Probability Of Incremental Cost-effectiveness Ratio Research Articles

#2622 COST-EFFECTIVENESS OF SGLT2 INHIBITORS FOR THE TREATMENT OF TYPE 2 DIABETES AND ITS COMPLICATIONS

Abstract Background and Aims Diabetes and its complications (e.g. chronic kidney disease [CKD] and cardiovascular disease [CVD]) impose significant clinical and financial burden. Recent large-scale randomized controlled trials have demonstrated cardiorenal benefit of the anti-diabetic drug sodium glucose co-transporter 2 (SGLT2) inhibitors, and they are approved for the treatment of CKD and/or heart failure (HF) in many countries. In the present study, we assessed the economic effectiveness of SGLT2 inhibitors for patients with type 2 diabetes (T2DM) using a cost-analysis model that adopts CKD-dependent increases in the risk of developing CVD. Method We constructed a natural history model for T2DM patients incorporating CKD, end-stage renal disease, and CVD including myocardial infarction, HF, and stroke as diabetic complications. All diseases except for CKD were considered independent (i.e., the development of CKD increases the risk of CVD manifestation but a patient who develops one disease does not present with another disease). By using a population-based microsimulation, we estimated the 10-year medical costs in Japanese Yen (JPY) and outcomes (development of complications and quality-adjusted life years [QALY]) for patients who initiated antidiabetic therapy with SGLT2 inhibitors or conventional therapy. Probabilistic sensitivity analysis (PSA) was performed with 1,000,000 iterations. Results The total medical costs per person were JPY 1,193,000 versus JPY 1,160,000 and the QALYs were 8.13 versus 8.02 years for the SGLT2 inhibitor strategy versus the conventional strategy, respectively. As a result, the incremental cost-effectiveness ratio (ICER) was 302,000 JPY/QALY, well below the threshold value of JPY 5,000,000/QALY. The PSA revealed that the probability of ICER being below the threshold was 97.7%. Conclusion We demonstrated that the use of SGLT2 inhibitors was cost-effective compared to the conventional strategy for treating patients with T2DM, and these results suggest clinical and financial benefit of SGLT2 inhibitors that can holistically approach T2DM and its renal and cardiovascular complications.

Lung cancer screening: who pays? Who receives? The European perspectives.

Lung cancer is the leading cause of cancer-related death worldwide, and its early detection is critical to achieving a curative treatment and to reducing mortality. Low-dose computed tomography (LDCT) is a highly sensitive technique for detecting noninvasive small lung tumors in high-risk populations. We here analyze the current status of lung cancer screening (LCS) from a European point of view. With economic burden of health care in most European countries resting on the state, it is important to reduce costs of screening and improve its effectiveness. Current cost-effectiveness analyses on LCS have indicated a favorable economic profile. The most recently published analysis reported an incremental cost-effectiveness ratio (ICER) of €3,297 per 1 life-year gained adjusted for the quality of life (QALY) and €2,944 per life-year gained, demonstrating a 90% probability of ICER being below €15,000 and a 98.1% probability of being below €25,000. Different risk models have been used to identify the target population; among these, the PLCOM2012 in particular allows for the selection of the population to be screened with high sensitivity. Risk models should also be employed to define screening intervals, which can reduce the general number of LDCT scans after the baseline round. Future perspectives of screening in a European scenario are related to the will of the policy makers to implement policy on a large scale and to improve the effectiveness of a broad screening of smoking-related disease, including cardiovascular prevention, by measuring coronary calcium score on LDCT. The employment of artificial intelligence (AI) in imaging interpretation, the use of liquid biopsies for the characterization of CT-detected undetermined nodules, and less invasive, personalized surgical treatments, will improve the effectiveness of LCS.

