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Journal articles on the topic 'Incremental cost-effectiveness ratio'

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Published: 4 June 2021
Last updated: 31 January 2023

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1

Bang, Heejung, and Hongwei Zhao. "Median-Based Incremental Cost-Effectiveness Ratio (ICER)." Journal of Statistical Theory and Practice 6, no. 3 (September 2012): 428–42. http://dx.doi.org/10.1080/15598608.2012.695571.

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Severens, Johan L., Theo M. De Boo, and Emmy M. Konst. "UNCERTAINTY OF INCREMENTAL COST-EFFECTIVENESS RATIOS." International Journal of Technology Assessment in Health Care 15, no. 3 (July 1999): 608–14. http://dx.doi.org/10.1017/s0266462399153157.

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Objective: To compare different methods to estimate the confidence interval of the incremental cost-effectiveness ratio (ICER).Methods: The adequacy of Fieller intervals and three methods for calculating bootstrap intervals are compared based on a simulation of 10,000 trials, using data from one trial.Results: Both Fieller and bootstrap methods lead to unsatisfactory results when the difference in effectiveness is approximately zero. Where this difference is significant, the four methods for calculating confidence intervals for ICER do not give very different results, but Fieller's interval performs best.Conclusions: Since Fieller's confidence limits are relatively easy to compute compared with bootstrap simulations, we recommend using this method.
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Lucherini, Stefano, Robert Hughes, and Paul Okhuoya. "PD44 Multi-Comparator Incremental Cost-Effectiveness Ratio: A New Framework For Cost-Effectiveness Analysis." International Journal of Technology Assessment in Health Care 34, S1 (2018): 144–45. http://dx.doi.org/10.1017/s0266462318003112.

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Introduction:Current practice in cost-effectiveness analysis (CEA) involves the estimation of the incremental cost-effectiveness ratio (ICER) between a new intervention and one alternative comparator reflecting the standard of care. As this focuses on pairwise comparisons, rather than considering the whole range of available alternatives at any given time, this method fails to capture the full impact of bringing the new intervention to market.Methods:A multi-comparator ICER (MC-ICER) evaluating the impact of the new technology on patients treated with all comparators used in clinical practice, rather than a theoretical ‘second-best’ alternative only, was estimated. This can be achieved by weighting the incremental costs and benefits for each comparator by its change in market share to generate an MC-ICER. This is shown using a stylized example with three comparators.Results:The traditional ICER against the second-best alternative was USD 200,000 per QALY, while the estimated multi-comparator ICER is USD 133,548 per QALY, corresponding to a 33 percent decrease. This reflects the fact that patients who switch to the new intervention are not only those who had been previously treated with one particular comparator, as is assumed in a traditional CEA. The difference between the traditional ICER and the MC-ICER depends on how the new intervention impacts on the uptake of each comparator.Conclusions:Results show that, when comparator selection was made excluding dominated and extendedly-dominated alternatives, the MC-ICER, produced using the method described above, is lower than the traditional ICER comparing the new intervention to the second-best comparator. This captures the fact that patients may switch to the new intervention not only from the second-best comparator, but from the whole range of alternative treatments. Such patient movements determine the real impact, or opportunity cost, of the new intervention on the healthcare system and, therefore, should be captured in CEA alongside traditional one-way ICERs.
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Heitjan, Daniel F., Alan J. Moskowitz, and William Whang. "Problems with Interval Estimates of the Incremental Cost—Effectiveness Ratio." Medical Decision Making 19, no. 1 (January 1999): 9–15. http://dx.doi.org/10.1177/0272989x9901900102.

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Frisman, M., and B. Geltzer. "PCV7: INCREMENTAL COST-EFFECTIVENESS RATIO IN ESTIMATION SOME HYPOTENSIVE DRUGS." Value in Health 3, no. 5 (September 2000): 312. http://dx.doi.org/10.1016/s1098-3015(11)70660-x.

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Cheung, Matthew C., Kelvin KW Chan, Shane Golden, Annette Hay, Joseph Pater, Anca Prica, Bingshu E. Chen, Natasha Leighl, and Nicole Mittmann. "Minimization of resource utilization data collected within cost-effectiveness analyses conducted alongside Canadian Cancer Trials Group phase III trials." Clinical Trials 18, no. 4 (April 19, 2021): 500–504. http://dx.doi.org/10.1177/17407745211005045.

