Liquid ventilation: new frontiers in the treatment of ARDS

1996 ◽  
Vol 16 (3) ◽  
pp. 53-58 ◽  
Author(s):  
S Dirkes
Keyword(s):  
Clinical Trial ◽  
Cost Effectiveness ◽  
Adverse Effects ◽  
Current Literature ◽  
Clinical Studies ◽  
Morbidity And Mortality ◽  
Hemodynamic Parameters ◽  
Liquid Ventilation ◽  
Simple Method ◽  
The Cost

At our institution, PLV continues to be used as an investigational therapy for patients with ARDS who meet the protocol criteria. Since this is the beginning of the first nonneonatal clinical trial of PLV, results of this therapy are not yet available. Adverse effects on hemodynamic parameters have not been documented in the current literature for patients treated with liquid ventilation. In addition, further clinical studies using PLV therapy will be necessary to determine whether it will significantly change the morbidity and mortality of ARDS in infants or adults. Other questions to be answered include the cost-effectiveness of using this therapy for patients with ARDS, as well as what type of program will be required to carry out this therapy. It is hoped that this type of ventilatory therapy will offer an effective, simple method of treatment for patients with ARDS in the future.

Modeling the cost-effectiveness of a new treatment for MS (natalizumab) compared with current standard practice in Sweden

2008 ◽  
Vol 14 (5) ◽  
pp. 679-690 ◽  
Author(s):  
G Kobelt ◽  
J Berg ◽  
P Lindgren ◽  
B Jonsson ◽  
L Stawiarz ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cost Effectiveness ◽  
Societal Perspective ◽  
Functional Disability ◽  
Health Benefit ◽  
Base Case ◽  
Current Standard ◽  
Disease Modifying Drugs ◽  
New Treatment ◽  
The Cost

Objective To estimate the cost-effectiveness of a new treatment (natalizumab) for multiple sclerosis (MS) compared with current standard therapy with disease-modifying drugs (DMDs) in Sweden. Methods A Markov model was constructed to illustrate disease progression based on functional disability (the Expanded Disability Status Scale (EDSS)). The effectiveness of natalizumab was based on a 2-year clinical trial in 942 patients (AFFIRM). The effectiveness of current DMDs was estimated from a matched sample of 512 patients in the Stockholm MS registry. Patients withdrawing from treatment were assumed to follow the disease course of 824 patients with relapsing–remitting disease at onset in the Ontario natural history cohort. Costs and utilities are based on a recent observational study in 1339 patients. All data sets were available at the patient level. Main results are presented from the societal perspective, over a 20-year time frame, in 2005 Euros (€1 = 9.25 SEK). Results In the base case, treatment with natalizumab was less expensive and more effective than treatment with current DMDs. When only healthcare costs were considered, the cost per quality-adjusted life year gained with natalizumab was €38 145. Results are sensitive only to the time horizon of the analysis and assumptions about effectiveness of natalizumab beyond the trial. Conclusions This cost-effectiveness analysis used registry data, cohort and observational studies to extrapolate the efficacy findings of natalizumab from the AFFIRM clinical trial to measure effectiveness in clinical practice. The analysis results suggest that for the population considered, natalizumab provides an additional health benefit at a similar cost to current DMDs from a societal perspective.

Prevalence of Abacavir Hypersensitivity Reaction and Cost-Effectiveness of HLA-B*5701 Screening: A Ten-Year Experience in The HRH Princess Maha Chakri Sirindhorn Medical Center

2021 ◽  
Vol 104 (10) ◽  
pp. 1698-1705
Keyword(s):  
Cost Effectiveness ◽  
Adverse Effects ◽  
Hypersensitivity Reaction ◽  
Human Leukocyte Antigen ◽  
Medical Center ◽  
Human Leukocyte ◽  
Leukocyte Antigen ◽  
Effectiveness Analysis ◽  
Use Pattern ◽  
The Cost

Background: Recently, the authors had reported a case with abacavir hypersensitivity reaction (ABC-HSR), the first diagnosed patient at the HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC). There was no data regarding the incidence or prevalence of ABC-HSR previously reported in Thailand. Objective: To study the prevalence of ABC-HSR, the abacavir use pattern and the cost effectiveness for the routine human leukocyte antigen (HLA)-B*5701 screening before abacavir use by analyses of the MSMC data. Materials and Methods: All patients at the MSMC who were prescribed abacavir from October 1, 2010 to September 30, 2020 were retrospectively reviewed for ABC-HSR and the abacavir use pattern at the time when abacavir was started. The cost-effectiveness analysis was applied by analyzing the cost between the routine HLA-B*5701 screening before abacavir use and the HLA-B*5701 confirmation for ABC-HSR. The cost for the prevention of a case of ABC-HSR was defined. Results: There were total of 54 patients who were prescribed abacavir and only one ABC-HSR case diagnosed. The prevalence of ABC-HSR was 1.85%. The main reason for the abacavir prescription was a substitution for tenofovir (TDF) because of the TDF adverse effects (81.13%). The HLA-B*5701 screening before abacavir use was done in 26.42% at the MSMC. If all eligible patients were routinely screened for the HLA-B*5701 allele before abacavir use, the cost would be 54,000 Baht. The cost for the diagnosis and the management of the ABC- HSR case was 7,230 Baht. The cost for the prevention of a case of ABC-HSR was 46,770 Baht. Conclusion: The prevalence of ABC-HSR was low. The main reason for abacavir use was a substitution for TDF. The cost for the prevention for a case of ABC-HSR was 46,770 Baht which would be less if the cost for the HLA-B*5701 test was reduced. Keywords: Abacavir; Hypersensitivity reaction; Prevalence; HLA-B*5701

