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Leahy TP, Durand-Zaleski I, Sampietro-Colom L, Kent S, Zöllner Y, Coyle D, Casadei G. The role of quantitative bias analysis for nonrandomized comparisons in health technology assessment: recommendations from an expert workshop. Int J Technol Assess Health Care 2023; 39:e68. [PMID: 37981828 DOI: 10.1017/s0266462323002702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
The use of treatment effects derived from nonrandomized studies (NRS) in health technology assessment (HTA) is growing. NRS carry an inherently greater risk of bias than randomized controlled trials (RCTs). Although bias can be mitigated to some extent through appropriate approaches to study design and analysis, concerns around data availability and quality and the absence of randomization mean residual biases typically render the interpretation of NRS challenging. Quantitative bias analysis (QBA) methods are a range of methods that use additional, typically external, data to understand the potential impact that unmeasured confounding and other biases including selection bias and time biases can have on the results (i.e., treatment effects) from an NRS. QBA has the potential to support HTA bodies in using NRS to support decision-making by quantifying the magnitude, direction, and uncertainty of biases. However, there are a number of key aspects of the use of QBA in HTA which have received limited discussion. This paper presents recommendations for the use of QBA in HTA developed using a multi-stakeholder workshop of experts in HTA with a focus on QBA for unmeasured confounding.
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Affiliation(s)
| | - Isabelle Durand-Zaleski
- AP-HP, Health Economics Research Unit, Department of Public Health, Henri Mondor Hospital, Paris, France
- Methods, UMRS 1153, French National Institute of Health and Medical Research, Paris, France
- Faculty of Medicine, Université Paris Est Creteil, Creteil, France
| | - Laura Sampietro-Colom
- Health Technology Assessment (HTA) Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - York Zöllner
- Department of Health Sciences, HAW Hamburg, Hamburg, Germany
| | - Doug Coyle
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Gianluigi Casadei
- Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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Van Ranst M, Zöllner Y, Schelling J, Palache B. The burden of seasonal influenza: improving vaccination coverage to mitigate morbidity and its impact on healthcare systems. Expert Rev Vaccines 2023. [PMID: 37264896 DOI: 10.1080/14760584.2023.2221345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
| | - York Zöllner
- Hamburg University of Applied Sciences, Hamburg, Germany
| | - Jörg Schelling
- University of Munich, Medizinische Klinik IV, Munich, Germany
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Snow M, Mandalia V, Custers R, Emans PJ, Kon E, Niemeyer P, Verdonk R, Gaissmaier C, Roeder A, Weinand S, Zöllner Y, Schubert T. Cost-effectiveness of a new ACI technique for the treatment of articular cartilage defects of the knee compared to regularly used ACI technique and microfracture. J Med Econ 2023; 26:537-546. [PMID: 36974460 DOI: 10.1080/13696998.2023.2194805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
AIMS For patients with cartilage defects of the knee, a new biocompatible and in situ cross-linkable albumin-hyaluronan-based hydrogel has been developed for matrix-associated autologous chondrocyte implantation (M-ACI) - NOVOCART® Inject plus (NInject)1. We aimed to estimate the potential cost-effectiveness of NInject, that is not available on the market, yet compared to spheroids of human autologous matrix-associated chondrocytes (Spherox®)2 and microfracture. MATERIALS AND METHODS An early Markov model was developed to estimate the cost-effectiveness in the United Kingdom (UK) from the payer perspective. Transition probabilities, response rates, utility values and costs were derived from literature. Since NInject has not yet been launched and no prices are available, its costs were assumed equal to those of Spherox®. Cycle length was set at one year and the time horizon chosen was notional patients' remaining lifetime. Model robustness was evaluated with deterministic and probabilistic sensitivity analyses (DSA; PSA) and value of information (VOI) analysis. The Markov model was built using TreeAge Pro Healthcare. RESULTS NInject was cost-effective compared to microfracture (ICER: ₤5,147) while Spherox® was extendedly dominated. In sensitivity analyses, the ICER exceeded conventional WTP threshold of ₤20,000 only when the utility value after successful first treatment with NInject was decreased by 20% (ICER: ₤69,620). PSA corroborated the cost-effectiveness findings of NInject, compared to both alternatives, with probabilities of 60% of NInject undercutting the aforementioned WTP threshold and being the most cost-effective alternative. The VOIA revealed that obtaining additional evidence on the new technology will likely not be cost-effective for the UK National Health Service. LIMITATIONS AND CONCLUSION This early Markov model showed that NInject is cost-effective for the treatment of articular cartilage defects in the knee, compared to Spherox and microfracture. However, as the final price of NInject has yet to be determined, the cost-effectiveness analysis performed in this study is provisional, assuming equal prices for NInject and Spherox.
