Favorable Cost-effectiveness Ratio Research Articles

Benefit-Risk Assessment of Becaplermin in the Treatment of Diabetic Foot Ulcers

Becaplermin is a recombinant platelet-derived growth factor composed of two B chains that is approved for the treatment of neuropathic diabetic foot ulcers extending into or beyond the subcutaneous tissue in patients with adequate arterial perfusion. The aim of this review is to assess the benefits and risks associated with the use of this agent. Randomized controlled trials have provided evidence for the efficacy of becaplermin in increasing healing rates, and cost analyses have repeatedly shown a favourable cost-effectiveness ratio. However, clinical experience has not met these high expectations and becaplermin is not widely used. Moreover, this agent has not been compared with other additional treatment modalities, notably bioengineered skin substitutes and extracellular matrix proteins, and such comparisons are eagerly awaited. Of particular note, increased cancer risk has been reported in patients treated with more than three tubes of becaplermin; thus, this agent should be used only when the anticipated benefits outweigh the potential harm, and with extreme caution in patients with diagnosed malignancy. Finally, longer follow-up data are necessary to shed more light on the potential risk of malignancy in connection with becaplermin use.

Economic implications of the first-line treatment of advanced renal cell carcinoma in Thailand: A cost-effectiveness analysis.

e15136 Background: Currently, there are several agents used to treat metastatic renal cell carcinoma (mRCC). However, limited studies comparing cost analysis among these available agents. Here we conducted a cost analysis of mRCC treatments in Thailand to determine the economic implications of these agents. Methods: A life-time Markov model was developed to simulate the patterns of disease progression and to determine the outcomes under treatment of available medicines including interferon-alpha (IFNa), sunitinib, sorafenib, and bevacizumab. Costs were measured based on the perspective of a healthcare provider. Resource utilization derived from retrospective chart reviews of 14 mRCC patients treated at the King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Costs and survival benefits were discounted annually at 3%. Results: The major assumption of the study was that the projected PFS and overall survival were longer for sunitinib than the other comparative treatments based on results of published studies. Cost-effectiveness analyses demonstrated that IFNa had the most favourable cost-effectiveness ratio at 1.3 Million Baht/QALYs followed by sunitinib, sorafenib, and bevacizumab at 1.7, 1.9, 9.3 Million Baht/QALYs respectively. However, sunitinib had a better incremental cost-effectiveness ratios (ICERs) over IFNa at 2.0 million Baht/PFY, 2.7 million Baht/LYG, and 3.6 million Baht/QALY gained. Both of sorafenib and bevacizumab plus IFNa cost-effectiveness were outperformed by sunitinib. Sensitivity analysis showed that the most sensitive parameters for sunitinib were the overall survivalefficacy and costs. Conclusions: Our study reveals that sunitinib has the good cost-effectiveness profiles as one of the first line treatment of mRCC. With current study model, it may be applicable to the situation in developing country with limit availability of TKIs in the treatment of mRCC. However, sunitinib's ICER comparing to IFNa is still beyond the ICER threshold for a developing country. This cost-effectiveness evidence should be taken into account in conjunction with other clinical, societal, and ethical considerations in the treatment of mRCC. No significant financial relationships to disclose.

Digoxin therapy: A persisting interest despite contrary winds

Digoxin therapy is used to treat heart failure patients for more than 200 years. However, absence of effect on overall mortality found in the DIG study associated with frequent adverse effects due to overdosing in elderly patients with impaired renal function finally persuaded medical opinion to the weak interest of digoxin in chronic heart failure. Its image of old-fashioned drug in the mind of young cardiology generations appears widely distorted, and suffers from the absence of promotion by pharmaceutical industry, given a very low cost and a rapid arrival onto the generic market. Yet, regarding strict data from the literature, it remains a lot of positive factors in favor of the interest for digoxin: reduction of morbidity, reduction of mortality at low serum concentration < 1.0 ng/ml, very low cost with favorable cost-effectiveness ratio. This article challenges some arguments for defending digoxin as another first-line therapy as well as ACE inhibitors and beta-blockers in the treatment of chronic heart failure.

