Calculation Of Cost-effectiveness Ratios Research Articles

Global representativeness and impact of funding sources in cost-effectiveness research on systemic therapies for advanced breast cancer: A systematic review

BackgroundBreast cancer (BC) is the most incident tumor and, consequently, any new intervention can potentially promote a considerable budget impact if incorporated. Cost-effectiveness (CE) studies assist in the decision-making process but may be influenced by the country's perspective of analysis and pharmaceutical industry funding. MethodsA systematic review of Medline, Scopus, and Web of Science from January 1st, 2012 to July 8th, 2022 was conducted to identify CE studies of tumor-targeted systemic-therapies for advanced BC. Articles without incremental cost-effectiveness ratio calculations were excluded. We extracted information on the country and class of drug studied, comparator type, authors’ conflicts of interest (COI), pharmaceutical industry funding, and authors' conclusions. Results71 studies comprising 204 CE assessments were included. The majority of studies were from the United States and Canada (44%), Asia (32%) and Europe (20%). Only 8% were from Latin America and none from Africa. 31% had pharmaceutical industry funding. The most studied drug classes were cyclin-dependent-kinase inhibitors (29%), anti-HER2 therapy (23%), anti-PD(L)1 (11%) and hormone therapy (11%). Overall, 34% of CE assessments had favorable conclusions. Pharmaceutical industry-funded articles had a higher proportion of at least one favorable conclusion (82% vs. 24%, p-value<0.001), European countries analyzed (45% vs. 9%, p-value = 0.003), and CE assessments with same class drug comparators (56% vs. 33%, p-value = 0.004). ConclusionsBreast cancer CE literature scarcely represents low-and-middle-income countries' perspectives and is influenced by pharmaceutical industry funding which targets European countries', frequently utilizes comparisons within same-drug class, and is more likely to have favorable conclusions.

Economic and social aspects of growth hormone therapy in children and adults with growth hormone deficiency. Literature review

In the Russian Federation growth hormone therapy (GHT) for children with growth hormone deficient children is funded from the state budget. The clinical effectiveness of GHT with human recombinant growth hormone was proven repeatedly in both world wide and Russian practice. Nevertheless, the economic and financial aspects of this therapy are in need of a detailed analysis. Such an analysis could serve as a possible instrument for well-grounded weighed decisions in the health care sector. One such instrument is a cost-effectiveness analysis, which involves the calculation of cost-effectiveness ratios or incremental cost-effectiveness ratios for determining the economic viability of new medical technologies or programs. Moreover, social aspects of GHT are also of great importance. A physician or a health care manager need to be informed about the effect of any therapy, including GHT, on the patient’s quality of life. While there is an overall agreement about the necessity and positive effect of GHT in children, the question remains somewhat disputable in the case of adult patients with growth hormone deficiency. Both world wide and in Russia there is no uniform agreement as to weather treatment is necessary in all cases of adult growth hormone deficiency, or weather treatment should be subsidized and provided for by the state or other financial resources, or weather GHT has indeed such a profound effect on the patient’s quality of life. The present article reviews the state of discussion around these questions to date for both children and adult patients. Available data on the cost-effectiveness analyses of GHT from several countries is highlighted and the effects of GHT on the quality of life are reviewed.

Cost-effectiveness of depressive episode pharmacological treatment

Background and Objectives There is a paucity of published cost-effectiveness studies of alternative scenarios in depressive episode acute medical care in Eastern European populations. Methods Prospective cost-effectiveness analysis was conducted on 65 depressive patients in a large university clinic [May 2010-February 2012]. Patient visits to attending psychiatrists were scheduled at baseline, 3rd and 8th week. HDRS-17 was deployed to assess clinical efficiency and Q-LES-Q-SF scale for life quality assessment. Resource use and costs were evidenced from the Clinic's electronic registry of discharge invoices [national currency 1 €≈115.85 CSD]. Societal perspective and time horizon of 14 weeks were adopted. Results No statistically significant difference in HDRS scores before and after introducing treatment [χ2=4.339; r=0.362]. QALY value increased by the following: 11.77 of the SSRI, 8.93 of the SNRI, and 12.54 of the heterocyclic antidepressant group. Mean ICERs were: SSRI to SNRI [-44,148 CSD/QALY]; SNRI to Heterocyclics [-45,716 CSD/QALY]; Heterocyclics to SSRI [-51,501 CSD/QALY]. Therapeutic response in increment free days: 28.69 days gained SSRI, 21.78 days SNRI, 30.59 days in heterocyclics. Incremental cost per additional depression free day gained was for: SSRI 346.38 CSD per day, SNRI 327.74 CSD, and heterocyclics 201.54 CSD. Conclusions This trial evidence elucidates that the heterocyclic antidepressants provide highest 'value for money' in QALYs for the depressive episode treatment. According to Incremental cost-effectiveness ratio calculations, heterocyclic antidepressant proved superior to other two options. Cost-effectiveness evaluations have heavier impact to clinical decision making with regards to major depressive disorder treatment in the absence of clear clinical superiority of any major pharmacological protocol.

