.
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Affiliation(s)
- Karl Claxton
- The London School of Economics and Political Science (LSE), Amrita Institute of Medical Sciences and Research Centre, London WC2A 2AE, UK, e-mail:
- World Bank Group, Lusaka 10101, Zambia, e-mail:
- University of Exeter Business School, Exeter EX4 4PU, UK, e-mail:
- University of York, Centre for Health Economics, York YO10 5DD, UK, e-mail:
- University of York, Centre for Health Economics York YO10 5DD, UK, e-mail:
- University of Alberta, School of Public Health Edmonton, Alberta T6G 1C9, Canada, e-mail:
| | - Miqdad Asaria
- The London School of Economics and Political Science (LSE), Amrita Institute of Medical Sciences and Research Centre, London WC2A 2AE, UK, e-mail:
| | | | - Julian Jamison
- University of Exeter Business School, Exeter EX4 4PU, UK, e-mail:
| | - James Lomas
- University of York, Centre for Health Economics, York YO10 5DD, UK, e-mail:
| | - Jessica Ochalek
- University of York, Centre for Health Economics York YO10 5DD, UK, e-mail:
| | - Mike Paulden
- University of Alberta, School of Public Health Edmonton, Alberta T6G 1C9, Canada, e-mail:
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139
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Segal L, Twizeyemariya A, Zarnowiecki D, Niyonsenga T, Bogomolova S, Wilson A, O'Dea K, Parletta N. Cost effectiveness and cost-utility analysis of a group-based diet intervention for treating major depression - the HELFIMED trial. Nutr Neurosci 2018; 23:770-778. [PMID: 30570386 DOI: 10.1080/1028415x.2018.1556896] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background/objectives: Major depression has a negative impact on quality of life, increasing the risk of premature death. It imposes social and economic costs on individuals, families and society. Mental illness is now the leading cause globally of disability/lost quality life and premature mortality. Finding cost-effective treatments for depression is a public health priority. We report an economic evaluation of a dietary intervention for treating major depression. Methods: This economic evaluation drew on the HELFIMED RCT, a 3-month group-based Mediterranean-style diet (MedDiet) intervention (including cooking workshops), against a social group-program for people with major depression. We conducted (i) a cost-utility analysis, utility scores measured at baseline, 3-months and 6-months using the AQoL8D, modelled to 2 years (base case); (ii) a cost-effectiveness analysis, differential cost/case of depression resolved (to normal/mild) measured by the DASS. Differential program costs were calculated from resources use costed in AUD2017. QALYs were discounted at 3.5%pa. Results: Best estimate differential cost/QALY gain per person, MedDiet relative to social group was AUD2775. Probabilistic sensitivity analysis, varying costs, utility gain, model period found 95% likelihood cost/QALY less than AUD20,000. Estimated cost per additional case of depression resolved, MedDiet group relative to social group was AUD2,225. Conclusions: A MedDiet group-program for treating major depression was highly cost-effective relative to a social group-program, measured in terms of cost/QALY gain and cost per case of major depression resolved. Supporting access by persons with major depression to group-based dietary programs should be a policy priority. A change to funding will be needed to realise the potential benefits.
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Affiliation(s)
- Leonie Segal
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Asterie Twizeyemariya
- School of Health Sciences, University of South Australia, Adelaide, Australia.,Faculty of Health Sciences, University of Canberra, Canberra, Australia
| | - Dorota Zarnowiecki
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Theo Niyonsenga
- School of Health Sciences, University of South Australia, Adelaide, Australia.,Faculty of Health Sciences, University of Canberra, Canberra, Australia
| | - Svetlana Bogomolova
- Ehrenberg-Bass Institute for Marketing Science, University of South Australia, Adelaide, Australia
| | - Amy Wilson
- Ehrenberg-Bass Institute for Marketing Science, University of South Australia, Adelaide, Australia
| | - Kerin O'Dea
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Natalie Parletta
- School of Health Sciences, University of South Australia, Adelaide, Australia
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140
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Edney L, Haji Ali Afzali H, Karnon J. Are the benefits of new health services greater than their opportunity costs? AUST HEALTH REV 2018; 43:508-510. [PMID: 30526796 DOI: 10.1071/ah18087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/28/2018] [Indexed: 11/23/2022]
Abstract
The Australian health system performs well compared with other developed countries, but there is potential for improved health outcomes through the consideration of the opportunity costs of funding new health services. The opportunity costs of funding a new health service are the benefits forgone from the activities that would be funded if the new health service was not funded. When the forgone activity cannot be observed directly, the expected opportunity costs have been estimated as the expected gain in quality-adjusted life years (QALYs) associated with marginal increases in government expenditure on health. We have previously estimated that a gain of 1 QALY is expected for every additional A$28033 of government expenditure on health. This paper discusses the relevance and proposed use of this estimate of opportunity costs to inform decisions around the public funding of new health services in Australia.
