Average Cost-effectiveness Ratio Research Articles

Cost-effectiveness of surgical interventions in low-income and middle-income countries: a systematic review and critical analysis of recent evidence

BackgroundCost-effectiveness evidence is a critical tool to support resource allocation decisions. There is growing recognition that the development of benefit packages for surgical care should be guided by such evidence,...

Modeling environmental-born melioidosis dynamics with recurrence: An application of optimal control

Melioidosis is a significant health problem in tropical and subtropical regions, especially in Southeast Asia and Northern Australia. Recurrent melioidosis is a major obstacle to eliminating the disease from the community in these nations. This work aims to propose and analyze a human melioidosis model with recurrent phenomena and an optimal control model by incorporating time-dependent control functions. The basic reproduction number (R0) of the uncontrolled model is derived using the method of the next-generation matrix. Using the construction of a Lyapunov functional, we present the global asymptotic dynamics of the autonomous model in the presence of recurrent for both disease-free and endemic equilibria. The global asymptotic stability of the model’s equilibria shows the absence of a backward bifurcation for the model in both cases, whether in the absence or presence of relapse. The sensitivity analysis aims to identify the parameters that have the most significant impact on the model’s dynamics. Furthermore, qualitative analysis of the model’s global dynamics and the changing effect of the most influential parameters on R0 are supported by numerical experiments, with the results being illustrated graphically. The model with time-dependent controls is analyzed using optimal control theory to assess the impact of various intervention strategies on the spread of the epidemic. The numerical results of the optimality system are carried out using the Forward–Backward Sweep method in Matlab. We also conducted a cost-effectiveness analysis using two approaches: the average cost-effectiveness ratio and the incremental cost-effectiveness ratio.

Cost-Effectiveness Analysis of Rehabilitation Methods for Stroke Survivors

Background: One of the challenges in stroke management is how to provide rehabilitation services to stroke patients in Iran. Objectives: This study aimed to evaluate and compare the cost-effectiveness of rehabilitation interventions for stroke patients in three settings: Hospitals, stroke units, and homes. Methods: This cross-sectional study was conducted from the perspective of the health system. A Markov model with a 20-year time horizon and 3-month cycles was used to analyze costs and outcomes. Cost data were collected from 210 patients undergoing rehabilitation in hospitals, homes, or stroke units. The cost-effectiveness analysis (CEA) was conducted by calculating the incremental cost-effectiveness ratio (ICER) using Tree Age software. Results: The average rehabilitation cost for the home strategy ($2306 ± 35.018) was less than that for the hospital ($2955 ± 48.18) and stroke unit ($3485 ± 51.63) strategies. Furthermore, the QALY of the home strategy (26.03) was 8 times higher than that of the hospital (17.99) and 19 times higher than that of the stroke unit (7.03). The average cost-effectiveness ratios for the hospital, stroke unit, and home groups were $11424, $33159, and $7233 per QALY, respectively. The ICERs for stroke unit and home rehabilitation relative to hospital rehabilitation were $2517 and $2145 per QALY, respectively. Conclusions: According to the results, the home-based rehabilitation strategy is more cost-effective than hospital and stroke unit rehabilitation strategies. Given the high rates of stroke and its associated costs in Iran, it is suggested that policymakers lay the groundwork for providing these services at home.

Efficacy and safety of quick penetrating solution heparin, quick penetrating solution diclofenac, and heparin gel in the prevention of infusion-associated superficial thrombophlebitis: A randomized controlled trial

