Cost-effectiveness Ratio Research Articles

Comprehensive evaluation of compound Kushen injection combined with zoledronic acid in treating bone metastasis cancer pain based on meta-analysis and decision tree model

ObjectiveTo evaluate the safety, efficacy, and cost-effectiveness of combining Compound Kushen Injection (CKI) with zoledronic acid in the treatment of bone metastasis-induced cancer pain in malignant tumors.MethodsA comprehensive search of Chinese and English databases identified randomized controlled trials (RCTs) investigating CKI combined with zoledronic acid for bone metastases in malignancies. Methodological quality assessments were performed on all included studies, and a meta-analysis was conducted using RevMan 5.4.1 software. A cost-effectiveness analysis from the perspective of China's healthcare system employed a decision tree model to evaluate the short-term economic impact of the two treatment regimens. Sensitivity analyses assessed the robustness of the results.ResultsFourteen studies involving 1,269 patients were included in the meta-analysis. The results demonstrated that CKI combined with zoledronic acid was more effective than zoledronic acid alone in treating bone metastatic cancer pain (OR = 3.43, 95% CI: 2.51–4.67, P < 0.0001), with no significant difference in adverse reactions between the two groups. Incremental cost-effectiveness ratio (ICER) analysis revealed that the combination therapy incurred an additional cost of ¥18,863.16 for each unit of effect gained compared to zoledronic acid alone. Sensitivity analyses indicated stable results, showing that under the assumption of a willingness-to-pay threshold set at the average per capita disposable income in 2023, the combination of CKI and zoledronic acid was more cost-effective than zoledronic acid alone in treating bone metastatic cancer pain.ConclusionCompared with zoledronic acid alone, the combination of CKI and zoledronic acid offers superior efficacy, high safety, and better cost-effectiveness in the treatment of bone metastasis-induced cancer pain in malignant tumors.

Rare Oncological Diseases and Their Large Slice in Demands to the Brazilian Government for Health Technologies Over 12 Years Since the Creation of CONITEC: Doenças Oncológicas Raras e Sua Grande Parcela Nas Demandas Por Tecnologias em Saúde ao Governo Brasileiro ao Longo de Doze Anos Desde a Criação da CONITEC.

To describe the characteristics of the demands for health technologies submitted to the Brazilian Government. A descriptive analysis was carried out by surveying the reports produced by the National Committee for the Incorporation of Health Technologies since its creation in Brazil until 2023. The extracted data were tabulated in 3 domains: identification of demand, epidemiological profile of the disease, and clinical evidence and economic assessment. A total of 778 among 813 reports were included (95.7%), of which 266 (34.2%) were related to rare diseases. Of these, 86 (32.3%) were related to oncology, for 73.3% of which there were requests for the incorporation of medicines, 51.0% from external demand, 48.2% related to public entities, and 58.7% had the recommendation as a final opinion. The total and average incremental budgetary impact of the incorporated technologies was R$36 683 014 441.02 and R$1 111 606 498.20 and the total and average incremental cost-effectiveness ratio was R$1 024 897.50/QALY and R$68 326.50/QALY, whereas for nonincorporated technologies it was R$3 055 888 437.38; R$ 127 328 684.89; R$ 952 263.85/QALY and; R$52 903.54/QALY, respectively. The oncology area had greater representation among the demands evaluated, with rare cancers representing the largest portion of health technologies demanded, and the decision to incorporate was the majority. The incremental budgetary impact and incremental cost-effectiveness ratio were greater for the incorporated technologies, 2 among them exceeded the cost-effectiveness threshold adopted by the National Committee for the Incorporation of Health Technologies.

Cost-effectiveness of an additional hysterectomy after initially conservative treatment for cervical adenocarcinoma in situ.

