Drivers Of Cost-effectiveness Research Articles

Economic Evaluation of Family Planning Interventions in Low and Middle Income Countries; A Systematic Review.

BackgroundA significant number of women in low and middle income countries (L-MICs) who need any family planning, experience a lack in access to modern effective methods. This study was conducted to review potential cost effectiveness of scaling up family planning interventions in these regions from the published literatures and assess their implication for policy and future research.Study designA systematic review was performed in several electronic databases i.e Medline (Pubmed), Embase, Popline, The National Bureau of Economic Research (NBER), EBSCOHost, and The Cochrane Library. Articles reporting full economic evaluations of strategies to improve family planning interventions in one or more L-MICs, published between 1995 until 2015 were eligible for inclusion. Data was synthesized and analyzed using a narrative approach and the reporting quality of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.ResultsFrom 920 references screened, 9 studies were eligible for inclusion. Six references assessed cost effectiveness of improving family planning interventions in one or more L-MICs, while the rest assessed costs and consequences of integrating family planning and HIV services, concerning sub-Saharan Africa. Assembled evidence suggested that improving family planning interventions is cost effective in a variety of L-MICs as measured against accepted international cost effectiveness benchmarks. In areas with high HIV prevalence, integrating family planning and HIV services can be efficient and cost effective; however the evidence is only supported by a very limited number of studies. The major drivers of cost effectiveness were cost of increasing coverage, effectiveness of the interventions and country-specific factors.ConclusionImproving family planning interventions in low and middle income countries appears to be cost-effective. Additional economic evaluation studies with improved reporting quality are necessary to generate further evidence on costs, cost-effectiveness, and affordability, and to support increased funding and investments in family planning programs.

Long-term cost-effectiveness of home versus clinic-based management of chronic heart failure: the WHICH? study

Background: The cost-effectiveness of a heart failure management intervention can be further informed by incorporating the expected benefits and costs of future survival.Methods: This study compared the long-term costs per quality-adjusted life year (QALY) gained from home-based (HBI) vs specialist clinic-based intervention (CBI) among elderly patients (mean age = 71 years) with heart failure discharged home (mean intervention duration = 12 months). Cost-utility analysis was conducted from a government-funded health system perspective. A Markov cohort model was used to simulate disease progression over 15 years based on initial data from a randomized clinical trial (the WHICH? study). Time-dependent hazard functions were modeled using the Weibull function, and this was compared against an alternative model where the hazard was assumed to be constant over time. Deterministic and probabilistic sensitivity analyses were conducted to identify the key drivers of cost-effectiveness and quantify uncertainty in the results.Results: During the trial, mortality was the highest within 30 days of discharge and decreased thereafter in both groups, although the declining rate of mortality was slower in CBI than HBI. At 15 years (extrapolated), HBI was associated with slightly better health outcomes (mean of 0.59 QALYs gained) and mean additional costs of AU$13,876 per patient. The incremental cost-utility ratio and the incremental net monetary benefit (vs CBI) were AU$23,352 per QALY gained and AU$15,835, respectively. The uncertainty was driven by variability in the costs and probabilities of readmissions. Probabilistic sensitivity analysis showed HBI had a 68% probability of being cost-effective at a willingness-to-pay threshold of AU$50,000 per QALY.Conclusion: Compared with CBI (outpatient specialized HF clinic-based intervention), HBI (home-based predominantly, but not exclusively) could potentially be cost-effective over the long-term in elderly patients with heart failure at a willingness-to-pay threshold of AU$50,000/QALY, albeit with large uncertainty.

