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Veijer C, van Hulst MH, Friedrichson B, Postma MJ, van Asselt ADI. Lessons Learned from Model-based Economic Evaluations of COVID-19 Drug Treatments Under Pandemic Circumstances: Results from a Systematic Review. PHARMACOECONOMICS 2024; 42:633-647. [PMID: 38727991 PMCID: PMC11126513 DOI: 10.1007/s40273-024-01375-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Following clinical research of potential coronavirus disease 2019 (COVID-19) treatments, numerous decision-analytic models have been developed. Due to pandemic circumstances, clinical evidence was limited and modelling choices were made under great uncertainty. This study aimed to analyse key methodological characteristics of model-based economic evaluations of COVID-19 drug treatments, and specifically focused on modelling choices which pertain to disease severity levels during hospitalisation, model structure, sources of effectiveness and quality of life and long-term sequelae. METHODS We conducted a systematic literature review and searched key databases (including MEDLINE, EMBASE, Web of Science, Scopus) for original articles on model-based full economic evaluations of COVID-19 drug treatments. Studies focussing on vaccines, diagnostic techniques and non-pharmaceutical interventions were excluded. The search was last rerun on 22 July 2023. Results were narratively synthesised in tabular form. Several aspects were categorised into rubrics to enable comparison across studies. RESULTS Of the 1047 records identified, 27 were included, and 23 studies (85.2%) differentiated patients by disease severity in the hospitalisation phase. Patients were differentiated by type of respiratory support, level of care management, a combination of both or symptoms. A Markov model was applied in 16 studies (59.3%), whether or not preceded by a decision tree or an epidemiological model. Most cost-utility analyses lacked the incorporation of COVID-19-specific health utility values. Of ten studies with a lifetime horizon, seven adjusted general population estimates to account for long-term sequelae (i.e. mortality, quality of life and costs), lasting for 1 year, 5 years, or a patient's lifetime. The most often reported parameter influencing the outcome of the analysis was related to treatment effectiveness. CONCLUSION The results illustrate the variety in modelling approaches of COVID-19 drug treatments and address the need for a more standardized approach in model-based economic evaluations of infectious diseases such as COVID-19. TRIAL REGISTRY Protocol registered in PROSPERO under CRD42023407646.
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Affiliation(s)
- Clazinus Veijer
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Marinus H van Hulst
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Martini Ziekenhuis, Groningen, The Netherlands
| | - Benjamin Friedrichson
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
- Department of Pharmocology and Therapy, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Antoinette D I van Asselt
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Elvidge J, Hopkin G, Narayanan N, Nicholls D, Dawoud D. Diagnostics and treatments of COVID-19: two-year update to a living systematic review of economic evaluations. Front Pharmacol 2023; 14:1291164. [PMID: 38035028 PMCID: PMC10687367 DOI: 10.3389/fphar.2023.1291164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives: As the initial crisis of the COVID-19 pandemic recedes, healthcare decision makers are likely to want to make rational evidence-guided choices between the many interventions now available. We sought to update a systematic review to provide an up-to-date summary of the cost-effectiveness evidence regarding tests for SARS-CoV-2 and treatments for COVID-19. Methods: Key databases, including MEDLINE, EconLit and Embase, were searched on 3 July 2023, 2 years on from the first iteration of this review in July 2021. We also examined health technology assessment (HTA) reports and the citations of included studies and reviews. Peer-reviewed studies reporting full health economic evaluations of tests or treatments in English were included. Studies were quality assessed using an established checklist, and those with very serious limitations were excluded. Data from included studies were extracted into predefined tables. Results: The database search identified 8,287 unique records, of which 54 full texts were reviewed, 28 proceeded for quality assessment, and 15 were included. Three further studies were included through HTA sources and citation checking. Of the 18 studies ultimately included, 17 evaluated treatments including corticosteroids, antivirals and immunotherapies. In most studies, the comparator was standard care. Two studies in lower-income settings evaluated the cost effectiveness of rapid antigen tests and critical care provision. There were 17 modelling analyses and 1 trial-based evaluation. Conclusion: A large number of economic evaluations of interventions for COVID-19 have been published since July 2021. Their findings can help decision makers to prioritise between competing interventions, such as the repurposed antivirals and immunotherapies now available to treat COVID-19. However, some evidence gaps remain present, including head-to-head analyses, disease-specific utility values, and consideration of different disease variants. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021272219], identifier [PROSPERO 2021 CRD42021272219].