Several European and American guidelines recommend to perform an additional hysterectomy in patients with cervical adenocarcinoma in situ (AIS), who initially received conservative treatment and who completed childbearing during follow-up. This study aimed to evaluate cost-effectiveness of performing an additional hysterectomy in comparison to expectative management. This post-hoc analysis was based on a retrospective cohort of patients diagnosed with AIS, who were conservatively treated by a radical (i.e., negative surgical margins) large loop excision of the transformation zone (LLETZ) or cold-knife conisation (CKC) in the Netherlands between 1990 and 2021. Based on these data, we estimated and compared the harms, benefits, and costs in 1000 simulated patients, both with and without an additional hysterectomy five years after conservative treatment for AIS. In the sensitivity analyses, we varied the timing of the additional hysterectomy, the risk of recurrent high-grade cervical dysplasia and cervical cancer risk after AIS treatment, and the utility loss for hysterectomy. Less than 2% of the patients who did not receive an additional hysterectomy after AIS developed cervical cancer. When an additional hysterectomy was performed, no quality adjusted life-years (QALYs) were gained and costs were 863% higher (€6203,485 versus €644,238). Only when assuming no utility loss for a hysterectomy, QALYs were gained resulting in a cost-effectiveness ratio of €144,273, which is far above the cost-effectiveness threshold of €20,000. It is not cost-effective to perform an additional hysterectomy after completion of childbearing in patients who were primarily treated by a radical LLETZ or CKC.

Economic and Clinical Benefits of Bivalent Respiratory Syncytial Virus Prefusion F (RSVpreF) Maternal Vaccine for Prevention of RSV in Infants: A Cost-Effectiveness Analysis for Mexico.

Respiratory syncytial virus (RSV) is a leading cause of respiratory infections in children. A novel RSVpreF vaccine for use among pregnant women for the prevention of RSV in infants is expected to be licensed in Mexico. Hence, the clinical and economic burden of RSV among infants in Mexico, with and without a year-round RSVpreF maternal vaccination program, was estimated. A cohort model was developed to project clinical and economic outcomes of RSV from birth to 1 year of age for maternal vaccination and no intervention. Incremental cost-effectiveness ratios were calculated from direct cost outcomes, life years, and quality-adjusted life years (QALYs). The value per dose of the RSVpreF for which the program would be cost-effective was explored. Analyses were conducted from the healthcare system perspective, with direct costs (2024 Mexican Pesos [MXN]) and outcomes discounted at 5% annually; scenario and sensitivity analyses tested the robustness of model settings and inputs. Compared to no intervention, a year-round RSVpreF vaccine administered to 1891 M pregnant women would prevent 15,768 hospitalizations, 5505 emergency department cases, and 5505 physician office visits annually, averting MXN 1754 M in direct medical costs with an increase of 3402 life years or 3666 QALYs. The RSVpreF vaccine would be cost-saving up to MXN 1301/dose and cost-effective up to MXN 2105-MXN 3715/dose under an assumed cost-effectiveness threshold range of 1-3× the gross domestic product (GDP) per capita (MXN 247,310) per QALY gained. Year-round RSVpreF maternal vaccination would substantially reduce RSV's clinical and economic burden among infants in Mexico and likely be a cost-effective program.

Cost-utility and cost–benefit analysis of a multi-component intervention (NEXpro) for neck-related symptoms in Swiss office workers

BackgroundNeck pain is a significant public health issue, especially among office workers, with a prevalence ranging from 42 to 68%. This study aimed to evaluate the cost-utility and cost-benefit of a multi-component intervention targeting neck pain in the general population of office workers in Switzerland. The 12-week multi-component intervention consisted of neck exercises, health promotion information workshops, and workplace ergonomics sessions.MethodsThe study was designed as a stepped-wedge cluster randomized controlled trial and assessed using an employer’s perspective. The main analysis focused on the immediate post-intervention period. Long-term effects were examined in a subsample at the 4, 8, and 12-month follow-ups. The intervention effects on costs and quality-adjusted life years (QALYs) were estimated using generalized linear mixed-effects models, controlling for confounding factors. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were presented, along with calculations of the break-even point and the return on investment. Various sensitivity analyses were performed.ResultsA total of 120 office workers participated in the trial, with 100 completing the intervention period and 94 completing the entire study. The main analysis included 392 observations. The intervention had a significant positive effect on QALYs and a nonsignificant effect on costs. The ICER was estimated at -25,325 per QALY gain, and the probability of the intervention being cost saving was estimated at 88%. The break-even point was reached one week after the end of the intervention.ConclusionThe multi-component intervention is likely to reduce company costs and simultaneously improve the quality of life of employees. However, the implementation of such interventions critically depends on evidence of their cost-effectiveness. As there is still a large research gap in this area, future studies are needed.Trial registrationClinicalTrials.gov, NCT04169646. Registered 15 November 2019-Retrospectively registered.Trial protocolAegerter AM, Deforth M, Johnston V, Ernst MJ, Volken T, Luomajoki H, et al. On-site multi-component intervention to improve productivity and reduce the economic and personal burden of neck pain in Swiss office-workers (NEXpro): protocol for a cluster-randomized controlled trial. BMC Musculoskelet Disord. 2020;21(1):391. https://doi.org/10.1186/s12891-020-03388-x.

