Need For Cost-effectiveness Analysis Research Articles

Cognitive remediation for schizophrenia: Clinician perspectives on implementation barriers and facilitators.

Neurocognitive deficits in schizophrenia have a major impact on functioning; however, they remain poorly targeted by available treatment offerings. Cognitive remediation (CR) is effective in improving neurocognition and functioning. Despite clinical guidelines for schizophrenia recommending CR, it is still not readily available in clinical services and sizeable attrition rates are reported in clinical trials. To elucidate the barriers and facilitators of CR access and engagement, we conducted a mixed methods qualitative-dominant study with 12 clinicians in Australia, in 2021, with 1 hr interviews and additional rating scales completed. Thematic analysis highlighted four themes (cognitive symptoms, CR intervention, motivation and engagement in CR, and CR implementation), and 14 subthemes. Clinicians emphasized the broad impact of cognitive deficits and outlined pros and cons of different CR approaches. Several factors were suggested as impacting engagement, including motivation assessments/techniques, neurocognitive insight, illness, and demographic factors. Lack of routine implementation in Australia was unanimously espoused and partly explained by a need for cost-effectiveness analyses, remote and flexible delivery, and increasing service resource provision and staff training in CR. This study offers key insights into CR access, while recommending methods for optimizing CR implementation and dissemination to improve recovery outcomes of people diagnosed with schizophrenia. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Low Screening Rates Despite a High Prevalence of Significant Liver Fibrosis in People with Diabetes from Primary and Secondary Care

Diabetes is a driver of non-alcoholic fatty liver disease (NAFLD) and fibrosis. We determine current practices in examining liver fibrosis in people with diabetes and record prevalence levels in primary and secondary care. We extracted HbA1c results ≥48 mmol/mol to identify people with diabetes, then examined the proportion who had AST, ALT, and platelets results, facilitating calculation of non-invasive fibrosis tests (NIT), or an enhanced liver fibrosis score. Fibrosis markers were requested in only 1.49% (390/26,090), of which 29.7% (n = 106) had evidence of significant fibrosis via NIT. All patients at risk of fibrosis had undergone transient elastography (TE), biopsy or imaging. TE and biopsy data showed that 80.6% of people with raised fibrosis markers had confirmed significant fibrosis. We also show that fibrosis levels as detected by NIT are marginally lower in patients treated with newer glucose lowering agents (sodium-glucose transporter protein 2 inhibitors, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists). In conclusion by utilising a large consecutively recruited dataset we demonstrate that liver fibrosis is infrequently screened for in patients with diabetes despite high prevalence rates of advanced fibrosis. This highlights the need for cost-effectiveness analyses to support the incorporation of widespread screening into national guidelines and the requirement for healthcare practitioners to incorporate NAFLD screening into routine diabetes care.

Therapeutic Potential of Dupilumab in the Treatment of Chronic Rhinosinusitis with Nasal Polyps: Evidence to Date.

Chronic rhinosinusitis with nasal polyposis (CRSwNP) is one of the most severe forms of chronic rhinosinusitis. CRSwNP is characterized by nasal and facial congestion, loss of sense of smell, rhinorrhea, and post-nasal drip. Treatments have been ineffective at controlling disease recurrence, despite multiple courses of medical and surgical therapies. Oral glucocorticoid therapy is often used to control exacerbations leaving the patient exposed to steroid-induced adverse effects. Thus, there is a clear unmet need for new treatments to achieve better control of the disease. Advances in understanding Type 2 inflammatory processes that occur in about 80% of the Western world patients with CRSwNP have resulted in new avenues for disease control. Biologics in the form of monoclonal antibodies, which target Type 2 inflammation, have helped control the severest forms of atopic dermatitis and asthma. Treatment regimes for CRSwNP now include biologics. In July 2019, dupilumab was the first monoclonal antibody to gain FDA approval for the treatment of CRSwNP. In this review, we summarize the proof of concept clinical trials and Phase 3 trials leading to approval of dupilumab, an anti-IL4 alpha receptor antagonist that blocks the actions of both IL4 and IL13. These studies show that dupilumab is a proven treatment option to control disease. Collective studies demonstrate a high safety profile. Questions arise as to the best use of dupilumab in the context of current treatment paradigms, and for which sub-population of the varied heterogeneous endotypes of CRSwNP patients. Recognizing the high cost of biologics forces the need for cost-effectiveness analysis.

