scholarly journals The cost-effectiveness of an HCV outreach intervention for at-risk populations in London, UK

2019 ◽  
Vol 74 (Supplement_5) ◽  
pp. v5-v16 ◽  
Author(s):  
Zoe Ward ◽  
Linda Campbell ◽  
Julian Surey ◽  
Steven Platts ◽  
Rachel Glass ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Drug Treatment ◽  
Peer Support ◽  
Secondary Care ◽  
Cost Effective ◽  
List Price ◽  
Housing Status ◽  
Intervention Cost ◽  
The Cost

Abstract Background HCV disproportionately affects marginalized communities such as homeless populations and people who inject drugs (PWID), posing a challenge to traditional health services. The HepFriend initiative in London is a model of care utilizing HCV outreach screening and peer support to link vulnerable individuals to HCV treatment in secondary care. Objectives To assess the cost-effectiveness of the HepFriend initiative from a healthcare provider perspective, compared with standard-of-care pathways (consisting of testing in primary care and other static locations, including drug treatment centres, and linkage to secondary care). Methods Cost-effectiveness analysis using a dynamic HCV transmission and disease progression model among PWID and those who have ceased injecting, including housing status and drug treatment service contact. The model was parameterized using London-specific surveillance and survey data, and primary intervention cost and effectiveness data (September 2015 to June 2018). Out of 461 individuals screened, 197 were identified as HCV RNA positive, 180 attended secondary care and 89 have commenced treatment to date. The incremental cost-effectiveness ratio (ICER) was determined using a 50 year time horizon. Results For a willingness-to-pay threshold of £20000 per QALY gained, the HepFriend initiative is cost-effective, with a mean ICER of £9408/QALY, and would become cost saving at 27% (£10525 per treatment) of the current drug list price. Results are robust to variations in intervention costs and model assumptions, and if treatment rates are doubled the intervention becomes more cost-effective (£8853/QALY). Conclusions New models of care that undertake active case-finding with enhanced peer support to improve testing and treatment uptake amongst marginalized and vulnerable groups could be highly cost-effective and possibly cost saving.

scholarly journals The cost-effectiveness of common strategies for the prevention of transmission of SARS-CoV-2 in universities.

2020 ◽  
Author(s):  
Zafar Zafari ◽  
Katia Korvizhkin ◽  
Lee Goldman ◽  
Peter Muennig
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Prevalence Rate ◽  
Cost Effective ◽  
Credible Interval ◽  
Added Value ◽  
Local Conditions ◽  
Cdc Guidelines ◽  
The Cost ◽  
The University

Background. The added value of interventions to prevent the transmission of SARS-CoV-2 among university affiliates is uncertain but needed as universities attempt to remain open. Methods. We use a decision-analytic simulation to examine the cost-effectiveness of common interventions to reduce SARS-CoV-2 transmission. We use Columbia University for reference values but our approach centers around an online model that allows users to tailor the model and interventions to their local conditions and existing strategies. All interventions are compared relative to implementing the Centers for Disease Control and Prevention (CDC) guidelines alone. Results. At prevalence rate of actively infectious cases of COVID-19 in the community surrounding the university of 0.1%, using a symptom-checking mobile application is cost-saving relative to CDC guidelines alone and the university can expect to remain open. At a prevalence of 1%, standardizing masks will be cost-saving. At a prevalence rate of 2%, thermal imaging cameras cost $965,070 (95% credible interval [CrI] = $198,821, $2.15 million)/quality-adjusted life year (QALY) gained. One-time testing on entry costs $1.08 million (95% CrI = $170,703, $3.33 million)/QALY gained. Weekly testing costs $820,119 (95% CrI = $452,673, $1.68 million)/QALY gained. Upgrades to ventilation systems or installation of far-ultraviolet C lighting systems will be cost-effective at a willingness-to-pay threshold of $200,000/QALY gained only if aerosols account for 86-90% of all on-campus transmission of SARS-CoV-2. Conclusions. The value of interventions to prevent transmission of SARS-CoV-2 vary greatly with the prevalence rate of actively infectious cases of COVID-19 in the community surrounding the university.