Abstract Background: The present study aimed to compare the efficacy, safety, and cost-effectiveness of quick penetrating solution (QPS) heparin, QPS diclofenac, and heparin gel in the prevention of superficial thrombophlebitis (ST). Materials and Methods: This randomized controlled trial was conducted after approval from the Institutional Ethics Committee and registration to Clinical Trial Registry of India. Patients of 18–60 years age, American Society of Anesthesiologists I/II, and who needed venous cannulation for at least 72 h were included in the study. Patients were randomly divided into three groups receiving study drugs (heparin gel, QPS heparin, and QPS diclofenac) every 8 hourly for a period of 72 h. Venous cannulation site was graded using the Visual Infusion Phlebitis Scale. Patients developing no ST, mean time to reach ST Grade 1 and 2, prevention of ST probability, and cost-effectiveness of interventions during the study period were assessed. Results: Out of 219 included patients, development of no ST in the study groups at 72 h of treatment were heparin gel (11%), QPS heparin (9.6%), and QPS diclofenac (2.7%). The mean time (hours) to develop any grade ST in the study arms was heparin gel (36.2 [11.9]), QPS heparin (40.0 [13.4]), and QPS diclofenac (37.0 [13.2]). The Kaplan–Meier analysis did not reveal significant differences for the prevention of any grade ST or severe ST in three treatment arms. The average cost-effectiveness ratio for preventing thrombophlebitis was 14.2 in heparin gel-, 13.2 in QPS heparin-, and 95.6 in QPS diclofenac-treated patients. Conclusion: Based on efficacy, safety, and cost-effectiveness, heparin gel or QPS heparin can be used to prevent ST due to intravenous cannulation in surgical patients. QPS diclofenac is not a cost-effective option to prevent ST.

An optimal control vaccine model of COVID-19 with cost-effective analysis

This study presents a comprehensive COVID-19 vaccination model, integrating breakthrough transmission, and evaluates its efficacy through various analytical techniques. To assess secondary infections, four effective reproduction rates are computed corresponding to different disease states. The sensitivity analysis of the reproduction rates is conducted using the PRCC to identify influential compartments and parameters. The model is extended to incorporate five time-dependent control interventions to reduce infected compartments, with optimisation performed using the Pontryagin maximum principle. A cost-effectiveness analysis of these strategies is conducted using the average cost-effectiveness ratio. Analysis shows that the model does not undergo backward bifurcation, meaning a stable disease-free equilibrium cannot coexist with a stable endemic equilibrium. The findings show that strict adherence to standard operating procedures is the most effective single intervention. In contrast, a combined approach incorporating all five control interventions is the most effective in averting infections with the lowest ACER.

Deterministic Double Dose Vaccination Model of COVID-19 Transmission Dynamics - Optimal Control Strategies with Cost-Effectiveness Analysis

In this study, we propose a deterministic double dose vaccination model of COVID-19 transmission dynamics optimal control with cost-effectiveness analysis. It is imperative for decision-makers and the government to prioritize the application of preventive and control measures for COVID-19 based on efficiency and costbenefit analysis. This is pivotal in resource-constrained regions where the disease is endemic. Thus, this work is mainly devoted with the development and analysis of an optimal control for COVID-19 dynamics with five timevarying functions; first dose vaccination, second dose vaccination, personal protection, testing or screening, and treatment. The model is qualitatively analysed with the overall goal to minimize the spread of COVID-19 and the costs related to control implementation with the aid of optimal control theory. The effect of adopting each control intervention in each of the three distinct groups which are created by classifying all conceivable combinations of at least three control interventions is demonstrated through the numerical simulations of the optimality system. Using the average cost-effectiveness ratio and incremental cost-effectiveness ratio techniques, the most economical control intervention is determined for each group. The study reveals that when the resources are readily available, application of the strategy that combines optimal first dose vaccination, personal protection, screening or testing and treatment is as efficient as implementing all the five optimal control interventions simultaneously as they both avert the same number of infections. However, in resource-limited communities when joint implementation of only three interventions is possible, the strategy combining personal protection, testing or screening and treatment is strongly recommended. Out of all the intervention options being considered, this strategy is also affirmed to be the most cost-effective overall. Economic evaluation of the control intervention strategies further suggests that combination of first dose vaccination, second dose vaccination, testing or screening and treatment is the most cost-effective strategy when implementation of only four interventions is strictly allowed.