PRS42 - Cost-Effectiveness Analyses of Pharmacologic Maintenance Treatment For Chronic Obstructive Pulmonary Disease: A Systematic Review

Objectives: We aimed to systematically review recently published articles that reported the cost-effectiveness of COPD maintenance treatments, with a focus on key findings, quality, and methodological issues. Methods: A systematic literature search was performed in EMBASE, Pubmed, UK-NHS (NHS-EED) and EURONHEED. All relevant articles published between 2011 and 2015 in either Dutch, English or German were included. Main study characteristics, methods and outcomes were extracted and critically assessed. The QHES was used as basis for quality assessment, but additional items were addressed as well. Results: Eighteen recent pharmacoeconomic analyses of COPD maintenance treatments were identified. Papers reported the cost-effectiveness of LAMA monotherapy (n= 6), PDE-4 inhibitors (n= 4), LABA/ICS combinations (n= 4), LABA monotherapy (n= 2) and LABA/LAMA combinations (n= 2). All but two studies were funded by the manufacturer and all studies indicated favourable cost-effectiveness; however, the number of QALYs gained was small. Less than half of the studies did report a COPD-specific outcome in addition to a generic outcome (mostly QALY). Exacerbation and mortality rates were found to be the main drivers of cost-effectiveness. According to the QHES, the quality of the studies was generally sufficient, but additional assessment revealed that most studies did poorly represent the cost-effectiveness of real-life medication use. Conclusions: The majority of studies showed that pharmacologic COPD maintenance treatment is cost-effective, but most studies poorly reflected real-life drug use. Consistent and COPD-specific methodology is recommended.

1025P - The cost-effectiveness of combination therapy: Challenges of the present, solutions for the future? A myeloma analysis

The number of treatments for cancer has increased over recent years. Monotherapy for some malignancies delivers only marginal benefit, whilst combination therapy (CT) improves results by using synergistic mechanisms of action. CT increases treatment cost however, and in an era of health care constrained by cost-containment, national reimbursement of CT conditional on cost-effectiveness is challenging. This research assesses drivers of CT cost-effectiveness, using myeloma as an example, to inform approaches to evidence based approaches to reimbursement. A 3-state cost-effectiveness model (pre-progression; post-progression; dead) for front-line treatment of myeloma was developed. Continuous lenalidomide + dexamethasone (Ld) data were extracted from published results and, using parametric modelling, extrapolated to 20 years, with costs based on UK prices. Add-on drug X was assumed to deliver survival benefit (PFS HR = 0.7; OS HR = 0.7), be dosed Q4W until disease progression, and cost £2,000/dose. Post-progression costs were £4,000/month. Scenario analyses considering differing evidence and treatment approaches included: improved PFS and OS; reduced dosing schedules; limited treatment duration; use as a doublet (i.e. Xd); reduced Drug X cost. Combination therapy XLd compared with Xd resulted in a base-case incremental cost-effectiveness ratio (ICER) of £111K/quality-adjusted life year (QALY). Scenario analysis representing 28.5% improvement in both PFS (ICER = £131K/QALY) and OS (ICER = £96K/QALY) did not substantially improve CE. In contrast, scenarios which induced substantial cost savings improved CE (X dosed Q8W, ICER = £69K/QALY; X cost = £1000/dose, ICER = £64k/QALY; halved Ld dosing, ICER = £8K/QALY; 24-month treatment cap, ICER = -£89K/QALY; doublet, ICER = -£96k/QALY). Clinical trials assess clinical outcomes, however these results suggest clinical outcomes alone may be insufficient to establish CT cost-effectiveness in myeloma. Pursuit of economic benefit beyond clinical outcomes, including resource-sparing approaches to treatment, may mitigate this risk and facilitate national reimbursement, and should therefore be considered in clinical trial design.

Systematic Review and Quality Appraisal of Cost-Effectiveness Analyses of Pharmacologic Maintenance Treatment for Chronic Obstructive Pulmonary Disease: Methodological Considerations and Recommendations.

