scholarly journals Motion – Laparoscopic Nissen Fundoplication Is More Cost-Effective than Oral PPI Administration: Arguments against the Motion

2002 ◽  
Vol 16 (9) ◽  
pp. 627-631 ◽  
Author(s):  
Amnon Sonnenberg
Keyword(s):  
Cost Effectiveness ◽  
Nissen Fundoplication ◽  
Markov Chain Model ◽  
Treatment Options ◽  
Cost Effective ◽  
Chain Model ◽  
Acid Suppression Therapy ◽  
Laparoscopic Nissen ◽  
Logical Fallacies ◽  
Surgical Treatments

Discussion of the cost effectiveness of medical and surgical treatments of gastroesophageal reflux disease (GERD) is plagued by a number of logical fallacies. Several of these defects in reasoning are reviewed. For example, it is inappropriate to compare the costs of therapies unless they are equally effective. The relative cost effectiveness of various treatment options is difficult to determine because monetary expenditures and gains in health status cannot easily be measured in commensurate units. Not everything can be translated into incremental cost effectiveness ratios. Two decision analyses from European investigators seemed to show that Nissen fundoplication was more cost effective than long term acid-suppression therapy, but they failed to consider the costs of surgical complications and failures. The most comprehensive decision analysis, employing a Markov chain model, found that the two treatment options were roughly equivalent, at least during the first seven years of follow-up. Decision analyses often do not reflect actual practice patterns and cannot provide solutions to problems that cannot be solved by appropriate medical reasoning. Moreover, results that are reported by specialized surgical centres probably cannot be duplicated by less experienced surgeons. The increasing incidence of esophageal adenocarcinoma has been erroneously attributed to the use of potent acid-suppressant medications, but the actual cause has been shown to be the decreased prevalence ofHelicobacter pylori. There are no significant differences in the incidence of this tumour after medical or surgical therapy of GERD. It is unlikely, however, that arguments will convince proponents of one treatment or another to change their opinions.

scholarly journals Cost-effectiveness of allergic rhinitis treatment: An exploratory study

2018 ◽  
Vol 6 ◽  
pp. 205031211879458
Author(s):  
Jan Titulaer ◽  
Habibollah Arefian ◽  
Michael Hartmann ◽  
Mustafa Z Younis ◽  
Orlando Guntinas-Lichius
Keyword(s):  
Allergic Rhinitis ◽  
Cost Effectiveness ◽  
Side Effects ◽  
Symptom Score ◽  
Treatment Options ◽  
Local Therapy ◽  
Cost Effective ◽  
Subcutaneous Immunotherapy ◽  
Control Group ◽  
Placebo Control

Allergic rhinitis is serious public health problems and one of the most common chronic diseases worldwide. We aimed to assess the cost-effectiveness of clinically relevant treatment options for allergic rhinitis using evidence-based literature. In addition, we aimed to develop recommendations for allergic rhinitis treatment based on health economic facts. We searched MEDLINE via PubMed from 2009 to 2014 to identify all therapeutic options described in the current literature and selected randomized controlled trials that used a symptom score, had at least one placebo control group and used adult patients. We analyzed the side effects and the number of cases in which treatment was discontinued for each treatment option. Local antihistamines were the most cost-effective local therapy and are recommended due to the low number of complications. Regarding systemic therapies, although the use of oral steroids is indeed significantly cost-effective, this treatment was found to be associated with strong side effects. Sublingual immunotherapy was identified as the most cost-effective immunotherapy and exhibits a good side-effect profile. Overall, local therapy with antihistamines was found to be the most cost-effective option of all therapies. This study showed that there are only minor differences between sublingual and subcutaneous immunotherapy. Based on our results, we recommend the use of an international, uniform nasal symptom score to facilitate the comparison of clinical trials on allergic rhinitis in the future.

scholarly journals Cost-Effectiveness Analysis of the Spanish Renal Replacement Therapy Program