Cost-effectiveness Analysis of Intraoperative Cell Salvage for Obstetric Hemorrhage

(Anesthesiology. 2018;128(2):328–337) Intraoperative cell salvage is recommended for blood conservation in cases of anticipated extreme blood loss, and reduces the need for allogeneic blood transfusion after cesarean delivery. There is a need for cost-effectiveness analysis of cell salvage in patients undergoing cesarean delivery to inform guidelines on obstetric blood management. Prior cost-effectiveness analysis demonstrated cost-savings in cases of massive transfusion or high risk of transfusion. This study aimed to use a societal perspective to analyze the cost-effectiveness of intraoperative cell salvage during cesarean delivery.

PHP286 - RESPONSES OF ISPOR MEMBERS TO THE RECOMMENDATIONS OF THE SPECIAL TASK FORCE ON US VALUE ASSESSMENT FRAMEWORKS

The concept of value based healthcare as a metaphor for assessing new therapeutic interventions has yet to identify additional metrics besides cost-effectiveness to inform public and private decision making. An ISPOR Special Task Force on Value Assessment Frameworks has recently been investigating the drivers in reimbursement decisions. Delegates at the ISPOR Europe 2017 Conference were invited to complete a questionnaire that specifically addressed current opinion on value assessment. This random survey attracted over 80 delegates from 24 countries, nearly 60% of whom considered cost-utility analysis to be a necessary component of a Value Assessment Framework. There was little agreement on whether a single transparent threshold for cost-effectiveness was appropriate, with many respondents suggesting a threshold that is much higher than the current cost/QALY. Over half (55%) of respondents considered surrogate endpoints to be acceptable for reimbursement decisions, whilst two thirds (64%) felt that MCDA might be a replacement for the QALY. Over half (53%) also felt that patients should play a more active role in health technology assessments, and risk sharing was considered to be an acceptable method of cost containment by over 70%. Finally, the majority of respondents (74%) felt it appropriate for manufacturers to command high prices for orphan drugs. In a country analysis, albeit limited by small numbers, there was general congruence between Europe and the US, apart from the need for cost-effectiveness analysis (60 vs 36% in favour, respectively). The Special Task Force has now recommended a refinement of the QALY to reflect societal values, and consider MCDA to be a viable alternative, whilst value assessment should incorporate both patient and population perspectives. The findings of this survey of ISPOR delegates were consistent with these recommendations, which illustrates the interest in the need for a Value Assessment Framework to aid reimbursement decisions.

Cost-effectiveness analysis of sequential biologic therapy with ixekizumab versus secukinumab as first-line treatment of moderate-to-severe psoriasis in the UK

Aims: Patients with psoriasis often undergo treatment with a sequence of biologic agents because of poor/loss of response to initial therapy. With the availability of newer agents like ixekizumab and secukinumab, there is a need for cost-effectiveness analyses to better reflect current clinical practice. This study aimed to assess the cost-effectiveness of a sequence of biologic therapies containing first-line ixekizumab vs first-line secukinumab in patients with moderate-to-severe plaque psoriasis in the UK.Materials and methods: A Markov model with a lifetime horizon was developed to compare the cost-effectiveness of ixekizumab and secukinumab treatment sequences: ixekizumab → ustekinumab → infliximab → best supportive care (BSC) vs secukinumab → ustekinumab → infliximab → BSC. The model used monthly cycles, and included four health states: trial period, treatment maintenance, BSC, and death. At the end of the trial period, responders transitioned to maintenance therapy; non-responders transitioned to the next biologic in the sequence. An annual discontinuation rate of 20% was assumed for maintenance therapy.Results: The ixekizumab sequence provided cost savings of £898 (£176,203 vs 177,101) [year 2015 values] and gained 0.03 more quality-adjusted life-years (QALYs: 1.45 vs 1.42) vs the secukinumab sequence over the lifetime horizon. Probabilistic sensitivity analysis showed an 89.8% likelihood that the ixekizumab sequence would be cost-effective at a threshold of £20,000 per QALY gained.Limitations: The analysis used list prices for drugs rather than confidential, preferentially priced Patient Access Scheme costs. In addition, efficacy input data were based on a network meta-analysis, as there were no head-to-head trials comparing ixekizumab and secukinumab.Conclusion: First-line treatment with ixekizumab as part of a specific sequential biologic therapy for moderate-to-severe plaque psoriasis in the UK provided slight advantages in cost savings and QALYs gained over a similar treatment sequence initiated with secukinumab. In view of the small magnitude of these differences, factors such as patient preferences (e.g. for number of injections) and long-term safety (e.g. related to time on the market) may also be important for clinical decision-making.