BackgroundWorldwide, chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic lung disease with considerable clinical and socioeconomic impact. Pharmacologic maintenance drugs (such as bronchodilators and inhaled corticosteroids) play an important role in the treatment of COPD. The cost effectiveness of these treatments has been frequently assessed, but studies to date have largely neglected the impact of treatment sequence and the exact stage of disease in which the drugs are used in real life.ObjectiveWe aimed to systematically review recently published articles that reported the cost effectiveness of COPD maintenance treatments, with a focus on key findings, quality and methodological issues.MethodsWe performed a systematic literature search in Embase, PubMed, the UK NHS Economic Evaluation Database (NHS-EED) and EURONHEED (European Network of Health Economics Evaluation Databases) and included all relevant articles published between 2011 and 2015 in either Dutch, English or German. Main study characteristics, methods and outcomes were extracted and critically assessed. The Quality of Health Economic Studies (QHES) instrument was used as basis for quality assessment, but additional items were also addressed.ResultsThe search identified 18 recent pharmacoeconomic analyses of COPD maintenance treatments. Papers reported the cost effectiveness of long-acting muscarinic antagonist (LAMA) monotherapy (n = 6), phosphodiesterase (PDE)-4 inhibitors (n = 4), long-acting beta agonist/inhaled corticosteroid (LABA/ICS) combinations (n = 4), LABA monotherapy (n = 2) and LABA/LAMA combinations (n = 2). All but two studies were funded by the manufacturer, and all studies indicated favourable cost effectiveness; however, the number of quality-adjusted life-years (QALYs) gained was small. Less than half of the studies reported a COPD-specific outcome in addition to a generic outcome (mostly QALYs). Exacerbation and mortality rates were found to be the main drivers of cost effectiveness. According to the QHES, the quality of the studies was generally sufficient, but additional assessment revealed that most studies poorly represented the cost effectiveness of real-life medication use.ConclusionsThe majority of studies showed that pharmacologic COPD maintenance treatment is cost effective, but most studies poorly reflected real-life drug use. Consistent and COPD-specific methodology is recommended.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-016-0448-2) contains supplementary material, which is available to authorized users.

Comparative cost-effectiveness of 11 oral antipsychotics for relapse prevention in schizophrenia within Singapore using effectiveness estimates from a network meta-analysis.

This study modelled the cost-effectiveness of 11 oral antipsychotics for relapse prevention among patients with remitted schizophrenia in Singapore. A network meta-analysis determined the relative efficacy and tolerability of 11 oral antipsychotics (amisulpride, aripiprazole, chlorpromazine, haloperidol, olanzapine, paliperidone, quetiapine, risperidone, sulpiride, trifluoperazine and ziprasidone). The clinical estimates were applied in a Markov model to estimate lifetime costs and quality-adjusted life-years gained. Quality-of-life data were obtained from published literature. Resource utilization and cost data were retrieved from local hospital databases. The annual direct cost of healthcare services for a patient experiencing a relapse episode was three-fold that of a patient not in relapse of schizophrenia. The most favourable pharmacological treatment for relapse prevention was olanzapine with an annual probability of relapse of 0.24 (0.13-0.38) with placebo as a reference of 0.75 (0.73-0.78). Olanzapine emerged as the dominant treatment with the highest quality-adjusted life-years gained and lowest lifetime costs. Ziprasidone, aripiprazole and paliperidone incurred higher lifetime costs compared with no treatment. Probability and cost of relapse were key drivers of cost-effectiveness in sensitivity analyses. The data can help prescribers in choosing appropriate treatment and payers in allocating resources for the clinical management of this serious psychiatric disorder.

Cost effectiveness and resource allocation of Plasmodium falciparum malaria control in Myanmar: a modelling analysis of bed nets and community health workers.

BackgroundFunding for malaria control and elimination in Myanmar has increased markedly in recent years. While there are various malaria control tools currently available, two interventions receive the majority of malaria control funding in Myanmar: (1) insecticide-treated bed nets and (2) early diagnosis and treatment through malaria community health workers. This study aims to provide practical recommendations on how to maximize impact from investment in these interventions.MethodsA simple decision tree is used to model intervention costs and effects in terms of years of life lost. The evaluation is from the perspective of the service provider and costs and effects are calculated in line with standard methodology. Sensitivity and scenario analysis are undertaken to identify key drivers of cost effectiveness. Standard cost effectiveness analysis is then extended via a spatially explicit resource allocation model.FindingsCommunity health workers have the potential for high impact on malaria, particularly where there are few alternatives to access malaria treatment, but are relatively costly. Insecticide-treated bed nets are comparatively inexpensive and modestly effective in Myanmar, representing a low risk but modest return intervention. Unlike some healthcare interventions, bed nets and community health workers are not mutually exclusive nor are they necessarily at their most efficient when universally applied. Modelled resource allocation scenarios highlight that in this case there is no “one size fits all” cost effectiveness result. Health gains will be maximized by effective targeting of both interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0886-x) contains supplementary material, which is available to authorized users.