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Background Cost-effectiveness analyses embedded within randomized trials allow for evaluation of value alongside conventional efficacy outcomes; however, collection of resource utilization data can require considerable trial resources. Methods We re-analyzed the results from four phase III Canadian Cancer Trials Group trials that embedded cost-effectiveness analyses to determine the impact of minimizing potential cost categories on the incremental cost-effectiveness ratios. For each trial, we disaggregated total costs into component incremental cost categories and recalculated incremental cost-effectiveness ratios using (1) only the top 3 cost categories, (2) the top 5 cost categories, and (3) all cost components. Using individual trial-level data, confidence intervals for each incremental cost-effectiveness ratio simulation were generated by bootstrapping and descriptively presented with the original confidence intervals (and incremental cost-effectiveness ratios) from the publications. Results Drug acquisition costs represented the highest incremental cost category in three trials, while hospitalization costs represented the other consistent cost driver and the top incremental cost category in the fourth trial. Recalculated incremental cost-effectiveness ratios based on fewer cost components (top 3 and top 5) did not differ meaningfully from the original published results. Based on conventional willingness-to-pay thresholds (US$50,000–US$100,000 per quality-adjusted life-year), none of the re-analyses would have changed the original perception of whether the experimental therapies were considered cost-effective. Conclusions These results suggest that the collection of resource utilization data within cancer trials could be narrowed. Omission of certain cost categories that have minimal impact on incremental cost-effectiveness ratio, such as routine laboratory investigations, could reduce the costs and undue burden associated with the collection of data required for cancer trial cost-effectiveness analyses.
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Goldstein, Daniel A., Bilal B. Ahmad, Qiushi Chen, Turgay Ayer, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers. "Cost-Effectiveness Analysis of Regorafenib for Metastatic Colorectal Cancer." Journal of Clinical Oncology 33, no. 32 (November 10, 2015): 3727–32. http://dx.doi.org/10.1200/jco.2015.61.9569.

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Purpose Regorafenib is a standard-care option for treatment-refractory metastatic colorectal cancer that increases median overall survival by 6 weeks compared with placebo. Given this small incremental clinical benefit, we evaluated the cost-effectiveness of regorafenib in the third-line setting for patients with metastatic colorectal cancer from the US payer perspective. Methods We developed a Markov model to compare the cost and effectiveness of regorafenib with those of placebo in the third-line treatment of metastatic colorectal cancer. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Drug costs were based on Medicare reimbursement rates in 2014. Model robustness was addressed in univariable and probabilistic sensitivity analyses. Results Regorafenib provided an additional 0.04 QALYs (0.13 life-years) at a cost of $40,000, resulting in an incremental cost-effectiveness ratio of $900,000 per QALY. The incremental cost-effectiveness ratio for regorafenib was > $550,000 per QALY in all of our univariable and probabilistic sensitivity analyses. Conclusion Regorafenib provides minimal incremental benefit at high incremental cost per QALY in the third-line management of metastatic colorectal cancer. The cost-effectiveness of regorafenib could be improved by the use of value-based pricing.
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Fukuda, Haruhisa, and Kensuke Moriwaki. "Cost-Effectiveness Analysis of Safety-Engineered Devices." Infection Control & Hospital Epidemiology 37, no. 9 (May 26, 2016): 1012–21. http://dx.doi.org/10.1017/ice.2016.110.

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OBJECTIVETo estimate the cost-effectiveness of safety-engineered devices (SEDs) relative to non-SEDs for winged steel needles, intravenous catheter stylets, suture needles, and insulin pen needles.DESIGNDecision analysis modeling.PARTICIPANTSHypothetical cohort of healthcare workers who utilized needle devices.METHODSWe developed a decision-analytic model to estimate and compare the life-cycle costs and benefits for SED and non-SED needle devices. For this cost-effectiveness analysis, we quantified the total direct medical cost per needlestick injury, number of needlestick injuries avoided, and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the robustness of the base-case analysis.RESULTSIn the base-case analysis, we calculated the incremental cost-effectiveness ratios of SED winged steel needles, intravenous catheter stylets, suture needles, and insulin pen needles to be $2,633, $13,943, $1,792, and $1,269 per needlestick injury avoided, respectively. Sensitivity analyses showed that the calculated incremental cost-effectiveness ratio values for using SEDs did not fall below zero even after adjusting the values of each parameter.CONCLUSIONThe use of SED needle devices would not produce cost savings for hospitals. Government intervention may be needed to systematically protect healthcare workers in Japan from the risk of bloodborne pathogen infections.Infect Control Hosp Epidemiol 2016;37:1012–1021
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Wu, Chien-Hua, and Shu-Mei Wan. "The precision of regression-type estimator for incremental cost–effectiveness ratio." Journal of Statistical Computation and Simulation 82, no. 8 (August 2012): 1105–14. http://dx.doi.org/10.1080/00949655.2011.572073.

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Veronesi, Giulia, Niccolò Navone, Pierluigi Novellis, Elisa Dieci, Luca Toschi, Laura Velutti, Michela Solinas, Elena Vanni, Marco Alloisio, and Simone Ghislandi. "Favorable incremental cost-effectiveness ratio for lung cancer screening in Italy." Lung Cancer 143 (May 2020): 73–79. http://dx.doi.org/10.1016/j.lungcan.2020.03.015.

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Blough, D. K. "PRM36 NONPARAMETRIC ESTIMATION OF INCREMENTAL COST EFFECTIVENESS RATIO ACCOUNTING FOR SKEWNESS." Value in Health 14, no. 3 (May 2011): A152. http://dx.doi.org/10.1016/j.jval.2011.02.843.

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12

Craig, Bruce A., and Michael A. Black. "Incremental cost-effectiveness ratio and incremental net-health benefit: two sides of the same coin." Expert Review of Pharmacoeconomics & Outcomes Research 1, no. 1 (October 2001): 37–46. http://dx.doi.org/10.1586/14737167.1.1.37.