2012 ◽  
Vol 32 (2) ◽  
pp. 192-199 ◽  
Author(s):  
Guillermo Villa ◽  
Lucía Fernández–Ortiz ◽  
Jesús Cuervo ◽  
Pablo Rebollo ◽  
Rafael Selgas ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Markov Chain Model ◽  
Cost Savings ◽  
Quality Adjusted Life Year ◽  
Cost Effectiveness Analysis ◽  
Chain Model ◽  
Therapy Program ◽  
Effectiveness Analysis

♦BackgroundWe undertook a cost-effectiveness analysis of the Spanish Renal Replacement Therapy (RRT) program for end-stage renal disease patients from a societal perspective. The current Spanish situation was compared with several hypothetical scenarios.♦MethodsA Markov chain model was used as a foundation for simulations of the Spanish RRT program in three temporal horizons (5, 10, and 15 years). The current situation (scenario 1) was compared with three different scenarios: increased proportion of overall scheduled (planned) incident patients (scenario 2); constant proportion of overall scheduled incident patients, but increased proportion of scheduled incident patients on peritoneal dialysis (PD), resulting in a lower proportion of scheduled incident patients on hemodialysis (HD) (scenario 3); and increased overall proportion of scheduled incident patients together with increased scheduled incidence of patients on PD (scenario 4).♦ResultsThe incremental cost-effectiveness ratios (ICERs) of scenarios 2, 3, and 4, when compared with scenario 1, were estimated to be, respectively, -€83 150, -€354 977, and -€235 886 per incremental quality-adjusted life year (ΔQALY), evidencing both moderate cost savings and slight effectiveness gains. The net health benefits that would accrue to society were estimated to be, respectively, 0.0045, 0.0211, and 0.0219 ΔQALYs considering a willingness-to-pay threshold of €35 000/ΔQALY.♦ConclusionsScenario 1, the current Spanish situation, was dominated by all the proposed scenarios. Interestingly, scenarios 3 and 4 showed the best results in terms of cost-effectiveness. From a cost-effectiveness perspective, an increase in the overall scheduled incidence of RRT, and particularly that of PD, should be promoted.

scholarly journals Cost-Effectiveness Analysis of Statins for Treatment of Hospitalized COVID-19 Patients

2021 ◽  
Author(s):  
Ronald Chow ◽  
Elizabeth Horn Prsic ◽  
Hyun Joon Shin
Keyword(s):  
Cost Effectiveness ◽  
Meta Analysis ◽  
Treatment Options ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Treatment Regimens ◽  
Effectiveness Analysis ◽  
Cost Effective Treatment ◽  
United States Healthcare ◽  
Statin Use

Introduction: A recent systematic review and meta-analysis by our group reported on thirteen published cohorts investigating 110,078 patients. Patients administered statins after their COVID-19 diagnosis and hospitalization were found to have a lower risk of mortality. Given this reported superiority, a logical next question would be whether statins are cost-effective treatment options for hospitalized COVID-19 patients. In this paper, we report on a cost-effectiveness analysis of statin-containing treatment regimens for hospitalized COVID-19 patients, from a United States healthcare perspective. Methods: A Markov model was used, to compare statin use and no statin use among hospitalized COVID-19 patients. The cycle length was one week, with a time horizon of 4 weeks. A Monte Carlo microsimulation, with 20,000 samples were used. All analyses were conducted using TreeAge Pro Healthcare Version 2021 R1.1. Results: Treatment of hospitalized COVID-19 patients with statins was both cheaper and more effective than treatment without statins; statin-containing therapy dominates over non-statin therapy. Conclusion: Statin for treatment of COVID-19 should be further investigated in RCTs, especially considering its cost-effective nature. Optimistically and pending the results of future RCTs, statins may also be used broadly for treatment of hospitalized COVID-19 patients.

