Cost-effectiveness Of Treatment Options Research Articles

EE451 The Economic and Humanistic Burden of Food Allergies and Cost-Effectiveness of Treatment Options: A Systematic Review

EE451 The Economic and Humanistic Burden of Food Allergies and Cost-Effectiveness of Treatment Options: A Systematic Review

Cost-effectiveness of overactive bladder treatments from a US commercial andpayer perspective.

Aim: The cost-effectiveness of treatment options (anticholinergics, β3-adrenoceptor agonists, onabotulinumtoxinA, sacral nerve stimulation and percutaneous tibial stimulation [the latter two including new rechargeable neurostimulators]) for the management of overactive bladder (OAB) were compared with best supportive care (BSC) using a previously published Markov model. Materials & methods: Cost-effectiveness was evaluated over a 15-year time horizon, and sensitivity analyses were performed using 2- and 5-year horizons. Discontinuation rates, resource utilization, and costs were derived from published sources. Results: Using Medicare and commercial costs over a 15-year time period, onabotulinumtoxinA 100U had incremental cost-effectiveness ratios (ICERs) gained of $39,591/quality-adjusted life-year (QALY) and $42,255/QALY, respectively, versus BSC, which were the lowest ICERs of all assessed treatments. The sensitivity analyses at 2- and 5-year horizons also showed onabotulinumtoxinA to be the most cost-effective of all assessed treatments versus BSC. Conclusion: OnabotulinumtoxinA 100U is currently the most cost-effective treatment for OAB.

Heterogeneity in Radiotherapeutic Parameter Assumptions in Cost-Effectiveness Analyses in Prostate Cancer: A Call for Uniformity

Cost-effectiveness analyses (CEAs) may provide useful data to inform management decisions depending on the robustness of a model's input parameters. We sought to determine the level of heterogeneity in health state utility values, transition probabilities, and cost estimates across published CEAs assessing primarily radiotherapeutic management strategies in prostate cancer. We conducted a systematic review of prostate cancer CEAs indexed in MEDLINE between 2000 and 2018 comparing accepted treatment modalities across all cancer stages. Search terms included "cost effectiveness prostate," "prostate cancer cost model," "cost utility prostate," and "Markov AND prostate AND (cancer OR adenocarcinoma)." Included studies were agreed upon. A Markov model was designed using the parameter estimates from the systematic review to evaluate the effect of estimate heterogeneity on strategy cost acceptability. Of 199 abstracts identified, 47 publications were reviewed and 37 were included; 508 model estimates were compared. Estimates varied widely across variables, including gastrointestinal toxicity risk (0%-49.5%), utility of metastatic disease (0.25-0.855), intensity-modulated radiotherapy cost ($21 193-$61 996), and recurrence after external-beam radiotherapy (1.5%-59%). Multiple studies assumed that different radiotherapy modalities delivering the same dose yielded varying cancer control rates. When using base estimates for similar parameters from included studies, the designed model resulted in 3 separate acceptability determinations. Significant heterogeneity exists across parameter estimates used to perform CEAs evaluating treatment for prostate cancer. Heterogeneity across model inputs yields variable conclusions with respect to the favorability and cost-effectiveness of treatment options. Decision makers are cautioned to review estimates in CEAs to ensure they are up to date and relevant to setting and population.

Readmission Trends Related to Unruptured Intracranial Aneurysm Treatment.

Background and Purpose: Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality. Prophylactic treatment of the unruptured intracranial aneurysm (UIA) is considered in a select group of patients thought to be at high for aneurysmal rupture. Hospital readmission rates can serve as a surrogate marker for the safety and cost-effectiveness of treatment options for UIAs; we present an analysis of the 30-day rehospitalization rates and predictors of readmission following UIA treatment with surgical and endovascular approaches.Methods: We retrospectively analyzed data from the National Readmission Database (NRD) derived from the Healthcare Cost and Utilization Project for the year 2014. The cohort included patients with a primary discharge diagnosis of a treated unruptured aneurysm. The primary outcome variable was the 30-day readmission rate in open surgical vs. endovascularly treated groups. The secondary outcomes included predictors of readmissions, and causes of 30-day readmissions in these two groups.Results: The 30-day readmission rate for the surgical group was 8.37% compared to 4.87% for the endovascular group. The index hospitalization duration was longer in the surgical group. A larger proportion of the patients readmitted following surgical treatment were hypertensive (76.35, vs. 63.43%), but the prevalence of other medical comorbidities was comparable in the two treatment groups.Conclusions: There is a higher likelihood for 30-day readmission, longer duration of initial hospitalization and a lower likelihood of discharge home following surgical treatment of UIAs when compared to endovascular treatment. These findings, however, do not demonstrate long-term superiority of one specific treatment modality.

