scholarly journals Cost-Effectiveness of Product Reformulation in Response to the Health Star Rating Food Labelling System in Australia

Nutrients ◽  
2018 ◽  
Vol 10 (5) ◽  
pp. 614 ◽  
Author(s):  
Ana Mantilla Herrera ◽  
Michelle Crino ◽  
Holly Erskine ◽  
Gary Sacks ◽  
Jaithri Ananthapavan ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effective ◽  
Cost Effectiveness Ratio ◽  
Star Rating ◽  
Life Years ◽  
Packaged Food ◽  
The Cost ◽  
The Impact ◽  
Labelling System

The Health Star Rating (HSR) system is a voluntary front-of-pack labelling (FoPL) initiative endorsed by the Australian government in 2014. This study examines the impact of the HSR system on pre-packaged food reformulation measured by changes in energy density between products with and without HSR. The cost-effectiveness of the HSR system was modelled using a proportional multi-state life table Markov model for the 2010 Australian population. We evaluated scenarios in which the HSR system was implemented on a voluntary and mandatory basis (i.e., HSR uptake across 6.7% and 100% of applicable products, respectively). The main outcomes were health-adjusted life years (HALYs), net costs, and incremental cost-effectiveness ratios (ICERs). These were calculated with accompanying 95% uncertainty intervals (95% UI). The model predicted that HSR-attributable reformulation leads to small changes in mean population energy intake (voluntary: −0.98 kJ/day; mandatory: −11.81 kJ/day). These are likely to result in changes in mean body weight (voluntary: −0.01 kg [95% UI: −0.012 to −0.006]; mandatory: −0.11 kg [95% UI: −0.14 to −0.07]), and HALYs gained (voluntary: 4207 HALYs gained [95% UI: 2438 to 6081]; mandatory: 49,949 HALYs gained [95% UI: 29,291 to 72,153]). The HSR system could be considered cost-effective relative to a willingness-to-pay threshold of A$50,000 per HALY (incremental cost effectiveness ratio for voluntary: A$1728 per HALY [95% UI: dominant to 10,445] and mandatory: A$4752 per HALY [95% UI: dominant to 16,236]).

scholarly journals Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina

2013 ◽  
Vol 29 (12) ◽  
pp. 2459-2472 ◽  
Author(s):  
Pablo Wenceslao Orellano ◽  
Nestor Vazquez ◽  
Oscar Daniel Salomon
Keyword(s):  
Cost Effectiveness ◽  
Early Diagnosis ◽  
Incremental Cost ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Sensitivity Analyses ◽  
Cost Effectiveness Ratio ◽  
Tegumentary Leishmaniasis ◽  
Life Years ◽  
The Cost

The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.

scholarly journals A Cost-Effectiveness Analysis of Newborn Screening for Severe Combined Immunodeficiency in the UK

2019 ◽  
Vol 5 (3) ◽  
pp. 28 ◽  
Author(s):  
Alice Bessey ◽  
James Chilcott ◽  
Joanna Leaviss ◽  
Carmen de la Cruz ◽  
Ruth Wong
Keyword(s):  
Cost Effectiveness ◽  
Severe Combined Immunodeficiency ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Combined Immunodeficiency ◽  
Tree Model ◽  
Life Years ◽  
The Uk ◽  
The Cost ◽  
The Impact

Severe combined immunodeficiency (SCID) can be detected through newborn bloodspot screening. In the UK, the National Screening Committee (NSC) requires screening programmes to be cost-effective at standard UK thresholds. To assess the cost-effectiveness of SCID screening for the NSC, a decision-tree model with lifetable estimates of outcomes was built. Model structure and parameterisation were informed by systematic review and expert clinical judgment. A public service perspective was used and lifetime costs and quality-adjusted life years (QALYs) were discounted at 3.5%. Probabilistic, one-way sensitivity analyses and an exploratory disbenefit analysis for the identification of non-SCID patients were conducted. Screening for SCID was estimated to result in an incremental cost-effectiveness ratio (ICER) of £18,222 with a reduction in SCID mortality from 8.1 (5–12) to 1.7 (0.6–4.0) cases per year of screening. Results were sensitive to a number of parameters, including the cost of the screening test, the incidence of SCID and the disbenefit to the healthy at birth and false-positive cases. Screening for SCID is likely to be cost-effective at £20,000 per QALY, key uncertainties relate to the impact on false positives and the impact on the identification of children with non-SCID T Cell lymphopenia.

