scholarly journals Cost–Utility of Mindfulness-Based Stress Reduction for Fibromyalgia versus a Multicomponent Intervention and Usual Care: A 12-Month Randomized Controlled Trial (EUDAIMON Study)

2019 ◽  
Vol 8 (7) ◽  
pp. 1068 ◽  
Author(s):  
Adrián Pérez-Aranda ◽  
Francesco D’Amico ◽  
Albert Feliu-Soler ◽  
Lance M. McCracken ◽  
María T. Peñarrubia-María ◽  
...  
Keyword(s):  
Stress Reduction ◽  
Controlled Trial ◽  
Indirect Costs ◽  
Cost Utility ◽  
Public Healthcare ◽  
Quality Adjusted Life Years ◽  
Randomized Controlled ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost–utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to treatment-as-usual (TAU) for patients with FM compared to an adjuvant multicomponent intervention (“FibroQoL”) and to TAU. We performed an economic evaluation alongside a 12 month, randomized, controlled trial; data from 204 (68 per study arm) of the 225 patients (90.1%) were included in the cost–utility analyses, which were conducted both under the government and the public healthcare system perspectives. The main outcome measures were the EuroQol (EQ-5D-5L) for assessing Quality-Adjusted Life Years (QALYs) and improvements in health-related quality of life, and the Client Service Receipt Inventory (CSRI) for estimating direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were also calculated. Two sensitivity analyses (intention-to-treat, ITT, and per protocol, PPA) were conducted. The results indicated that MBSR achieved a significant reduction in costs compared to the other study arms (p < 0.05 in the completers sample), especially in terms of indirect costs and primary healthcare services. It also produced a significant incremental effect compared to TAU in the ITT sample (ΔQALYs = 0.053, p < 0.05, where QALYs represents quality-adjusted life years). Overall, our findings support the efficiency of MBSR over FibroQoL and TAU specifically within a Spanish public healthcare context.

scholarly journals An Economic Evaluation of Thread Embedding Acupuncture for the Treatment of Lumbar Herniated Intervertebral Disc in a Randomized Controlled Clinical Trial

2021 ◽  
Vol 38 (4) ◽  
pp. 312-319
Author(s):  
Ha-Na Kim ◽  
Jun-Yeon Kim ◽  
Kyeong-Ju Park ◽  
Ji-Min Hwang ◽  
Jun-Yeong Jang ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Visual Analog Scale Score ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Randomized Controlled ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Background: Lumbar herniated intervertebral disc (LHIVD) is a frequently presented condition/disease in Korean medical institutions. In this study, the economics of thread embedding acupuncture (TEA) was evaluated in a randomized controlled trial comparing TEA with sham TEA (STEA).Methods: This economic evaluation was analyzed from a limited social perspective, and the per-protocol set was from a basic analysis perspective. The cost-effectiveness analysis was based on the change in visual analog scale score, and the cost-utility analysis was based on the quality-adjusted life years. The final results were expressed as the average cost-effectiveness ratio and incremental cost-effectiveness ratio, and furthermore sensitivity analysis was performed to confirm the robustness of the results observed.Results: The cost-effectiveness analysis showed that TEA was 9,908 won lower than STEA, while the decrease in 100 mm visual analog scale score was 8.5 mm greater in the TEA group compared with the STEA group (p > 0.05). The cost-utility analysis showed that TEA was 9,908 won lower than STEA, while the quality-adjusted life years of TEA was 0.0026 years higher than STEA (p > 0.05). These results were robust in the sensitivity analysis, but were not statistically significant.Conclusion: In treating LHIVD, TEA appeared to have cost-effectiveness and cost-utility compared with STEA. However, there were no significant differences between the groups in terms of cost, effectiveness, and utility indicators. Therefore, results must be interpreted prudently; this study was the 1st to conduct an economic evaluation of TEA for LHIVD.

scholarly journals Cost–utility analysis of minimally invasive surgery for lung cancer: a randomized controlled trial

2019 ◽  
Vol 56 (4) ◽  
pp. 754-761 ◽  
Author(s):  
Morten Bendixen ◽  
Christian Kronborg ◽  
Ole Dan Jørgensen ◽  
Claus Andersen ◽  
Peter Bjørn Licht
Keyword(s):  
Lung Cancer ◽  
Controlled Trial ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Randomized Controlled ◽  
Life Years ◽  
Stage 1 ◽  
Quality Adjusted Life

