Systematic Review Of Cost-effectiveness Studies Research Articles

Systematic review of cost-effectiveness analyses of novel oral anticoagulants for stroke prevention in atrial fibrillation

Introduction and ObjectivesNovel oral anticoagulants are emerging options for the prevention and treatment of thromboembolic diseases. They are increasingly used in clinical practice due to their simplicity of use and clinical benefits, but an important step is to evaluate their cost-effectiveness. The aim of the AFFORD study (A Review of Cost EFFectiveness of Novel ORal Anticoagulant Drugs) was to perform a systematic review of cost-effectiveness studies of novel oral anticoagulants for stroke prevention in non-valvular atrial fibrillation (AF). MethodsA systematic review of the literature was conducted by searching the PubMed, Embase, Scopus, Cochrane and Web of Knowledge databases to identify all cost-effectiveness studies of novel oral anticoagulants for stroke prevention in AF. ResultsThe search identified 27 studies, 18 with dabigatran, three with apixaban, two with rivaroxaban and four with at least two of these drugs. The incremental cost-effectiveness ratios were 30 405±16 101 euros per quality-adjusted life-year (QALY) for dabigatran 110 mg, 17 566±16 902 euros/QALY for dabigatran 150 mg, 8102±3252 euros/QALY for age-adjusted dabigatran, 11 897±3341 euros/QALY for apixaban and 17 960±12 005 euros/QALY for rivaroxaban. ConclusionThe present systematic review demonstrates that novel oral anticoagulants are cost-effective for stroke prevention in AF.

The Place of Dpp-4 Inhibitors in the Treatment Algorithm of Diabetes Type 2: A Systematic Review of Cost-Effectiveness Studies.

Objective To conduct a systematic review of cost-effectiveness, cost-utility, and cost-benefit studies of DPP-4 inhibitors for diabetes treatment versus other antidiabetics.

PCV111 - Stroke Prevention in Non-Valvular Atrial Fibrillation: Systematic Review of Cost-Effectiveness Studies

PCV111 - Stroke Prevention in Non-Valvular Atrial Fibrillation: Systematic Review of Cost-Effectiveness Studies

Investigating the value of abatacept in the treatment of rheumatoid arthritis: a systematic review of cost-effectiveness studies.

Background. Rheumatoid arthritis is a progressive inflammatory disease that affects greatly patients' quality of life and demands for aggressive management early on during the course of the disease. The discovery of biologics has equipped rheumatologists with evolutionary treatment tools but has also impacted greatly management costs. Objectives. To conduct a systematic review in order to evaluate the cost effectiveness of abatacept in the treatment of moderate to severe rheumatoid arthritis. Methods. Pubmed, the International Society for Pharmacoeconomics and Outcomes Research Outcomes Research Digest, the National Health System Economic Evaluation Database, and the Database of s of Reviews of Effects were searched. Results. In total 301 studies were identified and 42 met the inclusion criteria. Half of the selected studies evaluated abatacept in the treatment of rheumatoid arthritis, after failure of or intolerance to tumor necrosis factor alpha inhibitors. Of those, 82% were in favor of abatacept as a cost-effective or dominant strategy versus varying alternatives, whereas 18% favored other treatments. Conclusion. The majority of evidence from the published literature supports that abatacept can be a cost-effective alternative in the treatment of moderate to severe rheumatoid arthritis, especially in patients that have demonstrated inadequate response or intolerance to anti-TNF agents or conventional disease modifying antirheumatic drugs.

Screening for Gastric Cancer and Surveillance of Premalignant Lesions: a Systematic Review of Cost‐Effectiveness Studies

Cost-effectiveness studies are highly dependent on the models, settings, and variables used and should be based on systematic reviews. We systematically reviewed cost-effectiveness studies that address screening for gastric cancer and/or surveillance of precancerous conditions and lesions. A systematic review of cost-effectiveness studies was performed by conducting a sensitive search in seven databases (PubMed, Scopus, Web of Science, Current Contents Connect, Centre for Reviews and Dissemination, Academic Search Complete, and CINAHL Plus), independently evaluated by two investigators. Articles were evaluated for type of study, perspective, model, intervention, incremental cost-effectiveness ratio, clinical or cost variables, and quality, according to published guidelines. From 2395 abstracts, 23 articles were included: 19 concerning population screening and 4 on following up premalignant lesions. Studies on Helicobacter pylori screening concluded that serology was cost-effective, depending on cancer incidence and endoscopy cost (incremental cost-effectiveness ratio: 6264-25,881), and eradication after endoscopic resection was also cost-effective (dominant) based on one study. Studies on imaging screening concluded that endoscopy was more cost-effective than no screening (incremental cost-effectiveness ratio: 3376-26,836). Articles on follow-up of premalignant lesions reported conflicting results (incremental cost-effectiveness ratio: 1868-72,519 for intestinal metaplasia; 18,600-39,800 for dysplasia). Quality assessment revealed a unanimous lack of a detailed systematic review and fulfillment of a median number of 23 items (20-26) of 35 possible ones. The available evidence shows that Helicobacter pylori serology or endoscopic population screening is cost-effective, while endoscopic surveillance of premalignant gastric lesions presents conflicting results. Better implementation of published guidelines and accomplishment of systematic detailed reviews are needed.