The Effectiveness and Cost-Effectiveness of a Rural Employer-Based Wellness Program

The cost-effectiveness of employer-based wellness programs has been previously investigated with favorable financial and nonfinancial outcomes being detected. However, these investigations have mainly focused on large employers in urban settings. Very few studies examined wellness programs offered in rural settings. This paper aims to explore the effectiveness and cost-effectiveness of a rural employer-based wellness program. Six rural employers were categorized into 3 groups: a control group and 2 intervention groups with varying degrees of wellness activities. Participants were asked to complete an annual health risk assessment (HRA) that addressed 16 wellness areas. At the conclusion of 4 years, HRA and effectiveness data were utilized to examine program effectiveness and combined with program costs to estimate cost-effectiveness. The "Coaching and Referral" group-the highest in intensity of participant engagement-exhibited superior improvement in several wellness areas and in percentage of employees with good health indicators compared to the control and the Trail Marker, lower-intensity intervention groups. However, the Trail Markers had more favorable cost-effectiveness ratios. Rural worksite wellness programs have shown great potential in their effectiveness and cost-effectiveness. Such programs need not be too aggressive, tedious, and costly to generate a favorable return for employers and funders. However, employers should be encouraged to experiment with different levels of wellness program intensities until a more favorable outcome can be realized.

Cost-effectiveness of human papillomavirus vaccination for prevention of cervical cancer in Taiwan

BackgroundHuman papillomavirus (HPV) infection has been shown to be a major risk factor for cervical cancer. Vaccines against HPV-16 and HPV-18 are highly effective in preventing type-specific HPV infections and related cervical lesions. There is, however, limited data available describing the health and economic impacts of HPV vaccination in Taiwan. The objective of this study was to assess the cost-effectiveness of prophylactic HPV vaccination for the prevention of cervical cancer in Taiwan.MethodsWe developed a Markov model to compare the health and economic outcomes of vaccinating preadolescent girls (at the age of 12 years) for the prevention of cervical cancer with current practice, including cervical cytological screening. Data were synthesized from published papers or reports, and whenever possible, those specific to Taiwan were used. Sensitivity analyses were performed to account for important uncertainties and different vaccination scenarios.ResultsUnder the assumption that the HPV vaccine could provide lifelong protection, the massive vaccination among preadolescent girls in Taiwan would lead to reduction in 73.3% of the total incident cervical cancer cases and would result in a life expectancy gain of 4.9 days or 8.7 quality-adjusted life days at a cost of US$324 as compared to the current practice. The incremental cost-effectiveness ratio (ICER) was US$23,939 per life year gained or US$13,674 per quality-adjusted life year (QALY) gained given the discount rate of 3%. Sensitivity analyses showed that this ICER would remain below US$30,000 per QALY under most conditions, even when vaccine efficacy was suboptimal or when vaccine-induced immunity required booster shots every 13 years.ConclusionsAlthough gains in life expectancy may be modest at the individual level, the results indicate that prophylactic HPV vaccination of preadolescent girls in Taiwan would result in substantial population benefits with a favorable cost-effectiveness ratio. Nevertheless, we should not overlook the urgency to improve the compliance rate of cervical screening, particularly for older individuals.

Prognostic value, clinical effectiveness, and cost-effectiveness of high-sensitivity C-reactive protein as a marker for major cardiac events in asymptomatic individuals: A health technology assessment report

The aim of this study was to compare the predictive value, clinical effectiveness, and cost-effectiveness of high-sensitivity C-reactive protein (hs-CRP)-screening in addition to traditional risk factor screening in apparently healthy persons as a means of preventing coronary artery disease. The systematic review was performed according to internationally recognized methods. Seven studies on risk prediction, one clinical decision-analytic modeling study, and three decision-analytic cost-effectiveness studies were included. The adjusted relative risk of high hs-CRP-level ranged from 0.7 to 2.47 (p < .05 in four of seven studies). Adding hs-CRP to the prediction models increased the areas under the curve by 0.00 to 0.027. Based on the clinical decision analysis, both individuals with elevated hs-CRP-levels and those with hyperlipidemia have a similar gain in life expectancy following statin therapy. One high-quality economic modeling study suggests favorable incremental cost-effectiveness ratios for persons with elevated hs-CRP and higher risk. However, many model parameters were based on limited evidence. Adding hs-CRP to traditional risk factors improves risk prediction, but the clinical relevance and cost-effectiveness of this improvement remain unclear.