scholarly journals ANALISIS EFEKTIVITAS BIAYA PASIEN PNEUMONIA BALITA RAWAT INAP DI RUMAH SAKIT BHAYANGKARA MANADO

PHARMACON ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. 968
Author(s):  
Monica D. Lestari ◽  
Gayatri Citraningtyas ◽  
Hosea Jaya Edi
Keyword(s):  
Cost Effectiveness ◽  
Effective Treatment ◽  
Treatment Options ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Cost Effective Treatment ◽  
Retrospective Data Collection ◽  
Keywords Antibiotics ◽  
The Cost

ABSTRACTPneumonia is an infectious disease in the lower respiratory tract that affects the lung tissue. Ceftriaxone and Gentamicin antibiotics are the most numerous and good for use in the treatment of pneumonia, but of the two antibiotics is not yet known the options for more cost effective treatment, so it needs to be done the cost effectiveness analysis in order to facilitate the selection of more cost-effective treatment options especially in toddler. This study aims to determine which therapies are more cost-effective than the use of antibiotics Ceftriaxone and Gentamicin in pneumonia patients in the January-December 2018 period in the Bhayangkara Manado Hospital using descriptive research methods with retrospective data collection. The sample in this study were 22 patients, 12 patients using ceftriaxone antibiotics and 10 patients using gentamicin antibiotics. The results showed that pneumonia treatment in infants using Ceftriaxone antibiotics was more cost-effective with ACER ceftriaxone value of Rp. 503,872 / day and ICER value of Rp. 145,588 / day. Keywords : Antibiotics, CEA (Cost-Effectiveness Analysis), Pharmacoeconomy, Toddler Pneumonia. ABSTRAKPneumonia merupakan penyakit infeksi pada saluran pernapasan bagian bawah yang mengenai jaringan paru. Antibiotik Seftriakson dan Gentamisim yang paling banyak dan baik untuk digunakan dalam pengobatan pneumonia, namun dari kedua antibiotik tersebut belum diketahui pilihan terapi yang lebih cost-effective, sehingga perlu dilakukan analisis efektivitas biaya agar dapat mempermudah dalam pemilihan alternatif pengobatan yang lebih cost-effective khususnya pada balita. Penelitian ini bertujuan untuk menentukan terapi yang lebih cost-effective dari penggunaan antibiotik Seftriakson dan Gentamisin pada pasien pneumonia rawat inap periode Januari-Desember 2018 di Rumah Sakit Bhayangkara Manado dengan menggunakan metode penelitian deskriptif dengan pengambilan data secara retrospektif. Sampel pada penelitian ini sebanyak 22 pasien yaitu 12 pasien menggunakan antibiotik Seftriakson dan 10 pasien menggunakan antibiotik Gentamisin. Hasil penelitian menunjukkan pengobatan pneumonia pada balita menggunakan antibiotik Seftriakson lebih cost-effective dengan nilai ACER seftriakson sebesar Rp. 503,872/hari dan nilai ICER sebesar Rp. 145.588/hari. Kata Kunci : Pneumonia Balita, Antibiotik, CEA (Cost-Effectiveness Analysis), Farmakoekonomi

How nonrandomized trials (NRT) inform pan-Canadian Oncology Drug Review (pCODR) expert review committee (pERC) recommendations in blood cancer.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 100-100
Author(s):  
Missale Tiruneh ◽  
Stephanie Ross ◽  
Kristina Ellis ◽  
Maureen E. Trudeau ◽  
Catherine Moltzan ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Clinical Benefit ◽  
Burden Of Illness ◽  
Treatment Options ◽  
Indirect Comparison ◽  
Unmet Need ◽  
Cost Effective ◽  
Blood Cancer ◽  
Factors Affecting ◽  
Patient Values

