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Song Y, Shim E. Cost-effectiveness of the adjuvanted quadrivalent influenza vaccine for older adults in South Korea. Hum Vaccin Immunother 2024; 20:2348124. [PMID: 38714332 PMCID: PMC11085998 DOI: 10.1080/21645515.2024.2348124] [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: 02/09/2024] [Accepted: 04/23/2024] [Indexed: 05/09/2024] Open
Abstract
South Korea's National Immunization Program administers the quadrivalent influenza vaccine (QIV) to manage seasonal influenza, with a particular focus on the elderly. After reviewing the safety and immune response triggered by the adjuvanted QIV (aQIV) in individuals aged 65 and older, the Ministry of Food and Drug Safety in Korea approved its use. However, the extensive impact of aQIV on public health is yet to be fully understood. This study assessed the cost-effectiveness of replacing QIV with aQIV in South Korean adults aged 65 years and older. A dynamic transmission model, calibrated with national influenza data, was applied to compare the influence of aQIV and QIV on older adults and the broader population throughout a single influenza season. This study considered both the direct and indirect effects of vaccination on the elderly. We derived the incremental cost-effectiveness ratios (ICERs) from quality-adjusted life-years (QALYs) and costs incurred, validated through a probabilistic sensitivity analysis with 5,000 simulations. Findings suggest that transitioning to aQIV from QIV in the elderly would be cost-effective, particularly if aQIV's efficacy reaches or exceeds 56.1%. With an ICER of $29,267/QALY, considerably lower than the $34,998/QALY willingness-to-pay threshold, aQIV presents as a cost-effective option. Thus, implementing aQIV with at least 56.1% efficacy is beneficial from both financial and public health perspectives in mitigating seasonal influenza in South Korea.
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Affiliation(s)
- Youngji Song
- Department of Mathematics, Soongsil University, Seoul, Republic of Korea
| | - Eunha Shim
- Department of Mathematics, Soongsil University, Seoul, Republic of Korea
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Vallabh P, Ha M, Ahern K. Efficacy and Safety of Cisatracurium Compared to Vecuronium for Neuromuscular Blockade in Acute Respiratory Distress Syndrome. J Intensive Care Med 2023; 38:188-195. [PMID: 35821572 DOI: 10.1177/08850666221113504] [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: 01/08/2023]
Abstract
PURPOSE Previous studies analyzing neuromuscular blocking agents (NMBAs) in acute respiratory distress syndrome (ARDS) have evaluated the benefit of cisatracurium with conflicting results, and data evaluating other NMBAs remains limited. The objective of this study was to compare the efficacy and safety of cisatracurium to vecuronium in ARDS. MATERIALS AND METHODS A single-center, retrospective, propensity matched review of patients who received cisatracurium or vecuronium continuous infusions between October 1, 2017 and June 30, 2020 for ARDS was conducted. The primary endpoint was duration of mechanical ventilation. Secondary endpoints included change in PaO2/FiO2 ratio at 48 h, intensive care unit (ICU) and hospital mortality, and ICU and hospital length of stay (LOS). Safety endpoints included newly developed myopathy, presence of bradycardia or hypotension, and newly developed barotrauma or volutrauma. RESULTS Twenty-nine patients were included in each group. There was no statistically significant difference in the primary endpoint of ventilator days between cisatracurium and vecuronium groups (mean 15.9 vs. 20.5 days respectively; p = .2). No statistically significant differences were found in secondary endpoints of ICU mortality (51.7% vs. 51.7%) or length of stay (18.7 vs. 23.9 days, p = .19), hospital mortality (51.7% vs. 55.2%, p = .79) or length of stay (22 vs. 30.6 days, p = .08), or mean change in PaO2/FiO2 (29.8 vs. 36.6; p = .74). Statistically significant differences were not observed in safety endpoints of myopathy (37.9% vs. 37.9%), barotrauma or volutrauma (13.8% vs. 3.5%; p = .16), bradycardia (31% vs. 13.8%; p = .12), or hypotension (96.6% vs. 82.8%; p = .08). CONCLUSIONS No significant differences were seen in efficacy or safety endpoints between cisatracurium or vecuronium groups, suggesting that vecuronium may be a safe alternative agent for neuromuscular blockade in ARDS. Results of this analysis warrant confirmation in a larger, randomized study.
