A symptomatic approach to tuberculosis screening for high-risk groups in Malaysia: Cost-effectiveness and budget impact analysis

BACKGROUND

One of the crucial areas of eliminating TB is the early detection of cases through the screening programme. This study's focal point is to measure the relative cost-effectiveness and budget impact of the symptomatic approach compared to the existing approach of TB screening (consisted of both symptomatic and asymptomatic screening) among high-risk groups in Malaysia.

METHOD

The Cost-Effectiveness Analysis (CEA) was measured using a decision tree model and the outcome is presented in terms of cost per TB case detected and the ICER. Analysis was conducted using secondary data collected from the Disease Control Division, Sabah and Sarawak State Health Departments. The robustness of the model is determined by Deterministic and Probabilistic Sensitivity Analysis. Subsequently, Budget impact over 5 years period, from 2018 to 2022 was estimated for both approaches.

RESULTS

The symptomatic approach was more cost-effective than the existing approach with ICER of MYR 424.71. The cost of conducting Sputum for Acid Fast Bacilli (SAFB) was found as the key driver for ICER. Budget Impact Analysis showed that switching from the existing approach towards the symptomatic approach would result in a cost-saving of MYR 65.5 million over 5 years. However, this would lead to 4473 TB cases being undetected over the same duration.

CONCLUSION

This study suggests that the policymakers have to weigh the trade-off between cost-saving and TB case detection. This cost-saving can be channelled to new TB intervention programme with a higher chance of TB case detection. Nevertheless, any decision made must be in concordance to the objectives of the country's TB programme.

Budget impact analysis of a multifaceted nurse-led intervention to reduce indwelling urinary catheter use in New South Wales Hospitals

BACKGROUND

In hospitals, catheter acquired urinary tract infection causes significant resource waste and discomfort among admitted patients. An intervention for reducing indwelling catheterisations - No-CAUTI - was trialled across four hospitals in New South Wales, Australia. No-CAUTI includes: train-the-trainer workshops, site champions, compliance audits, and point prevalence surveys. The trial showed reductions on usual care catheterisation rates at 4- and 9-month post-intervention. This result was statistically non-significant; and post-intervention catheterisation rates rebounded between 4 and 9 months. However, No-CAUTI showed statistically significant catheterisation decreases for medical wards, female patients and for short-term catheterisations. This study presents a budget impact analysis of a projected five year No-CAUTI roll out across New South Wales public hospitals, from the cost perspective of the New South Wales Ministry of Health.

METHODS

Budget forecasts were made for five year roll outs of: i) No-CAUTI; and ii) usual care, among all public hospitals in New South Wales hosting overnight stays (n=180). The roll out design maintains intervention effectiveness with ongoing workshops, quality audits, and hospital surveys. Forecasts of catheterisations, procedures and treatments were modelled on No-CAUTI trial observations. Costs were sourced from trial records, the Medical Benefits Scheme, the Pharmaceutical Benefits Scheme and public wage awards. Cost and parameter uncertainties were considered with sensitivity scenarios.

RESULTS

The estimated five-year No-CAUTI roll-out cost was $1.5 million. It had an overall budget saving of $640,000 due to reductions of 100,100 catheterisations, 33,300 urine tests and 6,700 antibiotics administrations. Non-Metropolitan hospitals had a net saving of $1.2 million, while Metropolitan hospitals had a net cost of $0.54 million.

CONCLUSIONS

Compared to usual care, NO-CAUTI is expected to realise overall budget savings and decreases in catheterisations over five years. These findings allow a consideration of the affordability of a wide implementation.

TRIAL REGISTRATION

Registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12617000090314 ). First registered 17 January 2017, retrospectively. First enrolment, 15/11/2016.

Budget impact analysis of heparin-bonded polytetrafluoroethylene grafts (Propaten) against standard polytetrafluoroethylene grafts for below-the-knee bypass in patients with critical limb ischaemia in France

OBJECTIVES

To evaluate the budget impact of progressive replacement of standard polytetrafluoroethylene (PTFE) grafts by heparin-bound PTFE (Propaten) for below-the-knee (BTK) bypass in patients with critical limb ischaemia (CLI).

DESIGN

From a review of the scientific literature, we calculated a theoretical BTK primary patency for Propaten grafts. Using the French hospital expenditure database (PMSI), we retrospectively estimated a rehospitalisation rate for standard PTFE grafts. From these data, a model was created to assess the budget impact of a progressive replacement from standard PTFE grafts to Propaten grafts over a 5-year horizon. We performed an univariate sensitivity analysis to assess the robustness of our results.

