Healthcare Payer Research Articles

Effect of perceived injustice-targeted pain neuroscience education compared with biomedically focused education in breast cancer survivors: a study protocol for a multicentre randomised controlled trial (BCS-PI trial)

IntroductionCurrent treatments for pain in breast cancer survivors (BCSs) are mostly biomedically focused rather than biopsychosocially driven. However, 22% of BCSs with pain are experiencing perceived injustice, which is a...

Cost-Utility of an Exercise Referral Scheme Versus Doing Nothing in Flemish Adults: Exploring the Impact of Key Assumptions.

This health-economic evaluation assessed the cost-effectiveness of an exercise referral scheme (ERS) versus doing nothing in the Flemish region (Belgium), with a particular focus on the impact of several scenarios. A 14-state Markov model was applied to compare the expected costs and quality-adjusted life years (QALYs) of 2 alternatives: the Flemish ERS (2019 data, mean age 52y, 69.1% women) and doing nothing. A health care payer perspective was adopted and a lifetime time horizon was applied. A set of 18 scenario analyses is presented. In addition, univariate and probabilistic sensitivity analyses were performed. Under the assumptions selected for the base-case analysis, the Flemish ERS is moderately cost-effective compared with doing nothing, with an incremental cost-utility ratio of €28,609/QALY. Based on the scenario analyses, the results largely depend on the assumptions regarding the continuation of the intervention effect and the frequency with which the intervention is repeated. The greatest health gains can be made when a sustainable behavioral change is achieved among participants. The probabilistic sensitivity analysis confirmed that the cost-effectiveness results were not robust. If it is possible to induce a sustainable behavioral change with an intervention delivered at 2- or 5-year intervals, then the Flemish ERS is potentially cost-effective compared with doing nothing (given a €40,000/QALY threshold). These results suggest the importance of repeated implementation of the program together with careful monitoring of the adherence and the sustainability of the observed effects in a real-world setting.

Trends of Hepatocellular Carcinoma (HCC) Inpatients Mortality and Financial Burden From 2011 to 2017: A Nationwide Analysis.

Liver cancer, including Hepatocellular carcinoma (HCC) is the seventh most common tumor worldwide. Previously, the financial burden of HCC in the United States between 2002 and 2011 was noted to be continuously increasing. This study aims to evaluate temporal trends of hospitalizations due to HCC. This is a retrospective analysis utilizing the National Inpatient Sample (NIS) database. All subjects admitted between 2011 and 2017 with a diagnosis of HCC were identified. The primary trend characteristics were in-hospital mortality, hospital charges, and length of stay. An increase in hospitalization from 67,779 (0.18%) admissions in 2011 to 84,580 (0.23%) admissions in 2017(P<0.05) was noted. Most patients were 45 to 64 years old (median 50%), predominantly men (median 68%) (P<0.05). The primary health care payer was Medicare (Median 49%) and Medicaid (Median 18%) (P<0.05). The most common geographical location was the south (Median 36%) (P<0.05). Most patients were admitted to large hospitals (Median 62%) in urban areas (P<0.05). The median inpatient mortality was estimated to be 9% in 2017 (P<0.05), which has decreased from 10%(P<0.05) in 2011. The total charges per admission have increased steadily from $58,406 in 2011 to $78,791 in 2017 (P<0.05). The median length of stay has increased from 5.79 (SD 6.93) in 2011 to 6.07 (SD 8.3) in 2017(P<0.05). The most common mortality risk factor was sepsis, Acute renal failure, and GI hemorrhage. HCC-related admissions continue to be on the rise. HCC mortality has decreased across the years with earlier diagnoses and advances in therapy. However, we observed a significant increase in financial burden on health care with increasing in-hospital costs, a finding that needs to be verified in prospective trials.

Pharmacological class effects of anticancer drugs: opportunities for decreasing healthcare spending

In the field of general medicine, class effects, or therapeutic interchangeability, have been declared for several families of drugs including statins, calcium channel blockers and ACE inhibitors. The existence of...