Using Data and Statistics to Explain Investment Effectiveness on Flood Protection

2016 ◽  
Vol 11 (6) ◽  
pp. 1238-1243
Author(s):  
Kenichi Tsukahara ◽  
◽  
Noriyasu Kachi ◽  
Keyword(s):  
World War Ii ◽  
Cost Effectiveness ◽  
Poverty Alleviation ◽  
National Level ◽  
Flood Protection ◽  
Disaster Prevention ◽  
Prevention Measures ◽  
Simple Method ◽  
Development Goals ◽  
The Cost

Losses and damages caused by natural disasters have negatively impacted poverty alleviation and human development and undermine the achievement of the Millennium Development Goals (MDGs). However, disaster issues were not included in MDG targets set up in 2000. A new development agenda, Sustainable Development Goals (SDGs), was approved in the UN General Assembly in September 2015. In the SDGs, disaster issues are included in many targets such as target 11.5. To appropriately set targets and prepare monitoring measures for disaster-related issues, quantitatively measurable indicators of impacts of disaster risk reduction on economic growth and poverty alleviation should be prepared. In addition, to promote disaster prevention measures, we need to convince policy makers that such measures are highly essential for a country’s development and are cost-effective. Although the cost-effectiveness of single disaster prevention projects has been studied, aggregate effectiveness of these projects at a national level has not been presented. This study proposes a simple method to explain the cost-effectiveness of flood protection investment in Japan post World War II by using national aggregate data.

Cost-effectiveness of etanercept treatment in early active rheumatoid arthritis followed by dose adjustment

2011 ◽  
Vol 27 (3) ◽  
pp. 193-200 ◽  
Author(s):  
Gisela Kobelt ◽  
Ingrid Lekander ◽  
Andrea Lang ◽  
Bernd Raffeiner ◽  
Costantino Botsios ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trial ◽  
Cost Effectiveness ◽  
Disease Activity ◽  
Dose Reduction ◽  
Societal Perspective ◽  
Active Rheumatoid Arthritis ◽  
Biologic Treatment ◽  
Early Ra ◽  
The Cost

Objectives: To explore the cost-effectiveness of early biologic treatment, followed by dose-reduction in the case of remission, of active rheumatoid arthritis (RA), compared with standard treatment with methotrexate (MTX) in Sweden.Methods: Effectiveness (function, disease activity, erosions) in early RA for both alternatives was taken from a clinical trial comparing etanercept (ETA) combined with MTX to MTX alone. Patients discontinuing treatment can switch to another or their first biologic treatment. For patients in remission (Disease Activity Score [DAS28] < 2.6), ETA is reduced to half the dose. Return to full dose occurs when DAS28 reaches ≥ 3.2 again. Costs and utilities by level of functional capacity from an observational study are used. The model is analyzed as a micro-simulation and results are presented from the societal perspective for Sweden, for 10 years; costs (€2008) and effects are discounted at 3 percent. Sensitivity analysis was performed for the perspective, the time horizon, switching, and dose-reduction.Results: The main analysis conservatively assumes 50 percent switching at discontinuation. The cost per quality-adjusted life-year (QALY) gained with early ETA/MTX treatment is €13,500 (societal perspective, incremental cost of €15,500 and incremental QALYs of 1.15). With 75 percent switching, the cost per QALY gained was €10,400. Over 20 years, the cost per QALY gained was €8,200. Results were further sensitive to the time patients remained on half dose and the perspective.Conclusions and Policy Implications: This study combines clinical trial and clinical practice data to explore cost-effective treatment scenarios in early RA, including the use of biologics. Our results indicate that a situation where a considerable proportion of patients achieve remission, dose-adjustments will increase the cost-effectiveness of treatment.

