Long-term Markov Model Research Articles

Cost-effectiveness Analysis of the National Perinatal Hepatitis B Prevention Program

To analyze the cost-effectiveness of the national Perinatal Hepatitis B Prevention Program (PHBPP) over the lifetime of the 2009 US birth cohort and compare the costs and outcomes of the program to a scenario without PHBPP support. PHBPP's goals are to ensure all infants born to hepatitis B (HepB) surface antigen-positive women receive timely postexposure prophylaxis, complete HepB vaccine series, and obtain serologic testing after series completion. A decision analytic tree and a long-term Markov model represented the risk of perinatal and childhood infections under different prevention alternatives, and the long-term health and economic consequences of HepB infection. Outcome measures were the number of perinatal infections and childhood infections from infants born to HepB surface antigen-positive women, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost per QALY gained. The health outcomes and total costs of each strategy were compared incrementally. Costs were evaluated from the health care system perspective and expressed in US dollars at a 2010 price base. In all analyses, the PHBPP increased QALYs and led to higher reductions in the number of perinatal and childhood infections than no PHBPP, with a cost-effectiveness ratio of $2602 per QALY. In sensitivity analyses, the cost-effectiveness ratio was robust to variations in model inputs, and there were instances where the program was both more effective and cost saving. This study indicated that the current PHBPP represents a cost-effective use of resources, and ensuring the program reaches all pregnant women could present additional public health benefits.

SeHCAT [tauroselcholic (selenium-75) acid] for the investigation of bile acid malabsorption and measurement of bile acid pool loss: a systematic review and cost-effectiveness analysis

SeHCAT [tauroselcholic (selenium-75) acid] for the investigation of bile acid malabsorption and measurement of bile acid pool loss: a systematic review and cost-effectiveness analysis

PCV45 Long Term Cost-Effectiveness Analysis of Ticagrelor in Patients with Acute Coronary Syndromes From a Turkish Health Care Perspective Based on Data From the Plato Trial

The PLATO trial showed that in patients with acute coronary syndromes (ACS) treatment with ticagrelor compared with clopidogrel significantly reduced the rate of myocardial infarction, stroke, or death from vascular causes without a significant increase in the rate of overall major bleeding. The aim of this analysis is to estimate long-term cost-effectiveness of treating ACS patients with ticagrelor from a Turkish health care perspective. A two-part decision-analytic model, including a one-year decision tree and a long-term Markov model, was constructed to estimate lifetime costs, LYGs and QALYs of treating patients for one year with ticagrelor plus acetylsalicylic acid (ASA) compared with clopidogrel plus ASA. Event rates, health-care costs, and QALYs were estimated for the first year by using individual-patient data from PLATO. The cost was calculated by applying Turkish unit costs. For the second year onwards, necessary assumptions and external data sources were utilized to extrapolate quality-adjusted survival conditional on whether a non-fatal MI, a non-fatal stroke or no event occurred during the first year. Probabilistic ssensitivity analyses were performed. The willingness to pay threshold per QALY considered for the cost effectiveness analysis was 3 times GDP per capita. Ticagrelor was associated with life expectancy gains of 0.116 years primarily due to reduced rate of CV mortality and 0.101 additional QALYs and an incremental cost of 1662 TL compared to clopidogrel over a life time horizon.The incremental cost per life year and QALY gained were 14 297 TL and 16 415 TL respectively compared to clopidogrel. Probabilistic sensitivity analysis indicated > 99% probability of ticagrelor being cost-effective compared with clopidogrel at a willingness to pay of 52002 TL per QALY. Treating ACS patients with ticagrelor instead of clopidogrel for one year is cost-effective from the Turkish public health care perspective.

How best to handle the evidence in a cost-effectiveness analysis of TAVI in the UK

Methods A decision analytical model, incorporating a short–term decision tree and long-term Markov model were constructed. The use of Monte Carlo simulation and Value of Information analysis enables both the cost-effectiveness of TAVI to be estimated, based on the existing information, and the value of, and requirements for, further evidence collection to be determined. The model allows for the heterogeneous patient population by considering different three patient risk cohorts (low, medium and high). Initially the model was populated using the best available literature; then updated when RCT results became available. However, the trial data did not fully reflect UK practice as such the model was updated with UK Registry data. Probabilistic analysis is undertaken at each stage and results are presented for the costeffectiveness and the value of undertaking further research.

Short-course adjuvant trastuzumab therapy in early stage breast cancer in Finland: Cost-effectiveness and value of information analysis based on the 5-year follow-up results of the FinHer Trial

Background. Trastuzumab is a standard treatment of HER2-positive early breast cancer in many countries, and it is usually given as a one year adjuvant treatment. However, its cost-effectiveness has not been assessed in Finland. The Finland Herceptin (FinHer) trial has compared a shorter 9-week treatment protocol against no trastuzumab with promising results. The aim of this study was to assess the potential cost-effectiveness of the 9-week treatment based on the recently published five-year follow-up results of the FinHer trial. Methods. An evaluation model of breast cancer treatment was constructed using fitted survival estimates and a long-term Markov model. The cost-effectiveness of 9-week adjuvant treatment was assessed in a Finnish setting, compared to treatment without trastuzumab. The analysis was performed from a societal perspective, and a 3% discount rate was applied for future costs and outcomes. Value of information analysis was performed to estimate the potential value of further research. Results. According to the probabilistic analysis, the incremental cost-effectiveness ratio was €12 000 per quality adjusted life year (QALY), and €9300 per life year gained (LYG), when comparing adjuvant trastuzumab therapy to standard treatment without trastuzumab. The modelled incremental outcomes for trastuzumab treatment were 0.66 QALY and 0.85 LYG for a lifetime perspective. Value of information analysis showed that additional research on treatment effects would be most valuable for reducing uncertainty in the adoption decision. Conclusions. Adjuvant 9-week trastuzumab is likely to be a cost-effective treatment in the Finnish setting. Results from an ongoing trial comparing adjuvant 9-week treatment with the 12-month treatment will play a key role in addressing the uncertainty related to the treatment effect and potential cost-effectiveness of these two treatment protocols.