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Affiliation(s)
- Jamie Elvidge
- Science, Evidence and Analytics Directorate, National Institute for Health and Care Excellence, Manchester, United Kingdom
| | - Gareth Hopkin
- Science, Evidence and Analytics Directorate, National Institute for Health and Care Excellence, Manchester, United Kingdom
| | - Nithin Narayanan
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - David Nicholls
- Science, Evidence and Analytics Directorate, National Institute for Health and Care Excellence, Manchester, United Kingdom
| | - Dalia Dawoud
- Science, Evidence and Analytics Directorate, National Institute for Health and Care Excellence, Manchester, United Kingdom
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Gholipour K, Behpaie S, Iezadi S, Ghiasi A, Tabrizi JS. Costs of inpatient care and out-of-pocket payments for COVID-19 patients: A systematic review. PLoS One 2023; 18:e0283651. [PMID: 37729207 PMCID: PMC10511135 DOI: 10.1371/journal.pone.0283651] [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: 11/16/2022] [Accepted: 03/13/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To identify the costs of hospital care for patients with COVID-19 and the amount of out-of-pocket payments. METHODS We conducted a systematic review using Scopus and WEB OF SCIENCE and PubMed databases in April 5, 2022 and then updated in January 15, 2023. English articles with no publication year restrictions were included with study designs of cost-of-illness (COI) studies, cost analyses, and observational reports (cross-sectional studies and prospective and retrospective cohorts) that calculated the patient-level cost of care for COVID-19. Costs are reported in USD with purchasing power parity (PPP) conversion in 2020. The PROSPERO registration number is CRD42022334337. RESULTS The results showed that the highest total cost of hospitalization in intensive care per patient was 100789 USD, which was reported in Germany, and the lowest cost was 5436.77 USD, which was reported in Romania. In the present study, in the special care department, the highest percentage of total expenses is related to treatment expenses (42.23 percent), while in the inpatient department, the highest percentage of total expenses is related to the costs of hospital beds/day of routine services (39.07 percent). The highest percentage of out-of-pocket payments was 30.65 percent, reported in China, and the lowest percentage of out-of-pocket payments was 1.12 percent, reported in Iran. The highest indirect cost per hospitalization was 16049 USD, reported in USA, and the lowest was 449.07 USD, reported in India. CONCLUSION The results show that the COVID-19 disease imposed a high cost of hospitalization, mainly the cost of hospital beds/day of routine services. Studies have used different methods for calculating the costs, and this has negatively impacted the comparability costs across studies. Therefore, it would be beneficial for researchers to use a similar cost calculation model to increase the compatibility of different studies. Systematic review registration: PROSPERO CRD42022334337.
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Affiliation(s)
- Kamal Gholipour
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sama Behpaie
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shabnam Iezadi
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
| | - Akbar Ghiasi
- HEB School of Business & Administration, University of the Incarnate Word, San Antonio, Texas, United States of America
| | - Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Lieberum JN, Kaiser S, Kalbhenn J, Bürkle H, Schallner N. Predictive markers related to local and systemic inflammation in severe COVID-19-associated ARDS: a prospective single-center analysis. BMC Infect Dis 2023; 23:19. [PMID: 36631778 PMCID: PMC9832419 DOI: 10.1186/s12879-023-07980-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/02/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND As the COVID-19 pandemic strains healthcare systems worldwide, finding predictive markers of severe courses remains urgent. Most research so far was limited to selective questions hindering general assumptions for short- and long-term outcome. METHODS In this prospective single-center biomarker study, 47 blood- and 21 bronchoalveolar lavage (BAL) samples were collected from 47 COVID-19 intensive care unit (ICU) patients upon admission. Expression of inflammatory markers toll-like receptor 3 (TLR3), heme oxygenase-1 (HO-1), interleukin (IL)-6, IL-8, leukocyte counts, procalcitonin (PCT) and carboxyhemoglobin (CO-Hb) was compared to clinical course. Clinical assessment comprised acute local organ damage, acute systemic damage, mortality and outcome after 6 months. RESULTS PCT correlated with acute systemic damage and was the best predictor for quality of life (QoL) after 6 months (r = - 0.4647, p = 0.0338). Systemic TLR3 negatively correlated with impaired lung function (ECMO/ECLS: r = - 0.3810, p = 0.0107) and neurological short- (RASS mean: r = 0.4474, p = 0.0023) and long-term outcome (mRS after 6 m: r = - 0.3184, p = 0.0352). Systemic IL-8 correlated with impaired lung function (ECMO/ECLS: r = 0.3784, p = 0.0161) and neurological involvement (RASS mean: r = - 0.5132, p = 0.0007). IL-6 in BAL correlated better to the clinical course than systemic IL-6. Using three multivariate regression models, we describe prediction models for local and systemic damage as well as QoL. CO-Hb mean and max were associated with higher mortality. CONCLUSIONS Our predictive models using the combination of Charlson Comorbidity Index, sex, procalcitonin, systemic TLR3 expression and IL-6 and IL-8 in BAL were able to describe a broad range of clinically relevant outcomes in patients with severe COVID-19-associated ARDS. Using these models might proof useful in risk stratification and predicting disease course in the future. Trial registration The trial was registered with the German Clinical Trials Register (Trial-ID DRKS00021522, registered 22/04/2020).
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Affiliation(s)
- Jan Nikolaus Lieberum
- grid.7708.80000 0000 9428 7911Department of Anesthesiology and Critical Care Medicine, Medical Center, University of Freiburg, Freiburg, Germany ,grid.5963.9Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sandra Kaiser
- grid.7708.80000 0000 9428 7911Department of Anesthesiology and Critical Care Medicine, Medical Center, University of Freiburg, Freiburg, Germany ,grid.5963.9Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes Kalbhenn
- grid.7708.80000 0000 9428 7911Department of Anesthesiology and Critical Care Medicine, Medical Center, University of Freiburg, Freiburg, Germany ,grid.5963.9Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut Bürkle
- grid.7708.80000 0000 9428 7911Department of Anesthesiology and Critical Care Medicine, Medical Center, University of Freiburg, Freiburg, Germany ,grid.5963.9Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Schallner
- grid.7708.80000 0000 9428 7911Department of Anesthesiology and Critical Care Medicine, Medical Center, University of Freiburg, Freiburg, Germany ,grid.5963.9Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Pandit JJ. Is it worth treating patients with COVID-19 in intensive care? Utility, choice, costs and value. Anaesthesia 2022; 77:1326-1331. [PMID: 36227736 PMCID: PMC9874764 DOI: 10.1111/anae.15888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 01/27/2023]
Affiliation(s)
- J. J. Pandit
- Nuffield Department of AnaesthesiaOxford University Hospitals NHS Foundation TrustOxfordUK,Professor of AnaesthesiaUniversity of OxfordUK
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