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Welp H, Sindermann J, Dell'Aquila AM, Deschka H, Hoffmeier A, Scherer M. Economic aspects of long-term left ventricular assist device treatment for chronic heart failure. ESC Heart Fail 2024. [PMID: 38769653 DOI: 10.1002/ehf2.14774] [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] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/19/2023] [Accepted: 03/10/2024] [Indexed: 05/22/2024] Open
Abstract
AIMS Technological advances and the current shortage of donor organs have contributed to an increase in the number of left ventricular assist device (LVAD) implantations in patients with end-stage heart failure. Demographic change and medical progress might raise the number of these patients, resulting in a further increase in the number of LVAD implantations. The aim of this study was to evaluate the long-term costs of LVAD therapy and identify diagnoses resulting in expensive stays. METHODS AND RESULTS In this retrospective analysis of prospectively collected data, all patients after implantation of a second- or third-generation LVAD by 31 March 2022 were included. In addition to demographic and survival data, revenues and case mix points were determined for each patient. Of the 163 patients included, 75.5% were male. The mean age at LVAD implantation was 52 ± 14 years. The mean survival was 1458 ± 127 days. During follow-up, the total inpatient treatment time per patient was 70 ± 87 days. The average duration of outpatient treatment was 55.1%, based on the total duration of support. The average revenue per patient for the implant stay was $193 192.35 ± $111 801.29, for inpatient readmissions $52 068.96 ± $116 630.00, and for outpatient care $53 195.94 ± $62 363.53. CONCLUSIONS LVAD implantation in patients with end-stage heart failure leads to improved survival but a significant increase in treatment costs. Further multi-centre studies are necessary in order to be able to assess the effects of long-term LVAD treatment on the healthcare system.
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Affiliation(s)
- Henryk Welp
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
- Interdisciplinary Heart Failure Section, University Hospital of Muenster, Muenster, Germany
| | - Jürgen Sindermann
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
- Interdisciplinary Heart Failure Section, University Hospital of Muenster, Muenster, Germany
- Department of Cardiology I-Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital of Muenster, Muenster, Germany
| | - Angelo Maria Dell'Aquila
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
| | - Heinz Deschka
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
| | - Andreas Hoffmeier
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
| | - Mirela Scherer
- Department of Cardiothoracic Surgery, University Hospital of Muenster, Albert Schweitzer Campus 1, A1, 48149, Muenster, Germany
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Yao Y, Zhou Z, Geng T, Cai A, Li T, Yang J, Chen J, Li L. Long-term cost-effectiveness of transcatheter mitral valve repair in HF patients with secondary mitral regurgitation. ESC Heart Fail 2024. [PMID: 38515335 DOI: 10.1002/ehf2.14729] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 03/23/2024] Open
Abstract
AIMS The long-term cost-effectiveness of MitraClip in heart failure patients with secondary mitral regurgitation is still unclear. This study aimed to evaluate the long-term cost-effectiveness of MitraClip added to guideline-directed medical therapy vs. guideline-directed medical therapy alone in heart failure patients with secondary mitral regurgitation from the perspective of the healthcare systems of mainland China, the United Kingdom, Germany, and the United States. METHODS AND RESULTS A two-stage (decision + Markov) model was built. Health utilities were defined by the New York Heart Association class, heart failure re-hospitalization, and death and were calculated based on the 5 year follow-up results of the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation trial. Direct healthcare costs were derived from the nationally representative data. Future utilities and costs were discounted at country-specific rates. The primary outcome was the lifetime incremental cost-effectiveness ratio. The mean age of the base case in our model was 72.2 years. Over a lifetime horizon, treatment with MitraClip was associated with 829 fewer heart failure re-hospitalizations per 1000 treated patients. The MitraClip treatment was associated with incremental quality-adjusted life-year gains of 0.71, 0.76, 0.78, and 0.78, as well as incremental cost-effectiveness ratios of ¥468 462, £28 910, €26 045, and $71 199 per quality-adjusted life-year for a lifetime horizon in mainland China, the United Kingdom, Germany, and the United States, respectively. In probabilistic sensitivity analysis, 0.2%, 59.4%, 99.6%, and 84.7% of patients were cost-effective in mainland China, the United Kingdom, Germany, and the United States at the country-specific willingness-to-pay thresholds. CONCLUSIONS MitraClip + guideline-directed medical therapy was cost-effective in heart failure patients with secondary mitral regurgitation in the United Kingdom, Germany, and the United States, but not in mainland China from the perspective of the national healthcare system.