100 Background: In Canada, the Canadian Agency for Drugs and Technologies in Health’s pERC makes reimbursement recommendations for cancer drugs based on pCODR reviews of best available evidence, which in some circumstances, is from Phase II NRTs. To date, the majority of pERC recommendations based on NRT evidence have been for blood cancers. Objective: To examine aspects of NRT evidence that may influence pERC reimbursement recommendations for blood cancers. Methods: Final pERC Recommendations on blood cancer reviews supported by NRTs were included (July 2011 to June 2018). Factors that influenced Final Recommendations, such as clinical benefit, alignment with patient values and cost-effectiveness, were extracted. Results: As of June 2018, 10 conditional and 6 negative decisions were made in 13 Final Recommendations. Among conditional reimbursement recommendations, substantial need for treatment options and poor prognosis with available therapies were commonly noted. Assessment of the feasibility of randomized controlled trials (RCT) varied. The magnitude of benefit was impressive or a substantial benefit was seen in subgroups with greater need. Some recommendations noted benefit above historical outcomes or consistent evidence with other indications or trials. Most recommendations reported an improvement in quality of life (QoL) and a manageable toxicity profile. Limitations included short trial follow-up. Factors affecting cost-effectiveness and alignment with patient values varied. Among negative recommendations, there was less certainty about burden of illness and need. Uncertainty about magnitude of clinical benefit was attributed to lack of direct or indirect comparison to available options, lack of long term data or comparison to historical evidence, limited QoL data, and variability in toxicity. All cases were not cost-effective and partially aligned with patient values. Conclusions: pERC may accept evidence from NRTs to make reimbursement recommendations for blood cancers when there is a high burden of illness, unmet need, reasonable demonstration of efficacy and manageable toxicities. Feasibility of RCT was not a consistent factor.

Stochastic Energy Opportunity Windows in Advanced Manufacturing Systems

2015 ◽  
Author(s):  
Yang Li ◽  
Qing Chang ◽  
Xiaoning Jin ◽  
Jun Ni
Keyword(s):  
Energy Saving ◽  
Manufacturing Systems ◽  
Production Control ◽  
Environmental Concern ◽  
Markov Chain Model ◽  
Cost Effective ◽  
Chain Model ◽  
Global Competitiveness ◽  
Improve Energy Efficiency ◽  
Multistage Manufacturing

To improve energy efficiency is becoming more and more critical for manufacturing enterprises because of the rising energy costs, increased global competitiveness, environmental concern and more government regulations. Production control has been considered as one of the most cost-effective methods to achieve the goal. This paper discusses the energy saving opportunities in a multistage manufacturing system through strategically shut down machines to reduce their running time. We start from the investigation on what is the longest time that machines can be shut down or turn to energy saving mode without affecting system production. Then, energy opportunity windows (EOWs) of machines are defined. A Markov chain model is developed to estimate the EOWs. A case study is conducted to demonstrate the proposed model and its potential on energy saving in multistage manufacturing systems.

scholarly journals Motion – Laparoscopic Nissen Fundoplication Is More Cost Effective Than Oral PPI Administration: Arguments for the Motion

2002 ◽  
Vol 16 (9) ◽  
pp. 621-623 ◽  
Author(s):  
Lee L Swanström
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Dietary Habits ◽  
Nissen Fundoplication ◽  
Symptom Relief ◽  
Cost Effective ◽  
Laparoscopic Nissen Fundoplication ◽  
Related Factors ◽  
Laparoscopic Nissen

Gastroesophageal reflux disease is a mechanical disorder of the foregut. While medications can only provide symptom relief, surgery can correct the pathophysiological abnormality of the lower esophageal sphincter. The costs of medical and surgical therapy are much greater than the costs of medication or hospitalization alone. In the case of medical therapy, one must consider the costs of serial monitoring and of failed treatment. The effectiveness of treatment also depends on patient-related factors, including weight, socioeconomic factors, smoking, alcohol use, dietary habits and the use of nonsteroidal anti-inflammatory drugs. Surgical results depend on the experience and skill of the surgeon, as well as the attributes of the institution in which the procedure is undertaken. Therefore, studies that come from specialized centres may not be applicable to the community. Data from the author’s facility indicate that laparoscopic Nissen fundoplication is the most cost effective option when it is undertaken by experienced surgeons on otherwise healthy patients who have documented gastroesophageal reflux disease.