Abstract 1: Impact of Predicted Bleeding Risk on the Cost-Effectiveness of Direct Thrombin Inhibition vs. Heparin Monotherapy for Patients Undergoing PCI

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Amit P Amin ◽  
Steven P Marso ◽  
Sunil V Rao ◽  
John Messenger ◽  
John House ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Major Bleeding ◽  
Cost Effective ◽  
Bleeding Risk ◽  
Thrombin Inhibitors ◽  
Published Data ◽  
Life Years ◽  
The Cost ◽  
Predicted Risk

Introduction Direct thrombin inhibitors (DTI) reduce bleeding and are cost-saving in patients (pts) undergoing PCI when compared to unfractionated heparin (UFH) plus routine glycoprotein IIb/IIIa inhibition (GPI). Little is known about the cost-effectiveness of DTI alone vs. UFH alone, however. Methods We combined data on patient-level bleeding risk with several external data sources to estimate the economic impact of substituting DTI for UFH among unselected PCI patients. We used a validated model to predict the risk of major bleeding for 81,628 NCDR® CathPCI Registry® patients who received UFH only in 2004-06. DTI costs were estimated based on current FDA dosing guidelines and acquisition costs. The cost of major bleeding ($8722) was estimated based on data from the Mid America Heart Institute. The benefit of DTI vs. UFH alone was based on bleeding risk reduction from ISAR-REACT 3. A Markov model based on published data was used to estimate the loss in life expectancy associated with major bleeding. Results The overall rate of major bleeding in the reference population was 2.2%, the estimated cost of a major bleed was $8722, projected DTI costs were $641/pt and heparin costs were negligible ($4). Assuming that DTI use reduces the risk of bleeding by 33%, use of DTI for all patients was estimated to increase costs by $573/patient and was cost saving only for patients with a predicted risk of major bleeding >20% (0.16% of the overall population). When life years lost due to bleeding were included, at willingness-to-pay thresholds of $50K and $100K per life year gained, DTI was cost effective for patients with a bleeding risk ≥8% (2.5% patients) and ≥5% (7.9% of patients), respectively. Conclusions For patients undergoing PCI, substitution of DTI for UFH monotherapy is projected to increase costs for virtually all patients, but may be reasonably cost-effective for patients with a high predicted risk (≥5%) of bleeding.

scholarly journals Climate influences on the cost-effectiveness of vector-based interventions against malaria in elimination scenarios

2015 ◽  
Vol 370 (1665) ◽  
pp. 20130557 ◽  
Author(s):  
Paul E. Parham ◽  
Dyfrig A. Hughes
Keyword(s):  
Climate Change ◽  
Cost Effectiveness ◽  
Scale Up ◽  
Indoor Residual Spraying ◽  
Cost Effective ◽  
Climatic Conditions ◽  
Economic Modelling ◽  
Optimal Intervention ◽  
Intervention Cost ◽  
The Cost

Despite the dependence of mosquito population dynamics on environmental conditions, the associated impact of climate and climate change on present and future malaria remains an area of ongoing debate and uncertainty. Here, we develop a novel integration of mosquito, transmission and economic modelling to assess whether the cost-effectiveness of indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) against Plasmodium falciparum transmission by Anopheles gambiae s.s. mosquitoes depends on climatic conditions in low endemicity scenarios. We find that although temperature and rainfall affect the cost-effectiveness of IRS and/or LLIN scale-up, whether this is sufficient to influence policy depends on local endemicity, existing interventions, host immune response to infection and the emergence rate of insecticide resistance. For the scenarios considered, IRS is found to be more cost-effective than LLINs for the same level of scale-up, and both are more cost-effective at lower mean precipitation and higher variability in precipitation and temperature. We also find that the dependence of peak transmission on mean temperature translates into optimal temperatures for vector-based intervention cost-effectiveness. Further cost-effectiveness analysis that accounts for country-specific epidemiological and environmental heterogeneities is required to assess optimal intervention scale-up for elimination and better understand future transmission trends under climate change.

scholarly journals Cost-effectiveness of pharmacogenetic-guided treatment: are we there yet?