Systematic review of economic evaluations of human cell-derived wound care products for the treatment of venous leg and diabetic foot ulcers

BackgroundTissue engineering is an emerging field. Novel bioengineered skin substitutes and genetically derived growth factors offer innovative approaches to reduce the burden of diabetic foot and venous leg ulcers for both patients and health care systems. However, they frequently are very costly. Based on a systematic review of the literature, this study assesses the cost-effectiveness of these growth factors and tissue-engineered artificial skin for treating chronic wounds.MethodsOn the basis of an extensive explorative search, an appropriate algorithm for a systematic database search was developed. The following databases were searched: BIOSIS Previews, CRD databases, Cochrane Library, EconLit, Embase, Medline, and Web of Science. Only completed and published trial- or model-based studies which contained a full economic evaluation of growth factors and bioengineered skin substitutes for the treatment of chronic wounds were included. Two reviewers independently undertook the assessment of study quality. The relevant studies were assessed by a modified version of the Consensus on Health Economic Criteria (CHEC) list and a published checklist for evaluating model-based economic evaluations.ResultsEleven health economic evaluations were included. Three biotechnology products were identified for which topical growth factors or bioengineered skin substitutes for the treatment of chronic leg ulceration were economically assessed: (1) Apligraf®, a bilayered living human skin equivalent indicated for the treatment of diabetic foot and venous leg ulcers (five studies); (2) Dermagraft®, a human fibroblast-derived dermal substitute, which is indicated only for use in the treatment of full-thickness diabetic foot ulcers (one study); (3) REGRANEX® Gel, a human platelet-derived growth factor for the treatment of deep neuropathic diabetic foot ulcers (five studies). The studies considered in this review were of varying and partly low methodological quality. They calculated that due to shorter treatment periods, fewer complications and fewer inpatient episodes the initial cost of the novel biotechnology products may be offset, making the treatment cost-effective or even cost-saving. The results of most studies were sensitive to initial costs of the products and the evidence of effectiveness.ConclusionThe study results suggest that some growth factors and tissue-engineered artificial skin products feature favourable cost-effectiveness ratios in selected patient groups with chronic wounds. Despite the limitations of the studies considered, it is evident that health care providers and coverage decision makers should take not only the high cost of the biotechnology product but the total cost of care into account when deciding about the appropriate allocation of their financial resources. However, not only the cost-effectiveness but first of all the effectiveness of these novel biotechnology products deserve further research.

Eptifibatide: The evidence for its role in the management of acute coronary syndromes

Acute coronary syndromes and non-Q-wave myocardial infarction are often initiated by platelet activation. Eptifibatide is a cyclic heptapeptide and is the third inhibitor of glycoprotein (Gp) IIb/IIIa that has found broad acceptance after the specific antibody abciximab and the nonpeptide tirofiban entered the global market. Gp IIb/IIIa inhibitors act by inhibiting the final common pathway of platelet aggregation, and play an important role in the management of acute coronary syndromes. This review assesses the evidence for therapeutic value of eptifibatide as a Gp IIb/IIIa inhibitor in patients with acute coronary syndromes. Several large, randomized controlled trials show that eptifibatide as adjunctive therapy to standard care in patients with non-ST segment elevation acute coronary syndrome is associated with a significant reduction in the incidence of death or myocardial infarction. Data are limited regarding the use of eptifibatide in patients with ST segment elevation myocardial infarction. Cost-effectiveness analysis indicates that eptifibatide is associated with a favorable cost-effectiveness ratio relative to standard care. According to US cost-effectiveness analysis about 70% of the acquisition costs of eptifibatide are offset by the reduced medical resource consumption during the first year. Eptifibatide was well tolerated in most of the trials. Bleeding is the most commonly reported adverse event, with most major bleeding episodes occurring at the vascular access site. Major intracranial bleeds, stroke, or profound thrombocytopenia rarely occurred during eptifibatide treatment. Eptifibatide has gained widespread acceptance as an adjunct to standard anticoagulation therapy in patients with acute coronary syndromes, and may be particularly useful in the management of patients with elevated troponin or undergoing percutaneous coronary interventions.

