scholarly journals Applying quality assurance in real time to compliant long-term periodontal maintenance patients utilizing cost-effectiveness and cost utility

2014 ◽  
Vol 41 (6) ◽  
pp. 604-611 ◽  
Author(s):  
Øystein Fardal ◽  
Jostein Grytten
Keyword(s):  
Quality Assurance ◽  
Cost Effectiveness ◽  
Real Time ◽  
Cost Utility ◽  
Periodontal Maintenance

scholarly journals Cost-Effectiveness and Cost-Utility of Long-Term Management Strategies for Heartburn

2002 ◽  
Vol 5 (4) ◽  
pp. 312-328 ◽  
Author(s):  
Ron Goeree ◽  
Bernie J. O'Brien ◽  
Gordon Blackhouse ◽  
John Marshall ◽  
Andrew Briggs ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Management Strategies ◽  
Cost Utility ◽  
Term Management

Cost-utility and cost-effectiveness analyses of a long-term, high-intensity exercise program compared with conventional physical therapy in patients with rheumatoid arthritis

2005 ◽  
Vol 53 (1) ◽  
pp. 39-47 ◽  
Author(s):  
Wilbert B. van den Hout ◽  
Zuzana de Jong ◽  
Marten Munneke ◽  
Johanna M. W. Hazes ◽  
Ferdinand C. Breedveld ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cost Effectiveness ◽  
Physical Therapy ◽  
High Intensity ◽  
Exercise Program ◽  
Cost Utility ◽  
High Intensity Exercise

scholarly journals Long-term Cost-Effectiveness of Dexcom G6 Real-Time Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Patients With Type 1 Diabetes in the U.K.

2020 ◽  
Author(s):  
Stéphane Roze ◽  
John Isitt ◽  
Jayne Smith-Palmer ◽  
Mehdi Javanbakht ◽  
Peter Lynch
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Cost Effectiveness ◽  
Real Time ◽  
Glucose Monitoring ◽  
Baseline Hba1c ◽  
Self Monitoring ◽  
Quality Adjusted Life

<b>Objective</b> <p>A long-term health economic analysis was performed to establish the cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) (Dexcom G6) versus self-monitoring of blood glucose (SMBG) alone in UK-based patients with type 1 diabetes. </p> <p><b>Methods</b></p> <p>The analysis utilized the IQVIA CORE Diabetes Model. Clinical input data were sourced from the DIAMOND trial in adults with type 1 diabetes; simulations were performed separately in the overall population of patients with baseline HbA1c ≥7.5% (58 mmol/mol); and a secondary analysis was performed in patients with baseline HbA1c ≥8.5% (69 mmol/mol). The analysis was performed from the NHS healthcare payer perspective over a lifetime time horizon. </p> <p><b>Results</b></p> <p>In the overall population, G6 RT-CGM was associated with a mean incremental gain in quality-adjusted life expectancy of 1.49 quality-adjusted life years (QALYs) versus SMBG (mean [standard deviation; SD] 11.47 [2.04] QALYs versus 9.99 [1.84] QALYs). Total mean (SD) lifetime costs were also GBP 14,234 higher with RT-CGM (GBP 102,468 [35,681] versus GBP 88,234 [39,027]) resulting in an ICER of GBP 9,558 per QALY gained. Sensitivity analyses revealed that the findings were sensitive to changes in the quality of life benefit associated with reduced fear of hypoglycemia and avoidance of fingerstick testing as well as the HbA1c benefit associated with RT-CGM use. </p> <p><b>Conclusions</b></p> <p>For UK-based type 1 diabetes patients, the G6 RT-CGM device is associated with significant improvements in clinical outcomes and, over patient lifetimes, is a cost-effective disease management option relative to SMBG, based on a willingness-to-pay threshold of GBP 20,000 per QALY gained. </p>

scholarly journals The clinical effectiveness and cost-effectiveness of abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis: a systematic review and economic evaluation

2016 ◽  
Vol 20 (34) ◽  
pp. 1-222 ◽  
Author(s):  
Jonathan Shepherd ◽  
Keith Cooper ◽  
Petra Harris ◽  
Joanna Picot ◽  
Micah Rose
Keyword(s):  
Quality Of Life ◽  
Juvenile Idiopathic Arthritis ◽  
Cost Effectiveness ◽  
Systematic Reviews ◽  
Clinical Effectiveness ◽  
Cost Utility ◽  
Open Label ◽  
Biologic Dmards

