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Shah KK, Hedley JA, Robledo KP, Wyld M, Webster AC, Morton RL. Cost-effectiveness of Accepting Kidneys From Deceased Donors With Common Cancers-A Modeling Study. Transplantation 2024; 108:e187-e197. [PMID: 38499509 DOI: 10.1097/tp.0000000000004984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND The disparity between the demand for and supply of kidney transplants has resulted in prolonged waiting times for patients with kidney failure. A potential approach to address this shortage is to consider kidneys from donors with a history of common cancers, such as breast, prostate, and colorectal cancers. METHODS We used a patient-level Markov model to evaluate the outcomes of accepting kidneys from deceased donors with a perceived history of breast, prostate, or colorectal cancer characterized by minimal to intermediate transmission risk. Data from the Australian transplant registry were used in this analysis. The study compared the costs and quality-adjusted life years (QALYs) from the perspective of the Australian healthcare system between the proposed practice of accepting these donors and the conservative practice of declining them. The model simulated outcomes for 1500 individuals waitlisted for a deceased donor kidney transplant for a 25-y horizon. RESULTS Under the proposed practice, when an additional 15 donors with minimal to intermediate cancer transmission risk were accepted, QALY gains ranged from 7.32 to 20.12. This translates to an approximate increase of 7 to 20 additional years of perfect health. The shift in practice also led to substantial cost savings, ranging between $1.06 and $2.3 million. CONCLUSIONS The proposed practice of accepting kidneys from deceased donors with a history of common cancers with minimal to intermediate transmission risk offers a promising solution to bridge the gap between demand and supply. This approach likely results in QALY gains for recipients and significant cost savings for the health system.
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Affiliation(s)
- Karan K Shah
- Health Economics and Health Technology Assessment, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - James A Hedley
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Kristy P Robledo
- Health Economics and Health Technology Assessment, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Melanie Wyld
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - Angela C Webster
- Health Economics and Health Technology Assessment, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Collaborative Centre for Organ Donation Evidence, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - Rachael L Morton
- Health Economics and Health Technology Assessment, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Baye TA, Gebeyehu H, Bekele M, Abdelmenan S, Ashengo TA, Mengistu B. The economic burden of hemodialysis and associated factors of among patients in private and public health facilities: a cross-sectional study in Addis Ababa, Ethiopia. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:25. [PMID: 38575968 PMCID: PMC10996090 DOI: 10.1186/s12962-024-00530-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/08/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION The treatment of kidney disease, including hemodialysis, poses challenges in healthcare and finances. Despite limited data on hemodialysis costs and determinants in Ethiopia, existing literature indicates a paucity of evidence regarding the economic burden of hemodialysis. This study aims to evaluate the direct and indirect costs of hemodialysis among end-stage renal disease (ESRD) patients, alongside associated factors, among selected governmental and private institutions in Addis Ababa, Ethiopia. METHODS An institutional-based cross-sectional study using a simple random sampling technique was conducted from September 10 to November 1, 2021. One hundred twenty-eight patients participated in the study. Data was collected using an interviewer-administered questionnaire. The analysis used proportion and frequency measures of central tendency and linear regression measures. Both simple and multiple linear regression models were used to assess associated factors. The final model used a P value < 0.05 at 95% confidence interval (CI) was used to determine significance. RESULT The mean cost of hemodialysis in a representative sample of selected hospitals in Addis Ababa was 7,739.17 $ ±2,833.51 $, with direct medical cost contributing 72.9% of the total cost. Furthermore, the institution type (private or public) and duration on hemodialysis were associated with an increased cost of hemodialysis. CONCLUSION Our findings underline the necessity for policymakers, program administrators, and healthcare institution executives to prioritize this group, recognizing the substantial load they bear and extending these services in government facilities to a broader patient population.
