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Ross A, Kim J, McKay M, Pappas E, Hardaker N, Whalan M, Peek K. The economics of a national anterior cruciate ligament injury prevention program for amateur football players: a Markov model analysis. Med J Aust 2024; 221:149-155. [PMID: 38992929 DOI: 10.5694/mja2.52385] [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: 10/04/2023] [Accepted: 01/15/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES To estimate the long term cost savings, return on investment, and gain in quality-adjusted life years (QALYs) that could be achieved by a national anterior cruciate ligament (ACL) injury prevention program for amateur football (soccer) players in Australia. STUDY DESIGN Markov model decision analysis. SETTING, PARTICIPANTS Two hypothetical scenarios including all amateur football players in Australia (340 253 players): no intervention, and a national ACL injury prevention program. Transitions between health states, including ACL rupture, meniscal injury, knee osteoarthritis, and total knee replacement were made in one-year cycles over 35 years from a societal perspective. MAIN OUTCOME MEASURES Cost savings, return on investment, and QALY gain achieved in the prevention program scenario relative to control scenario, by age group (10-17, 18-34, 35 years or older) and gender. SECONDARY OUTCOMES incidence of ACL rupture, knee osteoarthritis, total knee replacement, and total knee replacement revision. RESULTS The total mean cost of an ACL injury was estimated to be $30 665. The national injury prevention program was projected to save $52 539 751 in medical and societal costs caused by ACL ruptures in amateur footballers over 35 years; the estimated return on each dollar invested in the program was $3.51. Over this period, the number of players with ruptured ACLs could be reduced by 4385 (9%), the number of knee osteoarthritis cases by 780 (8.1%), and the number of total knee replacements by 121 (8.1%); 445 QALYs were gained. CONCLUSION Our findings support investing in a national, evidence-based program for the primary prevention of ACL injuries in amateur football players.
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Affiliation(s)
- Andrew Ross
- The University of Sydney, Sydney, NSW
- Victoria University, Melbourne, VIC
| | - Joosup Kim
- Southern Clinical School, Monash University, Melbourne, VIC
| | - Marnee McKay
- Sydney School of Health Sciences, University of Sydney, Sydney, NSW
| | - Evangelos Pappas
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW
| | - Natalie Hardaker
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
- Accident Compensation Corporation, Wellington, New Zealand
| | - Matt Whalan
- Centre of Medical and Exercise Physiology, University of Wollongong, Wollongong, NSW
- Football Australia, Sydney, NSW
| | - Kerry Peek
- Sydney School of Health Sciences, University of Sydney, Sydney, NSW
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Song Y, Choi W, Shim E. Cost-Effectiveness of Human Papillomavirus Vaccination in the UK: Two Versus Single-Dose of Nonavalent HPV Vaccination. Am J Prev Med 2024; 67:231-240. [PMID: 38508425 DOI: 10.1016/j.amepre.2024.03.008] [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] [Received: 11/21/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION The UK implemented a single-dose HPV vaccination policy in September 2023, aiming for sustained protection, better vaccine coverage, and reduced healthcare costs. This research assesses the cost-effectiveness of both one-dose and two-dose schedules from a healthcare perspective. METHODS Using an age-structured dynamic model, the study analyzed long-term health and economic outcomes of these two different vaccination approaches. It focused on the effects of vaccinating 12- to 13-year-olds with the 9-valent HPV vaccine in either single-dose or two-dose regimens from 2023 to 2093. The analysis, conducted in 2023-2024, explored different immunity durations (10, 30 years, or lifetime) and efficacy levels for the single-dose strategy. RESULTS The study indicated that in the UK, vaccinating 12- to 13-year-olds with a two-dose regimen is not considered cost-effective compared to the single-dose option, assumed to be 90% as effective for 10 years. The incremental cost-effectiveness ratios for two doses ranged from £230,903 to £1,082,916 per quality-adjusted life year (QALY), significantly exceeding the UK's £20,000/QALY willingness-to-pay threshold. Over 70 years, a switch from a two-dose to a single-dose vaccination schedule could potentially lead to savings of over £1,073 million in the healthcare system. Furthermore, the single-dose regimen was cost-effective compared to no vaccination, with an incremental cost-effectiveness ratio below £2,040/QALY. CONCLUSIONS The study affirms the cost-effectiveness of the UK's single-dose HPV vaccine, in sync with its September 2023 policy shift. The shift not only provides financial benefits but also simplifies vaccine administration, strategically reducing HPV's epidemiological and economic impacts.
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Affiliation(s)
- Youngji Song
- Department of Mathematics, Soongsil University, Seoul, Republic of Korea
| | - Wongyeong Choi
- Department of Mathematics, Soongsil University, Seoul, Republic of Korea
| | - Eunha Shim
- Department of Mathematics, Soongsil University, Seoul, Republic of Korea.
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Gannon B, Franklin D, Vo V, Babl FE, Schibler A. Cost-effectiveness of nasal high-flow in children with acute hypoxaemic respiratory failure. J Paediatr Child Health 2024; 60:229-239. [PMID: 38757897 DOI: 10.1111/jpc.16558] [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: 02/13/2023] [Revised: 01/31/2024] [Accepted: 04/21/2024] [Indexed: 05/18/2024]
Abstract
AIM A pilot randomised controlled trial assessed the early application of nasal high-flow (NHF) therapy compared with standard oxygen therapy (SOT), in children aged 0 to 16 years presenting to paediatric emergency departments with acute hypoxaemic respiratory failure (AHRF). The study estimated the need to escalate therapy and hospital length of stay in the NHF group compared with SOT. This sub-study then assessed the subsequent cost-effectiveness. METHODS A decision tree-based model was developed, alongside the clinical study, to estimate cost-effectiveness, from the healthcare sector perspective. The primary health economics outcome is measured as incremental cost per length of hospital stay avoided. Incremental cost effectiveness ratios (ICER) measuring change in cost per change in length of stay, were obtained for four samples, depending on responder status and obstructive airways disease. These were (1) obstructive and responder, (2) non-obstructive and responder, (3) obstructive and non-responder and (4) non obstructive and non-responder. Bootstrapping of parameters accounted for uncertainty in estimates of cost and outcome. RESULTS The ICER for patients randomised to NHF, indicated an additional A$367.20 for a lower hospital length of stay (in days) in the non-obstructive/non-responder sample. In the bootstrap sample, this was found to be cost effective above a willingness to pay threshold of A$10 000. The ICER was A$440.86 in the obstructive/responder sample and A$469.56 in the non-obstructive/responder sample - but both resulted in a longer length of stay. The ICER in the obstructive/non-responder sample was A$52 167.76, also with a longer length of stay, mainly impacted by a small sample of severe cases. CONCLUSION As first-line treatment, NHF is unlikely to be cost-effective compared with SOT, but for non-obstructive patients who required escalation in care (non-obstructive non-responder), NHF is likely to be cost-effective if willingness-to-pay per reduced hospital length of stay is more than A$10 000 per patient.