Abstract OBJECTIVES: Minimally invasive video-assisted thoracic surgery (VATS) was first introduced in the early 1990s. For decades, numerous non-randomized studies demonstrated advantages of VATS over thoracotomy with lower morbidity and shorter hospital stay, but only recently did a randomized trial document that VATS results in lower pain scores and better quality of life. Opposing arguments for VATS have always been increased costs and concerns about oncological adequacy. In this paper, we aim to investigate the cost-effectiveness of VATS. METHODS: The study was designed as a cost–utility analysis of the first 12 months following surgery and was performed together with a clinical randomized controlled trial of VATS versus thoracotomy for lobectomy of stage 1 lung cancer during a 6-year period (2008–2014). All health-related expenses were retrieved from a national database (Statistics Denmark) including hospital readmissions, outpatient clinic visits, prescription medication costs, consultations with general practitioners, specialists, physiotherapists, psychologists and chiropractors. RESULTS: One hundred and three VATS patients and 103 thoracotomy patients were randomized. Mean costs per patient operated by VATS were 103 108 Danish Kroner (Dkr) (€13 818) and 134 945 Dkr (€18 085) by thoracotomy, making the costs for VATS 31 837 Dkr (€4267) lower than thoracotomy (P < 0.001). The difference in quality-adjusted life years gained over 52 weeks of follow-up was 0.021 (P = 0.048, 95% confidence interval −0.04 to −0.00015) in favour of VATS. The median duration of the surgical procedure was shorter after thoracotomy (79 vs 100 min; P < 0.001). The mean length of hospitalization was shorter following VATS (4.8 vs 6.7 days; P = 0.027). The use of other resources was not significantly different between groups. The costs of resources were lower in the VATS group. This difference was primarily due to reduced costs of readmissions (VATS 29 247 Dkr vs thoracotomy 51 734 Dkr; P < 0.001) and costs of outpatient visits (VATS 51 412 Dkr vs thoracotomy 61 575 Dkr; P = 0.012). CONCLUSIONS: VATS is a cost-effective alternative to thoracotomy following lobectomy for stage 1 lung cancer. Economical outcomes as measured by quality-adjusted life years were significantly better and overall costs were lower for VATS. Clinical Trial Registration Number: NCT01278888.

scholarly journals Cost-utility of venoarterial extracorporeal membrane oxygenation in cardiogenic shock and cardiac arrest

2020 ◽  
Vol 9 (4) ◽  
pp. 333-341
Author(s):  
Salla Jäämaa-Holmberg ◽  
Birgitta Salmela ◽  
Raili Suojaranta ◽  
Karl B Lemström ◽  
Jyri Lommi
Keyword(s):  
Cardiac Arrest ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Background: The use of venoarterial extracorporeal membrane oxygenation in cardiogenic shock keeps increasing, but its cost-utility is unknown. Methods: We studied retrospectively the cost-utility of venoarterial extracorporeal membrane oxygenation in a five-year cohort of consequent patients treated due to refractory cardiogenic shock or cardiac arrest in a transplant centre in 2013–2017. In our centre, venoarterial extracorporeal membrane oxygenation is considered for all cardiogenic shock patients potentially eligible for heart transplantation, and for selected postcardiotomy patients. We assessed the costs of the index hospitalization and of the one-year hospital costs, and the patients’ health-related quality of life (response rate 71.7%). Based on the data and the population-based life expectancies, we calculated the amount and the costs of quality-adjusted life years gained both without discount and with an annual discount of 3.5%. Results: The cohort included 102 patients (78 cardiogenic shock; 24 cardiac arrest) of whom 67 (65.7%) survived to discharge and 66 (64.7%) to one year. The effective costs per one hospital survivor were 242,303€. Median in-hospital costs of the index hospitalization per patient were 129,967€ (interquartile range 150,340€). Mean predicted number of quality-adjusted life years gained by the treatment was 20.9 (standard deviation 9.7) without discount, and the median cost per quality-adjusted life year was 7474€ (interquartile range 10,973€). With the annual discount of 3.5%, 13.0 (standard deviation 4.8) quality-adjusted life years were gained with the cost of 12,642€ per quality-adjusted life year (interquartile range 15,059€). Conclusions: We found the use of venoarterial extracorporeal membrane oxygenation in refractory cardiogenic shock and cardiac arrest justified from the cost-utility point of view in a transplant centre setting.