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Affiliation(s)
| | - Hamelmal Gebeyehu
- Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mahteme Bekele
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | | | | | - Berhanu Mengistu
- Department of Human Nutrition, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
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Yousefi M, Rezaei S, Hajebrahimi S, Falsafi N, Keshvari-Shad F. Peritoneal dialysis vs. hemodialysis among patients with end-stage renal disease in Iran: which is more cost-effective? BMC Nephrol 2024; 25:85. [PMID: 38448887 PMCID: PMC10916316 DOI: 10.1186/s12882-024-03530-0] [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: 08/13/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND There is little economic evidence on different modalities among patients with end-stage renal disease (ESRD) in Iran. This study aimed to assess the cost-utility of peritoneal dialysis (PD) and hemodialysis (HD) among ESRD patients in Iran. METHODS From the health system perspective and with a 10-year time horizon, we conducted a cost-utility analysis based on a Markov model to compare three strategies of PD and HD [the second scenario (30% PD, 70% HD), the third scenario (50% PD, 50% HD) and the fourth scenario (70% PD, 30% HD)] among ESRD patients with the current situation (PD, 3% vs. HD, 97%) as the basic scenario (the first scenario) in Iran. Cost data for PD, HD and kidney transplantation were extracted from the medical records of 720 patients in the Health Insurance Organization (HIO) database. The Iranian version of the EQ-5D-5 L questionnaire was filled out through direct interview with 518 patients with ESRD to obtain health utility values. Other variables such as transition probabilities and survival rates were extracted from the literature. To examine the uncertainty in all variables included in the study, a probabilistic sensitivity analysis (PSA) was performed. TreeAge Pro 2020 software was used for data analysis. FINDINGS Our analysis indicated that the average 10-year costs associated with the first scenario (S1), the second scenario (S2), the third scenario (S3) and the fourth scenario (S4) were 4750.5, 4846.8, 4918.2, and 4989.6 million Iranian Rial (IRR), respectively. The corresponding average quality-adjusted life years (QALYs) per patient were 2.68, 2.72, 2.75 and 2.78, respectively. The ICER for S2, S3 and S4 scenarios was estimated at 2268.2, 2266.7 and 2266.7 per a QALY gained, respectively. The analysis showed that at a willingness-to-pay (WTP) threshold of 3,000,000,000 IRR (2.5 times the GDP per capita), the fourth scenario had a 63% probability of being cost-effective compared to the other scenarios. CONCLUSION Our study demonstrated that the fourth scenario (70% PD vs. 30% HD) compared to the current situation (3% PD vs. 97% HD) among patients with ESKD is cost-effective at a threshold of 2.5 times the GDP per capita (US$4100 in 2022). Despite the high cost of PD, due to its greater effectiveness, it is recommended that policymakers pursue a strategy to increase the use of PD among ESRD patients.
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Affiliation(s)
- Mahmood Yousefi
- National Center for Health Insurance Research, Tehran, Iran
- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Niloofar Falsafi
- Department of Health Economics, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Keshvari-Shad
- National Center for Health Insurance Research, Tehran, Iran.
- Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran.
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Liu M, Di YM, Zhang AL, Chen J, Wang R, Huang J, Zhang L, Xue CC, Liu X. Renal-protective effects of Chinese medicinal herbs and compounds for diabetic kidney disease in animal models: protocol for systematic review and meta-analysis. Syst Rev 2024; 13:23. [PMID: 38217017 PMCID: PMC10785383 DOI: 10.1186/s13643-023-02446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/23/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD) is a common and severe complication of diabetes that can lead to end-stage renal disease with no cure. The first-line drugs recommended by clinical guidelines fail to achieve satisfactory effects for people with DKD. A Chinese herbal medicine Tangshen Qushi Formula (TQF) shows preliminary efficacy and safety in preserving renal function for people with DKD, but the effects on comprehensive renal outcomes remain unclear. We will conduct a systematic review and meta-analysis to evaluate the effects of TQF herbs and their compounds identified from ultra-high performance liquid chromatography-MS/MS in diabetic animal models with renal outcomes. METHODS This protocol complies with the guideline Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We will include studies investigating the effects of TQF herbs and compounds on diabetic rats or mice with renal outcomes. Six electronic databases will be searched from their inception to February 2023. Quality assessment will be conducted using SYRCLE's risk of bias tool. Standardized or weighted mean differences will be estimated for renal outcomes (creatinine, urea, proteinuria, histological changes, oxidative stress, inflammation, and kidney fibrosis). Data will be pooled using random-effects models. Heterogeneity across studies will be expressed as I2. Sensitivity analyses will explore treatment effects in adjusted models and within subgroups. Funnel plots and Egger's test will be used to explore publication bias. DISCUSSION The results of this review will provide valuable insights into the potential effects of TQF in managing DKD. The limitation is that the included studies will be animal studies from specific databases, and the interpretation of the findings must be cautious. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023432895. Registered on 19 July 2023 ( https://www.crd.york.ac.uk/PROSPERO/#recordDetails ).