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Affiliation(s)
- Martyn Snow
- The Royal Orthopaedic Hospital, Birmingham, UK
- The Robert Jones and Agnes Hunt, Oswestry, UK
| | | | - Roel Custers
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter J Emans
- Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Elizaveta Kon
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Casa di Cura Toniolo, Bologna, Italy
| | | | | | | | | | | | - York Zöllner
- Hamburg University of Applied Sciences, Hamburg, Germany
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4
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Vogelmann T, Roessler PP, Buhs M, Ostermeier S, Gille J, Hoburg A, Zöllner Y, Schwarz S, Schubert T, Grebe M, Zinser W. Long-term cost-effectiveness of matrix-associated chondrocyte implantation in the German health care system: a discrete event simulation. Arch Orthop Trauma Surg 2023; 143:1417-1427. [PMID: 35064292 PMCID: PMC9957880 DOI: 10.1007/s00402-021-04318-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cartilage defects in the knee can be caused by injury, various types of arthritis, or degeneration. As a long-term consequence of cartilage defects, osteoarthritis can develop over time, often leading to the need for a total knee replacement (TKR). The treatment alternatives of chondral defects include, among others, microfracture, and matrix-associated autologous chondrocyte implantation (M-ACI). The purpose of this study was to determine cost-effectiveness of M-ACI in Germany with available mid- and long-term outcome data, with special focus on the avoidance of TKR. MATERIALS AND METHODS We developed a discrete-event simulation (DES) that follows up individuals with cartilage defects of the knee over their lifetimes. The DES was conducted with a status-quo scenario in which M-ACI is available and a comparison scenario with no M-ACI available. The model included 10,000 patients with articular cartilage defects. We assumed Weibull distributions for short- and long-term effects for implant failures. Model outcomes were costs, number of TKRs, and quality-adjusted life years (QALYs). All analyses were performed from the perspective of the German statutory health insurance. RESULTS The majority of patients was under 45 years old, with defect sizes between 2 and 7 cm2 (mean: 4.5 cm2); average modeled lifetime was 48 years. In the scenario without M-ACI, 26.4% of patients required a TKR over their lifetime. In the M-ACI scenario, this was the case in only 5.5% of cases. Thus, in the modeled cohort of 10,000 patients, 2700 TKRs, including revisions, could be avoided. Patients treated with M-ACI experienced improved quality of life (22.53 vs. 21.21 QALYs) at higher treatment-related costs (18,589 vs. 14,134 € /patient) compared to those treated without M-ACI, yielding an incremental cost-effectiveness ratio (ICER) of 3376 € /QALY. CONCLUSION M-ACI is projected to be a highly cost-effective treatment for chondral defects of the knee in the German healthcare setting.