Cost-effectiveness of l-glutamine versus crizanlizumab for adults with sickle cell disease: model focused on reducing pain episode costs from Qatar's healthcare perspective.

Treatment options for preventing vaso-occlusive crises among sickle cell disease patients are on the rise, especially if hydroxyurea treatment has failed. This economic analysis is conducted to assess the comparative clinical effectiveness, safety, and acquisition cost of l-glutamine and crizanlizumab for older adolescents and adults (⩾16 years old) with sickle cell disease in Qatar, with an emphasis on treatment costs and acute pain crises. We conduct a decision-tree model, where we compare the clinical and economic outcomes of two novel Food and drug administration (FDA)-approved medications which are available in Qatar; l-glutamine and crizanlizumab over a time horizon of 1 year in a hypothetical cohort of adult sickle cell disease patients from a Qatar healthcare perspective. The main outcome is incremental cost per sickle cell disease-related acute pain crises averted. Model clinical parameters were derived from individual drug randomized trials, published literature, whereas cost parameters from Qatar healthcare payer system (2020-2021). A sensitivity analysis was carried out, and the study results were robust around model inputs. Costs were converted to 2020 US dollars. Study results showed that both treatment modalities' costs were the main driver of this analysis, with an average annual cost of the treatments per patient being $189,014 for crizanlizumab (5 mg/kg), $143,798 for crizanlizumab (2.5 mg/kg), and $74,323 for l-glutamine. The probability of no first-time sickle cell disease-related vaso-occlusive crises averted was 0.001/year for glutamine, 0.26/year for crizanlizumab (5 mg/kg), and 0.34/year for crizanlizumab (2.5 mg/kg). Lower dose crizanlizumab (2.5 mg/kg) dominated the higher one (5 mg/kg). The incremental cost-effectiveness ratio of crizanlizumab (2.5 mg/kg), when compared to l-glutamine was $81,265 per sickle cell disease-related vaso-occlusive crises averted. When comparing crizanlizumab (5 mg/kg) and l-glutamine, crizanlizumab (5 mg/kg) showed higher efficacy, yet the crizanlizumab incremental cost-effectiveness ratio was at $459,620 than l-glutamine. Crizanlizumab (2.5 mg/kg) may be a cost-effective intervention, yet it is not the approved dose for preventing vaso-occlusive crises in adolescents and adults with sickle cell disease. Crizanlizumab (5 mg/kg) was more cost-effective than the approved l-glutamine per sickle cell disease vaso-occlusive crisis prevented. Of note, we primarily focused on modeling acute vaso-occlusive pain, which limited our ability to consider other key outcomes in sickle cell disease.

Empirical antibiotics versus definitive antibiotics for Sepsis patients in Indonesia: A cost-effectiveness analysis

Sepsis is a life-threatening issue worldwide. Antibiotics, including antibiotic treatment (ET) and culture-based treatment (CBT), are crucial therapies for sepsis treatment. However, there is insufficient evidence to compare their cost-effectiveness in Indonesia. This study evaluates the cost-effectiveness of these two antibiotic approaches in Indonesian patients. A decision-tree model was developed from a healthcare payer perspective, with a 1-year time horizon. The Incremental Cost-Effectiveness Ratio (ICER), i.e., the incremental cost per death averted, was estimated to compare the cost-effectiveness between two interventions. The willingness-to-pay threshold (WTP) was one to three times the gross domestic product (GDP) per capita (1 GDP per capital: IDR 72,333,083 [US$ 4,788]). One-way and probability sensitivity analyses were performed to assess the robustness of our findings. In base-case analysis, CBT prevented 347 patient deaths compared to ET, incurring an additional cost of IDR 8,873,397,000 (US$ 588,000) with an ICER of IDR 25,571,749 (US$ 1,693) per death averted. The probability of CBT being cost-effective was 72%–80% using the one- and three-times GDP per capita threshold, respectively. Utilizing the CBT for sepsis treatment is cost-effective compared with the ET. These findings can support clinicians and policymakers in facilitating the use of CBT in sepsis treatment in Indonesia.