Lenvatinib versus sorafenib for unresectable hepatocellular carcinoma: a cost–effectiveness analysis

2020 ◽  
Vol 9 (8) ◽  
pp. 553-562
Author(s):  
Hongfu Cai ◽  
Longfeng Zhang ◽  
Na Li ◽  
Bin Zheng ◽  
Maobai Liu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Years ◽  
Cost Effectiveness Ratio ◽  
Phase 3 ◽  
Sorafenib Treatment ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Aim: To investigate the cost–effectiveness of lenvatinib and sorafenib in the treatment of patients with nonresected hepatocellular carcinoma in China. Materials & methods: Markov model was used to simulate the direct medical cost and quality-adjusted life years (QALY) of patients with hepatocellular carcinoma. Clinical data were derived from the Phase 3 randomized clinical trial in a Chinese population. Results: Sorafenib treatment resulted in 1.794 QALYs at a cost of $43,780.73. Lenvatinib treatment resulted in 2.916 QALYs for patients weighing <60 and ≥60 kg at a cost of $57,049.43 and $75,900.36, The incremental cost–effectiveness ratio to the sorafenib treatment group was $11,825.94/QALY and $28,627.12/QALY, respectively. Conclusion: According to WHO’s triple GDP per capita, the use of lenvatinib by providing drugs is a cost-effective strategy.

scholarly journals Cost Effectiveness Analysis Using Disability-Adjusted Life Years for Cataract Surgery

2020 ◽  
Vol 17 (16) ◽  
pp. 6010
Author(s):  
Thinni Nurul Rochmah ◽  
Anggun Wulandari ◽  
Maznah Dahlui ◽  
Ernawaty ◽  
Ratna Dwi Wulandari
Keyword(s):  
Cost Effectiveness ◽  
Cataract Surgery ◽  
Cost Effective ◽  
Disability Adjusted Life Years ◽  
Cost Effectiveness Ratio ◽  
Small Incision Cataract Surgery ◽  
Post Surgery ◽  
Disability Adjusted Life ◽  
Life Years ◽  
The Cost

Cataracts are the second most prioritized eye disease in the world. Cataracts are an expensive treatment because surgery is the only method that can treat the disease. This study aims to analyze the cost effectiveness of each operating procedure. Specifically, phacoemulsification and Small Incision Cataract Surgery (SICS) with Disability-Adjusted Life Years (DALYs) as the effectiveness indicator is used. This study is an observational analytic study with a prospective framework. The sample size is 130 patients who have undergone phacoemulsification and 25 patients who have undergone SICS. The DALY for phacoemulsification at Day-7 (D-7) is 0.3204, and at Day-21 (D-21), it is 0.3204, while the DALY for SICS at D-7 is 0.3060, and at D-21, it is 0.3158. The incremental cost effectiveness ratio (ICER) for cataract surgery at D-7 is USD $1872.49, and at D-21, it is USD $5861.71, whereas the Indonesian Gross Domestic Product (GDP) is USD $4174.90. In conclusion, the phacoemulsification technique is more cost effective than the SICS technique. The ICER value is very cost effective at D-7 post-surgery compared to at D-21 post-surgery because the ICER is less than 1 GDP per capita per DALY.

Societal and Economic Effect of Meniscus Scaffold Procedures for Irreparable Meniscus Injuries

2016 ◽  
Vol 44 (7) ◽  
pp. 1724-1734 ◽  
Author(s):  
Jan J. Rongen ◽  
Tim M. Govers ◽  
Pieter Buma ◽  
Janneke P.C. Grutters ◽  
Gerjon Hannink
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Incremental Cost ◽  
Medial Meniscus ◽  
Relative Risk Reduction ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
The Cost ◽  
Meniscus Scaffolds

