A simulation-based framework for risk assessment and probabilistic sensitivity analysis of base-isolated structures

ObjectivesArgentina is a low and middle-income country (LMIC) with a highly fragmented healthcare system that conflicts with access to healthcare stated by the country’s Universal Health Coverage plan. A tele-mammography network could improve access to breast cancer screening decreasing its mortality. This research aims to conduct an economic evaluation of the implementation of a tele-mammography program to improve access to healthcare.MethodsA cost-utility analysis was performed to explore the incremental benefit of annual tele-mammography screening for at-risk Argentinian women over 40 years old. A Markov model was developed to simulate annual mammography or tele-mammography screening in two hypothetical population-based cohorts of asymptomatic women. Parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analysis. Model structure uncertainty was also explored to test the robustness of the results.ResultsIt was estimated that 31 out of 100 new cases of breast cancer would be detected by mammography and 39/100 by tele-mammography. The model returned an incremental cost-effectiveness ratio (ICER) of £26 051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended threshold of £26 288/QALY for Argentina. Deterministic sensitivity analysis showed the ICER is most sensitive to the uptake and sensitivity of the screening tests. Probabilistic sensitivity analysis showed tele-mammography is cost-effective in 59% of simulations.DiscussionTele-mammography should be considered for adoption as it could improve access to expertise in underserved areas where adherence to screening protocols is poor. Disaggregated data by province is needed for a better- informed policy decision. Telemedicine could also be beneficial in ensuring the continuity of care when health systems are under stress like in the current COVID-19 pandemic.ConclusionThere is a 59% chance that tele-mammography is cost-effective compared to mammography for at-risk Argentinian women over 40- years old, and should be adopted to improve access to healthcare in underserved areas of the country.

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Cost-effectiveness of pembrolizumab for treatment of platinum-resistant recurrent or metastatic head and neck squamous cell carcinoma in China: an economic analysis based on a randomised, open-label, phase III trial

BMJ Open ◽

10.1136/bmjopen-2020-038867 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038867 ◽

Cited By ~ 1

Author(s):

Wenxiu Xin ◽

Haiying Ding ◽

Qilu Fang ◽

Xiaowei Zheng ◽

Yinghui Tong ◽

...

Keyword(s):

Sensitivity Analysis ◽

Squamous Cell Carcinoma ◽

Cost Effectiveness ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Probabilistic Sensitivity Analysis ◽

Cost Effective ◽

Platinum Resistant ◽

The Cost

BackgroundPembrolizumab was recently demonstrated to have survival benefit in patients with recurrent or metastatic head and neck squamous cell carcinoma (r/mHNSCC). However, the cost-effectiveness of pembrolizumab versus chemotherapy in China remains uncertain.ObjectiveThis analysis aimed to describe the cost-effectiveness of pembrolizumab versus standard-of-care (SOC) therapy in r/mHNSCC in China.DesignA Markov model consisting of three health states (stable, progressive and dead) was developed to compare the cost and effectiveness of pembrolizumab with SOC in platinum-resistant r/mHNSCC. Model inputs for transition probabilities and toxicity were collected from the KEYNOTE-040 trial, while health utilities were estimated from a literature review. Cost data were acquired for the payer’s perspective in China. Costs and outcomes were discounted at an annual rate of 3.0%. Sensitivity analyses were conducted to test the uncertainties surrounding model parameters.Outcome measuresThe primary outcome was incremental cost-effectiveness ratios (ICERs), which were calculated as the cost per quality-adjusted life years (QALYs).ResultsThe total mean cost of pembrolizumab and SOC was US$45 861 and US$41 950, respectively. As for effectiveness, pembrolizumab yielded 0.31 QALYs compared with 0.25 QALYs for SOC therapy. The ICER for pembrolizumab versus SOC was US$65 186/QALY, which was higher than the willingness-to-pay threshold (WTP) of US$28 130/QALY in China. The univariate sensitivity analysis indicated that utility values for progressive state, probability from stable to progressive in the SOC group, as well as cost of pembrolizumab were the three most influential variables on ICER. The probabilistic sensitivity analysis demonstrated that standard therapy was more likely to be cost-effective compared with pembrolizumab at a WTP value of US$28 130/QALY. Results were robust across both univariate analysis and probabilistic sensitivity analysis.ConclusionsPembrolizumab is not likely to be a cost-effective strategy compared with SOC therapy in patients with platinum-resistant r/mHNSCC in China.Trial registration numberNCT02252042; Post-results.

