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Njei B, Yi I, Strazzabosco M. Cost-effectiveness analysis: The missing factor in the management of HCC. Clin Liver Dis (Hoboken) 2024; 23:e0178. [PMID: 38860130 PMCID: PMC11164007 DOI: 10.1097/cld.0000000000000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/08/2024] [Indexed: 06/12/2024] Open
Affiliation(s)
- Basile Njei
- Liver Center, Digestive Disease Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Irvin Yi
- Liver Center, Digestive Disease Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mario Strazzabosco
- Liver Center, Digestive Disease Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut, USA
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2
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Cortesi PA, Antonazzo IC, Gasperini C, Nica M, Ritrovato D, Mantovani LG. Cost-effectiveness and budget impact analysis of siponimod in the treatment of secondary progressive multiple sclerosis in Italy. PLoS One 2022; 17:e0264123. [PMID: 35259168 PMCID: PMC8903273 DOI: 10.1371/journal.pone.0264123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Siponimod is an effective treatment for patients with secondary progressive multiple sclerosis (SPMS), with active disease evidenced by relapses or imaging features characteristic of multiple sclerosis inflammatory activity, however there is a need to evaluate its economic value and sustainability compared to other disease modifying-therapies (DMTs). Objective To estimate the siponimod cost-effectiveness profile and its relative budget impact compared with other DMTs, by using the Italian National Healthcare System perspective. Methods We performed: 1) a cost-effectiveness analysis (CEA) vs interferon beta-1b using an analytical Markov model and a life time-horizon, and 2) a budget impact analysis by using 3-years time-horizon. The results were reported as incremental cost-effectiveness ratio (ICER) and net-monetary benefit (NMB) for CEA, using a willingness to pay threshold of €40,000 per QALY gained, and as difference in the overall budget (Euro) between the scenario with and without siponimod for budget impact. Results In the base case scenario siponimod resulted cost-effective compared with interferon beta-1b 28,891€ per QALY. Overall, the market access of siponimod was associated to an increased budget of about 3€ millions (+0.9%) in the next 3 years simulated. Conclusion Compared to interferon beta-1b, siponimod seems to be cost-effective in SPMS patients and sustainable, with less than 1% overall budget increased in the next 3 years. Future studies need to confirm our results in the real word setting and in other countries.
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Affiliation(s)
- Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
- Value-Based Healthcare Unit, IRCCS MultiMedica, Sesto San Giovanni, Italy
| | | | - Claudio Gasperini
- Department of Neurology, Multiple Sclerosis Centre, San Camillo-Forlanini Hospital, Rome, Italy
| | | | | | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
- Value-Based Healthcare Unit, IRCCS MultiMedica, Sesto San Giovanni, Italy
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3
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Hui Y, Li N, Yu Z, Li C, Wang X, Li Y, Sun M, Yang W, Guo G, Fan X, Lin L, Cui B, Chen X, Wang B, Zhang J, Sun C. Health-Related Quality of Life and Its Contributors According to a Preference-Based Generic Instrument in Cirrhosis. Hepatol Commun 2022; 6:610-620. [PMID: 34558226 PMCID: PMC8870013 DOI: 10.1002/hep4.1827] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/25/2021] [Accepted: 09/05/2021] [Indexed: 01/13/2023] Open
Abstract
It is essential to determine contributors around impairment in health-related quality of life (HRQoL) in patients with cirrhosis aiming at improving health care and therapeutic strategy. Studies simultaneously incorporating disease severity based on biochemical parameters and other physical/psychological effects (i.e., sleep disturbance and frailty) are heterogeneous and the subject of the present study. We analyzed and compared HRQoL, using the EuroQol Group 5 Dimension (EQ-5D) questionnaire and the utility index retrieved, in patients with cirrhosis and across groups stratified by sleep disturbance or frailty phenotype. Sleep disturbance and frailty were determined by the Pittsburgh Sleep Quality Index (PSQI) and Frailty Index, respectively. Multiple linear regression was implemented to clarify contributors of poor HRQoL. In this cohort of 227 patients with mean age of 61.7 years and 47.2% male, more than half of the study population represented impairment in HRQoL in at least one domain, according to EQ-5D. Furthermore, sleep disturbance and frailty have proved to be independently associated with poor HRQoL in two separate regression models, whereas conventional scoring systems such as Child-Pugh classification and Model for End-Stage Liver Disease are not closely relevant. Intriguingly, not all health domains within EQ-5D correlated well with PSQI and Frailty Index, with the exception of usual activities. Pain and anxiety/depression were the most frequently affected HRQoL domains even in patients without sleep disturbance or frailty. Conclusion: Impaired HRQoL is prevalent in patients with decompensated cirrhosis. Sleep disturbance and frailty are independently associated with poor HRQoL. It is imperative to timely intervene with these symptoms and deliver tailored health care.