Economic evaluation of two-Strain covid-19 compartmental epidemic model with pharmaceutical and non-pharmaceutical interventions and spatio-temporal patterns

This paper is a novel attempt to analyze different aspects of a two-strain epidemic model. The paper introduces a novel approach to analyzing a two-strain epidemic model, emphasizing the efficacy of combining non-pharmaceutical interventions and vaccination, particularly against new variants. Additionally, it presents a unique spatio-temporal model to assess spatial distribution of infections, offering fresh insights into how spatial factors influence disease transmission and control. The analysis involves stability analysis(local and global) and optimal control. Time-dependent social/non-pharmaceutical interventions coupled with vaccination of the susceptible class in the presence of both strains are analyzed using Pontryagin’s Maximum Principle. The numerical section shows the behavior of the infected class with and without control, the control intensity trend for the scenario when only non-pharmaceutical interventions (NPI) are practiced for the original strain, and when both NPI and vaccination are incorporated with the emergence of the new strain. The evaluation of the Incremental average ratio (IAR) and Incremental cost-effectiveness ratio (ICER) determines that NPI and vaccination as a combination is better and ideal in terms of costs incurred and effectiveness as a whole in averting infection in the presence of a new variant. Finally, we have also proposed a spatio-temporal pattern for the new strain model to analyze patterns using the finite element method by PDE Toolbox to show the effect of different initial conditions and geometry on the density of the infected population.

Costs and Projected Effect of a Federally Qualified Health Center-Based Mailed Colorectal Cancer Screening Program in Texas.

Mailed stool testing for colorectal cancer (CRC) may improve screening uptake and reduce the incidence and mortality of CRC, especially among patients at federally qualified health centers (FQHCs). To expand screening programs it is important to identify cost-effective approaches. We developed a decision-analytic model to estimate the cost, effects on screening and patient outcomes (CRCs detected, CRCs prevented, CRC deaths prevented), and cost-effectiveness of implementing a state-wide mailed stool testing program over 5 years among unscreened, age-eligible (aged 50-75 y) patients at FQHCs in Texas. We compared various outreach strategies and organizational structures (centralized, regional, or a hybrid). We used data from our existing regional mailed stool testing program and recent systematic reviews to set parameters for the model. Costs included start-up and ongoing activities and were estimated in 2022 US dollars from the perspective of a hypothetical third-party payer. Cost-effectiveness was assessed by using both incremental and average cost-effectiveness ratios. Using either a statewide centralized or hybrid organizational configuration to mail stool tests to newly eligible FQHC patients and patients who have responded at least once since program inception is likely to result in the best use of resources over 5 years, enabling more than 110,000 additional screens, detecting an incremental 181 to 194 CRCs, preventing 91 to 98 CRCs, and averting 46 to 50 CRC deaths, at a cost of $10 million to $11 million compared with no program. A statewide mailed stool testing program for FQHC patients can be implemented at reasonable cost with considerable effects on CRC screening outcomes, especially when its structure maximizes program efficiency while maintaining effectiveness.

Cost-effectiveness analysis of amlodipine and candesartan in the inpatient setting at Mataram University Hospital in Indonesia, 2021

Background: Hypertension requires ongoing treatment, which could be costly. There are different single-drug therapy options available, such as amlodipine or candesartan, which have varying costs. Objective: This study aimed to analyse the cost-effectiveness of amlodipine and candesartan in hypertensive patients by determining the Average Cost Effectiveness Ratio (ACER) and Incremental Cost Effectiveness Ratio (ICER) ratios from a hospital perspective. Method: This study used probability sampling of retrospective data from 2021 for the analysis. All inpatients who were given single therapy with amlodipine of 10 mg or candesartan of 16 mg were included. Direct medical costs were collected, including medicine and room costs, doctor visits, medical procedures, labour and administration. The effectiveness of the therapy was measured by blood pressure reduction from each therapy. ACER and ICER analyses were conducted to determine the most cost-effective therapy. Result: A total of 18 samples met the inclusion criteria, 14 patients received amlodipine therapy, and four received candesartan therapy. The results showed that the cost-effectiveness of antihypertensive therapy with amlodipine and candesartan, as measured by ACER, was IDR 74,851.15 and IDR 87,809.25, respectively. The ICER value obtained was IDR 362,768. Conclusion: The results may suggest that amlodipine is more cost-effective than candesartan.