Design and Analytic Considerations in Determining the Cost-Effectiveness of Early Intervention in Asthma from a Multinational Clinical Trial

2001 ◽  
Vol 22 (4) ◽  
pp. 420-437 ◽  
Author(s):  
Sean D Sullivan ◽  
Bengt Liljas ◽  
Martin Buxton ◽  
Carl Johan Lamm ◽  
Paul O'Byrne ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Early Intervention ◽  
Cost Effectiveness ◽  
The Cost ◽  
Multinational Clinical Trial

scholarly journals Economic Evaluation of Daratumumab and Pomalidomide and Dexamethasone Versus Isatuximab and Pomalidomide and Dexamethasone for Patients with Relapsed or Refractory Multiple Myeloma

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 19-20
Author(s):  
Neda Alrawashdh ◽  
Abdulaali Almutairi ◽  
Ali McBride ◽  
Ivo Abraham
Keyword(s):  
Clinical Trial ◽  
Multiple Myeloma ◽  
Cost Effectiveness ◽  
Time Horizon ◽  
Cost Utility ◽  
Phase Iii ◽  
Health States ◽  
Time Horizons ◽  
Life Years ◽  
The Cost

Background. Although several new treatments are available for patients with multiple myeloma (MM), most patients eventually relapse at a median time of 8.0 months (95%CI: 6.3-8.9). Patients with relapsed and refractory MM (R/R MM) who have had several lines of previous therapy or who are refractory to lenalidomide and proteasome inhibitors require alternative options. Daratumumab and isatuximab are monoclonal antibodies that bind to the human CD38 receptor. Phase II/III clinical trials showed that isatuximab (ISA) or daratumumab (DARA) in combination with pomalidomide (POM-d) and low-dose dexamethasone (DEXA) significantly improve progression-free survival (PFS) in patients with R/R MM. No studies have assessed the comparative efficacy and cost-effectiveness of both regimens in management of R/R MM. We performed an indirect comparison of both regimens in terms of PFS and overall survival (OS) and evaluated the cost-effectiveness and cost-utility of DARA+POM-d+DEXA and ISA+POM-d+DEXA from a US payer's perspective. Methods. A partitioned survival model was developed to create three health states (pre-progression, progression, and death). The model was run three times with different time horizons (one, three and five years). To simulate health outcomes for each treatment regimen, transition probabilities between the three health states were derived from parametric exponential and lognormal distributions fitted to Kaplan-Meier (KM) curves of PFS and OS of the phase Ib clinical trial (Chari et al.; Blood 2017) for DARA+POM-d+DEXA and the phase III clinical trial (Attal et al.; Lancet 2019) for ISA+POM-d+DEXA. Wholesale acquisition costs (WAC) were obtained from RedBook for each regimen. Pre-progression costs included costs of regimens; premedication (50 mg diphenhydramine, 650 mg acetaminophen, 50 mg ranitidine); managing side effects; routine care and monitoring; and medication administration. Costs were inflated based on the medical consumer price index to the second quarter of 2020. Utilities were obtained from literature and assumed the same for both interventions. Annual discount rate of 3.5% was applied for costs and outcomes beyond the first year. The life years (LY) and quality adjusted LY (QALY) for each treatment, and the incremental cost-effectiveness (ICER) and cost-utility ratios (ICUR) were estimated in both base and probabilistic sensitivity analyses (PSA:10,000 simulations). The cost-effectiveness plane (CEP) and cost-effectiveness acceptability curves (CEAC) were plotted. Results. In the naïve patient simulation, median PFS and OS were estimated to be 9.5 months and 18 months for DARA+POM-d+DEXA, and 14.5 months and 26 months for ISA+POM-d +DEXA. As shown in the table below, ISA+POM-d+DEXA is associated with greater LY and QALY gains at one-, three- and five-year time horizons. The costs of ISA+POM-d+DEXA at one- and three- year time horizons are less than that of DARA+POM-d+DEXA, which resulted in saving (decremental) ICERs. At 5 years' time horizon, ISA+POM-d+DEXA was associated with incremental benefits (0.57 LY, 0.35 QALY) and incremental costs of $88,271 when compared with DARA+POM-d+DEXA. Per the CEAC plot, the probability that ISA+POM-d+DEXA is cost-effective was 100%, 65% and 23% at a willingness to pay threshold (WTP) of $100,000 per QALY in one-, three- and five-year time horizons. Conclusions. Clinically, ISA+POM-d+DEXA is associated with incremental survival gains of ~1 month and quality-adjusted survival gains of 0.5 month than DARA+POM-d+DEXA when patients are treated for one year. The benefits increase with treatment duration to reach ~7 months life year gains and 4 months quality-adjusted life year gains if patients treated for 5 years. Due to its lower total costs, Isatuximab based-regimen yielded saving ICERs at one and three years. However, ISA+POM-d+DEXA cost exceeded DARA+POM-d+DEXA at 5 years' time horizon to yield an ICER above the WTP. Disclosures McBride: Merck: Speakers Bureau; Pfizer: Consultancy; Sandoz: Consultancy; MorphoSys: Consultancy; Bristol-Myers Squibb: Consultancy; Coherus BioSciences: Consultancy, Speakers Bureau. Abraham:Celgene: Consultancy; Terumo: Consultancy; Rockwell Medical: Consultancy; Janssen: Consultancy; Mylan: Consultancy; Sandoz: Consultancy; Coherus BioSciences: Research Funding, Speakers Bureau; MorphoSys: Consultancy.

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