scholarly journals Cost-utility of brief psychological treatment for depression and anxiety

2006 ◽  
Vol 188 (4) ◽  
pp. 323-329 ◽  
Author(s):  
Leona Hakkaart-Van Roijen ◽  
Annemieke Van Straten ◽  
Maiwenn Al ◽  
Frans Rutten ◽  
Marianne Donker
Keyword(s):  
Brief Therapy ◽  
Psychological Treatment ◽  
Controlled Trial ◽  
Indirect Costs ◽  
Direct Costs ◽  
Cost Utility ◽  
Depression And Anxiety ◽  
Treatment Groups ◽  
Life Years ◽  
The Cost

BackgroundThe cost-utility of brief therapy compared with cognitive–behavioural therapy (CBT) and care as usual in the treatment of depression and anxiety has not yet been determined.AimsTo assess the cost-utility of brief therapy compared with CBT and care as usual.MethodA pragmatic randomised controlled trial involving 702 patients was conducted at 7 Dutch mental healthcare centres (MHCs). Patients were interviewed at baseline and then every 3 months over a period of 1.5 years, during which time data were collected on direct costs, indirect costs and quality of life.ResultsThe mean direct costs of treatment at the MHCs were significantly lower for brief therapy than for CBT and care as usual. However, after factoring in other healthcare costs and indirect costs, no significant differences between the treatment groups could be detected. We found no significant differences in quality-adjusted life-years between the groups.ConclusionsCost-utility did not differ significantly between the three treatment groups.

scholarly journals Managing female urinary incontinence: A regional prospective analysis of cost-utility ratios (curs) and effectiveness

2014 ◽  
Vol 86 (2) ◽  
pp. 112 ◽  
Author(s):  
Elisabetta Costantini ◽  
Massimo Lazzeri ◽  
Vittorio Bini ◽  
Alessandro Zucchi ◽  
Emanuele Scarponi ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Pelvic Floor Muscle ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Group A ◽  
Grade Ii ◽  
Group B ◽  
The Cost ◽  
Quality Adjusted Life

Introduction: To evaluate the cost-utility of incontinence treatments, particularly anticholinergic therapy, by examining costs and quality-adjusted life years. Materials and methods: A prospective cohort study of women who were consecutively referred by general practitioners (GPs) to the Urology Department because of urinary incontinence. The primary outcome was evaluation of the cost-utility of incontinence treatments (surgery, medical therapy and physiotherapy) for stress and/or urgency incontinence by examining costs and quality-adjusted life years. Results: 137 consecutive female patients (mean age 60.6 ± 11.6; range 36-81) were enrolled and stratified according to pathologies: SUI and UUI. Group A: SUI grade II-III: 43 patients who underwent mid-urethral sling (MUS); Group B: SUI grade I-II 57 patients who underwent pelvic floor muscle exercise and Group C: UUI: 37 patients who underwent antimuscarinic treatment with 5 mg solifenacin daily. The cost utility ratio (CUR) was estimated as saving more than €1200 per QALY for surgery and physiotherapy and as costing under € 100 per QALY for drug therapy. Conclusions: This study shows that appropriate diagnosis and treatment of a patient with incontinence lowers National Health Service costs and improves the benefits of treatment and quality of life.

Kosten-Effektivitäts- und Kosten-Nutzwert-Analysen der Antirefluxmedizin

2018 ◽  
Vol 81 (12) ◽  
pp. 1048-1056
Author(s):  
Ines Gockel ◽  
Undine Gabriele Lange ◽  
Olaf Schürmann ◽  
Boris Jansen-Winkeln ◽  
Rainer Sibbel ◽  
...  
Keyword(s):  
Incremental Cost ◽  
Controlled Trial ◽  
Cost Utility ◽  
Cochrane Library ◽  
Randomisierte Studien ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Barrett Ösophagus ◽  
Vergleichende Studien ◽  
Quality Adjusted Life