Cost Effectiveness of Fixation Versus Total Hip Arthroplasty in Vancouver B2 Periprosthetic Femur Fractures: A Predictive Markov Analysis.

Although Vancouver B2 periprosthetic fractures (PPFs) have been historically managed with revision total hip arthroplasty (rTHA), open reduction and internal fixation (ORIF) has been proposed as an alternative option for reasons including lower cost and surgical time. The purpose of this study was to, therefore, create a Markov model to assess the cost effectiveness of ORIF versus rTHA for Vancouver B2 periprosthetic femur fractures and evaluate various inflection points for varying costs and outcome measures. A Markov model was built using discrete and mutually exclusive health states of the hypothetical patient with Vancouver B2 PPF. A decision tree was created on possible outcomes for each health state, using probabilities defined in the recent PPF literature. Direct costs and quality-adjusted life-years for each surgery and complication state were also collected. One-way and two-way deterministic sensitivity analyses were conducted to better understand the effect of 1 to 2 variables on the incremental cost-effectiveness ratio. The hypothetical patient with a Vancouver B2 PPF that was treated with rTHA incurred a cost of $52,559.64 with an effectiveness of 0.71. When treated with ORIF, the cost was $47,371.97 with an effectiveness of 0.38. The incremental cost and effectiveness of rTHA over ORIF were found to be $5,187.67 and 0.33, respectively. The cost of rTHA, the cost of ORIF, and the effectiveness of ORIF were the most influential variables in the model. On two-way sensitivity analysis, rTHA was more cost effective than ORIF within realistic healthcare parameters. From the payer perspective, we estimate that rTHA is more cost effective than ORIF for the treatment of Vancouver B2 PPFs within certain cost and quality-of-life parameters.

Cost-effectiveness of plasmapheresis and hemoperfusion in COVID-19 survivors: A six-month follow-up analysis after hospital discharge.

To evaluate the short- and long-term clinical and financial outcomes of apheresis in COVID-19 survivors after hospital discharge. Intensive care unit-discharged patients were followed for 6 months. Vital signs, laboratory markers, quality of life, and direct medical costs were analyzed to calculate incremental cost-effectiveness ratios (ICER) and to plot cost-effectiveness planes and acceptability curves. A total of 68 patients (45 control, 18 plasmapheresis, and 5 hemoperfusion) were included. ICERs for plasmapheresis and hemoperfusion patients at discharge were $867.58 and $198.89 per quality-adjusted life years (QALY) gained, respectively. Respiration and blood pressure improved significantly at discharge. The improvements in oxygenation markers for plasmapheresis and hemoperfusion groups were lower than controls (8.56 ± 10.31 and 11.75 ± 16.88 vs. 11.37 ± 7.28 percent for SpO2, 11.15 ± 21.15 and 11.05 ± 24.95 vs. 16.03 ± 5.61 mm Hg for PaO2, respectively) However, the respiratory rate improvements corresponded to ICERs of $1034.77 and $269.94 for plasmapheresis and hemoperfusion, respectively. The ICERs for increasing mean arterial pressure were $24.83 and $30.94 per mm Hg, and plasmapheresis was more cost-effective than hemoperfusion in increasing serum calcium levels ($1649.35 per mg/dL). At 1-month post-discharge, both treatments showed worse outcomes compared to controls. At 6 months, the plasmapheresis ICER ($1884.95) exceeded the willingness-to-pay threshold. The ICER for plasmapheresis at 6 months was $112.83 per rehospitalization day avoided, while hemoperfusion remained less effective than controls. While plasmapheresis and hemoperfusion improved some clinical outcomes, their high costs and limited long-term cost-effectiveness suggest that these interventions may not be economically justified for treating COVID-19 patients. Careful evaluation is needed when considering their use in clinical practice.