scholarly journals Economic and epidemiological evaluation of interventions to reduce the burden of hepatitis C in Yunnan province, China

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245288
Author(s):  
Alastair Heffernan ◽  
Yanling Ma ◽  
Shevanthi Nayagam ◽  
Polin Chan ◽  
Zhongdan Chen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hepatitis C ◽  
Yunnan Province ◽  
Treatment Options ◽  
Scale Up ◽  
Cost Effective ◽  
Credible Interval ◽  
Hiv Care ◽  
Healthcare Sector ◽  
Hcv Treatment

Background The paradigm shift in hepatitis C virus (HCV) treatment options in the last five years has raised the prospect of eliminating the disease as a global health threat. This will require a step-change in the number being treated with the new direct-acting antivirals (DAAs). Given constrained budgets and competing priorities, policy makers need information on how to scale-up access to HCV treatment. To inform such decisions, we examined the cost effectiveness of screening and treatment interventions in Yunnan, China. Methods and findings We simulated the HCV epidemic using a previously published model of HCV transmission and disease progression, calibrated to Yunnan data, and implemented a range of treatment and screening interventions from 2019. We incorporated treatment, diagnosis, and medical costs (expressed in 2019 US Dollars, USD) to estimate the lifetime benefits and costs of interventions. Using this model, we asked: is introducing DAAs cost effective from a healthcare sector perspective; what is the optimal combination of screening interventions; and what is the societal return on investment of intervention? The incremental cost-effectiveness ratio (ICER) of switching to DAAs with a median cost of 7,400 USD (50,000 Chinese Yuan) per course is 500 USD/disability adjusted life year (DALY) averted; at a threshold of 50% of Yunnan gross domestic product (2,600 USD), switching to DAAs is cost effective 94% of the time. At this threshold, the optimal, cost-effective intervention comprises screening people who inject drugs, those in HIV care, men who have sex with men, and ensuring access to DAAs for all those newly diagnosed with HCV. For each USD invested in this intervention, there is an additional 0·80 USD (95% credible interval: 0·17–1·91) returned through reduced costs of disease or increased productivity. Returns on investment are lower (and potentially negative) if a sufficiently long-term horizon, encompassing the full stream of future benefits, is not adopted. The study had two key limitations: costing data were not always specific to Yunnan province but were taken from China-level studies; and modelled interventions may require more operational research to ensure they can be effectively and efficiently rolled-out to the entire province. Conclusions Introducing DAAs is cost effective, the optimal package of screening measures is focussed on higher risk groups, and there are likely to be positive returns from investing in such HCV interventions. Our analysis shows that targeted investment in HCV interventions will have net benefits to society; these benefits will only increase as DAA costs fall.

scholarly journals Gastro-oesophageal reflux: an overview of the pharmacotherapeutic treatment options

2017 ◽  
Vol 59 (3) ◽  
pp. 41-44
Author(s):  
L Malan ◽  
Q Labuschagne ◽  
N Schellack ◽  
G Schellack ◽  
J C Meyer
Keyword(s):  
Cost Effectiveness ◽  
Side Effects ◽  
Proton Pump ◽  
Reflux Disease ◽  
Acid Production ◽  
Treatment Options ◽  
Oesophageal Reflux ◽  
Causative Factors ◽  
Acid Suppression Therapy ◽  
Appropriate Therapy

Gastro-oesophageal reflux disease (GORD) produces symptoms that cause great irritation to the patient. Pharmacotherapeutic management is directed at minimising these symptoms and reducing the causative factors, e.g. acid production, thereby providing relief. Currently available agents include simple antacids and acid suppression therapy, including histamine 2-receptor antagonists, proton pump inhibitors, mucosal or cytoprotective agents and pro-motility agents. Deciding on appropriate therapy will depend on the diagnosis, side-effects and cost-effectiveness of the treatment.

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