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Parmigiani G. Benefits and Harms of Interception and Early Detection of Cancer. Hematol Oncol Clin North Am 2024; 38:731-741. [PMID: 38789374 DOI: 10.1016/j.hoc.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Strategies for early detection and interception of cancer are based on 2 synergistic elements: proactive search for asymptomatic cancer, precancer, or cancer predisposition and proactive disruption of cancer evolution. Benefits and harms of both these elements will vary widely depending on the screened populations, the types of cancers targeted, the detection modalities, and the health care delivery approaches following diagnosis. This article attempts to identify common elements that can inform the evaluation of alternative strategies across many of these scenarios.
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Affiliation(s)
- Giovanni Parmigiani
- Department of Data Science, Dana Farber Cancer Institute; Department of Biostatistics, Harvard T.H. Chan School of Public Health.
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Tiwari A, Khanikar D, Rathod SG. Autoimmune hepatitis: Azathioprine or mycophenolate mofetil for inducing remission? J Hepatol 2024; 81:e38-e39. [PMID: 38403031 DOI: 10.1016/j.jhep.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Avinash Tiwari
- Department of Gastroenterology, Regency Hospital Ltd: Kanpur, Uttar Pradesh, 208005, India.
| | - Duncan Khanikar
- Department of Oncology, Assam Cancer Care Foundation(Dibrugarh Branch): Guwahati, Assam, India
| | - Santosh Govind Rathod
- Department of Hematology, Sher-i-Kashmir Institute of Medical Sciences. Soura, Srinagar, Jammu, and Kashmir, 190011, India
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Li XC, Qian HR, Zhang YY, Zhang QY, Liu JS, Lai HY, Zheng WG, Sun J, Fu B, Zhou XN, Zhang XX. Optimal decision-making in relieving global high temperature-related disease burden by data-driven simulation. Infect Dis Model 2024; 9:618-633. [PMID: 38645696 PMCID: PMC11026972 DOI: 10.1016/j.idm.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/27/2024] [Accepted: 03/09/2024] [Indexed: 04/23/2024] Open
Abstract
The rapid acceleration of global warming has led to an increased burden of high temperature-related diseases (HTDs), highlighting the need for advanced evidence-based management strategies. We have developed a conceptual framework aimed at alleviating the global burden of HTDs, grounded in the One Health concept. This framework refines the impact pathway and establishes systematic data-driven models to inform the adoption of evidence-based decision-making, tailored to distinct contexts. We collected extensive national-level data from authoritative public databases for the years 2010-2019. The burdens of five categories of disease causes - cardiovascular diseases, infectious respiratory diseases, injuries, metabolic diseases, and non-infectious respiratory diseases - were designated as intermediate outcome variables. The cumulative burden of these five categories, referred to as the total HTD burden, was the final outcome variable. We evaluated the predictive performance of eight models and subsequently introduced twelve intervention measures, allowing us to explore optimal decision-making strategies and assess their corresponding contributions. Our model selection results demonstrated the superior performance of the Graph Neural Network (GNN) model across various metrics. Utilizing simulations driven by the GNN model, we identified a set of optimal intervention strategies for reducing disease burden, specifically tailored to the seven major regions: East Asia and Pacific, Europe and Central Asia, Latin America and the Caribbean, Middle East and North Africa, North America, South Asia, and Sub-Saharan Africa. Sectoral mitigation and adaptation measures, acting upon our categories of Infrastructure & Community, Ecosystem Resilience, and Health System Capacity, exhibited particularly strong performance for various regions and diseases. Seven out of twelve interventions were included in the optimal intervention package for each region, including raising low-carbon energy use, increasing energy intensity, improving livestock feed, expanding basic health care delivery coverage, enhancing health financing, addressing air pollution, and improving road infrastructure. The outcome of this study is a global decision-making tool, offering a systematic methodology for policymakers to develop targeted intervention strategies to address the increasingly severe challenge of HTDs in the context of global warming.
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Affiliation(s)
- Xin-Chen Li
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Institute of One Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hao-Ran Qian
- School of Data Science, Fudan University, Shanghai, People's Republic of China
| | - Yan-Yan Zhang
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Institute of One Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Qi-Yu Zhang
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Institute of One Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jing-Shu Liu
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Institute of One Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Hong-Yu Lai
- School of Data Science, Fudan University, Shanghai, People's Republic of China
| | - Wei-Guo Zheng
- School of Data Science, Fudan University, Shanghai, People's Republic of China
| | - Jian Sun
- School of Data Science, Fudan University, Shanghai, People's Republic of China
| | - Bo Fu
- School of Data Science, Fudan University, Shanghai, People's Republic of China
| | - Xiao-Nong Zhou
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Institute of One Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xiao-Xi Zhang
- School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
- Institute of One Health, Shanghai Jiao Tong University, Shanghai, People's Republic of China
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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Sharda S, Gupta A, Jyani G, Prinja S, Goyal A. Modeling the cost-effectiveness of school-based supervised toothbrushing program in reducing the dental caries burden in India. Int J Paediatr Dent 2024. [PMID: 38807269 DOI: 10.1111/ipd.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 04/22/2024] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Supervised toothbrushing (STB) significantly reduces the incidence and progression of dental caries. School years present a favorable age for introducing such healthy habits for a lifetime. AIM To estimate the cost-effectiveness of implementing a STB program in India in preventing dental caries incidence. DESIGN An operational framework of a national STB program was devised. A mathematical model was then developed to evaluate this program's clinical effectiveness and economic impact in the Indian scenario. This study considered a hypothetical cohort of the Indian population aged from 6 to 75 years. Two groups were compared: no intervention and STB in government schools. The health outcomes assessed were a number of tooth caries incidences averted and quality-adjusted life years gained. RESULTS The STB program in the government schools of India would prevent at least one tooth from developing caries in an individual's lifetime. Considering the current treatment-seeking behavior, the STB program saves INR 153 (US$ 1.95) per carious tooth incidence averted and INR 22 202 (US$ 283) per QALY gained. CONCLUSION In India, the school-based STB program is expected to be a cost-effective strategy for reducing the dental caries burden and its associated treatment costs.