Zusammenfassung Einleitung Die laparaskopische Antirefluxplastik und die medikamentöse Therapie mit Säureblockern sind Goldstandard der Therapie der gastroösophagealen Refluxerkrankung. Aufgrund begrenzter Ressourcen bei gleichzeitig steigenden Gesundheitsbedürfnissen und -kosten sollen in der vorliegenden Arbeit beide Methoden nicht nur hinsichtlich des medizinisch besten Resultats, sondern auch in Bezug auf ihre gesundheitsökonomische Überlegenheit untersucht werden. Methodik Es erfolgte eine elektronische Literaturanalyse in den Datenbanken MEDLINE, PubMed, Cochrane Library, ISRCTN (International Standard Randomization Controlled Trial Number) sowie in der NHS Economic Evaluation Database bis 01/2017. Eingeschlossen wurden nur Studien, welche als Zielparameter die Effektgrößen QALY (=Quality-Adjusted Life Years) (unter Berücksichtigung verschiedener Lebensqualitäts-Scores) im Vergleich von laparoskopischer Fundoplikatio und medikamentöser Therapie umfassten. Kriterien, anhand derer die Studien gegenübergestellt und verglichen wurden, waren die Effektgrößen QALY (Quality-Adjusted Life Years) bzw. daraus resultierend ICER (Incremental Cost-Effectiveness Ratio=inkrementelle Kosten-Effektivitäts-Relation)/ICUR (Incremental Cost-Utility Ratio=inkrementelle Kosten-Nutzen-Relation). Je inkludierter Publikation wurde anhand dieser Parameter die Superiorität des jeweiligen Verfahrens herausgearbeitet. Resultate Es konnten insgesamt 18 vergleichende Studien in der aktuellen Literatur zu o. g. Suchbegriffen identifiziert werden, die die definierten Einschlußkriterien erfüllten. 6 Studien konnten final in unsere Analysen eingeschlossen werden. Es zeigt sich bei 3 der 6 analysierten Publikationen eine bessere Kosteneffektivität zugunsten der laparoskopischen Fundoplikatio. Limitationen sind aufgrund unterschiedlicher Zeithorizonte, Evidenzlevel der Studien und zugrundeliegender Ressourcen/Kosten der Analysen, verschiedener Gesundheitssysteme und angewandter Lebensqualitäts-Instrumente gegeben. Schlussfolgerung Künftige prospektiv-randomisierte Studien müssen diesen Vergleich noch ausführlicher untersuchen. Zudem findet sich ein großes Potenzial für weitere Studien in der gesundheitsökonomischen Beurteilung von Früherkennungs- und Präventionsmaßnahmen der Refluxerkrankung bzw. des Barrett-Ösophagus und -Karzinoms.

scholarly journals The clinical and economic efficiency of treatment in patients with chronic heart failure

2013 ◽  
Vol 4 (1) ◽  
pp. 72-76
Author(s):  
E. I Tarlovskaya ◽  
S. V Malchikova
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Standard Therapy ◽  
Cost Effective ◽  
Cost Utility ◽  
Cost Structure ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Objective: to study the clinical and economic benefits of adding ivabradine to standard therapy for chronic heart failure (CHF). Subjects and methods. A clinical and economic analysis of the pharmacoeconomic efficacy of ivabradine (Coraxan Servier, France) in patients with CHF was made using the Markov simulation on the basis of the SHIFT trial. The cost-utility ratio (CUR) was calculated by the formula: CUR=DC/Ut, where DC is the direct cost of treatment; Ut is the cost utility expressed in life-years gained (LYG) and quality-adjusted life years (QALY). While calculating the latter, the model used the utility value derived in the SHIFT-PRO trial, by applying the EQ-5D questionnaire. Results. The monthly cost of standard pharmacotherapy was 799,14 rbl. per person. The treatment involving ivabradine cost 1807,77 rbl. The mean total direct cost for treating one patient was 64 741,09 and 47 647,83 rbl. in the ivabradine and placebo groups, respectively. The costs of hospital stay were ascertained to constitute 60% of all the direct costs in patients receiving standard therapy. On the contrary, addition of ivabradine to standard therapy allows avoidance of 309 admissions for worsening CHF, which permitted 23 709 879 rbl. to be saved. Reducing the costs of hospitalization enables one to spend 67% of the means for pharmacotherapy. Following a 10-year simulation period, the standard therapy remains more inexpensive than therapy involving ivabradine (74 585,31 rbl. per person versus 120 843,30 rbl per person) and ensures the lower cost of one LYG and one QALY. At the same time, the therapy added by ivabradine can prevent 1300 admissions for CHF and about 500 deaths per 10,000 patients over 10 years. This will lead to more life-years gained (4,277 LYGs on ivabradine therapy versus 4,083 LYGs on standard therapy), including quality-adjusted life years (3,031 QALYs on ivabradine therapy versus 2,839 QALYs on standard therapy). When ivabradine was added to standard therapy, the cost of one LYG was 238 443 rbl. and that of QALY was 240 927 rbl. Thus, the estimated medical intervention is a cost-effective investment. Conclusions: 1. To enhance the efficiency of CHF treatment with ivabradine causes a rational change in the cost structure. 2. To reduce the costs of hospitalizations and to change the cost structure provide a possibility of increasing those of qualitative therapy. 3. To incorporate ivabradine in therapy for systolic CHF can gain more additional life years, including quality-adjusted life years. 4. To increase expenses on therapy involving ivabradine per LYG is a cost-effective investment.