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Affiliation(s)
- Younan Yao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Ziyou Zhou
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
- Department of Cardiology, School of Medicine, South China University of Technology, Guangzhou, China
| | - Tian Geng
- Department of Emergency, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Anping Cai
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Tian Li
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Junqing Yang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
- Department of Cardiology, School of Medicine, South China University of Technology, Guangzhou, China
| | - Liwen Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510080, China
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Davis JA, Booth D, McEwan P, Solomon SD, McMurray JJV, de Boer RA, Comin-Colet J, Bachus E, Chen J. Cost-effectiveness of dapagliflozin for patients with heart failure across the spectrum of ejection fraction: A pooled analysis of DAPA-HF and DELIVER data. Eur J Heart Fail 2024. [PMID: 38509642 DOI: 10.1002/ejhf.3197] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Abstract
AIM To assess the cost-effectiveness of dapagliflozin in addition to usual care, compared with usual care alone, in a large population of patients with heart failure (HF), spanning the full range of left ventricular ejection fraction (LVEF). METHODS AND RESULTS Patient-level data were pooled from HF trials (DAPA-HF, DELIVER) to generate a population including HF with reduced, mildly reduced and preserved LVEF, to increase statistical power and enable exploration of interactions among LVEF, renal function and N-terminal pro-B-type natriuretic peptide levels, as they are relevant determinants of health status in this population. Survival and HF recurrent event risk equations were derived and applied to a lifetime horizon Markov model with health states defined by Kansas City Cardiomyopathy Questionnaire total symptom score quartiles; costs and utilities were in the UK setting. The base case incremental cost-effectiveness ratio (ICER) was £6470 per quality-adjusted life year (QALY) gained, well below the UK willingness-to-pay (WTP) threshold of £20 000/QALY gained. In interaction sensitivity analyses, the highest ICER was observed for elderly patients with preserved LVEF (£16 624/QALY gained), and ranged to a region of dominance (increased QALYs, decreased costs) for patients with poorer renal function and reduced/mildly reduced LVEF. Results across the patient characteristic interaction plane were mostly between £5000 and £10 000/QALY gained. CONCLUSIONS Dapagliflozin plus usual care, versus usual care alone, yielded results well below the WTP threshold for the UK across a heterogeneous population of patients with HF including the full spectrum of LVEF, and is likely a cost-effective intervention.
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Affiliation(s)
- Jason A Davis
- Health Economics and Outcomes Research Ltd., Rhymney House, Unit A Copse Walk, Cardiff Gate Business Park, Pontprennau, UK
| | - David Booth
- Health Economics and Outcomes Research Ltd., Rhymney House, Unit A Copse Walk, Cardiff Gate Business Park, Pontprennau, UK
| | - Phil McEwan
- Health Economics and Outcomes Research Ltd., Rhymney House, Unit A Copse Walk, Cardiff Gate Business Park, Pontprennau, UK
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Josep Comin-Colet
- Cardiology Department, Bellvitge University Hospital (IDIBELL), University of Barcelona and CIBERCV, Barcelona, Spain
| | - Erasmus Bachus
- AstraZeneca R&D BioPharmaceuticals, One Medimmune Way, Gaithersburg, MD, USA
| | - Jieling Chen
- AstraZeneca R&D BioPharmaceuticals, One Medimmune Way, Gaithersburg, MD, USA
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Rodriguez-Martinez CE, Sossa-Briceño MP, Nino G. Oxygen saturation thresholds for bronchiolitis at high altitudes: a cost-effectiveness analysis. Expert Rev Pharmacoecon Outcomes Res 2023; 23:527-533. [PMID: 36922366 DOI: 10.1080/14737167.2023.2192482] [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] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND There is evidence suggesting that exaggerated reliance on pulse oximetry (SpO2) and the use of arbitrary/inadequate thresholds of SpO2 might drive unnecessary hospitalizations for viral bronchiolitis, especially among high-altitude residents. The aim of the present study was to compare the cost-effectiveness of two oxygen SpO2 thresholds for deciding whether infants with viral bronchiolitis living at high altitudes need hospital admission or can be discharged home. METHODS A cost-effectiveness study was performed to compare the cost and clinical outcomes of two oxygen SpO2 thresholds, adjusted or not, to an altitude above the sea level of Bogota, Colombia (2640 m), for deciding whether infants with viral bronchiolitis need hospitalization or can be discharged home. The principal outcome was avoidance of hospital admission. RESULTS Compared to the use of an SpO2 threshold of 90%, using an SpO2 threshold of 85% in infants with viral bronchiolitis was associated with lower overall costs (US$130.4 vs. US$194.0 average cost per patient) and a higher probability of hospitalization avoided (0.7500 vs. 0.5900), thus leading to dominance. CONCLUSIONS The use of an SpO2 threshold below 90% for deciding on hospitalization in infants with viral bronchiolitis living at high altitudes appears to be logical, secure, and cost-effective.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
- Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | - Monica P Sossa-Briceño
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Gustavo Nino
- Division of Pediatric Pulmonary, Sleep Medicine and Integrative Systems Biology. Center for Genetic Research, Children's National Medical Center, George Washington University, Washington, United States
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Latimer NR, Pollard D, Towse A, Henshall C, Sansom L, Ward RL, Bruce A, Deakin C. Challenges in valuing and paying for combination regimens in oncology: reporting the perspectives of a multi-stakeholder, international workshop. BMC Health Serv Res 2021; 21:412. [PMID: 33941174 PMCID: PMC8091555 DOI: 10.1186/s12913-021-06425-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 10/27/2020] [Accepted: 04/21/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It is increasingly common for two or more treatments for cancer to be combined as a single regimen. Determining value and appropriate payment for such regimens can be challenging. This study discusses these challenges, and possible solutions. METHODS Stakeholders from around the world attended a 2-day workshop, supported by a background paper. This study captures key outcomes from the discussion, but is not a consensus statement. RESULTS Workshop attendees agreed that combining on-patent treatments can result in affordability and value for money challenges that delay or deny patient access to clinically effective treatments in many health systems. Options for addressing these challenges include: (i) Increasing the value of combination therapies through improved clinical development; (ii) Willingness to pay more for combinations than for single drugs offering similar benefit, or; (iii) Aligning the cost of constituent therapies with their value within a regimen. Workshop attendees felt that (i) and (iii) merited further discussion, whereas (ii) was unlikely to be justifiable. Views differed on the feasibility of (i). Key to (iii) would be systems allowing different prices to apply to different uses of a drug. CONCLUSIONS Common ground was identified on immediate actions to improve access to combination regimens. These include an exploration of the legal challenges associated with price negotiations, and ensuring that pricing systems can support implementation of negotiated prices for specific uses. Improvements to clinical development and trial design should be pursued in the medium and longer term.
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Affiliation(s)
- Nicholas R Latimer
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, UK.
| | - Daniel Pollard
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, UK
| | | | | | - Lloyd Sansom
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Robyn L Ward
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Carla Deakin
- National Institute for Health and Care Excellence, Manchester, UK
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Wei H, Cui C, Cui X, Liu Y, Li D. Cost-effectiveness analysis of dabigatran, rivaroxaban and warfarin in the prevention of stroke in patients with atrial fibrillation in China. BMC Health Serv Res 2021; 21:96. [PMID: 33509171 PMCID: PMC7841891 DOI: 10.1186/s12913-021-06084-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 01/13/2021] [Indexed: 01/15/2023] Open
Abstract
Background and objective To evaluate the cost-effectiveness of new anticoagulants and warfarin in the prevention of stroke in Chinese patients with atrial fibrillation (AF). Methods The Markov model was constructed to compare patients’ quality-adjusted life-years (QALYs) using drug cost, the cost of the examination after taking a drug, and the incremental cost of other treatments. Both dabigatran (110 and 150 mg, twice a day) and rivaroxaban (20 mg, once a day) were compared with warfarin (3–6 mg, once a day). Willingness to pay, three times the 2018 China GDP per capita (9481.88 $), was the cost-effect threshold in our study. Results The total cost were was 5317.31$, 29673.33$, 23615.49$, and 34324.91$ for warfarin, rivaroxaban, dabigatran 110 mg bid, and dabigatran 150 mg bid, respectively. The QALYs for each of the four interventions were 11.07 years, 15.46 years, 12.4 years, and 15 years, respectively. The cost-effectiveness analysis of the three new oral anticoagulants and warfarin showed that the incremental cost-effectiveness ratio (ICER) was 5548.07$/QALY when rivaroxaban was compared with warfarin. Rivaroxaban was the most cost-effective choice and warfarin was the least. Conclusions In Chinese patients with AF, although warfarin is cheaper, rivaroxaban has a better cost-effectiveness advantage from an economic point of view.