Mobile Health in Solid Organ Transplant: The Time Is Now.

Despite being in existence for >40 years, the application of telemedicine has lagged significantly in comparison to its generated interest. Detractors include the immobile design of most historic telemedicine interventions and the relative lack of smartphones among the general populace. Recently, the exponential increase in smartphone ownership and familiarity have provided the potential for the development of mobile health (mHealth) interventions that can be mirrored realistically in clinical applications. Existing studies have demonstrated some potential clinical benefits of mHealth in the various phases of solid organ transplantation (SOT). Furthermore, studies in nontransplant chronic diseases may be used to guide future studies in SOT. Nevertheless, substantially more must be accomplished before mHealth becomes mainstream. Further evidence of clinical benefits and a critical need for cost-effectiveness analysis must prove its utility to patients, clinicians, hospitals, insurers, and the federal government. The SOT population is an ideal one in which to demonstrate the benefits of mHealth. In this review, the current evidence and status of mHealth in SOT is discussed, and a general path forward is presented that will allow buy-in from the health care community, insurers, and the federal government to move mHealth from research to standard care.

Mobile x-ray services; outcome for nursing home residents and society - a literature review

Introduction: Nursing home residents who are in need of radiological services usually transfers to hospital, even for x-ray examinations like chest or skeletal x-ray possible to provide with a digital mobile x-ray unit at site. Nursing home residents, and especially residents with dementia, needs familiar surroundings to feel safe. New surroundings like the x-ray department in a hospital may lead to increased anxiety or disorientation. To achieve person-centred processes in healthcare services the organization needs to facilitate person-centred care. The objective of this study is to summarize the benefits nursing home residents and the society in general gets for mobile x-ray services. Methods: A systematic literature search was performed in PubMed, Cinahl, AgeLine, EBSCOhost and SveMed+ databases in October 2015. Studies were eligible when reporting on mobile x-ray units serving nursing homes. The following search terms were used: Mobile radiography, Cost effectiveness, Nursing home, Portable radiography, Mobile health units and different combinations of these search phrases. A Google search gave access to a cost-effectiveness report from Norway. Articles in English, German and Norwegian were included. The author selected studies, assessed studies, and extracted data in the review. Results: Ten articles and one cost-effectiveness analysis were included in the review. The review shows mobile x-ray units set up in Australia, Italy, Switzerland, Sweden and Norway. Six studies shows mobile x-ray units to reduce the burden of transportation to hospital for chest, skeletal and abdominal x-ray examinations. Five studies reports reduction in hospitalizations or visits to the emergency room. Reduction in resourced used when staff accompany residents to hospital were found in six studies. One study and one cost-effectiveness analysis shows cost-effectiveness of mobile x-ray services in Norway, one study shows cost-effectiveness in Sweden. Discussion: Transfer of residents to hospital for simple x-ray examinations lead to a significant and partly unethical burden for nursing home residents, and especially those with dementia. Examinations performed locally in nursing homes reduced unnecessary anxiety and confusion, especially for residents with dementia. One study found 17% of the residents in their study examined at hospital developed delirium requiring treatment, were as none of the residents examined at home developed delirium. Included studies show mobile radiography services to decrease the need for hospitalization and transportation of nursing home residents. More patients receive treatment at the nursing home with reduction of medical complications after hospital treatment. Being in the nursing home the care environment are more suited for nursing home residents compared to the x-ray department or a hospital ward. Mobile x-ray services therefore can contribute to person-centred care processes in nursing homes. Mobile x-ray units might pose a need for knowledge in nursing homes on preparation for and carrying out x-ray procedures. Nursing homes might also needs increased knowledge in treatments usually given in hospitals. In addition to benefits for residents, there are potential socio-economic benefits from mobile x-ray services. Calculations showed cost-effectiveness in Oslo and other urban areas of Norway even without including reduced costs from reduction in hospitalizations. Cost reduction estimated to 30-60% per x-ray examination depending on the number of examinations per nursing home visit and the distance between nursing home and hospital. The costs of the service and the savings are not within the same budget. This poses challenges for decision-makers to be able to see an increased cost in their department to be part of an overall cost reduction for society. Conclusion: Mobile x-ray services provides a way to organize the radiological service for nursing home residents highly beneficial for the residents. Reducing anxiety, confusing and delirium. The reduction in use of ambulance and taxi transportation with personnel accompanying the residents to hospital proves the mobile x-ray services to be cost-effective in urban areas of Norway and in Sweden. There is a limited number of studies on mobile x-ray services; Norway being the country with the largest contribution therefore dominates the results. There is a need for cost-effectiveness analysis for larger areas and more countries. There is a need for further research on the quality of mobile x-ray services and strategic leadership when establishing mobile services.