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Affiliation(s)
- Brenda Gannon
- School of Economics, University of Queensland, Brisbane, Queensland, Australia
- University of Queensland Centre for the Business and Economics of Health, Brisbane, Queensland, Australia
| | - Donna Franklin
- Children's Emergency and Critical Care Research, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia
| | - Vinh Vo
- School of Economics, University of Queensland, Brisbane, Queensland, Australia
| | - Franz E Babl
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Andreas Schibler
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia
- St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia
- Critical Care Research Group, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia
- Wesley Medical Research, Brisbane, Queensland, Australia
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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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Jais S, Oe M, Sanada H, Sasongko A, Haryanto H. Evaluating the cost-effectiveness of diabetic foot ulcer management by wound care specialists in Indonesia. Wound Repair Regen 2024; 32:80-89. [PMID: 38149767 DOI: 10.1111/wrr.13147] [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: 08/12/2023] [Revised: 11/24/2023] [Accepted: 12/12/2023] [Indexed: 12/28/2023]
Abstract
Diabetic foot ulcers affect quality of life and economically burden patients and the Indonesian healthcare system. The comparative cost-effectiveness of wound care specialists in private practices (e.g., wound clinics) and wound care nurses in national hospitals remains unknown. Thus, we used a decision tree to compare the cost and healing rates for patients after 12 weeks of wound care. Uncertainty was addressed using one-way and probabilistic sensitivity analyses. Among 89 participants (42 in the national hospital and 47 in the private practice), no significant differences were observed between the two groups in terms of sex, age, education level, smoking status, duration of diabetes, Wagner wound classification, glycated haemoglobin levels, neuropathy status, ankle-brachial index, baseline characteristics, quality of life, DMIST (depth, maceration, inflammation/infection, size, tissue type of the wound bed, type of wound edge, and tunnelling/undermining) score and wound location (p > 0.05). However, significant differences were observed for days from first visit/assessment until complete healing, mean quality of life (p ≤ 0.001) and wound size (p = 0.047). Wound care specialists in private practices had a significantly lower cost of 2,804,423.3 Indonesian rupiah compared to 6,483,493.4 Indonesian rupiah for wound care nurses in national hospitals. The incremental cost-effectiveness ratio was -165,723.9. Therefore, wound care specialists in private practices are more cost-effective for managing diabetic foot ulcers. Probability sensitivity analysis confirmed that 80%-90% of the scenarios were cost-effective. These findings may inform healthcare resource allocation in Indonesia. Additionally, evidence-based cost-effectiveness measures were strengthened in private practices and national hospitals.
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Affiliation(s)
- Suriadi Jais
- Graduate Nursing Program, Institut Teknologi dan Kesehatan Muhammadiyah Kalbar, Pontianak, Kalimantan Barat, Indonesia
| | - Makoto Oe
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiromi Sanada
- Ishikawa Prefectural Nursing University, Kahoku-gun, Ishikawa, Japan
| | - Agung Sasongko
- Program Studi Manajemen Informatika, Universitas Bina Sarana Informatika, Pontianak, Indonesia
| | - Haryanto Haryanto
- Graduate Nursing Program, Institut Teknologi dan Kesehatan Muhammadiyah Kalbar, Pontianak, Kalimantan Barat, Indonesia
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Kindred M, Shabrina Z, Zakiyah N. Exploratory Approach to Incorporating Carbon Footprint in Health Technology Assessment (HTA) Modelling: Cost-Effectiveness Analysis of Health Interventions in the United Kingdom. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:49-60. [PMID: 37948035 PMCID: PMC10761369 DOI: 10.1007/s40258-023-00839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Health interventions contribute to the production of greenhouse gas emissions. Thus, reducing carbon footprint is essential in supporting the UK National Health Service (NHS) pathway to net zero. This study explores the approach in which carbon footprint can be included when applying Health Technology Assessment (HTA) modelling using obesity intervention in the United Kingdom (UK) as a case study. METHODS Using decision analytic modelling, we conducted an HTA incorporating the impacts of obesity-related treatment decisions on UK carbon emissions. A cohort Markov model was used to track the emissions of the UK population after receiving one of two obesity treatments: semaglutide and bariatric surgery. RESULTS This study introduced two new carbon measurement tools that may be useful for future policymaking, incremental carbon footprint effectiveness ratio (ICFER) and incremental carbon footprint cost ratio (ICFCR), which made it possible to assess the emission impacts of proposed health policies. Using the obesity intervention case study, we found that both treatments have an incremental cost-effectiveness ratio (ICER) of < £20,000 per quality-adjusted life-years (QALYs) gained. This is below the UK threshold, indicating that these are cost-effective treatments for obesity, but could increase the NHS carbon footprint. However, it could reduce the overall UK societal carbon footprint by reducing the number of people with obesity. The ICFCR shows a reduction of 1.13-4.51 kgCO2e (kilogram of carbon dioxide equivalent) for every pound spent on obesity treatment. CONCLUSION This study illustrates a case study for estimating the effect of health policies on carbon emissions and provides a quantitative measure for obesity-related treatment decisions.
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Affiliation(s)
- Max Kindred
- Department of Geography, King's College London, London, UK
| | - Zahratu Shabrina
- Department of Geography, King's College London, London, UK.
- Regional Innovation, Graduate School, Universitas Padjadjaran, Bandung, West Java, Indonesia.
| | - Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, West Java, Indonesia
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Bojic S, Ladjevic N, Palibrk I, Soldatovic I, Likic-Ladjevic I, Meissner W, Zaslansky R, Stamer UM, Baumbach P, Stamenkovic D. Cost-effectiveness of the Perioperative Pain Management Bundle a registry-based study. Front Public Health 2023; 11:1157484. [PMID: 37744520 PMCID: PMC10513912 DOI: 10.3389/fpubh.2023.1157484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction The Perioperative Pain Management Bundle was introduced in 10 Serbian PAIN OUT network hospitals to improve the quality of postoperative pain management. The Bundle consists of 4 elements: informing patients about postoperative pain treatment options; administering a full daily dose of 1-2 non-opioid analgesics; administering regional blocks and/or surgical wound infiltration; and assessing pain after surgery. In this study, we aimed to assess the cost-effectiveness of the Bundle during the initial 24 h after surgery. Materials and methods The assessment of cost-effectiveness was carried out by comparing patients before and after Bundle implementation and by comparing patients who received all Bundle elements to those with no Bundle element. Costs of postoperative pain management included costs of the analgesic medications, costs of labor for administering these medications, and related disposable materials. A multidimensional Pain Composite Score (PCS), the effectiveness measurement, was obtained by averaging variables from the International Pain Outcomes questionnaire evaluating pain intensity, interference of pain with activities and emotions, and side effects of analgesic medications. The incremental cost-effectiveness ratio (ICER) was calculated as the incremental change in costs divided by the incremental change in PCS and plotted on the cost-effectiveness plane along with the economic preference analysis. Results The ICER value calculated when comparing patients before and after Bundle implementation was 181.89 RSD (1.55 EUR) with plotted ICERs located in the northeast and southeast quadrants of the cost-effectiveness plane. However, when comparing patients with no Bundle elements and those with all four Bundle elements, the calculated ICER was -800.63 RSD (-6.82 EUR) with plotted ICERs located in the southeast quadrant of the cost-effectiveness plane. ICER values differ across surgical disciplines. Conclusion The proposed perioperative pain management Bundle is cost-effective. The cost-effectiveness varies depending on the number of implemented Bundle elements and fluctuates across surgical disciplines.
