Mean Cost-effectiveness Ratios Research Articles

Cost-effectiveness of bivalent respiratory syncytial virus prefusion F vaccine for prevention of respiratory syncytial virus among older adults in Germany

ABSTRACT Introduction Among older adults, lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) is common. We evaluated the cost-effectiveness of bivalent RSV prefusion F protein-based vaccine (RSVpreF) for prevention of RSV-LRTI among older adults in Germany. Research design and methods A static cohort model was developed to estimate lifetime health and economic outcomes of RSV-LRTI among adults aged 60–99 years in Germany, with (vs. without) use of RSVpreF. Vaccine uptake ranged from 27% to 54%. Vaccine effectiveness was derived from trial data and was assumed to last over 3 years, with some waning, following vaccination. Base case analyses were conducted from the societal perspective (costs/benefits discounted 3% annually); sensitivity analyses also were conducted. Results Among adults aged 60–99 years (N = 25.3 M), RSVpreF prevented 117,360 cases of hospitalized RSV-LRTI, 100,433 cases of ambulatory RSV-LRTI, and 9,298 RSV-LRTI-related deaths over a lifetime horizon. With total overall costs higher by 1.8 € billion and 49,576 quality-adjusted life-years (QALYs) gained, cost-effectiveness of RSVpreF was 36,064 €/QALY. In probabilistic sensitivity analyses, the mean cost-effectiveness ratio was 36,518 €/QALY; 925 of 1,000 replications yielded ratios <50,000 €/QALY. Conclusions RSVpreF has the potential to greatly reduce the public health and economic burden of RSV among older adults in Germany.

Money Well Spent? The Cost-Effectiveness of a Texting Intervention Targeting College Persistence

Past studies of texting interventions designed to promote college student persistence have given little attention to assessing both the fixed and variable costs of such initiatives. In addition, they typically have not assessed costs relative to the desired outcome(s). In this case study, we assessed the costs of implementing a text messaging program relative to persistence outcomes using a randomized field experiment in one college. The intervention’s cost per student was $18.76 and the cost per text was $0.85 per student. Mean cost-effectiveness ratios per student retained ranged from $1,312 to $750. Sensitivity analyses revealed increases in the number of students texted or gains in academic advisors’ efficiencies both contributed to sizable declines in the cost-effectiveness ratios. We conclude the texting intervention was cost-effective relative to other published interventions that have targeted college persistence.

Cost-effectiveness analysis of pharmaceutical care for hypertensive patients from the perspective of the public health system in Brazil.

IntroductionOnly 20% of patients with systemic arterial hypertension (SAH) have blood pressure within recommended parameters. SAH has been the main risk factor for morbidity and mortality of cardiovascular diseases, which affects the burden of the Public Health System (PHS). Some studies have shown the effectiveness of Pharmaceutical Care (PC) in the care of hypertensive patients.ObjectiveTo perform a cost-effectiveness analysis to compare SAH treatment with PC management and conventional treatment for hypertensive patients offered by the PHS.MethodsA cost-effectiveness study nested to a quasi-experimental study was conducted, in which 104 hypertensive patients were followed up in a PC program. Blood pressure control was considered as the outcome for the economic analysis and the costs were direct and non-direct medical costs.ResultsPC was dominant for two years in the post-PC period compared with the pre-PC year. The mean cost effectiveness ratio (CER) for the CERPre-PC, CERPC, and CERPost-PC periods were: US$ 364.65, US$ 415.39, and US$ 231.14 respectively. The incremental cost effectiveness ratio (ICER) analysis presented ICER of US$ 478.41 in the PC period and US$ 42.95 in the post PC period. Monte Carlo sensitivity analysis presented mean ICERPC and ICERPost-PC equal to US$ 605.09 and US$ 128.03, reaching US$ 1,725.00 and US$ 740.00 respectively.ConclusionEven for the highest ICER, the values were below the cost effectiveness threshold, which means that PC was a cost effective strategy for the care of hypertensive patients in the PHS.

Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations

Objective To quantify the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide.Design Global modeling study.Setting 183 countries.Population...