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Affiliation(s)
| | | | | | | | - Justus Gille
- University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | | | - York Zöllner
- Hamburg University of Applied Sciences, Hamburg, Germany
| | | | - Tino Schubert
- LinkCare GmbH, Kyffhäuserstr. 64, 70469 Stuttgart, Germany
| | | | - Wolfgang Zinser
- OrthoExpert Fohnsdorf, Austria and GFO-Kliniken Niederrhein, Dinslaken, Germany
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Sarica SH, Gallacher PJ, Dhaun N, Sznajd J, Harvie J, McLaren J, McGeoch L, Kumar V, Amft N, Erwig L, Marks A, Bruno L, Zöllner Y, Black C, Basu N. Multimorbidity in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Results From a Longitudinal, Multicenter Data Linkage Study. Arthritis Rheumatol 2021; 73:651-659. [PMID: 33058567 DOI: 10.1002/art.41557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/08/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is considered a chronic, relapsing condition. To date, no studies have investigated multimorbidity in AAV nationally. This study was undertaken to characterize temporal trends in multimorbidity and report excess health care expenditures associated with multimorbidities in a national AAV cohort from Scotland. METHODS Eligible patients with AAV were diagnosed between 1997 and 2017. Each patient was matched with up to 5 general population controls. Linked morbidity and health care expenditure data were retrieved from a Scottish national hospitalization repository and from published national cost data. Multimorbidity was defined as the development of ≥2 disorders. Prespecified morbidities, individually and together, were analyzed for risks and associations over time using modified Poisson regression, discrete interval analysis, and chi-square test for trend. The relationship between multimorbidities and health care expenditure was investigated using multivariate linear regression. RESULTS In total, 543 patients with AAV (median age 58.7 years [range 48.9-68.0 years]; 53.6% male) and 2,672 general population controls (median age 58.7 years [range 48.9-68.0 years]; 53.7% male) were matched and followed up for a median of 5.1 years. AAV patients were more likely to develop individual morbidities at all time points, but especially <2 years after diagnosis. The highest proportional risk observed was for osteoporosis (adjusted incidence rate ratio 8.0, 95% confidence interval [95% CI] 4.5-14.2). After 1 year, 23.0% of AAV patients and 9.3% of controls had developed multimorbidity (P < 0.0001). After 10 years, 37.0% of AAV patients and 17.3% of controls were reported to have multimorbidity (P < 0.0001). Multimorbidity was associated with disproportionate increases in health care expenditures in AAV patients. Health care expenditure was highest for AAV patients with ≥3 morbidities (3.89-fold increase in costs, 95% CI 2.83-5.31; P < 0.001 versus no morbidities). CONCLUSION These findings emphasize the importance of holistic care in patients with AAV, and may identify a potentially critical opportunity to consider early screening.
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Affiliation(s)
| | - Peter J Gallacher
- University of Edinburgh British Heart Foundation Center of Research Excellence, University of Edinburgh, Edinburgh, UK
| | - Neeraj Dhaun
- University of Edinburgh British Heart Foundation Center of Research Excellence, University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | - Nicole Amft
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Angharad Marks
- Abertawe Bro Morgannwg University Health Board, Swansea, UK
| | - Laura Bruno
- Hamburg University of Applied Sciences, Hamburg, Germany
| | - York Zöllner
- Hamburg University of Applied Sciences, Hamburg, Germany
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Quirke E, Suvalo O, Sukhovii O, Zöllner Y. Transitioning to community-based mental health service delivery: opportunities for Ukraine. J Mark Access Health Policy 2020; 8:1843288. [PMID: 33235691 PMCID: PMC7671671 DOI: 10.1080/20016689.2020.1843288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/13/2020] [Accepted: 10/23/2020] [Indexed: 05/28/2023]
Abstract
Background and objectives: Ukraine's mental health system has been found to be inadequate and unresponsive to the needs of the population, in view of its emphasis on inpatient service delivery. This study sought to identify potential changes to the organization and financing of mental health services within the Ukrainian health system that would facilitate the delivery of mental health services in a community-based setting. Methodology: A systematic literature review was undertaken to identify organizational and financing features that have been successfully used to enable and incentivize the delivery of community-based mental health services in Central or Eastern European and/or former Soviet Union countries. Results: There was limited literature on the organizational and financing features that facilitate the delivery of community-based care. Key facilitators for transitioning from institution-based to community-based mental health service delivery include; a clear vision for community-based care, investment in the mental health system, and mechanisms that allow health funding to follow the patient through the health system. Conclusions: Ukraine should adopt strategic purchasing mechanisms to address inefficiency in the financing of its mental health system, and prioritize collaborative planning and delivery of mental health services. Ongoing reform of the Ukrainian health system provides momentum for instituting such changes.