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Affiliation(s)
- Suzana Bojic
- Department of Anesthesiology and Intensive Care, University Hospital Medical Centre “Dr. Dragisa Misovic – Dedinje”, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nebojsa Ladjevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Centre of Anaesthesia and Resuscitation University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ivan Palibrk
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Centre of Anaesthesia and Resuscitation University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ivan Soldatovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Likic-Ladjevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Winfried Meissner
- Department of Anesthesiology and Intensive Care, University Hospital Jena, Jena, Germany
| | - Ruth Zaslansky
- Department of Anesthesiology and Intensive Care, University Hospital Jena, Jena, Germany
| | - Ulrike M Stamer
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Baumbach
- Department of Anesthesiology and Intensive Care, University Hospital Jena, Jena, Germany
| | - Dusica Stamenkovic
- Medical Faculty of Military Medical Academy, University of Defense, Belgrade, Serbia
- Department of Anesthesiology and Intensive Care, Military Medical Academy, Belgrade, Serbia
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Duruflé A, Le Meur C, Piette P, Fraudet B, Leblong E, Gallien P. Cost effectiveness of a telerehabilitation intervention vs home based care for adults with severe neurologic disability: A randomized clinical trial. Digit Health 2023; 9:20552076231191001. [PMID: 37545632 PMCID: PMC10403989 DOI: 10.1177/20552076231191001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023] Open
Abstract
Context Several options are available for the care of neurological conditions including care delivered in rehabilitation centres, at home or remotely. While economic studies are available comparing centres and homes, very little economic data relates to mobile teams comparing face-to-face and remote care. Objective To conduct an economic study comparing face-to-face care at home and care delivered remotely (tele-rehabilitation). Method A randomised clinical study with two groups; a control group receiving home care and an experimental group receiving tele-rehabilitation. The primary outcome measure was the ICER (Incremental Cost Effectiveness Ratio). Participants Patients with severe neurological disabilities. Results 80 patients were enrolled in the study; 77 were analysed to calculate the ICER, which was positive and located in the SW quadrant. A bootstrap with 1000 replications was positioned at 72.8% in the SW quadrant. Conclusion Tele-rehabilitation is an acceptable alternative to the management of neurological patients at home. In the mildest cases, remote-rehabilitation may even be dominant. More extensive studies are needed to specify the indications.
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Affiliation(s)
| | - Claire Le Meur
- Rehabilitation Center, Pôle Saint Helier, Rennes, France
| | - Patrice Piette
- Rehabilitation Center, Pôle Saint Helier, Rennes, France
| | | | - Emilie Leblong
- Rehabilitation Center, Pôle Saint Helier, Rennes, France
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De Rubeis G, Fabiano S, Bertaccini L, Wlderk A, Pezzella FR, Anticoli S, Saba L, Gasperini C, Pampana E. Is Mechanical Thrombectomy or Thrombolysis Universally Cost-Effective? A Systematic Review of the Literature. World Neurosurg 2023; 169:e29-e39. [PMID: 36202340 DOI: 10.1016/j.wneu.2022.09.127] [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: 07/25/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Thrombolysis (rTPA) and mechanical thrombectomy (MT) are cost-effective treatments for ischemic stroke. However, little is known about the impact of different types of health systems (HSs) on the outcome and cost of ischemic stroke. METHODS Literature search was performed on PubMed/OVID for studies without time limits. The year of publication, type of HS, cost of intervention treatment (rTPA/MT), cost of control strategy (conservative treatment or rTPA), quality-adjusted life years (QALYs) gained, and percentage of gross domestic product spent on health were recorded. The inclusion criteria were English literature, cost-effectiveness, and cost-utility analyses. The exclusion criterion was the absence of geographic coherence between the derived QALYs and the costs. The costs were inflated to 2021 and then converted to US dollar/euro. An analysis of variance or Kruskal-Wallis test was used to compare the percentage of cost reduction and the QALYs gained. Gross domestic product percentage was correlated with the QALYs gained. RESULTS Thirty-five studies were analyzed. No significant differences in the percentage of cost reduction were found among the different types of HS (Beveridge -14.74% [95% confidence interval {CI} -57.94/53.08] vs. Bismarck -2.27% [95% CI -122.73/118.18] vs. national insurance -0.015% [95% CI -16.96/51.00] vs. private insurance -4.05% [95% CI -32.62/13.18]). No differences were found in QALYs gained among the different HS (Beveridge 1021 [95% CI -36.37/1705.04] vs. Bismarck 440 [95% CI -2290.68/3870.68] vs. national insurance 643 [95% CI -137.54/2366.21] vs. private insurance 550 [95% CI 131.54/1128.06]). No differences were found among the QALYs gained between rTPA/conservative treatment versus rTPA/MT and rtPA + MT/MT. The percentage of gross domestic product spent on health did not correlate with the QALYs gained (rho = -0.16; P = 0.56). CONCLUSIONS MT and rTPA are independently cost-effective among different HS.
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Affiliation(s)
- Gianluca De Rubeis
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy.
| | - Sebastiano Fabiano
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Luca Bertaccini
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Andrea Wlderk
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Sabrina Anticoli
- Emergency Department, UOSD Stroke Unit, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Luca Saba
- Department of Medical Imaging, Azienda Ospedaliero Universitaria (A.O.U.) of Cagliari-Polo di Monserrato, Cagliari, Italy
| | - Claudio Gasperini
- Department of Neuroscience, UOC Neurology, S Camillo Forlanini Hospital, Rome, Italy
| | - Enrico Pampana
- Department of Diagnostic, UOC of Diagnostic and Interventional Neuroradiology, San Camillo-Forlanini Hospital, Rome, Italy
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10
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de Vos J, Visser LA, de Beer AA, Fornasa M, Thoral PJ, Elbers PWG, Cinà G. The Potential Cost-Effectiveness of a Machine Learning Tool That Can Prevent Untimely Intensive Care Unit Discharge. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:359-367. [PMID: 35227446 DOI: 10.1016/j.jval.2021.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/06/2021] [Accepted: 06/29/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The machine learning prediction model Pacmed Critical (PC), currently under development, may guide intensivists in their decision-making process on the most appropriate time to discharge a patient from the intensive care unit (ICU). Given the financial pressure on healthcare budgets, this study assessed whether PC has the potential to be cost-effective compared with standard care, without the use of PC, for Dutch patients in the ICU from a societal perspective. METHODS A 1-year, 7-state Markov model reflecting the ICU care pathway and incorporating the PC decision tool was developed. A hypothetical cohort of 1000 adult Dutch patients admitted in the ICU was entered in the model. We used the literature, expert opinion, and data from Amsterdam University Medical Center for model parameters. The uncertainty surrounding the incremental cost-effectiveness ratio was assessed using deterministic and probabilistic sensitivity analyses and scenario analyses. RESULTS PC was a cost-effective strategy with an incremental cost-effectiveness ratio of €18 507 per quality-adjusted life-year. PC remained cost-effective over standard care in multiple scenarios and sensitivity analyses. The likelihood that PC will be cost-effective was 71% at a willingness-to-pay threshold of €30 000 per quality-adjusted life-year. The key driver of the results was the parameter "reduction in ICU length of stay." CONCLUSIONS We showed that PC has the potential to be cost-effective for Dutch ICUs in a time horizon of 1 year. This study is one of the first cost-effectiveness analyses of a machine learning device. Further research is needed to validate the effectiveness of PC, thereby focusing on the key parameter "reduction in ICU length of stay" and potential spill-over effects.
