Cost-effectiveness Analysis Studies Research Articles

Advantages of Monte Carlo Confidence Intervals for Incremental Cost-Effectiveness Ratios: A Comparison of Five Methods

Cost-effectiveness analysis studies in education often prioritize descriptive statistics of cost-effectiveness measures, such as the point estimate of the incremental cost-effectiveness ratio (ICER), while neglecting inferential statistics like confidence intervals (CIs). Without CIs, it is impossible to make meaningful comparisons of alternative educational strategies, as there is no basis for assessing the uncertainty of point estimates or the plausible range of ICERs. This study evaluates the relative performance of five methods of constructing CIs for ICERs in randomized controlled trials with cost-effectiveness analyses. We found that the Monte Carlo interval method based on summary statistics consistently performed well regarding coverage, width, and symmetry. It yielded estimates comparable to the percentile bootstrap method across multiple scenarios. In contrast, Fieller’s method did not work well with small samples and small treatment effects. Further, Taylor’s method and the Box method performed least well. We discuss two-sided and one-sided hypothesis testing based on ICER CIs, develop tools for calculating these ICER CIs, and demonstrate the calculation using an empirical example. We conclude with suggestions for applications and extensions of this work.

Cost-effectiveness of gestational diabetes screening in middle-income countries: a systematic review

The majority of GDM occurs in low- and middle-income countries. GDM is associated with increased maternal and infant complications as well as an increased burden of health financing. Accurate and cost-effective screening is needed for prevention and further treatment. Unfortunately, there is a lack of research on the cost-effectiveness of GDM screening in middle-income countries. The objective of this study was to uncover scientific proof concerning the cost-effectiveness analysis of screening for gestational diabetes in middle-income countries. We conducted a systematic review using Pubmed and ScienceDirect. Four reviewers screened the title and abstract of each article, followed by the selection of the full text based on the inclusion criteria (cost-effectiveness analysis studies of GDM screening and original research). Quality articles were assessed using the CHEC-Extended tool. A total search of 1239 articles found 3 studies that met the inclusion criteria. A screening program is more cost-effective than no screening, this represents a savings of $1,329,671. The ICER value is less than 3x GDP per capita, which indicates that the intervention is cost-effective. Compared to two-step screening, one-step screening is more likely to be cost-effective since it detects more cases. As the prevention of DALYs is mainly due to the prevention of T2DM, middle-income countries should focus more on postnatal care for women with GDM in the future. It is advised that long-term follow-up studies be a major focus of future research in order to evaluate the follow-up GDM screening intervention's possible long-term health benefits and financial effects.

A Review of the Cost-Effectiveness Evidence for FDA-Approved Cell and Gene Therapies.

Cell and gene therapy (CGT) innovations have provided several significant breakthroughs in recent years. However, CGTs often come with a high upfront cost, raising questions about patient access, affordability, and long-term value. This study reviewed cost-effectiveness analysis (CEA) studies that have attempted to assess the long-term value of Food and Drug Administration (FDA)-approved CGTs. Two reviewers independently searched the Tufts Medical Center CEA Registry to identify all studies for FDA-approved CGTs, per January 2023. A data extraction template was used to summarize the evidence in terms of the incremental cost-effectiveness ratio expressed as the cost per quality-adjusted life year (QALY) and essential modeling assumptions, combined with a template to extract the adherence to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. The review identified 26 CEA studies for seven CGTs. Around half of the base-case cost-effectiveness results indicated that the cost per QALY was below $100,000-$150,000, often used as a threshold for reasonable cost-effectiveness in the United States. However, the results varied substantially across studies for the same treatment, ranging from being considered very cost-effective to far from cost-effective. Most models were based on data from single-arm trials with relatively short follow-ups, and different long-term extrapolations between studies caused large differences in the modeled cost-effectiveness results. In sum, this review showed that, despite the high upfront costs, many CGTs have cost-effectiveness evidence that can support long-term value. Nonetheless, substantial uncertainty regarding long-term value exists because so much of the modeling results are driven by uncertain extrapolations beyond the clinical trial data.

Cost of Low-Value Imaging Worldwide: A Systematic Review.