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Affiliation(s)
- Eleanor Quirke
- Hamburg University of Applied Sciences, Hamburg, Germany
| | | | - Oleksii Sukhovii
- Centre for Mental Health and Monitoring of Drugs and Alcohol Ministry of Health of Ukraine, Kyiv, Ukraine
| | - York Zöllner
- Hamburg University of Applied Sciences, Hamburg, Germany
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7
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Dagher M, Sabidó M, Zöllner Y. Effect of age on the effectiveness of the first-line standard of care treatment in patients with metastatic colorectal cancer: systematic review of observational studies. J Cancer Res Clin Oncol 2019; 145:2105-2114. [PMID: 31201484 PMCID: PMC6658416 DOI: 10.1007/s00432-019-02948-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/29/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE Most metastatic colorectal cancer (mCRC) patients are elderly. This systematic review identifies and describes observational studies evaluating the influence of age on first-line treatment effectiveness in real-world practice. METHODS Medline and EMBASE were searched up to May 2016. The included studies were those that investigated first-line treatment of mCRC and reported age groups and overall survival (OS), progression-free survival (PFS) or overall response rate (ORR) were included. Studies published before 2008 were excluded. Study quality was assessed using the Newcastle-Ottawa Scale. Data were evaluated by age group (< 70 vs. ≥ 70 years; 65-75 vs. ≥ 75 years) and outcome. A pooled survival median was calculated for patients (cutoff = 70 years). RESULTS In total, 11 articles with 11,063 patients were included. Four studies using a cutoff of 70 years of age reported OS and PFS, and two studies reported ORRs. In terms of OS, all studies showed a higher OS for those < 70 years of age than for those ≥ 70 years of age. PFS did not find differences by age. For ORRs, one study favoured the younger group, while the second study did not differ by age. Based on three studies, the pooled medians for < 70 years of age and ≥ 70 years of age were the same for PFS (10.2) and were 27.0 and 22.9 for OS, respectively. All included studies were of high or acceptable quality. CONCLUSIONS The results suggest that age has no effect on PFS. For ORR, the results were inconsistent between studies. Younger patients in general had better OS, which might be partly explained by more aggressive treatment. This treatment seemed not to be guided by performance status or number of metastatic sites.
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Affiliation(s)
- Mohammed Dagher
- Hamburg University of Applied Sciences, 21033 Hamburg, Germany
| | - Meritxell Sabidó
- Global Epidemiology Department, Merck KGaA, Frankfurter Str. 250, 64293 Darmstadt, Germany
| | - York Zöllner
- Hamburg University of Applied Sciences, 21033 Hamburg, Germany
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8
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Hartmann N, Bartels DB, Zöllner Y. Charakterisierung von Patienten mit idiopathischer Lungenfibrose eines gesundheitsbezogenen sozialen Netzwerks. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- N Hartmann
- Boehringer Ingelheim GmbH, Global Epidemiology, Ingelheim am Rhein
- Hochschule für Angewandte Wissenschaften Hamburg, Gesundheitswissenschaften, Hamburg
| | - DB Bartels
- Boehringer Ingelheim GmbH, Global Epidemiology, Ingelheim am Rhein
- Medizinische Hochschule Hannover, Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Hannover
| | - Y Zöllner
- Hochschule für Angewandte Wissenschaften Hamburg, Gesundheitswissenschaften, Hamburg
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Lewis A, Torvinen S, Dekhuijzen PNR, Chrystyn H, Melani A, Zöllner Y, Kolbe K, Watson AT, Blackney M, Plich A. Budesonide + formoterol delivered via Spiromax ® for the management of asthma and COPD: The potential impact on unscheduled healthcare costs of improving inhalation technique compared with Turbuhaler ®. Respir Med 2017; 129:179-188. [PMID: 28732829 DOI: 10.1016/j.rmed.2017.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/15/2017] [Accepted: 06/26/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fixed-dose combinations of inhaled corticosteroids and long-acting β2 agonists are commonly used for the treatment of asthma and COPD. However, the most frequently prescribed dry powder inhaler delivering this medicine - Symbicort® (budesonide and formoterol, BF) Turbuhaler® - is associated with poor inhalation technique, which can lead to poor disease control and high disease management costs. A recent study showed that patients make fewer inhaler errors when using the novel DuoResp® (BF) Spiromax® inhaler, compared with BF Turbuhaler®. Therefore switching patients from BF Turbuhaler® to BF Spiromax® could improve inhalation technique, and potentially lead to better disease control and healthcare cost savings. METHODS A model was developed to estimate the budget impact of reducing poor inhalation technique by switching asthma and COPD patients from BF Turbuhaler® to BF Spiromax® over three years in Germany, Italy, Sweden and the UK. The model estimated changes to the number, and associated cost, of unscheduled healthcare events. The model considered two scenarios: in Scenario 1, all patients were immediately switched from BF Turbuhaler® to BF Spiromax®; in Scenario 2, 4%, 8% and 12% of patients were switched in years 1, 2 and 3 of the model, respectively. RESULTS In Scenario 1, per patient cost savings amounted to €60.10, €49.67, €94.14 and €38.20 in Germany, Italy, Sweden and the UK, respectively. Total cost savings in each country were €100.86 million, €19.42 million, €36.65 million and €15.44 million over three years, respectively, with an estimated 597,754, 151,480, 228,986 and 122,368 healthcare events avoided. In Scenario 2, cost savings totalled €8.07 million, €1.55 million, €2.93 million and €1.23 million over three years, respectively, with 47,850, 12,118, 18,319, and 9789 healthcare events avoided. Savings per patient were €4.81, €3.97, €7.53 and €3.06. CONCLUSIONS We demonstrated that reductions in poor inhalation technique by switching patients from BF Turbuhaler® to BF Spiromax® are likely to improve patients' disease control and generate considerable cost savings through healthcare events avoided.