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Bayesian data fusion: Probabilistic sensitivity analysis for unmeasured confounding using informative priors based on secondary data

Biometrics ◽

10.1111/biom.13436 ◽

2021 ◽

Author(s):

Leah Comment ◽

Brent A. Coull ◽

Corwin Zigler ◽

Linda Valeri

Keyword(s):

Sensitivity Analysis ◽

Data Fusion ◽

Probabilistic Sensitivity Analysis ◽

Secondary Data ◽

Informative Priors ◽

Unmeasured Confounding ◽

Bayesian Data Fusion

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PNS212 Applying a Normal Distribution to Costs in Probabilistic Sensitivity Analysis â€“ NOT Necessarily a Negative Outcome

Value in Health ◽

10.1016/j.jval.2020.08.1656 ◽

2020 ◽

Vol 23 ◽

pp. S676

Author(s):

N. Manga

Keyword(s):

Sensitivity Analysis ◽

Normal Distribution ◽

Probabilistic Sensitivity Analysis ◽

Negative Outcome

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Cost-effectiveness of dual-mobility components in patients with displaced femoral neck fractures

The Bone & Joint Journal ◽

10.1302/0301-620x.103b12.bjj-2021-0495.r2 ◽

2021 ◽

Vol 103-B (12) ◽

pp. 1783-1790

Author(s):

Spencer Montgomery ◽

Jonathan Bourget-Murray ◽

Daniel Z. You ◽

Leo Nherera ◽

Amir Khoshbin ◽

...

Keyword(s):

Sensitivity Analysis ◽

Cost Effectiveness ◽

Femoral Neck ◽

Incremental Cost ◽

Probabilistic Sensitivity Analysis ◽

Cost Effective ◽

Physiological Age ◽

Base Case ◽

Dual Mobility ◽

Displaced Femoral Neck Fractures

Aims Total hip arthroplasty (THA) with dual-mobility components (DM-THA) has been shown to decrease the risk of dislocation in the setting of a displaced neck of femur fracture compared to conventional single-bearing THA (SB-THA). This study assesses if the clinical benefit of a reduced dislocation rate can justify the incremental cost increase of DM-THA compared to SB-THA. Methods Costs and benefits were established for patients aged 75 to 79 years over a five-year time period in the base case from the Canadian Health Payer’s perspective. One-way and probabilistic sensitivity analysis assessed the robustness of the base case model conclusions. Results DM-THA was found to be cost-effective, with an estimated incremental cost-effectiveness ratio (ICER) of CAD $46,556 (£27,074) per quality-adjusted life year (QALY). Sensitivity analysis revealed DM-THA was not cost-effective across all age groups in the first two years. DM-THA becomes cost-effective for those aged under 80 years at time periods from five to 15 years, but was not cost-effective for those aged 80 years and over at any timepoint. To be cost-effective at ten years in the base case, DM-THA must reduce the risk of dislocation compared to SB-THA by at least 62%. Probabilistic sensitivity analysis showed DM-THA was 58% likely to be cost-effective in the base case. Conclusion Treating patients with a displaced femoral neck fracture using DM-THA components may be cost-effective compared to SB-THA in patients aged under 80 years. However, future research will help determine if the modelled rates of adverse events hold true. Surgeons should continue to use clinical judgement and consider individual patients’ physiological age and risk factors for dislocation. Cite this article: Bone Joint J 2021;103-B(12):1783–1790.

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