Cost-effectiveness of Preventive Transarterial Embolization for Splenic Artery Aneurysm Below the Guideline-Recommended Size Threshold: A Japanese Claims-Based Study.

Screening for Nonalcoholic Fatty Liver Disease in Persons with Type 2 Diabetes in the United States Is Cost-effective: A Comprehensive Cost-Utility Analysis

Cost-effectiveness analysis in cardiac surgery: A review of its concepts and methodologies

Introduction. The use of an implantable cardioverter-defibrillator reduces the probability of sudden cardiac death in patients with heart failure. Objective. To determine the cost-utility relationship of an implantable cardioverter-defibrillator compared to optimal pharmacological therapy for ischemic or non-ischemic NYHA II-III heart failure patients in Colombia. Materials and methods. A Markov model was developed. The model includes costs, effectiveness and quality of life from the perspective of the Colombian health system. For the baseline case, a time horizon of 10 years and discount rates of 3% for costs and 3.5% for benefits were adopted. The transition probabilities were obtained from a systematic review of the literature. The outcome used was the quality-adjusted life years. Consulting with the manufacturers of the device offered in the Colombian market, and using national-level pricing manuals, costs were calculated. Probabilistic and deterministic sensitivity analyses were conducted. Results. In the base case, the incremental cost-effectiveness ratio for the implantable cardioverter-defibrillator was 13,187 USD per quality-adjusted life year gained. For a willingness-to-pay equivalent to three times the gross domestic product per capita as a reference (19,139 USD in 2017), the device is a cost-effective strategy for the Colombian health system. However, the result is sensitive to changes in the time horizon, the probability of death and the device price. Conclusions. The use of an implantable cardioverter-defibrillator for preventing sudden cardiac death in patients with heart failure is a cost-effective strategy for Colombia. The results should be examined considering the uncertainty.

This study aimed to evaluate and compare nivolumab's cost-effectiveness with chemotherapy in patients with advanced esophageal squamous cell carcinoma from the Chinese healthcare system perspective. To this end, the researchers utilized a partitioned survival model with three mutually exclusive health stages. The characteristics of the patients used as inclusion and exclusion criteria in this model were the same as those used for patients with advanced esophageal squamous cell carcinoma in the ATTRACTION-3 study. The ATTRACTION-3 trial, which took place between January 7, 2016 and November 12, 2018, also yielded important clinical data. Data on medical and economic preferences were collected from real-world clinical practices. Costs, quality-adjusted life years, and incremental cost-effectiveness ratio were calculated for the two therapy options. The model uncertainty was investigated using a deterministic and probabilistic sensitivity analysis. When compared to chemotherapy, nivolumab was linked with an increase of 0.28 quality-adjusted life years with an increased cost of US$ 36,956.81 per patient in the base case analysis of a hypothetical sample of 419 patients. The incremental cost-effectiveness ratio in the deterministic sensitivity analysis was US$ 132,029.46/quality-adjusted life year, with a 48.02% probability of being cost-effective at willingness-to-pay thresholds of US$ 132,029.22/quality-adjusted life year. The incremental cost-effectiveness ratio remained greater than US$ 80,000/quality-adjusted life year in the deterministic sensitivity analyses. To be more cost-effective and remain below the threshold of 37,653 US$/quality-adjusted life year, which the Chinese population can afford, nivolumab's price would have to be lowered sharply by 53.50%. Nivolumab is clinically beneficial but not cost-effective when compared to chemotherapy. A substantial reduction in nivolumab's drug acquisition cost would be necessary to make it cost-effective for immunotherapy.