Are cancer cost-effectiveness analyses presented at major conferences published timely without bias? A systematic review

6560 Background: Cancer cost-effectiveness analyses (CEA) should be published timely without publication bias of studies with more favourable incremental cost-effectiveness ratios (ICER) in order to be informative to policy makers and stakeholders. This study examined the publication pattern of CEA presented in the annual meetings of the American Society of Clinical Oncology (ASCO) and the international annual meetings of the International Society of Pharmacoeconomics and Outcome Research (ISPOR). Methods: Abstracts from ASCO and ISPOR from 1997 to 2007 were reviewed. CEA with primary outcomes as incremental cost per life year gained or quality-adjusted life year (QALY) were included. Data including ICER (adjusted to USD), cancer type, country, and quality indicators were extracted. Publication search was conducted using Medline, HealthStar and EconLit. Time-to-publication analysis was conducted with exploratory analyses on predictors of publication. Results: 137 abstracts were included. Only 48 were published. The actuarial 1-, 2-, 3-, 5-year publication rates were 12%, 25%, 33%, 42%, respectively. CEA using a lifetime horizon (HR = 2.3, p = 0.01) were more likely to be published. There were trends of CEA presented in ASCO (HR = 1.8, p = 0.07) or on breast cancer (HR = 1.7 p = 0.06) towards being published. Favourable ICER and country did not predict publication. Among the 77 cost-utility analyses, when using cutoff at $20,000, $50,000, and $100,000/QALY, 55%, 82%, and 87% were cost-effective, respectively. US abstracts were more likely to report ICER &gt; $50,000/QALY (OR = 4, p = 0.05). Quality indicators such as the use of lifetime horizon, societal perceptive, and probabilistic sensitivity analysis were stated explicitly in only 22%, 17%, and 16% of abstracts, respectively. Conclusions: The publication rate of CEA abstracts was low and not timely for open discussions among stakeholders when making policy decision. While there was no direct evidence of publication bias of favourable ICER CEA on the abstract-to-publication level, very favourable ICERs were reported by most abstracts, which might suggest non-submission of unfavourable ICER CEA for abstract presentation. The overall quality of study design or reporting of CEA abstracts appeared suboptimal. No significant financial relationships to disclose.

Cost-effectiveness Modeling of Intrathecal Baclofen Therapy Versus Other Interventions for Disabling Spasticity

Objective. To assess by simulation the cost-effectiveness of intrathecal baclofen (ITB) therapy compared with conventional medical treatments for patients with disabling spasticity and functional dependence caused by any neurological disease. Methods. Two models were created to simulate therapeutic strategies for managing severe spasticity, one with and one without the use of ITB, to assess various treatment sequences over 2 years based on current medical practices in France. Successful treatment at each evaluation was defined as a combination of: (1) the increased patient and caregiver satisfaction as assessed by goal attainment scaling (GAS), and (2) a decrease of at least 1 point on the Ashworth score. Probabilistic sensitivity analyses were performed using 5000 Monte-Carlo simulations taking into account specific distribution curves for direct costs and effectiveness parameters in each treatment option. Results. The model simulations suggest that including ITB as a first option strategy in the management of function of severely impaired patients with disabling spasticity results in a higher success rate (78.7% vs 59.3%; P < .001). In addition, the ITB therapy model revealed a lower cost (59 391 vs 88 272; P < .001) and an overall more favorable cost-effectiveness ratio (75 204/success vs 148 822/success; P < .001), compared with conventional medical management without ITB. Conclusion. Within the assumptions of our modeling, ITB therapy evaluated by a combination of treatment success criteria at 6-month intervals over a 2-year period may be a cost-effective strategy compared to conventional medical management alone.