The cost effectiveness of vacuum-assisted versus core-needle versus surgical biopsy of breast lesions

ObjectivesTo determine the cost effectiveness of breast biopsy by 9G vacuum-assisted guided by vertical stereotaxy or ultrasonography in comparison with breast biopsy by 14G core-needle biopsy and surgical biopsy. Material and methodsWe analyzed a total of 997 biopsies (181 vacuum-assisted, 626 core, and 190 surgical biopsies). We calculated the total costs (indirect and direct) of the three types of biopsy. We did not calculate intangible costs. We measured the percentage of correct diagnoses obtained with each technique. To identify the most cost-effective option, we calculated the mean ratios for the three types of biopsies. ResultsTotal costs amounted to €225.09 for core biopsy, €638.90 for vacuum-assisted biopsy, and €1780.01 for surgical biopsy. The overall percentage of correct diagnoses was 91.81 per cent for core biopsy, 94.03 per cent for vacuum-assisted biopsy, and 100 per cent for surgical biopsy; however, these differences did not reach statistical significance (P=0.3485). For microcalcifications, the percentage of correct diagnoses was 50 per cent for core biopsy and 96.77 per cent for vacuum-assisted biopsy (P<0.0001). For nodules, there were no significant differences among techniques. The mean cost-effectiveness ratio considering all lesions was 2.45 for core biopsy, 6.79 for vacuum-assisted biopsy, and 17.80 for surgical biopsy. ConclusionCore biopsy was the dominant option for the diagnosis of suspicious breast lesions in general. However, in cases with microcalcifications, the low percentage of correct diagnoses achieved by core biopsy (50 per cent) advises against its use in this context, where vacuum-assisted biopsy would be the technique of choice because it is more cost-effective than surgical biopsy, the other technique indicated for biopsying microcalcifications.

Estudio de costo-efectividad de la biopsia mamaria asistida por vacío versus biopsia con aguja gruesa o arpón

ObjectivesTo determine the cost effectiveness of breast biopsy by 9G vacuum-assisted guided by vertical stereotaxy or ultrasonography in comparison with breast biopsy by 14G core-needle biopsy and surgical biopsy. Material and methodsWe analyzed a total of 997 biopsies (181 vacuum-assisted, 626 core, and 190 surgical biopsies). We calculated the total costs (indirect and direct) of the three types of biopsy. We did not calculate intangible costs. We measured the percentage of correct diagnoses obtained with each technique. To identify the most cost-effective option, we calculated the mean ratios for the three types of biopsies. ResultsTotal costs were €225.09 for core biopsy, €638.90 for vacuum-assisted biopsy, and €1780.01 for surgical biopsy. The overall percentage of correct diagnoses was 91.81% for core biopsy, 94.03% for vacuum-assisted biopsy, and 100% for surgical biopsy; however, these differences did not reach statistical significance (p=0.3485). For microcalcifications, the percentage of correct diagnoses was 50% for core biopsy and 96.77% for vacuum-assisted biopsy (p<0.0001). For nodules, there were no significant differences among techniques. The mean cost-effectiveness ratio considering all lesions was 2.45 for core biopsy, 6.79 for vacuum-assisted biopsy, and 17.80 for surgical biopsy. ConclusionCore biopsy was the dominant option for the diagnosis of suspicious breast lesions in general. However, in cases with microcalcifications, the low percentage of correct diagnoses achieved by core biopsy (50%) advises against its use in this context, where vacuum-assisted biopsy would be the technique of choice because it is more cost-effective than surgical biopsy, the other technique indicated for biopsying microcalcifications.