Imaging with low or no benefit for the patient undermines the quality of care and amounts to vast opportunity costs. More than 3.6 billion imaging examinations are performed annually, and about 20-50% of these are of low value. This study aimed to synthesize knowledge of the costs of low-value imaging worldwide. This systematic review was based on the PRISMA statement. The database search was developed in Medline and further adapted to Embase-Ovid, Cochrane Library, and Scopus. Primary empirical studies assessing the costs of low-value diagnostic imaging were included if published between 2012 and March 2022. Studies designed as randomized controlled trials, non-randomized trials, cohort studies, cross-sectional studies, descriptive studies, cost analysis, cost-effectiveness analysis, and mixed-methods studies were eligible. The analysis was descriptive. Of 5,567 records identified, 106 were included. Most of the studies included were conducted in the USA (n = 76), and a hospital or medical center was the most common setting (n = 82). Thirty-eight of the included studies calculated the costs of multiple imaging modalities; in studies with only one imaging modality included, conventional radiography was the most common (n = 32). Aggregated costs for low-value examinations amounts to billions of dollars per year globally. Initiatives to reduce low-value imaging may reduce costs by up to 95% without harming patients. This study is the first systematic review of the cost of low-value imaging worldwide, documenting a high potential for cost reduction. Given the universal challenges with resource allocation, the large amount used for low-value imaging represents a vast opportunity cost and offers great potential to improve the quality and efficiency of care.

A nationwide multicenter study of the cost effectiveness of five leading drugs for pharmacological management of cervicobrachial symptoms

BackgroundCervicobrachial pain frequently affects the quality of life (QOL) of the general public and has a significant economic impact on the health care systems of various countries. There are a number of treatment options for this disease, including widely-used drug therapy, but the effectiveness of each option is indeterminate, and there have been no published cost-effectiveness analysis studies so far. This prospective observational study aimed to examine the cost-effectiveness of drug treatment for cervicobrachial symptoms. MethodsA 6-month medication regimen for each of five frequently-prescribed drugs for cervicobrachial symptoms was administered to 322 patients at 24 centers in Japan. Outcome measures, including of the EuroQol Group 5D, Short Form-8, and Visual Analog Scale (VAS), were investigated at baseline and every month thereafter. Incremental cost-effectiveness ratios (ICERs) of the drug cost to quality-adjusted life years (QALYs) were calculated. A stratified analysis of patient characteristics was also performed to identify baseline factors potentially affecting cost-effectiveness. ResultsThe ICER of entire drug treatment for cervicobrachial symptoms was 7,491,640 yen. Compared with the reference willingness-to-pay, the ICER was assumed to not be cost-effective. A certain number of QALYs were gained during the first 3 months after the treatment intervention, but almost no QALYs were gained during the following 3 months. Stratified analysis showed that cost-effectiveness was extremely low for patients with high baseline VAS and high QOL. ConclusionsThe available medications for cervicobrachial symptoms did not have excellent cost-effectiveness. Although a certain number of QALYs were gained during the first 3 months after medication, no QALYs were gained in the latter half of the study period, suggesting that it is not advisable to continue the medication needlessly. Level of evidenceII, prospective cohort study.

Prehabilitation programs - a systematic review of the economic evidence.

Prehabilitation, which involves improving a patient's physical and psychological condition before surgery, has shown potential benefits but has yet to be extensively studied from an economic perspective. To address this gap, a systematic review was conducted to summarize existing economic evaluations of prehabilitation interventions. The PRISMA Protocols 2015 checklist was followed. Over 16,000 manuscripts were reviewed, and 99 reports on preoperative interventions and screening tests were identified, of which 12 studies were included in this analysis. The costs are expressed in Pounds (GBP, £) and adjusted for inflation to December 2022. The studies were conducted in Western countries, focusing on specific surgical subspecialties. While the interventions and study designs varied, most studies demonstrated cost savings in the intervention group compared to the control group. Additionally, all cost-effectiveness analysis studies favored the intervention group. However, the review also identified several limitations. Many studies had a moderate or high risk of bias, and critical information such as time horizons and discount rates were often missing. Important components like heterogeneity, distributional effects, and uncertainty were frequently lacking as well. The misclassification of economic evaluation types highlighted a lack of knowledge among physicians in prehabilitation research. This review reveals a lack of robust evidence regarding the economics of prehabilitation programs for surgical patients. This suggests a need for further research with rigorous methods and accurate definitions.