Cost-effectiveness analysis of 11 pharmacotherapies for recurrent glioblastoma in the USA and China.

Several studies have systematically assessed the efficacy and safety of progressive or recurrent glioblastoma multiforme (GBM). However, the discernible limitations of efficacy and the elevated costs of interventions instigate an investigation into the cost-effectiveness of these treatments. This study aimed to evaluate cost-effectivenesses of 11 pharmacotherapeutic interventions for recurrent GBM from the perspective of healthcare payers in the United States (US) and China. A model-based pharmacoeconomic evaluation. A partitioned survival model was employed to evaluate the cost-effectiveness of 11 distinct drug-based treatments. The clinical efficacy and safety data were obtained from a network meta-analysis, while the medical expenditure and health utility were primarily derived from published literature. One-way sensitivity analyses, scenario analyses, and probabilistic sensitivity analyses (PSA) were performed to scrutinize the impact of potential uncertainties to ensure the robustness of the model. The primary endpoint was the incremental cost-effectiveness ratio. Among the therapeutic interventions evaluated, lomustine emerged as the cheapest option, with costs amounting to $78,998 in the United States and $30,231 in China, respectively. Regorafenib displayed the highest quality-adjusted life years at 0.475 in the United States and 0.465 in China. The one-way sensitivity analyses underscored that drug price was a key factor influencing cost-effectiveness. Both scenario and PSA consistently demonstrated that, considering the willingness-to-pay thresholds, lomustine was a cost-effective treatment with probability of more than 94%. In comparison to the alternative antitumor agents, lomustine was likely to be a cost-effective option for relapsed GBM patients from the perspective of healthcare payers in both the United States and China.

Carrot Health: digitizing health care through consumer analytics

Theoretical basis The case is designed to be used with the digital business model framework developed by Peter Weill and Stephanie Woerner of Massachusetts Institute of Technology (MIT) (Weill and Woerner, 2015) and is referred to as the W &amp; W framework. This approach provides a useful structure for thinking through the strategic options facing environments ripe for digital transformation. Research methodology Research for this case was conducted through face-to-face interviews with the protagonist, as well as through a review of their business planning documents and other data and documentation provided by the founder. Some of the market and industry data were obtained using secondary research and industry reports. Interviews were digitally recorded and transcribed to ensure accuracy. Case overview/synopsis The case follows the story of Kurt Waltenbaugh, a Minnesota entrepreneur who shared the dream of using data analytics to reduce costs within the US health-care system. In early 2014, Waltenbaugh and a physician colleague founded Carrot Health to bring together their personal experience and expertise in both consumer data analytics and health care. From the beginning, they focused on how to use data analytics to help identify high-risk/high-cost patients who had not yet sought medical treatment. They believed that they could use these insights to encourage early medical interventions and, as a result, lower the long-term cost of care. Carrot’s initial success found them in a consultative role, working on behalf of insurance companies. Through this work, they honed their capabilities by helping their clients combine existing claims data with external consumer behavioral data to identify new potential customers. These initial consulting contracts gave Carrot the opportunity to develop its analytic tools, business model and, importantly, to earn some much-needed cash flow during the start-up phase. However, they also learned that, while insurance companies were willing to purchase data insights for one-off market expansion projects, it was much more difficult to motivate them to use data proactively to eliminate costs on an ongoing basis. Waltenbaugh believed that Carrot’s greatest potential lay in their ability to develop predictive models of health outcomes, and this case explores Carrot’s journey through strategic decisions and company transformation. Complexity academic level This case is intended for either an undergraduate or graduate course on entrepreneurial strategy. It provides an effective introduction to the unique structure and constraints which apply to an innovative start-up within the health-care industry. The case also serves as a platform to explore the critical criteria to be considered when developing a digital transformation strategy and exposing students to the digital business model developed by Weill and Woerner (2015) at MIT (referred to in this instructor’s manual as the W&amp;W framework). The case was written to be used in an advanced strategy Master of Business Administration (MBA) class, an undergraduate specialty health-care course or as part of a health-care concentration in a regular MBA, Master of Health Care Administration (MHA) or Master of Public Health (MPH). It may be taught toward the end of a course on business strategy when students are building on generic strategy frameworks and adapting their strategic thinking to the characteristics of specific industries or sectors. However, the case can also be taught as part of a course on health-care innovation in which case it also serves well as an introduction to the health-care payments and insurance system in the USA. Finally, the case can be used in a specialized course on digital transformation strategy in which case it serves as an introduction to the MIT W&amp;W framework. The case is particularly well-suited to students who are familiar with traditional frameworks for business strategy and business models. The analysis builds on this knowledge and introduces students interested in learning about the opportunities and challenges of digital strategy. Equally, the case works well for students with clinical backgrounds, who are interested in how business strategy can influence changes within the health-care sphere. Finally, an important aspect of the case design was to develop students’ analytical confidence by encouraging them to “get their hands dirty” and to carry out some basic exploratory data analytics themselves. As such, the case requires students to combine and correlate data and to experience the potentially powerful combination of clinical and consumer data. Instructors should find that the insights from these activities give students unique insights into the potential for of data analytics to move health care from a reactive/treatment ethos to a proactive/intervention ethos. This experience can be particularly revealing for students with clinical backgrounds who may initially be resistant to the use of clinical data by commercial organizations.