Cost-effectiveness of surgical treatment for degenerative spondylolisthesis and spinal stenosis.

Systematic review. To identify cost-effective treatment strategies for lumbar spine degenerative diseases. There is a paucity of literature assisting physicians and society regarding the cost-efficiency of management of lumbar spine conditions. Limited articles on selective operative and nonoperative therapies have been published for a variety of lumbar conditions. A systematic search of PubMed, EMBASE, the Cochrane Collaboration data base, University of York, Centre for Reviews and Dissemination (National Health Services Economic Evaluation Database and health technology assessment), and the Tufts CEA Registry was conducted through December 16, 2013. Three specific questions were addressed for adult patients: (1) What is the evidence that surgery is cost-effective compared with nonsurgical management for lumbar degenerative spondylolisthesis or stenosis? (2) What is the evidence that fusion is cost-effective compared with no fusion for degenerative spondylolisthesis or stenosis? and (3) What is the evidence that instrumentation is cost-effective compared with none for degenerative spondylolisthesis? The Quality of Health Economic Studies instrument was used to provide an initial basis for critical appraisal of included economic studies. Articles were further refined with individual review based on inclusion/exclusion criteria. Initial search resulted in 122 potentially relevant citations, 115 of which were excluded at title and abstract levels and 3 at full-text reviews, leaving 5 for analysis. No non-English language text met inclusion/exclusion criteria. All studies illustrated a clinical benefit of surgical treatment as measured by quality-adjusted life year (0.11-8.05). Surgical treatments had a greater financial cost than nonoperative care ($5883-$26,035). Incremental cost-effectiveness ratio calculations noted operative treatment over nonoperative treatment for spondylolisthesis ($59,487-$115,600) per quality-adjusted life year. However, cost for patients without spondylolisthesis varied greatly from nonoperative treat dominating to $77,600 per quality-adjusted life year favoring surgery. Because the articles had heterogeneous methods and patient population, conclusion differed greatly on cost assessment. Limited quality data exist on cost-effective treatment of degenerative lumbar spinal conditions, despite more recent interest related to this topic. It is important that future research efforts focus on constructing higher quality trials in this area to help determine the most cost-effective care. 3.

The Cost-Effectiveness of Initial Treatment of Multiple Myeloma in the U.S. With Bortezomib Plus Melphalan and Prednisone Versus Thalidomide Plus Melphalan and Prednisone or Lenalidomide Plus Melphalan and Prednisone With Continuous Lenalidomide Maintenance Treatment

The outlook for transplant-ineligible multiple myeloma patients has improved enormously over recent years with the incorporation of new agents into standard regimens. Novel regimens combine melphalan and prednisone (MP) with bortezomib (VMP), with thalidomide (MPT), and with lenalidomide with (MPR-R) and without (MPR) lenalidomide maintenance. The efficacy, safety, and cost-effectiveness of these regimens have not yet been compared; therefore, we conducted a pharmacoeconomic analysis using data from randomized controlled trials versus MP. Using a Markov model developed from a U.S. payer's perspective, we compared VMP with MPT and MPR-R over a lifetime horizon. MPT and MPR-R were chosen because, like VMP, they are superior to MP in response and outcomes. Data from the Velcade as Initial Standard Therapy in Multiple Myeloma (VISTA; VMP), Intergroupe Francophone du Myelome (IFM) 99-06 (MPT), and MM-015 (MPR-R) trials were used. The IFM 99-06 study was selected because of the superior activity in this study compared with other MPT studies. Using patient-level (VMP) and published (MPT, MPR-R) data, we estimated the health-state transition and adverse event probabilities for each regimen, related costs, and state-specific utility estimates. Costs (in 2010 U.S. dollars) and health outcomes were discounted at 3%. Discounted lifetime direct medical costs were lowest with VMP at $119,102. MPT cost $142,452 whereas MPR-R cost $248,358. Incremental cost-effectiveness ratio calculations projected that VMP would confer cost savings and better health outcomes relative to MPT and MPR-R. We conclude that VMP is highly likely to be cost-effective compared with MP, MPT, and MPR-R.