The Case for the Cost-effectiveness Analysis of Contextual HIV/AIDS Interventions and the Extent to which it is Relevant to South Africa

Uncertainty and importance of CE evidence of health care interventions more generally, and of HIV/AIDS interventions in particular have been two main reasons put forward to justify the need for cost-effectiveness analysis (CEA) of such interventions. However, CEA focused more on HIV/AIDS interventions, characterized by different set of activities and less on contextual HIV/AIDS interventions (CHIs), characterized by different contexts of implementation. Has the irrelevance of uncertainty and importance argument to CHIs been the reason for limited CEA of such interventions? Using uncertainty and importance of CE evidence arguments which have been used to motivate the conduct of CEA, this paper argues the case for CEA of CHIs and assesses the extent to which this case is relevant to South Africa. The paper finds that the case is strong and that it is relevant to South Africa to a great extent. It recommends more CEA of CHIs for the sake of efficiency-related policy advancement particularly in South Africa. DOI: 10.5901/mjss.2013.v4n3p743

Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease

BackgroundThe need for cost effectiveness analyses in randomized controlled trials that compare treatment options is increasing. The selection of the optimal utility measure is important, and a central question is whether the two most commonly used indexes - the EuroQuol 5D (EQ5D) and the Short Form 6D (SF6D) – can be used interchangeably. The aim of the present study was to compare change scores of the EQ5D and SF6D utility indexes in terms of some important measurement properties. The psychometric properties of the two utility indexes were compared to a disease-specific instrument, the Oswestry Disability Index (ODI), in the setting of a randomized controlled trial for degenerative disc disease.MethodsIn a randomized controlled multicentre trial, 172 patients who had experienced low back pain for an average of 6 years were randomized to either treatment with an intensive back rehabilitation program or surgery to insert disc prostheses. Patients filled out the ODI, EQ5D, and SF-36 at baseline and two-year follow up. The utility indexes was compared with respect to measurement error, structural validity, criterion validity, responsiveness, and interpretability according to the COSMIN taxonomy.ResultsAt follow up, 113 patients had change score values for all three instruments. The SF6D had better similarity with the disease-specific instrument (ODI) regarding sensitivity, specificity, and responsiveness. Measurement error was lower for the SF6D (0.056) compared to the EQ5D (0.155). The minimal important change score value was 0.031 for SF6D and 0.173 for EQ5D. The minimal detectable change score value at a 95% confidence level were 0.157 for SF6D and 0.429 for EQ5D, and the difference in mean change score values (SD) between them was 0.23 (0.29) and so exceeded the clinical significant change score value for both instruments. Analysis of psychometric properties indicated that the indexes are unidimensional when considered separately, but that they do not exactly measure the same underlying construct.ConclusionsThis study indicates that the difference in important measurement properties between EQ5D and SF6D is too large to consider them interchangeable. Since the similarity with the “gold standard” (the disease-specific instrument) was quite different, this could indicate that the choice of index should be determined by the diagnosis.