SETTING

French National Health Insurance (FNHI) perspective.

PARTICIPANT

Patients with CLI.

MAIN OUTCOME MEASURES

Budget impact analysis.

RESULTS

Data extraction from the PMSI revealed that 656 patients were treated with PTFE grafts in 2011 in French public hospitals for a BTK bypass. Assuming a 2-year survival rate of 76.8%, observed reinterventions rate for standard PTFE grafts at 24 months from the PMSI was 35.1%. The mean rehospitalisation cost was €10 689. The budget impact analysis based on these data found a net cumulative 5-year payer budget reduction of €112 420 in favour of Propaten, under the assumption of a 75.6% primary patency for Propaten grafts for a projected population of 3215 patients of which 801 received a Propaten graft.

CONCLUSIONS

Our budget impact analysis showed a positive impact on the national health insurance budget of the replacement of standard PTFE grafts by Propaten grafts for BTK bypass in patients with CLI in France. This supports the enactment of a reimbursement policy by the FNHI.

Budget impact and cost-effectiveness analyses of direct-acting antivirals for chronic hepatitis C virus infection in Hong Kong. Eur J Clin Microbiol Infect Dis. 2017;36:1801-1809. [PMID: 28516201 DOI: 10.1007/s10096-017-2995-7]

The purpose of this investigation was to evaluate the budget impact and cost-effectiveness of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infection in Hong Kong. A decision analytic model was developed to compare short-term costs and health outcomes of patients with chronic HCV genotype 1 infection in Hong Kong who were treated with an interferon (INF)-based treatment (dual therapy of pegylated interferon and ribavirin) or DAA-based treatments (sofosbuvir or ledipasvir/sofosbuvir or ombitasvir/paritaprevir/ritonavir plus dasabuvir). Compared to INF-based treatment, DAA-based treatments yielded an incremental cost of $24,677-$31,171 per course while improving the rate of sustained virologic response (SVR) from 59-66% to 82.3-99.8%. The incremental cost-effective ratios of DAA-based treatments ranged from $9724 to $29,189 per treatment success, which were all below the cost-effectiveness threshold of local GDP per capita ($42,423 in 2015). Introducing DAAs resulted in a 126.1% ($383.7 million) budget increase on HCV infection management over 5 years. A 50% change in DAA medication costs reflected a change in the incremental budget from $55.2 to $712.3 million. DAA-based treatments are cost-effective alternatives to INF-based treatment in Hong Kong. Introducing DAAs to the public hospital formulary yields a considerable budget increase but is still economically favorable to the local government.

Introduction of a quadrivalent influenza vaccine in Italy: a budget impact analysis

Every year in Italy, the Ministry of Health (MoH) offers influenza vaccination free of charge to all subjects at risk and to all subjects aged ≥ 65 year old. Until 2014-2015 immunization campaign against Trivalent Influenza Vaccine (TIVs) were the only vaccines used in Italy. Traditional TIVs contain antigens from three viral strains: A(H1N1), A(H3N2), and one of the two B lineages: B(Victoria) or B(Yamagata). Each year, the World Health Organization (WHO) decides which viral strains should be included in the next seasonal influenza vaccine. However, accurately predicting which B-lineage strain will predominate in the upcoming season has proved to be a challenging task, owing to the co-circulation of both lineages. To address the issue of B-mismatch, a new Quadrivalent Influenza Vaccine (QIV) containing both B-lineage strains has been developed, in order to achieve broader protection against influenza. The new QIV was approved in Italy in 2015 and included by the MoH in the national recommendations for the seasonal immunization campaign against influenza 2015-2016. Recently, a Health Technology Assessment (HTA) Report has shown that, in comparison with TIVs, the new QIV is cost-effective (Incremental Cost-Effectiveness Ratio (ICER) = € 18,883/ (QALY) Quality-Adjusted Life-Year) from the Italian National Health Service (NHS) perspective. The present Budget Impact Analysis (BIA) showed that the introduction of the QIV with a 9% market share in the vaccine mix for the 2015-2016 flu campaign would yield an annual saving of € 674,089, mainly owing to the broader protection offered by QIV vs TIVs with an estimated 49.12% B-mismatch.