Cost-Effectiveness of Trastuzumab as Adjuvant Therapy for Early Breast Cancer: A Systematic Review

To identify published, original, cost-effectiveness analyses presenting cost/quality-adjusted life year (QALY) ratios for trastuzumab used as an adjuvant treatment for HER2-positive early breast cancer and to evaluate the quality of reporting the favorable cost-effectiveness ratios. The terms trastuzumab adjuvant therapy, cost-effectiveness, quality-adjusted, QALY, and early breast cancer were searched in MEDLINE, PubMed, Embase, and CancerLit, as well as in Cochrane economic evaluation and reference lists from 1998 to June 2008. Only English-language publications were eligible. All published studies examining cost-effectiveness outcomes on the basis of modeling or clinical trials were included. Cost-effectiveness analysis that measured health effects in units other than QALY, life year gained, neoadjuvant data, reviews, and comments were excluded. Each study was assessed independently by 2 trained reviewers. Thirteen of the 239 articles identified met the inclusion criteria, with 23 cost-effectiveness ratios pertaining to treatment of early breast cancer. These ratios ranged from $5020/QALY to $134,610/QALY. Most studies reported favorable cost-effectiveness values (ie, below $50,000/QALY). About 84.6% were conducted using a Markov model based on data from clinical trials and 15.3% were analyzed by other economic or cost models; 84.6% reported sensitivity analysis, 11 studies (84.6%) clearly described a justification of selecting study design, and only 15.3% noted study limitations. All studies mentioned their perspective; 92.3% did not show the funding source. Methods of reporting costs, effectiveness, and time-horizons for disease states varied significantly. Nine (69.2%) studies used a discount rate of 3%, 3 studies used a discount rate of 5%, and 1 study used 3.5%. The mean quality of the studies was 4.43. Most studies presenting the frequently proposed threshold of QALY suggest that trastuzumab may be cost-effective for treatment of early breast cancer in a 1-year treatment regimen.

Docetaxel plus cyclophosphamide is cost-effective compared to doxorubicin plus cyclophosphamide, based on an economic analysis of US oncology trial 9735: additional rationale to avoid anthracyclines in the adjuvant treatment of operable breast cancer?.

Abstract Abstract #6105 Background: Extended 7-year follow-up of the US Oncology Adjuvant Trial 9735 demonstrated that docetaxel plus cyclophosphamide (TC) as adjuvant treatment of operable invasive breast cancer significantly improves disease-free survival (DFS) and overall survival (OS) compared to doxorubicin plus cyclophosphamide (AC). DFS was 81% vs. 75%, respectively (p = 0.033) and OS was 87% vs. 82%, respectively (p = 0.032). A lifetime cost-effectiveness analysis of TC versus AC was conducted from a Canadian (province of Ontario) government payer perspective, based on head-to-head clinical data from Trial 9735. Methods: Survival and monthly risk of disease recurrence of women with early stage breast cancer (base case typifying those entered into the trial) was estimated up to 7 years using OS and DFS data from Trial 9735. Survival was extrapolated to lifetime using life expectancy estimates from the Canadian general population. Canadian resource utilization and unit costs were applied to estimate the costs of chemotherapy (including drug and administration costs), chemotherapy-related toxicities and disease recurrence. Quality of life (utility) weights for health states and events, used in the calculation of quality-adjusted life years (QALYs), were derived from the literature. Total costs, life years and QALYs were calculated for a lifetime horizon. Results: Life years and QALYs were higher for TC patients compared to AC patients, due primarily to longer survival and fewer recurrences for patients receiving TC. The predicted life expectancy of patients receiving TC and AC was 14.64 and 14.02 years, respectively. Mean total lifetime disease-related costs were $12,840 with TC and $8,579 with AC; the difference in costs was driven by higher drug acquisition costs for TC. Cost per life year gained (TC vs. AC) was $6,842 and cost per QALY gained was $8,251, discounting costs and outcomes at 5% per year. Base case results were most sensitive to assumptions regarding time horizon. In a sensitivity analysis conducted with a 7-year time horizon (the time frame of the clinical trial), cost per life year gained was $36,120 and cost per QALY gained was $43,248. In additional one-way sensitivity analyses conducted with a lifetime horizon and alternative assumptions regarding survival extrapolation, utility estimates, costs and discount rate, cost per life year gained remained between $2,982 and $7,538 and cost per QALY gained remained between $3,600 and $9,090. Conclusion: In patients with early stage, operable, invasive breast cancer, adjuvant treatment with TC provides gains in terms of life years and QALYs compared to AC and results in favourable cost-effectiveness ratios that should be acceptable in most jurisdictions. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6105.