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Affiliation(s)
- Hongtao Wei
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China
| | - Can Cui
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China
| | - Xiangli Cui
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China.
| | - Yi Liu
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China
| | - Dandan Li
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China
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Cleary SM, Wilkinson T, Tamandjou Tchuem CR, Docrat S, Solanki GC. Cost-effectiveness of intensive care for hospitalized COVID-19 patients: experience from South Africa. BMC Health Serv Res 2021; 21:82. [PMID: 33482807 PMCID: PMC7820836 DOI: 10.1186/s12913-021-06081-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Given projected shortages of critical care capacity in public hospitals during the COVID-19 pandemic, the South African government embarked on an initiative to purchase this capacity from private hospitals. In order to inform purchasing decisions, we assessed the cost-effectiveness of intensive care management for admitted COVID-19 patients across the public and private health systems in South Africa. METHODS Using a modelling framework and health system perspective, costs and health outcomes of inpatient management of severe and critical COVID-19 patients in (1) general ward and intensive care (GW + ICU) versus (2) general ward only (GW) were assessed. Disability adjusted life years (DALYs) were evaluated and the cost per admission in public and private sectors was determined. The model made use of four variables: mortality rates, utilisation of inpatient days for each management approach, disability weights associated with severity of disease, and the unit cost per general ward day and per ICU day in public and private hospitals. Unit costs were multiplied by utilisation estimates to determine the cost per admission. DALYs were calculated as the sum of years of life lost (YLL) and years lived with disability (YLD). An incremental cost-effectiveness ratio (ICER) - representing difference in costs and health outcomes of the two management strategies - was compared to a cost-effectiveness threshold to determine the value for money of expansion in ICU services during COVID-19 surges. RESULTS A cost per admission of ZAR 75,127 was estimated for inpatient management of severe and critical COVID-19 patients in GW as opposed to ZAR 103,030 in GW + ICU. DALYs were 1.48 and 1.10 in GW versus GW + ICU, respectively. The ratio of difference in costs and health outcomes between the two management strategies produced an ICER of ZAR 73,091 per DALY averted, a value above the cost-effectiveness threshold of ZAR 38,465. CONCLUSIONS Results indicated that purchasing ICU capacity from the private sector during COVID-19 surges may not be a cost-effective investment. The 'real time', rapid, pragmatic, and transparent nature of this analysis demonstrates an approach for evidence generation for decision making relating to the COVID-19 pandemic response and South Africa's wider priority setting agenda.
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Affiliation(s)
- S M Cleary
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - T Wilkinson
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - C R Tamandjou Tchuem
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - S Docrat
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - G C Solanki
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,NMG Consultants and Actuaries, Cape Town, South Africa
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Wu B, Gu X, Zhang Q, Xie F. Cost-Effectiveness of Osimertinib in Treating Newly Diagnosed, Advanced EGFR-Mutation-Positive Non-Small Cell Lung Cancer. Oncologist 2018; 24:349-357. [PMID: 30257889 DOI: 10.1634/theoncologist.2018-0150] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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] [Received: 03/09/2018] [Accepted: 07/24/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The objective of this study was to assess cost and effectiveness of osimertinib in treating newly diagnosed advanced non-small cell lung cancer with an epidermal growth factor receptor (EGFR) mutation from a public payer's perspective in the U.S. and China. MATERIALS AND METHODS Markov models were developed to compare three treatment strategies: first-line use of osimertinib, first-line use of the standard first-generation EGFR-tyrosine kinase inhibitor (EGFR-TKI) followed by the second-line use of osimertinib, and the standard first-generation EGFR-TKI therapy (standard care [SOC]). Clinical data, cost, and utility data were mainly derived from published literatures. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the incremental cost per quality-adjusted life year (QALY) between the treatments. RESULTS The resultant incremental cost per QALY gained for the first-line osimertinib versus SOC was $312,903 in the U.S. and $41,512 in China. The incremental cost per QALY for the second-line osimertinib versus SOC was $284,532 in the U.S. and $38,860 in China. The probability of the SOC strategy being cost-effective is 1.0 if the willingness to pay threshold is below $150,000/QALY in the U.S. and below $30,000/QALY in China. CONCLUSION Osimertinib as first-line treatment could gain more health benefits in comparison with standard EGFR-TKIs or second-line use of osimertinib. However, because of the high cost of treatment, the cost-effectiveness analyses were not in favor of the first-line use of osimertinib from a public payer's perspective in the U.S. and China. IMPLICATIONS FOR PRACTICE Osimertinib as first-line treatment yielded the greatest health outcomes but is not a cost-effective strategy for lung cancer in the U.S. and China. The price of osimertinib has a substantial impact on economic outcomes.