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Affiliation(s)
- Shweta Sharda
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Arpit Gupta
- Unit of Public Health & Preventive Dentistry, Oral Health Sciences CentreI National Resource Centre for Oral Healthcare of Children & Elderly, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashima Goyal
- Head, Oral Health Sciences Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Almusafer M, Narayan Y, Nnorom I, Karna S, Katsouri A, Russo GI, Morgado A, Symeonidis EN, Buchholz N, Papatsoris A, Tsampoukas G. Exploring pharmacological interventions in benign prostate hyperplasia: the role of cost-effectiveness analysis in daily practice and future directions. Expert Opin Pharmacother 2024; 25:907-914. [PMID: 38828638 DOI: 10.1080/14656566.2024.2362272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/28/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Benign Prostate Hyperplasia (BPH) significantly impacts men's health and quality of life, with its prevalence rising with age. This review critically examines the cost-effectiveness of pharmacological interventions for BPH to optimize patient outcomes and healthcare resource utilization. AREAS COVERED This review explores the integration of cost-effectiveness analysis (CEA) into clinical practice, balancing clinical efficacy with economic efficiency in BPH management. We performed a critical literature search, including recent studies on the economic evaluation of BPH treatments, focusing on pharmacotherapies such as alpha-blockers and 5-alpha reductase inhibitors. Additionally, we discussed the concept of CEA and evaluated the role of medicinal reconciliation and the avoidance of polypharmacy in favor of optimal BPH treatment. EXPERT OPINION Cost-effectiveness analysis is crucial for evaluating BPH treatments, with evidence suggesting a shift towards surgical interventions may offer greater long-term economic benefits. However, these models must be applied cautiously, considering clinical evidence and patient preferences to ensure equitable and patient-centric healthcare.
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Affiliation(s)
- Murtadha Almusafer
- Scientific Office, U-merge Ltd, London, UK
- Department of Urology, University of Basrah, Basrah, Iraq
| | | | - Ijeoma Nnorom
- Department of Urology, Homerton Healthcare NHS Foundation Trust, Homerton, UK
| | - Sourabh Karna
- Department of Urology, Milton Keynes University Hospital, Milton Keynes, UK
| | | | | | - Afonso Morgado
- Serviço de Urologia, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Evangelos N Symeonidis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Athanasios Papatsoris
- Scientific Office, U-merge Ltd, London, UK
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsampoukas
- Scientific Office, U-merge Ltd, London, UK
- Department of Urology, Homerton Healthcare NHS Foundation Trust, Homerton, UK
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Tiwari A. The OCEAN Study: Has Octreotide Quenched the Thirst for Angiodysplasia-Related Bleed? Gastroenterology 2024:S0016-5085(24)00489-X. [PMID: 38679395 DOI: 10.1053/j.gastro.2024.04.023] [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: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Avinash Tiwari
- Department of Gastroenterology, Regency Hospital Ltd, Kanpur, Uttar Pradesh, India
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Haug M, Oja M, Pajusalu M, Mooses K, Reisberg S, Vilo J, Giménez AF, Falconer T, Danilović A, Maljkovic F, Dawoud D, Kolde R. Markov modeling for cost-effectiveness using federated health data network. J Am Med Inform Assoc 2024; 31:1093-1101. [PMID: 38472144 PMCID: PMC11031209 DOI: 10.1093/jamia/ocae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To introduce 2 R-packages that facilitate conducting health economics research on OMOP-based data networks, aiming to standardize and improve the reproducibility, transparency, and transferability of health economic models. MATERIALS AND METHODS We developed the software tools and demonstrated their utility by replicating a UK-based heart failure data analysis across 5 different international databases from Estonia, Spain, Serbia, and the United States. RESULTS We examined treatment trajectories of 47 163 patients. The overall incremental cost-effectiveness ratio (ICER) for telemonitoring relative to standard of care was 57 472 €/QALY. Country-specific ICERs were 60 312 €/QALY in Estonia, 58 096 €/QALY in Spain, 40 372 €/QALY in Serbia, and 90 893 €/QALY in the US, which surpassed the established willingness-to-pay thresholds. DISCUSSION Currently, the cost-effectiveness analysis lacks standard tools, is performed in ad-hoc manner, and relies heavily on published information that might not be specific for local circumstances. Published results often exhibit a narrow focus, central to a single site, and provide only partial decision criteria, limiting their generalizability and comprehensive utility. CONCLUSION We created 2 R-packages to pioneer cost-effectiveness analysis in OMOP CDM data networks. The first manages state definitions and database interaction, while the second focuses on Markov model learning and profile synthesis. We demonstrated their utility in a multisite heart failure study, comparing telemonitoring and standard care, finding telemonitoring not cost-effective.
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Affiliation(s)
- Markus Haug
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
| | - Marek Oja
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
| | - Maarja Pajusalu
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
| | - Kerli Mooses
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
| | - Sulev Reisberg
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
| | - Jaak Vilo
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
| | | | - Thomas Falconer
- Columbia University Irving Medical Center, New York, NY 10032, United States
| | | | - Filip Maljkovic
- Department of Health Information Systems, Heliant, Belgrade 11000, Serbia
| | - Dalia Dawoud
- National Institute for Health and Care Excellence, London WC1V 6NA, United Kingdom
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, Tartu 51009, Estonia
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David MC, Higashi H. Cost-Effectiveness of an Intensive Upper Limb Rehabilitation Therapy for Children With Unilateral Cerebral Palsy: An Economic Evaluation of a Randomized Controlled Trial. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2024; 11:103-111. [PMID: 38779334 PMCID: PMC11110886 DOI: 10.36469/001c.94460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/04/2024] [Indexed: 05/25/2024]
Abstract
Background: Unilateral cerebral palsy is a major cause of childhood disability and a substantial economic burden. Intensive group-based therapy, consisting of hybrid constraint-induced movement and bimanual therapies, has been shown to be effective in improving specific quality-of-life domains in children with this disability. Our objective in this study was to assess if this intervention was cost-effective compared with standard care. Methods: An open-label, parallel, randomized controlled trial with an embedded economic evaluation of the intervention was conducted. A total of 47 children were randomized to either the intervention group (n = 27) or the standard care (n = 20) group. The effectiveness of the intervention was assessed using the Cerebral Palsy Quality of Life (Child) questionnaire across several domains. Nonparametric bootstrapping was used to quantify uncertainty intervals (UIs) for incremental cost-effectiveness ratios. Results: The incremental cost-effectiveness ratios for the intervention were 273 ( 95 107 to 945 ) f o r P a i n a n d I m p a c t o f D i s a b i l i t y , 1071 (95% UI: -5718 t o 4606) for Family Health and 1732 ( 95 6448 to 8775 ) f o r A c c e s s t o S e r v i c e s . F o r t h e 4 r e m a i n i n g d o m a i n s , t h e i n t e r v e n t i o n w a s d o m i n a t e d b y s t a n d a r d c a r e . A t a w i l l i n g n e s s - t o - p a y t h r e s h o l d o f 1000, only for the Pain and Impact of Disability domain was the intervention likely to have a probability of being cost-effective exceeding 0.75. Conclusions: Other than the Pain and Impact of Disability domain, there was insufficient evidence demonstrating the intervention to be cost-effective over a 13-week time horizon.