BackgroundJuvenile idiopathic arthritis (JIA) is characterised by joint pain, swelling and a limitation of movement caused by inflammation. Subsequent joint damage can lead to disability and growth restriction. Treatment commonly includes disease-modifying antirheumatic drugs (DMARDs), such as methotrexate. Clinical practice now favours newer drugs termed biologic DMARDs where indicated.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of four biologic DMARDs [etanercept (Enbrel®, Pfizer), abatacept (Orencia®, Bristol-Myers Squibb), adalimumab (Humira®, AbbVie) and tocilizumab (RoActemra®, Roche) – with or without methotrexate where indicated] for the treatment of JIA (systemic or oligoarticular JIA are excluded).Data sourcesElectronic bibliographic databases including MEDLINE, EMBASE, The Cochrane Library and the Database of Abstracts of Reviews of Effects were searched for published studies from inception to May 2015 for English-language articles. Bibliographies of related papers, systematic reviews and company submissions were screened and experts were contacted to identify additional evidence.Review methodsSystematic reviews of clinical effectiveness, health-related quality of life and cost-effectiveness were undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A cost–utility decision-analytic model was developed to compare the estimated cost-effectiveness of biologic DMARDs versus methotrexate. The base-case time horizon was 30 years and the model took a NHS perspective, with costs and benefits discounted at 3.5%.ResultsFour placebo-controlled randomised controlled trials (RCTs) met the inclusion criteria for the clinical effectiveness review (one RCT evaluating each biologic DMARD). Only one RCT included UK participants. Participants had to achieve an American College of Rheumatology Pediatric (ACR Pedi)-30 response to open-label lead-in treatment in order to be randomised. An exploratory adjusted indirect comparison suggests that the four biologic DMARDs are similar, with fewer disease flares and greater proportions of ACR Pedi-50 and -70 responses among participants randomised to continued biologic DMARDs. However, confidence intervals were wide, the number of trials was low and there was clinical heterogeneity between trials. Open-label extensions of the trials showed that, generally, ACR responses remained constant or even increased after the double-blind phase. The proportions of adverse events and serious adverse events were generally similar between the treatment and placebo groups. Four economic evaluations of biologic DMARDs for patients with JIA were identified but all had limitations. Two quality-of-life studies were included, one of which informed the cost–utility model. The incremental cost-effectiveness ratios (ICERs) for adalimumab, etanercept and tocilizumab versus methotrexate were £38,127, £32,526 and £38,656 per quality-adjusted life year (QALY), respectively. The ICER for abatacept versus methotrexate as a second-line biologic was £39,536 per QALY.LimitationsThe model does not incorporate the natural history of JIA in terms of long-term disease progression, as the current evidence is limited. There are no head-to-head trials of biologic DMARDs, and clinical evidence for specific JIA subtypes is limited.ConclusionsBiologic DMARDs are superior to placebo (with methotrexate where permitted) in children with (predominantly) polyarticular course JIA who have had an insufficient response to previous treatment. Randomised comparisons of biologic DMARDs with long-term efficacy and safety follow-up are needed to establish comparative effectiveness. RCTs for JIA subtypes for which evidence is lacking are also required.Study registrationThis study is registered as PROSPERO CRD42015016459.FundingThe National Institute for Health Research Health Technology Assessment programme.

scholarly journals Economic impact of potentially inappropriate prescribing and related adverse events in older people: a cost-utility analysis using Markov models

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e021832 ◽  
Author(s):  
Frank Moriarty ◽  
Caitriona Cahir ◽  
Kathleen Bennett ◽  
Tom Fahey
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Markov Models ◽  
Inappropriate Prescribing ◽  
Cost Effective ◽  
Cost Utility ◽  
Maximal Dose ◽  
Potentially Inappropriate Prescribing ◽  
Utility Analysis

ObjectivesTo determine the economic impact of three drugs commonly involved in potentially inappropriate prescribing (PIP) in adults aged ≥65 years, including their adverse effects (AEs): long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), benzodiazepines and proton pump inhibitors (PPIs) at maximal dose; to assess cost-effectiveness of potential interventions to reduce PIP of each drug.DesignCost-utility analysis. We developed Markov models incorporating the AEs of each PIP, populated with published estimates of probabilities, health system costs (in 2014 euro) and utilities.ParticipantsA hypothetical cohort of 65 year olds analysed over 35 1-year cycles with discounting at 5% per year.Outcome measuresIncremental cost, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios with 95% credible intervals (CIs, generated in probabilistic sensitivity analysis) between each PIP and an appropriate alternative strategy. Models were then used to evaluate the cost-effectiveness of potential interventions to reduce PIP for each of the three drug classes.ResultsAll three PIP drugs and their AEs are associated with greater cost and fewer QALYs compared with alternatives. The largest reduction in QALYs and incremental cost was for benzodiazepines compared with no sedative medication (€3470, 95% CI €2434 to €5001; −0.07 QALYs, 95% CI −0.089 to –0.047), followed by NSAIDs relative to paracetamol (€806, 95% CI €415 and €1346; −0.07 QALYs, 95% CI −0.131 to –0.026), and maximal dose PPIs compared with maintenance dose PPIs (€989, 95% CI -€69 and €2127; −0.01 QALYs, 95% CI −0.029 to 0.003). For interventions to reduce PIP, at a willingness-to-pay of €45 000 per QALY, targeting NSAIDs would be cost-effective up to the highest intervention cost per person of €1971. For benzodiazepine and PPI interventions, the equivalent cost was €1480 and €831, respectively.ConclusionsLong-term benzodiazepine and NSAID prescribing are associated with significantly increased costs and reduced QALYs. Targeting inappropriate NSAID prescribing appears to be the most cost-effective PIP intervention.

scholarly journals Long-term Cost-Effectiveness of Dexcom G6 Real-Time Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Patients With Type 1 Diabetes in the U.K.