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Affiliation(s)
- Juliette de Vos
- Pacmed B.V., Amsterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Laurenske A Visser
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | | | - Patrick J Thoral
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paul W G Elbers
- Department of Intensive Care Medicine, Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Sandmann F, Ramsay M, Edmunds WJ, Choi YH, Jit M. How to Prevent Vaccines Falling Victim to Their Own Success: Intertemporal Dependency of Incidence Levels on Indirect Effects in Economic Reevaluations. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1391-1399. [PMID: 34593161 PMCID: PMC9525135 DOI: 10.1016/j.jval.2021.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Incremental cost-effectiveness analyses may inform the optimal choice of healthcare interventions. Nevertheless, for many vaccines, benefits fluctuate with incidence levels over time. Reevaluating a vaccine after it has successfully decreased incidences may eventually cause a disease resurgence if switching to a vaccine with lower indirect benefits. Decisions may successively alternate between vaccines alongside repeated rises and falls in incidence and when indirect effects from historic use are ignored. Our suggested proposal aims to prevent suboptimal decision making. METHODS We used a conceptual model of demand to illustrate alternating decisions between vaccines because of time-varying levels of indirect effects. Similar to the concept of subsidies, we propose internalizing the indirect effects achievable with vaccines. In a case study over 60 years, we simulated a hypothetical 10-year reevaluation of 2 oncogenic human papillomavirus vaccines, of which only 1 protects additionally against anogenital warts. RESULTS Our case study showed that the vaccine with additional warts protection is initially valued higher than the vaccine without additional warts protection. After 10 years, this differential decreases because of declines in warts incidence, which supports switching to the nonwarts vaccine that causes a warts resurgence eventually. Instead, pricing the indirect effects separately supports continuing with the warts vaccine. CONCLUSIONS Ignoring how the observed incidences depend on the indirect effects achieved with a particular vaccine may lead to repeated changes in vaccines at successive reevaluations, with unintended resurgences, economic inefficiencies, and eroding vaccine confidence. We propose internalizing indirect effects to prevent vaccines falling victim to their own success.
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Affiliation(s)
- Frank Sandmann
- Statistics, Modelling, and Economics Department, National Infection Service, Public Health England, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Mary Ramsay
- Immunisation and Countermeasures Department, National Infection Service, Public Health England, London, UK
| | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Yoon H Choi
- Statistics, Modelling, and Economics Department, National Infection Service, Public Health England, London, UK
| | - Mark Jit
- Statistics, Modelling, and Economics Department, National Infection Service, Public Health England, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; School of Public Health, University of Hong Kong, Hong Kong SAR, China
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12
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Sandmann F, Jit M, Andrews N, Buckley HL, Campbell H, Ribeiro S, Sile B, Stowe J, Tessier E, Ramsay M, Amirthalingam G, Choi YH. Evaluating the impact of a continued maternal pertussis immunisation programme in England: A modelling study and cost-effectiveness analysis. Vaccine 2021; 39:4500-4509. [PMID: 34183204 DOI: 10.1016/j.vaccine.2021.06.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION An unexpected resurgence of pertussis cases and infant deaths was observed in some countries that had switched to acellular pertussis vaccines in the primary immunisation schedule. In response to the outbreaks, maternal pertussis vaccination programmes in pregnant women have been adopted worldwide, including the USA in 2011 and the UK in 2012. Following the success of the programme in England, we evaluated the health and economic impact of stopping versus continuing the maternal pertussis immunisation to inform public health policy making. METHODS We used a mathematical model to estimate the number of infant hospitalisations and deaths related to pertussis in England over 2019-2038. Losses in quality-adjusted life years, QALYs, were considered for infants (aged 0-2 months) who survived or died from pertussis, bereaved parents (of infants who died from pertussis), and women with pertussis (aged 20-44 years). Direct medical costs to the National Health Service included infant hospitalisations, maternal vaccinations, and disease in women. Costs and QALYs were discounted at 3.5%. Changes in the incremental cost-effectiveness ratio, ICER, were explored in sensitivity analyses. RESULTS The model supports continuing the maternal pertussis immunisation programme as a cost-effective intervention at an ICER of £14,500/QALY (2.5% and 97.5%-quantile: £7,300/QALY to £32,400/QALY). Stopping versus continuing the maternal programme results in an estimated mean of 972 (range 582 to 1489) versus 308 (184 to 471) infant hospitalisations annually. Results were most sensitive to the number of hospitalisations and deaths when stopping the maternal programme. At a cost-effectiveness threshold of £30,000/QALY, the probability of the maternal programme being cost-effective was 96.2%. CONCLUSION Our findings support continuing the maternal pertussis vaccination programme as otherwise higher levels of disease activity and infant mortality are expected to return. These results have led policy makers to decide to continue the maternal programme in the UK routine immunisation schedule.
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Affiliation(s)
- Frank Sandmann
- Statistics, Modelling and Economics Department, National Infection Service (NIS), Public Health England (PHE), London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Mark Jit
- Statistics, Modelling and Economics Department, National Infection Service (NIS), Public Health England (PHE), London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, UK; School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | - Nick Andrews
- Statistics, Modelling and Economics Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | | | - Helen Campbell
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Sonia Ribeiro
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Bersabeh Sile
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Julia Stowe
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Elise Tessier
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Mary Ramsay
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Gayatri Amirthalingam
- Immunisation and Countermeasures Department, National Infection Service (NIS), Public Health England (PHE), London, UK
| | - Yoon H Choi
- Statistics, Modelling and Economics Department, National Infection Service (NIS), Public Health England (PHE), London, UK
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Petrou P. The tyranny of the SW quadrant. J Med Econ 2021; 24:741-742. [PMID: 33900900 DOI: 10.1080/13696998.2021.1922210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Panagiotis Petrou
- Pharmacoepidemiology-Pharmacovigilance, University of Nicosia, School of Sciences and Engineering, Pharmacy School, Nicosia, Cyprus
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Hepgul N, Wilson R, Yi D, Evans C, Bajwah S, Crosby V, Wilcock A, Lindsay F, Byrne A, Young C, Groves K, Smith C, Burman R, Chaudhuri KR, Silber E, Higginson IJ, Gao W. Immediate versus delayed short-term integrated palliative care for advanced long-term neurological conditions: the OPTCARE Neuro RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background
Palliative care is recommended to help meet the needs of patients with progressive non-cancer conditions, such as long-term neurological conditions. However, few trials have tested palliative care in this population.