Análisis de costo-efectividad de panitumumab + FOLFOX en CCRm RAS-WT

ObjectiveTo conduct a cost-effectiveness analysis of panitumumab+FOLFOX vs. bevacizumab+FOLFOX as first-line therapy in RAS-WT mCRC patients. MethodUsing a Markov model, a hypothetical cohort of patients was assessed throughout seven health stages in two-week transition cycles. Progression-free survival (PFS) and overall survival (OS) were taken from the PEAK trial. The use of resources was obtained from a panel of five oncologists at four public hospitals. The costs include chemotherapy, follow-up, adverse events, metastases resection, second-line therapy, palliative care, and funeral expenses. IMSS’ costs were applied, with costs and benefits discounted at 5% for a 5-year time line. A cost-minimisation analysis vs. cetuximab was performed due to the OS equivalence according to the ASPECCT trial and similar PFS and OS results as first-line in RAS-WT populations. ResultsTotal costs are $1,048,009.42 for panitumumab and $872,201.70 for bevacizumab with a mean of 3.47 and 2.80 years of life, and a mean cost-effectiveness ratio per month of OS of $25,173 and $25,932, respectively. The 10-month projection for anti-EGFR therapies reveals a total cost of $779,873.60 for panitumumab and $1,119,871.90 for cetuximab, which represents savings of $339,998.30 (30.4%) per patient. ConclusionsPanitumumab as first-line treatment improves clinical parameters in RAS-WT mCRC patients and has a mean cost-effectiveness ratio similar to bevacizumab in this population. Compared to cetuximab, panitumumab represents a cost-saving strategy for public healthcare institutions in Mexico.

PCN92 - Cost effectiveness Analysis of Panitumumab + Folfox As 1st Line of Treatment of Mcrc Ras-Wt

To perform a cost-effectiveness analysis of Panitumumab+FOLFOX vs Bevacizumab+FOLFOX as first-line treatment on RAS-WT mCRC patients from the Mexican public healthcare system perspective. METHODS: The evaluation was performed using a Markov model that simulates a hypothetical cohort of patients over seven health-stages in two-week transition cycles. Progression-free survival (PFS) and overall survival (OS) were used as reported in the PEAK trial. Resource use was obtained from five oncologists at four public healthcare institutions. Costs include chemotherapy, follow-up, adverse events, metastasis resection, second-line treatment, palliative care, and funeral costs. Mexican Social Security Institute costs were applied. Costs and benefits are discounted at 5% for a 10-year time line. Additionally, a cost-minimization vs Cetuximab was performed due to equivalence in OS described in the ASPECCT trial and similar values of PFS and OS reported in first line for comparable populations. The total costs are $1,048,009.42 for Panitumumab (mean life of 3.47 years), and $872,201.70 for Bevacizumab (mean life of 2.80 years), with a mean cost-effectiveness ratio per month of OS of $25.173 and $25.932, respectively. The 10-month projection for anti-EGFR therapies reveals a total cost of $779,873.60 for Panitumumab and $1,119,871.90 for Cetuximab, which represents savings of $339,998.30 (30.4%) per patient. Panitumumab as first-line treatment improves the clinical parameters of RAS-WT mCRC patients and presents a mean cost-effectiveness ratio similar to Bevacizumab in this population. Regarding to Cetuximab, Panitumumab is a cost-saving strategy, with reduction in total costs of treatment and administration for public healthcare institutions in Mexico.

Cost-effectiveness modelling of percutaneous coronary interventions in stable coronary artery disease.

The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents (DES) vs bare metal stent (BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years (60% of success) when compared to BMS (58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs (P < 0.05) per success for the BMS strategy (15520 €/success), as compared to the DES strategy (15588 €/success). Incremental cost-effectiveness ratio is 18850 € for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available.

Cost‐effectiveness of a nurse‐led education and psychosocial programme for patients with chronic heart failure and their partners

This randomised controlled trial was conducted to estimate the cost-effectiveness of a nurse-led education and psychosocial support programme for patients with heart failure (HF) and their partners. There are few studies evaluating cost-effectiveness of interventions among HF patient-partner dyads. Dyads randomised to the experimental group received nurse-led counselling, computer-based education and written materials aimed at developing problem-solving skills at two, six and 12 weeks after hospitalisation with HF exacerbation. The dyads in the control group received usual care. A cost-effectiveness analysis that included costs associated with staff time to deliver the intervention and travel costs was conducted at 12 months. Quality-adjusted life-year (QALY) weights for patients and partners were estimated by SF-6D. A total of 155 dyads were included. The intervention cost was €223 per patient. Participants in both groups showed improvements in QALY weights after 12 months. However, no significant difference in QALY weights was found between the patients in the two groups, nor among their partners. The intervention was not proven cost-effective, neither for patients nor for partners. The intervention, however, had trends (but not significant) effects on the patient-partner dyads, and by analysing the QALY gained from the dyad, a reasonable mean cost-effectiveness ratio was achieved. The study shows trends of a cost-effective education and psychosocial care of HF patient-partner dyads.