Analysis of health outcomes in acute myocardial infarction: A value-based healthcare approach

Introduction: Understanding the impact of value-based healthcare and various healthcare payment models on the health outcomes of patients with acute myocardial infarction (AMI) is pivotal for guiding clinical strategies and decisions. Objective: To compare health outcomes and costs associated with healthcare for AMI patients under insurance prospective global payment (PGP) and fee-for-service models. Materials and Methods: A retrospective cohort study encompassing AMI patients was conducted from 2021-2023. Convenience sampling of participants over 18 years of age diagnosed with type 2 myocardial infarction was conducted. Analysis was based on Colombian healthcare system payment models: PGP and fee-for-service. Results: The study involved 2134 patients, 657 (31%) under PGP and 1477 (69%) under fee-for-service. Length of hospital stay was associated with the payment model (coefficient -0.68, CI 95%: 0.40 to 0.98, p=0.037). Payment models also correlated with costs (845 USD, CI 95%: 87.92 to 1601; p=0.02 ). In-hospital mortality is not associated with either of the two contracting models. Quality-adjusted life years (QALYs) totaled 1.6 over a 2-year follow-up. Discussion: It is evident that throughout the care cycle at the Center of Excellence for Acute Myocardial Infarction, there is added value for patients with the PGP model, as the costs are lower and health outcomes comparable to the fee-for-service model. Conclusions: The findings of this study underscore the importance of understanding the relationship between value-based healthcare, different healthcare payment models, and health outcomes in AMI patients.

Establishing Platform Engineering Paradigms: Unleashing a DevOps Metamorphosis

This paper presents a high-level overview of a company’s initiative to transform into a 'DevOps' organization, particularly focusing on the establishment of a Platform Engineering Group. In response to evolving industry dynamics, HealthEdge, a provider of healthcare payor software, embarked on a journey in 2018 to embrace DevOps principles. The Platform Engineering Group undertook the ambitious task of modernizing an antiquated technology stack, transitioning towards a contemporary, Software-as-a-Service (SaaS) paradigm. The article delves into the goals of reshaping an engineering focused organization and navigating the complexities of transitioning a flexible software stack into a self-serving, efficient, and scalable technological framework. While acknowledging the inherent variability in the implementation of such models, the article offers a simplified yet insightful perspective on HealthEdge's approach to addressing specific challenges in their DevOps transformation. Importantly, the paper emphasizes that the presented process/model is based on practical experiences and acquired knowledge rather than being an invented or rigidly adhered-to framework.