Biologics in the treatment of active Psoriatic arthritis in China: a network meta-analysis and cost-effectiveness analysis

ABSTRACT Background Biologics are recommended for use in patients with psoriatic arthritis (PsA) after the failure of conventional systemic disease-modifying anti-rheumatic drugs (csDMARDs). However, compared to csDMARDs, biologics are significantly more expensive. The aim of this study was to evaluate the cost-effectiveness of biologic treatments for active PsA patients who have failed treatment with csDMARDs, from the perspective of the Chinese healthcare system. Research design and methods A discrete event simulation model was constructed to estimate health and economic outcomes of patients. The seven biologics recommended by the Chinese psoriasis treatment guidelines were included in the evaluation. One-way and probabilistic sensitivity analysis were performed to ensure that our results were robust. Results Our results found that compared to the standard of care (SoC) and all other biologics strategies, secukinumab (SEC) had the highest quality-adjusted life years, and at a willingness-to-pay (WTP) threshold of US $38,161 per QALY, SEC was the most cost-effective option, with an incremental cost-effectiveness ratio of $14,968 per QALY. One-way sensitivity analysis and probabilistic sensitivity analysis confirmed the robust of this result. Conclusions From the perspective of the Chinese healthcare system, biologics are estimated to be cost-effective compared to SoC. Among these, SEC is the most cost-effective option.

The Cost-Effectiveness of CDK4/6 Inhibitors in Treating HR+/HER2- Metastatic Breast Cancer Patients in the USA: When Non-medication Expenses are Considered.

Cyclin-dependent kinase (CDK)4/6 inhibitors in combination with endocrine therapy (ET) significantly enhance progression-free survival and overall survival in patients diagnosed with HR+/HER2- metastatic breast cancer (MBC). However, they are highly expensive, and their economic impact has not been fully evaluated. This is a retrospective secondary analysis evaluating the cost effectiveness of these drugs, differentiating between medication-related and non-medication costs from a healthcare perspective. We identified 3879 patients diagnosed with MBC who received either CDK4/6i+ET (N = 2137) or ET alone (N = 1742) as first-line treatment between February 2015 and November 2021 using a USA-wide electronic health record-derived de-identified database. SEER-Medicare claims spending data were used to quantify monthly costs as a supplement to the database. Relevant costs included prescribed medications (ET and/or CDK4/6i) and overall other costs. The effectiveness was measured as progression-free duration in months. The incremental cost effectiveness ratio (ICER) analysis was conducted to examine the cost effectiveness of first-line CDK4/6i as compared with first-line ET alone. For medication costs, CDK4/6i+ET (mean cost: $240,723.7; mean effect: 19.2 months of delayed progression) compared with ET alone (mean cost: $5159.7; mean effect: 16 months without progression) resulted in an ICER of $73,098 per month of delayed progression. For non-medication costs, CDK4/6i+ET (mean cost: $43,656.6) compared with ET alone (mean cost: $66,083.5) resulted in an ICER of -$7178 per month of delayed progression. The cost of treating HR+/HER2- MBC is driven by the cost of CDK4/6i. Using CDK4/6i+ET reduces non-medication costs compared to ET alone, but these savings are offset by high CDK4/6i medication costs. Lowering the market cost of CDK4/6i or targeting those who can benefit the most could improve the cost effectiveness of CDK4/6i from Medicare perspective.

Cost-utility of lumbar interbody fusion surgery: A systematic review.