Introduction: Crohn’s disease (CD) patients that lose response to biologics experience reduced quality of life (QoL) and costly hospitalizations. Precision-guided dosing provides clinicians with a comprehensive pharmacokinetic (PK) profile that allows for the next biologic dose to be personalized. We analyzed the cost-effectiveness of infliximab (IFX) Precision-guided dosing relative to two IFX dose intensification strategies (DIS). Methods: We developed a hybrid (Markov and decision tree) model of CD patients who had a clinical response to IFX induction and entered IFX maintenance in “remission” or “mild symptoms” health states. The analysis took a US payer perspective, a time horizon of 2 years in the base case, and a cycle length of 4 weeks. There were 3 comparators for IFX dosing: Precision-guided dosing, dose intensification based on symptoms, inflammatory markers, and trough IFX concentration (DIS1), and IFX dose intensification based on symptoms alone (DIS2). Patients that failed IFX initiated ustekinumab (UST), followed by vedolizumab, and conventional therapy. Transition probabilities for IFX were estimated from real-world clinical PK data and interventional clinical trial (PMID: 34978325; 29317275) patient-level data. All other transition probabilities were derived from published randomized clinical trials and cost-effectiveness analyses. Utility values were sourced from previous health technology assessments. Direct costs included biologic acquisition and infusion, surgeries and procedures, conventional therapy, and lab testing. The primary outcomes were total discounted costs, total quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). The robustness of results was assessed via one-way sensitivity and scenario analyses. Results: Total costs and QALYs at 2 years are presented in Table. The ICERs of Precision-guided dosing relative to DIS1 and DIS2 were 171,810 and 127,990, respectively. One-way sensitivity analyses (Figure) demonstrated that the cost-effectiveness of Precision-guided dosing was most sensitive to the time between IFX doses. Precision-guided dosing had the lowest proportion of patients requiring a new biologic through 2 years (0.5% vs 2.4% and 27.7% for DIS1 and DIS2, respectively). Conclusion: Precision-guided dosing provides substantial clinical and QoL benefits for adult CD patients by maintaining clinical remission and avoiding IFX failure; it is cost-effective relative to other DISs at a WTP of $175,000/QALY.Figure 1.: Precision-guided Dosing ICER Relative to DIS2 † Varied by ±10% * Varied by ±5% CD: Crohn's disease, DIS: dose intensification strategy, ICER: incremental cost-effectiveness ratio, IFX: infliximab, M-S: moderate-severe, PMPM: per member per month, Rem: remission Table 1. - Base Case Results (2-year Horizon Discounted) DIS Total QALYs Total Costs ICER Relative to Precision-guided Dosing ICER Relative to DIS1 ICER Relative to DIS2 Incremental NMB vs DIS1 (WTP $150,000/QALY) Incremental NMB vs DIS1 (WTP $50,000/QALY) Incremental NMB vs DIS2 (WTP $150,000/QALY) Incremental NMB vs DIS2 (WTP $50,000/QALY) Precision-guided Dosing* 1.572 $50,753 - 171,810 127,990 -$765 -$4,274 $1,816 -$6,436 DIS1† 1.537 $44,725 171,810 - 95,581 - - $2,581 -$2,162 DIS2 ‡ 1.489 $40,191 127,990 95,581 - -$2,581 $2,162 - - DIS: dose intensification strategy, ICER: incremental cost-effectiveness ratio, NMB: net monetary benefit, QALY: quality-adjusted life year, WTP: willingness to pay.*Model informed precision dosing with homogenous mobility shift assay (Prometheus Laboratories).†Dose intensification based on a combination of symptoms, inflammatory markers and proactive therapeutic drug monitoring. Corresponds to cohorts 1 and 2 of the TAILORIX clinical trial.‡Dose intensification reactive on symptoms only. Corresponds to cohort 3 of the TAILORIX clinical trial.