How to measure the cost‐effectiveness of periodontal treatments

There is a need to measure efficiency of periodontal treatments. Efficiency questions can be addressed through a variety of economic evaluation techniques: cost minimization, cost-effectiveness, cost utility and cost-benefit analysis. Each of these techniques is outlined in this article, including a detailed discussion of different preference-based outcome (utility) measures. Despite the need, few analyses have been undertaken in periodontology. There are several issues in undertaking cost-effectiveness analyses specific to periodontology and these are examined in detail: outcome measures including patient-based vs. clinical measures of outcome; discounting or taking into account time preference for outcomes and costs; problems of costing, including the perspective taken in an analysis; interpreting the evidence, in particular using incremental cost-effectiveness ratios; and global variation in periodontal care delivery, including healthcare systems and the use of hygienists. The need for cost-effectiveness analysis in periodontology is explored further, and the need to involve a health economist in such an evaluation is underlined.

Editorial

In the more than 25 years since the advent of the HIV/ AIDS pandemic the commitment of international agencies national governments the private sector people living with HIV/AIDS and donors have contributed to dramatic changes in the global response. Trends in HIV prevalence have stabilized in some developing countries greater coverage of key prevention interventions such as the prevention of mother-to-child transmission have at times been achieved and access to treatment has increased fivefold between 2003 and 2006. In addition to increased prevention and treatment provision successful strides have also occurred in the mobilization of global financial resources for HIV/AIDS. According to estimates of the Joint United Nations Programme on HIV/AIDS (UNAIDS) global HIV/ AIDS spending rose from approximately US $300 million in 1996 to approximately US$10 billion in 2007 a more than 30-fold increase. The impact of HIV/AIDS has however increased as the epidemic matures and with new infections estimated at 2.5 million per year expanded prevention efforts are still sorely needed. Even with the unprecedented level of funding now available an additional US$8.1 billion is still required if universal access to prevention treatment and care is to be provided to all those infected with HIV. Questions have thus shifted towards how to combine or maximize outcomes from HIV/AIDS treatment and prevention strategies efficiently. To this end the papers in this supplement explore the question: how do we best utilize the increased funding available? (excerpt)

Trastuzumab in adjuvant breast cancer therapy. A model based cost-effectiveness analysis

Trastuzumab has shown activity in early breast cancer patients that overexpress HER2. Significant resources have to be allocated to finance this therapy, underlining the need for cost-effectiveness analysis. A model was set up, societal costs were calculated and the discount rate was 3%. Life expectancy data were based on the literature and prolonged according to qualified guess (10% and 20% absolute improvement in overall survival (OS)). The comparator was the FEC100 regimen. The median additional health care cost per patient treated was €33 597. The yielding cost per life year gained (LYG) was €15 341 with a 20% improved OS and €35 947 with 10% improved OS. The corresponding net health care cost per quality adjusted life year (QALY) was €19 176 and €44 934. Including all resource use the figures were €8148 and €30 290 per LYG. Sensitivity analyses documented survival gain, price of trastuzumab, production gain and discount rate to be the major factors influencing cost-effectiveness ratio. Trastuzumab is indicated cost effective in Norway.

The economics of alcohol

The use of economic arguments with regard to four aspects of alcohol policy is described and discussed. The first aspect is the impact of a potential reduction in alcohol consumption on employment by alcohol production and trade. It is shown that employment is quite independent of the level of consumption. The second aspect is the opportunity for serving the public health and state finance interests at the same time by developing alcohol taxation. The third aspect is the relationship between the public revenue from alcohol and the public costs for alcohol-related problems. A "polluter pays" principle with regard to alcohol would mean higher taxation of alcoholic beverages. The fourth aspect is the need for cost-effectiveness analyses to support the choices by the decision makers between different alcohol policy options. It is concluded that such analyses could have impact on the priorities in public health policy on alcohol.

The economics of alcohol

The use of economic arguments with regard to four aspects of alcohol policy is described and discussed. The first aspect is the impact of a potential reduction in alcohol consumption on employment by alcohol production and trade. It is shown that employment is quite independent of the level of consumption. The second aspect is the opportunity for serving the public health and state finance interests at the same time by developing alcohol taxation. The third aspect is the relationship between the public revenue from alcohol and the public costs for alcohol‐related problems. A "polluter pays" principle with regard to alcohol would mean higher taxation of alcoholic beverages. The fourth aspect is the need for cost‐effectiveness analyses to support the choices by the decision makers between different alcohol policy options. It is concluded that such analyses could have impact on the priorities in public health policy on alcohol.