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Affiliation(s)
- A Lewis
- Covance Market Access, London, United Kingdom
| | - S Torvinen
- Market Access Department, Teva Pharmaceuticals Europe B.V., The Netherlands
| | - P N R Dekhuijzen
- Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, The Netherlands
| | - H Chrystyn
- Talmedica Ltd, Rossendale and Faculty of Human and Health Sciences, University of Plymouth, Plymouth, United Kingdom
| | - A Melani
- Respiratory Rehabilitation and Pathophysiology Unit, Cardiovascular and Lung Department, Policlinico le Scotte, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Y Zöllner
- Hamburg University of Applied Sciences, Hamburg, Germany; Econ-Epi, Wentorf/Hamburg, Germany
| | - K Kolbe
- Econ-Epi, Wentorf/Hamburg, Germany
| | - A T Watson
- Covance Market Access, London, United Kingdom
| | - M Blackney
- Covance Market Access, London, United Kingdom.
| | - A Plich
- Market Access Department, Teva Pharmaceuticals Europe B.V., The Netherlands
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Maman K, Zöllner Y, Greco D, Duru G, Sendyona S, Remy V. The value of childhood combination vaccines: From beliefs to evidence. Hum Vaccin Immunother 2015; 11:2132-41. [PMID: 26075806 PMCID: PMC4635899 DOI: 10.1080/21645515.2015.1044180] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/26/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022] Open
Abstract
Although vaccination is one of the most cost-effective health care interventions, under-vaccination and variation in coverage rates lower than policy targets is rising in developed countries, partly due to concerns about vaccination value and benefits. By merging various antigens into a single product, combination vaccines represent a valuable tool to mitigate the burden associated with the numerous injections needed to protect against vaccine preventable infectious diseases and increase coverage rate, possibly through various behavioral mechanisms which have yet to be fully explored. Beyond their cost-effectiveness in protecting against more diseases with fewer injections, combination vaccines also have several other benefits, for children, their parents/carers, as well as for the health system and the population as a whole. The objectives of this review are to identify and illustrate the value of combination vaccines for childhood immunization. Evidence was classified into 2 groups: benefits for society and benefits for public health and healthcare systems. This article also highlights the value of innovation and challenges of combination vaccine development as well as the need for an increased number of suppliers to mitigate the impact of any potential vaccine shortage. Increasing public confidence in vaccines and combination vaccines is also critical to fully exploit their benefits.
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Affiliation(s)
| | - York Zöllner
- Health Economics; Hamburg University of Applied Sciences; Hamburg, Germany
| | - Donato Greco
- Centre for Science; Society and Citizenship; Rome, Italy
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11
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Rémy V, Zöllner Y, Heckmann U. Vaccination: the cornerstone of an efficient healthcare system. J Mark Access Health Policy 2015; 3:27041. [PMID: 27123189 PMCID: PMC4802703 DOI: 10.3402/jmahp.v3.27041] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 05/11/2015] [Accepted: 05/13/2015] [Indexed: 05/09/2023]
Abstract
Vaccination has made an important contribution to the decreased incidence of numerous infectious diseases and associated mortality. In 2013, it was estimated that 103 million cases of childhood diseases in the United States had been prevented by the use of vaccines since 1924. These health effects translate into positive economic results, as vaccination can provide significant savings by avoiding the direct and indirect costs associated with treating the disease and possible long-term disability. A recent US study estimated that every dollar spent on childhood vaccination could save US$3 from a payer perspective and US$10 from a societal perspective. The first vaccines set a high standard from a public health 'return on investment' perspective, because they are highly cost-saving. Today, however, where only a few healthcare interventions are considered to be cost-saving, the challenge that decision-makers typically face is to identify such healthcare interventions that are deemed cost-effective, that is, provide extra benefit at a reasonable extra cost. Some of the newer vaccines provide a solution to some of today's important health issues, such as cervical cancers with human papillomavirus vaccines, or debilitating diseases with herpes zoster vaccines. These recent, more expensive vaccines have been shown to be cost-effective in several economic analyses. Overall, vaccination can still be regarded as one of the most cost-effective healthcare interventions.
