Uncertainty, Probabilistic Analysis and Outputs from Cost Effectiveness Analyses

2015 ◽  
pp. 59-76
Author(s):  
Richard Edlin ◽  
Christopher McCabe ◽  
Claire Hulme ◽  
Peter Hall ◽  
Judy Wright
Keyword(s):  
Cost Effectiveness ◽  
Probabilistic Analysis

scholarly journals Photodynamic Therapy for Barrett’s Esophagus with High-Grade Dysplasia: A Cost-Effectiveness Analysis

2007 ◽  
Vol 21 (4) ◽  
pp. 217-222 ◽  
Author(s):  
Dan Comay ◽  
Gord Blackhouse ◽  
Ron Goeree ◽  
David Armstrong ◽  
John K Marshall
Keyword(s):  
Photodynamic Therapy ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Barrett’S Esophagus ◽  
Probabilistic Analysis ◽  
Barrett's Esophagus ◽  
Cost Effective ◽  
High Grade Dysplasia ◽  
High Grade ◽  
Male Patients

OBJECTIVES: To assess the cost-effectiveness of photodynamic therapy (PDT) and esophagectomy (ESO) relative to surveillance (SURV) for patients with Barrett’s esophagus (BE) and high-grade dysplasia (HGD).METHODS: A Markov decision tree was constructed to estimate costs and health outcomes of PDT, ESO and SURV in a hypothetical cohort of male patients, 50 years of age, with BE and HGD. Outcomes included unadjusted life-years (LYs) and quality-adjusted LYs (QALYs). Direct medical costs (2003 CDN$) were measured from the perspective of a provincial ministry of health. The time horizon for the model was five years (cycle length three months), and costs and outcomes were discounted at 3%. Model parameters were assigned unique distributions, and a probabilistic analysis with 10,000 Monte Carlo simulations was performed.RESULTS: SURV was the least costly strategy, followed by PDT and ESO, but SURV was also the least effective. In terms of LYs, the incremental cost-effectiveness ratios were $814/LY for PDT versus SURV and $3,397/LY for ESO versus PDT. PDT dominated ESO for QALYs in the base-case. The incremental cost-effectiveness ratio of PDT versus SURV was $879/QALY. In probabilistic analysis, PDT was most likely to be cost-effective at willingness-to-pay (WTP) values between $100/LY and $3,500/LY, and ESO was most likely to be cost-effective for WTP values over $3500/LY. For quality-adjusted survival, PDT was most likely to be cost-effective for all WTP thresholds above $1,000/QALY. The likelihood that PDT was the most cost-effective strategy reached 0.99 at a WTP ceiling of $25,000/QALY.CONCLUSIONS: In male patients with BE and HGD, PDT and ESO are cost-effective alternatives to SURV.

scholarly journals Cost-effectiveness of brentuximab vedotin in advanced stage Hodgkin’s lymphoma: a probabilistic analysis

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
A. J. N. Raymakers ◽  
S. Costa ◽  
D. Cameron ◽  
D. A. Regier
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Probabilistic Analysis ◽  
Hodgkin’S Lymphoma ◽  
Transition Probabilities ◽  
Cost Effective ◽  
Brentuximab Vedotin ◽  
Hodgkin's Lymphoma ◽  
Current Evidence ◽  
Frontline Therapy

