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Marquina C, Lloyd M, Ng W, Hess J, Evans S, Ademi Z. Evaluating Health and Well-Being Returns on Investment in a Cancer Biobank. Biopreserv Biobank 2024. [PMID: 38828511 DOI: 10.1089/bio.2024.0014] [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: 06/05/2024] Open
Abstract
Objectives: To evaluate the population health returns from investment in the Victorian Cancer Biobank (VCB), a research consortium including five hospital-integrated sample repositories located in Melbourne, Australia. Methods: This economic evaluation assigned monetary values to the health gains attributable to VCB-supported research. These were then compared with the total investment in VCB infrastructure since inception (2006-2022) to determine the return on investment (ROI). A time lag of 40 years was incorporated, recognizing the delay from investment to impact in scientific research. Health gains were therefore measured for the years 2046-2066, with a 3% discount rate applied. Health gains were measured in terms of disability-adjusted life years (DALYs) attributable to VCB-associated research, with monetary cost assigned via the standardized value of a statistical life year (AU$227,000). The age-standardized DALY rate attributable to cancer was modeled for two standpoints (1) extrapolating the current decreasing trajectory and (2) assuming nil future improvement from current rates, with 33% of the difference attributed to scientific innovation. The proportion of the aggregate health gain attributable to VCB-supported research was estimated from the number of VCB-credited scientific publications as a proportion of total oncology publications over the same period. Results: The AU$32,628,016 of public funding invested in VCB activities over the years 2006-2022 is projected to generate AU$84,561,373 in total (discounted) savings. ROI was AU$1.59 for each AU$1 invested. Conclusions: The VCB offers a strong ROI in terms of impacts on health, justifying the expenditure of public funds and supporting the use of biobanks to advance scientific research.
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Affiliation(s)
- Clara Marquina
- Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
| | - Melanie Lloyd
- Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
| | - Wayne Ng
- Victorian Cancer Biobank, Melbourne, Australia
- Cancer Council Victoria, Melbourne, Australia
| | - Jonas Hess
- Victorian Cancer Biobank, Melbourne, Australia
- Cancer Council Victoria, Melbourne, Australia
| | - Sue Evans
- Victorian Cancer Registry, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Zanfina Ademi
- Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Qiu T, Aballéa S, Pochopień M, Toumi M, Dussart C, Yan D. A systematic review on the appropriate discounting rates for the economic evaluation of gene therapies: whether a specific approach is justified to tackle the challenges? Int J Technol Assess Health Care 2024; 40:e23. [PMID: 38725378 DOI: 10.1017/s0266462324000096] [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: 05/24/2024]
Abstract
OBJECTIVES Discounting the cost and effect for health intervention is a controversial topic over the last two decades. In particular, the cost-effectiveness of gene therapies is especially sensitive to the discount rate because of the substantial delay between the upfront cost incurred and long-lasing clinical benefits received. This study aims to investigate the influence of employing alternative discount rates on the incremental cost-effectiveness ratio (ICER) of gene therapies. METHODS A systematic review was conducted to include health economic evaluations of gene therapies that were published until April 2023. RESULTS Sensitivity or scenario analysis indicated that discount rate represented one of the most influential factors for the ICERs of gene therapies. Discount rate for cost and benefit was positively correlated with the cost-effectiveness of gene therapies, that is, a lower discount rate significantly improves the ICERs. The alternative discount rate employed in some cases could be powerful to alter the conclusion on whether gene therapies are cost-effective and acceptable for reimbursement. CONCLUSIONS Although discount rate will have substantial influence on the ICERs of gene therapies, there lacks solid evidence to justify a different discounting rule for gene therapies. However, it is proposed that the discount rate in the reference case should be updated to reflect the real-time preference, which in turn will affect the ICERs and reimbursement of gene therapies more profoundly than conventional therapies.