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Affiliation(s)
- Michael C. David
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Hideki Higashi
- School of Public Health, The University of Queensland, Herston , Australia
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Baek HS, Ha J, Kim K, Bae JS, Kim JS, Kim S, Lim DJ, Kim CM. Cost-Utility Analysis of Early Detection with Ultrasonography of Differentiated Thyroid Cancer: A Retrospective Study on a Korean Population. Endocrinol Metab (Seoul) 2024; 39:310-323. [PMID: 38590123 PMCID: PMC11066449 DOI: 10.3803/enm.2023.1870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGRUOUND There is debate about ultrasonography screening for thyroid cancer and its cost-effectiveness. This study aimed to evaluate the cost-effectiveness of early screening (ES) versus symptomatic detection (SD) for differentiated thyroid cancer (DTC) in Korea. METHODS A Markov decision analysis model was constructed to compare the cost-effectiveness of ES and SD. The model considered direct medical costs, health outcomes, and different diagnostic and treatment pathways. Input data were derived from literature and Korean population studies. Incremental cost-effectiveness ratio (ICER) was calculated. Willingness-to-pay (WTP) threshold was set at USD 100,000 or 20,000 per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted to address uncertainties of the model's variables. RESULTS In a base case scenario with 50 years of follow-up, ES was found to be cost-effective compared to SD, with an ICER of $2,852 per QALY. With WTP set at $100,000, in the case with follow-up less than 10 years, the SD was cost-effective. Sensitivity analysis showed that variables such as lobectomy probability, age, mortality, and utility scores significantly influenced the ICER. Despite variations in costs and other factors, all ICER values remained below the WTP threshold. CONCLUSION Findings of this study indicate that ES is a cost-effective strategy for DTC screening in the Korean medical system. Early detection and subsequent lobectomy contribute to the cost-effectiveness of ES, while SD at an advanced stage makes ES more cost-effective. Expected follow-up duration should be considered to determine an optimal strategy for DTC screening.
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Affiliation(s)
- Han-Sang Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwangsoon Kim
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ja Seong Bae
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Soo Kim
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sungju Kim
- Healthcare Group, Lee & Ko, Seoul, Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul-Min Kim
- Department of Family Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Mohd Hassan NZA, Bahari MS, Raman S, Aminuddin F, Mohd Nor Sham Kunusagaran MSJ, Zaimi NA, Wong MF, Mostapha M, Mohamad Nor AT, Shahari MR. Modelling cost-effectiveness of replacement strategies for ambulance services in the Ministry of Health Malaysia. BMC Health Serv Res 2024; 24:168. [PMID: 38321452 PMCID: PMC10848625 DOI: 10.1186/s12913-024-10557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 01/03/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Emergency Medical Service (EMS) is a very crucial aspect of the healthcare system in providing urgent management and transportation of patients during emergencies. The sustainability of the services is however greatly impacted by the quality and age of ambulances. While this has led to numerous replacement policy recommendations, the implementations are often limited due to a lack of evidence and financial constraints. This study thus aims to develop a cost-effectiveness model and testing the model by evaluating the cost-effectiveness of 10-year and 15-year compulsory ambulance replacement strategies in public healthcare for the Malaysian Ministry of Health (MOH). METHODS A Markov model was developed to estimate the cost and outcomes ambulance replacement strategies over a period of 20 years. The model was tested using two alternative strategies of 10-year and 15-year. Model inputs were derived from published literature and local study. Model development and economic analysis were accomplished using Microsoft Excel 2016. The outcomes generated were costs per year, the number of missed trips and the number of lives saved, in addition to the Incremental Cost-Effectiveness Ratio (ICER). One-Way Deterministic Sensitivity Analysis (DSA) and Probabilistic Sensitivity Analysis (PSA) were conducted to identify the key drivers and to assess the robustness of the model. RESULTS Findings showed that the most expensive strategy, which is the implementation of 10 years replacement strategy was more cost-effective than 15 years ambulance replacement strategy, with an ICER of MYR 11,276.61 per life saved. While an additional MYR 13.0 million would be incurred by switching from a 15- to 10-year replacement strategy, this would result in 1,157 deaths averted or additional live saved per year. Sensitivity analysis showed that the utilization of ambulances and the mortality rate of cases unattended by ambulances were the key drivers for the cost-effectiveness of the replacement strategies. CONCLUSIONS The cost-effectiveness model developed suggests that an ambulance replacement strategy of every 10 years should be considered by the MOH in planning sustainable EMS. While this model may have its own limitation and may require some modifications to suit the local context, it can be used as a guide for future economic evaluations of ambulance replacement strategies and further exploration of alternative solutions.
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Affiliation(s)
- Nor Zam Azihan Mohd Hassan
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia.
| | - Mohd Shahri Bahari
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Sivaraj Raman
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Farhana Aminuddin
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Mohd Shaiful Jefri Mohd Nor Sham Kunusagaran
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Nur Amalina Zaimi
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Min Fui Wong
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Marhaini Mostapha
- Centre of Health Economics Research, Institute for Health Systems Research (IHSR), National Institutes of Health (NIH), Ministry of Health Malaysia, Setia Alam, Shah Alam, Selangor Darul Ehsan, Malaysia
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Lancellotti P, Fattouch K, Modine T. Is transcatheter aortic valve implantation for aortic stenosis cost-effective? Acta Cardiol 2024; 79:95-97. [PMID: 37962324 DOI: 10.1080/00015385.2023.2281110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/05/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, CHU SartTilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Liège, Belgium
| | - Khalil Fattouch
- Department of Cardiovascular surgery, GVM Care and Research, Maria Eleonora Hospital and Dichirinos University, Palermo, Italy
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12
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Frausing MHJP, Nielsen JC, Westergaard CL, Gerdes C, Kjellberg J, Boriani G, Kronborg MB. Economic analyses in cardiac electrophysiology: from clinical efficacy to cost utility. Europace 2024; 26:euae031. [PMID: 38289720 PMCID: PMC10858642 DOI: 10.1093/europace/euae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/24/2024] [Indexed: 02/01/2024] Open
Abstract
Cardiac electrophysiology is an evolving field that relies heavily on costly device- and catheter-based technologies. An increasing number of patients with heart rhythm disorders are becoming eligible for cardiac interventions, not least due to the rising prevalence of atrial fibrillation and increased longevity in the population. Meanwhile, the expansive costs of healthcare face finite societal resources, and a cost-conscious approach to new technologies is critical. Cost-effectiveness analyses support rational decision-making in healthcare by evaluating the ratio of healthcare costs to health benefits for competing therapies. They may, however, be subject to significant uncertainty and bias. This paper aims to introduce the basic concepts, framework, and limitations of cost-effectiveness analyses to clinicians including recent examples from clinical electrophysiology and device therapy.