Cost‐effectiveness of human papilloma virus vaccination in Iceland

To evaluate the likely cost-effectiveness of introducing routine HPV vaccination in Iceland. Prospective cost-effectiveness analysis of human papilloma virus (HPV) vaccination. Population of 12-year-old girls in the Icelandic population. A model was developed, comparing a cohort of all 12-year-old girls alive in year 2006, with or without vaccination. The model was based on the epidemiology of cervical cancer in Iceland and its premalignant stages as well as the costs involved in the treatment of each stage, assuming that the vaccines only prevent infections caused by HPV 16/18 at an efficacy of 95% and participation rate of 90%, no catch-up vaccination, no vaccination of boys and no booster dose needed. All costs were calculated on the basis of the price level of mid-year 2006 with a 3% discount rate. Incremental cost-effectiveness ratio calculations were performed and sensitivity analysis was carried out on factors most relevant for cost-effectiveness. Vaccination costs in excess of savings would be about euro313.000/year. Vaccination would reduce the number of women diagnosed with cervical cancer by almost 9, prevent the death of 1.7 women and result in 16.9 quality-adjusted life years gained annually. The incremental cost-effectiveness ratio was calculated to be about euro18.500/quality-adjusted life year saved. HPV vaccination seems to be cost-effective in Iceland, but this was sensitive to various parameters in the model, mainly the discount rate, the price of the vaccines and the need for a booster dose.

A cost-effectiveness comparison of embryo donation with oocyte donation

To compare the cost-effectiveness of embryo donation (ED) to that of oocyte donation (OD). Calculation of cost-effectiveness ratios (costs per outcome achieved) using data derived from clinical practices. In vitro fertilization centers and embryo donation programs. Infertile couples undergoing oocyte donation or embryo donation. Oocyte donation or embryo donation cycles. Cost-effectiveness ratios. For a single cycle, ED is approximately twice as cost-effective as OD, with a cost-effectiveness ratio of $21,990 per live delivery compared to 40,600 dollars. When strategies of up to three cycles (to achieve one live delivery) are used, ED costs 13,505 dollars per live delivery compared to 31,349 dollars for OD. Cost-effectiveness is a compelling reason for infertile couples to consider embryo donation.

Setting priorities for the health care sector in Zimbabwe using cost-effectiveness analysis and estimates of the burden of disease.

BackgroundThis study aimed at providing information for priority setting in the health care sector of Zimbabwe as well as assessing the efficiency of resource use. A general approach proposed by the World Bank involving the estimation of the burden of disease measured in Disability-Adjusted Life Years (DALYs) and calculation of cost-effectiveness ratios for a large number of health interventions was followed.MethodsCosts per DALY for a total of 65 health interventions were estimated. Costing data were collected through visits to health centres, hospitals and vertical programmes where a combination of step-down and micro-costing was applied. Effectiveness of health interventions was estimated based on published information on the efficacy adjusted for factors such as coverage and compliance.ResultsVery cost-effective interventions were available for the major health problems. Using estimates of the burden of disease, the present paper developed packages of health interventions using the estimated cost-effectiveness ratios. These packages could avert a quarter of the burden of disease at total costs corresponding to one tenth of the public health budget in the financial year 1997/98. In general, the analyses suggested that there was substantial potential for improving the efficiency of resource use in the public health care sector.DiscussionThe proposed World Bank approach applied to Zimbabwe was extremely data demanding and required extensive data collection in the field and substantial human resources. The most important limitation of the study was the scarcity of evidence on effectiveness of health interventions so that a range of important health interventions could not be included in the cost-effectiveness analysis. This and other limitations could in principle be overcome if more research resources were available.ConclusionThe present study showed that it was feasible to conduct cost-effectiveness analyses for a large number of health interventions in a developing country like Zimbabwe using a consistent methodology.