Lumbar interbody fusion (LIF) is a common surgical intervention for treating lumbar degenerative disorders. Increasing demand has contributed to ever-increasing healthcare expenditure and economic burden. To address this, cost-utility analyses (CUAs) compare value in the context of patient outcomes. CUAs quantify health improvements using quality-adjusted life years (QALYs), allowing decision-makers to determine procedure value. While there is a growing body of literature assessing LIF value, a comprehensive synthesis of LIF CUAs is lacking. This systematic review aims to address this gap by assessing all available CUAs of LIF techniques, to support evidence-based practices that improve outcomes and promote efficient resource use. Systematic review. This study sample consisted of adult patients with lumbar degenerative conditions specifically treated with lumbar interbody fusion, including grade I or II degenerative spondylolisthesis, lumbar spinal stenosis, disc degeneration, and spondylosis, with or without low back and/or leg pain. Direct (healthcare) and indirect (non-healthcare) costs, cost sources and calculation methods, utility scores, QALY gain, cost-utility, incremental cost-effectiveness ratios, and willingness-to-pay thresholds. Outcomes were reported as median and interquartile ranges (IQR). A systematic review was conducted following PRISMA guidelines. PubMed, Web of Science, and Embase were searched from inception to October 23, 2023, for CUAs reporting QALYs and costs of LIF procedures. Relevant studies were selected and data extracted. Subgroup analyses compared minimally invasive versus open surgery and anterior versus posterior approaches. Study quality was assessed using the CHEC-Extended tool. Quantitative meta-analysis was not performed due to methodological heterogeneity. Out of 2047 identified studies, 14 met inclusion criteria. The mean CHEC-Extended score was 72.1%. Most studies reported on TLIF (n=11) and utilized EQ-5D questionnaire to calculate utility (n=9). Direct costs were sourced from institutional databases, Medicare, DRGs, Redbook, and a variety of other sources. Most indirect costs were estimated from productivity loss. TLIF demonstrated the highest median QALY gain over 1 year (0.43, IQR 0.121-0.705), while PLIF was highest over 2 years (1.33). ALIF was most favorable over 1 year ($30901/QALY) and OLIF was most favorable over 2 years ($11187/QALY). PLIF, TLIF, and LLIF exhibited similar cost-utility over 2 years ($44383, $45628, $48576/QALY). MIS was substantially favorable to OS at 1 year ($42635 vs. $226304), though similar at 2 years ($48576 vs. $45628/QALY). Anterior approach was favorable to posterior approach at 1 year ($30901.5 vs. $81038) and 2 years ($29881.9 vs. $44383). Cost-utility comparisons substantially varied and were sensitive to utility measures, study methodology, cost sourcing, and follow-up duration. This is the first systematic review to comprehensively assess CUAs of all LIF approaches in the existing literature. While certain approaches, such as ALIF and OLIF, may demonstrate favorable outcomes, these conclusions are limited by high methodological heterogeneity and a limited study pool. By addressing existing gaps in study design and reporting, future comparative cost-utility research can better inform evidence-based decision-making and optimize the value of spinal surgical care.

Prognostic Testing for Prostate Cancer-A Cost-Effectiveness Analysis Comparing a Prostatype P-Score Biomarker Approach to Standard Clinical Practice.

The Prostatype score (P-score) is a prognostic biomarker that integrates a three-gene (IGFBP3, F3, and VGLL3) signature derived from prostate biopsy samples, with key clinical parameters, including prostate-specific antigen (PSA) levels, Gleason grade, and tumor stage at diagnosis. The test has demonstrated superior predictive accuracy for prostate cancer outcomes compared with traditional risk categorization systems such as D'Amico. Notably, it reclassifies a higher proportion of patients into the low-risk category, making them eligible for active surveillance. This study assessed the cost-effectiveness of the P-score in comparison with D'Amico and the Swedish National Prostate Cancer Register (NPCR) risk categorization systems. A two-step decision analytic model was developed. The model consisted of a decision tree-informed Markov structure estimating the lifetime outcomes of 60-year-old men with diagnosed prostate cancer. Prostate cancer was classified as low-risk, intermediate-risk, or high-risk using either the P-score or D'Amico. Initial therapy was based on observed treatment patterns from the Swedish NPCR. Costs (SEK, year 2022) and quality-adjusted life years (QALYs) were estimated from a healthcare perspective and discounted at 3% per year; incremental cost-effectiveness ratio (ICER) was the primary outcome. The P-score led to cost savings and generated an additional 0.19 QALYs compared with D'Amico. The added costs of the genetic test and higher costs of active surveillance and radiotherapy were counterbalanced by savings from reduced costs of surgery, treatment-related side-effects, and metastatic disease. The gain in QALYs was primarily due to the avoidance of metastatic disease and a reduction in treatment-related side-effects. The results of this study suggest that the P-score is likely to be a cost-effective alternative to D'Amico for prognostic evaluation of newly diagnosed prostate cancer in Sweden and compared with NPCR when health-related quality of life was included.