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Affiliation(s)
- Priya Vallabh
- Department of Pharmacy, 41528UMass Memorial Medical Center, Worcester, MA, USA
| | - Michael Ha
- Department of Pharmacy, 41528UMass Memorial Medical Center, Worcester, MA, USA
| | - Krystina Ahern
- Department of Pharmacy, 41528UMass Memorial Medical Center, Worcester, MA, USA
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Robinson LA, Eber MR, Hammitt JK. Valuing COVID-19 Morbidity Risk Reductions. JOURNAL OF BENEFIT-COST ANALYSIS 2022; 13:247-268. [PMID: 36090595 PMCID: PMC9455599 DOI: 10.1017/bca.2022.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Many economic analyses, including those that address the COVID-19 pandemic, focus on the value of averting deaths and do not include the value of averting nonfatal illnesses. Yet incorporating the value of averting nonfatal cases may change conclusions about the desirability of the policy. While per case values may be small, the number of nonfatal cases is often large, far outstripping the number of fatal cases. The value of averting nonfatal cases is also increasingly important in evaluating COVID-19 policy options as vaccine- and infection-related immunity and treatments reduce the case-fatality rate. Unfortunately, little valuation research is available that explicitly addresses COVID-19 morbidity. We describe and implement an approach for approximating the value of averting nonfatal illnesses or injuries and apply it to COVID-19 in the United States. We estimate gains from averting COVID-19 morbidity of about 0.01 quality-adjusted life year (QALY) per mild case averted, 0.02 QALY per severe case, and 3.15 QALYs per critical case. These gains translate into monetary values of about $5,300 per mild case, $11,000 per severe case, and $1.8 million per critical case. While these estimates are imprecise, they suggest the magnitude of the effects.
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Affiliation(s)
| | - Michael R. Eber
- Harvard T.H. Chan School of Public Health and Harvard Graduate School of Arts and Sciences
| | - James K. Hammitt
- Harvard T.H. Chan School of Public Health and Toulouse School of Economics, Université de Toulouse Capitole
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Cost-utility analysis of antiviral use under pandemic influenza using a novel approach - linking pharmacology, epidemiology and heath economics. Epidemiol Infect 2018; 146:496-507. [PMID: 29446343 DOI: 10.1017/s0950268818000158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Simulation models are used widely in pharmacology, epidemiology and health economics (HEs). However, there have been no attempts to incorporate models from these disciplines into a single integrated model. Accordingly, we explored this linkage to evaluate the epidemiological and economic impact of oseltamivir dose optimisation in supporting pandemic influenza planning in the USA. An HE decision analytic model was linked to a pharmacokinetic/pharmacodynamics (PK/PD) - dynamic transmission model simulating the impact of pandemic influenza with low virulence and low transmissibility and, high virulence and high transmissibility. The cost-utility analysis was from the payer and societal perspectives, comparing oseltamivir 75 and 150 mg twice daily (BID) to no treatment over a 1-year time horizon. Model parameters were derived from published studies. Outcomes were measured as cost per quality-adjusted life year (QALY) gained. Sensitivity analyses were performed to examine the integrated model's robustness. Under both pandemic scenarios, compared to no treatment, the use of oseltamivir 75 or 150 mg BID led to a significant reduction of influenza episodes and influenza-related deaths, translating to substantial savings of QALYs. Overall drug costs were offset by the reduction of both direct and indirect costs, making these two interventions cost-saving from both perspectives. The results were sensitive to the proportion of inpatient presentation at the emergency visit and patients' quality of life. Integrating PK/PD-EPI/HE models is achievable. Whilst further refinement of this novel linkage model to more closely mimic the reality is needed, the current study has generated useful insights to support influenza pandemic planning.