TRANSMISSION DYNAMICS OF COVID-19 WITH DIABETES IN INDIA: A COST-EFFECTIVE AND OPTIMAL CONTROL ANALYSIS

In this study, we develop a mathematical model to examine the dynamics of COVID-19 with diabetes. Recognizing the increased vulnerability of diabetic patients, we proposed separate isolation classes for COVID-19 cases with and without diabetes. The model is parameterized using real data from India for the period March 2021 to September 2021. Sensitivity analysis for the basic reproduction number shows that isolation (for COVID-19 with diabetes) plays a significant role in lessening COVID-19 cases. Through numerical evaluations, we demonstrate that timely and focused care, including hospitalization/isolation, and treatment for COVID-19 patients with diabetes, can substantially reduce the disease burden by nearly three-fold. The optimal control problem with different strategies has also been discussed. We obtain that vaccination (with the least Average Cost-Effectiveness Ratio (ACER) and a combined strategy (with the highest Infection-Averted Ratio (IAR) are the most cost-saving and effective interventions to eradicate the disease.

Cost-Effectiveness Analysis of Denosumab in the Prevention of Skeletal-Related Events Among Patients With Breast Cancer With Bone Metastasis in India.

Denosumab is clinically superior to zoledronic acid (ZA) for preventing and delaying time to first and subsequent skeletal-related events (SREs) among patients with breast cancer (BC) with bone metastases. We evaluated the cost and health benefits of denosumab and ZA (once every 4 weeks and once every 12 weeks) among four different molecular subtypes of BC with bone metastases in India. A Markov model was developed in Microsoft Excel to estimate lifetime health consequences and resulting costs among cohort of 1,000 patients with BC with bone metastasis, for three intervention scenarios, namely denosumab (once every 4 weeks), ZA (once every 4 weeks), and ZA (once every 12 weeks). The health outcomes were measured in terms of SREs averted and quality-adjusted life-years (QALYs) gained. The cost of each intervention scenario was measured using both the health system and the patient's perspectives. Indirect costs because of lost productivity were not included. The future costs and outcomes were discounted at the standard rate of 3%. Over a lifetime, the incremental number of SREs averted with use of denosumab once every 4 weeks (compared with ZA once every 4 weeks and once every 12 weeks) among patients with luminal A, luminal B, human epidermal growth factor receptor 2-enriched, and triple negative breast cancer were estimated as 0.39, 0.26, 0.25, and 0.19, respectively. The number of QALYs lived were slightly higher in the denosumab arm (1.45-2.80) compared with ZA once every 4 weeks and once every 12 weeks arms (1.44-2.78). However, denosumab once every 4 weeks was not found to be a cost-effective alternative for either of the four molecular subtypes of breast cancer. ZA once every 12 weeks was found to be a cost-effective option with an average cost-effectiveness ratio ranging between ₹68,254 and ₹73,636. ZA once every 12 weeks is the cost-effective treatment option for BC with bone metastases in India. The present study findings hold significance for standard treatment guidelines under India's government-funded health insurance program.

ANALISIS EFEKTIVITAS BIAYA PENGOBATAN HIPERTENSI PADA PASIEN RAWAT JALAN DI KLINIK NURUL HASANAH TAHUN 2022

Hypertension or high blood pressure is a serious medical condition that significantly increases the risk of heart, brain, kidney and other diseases. Prevalence of the population with high blood pressure is 34.11%. The aim of this research is to determine the cost effectiveness between the use of the antihypertensive drugs amlodipine and candesartan in BPJS outpatient hypertension patients at the Nurul Hasanah Kapuas Clinic in 2022. This research uses the CEA pharmacoeconomic method based on the direct medical cost perspective used, namely health service cost data. The results obtained from this research are that amlodipine therapy is more cost effective than candesartan with an Average Cost Effectiveness Ratio (ACER) value for amlodipine of Rp. 156,441.92 and candesartan Rp. 166,527.78.