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Affiliation(s)
- Bin Wu
- Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Xiaohua Gu
- Department of Respiratory Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Qiang Zhang
- Department of Oncology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Feng Xie
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- The Research Institute of St. Joe's Hamilton, Ontario, Canada
- Program for Health Economics and Outcome Measures, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis, Hamilton, Ontario, Canada
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DiazOrdaz K, Franchini AJ, Grieve R. Methods for estimating complier average causal effects for cost-effectiveness analysis. J R Stat Soc Ser A Stat Soc 2018; 181:277-297. [PMID: 29353967 PMCID: PMC5763423 DOI: 10.1111/rssa.12294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In randomized controlled trials with treatment non-compliance, instrumental variable approaches are used to estimate complier average causal effects. We extend these approaches to cost-effectiveness analyses, where methods need to recognize the correlation between cost and health outcomes. We propose a Bayesian full likelihood approach, which jointly models the effects of random assignment on treatment received and the outcomes, and a three-stage least squares method, which acknowledges the correlation between the end points and the endogeneity of the treatment received. This investigation is motivated by the REFLUX study, which exemplifies the setting where compliance differs between the randomized controlled trial and routine practice. A simulation is used to compare the methods' performance. We find that failure to model the correlation between the outcomes and treatment received correctly can result in poor confidence interval coverage and biased estimates. By contrast, Bayesian full likelihood and three-stage least squares methods provide unbiased estimates with good coverage.
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Affiliation(s)
- K. DiazOrdaz
- London School of Hygiene and Tropical MedicineUK
| | | | - R. Grieve
- London School of Hygiene and Tropical MedicineUK
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Goldstein DA, Chen Q, Ayer T, Chan KKW, Virik K, Hammerman A, Brenner B, Flowers CR, Hall PS. Bevacizumab for Metastatic Colorectal Cancer: A Global Cost-Effectiveness Analysis. Oncologist 2017; 22:694-699. [PMID: 28592621 DOI: 10.1634/theoncologist.2016-0455] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 11/16/2016] [Accepted: 03/21/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the U.S., the addition of bevacizumab to first-line chemotherapy in metastatic colorectal cancer (mCRC) has been demonstrated to provide 0.10 quality-adjusted life years (QALYs) at an incremental cost-effectiveness ratio (ICER) of $571,000/QALY. Due to variability in pricing, value for money may be different in other countries. Our objective was to establish the cost-effectiveness of bevacizumab in mCRC in the U.S., U.K., Canada, Australia, and Israel. METHODS We performed the analysis using a previously established Markov model for mCRC. Input data for efficacy, adverse events, and quality of life were considered to be generalizable and therefore identical for all countries. We used country-specific prices for medications, administration, and other health service costs. All costs were converted from local currency to U.S. dollars at the exchange rates in March 2016. We conducted one-way and probabilistic sensitivity analyses (PSA) to assess the model robustness across parameter uncertainties. RESULTS Base case results demonstrated that the highest ICER was in the U.S. ($571,000/QALY) and the lowest was in Australia ($277,000/QALY). In Canada, the U.K., and Israel, ICERs ranged between $351,000 and $358,000 per QALY. PSA demonstrated 0% likelihood of bevacizumab being cost-effective in any country at a willingness to pay threshold of $150,000 per QALY. CONCLUSION The addition of bevacizumab to first-line chemotherapy for mCRC consistently fails to be cost-effective in all five countries. There are large differences in cost-effectiveness between countries. This study provides a framework for analyzing the value of a cancer drug from the perspectives of multiple international payers. IMPLICATIONS FOR PRACTICE The cost-effectiveness of bevacizumab varies significantly between multiple countries. By conventional thresholds, bevacizumab is not cost-effective in metastatic colon cancer in the U.S., the U.K., Australia, Canada, and Israel.