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13

Goldstein, Daniel A., Qiushi Chen, Turgay Ayer, David H. Howard, Joseph Lipscomb, Bassel F. El-Rayes, and Christopher R. Flowers. "First- and Second-Line Bevacizumab in Addition to Chemotherapy for Metastatic Colorectal Cancer: A United States–Based Cost-Effectiveness Analysis." Journal of Clinical Oncology 33, no. 10 (April 1, 2015): 1112–18. http://dx.doi.org/10.1200/jco.2014.58.4904.

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Purpose The addition of bevacizumab to fluorouracil-based chemotherapy is a standard of care for previously untreated metastatic colorectal cancer. Continuation of bevacizumab beyond progression is an accepted standard of care based on a 1.4-month increase in median overall survival observed in a randomized trial. No United States–based cost-effectiveness modeling analyses are currently available addressing the use of bevacizumab in metastatic colorectal cancer. Our objective was to determine the cost effectiveness of bevacizumab in the first-line setting and when continued beyond progression from the perspective of US payers. Methods We developed two Markov models to compare the cost and effectiveness of fluorouracil, leucovorin, and oxaliplatin with or without bevacizumab in the first-line treatment and subsequent fluorouracil, leucovorin, and irinotecan with or without bevacizumab in the second-line treatment of metastatic colorectal cancer. Model robustness was addressed by univariable and probabilistic sensitivity analyses. Health outcomes were measured in life-years and quality-adjusted life-years (QALYs). Results Using bevacizumab in first-line therapy provided an additional 0.10 QALYs (0.14 life-years) at a cost of $59,361. The incremental cost-effectiveness ratio was $571,240 per QALY. Continuing bevacizumab beyond progression provided an additional 0.11 QALYs (0.16 life-years) at a cost of $39,209. The incremental cost-effectiveness ratio was $364,083 per QALY. In univariable sensitivity analyses, the variables with the greatest influence on the incremental cost-effectiveness ratio were bevacizumab cost, overall survival, and utility. Conclusion Bevacizumab provides minimal incremental benefit at high incremental cost per QALY in both the first- and second-line settings of metastatic colorectal cancer treatment.
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O’Mahony, James F. "Does Cost-Effectiveness Analysis Really Need to Abandon the Incremental Cost-Effectiveness Ratio to Embrace Net Benefit?" PharmacoEconomics 38, no. 8 (June 15, 2020): 777–79. http://dx.doi.org/10.1007/s40273-020-00931-5.

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Wu, Bin, and Lizheng Shi. "Cost-Effectiveness of Maintenance Olaparib for Germline BRCA-Mutated Metastatic Pancreatic Cancer." Journal of the National Comprehensive Cancer Network 18, no. 11 (November 2020): 1528–36. http://dx.doi.org/10.6004/jnccn.2020.7587.

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Background: Maintenance therapy with the PARP inhibitor olaparib for metastatic pancreatic cancer (MPC) with a germline BRCA1 or BRCA2 mutation has been shown to be effective. We aimed to evaluate the cost-effectiveness of maintenance olaparib for MPC from the US payer perspective. Materials and Methods: A partitioned survival model was adopted to project the disease course of MPC. Efficacy and toxicity data were gathered from the Pancreas Cancer Olaparib Ongoing (POLO) trial. Transition probabilities were estimated from the reported survival probabilities in each POLO group. Cost and health preference data were derived from the literature. The incremental cost-utility ratio, incremental net-health benefit, and incremental monetary benefit were measured. Subgroup analysis, one-way analysis, and probabilistic sensitivity analysis were performed to explore the model uncertainties. Results: Maintenance olaparib had an incremental cost-utility ratio of $191,596 per additional progression-free survival (PFS) quality-adjusted life-year (QALY) gained, with a high cost of $132,287 and 0.691 PFS QALY gained, compared with results for a placebo. Subgroup analysis indicated that maintenance olaparib achieved at least a 16.8% probability of cost-effectiveness at the threshold of $200,000/QALY. One-way sensitivity analyses revealed that the results were sensitive to the hazard ratio of PFS and the cost of olaparib. When overall survival was considered, maintenance olaparib had an incremental cost-utility ratio of $265,290 per additional QALY gained, with a high cost of $128,266 and 0.483 QALY gained, compared with results for a placebo. Conclusions: Maintenance olaparib is potentially cost-effective compared with placebo for patients with a germline BRCA mutation and MPC. Economic outcomes could be improved by tailoring treatment based on individual patient factors.
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Kjeldsen, Hans C., Mickael Bech, and Bo Christensen. "Cost-effectiveness analysis of two management strategies for dyspepsia." International Journal of Technology Assessment in Health Care 23, no. 3 (June 19, 2007): 376–84. http://dx.doi.org/10.1017/s0266462307070420.