2016 ◽  
Author(s):  
Moira Verbelen ◽  
Michael E Weale ◽  
Cathryn M Lewis
Keyword(s):  
Genetic Testing ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Genetic Information ◽  
Cost Effective ◽  
Economic Evaluations ◽  
Treatment Needs ◽  
The Us ◽  
The Cost ◽  
The Impact

AbstractPharmacogenetics (PGx) has the potential to personalize pharmaceutical treatments. Many relevant gene-drug associations have been discovered, but PGx guided treatment needs to be cost-effective as well as clinically beneficial to be incorporated into standard healthcare. Progress in this area can be assessed by reviewing economic evaluations to determine the cost-effectiveness of PGx testing versus standard treatment. We performed a review of economic evaluations for PGx associations listed in the US Food and Drug Administration (FDA) Table of Pharmacogenomic Biomarkers in Drug Labeling (http://www.fda.gov/Drugs/ScienceResearch/ResearchAreas/Pharmacogenetics/ucm083378.htm). We determined the proportion of evaluations that found PGx guided treatment to be cost-effective or dominant over the alternative strategies, and we estimated the impact on this proportion of removing the cost of genetic testing. Of the 130 PGx associations in the FDA table, 44 economic evaluations, relating to 10 drugs, were identified. Of these evaluations, 57% drew conclusions in favour of PGx testing, of which 30% were cost-effective and 27% were dominant (cost-saving). If genetic information was freely available, 75% of economic evaluations would support PGx guided treatment, of which 25% would be cost-effective and 50% would be dominant. Thus, PGx guided treatment can be a cost-effective and even cost-saving strategy. Having genetic information readily available in the clinical health record is a realistic future prospect, and would make more genetic tests economically worthwhile. However, few drugs with PGx associations have been studied and more economic evaluations are needed to underpin the uptake of genetic testing in clinical practice.

scholarly journals Cost/effectiveness analysis of atorvastatin in patients with acute coronary syndromes

2010 ◽  
Vol 11 (2) ◽  
pp. 83-89 ◽  
Author(s):  
Simona Cammarota ◽  
Enrica Menditto ◽  
Daria Putignano ◽  
Anna Citarella
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Standard Dose ◽  
Cost Effective ◽  
High Dose ◽  
Effectiveness Analysis ◽  
Italian National Health Service ◽  
Coronary Syndromes ◽  
Italian National Health ◽  
The Cost

Introduction: recent clinical trials found that high-dose statin therapy, compared with conventional-dose statin therapy, reduces the risk of cardiovascular events in patients with acute coronary syndromes (ACS) and stable coronary artery disease (CAD). With the introduction of simvastatin and pravastatin generics and the next patent expiration of atorvastatin, projected for 2011 in Italy, it is natural to ask: what is the most cost-effective treatment for a rational use of resources?Aim: the aim of this study was to estimate the cost-effectiveness of high-dose atorvastatin versus conventional standard-dose statins based on the scenario of atovastatin price evolution.Methods: a cost-effectiveness analysis was conducted in the perspective of the Italian National Health Service over the 4.9 years time horizon. Clinical data were obtained from a pooled analyses of the 3 clinical trials that directly compared high-dose atorvastatin with conventional standard-dose statins in patients with either ACS or CAD. Hospitalizations were quantified based on the Italian National Health Service tariffs and drug costs according to the Italian National Therapeutic Formulary (2009). Assuming the cost of atorvastatin reduces in line with that observed for simvastatin when the patent expires, 3 scenarios were constructed: atorvastatin current price (scenario 1); 55% price discount (scenario 2); 65% price discount (scenario 3). Effects were measured in terms of primary composite endpoint (coronary death or any adverse cardiovascular event). All costs were discounted at 3% per annum. Sensitivity analyses were performed to assess the robustness of findings. Results: intensive therapy with atorvastatin provided a hospitalization cost saving of 245,519.36 € per 1,000 patients. Under the assumptions established for scenario 1 and scenario 2, the incremental cost-effectiveness of treatment with atorvastatin 80 mg was estimated to be 20,289.72 € and 917.05 € for patient free from event, respectively; it was cost-saving for the scenario 3. Conclusions: high-dose atorvastatin represented a cost-effective use of healthcare resources in Italy. If the cost of atorvastatin reduces by 65% when the patent expires, for every million patient with SCA or CAD stable, treated for 5 years, the high-dose atorvastatin strategy potentially yields a cost-saving of ~2,4 billion € for the NHS.