Healthcare costs and utilization associated with pain among breast cancer survivors: a propensity score matched cohort study using SEER-Medicare data.

To assess healthcare costs and utilization of treatment-related pain among breast cancer survivors. A retrospective matched cohort study using Surveillance Epidemiology and End Results SEER-Medicare linked data was conducted. The study population included older breast cancer survivors continuously enrolled in Medicare parts A, B, and D in the baseline and 1-year follow-up periods. Survivors with pain were matched to survivors without pain using PSM. Incremental all-cause healthcare costs associated with pain were calculated using a two-part model. Incremental healthcare utilization of inpatient hospitalizations, ER, outpatient, and physician services were estimated using the negative binomial model. The study included 101,120 non-metastatic breast cancer patients between July 2007 and September 2013. The final analytical cohort after matching included 5891 survivors in both groups. The incremental annual all-cause total healthcare costs per patient were higher in survivors with pain as compared to survivors without pain (Δ = 4379.00 (95% CI: 4308.00-4448.80). The main cost drivers were hospitalizations at 71%, followed by ER at 16% and physician services at 9% for survivors diagnosed with pain. Annual all-cause healthcare resource utilization was also found to be higher in survivors with pain as compared to survivors without pain across all categories of use. Similar trends were observed when stratified by surgery type and subgrouped by pain type and pain-related costs. This study provided baseline data that can be used for future cost-effectiveness analysis studies and burden of illness studies. Treatment-related costs have a substantial burden on healthcare costs andthe utilization of Medicare.

P47 Integrating a Polygenic Risk Score for Coronary Artery Disease As a Risk Enhancing Factor in the Pooled Cohort Equation: A Cost-Effectiveness Analysis Study

Polygenic risk score for coronary artery disease (CAD-PRS) improves precision in determining the risk of atherosclerotic cardiovascular disease (ASCVD) but health benefits and healthcare costs associated with CAD-PRS are unknown. We examined the cost-effectiveness of including CAD-PRS as a risk-enhancing-factor in the pooled-cohort-equation (PCE)—the standard-of-care for determining the risk of ASCVD—versus the PCE-alone.

A Cost-Effectiveness Analysis of Self-Monitoring Blood Glucose Practice in Type 2 Diabetes Mellitus Patients in a Teaching Hospital

Self-monitoring blood glucose (SMBG) practice had been recognized as one of the important components in the management of patients with T2DM. It was found that this practice was associated with improved glycemic control and decreased risk of disease complications that lead to improvement in quality of life (QOL). In the era of rising healthcare costs and the increasing prevalence of T2DM, an economic evaluation of this practice is needed. Therefore, the main purpose of this study was to measure the cost-effectiveness of SMBG practice among T2DM patients by using the decision analytical model. An economic evaluation in the form of a cost-effectiveness analysis study was conducted among hospitalized T2DM patients in a teaching hospital. Data collection was conducted using a costing checklist and case report form. The costing analysis was conducted using a decision analytical model which involved theoretical model building and testing of primary data from a prospective cross-sectional study. A total of 100 patients participated in this study. The estimated mean for the total annual patients' cost for the patient not practicing SMBG and practicing SMBG was RM 76.82 (SD + RM2.43) and RM 609.83 (SD + RM 2.66), respectively. The cost difference was statistically (t [98] = -11.1, p=<0.05). The incremental cost-effectiveness ratio (ICER) was RM 10,165.19 per quality-adjusted life year (QALY). Sensitivity analysis showed that the probability of improvement in glycemic control with SMBG practice was the key parameter in this model. Therefore, the SMBG practice in T2DM patients was found to be cost-effective and should be advocated among T2DM patients. Despite its limitation in terms of the structural uncertainty, the finding from this study would provide valuable information to policymakers in the aspect of health care financing allocation. Future research by using complex cost modeling is recommended to explore other cost determinants for SMBG practice.