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Objectives:To compare the cost-effectiveness of endoscopy and empirical proton pump inhibition (PPI) therapy for management of dyspepsia in primary care.Methods:A randomized controlled trial, including prospective collection of economic resource data, was conducted in general practice from June 2000 to August 2002, Aarhus County, Denmark. We randomly assigned 368 dyspeptic patients from thirty-two general practices to treatment with omeprazol 40 mg for 2 weeks (n=184) or endoscopy (n=184). The study adopted a societal perspective, and the year of costing was 2006. Outcome measures: days free of dyspeptic symptoms and proportion of patients with dyspepsia after 1 year based on patients' and general practitioners' (GPs) assessment. Costs were estimated from patient and GP questionnaires and from medical records.Results:The incremental cost-effectiveness (CE) ratio for 1 day free of dyspeptic symptoms using the endoscopy strategy was €/day 154 compared with the PPI strategy. The incremental CE ratio for one person free of dyspeptic symptoms after 1 year using the endoscopy strategy was €13,905 based on the patients' evaluation, and the incremental CE ratio for one person free of predominant symptoms after 1 year was €5,990 according to the GPs' evaluation. The PPI strategy was both cheaper and more effective than the endoscopy strategy when reflux was the predominant symptom.Conclusions:A strategy using empirical antisecretory PPI therapy should be recommended if the alternative is an endoscopy strategy for managing dyspeptic patients in general practice, especially if reflux was the predominant symptom.
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Benjamin, Jamaal L., Jack Rychik, Jordan A. Johnstone, Gregory J. Nadolski, and Maxim Itkin. "Cost-Effectiveness of Percutaneous Lymphatic Embolization for Management of Plastic Bronchitis." World Journal for Pediatric and Congenital Heart Surgery 10, no. 4 (July 2019): 407–13. http://dx.doi.org/10.1177/2150135119842866.

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Background: Plastic bronchitis is a dreaded complication of single ventricle physiology occurring following palliation via Fontan procedure. Medical management of plastic bronchitis often fails, requiring heart transplantation. Percutaneous lymphatic embolization is an emerging treatment for plastic bronchitis. Methods: To determine the cost-effectiveness of competing management strategies, a modified Markov model was constructed with patients transiting through treatments—medical management, lymphatic embolization, or heart transplantation from a hospital system perspective. Health state transitions were modeled using an institutional review board–approved retrospective review of the Children’s Hospital of Pennsylvania’s plastic bronchitis cohort. Medication pricing data were obtained from the National Inpatient Sample. Differences in costs and quality-adjusted life years (QALYs) over a five-year horizon for each group were determined. The incremental cost-effectiveness ratio was then calculated. Results: The mean cost of lymphatic embolization from procedure performance was US$340,941, US$385,841 for heart transplantation, and US$594,520 for medical management. The mean quality-adjusted survival of lymphatic embolization yielded an additional 0.66 QALYs ( P < .03) relative to heart transplantation and 1.3 ( P < .0001) relative to medical management. Orthotopic heart transplantation yielded an additional 0.66 QALYs ( P = .06) when comparing heart transplantation to medical management. Compared to medical management, lymphatic embolization generated an incremental cost-effectiveness ratio of US$192,105. Similarly, compared to heart transplantation, lymphatic embolization yielded an incremental cost-effectiveness ratio of US$68,030. Conclusions: Of the available plastic bronchitis treatments, with a willingness to pay of US$150,000, lymphatic embolization produces an incremental cost-effectiveness ratio within the bounds considered to be cost-effective, potentially causing financial benefits to the health system.
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Clay, E., S. Aballea, C. François, and M. Toumi. "PRM35 - INCREMENTAL COST EFFECTIVENESS RATIO (ICER) THRESHOLD, THE END OF HORIZONTAL EQUITY?" Value in Health 21 (October 2018): S361. http://dx.doi.org/10.1016/j.jval.2018.09.2158.

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Wang, J. D., and M. C. Hung. "PRM6 DEVELOPMENT OF AN INCREMENTAL COST-EFFECTIVENESS RATIO WITH SOME EQUITY IMPLICATION." Value in Health 14, no. 3 (May 2011): A146. http://dx.doi.org/10.1016/j.jval.2011.02.814.

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Edney, Laura Catherine, Hossein Haji Ali Afzali, Terence Chai Cheng, and Jonathan Karnon. "Estimating the Reference Incremental Cost-Effectiveness Ratio for the Australian Health System." PharmacoEconomics 36, no. 2 (December 22, 2017): 239–52. http://dx.doi.org/10.1007/s40273-017-0585-2.

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Safonov, Anton, Weiwei Shi, James Platt, Bilge Aktas, Tomoko Kurita, Lajos Pusztai, and Christos Hatzis. "A framework to assess the cost effectiveness of predictive biomarkers in oncology: Test Incremental Cost Effectiveness Ratio (TICER)." Journal of Clinical Oncology 33, no. 15_suppl (May 20, 2015): 6621. http://dx.doi.org/10.1200/jco.2015.33.15_suppl.6621.

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Aguilar-Serra, Javier, Vicente Gimeno-Ballester, Alfonso Pastor-Clerigues, Javier Milara, Ezequiel Marti-Bonmati, Cristina Trigo-Vicente, and Julio Cortijo. "Dacomitinib in first-line treatment of advanced EGFR-mutated non-small-cell lung cancer: a cost–effectiveness analysis." Journal of Comparative Effectiveness Research 10, no. 4 (March 2021): 325–35. http://dx.doi.org/10.2217/cer-2020-0233.