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Affiliation(s)
- Yangyang Hui
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Nan Li
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina
| | - Zihan Yu
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Chaoqun Li
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Department of Internal MedicineTianjin Hexi HospitalTianjinChina
| | - Xiaoyu Wang
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Yifan Li
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Mingyu Sun
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Wanting Yang
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Gaoyue Guo
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Xiaofei Fan
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Lin Lin
- Department of GastroenterologyTianjin Medical University General Hospital Airport HospitalTianjin Airport Economic AreaTianjinChina
| | - Binxin Cui
- Department of GastroenterologyTianjin Medical University General Hospital Airport HospitalTianjin Airport Economic AreaTianjinChina
| | - Xin Chen
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Bangmao Wang
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Jie Zhang
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina
| | - Chao Sun
- Department of Gastroenterology and HepatologyTianjin Medical University General HospitalTianjinChina.,Tianjin Institute of Digestive DiseaseTianjin Medical University General HospitalTianjinChina.,Department of GastroenterologyTianjin Medical University General Hospital Airport HospitalTianjin Airport Economic AreaTianjinChina
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4
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Cortesi PA, Conti S, Scalone L, Jaffe A, Ciaccio A, Okolicsanyi S, Rota M, Fabris L, Colledan M, Fagiuoli S, Belli LS, Cesana G, Strazzabosco M, Mantovani LG. Health related quality of life in chronic liver diseases. Liver Int 2020; 40:2630-2642. [PMID: 32851764 DOI: 10.1111/liv.14647] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/03/2020] [Accepted: 08/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS The impact of chronic liver diseases (CLDs) on health-related quality of life (HRQoL) is relevant to understand the burden of these conditions and inform decision-making processes related to their care. Studies simultaneously comparing the HRQoL of patients affected by the major CLDs to that of the general population are still lacking and are the subject of this study. METHODS Using the EQ-5D-3L questionnaire, we analysed and compared HRQoL data from 2962 Italian patients affected by CLDs and forming a representative sample of the general Italian population (6800 individuals). Exploratory analyses were conducted to investigate the effects of each CLD on HRQoL, using the general population as reference and adjusting for possible confounders. RESULTS Patients with CLDs (HBV, HCV, PSC, PBC, AIH, NAFLD/NASH) in the chronic hepatitis stage and with compensated cirrhosis (CC) showed HRQoL similar to the general population. However, AIH were more likely to report problems in self-care and lower EQ-5D VAS score, while NAFLD/NASH and HCV showed an increased risk of anxiety/depression. On the other hand, with progression to more advanced stages of liver disease (DC or HCC), HRQoL decreased significantly with higher risk of reporting problems in the physical domains, and significant reductions in the VAS and utility index scores. CONCLUSIONS Different subtypes of CLD affected different QoL domains. This study therefore provides a real estimate of the impact of CLDs on patients' HRQoL, and represents a much needed tool to inform decision-making while assessing the effectiveness and cost-effectiveness of the care of these patients.