How the Creation of Healthcare Preparedness Measures Can Improve Community Medicine: The Link Between Healthcare Payment Policy and Disaster Preparedness

The Covid-19 pandemic highlighted the need to better understand the relationship between value-based payment programs and hospital disaster preparedness

The Current State and Growth Potential of Voluntary Health Insurance Market in Russia

In the article the authors consider the current state of voluntary health insurance (VHI) in Russia and assess the factors of influence its further development using general theoretical and statistical methods. Significant influence of the corporate sector on the VHI market was substantiated. It has been found that VHI, being a market product, depends significantly on demand and supply. In particular, VHI depends from the solvency of insured persons and inflation fluctuations where the increase in the cost of paid health care is of particular importance. Years of pandemics and geopolitical phenomena in Russia affected the incomes of citizens and businesses (especially for outbound tourism). This mirrored the losses and slow growth of the Russian VHI market. The decline in insurance premiums in the corporate sector on the VHI market significantly aggravates the position of this segment in the personal insurance market. Improving the insurance culture, affordability of VHI and stimulation of demand (incl. in the form of tax credits) remains a pressing issue, as the market has potential. Population welfare, insurance culture, availability and quality of insurance protection become starting points for the emerging VHI market in Russia.

Integrated health and social care with a CALD focus: a service mapping study in Sydney Metropolitan

Background: Underrepresented and underserved communities such as culturally and linguistically diverse (CALD) groups experience higher reported prevalence and severity of multimorbidity along with unmet social needs and disadvantages in accessing services. Minority populations report higher rates of emergency department presentations globally and nationally and it is understood that services are more frequently accessed on consumer initiative when problems become acute and critical, demonstrating significant barriers for early intervention. In Australia, most of the efforts to reduce over-utilisation of emergency care have focused on developing integrated health and social care approaches for the general population. There is little evidence available on how CALD populations are involved in the design and implementation of integrated care health and social care initiatives and how their needs are identified and addressed.&#x0D; Methods: A service mapping study informing the development of a framework for comparative analysis of integrated health and social care services targeting CALD populations will be sought. Semi-structured interviews, with key stakeholders and decision-makers representing health and social services, as well as document review, will inform the development of a map of integrated health and social care services available for individuals from culturally and linguistically diverse backgrounds. Core defining elements of the mapped services comprise the basis for the framework that enables comparison of level of integration with a CALD focus, including governance and partnerships, health and social care staff, financing and payment systems, and data sharing and use. &#x0D; Implications: This study will advance the understanding of how integrated health and social care policies (policy learning) and services are conceptualised, developed, and implemented at a local level (policy implementation) to address the needs of CALD populations. and how they can better respond to the health and social needs of CALD consumers.

Administrative action on drug pricing: Lessons and opportunities for the Center for Medicare and Medicaid Innovation.

In October 2022, the Biden administration issued an executive order to the Center for Medicare and Medicaid Innovation (CMMI) to develop new health care payment and delivery models to lower prescription drug costs and promote access to innovative therapies. In response, the agency proposed 3 novel drug payment models for testing. To understand the impact that CMMI demonstration projects can have on the prescription drug market. We examined each of the models listed on the CMMI website and searched the Federal Register and news articles for additional models that contained interventions related to patient out-of-pocket drug costs, Medicare drug spending, or Medicaid drug spending. We excluded models with indirect effects on drug costs (for example, bundled payments). We comprehensively reviewed all previous cases in which CMMI has attempted models addressing prescription drug costs and spending and evaluated the circumstances, impact, and lessons learned that may aid policymakers in the design and implementation of new models. We identified 9 CMMI models containing direct interventions related to drug costs. Among prior models addressing drug prices, nearly half (44%, 4/9) were not implemented because of their scope, voluntary nature, and procedural challenges. No implemented models met the CMMI standard for expansion, although key elements of the Senior Savings model limiting monthly insulin costs to $35 were later incorporated into the Inflation Reduction Act. In future CMMI implementation efforts, we suggest maximizing voluntary collaboration when selection bias concerns are minimal, using mandatory models when not, ensuring that the geographic scope is not overly ambitious, and adhering closely to statutory authority and established administrative procedure to minimize legal challenges and maximize model demonstration utility.