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Aim: To assess the cost–effectiveness of first-line treatment with dacomitinib compared with gefitinib in patients newly diagnosed with advanced NSCLC EGFR-positive in the context of Spain. Materials & methods: A partitioned survival model was developed including costs, utilities and disutilities to estimate quality-adjusted life-year (QALY) and incremental cost–effectiveness ratio when treating with dacomitinib versus gefitinib. Results: Dacomitinib presented higher QALYs (0.51) compared with gefitinib (0.45). Dacomitinib costs were €33,061 in comparison with €26,692 for gefitinib arm. An incremental cost–effectiveness ratio of €111,048 was obtained for dacomitinib. Conclusion: Dacomitinib was more effective in terms of QALYs gained than gefitinib. However, to obtain a cost–effectiveness alternative, a discount greater than 25% in dacomitinib acquisition cost is required.
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Ellis, Charles, Richard C. Lindrooth, and Jennifer Horner. "Retrospective Cost-Effectiveness Analysis of Treatments for Aphasia: An Approach Using Experimental Data." American Journal of Speech-Language Pathology 23, no. 2 (May 2014): 186–95. http://dx.doi.org/10.1044/2013_ajslp-13-0037.

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Purpose Evidence supports the effectiveness of speech-language treatment for individuals with aphasia, yet less is known about the cost-effectiveness of such treatments. The purpose of this study was to examine the incremental cost and cost-effectiveness of aphasia treatment using previously published data. Method The authors completed a retrospective cost-effectiveness analysis using experimental data that they extracted from 19 previously published aphasia treatment studies. Average and incremental cost-effectiveness ratios were calculated based on participants' pre- and posttreatment proficiency scores. Results The average cost-effectiveness ratio for all sessions was $9.54 for each 1% increase in the outcome of interest. Measures of incremental cost-effectiveness indicated that aphasia treatments resulted in statistically significant improvements up to and including 17 treatment sessions. Increases in proficiency occurred at a cost of approximately $7.00 per 1% increase for the first 3 sessions to more than $20.00 in the 14th session; the ratio was either not statistically significant or dominated (more costly and less effective) in later sessions. Conclusions This cost-effectiveness analysis demonstrated that initial aphasia treatment sessions resulted in relatively larger and more cost-effective benefits than did later aphasia treatment sessions. The findings reported here are preliminary and have limitations. Prospective studies are needed to examine the cost-effectiveness of speech-language treatment for individuals with aphasia.
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Shijoh, Yoko, Shota Saito, Zhehao Dai, and Sachiko Ohde. "Cost-effectiveness analysis of patent foramen ovale closure versus medical therapy alone after cryptogenic stroke." PLOS ONE 17, no. 6 (June 3, 2022): e0268690. http://dx.doi.org/10.1371/journal.pone.0268690.

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Background Closure of a patent foramen ovale reduces the risk of recurrent stroke compared with medical therapy alone in young patients with cryptogenic strokes revealed by randomized control trials. Some cost-effectiveness analyses outside Japan have shown that patent foramen ovale closure is cost-effective, but no studies have examined cost-effectiveness in Japan. The objective of this study is to assess cost-effectiveness, from the perspective of a Japanese healthcare payer, of patent foramen ovale closure versus medical therapy alone for patients with patent foramen ovale related to cryptogenic strokes. Methods A cost-effectiveness study was conducted by developing a decision tree and a Markov model. Probabilities and a 5.9-year time horizon followed the RESPECT study. Utilities and costs were based upon published studies and assumptions. All assumptions were assessed by experts, including a cardiologist and a statistical expert. The target population comprised patients with cryptogenic stroke and patent foramen ovale, aged 60 years or younger. The model was discounted at 2.0% and its cycle was one month. A willingness-to-pay threshold is set at $50,000 / quality-adjusted life years (QALYs). Incremental cost-effectiveness ratio was evaluated. Then one-way sensitivity analyses as deterministic sensitivity analysis, and probabilistic sensitivity analyses were performed to assess data robustness. Results Incremental quality-adjusted life years, incremental costs, and incremental cost-effectiveness ratio were 0.464, $13,562, and $29,208 per QALY gained, respectively. One-way sensitivity analysis showed that the stable state utility score difference between patent foramen ovale closure and medical therapy had the largest impact on incremental cost-effectiveness ratio. Patent foramen ovale closure is cost-effective at a stable state utility score difference of >0.051, compared with medical therapy. Probabilistic sensitivity analyses demonstrated that patent foramen ovale closure was 50.3% cost-effective. Conclusions Patent foramen ovale closure was cost-effective compared with medical therapy for Japanese patients with cryptogenic stroke who were ≤60 years.
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Jiang, Wei, Zhichao He, Tiantian Zhang, Chongchong Guo, Jianli Zhao, Jianhong Zhu, Junyan Wu, et al. "Cost–effectiveness analysis of ribociclib plus fulvestrant for hormone receptor-positive/human EGF receptor 2-negative breast cancer." Immunotherapy 13, no. 8 (June 2021): 661–68. http://dx.doi.org/10.2217/imt-2020-0237.