scholarly journals Economic evaluation of orphan drug Lutetium-Octreotate vs. Octreotide long-acting release for patients with an advanced midgut neuroendocrine tumour in the Netherlands

2021 ◽  
Author(s):  
Marije E. Hagendijk ◽  
Simon van der Schans ◽  
Cornelis Boersma ◽  
Maarten J. Postma ◽  
Simon van der Pol
Keyword(s):  
Cost Effectiveness ◽  
The Netherlands ◽  
Price Level ◽  
Cost Effective ◽  
List Price ◽  
High Dose ◽  
Positive Effects ◽  
Long Acting ◽  
The Cost ◽  
The Impact

Abstract Objectives Multiple studies showed positive effects of Lutetium-Octreotate (LO) treatment in neuroendocrine tumours. LO has been used in the Netherlands since the 1980s and recently received the orphan status shortly after the acquisition by Novartis. Since then, the official list price has increased sixfold. From a value-based pricing perspective, we analysed the impact of the increase in price on the incremental cost-effectiveness ratio (ICER) of LO treatment compared to optimal best supportive care, a high dose of Octreotide long-acting release (O-LAR), using the clinical data of the NETTER-1 trial. Methods A Markov model was developed to evaluate the costs per quality-adjusted life-year (QALY) for LO treatment compared to O-LAR from the healthcare perspective. A scenario analysis was conducted to compare the cost-effectiveness with the initial and increased price level of the LO-treatment. Results At the increased price level, the cost-effectiveness analysis rendered a deterministic ICER of €53,500 per QALY, while at the initial pricing, the ICER was €19,000 per QALY. The probabilistic sensitivity analysis (PSA) showed that LO had a high probability of being cost-effective at both the increased and initial price level, considering a cost-effectiveness threshold of €80,000. Conclusions Even at the increased price level, LO treatment can still be considered cost-effective using the applicable Dutch willingness-to-pay threshold of 80,000 euro per QALY. Considering the public scrutiny in relation to this price increase, these outcomes raise the question whether traditional cost-effectiveness methods are sufficient in fully capturing the societal acceptance of prices of new medicines.

scholarly journals The Cost-Effectiveness of Expanding Vaccination with a Cell-Based Influenza Vaccine to Low Risk Adults Aged 50 to 64 Years in the United Kingdom

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 598
Author(s):  
Michele A. Kohli ◽  
Michael Maschio ◽  
Joaquin F. Mould-Quevedo ◽  
Mansoor Ashraf ◽  
Michael F. Drummond ◽  
...  
Keyword(s):  
At Risk ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Transmission Model ◽  
List Price ◽  
Annual Number ◽  
Base Case ◽  
The Uk ◽  
The Cost

Background: In response to COVID-19, the UK National Health Service (NHS) extended influenza vaccination in 50- to 64-year-olds from at-risk only to all in this age group for the 2020/21 season. The objective of this research is to determine the cost-effectiveness of continuing to vaccinate all with a quadrivalent cell-based vaccine (QIVc) compared to returning to an at-risk only policy after the pandemic resolves. Methods: A dynamic transmission model, calibrated to match infection data from the UK, was used to estimate the clinical and economic impact of vaccination across 10 influenza seasons. The base case effectiveness of QIVc was 63.9% and the list price was GBP 9.94. Results: Vaccinating 50% of all 50- to 64-year-olds with QIVc reduced the average annual number of clinical infections (−682,000), hospitalizations (−5800) and deaths (−740) in the UK. The base case incremental cost per quality-adjusted life-year gained (ICER) of all compared to at-risk only was GBP6000 (NHS perspective). When the cost of lost productivity was considered, vaccinating all 50- to 64-year-olds with QIVc became cost-saving. Conclusion: Vaccinating all 50- to 64-year-olds with QIVc is likely to be cost-effective. The NHS should consider continuing this policy in future seasons.