ANALISIS EFEKTIVITAS BIAYA (Cost Effectiveness Analysis) PENGGUNAAN ANTIPSIKOTIK MONOTERAPI ATIPIKAL DENGAN KOMBINASI ATIPIKAL DAN TIPIKAL PADA PASIEN RAWAT INAP SKIZOFRENIA DI RUMAH SAKIT JIWA GRHASIA YOGYAKARTA

Schizophrenia is a serious mental disorder characterized by impaired thinking, hallucinations and social behavior. Yogyakarta Special Region (DIY) ranks 2nd with a prevalence of schizophrenia reaching 10.4 per 1,000 population. The high number of people suffering from mental disorders can lead to increasingly expensive costs. To reduce the problem of health financing, a cost-effectiveness analysis is needed by calculating the cost of antipsychotic drugs and calculating the Average Cost Effectiveness Ratio value. The aim of this study was to determine the cost-effectiveness of using atypical antipsychotic monotherapy with atypical and typical combinations in schizophrenia patients at RSJ Grhasia Yogyakarta. The research method was carried out descriptively and retrospectively using medical record data for the period January-December 2022, with a proportional sampling technique. Results: research shows that atypical monotherapy antipsychotics are more cost-effective with an Average Cost Effectiveness Ratio value of IDR 204.4/week of therapeutic treatment compared to atypical-typical combination antipsychotics with a greater value of IDR 343.2/week of therapeutic treatment. Conclusion: The antipsychotics used by inpatient schizophrenia patients at RSJ Grhasia Yogyakarta had the highest effectiveness, namely in the atypical monotherapy therapy group, amounting to (93.02%).

Analysis Of The Cost Effectiveness Of Oral Iron Cleaning Drugs Between Deferipron And Deferasiroks In Patients With Thalasemia Major At Bhayangkara Kindergarten Hospital. Ii Setukpa Lemdiklat Polri

Thalassemia is a blood disorder characterized by reduced or absent synthesis of globin chains, particularly thalassemia major, imposes significant financial burdens due to the lifelong need for blood transfusions and iron chelation drugs. This research aims to assess the cost and efficacy of oral iron chelators, specifically deferasirox and deferiprone, in treating thalassemia major patients at Setukpa Lemdiklat Polri Tk—II Hospital in 2023. The data were retrospectively gathered through total sampling from patients' medical records and the hospital information system. The findings indicate that the average total treatment cost for thalassemia major patients using deferasirox (IDR 52,969,775,-) is higher than deferiprone (IDR 49,407,613,-). Deferasirox exhibits greater effectiveness (1,364 ng/mL) than deferiprone (1,210 ng/mL). The cost-effectiveness ratio of deferasirox (IDR 38,834,-) is lower than that of deferiprone (IDR 40,833,-). Transitioning from deferiprone to deferasirox incurs an additional IDR 23,130 per unit cost. The average cost-effectiveness ratio suggests that deferasirox is more economically efficient than deferiprone.thalassemia major

Real-World Clinical Equivalence of Generic and Branded Tofacitinib: A Prospective Longitudinal Cohort Study in Patients With Rheumatoid Arthritis

ObjectivesTo explore the clinical efficacy and safety of generic tofacitinib vs brand name tofacitinib in patients with rheumatoid arthritis (RA) in a single-center comparative study based on a prospective real-world cohort. MethodsPatients with RA receiving tofacitinib, either generic (Kelejia) or branded (Xeljanz), from March 2017, to December 31, 2022, were enrolled. The primary outcome was the simplified disease activity index (SDAI)–defined remission rate at month 6. Secondary outcomes included the rates of remission and low disease activity defined by other composite scores; European Alliance of Associations for Rheumatology response rate, and ultrasonic synovitis scores at months 1, 3, 6, and 12. Cost-effectiveness was investigated. Propensity score–based inverse probability of treatment weighting was adopted to reduce selection bias. ResultsA total of 204 patients were enrolled: 59 in the generic group and 145 in the branded group. An SDAI-defined remission was achieved in 41.1% and 39.2% of patients in the generic and branded groups, respectively, at month 6 (P=.85). Rates of remission and low disease activity achievement, changes in clinical disease activity scores, and power Doppler and gray scale synovitis scores at months 1, 3, 6, and 12 were comparable between the 2 groups. Similar proportions of patients in the groups achieved moderate/good response at months 1, 3, 6, and 12. Rates of drug retention and adverse effects were also similar in the 2 groups. Both Kelejia and Xeljanz were cost-effective, but Kelejia had a lower average cost-effectiveness ratio. ConclusionGeneric tofacitinib (Keljia) had equivalent clinical efficacy and safety and better cost-effectiveness compared with its originator (Xeljanz).