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Lazo-Langner A, Rodger MA, Barrowman NJ, Ramsay T, Wells PS, Coyle DA. Comparing multiple competing interventions in the absence of randomized trials using clinical risk-benefit analysis. BMC Med Res Methodol 2012; 12:3. [PMID: 22233221 PMCID: PMC3292458 DOI: 10.1186/1471-2288-12-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 01/10/2012] [Indexed: 12/04/2022] Open
Abstract
Background To demonstrate the use of risk-benefit analysis for comparing multiple competing interventions in the absence of randomized trials, we applied this approach to the evaluation of five anticoagulants to prevent thrombosis in patients undergoing orthopedic surgery. Methods Using a cost-effectiveness approach from a clinical perspective (i.e. risk benefit analysis) we compared thromboprophylaxis with warfarin, low molecular weight heparin, unfractionated heparin, fondaparinux or ximelagatran in patients undergoing major orthopedic surgery, with sub-analyses according to surgery type. Proportions and variances of events defining risk (major bleeding) and benefit (thrombosis averted) were obtained through a meta-analysis and used to define beta distributions. Monte Carlo simulations were conducted and used to calculate incremental risks, benefits, and risk-benefit ratios. Finally, net clinical benefit was calculated for all replications across a range of risk-benefit acceptability thresholds, with a reference range obtained by estimating the case fatality rate - ratio of thrombosis to bleeding. Results The analysis showed that compared to placebo ximelagatran was superior to other options but final results were influenced by type of surgery, since ximelagatran was superior in total knee replacement but not in total hip replacement. Conclusions Using simulation and economic techniques we demonstrate a method that allows comparing multiple competing interventions in the absence of randomized trials with multiple arms by determining the option with the best risk-benefit profile. It can be helpful in clinical decision making since it incorporates risk, benefit, and personal risk acceptance.
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Chan ALF, Leung HWC, Huang SF. Cost effectiveness of cetuximab concurrent with radiotherapy for patients with locally advanced head and neck cancer in Taiwan: a decision-tree analysis. Clin Drug Investig 2012; 31:717-26. [PMID: 21744880 DOI: 10.2165/11588980-000000000-00000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Concomitant chemotherapy with radiotherapy is considered to be the standard of care for patients with head and neck cancer and good performance status. However, published reports on the cost effectiveness of this therapeutic approach are extremely rare. OBJECTIVE The aim of this study was to estimate the cost effectiveness of cetuximab combined with radiotherapy compared with radiotherapy alone in patients with locally advanced squamous cell carcinoma of the head and neck. METHODS A decision-tree analysis was used to compare cetuximab combined with radiotherapy and radiotherapy alone in the treatment of patients with locally advanced squamous cell carcinoma of the head and neck from the perspective of the national health payer (the Bureau of National Health Insurance [BNHI]) in Taiwan. The model was based on individual patient data extracted from an international phase III trial. The direct medical costs of care were estimated by clinical expert panels based on the reimbursement price of the BNHI (2007 values). One-way sensitivity analyses were performed while varying the costs and clinical parameters. RESULTS The incremental cost per quality-adjusted life-year (QALY) for patients receiving radiotherapy in combination with cetuximab compared with radiotherapy alone was $US36 992/QALY in the base-case analysis (2007 values). The sensitivity analysis showed the highest net benefit for radiotherapy alone if the cost of cetuximab increased by 50%. CONCLUSION This study demonstrated that the addition of cetuximab to high-dose radiotherapy regimens is likely to be cost effective in Taiwan because the incremental cost per QALY is below the commonly accepted cost-effectiveness threshold.