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Affiliation(s)
- Maria Hee Jung Park Frausing
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld 99, DK-8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Bvld. 99, DK-8200 Aarhus, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld 99, DK-8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Bvld. 99, DK-8200 Aarhus, Denmark
| | - Caroline Louise Westergaard
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld 99, DK-8200 Aarhus, Denmark
| | - Jakob Kjellberg
- The Danish Center for Social Science Research, VIVE, Copenhagen, Denmark
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld 99, DK-8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Bvld. 99, DK-8200 Aarhus, Denmark
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Werbrouck A, Schmidt M, Putman K, Simoens S, Verhaeghe N, Annemans L. Cost-Utility of an Exercise Referral Scheme Versus Doing Nothing in Flemish Adults: Exploring the Impact of Key Assumptions. J Phys Act Health 2024; 21:59-67. [PMID: 37879617 DOI: 10.1123/jpah.2023-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/30/2023] [Accepted: 09/14/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND This health-economic evaluation assessed the cost-effectiveness of an exercise referral scheme (ERS) versus doing nothing in the Flemish region (Belgium), with a particular focus on the impact of several scenarios. METHODS A 14-state Markov model was applied to compare the expected costs and quality-adjusted life years (QALYs) of 2 alternatives: the Flemish ERS (2019 data, mean age 52 y, 69.1% women) and doing nothing. A health care payer perspective was adopted and a lifetime time horizon was applied. A set of 18 scenario analyses is presented. In addition, univariate and probabilistic sensitivity analyses were performed. RESULTS Under the assumptions selected for the base-case analysis, the Flemish ERS is moderately cost-effective compared with doing nothing, with an incremental cost-utility ratio of €28,609/QALY. Based on the scenario analyses, the results largely depend on the assumptions regarding the continuation of the intervention effect and the frequency with which the intervention is repeated. The greatest health gains can be made when a sustainable behavioral change is achieved among participants. The probabilistic sensitivity analysis confirmed that the cost-effectiveness results were not robust. CONCLUSIONS If it is possible to induce a sustainable behavioral change with an intervention delivered at 2- or 5-year intervals, then the Flemish ERS is potentially cost-effective compared with doing nothing (given a €40,000/QALY threshold). These results suggest the importance of repeated implementation of the program together with careful monitoring of the adherence and the sustainability of the observed effects in a real-world setting.
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Affiliation(s)
- Amber Werbrouck
- Interuniversity Centre for Health Economics Research, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
- Interuniversity Centre for Health Economics Research, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Masja Schmidt
- Interuniversity Centre for Health Economics Research, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Koen Putman
- Interuniversity Centre for Health Economics Research, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Nick Verhaeghe
- Interuniversity Centre for Health Economics Research, Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
- Interuniversity Centre for Health Economics Research, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieven Annemans
- Interuniversity Centre for Health Economics Research, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Carlisle KM, Brown JP, Kim J, Turner DJ, Slejko JF, Kuo JH, Mullins CD, Hu Y. Age-stratified comparison of active surveillance versus radiofrequency ablation for papillary thyroid microcarcinoma using decision analysis. Surgery 2024; 175:153-160. [PMID: 37872047 PMCID: PMC10845124 DOI: 10.1016/j.surg.2023.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/09/2023] [Accepted: 06/20/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Papillary thyroid microcarcinomas may be treated with radiofrequency ablation, active surveillance, or surgery. The objective of this study was to use mathematical modeling to compare treatment alternatives for papillary thyroid microcarcinomas among those who decline surgery. We hypothesized that radiofrequency ablation would outperform active surveillance in avoiding progression and surgery but that the effect size would be small for older patients. METHODS We engaged stakeholders to identify meaningful long-term endpoints for papillary thyroid microcarcinoma treatment-(1) cancer progression/surgery, (2) need for thyroid replacement therapy, and (3) permanent treatment complication. A Markov decision analysis model was created to compare the probability of these endpoints after radiofrequency ablation or active surveillance for papillary thyroid microcarcinomas and overall cost. Transition probabilities were extracted from published literature. Model outcomes were estimated to have a 10-year time horizon. RESULTS The primary outcome yielded a number needed to treat of 18.1 for the avoidance of progression and 27.4 for the avoidance of lifelong thyroid replacement therapy for radiofrequency ablation compared to active surveillance. However, as patient age increased, the number needed to treat to avoid progression increased from 5.2 (age 20-29) to 39.1 (age 60+). The number needed to treat to avoid lifelong thyroid replacement therapy increased with age from 7.8 (age 20-29) to 59.3 (age 60+). The average 10-year cost/treatment for active surveillance and radiofrequency ablation were $6,400 and $11,700, respectively, translating to a cost per progression-avoided of $106,500. CONCLUSION As an alternative to active surveillance, radiofrequency ablation may have a greater therapeutic impact in younger patients. However, routine implementation may be cost-prohibitive for most patients with papillary thyroid microcarcinomas.
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Affiliation(s)
- Kendyl M Carlisle
- Department of Surgery, University of Maryland, Baltimore, Baltimore, MD
| | - Jessica P Brown
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | - Justin Kim
- Department of Surgery, University of Maryland, Baltimore, Baltimore, MD
| | - Douglas J Turner
- Department of Surgery, University of Maryland, Baltimore, Baltimore, MD
| | - Julia F Slejko
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Jennifer H Kuo
- Department of Surgery, Columbia University Medical Center, New York, NY
| | - C Daniel Mullins
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, MD
| | - Yinin Hu
- Department of Surgery, University of Maryland, Baltimore, Baltimore, MD.