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Aim: To evaluate the cost–effectiveness of ribociclib plus fulvestrant versus fulvestrant in hormone receptor-positive/human EGF receptor 2-negative advanced breast cancer. Materials & methods: A three-state Markov model was developed to evaluate the costs and effectiveness over 10 years. Direct costs and utility values were obtained from previously published studies. We calculated incremental cost–effectiveness ratio to evaluate the cost–effectiveness at a willingness-to-pay threshold of $150,000 per additional quality-adjusted life year. Results: The incremental cost–effectiveness ratio was $1,073,526 per quality-adjusted life year of ribociclib plus fulvestrant versus fulvestrant. Conclusions: Ribociclib plus fulvestrant is not cost-effective versus fulvestrant in the treatment of advanced hormone receptor-positive/human EGF receptor 2-negative breast cancer. When ribociclib is at 10% of the full price, ribociclib plus fulvestrant could be cost-effective.
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Hewitt, Jennifer, Sopany Saing, Stephen Goodall, Timothy Henwood, Lindy Clemson, and Kathryn Refshauge. "An economic evaluation of the SUNBEAM programme: a falls-prevention randomized controlled trial in residential aged care." Clinical Rehabilitation 33, no. 3 (October 30, 2018): 524–34. http://dx.doi.org/10.1177/0269215518808051.

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Objective: To estimate the cost-effectiveness of a strength and balance exercise programme (SUNBEAM) which has been shown to be clinically effective in reducing the rate of falls in residents of aged care facilities. Design: An economic evaluation was conducted alongside a pragmatic cluster randomized controlled trial that included 16 residential care facilities and 221 participants. Mean participant age was 86 years, 65% were female and 78% relied on a mobility aide. A cost-effectiveness analysis examined the costs of providing the exercise programme and costs of health service use arising from falls in each arm (intervention and usual care) over 12 months. Main measures: Incremental cost-effectiveness ratios were calculated for the cost per fall avoided. Costs were bootstrapped to obtain adjusted confidence intervals for the incremental cost-effectiveness ratios. Results: Of 63 facilities contacted, 16 met the eligibility criteria and were randomized to the intervention or usual care (1:1). There were 142 falls in the intervention group and 277 in the usual care group. 72 injurious falls occurred in the intervention group versus 157 with usual care. Delivery of the SUNBEAM programme cost $463 per participant. The mean total cost of each fall (regardless of group) was $400.09 and the mean cost of each injurious fall was $708.27. The incremental cost-effectiveness ratio was $22 per fall per person avoided with the mean bootstrapped incremental cost-effectiveness ratio $18 per fall avoided (95% CI: −$380.34 to $417.85). Conclusion: The SUNBEAM programme can be considered cost-effective, relative to other fall-prevention interventions in older adults.
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Saito, Shota, Kyoko Nakazawa, Masayuki Nagahashi, Takashi Ishikawa, and Kouhei Akazawa. "Cost–effectiveness of BRCA1/2 mutation profiling to target olaparib use in patients with metastatic breast cancer." Personalized Medicine 16, no. 6 (November 2019): 439–48. http://dx.doi.org/10.2217/pme-2018-0141.

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Aim: Olaparib monotherapy improves progression-free survival in patients with metastatic breast cancer and BRCA1/2 mutations. We evaluated the cost–effectiveness of BRCA1/2 mutation profiling to target olaparib use. Methods: A Markov cohort model was generated to compare the 5-year cost–effectiveness of BRCA1/2 mutation profiling to target olaparib use. Results: The incremental cost–effectiveness ratio of BRCA1/2 mutation profiling plus olaparib monotherapy was JPY14,677,259/quality-adjusted life year (QALY) (US$131,047/QALY), compared with standard chemotherapy alone. Conclusion: BRCA1/2 mutation profiling to target olaparib use is not a cost-effective strategy for metastatic breast cancer. The strategy provides minimal incremental benefit at a high incremental cost per QALY. Hence, further cost reductions in the cost of both BRCA1/2 mutation profiling and olaparib are required.
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Aguilar-Serra, Javier, Vicente Gimeno-Ballester, Alfonso Pastor-Clerigues, Javier Milara, Ezequiel Marti-Bonmati, Cristina Trigo-Vicente, Manuel Alós-Almiñana, and Julio Cortijo. "Osimertinib in first-line treatment of advanced EGFR-mutated non-small-cell lung cancer: a cost–effectiveness analysis." Journal of Comparative Effectiveness Research 8, no. 11 (August 2019): 853–63. http://dx.doi.org/10.2217/cer-2019-0029.

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Aim: Osimertinib improves progression-free survival in first-line EGFR mutation–positive non-small-cell lung cancer. Materials & methods: A Markov cohort model including costs, utilities and disutilities, was conducted to estimate quality-adjusted life-year (QALY) and incremental cost–effectiveness ratio when treating with osimertinib versus standard first-line tyrosine kinase inhibitors (TKIs). Results: Osimertinib presented higher QALYs (0.61) compared with standard EGFR–TKIs (0.42). Osimertinib costs were €83,258.99, in comparison with €29,209.45 for the standard EGFR–TKIs. An incremental cost–effectiveness ratio of €273,895.36/QALY was obtained for osimertinib. Conclusion: Osimertinib was more effective in terms of QALYs gained than comparators (erlotinib–gefitinib). However, to obtain a cost–effectiveness alternative, a discount greater than 60% in osimertinib acquisition cost is required.
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Wei, Xiaoxia, Jiaqin Cai, Jie Zhuang, Bin Zheng, Yuxia Sui, Guifeng Zhang, Ying Lin, and Hong Sun. "CYP2D6*10 pharmacogenetic-guided SERM could be a cost-effective strategy in Chinese patients with hormone receptor-positive breast cancer." Pharmacogenomics 21, no. 1 (January 2020): 43–53. http://dx.doi.org/10.2217/pgs-2019-0073.