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Affiliation(s)
- Vanessa Rémy
- Sanofi Pasteur MSD, Lyon, France
- Correspondence to: Vanessa Rémy, Sanofi Pasteur MSD, 162 avenue Jean Jaure`s, 69367 Lyon Cedex 07,
France,
| | - York Zöllner
- Hamburg University of Applied Sciences, Hamburg, Germany
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12
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Affiliation(s)
| | - Nathalie Henne
- Hamburg University of Applied Sciences, Hamburg, Germany
| | - York Zöllner
- Hamburg University of Applied Sciences, Hamburg, Germany
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13
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Ricciardi GW, Toumi M, Weil-Olivier C, Ruitenberg EJ, Dankó D, Duru G, Picazo J, Zöllner Y, Poland G, Drummond M. Comparison of NITAG policies and working processes in selected developed countries. Vaccine 2014; 33:3-11. [PMID: 25258100 DOI: 10.1016/j.vaccine.2014.09.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 09/05/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Vaccines are specific medicines characterized by two country-specific market access processes: (1) a recommendation by National Immunization Technical Advisory Group (NITAG), and (2) a funding policy decision. OBJECTIVES The objective of this study was to compare and analyze NITAGs of 13 developed countries by describing vaccination committees' bodies and working processes. METHODS Information about NITAGs bodies and working processes was searched from official sources from June 2011 to November 2012. Retrieved information was completed from relevant articles identified through a systematic literature review and by information provided by direct contact with NITAGs or parent organizations. An expert panel was also conducted to discuss, validate, and provide additional input on obtained results. RESULTS While complete information, defined as 100%, was retrieved only for the UK, at least 80% of data was retrieved for 9 countries out of the 13 selected countries. Terms of references were identified in 7 countries, and the main mission for all NITAGs was to provide advice for National immunization programs. However, these terms of references did not fully encompass all the actual missions of the NITAGs. Decision analysis frameworks were identified for 10 out of the 13, and all NITAGs considered at least four criteria for decision-making: disease burden, efficacy/effectiveness, safety and cost-effectiveness. Advices were published by most NITAGs, but few NITAGs published meeting agendas and minutes. Only the United States had open meetings. CONCLUSIONS This study supports previous findings about the disparities in NITAGs processes which could potentially explain the disparity in access to vaccinations and immunization programs across Europe. With NITAGs recommendations being used by policy decision makers for implementation and funding of vaccine programs, guidances should be well-informed and transparent to ensure National Immunization Programs' (NIP) credibility among the public and health care professionals.
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Affiliation(s)
- G W Ricciardi
- European Public Health Association and Department of Public Health, Catholic University of the Sacred Heart, Rome, Italy
| | - M Toumi
- University Aix-Marseille, Faculty of Medicine - Public Health, Marseilles, France.