Background: Meniscus scaffolds are currently evaluated clinically for their efficacy in preventing the development of osteoarthritis as well as for their efficacy in treating patients with chronic symptoms. Procedural costs, therapeutic consequences, clinical efficacy, and future events should all be considered to maximize the monetary value of this intervention. Purpose: To examine the socioeconomic effect of treating patients with irreparable medial meniscus injuries with a meniscus scaffold. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: Two Markov simulation models for patients with an irreparable medial meniscus injury were developed. Model 1 was used to investigate the lifetime cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by the possibility of preventing the development of osteoarthritis. Model 2 was used to investigate the short-term (5-year) cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by alleviating clinical symptoms, specifically in chronic patients with previous meniscus surgery. For both models, probabilistic Monte Carlo simulations were applied. Treatment effectiveness was expressed as quality-adjusted life-years (QALYs), while costs (estimated in euros) were assessed from a societal perspective. We assumed €20,000 as a reference value for the willingness to pay per QALY. Next, comprehensive sensitivity analyses were performed to identify the most influential variables on the cost-effectiveness of meniscus scaffolds. Results: Model 1 demonstrated an incremental cost-effectiveness ratio of a meniscus scaffold treatment of €54,463 per QALY (€5991/0.112). A threshold analysis demonstrated that a meniscus scaffold should offer a relative risk reduction of at least 0.34 to become cost-effective, assuming a willingness to pay of €20,000. Decreasing the costs of the meniscus scaffold procedure by 33% (€10,160 instead of €15,233; an absolute change of €5073) resulted in an incremental cost-effectiveness ratio of €7876 per QALY. Model 2 demonstrated an incremental cost-effectiveness ratio of a meniscus scaffold treatment of €297,727 per QALY (€9825/0.033). On the basis of the current efficacy data, a meniscus scaffold provides a relative risk reduction of “limited benefit” postoperatively of 0.37 compared with standard treatment. A threshold analysis revealed that assuming a willingness to pay of €20,000, a meniscus scaffold would not be cost-effective within a period of 5 years. Most influential variables on the cost-effectiveness of meniscus scaffolds were the cost of the scaffold procedure, cost associated with osteoarthritis, and quality of life before and after the scaffold procedure. Conclusion: Results of the current health technology assessment emphasize that the monetary value of meniscus scaffold procedures is very much dependent on a number of influential variables. Therefore, before implementing the technology in the health care system, it is important to critically assess these variables in a relevant context. The models can be improved as additional clinical data regarding the efficacy of the meniscus scaffold become available.

Evaluating the cost-effectiveness of hydrogel spacer in radiotherapy (RT) of prostate cancer (PC).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 43-43
Author(s):  
Rahul Ramesh Khairnar ◽  
Joseph Levy ◽  
Mark Mishra
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Intensity Modulated Radiation Therapy ◽  
Cost Effective ◽  
Credible Interval ◽  
Phase Iii ◽  
Incremental Effectiveness ◽  
Life Years ◽  
The Cost ◽  
Fee Schedule

43 Background: A hydrogel rectal spacer (HRS) is an FDA-approved medical device used to increase the separation between the rectum and the prostate. A recent phase III trial demonstrated a small reduction in the incidence of RT toxicities associated with use of HRS. We conducted a cost-effectiveness analysis of HRS use in PC patients undergoing intensity modulated radiation therapy (IMRT). Methods: A multi-state Markov model was constructed to examine the cost-effectiveness of HRS in men with localized PC receiving IMRT in the US (arms: IMRT alone vs. IMRT + HRS). Subgroups included delivery site of IMRT (hospital vs. ambulatory) and baseline sexual function (SF) (general population vs. those with good SF). Based on previous studies, recurrence and survival were assumed equal for both arms. Data on SF, gastrointestinal and genitourinary toxicities incidence, as well as potential risks associated with HRS implantation were obtained from a recently published clinical trial. Health utilities and costs were derived from the literature and 2018 Physician Fee Schedule. Quality-adjusted life years (QALYs) and costs were modeled for a 5-year period from receipt of RT. Probabilistic sensitivity analysis (PSA) and value-based threshold analysis were conducted. Costs and utilities were discounted at 3% annually. Results: The per-person 5-year incremental cost for HRS administered in a hospital was $4,008 and the incremental effectiveness was 0.0273 QALYs. The incremental cost-effectiveness ratio (ICER) was $146,746 (95% credible interval from PSA $125,638 – $178,049) for PC patients undergoing HRS insertion in a hospital vs. $73,359 ($66,732 – $86,767) for patients undergoing HRS insertion in an ambulatory facility. For men with good SF, the ICER was $55,153 ($46,002 – $76,090) and $26,542 ($17,399 – $46,044) in hospital vs. ambulatory facility. Conclusions: This study is the first to evaluate the cost-effectiveness of HRS based on long-term toxicity data. Based on the current Medicare Physician Fee Schedule, HRS is cost-effective in men with good SF at a willingness to pay threshold of $100,000 and it is marginally cost-effective for the entire population depending on the facility where the HRS is inserted.

scholarly journals Economic evaluation of sacubitril/valsartan versus enalapril in the treatment of heart failure with reduced ejection fraction

2020 ◽  
Author(s):  
Haiqiang SANG ◽  
Yaohui JIANG ◽  
Zhe WANG ◽  
Rujie ZHENG
Keyword(s):  
Heart Failure ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Ejection Fraction ◽  
Incremental Cost ◽  
Cost Effective ◽  
Incremental Cost Effectiveness Ratio ◽  
Cost Effectiveness Ratio ◽  
Reduced Ejection Fraction ◽  
The Cost