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Affiliation(s)
- Laura Edney
- School of Public Health, University of Adelaide, Level 9, Adelaide Health & Medical Sciences Building, Adelaide, SA 5000, Australia.
| | - Hossein Haji Ali Afzali
- School of Public Health, University of Adelaide, Level 9, Adelaide Health & Medical Sciences Building, Adelaide, SA 5000, Australia.
| | - Jonathan Karnon
- School of Public Health, University of Adelaide, Level 9, Adelaide Health & Medical Sciences Building, Adelaide, SA 5000, Australia.
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141
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Mortimer D, Bosch M, Mckenzie JE, Turner S, Chau M, Ponsford JL, Knott JC, Gruen RL, Green SE. Economic evaluation of the NET intervention versus guideline dissemination for management of mild head injury in hospital emergency departments. Implement Sci 2018; 13:147. [PMID: 30518430 PMCID: PMC6280545 DOI: 10.1186/s13012-018-0834-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based guidelines for the management of mild traumatic brain injury (mTBI) in the emergency department (ED) are now widely available, and yet, clinical practice remains inconsistent with the guidelines. The Neurotrauma Evidence Translation (NET) intervention was developed to increase the uptake of guideline recommendations and improve the management of minor head injury in Australian emergency departments (EDs). However, the adoption of this type of intervention typically entails an upfront investment that may or may not be fully offset by improvements in clinical practice, health outcomes and/or reductions in health service utilisation. The present study estimates the cost and cost-effectiveness of the NET intervention, as compared to the passive dissemination of the guideline, to evaluate whether any improvements in clinical practice or health outcomes due to the NET intervention can be obtained at an acceptable cost. METHODS AND FINDINGS Study setting: The NET cluster randomised controlled trial [ACTRN12612001286831]. STUDY SAMPLE Seventeen EDs were randomised to the control condition and 14 to the intervention. One thousand nine hundred forty-three patients were included in the analysis of clinical practice outcomes (NET sample). A total of 343 patients from 14 control and 10 intervention EDs participated in follow-up interviews and were included in the analysis of patient-reported health outcomes (NET-Plus sample). OUTCOME MEASURES Appropriate post-traumatic amnesia (PTA) screening in the ED (primary outcome). Secondary clinical practice outcomes: provision of written information on discharge (INFO) and safe discharge (defined as CT scan appropriately provided plus PTA plus INFO). Secondary patient-reported, post-discharge health outcomes: anxiety (Hospital Anxiety and Depression Scale), post-concussive symptoms (Rivermead), and preference-based health-related quality of life (SF6D). METHODS Trial-based economic evaluations from a health sector perspective, with time horizons set to coincide with the final follow-up for the NET sample (2 months post-intervention) and to 1-month post-discharge for the NET-Plus sample. RESULTS Intervention and control groups were not significantly different in health service utilisation received in the ED/inpatient ward following the initial mTBI presentation (adjusted mean difference $23.86 per patient; 95%CI - $106, $153; p = 0.719) or over the longer follow-up in the NET-plus sample (adjusted mean difference $341.78 per patient; 95%CI - $58, $742; p = 0.094). Savings from lower health service utilisation are therefore unlikely to offset the significantly higher upfront cost of the intervention (mean difference $138.20 per patient; 95%CI $135, $141; p < 0.000). Estimates of the net effect of the intervention on total cost (intervention cost net of health service utilisation) suggest that the intervention entails significantly higher costs than the control condition (adjusted mean difference $169.89 per patient; 95%CI $43, $297, p = 0.009). This effect is larger in absolute magnitude over the longer follow-up in the NET-plus sample (adjusted mean difference $505.06; 95%CI $96, $915; p = 0.016), mostly due to additional health service utilisation. For the primary outcome, the NET intervention is more costly and more effective than passive dissemination; entailing an additional cost of $1246 per additional patient appropriately screened for PTA ($169.89/0.1363; Fieller's 95%CI $525, $2055). For NET to be considered cost-effective with 95% confidence, decision-makers would need to be willing to trade one quality-adjusted life year (QALY) for 25 additional patients appropriately screened for PTA. While these results reflect our best estimate of cost-effectiveness given the data, it is possible that a NET intervention that has been scaled and streamlined ready for wider roll-out may be more or less cost-effective than the NET intervention as delivered in the trial. CONCLUSIONS While the NET intervention does improve the management of mTBI in the ED, it also entails a significant increase in cost and-as delivered in the trial-is unlikely to be cost-effective at currently accepted funding thresholds. There may be a scope for a scaled-up and streamlined NET intervention to achieve a better balance between costs and outcomes. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12612001286831 , date registered 12 December 2012.