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Singh PK, Sethi MK, Mishra TS, Kumar P, Ali SM, Sasmal PK, Mishra SS. Comparison of surgical site infection (SSI) between negative pressure wound therapy (NPWT) assisted delayed primary closure and conventional delayed primary closure in grossly contaminated emergency abdominal surgeries: a randomized controlled trial. Langenbecks Arch Surg 2023; 409:19. [PMID: 38150073 DOI: 10.1007/s00423-023-03202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE NPWT has been tried in many surgical fields, including colorectal, thoracic, vascular, and non-healing wounds, for the prevention of SSI. However, its efficacy in the prevention of SSI-grade IV closed abdominal wounds is yet to be explored. METHODS All patients with grade IV abdominal wounds were included in the study. They were randomized into the conventional arm and the VAC arm after confirming the diagnosis intra-operatively. The sheath was closed, and the skin was laid open in the postoperative period. In the VAC arm, the NPWT dressing was applied on postoperative day (POD)-1 and removed on POD-5. In the conventional arm, only regular dressing was done postoperatively. The skin was closed with a delayed primary intention on POD-5 in both arms. The sutures were removed after 7 to 10 days of skin closure. RESULTS The rate of SSI (10% in the VAC arm vs. 37.5% in the conventional arm, p-value = 0.004) was significantly lower in the VAC arm, as were the rates of seroma formation (2.4% in the VAC arm vs. 20% in the conventional arm, p = 0.014) and wound dehiscence (7.3% vs. 30%, p = 0.011). The conventional arm had a significant delay in skin closure beyond POD5 due to an increased rate of SSI, which also led to a prolonged hospital stay (5 days in the VAC arm vs. 6.5 days in the conventional arm, p-value = 0.005). CONCLUSION The VAC dressing can be used routinely in grade IV closed abdominal wounds to reduce the risk of SSI and wound dehiscence.
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Affiliation(s)
- Pradeep Kumar Singh
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - Mahesh Kumar Sethi
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India.
| | | | - Pankaj Kumar
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
| | - S Manwar Ali
- Department of General Surgery, AIIMS Bhubaneswar, Bhubaneswar, Odisha, India
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Baris VK, Seren Intepeler S. Evaluation of the cost-effectiveness of a multicomponent fall prevention program in hospitalized patients. Nurs Health Sci 2023; 25:585-596. [PMID: 37706623 DOI: 10.1111/nhs.13051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/10/2023] [Accepted: 08/28/2023] [Indexed: 09/15/2023]
Abstract
The aim of this pre- and post-interventional study was to analyze the cost-effectiveness of the multicomponent fall prevention program in hospitalized patients. To achieve this aim, cost-effectiveness analysis performed using decision tree modeling was compared with the implementation of the fall prevention program and usual care. The primary outcome was the number of patient falls. The uncertainty in cost and effectiveness data was evaluated using one-way sensitivity analysis, best-worst-case scenario analysis, and probabilistic sensitivity analysis. According to cost-effectiveness analysis, implementation of the fall prevention program was dominantly cost-effective. As a result of the probabilistic sensitivity analysis, it was revealed that, even if willing-to-pay per-fall prevented value was 0, the probability of being cost-effective was 54.4% for the fall prevention program. Economic evaluation results showed that implementing the multicomponent fall prevention program was dominantly cost-effective in hospitalized patients. Nurses and nurse managers can benefit from economic evaluations in their decision-making processes to implement fall prevention programs.
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Affiliation(s)
- Veysel Karani Baris
- Nursing Faculty, Nursing Management Department, Dokuz Eylul University, Izmir, Turkey
| | - Seyda Seren Intepeler
- Nursing Faculty, Nursing Management Department, Dokuz Eylul University, Izmir, Turkey
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17
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Cai Y, Chang K, Nazeha N, Gosavi TD, Shen JY, Hong W, Tan YL, Graves N. The cost-effectiveness of a real-time seizure detection application for people with epilepsy. Epilepsy Behav 2023; 148:109441. [PMID: 37748415 DOI: 10.1016/j.yebeh.2023.109441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES Automated seizure detection modalities can increase safety among people with epilepsy (PWE) and reduce seizure-related anxiety. We evaluated the potential cost-effectiveness of a seizure detection mobile application for PWE in Singapore. METHODS We used a Markov cohort model to estimate the expected changes to total costs and health outcomes from a decision to adopt the seizure detection application versus the current standard of care from the health provider perspective. The time horizon is ten years and cycle duration is one month. Parameter values were updated from national databases and published literature. As we do not know the application efficacy in reducing seizure-related injuries, a conservative estimate of 1% reduction was used. Probabilistic sensitivity analysis, scenario analyses, and value of information analysis were performed. RESULTS At a willingness-to-pay of $45,000/ quality-adjusted life-years (QALY), the incremental cost-effectiveness ratio was $1,096/QALY, and the incremental net monetary benefit was $13,656. Probabilistic sensitivity analyses reported that the application had a 99.5% chance of being cost-effective. In a scenario analysis in which the reduction in risk of seizure-related injury was 20%, there was a 99.8% chance that the application was cost-effective. Value of information analysis revealed that health utilities was the most important parameter group contributing to model uncertainty. CONCLUSIONS This early-stage modeling study reveals that the seizure detection application is likely to be cost-effective compared to current standard of care. Future prospective trials will be needed to demonstrate the real-world impact of the application. Changes in health-related quality of life should also be measured in future trials.