Cost-effectiveness of the addition of sintilimab as a first-line therapy for locally advanced or metastatic oesophageal squamous cell carcinoma: a Chinese healthcare system perspective

BackgroundThe ORIENT-15 double-blind randomized controlled trial demonstrated that the addition of sintilimab to chemotherapy for locally advanced or metastatic oesophageal squamous cell carcinoma (OSCC) resulted in better clinical outcomes. In this analysis, we sought to evaluate the cost-effectiveness of sintilimab as a first-line treatment for locally advanced or metastatic OSCC from a healthcare system perspective in China.MethodsA partitioned survival model was constructed to perform a cost-effectiveness analysis comparing chemotherapy alone with sintilimab for locally advanced or metastatic OSCC patients. Clinical data were obtained from the ORIENT-15 trial and extrapolated to 10 years. Health state utilities and costs were sourced from the literature and from public healthcare institutions. The primary outcomes included the incremental cost-effectiveness ratio (ICER) and quality-adjusted life-years (QALYs). Two different sensitivity analyses, one-way and probabilistic, were performed to assess model uncertainty.ResultsSintilimab-based chemotherapy was more costly ($31699.21 vs. $20687.42) and more effective (0.74 vs. 0.53) than placebo-based chemotherapy, resulting in an ICER of $51908.19 /QALY, which is greater than the willingness-to-pay (WTP) threshold of China ($38223/QALY). Sensitivity analysis demonstrated that the PFS and cost of sintilimab were the major influencing factors affecting the results.ConclusionsIn patients with locally advanced or metastatic OSCC, sintilimab chemotherapy could improve survival time and health benefits compared with traditional chemotherapy, but the present analysis suggests that sintilimab is not a cost-effective treatment option in China.

Endoscopic sleeve gastroplasty versus lifestyle modifications for class II obesity patients: a French cost-effectiveness analysis.

Obesity is a worldwide epidemic, with up to 17% of French population affected. European guidelines recommend surgical management at specific weight and comorbidity level; however, less than 2% of eligible patients undergo surgical bariatric interventions. To extend the benefits of bariatric interventions to the untreated population with obesity, endoscopic techniques such as endoscopic sleeve gastroplasty (ESG) have been developed. Analysis of costs and long-term benefits of ESG across stakeholders is needed. This work aimed to assess the healthcare economic and outcomes for ESG in the French healthcare system. A cost-utility analysis study was conducted to evaluate class II obesity patients, stratified into ESG and lifestyle modifications or lifestyle modifications alone groups. Health benefits were measured as quality-adjusted life years (QALY) and costs benefits expressed as incremental cost-effectiveness ratio (ICER). A 6-state Markov model was used and base case scenario analysis was used to assess ESG benefits against lifestyle modifications only. One-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis were performed to evaluate uncertainty on health care interventions and worse case scenarios, respectively. ESG population from the France center included 59 patients, lifestyle modification group was drawn from the MERIT cohort. The base case scenario showed higher costs for ESG procedure compared to lifestyle modifications alone; however, gain in terms of QALY (+ 1,3) is observed maintaining ICER below the set threshold. Also OWSA and probabilistic analysis confirmed ESG cost-effectiveness. OWSA allowed identification of ICER-influencing factors; probabilistic sensitivity analysis confirmed ESG to be cost-effective in 99.29% of iterations. ESG is cost-effective in the French healthcare system. Its potential to reach an untreated portion of the population living with obesity should prompt its uptake into clinical practice. The results of this study should sustain ESG implementation throughout France and possible integration of its reimbursement by the public healthcare system.

Helping people with psychosis with a low-cost intervention DIALOG+: protocol for the economic evaluation in a randomised control trial in India and Pakistan

BackgroundApproximately 69%–89% of people with severe mental illnesses, particularly psychosis, experience a treatment gap in low- and middle-income countries (LMICs) due to factors such as low public spending on health...

Cost-effectiveness of tyrosine kinase inhibitor treatment strategies for chronic myeloid leukemia in South Africa.

The treatment of chronic myeloid leukemia through tyrosine kinase inhibitors (TKIs) has achieved promising efficacy and safety outcomes, however the costs are associated with a substantial economic burden. The objective of this study was to develop a Markov model with a 20-year time horizon to assess the cost effectiveness of TKIs from a public healthcare system perspective in South Africa. We constructed a Markov model to compare three strategies in which treatment was initiated with either imatinib, nilotinib, or dasatinib. Treatment was switched to another TKI in the case of intolerance or resistance to the initial TKI. Effectiveness and utility data were obtained from published literature. Cost data was obtained from local sources for generic imatinib and branded second-generation TKIs and based on national tariffs. Outcomes were reported in total costs and quality-adjusted life years (QALYs). Outcomes were based on calculated incremental cost effectiveness ratios (ICERs) and compared to a willingness-to-pay (WTP) threshold. Sensitivity analyses were conducted to determine the robustness of the model outcomes. The base-case results showed that imatinib was favored over nilotinib and dasatinib by having the lowest cost at $120 719.55 and providing 5.93 QALYs. Compared to imatinib strategy, nilotinib had an ICER of $26 620.27 per QALY and dasatinib had an ICER of $35 934.94 per QALY, both exceeding the WTP threshold of $18 760 per QALY gained. The sensitivity analysis indicated the robustness of the results. Imatinib remains the most cost-effective first-line treatment for adults diagnosed with CML in South Africa, with a high probability of being cost-effective across a range of WTP thresholds. Nilotinib and Dasatinib, though offering clinical benefits, their affordability remains a challenge within the current healthcare system and should remain reserved for second-line treatment.