| | | | - E J Ruitenberg
- Health Council of the Netherlands, The Hague, VU University Amsterdam, Amsterdam, The Netherlands
| | - D Dankó
- Corvinus University of Budapest, Budapest, Hungary
| | - G Duru
- CYKLAD Group, Rillieux Pape, France
| | - J Picazo
- Hospital Clinico, Universidad Complutense, Madrid, Spain
| | - Y Zöllner
- Faculty of Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - G Poland
- Mayo Vaccine Research Group, Mayo Clinic, Rochester, MN, USA
| | - M Drummond
- Centre for Health Economics, University of York, York, UK
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Hechtner MC, Vogt T, Zöllner Y, Schröder S, Sauer JB, Binder H, Singer S, Mikolajczyk R. Quality of life in Parkinson's disease patients with motor fluctuations and dyskinesias in five European countries. Parkinsonism Relat Disord 2014; 20:969-74. [DOI: 10.1016/j.parkreldis.2014.06.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 05/21/2014] [Accepted: 06/01/2014] [Indexed: 10/25/2022]
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15
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Schröder S, Kuessner D, Arnold G, Zöllner Y, Jones E, Schaefer M. Do neurologists in Germany adhere to the national Parkinson's disease guideline? Neuropsychiatr Dis Treat 2011; 7:103-10. [PMID: 21552312 PMCID: PMC3083983 DOI: 10.2147/ndt.s8895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Indexed: 11/23/2022] Open
Abstract
Implementation of guidelines can improve clinical practice. The aim in this study was to investigate whether neurologists in Germany adhered to the national Parkinson's disease guideline. Data were obtained from a cross-sectional survey of 60 neurologists. Analyses were performed on 320 patients with idiopathic Parkinson's disease with either low grades of functional impairment (Hoehn and Yahr stage I) or higher grades of functional impairment (stage II-V) but without motor complications. The sample was divided into four groups depending on age and grade of functional impairment. For each group, a biometric parameter on the use of dopamine agonists and L-dopa was defined based on the guideline. In patients aged <70 years, the recommendation to use dopamine agonists without L-dopa (parameter 1) was observed in 53% of patients with lower grades of functional impairment, whilst recommended use of dopamine agonists in more functionally impaired patients (parameter 2) was followed to a greater extent (84%). In patients aged ≥70 years, recommendations to use L-dopa without dopamine agonists were adhered to in only 50% of less functionally impaired (parameter 3) and 52% of more functionally impaired (parameter 4) patients. In conclusion, our results indicated there was moderate but not full adherence to the guideline.
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Affiliation(s)
- Sabrina Schröder
- Institute of Clinical Pharmacology, Charité University Medicine, CCM, Berlin, Germany
| | | | - Guy Arnold
- Department of Neurology, Sindelfingen-Böblingen Hospital, Sindelfingen, Germany
| | | | | | - Marion Schaefer
- Institute of Clinical Pharmacology, Charité University Medicine, CCM, Berlin, Germany
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16
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Schwander B, Gradl B, Zöllner Y, Lindgren P, Diener HC, Lüders S, Schrader J, Villar FA, Greiner W, Jönsson B. Cost-utility analysis of eprosartan compared to enalapril in primary prevention and nitrendipine in secondary prevention in Europe--the HEALTH model. Value Health 2009; 12:857-871. [PMID: 19508663 DOI: 10.1111/j.1524-4733.2009.00507.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To investigate the cost-utility of eprosartan versus enalapril (primary prevention) and versus nitrendipine (secondary prevention) on the basis of head-to-head evidence from randomized controlled trials. METHODS The HEALTH model (Health Economic Assessment of Life with Teveten for Hypertension) is an object-oriented probabilistic Monte Carlo simulation model. It combines a Framingham-based risk calculation with a systolic blood pressure approach to estimate the relative risk reduction of cardiovascular and cerebrovascular events based on recent meta-analyses. In secondary prevention, an additional risk reduction is modeled for eprosartan according to the results of the MOSES study ("Morbidity and Mortality after Stroke--Eprosartan Compared to Nitrendipine for Secondary Prevention"). Costs and utilities were derived from published estimates considering European country-specific health-care payer perspectives. RESULTS Comparing eprosartan to enalapril in a primary prevention setting the mean costs per quality adjusted life year (QALY) gained were highest in Germany (Euro 24,036) followed by Belgium (Euro 17,863), the UK (Euro 16,364), Norway (Euro 13,834), Sweden (Euro 11,691) and Spain (Euro 7918). In a secondary prevention setting (eprosartan vs. nitrendipine) the highest costs per QALY gained have been observed in Germany (Euro 9136) followed by the UK (Euro 6008), Norway (Euro 1695), Sweden (Euro 907), Spain (Euro -2054) and Belgium (Euro -5767). CONCLUSIONS Considering a Euro 30,000 willingness-to-pay threshold per QALY gained, eprosartan is cost-effective as compared to enalapril in primary prevention (patients >or=50 years old and a systolic blood pressure >or=160 mm Hg) and cost-effective as compared to nitrendipine in secondary prevention (all investigated patients).
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17
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Rychlik R, Heinen-Kammerer T, Rusche H, Piercy J, Scuffham P, Zöllner Y. [Cost-effectiveness of prophylaxis and treatment of influenza]. Dtsch Med Wochenschr 2003; 128:2267-70. [PMID: 14574642 DOI: 10.1055/s-2003-43100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- R Rychlik
- Institut für Empirische Gesundheitsökonomie, Burscheid.
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