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Affiliation(s)
- Paolo A Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Luciana Scalone
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Ariel Jaffe
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Antonio Ciaccio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Stefano Okolicsanyi
- Department of Surgical Disciplines, Gastroenterology and Digestive Endoscopy, Umberto Parini Hospital, Aosta, Italy
| | - Matteo Rota
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy.,Department of Molecular and Traslational Medicine, University of Brescia, Brescia, Italy
| | - Luca Fabris
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Department of Molecular Medicine, University of Padua School of Medicine, Padua, Italy
| | - Michele Colledan
- Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Gastroenterology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luca S Belli
- Department of Hepatology and Gastroenterology, Liver Unit, Niguarda Hospital, Milan, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Mario Strazzabosco
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Lorenzo G Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy.,IRCCS Multimedica, Sesto San Giovanni, Italy
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5
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van de Vijver DAMC, Richter AK, Boucher CAB, Gunsenheimer-Bartmeyer B, Kollan C, Nichols BE, Spinner CD, Wasem J, Schewe K, Neumann A. Cost-effectiveness and budget effect of pre-exposure prophylaxis for HIV-1 prevention in Germany from 2018 to 2058. ACTA ACUST UNITED AC 2020; 24. [PMID: 30782266 PMCID: PMC6381659 DOI: 10.2807/1560-7917.es.2019.24.7.1800398] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundPre-exposure prophylaxis (PrEP) is a highly effective HIV prevention strategy for men-who-have-sex-with-men (MSM). The high cost of PrEP has until recently been a primary barrier to its use. In 2017, generic PrEP became available, reducing the costs by 90%.AimOur objective was to assess cost-effectiveness and costs of introducing PrEP in Germany.MethodsWe calibrated a deterministic mathematical model to the human immunodeficiency virus (HIV) epidemic among MSM in Germany. PrEP was targeted to 30% of high-risk MSM. It was assumed that PrEP reduces the risk of HIV infection by 85%. Costs were calculated from a healthcare payer perspective using a 40-year time horizon starting in 2018.ResultsPrEP can avert 21,000 infections (interquartile range (IQR): 16,000-27,000) in the short run (after 2 years scale-up and 10 years full implementation). HIV care is predicted to cost EUR 36.2 billion (IQR: 32.4-40.4 billion) over the coming 40 years. PrEP can increase costs by at most EUR 150 million within the first decade after introduction. Ten years after introduction, PrEP can become cost-saving, accumulating to savings of HIV-related costs of EUR 5.1 billion (IQR: 3.5-6.9 billion) after 40 years. In a sensitivity analysis, PrEP remained cost-saving even at a 70% price reduction of antiretroviral drug treatment and a lower effectiveness of PrEP.ConclusionIntroduction of PrEP in Germany is predicted to result in substantial health benefits because of reductions in HIV infections. Short-term financial investments in providing PrEP will result in substantial cost-savings in the long term.
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Affiliation(s)
| | - Ann-Kathrin Richter
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | | | | | - Christian Kollan
- Department for Infectious Disease epidemiology, Robert Koch Institute, Berlin, Germany
| | - Brooke E Nichols
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Global Health, Boston University, Boston, United States.,Viroscience department, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Christoph D Spinner
- dagnä (Deutsche Arbeitsgemeinschaft niedergelassener Ärzte in der Versorgung HIV-Infizierter), Berlin, Germany.,Department of Medicine II, University Hospital Klinikum rechts der Isar, Munich, Germany
| | - Jürgen Wasem
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Knud Schewe
- dagnä (Deutsche Arbeitsgemeinschaft niedergelassener Ärzte in der Versorgung HIV-Infizierter), Berlin, Germany
| | - Anja Neumann
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
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6
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El-Tahan RR, Ghoneim AM, Zaghloul H. Dissection of two drug-targeted regions of Hepatitis C virus subtype 4a infecting Egyptian patients. Virus Genes 2020; 56:564-581. [PMID: 32572756 PMCID: PMC7307947 DOI: 10.1007/s11262-020-01776-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 06/16/2020] [Indexed: 12/11/2022]
Abstract
Recently, treatment of HCV infection has been improved after the development of direct acting antivirals (DAAs) which target different viral proteins (NS3-4A, NS5A and NS5B). The activity and effectiveness of these DAAs are affected by the presence of resistance associated substitutions (RASs). This study aimed to characterize HCV genotypes circulating among Egyptian HCV patients, to dissect the full sequences of HCV NS3-4A and NS5B regions, and to characterize RASs associated with NS3-4A and NS5B inhibitors in HCV treatment-naïve patients. Genotyping of 80 HCV samples from treatment-naïve patients was done using restriction fragment length polymorphism and phylogenetic analysis based on some full NS5B sequences. Results showed the prevalence of HCV subtype 4a. Twenty four new full sequences of NS3-4A and NS5B regions of subtype 4a were deposited in the GenBank database. In general, the substitutions associated with NS3-4A-targeting drugs were absent predicting possible responsiveness of Egyptian HCV patients to these drugs. In addition, the absence of amino acid substitutions associated with resistance to Sofosbuvir may predict good response to treatment with Sofosbuvir. Some amino acid substitutions associated with resistance to different classes of non-nucleoside inhibitors were detected. Further investigations on treated Egyptian HCV patients may evaluate the effectiveness of the massively used drugs. Many predicted T-cell-binding epitopes in NS3-4A and NS5B regions were found to be highly conserved in the currently studied isolates; a finding that might be important for HCV vaccine development. We demonstrated potential NS3 epitopes that could be used in engineering T cells against HCV epitopes.