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Aim: To assess the cost–effectiveness of CYP2D6*10 genetic testing for the management of Chinese women with hormone receptor-positive (HR+) breast cancer treated with selective estrogen receptor modulator. Methods: A Markov model was developed to evaluate a total expected cost and an incremental cost-effectiveness ratio (ICER). Robustness of the model was addressed in one-way analyses and probabilistic sensitivity analysis. Results: The cost of strategies of tamoxifen, toremifene without genotyping and the strategy base on CYP2D6*10 genotype were $63,879.19, $90,156.60 and $95,021.41, and the quality-adjusted life years gained are 8.1588, 12.89687 and 13.85911, respectively. The incremental cost-effectiveness ratio of the CYP2D6*10 testing versus toremifene were 5,055.74221/quality-adjusted life year, respectively. Conclusion: CYP2D6*10 pharmacogenetic-guided selective estrogen receptor modulator can be a cost-effective strategy in the Chinese patients with hormone receptor-positive breast cancer.
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Pratiwi, Febhi, Candra Eka Puspitasari, GAP Sri Erwinayanti, and Royani Widiyastuti. "Analisis Efektivitas Biaya Amitriptilin dan Gabapentin pada Pasien Stroke dengan Nyeri Neuropati di Instalasi Rawat Inap RSUD Provinsi NTB Tahun 2017." Jurnal Sains dan Kesehatan 2, no. 4 (December 31, 2020): 373–78. http://dx.doi.org/10.25026/jsk.v2i4.186.

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Neuropathic pain which is suffered by stroke patients is a pain that occurred because of the damage of the somato sensory system. The first-line therapy of neuropathic pain can be done by using amitriptyline and gabapentin. Both amitriptyline and gabapentin have significant cost-effectiveness differences. This research aims to investigate the cost effectiveness of both amitriptyline and gabapentin through stroke patients who suffered neuropathic pain. The techniques of data collection applied to a total sampling which are 17 samples were collected. The data were retrospective by the year of 2017, meanwhile, the research was conducted from April to July 2019. Clinical evaluation of neuropathic pain is conducted by applying the Wong Baker Pain Rating Scale. Amitriptyline and gabapentin cost effectiveness analysis showed Average Cost-Effectiveness Ratio (ACER) are Rp 45.443,08 and Rp 52.241,52 and Incremental Cost-Effectiveness Ratio (ICER) Rp 72.636,87. Based on the results, Incremental Net Benefit (INB) showed that gabapentin is the most cost-effective than amitrityline with Rp + 59.078,37 score. Keywords: Stroke, neuropathic pain, amitriptyline, gabapentin, cost-effectiveness analysis
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Kamae, I., K. Yamabe, and T. Sugimoto. "An analytical method for estimating the boundaries of an incremental cost-effectiveness ratio." Value in Health 17, no. 3 (May 2014): A201. http://dx.doi.org/10.1016/j.jval.2014.03.1175.

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Skrepnek, G. H., and A. Sahai. "Efficient estimation of the incremental cost-effectiveness ratio (ICER) using a new perspective." Value in Health 17, no. 3 (May 2014): A202. http://dx.doi.org/10.1016/j.jval.2014.03.1177.

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Nagase, Aki, Tetsuo Hatanaka, Hiroshi Kaneko, Tetsuya Sakamoto, and Seishiro Marukawa. "Incremental cost-effectiveness ratio of the nationwide Public Access Defibrillation program in Japan." Resuscitation 84 (October 2013): S5. http://dx.doi.org/10.1016/j.resuscitation.2013.08.028.

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Liu, Maobai, Shuli Qu, Yanjun Liu, Xingxing Yao, and Wei Jiang. "Comparative clinical effects and cost–effectiveness of maximum androgen blockade, docetaxel with androgen deprivation therapy and ADT alone for the treatment of mHSPC in China." Journal of Comparative Effectiveness Research 8, no. 11 (August 2019): 865–77. http://dx.doi.org/10.2217/cer-2018-0133.

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Aim: To compare the clinical effects and cost–effectiveness of maximum androgen blockade (MAB), docetaxel to androgen deprivation therapy (Doc-ADT) and ADT alone for the treatment of patients with metastatic hormone-sensitive prostate cancer in China. Methods: A network meta-analysis and a Markov model were adopted for effectiveness and economic evaluation. Results: The hazard ratios of overall survival and progression-free survival were 0.782 and 0.628 for Doc-ADT versus ADT alone; 0.897 and 0.824 for MAB versus ADT alone. Doc-ADT was cost-effective compared with MAB and ADT alone, with an incremental cost–effectiveness ratio of CNY 96,848 and CNY 67,758 per quality-adjusted life year, respectively. MAB was cost-effective compared with ADT alone, with an incremental cost–effectiveness ratio of CNY 137,487 per quality-adjusted life year. Conclusion: Doc-ADT is likely the optimal option from the perspective of both clinical outcomes and economic considerations.
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Barrington, David A., Crystal Tubbs, Haller J. Smith, J. Michael Straughn, Jr, Leigha Senter, and David E. Cohn. "Niraparib maintenance in frontline management of ovarian cancer: a cost effectiveness analysis." International Journal of Gynecologic Cancer 30, no. 10 (August 4, 2020): 1569–75. http://dx.doi.org/10.1136/ijgc-2020-001550.