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Affiliation(s)
- Tingting Qiu
- Beijing Institute of Clinical Pharmacy, Beijing Friendship Hospital of Capital Medical University, Beijing, China
- Public Health Department, Aix-Marseille University, Marseille, France
| | - Samuel Aballéa
- Public Health Department, Aix-Marseille University, Marseille, France
| | - Michal Pochopień
- Public Health Department, Aix-Marseille University, Marseille, France
| | - Mondher Toumi
- Public Health Department, Aix-Marseille University, Marseille, France
| | - Claude Dussart
- Faculté de Pharmacie, Université Claude Bernard Lyon 1, Lyon, France
| | - Dan Yan
- Beijing Institute of Clinical Pharmacy, Beijing Friendship Hospital of Capital Medical University, Beijing, China
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Engel L, Alvarez-Jimenez M, Cagliarini D, D’Alfonso S, Faller J, Valentine L, Koval P, Bendall S, O’Sullivan S, Rice S, Miles C, Penn DL, Phillips J, Russon P, Lederman R, Killackey E, Lal S, Maree Cotton S, Gonzalez-Blanch C, Herrman H, McGorry PD, Gleeson JFM, Mihalopoulos C. The Cost-Effectiveness of a Novel Online Social Therapy to Maintain Treatment Effects From First-Episode Psychosis Services: Results From the Horyzons Randomized Controlled Trial. Schizophr Bull 2024; 50:427-436. [PMID: 37261464 PMCID: PMC10919787 DOI: 10.1093/schbul/sbad071] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Digital interventions have potential applications in promoting long-term recovery and improving outcomes in first-episode psychosis (FEP). This study aimed to evaluate the cost-effectiveness of Horyzons, a novel online social therapy to support young people aged 16-27 years following discharge from FEP services, compared with treatment as usual (TAU) from a healthcare sector and a societal perspective. STUDY DESIGN A cost-effectiveness analysis (CEA), based on the change in social functioning, and a cost-utility analysis (CUA) using quality-adjusted life years were undertaken alongside a randomized controlled trial. Intervention costs were determined from study records; resources used by patients were collected from a resource-use questionnaire and administrative data. Mean costs and outcomes were compared at 18 months and incremental cost-effectiveness ratios were calculated. Uncertainty analysis using bootstrapping and sensitivity analyses was conducted. STUDY RESULTS The sample included 170 participants: Horyzons intervention group (n = 86) and TAU (n = 84). Total costs were significantly lower in the Horyzons group compared with TAU from both the healthcare sector (-AU$4789.59; P < .001) and the societal perspective (-AU$5131.14; P < .001). In the CEA, Horyzons was dominant, meaning it was less costly and resulted in better social functioning. In the CUA, the Horyzons intervention resulted in fewer costs but also yielded fewer QALYs. However, group differences in outcomes were not statistically significant. When young people engaged more with the platform, costs were shown to decrease and outcomes improved. CONCLUSIONS The Horyzons intervention offers a cost-effective approach for improving social functioning in young people with FEP after discharge from early intervention services.