scholarly journals Tubular Diskectomy vs Conventional Microdiskectomy for the Treatment of Lumbar Disk-Related Sciatica: Cost Utility Analysis Alongside a Double-Blind Randomized Controlled Trial

Neurosurgery ◽  
2011 ◽  
Vol 69 (4) ◽  
pp. 829-836 ◽  
Author(s):  
M Elske van den Akker ◽  
Mark P Arts ◽  
Wilbert B van den Hout ◽  
Ronald Brand ◽  
Bart W Koes ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Controlled Trial ◽  
Cost Effective ◽  
Cost Utility ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Double Blind ◽  
Lumbar Disk ◽  
Life Years ◽  
Quality Adjusted Life

Abstract BACKGROUND: Conventional microdiskectomy is the most frequently performed surgery for patients with sciatica caused by lumbar disk herniation. Transmuscular tubular diskectomy has been introduced to increase the rate of recovery, although evidence of its efficacy is lacking. OBJECTIVE: To determine whether a favorable cost-effectiveness for tubular diskectomy compared with conventional microdiskectomy is attained. METHODS: Cost utility analysis was performed alongside a double-blind randomized controlled trial conducted among 325 patients with lumbar disk related sciatica lasting &gt;6 to 8 weeks at 7 Dutch hospitals comparing tubular diskectomy with conventional microdiskectomy. Main outcome measures were quality-adjusted life-years at 1 year and societal costs, estimated from patient reported utilities (US and Netherlands EuroQol, Short Form Health Survey-6D, and Visual Analog Scale) and diaries on costs (health care, patient costs, and productivity). RESULTS: Quality-adjusted life-years during all 4 quarters and according to all utility measures were not statistically different between tubular diskectomy and conventional microdiskectomy (difference for US EuroQol, −0.012; 95% confidence interval, −0.046 to 0.021). From the healthcare perspective, tubular diskectomy resulted in nonsignificantly higher costs (difference US $460; 95% confidence interval, −243 to 1163). From the societal perspective, a nonsignificant difference of US $1491 (95% confidence interval, −1335 to 4318) in favor of conventional microdiskectomy was found. The nonsignificant differences in costs and quality-adjusted life-years in favor of conventional microdiskectomy result in a low probability that tubular diskectomy is more cost-effective than conventional microdiskectomy. CONCLUSION: Tubular diskectomy is unlikely to be cost-effective compared with conventional microdiskectomy.

Utilities and Quality-Adjusted Life Years

1989 ◽  
Vol 5 (4) ◽  
pp. 559-575 ◽  
Author(s):  
George W. Torrance ◽  
David Feeny
Keyword(s):  
Quality Of Life ◽  
Cost Utility ◽  
Health Improvement ◽  
Quality Adjusted Life Years ◽  
Utility Analysis ◽  
Quality Adjustment ◽  
Life Years ◽  
Quality Adjusted Life ◽  
Broad Overview

Utilities and quality-adjusted life years (QALYs) are reviewed, with particular focus on their use in technology assessment. This article provides a broad overview and perspective on these two techniques and their interrelationship, with reference to other sources for details of implementation. The historical development, assumptions, strengths/weaknesses, and applications of each are summarized.Utilities are specifically designed for individual decision-making under uncertainty, but, with additional assumptions, utilities can be aggregated across individuals to provide a group utility function. QALYs are designed to aggregate in a single summary measure the total health improvement for a group of individuals, capturing improvements from impacts on both quantity of life and quality of life– with quality of life broadly defined. Utilities can be used as the quality-adjustment weights for QALYs; they are particularly appropriate for that purpose, and this combination provides a powerful and highly useful variation on cost-effectiveness analysis known as cost-utility analysis.

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