A cost-effectiveness analysis of delayed breast reconstruction with pedicled flaps from the back

<h2>Summary</h2><h3>Background</h3> Variability in breast reconstruction methods provides an opportunity to investigate whether a method is superior to another with regard to cost, quality, or both. We performed a cost-effectiveness analysis (CEA) study based on tertiary endpoint data from a randomized clinical trial to compare the cost-effectiveness of delayed breast reconstruction by either a latissimus dorsi flap (LD) or a thoracodorsal artery perforator flap (TAP). <h3>Material & methods</h3> A total of 50 women were included for unilateral delayed breast reconstruction and were randomized to reconstruction by either the LD flap (<i>n</i> = 18) or the TAP flap (<i>n</i> = 22). The CEA was based on differences in shoulder function after the reconstruction. Direct and indirect costs relating to the two procedures were assessed by the Danish Diagnosis-Related Groups tariffs. <h3>Results</h3> Our analysis showed a significant positive effect of introducing the TAP flap on the total shoulder score with an additional cost of $2779. The incremental cost-effectiveness ratio was $4481 and based on a willingness to pay (WTP) $500, we found an estimated net benefit of $519, which was statistically significant (<i>p</i> = 0.0375). The cost-effectiveness acceptability curve indicated that there is a 96.3% probability for the TAP flap being cost-effective to the LD flap at a WTP threshold of $500. <h3>Conclusion</h3> From a societal perspective, our cost-effective analysis demonstrated that the TAP flap is the more cost-effective method of breast reconstruction compared to the LD flap with respect to patient-reported shoulder-related disability.

Behaviour modification intervention for patients with chronic kidney disease could provide a mid- to long-term reduction in public health care expenditure: budget impact analysis.

A recent cost-effectiveness analysis (CEA) study evaluated the widespread diffusion of behaviour modification intervention for patients with chronic kidney disease (CKD). Incorporating this behaviour modification intervention, comprising educational sessions on nutrition/lifestyle and support for regular patient visits, to the current CKD guideline-based practice was found to be cost-effective. This study aimed to examine the affordability of this efficient new practice under the hypothesis that the behaviour modification intervention would be initiated by general physicians (GPs). A budget impact analysis was conducted by defining the target population as patients aged 40-74years with stage-3-5 CKD based on the prevalence of definitive CKD in the Japanese general population. Costs expended by social insurers without discount were counted as budgets. We estimated the annual budget impact for 15years by running our CEA model, assuming that it would be good for the span. We estimated the number of patients with end-stage kidney disease (ESKD) to decrease by 4,496 in the fifteenth year of the new practice using our CEA model. Compared to that in the current practice, the budget impact as total additional expenditure of the new practice was estimated to be negative by the tenth year in the base case. The widespread diffusion of behaviour modification intervention would contain public health care expenditure over the mid-to-long term, resulting from a reduction in progression to ESKD. We suggest that providing sufficient economic incentives to GPs and strengthening recommendations in CKD guidelines would realise effective GP-initiated interventions.

Cost-effectiveness Analysis of Air Emergency Versus Ground Emergency Medical Services Regarding the Patient's Transportation and Treatment in Selected Hospital.

Background: The prehospital emergency system is the first initiator of medical care as an alternative to hospitals and health care services that helps patients and injured people in critical situations and accidents. This study aimed to evaluate the cost-effectiveness of air ambulance versus ground ambulance regarding the patient's transportation and treatment. Methods: In this cost-effectiveness analysis study, 300 patients who were transferred to the Shohadaye HaftomTir hospital by air ambulance and 300 patients transferred by ground ambulance during the study period were selected in 2021-2022. This study examined the costs from the society's perspective. After drawing the decision tree model in TreeAge software, the incremental cost-effectiveness ratio was calculated; and to evaluate the strength of the analysis results, one-way and two-way sensitivity analyses were done on all costs and consequence parameters. Results: The effectiveness rate in the ground ambulance group and in the air ambulance group was 0.42591 and 0.5566, respectively, and the total cost of transportation and treatment by ambulance in these patients was $412.88 and for patients transported and treated by air ambulance was $11898.05. Therefore, air ambulance costs more and is more effective than ground ambulance, and the amount of incremental cost and effectiveness of air ambulance compared with ground ambulance was $11485.17 and 0.130773 units, respectively. The incremental cost-effectiveness ratio (ICER) of the 2 strategies was 87825.28, and the cost-effectiveness threshold was $7200. To determine the strength of the study results, one-way and two-way sensitivity analyses were done and the results of the cost-effectiveness analysis was not changed. Conclusion: Our study showed that ground ambulance is more cost-effective than air ambulance and the most important reason is that the total cost of air ambulance is 26 times more than ground ambulance, however, it is more effective than ground ambulance.