Cost-effectiveness of Oral Iron Chelation in Patients with Thalassemia Major: A Systematic Review

Thalassemia major, as a red blood cell disorder that is passed from both parents to their children, requires high costs and the use of iron chelation drugs throughout the patient's life. Pharmacoeconomics studies in patients with thalassemia major needs to be conducted to determine the efficiency and effectiveness of selecting oral iron chelation drugs. This study aims to analyze the cost and cost-effectiveness of using oral iron chelation drugs such as deferasirox and deferiprone. This systematic review was conducted from Pubmed and Scopus, to identify the cost-effectiveness of deferasirox and deferiprone. Eight studies met the inclusion criteria for the review. farthermor selected the papers, extracted the data, and assessed the methodological quality of the included documents. In brief, deferasirox is cost-effective than deferiprone. Moreover, the cost-effectiveness is not an absolute issue when in different countries (regions) the results are opposite for other countries (regions). As a result, the local/national context had a substantial influence on the results of the pharmacoeconomic evaluation. From the average cost-effectiveness ratio, it can be concluded that deferasirox is more cost-effective than deferiprone.

High-Efficiency Particulate Air Filters for Preventing Wildfire-related Asthma Complications: A Cost-Effectiveness Study.

Rationale: Air pollution caused by wildfire smoke is linked to adverse health outcomes, especially for people living with asthma. Objectives: To evaluate whether government rebates for high-efficiency particulate air (HEPA) filters, which reduce concentrations of smoke particles indoors, are cost effective in managing asthma and preventing exacerbations in British Columbia (BC), Canada. Methods: We used a Markov model to analyze health states for asthma control, exacerbation severity, and death over a retrospective time horizon of 5 years (2018-2022). Concentrations of wildfire smoke-derived particulate matter with an aerodynamic diameter ⩽2.5 μm (PM2.5) from the Canadian Optimized Statistical Smoke Exposure Model and relevant literature informed the model. The base-case analysis assumed continuous use of a HEPA filter. Costs and quality-adjusted life-years (QALYs) resulting from varying rebates were computed for each Health Service Delivery Area (HSDA). Measurements and Main Results: In the base-case analysis, HEPA filter use resulted in increased costs of $83.34 (SE, $1.03) and increased QALYs of 0.0011 (SE, 0.0001) per person. The average incremental cost-effectiveness ratio among BC HSDAs was $74,652/QALY (SE, $3,517), with incremental cost-effectiveness ratios ranging from $40,509 to $89,206 per QALY in HSDAs. Across the province, the intervention was projected to prevent 4,418 exacerbations requiring systemic corticosteroids, 643 emergency department visits, and 425 hospitalizations during the 5-year time horizon. A full rebate was cost effective in 1 of the 16 HSDAs across BC. The probability of cost-effectiveness ranged from 0.1% to 74.8% across HSDAs. A $100 rebate was cost effective in most HSDAs. Conclusions: The cost-effectiveness of HEPA filters in managing wildfire smoke-related asthma issues in BC varies by region. Government rebates up to two-thirds of the filter cost are generally cost effective, with a full rebate being cost effective only in Kootenay Boundary.

POLA PENGGUNAAN DAN ANALISIS EFEKTIVITAS BIAYA OBAT ANTINYERI PADA PASIEN DIABETIK NEUROPATI DI RUMAH SAKIT ISLAM SULTAN AGUNG SEMARANG

Diabetic neuropathy is gathering symptom clinic which influence system nerves, well single or combination and could happen in a manner suddenly, no detected, with symptom clinic and no specific signs but dangerous. Incidence diabetic neuropathy happen between 60% to 70% on type I and type II DM patients. Methods of data collection carried out prospectively. Data were obtained from outpatient data with a diagnosis of diabetic neuropathy who met the inclusion criteria and received analgetics from September to December 2020. Then a cost-effectiveness analysis was performed by calculating the ACER (Average Cost-Effectiveness Ratio) and ICER (Incremental Cost-Effectiveness Ratio) values. The results showed that the most commonly used analgetics was gabapentin at 65.96%, either alone or in combination with an effectiveness percentage of 83.87%. The use of analgetics with the lowest cost is a single Paracetamol of IDR 73,770. The lowest ACER values were shown in the use of the single analgetics Paracetamol and the combination of Amitriptyline-Paracetamol, namely 737.70 and 805.30.

