Willingness to pay for a quality adjusted life year across different time horizons: direct elicitation in Quebec.

EE517 Willingness to Pay for a Quality Adjusted Life Year Across Different Time Horizons: Direct Elicitation in Quebec

Objective To assess whether revascularisation that is considered to be clinically appropriate is also cost effective.Design Prospective observational study comparing cost effectiveness of coronary artery bypass grafting, percutaneous coronary intervention,...

905 Cost Effectiveness of Cardiac Resynchronization Therapy (CRT) for Mild to Moderate Heart Failure

A welfare economic approach to measure outcomes in stuttering: Comparing willingness to pay and quality adjusted life years

Does sperm retrieval increase cost without benefit for men with non-obstructive azoospermia? A cost-effectiveness analysis of sperm retrieval vs. donor sperm

e16623 Background: The availability of newer therapeutic options to treat patients with cancer often depend on falling at or below economic value thresholds; namely, dollars per quality adjusted life years (QALY). The issue is that for patients with end stage cancer, these economic values (Cost/ QALY) tend to infinity as life expectancy diminishes. We compare and contrast the application and implications of life years gained (LYG) and Quality Adjusted Life Years (QALYs), when overall survival is less than one year for end stage cancer. Methods: We conducted a systematic search of published and publically available literature using Medline (1980-2010) and Google for: “End Stage Cancer (ESC),” “Life Years Gained (LYG),” and “Quality Adjusted Life Years (QALYs)” and their combinations. Extracted citations were reviewed by two researchers for relevance. Results: The Medline search yielded 7,488 citations for ESC, 2,920 for LYG and 7,138 for QALYs, and 3 and 20 for the combinations of ESC, LYG and QALY. The Google search yield 5 citations, all more on-target to the study aims. LYG is a mortality measure quantifying the incremental net benefit (INB) of two treatment strategies in terms of changes in life expectancy while QALYs weigh life expectancy by a value between 0 (death) and 1 (perfect health). In reviewing quality-weighting survival time, the literature found QALYs were biased with age, disease and how those weights were assessed. Social and personal aversion to risk also sway thQALY measure. LYG lack those design biases, although LYG cannot differentiate safety profiles among anticancer agents. The cancer literature with LYG and QALY did not differentiate between their application to end-stage versus earlier stage, missing economic inefficiencies and a violation of the fundamental axiom of health economic assessments, life is a ‘good’ thing. Conclusions: LYG, a mortality measure, is better suited for end stage cancer than QALY because even small changes in utility weights result in inefficiencies which can under or overestimate the QALY measure and as survival diminishes standard economic theory would predict that any resource use becomes unaffordable.

Sentinel node biopsy in patients with primary cutaneous melanoma of any thickness: A cost-effectiveness analysis

Background:There is only limited information about the cost-effectiveness of drug-eluting stents compared with bare-metal stents in Turkey.Aims:To evaluate bare-metal and drug-eluting stents used in the treatment of coronary artery disease from the perspective of the reimbursement institution with cost-effectiveness analysis.Study Design:Retrospective cost-effectiveness analysis.Methods:In our study, 329 patients diagnosed with coronary artery disease and treated with bare-metal or drug-eluting stents in the cardiology clinics of a public university hospital between January 1 and December 31, 2016 were investigated. Bare-metal and drug-eluting stents used in the treatment of coronary artery disease were evaluated retrospectively with cost-effectiveness analysis from the perspective of the reimbursement institution.Results:The cost of treatment with a bare-metal stent was 2,131.41 Turkish Liras, and the cost of treatment with a drug-eluting stent was 3,546.14 Turkish Liras; the Quality Adjusted Life Years value of treatment with a bare-metal stent was 0.8371, and the Quality Adjusted Life Years value of treatment with a drug-eluting stent was 0.8924. All these data were analyzed by decision tree. As a result of decision tree analysis, the weighted cost of treatment with a bare-metal stent was 2,340.71 Turkish Liras and weighted Quality Adjusted Life Years value was 0.8332; and the weighted cost of treatment with drug-eluting stent was 3,970.90 Turkish Liras and the weighted Quality Adjusted Life Years value of the treatment with drug-eluting stent was 0.8911. With these values, the additional cost-effectiveness ratio was calculated as 28,179.12 Turkish Liras per acquired Quality Adjusted Life Years. The additional cost-effectiveness ratio is in the first zone in the cost-effectiveness plane and below the very threshold of cost-effectiveness.Conclusion:In our study, it was concluded that drug-eluting stents are cost effective compared with bare-metal stents in the treatment of coronary artery disease. Considering the cost and effectiveness of the drug-eluting stent, it is thought that increasing reimbursement for this technology by the reimbursement agency would be beneficial for the service provider.

Cost-utility analysis of vagus nerve stimulators for adults with medically refractory epilepsy

To evaluate the clinical benefits and cost-effectiveness of the sensor-augmented pump compared with self-monitoring of plasma glucose plus continuous subcutaneous insulin infusion in people with Type 1 diabetes. The CORE Diabetes Model was used to simulate disease progression in a cohort of people with baseline characteristics taken from a published meta-analysis. Direct and indirect costs for 2010-2011 were calculated from a societal payer perspective, with cost-effectiveness calculated over the patient's lifetime. Discount rates of 3% per annum were applied to the costs and the clinical outcomes. Use of the sensor-augmented pump was associated with an increase in mean discounted, quality-adjusted life expectancy of 0.76 quality-adjusted life years compared with continuous subcutaneous insulin infusion (13.05±0.12 quality-adjusted life years vs 12.29±0.12 quality-adjusted life years, respectively). Undiscounted life expectancy increased by 1.03years for the sensor-augmented pump compared with continuous subcutaneous insulin infusion. In addition, the onset of complications was delayed (by a mean of 1.15years) with use of the sensor-augmented pump. This analysis resulted in an incremental cost-effectiveness ratio of 367,571 SEK per quality-adjusted life year gained with the sensor-augmented pump. The additional treatment costs related to the use of the sensor-augmented pump were partially offset by the savings attributable to the reduction in diabetes-related complications and the lower frequency of self-monitoring of plasma glucose. Analysis using the CORE Diabetes Model showed that improvements in glycaemic control associated with sensor-augmented pump use led to a reduced incidence of diabetes-related complications and a longer life expectancy. Use of the sensor-augmented pump was associated with an incremental cost-effectiveness ratio of 367,571 SEK per quality-adjusted life year gained, which is likely to represent good value for money in the treatment of Type 1 diabetes in Sweden.