Economic Evaluations of Treatments for Inflammatory Bowel Diseases: A Literature Review

Objective The objective of this literature review was to evaluate the existing evidence regarding the cost-effectiveness of treatment options in IBD. Methods A systematic review of the literature was conducted to identify economic evaluations of IBD therapy. The literature search was performed using electronic databases MEDLINE and EMBASE. Searches were limited to full economic evaluations published in English or French between 2004 and 2016. Results A total of 5,403 potentially relevant studies were identified. After screening titles and abstracts, 48 studies were included, according to the eligibility criteria. A total of 56% and 42% of the studies were assessing treatments of UC or CD, respectively. Treatment options under evaluation included biological agents, mesalamine, immunosuppressants, and surgery. The majority of studies evaluated the cost-effectiveness of biological treatments. Biological therapies were dominant in 23% of the analyses and were cost-effective according to a $CAD50,000/QALY and $CAD100,000/QALY threshold in 41% and 62% of the analyses, respectively. Conclusion This literature review provided a comprehensive overview of the economic evaluations for the different treatment options for IBD over the past 12 years and represents a helpful reference for future economic evaluations.

Overuse of Cardiovascular Services: Evidence, Causes, and Opportunities for Reform.

Cardiovascular disease is the leading cause of death in the United States and constitutes 17% of overall national health expenditures,1 with noninvasive testing contributing much of the cost growth in recent years.2,3 Cardiovascular medicine has long been at the forefront of evidence-based practice, with arguably the longest-standing and most comprehensive array of efforts to measure risk factors and outcomes, to analyze the clinical effectiveness and cost-effectiveness of treatment options, and to formulate practice recommendations.4,5 Professional societies for cardiovascular medicine have established health policy statements,6 national databases on quality,7 clinical guidelines,8 and appropriate use criteria9 (AUC) for high-cost cardiovascular services (Table 1). More recently, the profession has taken steps to right-size cardiovascular services by defining the problem of overuse and underuse and working to shape clinical and policy interventions that improve quality and access and reduce unnecessary cost.10 For example, the American College of Cardiology Wisconsin and Florida chapters recently received a $15.8 million Centers for Medicare & Medicaid Innovation grant to pilot a comprehensive cardiovascular program to improve quality and to reduce cost of cardiovascular care through better data transparency, patient engagement, and shared decision making (SDM). View this table: Table 1. Summary of Initiatives to Identify and Reduce Overuse in Cardiovascular Medicine Despite efforts to improve the value of cardiovascular care, there is a concern that significant overuse of cardiovascular services persists in the United States. The published evidence of overuse is necessarily incomplete for 2 key reasons. First, for many tests and treatments, there is a lack of agreement on the basic definition of overuse. The Institute of Medicine originally defined overuse as occurring when “a health care service is provided under circumstances in which its potential for harm exceeds the possible benefit”.11 Others have since expanded the notion of …

Economic and Human Costs of Restless Legs Syndrome

Restless legs syndrome (RLS) is a common and often underestimated neurological disorder, with a prevalence ranging from approximately 2.5% to 10% in Western industrialized countries. The aim of the present study was to summarize the research findings on the human and economic costs associated with RLS in populations without any co-morbidities or potentially confounding health conditions. A further objective was to identify studies on the cost effectiveness of RLS treatments. A systematic literature search was performed. Two researchers independently assessed the relevance of each publication. Studies published before August 2008 were included if they assessed quality of life in patients suffering from RLS, determined total or patient-related costs attributable to RLS, and/or evaluated the cost effectiveness of treatment options for RLS. A total of 725 references were identified, including 100 full-text articles. Fifteen of these publications met all of the selection criteria and were included in the present review. Seven abstracts that focused on the economic burden of RLS and/or the cost effectiveness of different treatment strategies in RLS patients were also included. RLS was associated, in the included studies, with reductions in quality of life similar to those seen in patients with other chronic conditions. The cost-of-illness studies were heterogeneous but indicated that RLS was associated with a substantial economic burden, resulting in high direct and indirect costs to society. Although effective and cost-effective treatments appear to be available, further research is warranted, especially regarding the economic burden of RLS and the cost effectiveness of available treatment options.

Traumatic Thoracic and Lumbar Spinal Fractures: Operative or Nonoperative Treatment