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Affiliation(s)
- Radwa R El-Tahan
- Zoology Department, Faculty of Science, Damietta University, New Damietta, P.O. 34517, Damietta, Egypt
| | - Ahmed M Ghoneim
- Zoology Department, Faculty of Science, Damietta University, New Damietta, P.O. 34517, Damietta, Egypt.
| | - Hosam Zaghloul
- Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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7
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Strazzabosco M, Cortesi PA, Conti S, Okolicsanyi S, Rota M, Ciaccio A, Cozzolino P, Fornari C, Gemma M, Scalone L, Cesana G, Fabris L, Colledan M, Fagiuoli S, Ideo G, Zavaglia C, Perricone G, Munari LM, Mantovani LG, Belli LS. Clinical outcome indicators in chronic hepatitis B and C: A primer for value-based medicine in hepatology. Liver Int 2020; 40:60-73. [PMID: 31654608 PMCID: PMC10916792 DOI: 10.1111/liv.14285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/03/2019] [Accepted: 10/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Chronic liver diseases (CLDs) are major health problems that require complex and costly treatments. Liver-specific clinical outcome indicators (COIs) able to assist both clinicians and administrators in improving the value of care are presently lacking. The Value-Based Medicine in Hepatology (VBMH) study aims to fill this gap, devising and testing a set of COIs for CLD, that could be easily collected during clinical practice. Here we report the COIs generated and recorded for patients with HBV or HCV infection at different stages of the disease. METHODS/RESULTS In the first phase of VBMH study, COIs were identified, based on current international guidelines and literature, using a modified Delphi method and a RAND 9-point appropriateness scale. In the second phase, COIs were tested in an observational, longitudinal, prospective, multicentre study based in Lombardy, Italy. Eighteen COIs were identified for HBV and HCV patients. Patients with CLD secondary to HBV (547) or HCV (1391) were enrolled over an 18-month period and followed for a median of 4 years. The estimation of the proposed COIs was feasible in the real-word clinical practice and COI values compared well with literature data. Further, the COIs were able to capture the impact of new effective treatments like direct-acting antivirals (DAAs) in the clinical practice. CONCLUSIONS The COIs efficiently measured clinical outcomes at different stages of CLDs. While specific clinical practice settings and related healthcare systems may modify their implementation, these indicators will represent an important component of the tools for a value-based approach in hepatology and will positively affect care delivery.
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Affiliation(s)
- Mario Strazzabosco
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Paolo A. Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Stefano Okolicsanyi
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
| | - Matteo Rota
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
- Department of Molecular and Traslational Medicine, University of Brescia, Brescia, Italy
| | - Antonio Ciaccio
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
| | - Paolo Cozzolino
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Carla Fornari
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Marta Gemma
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
- International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
| | - Luciana Scalone
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Luca Fabris
- International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
- Liver Center & Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Molecular Medicine, University of Padua School of Medicine, Padua, Italy
| | - Michele Colledan
- Department of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stefano Fagiuoli
- Department of Gastroenterology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Claudio Zavaglia
- Hepatology and Gastroenterology Unit - Liver Unit, ASST GOM Niguarda, Milan, Italy
| | - Giovanni Perricone
- Hepatology and Gastroenterology Unit - Liver Unit, ASST GOM Niguarda, Milan, Italy
| | | | - Lorenzo G. Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Milan, Italy
| | - Luca S. Belli
- International Center for Digestive Health, University of Milan-Bicocca, Milan, Italy
- Hepatology and Gastroenterology Unit - Liver Unit, ASST GOM Niguarda, Milan, Italy
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8
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Cortesi PA, Barca R, Giudicatti G, Mossini S, Ciaccio A, Iannazzo S, Micale M, Cesana G, Mantovani LG. Systematic review: economic evaluations of HCV screening in the direct-acting antivirals era. Aliment Pharmacol Ther 2019; 49:1126-1133. [PMID: 30843268 DOI: 10.1111/apt.15201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/26/2018] [Accepted: 02/01/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The World Health Organization estimated that 90% of the infected people need to be diagnosed and 80% need to be treated to reach the aim of hepatitis C virus (HCV) elimination by 2030. For this reason, all possible strategies to detect and treat HCV-infected people need to be carefully evaluated to implement the best one. AIM To review and synthesise the economic evaluations of HCV screening programs conducted in the era of direct-acting antiviral agents regimens. METHODS A systematic literature review was conducted until April 2018 to provide information on the costs and effectiveness of HCV screenings in direct-acting antiviral agents era. A critical assessment of the quality of economic evaluations retrieved was conducted. RESULTS The literature search identified 716 references; 17 of them assessed cost and effectiveness of screening programs and antiviral treatments in different populations: general population (n = 7), drug users (n = 5), high-risk populations (n = 4) and other populations (n = 3). The HCV screening and direct-acting antiviral agents treatment appear to be good value for money, both in general and high-risk populations, if a cost per quality adjusted life years of $50 000 is set as willingness to pay threshold. Some studies showed the value of including lower stage of fibrosis in the treatment selection criteria. CONCLUSIONS Several HCV screening strategies plus direct-acting antiviral agents treatments resulted cost-effectiveness in different populations. However, there is still need of country and population-specific evaluations within the different HCV screening and treatment strategies available, in order to assess their cost-effectiveness and sustainability and fully support an evidence-informed policy for HCV elimination.