Cost-effectiveness analysis of docetaxel (Taxotere®) vs. 5-fluorouracil in combined therapy in the initial phases of breast cancer

The randomised controlled trial BCIRG001 has recently demonstrated that docetaxel in combination with doxorubicin and cyclophosphamide (TAC) has better efficacy than the standard treatment (FAC, i.e., 5-fluorouracil, doxorubicin and cyclophosphamide) in the adjuvant treatment of patients with node-positive breast cancer. The cost-effectiveness of TAC vs. FAC in the Spanish setting is analysed. Clinical outcomes from trial BCIRG001 were combined with Spanish costs and longterm efficacy of FAC and TAC extrapolated up to 5 years by means of a Markov model. Results are shown as cost per life year gained (C/LYG) and cost per quality-adjusted life year (C/QALY). Costs and effects were discounted at a rate of 3%. Mean survival was 17.8 and 16.5 years for TAC and FAC, with total costs of euro14,611 and euro11,586, respectively. The results of the cost-effectiveness analysis showed that TAC achieves a C/LYG and a C/QALY of only euro2345 and euro2631, respectively. Sensitivity analysis confirmed the robustness of the results. Combined therapy based on docetaxel (TAC) is not only an effective option, but also presents a favourable cost-effectiveness ratio, clearly below the Spanish efficiency threshold in all the scenarios considered.

Recommendations for the prevention and treatment of influenza using antiviral drugs based on cost–effectiveness

Influenza is an acute respiratory disease that causes epidemics and pandemics in the human population of temperate regions. Influenza epidemics occur every year during the winter months, affecting approximately 10% of the population. The primary strategy for reducing the effect of influenza in the community is to vaccinate persons who are at risk or caring for high-risk individuals each year before seasonal increases in influenza virus circulation occur. Antiviral drugs can be used for the treatment of influenza and the prevention of seasonal and post-exposure influenza. Four antiviral drugs are available for the prevention and treatment of influenza infections: oseltamivir, zanamivir, rimantadine and amantadine. Antiviral drugs can be used for the treatment of influenza and for post-exposure and seasonal influenza prevention. The cost–effectiveness of antiviral therapies ranged from cost savings to more than US$130,000 per quality-adjusted life-year (QALY) for influenza treatment, from GB£9000 to more than £1 million per QALY for seasonal prevention and from cost savings to £100,000 per QALY for post-exposure prevention. Based on the cost–effectiveness threshold of £30,000 or $40,000 per QALY, antiviral therapies can be recommended for influenza treatment and post-exposure prevention in healthy and high-risk individuals and for seasonal prevention in high-risk individuals. Zanamivir, oseltamivir and amantadine have favorable cost–effectiveness ratios for these interventions, but amantadine should only be used in countries with a low prevalence of resistant virus. The stockpile of antiviral drugs should be maintained in developed countries because they are cost effective for the prevention and treatment of a possible influenza pandemic.