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Affiliation(s)
- Meifang Liu
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuan Ming Di
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Anthony Lin Zhang
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Junhui Chen
- The Second Clinical College of Guangzhou University of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ruobing Wang
- The Second Clinical College of Guangzhou University of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Juan Huang
- Pharmaceutical Research Department for New Drug Development and Authentication of Chinese Medicines, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lei Zhang
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Charlie Changli Xue
- The China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.
| | - Xusheng Liu
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Fidan C, Ağırbaş İ. The effect of renal replacement therapy on health-related quality of life in end-stage renal disease: a meta-analysis. Clin Exp Nephrol 2023; 27:829-846. [PMID: 37466815 DOI: 10.1007/s10157-023-02377-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND End-stage renal disease (ESRD) patients judge health-related quality of life (HRQoL) as an essential outcome. In meta-analysis studies, there is ongoing debate regarding the impact of renal replacement therapy (RRT) methods on HRQoL in ESRD patients. Hence, the main objective of this study was to examine the influence of RRT method utilization on HRQoL in individuals with ESRD. Additionally, the secondary objective was to explore the impact of RRT method use on HRQoL, considering various moderator variables. METHODS RRT methods called hemodialysis (HD), peritoneal dialysis (PD), home dialysis (HoD), and kidney transplantation (KT) are used to treat ESRD. HD was defined as in-center HD (ICHD) and home HD (HHD). HoD was defined as HHD and PD. The estimated Hedges' g were conducted by random effect meta-analysis. RESULTS A total of 111 publications, including 50.151 patients, were included. KT was better at improving patients' HRQoL than other methods. PD was better at improving patients' HRQoL than HD. HoD was better at improving patients' HRQoL than ICHD. Sensitivity analyses yielded similar results. Publication bias was not tested. The subgroup and meta-regression analyses showed that the moderating variables had a statistically significant effect on the HRQoL of patients with ESRD. CONCLUSION For the treatment of ESRD, either KT, PD, or HoD can be used in terms of HRQoL. We need to improve the factors affecting the HRQoL of ESRD patients undergoing HD and ICHD. Healthcare professionals should consider the factors that influence HRQoL and choose an RTT method for each ESRD patient.
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Affiliation(s)
- Cuma Fidan
- Department of Healthcare Management, Health Sciences Faculty, Mus Alparslan University, 49250, Mus, Turkey.
| | - İsmail Ağırbaş
- Department of Healthcare Management, Ankara University, Ankara, Turkey
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Xu W, Zhang Z, Li D, Dai W, Pan C, Guo M, Zhao Y, Cui X. Immunosuppressive therapy for progressive idiopathic membranous nephropathy: a cost-effectiveness analysis in China. BMC Health Serv Res 2023; 23:361. [PMID: 37046255 PMCID: PMC10091593 DOI: 10.1186/s12913-023-09365-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND This study aims to evaluate the cost-effectiveness of immunosuppressive therapy for patients with progressive idiopathic membranous nephropathy (IMN) from the Chinese healthcare system perspective. METHODS To estimate the cost-effectiveness of four regimens namely cyclophosphamide, cyclosporine, rituximab and tacrolimus-rituximab in treatment of IMN recommended by the updated Kidney Disease: Improving Global Outcomes (KDIGO) guideline 2021, a Markov model with five discrete states (active disease, remission, dialysis, kidney transplant and death) based on IMN patients aged 50 or above over a 30-years time horizon was constructed. Total costs were imputed from the Chinese healthcare system perspective, and health outcomes were converted into quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) was used to describe the results. The willingness-to-pay (WTP) threshold was set at $12,044 (China's 2021 Gross Domestic Product per capita). Sensitivity analyses were performed to test the uncertainties of the results. RESULT Compared with cyclophosphamide, both cyclosporine (incremental cost $28,337.09, incremental QALY-1.63) and tacrolimus-rituximab (incremental cost $28,324.13, incremental QALY -0.46) were considered at strictly dominated for their negative values in QALYs, and the ICER value of rituximab was positive (incremental cost $9,162.19, incremental QALY 0.44). Since the ICER of rituximab exceeds the pre-determined threshold, cyclophosphamide was likely to be the best choice for the treatment of IMN within the acceptable threshold range. The results of the sensitivity analysis revealed that the model outcome was mostly affected by the probability of remission in rituximab. In a probabilistic sensitivity analysis, cyclophosphamide had 62.4% probability of being cost-effective compared with other regimens when the WTP was $12,044 per QALY. When WTP exceeded $18,300, rituximab was more cost-effective than cyclophosphamide. CONCLUSION Compared with cyclosporine, rituximab and tacrolimus-rituximab, our model results indicated that cyclophosphamide represented the most cost-effective regimen for patients with progressive IMN in China.