Addressing Social Needs in Clinical Settings: Implementation and Impact on Health Care Utilization, Costs, and Integration of Care.

In recent years, health care policy makers have focused increasingly on addressing social drivers of health as a strategy for improving health and health equity. Impacts of social, economic, and environmental conditions on health are well established. However, less is known about the implementation and impact of approaches used by health care providers and payers to address social drivers of health in clinical settings. This article reviews current efforts by US health care organizations and public payers such as Medicaid and Medicare to address social drivers of health at the individual and community levels. We summarize the limited available evidence regarding intervention impacts on health care utilization, costs, and integration of care and identify key lessons learned from current implementation efforts.

RESPONDING TO THE HEALTH CARE ENVIRONMENT: DEVELOPMENT OF CBO NETWORKS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH

Abstract AAAs, with their wide array of community partnerships and ability to respond to local needs and context, are an important connection between social and health care. Recent research describes the impact of AAA services and partnerships on population health, and AAAs are increasingly contracting with health care systems and payers to provide a variety of supportive services that enable older adults to live at home and in the community. To better meet the needs of health care partners, and to maximize their service reach and impact, AAAs and other community-based organizations (CBOs) are increasingly forming networks to contract with health care entities. Data from the 2021 CBO-Health Care Contracting Survey shows that 44 percent of AAAs are part of a network that provides contracted services to health care entities, but little is known about how these networks are formed and sustained. Findings from a new qualitative study on CBO networks, which consisted of 23 semi-structured interviews with network leads (also known as community hubs) and member organizations, describe how AAAs and other CBOs are developing networks and contracting with health care entities. This session will share findings from the qualitative study to describe the opportunities and ongoing challenges of network participation. Networks allow CBOs to serve more people and contract with health care partners to provide integrated care, but ongoing challenges include lack of data infrastructure and financial viability for members that may have fewer clients to serve. This session will also discuss the policy implications of these findings.

THE INTERSECTION OF SOCIAL DETERMINANTS OF HEALTH AND FAMILY CARE OF PEOPLE LIVING WITH DEMENTIA

Abstract In this presentation, we will synthesize current research to illustrate the intersection of social determinants of health (SDOHs) and Alzheimer’s disease and related dementia (ADRD) caregiving, and outline how public health can support ADRD family caregivers in the U.S. There is an abundance of research that demonstrates family caregivers of relatives living with ADRD experience adverse health outcomes. In addition, family care for persons with ADRD overlaps with SDOHs. Public health actions such as improved surveillance and identification of ADRD caregivers; building and enhancing community partnerships; advancing dementia-capable health care and related payment incentives; and reducing the stigma of dementia and ADRD caregiving can enhance support and services for families. By engaging in these actions, public health practitioners could more effectively address the myriad of challenges facing ADRD caregivers most at risk for emotional, social, financial, psychological, and health disruption.

CONDUCTING A COUNTYWIDE ALZHEIMER’S DISEASE AND RELATED DEMENTIAS CAREGIVER LANDSCAPE ANALYSIS

Abstract In Los Angeles County (LAC), approximately 1 in 5 caregivers provide care to older adults with dementia and cognitive impairment. By 2040, a projected 1.5 million Californians will be living with Alzheimer’s disease and related dementias, foreshadowing an unprecedented need for family caregivers across the state. In 2021, the LAC Department of Public Health launched the Centers for Disease Control and Prevention-funded LA BOLD initiative with the intent of developing a strategic plan to address dementia awareness and care in LAC, including improving local infrastructure for supporting unpaid family caregivers. To support this effort, LA BOLD commissioned the University of Southern California Family Caregiver Support Center to conduct a landscape analysis of the caregiver population in LAC. The analysis used a multi-method approach that included: primary analysis of community-based organization surveys, stakeholder interviews, focus groups with family caregivers, and secondary analyses of California Health Interview Survey and California Caregiver Resource Center System CareNav™ data and an environmental scan of best-practice caregiving models in use in other states. Results informed the development of three functional recommendations specific to LAC caregivers: 1) Leverage existing infrastructure to strengthen and build family caregiver services and supports; 2) Promote health care payer, provider, and system recognition of and support for family caregivers; and 3) Increase respite services for caregivers. This presentation highlights the methods and the findings from the landscape analysis, providing insights into the barriers and opportunities that a growing caregiver population of persons with dementia may pose to LAC.