Objectives
To determine the effectiveness and cost-effectiveness of short-term integrated palliative care in improving symptoms, improving patient- and caregiver-reported outcomes and reducing hospital use for people severely affected by long-term neurological conditions.
Design
Pragmatic, randomised controlled, multicentre, fast-track trial, with an embedded qualitative component and surveys.
Setting
Seven UK centres (South London, Nottingham, Liverpool, Cardiff, Brighton, Ashford and Sheffield) with multiprofessional palliative care teams and neurology services.
Participants
People living with multiple sclerosis, idiopathic Parkinson’s disease, motor neurone disease, multiple system atrophy or progressive supranuclear palsy, with unresolved symptoms and/or complex psychosocial needs. The qualitative study involved patients, caregivers and health-care staff.
Interventions
Participants were randomised to receive short-term integrated palliative care, delivered by multiprofessional teams, immediately or after a 12-week wait (standard care group).
Main outcome measures
The primary outcome was a combined score of eight symptoms measured by the Integrated Palliative care Outcome Scale for Neurological conditions 8 symptom subscale (IPOS Neuro-S8) at 12 weeks. Secondary outcomes included patients’ other physical and psychological symptoms, quality of life (EuroQol-5 Dimensions, five-level version), care satisfaction, caregiver burden, service use and cost, and harms. Data were analysed using multiple imputation, generalised linear mixed models, incremental cost-effectiveness ratios (threshold was the National Institute for Health and Care Excellence £20,000 per quality-adjusted life-year) and cost-effectiveness planes. Qualitative data were analysed thematically.
Results
We recruited 350 patients and 229 caregivers. There were no significant between-group differences for primary or secondary outcomes. Patients receiving short-term integrated palliative care had a significant improvement, from baseline to 12 weeks, on the primary outcome IPOS Neuro-S8 (–0.78, 95% confidence interval –1.29 to –0.26) and the secondary outcome of 24 physical symptoms (–1.95, 99.55% confidence interval –3.60 to –0.30). This was not seen in the control group, in which conversely, care satisfaction significantly reduced from baseline to 12 weeks (–2.89, 99.55% confidence interval –5.19 to –0.59). Incremental cost-effectiveness ratios were smaller than the set threshold (EuroQol-5 Dimensions index score –£23,545; IPOS Neuro-S8 –£1519), indicating that the intervention provided cost savings plus better outcomes. Deaths, survival and hospitalisations were similar between the two groups. Qualitative data suggested that the impact of the intervention encompassed three themes: (1) adapting to losses and building resilience, (2) attending to function, deficits and maintaining stability, and (3) enabling caregivers to care.
Conclusions
Our results indicate that short-term integrated palliative care provides improvements in patient-reported physical symptoms at a lower cost and without harmful effects when compared with standard care.
Limitations
Outcome measures may not have been sensitive enough to capture the multidimensional changes from the intervention. Our surveys found that the control/standard and intervention services were heterogeneous.
Future work
Refining short-term integrated palliative care and similar approaches for long-term neurological conditions, focusing on better integration of existing services, criteria for referral and research to improve symptom management.
Trial registration
Current Controlled Trials ISRCTN18337380.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 36. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Nilay Hepgul
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Rebecca Wilson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Catherine Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- Sussex Community NHS Foundation Trust, Brighton, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Vincent Crosby
- Department of Palliative Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Wilcock
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Anthony Byrne
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - Carolyn Young
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Clare Smith
- Department of Palliative Care, Ashford and St. Peter’s Hospitals NHS Foundation Trust, Surrey, UK
| | - Rachel Burman
- Department of Palliative Care, King’s College Hospital, London, UK
| | - K Ray Chaudhuri
- National Parkinson Foundation Centre of Excellence, King’s College Hospital and King’s College London, London, UK
| | - Eli Silber
- Department of Neurology, King’s College Hospital, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
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Rotteveel AH, Lambooij MS, Zuithoff NPA, van Exel J, Moons KGM, de Wit GA. Valuing Healthcare Goods and Services: A Systematic Review and Meta-Analysis on the WTA-WTP Disparity. PHARMACOECONOMICS 2020; 38:443-458. [PMID: 32096146 DOI: 10.1007/s40273-020-00890-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE The objective of this systematic review was to review the available evidence on the disparity between willingness to accept (WTA) and willingness to pay (WTP) for healthcare goods and services. METHODS A tiered approach consisting of (1) a systematic review, (2) an aggregate data meta-analysis, and (3) an individual participant data meta-analysis was used. MEDLINE, EMBASE, Scopus, Scisearch, and Econlit were searched for articles reporting both WTA and WTP for healthcare goods and services. Individual participant data were requested from the authors of the included studies. RESULTS Thirteen papers, reporting WTA and WTP from 19 experiments/subgroups, were included in the review. The WTA/WTP ratios reported in these papers, varied from 0.60 to 4.01, with means of 1.73 (median 1.31) for 15 estimates of the mean and 1.58 (median 1.00) for nine estimates of the median. Individual data obtained from six papers, covering 71.2% of the subjects included in the review, yielded an unadjusted WTA/WTP ratio of 1.86 (95% confidence interval 1.52-2.28) and a WTA/WTP ratio adjusted for age, sex, and income of 1.70 (95% confidence interval 1.42-2.02). Income category and age had a statistically significant effect on the WTA/WTP ratio. The approach to handling zero WTA and WTP values has a considerable impact on the WTA/WTP ratio found. CONCLUSIONS AND IMPLICATIONS The results of this study imply that losses in healthcare goods and services are valued differently from gains (ratio > 1), but that the degree of disparity found depends on the method used to obtain the WTA/WTP ratio, including the approach to zero responses. Irrespective of the method used, the ratios found in our meta-analysis are smaller than the ratios found in previous meta-analyses.
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Affiliation(s)
- Adriënne H Rotteveel
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands.