Pre-eclampsia Diagnosis and Treatment Options: A Review of Published Economic Assessments.

BackgroundPre-eclampsia is a pregnancy complication affecting both mother and fetus. Although there is no proven effective method to prevent pre-eclampsia, early identification of women at risk of pre-eclampsia could enhance appropriate application of antenatal care, management and treatment. Very little is known about the cost effectiveness of these and other tests for pre-eclampsia, mainly because there is no clear treatment path. The aim of this study was to provide a comprehensive overview of the existing evidence on the health economics of screening, diagnosis and treatment options in pre-eclampsia.MethodsWe searched three electronic databases (PubMed, EMBASE and the Cochrane Library) for studies on screening, diagnosis, treatment or prevention of pre-eclampsia, published between 1994 and 2014. Only full papers written in English containing complete economic assessments in pre-eclampsia were included.ResultsFrom an initial total of 138 references, six papers fulfilled the inclusion criteria. Three studies were on the cost effectiveness of treatment of pre-eclampsia, two of which evaluated magnesium sulphate for prevention of seizures and the third evaluated the cost effectiveness of induction of labour versus expectant monitoring. The other three studies were aimed at screening and diagnosis, in combination with subsequent preventive measures. The two studies on magnesium sulphate were equivocal on the cost effectiveness in non-severe cases, and the other study suggested that induction of labour in term pre-eclampsia was more cost effective than expectant monitoring. The screening studies were quite diverse in their objectives as well as in their conclusions. One study concluded that screening is probably not worthwhile, while two other studies stated that in certain scenarios it may be cost effective to screen all pregnant women and prophylactically treat those who are found to be at high risk of developing pre-eclampsia.DiscussionThis study is the first to provide a comprehensive overview on the economic aspects of pre-eclampsia in its broadest sense, ranging from screening to treatment options. The main limitation of the present study lies in the variety of topics in combination with the limited number of papers that could be included; this restricted the comparisons that could be made. In conclusion, novel biomarkers in screening for and diagnosing pre-eclampsia show promise, but their accuracy is a major driver of cost effectiveness, as is prevalence. Universal screening for pre-eclampsia, using a biomarker, will be feasible only when accuracy is significantly increased.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-015-0291-x) contains supplementary material, which is available to authorized users.

Lifetime cost effectiveness of different brands of prosthesis used for total hip arthroplasty: a study using the NJR dataset.

There is little evidence on the cost effectiveness of different brands of hip prostheses. We compared lifetime cost effectiveness of frequently used brands within types of prosthesis including cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed) and hybrid (Exeter V40 Trilogy, Exeter V40 Trident, and CPT Trilogy). We used data from three linked English national databases to estimate the lifetime risk of revision, quality-adjusted life years (QALYs) and cost. For women with osteoarthritis aged 70 years, the Exeter V40 Elite Plus Ogee had the lowest risk of revision (5.9% revision risk, 9.0 QALYs) and the CPT Trilogy had the highest QALYs (10.9% revision risk, 9.3 QALYs). Compared with the Corail Pinnacle (9.3% revision risk, 9.22 QALYs), the most commonly used brand, and assuming a willingness-to-pay of £20,000 per QALY gain, the CPT Trilogy is most cost effective, with an incremental net monetary benefit of £876. Differences in cost effectiveness between the hybrid CPT Trilogy and Exeter V40 Trident and the cementless Corail Pinnacle and Taperloc Exceed were small, and a cautious interpretation is required, given the limitations of the available information. However, it is unlikely that cemented brands are among the most cost effective. Similar patterns of results were observed for men and other ages. The gain in quality of life after total hip arthroplasty, rather than the risk of revision, was the main driver of cost effectiveness. Cite this article: Bone Joint J 2015;97-B:762-70.