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Affiliation(s)
- Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Roberta Barca
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Giulia Giudicatti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Sergio Mossini
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Antonio Ciaccio
- Unit of Gastroenterology, Department of Medicine, Hospital San Gerardo, Monza, Italy.,International Center for Digestive Health, University of Milan-Bicocca, Monza, Italy
| | - Sergio Iannazzo
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.,SIHS Health Economics Consulting, Turin, Italy
| | - Mariangela Micale
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - Giancarlo Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
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9
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Popping S, Hullegie SJ, Boerekamps A, Rijnders BJA, de Knegt RJ, Rockstroh JK, Verbon A, Boucher CAB, Nichols BE, van de Vijver DAMC. Early treatment of acute hepatitis C infection is cost-effective in HIV-infected men-who-have-sex-with-men. PLoS One 2019; 14:e0210179. [PMID: 30629662 PMCID: PMC6328146 DOI: 10.1371/journal.pone.0210179] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/18/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Treatment of hepatitis C virus infections (HCV) with direct acting antivirals (DAA) can prevent new infections since cured individuals cannot transmit HCV. However, as DAAs are expensive, many countries defer treatment to advances stages of fibrosis, which results in ongoing transmission. We assessed the epidemiological impact and cost-effectiveness of treatment initiation in different stages of infection in the Netherlands where the epidemic is mainly concentrated among HIV-infected MSMs. METHODS We calibrated a deterministic mathematical model to the Dutch HCV epidemic among HIV-infected MSM to compare three different DAA treatment scenarios: 1) immediate treatment, 2) treatment delayed to chronic infection allowing spontaneous clearance to occur, 3) treatment delayed until F2 fibrosis stage. All scenarios are simulated from 2015 onwards. Total costs, quality adjusted life years (QALY), incremental cost-effectiveness ratios (ICERs), and epidemiological impact were calculated from a providers perspective over a lifetime horizon. We used a DAA price of €35,000 and 3% discounting rates for cost and QALYs. RESULTS Immediate DAA treatment lowers the incidence from 1.2/100 person-years to 0.2/100 person-years (interquartile range 0.1-0.2) and the prevalence from 5.0/100 person-years to 0.5/100 person-years (0.4-0.6) after 20 years. Delayed treatment awaiting spontaneous clearance will result in a similar reduction. However, further delayed treatment to F2 will increases the incidence and prevalence. Earlier treatment will cost society €68.3 and €75.1 million over a lifetime for immediate and awaiting until the chronic stage, respectively. The cost will increase if treatment is further delayed until F2 to €98.4 million. Immediate treatment will prevent 7070 new infections and gains 3419 (3019-3854) QALYs compared to F2 treatment resulting in a cost saving ICER. Treatment in the chronic stage is however dominated. CONCLUSIONS Early DAA treatment for HIV-infected MSM is an excellent and sustainable tool to meet the WHO goal of eliminating HCV in 2030.