Abstract Background: In 2020, sacubitril/valsartan(formerly LCZ696) will implement the new negotiated price of medical insurance in China, and the cost of treatment will be significantly reduced. The aim of study is to evaluate the economy of sacubitril/valsartan(SAC/VAL) compared with an angiotensin converting enzyme inhibitor (ACEI) (enalapril) in the treatment of heart failure with reduced ejection fraction (HFrEF) in China.Method: A Markov model was developed to project clinical and economic outcomes of SAC/VAL versus enalapril for 64-year-old patients with HFrEF over 10 years from the Chinese medical and health system perspective. A cost-utility analysis was performed mostly based on data from the PARADIGM trial. Other transition probability, costs, and utilities were obtained from published literature and public databases. The primary outcome were total and incremental costs and quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) for SAC/VAL relative to enalapril. The model was verified the uncertainty using the sensitivity analysis furtherly.Results: Compared with enalapril, SAC/VAL cost more than enalapril (¥96532 vs. ¥34560) and was more cost-effective (4.6 QALYs vs. 4.3 QALYs), resulting in an incremental cost-effectiveness ratio of ¥185720 per QALY gained for patients with HFrEF at a WTP threshold of ¥212676 per QALY. Sensitivity analysis demonstrated the robustness of the model, identifying the death on the SAC/VAL group as a significant drivers of the cost-effectiveness. At the national negotiation price (¥9.95 per 100mg), probability of SAC/VAL being cost-effective was about 53% at a WTP threshold of ¥212676 per QALY.Conclusion: SAC/VAL was associated with clinical benefit and may be cost-effective compared with an ACEI (the current standard of care) in patients with HFrEF.

scholarly journals Cost-effectiveness of a market-based home fortification of food with micronutrient powder programme in Bangladesh

2020 ◽  
pp. 1-12
Author(s):  
Sayem Ahmed ◽  
Haribondhu Sarma ◽  
Zahid Hasan ◽  
Mahfuzur Rahman ◽  
Mohammad Wahid Ahmed ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effective ◽  
Fe Deficiency ◽  
Deficiency Anaemia ◽  
Micronutrient Powder ◽  
Start Up ◽  
Life Years ◽  
The Cost ◽  
Home Fortification

Abstract Objective: We estimated the cost-effectiveness of home fortification with micronutrient powder delivered in a sales-based programme in reducing the prevalence of Fe deficiency anaemia among children 6–59 months in Bangladesh. Design: Cross-sectional interviews with local and central-level programme staff and document reviews were conducted. Using an activity-based costing approach, we estimated start-up and implementation costs of the programme. The incremental cost per anaemia case averted and disability-adjusted life years (DALY) averted were estimated by comparing the home fortification programme and no intervention scenarios. Setting: The home fortification programme was implemented in 164 upazilas (sub-districts) in Bangladesh. Participants: Caregivers of child 6–59 months and BRAC staff members including community health workers were the participants for this study. Results: The home fortification programme had an estimated total start-up cost of 35·46 million BDT (456 thousand USD) and implementation cost of 1111·63 million BDT (14·12 million USD). The incremental cost per Fe deficiency anaemia case averted and per DALY averted was estimated to be 1749 BDT (22·2 USD) and 12 558 BDT (159·3 USD), respectively. Considering per capita gross domestic product (1516·5 USD) as the cost-effectiveness threshold, the home fortification programme was highly cost-effective. The programme coverage and costs for nutritional counselling of the beneficiary were influential parameters for cost per DALY averted in the one-way sensitivity analysis. Conclusions: The market-based home fortification programme was a highly cost-effective mechanism for delivering micronutrients to a large number of children in Bangladesh. The policymakers should consider funding and sustaining large-scale sales-based micronutrient home fortification efforts assuming the clear population-level need and potential to benefit persists.

scholarly journals Healthcare Costs and Life-years Gained From Treatments Within the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) Trial on Cryptococcal Meningitis: A Comparison of Antifungal Induction Strategies in Sub-Saharan Africa

2019 ◽  
Vol 69 (4) ◽  
pp. 588-595 ◽  
Author(s):  
Tao Chen ◽  
Lawrence Mwenge ◽  
Shabir Lakhi ◽  
Duncan Chanda ◽  
Peter Mwaba ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Resource Use ◽  
Cryptococcal Meningitis ◽  
Cost Effective ◽  
Sub Saharan Africa ◽  
Cost Effectiveness Ratio ◽  
Parametric Bootstrapping ◽  
Life Years ◽  
Sub Saharan ◽  
The Cost