Cost-Effectiveness of HIV Screening of Blood Donations in Accra (Ghana)

Objectives Areas with high HIV-incidence rates compared to the developed world may benefit from additional testing in blood banks and may show more favorable cost-effectiveness ratios. We evaluated the cost-effectiveness of adding p24 antigen, mini pool nucleic acid amplification testing (MP-NAT), or individual donation NAT (ID-NAT) to the HIV-antibody screening at the Korle Bu Teaching Hospital (Accra, Ghana), where currently only HIV-antibody screening is undertaken. Methods The residual risk of HIV transmission was derived from blood donations to the blood bank of the Korle Bu Teaching Hospital in 2004. Remaining life expectancies of patients receiving blood transfusion were estimated using the World Health Organization life expectancies. Cost-effectiveness ratios for adding the tests to HIV-antibody screening only were determined using a decision tree model and a Markov model for HIV. Results The prevalence of HIV was estimated at 1.51% in 18,714 donations during 2004. The incremental cost per disability-adjusted life-year (DALY) averted was US$1237 for p24 antigen, US$3142 for MP-NAT and US$7695 compared to the next least expensive strategy. HIV-antibody screening itself was cost-saving compared to no screening at all, gaining US$73.85 and averting 0.86 DALY per transfused patient. Up to a willingness-to-pay of US$2736 per DALY averted, HIV-antibody screening without additional testing was the most cost-effective strategy. Over a willingness-to-pay of US$11,828 per DALY averted, ID-NAT was significantly more cost-effective than the other strategies. Conclusions Adding p24 antigen, MP-NAT, or ID-NAT to the current antibody screening cannot be regarded as a cost-effective health-care intervention for Ghana.

Cost effectiveness, chemotherapy, and the clinician

Economic evaluations of health care can be used by policy makers and other decision makers to compare the cost effectiveness of different treatment strategies and to make decisions about the allocation of scarce resources, such as dollars spent on health care. This commentary focuses on two journal articles address the cost effectiveness of docetaxel, doxorubicin and cyclophosphamide (TAC) compared to 5-fluorouracil, doxorubicin and cyclophosphamide (FAC) in the adjuvant treatment of breast cancer using data from a clinical trial, BCIRG 001 Both studies found that, despite the higher costs of TAC, the greater efficacy of this regimen in patients enrolled in BCIRG 001 led to a favourable cost effectiveness ratio.

The Potential of a Radiosensitive Intracerebral Probe to Monitor 18F-MPPF Binding in Mouse Hippocampus In Vivo

As mouse imaging has become more challenging in preclinical research, efforts have been made to develop dedicated PET systems. Although these systems are currently used for the study of physiopathologic murine models, they present some drawbacks for brain studies, including a low temporal resolution that limits the pharmacokinetic study of radiotracers. The aim of this study was to demonstrate the ability of a radiosensitive intracerebral probe to measure the binding of a radiotracer in the mouse brain in vivo. The potential of a probe 0.25 mm in diameter for pharmacokinetic studies was assessed. First, Monte Carlo simulations followed by experimental studies were used to evaluate the detection volume and sensitivity of the probe and its adequacy for the size of loci in the mouse brain. Second, ex vivo autoradiography of 5-hydroxytryptamine receptor 1A (5-HT(1A)) receptors in the mouse brain was performed with the PET radiotracer 2'-methoxyphenyl-(N-2'-pyridinyl)-p-(18)F-fluorobenzamidoethylpiperazine ((18)F-MPPF). Finally, the binding kinetics of (18)F-MPPF were measured in vivo in both the hippocampus and the cerebellum of mice. Both the simulations and the experimental studies demonstrated the feasibility of using small probes to measure radioactive concentrations in specific regions of the mouse brain. Ex vivo autoradiography showed a heterogeneous distribution of (18)F-MPPF consistent with the known distribution of 5-HT(1A) in the mouse brain. Finally, the time-activity curves obtained in vivo were reproducible and validated the capacity of the new probe to accurately measure (18)F-MPPF kinetics in the mouse hippocampus. Our results demonstrate the ability of the tested radiosensitive intracerebral probe to monitor binding of PET radiotracers in anesthetized mice in vivo, with high temporal resolution suited for compartmental modeling.