An economic evaluation of first-line cryoballoon ablation vs antiarrhythmic drug therapy for the treatment of paroxysmal atrial fibrillation from a U.S. Medicare perspective.

Three recent randomized controlled trials have demonstrated that, as an initial rhythm control strategy, first-line cryoballoon ablation (cryoablation) reduces atrial arrhythmia recurrence compared with antiarrhythmic drugs (AADs) in patients with symptomatic paroxysmal atrial fibrillation (PAF). The study sought to evaluate the cost-effectiveness of first-line cryoablation compared with first-line AADs for treating symptomatic PAF from a U.S. Medicare payer perspective. Individual patient-level data from 703 participants with PAF enrolled into the Cryo-FIRST (NCT01803438), STOP AF First (NCT03118518), and EARLY-AF (NCT02825979) trials were used to derive parameters for the cost-effectiveness model. The cost-effectiveness model used a hybrid decision tree and Markov structure. The decision tree had a 1-year time horizon and was used to inform the initial health state allocation in the first cycleof the Markov model. The Markov model used a 40-year time horizon (3-month cycle length). Health benefits were expressed in quality-adjusted life years (QALYs). Costs and benefits were discounted at 3% per year. Cryoablation was estimated to yield higher QALYs (+0.17) and higher costs (+$4274) per patient over a 40-year time horizon than AADs. Ultimately, this produced an average incremental cost-effectiveness ratio of $24,637 per QALY gained. Independent of initial treatment, individuals were expected to receive ∼1.2 ablations over a lifetime. There was a 45% relative reduction in time spent in atrial fibrillation health states for those initially treated with cryoablation compared with AADs. Initial rhythm control with first-line cryoballoon ablation is highly cost-effective compared with first-line AADs from a U.S. Medicare payer perspective.

Assessing the cost-effectiveness of economic strengthening and parenting support for preventing violence against adolescents in Mpumalanga Province, South Africa: An economic modelling study using non-randomised data.

There is limited evidence around the cost-effectiveness of interventions to reduce violence against children in low- and middle-income countries. We used a decision-analytic model to evaluate the cost-effectiveness of three intervention scenarios for reducing adolescent emotional, physical, and sexual abuse in Mpumalanga Province, South Africa. The intervention scenarios were: 1) Community grant outreach to link households to South Africa's Child Support Grant (CSG) if they are eligible, but not receiving it; 2) Group-based parenting support; and 3) Group-based parenting support 'plus' linkage to the CSG. We estimated average cost-effectiveness ratios (ACERs) for intervention scenarios over a ten-year time horizon, and compared them to a South Africa-specific willingness-to-pay (WTP) threshold (USD3390). Health effects were expressed in disability-adjusted life years (DALYs) averted. Our model considered four combinations of routine service versus trial-based costing, and population-average versus high prevalence of violence. Under routine service costing, ACERs for grant outreach and parenting support were below the WTP threshold when considering a population-average prevalence of violence USD2850 (Lower: USD1840-Upper: USD10,500) and USD2620 (USD1520-USD9800) per DALY averted, respectively; and a high prevalence of violence USD1320 (USD908-USD5180) and USD1340 (USD758-USD4910) per DALY averted, respectively. The incremental cost-effectiveness of parenting support plus grant linkage relative to parenting support alone was USD462 (USD346-USD1610) and USD225 (USD150-USD811) per DALY averted at a population-average and high prevalence of violence, respectively. Under trial-based costing, only the ACER for grant outreach was below the WTP threshold when considering a high prevalence of violence USD2580 (USD1640-USD9370) per DALY averted. Confidence intervals for all ACERs crossed the WTP threshold. In conclusion, grant outreach and parenting support are likely to be cost-effective intervention scenarios for reducing violence against adolescents if they apply routine service costing and reach high risk groups. Combining parenting support with grant linkage is likely to be more cost-effective than parenting support alone.