Cost-effectiveness analysis of pembrolizumab plus chemotherapy versus chemotherapy in untreated advanced pleural mesothelioma in the Chinese healthcare system.

The combination of pembrolizumab and chemotherapy has demonstrated notable clinical advantages in improving overall survival than chemotherapy alone for patients with untreated advanced pleural mesothelioma. The purpose of this study was to assess its cost-effectiveness. A Markov state-transition model was constructed using data from the IND227 phase 3 randomized clinical trial. Utility values for health states were taken from the IND227 trial, and direct medical costs were from the pertinent literature and local pricing data. Outcomes measured included quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefit (INHB), and incremental net monetary benefit (INMB). To manage the uncertainty in the model, both probabilistic sensitivity analysis (PSA) and one-way sensitivity analysis (OWSA) were used. In the base-case analysis, pembrolizumab plus chemotherapy resulted in an incremental gain of 0.23 QALYs at an additional cost of $18,199.63, resulting in an ICER of $80,557.23/QALY. This was not favorable compared to China's willingness-to-pay (WTP) threshold of $38,042.49/QALY, with an INHB of -0.25 QALYs and an INMB of $-9,605.00. Subgroup analyses showed ICERs for pembrolizumab plus chemotherapy versus chemotherapy of $33,917.61 and $99,536.73 in non-epithelioid and epithelioid patients, respectively. PSA indicated probabilities of cost-effectiveness for pembrolizumab plus chemotherapy at 0.55%, 69.41%, and 0.14% for the entire population and the non-epithelioid and epithelioid subgroups, respectively. In the Chinese healthcare system, the combination of pembrolizumab and chemotherapy did not prove to be more cost-effective than chemotherapy alone as an initial treatment for untreated advanced pleural mesothelioma, with the exception of patients who have non-epithelioid histology.

Cost-Effectiveness of Itopride Hydrochloride for the Treatment of Functional Dyspepsia in Vietnam

Background/Objectives: Functional dyspepsia is associated with abdominal pain and nausea, which leads to reduced quality of life, loss of productivity, and economic loss for patients. Itopride hydrochloride (itopride) stimulates the gastrointestinal smooth muscles, thereby promoting gastric emptying. It has been shown to significantly improve symptoms in patients with functional dyspepsia without severe side effects. Itopride has been available in Vietnam for many years; however, the cost-effectiveness of the drug has not been established. The aim of this study is to estimate the cost-effectiveness of itopride for the treatment of functional dyspepsia in Vietnam. Methods: A 3-stage Markov model with the following health states—controlled functional dyspepsia, uncontrolled functional dyspepsia, and dead—was developed. Functional dyspepsia was used to assess itopride over 10 years using 8-week cycles. A broader Vietnamese societal perspective was assumed for the analysis. Input was retrieved from the literature and through local clinical input from physicians in Vietnam. Output was reported as an incremental cost-effectiveness ratio (ICER) per quality-adjusted life years (QALY). A GDP/capita threshold (very cost-effective: 1 × GDP = Vietnamese Dong (VND) 64.1 M, cost-effective: 3 × GDP = VND 192.2 M) was used as recommended by the WHO in Vietnam. One-way and probabilistic sensitivity analyses were performed. Results: Itopride use resulted in an additional 0.28 QALYs at an extra cost of VND 11.2 M. This resulted in an ICER of VND 39.7 M per QALY, which is lower than the threshold of VND 192.2 M. One-way sensitivity analyses showed that the ICER was sensitive to varying the efficacy VND 31.8 M to VND 88.3 M), cost of itopride (ICER: VND 43.1 M to VND 56.5 M), and the health utility values (ICER: VND 45.2 M to VND 55.3 M). More than 80% of the simulations in the probabilistic sensitivity analysis were cost-effective at the 1 × GDP (VND 64.1 M) threshold, and 91.3% were cost-effective at the 3 × GDP (VND 192.2 M) threshold. Conclusion: This study shows that itopride hydrochloride is a very cost-effective treatment for functional dyspepsia in Vietnam, with the ICER (VND 39.7 M/QALY) being even lower than the 1 × GDP (VND 64.1 M) threshold.