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Mattijs S Lambooij
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Nicolaas P A Zuithoff
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Ardine de Wit
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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16
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Thakar S, Rajagopal N, Mani S, Shyam M, Aryan S, Rao AS, Srinivasa R, Mohan D, Hegde AS. Comparison of telemedicine with in-person care for follow-up after elective neurosurgery: results of a cost-effectiveness analysis of 1200 patients using patient-perceived utility scores. Neurosurg Focus 2019; 44:E17. [PMID: 29712532 DOI: 10.3171/2018.2.focus17543] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The utility of telemedicine (TM) in neurosurgery is underexplored, with most of the studies relating to teletrauma or telestroke programs. In this study, the authors evaluate the cost-effectiveness of TM consultations for follow-up care of a large population of patients who underwent neurosurgical procedures. METHODS A decision-analytical model was used to assess the cost-effectiveness of TM for elective post-neurosurgical care patients from a predominantly nonurban cohort in West Bengal, India. The model compared TM care via a nodal center in West Bengal to routine, in-person, per-episode care at the provider site in Bangalore, India. Cost and effectiveness data relating to 1200 patients were collected for a 52-month period. The effectiveness of TM care was calculated using efficiency in terms of the percentage of successful TM consultations, as well as patient-perceived utility values for overall experience of the type of health care access that they received. Incremental cost-effectiveness ratio (ICER) analysis was done using the 4-quadrant charting of the cost-effectiveness plane. One-way sensitivity and tornado analyses were performed to identify thresholds where the care strategy would change. RESULTS The overall utility for the 3 TM scenarios was found to be higher (89%) than for the utility of routine care (80%). TM was found to be more cost-effective (Indian rupee [INR] 2630 per patient) compared to routine care (INR 6848 per patient). The TM strategy "dominates" that of routine care by being more effective and less expensive (ICER value of -39,400 INR/unit of effectiveness). Sensitivity analysis revealed that cost-effectiveness of TM was most sensitive to changes in the number of TM patients, utility and success rate of TM, and travel distance to the TM center. CONCLUSIONS TM care dominates the in-person care strategy by providing more effective and less expensive follow-up care for a remote post-neurosurgical care population in India. In the authors' setting, this benefit of TM is sustainable even if half the TM consultations turn out to be unsuccessful. The viability of TM as a cost-effective care protocol is attributed to a combination of factors, like an adequate patient volume utilizing TM, patient utility, success rate of TM, and the patient travel distance.
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Affiliation(s)
| | | | | | - Maya Shyam
- Finance and Accounts, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India
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17
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Abstract
BACKGROUND Traditional decision rules have limitations when a new technology is less effective and less costly than a comparator. We propose a new probabilistic decision framework to examine non-inferiority in effectiveness and net monetary benefit (NMB) simultaneously. We illustrate this framework using the example of repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT) for treatment-resistant depression. METHODS We modeled the quality-adjusted life-years (QALYs) associated with the new intervention (rTMS), an active control (ECT), and a placebo control, and we estimated the fraction of effectiveness preserved by the new intervention through probabilistic sensitivity analysis (PSA). We then assessed the probability of cost-effectiveness using a traditional cost-effectiveness acceptability curve (CEAC) and our new decision-making framework. In our new framework, we considered the new intervention cost-effective in each simulation of the PSA if it preserved at least 75 percent of the effectiveness of the active control (thus demonstrating non-inferiority) and had a positive NMB at a given willingness-to-pay threshold (WTP). RESULTS rTMS was less effective (i.e., associated with fewer QALYs) and less costly than ECT. The traditional CEAC approach showed that the probabilities of rTMS being cost-effective were 100 percent, 39 percent, and 14 percent at WTPs of $0, $50,000, and $100,000 per QALY gained, respectively. In the new decision framework, the probabilities of rTMS being cost-effective were reduced to 23 percent, 21 percent, and 13 percent at WTPs of $0, $50,000, and $100,000 per QALY, respectively. CONCLUSIONS This new framework provides a different perspective for decision making with considerations of both non-inferiority and WTP thresholds.
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18
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Costa N, Mounié M, Bernard G, Bieler L, Molinier L, Serrano E, de Bonnecaze G. Cost-effectiveness of trans-nasal endoscopic sphenopalatine artery ligation vs arterial embolisation for intractable epistaxis: Long-term analyses. Clin Otolaryngol 2019; 44:511-517. [PMID: 30720918 DOI: 10.1111/coa.13299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 06/04/2018] [Accepted: 01/26/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Trans-nasal endoscopic sphenopalatine artery ligation (TESPAL) and endovascular arterial embolisation both provide excellent success rates for intractable epistaxis. Recent economic models suggest that TESPAL could be a cost-saving strategy. Our main aim was to perform cost-effectiveness analyses on TESPAL compared with embolisation to treat patients with epistaxis. DESIGN We performed retrospective, monocentric, comparative analyses on patients referred to our centre and treated with embolisation or TESPAL. SETTING This economic evaluation was carried out from a payer's perspective (ie French National Health Insurance) within a time horizon of 12 months. PARTICIPANTS Thirty-seven TESPAL procedures and thirty-nine embolisation procedures to treat intractable epistaxis were used in the analyses. MAIN OUTCOME MEASURES The primary outcome is presented as the cost per 1% of non-recurrence. Effectiveness was defined as avoiding recurrence of epistaxis during the 1-year follow-up. Cost estimates were performed from the payer's perspective. RESULTS Hospitalisation costs were higher for embolisation compared with TESPAL (5972 vs 3769 euros). On average, hospitalisation costs decreased by 41% when a patient was treated by TESPAL compared with an embolisation strategy (P = 0.06). The presence of comorbidities increased hospitalisation costs by 79% (P = 0.04). TESPAL enabled 1867€ to be gained in intractable epistaxis. CONCLUSIONS The outcomes from our decision model confirm that TESPAL is more cost-effective for patients with intractable epistaxis.
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Affiliation(s)
- Nadège Costa
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France.,Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Toulouse, France
| | - Michael Mounié
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France.,Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Toulouse, France.,University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Toulouse Cedex 9, France
| | - Geraldine Bernard
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France
| | - Laurent Bieler
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France
| | - Laurent Molinier
- Medical Information Department, University Hospital of Toulouse, Toulouse Cedex 9, France.,Unité Inserm 1027, Faculté de Médecine, National Institute for Health and Medical Research (Inserm), Toulouse, France.,University of Science of Toulouse III, Université Paul Sabatier Toulouse III, Toulouse Cedex 9, France
| | - Elie Serrano
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
| | - Guillaume de Bonnecaze
- Otorhinolaryngology, Head and Neck Surgery Department, University Hospital Rangueil-Larrey, Toulouse, France
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Cost-effectiveness of care for people with psychosis in the community and psychiatric hospitals in the Czech Republic: an economic analysis. Lancet Psychiatry 2018; 5:1023-1031. [PMID: 30415938 DOI: 10.1016/s2215-0366(18)30388-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 09/05/2018] [Accepted: 09/28/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The absence of economic evidence hinders current reforms of hospital-based mental health systems in central and eastern Europe. We aimed to assess the cost-effectiveness of discharge to community care for people with chronic psychoses compared with care in psychiatric hospitals in the Czech Republic. METHODS We did a prospective study of people aged 18-64 years with chronic psychotic disorders in the Czech Republic who had been discharged into community services or were receiving inpatient psychiatric care for at least 3 months at baseline. We measured health-related quality of life with the EuroQol five-dimension five-level questionnaire. Adjusting for baseline differences between the two groups, we assessed differences in societal costs in 2016 and quality-adjusted life-years (QALYs) during a 12-month follow-up, which we then used to estimate the incremental cost-effectiveness ratio (ICER). We did multiple sensitivity analyses to assess the robustness of our results. FINDINGS In our baseline case scenario, we included 115 patients who were either community service users (n=35) or inpatients (n=80) at baseline. The two groups were similar in terms of baseline characteristics. The annual QALY was 0·77 in patients receiving community care at baseline compared with 0·80 in patients in hospital at baseline (difference 0·03, 95% CI -0·04 to 0·10), but the costs of discharge to the community were €8503 compared with €16 425 for no discharge (difference €7922, 95% CI 4497-11 346), such that the ICER reached more than €250 000 per QALY. This ICER is substantially higher than levels that are conventionally considered to be cost-effective and the estimated probability that discharge to the community was cost-effective was very high (≥97%). None of the sensitivity analyses changed these results qualitatively. INTERPRETATION This study provides economic evidence for deinstitutionalisation by showing that discharge to community care is cost-effective compared with care in psychiatric hospitals in the Czech Republic. These findings add to the human rights and clinical-based arguments for mental health-care reforms in central and eastern Europe. FUNDING Ministry of Education, Youth and Sports of the Czech Republic; EEA and Norway Grants.