A center parallel cohort study with blinded inclusion based on clinical equipoise. To compare outcomes of nonoperative and operative treatment strategies in terms of quality of life and neurologic and functional status. Despite a considerable body of literature, sound evidence regarding the optimal treatment for traumatic thoracic and lumbar spine fractures is lacking. Medical records of patients hospitalized for traumatic spinal fractures between 1991 and 2002 were identified in 2 trauma centers in the same country with established and different treatment strategies. Eligibility was retrospectively assessed for each case by a panel of orthopaedic surgeons who were representative of the 2 medical centers, and who were blinded to the treatment actually administered. Patients were included in the study when there was disagreement on the suggested treatment method. Thus, 2 comparable groups were identified undergoing nonoperative or operative treatment. Outcome assessment and comparison across groups focused on quality of life, residual pain, neurologic recovery, and employment in the middle-long-term follow-up. Discordance in regards to choice of treatment was identified in 190 (95 treated nonoperative, 95 operative) of 636 potentially eligible patients. Patients were comparable regarding baseline characteristics, except for a somewhat higher proportion of males and neurologic impairment in the operative group. Seventeen percent of the nonoperative and 21% of the operative group developed complications and 3 patients displayed neurologic deterioration for which a treatment change was considered necessary. Follow-up was complete in 79%; mean follow-up time was 6.2 years with a minimum of 2 years. Pain scores, disability indexes, and general health outcome were comparable at follow-up. Compared with matched population norms, outcomes were poorer regardless of treatment method. Neurologic recovery was better in the operative group, but this difference did not reach statistical significance. Multivariate regression analyses revealed that female gender and neurologic impairment were independent predictors of poor functional outcome. Eighty-eight and 83% of the nonoperatively and operatively treated patients were employed at some point after a rehabilitation period. Overall outcome of nonoperative and operative treatment in middle-long-term follow up is comparable, although there seems to be a difference in neurologic recovery patterns. Studies on the cost-effectiveness of treatment options and the patterns of recovery within 2 years after injury would assist in guideline development and stimulate interest for future research.

Cost-effectiveness of moderate-to-severe psoriasis treatment

Psoriasis is a common, chronic inflammatory disease that can cause as much disability as cancer, diabetes or other major medical illnesses. Traditional therapies for treating moderate-to-severe psoriasis include phototherapy, methotrexate, oral retinoids and ciclosporin. New biological treatments provide further therapeutic options, but add to the already considerable cost of managing psoriasis. Expert panels have published guidelines for the use of biological agents in managing moderate-to-severe psoriasis; however, few if any of these guidelines appropriately consider the cost-effectiveness of treatment options. When considering cost-effectiveness in addition to safety and efficacy, ultraviolet Type B phototherapy seems to be the best first-line agent for the control of moderate-to-severe psoriasis, despite a small potential for cumulative toxicity. The biologics should be considered as second-line agents alongside the traditional systemic treatments when phototherapy proves to be ineffective or is otherwise contraindicated, such as in patients with psoriatic arthritis.

Evidence-based prescribing [cite this article?

SummaryThe discipline of evidence-based prescribing is relatively new to nurses and other non-medical prescribers. The introduction of clinical governance, which emphasises accountability, quality and efficiency, means that it is no longer acceptable to base clinical decisions on personal opinion. Prescribing itself is just one stage in making a rational treatment decision, which requires a fully structured approach. This article will highlight some of the considerations that the prescriber has to take into account, including: the efficacy and cost-effectiveness of treatment options, how to check the evidence, the benefits or harms of a treatment and, the patient's own involvement in the treatment plan.

Cost effectiveness of treatment options in advanced breast cancer in the UK.

To compare clinical and economic study data for docetaxel, paclitaxel and vinorelbine in the treatment of anthracycline-resistant advanced breast cancer. A Markov decision-analysis model to simulate the clinical course of a 'typical' patient with advanced breast cancer during salvage chemotherapy was updated with response rates and adverse effect rates from phase III clinical trial data for docetaxel, paclitaxel and vinorelbine. Costs were taken from UK national databases and hospitals. Utilities were estimated from 30 oncology nurses in the UK using the standard gamble method. National Health Service. When compared with other chemotherapeutic agents, docetaxel has been shown to increase response rate, time to progression and survival in patients with advanced breast cancer. In the base-case analysis, the incremental cost-utility ratio for docetaxel versus paclitaxel was pound1995 per quality-adjusted life year (QALY) gained (1998 values). The incremental cost-utility ratio for docetaxel versus vinorelbine was pound14 055 per QALY gained. In the comparison with vinorelbine, docetaxel provided the equivalent of an additional 92 days of perfect health. Sensitivity analyses confirmed the robustness of the model and the validity of the base-case analysis results. Even in the worst case scenarios, docetaxel remained cost effective compared with paclitaxel and vinorelbine. These findings support the use of the taxoids, notably docetaxel, in the management of advanced breast cancer.

Costs of schizophrenia.

Schizophrenia is a common and burdensome illness, with implications not only for the health service but for a host of other care agencies--public and private--as well as for patients, families and the wider society. The paper reviews available UK evidence on the cost of schizophrenia (broadly defined) and on the cost-effectiveness of treatment options and alternative care arrangements. New evidence potentially alters our view of the costs of this illness. Aggregating the identifiable direct and indirect costs of schizophrenia for England suggests an annual cost of 2.6 billion pounds, but even this sum omits some indirect impacts which cannot currently be costed. Just over half the identified total is accounted for by the direct costs falling to the NHS, local authorities, charities and the criminal justice system. In helping to tackle this cost burden, there is now a body of evidence on cost-effective community care arrangements, antipsychotic drugs and psychological interventions. Although the costs of schizophrenia are considerable, there are treatments and care arrangements which can reduce this aggregate burden while maintaining or improving effectiveness.