scholarly journals Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

2017 ◽  
Vol 21 (80) ◽  
pp. 1-280 ◽  
Author(s):  
Ros Wade ◽  
Stephen Rice ◽  
Alexis Llewellyn ◽  
Eoin Moloney ◽  
Julie Jones-Diette ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cost Effectiveness ◽  
Secondary Care ◽  
Value Of Information ◽  
Cost Effective ◽  
Axillary Hyperhidrosis ◽  
Primary Hyperhidrosis ◽  
The Cost

BackgroundHyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable.ObjectiveTo establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care.MethodsA systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only.Results and conclusionsFifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life.LimitationsThe evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla.Future workBased on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses.Study registrationThis study is registered as PROSPERO CRD42015027803.FundingThe National Institute for Health Research Health Technology Assessment programme.

scholarly journals Cost-effectiveness of surgical treatments compared with early structured physiotherapy in secondary care for adults with primary frozen shoulder

2021 ◽  
Vol 2 (8) ◽  
pp. 685-695
Author(s):  
Belen Corbacho ◽  
Stephen Brealey ◽  
Ada Keding ◽  
Gerry Richardson ◽  
David Torgerson ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Secondary Care ◽  
Controlled Trial ◽  
Frozen Shoulder ◽  
Cost Effective ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Arthroscopic Capsular Release ◽  
Life Years ◽  
The Cost

Aims A pragmatic multicentre randomized controlled trial, UK FROzen Shoulder Trial (UK FROST), was conducted in the UK NHS comparing the cost-effectiveness of commonly used treatments for adults with primary frozen shoulder in secondary care. Methods A cost utility analysis from the NHS perspective was performed. Differences between manipulation under anaesthesia (MUA), arthroscopic capsular release (ACR), and early structured physiotherapy plus steroid injection (ESP) in costs (2018 GBP price base) and quality adjusted life years (QALYs) at one year were used to estimate the cost-effectiveness of the treatments using regression methods. Results ACR was £1,734 more costly than ESP ((95% confidence intervals (CIs) £1,529 to £1,938)) and £1,457 more costly than MUA (95% CI £1,283 to £1,632). MUA was £276 (95% CI £66 to £487) more expensive than ESP. Overall, ACR had worse QALYs compared with MUA (-0.0293; 95% CI -0.0616 to 0.0030) and MUA had better QALYs compared with ESP (0.0396; 95% CI -0.0008 to 0.0800). At a £20,000 per QALY willingness-to-pay threshold, MUA had the highest probability of being cost-effective (0.8632) then ESP (0.1366) and ACR (0.0002). The results were robust to sensitivity analyses. Conclusion While ESP was less costly, MUA was the most cost-effective option. ACR was not cost-effective. Cite this article: Bone Jt Open 2021;2(8):685–695.

scholarly journals Assessing cost-effectiveness of hepatitis C testing pathways in Georgia using the Hep C Testing Calculator

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Madeline Adee ◽  
Yueran Zhuo ◽  
Huaiyang Zhong ◽  
Tiannan Zhan ◽  
Rakesh Aggarwal ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hepatitis C ◽  
Cost Saving ◽  
Cost Effective ◽  
Current Standard ◽  
Lifetime Horizon ◽  
Soc Testing ◽  
Program Costs ◽  
The Cost ◽  
Hcv Testing

AbstractThe cost of testing can be a substantial contributor to hepatitis C virus (HCV) elimination program costs in many low- and middle-income countries such as Georgia, resulting in the need for innovative and cost-effective strategies for testing. Our objective was to investigate the most cost-effective testing pathways for scaling-up HCV testing in Georgia. We developed a Markov-based model with a lifetime horizon that simulates the natural history of HCV, and the cost of detection and treatment of HCV. We then created an interactive online tool that uses results from the Markov-based model to evaluate the cost-effectiveness of different HCV testing pathways. We compared the current standard-of-care (SoC) testing pathway and four innovative testing pathways for Georgia. The SoC testing was cost-saving compared to no testing, but all four new HCV testing pathways further increased QALYs and decreased costs. The pathway with the highest patient follow-up, due to on-site testing, resulted in the highest discounted QALYs (123 QALY more than the SoC) and lowest costs ($127,052 less than the SoC) per 10,000 persons screened. The current testing algorithm in Georgia can be replaced with a new pathway that is more effective while being cost-saving.

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