Cost-Effectiveness of HPV-Vaccination in Medium or Low Income Countries with High Cervical Cancer Incidence – A Systematic Review

Background: Prophylactic human papilloma virus (HPV) vaccines represent a promising option for cervical cancer (CC) prevention in countries where screening, diagnostics and treatment have difficulties in producing significant reductions in CC incidence/mortality. Numerous studies have evaluated the cost-effectiveness of HPV vaccination strategies including female vaccination alone, female vaccination combined with different screening strategies, or female and male vaccination. Countries with the highest CC incidences, however, have the least resources to implement any CC prevention programs. To understand priorities in low vs. middle income countries with high CC incidence pertinent cost-efficacy studies on CC interventions were compared. Methods: We conducted a systematic review of cost-effectiveness studies including only countries with high CC incidence (>14.5) and GDP per capita below the high income group (<37,162 2010 international $). Results: We identified 16 cost-effectiveness studies (with the bivalent 16/18 or the quadrivalent 6/11/16/18 vaccine) including 25 countries from Europe, Africa, Latin America, and Asia. CC incidence ratios vary from 14.8 (Kenya) to 38.3 (Mozambique) and GDP per capita from 913 (Mozambique) I$ to 27063 I$ (Slovenia). High income countries that met the high CC incidence criteria included Ireland (14.7) and Denmark (18.4). Sub-Saharan African countries excluded, the CC incidence rates were comparable in the middle- and low-income countries (median 18.5 vs. 22). All of the studies concluded that HPV vaccination of females is very effective, especially combined with a screening, and cost-effective assuming a low to moderate vaccine price at the same time underlining that the commonly used cost-effectiveness thresholds do not always equal affordability. Conclusion: Our systematic review showed that HVP vaccination alone or combined with screening strategies is cost-effective in countries with high CC incidence and moderate to low GDP per capita. Affordability of the vaccination program is a crucial determinant for the success of cervical cancer prevention by country, and determines whether rapidly increasing differences between the middle-and low-income countries in HPV disease burden are imminent in the future.

Are physical activity interventions in primary care and the community cost-effective? A systematic review of the evidence

The health and economic burden of physical inactivity is well documented. A wide range of primary care and community-based interventions are available to increase physical activity. It is important to identify which components of these interventions provide the best value for money. To assess the cost-effectiveness of physical activity interventions in primary care and the community. Systematic review of cost-effectiveness studies based on randomised controlled trials of interventions to increase adult physical activity that were based in primary health care or the community, completed between 2002 and 2009. Electronic databases were searched to identify relevant literature. Results and study quality were assessed by two researchers, using Drummond's checklist for economic evaluations. Cost-effectiveness ratios for moving one person from inactive to active, and cost-utility ratios (cost per quality-adjusted life-year [QALY]) were compared between interventions. Thirteen studies fulfilled the inclusion criteria. Eight studies were of good or excellent quality. Interventions, study populations, and study designs were heterogeneous, making comparisons difficult. The cost to move one person to the 'active' category at 12 months was estimated for four interventions ranging from €331 to €3673. The cost-utility was estimated in nine studies, and varied from €348 to €86,877 per QALY. Most interventions to increase physical activity were cost-effective, especially where direct supervision or instruction was not required. Walking, exercise groups, or brief exercise advice on prescription delivered in person, or by phone or mail appeared to be more cost-effective than supervised gym-based exercise classes or instructor-led walking programmes. Many physical activity interventions had similar cost-utility estimates to funded pharmaceutical interventions and should be considered for funding at a similar level.

Modelling Disease Progression in??Alzheimer???s Disease

The literature reporting economic evaluations related to the treatment of Alzheimer's disease (AD) has developed over the last decade. Most analyses have used economic models to estimate the cost effectiveness of drugs for the treatment of AD. This review considers the range of methods used in the published cost-effectiveness literature to model AD progression and the effect of interventions on the progression of AD. The review builds on and updates an earlier systematic review of cost-effectiveness studies on drugs for AD. Systematic and rigorous methods were used to search the literature for economic evaluations estimating the cost effectiveness of donepezil, rivastigmine, galantamine or memantine in AD. The literature search covered a wide range of electronic databases (e.g. MEDLINE, EMBASE), and included literature from the inception of databases up to the end of 2005. The search identified 22 published economic evaluations. An outline and brief critical review of the identified studies is provided, and thereafter the methods used to model disease progression were considered in more detail. The review employs recent guidance on good practice in decision-analytic modelling in HTA to critically review the modelling methods used. Using this guidance, the models are assessed against the broad criteria of model structure, data inputs and assessment of uncertainty and inconsistency. Concerns were noted over the model structure employed in all models. The reliance on cognitive scores to model AD, the progression of the disease, and the effect of treatment on costs and consequences is regarded as a serious limitation in almost all of the studies identified. There are also limitations over the data used to populate published models, especially around the failure of studies to document and establish the basis for the modelling of treatment effects. It is also clear that studies modelling AD progression, and subsequently the cost effectiveness of treatment, have not addressed uncertainty or consistency (internal and/or external) in sufficient detail. Further research is required on more appropriate methods for the modelling of AD progression. In the meantime, future economic evaluations of treatment need to be more explicit on the methods used to model AD, and the data used to populate models.