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Affiliation(s)
- Wanyi Xu
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Yong-an Road, Xi-Cheng District, Beijing, 100050, PR China
| | - Zhiqi Zhang
- School of Pharmacy, Capital Medical University, Beijing, PR China
| | - Dandan Li
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Yong-an Road, Xi-Cheng District, Beijing, 100050, PR China
| | - Wendi Dai
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Chen Pan
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Yong-an Road, Xi-Cheng District, Beijing, 100050, PR China
| | - Mingxing Guo
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Yong-an Road, Xi-Cheng District, Beijing, 100050, PR China
| | - Ying Zhao
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Yong-an Road, Xi-Cheng District, Beijing, 100050, PR China
| | - Xiangli Cui
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Yong-an Road, Xi-Cheng District, Beijing, 100050, PR China.
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Busink E, Kendzia D, Kircelli F, Boeger S, Petrovic J, Smethurst H, Mitchell S, Apel C. A systematic review of the cost-effectiveness of renal replacement therapies, and consequences for decision-making in the end-stage renal disease treatment pathway. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:377-392. [PMID: 35716316 PMCID: PMC10060297 DOI: 10.1007/s10198-022-01478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Comparative economic assessments of renal replacement therapies (RRT) are common and often used to inform national policy in the management of end-stage renal disease (ESRD). This study aimed to assess existing cost-effectiveness analyses of dialysis modalities and consider whether the methods applied and results obtained reflect the complexities of the real-world treatment pathway experienced by ESRD patients. METHODS A systematic literature review (SLR) was conducted to identify cost-effectiveness studies of dialysis modalities from 2005 onward by searching Embase, MEDLINE, EBM reviews, and EconLit. Economic evaluations were included if they compared distinct dialysis modalities (e.g. in-centre haemodialysis [ICHD], home haemodialysis [HHD] and peritoneal dialysis [PD]). RESULTS In total, 19 cost-effectiveness studies were identified. There was considerable heterogeneity in perspectives, time horizon, discounting, utility values, sources of clinical and economic data, and extent of clinical and economic elements included. The vast majority of studies included an incident dialysis patient population. All studies concluded that home dialysis treatment options were cost-effective interventions. CONCLUSIONS Despite similar findings across studies, there are a number of uncertainties about which dialysis modalities represent the most cost-effective options for patients at different points in the care pathway. Most studies included an incident patient cohort; however, in clinical practice, patients may switch between different treatment modalities over time according to their clinical need and personal circumstances. Promoting health policies through financial incentives in renal care should reflect the cost-effectiveness of a comprehensive approach that considers different RRTs along the patient pathway; however, no such evidence is currently available.
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Affiliation(s)
- Ellen Busink
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany.