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Affiliation(s)
| | - Sebastiaan J. Hullegie
- Department of Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Anne Boerekamps
- Department of Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Bart J. A. Rijnders
- Department of Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Robert J. de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Annelies Verbon
- Department of Internal Medicine and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | | | - Brooke E. Nichols
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
- Department of Global Health, Boston University, Boston, United States
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10
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Cortesi PA, Belli LS, Facchetti R, Mazzarelli C, Perricone G, De Nicola S, Cesana G, Duvoux C, Mantovani LG, Strazzabosco M. The optimal timing of hepatitis C therapy in liver transplant-eligible patients: Cost-effectiveness analysis of new opportunities. J Viral Hepat 2018; 25:791-801. [PMID: 29406608 DOI: 10.1111/jvh.12877] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023]
Abstract
Different strategies of DAAs treatment are currently possible both pre- and postliver transplantation (LT). Clinical and economic consequences of these strategies still need to be adequately investigated; this study aims at assessing their cost-effectiveness. A decision analytical model was created to simulate the progression of HCV-infected patients listed for decompensated cirrhosis (DCC) or for hepatocellular carcinoma (HCC). Three DAAs treatment strategies were compared: (i) a 12-week course of DAAs prior to transplantation (PRE-LT), (ii) a 4-week course of DAAs starting at the time of transplantation (PERI-LT) and (iii) a 12-week course of DAAs administered at disease recurrence (POST-LT). The population was substratified according to HCC presence and, in those without HCC, according to the MELD score at listing. Data on DAAs effectiveness were estimated using a cohort of patients still followed by 11 transplant centres of the European Liver and Intestine Transplant Association and by data available in the literature. In this study, PRE-LT treatment strategy was dominant for DCC patients with MELD<16 and cost-effective for those with MELD16-20, while POST-LT strategy emerged as cost-effective for DCC patients with MELD>20 and for those with HCC. Sensitivity analyses confirmed PRE-LT as the cost-effective strategy for patients with MELD≤20. In conclusion, PRE-LT treatment is cost-effective for patients with MELD≤20 without HCC, while treatments after LT are cost-effective in cirrhotic patients with MELD>20 and in those with HCC. It is worth reminding, though, that the final choice of a specific regimen at the patient level will have to be personalized based on clinical, social and transplant-related factors.
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Affiliation(s)
- P A Cortesi
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - L S Belli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy.,International Center for Disease Health (ICDH), University of Milan-Bicocca, Monza, Italy
| | - R Facchetti
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - C Mazzarelli
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - G Perricone
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - S De Nicola
- Department of Hepatology and Gastroenterology, Niguarda Hospital, Milan, Italy
| | - G Cesana
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy
| | - C Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital, Paris-Est University, Creteil, France
| | - L G Mantovani
- Research Centre on Public Health (CESP), University of Milan-Bicocca, Monza, Italy.,International Center for Disease Health (ICDH), University of Milan-Bicocca, Monza, Italy
| | - M Strazzabosco
- International Center for Disease Health (ICDH), University of Milan-Bicocca, Monza, Italy.,Department of Internal Medicine, Liver Center, Yale University, New Haven, CT, USA
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11
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Sandman L. Prioritising, Ranking and Resource Implementation - A Normative Analysis. Int J Health Policy Manag 2018; 7:532-541. [PMID: 29935130 PMCID: PMC6015508 DOI: 10.15171/ijhpm.2017.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 10/10/2017] [Indexed: 12/15/2022] Open
Abstract
Background: Priority setting in publicly financed healthcare systems should be guided by ethical norms and other considerations viewed as socially valuable, and we find several different approaches for how such norms and considerations guide priorities in healthcare decision-making. Common to many of these approaches is that interventions are ranked in relation to each other, following the application of these norms and considerations, and that this ranking list is then translated into a coverage scheme. In the literature we find at least two different views on how a ranking list should be translated into coverage schemes: (1) rationing from the bottom where everything below a certain ranking order is rationed; or (2) a relative degree of coverage, where higher ranked interventions are given a relatively larger share of resources than lower ranked interventions according to some "curve of coverage."
Methods: The aim of this article is to provide a normative analysis of how the background set of ethical norms and other considerations support these two views.
Results: The result of the analysis shows that rationing from the bottom generally gets stronger support if taking background ethical norms seriously, and with regard to the extent the ranking succeeds in realising these norms. However, in non-ideal rankings and to handle variations at individual patient level, there is support for relative coverage at the borderline of what could be covered. A more general relative coverage curve could also be supported if there is a need to generate resources for the healthcare system, by getting patients back into production and getting acceptance for priority setting decisions.
Conclusion: Hence, different types of reasons support different deviations from rationing from the bottom. And it should be noted that the two latter reasons will imply a cost in terms of not living up to the background set of ethical norms.
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Affiliation(s)
- Lars Sandman
- National Center for Priority Setting in Health-Care, Department of Medicine and Health, Linköping University, Linköping, Sweden.,Academy for Care, Worklife and Welfare, University of Borås, Borås, Sweden
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