Pre-hospital ECPR cost analysis and cost effectiveness modelling study.

The use of extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) is increasing. Prehospital ECPR (PH-ECPR) for out-of-hospital cardiac arrest (OHCA) may improve both equity of access and outcomes but its cost effectiveness has yet to be determined. Cost analyses of PH-ECPR was performed utilizing current PH-ECPR trial, NSW Ambulance Cardiac Arrest Registry (CAR), geospatial modelling and in-hospital costings data. Markov modelling was completed to combine the PH-ECPR cost analysis with reported patient outcomes across multiple ECPR strategies. Bridging formulae from ECPR survivor cerebral performance category (CPC) scores were used to estimate cost per quality adjusted life years (QALY) and Incremental Cost Effectiveness Ratios (ICERs). Probabilistic Sensitivity Analysis was completed to assess the probability of cost effectiveness for base case and PH-ECPR strategy variations. Assuming a base case of 100 patients per year, with a 25% team allocation to ECPR, the average pre-hospital ECPR cost per patient was $12,741 and total of $88,656 AUD equating to approximately $44,000 per QALY. Addition of a conservative 10% kidney organ donation rate reduces the cost per QALY to $22,000. Patient survival rate, the proportion of time the pre-hospital ECPR team are allocated to ECPR and organ donation significantly impact PH-ECPR cost effectiveness. Initial cost analysis and modelling indicate PH-ECPR service strategies are likely to be cost effective and comparable to other medical interventions. Survival rate and service integration into non ECPR clinical tasks are key aspects contributing to cost effectiveness.

Cost–utility analysis of MR imaging-guided transurethral ultrasound ablation for the treatment of low- to intermediate-risk localised prostate cancer

BackgroundMagnetic resonance-guided transurethral ultrasound ablation (MR-TULSA) is a new focal therapy for treating localised prostate cancer that is associated with fewer adverse effects (AEs) compared with established treatments. To support...

US cost-effectiveness analysis of apixaban compared with warfarin, dabigatran and rivaroxaban for nonvalvular atrial fibrillation, focusing on equal value of life years and health years in total.

Aim: Warfarin and direct-acting oral anticoagulants (DOACs) are widely prescribed to patients with nonvalvular atrial fibrillation (NVAF) to reduce risk of stroke and systemic embolism (SE). This study aimed to assess the cost-effectiveness of apixaban compared with warfarin, dabigatran and rivaroxaban, for patients with NVAF from a US healthcare payer (Medicare) perspective. Methods: A cohort-level Markov model was developed based on a previously published model, for the US setting, factoring in anticipated price decreases due to market entry of generic drugs. Two retrospective cohort studies in US Medicare patients provided inputs to quantify clinical events in the base case setting and in a scenario analysis. For this study, equal value of life-years (evLYs) and health years in total (HYT) were used. Cost-effectiveness was assessed based on a willingness-to-pay threshold of $100,000 per evLY gained (evLYG) or HYT gained (HYTG). Results: Apixaban treatment was associated with gains of 2.23, 1.08 and 1.72 evLYs and 2.26, 1.08 and 1.73 HYTs, compared with warfarin, dabigatran and rivaroxaban, respectively. In the base case analysis from a Medicare perspective, apixaban was cost-effective (i.e., value for money) compared with warfarin, dabigatran and rivaroxaban, with corresponding incremental cost-effectiveness ratio (ICER) per evLYG (and HYTG) of $10,501 ($10,350), $7809 ($7769) and $758 ($768), respectively. When a societal perspective was included, and in a scenario analysis using US Medicare data from the Ray et al. study to quantify treatment effects, apixaban dominated rivaroxaban (i.e., less expensive and more effective) in terms of ICER per evLYG (and HYTG). Conclusion: Using dynamic pricing assumptions, treatment with apixaban compared with warfarin, dabigatran and rivaroxaban was associated with incremental evLYs and HYT and represents a cost-effective treatment option in patients with NVAF, from a US healthcare payer (Medicare) perspective.