Cost-effectiveness analysis of intravascular ultrasound-guided peripheral vascular interventions in patients with femoropopliteal peripheral artery disease.

Background: Intravascular ultrasound (IVUS)-guided percutaneous transluminal angioplasty (PTA) might offer clinical benefits compared to angiography-guided PTA in patients with peripheral artery disease (PAD). A cost-effectiveness model was developed to examine the benefits and costs of IVUS-guided PTA versus angiography-guided PTA in PAD patients with femoropopliteal (FP) occlusive disease. Methods: A two-step model (a one-year decision tree followed by a lifetime semi-Markov model) was developed from a German healthcare payer perspective to estimate the costs and outcomes over a one-year and lifetime horizon. Clinical events included target lesion revascularization (TLR), amputation, and death. Transition probabilities and utility values were derived from published literature. Healthcare costs were based on German Diagnosis Related Groups (DRG) codes. Costs and outcomes were discounted at a rate of 3% per year. The incremental cost-effectiveness ratio (ICER) was calculated, and sensitivity analyses were performed to assess the robustness of the results. Results: In the one-year horizon, IVUS-guided PTA resulted in incremental quality-adjusted life-years (QALY) and costs of 0.02 and €919 per patient respectively, with a corresponding ICER of €45,195/QALY gained versus angiography-guided PTA. In the lifetime horizon, IVUS-guided PTA outperforms angiography-guided PTA; it was associated with a cost saving of €46 per patient and incremental QALY of 0.22. Utility value for post-TLR, as well as probabilities of death and TLR had the greatest impact on the one-year ICER, while cost of TLR and probabilities of TLR and amputation influenced the lifetime ICER most. The probability of IVUS-guided PTA being cost-effective at a willingness-to-pay (WTP) threshold of €50,000/QALY was 50.4% in the one-year horizon and increased to 85.9% in the lifetime horizon. Conclusions: In this analysis IVUS-guided PTA among patients with symptomatic FP atherosclerosis was cost-saving in a lifetime horizon from the German healthcare payer perspective.

Evaluating the cost utility of estradiol plus dydrogesterone for the treatment of menopausal women in China

AimEvaluate the cost utility of menopausal hormone therapy for women in China.Materials and methodsA bespoke Markov cost utility model was developed to evaluate a cohort of symptomatic perimenopausal women (>45 years) with intact uterus in China in accordance with China’s Pharmacoeconomic guideline. Short (5-year) and long (10-year) treatment durations were evaluated over a lifetime model time horizon with 12-month cycle duration. Societal and healthcare payer perspectives were evaluated in the context of a primary care provider/prescriber, outpatient setting with inpatient care for patients with chronic conditions. Disease risk and mortality parameters were derived from focused literature searches, and China Diagnosis-related Group cost data was included. Comprehensive scenario, univariate and probabilistic sensitivity analysis were undertaken along with independent validation. This is the first model to include MHT-related disease risks.ResultsAccording to base case results, the total cost for MHT was 22,516$ (150,106¥) and total quality adjusted life years 12.32 versus total cost of no MHT 30,824$ (205,495¥) and total quality adjusted life years 11.16 resulting in a dominant incremental cost effectiveness ratio of −7,184$ (−47,898¥) per QALY. Results hold true over a range of univariate deterministic sensitivity and scenario analyses. Probabilistic analysis showed a 91% probability of being cost effective at a willingness to pay threshold of three times Gross Domestic Product per capita in China.ConclusionContingent on the structure and assumptions of the model, combination of estradiol plus dydrogesterone MHT is potentially cost saving in symptomatic women over the age of 45 years in China.