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Bremer V, Becker D, Kolovos S, Funk B, van Breda W, Hoogendoorn M, Riper H. Predicting Therapy Success and Costs for Personalized Treatment Recommendations Using Baseline Characteristics: Data-Driven Analysis. J Med Internet Res 2018; 20:e10275. [PMID: 30131318 PMCID: PMC6123535 DOI: 10.2196/10275] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/05/2018] [Accepted: 06/16/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Different treatment alternatives exist for psychological disorders. Both clinical and cost effectiveness of treatment are crucial aspects for policy makers, therapists, and patients and thus play major roles for healthcare decision-making. At the start of an intervention, it is often not clear which specific individuals benefit most from a particular intervention alternative or how costs will be distributed on an individual patient level. OBJECTIVE This study aimed at predicting the individual outcome and costs for patients before the start of an internet-based intervention. Based on these predictions, individualized treatment recommendations can be provided. Thus, we expand the discussion of personalized treatment recommendation. METHODS Outcomes and costs were predicted based on baseline data of 350 patients from a two-arm randomized controlled trial that compared treatment as usual and blended therapy for depressive disorders. For this purpose, we evaluated various machine learning techniques, compared the predictive accuracy of these techniques, and revealed features that contributed most to the prediction performance. We then combined these predictions and utilized an incremental cost-effectiveness ratio in order to derive individual treatment recommendations before the start of treatment. RESULTS Predicting clinical outcomes and costs is a challenging task that comes with high uncertainty when only utilizing baseline information. However, we were able to generate predictions that were more accurate than a predefined reference measure in the shape of mean outcome and cost values. Questionnaires that include anxiety or depression items and questions regarding the mobility of individuals and their energy levels contributed to the prediction performance. We then described how patients can be individually allocated to the most appropriate treatment type. For an incremental cost-effectiveness threshold of 25,000 €/quality-adjusted life year, we demonstrated that our recommendations would have led to slightly worse outcomes (1.98%), but with decreased cost (5.42%). CONCLUSIONS Our results indicate that it was feasible to provide personalized treatment recommendations at baseline and thus allocate patients to the most beneficial treatment type. This could potentially lead to improved decision-making, better outcomes for individuals, and reduced health care costs.
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Affiliation(s)
- Vincent Bremer
- Institute of Information Systems, Leuphana University, Lüneburg, Germany
| | - Dennis Becker
- Institute of Information Systems, Leuphana University, Lüneburg, Germany
| | - Spyros Kolovos
- Department of Clinical, Neuro- & Developmental Psychology, Vrije University, Amsterdam, Netherlands.,Department of Health Sciences, Vrije University, Amsterdam, Netherlands
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University, Lüneburg, Germany
| | - Ward van Breda
- Department of Computer Science, Vrije University, Amsterdam, Netherlands
| | - Mark Hoogendoorn
- Department of Computer Science, Vrije University, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro- & Developmental Psychology, Vrije University, Amsterdam, Netherlands
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Lee AY, Butt T, Chew E, Agron E, Clemons TE, Egan CA, Lee CS, Tufail A. Cost-effectiveness of age-related macular degeneration study supplements in the UK: combined trial and real-world outcomes data. Br J Ophthalmol 2017; 102:465-472. [PMID: 28835423 DOI: 10.1136/bjophthalmol-2017-310939] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 07/22/2017] [Accepted: 07/24/2017] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the cost-effectiveness of Age-Related Eye Disease Study (AREDS) 1 & 2 supplements in patients with either bilateral intermediate age-related macular degeneration, AREDS category 3, or unilateral neovascular age-related macular degeneration AMD (nAMD), AREDS category 4. METHODS A patient-level health state transition model based on levels of visual acuity in the better-seeing eye was constructed to simulate the costs and consequences of patients taking AREDS vitamin supplements. SETTING UK National Health Service (NHS). The model was populated with data from AREDS and real-world outcomes and resource use from a prospective multicentre national nAMD database study containing 92 976 ranibizumab treatment episodes. INTERVENTIONS Two treatment approaches were compared: immediate intervention with AREDS supplements or no supplements. MAIN OUTCOME MEASURES quality-adjusted life years (QALYs) and healthcare costs were accrued for each strategy, and incremental costs and QALYs were calculated for the lifetime of the patient. One-way and probabilistic sensitivity analyses were employed to test the uncertainty of the model. RESULTS For AREDS category 3, the incremental cost-effectiveness ratio was £30 197. For AREDS category 4 compared with no intervention, AREDS supplements are more effective (10.59 vs 10.43 QALYs) and less costly (£52 074 vs 54 900) over the lifetime of the patient. CONCLUSIONS The recommendation to publicly fund AREDS supplements to category 3 patients would depend on the healthcare system willingness to pay. In contrast, initiating AREDS supplements in AREDS category 4 patients is both cost saving and more effective than no supplement use and should therefore be considered in public health policy.
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Affiliation(s)
- Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Thomas Butt
- Institute of Ophthalmology, University College London, London, UK
| | - Emily Chew
- Division of Epidemiology and Clinical Research, National Institutes of Health, Bethesda, Maryland, USA
| | - Elvira Agron
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, USA
| | | | - Catherine A Egan
- Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital, London, UK
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA
| | - Adnan Tufail
- Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital, London, UK
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Boudreau DM, Guzauskas GF, Chen E, Lalla D, Tayama D, Fagan SC, Veenstra DL. Cost-Effectiveness of Recombinant Tissue-Type Plasminogen Activator Within 3 Hours of Acute Ischemic Stroke. Stroke 2014; 45:3032-9. [DOI: 10.1161/strokeaha.114.005852] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Despite the availability of results from multiple newer clinical trials and changing healthcare costs, the cost-effectiveness of recombinant tissue-type plasminogen activator (r-tPA) for treatment of acute ischemic stroke within 0 to 3 hours of symptom onset was last evaluated in 1998 for the United States Using current evidence, we evaluate the long-term cost-effectiveness of r-tPA administered 0 to 3 hours after acute ischemic stroke onset versus no r-tPA.