Polyurethane Versus Calcium Alginate Dressings for Split-Thickness Skin Graft Donor Site: A Systematic Review and Meta-Analysis.

Herein, we compare the outcomes of polyurethane and calcium alginate dressings for split-thickness skin graft (STSG) donor sites.A systematic review and meta-analysis were conducted with a search of electronic databases to identify all randomised controlled trials (RCTs) and observational studies comparing the outcomes of polyurethane dressing versus calcium alginate for STSG donor sites. Primary outcomes were pain intensity, convenience for staff and patients, and adverse effects (namely, excessive exudate, infection rate, and hematoma). Secondary outcome measures included the assessment of healing, dressing changes, cosmetic appearance, and cost. Fixed and random-effect models were used for the analysis.Four RCTs enrolling 127 subjects were identified. There was no significant difference between polyurethane and calcium alginate in terms of pain intensity on Day 1 (mean difference (MD) 0.13, P = 0.80) and Day 5 (MD = 0.20, P = 0.38), as well as the ease of application (odds ratio (OR) = 3.08, P = 0.47). However, there was a statistically significant improvement in patient comfort, favouring the polyurethane group (OR = 44.11, P < 0.00001). In addition, no statistically significant differences were noted in terms of adverse effects between the two dressings. In terms of cost, the calcium gluconate dressing had an overall higher cost compared to polyurethane.Polyurethane is a more favourable dressing compared to calcium alginate for STSG donor sites in terms of patient comfort, healing, and cosmetic outcomes. However, comparable results were noted in terms of pain intensity, ease of application, and adverse effects profile. Cost-effectiveness analysis studies are required to justify its routine use.

Heart Function Clinics for Patients With Heart Failure

&#x0D; Low- to moderate-quality clinical evidence suggested that heart failure clinics were associated with significant reductions in all-cause mortality, reductions in heart failure‒related hospitalization, better guideline-directed medical therapy management, and higher adherence to heart failure medications compared to usual care. The findings for all-cause hospitalization were mixed.&#x0D; One low-quality economic study in Denmark found that heart failure clinics were associated with higher costs but no significant difference in mortality rates compared with the usual care. Another moderate cost-effectiveness analysis study in Canada revealed that heart failure clinic interventions were cost-effective compared to standard care, with an incremental cost-effectiveness ratio below the willingness-to-pay threshold.&#x0D;

Abstract 891: Cost-effectiveness of CDK4/6 inhibitors in the first-line treatment of HR+/HER2- metastatic breast cancer in postmenopausal women in the United States

Abstract BACKGROUND: Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors are changing the management of the patients with hormone receptor-positive/HER2-negative metastatic breast cancer (HR+/HER2- MBC). The addition of CDK4/6 inhibitors to endocrine therapy is more efficacious than endocrine therapy alone for HR+/HER2- MBC patients, but it is also more expensive. This cost-effectiveness analysis study was designed to evaluate the economic value of adding CDK4/6 inhibitors to letrozole, an aromatase inhibitor. OBJECTIVE: We aimed to evaluate the cost-effectiveness of abemaciclib plus letrozole or ribociclib plus letrozole or palbociclib plus letrozole versus letrozole monotherapy in the first-line treatment of HR+/HER2− MBC in the United States. METHODS: We constructed a Markov-based decision-analytic model using TreeAge Software LLC, Cambridge, MA. Our model simulates lifetime costs and health outcomes over a 40-year lifetime horizon from a third-party payer perspective. The model incorporated the clinical course of a progression-free or stable disease, progressed disease, death, Neutropenia as a major adverse effect, and cancer-specific mortality. All clinical and utilities data were derived from the literature and clinical trials, including PALOMA-2, MONALEESA-2, and MONARCH-3. For consistent comparison, only letrozole specific data was derived from MONARCH-3. Outcomes were measured by costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of the results against uncertainties in the model parameters. RESULTS: In our base case, the total health care costs for Palbociclib, Ribociclib, and Abemaciclib plus letrozole were $680,596, $ 676,292, and $ 635,606, respectively while the cost of letrozole monotherapy was $162,378. Palbociclib plus letrozole and Ribociclib plus letrozole were dominated strategies by Abemaciclib plus letrozole. Higher QALYs was associated with Abemaciclib plus letrozole (6.91 QALYs vs 5.83 QALYs for letrozole). Compared to letrozole monotherapy, Abemaciclib plus letrozole resulted in ICER of $ 436,855 per QALY. At willingness-to-pay thresholds of $100,000 per QALY gained, none of the strategies was found to be cost-effective. Letrozole monotherapy was the optimal choice. The model was sensitive to certain parameters such as cost of Abemaciclib, and transition probability of stable to the progressed state for Abemaciclib and letrozole. Base case results were consistent with the findings from the Monte Carlo simulation. CONCLUSIONS: Our study found that none of the CDK4/6 inhibitors were cost-effective. Because of the current cost of CDK4/6 inhibitors, letrozole monotherapy was found to be an optimal choice for the first-line treatment of HR+/HER2- MBC. Citation Format: Prajakta P. Masurkar, Haluk Damgacioglu, Ashish Deshmukh, Meghana Trivedi. Cost-effectiveness of CDK4/6 inhibitors in the first-line treatment of HR+/HER2- metastatic breast cancer in postmenopausal women in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 891.