Impact of vaccinating boys and men against HPV in the United States

We assessed the public health impact and value of vaccinating boys and men with the quadrivalent HPV vaccine in the United States. We used mathematical population models, accounting for both the direct and indirect protective effects of vaccination. Inputs for the models were obtained from public data sources, published literature, and analyses of clinical trial data. Compared with a program of vaccinating girls and women only, including boys and men 9–26 years of age would further decrease the cumulative mean number of genital wart cases, cervical intraepithelial neoplasia 2/3 cases, cancer cases, and cancer deaths by 5,146,000, 708,000, 116,000, and 40,000, respectively, within 100 years. The mean cost-effectiveness ratio (2008 US $) of this strategy was $25,700 (range: 13,600–48,800) per QALY gained if vaccination protects against all HPV 6/11/16/18-associated diseases, and $69,000 (range: 37,700–152,300)/QALY if it only protects against diseases currently in the vaccine indication. Vaccinating boys and men age 9–26 against all HPV 6/11/16/18-associated diseases provides substantial public health benefits and is cost-effective at commonly cited thresholds.

Cost-effectiveness modelling of biological treatment sequences in moderate to severe rheumatoid arthritis in France

Modern treatment of RA includes the use of biologics. Their cost is high and comparison between different treatment strategies is needed. Direct medical costs of RA in France were evaluated based on expert opinion. Then, simulation-decision analytical models were developed to assess four biologic treatment sequences over 2 years in patients failing to respond to at least one anti-TNF agent. Effectiveness was expressed in theoretical expected number of days (TEND) in remission or low disease activity [low disease activity score (LDAS)] based on DAS-28 scores. Direct medical costs of RA in France (excluding the cost of biologics) were estimated at euro 905 (s.d. 263) for 6 months and euro 696 (s.d. 240) for each subsequent 6 months (P < 0.001) for patients achieving LDAS and euro 1215 for 6 months (s.d. 405) for patients not achieving LDAS. Based on LDAS criteria, using abatacept after an inadequate response to the first anti-TNF agent (etanercept) appeared significantly (P < 0.01) more efficacious over a 2-year period (102 TEND) compared with using rituximab at a 6-month re-treatment interval (82 TEND). Mean cost-effectiveness ratios showed significantly lower costs (P < 0.01) per TEND with abatacept as second biologic agent (euro 278) compared with rituximab (euro 303). After an inadequate response to two anti-TNF agents, using abatacept also appeared significantly more efficacious than an anti-TNF agent (P < 0.01). All comparisons were confirmed when using remission criteria instead of LDAS. Advanced simulation models based on clinical evidence and medical practice appear to be a promising approach for comparing cost-effectiveness of biologic strategies in RA.

Cost-effectiveness analysis of Mectizan treatment Programmes for Onchocerciasis Control: Operational Experiences in two districts of Southwestern Nigeria

Objectives: This study analyzed the operational costs of two Mectizan treatment strategies in relation to their effectiveness.Methods: The study was conducted in 24 communities located in Irewole and Egbeda districts of Osun and Oyo State, Nigeria respectively. Cost-effectiveness analysis included retrospective analysis of cost of treatment, review of records of distributors, estimation of overall cost-effectiveness ratios of treatment and distribution, calculation of mean cost-effectiveness ratios and statistical comparison of the mean cost-effectiveness ratios.Results: Overall cost of treatment per person through mobile distribution was N27.39 (USD1.16) while the corresponding overall cost through community-directed distribution was N14.35 (USD0.61). Overallcost of distribution per tablet through mobile distribution was N20.97 (USD0.89) while the corresponding overall cost through community-directed distribution was N8.39 (USD0.36). The difference between the mean cost-effectiveness ratios for treatments through mobile distribution, 56.79, and communitydirected distribution, 32.53, was not statistically significant (p=0.120265). Similarly, the difference between the mean cost-effectiveness ratios for distribution of tablets through mobile distribution, 40.83, and community-directed distribution, 19.17, was not statistically significant (p=0.167249). Treatment coverages were 59% and 80%, and 2,376 and 4,148 tablets were respectively distributed,Conclusion: Distribution of Mectizan tablets by community-directed distributors was more cost-effective than by mobile health staff, but the differences in cost were not statistically significant. However, thiscould ensure self-reliance and sustainability of treatment programmes, which are prerequisites for decision making on treatment strategies.