2020 ◽  
Author(s):  
Stéphane Roze ◽  
John Isitt ◽  
Jayne Smith-Palmer ◽  
Mehdi Javanbakht ◽  
Peter Lynch
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Cost Effectiveness ◽  
Real Time ◽  
Glucose Monitoring ◽  
Baseline Hba1c ◽  
Self Monitoring ◽  
Quality Adjusted Life

<b>Objective</b> <p>A long-term health economic analysis was performed to establish the cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) (Dexcom G6) versus self-monitoring of blood glucose (SMBG) alone in UK-based patients with type 1 diabetes. </p> <p><b>Methods</b></p> <p>The analysis utilized the IQVIA CORE Diabetes Model. Clinical input data were sourced from the DIAMOND trial in adults with type 1 diabetes; simulations were performed separately in the overall population of patients with baseline HbA1c ≥7.5% (58 mmol/mol); and a secondary analysis was performed in patients with baseline HbA1c ≥8.5% (69 mmol/mol). The analysis was performed from the NHS healthcare payer perspective over a lifetime time horizon. </p> <p><b>Results</b></p> <p>In the overall population, G6 RT-CGM was associated with a mean incremental gain in quality-adjusted life expectancy of 1.49 quality-adjusted life years (QALYs) versus SMBG (mean [standard deviation; SD] 11.47 [2.04] QALYs versus 9.99 [1.84] QALYs). Total mean (SD) lifetime costs were also GBP 14,234 higher with RT-CGM (GBP 102,468 [35,681] versus GBP 88,234 [39,027]) resulting in an ICER of GBP 9,558 per QALY gained. Sensitivity analyses revealed that the findings were sensitive to changes in the quality of life benefit associated with reduced fear of hypoglycemia and avoidance of fingerstick testing as well as the HbA1c benefit associated with RT-CGM use. </p> <p><b>Conclusions</b></p> <p>For UK-based type 1 diabetes patients, the G6 RT-CGM device is associated with significant improvements in clinical outcomes and, over patient lifetimes, is a cost-effective disease management option relative to SMBG, based on a willingness-to-pay threshold of GBP 20,000 per QALY gained. </p>

scholarly journals Blood pressure telemonitoring and remote counseling in uncontrolled hypertension

2021 ◽  
Vol 93 (1) ◽  
pp. 30-40
Author(s):  
Mikhail V. Ionov ◽  
Olga V. Zhukova ◽  
Nadezhda E. Zvartau ◽  
Alexandra O. Konradi
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Predictive Modeling ◽  
Social Impact ◽  
Cost Utility ◽  
Uncontrolled Hypertension ◽  
Life Years ◽  
Cardiovascular Morbidity And Mortality

Telehealth is a useful adjunct in hypertension (HTN) management. Despite obvious short-term clinical benefit, long-term social impact and cost-effectiveness have not been fully investigated. Aim. Predictive modeling of long-term clinical and social outcomes and the cost-effectiveness analysis of blood pressure (BP) telemonitoring and remote counseling (BPTM) in patients with HTN. Materials and methods. A Markov cohort-based (1000 patients in each study arm) model was developed and adopted a 10-year time horizon with 12-month time cycles. Cost and outcome data collected from the three-month study of 240 patients (160 in BPTM group and 80 controls, 48 y.o.). All patients started at a non-complicated HTN well state with a certain possibility of disease progression in a number of health states over a discrete time period. BPTM was compared with usual care in terms of 10-year healthcare costs, quality adjusted life years (QALY) using a Ministry of Health of Russian Federation perspective. Results. In the long-term run when compared with usual care BPTM was more effective in terms mortality (67 versus 91 patients lost and 9.6 versus 9.71 life years gained) and costs (cost of illness 102 508 000 RUR versus 145 237 700 RUR). Taking quality of life measures into account, the effect of BPTM was also more pronounced (8.31 versus 7.82 QALYs gained). The resultant incremental cost-utility ratio for BPTM was 275 178.98 RUR/1 QALY gained/1 patient (134 837.70 RUR/0.49 QALY/1 patient). Conclusion. According to the results of predictive modeling, implementation of BPTM into clinical practice is likely lead to reduced cardiovascular morbidity and mortality in a cost-effective way.

Sign in / Sign up

Export Citation Format

Share Document