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Affiliation(s)
- Daniel A Goldstein
- Davidoff Center, Rabin Medical Center, Petach, Tikvah, Israel
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Qiushi Chen
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Turgay Ayer
- H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Kelvin K W Chan
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Kiran Virik
- Department of Medicine, University of Tasmania, Tasmania, Australia
| | | | - Baruch Brenner
- Davidoff Center, Rabin Medical Center, Petach, Tikvah, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | | | - Peter S Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, United Kingdom
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Silva Miguel L, Ferreira J. [Clinical and economic consequences of using dabigatran or rivaroxaban in patients with non-valvular atrial fibrillation]. Rev Port Cardiol 2016; 35:141-8. [PMID: 26928016 DOI: 10.1016/j.repc.2015.09.009] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/13/2015] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Atrial fibrillation is a supraventricular arrhythmia that increases the risk of ischemic stroke and other thromboembolic events. Recently new treatment options have emerged whose cost-effectiveness relative to conventional therapy (warfarin) is well demonstrated. This study compares the clinical benefits and economic costs associated with the new oral anticoagulants most used in Portugal: dabigatran and rivaroxaban. METHODS The results of an indirect comparison of the RE-LY and ROCKET AF trials, which enabled differences in the efficacy of dabigatran and rivaroxaban to be determined, were used in a Markov model simulating patient outcomes in terms of ischemic and hemorrhagic stroke, transient ischemic attack, systemic embolism, acute myocardial infarction and intra- and extracranial bleeding. RESULTS The use of dabigatran is associated with better clinical results. The reduction in events is reflected in longer survival (8.41 vs. 8.26 years) and more quality-adjusted life years (5.87 vs. 5.74), while the lower daily treatment cost and the reduction in event-related costs lead to a saving of 367 euros per patient from a societal perspective. CONCLUSIONS The results show that dabigatran is a dominant alternative, i.e., it produces better clinical results at a lower cost. Sensitivity analysis demonstrates that the results are robust even considering the uncertainty inherent in an indirect comparison. It can thus be concluded that in clinical practice in Portugal the use of dabigatran is to be preferred to the use of rivaroxaban.
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Affiliation(s)
- Luís Silva Miguel
- Centro de Investigação Sobre Economia Portuguesa, Instituto Superior de Economia e Gestão, Universidade de Lisboa, Lisboa, Portugal.
| | - Jorge Ferreira
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Ferreira J, Mirco A. Systematic review of cost-effectiveness analyses of novel oral anticoagulants for stroke prevention in atrial fibrillation. Rev Port Cardiol 2015; 34:179-91. [PMID: 25727748 DOI: 10.1016/j.repc.2014.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 07/11/2014] [Accepted: 08/16/2014] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Novel oral anticoagulants are emerging options for the prevention and treatment of thromboembolic diseases. They are increasingly used in clinical practice due to their simplicity of use and clinical benefits, but an important step is to evaluate their cost-effectiveness. The aim of the AFFORD study (A Review of Cost EFFectiveness of Novel ORal Anticoagulant Drugs) was to perform a systematic review of cost-effectiveness studies of novel oral anticoagulants for stroke prevention in non-valvular atrial fibrillation (AF). METHODS A systematic review of the literature was conducted by searching the PubMed, Embase, Scopus, Cochrane and Web of Knowledge databases to identify all cost-effectiveness studies of novel oral anticoagulants for stroke prevention in AF. RESULTS The search identified 27 studies, 18 with dabigatran, three with apixaban, two with rivaroxaban and four with at least two of these drugs. The incremental cost-effectiveness ratios were 30 405 ± 16 101 euros per quality-adjusted life-year (QALY) for dabigatran 110 mg, 17 566 ± 16 902 euros/QALY for dabigatran 150 mg, 8102 ± 3252 euros/QALY for age-adjusted dabigatran, 11 897 ± 3341 euros/QALY for apixaban and 17 960 ± 12 005 euros/QALY for rivaroxaban. CONCLUSION The present systematic review demonstrates that novel oral anticoagulants are cost-effective for stroke prevention in AF.