Abstract Background Mortality from cryptoccocal meningitis remains high. The ACTA trial demonstrated that, compared with 2 weeks of amphotericin B (AmB) plus flucystosine (5FC), 1 week of AmB and 5FC was associated with lower mortality and 2 weeks of oral flucanozole (FLU) plus 5FC was non-inferior. Here, we assess the cost-effectiveness of these different treatment courses. Methods Participants were randomized in a ratio of 2:1:1:1:1 to 2 weeks of oral 5FC and FLU, 1 week of AmB and FLU, 1 week of AmB and 5FC, 2 weeks of AmB and FLU, or 2 weeks of AmB and 5FC in Malawi, Zambia, Cameroon, and Tanzania. Data on individual resource use and health outcomes were collected. Cost-effectiveness was measured as incremental costs per life-year saved, and non-parametric bootstrapping was done. Results Total costs per patient were US $1442 for 2 weeks of oral FLU and 5FC, $1763 for 1 week of AmB and FLU, $1861 for 1 week of AmB and 5FC, $2125 for 2 weeks of AmB and FLU, and $2285 for 2 weeks of AmB and 5FC. Compared to 2 weeks of AmB and 5FC, 1 week of AmB and 5FC was less costly and more effective and 2 weeks of oral FLU and 5FC was less costly and as effective. The incremental cost-effectiveness ratio for 1 week of AmB and 5FC versus oral FLU and 5FC was US $208 (95% confidence interval $91–1210) per life-year saved. Clinical Trials Registration ISRCTN45035509. Conclusions Both 1 week of AmB and 5FC and 2 weeks of Oral FLU and 5FC are cost-effective treatments.

scholarly journals The economic impact and cost-effectiveness of combined vector-control and dengue vaccination strategies in Thailand: results from a dynamic transmission model

2020 ◽  
Vol 14 (10) ◽  
pp. e0008805
Author(s):  
Gerhart Knerer ◽  
Christine S. M. Currie ◽  
Sally C. Brailsford
Keyword(s):  
Public Health ◽  
Cost Effectiveness ◽  
Vector Control ◽  
Dengue Fever ◽  
Control Strategies ◽  
Cost Effective ◽  
Scenario Analyses ◽  
Life Years ◽  
The Cost ◽  
The Impact

Background and aims Dengue fever is a major public health problem in tropical/subtropical regions. Prior economic analyses have predominantly evaluated either vaccination or vector-control programmes in isolation and do not really consider the incremental benefits and cost-effectiveness of mixed strategies and combination control. We estimated the cost-effectiveness of single and combined approaches in Thailand. Methods The impacts of different control interventions were analysed using a previously published mathematical model of dengue epidemiology and control incorporating seasonality, age structure, consecutive infection, cross protection, immune enhancement and combined vector-host transmission. An economic model was applied to simulation results to estimate the cost-effectiveness of 4 interventions and their various combinations (6 strategies): i) routine vaccination of 1-year olds; ii) chemical vector control strategies targeting adult and larval stages separately; iii) environmental management/ public health education and awareness [EM/ PHEA]). Payer and societal perspectives were considered. The health burden of dengue fever was assessed using disability-adjusted life-years (DALYs) lost. Costs and effects were assessed for 10 years. Costs were discounted at 3% annually and updated to 2013 United States Dollars. Incremental cost-effectiveness analysis was carried out after strategies were rank-ordered by cost, with results presented in a table of incremental analysis. Sensitivity and scenario analyses were undertaken; and the impact and cost-effectiveness of Wolbachia was evaluated in exploratory scenario analyses. Results From the payer and societal perspectives, 2 combination strategies were considered optimal, as all other control strategies were dominated. Vaccination plus adulticide plus EM/ PHEA was deemed cost-effective according to multiple cost-effectiveness criteria. From the societal perspective, incremental differences vs. adulticide and EM/ PHEA resulted in costs of $157.6 million and DALYs lost of 12,599, giving an expected ICER of $12,508 per DALY averted. Exploratory scenario analyses showed Wolbachia to be highly cost-effective ($343 per DALY averted) vs. other single control measures. Conclusions Our model shows that individual interventions can be cost-effective, but that important epidemiological reductions and economic impacts are demonstrated when interventions are combined as part of an integrated approach to combating dengue fever. Exploratory scenario analyses demonstrated the potential epidemiological and cost-effective impact of Wolbachia when deployed at scale on a nationwide basis. Our findings were robust in the face of sensitivity analyses.

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