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Affiliation(s)
- Yiying Cai
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Kevin Chang
- Office for Service Transformation, SingHealth, 10 Hospital Boulevard, SingHealth Tower, Singapore 168582, Singapore
| | - Nuraini Nazeha
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore
| | - Tushar Divakar Gosavi
- Department of Neurology, National Neuroscience Institute, 11 Jln Tan Tock Seng, Singapore 308433, Singapore
| | - Jia Yi Shen
- Department of Neurology, National Neuroscience Institute, 11 Jln Tan Tock Seng, Singapore 308433, Singapore
| | - Weiwei Hong
- Office for Service Transformation, SingHealth, 10 Hospital Boulevard, SingHealth Tower, Singapore 168582, Singapore
| | - Yee-Leng Tan
- Department of Neurology, National Neuroscience Institute, 11 Jln Tan Tock Seng, Singapore 308433, Singapore
| | - Nicholas Graves
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
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Baek HS, Ha J, Kim K, Bae J, Kim JS, Kim S, Lim DJ, Kim C. Cost-Effectiveness of Active Surveillance Compared to Early Surgery of Small Papillary Thyroid Cancer: A Retrospective Study on a Korean Population. J Korean Med Sci 2023; 38:e264. [PMID: 37644680 PMCID: PMC10462480 DOI: 10.3346/jkms.2023.38.e264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/18/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Recently, active surveillance (AS) has been introduced as an alternative to early surgery (ES) for the management of papillary thyroid microcarcinoma (PTMC), because of its indolent features and low mortality. However, its cost effects have not been determined and the findings of current studies differ, according to each country's medical system. METHODS A Markov model was constructed to compare the cost-effectiveness of AS and ES, based on a reference case of a 40-year-old patient diagnosed with PTMC. Costs and transition probabilities were derived from previous clinical studies in Korean populations, and the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) were calculated. The willingness-to-pay (WTP) threshold was set at USD 100,000 per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted to address the uncertainties in the model's variables. RESULTS From the base scenario, the cumulative costs and effectiveness were both higher in ES than AS. The ICER for ES, compared with AS, was USD 6,619.86/QALY, lower than the set WTP. The NMB difference between AS and ES increased across the stages (USD 5,980 at the first stage and USD 159,667 at the last stage). The ICER increased along with decreasing age and increasing cost of surgery. The higher the ES utility score and the lower that of AS, the more cost-effective ES, with WTP set at USD 30,000. CONCLUSION In the current Korean medical system, ES is more cost-effective than AS. ES is more cost-effective as it is diagnosed at young age and followed-up for a long time.
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Affiliation(s)
- Han-Sang Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwangsoon Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jaseong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sungju Kim
- Healthcare Group, Lee & Ko, Seoul, Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Chulmin Kim
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Carvalho de Oliveira CC, Agati LB, Ribeiro CM, Resende Aguiar VC, Caffaro RA, da Silva Santos M, Alves Fernandes RR, Alberto da Silva Magliano C, Tafur A, Spyropoulos AC, Lopes RD, Fareed J, Ramacciotti E. Cost-effectiveness analysis of extended thromboprophylaxis with rivaroxaban versus no prophylaxis in high-risk patients after hospitalisation for COVID-19: an economic modelling study. LANCET REGIONAL HEALTH. AMERICAS 2023; 24:100543. [PMID: 37366432 PMCID: PMC10288203 DOI: 10.1016/j.lana.2023.100543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
Background In patients at high risk of thromboembolism who were discharged after hospitalisation due to COVID-19, thromboprophylaxis with rivaroxaban 10 mg/day for 35 days significantly improved clinical outcomes, reducing thrombotic events compared with no post-discharge anticoagulation. The present study aimed to estimate the cost-effectiveness of this anticoagulation strategy. Methods Using the database of the MICHELLE trial, we developed a decision tree to estimate the cost-effectiveness of thromboprophylaxis with rivaroxaban 10 mg/day for 35 days versus no thromboprophylaxis in high-risk post-discharge patients for COVID-19 through an incremental cost-effectiveness analysis. Findings 318 patients in 14 centres in Brazil were enrolled in the primary MICHELLE trial. The mean age was 57.1 years (SD 15.2), 127 (40%) were women, 191 (60%) were men, and the mean body-mass index was 29.7 kg/m2 (SD 5.6). Rivaroxaban 10 mg per day orally for 35 days after discharge decreased the risk of events defined by the primary efficacy outcome by 67% (relative risk 0.33, 95% CI 0.12-0.90; p = 0.03). The mean cost for thromboprophylaxis with rivaroxaban was $53.37/patient, and no prophylaxis was $34.22/patient, with an incremental cost difference of $19.15. The effectiveness means obtained in the intervention group was 0.1457, while in the control group was 0.1421, determining an incremental QALY difference of 0.0036. The estimated incremental cost-effectiveness ratio (ICER) was $5385.52/QALY. Interpretation Extended treatment with Rivaroxaban as thromboprophylaxis after hospital discharge for high-risk patients with COVID-19 is a cost-effective treatment option. Funding Modest funding was provided by Science Valley Research Institute, São Paulo, Brazil.
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Affiliation(s)
- Caroline Cândida Carvalho de Oliveira
- Science Valley Research Institute, Santo André, São Paulo, Brazil
- Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André, São Paulo, Brazil
- Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | | | | | - Valéria Cristina Resende Aguiar
- Science Valley Research Institute, Santo André, São Paulo, Brazil
- Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André, São Paulo, Brazil
| | | | | | | | | | - Alfonso Tafur
- Northshore University Health System, Evanston, IL, USA
| | - Alex C Spyropoulos
- Zucker School of Medicine at Hofstra/Northwell and the Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Renato Delascio Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jawed Fareed
- Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
| | - Eduardo Ramacciotti
- Science Valley Research Institute, Santo André, São Paulo, Brazil
- Hospital e Maternidade Christóvão da Gama, Grupo DASA, Santo André, São Paulo, Brazil
- Hemostasis & Thrombosis Research Laboratories at Loyola University Medical Center, Maywood, IL, USA
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Glasser JL, Patel SA, Li NY, Patel RA, Daniels AH, Antoci V. Understanding Health Economics in Joint Replacement Surgery. Orthopedics 2022; 45:e174-e182. [PMID: 35394379 DOI: 10.3928/01477447-20220401-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The number of arthroplasty procedures has been rising at a significant rate, contributing to a notable portion of the nation's health care spending. This growth has contributed to an increase in the number of health care economic studies in the field of adult reconstruction surgery. Although these articles are filled with important information, they can be difficult to understand without a background in business or economics. The goal of this review is to define the common terminology used in health care economic studies, assess their value and benefit in the context of total joint arthroplasty, and highlight shortcomings in the current literature. [Orthopedics. 2022;45(4):e174-e182.].