Cost-Effectiveness Analysis of Community Case Management of Childhood Diarrhea in Burundi

ObjectiveThis study aimed to evaluate the cost-effectiveness of community case management (CCM) program of childhood diarrhea by providing oral rehydration salts and zinc through community health workers in Burundi. MethodsA cost-effectiveness analysis study using a Markov modeling approach was undertaken to assess the CCM program of diarrhea from both provider and societal perspectives. The CCM program was compared with the routine management of childhood diarrhea at health facilities. Primary data on the cost of childhood diarrhea management were collected. Both economic and health outcomes were assessed for a period of 5 years, and a discount rate of 3% was applied. One-way and probabilistic sensitivity analyses were performed. ResultsThe CCM program was found to be both less costly and more effective resulting to a negative value of incremental cost-effectiveness ratios, indicating that the program was dominant producing cost savings. Compared with the routine treatment of diarrhea at health facilities, the CCM program would avert 2749 additional disability-adjusted life years over a period of 5 years. The economic burden was reduced of US$1 056 699 and US$2 328 531 from the provider and societal perspectives, respectively. The cost-effectiveness estimates were mostly sensitive to the discount rate and the cost of outpatient visits at health facilities. The intervention remained dominant with a 100% probability of cost savings within 10 000 simulations of the sensitivity analysis. ConclusionsProviding inexpensive diarrheal treatment (oral rehydration salts and zinc) in communities is an attractive cost-effective intervention. Evidence from this study should be used to scale up the coverage of this life- and cost-saving intervention.

A pharmacoeconomic evaluation of pharmaceutical treatment options for prostate cancer

ABSTRACT Introduction Prostate cancer is one of the most common neoplasms in men. For many years the mainstay of treatment was androgen deprivation therapy, but during last decade many novel agents have emerged, accompanied by increased costs for healthcare systems. Areas covered In this literature review, the authors provide a pharmacoeconomic review of several pharmaceutical agents used in several disease stages, by summarizing evidence from cost-analysis, cost-effectiveness, cost-utility, cost-saving, cost-benefit and budgetary impact analysis studies. Expert opinion The rapid development of therapeutic agents for prostate cancer has put a great budgetary burden on healthcare systems, since these drugs are prolonging survival and improving quality of life . Since existing data are now mature enough from a number of clinical trials with long-term follow-up, policy makers should propose not only the most clinically effective but also the most cost-effective agents, in order for every patient to gain access at least to some of these therapies. Docetaxel addition seems to be a cost-effective option, when compared to both abiraterone and enzalutamide (due to costs related to acquisition and side effects). Cabazitaxel is a strong candidate after docetaxel failure, while both denosumab and bisphosphonates are cost-effective for reducing skeletal-related events in metastatic disease.