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Affiliation(s)
- Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Daniela Cagliarini
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Simon D’Alfonso
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Jan Faller
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lee Valentine
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Koval
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Bendall
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shaunagh O’Sullivan
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Simon Rice
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Chris Miles
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Jess Phillips
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Penni Russon
- School of Communication, University of Technology Sydney, Sydney, NWS, Australia
| | - Reeva Lederman
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sue Maree Cotton
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cesar Gonzalez-Blanch
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
- University Hospital Marques de Valdecilla-IDIVAL, Santander, Spain
| | - Helen Herrman
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Patrick D McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - John F M Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Deakin Health Economics, Deakin University, Burwood, VIC, Australia
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Scally E, Watts CG, Nugent C, Houghton R. A nurse-led approach to urgent results management at Sydney Sexual Health Centre demonstrates benefits to client outcomes and cost savings: a time efficiency and health system cost analysis. Sex Health 2024; 21:NULL. [PMID: 38071757 DOI: 10.1071/sh22200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/20/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND The timely provision of test results to facilitate early access to treatment is an essential component of sexually transmissible infection (STI) control and contributes to a significant proportion of the workload at sexual health services. We aimed to estimate the time to deliver client results and treatment as well as the health system costs of the nurse-led urgent results management model at the Sydney Sexual Health Centre (SSHC) compared to an alternative 'ordering clinician' model. METHODS We conducted a retrospective analysis of urgent results managed by the results nurse over 2weeks in 2019 and an observational study over 2weeks in 2021, where 10 clinicians managed five of their own urgent results. Additional activity data were gathered to determine the annual health system costs for both models. RESULTS In the nurse-led model 211 of 280 clients required notification; 156 (73.9%) were notified on the day their results became available, and the median time to treatment (n =137) was 1day. The annual health system cost for the nurse-led model was A$3922143. In the ordering clinician model, 17 (42.5%) clients were notified on the same day, and of the 27 clients treated at SSHC, the median time to treatment increased to 4days. The annual health system cost for the ordering clinician model was A$4043667.28 compared with the nurse-led model, and an additional 33.3h per week of clinician time was required for the same level of service provision. CONCLUSIONS This study highlights the strengths of the nurse-led results model at SSHC, demonstrating improved client outcomes for STI notification and treatment times and health systems savings.
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Affiliation(s)
- E Scally
- Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - C G Watts
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - C Nugent
- Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - R Houghton
- Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, NSW, Australia
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Mann GB, Skandarajah AR, Zdenkowski N, Hughes J, Park A, Petrie D, Saxby K, Grimmond SM, Murugasu A, Spillane AJ, Chua BH, Badger H, Braggett H, Gebski V, Mou A, Collins JP, Rose AK. Postoperative radiotherapy omission in selected patients with early breast cancer following preoperative breast MRI (PROSPECT): primary results of a prospective two-arm study. Lancet 2024; 403:261-270. [PMID: 38065194 DOI: 10.1016/s0140-6736(23)02476-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/13/2023] [Accepted: 11/02/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Adjuvant breast radiotherapy as a standard component of breast-conserving treatment for early cancer can overtreat many women. Breast MRI is the most sensitive modality to assess local tumour burden. The aim of this study was to determine whether a combination of MRI and pathology findings can identify women with truly localised breast cancer who can safely avoid radiotherapy. METHODS PROSPECT is a prospective, multicentre, two-arm, non-randomised trial of radiotherapy omission in patients selected using preoperative MRI and postoperative tumour pathology. It is being conducted at four academic hospitals in Australia. Women aged 50 years or older with cT1N0 non-triple-negative breast cancer were eligible. Those with apparently unifocal cancer had breast-conserving surgery (BCS) and, if pT1N0 or N1mi, had radiotherapy omitted (group 1). Standard treatment including excision of MRI-detected additional cancers was offered to the others (group 2). All were recommended systemic therapy. The primary outcome was ipsilateral invasive recurrence rate (IIRR) at 5 years in group 1. Primary analysis occurred after the 100th group 1 patient reached 5 years follow-up. Quality-adjusted life-years (QALYs) and cost-effectiveness of the PROSPECT pathway were analysed. This study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12610000810011). FINDINGS Between May 17, 2011, and May 6, 2019, 443 patients with breast cancer underwent MRI. Median age was 63·0 years. MRI detected 61 malignant occult lesions separate from the index cancer in 48 patients (11%). Of 201 group 1 patients who had BCS without radiotherapy, the IIRR at 5 years was 1·0% (upper 95% CI 5·4%). In group 1, one local recurrence occurred at 4·5 years and a second at 7·5 years. In group 2, nine patients had mastectomy (2% of total cohort), and the 5-year IIRR was 1·7% (upper 95% CI 6·1%). The only distant metastasis in the entire cohort was genetically distinct from the index cancer. The PROSPECT pathway increased QALYs by 0·019 (95% CI 0·008-0·029) and saved AU$1980 (95% CI 1396-2528) or £953 (672-1216) per patient. INTERPRETATION PROSPECT suggests that women with unifocal breast cancer on MRI and favourable pathology can safely omit radiotherapy. FUNDING Breast Cancer Trials, National Breast Cancer Foundation, Cancer Council Victoria, the Royal Melbourne Hospital Foundation, and the Breast Cancer Research Foundation.