| | - Dana Kendzia
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany
| | - Fatih Kircelli
- Global Medical Information & Education, Fresenius Medical Care, Bad Homburg, Germany
| | - Sophie Boeger
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany
| | - Jovana Petrovic
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany
| | | | | | - Christian Apel
- Health Economics, Market Access & Political Affairs, Fresenius Medical Care, Else-Kröner-Straße 3, 61352, Bad Homburg, Germany
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Kong W, Yang X, Shu Y, Li S, Song B, Yang K. Cost-effectiveness analysis of ceftazidime-avibactam as definitive treatment for treatment of carbapenem-resistant Klebsiella pneumoniae bloodstream infection. Front Public Health 2023; 11:1118307. [PMID: 36926178 PMCID: PMC10011158 DOI: 10.3389/fpubh.2023.1118307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
Background Ceftazidime-avibactam (CAZ-AVI) is a novel antibiotic that has been confirmed in the United States and China for use in patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection (BSI). However, the cost-effectiveness of CAZ-AVI is unknown in China. This study aimed to evaluate the cost-effectiveness of CAZ-AVI compared to polymyxin B (PMB) monotherapy or PMB-based therapy for the treatment of CRKP BSI from the Chinese healthcare perspective. Methods A hybrid decision tree and Markov model were constructed for a hypothetical cohort of patients with CRKP BSI. The time horizon of the Markov model was 5 years with an annual discount rate of 5% used in both costs and quality-adjusted life-years (QALYs). The model data was derived from published literature and publicly available database. Regimens with an incremental cost-effectiveness ratio (ICER) lower than the willingness-to-pay (WTP) threshold of $ 11,600 per QALY were considered cost-effective. Deterministic and probabilistic sensitivity analyses were performed to examine the robustness of model analysis. Results In the base-analysis, CAZ-AVI provided an additional 60 QALYs and reduced the cost by $ 2,218,300, yielding an ICER of $ -36,730.9/QALY, well below the WTP threshold of $ 11,600 per QALY when compared with PMB-based therapy. CAZ-AVI provided an additional 350 QALYs and increased the cost of $ 208,400, producing an ICER of $ 591.7/QALY that was below the WTP threshold compared to PMB monotherapy. At a $ 11,600/QALY threshold, results were sensitive to the cost of PMB-based strategy, the cost of CAZ-AVI strategy, the probability of cure with CAZ-AVI, and the probability of cure with PMB or PMB-based therapy. CAZ-AVI was an optimal regimen in 76.9% and 80.8% of 10,000 Monte Carlo simulations at $ 11,600/QALY and $ 34,800/QALY, respectively. Meanwhile, CAZ-AVI was cost-effective at the WTP thresholds of all 31 Chinese provinces in 61.4% (Gansu) to 83.1% (Beijing) of simulations. Conclusions Ceftazidime-avibactam is expected to be a cost-effective treatment compared with PMB monotherapy or PMB-based therapy for CRKP BSI from the Chinese healthcare perspective.
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Affiliation(s)
- Wenqiang Kong
- Department of Pharmacy, Zi Gong First People's Hospital, Zi Gong, China
| | - Xueting Yang
- Department of Pharmacy, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kun Ming, China
| | - Yunfeng Shu
- Department of Pharmacy, Zi Gong First People's Hospital, Zi Gong, China
| | - Shiqin Li
- Department of Pharmacy, Zi Gong First People's Hospital, Zi Gong, China
| | - Bihui Song
- Department of Pharmacy, Zi Gong First People's Hospital, Zi Gong, China
| | - Kun Yang
- Department of Hematology, Zigong First People's Hospital, Zigong, China
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Gonzalez FM, Gonzalez FDR. Is the near coming xenotransplantation era relieving us from needing to look for more non-living organ donors? World J Transplant 2022; 12:388-393. [PMID: 36570406 PMCID: PMC9782685 DOI: 10.5500/wjt.v12.i12.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/19/2022] [Accepted: 11/30/2022] [Indexed: 12/16/2022] Open
Abstract
Despite organ transplantation being the most successful treatment for end-stage organ dysfunction, the number of annual solid organ transplantations is much lower than that required to satisfy the demand of patients on waiting lists. The explanation for this phenomenon is the relative scarcity of non-living organ donors due to several factors, such as: (1) Late arrival of patients with a neurocritical condition to an emergency service; (2) lack of detection of those patients as possible organ donors by health professionals dedicated to procurement or by clinicians at emergency and intensive care units, for instance; (3) late transfer of the patient to an intensive care unit to try to recover their health and to provide hemodynamic, ventilatory, and metabolic support; (4) lack of confirmation of the physiological status of the possible donor; (5) late or incorrect positive diagnosis of the subject’s death, either due to brain or cardiac death; (6) difficulty in obtaining legal authorization, either by direct relatives or by the authority, for the extraction of organs; and (7) deficient retrieval surgery of the organs actually donated. The recent reports of relatively successful xenotransplants from genetically modified pigs open the possibility to fix this mismatch between supply and demand, but some technical (organ rejection and opportunistic infections), and economic issues, still remain before accepting a progressive replacement of the organ sources for transplantation. An approximate economic cost analysis suggests that the hypothetical acquisition cost of any genetically modified pig derived organ is high and would not even satisfy the solid organ demand of the wealthiest countries.
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Affiliation(s)
- Fernando M Gonzalez
- Department of Nephrology, Faculty of Medicine, Universidad de Chile, Santiago 7500922, Chile
| | - Francisca del Rocío Gonzalez
- Web Intelligence Centre, Faculty of Physics and Mathematical Sciences, Universidad de Chile, Santiago 8370397, Chile
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