Abstract Background Treatment with ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) is a well-established therapy for advanced Hodgkin’s lymphoma (HL). However, the recently completed ECHELON-1 trial showed potential net clinical benefit for brentuximab vedotin (BREN+AVD) compared to ABVD as frontline therapy in patients with advanced Hodgkin’s lymphoma. The objective of this analysis is to determine whether, on current evidence, BREN+AVD is cost-effective relative to ABVD as frontline therapy in patients with advanced HL. Methods We constructed a probabilistic Markov model with two arms and six mutually exclusive health states, using six-month cycle lengths, and a 15-year time horizon. Time-dependent transition probabilities were calculated from ‘real-world’ data collected by the BC Cancer’s Centre for Lymphoid Cancer database or from the literature for ABVD. Time-dependent transition probabilities for BREN+AVD were taken from the ECHELON-1 trial. We estimated the incremental cost and effects per patient of each therapy and calculated the incremental cost-effectiveness ratio (ICER). Costs were measured in 2018 Canadian dollars and effects measured in quality-adjusted life years (QALYs). A probabilistic analysis was used to generate a cost-effectiveness acceptability curve (CEAC). Results The incremental cost between standard therapy with ABVD and therapy with BREN+AVD was estimated to be $192,336. The regimen of BREN+AVD resulted in a small benefit in terms of QALYs (0.46 QALYs). The estimated ICER was $418,122 per QALY gained. The probabilistic analysis suggests very few (8%) simulations fall below $100,000 per QALY. Even at a threshold of $200,000 per QALY gained, there was only a 24% chance that BREN+AVD would be considered cost-effective. Sensitivity analyses evaluating price reductions for brentuximab showed that these reductions needed to be in excess of 70% for this regimen to be cost-effective at a threshold of $100,000 per QALY. Conclusions There may be a clinical benefit associated with BREN+AVD, but on current evidence the benefit is not adequately substantive compared to ABVD therapy given the cost of brentuximab vedotin. Agencies responsible for making decisions about BREN+AVD as frontline therapy for patients with advanced HL should consider whether they are willing to implement this treatment given the current uncertainty and cost-benefit profile, or negotiate substantial price-reductions from the manufacturer should they choose to reimburse.

scholarly journals Cost-Effectiveness of Nivolumab Plus Ipilimumab With and Without Chemotherapy for Advanced Non-Small Cell Lung Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Szu-Chun Yang ◽  
Natalia Kunst ◽  
Cary P. Gross ◽  
Jung-Der Wang ◽  
Wu-Chou Su ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Cost Effectiveness ◽  
Small Cell Lung Cancer ◽  
Probabilistic Analysis ◽  
Cost Effective ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
The U.S

BackgroundFirst-line treatment with nivolumab plus ipilimumab (N+I) or nivolumab plus ipilimumab with two cycles of chemotherapy (N+I+chemotherapy) improve overall survival and progression-free survival for patients with metastatic non-small cell lung cancer (NSCLC), yet researchers have not concomitantly compared the cost-effectiveness of N+I and N+I+chemotherapy with chemotherapy alone.Materials and methodsUsing outcomes data from the CheckMate 227 and CheckMate 9LA phase 3 randomized trials, we developed a Markov model with lifetime horizon to compare the costs and effectiveness of N+I and N+I+chemotherapy versus chemotherapy from the U.S. health care sector perspective. Subgroup analysis by programmed death-ligand 1 (PD-L1) expression levels (≥1% and <1%) and probabilistic analysis were performed.ResultsThe incremental cost-effectiveness ratio (ICER) of N+I versus chemotherapy was $239,072 per QALY, and $838,198 per QALY for N+I+chemotherapy versus N+I. The ICER of N+I versus chemotherapy was $246,584 per QALY for patients with PD-L1 ≥ 1% and $185,620 per QALY for those with PD-L1 < 1%. In probabilistic analysis, N+I had a 2.6% probability of being cost-effective at a willingness-to-pay threshold of $150,000 per QALY. The probability was 0.4% for patients with PD-L1 ≥ 1% and 10.6% for patients with PD-L1 < 1%.ConclusionFirst-line N+I or N+I+chemotherapy for metastatic NSCLC was not cost-effective regardless of PD-L1 expression levels from the U.S. health care sector perspective.

Cost-effectiveness of dental implants: a utility analysis

1990 ◽  
Vol 54 (11) ◽  
pp. 688-689 ◽  
Author(s):  
J Jacobson ◽  
B Maxson ◽  
K Mays ◽  
J Peebles ◽  
C Kowalski
Keyword(s):  
Cost Effectiveness ◽  
Dental Implants ◽  
Utility Analysis
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