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Affiliation(s)
- Gregory Bruce Mann
- The Royal Melbourne Hospital, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia; Breast Cancer Trials, Newcastle, NSW, Australia; Department of Surgery, The University of Melbourne, Parkville, VIC, Australia.
| | - Anita Rohini Skandarajah
- The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | | | | | - Allan Park
- The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash University, Caulfield East, VIC, Australia
| | - Karinna Saxby
- Centre for Health Economics, Monash University, Caulfield East, VIC, Australia; Melbourne Institute of Applied Economic and Social Research, Parkville, VIC, Australia
| | - Sean M Grimmond
- The University of Melbourne Centre for Cancer Research, Parkville, VIC, Australia
| | | | - Andrew J Spillane
- University of Sydney, Wollstonecraft, NSW, Australia; Mater Hospital, Wollstonecraft, NSW, Australia
| | - Boon H Chua
- UNSW Medicine & Health, The University of New South Wales, Sydney, NSW, Australia
| | | | | | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Arlene Mou
- The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Radiology, The University of Melbourne, Parkville, VIC, Australia
| | - John P Collins
- The Royal Melbourne Hospital, Parkville, VIC, Australia; Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | - Allison K Rose
- The Royal Melbourne Hospital, Parkville, VIC, Australia; The Royal Women's Hospital, Parkville, VIC, Australia; Department of Radiology, The University of Melbourne, Parkville, VIC, Australia
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Sharma S, Bressler RD, Bhopal A, Norheim OF. The global temperature-related mortality impact of earlier decarbonization for the Australian health sector and economy: A modelling study. PLoS One 2022; 17:e0271550. [PMID: 35921296 PMCID: PMC9348697 DOI: 10.1371/journal.pone.0271550] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 07/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background Sustained elevated concentration of GHGs is predicted to increase global mortality. With the Australian health sector responsible for 7% of the nation’s GHG emissions, the benefits and costs of various decarbonisation trajectories are currently being investigated. To assist with this effort, we model the impact earlier decarbonisation has on temperature-related mortality. Design We used DICE-EMR, an Integrated Assessment Model with an endogenous mortality response, to simulate Australian GHG trajectories and estimate the temperature-related mortality impact of early decarbonisation. We modelled a linear decline of the Australian health sector’s and economy’s GHG annual emissions to net-zero targets of 2040 and 2050. Main outcome measure Deaths averted and monetary-equivalent welfare gain. Results Decarbonisation of the Australian health sector by 2050 and 2040 is projected to avert an estimated 69,000 and 77,000 global temperature-related deaths respectively in a Baseline global emissions scenario. Australian economy decarbonisation by 2050 and 2040 is projected to avert an estimated 988,000 and 1,101,000 global deaths respectively. Assuming a low discount rate and high global emissions trajectory, we estimate a monetary equivalent welfare gain of $151 billion if the Australian health sector decarbonises by 2040, only accounting for the benefits in reducing temperature-related mortality. Conclusions Earlier decarbonisation has a significant impact on temperature-related mortality. Many uncertainties exist and health impacts other than temperature-related mortality are not captured by this analysis. Nevertheless, such models can help communicate the health risk of climate change and improve climate policy decision making.
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Affiliation(s)
- Siddhanth Sharma
- Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway
- * E-mail: ,
| | - R. Daniel Bressler
- School of International and Public Affairs, Columbia University, New York, NY, United States of America
| | - Anand Bhopal
- Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway
| | - Ole F. Norheim
- Bergen Centre for Ethics and Priority Setting, University of Bergen, Bergen, Norway
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