Cost-effectiveness of a fixed-dose combination of solifenacin and oral controlled adsorption system formulation of tamsulosin in men with lower urinary tract symptoms associated with benign prostatic hyperplasia.

BackgroundStorage symptoms, associated with benign prostatic hyperplasia (BPH), often co-exist with voiding symptoms in men with lower urinary tract symptoms (LUTS). Storage symptoms are likely to be most bothersome, and may not be adequately resolved by treatment with α-blocker or antimuscarinic monotherapy. A recent randomised controlled phase 3 trial (NEPTUNE) demonstrated that a fixed-dose combination (FDC) of solifenacin 6 mg plus an oral controlled absorption system (OCAS™) formulation of tamsulosin (TOCAS, 0.4 mg) improved storage symptoms, as well as quality of life, compared with TOCAS alone in men with moderate-to-severe storage symptoms and voiding symptoms. This analysis aimed to assess the cost-effectiveness of a FDC tablet of solifenacin 6 mg plus TOCAS relative to tolterodine plus tamsulosin given concomitantly, from the perspective of the UK National Health Service (NHS).MethodsA Markov model was developed for men aged ≥45 years with LUTS/BPH who have moderate-to-severe storage symptoms and voiding symptoms. The model calculated cost-effectiveness over an analytical time horizon of 1 year and estimated total treatment costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratio.ResultsThe FDC tablet of solifenacin 6 mg plus TOCAS was associated with lower total annual costs (£860 versus £959) and increased QALYs (0.839 versus 0.836), and was therefore dominant compared with tolterodine plus tamsulosin. Time horizon, discontinuation or withdrawal rates, drug cost and utility values were the main drivers of cost-effectiveness. The probability that the FDC tablet of solifenacin 6 mg plus TOCAS is cost-effective was 100% versus tolterodine plus tamsulosin, at a willingness-to-pay threshold of £20,000/QALY gained.ConclusionsThe FDC tablet of solifenacin 6 mg plus TOCAS provides important clinical benefits and is a cost-effective treatment strategy in the UK NHS compared with tolterodine plus tamsulosin for men with both storage and voiding LUTS/BPH.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-015-0031-8) contains supplementary material, which is available to authorized users.

Economic Evaluation of Fidaxomicin for the Treatment of Clostridium Difficile Infection (C. difficile-associated diarrhoea) in Ireland.

Background: Clostridium difficile is associated with 20-30% of cases of antibiotic-associated diarrhoea. The incidence of C. difficile infection (CDI) is higher in Ireland than in other countries in Europe, and it is associated with considerable morbidity. Previously recommended standard therapeutic options were vancomycin and metronidazole, but the macrocyclic antibiotic fidaxomicin has recently been recommended for use in adults with CDI in Ireland. Objectives: To perform a cost-utility analysis of fidaxomicin compared to oral metronidazole (used to treat initial non-severe disease and first non-severe recurrence) and oral vancomycin (used to treat severe disease and any non-severe recurrence beyond the first) for the treatment of CDI. Methods: A Markov model was used to determine the cost-utility of fidaxomicin in the treatment of all adult CDI patients (base case), patients with severe CDI and patients with initial CDI recurrences, respectively. Patients enter the model in the CDI health state and are treated either with fidaxomicin or current standard of care (oral metronidazole for non-severe CDI; vancomycin for severe CDI) for 10 days. The time horizon was 1 year. Deterministic and probabilistic sensitivity analyses were performed. Health state utilities were derived from the literature. The perspective was that of the Irish Health Service Executive (HSE). Results: In the base case, fidaxomicin was dominant to current standard-of-care therapy, with cost savings of €2,904 and incremental quality-adjusted life year (QALY) gain of 0.031. The main drivers of costeffectiveness were recurrence rates and cost of hospitalization. Fidaxomicin was also dominant for all patient subgroups. The probability of fidaxomicin being cost-effective in all patients with CDI at a willingness to pay threshold of €45,000 per QALY gained was 82%. Conclusion: Fidaxomicin was dominant to the current standard-of-care therapy for CDI. Based on this analysis, fidaxomicin has received reimbursement for CDI treatment under the High Tech Drug Scheme in Ireland.