Background: Influenza can exacerbate chronic coronary heart diseases (CHD) and health policy recommends influenza vaccination in this population group. However, cost effectiveness of influenza vaccination in protecting CHD population has not been, to our knowledge, well studied before especially in CHD patients with different disease severities. Objectives: To assess life-time cost utility of influenza vaccination in CHD patients either with angina and/or cardiac arrest/myocardial infarction (CA/MI) and to identify the most cost-effective influenza vaccination strategies. Method: The Markov model of CHD progression concurrent with the influenza infection was developed to quantify life-time costs and health effects of the three influenza vaccination strategies compared with no influenza vaccination (base case): (1) influenza vaccination in all CHD patients, (2) influenza vaccination in CA/MI patients-only, and (3) influenza vaccination in angina patients-only. The cost-effectiveness analysis (CEA) was based on the societal perspective. Deterministic and probabilistic sensitivity analyses were performed to identify variables that influence the sensitivity of the results and examine the effects of model parameters uncertainty, respectively. Results: For the base case, the expected value (EV) results of no influenza vaccination, influenza vaccination in all CHD groups, influenza vaccination in angina patients, and influenza vaccination in CA/MI are 346,437 Thai baht (THB) yielded 18.26 Quality adjusted life year (QALYs), 454,664 THB yielded 21.46 QALYs, 360,786 THB yielded 19.96 QALYs, and 437,901 THB yielded 19.72 QALYs; respectively. CEA graph comparing all influenza vaccination strategies shows that vaccination in all CHD patients groups and angina patients are in the costeffectiveness frontier, but not influenza vaccination in CA/MI patients. The cost-effectiveness rankings report shows that the willingness-to-pay (WTP) threshold (100,000 THB) is greater than the incremental cost effectiveness ratio (ICER) of vaccination in all CHD groups (ICER = 33,813 THB per QALY gained) and angina group (8,420 THB per QALY gained) and therefore the vaccination in all CHD groups, which is more expensive, but more effective would be recommended. The deterministic sensitivity analysis shows the most influential parameters driving the cost-effectiveness of vaccination strategies are the effect of influenza vaccination on CHD both for acute myocardial infarction and cardiovascular death, respectively. The probabilistic sensitivity analysis shows the same influenza strategy recommendation (vaccination in all CHD groups) as the base case analysis. Conclusion: From a societal perspective, influenza vaccination in all CHD groups is recommended. The information from economic modeling should be confirmed by primary economic research. Keywords: Coronary heart disease, cost-utility, influenza vaccine, Markov model, Thailand

Pricing, reimbursements and coverage decisions for medical innovations and services are complex. In many countries, valuing medical technologies is the responsibility of national health-care systems that strive for distributive efficiency under fiscal constraints on medical spending. In the UK, the National Institute for Health and Clinical Excellence (NICE) is charged with the difficult task of assessing new and existing medical technologies, and making recommendations that guide NHS coverage decisions. These are responsibilities that NICE carries out rigorously and with the objective of achieving efficiency in the allocation of NHS resources. Nevertheless, the current process of health technology appraisal (HTA) has been criticized for failure to systematically incorporate important sources of value from new innovations. In maintaining NICE’s current approach to HTA, the UK risks suboptimal patient outcomes and social welfare relative to what could be achieved if limited NHS resources were targeted toward those technologies with greatest social value. Perhaps recognizing these limitations, NICE commissioned Professor Sir Ian Kennedy in January, 2009, to carry out a study of valuing innovation aimed at addressing the approach that should be adopted by NICE to ensure that innovation is properly taken into account when establishing the value of new health technologies; whether particular forms of value be considered more important than others; how should innovation in health technologies be defined and understanding the relationship between innovation and value. As part of this process, we were asked to present our views on what such new approaches may be and how they could be implemented in practice within the NICE regulatory framework. This work was presented to the Kennedy Commission on May 19, 2009. We discuss these approaches below, and expand on ways in which important value dimensions can be integrated within the current framework. While framed in response to the Kennedy study, these views are broadly applicable to other health-care systems charged with valuing innovation and achieving distributive efficiency.