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Affiliation(s)
- Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia.
| | - Marije Bosch
- Department of Surgery, Monash University, Melbourne, Australia.,National Trauma Research Institute, Alfred Hospital and Monash University, Melbourne, Australia.,Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Joanne E Mckenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Simon Turner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marisa Chau
- Department of Surgery, Monash University, Melbourne, Australia.,National Trauma Research Institute, Alfred Hospital and Monash University, Melbourne, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia.,School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Jonathan C Knott
- Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Russell L Gruen
- National Trauma Research Institute, Alfred Hospital and Monash University, Melbourne, Australia.,Lee Kong Chian School of Medicine, Nanyang Technological University, Melbourne, Singapore
| | - Sally E Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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142
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Teptsova TS, Bezdenezhnyh TP, Fedyaeva VK, Musina NZ, Hachatryan GR, Tarasov VV. Determination of a willingness-to-pay threshold and decision-making in financing the healthcare technologies. ACTA ACUST UNITED AC 2018. [DOI: 10.17749/2070-4909.2018.11.3-013-022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim was to develop a methodology for determining the willingness to pay threshold (WTPT) and its upper limit value within the Russian health care system.Materials and methods. WTPT was calculated based on the shadow budget price (i. e. determining the WTPT by the suppling party). This method is an empirical assessment of the cost-effectiveness threshold that reflects the utmost productivity of the health care system, as determined from the relationship between changes in healthcare expenditure and health outcomes achieved. The state’s willingness to pay for improving their citizens’ healthcare was evaluated considering the population of the Russian Federation, mortality and life expectancy in different age and gender groups, as well as the volume of government spending. The cost of disability-adjusted life-year prevented (DALY) and the cost of quality-adjusted life-year saved (QALY) were determined by the suppling party, that is, they reflect the cost the state is willing to pay for improving the health of their population under conditions of limited budget. The described approach considers the performance of the country’s healthcare system over a certain period and the costs incurred in functioning of the system.Results. As part of this study, it was found that the cost of one additionally prevented DALY would be 313,878.21 rubles, and the cost of one additionally saved QALY – 365,060.31 rubles.Conclusion. The WTPT for medical technologies in the Russian Federation, determined by estimating the shadow budget price will amount to 313,878.21 rubles for one prevented DALY and 365 060,31 rubles for one saved QALY. With regard to clinical and economic analysis, medical technologies with the incremental cost-effectiveness indicator not exceeding the one calculated in this study can be seen as cost-effective. The obtained threshold value is a recommendation. A medical technology can be approved even with a WTPT higher than the recommended level, because this specific technology may have additional advantages other than WTPT when compared with the reference technologies.