DNAS: A Driver Nighttime Assistance System using Rear-View Smartphone

Owing to the poor visibility and improper behaviour, driving at nighttime is much more dangerous. In this paper, we present a cost-effective driver nighttime assistance system (DNAS), which runs on Android smartphones. In DNAS, smartphones are placed on the rear windshield, for periodically capturing road condition by the camera sensor, and warning the drivers of dangerous speeding or tailgating event. To achieve this function, firstly, DNAS uses the bright vehicle headlights and their dimension to determine the following vehicles from the captured images. Then, it analyses their temporal and spatial characteristics in the successive frames. Finally it works out the safety critical events to send out warning sounds. We evaluate the effectiveness of DNAS based on two different real driving routes. The results show that DNAS, on average, is able to detect speeding and tailgating with an accuracy of 87.7% and 83.3% recall, respectively.

Systematic review of cost-effectiveness analyses of treatments for psoriasis.

Psoriasis is a chronic inflammatory disease of the skin that has a major effect on an individual's physical and mental function. The disease is associated with increased healthcare resource use and costs, therefore cost-effectiveness analysis (CEA) can be used to assist decision makers with determining which treatments are optimal within a constrained healthcare system budget. Our aim was to systematically review the current literature on the CEA of existing treatment options for psoriasis, assess the quality of these studies, and summarize the evidence on the drivers of cost effectiveness. A literature search using Medical Subject Headings and keywords was performed in the MEDLINE, EMBASE and Health Technology Assessment databases, as well as the National Health Service Economic Evaluation Database; the CEA Registry was searched using keywords only. All references within the relevant review articles were examined manually. Two researchers independently determined the final articles and a third researcher resolved any discrepancies. We evaluated study quality in terms of the study perspective, effectiveness measures, cost measures, economic model, and time horizon. Any sensitivity analyses conducted in the studies were examined to identify the drivers of cost effectiveness, which included any variables leading to changes in the study conclusions. Fifty-three articles were included in our final review: 70% did not explicitly include costs related to adverse events; approximately one-quarter used quality-adjusted life-years; and 34% applied a time horizon under 1 year. In 18 of the 38 studies that conducted a sensitivity analysis, the cost-effectiveness results were impacted by uncertainty. The main key drivers of cost effectiveness were the costs related to the treatment, values and choice of efficacy, utility values, hospitalization for non-responders, time horizon, model structure, and utility mapping method. High-quality cost-effectiveness studies are required to facilitate resource allocation decision making. To improve study quality, future research should provide evidence on the long-term experience with psoriasis treatments, and resolve the uncertainty associated with key drivers of cost effectiveness.

A Systematic Review of Cost-Effectiveness Analyses of Drugs for Postmenopausal Osteoporosis

Given the limited availability of healthcare resources and the recent introduction of new anti-osteoporosis drugs, the interest in the cost effectiveness of drugs in postmenopausal osteoporosis remains and even increases. This study aims to identify all recent economic evaluations on drugs for postmenopausal osteoporosis, to critically appraise the reporting quality, and to summarize the results. A literature search using Medline, the National Health Service Economic Evaluation database and the Cost-Effectiveness Analysis Registry was undertaken to identify original articles published between January 1, 2008 and December 31, 2013. Studies that assessed cost effectiveness of drugs in postmenopausal osteoporosis were included. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement was used to assess the quality of reporting of these articles. Of 1,794 articles identified, 39 studies fulfilled the inclusion criteria. They were conducted in 14 different countries and nine active interventions were assessed. When compared with no treatment, active osteoporotic drugs were generally cost effective in postmenopausal women aged over 60-65years with low bone mass, especially those with prior vertebral fractures. Key drivers of cost effectiveness included individual fracture risk, medication adherence, selected comparators and country-specific analyses. Quality of reporting varied between studies with an average score of 17.9 out of 24 (range 7-21.5). This review found a substantial number of published cost-effectiveness analyses of drugs in osteoporosis in the last 6years. Results and critical appraisal of these articles can help decision makers when prioritizing health interventions and can inform the development of future economic evaluations.