BackgroundDeep vein thrombosis and pulmonary embolism are known by the collective name venous thromboembolism. Deep vein thrombosis is the third most common cardiovascular disorder in the world. The disease is also prevalent in Africa including Ethiopia, besides lack of studies that show epidemiology of the disease.ObjectiveTo assess cost effectiveness of rivaroxaban compared to warfarin-based therapy for deep vein thrombosis patients in Ethiopia.MethodsA Markov model was built to compare cost and effectiveness of rivaroxaban 15mg bid for three weeks and 20mg per day for the rest to adjusted dose of warfarin for one year using a restricted societal perspective. The population in this analysis was a hypothetical cohort of deep vein thrombosis patients 40 years old with no contraindication, comorbidity and concomitant therapy. The patients were followed yearly for 24 years up to their average life expectancy.ResultsRivaroxaban therapy resulted in higher quality adjusted life years with a value of 16.78, while warfarin-based treatment resulted in 16.34 quality adjusted life years. Total lifetime costs were $988.58 for rivaroxaban and $932.92 for unfractionated heparin/warfarin. Therefore, rivaroxaban resulted in a gain of 0.443 quality adjusted life years at an additional cost of $55.661. The incremental cost effectiveness ratios for rivaroxaban compared with warfarin was $125.683 per quality adjusted life year saved which is less than willingness to pay threshold of $783 per quality adjusted life year saved. Warfarin resulted in a net monetary benefit of $11,859.72, while that of rivaroxaban is $12,150.82, meaning rivaroxaban is cost-effective. Sensitivity analyses found that the model was sensitive to utility of no deep vein thrombosis, effectiveness of rivaroxaban and cost of rivaroxaban respectively.ConclusionThis study showed that rivaroxaban is a cost effective alternative and substituting rivaroxaban for warfarin is acceptable to willingness to pay threshold.

P-629: Assisted reproductive treatments versus unprotected intercourse to achieve pregnancy for HIV serodiscordant couples: A cost-effectiveness analysis

Disability adjusted life years (DALYs) have been launched by the World Bank and backed by the World Health Organisation as a measure of the global burden of disease. 1 2 The aim is ambitious: “The burden of disease has yet to entirely replace traditional approaches to the assessment of health needs as an influence on political decision making.”3 Just like quality adjusted life years (QALYs), DALYs combine information about morbidity and mortality in numbers of healthy years lost. In the DALY approach, each state of health is assigned a disability weighting on a scale from zero (perfect health) to one (death) by an expert panel.2 To calculate the burden of a certain disease, the disability weighting is multiplied by the number of years lived in that health state and is added to the number of years lost due to that disease (figure) Future burdens are discounted at a rate of 3% per year, and the value of the lifetime is weighted so that years of life in childhood and old age are counted less. DALYs and QALYs are complementary concepts. QALYs are years of healthy life lived; DALYs are years of healthy life lost. Both approaches multiply the number of years (x axis) by the quality of those years (y axis). QALYs use “utility” weights of health states; DALYs use “disability weights” to reflect the burden of the same states. For example, if the utility of deafness is 0.67, the disability weight of deafness is 1−0.67=0.33 Disregarding age weighting and discounting, and assuming life expectancy of 80 years, a deaf man living 50 years represents 0.67×50=33.4 QALYs gained and 0.33×50+30×1=46.6 DALYs lost #### Summary points DALYs (disability adjusted life years) have been launched by the World Bank and the World Health Organisation as a combined measure of morbidity and mortality The …

Disability adjusted life years (DALYs) have been launched by the World Bank and backed by the World Health Organisation as a measure of the global burden of disease. 1 2...

Self-monitoring and self-titration of antihypertensives (self-management) is a novel intervention which improves blood pressure control. However, little evidence exists regarding the cost-effectiveness of self-monitoring of blood pressure in general and self-management in particular. This study aimed to evaluate whether self-management of hypertension was cost-effective. A cohort Markov model-based probabilistic cost-effectiveness analysis was undertaken extrapolating to up to 35 years from cost and outcome data collected from the telemonitoring and self-management in hypertension trial (TASMINH2). Self-management of hypertension was compared with usual care in terms of lifetime costs, quality adjusted life years and cost-effectiveness using a UK Health Service perspective. Sensitivity analyses examined the effect of different time horizons and reduced effectiveness over time from self-management. In the long-term, when compared with usual care, self-management was more effective by 0.24 and 0.12 quality adjusted life years (QALYs) gained per patient for men and women, respectively. The resultant incremental cost-effectiveness ratio for self-management was £1624 per QALY for men and £4923 per QALY for women. There was at least a 99% chance of the intervention being cost-effective for both sexes at a willingness to pay threshold of £20,000 per QALY gained. These results were robust to sensitivity analyses around the assumptions made, provided that the effects of self-management lasted at least two years for men and five years for women. Self-monitoring with self-titration of antihypertensives and telemonitoring of blood pressure measurements not only reduces blood pressure, compared with usual care, but also represents a cost-effective use of health care resources.