Cost-Effectiveness of Long-Acting Risperidone Injection versus Alternative Atypical Antipsychotic Agents in Patients with Schizophrenia in China

To determine the most cost-effective strategy involving first-line treatment with long-acting risperidone, olanzapine, and quetiapine from the perspective of the Chinese health-care system. A decision analytical model was applied. The model used a time horizon of 2 years. The probabilities of treatment response of different agents and the relapse and hospitalization rates were estimated by a Delphi panel of 17 senior psychiatrists in China. The unit cost for each medical service was calculated from the price system database built by China National Development and Reform Commission and the medical resource utilization was estimated by the Delphi panel. The principal efficacy measure was the proportion of patients successfully treated. Various sensitivity analyses were carried out to test the robustness of the model. The proportion of patients successfully treated over the 2-year period was 46.71% for long-acting risperidone, 39.93% for olanzapine, and 31.28% for quetiapine. The mean cost-effectiveness ratios were RMB189,427, RMB202,432, and RMB233,015 per successfully treated patient for long-acting risperidone, quetiapine and olanzapine, respectively. Results of the sensitivity analyses confirmed that the results were robust. The results showed that long-acting risperidone is more cost-effective than olanzapine and quetiapine for patients with schizophrenia in long-term maintenance treatment.

Cost-effectiveness of urokinase and alteplase for treatment of acute peripheral artery disease: Comparison in a decision analysis model

The cost-effectiveness of urokinase and alteplase for the treatment of acute peripheral artery disease (PAD) was compared using decision analysis. A literature-based decision model to evaluate cost-effectiveness was constructed using a base case of a 65-year-old man with acute PAD. Successful treatment outcomes were defined as clot lysis with a subsequent 30-day survival posttreatment. Direct medical costs were assessed from the payer perspective in the United States and analyzed using sensitivity analyses. A Monte Carlo analysis with 5000 patients was performed to obtain mean and incremental cost-effectiveness ratios (ICERs). The mean cost-effectiveness ratio was $67,581 (95% confidence interval [CI], $36,899 to $108,836) per 30-day treatment success for alteplase and $78,729 (95% CI, $43,411 to $130,063 for urokinase). The ICER for urokinase relative to alteplase was $332,309 per additional 30-day treatment success (95% CI, $-565,540 to $1,661,247). Approximately 75% of simulated cases indicated that urokinase was associated with increased costs and increased treatment success compared with alteplase. Results of a post hoc sensitivity analysis indicated that dominance decreased to approximately 10% of cases only under the most strict criteria. Decision analysis found an ICER of $332,309 per additional 30-day treatment success for urokinase relative to alteplase in the treatment of PAD from the perspective of the payer in the United States. In about 75% of cases resulting from a Monte Carlo simulation, urokinase was associated with increased costs and slightly increased treatment success compared with alteplase, although this finding was sensitive to the distributional assumptions made concerning certain costs in the model.

Optimizing Choledocholithiasis Management

Endoscopic retrograde cholangiopancreatography (ERCP) is more cost-effective for managing incidental choledocholithiasis (CDL) after laparoscopic cholecystectomy and intraoperative cholangiogram (LC/IOC) than laparoscopic common bile duct exploration (LCBDE). A cost-effectiveness analysis was performed to compare ERCP with LCBDE. Sensitivity analyses were performed to determine the key contributors to cost-effectiveness between the 2 treatment options. Costs were approached from the institutional perspective considering a typical patient undergoing LC/IOC at a large referral center. The base case patient evaluated was a woman 18 years of age or older with symptomatic cholelithiasis and incidental CDL discovered at the time of LC/IOC. Endoscopic retrograde cholangiopancreatography with drainage procedure performed after LC/IOC or LCBDE during LC/IOC. Costs, quality-adjusted life years gained, mean cost-effectiveness ratios, and incremental cost-effectiveness ratios. In the base case analysis, ERCP was the optimal treatment choice with a cost of $24 300 for 0.9 quality-adjusted life years gained compared with $28 400 and 0.88 quality-adjusted life years for LCBDE. Endoscopic retrograde cholangiopancreatography remained the optimal strategy for CDL in multiway probabilistic sensitivity analysis. If LCBDE were performed and the cost of a potential operative case lost was $3100 or less and the cost of ERCP hospitalization was $18 000 or more, then LCBDE became the preferred treatment for CDL. Endoscopic retrograde cholangiopancreatography was both less costly and more effective than LCBDE. Factors important to choosing the best strategy for CDL management included the cost of a potential case lost due to LCBDE performance and the cost of ERCP hospitalization.