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Efficacy, cost-minimization, and budget impact of a personalized discharge letter for basal cell carcinoma patients to reduce low-value follow-up care. PLoS One 2022; 17:e0260978. [PMID: 35073333 PMCID: PMC8786164 DOI: 10.1371/journal.pone.0260978] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/21/2021] [Indexed: 01/04/2023] Open
Abstract
Background The incidence of keratinocyte carcinomas is high and rapidly growing. Approximately 80% of keratinocyte carcinomas consist of basal cell carcinomas (BCC) with 50% of these being considered as low-risk tumors. Nevertheless, 83% of the low-risk BCC patients were found to receive more follow-up care than recommended according to the Dutch BCC guideline, which is one visit post-treatment for this group. More efficient management could reduce unnecessary follow-up care and related costs. Objectives To study the efficacy, cost-utility, and budget impact of a personalized discharge letter for low-risk BCC patients compared with usual care (no personalized letter). Methods In a multi-center intervention study, a personalized discharge letter in addition to usual care was compared to usual care in first-time BCC patients. Model-based cost-utility and budget impact analyses were conducted, using individual patient data gathered via surveys. The outcome measures were number of follow-up visits, costs and quality adjusted life years (QALY) per patient. Results A total of 473 first-time BCC patients were recruited. The personalized discharge letter decreased the number of follow-up visits by 14.8% in the first year. The incremental costs after five years were -€24.45 per patient. The QALYs were 4.12 after five years and very similar in both groups. The national budget impact was -€2,7 million after five years. Conclusions The distribution of a personalized discharge letter decreases the number of unnecessary follow-up visits and implementing the intervention in a large eligible population would results in substantial cost savings, contributing to restraining the growing BCC costs.
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Jiao XL, Li SC, Hao L, Wang TG, Chen JF. Cost-benefit analysis of hepatic resection, radiofrequency ablation and liver transplantation in small hepatocellular carcinoma. Expert Rev Pharmacoecon Outcomes Res 2021; 22:307-313. [PMID: 34433363 DOI: 10.1080/14737167.2021.1973432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the cost-effectiveness ratio of surgical treatment options for small hepatocellular carcinoma (SHC) by using the decision tree model and providing a reference for the clinical therapeutic decisions for SHC. METHODS The data of 719 cases with SHC in the BCLC 0-A who were treated in the past were collected. The survival duration and treatment cost of patients in each experimental group after hepatic resection (HR), radiofrequency ablation (RFA), and orthotopic liver transplantation (OLT) were statistically analyzed. RESULTS For SHC with a diameter of less than 3.0 cm, HR, RFA, and OLT had similar cost-effectiveness ratios. OLT could achieve a longer life expectancy, but it was greatly affected by the dropout rate while waiting for the liver donor. RFA was preferred when the willingness to pay (WTP) < 2,5000 RMB/QALY, OLT was preferred when WTP > 75,000 RMB/QALY, and HR was preferred when WTP was between the two. EXPERT OPINION HR in SHC with OLT had the longest life expectancy, but due to the limitations of organ sources, OLT was the preferred treatment option when the WTP was large enough.
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Affiliation(s)
- Xue-Li Jiao
- Department of Hepatobiliary Surgery, Qingdao Hospital of Traditional Chinese Medicine(Qingdao Hiser Hospital), Qingdao, China
| | - Shou-Chuan Li
- Department of Hepatobiliary Surgery, Qingdao Hospital of Traditional Chinese Medicine(Qingdao Hiser Hospital), Qingdao, China
| | - Lei Hao
- Department of Hepatobiliary Surgery, Qingdao Hospital of Traditional Chinese Medicine(Qingdao Hiser Hospital), Qingdao, China
| | - Ting-Gang Wang
- Department of Hepatobiliary Surgery, Qingdao Hospital of Traditional Chinese Medicine(Qingdao Hiser Hospital), Qingdao, China
| | - Jian-Feng Chen
- Department of Hepatobiliary Surgery, Qingdao Hospital of Traditional Chinese Medicine(Qingdao Hiser Hospital), Qingdao, China
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Baek HS, Jeong CH, Ha J, Bae JS, Kim JS, Lim DJ, Kim CM. Cost-Effectiveness Analysis of Active Surveillance Compared to Early Surgery in Small Papillary Thyroid Cancer: A Systemic Review. Cancer Manag Res 2021; 13:6721-6730. [PMID: 34471385 PMCID: PMC8405161 DOI: 10.2147/cmar.s317627] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/20/2021] [Indexed: 12/31/2022] Open
Abstract
Papillary thyroid microcarcinoma (PTMC) has indolent features and low mortality. Recently, active surveillance (AS) instead of early surgery (ES) has been introduced as one treatment option but economical preference has not been established. The study objective was to systemically review the literature relating to cost-effectiveness of AS compared to ES for PTMC. Keywords were selected through PICO (Population, Intervention, Comparison, and Outcomes) tools. The search was conducted using PubMed, Cochrane, EMBASE, and Elsevier databases. Papers that had irrelevant titles were written in foreign languages, or had no original results were excluded. Out of the 62 papers extracted, five relevant to the subject matter of this study were identified. Three papers made their own decision models and proceeded with cost-effectiveness analysis (CEA), but the remaining two simply compared costs rather than cost-effectiveness. In terms of cost-effectiveness, three papers preferred AS, one preferred ES, and one preferred neither. The major differences in the CEA might arise from variations in each country’s medical insurance system, the utility score systems, and decision models used. In subgroup analysis, two papers preferred AS to ES for patients at a younger age at diagnosis in terms of cost-effectiveness as well as tumor biological characteristics. Although AS has been generally more cost-effective than ES in previous publications, younger age at diagnosis could be one factor contributing to preference for ES. The CEA of prospective cohorts based on the decision model and utility score for thyroid cancer should be undertaken to confirm the cost-effectiveness of AS.