Cost-effectiveness analysis of percutaneous mitral valve repair with the MitraClip delivery system for patients with mitral regurgitation in Japan

Aims: The objective of the study is to evaluate the cost-effectiveness of percutaneous mitral valve repair (TMVr) with the MitraClip NT system (MitraClip procedure) for patients with symptomatic severe mitral regurgitation (MR) at high surgical risk in line with the methodological guideline for cost-effectiveness evaluation by the Ministry of Health, Labour and Welfare.Material and Methods: The cost-effectiveness of MitraClip procedure was evaluated using a Markov model. Patients are classified into four New York Heart Association classes in each cycle. The model considered MitraClip complication (“major vascular complication”, “major bleeding complication”, “non-cerebral thromboembolism”), adverse events, re-implantation with MitraClip device, mitral valve surgery, and congestive heart failure hospitalization. For the evidence on additional benefits, a study compared with propensity score-matched medical therapy group was used in the analysis. The analysis was conducted from the perspective of a public healthcare payer with a discount rate of 2% for both cost and effectiveness.Results: In the base-case analysis, total cost and quality-adjusted life year (QALY) gained (Life year (LY) gained) were 7,541,151 JPY and 3.23 QALYs (3.85 LYs) for MitraClip group, and 4,699,692 JPY and 1.79 QALYs (2.43 LYs) for medical therapy group, respectively. The incremental cost-effectiveness ratio (ICER) of MitraClip procedure versus medical therapy was 1.97 million JPY/QALY (US$18,570/QALY, US$1 = 106 JPY), which was evaluated to be cost-effective. The probability of ICER of MitraClip procedure versus medical therapy being 5 million JPY/QALY was 96.7%.Limitations: There are two limitations. Firstly, the parameters for the comparators were based on some assumptions. However, it was a conservative setting against MitraClip group. Secondary, the mortality rate and adverse events of MitraClip group in a lifetime were estimated from data during a year after the procedure.Conclusions: MitraClip procedure improved life-years and quality of life in patients at high surgical risk and it was also a cost-effective treatment option.

PND42 - Cost-Effectiveness Of Levofloxacin Inhalation Solution Vs. Aztreonam Inhalation Solution In Cystic Fibrosis Patients In Belgium

To conduct an economic evaluation of levofloxacin inhalation solution (LIS) compared to aztreonam lysine inhalation solution (AZLI) in Belgium for the treatment of chronic Pseudomonas aeruginosa lung infection in adult cystic fibrosis (CF) patients. A 24-week cycle Markov model was developed to estimate the expected costs and quality-adjusted life year (QALY) gains over three- and five-years. The model simulated the disease progression of CF patients as measured by the decrease in forced expiratory volume in 1 second (FEV1) percent predicted as well as lung transplantation and death. The base case analysis was conducted from the Belgian health care perspective at 3 years and sensitivity analysis at 5-years. In the base case LIS was dominant vs. AZLI over two studied time horizons from the health care perspective. LIS was associated with a gain in QALYs of 0.117 and 0.224 over three- and five-year time horizons, respectively, and was cost saving (-€515 and -€952, over three- and five-year time horizons, respectively) compared to AZLI. In addition to the base case analysis, two scenarios were conducted to assess the impact of parameter uncertainty on the model results. In all scenarios, conclusions are similar to the base case analysis: LIS was associated with a QALY gain and was cost-saving compared to AZLI. In general, the sensitivity analyses showed that the incremental cost-effectiveness ratio (ICER) was mainly sensitive to the costs of CF management and the mortality. The probability of ICER being less than €50,000 was 89.5%. This model simulated the disease progression of CF patients as measured by the decrease in FEV1 percent predicted. The base case results showed that the cost-effectiveness analysis of LIS is a dominant treatment option vs. AZLI over three- and five-year time horizons from the Belgian healthcare perspective.

Cost-effectiveness of ranibizumab in treatment of diabetic macular oedema (DME) causing visual impairment: evidence from the RESTORE trial

Background/aimsTo evaluate the cost-effectiveness of ranibizumab as either monotherapy or combined with laser therapy, compared with laser monotherapy, in the treatment of diabetic macular oedema (DME) causing visual impairment from...