Análisis coste-efectividad de tipo probabilístico del tratamiento de la apnea del sueño

Objective To describe the application of a probabilistic costeffectiveness analysis to nasal continuous positive airway passage (nCPAP) treatment of obstructive sleep apnea syndrome (OSAS). Material and Methods The probabilistic model was constructed from a discrete Markov model. This probabilistic approach is characterized by the introduction of variables as probability distributions. The model performed 2,000 Monte Carlo simulations, and incremental costs and effectiveness were calculated in each. The results were analyzed through the costeffectiveness plane, the acceptability curve, the net benefit rule, and the expected value of perfect information (EVPI). Results The mean cost-effectiveness ratio for nCPAP treatment was 5,480 €/QALY (quality-adjusted life year). Using an acceptability threshold of 30,000 €/QALY, the probabilistic analysis showed that nCPAP was the optimal treatment in 98.5% of the simulations. The EVPI showed that the parameter causing greatest uncertainty in the final results was the quality of life gain through nCPAP treatment. Conclusions The results of our probabilistic analysis are endorsed by previous deterministic studies confirming that nCPAP treatment of OSAS is the most cost-effective strategy. An additional advantage of probabilistic analysis is that it allows uncertainty to be quantified; in the present case the probability of making the wrong decision was below 5%. Furthermore, this study reveals that to reduce uncertainty, research should center on improving information on quality of life.

Long-acting risperidone compared with oral olanzapine and haloperidol depot in schizophrenia: a Belgian cost-effectiveness analysis

Patients with schizophrenia suffer numerous relapses and rehospitalizations that are associated with high direct and indirect medical expense. Suboptimal therapeutic efficacy and, in particular, problems with compliance are major factors leading to relapse. Atypical antipsychotic agents offer improved efficacy and a lower rate of extrapyramidal adverse effects compared with conventional antipsychotic drugs. Long-acting intramuscular risperidone combines these benefits with improvements in compliance associated with depot injections. To assist decision making regarding the place of long-acting risperidone in therapy, a cost-effectiveness analysis of strategies involving first-line treatment with long-acting risperidone, oral olanzapine or depot haloperidol was performed from the perspective of the Belgian healthcare system. A decision tree model was created to compare the cost effectiveness of three first-line treatment strategies in a sample of young schizophrenic patients who had been treated for 1 year and whose disease had not been diagnosed for longer than 5 years. The model used a time horizon of 2 years, with health state transition probabilities, resource use and cost estimates derived from clinical trials, expert opinion and published prices. The four health states in the model were derived from an analysis of the literature. The principal efficacy measure was the proportion of patients successfully treated, defined as those who responded to initial treatment and who had none to two episodes of clinical deterioration without needing a change of treatment over the 2-year period. Comprehensive sensitivity analysis was carried out to test the robustness of the model. A greater proportion of patients were successfully treated with long-acting risperidone (82.7%) for 2 years, compared with those treated with olanzapine (74.8%) or haloperidol (57.3%). Total mean costs per patient over 2 years were 16,406 Euro with long-acting risperidone, 17,074 Euro with olanzapine and 21,779 Euro with haloperidol (year of costing 2003). The mean cost-effectiveness ratios were 19,839 Euro, 22,826 Euro and 38,008 Euro per successfully treated patient for long-acting risperidone, olanzapine and haloperidol, respectively. Results of the sensitivity analysis confirmed that the results were robust to a wide variation of different input variables (effectiveness, dosing distribution, patient status according to healthcare system). Long-acting risperidone was the dominant strategy, being both more effective and less costly than either oral olanzapine or depot haloperidol. Long-acting risperidone appears to represent a favourable first-line strategy for patients with schizophrenia requiring long-term maintenance treatment.

