Cost-effectiveness Of Noninvasive Tests Research Articles

Effects of Patient Compliance on the Cost-Effectiveness of Non-invasive Tests for Initial Diagnosis of H. pylori Infection in a High Prevalence Population

Effects of Patient Compliance on the Cost-Effectiveness of Non-invasive Tests for Initial Diagnosis of H. pylori Infection in a High Prevalence Population

Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C.

The cost-effectiveness of noninvasive tests (NITs) as alternatives to liver biopsy is unknown. We compared the cost-effectiveness of using NITs to inform treatment decisions in adult patients with chronic hepatitis C (CHC). We conducted a systematic review and meta-analysis to calculate the diagnostic accuracy of various NITs using a bivariate random-effects model. We constructed a probabilistic decision analytical model to estimate health care costs and outcomes (quality-adjusted life-years; QALYs) using data from the meta-analysis, literature, and national UK data. We compared the cost-effectiveness of four treatment strategies: testing with NITs and treating patients with fibrosis stage ≥F2; testing with liver biopsy and treating patients with ≥F2; treat none; and treat all irrespective of fibrosis. We compared all NITs and tested the cost-effectiveness using current triple therapy with boceprevir or telaprevir, but also modeled new, more-potent antivirals. Treating all patients without any previous NIT was the most effective strategy and had an incremental cost-effectiveness ratio (ICER) of £9,204 per additional QALY gained. The exploratory analysis of currently licensed sofosbuvir treatment regimens found that treat all was cost-effective, compared to using an NIT to decide on treatment, with an ICER of £16,028 per QALY gained. The exploratory analysis to assess the possible effect on results of new treatments, found that if SVR rates increased to >90% for genotypes 1-4, the incremental treatment cost threshold for the “treat all” strategy to remain the most cost-effective strategy would be £37,500. Above this threshold, the most cost-effective option would be noninvasive testing with magnetic resonance elastography (ICER = £9,189). Conclusions: Treating all adult patients with CHC, irrespective of fibrosis stage, is the most cost-effective strategy with currently available drugs in developed countries. (Hepatology 2014;60:832–843)

Cost-Effectiveness of Noninvasive Testing and Treatment Strategies for H. pylori Infection in Children With Dyspepsia

Objective: We sought to model the cost-effectiveness of endoscopy, noninvasive testing and treatment strategies for Helicobacter pylori infection in children with recurrent abdominal pain in two health care systems, those of the United States and Finland. Methods: Initial serological testing and treatment was compared to empirical treatment with antimicrobials, endoscopy with rapid urease testing, and 13C urea breath testing. Key assumptions and ranges were obtained from the published literature. Costs were determined for the acquisition of various tests and actual reimbursement figures were used for procedural costs. Results: The disease management costs were very similar for both endoscopy ($643.00) and serology ($646.00) in the United States. In Finland, endoscopy ($173.00) was less expensive than serology ($192.00). The 13C urea breath test was the most expensive procedure in the United States. Sensitivity analysis demonstrated that serological testing became the preferred path if its cost was < $42 in the United States. Empirical treatment of children with dyspepsia was not cost-effective in either country. Sensitivity analysis showed that when prevalence of infection was > 53% in children with recurrent abdominal pain, empirical therapy with endoscopy reserved for failures was the optimal path. Conclusions: In developed countries like the United States and Finland, significant cost savings are unlikely with an initial test and treat strategy based on serology. Noninvasive testing and treatment of H. pylori infection can be cost-effective in populations with highly prevalent rates of infection.

Cost-effectiveness of Noninvasive Testing for Osteomyelitis-Reply

ABSTRACT In Reply. —Economic analyses of health care strategies must carefully differentiate costs from charges.1 Costs represent the actual amount paid for resources consumed in providing a service, while charges represent the price requested for reimbursement of that service. Because market forces affect charges, large and seemingly arbitrary differences between costs and charges for different services may exist.2 We agree with Dr Makler that it is important to use costs, which correspond more closely to actual resource consumption, and not charges, when performing cost-effectiveness analyses.Makler believes that the costs listed in our analysis are not representative, quoting the 1993 Medicare resource-based relative value scale—based reimbursement for a three-phase bone scan of $204.06 as proof. We believe this is an underestimate, which may include neither the costs of the radiopharmaceutical nor the hospital costs for the addition of a three-phase scan to the regional scan. Unfortunately, even costs vary