Key Drivers of Cost-Effectiveness of Anti-Cancer Drugs

ABSTRACT Aim: Health economic models are often complex, with numerous parameters. Here, the intention is to give some insight in to the sensitivity of cost-effectiveness to various parameters that routinely appear in economic models. Methods: Economics models written and reviewed at the author's institution in the UK from 2007 to 2014 were studied. These included one model for metastatic colorectal cancer, one for renal cell carcinoma, four for chronic lymphocytic leukaemia, three for chronic myeloid leukaemia, one for gastro-intestinal stromal tumours, and one for multiple myeloma. In all these analyses, the impact of various model parameters on the incremental cost-effectiveness ratio was inspected. Results: Cost-effectiveness is generally very sensitive to: Mean overall survival, Adjustment for treatment switching where appropriate, Mean treatment duration, Drug cost per month, Utilities (quality of life) on and off treatment. Cost-effectiveness tends to be sensitive to: Cost of drug administration, Drug dose intensity, Medical management costs, Cost of subsequent treatments, Discount rate for chronic diseases, Vial wastage, Mean progression free survival. Cost-effectiveness is generally insensitive to: Costs of adverse events, Disutilities of adverse events, Cost of blood tests, Discount rates for acute diseases, Costs of death. Conclusions: It is possible to identify parameters that usually strongly influence the cost-effectiveness of anti-cancer drugs.Where possible, it is recommended that information should be provided in published trials to inform these key parameters. Disclosure: All authors have declared no conflicts of interest.

A Novel Single-Stage High-Power-Factor LED Street-Lighting Driver With Coupled Inductors

This paper proposes a single-stage high-power-factor (HPF) LED driver with coupled inductors for street-lighting applications. The presented LED driver integrates a dual buck-boost power-factor-correction (PFC) ac-dc converter with coupled inductors and a half-bridge-type LLC dc-dc resonant converter into a single-stage-conversion circuit topology. The coupled inductors inside the dual buck-boost converter subcircuit are designed to be operated in the discontinuous-conduction mode for obtaining high power-factor (PF). The half-bridge-type LLC resonant converter is designed for achieving soft-switching on two power switches and output rectifier diodes, in order to reduce their switching losses. This paper develops and implements a cost-effective driver for powering a 144-W-rated LED street-lighting module with input utility-line voltage ranging from 100 to 120 V. The tested prototype yields satisfying experimental results, including high circuit efficiency (>89.5%), low input-current total-harmonic distortion (<; 5.5%), high PF (> 0.99), low output-voltage ripple (<; 7.5%), and low output-current ripple (<; 5%), thus demonstrating the feasibility of the proposed LED driver.

Systematic review of the cost effectiveness of radiation therapy for prostate cancer from 2003 to 2013.

Prostate cancer remains a prevalent diagnosis with a spectrum of treatment choices that offer similar oncologic outcomes but differing side effect profiles and associated costs. As the technology for prostate radiation therapy has advanced, its associated costs have escalated, thus making cost-effectiveness analyses critical to assess the value of competing treatment options, including watchful waiting, surgery, brachytherapy, intensity-modulated radiation therapy (IMRT), 3D-conformal radiation therapy (3D-CRT), proton beam therapy (PBT), and stereotactic body radiation therapy (SBRT). The aim of this systematic review was to identify articles that performed a cost-effectiveness analysis on different radiation treatment options for localized prostate cancer, summarize their findings, and highlight the main drivers of cost effectiveness. A literature search was performed on two databases, PubMed and the Cost-Effectiveness Analysis Registry ( https://research.tufts-nemc.org/cear4 ), using search terms that included 'prostate', 'cost effectiveness prostate radiation' and 'cost analysis comparative effectiveness prostate radiation'. Studies were included in this review if the cost data were from 2002 or later, and outcomes reported both cost and effectiveness, preferably including a cost-utility analysis with the outcome of an incremental cost-effectiveness ratio with quality-adjusted life-year (QALY) as the effectiveness measure. There were 14 articles between 2003 and 2013 that discussed cost effectiveness of prostate radiotherapy in men over the age of 65. All but four of the papers were from the US; the others were from Canada and the UK. The majority of the papers used Markov decision analysis and estimated cost from a payer's perspective, usually from Medicare reimbursement data. Assumptions for the model and utilities to calculate QALYs were estimated using published literature at the time of the analysis. Each analysis had a sensitivity analysis to compensate for the uncertainty of the model inputs. The main drivers of cost effectiveness were the cost of the radiation treatment and the differential QALYs accrued because of different treatment-related morbidities. Brachytherapy was consistently found to be more cost effective when compared with surgery and other radiation treatment options. IMRT was cost effective when compared with 3D-CRT. PBT was not found to be cost effective in any of the analyses, mostly due to the high costs of PBT. SBRT was the newest technology that was analyzed, and it was also found to be cost effective compared with IMRT and PBT. Cost-effectiveness research of prostate radiation treatments allows patients, providers, and payers to better understand the true value of each treatment choice. Due to the variation in each of these analyses (e.g., costing, and disease and complication assumptions, etc.), it is difficult to generalize the results. One must be careful in drawing conclusions from these studies and extrapolating to individual patients, particularly with the clear utility dependence seen in the majority of these studies.