Cost-Effectiveness of Clopidogrel: Seeing through the Smoke

The authors reviewed various recommendations and practices for cost-effectiveness analysis. They also performed a PubMed search for clopidogrel and cost-effectiveness from 2004 to early 2008 to obtain original analyses published in English to look for possible associations of assumptions and conclusions with reported pharmaceutical support. . Inclusion of incident cases and truncation at a sensible follow-up time more appropriately reflect the burden to be assumed by third-party payers. Extending the time horizon too far runs the risk of decreasing any relation with future reality. Parsimony cannot justify simplifications that omit relevant issues such as noncoronary costs, which worsen the calculated cost-effectiveness ratio of clopidogrel by 5% to 27%. The choice of the population to be analyzed has a major effect on cost-effectiveness: pharmaceutically sponsored studies published between 2004 and early 2008 focused on high-risk patients and have routinely shown more favorable cost-effectiveness ratios for clopidogrel than studies without pharmaceutical support. . Any entity hoping to make the cost-effectiveness ratio of clopidogrel look more favorable would prefer the isolated, cohort approach and limit the analysis to high-risk patients most likely to benefit from it. This approach ignores the reality of medical policies and does not address the most relevant questions regarding the optimum use of clopidogrel.

Cost-effectiveness analysis of electrochemotherapy with the Cliniporatortrade mark vs other methods for the control and treatment of cutaneous and subcutaneous tumors.

Tumors of any histological origin can give rise to cutaneous and subcutaneous metastases during follow-up. This study aims to evaluate the costs and benefits of electrochemotherapy (ECT) with the Cliniporatortrade mark vs other currently used methods in the control and treatment of cutaneous and subcutaneous advanced neoplasms. A cost-effectiveness analysis was carried out on ECT using the Cliniporator vs other techniques (radiotherapy, hyperthermia associated with radiotherapy and chemotherapy, interferon-alpha, and isolated limb perfusion) for the control and treatment of cutaneous and subcutaneous neoplasms. The direct health costs were attributed a value according to the Italian National Healthcare System. Resource consumption and clinical outcomes were derived from cost survey data collection and literature review. ECT is cost-effective with an incremental cost effectiveness ratio (ICER) of euro1,571.53 to achieve a further additional response. Radiotherapy and interferon-alpha are the least effective strategies. A combination of hyperthermia, chemotherapy, radiotherapy, and interferon-alpha treatment are dominated by ECT (more costly and less effective). Isolated limb perfusion is the most effective treatment, but is very costly (euro18,530.47) because of the use of antiblastic drugs (TNFalpha), with an ICER of euro92,717.29. After sensitivity analysis, the study results confirm the favorable cost-effectiveness ratio of ECT with the Cliniporator and justify its wider use.

Costs and cost-effectiveness of the nursing programme ‘Coping with itch’ for patients with chronic pruritic skin disease

Itch, a major symptom of many skin diseases, has a great impact on quality of life. The nursing programme 'Coping with itch' aims at reducing itch and at helping patients to cope with itch. To explore costs and cost-effectiveness of the programme. A randomized controlled study was carried out with 56 patients. Data were gathered on medical consumption, days off work and the frequency of itching and scratching. Differences between both groups, the cost-effectiveness ratio and the percentage of patients falling into the four quadrants of the cost-effectiveness analysis plane were determined. The intervention group experienced a gain of 6 days with little itching [95% confidence interval (CI) -16-28] at 3 months and a gain of 35 days (95% CI -33-96) at 9 months. They paid more visits to the dermatology nurse than the control group. The point estimate of the incremental cost-effectiveness ratio was euro129.91 and euro16.60 per day with little itching at 3 months and at 9 months, respectively. At 3 months, 70% of the patients experienced favourable results and 14% of them had lower costs. At 9 months, 87% had favourable results and 31% of them had lower costs. Most of the expenses associated with the 'Coping with itch' programme were incurred during the first 3 months, but the benefits in terms of days with little itch appeared to persist and increase beyond 3 months, thus leading to a more favourable incremental cost-effectiveness ratio.