Cost-effectiveness of statin therapy for secondary prevention among patients with coronary artery disease and baseline LDL-C 70–100 mg/dL in Taiwan

Cost-effectiveness of health coaching and financial incentives to promote physical activity after total knee replacement

Objective:Stakeholders in Europe remain interested in assessments of country-specific value of self-monitoring of blood glucose (SMBG) for patients with type 2 diabetes treated with oral anti-diabetes drugs (OADs). This study used the IMS-CORE Diabetes Model to project the long-term (40-year) cost-effectiveness of SMBG at once, twice, or three times per day (vs. no SMBG) for this population from national reimbursement system perspectives in France, Germany, Italy, and Spain.Methods:SMBG input costs (strips, lancets, meters, nurse training) were supplied by LifeScan in €2007 values and applied as appropriate for each country's reimbursement policy. Cohort characteristics and assumed HbA1c effects came from a US Kaiser Permanente longitudinal analysis of new SMBG users. Country-specific estimations for use of screening programs and several concomitant medications, as well as mortality rates were used. Country-specific complication costs from published sources were inflated to €2007. Base case outcomes were discounted at 3% per annum for France, Germany, and Italy; 6% for Spain. Sensitivity analyses varied time horizon and discount rates for each country. They also included a −0.036 dis-utility for SMBG in year 1.Main outcome measures:Primary outcomes included total direct costs, gains in quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) over 40 years.Results:ICERs were largest in France (with meter costs included), and in Italy (with highest reimbursed costs for strips/lancets). ICERs for SMBG once, twice, and three times per day were €12 114, €6282, and €7958 (respectively) in France; and €12 694, €11 934, and €15 368 in Italy. ICERs for SMBG once or twice per day were <€2000 in Germany and <€4000 in Spain. ICERs for SMBG three times per day were <€6000/QALY in both countries. Results were most sensitive to the 5-year time horizon, although ICERs for SMBG once per day were below €50 000/QALY in all countries but Italy (ICER = €77 064). Five-year ICERs for SMBG twice per day were below €40 000/QALY for all four countries, and those for SMBG three times per day were below €45 000/QALY. With the SMBG dis-utility, ICERs increased modestly (€321– €2264/QALY) in all scenarios except SMBG once per day in France (€9578 increase) and Italy (€5979 increase). Study limitations include the use of relatively short-term data from a single US observational study for SMBG clinical effects, unknown levels of patient adherence, and assumptions regarding the duration of clinical effects.Conclusions:With cost assumptions reflecting current reimbursement levels in France, Germany, Italy, and Spain, SMBG was found to be cost-effective across a 40-year time horizon, with all base case ICERs <16 000/QALY. This study adds to the literature on the country-specific, long-term value of SMBG for type 2 diabetes patients treated with OADs. Under current model assumptions, variations in cost-effectiveness results stemmed primarily from payer reimbursement practices for SMBG within each country.

26 Background: Stereotactic body radiotherapy (SBRT) has been proposed for the palliation of painful vertebral bone metastases because higher radiation doses may confer better pain control. A Phase III clinical trial comparing SBRT with single fraction external beam radiotherapy (EBRT) is now ongoing. We performed a cost-effectiveness analysis to compare these strategies. Methods: A Markov model, using a 1-month cycle over a lifetime horizon, was developed to compare the cost effectiveness of SBRT (16 or 18 Gy in 1 fraction) to 8 Gy in 1 fraction of EBRT. Transition probabilities, quality of life utilities, and costs associated with SBRT and EBRT were captured in the model. Costs were based on Medicare reimbursement in 2014. Strategies were compared using the incremental cost effectiveness ratio (ICER), and effectiveness was measured in quality-adjusted life years (QALYs). To account for uncertainty, one-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay (WTP) threshold of $100,000/QALY gained. Results: Base case pain relief after the treatment was assumed as 20% higher in SBRT. Treatment costs for SBRT and EBRT were $9000 and $1087, respectively. In the base case analysis, SBRT resulted in an ICER of $124,552/QALY gained. In one-way sensitivity analyses, results were most sensitive to variation of the utility of unrelieved pain (range: $89,330 to $592,720/QALY gained); the utility of relieved pain post-treatment and median survival were also sensitive to variation. If median survival is ≥11 months (base case estimate: 9 months), SBRT cost &lt;$100,000/QALY gained. Probabilistic sensitivity analysis demonstrated that SBRT was favored in 30% of model iterations at a WTP threshold of $100,000/QALY gained. Conclusions: SBRT for palliation of vertebral bone metastases is not cost-effective compared to EBRT based upon the ICER analysis with the WTP of $100,000/QALY gained. However, if median survival is ≥11 months, SBRT is economically reasonable, suggesting that selective SBRT usage in patients with longer expected survival may be the most cost-effective approach.