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Affiliation(s)
- Han-Sang Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chai-Ho Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ja-Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul-Min Kim
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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24
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Prinja S, Jyani G, Gupta N, Rajsekar K. Adapting health technology assessment for drugs, medical devices, and health programs: Methodological considerations from the Indian experience. Expert Rev Pharmacoecon Outcomes Res 2021; 21:859-868. [PMID: 33882762 DOI: 10.1080/14737167.2021.1921575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Heterogeneity in methods of economic evaluation makes the use of health technology assessment (HTA) evidence difficult. Thereby, several countries including India have developed their own standard guidelines for conducting HTAs. However, diverse HTA studies involving drugs, medical devices, health programs, and platforms require an adaptation of the standard methods. AREAS COVERED This review presents the specific characteristics of HTAs involving medical devices and health programs requiring adaptation of the standard guidelines. We use recent HTA studies in India to illustrate specific issues. These considerations involve the nature of decision-making problems, multiple scenarios in case of health programs, and specific attention to costing and the valuation of consequences. In case of medical devices, we discuss the issue of costing application of devices, multiple usage, learning curve for achieving effects, long causal path for health outcomes, and the issue of valuing false positives. EXPERT OPINION While standard guidelines are essential, specific features of health programs and medical devices need to be considered while undertaking HTAs. Additionally, the context in which the HTA is being undertaken, characteristics of the health system, methods of financing healthcare, and demand-side characteristics of healthcare utilization should be reflected in the HTA for health programs and medical devices.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Jyani
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
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25
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Bulsei J, Leplus A, Donnet A, Regis J, Lucas C, Buisset N, Raoul S, Guegan-Massardier E, Derrey S, Jarraya B, Valade D, Roos C, Creach C, Chabardes S, Giraud P, Voirin J, Colnat-Coulbois S, Caire F, Rigoard P, Fontas E, Lanteri-Minet M, Fontaine D. Occipital Nerve Stimulation for Refractory Chronic Cluster Headache: A Cost-Effectiveness Study. Neuromodulation 2021; 24:1083-1092. [PMID: 33886139 DOI: 10.1111/ner.13394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Occipital nerve stimulation (ONS) is proposed to treat refractory chronic cluster headache (rCCH), but its cost-effectiveness has not been evaluated, limiting its diffusion and reimbursement. MATERIALS AND METHODS We performed a before-and-after economic study, from data collected prospectively in a nation-wide registry. We compared the cost-effectiveness of ONS associated with conventional treatment (intervention and postintervention period) to conventional treatment alone (preintervention period) in the same patients. The analysis was conducted on 76 rCCH patients from the French healthcare perspective at three months, then one year by extrapolation. Because of the impact of the disease on patient activity, indirect cost, such as sick leave and disability leave, was assessed second. RESULTS The average total cost for three months was €7602 higher for the ONS strategy compared to conventional strategy with a gain of 0.07 quality-adjusted life-years (QALY), the incremental cost-effectiveness ratio (ICER) was then €109,676/QALY gained. The average extrapolated total cost for one year was €1344 lower for the ONS strategy (p = 0.5444) with a gain of 0.28 QALY (p < 0.0001), the ICER was then €-4846/QALY gained. The scatter plot of the probabilistic bootstrapping had 80% of the replications in the bottom right-hand quadrant, indicating that the ONS strategy is dominant. The average indirect cost for three months was €377 lower for the ONS strategy (p = 0.1261). DISCUSSION This ONS cost-effectiveness study highlighted the limitations of a short-time horizon in an economic study that may lead the healthcare authorities to reject an innovative strategy, which is actually cost-effective. One-year extrapolation was the proposed solution to obtain results on which healthcare authorities can base their decisions. CONCLUSION Considering the burden of rCCH and the efficacy and safety of ONS, the demonstration that ONS is dominant should help its diffusion, validation, and reimbursement by health authorities in this severely disabled population.
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Affiliation(s)
- Julie Bulsei
- Delegation of Clinical Research, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Aurélie Leplus
- Department of Neurosurgery, Université Côte d'Azur, CHU de Nice, Nice, France.,Université Côte d'Azur, CHU de Nice, FHU INOVPAIN, Nice, France.,UR2CA, Université Côte d'Azur, Nice, France
| | - Anne Donnet
- Université Côte d'Azur, CHU de Nice, FHU INOVPAIN, Nice, France.,Pain Clinic, Hopital La Timone, Marseille, France
| | - Jean Regis
- Department of Functional Neurosurgery, Aix-Marseille University, Hopital La Timone, Marseille, France
| | | | - Nadia Buisset
- Department of Neurosurgery, CHU de Lille, Lille, France
| | - Sylvie Raoul
- Department of Neurosurgery, CHU de Nantes, Nantes, France
| | | | | | - Bechir Jarraya
- Department of Neurosurgery, Hopital Foch, Suresnes, France.,Université de Versailles Saint-Quentin en Yvelines/Université Paris-Saclay, Versailles, France
| | - Dominique Valade
- Department of Neurosurgery, Hopital Pitié-Sapêtrière, Paris, France
| | - Caroline Roos
- Emergency Headache Centre, Hopital Lariboisière, Paris, France
| | | | | | - Pierric Giraud
- Department of Neurology, Hopital d'Annecy, Annecy, France
| | - Jimmy Voirin
- Department of Neurosurgery, Hopitaux Civils de Colmar, Colmar, France
| | | | - Francois Caire
- Department of Neurosurgery, CHU de Limoges, Limoges, France
| | | | - Eric Fontas
- Delegation of Clinical Research, CHU de Nice, Université Côte d'Azur, Nice, France
| | - Michel Lanteri-Minet
- Université Côte d'Azur, CHU de Nice, FHU INOVPAIN, Nice, France.,UR2CA, Université Côte d'Azur, Nice, France.,Pain Department, Université Cote d'Azur, CHU de Nice, Nice, France.,INSERM/UdA, U1107, Neuro-Dol, Auvergne University, Clermont-Ferrand, France
| | - Denys Fontaine
- Department of Neurosurgery, Université Côte d'Azur, CHU de Nice, Nice, France.,Université Côte d'Azur, CHU de Nice, FHU INOVPAIN, Nice, France.,UR2CA, Université Côte d'Azur, Nice, France
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26
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Patel SA, McDonald CL, Li NY, Babu JM, Daniels AH, Rihn JA. Understanding Health Economics in Spine Surgery. JBJS Rev 2021; 9:01874474-202103000-00001. [PMID: 33667198 DOI: 10.2106/jbjs.rvw.20.00124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
» The United States has faced substantial increases in health-care expenditure, with specifically large increases in spine surgery costs. » Many different formulas are utilized to determine value in spine surgery, including cost- benefit analyses, cost-effectiveness analyses, and cost-utility analyses, with the overall determination of value being quality/cost. » Quality often is calculated indirectly using either process measures or outcome measures and represents the potential benefit of a given intervention, usually over a specific time period to yield quality-adjusted life years. » Costs are particularly difficult to calculate given the interhospital, regional, national, and global variability, as well as indirect costs of an intervention, and many different methods are utilized to estimate costs. » Spine surgeons should be familiar with the elements that compose cost-effectiveness and their potential shortcomings in order for providers and health-care policy makers to identify the highest-quality studies and interventions that provide the greatest benefit to patients.
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Affiliation(s)
| | | | - Neill Y Li
- Rhode Island Hospital, Providence, Rhode Island
| | | | | | - Jeffrey A Rihn
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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