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Affiliation(s)
| | - Ana Mirco
- Serviços Farmacêuticos, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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Gouveia M, Borges M, Trindade R, Rikner K. Economic evaluation of ticagrelor for secondary prevention following acute coronary syndromes. Rev Port Cardiol 2014; 34:17-25. [PMID: 25528973 DOI: 10.1016/j.repc.2014.08.004] [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] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/16/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES To estimate the cost-effectiveness and cost-utility of ticagrelor in the treatment of patients with acute coronary syndromes (unstable angina or myocardial infarction with or without ST-segment elevation), including patients treated medically and those undergoing percutaneous coronary intervention or coronary artery bypass grafting. METHODS A short-term decision tree and a long-term Markov model were used to simulate the evolution of patients' life-cycles. Clinical effectiveness data were collected from the PLATO trial and resource use data were obtained from the Hospital de Santa Marta database, disease-related group legislation and the literature. RESULTS Ticagrelor provides increases of 0.1276 life years and 0.1106 quality-adjusted life years (QALYs) per patient. From a societal perspective these clinical gains entail an increase in expenditure of €610. Thus the incremental cost per life year saved is €4780 and the incremental cost per QALY is €5517. CONCLUSIONS The simulation results show that ticagrelor reduces events compared to clopidogrel. The costs of ticagrelor are partially offset by lower costs arising from events prevented. The use of ticagrelor in clinical practice is therefore cost-effective compared to generic clopidogrel.
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Affiliation(s)
- Miguel Gouveia
- Católica Lisbon School of Business and Economics, Universidade Católica Portuguesa, Lisboa, Portugal
| | - Margarida Borges
- Unidade de Farmacologia Clínica, Centro Hospitalar de Lisboa Central EPE & Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Rosário Trindade
- Corporate Affairs & Market Access Department, AstraZeneca - Produtos Farmacêuticos, Lda., Lisboa, Portugal.
| | - Klas Rikner
- Global Clinical Development Department, AstraZeneca, Mölndal, Suécia
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Kimura M, Nagao K. Role of varicocele repair for male infertility in the era of assisted reproductive technologies. Reprod Med Biol 2014; 13:185-192. [PMID: 29699160 DOI: 10.1007/s12522-014-0181-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 03/21/2014] [Accepted: 04/30/2014] [Indexed: 01/10/2023] Open
Abstract
Varicocele is an abnormal condition characterized by dilatation of the pampiniform plexus veins draining the testis and is present in 15 % of men. Varicoceles have an adverse effect on spermatogenesis and are the most common cause of male infertility. Approximately 35 % of infertile men and more than 70 % of men with secondary infertility were reported to have varicoceles. Although data on methods of varicocele repair are accumulating, there remains controversy regarding the indications and techniques for varicocele repair. In addition, the role of varicocele repair in this era of assisted reproductive technologies continues to be debated. In this study, we performed a comprehensive PubMed search in order to review the current status of varicocele repair for male infertility. We reviewed English-language studies published from 1992 through 2013. After reviewing the articles, we identified a recent meta-analysis of four randomized controlled trials, which found that varicocele repair for oligozoospermic men was associated with better pregnancy rates as compared with observation. Our review of prospective studies showed that all semen parameters, including sperm concentration, motility, and progressive motility, were significantly improved after varicocele repair. We also summarize the findings of recent studies reporting beneficial effects of varicocele repair, i.e., decreased oxidative stress and sperm DNA fragmentation after varicocele repair and superior cost effectiveness versus in vitro fertilization/intracytoplasmic sperm injection alone, which may be important in the era of assisted reproductive technologies. Varicocele repair is a widespread, well-established procedure that can improve semen parameters in men with infertility. The effect of such treatment on the pregnancy rate is unclear because evidence is limited due to difficulties in recruiting patients for studies. Among the repair techniques, microsurgical repair using a subinguinal approach is potentially the best practice, although this procedure requires training in microsurgery. All these topics require further research in studies with sufficient patient enrollment and follow-up.
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Affiliation(s)
- Masaki Kimura
- Department of Urology Teikyo University School of Medicine Tokyo Japan
| | - Koichi Nagao
- Department of Urology Toho University School of Medicine Tokyo Japan
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