Is SABR Cost-Effective in Oligometastatic Cancer? An Economic Analysis of SABR-Comet

HighlightsWhat are the main findings?rhTNFR:Fc provided 0.74 additional QALYs at an incremental cost of CNY 9447.96 versus methotrexate, giving an ICER of CNY 12,783.56 per QALY, well below the 2024 China per capita GDP threshold. Results were robust in probabilistic analysis and most sensitive to utility inputs; adverse events were broadly similar across arms.Scenario analyses were consistent with the base case. rhTNFR:Fc plus methotrexate remained cost-effective versus methotrexate alone with an ICER of CNY 12,834.05 per QALY. Under patient and payer perspectives, the ICERs were CNY 8079.04 and CNY 7630.34 per QALY.What are the implications of the main findings?Clinicians can adopt rhTNFR:Fc more proactively, including early in the treatment course, to achieve greater symptom relief and longer-term benefits.Policymakers can provide stronger preferential policies and safeguards, such as higher reimbursement, to support wider standardized use and improve population health outcomes.Background/Objectives: To evaluate the cost-effectiveness of recombinant tumor necrosis factor receptor Fc fusion protein compared with methotrexate as first-line therapy for active rheumatoid arthritis in China using evidence from a Chinese head-to-head randomized trial. Methods: A Markov model with 6 months per cycle was developed to estimate costs and health utilization in the lifetime of patients with RA from the Chinese healthcare system. The analysis data were derived from the randomized clinical trial in China. The primary cost includes drug and other medical costs. The health utilities quality-adjusted life years (QALYs) were derived using EQ-5D-5L mapping from disease-specific health assessment questionnaire (HAQ) scores obtained in clinical trials. The cost-effectiveness analysis was conducted by calculating the incremental cost-effectiveness ratio (ICER) values for rhTNFR:Fc and MTX. One-way and probabilistic sensitivity analyses were conducted to test the robustness of the base-case result. Results: In the base case, rhTNFR:Fc yielded 8.20 QALYs versus 7.46 with methotrexate, resulting in an ICER of CNY 12,783.56 per QALY. Scenario ICERs for bDMARD group combination treatment were 11,776.31 per QALY. Scenario ICERs were CNY 8079.04 per QALY for the patient perspective and CNY 7630.34 per QALY for the medical insurance perspective. One-way analysis highlighted utility inputs as the main drivers, and probabilistic analysis indicated a high probability of cost-effectiveness across common willingness-to-pay thresholds. Conclusions: The fusion protein strategy achieved an incremental cost-effectiveness ratio far below the 2024 China per capita gross domestic product threshold of CNY 95,749 per quality-adjusted life year. As first-line therapy for active rheumatoid arthritis, it is cost-effective relative to methotrexate in the Chinese setting.

Hysterectomy versus chemotherapy for low-risk non-metastatic gestational trophoblastic neoplasia (GTN): A cost-effectiveness analysis

Is Unilateral Cochlear Implantation Cost‐Effective for the Treatment of Bilateral Sensorineural Hearing Loss?