Avalanche Hazard Mitigation Strategies Assessed by Cost Effectiveness Analyses and Cost Benefit Analyses—evidence from Davos, Switzerland

This paper demonstrates the application of cost effectiveness analysis and cost benefit analysis to alternative avalanche risk reduction strategies in Davos, Switzerland. The advantages as well as limitations of such analysis for natural hazards planning are discussed with respect to 16 avalanche risk reduction strategies. Scenarios include risk reduction measures that represent the main approaches to natural hazards planning in Switzerland, such as technical, organisational, and land use planning measures. The methodologies used outline how concepts and techniques from risk analysis, hazard mapping, Geographic Information System, and economics can be interdisciplinary combined. The results suggest important considerations, such as possible sources of uncertainty due to different choices in the calculation of cost effectiveness ratio and net present value. Given the parameters and assumptions, it seems as if the current approach to avalanche risk reduction in the study area approximates to economic and cost efficiency and serves the aim of reducing risk to human fatalities.

The Usefulness of Ratios for Allocation Decisions: The Case of Stroke

Economic evaluation is becoming increasingly important in the field of stroke as well. The results of economic evaluation can be expressed in cost per quality-adjusted life years (QALY) gained, which enables policy makers to compare the relative efficiency of different interventions regarding different diseases. Although using the concept of QALY is preferable from a theoretical point of view, in medical practice more often cost-effectiveness analysis (CEA), and not cost-utility analysis, is applied for practical reasons. One of the main limitations of CEA is that the results may be compared only with results of other CEAs, using the same effect parameter. The calculation of cost-effectiveness ratios (CERs) in many cases is misleading for resource allocation. Effects should be expressed in interval or ratio scales in order to calculate CERs, which is rarely the case. The calculation of a CER in a CEA should only be performed if, and only if, the investigator is convinced that there is a constant relation between the specific effect parameter and the ultimate gain in health.

Deep venous thrombosis prophylaxis in trauma: cost analysis

Deep vein thrombosis and pulmonary embolism are major risks in patients experiencing major trauma. Currently, the American College of Chest Physicians recommends low molecular weight heparin as prophylaxis in trauma patients with identifiable risk factors in the absence of contraindications. Enoxaparin is the only low molecular weight heparin available in the US that has been evaluated to date in this indication. The purpose of this study was to perform incremental cost-effectiveness ratio calculations for enoxaparin versus no prophylaxis as thromboembolic prophylaxis in trauma patients. These calculations demonstrate that a cost of $279.43 would be incurred for each thromboembolic event avoided if enoxaparin 30 mg every 12 h were routinely used as prophylaxis in this population, compared with no prophylaxis. Sensitivity analyses demonstrate that if the incidence of proximal vein thrombosis in patients prophylaxed with enoxaparin approached 1.8%, if the actual rate of these thrombi exceeded 19.4% in untreated patients, or if the cost of the drug was decreased to $15.25 per dose, a cost saving would be experienced in routine prophylaxis with this agent.

PID17: DETERMINATION OF THE COST-EFFECTIVENESS OF A TUBERCULOSIS PREVENTION PROGRAM ALONG THE US/ MEXICO BORDER USING MARKOV PROCESS MODELING WITHIN A PREVENTION EFFECTIVENESS FRAMEWORK

A prevention effectiveness analysis framework was used to estimate the costefifectiveness of a county administered tuberculosis prevention program along the U.S. / Mexico border. The tuberculosis prevention program under study used prophylactic isoniazid therapy in patients who have tested positive for tuberculosis infection. This analysis determined the cost-effectiveness of the current program versus no program from the perspective of the county government and was modeled for two time periods; five years and 15 years post preventive therapy initiation. Costs were calculated using actual data from tuberculosis prevention and active tuberculosis treatment programs as well as hospital discharge data. The outcome of interest, cases of active tuberculosis averted, was calculated through a Monte Carlo simulated Markov process model. Average and incremental cost-effectiveness ratios were then calculated for the tuberculosis prevention program scenario. The cost-effectiveness ratios were calculated separately with the inclusion or exclusion of the tuberculosis contagion costs. The results of the cost-effectiveness ratio calculations established that the prevention of active tuberculosis cases with the tuberculosis prevention program is considerably cost-effective. Every baseline incremental cost-effectiveness ratio, across the five and 15 year analysis periods (irrespective of contagion costs) determined in this prevention effectiveness study demonstrated cost savings. Additionally, the cost savings were substantial. The results indicate that rather than incurring costs to avert active