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Affiliation(s)
- Agnes L F Chan
- Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan
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Merchant RM, Becker LB, Abella BS, Asch DA, Groeneveld PW. Cost-Effectiveness of Therapeutic Hypothermia After Cardiac Arrest. Circ Cardiovasc Qual Outcomes 2009; 2:421-8. [DOI: 10.1161/circoutcomes.108.839605] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Raina M. Merchant
- From the Robert Wood Johnson Foundation Clinical Scholars program (R.M.M.), the Center for Resuscitation Science and Department of Emergency Medicine (R.M.M., L.B.B., B.S.A.), and the Leonard Davis Institute of Health Economics (R.M.M., D.A.A., P.V.G.), University of Pennsylvania, Philadelphia, Pa; and the Philadelphia Veterans Affairs Medical Center (D.A.A., P.W.G.), Philadelphia, Pa
| | - Lance B. Becker
- From the Robert Wood Johnson Foundation Clinical Scholars program (R.M.M.), the Center for Resuscitation Science and Department of Emergency Medicine (R.M.M., L.B.B., B.S.A.), and the Leonard Davis Institute of Health Economics (R.M.M., D.A.A., P.V.G.), University of Pennsylvania, Philadelphia, Pa; and the Philadelphia Veterans Affairs Medical Center (D.A.A., P.W.G.), Philadelphia, Pa
| | - Benjamin S. Abella
- From the Robert Wood Johnson Foundation Clinical Scholars program (R.M.M.), the Center for Resuscitation Science and Department of Emergency Medicine (R.M.M., L.B.B., B.S.A.), and the Leonard Davis Institute of Health Economics (R.M.M., D.A.A., P.V.G.), University of Pennsylvania, Philadelphia, Pa; and the Philadelphia Veterans Affairs Medical Center (D.A.A., P.W.G.), Philadelphia, Pa
| | - David A. Asch
- From the Robert Wood Johnson Foundation Clinical Scholars program (R.M.M.), the Center for Resuscitation Science and Department of Emergency Medicine (R.M.M., L.B.B., B.S.A.), and the Leonard Davis Institute of Health Economics (R.M.M., D.A.A., P.V.G.), University of Pennsylvania, Philadelphia, Pa; and the Philadelphia Veterans Affairs Medical Center (D.A.A., P.W.G.), Philadelphia, Pa
| | - Peter W. Groeneveld
- From the Robert Wood Johnson Foundation Clinical Scholars program (R.M.M.), the Center for Resuscitation Science and Department of Emergency Medicine (R.M.M., L.B.B., B.S.A.), and the Leonard Davis Institute of Health Economics (R.M.M., D.A.A., P.V.G.), University of Pennsylvania, Philadelphia, Pa; and the Philadelphia Veterans Affairs Medical Center (D.A.A., P.W.G.), Philadelphia, Pa
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Ortiz-Gómez JR, Fabregat-López J. [On extubation, residual curarization, and their circumstances]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:335-338. [PMID: 19725339 DOI: 10.1016/s0034-9356(09)70404-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Nagy PG, Konewko R, Warnock M, Bernstein W, Seagull J, Yan Xiao, George I, Park A. Novel, Web-Based, Information-Exploration Approach for Improving Operating Room Logistics and System Processes. Surg Innov 2008; 15:7-16. [DOI: 10.1177/1553350608316573] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Routine clinical information systems now have the ability to gather large amounts of data that surgical managers can access to create a seamless and proactive approach to streamlining operations and minimizing delays. The challenge lies in aggregating and displaying these data in an easily accessible format that provides useful, timely information on current operations. A Web-based, graphical dashboard is described in this study, which can be used to interpret clinical operational data, allow managers to see trends in data, and help identify inefficiencies that were not apparent with more traditional, paper-based approaches. The dashboard provides a visual decision support tool that assists managers in pinpointing areas for continuous quality improvement. The limitations of paper-based techniques, the development of the automated display system, and key performance indicators in analyzing aggregate delays, time, specialties, and teamwork are reviewed. Strengths, weaknesses, opportunities, and threats associated with implementing such a program in the perioperative environment are summarized.
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Affiliation(s)
- Paul G. Nagy
- Department of Diagnostic Imaging, University of Maryland School of Medicine,
| | - Ramon Konewko
- Department of Surgery University of Maryland Medical Center, Baltimore, Maryland
| | - Max Warnock
- Department of Diagnostic Imaging, University of Maryland School of Medicine
| | - Wendy Bernstein
- Deopartment of Anesthesia, University of Maryland Medical Center
| | - Jacob Seagull
- Department of Surgery University of Maryland School of Medicine
| | - Yan Xiao
- Deopartment of Anesthesia, University of Maryland Medical Center
| | - Ivan George
- Department of Surgery University of Maryland School of Medicine
| | - Adrian Park
- Department of Surgery University of Maryland School of Medicine
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Dino G, Horn K, Abdulkadri A, Kalsekar I, Branstetter S. Cost-Effectiveness Analysis of the Not On Tobacco Program for Adolescent Smoking Cessation. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2008; 9:38-46. [DOI: 10.1007/s11121-008-0082-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Accepted: 01/08/2008] [Indexed: 11/30/2022]
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