Methods—
A disease-based decision model to project lifetime outcomes of patients after acute ischemic stroke by r-tPA treatment status from the US payer perspective was developed. Model inputs were derived from a recent meta-analysis of r-tPA trials, cohort studies, and health state preference studies. Cost data, inflated to 2013 dollars, were based on drug wholesale acquisition cost and the literature. To compare r-tPA to no r-tPA, we calculated incremental total direct costs, incremental quality-adjusted life years, and incremental cost-effectiveness ratios. We performed 1-way and probabilistic sensitivity analyses to evaluate uncertainty in the results.
Results—
r-tPA resulted in a gain of 0.39 quality-adjusted life years (95% confidence range, 0.16–0.66) on average per patient and a lifetime cost-saving of $25 000 (95% confidence range, −$42 500 to −$11 000) compared with no r-tPA. In probabilistic sensitivity analyses, r-tPA was dominant compared with no r-tPA in ≈100% of simulations. The model was sensitive to inputs for r-tPA efficacy, healthcare costs for disabled patients, mortality rates for disabled and nondisabled patients, and quality of life estimates.
Conclusions—
Our analysis supports earlier economic evaluations that r-tPA is a cost-effective method to treat stroke. Appropriate use of r-tPA should be prioritized nationally.
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Affiliation(s)
- Denise M. Boudreau
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
| | - Gregory F. Guzauskas
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
| | - Er Chen
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
| | - Deepa Lalla
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
| | - Darren Tayama
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
| | - Susan C. Fagan
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
| | - David L. Veenstra
- From the University of Washington, Seattle (D.M.B., G.F.G., D.L.V.); Genentech, Inc South San Francisco, CA (E.C., D.T.); Palo Alto Outcomes Research, CA (D.L.); and University of Georgia College of Pharmacy, Athens (S.C.F.)
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Young KC, Benesch CG, Jahromi BS. Cost-effectiveness of multimodal CT for evaluating acute stroke. Neurology 2010; 75:1678-85. [PMID: 20926786 DOI: 10.1212/wnl.0b013e3181fc2838] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Multimodal CT, including noncontrast CT (NCCT), CT with contrast, CT angiography (CTA), and perfusion CT (CTP), is increasingly used in acute stroke patients to identify candidates for endovascular therapy. Our goal is to explore the cost-effectiveness of multimodal CT as a diagnostic test. METHODS A Markov model compared multimodal CT to NCCT in a hypothetical cohort of nonhemorrhagic stroke patients presenting within 3 hours of symptom onset who were potential IV tPA candidates. Patients who failed to improve after IV tPA or in whom IV tPA was contraindicated were candidates for endovascular therapy. Direct costs (2008 USD), outcomes, and probabilities were obtained from the literature. RESULTS For the 3-month time horizon, multimodal CT had lower costs (-$1,716), had greater quality-adjusted life-years (QALYs, 0.004), and was the cost-effective choice 100% of the time for a willingness-to-pay of $100,000/QALY (probabilistic sensitivity analysis). The number needed to screen with multimodal CT to avoid 1 diagnostic angiogram was 2. Over a lifetime, multimodal CT had lower costs (-$2,058), had greater QALYs (0.008), and was cost-effective, with a 90.1% likelihood, for a willingness-to-pay of $100,000/QALY. CONCLUSIONS Multimodal CT appears to be a cost-saving screening tool over the short term. However, additional data regarding clinical outcomes following multimodal CT-guided intra-arterial treatment are needed before the long-term cost-effectiveness can be suitably addressed. This analysis can be incorporated into future discussions of multimodal CT as a diagnostic test for unselected patients, within and beyond the 3-hour IV tPA time window.
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Affiliation(s)
- Kate C Young
- Department of Neurology, University of Rochester, 601 Elmwood Ave., Box 681, Rochester, NY 14642, USA.
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Klok RM, Arents NLA, de Vries R, Thijs JC, Brouwers JRBJ, Kleibeuker JH, Postma MJ. Economic evaluation of a randomized trial comparing Helicobacter pylori test-and-treat and prompt endoscopy strategies for managing dyspepsia in a primary-care setting. Clin Ther 2006; 27:1647-57. [PMID: 16330302 DOI: 10.1016/j.clinthera.2005.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2005] [Indexed: 11/15/2022]
Abstract
BACKGROUND In western European countries, most dyspeptic patients are initially managed by their general practitioners (GPs), who use a range of strategies to manage dyspepsia. We performed an economic analysis of a Helicobacter pylori test-and-treat strategy versus a prompt endoscopy approach in a primary care setting. METHODS Data were used from the Strategy: Endoscopy versus Serology (SENSE) study, performed in The Netherlands from 1998 to 2001. Patients were randomized to a prompt endoscopy (n = 105) or test-and-treat (n = 118) group. Follow-up lasted 1 year. Adverse events were not recorded in the SENSE study. Health care costs were based on the total amount of dyspepsia-related drugs used, the number of dyspepsia-related GP visits, the number of diagnostic tests, and the number of dyspepsia-related referrals to specialists. The use of medical resources was calculated as standardized costs for 1999, recorded as euros. (On December 31, 1999, 1.00 Euro = 1.00 US dollar.) Quality of life was measured at inclusion and 1 year later, using the RAND-36 questionnaire. To calculate quality-adjusted life-years (QALYs), we transformed the individual scores of the RAND-36 into 1 overall score, the Health Utilities Index Mark 2, which introduced a limitation to the study. An incremental cost-effectiveness ratio (ICER) was calculated. The 95% confidence limits were calculated using a parametric bootstrap method with angular transformation. All cost data were analyzed from a third-party payer perspective. RESULTS The total costs per patient were 511 Euros, with 0.037 QALY gained per patient, in the test-and-treat group, and 748 Euros, with 0.032 QALY gained per patient, in the endoscopy group (between groups, P < 0.001 and P = NS, respectively). The point estimate of the ICER indicated that the test-and-treat strategy yielded cost savings and QALYs gained. Parametric bootstrap confidence limits indicated cost savings per QALY gained in 75.7% of the bootstrap simulations. CONCLUSION This analysis of data from the SENSE1026 study suggests that the H pylori test-and-treat strategy was more cost-effective than prompt endoscopy in the initial management of dyspepsia in general practice, from the perspective of a third-party payer.
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Affiliation(s)
- Rogier M Klok
- Groningen University Institute for Drug Exploration, Department of Social Pharmacy, Pharmacoepidemiology and Pharmacotherapy, The Netherlands.
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