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Affiliation(s)
- T. S. Teptsova
- I. M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
| | - T. P. Bezdenezhnyh
- Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation
| | - V. K. Fedyaeva
- Russian Presidential Academy of National economy and Public Administration, Federal State educational Institution of Higher Professional education; Research Financial Institution of the Ministry of Finance of the Russian Federation, Federal State Budget Institution
| | - N. Z Musina
- I. M. Sechenov First Moscow State Medical University, Ministry of Health of Russia ; Russian Presidential Academy of National economy and Public Administration, Federal State educational Institution of Higher Professional education; Research Financial Institution of the Ministry of Finance of the Russian Federation, Federal State Budget Institution
| | - G. R. Hachatryan
- Russian Presidential Academy of National economy and Public Administration, Federal State educational Institution of Higher Professional education; Research Financial Institution of the Ministry of Finance of the Russian Federation, Federal State Budget Institution
| | - V. V. Tarasov
- I. M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
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143
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Si S, Moss J, Karnon J, Stocks N. Cost-effectiveness evaluation of the 45-49 year old health check versus usual care in Australian general practice: A modelling study. PLoS One 2018; 13:e0207110. [PMID: 30412596 PMCID: PMC6226178 DOI: 10.1371/journal.pone.0207110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/25/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To assess the potential cost-effectiveness of the 45-49 year old health check versus usual care in Australian general practice using secondary data sources. METHOD Risk factor profiles were generated for a hypothetical Australian cohort using data from the National Health Survey. Intervention effects were modelled based on a meta-analysis on risk factor changes in the 5 years after a health check. The Framingham Risk Equation was applied to estimate the 5-year cardiovascular disease (CVD) incidence in the health check and usual care group respectively. A Markov model was then constructed to extrapolate long-term CVD outcomes, health care costs and Quality Adjusted Life Years (QALYs) in both groups. Health check-related costs, applied to the health check group, were estimated from clinical guideline and experts' opinion. Lifetime costs, applied to both groups, included costs of hospitalization for CVD events and associated post-event health service use. The Incremental Cost-Effectiveness Ratio (ICER) was calculated for male and female patients respectively. RESULTS Compared to usual care, the health check reduced CVD incidence for both males (RR = 0.87) and females (RR = 0.91) over a 5-year time. In a lifetime projection, health check led to an average 0.008 and 0.003 QALYs gained per male and female participants respectively. The estimates ICERs were AU $42,355 and AU $133,504 per QALY gained for males and females, respectively. A probabilistic sensitivity analysis demonstrated a probability of cost-effectiveness of 17.5% and 0% for male and female attendees, assuming a willingness to pay threshold of AU $28,000 per QALY gained. CONCLUSION The 45-49 year old health check is associated with a small expected QALY gain per participant, though the persons avoiding CVD events experience large health gains. The mean ICER is larger than an empirical estimate of the threshold ICER and the evaluated health check is highly unlikely to be cost-effective.
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Affiliation(s)
- Si Si
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John Moss
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Jonathan Karnon
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, Australia
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144
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Ochalek J, Lomas J, Claxton K. Estimating health opportunity costs in low-income and middle-income countries: a novel approach and evidence from cross-country data. BMJ Glob Health 2018; 3:e000964. [PMID: 30483412 PMCID: PMC6231096 DOI: 10.1136/bmjgh-2018-000964] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 01/24/2023] Open
Abstract
The economic evaluation of healthcare interventions requires an assessment of whether the improvement in health outcomes they offer exceeds the improvement in health that would have been possible if the additional resources required had, instead, been made available for other healthcare activities. Therefore, some assessment of these health opportunity costs is required if the best use is to be made of the resources available for healthcare. This paper provides a framework for generating country-specific estimates of cost per disability-adjusted life year (DALY) averted 'thresholds' that reflect health opportunity costs. We apply estimated elasticities on mortality, survival, morbidity and a generic measure of health, DALYs, that take account of measures of a country's infrastructure and changes in donor funding to country-specific data on health expenditure, epidemiology and demographics to determine the likely DALYs averted from a 1% change in expenditure on health. The resulting range of cost per DALY averted 'threshold' estimates for each country that represent likely health opportunity costs tend to fall below the range previously suggested by WHO of 1-3× gross domestic product (GDP) per capita. The 1-3× GDP range and many other previous and existing recommendations about which interventions are cost-effective are not based on an empirical assessment of the likely health opportunity costs, and as a consequence, the health effects of changes in health expenditure have tended to be underestimated, and there is a risk that interventions regarded as cost-effective reduce rather than improve health outcomes overall.
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Affiliation(s)
| | - James Lomas
- Centre for Health Economics, University of York, York, UK
| | - Karl Claxton
- Centre for Health Economics, University of York, York, UK
- Department of Economics and Related Studies, University of York, York, UK
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145
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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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