Computed Tomography Angiography versus Digital Subtraction Angiography as a Primary Diagnostic Tool in Nontraumatic Subarachnoid Hemorrhage: Cost-Effectiveness Analysis Study

Digital subtraction angiography (DSA) and computed tomographic angiography (CTA) are used to identify the cause of nontraumatic subarachnoid hemorrhage (SAH). There is no consensus on which to choose as the first diagnostic tool. We aimed to compare the cost-effectiveness of CTA versus DSA as a primary tool for identifying the cause of nontraumatic SAH. A decision analysis model was built to simulate patients undergoing DSA or CTA as a primary diagnostic tool for the cause of nontraumatic SAH. The input data for the study were extracted from literature. Probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of the model. In the base case calculation, it cost $1261.82 less and yielded 0.0001 quality-adjusted life year (QALY) when DSA was used as a primary diagnostic imaging tool for nontraumatic SAH. Choosing DSA as a primary tool was cost-effective in more than 65% of iterations in probabilistic sensitivity analysis. Deterministic sensitivity analyses show when the probability of using endovascular treatment is >47.2%, choosing DSA is more cost-effective; otherwise, CTA is more optimal. CTA is more cost-effective when the cost for DSA >2.6× CTA+ $600. Based on current literature and our model DSA as a primary diagnostic tool for the cause of nontraumatic SAH is more cost-effective. However, in clinical practice physicians can choose either DSA or CTA according to the scale of endovascular procedures used in their center, as well as the cost correlation between CTA and DSA, which varies among institutions.

Reporting Quality of Cost-Effectiveness Analyses Conducted in Saudi Arabia: A Systematic Review

ObjectivesPharmacoeconomics and health economics in general is a new field that is still developing and emerging, not only in Saudi Arabia but all over the world. The objective of this study is to collect all published cost-effectiveness analysis (CEA) studies conducted based on Saudi settings and to evaluate their reporting quality. MethodsWe used PRISMA guidelines to search for all English-language CEAs conducted in Saudi Arabia in 3 databases: Medline, Embase, and Scopus. Keywords used in the search were: cost-effectiveness, cost-benefit, cost-utility, economic evaluation, Saudi Arabia. The data extracted were analyzed to assess reporting quality based on Consolidated Health Economic Evaluation Reporting Guidelines (CHEERS) and the second panel recommendations. ResultsThe 3 databases yielded 859 articles after removing duplicates. Only 7 articles included as final results following PRISMA guidelines. These 7 studies were published between 2015 and 2020. The CEA studies varied in their reporting quality; however, there were common missing required items among all of them, such as justifying choosing of a specific model and time horizon and reporting the ethical implications of the studied interventions. ConclusionSeven published CEA studies were conducted based on Saudi settings as revealed by this review. The included studies reported the more important aspects of CEA studies. However, there were missed reporting items based on the checklists we used to assess CEAs in this review. Although perfect and complete adherence to CHEERS or the second panel guidelines is a high standard, future CEAs should adhere to such standards. Transparency and good reporting are cornerstones in CEAs, and future CEAs should report their methods, findings, and results in a more transparent and efficient way.

Neuropsychological rehabilitation interventions for people with an acquired brain injury. A protocol for a systematic review of economic evaluation.

Background: New emerging evidence has demonstrated the need for effective interventions to help people living with an acquired brain injury (ABI). Evidence on cost-effectiveness, which can help inform use of limited resources, is scarce in this area and therefore the purpose of this systematic review is to critically appraise and consolidate the current evidence on economic evaluations of ABI rehabilitation interventions. Methods: Systematic review methodology will be applied to identify, select and extract data from published economic evaluation studies (trial-based, non-trial based, simulation-based, decision model and trial-based model economic evaluations) of ABI treatment interventions in adults. A systematic literature search will be conducted on the following electronic databases: EMBASE, Econlit, CINAHL, Medline, the National Health Service Economic Evaluation Database and PsyclNFO. This review will only include cost-effectiveness analysis studies (e.g., cost per life year gained), cost-benefit and cost minimisation analyses in which the designs were randomised controlled trials (RCTs), non-RCT studies, cost-utility analyses (e.g., cost per quality-adjusted life year (QALY) gained or cost per disability-adjusted life year averted), cohort studies, and modelling studies. Only studies that were published in the english language, associated with adults who have an ABI will be included. There will be no restrictions on perspective, sample size, country, follow-up duration or setting. The search strategy terms will include the following: acquired brain injury, brain*; cost*; or cost-benefit analysis*. Following data extraction, a narrative summary and tables will be used to summarize the characteristics and results of included studies. Discussion: The findings from this review will be beneficial to health policy decision makers when examining the evidence of economic evaluations in this field. In addition, it is anticipated that this review will identify gaps in the current economic literature to inform future-related research. Systematic review registration: PROSPERO CRD42020187469 (25 th June 2020).