PMH2 - Meta-analysis of drivers of cost-effectiveness from short-term lurasidone clinical trials: Effect of changing daily dose on panss total score and weight

PMH2 - Meta-analysis of drivers of cost-effectiveness from short-term lurasidone clinical trials: Effect of changing daily dose on panss total score and weight

Practitioner versus participant perspectives on conservation tenders

Extensive clearing of native vegetation on rural properties throughout Australia over the last century has generated significant damage to biodiversity. Conservation tenders have been broadly used to reduce the detrimental impact of such widespread clearance. To date, Australian conservation tender research has largely been limited to program evaluations and landholder surveys. This analysis differs by comparing and contrasting the views of non-landholders involved with these programs with those of participant landholders. The non-landholder group consists of individuals with involvement in conservation tenders across Australia. By contrast, the landholder group consists of individuals with participation experience in a series of Victorian tender initiatives. Each group is surveyed to investigate the drivers of cost-effectiveness within tender programs and landholder participation. This analysis explores these two perspectives, revealing important convergences and divergences in opinion. Both practitioners and landholders indicate that programs supported by close agency–landholder relationships and offering flexibility to landholders are most likely to succeed, particularly where landholders perceive the tender instrument to be fair. Whilst practitioners emphasise the role of transaction costs issues and program characteristics in achieving cost-effective biodiversity outcomes, landholders indicate that these factors are less important to participation rates. This research is important to guide future implementation of tender programs both in Australia and internationally.

Markov modeling and discrete event simulation in health care: a systematic comparison.

The aim of this study was to assess if the use of Markov modeling (MM) or discrete event simulation (DES) for cost-effectiveness analysis (CEA) may alter healthcare resource allocation decisions. A systematic literature search and review of empirical and non-empirical studies comparing MM and DES techniques used in the CEA of healthcare technologies was conducted. Twenty-two pertinent publications were identified. Two publications compared MM and DES models empirically, one presented a conceptual DES and MM, two described a DES consensus guideline, and seventeen drew comparisons between MM and DES through the authors' experience. The primary advantages described for DES over MM were the ability to model queuing for limited resources, capture individual patient histories, accommodate complexity and uncertainty, represent time flexibly, model competing risks, and accommodate multiple events simultaneously. The disadvantages of DES over MM were the potential for model overspecification, increased data requirements, specialized expensive software, and increased model development, validation, and computational time. Where individual patient history is an important driver of future events an individual patient simulation technique like DES may be preferred over MM. Where supply shortages, subsequent queuing, and diversion of patients through other pathways in the healthcare system are likely to be drivers of cost-effectiveness, DES modeling methods may provide decision makers with more accurate information on which to base resource allocation decisions. Where these are not major features of the cost-effectiveness question, MM remains an efficient, easily validated, parsimonious, and accurate method of determining the cost-effectiveness of new healthcare interventions.