Cost-effectiveness of almotriptan and rizatriptan in the treatment of acute migraine

Background: Migraine is a common disorder that costs US employers billions of dollars each year in missed workdays and reduced productivity. Seven triptans, including almotriptan and rizatriptan, are recommended as first-line therapy for acute migraine. Objective: The aim of this study was to assess the relative cost-effectiveness of almotriptan and rizatriptan in the treatment of acute migraine. Methods: A model was built to compare almotriptan 12.5 mg and rizatriptan 10 mg for the treatment of a single, acute migraine attack. Cost-effectiveness (in year-1999 US $) was evaluated from the perspective of a US health care payer. Mean and incremental cost-effectiveness ratios (CERs) were calculated. The effectiveness measure was the proportion of patients who achieved sustained freedom from pain with no adverse events (SNAE). Data on sustained pain-free outcomes and adverse-event rates were obtained from a meta-analysis of oral triptan trials. Efficacy and tolerability were assumed to be independent in the base-case scenario, so the total direct cost of treating a single migraine attack was calculated, adding drug costs to health service costs per attack. Results: In the base-case analysis, the mean CERs for almotriptan 12.5 mg and rizatriptan 10 mg were $91.12 and $131.26, respectively, per attack at which SNAE was achieved after treatment. The incremental CER for almotriptan (compared with rizatriptan 10 mg) was $6.94 per additional SNAE achieved. The economic benefit of almotriptan 12.5 mg was robust in a range of sensitivity analyses. Conclusion: Almotriptan 12.5 mg was more cost-effective than rizatriptan 10 mg for the treatment of acute migraine in this analysis based on published data.

Inhaled salmeterol/fluticasone propionate combination. A pharmacoeconomic review of its use in the management of asthma.

Cost estimates from developed countries indicate that asthma accounts for up to 2% of the economic cost of all diseases. A large proportion of asthma-related costs are attributable to poor asthma control. Treatment strategies which improve clinical outcomes in patients with asthma, therefore, have the potential for significant economic benefits, and it is important to evaluate new asthma therapies for cost effectiveness. Several studies have established that salmeterol and fluticasone propionate combined in a single dry powder inhalation device are at least as effective as a combination of the 2 drugs administered via separate dry powder inhalers and more effective than monotherapy with fluticasone propionate or budesonide. Importantly, pharmacoeconomic analysis of several of these studies show that the salmeterol/fluticasone propionate combination is cost effective relative to monotherapy with fluticasone propionate or budesonide. Although the total cost of asthma management tended to be slightly higher with salmeterol/fluticasone propionate than with inhaled corticosteroid monotherapy, in most cases mean cost-effectiveness ratios were lower (i.e. more favourable) for salmeterol/fluticasone propionate than either fluticasone propionate or budesonide. Cost effectiveness was assessed according to 3 end-points: successfully treated weeks, symptom-free days and episode-free days. Mean cost-effectiveness ratios consistently favoured salmeterol/fluticasone propionate over the comparator drug for the end-point successfully treated weeks, and in most cases the other 2 end-points also favoured the combination product over the comparator. In a further study, salmeterol/fluticasone was also less costly than therapy with formoterol and budesonide administered via 2 separate inhalers. Studies of health-related quality of life (HR-QOL) using the Asthma Quality of Life Questionnaire indicate that salmeterol/fluticasone propionate produces clinically meaningful improvements in overall HR-QOL relative to salmeterol monotherapy or placebo. Improvements in overall HR-QOL were statistically significantly greater for salmeterol/fluticasone propionate than with fluticasone propionate or budesonide alone, although the differences between treatments did not exceed the threshold for clinical significance. In conclusion, short term cost-effectiveness data show that salmeterol/fluticasone propionate is more cost effective than the inhaled corticosteroids budesonide and fluticasone propionate alone. The combination product also appears to improve HR-QOL relative to placebo or salmeterol alone.