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ObjectivesNiraparib maintenance after frontline chemotherapy for advanced ovarian cancer extends progression free survival. The objective of this study was to determine the cost effectiveness of niraparib maintenance therapy in patients with newly diagnosed ovarian cancer.MethodsDecision analysis models compared the cost of observation versus niraparib maintenance following chemotherapy for five groups: all newly diagnosed ovarian cancer patients (overall), those with homologous recombination deficiency, those harboring BRCA mutations (BRCA), homologous recombination deficiency patients without BRCA mutations (homologous recombination deficiency non-BRCA), and non-homologous recombination deficiency patients. Drug costs were estimated using average wholesale prices. Progression free survival was estimated from published data and used to estimate projected overall survival. Incremental cost effectiveness ratios per quality adjusted life year were calculated. Sensitivity analyses varying the cost of niraparib were performed. The willingness-to-pay threshold was set at US$100 000 per quality adjusted life year saved.ResultsFor the overall group, the cost of observation was US$5.8 billion versus $20.5 billion for niraparib maintenance, with an incremental cost effectiveness ratio of $72 829. For the homologous recombination deficiency group, the observation cost was $3.0 billion versus $14.8 billion for niraparib maintenance (incremental cost effectiveness ratio $56 329). Incremental cost effectiveness ratios for the BRCA, homologous recombination deficiency non-BRCA, and non-homologous recombination deficiency groups were $58 348, $50 914, and $88 741, respectively. For the overall and homologous recombination deficiency groups, niraparib remained cost effective if projected overall survival was 2.2 and 1.5 times progression free survival, respectively.ConclusionsFor patients with newly diagnosed ovarian cancer, maintenance therapy with niraparib was cost effective. Cost effectiveness was improved when analyzing those patients with homologous recombination deficiency and BRCA mutations. Efforts should continue to optimize poly-ADP-ribose polymerase utilization strategies.
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Ahumada-Canale, Antonio, Constanza Vargas, Carlos Balmaceda, Francisco Martinez-Mardones, José Cristian Plaza-Plaza, Shalom Benrimoj, and Victoria Garcia-Cardenas. "Medication review with follow-up for cardiovascular outcomes: a trial based cost–utility analysis." Journal of Comparative Effectiveness Research 10, no. 3 (February 2021): 229–42. http://dx.doi.org/10.2217/cer-2020-0171.

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Aim: To assess the trial-based cost–effectiveness of medication review with follow-up compared with usual care in primary care. Materials & methods: A cluster randomized controlled trial included patients if they were independent older adults, receiving five or more prescriptions, with moderate or high cardiovascular risk. Costs were estimated from the public healthcare sector perspective, and health benefits were measured as quality-adjusted life years. Both of which were used to calculate the incremental cost–effectiveness ratio. Results: Twelve centers completed the study, six (146 patients) in the intervention group and six (145 patients) in the control group. The base-case analysis showed an incremental cost–effectiveness ratio of US$ (2019) 434.4/quality-adjusted life year (95% CI 64.20–996.03). Conclusion: The intervention was cost-effective in the public primary care setting.
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Orellano, Pablo Wenceslao, Nestor Vazquez, and Oscar Daniel Salomon. "Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina." Cadernos de Saúde Pública 29, no. 12 (December 2013): 2459–72. http://dx.doi.org/10.1590/0102-311x00172512.

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The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.
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Pliakos, Elina Eleftheria, Panayiotis D. Ziakas, and Eleftherios Mylonakis. "Economic Analysis of Infectious Disease Consultation for Staphylococcus aureus Bacteremia Among Hospitalized Patients." JAMA Network Open 5, no. 9 (September 29, 2022): e2234186. http://dx.doi.org/10.1001/jamanetworkopen.2022.34186.

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ImportanceStaphylococcus aureus bacteremia is associated with a significant burden of mortality, morbidity, and health care costs. Infectious disease consultation may be associated with reduced mortality and bacteremia recurrence rates.ObjectiveTo evaluate the cost-effectiveness of infectious disease consultation for Staphylococcus aureus bacteremia.Design, Setting, and ParticipantsIn this economic evaluation, a decision-analytic model was constructed comparing infectious disease consult with no consult. The population was adult hospital inpatients with Staphylococcus aureus bacteremia diagnosed with at least 1 positive blood culture. Cost-effectiveness was calculated as deaths averted and incremental cost-effectiveness ratios. Uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. Costs and outcomes were calculated for a time horizon of 6 months. The analysis was performed from a societal perspective and included studies that had been published by January 2022.InterventionsPatients received or did not receive formal bedside consultation after positive blood cultures for Staphylococcus aureus bacteremia.Main Outcomes and MeasuresThe main outcomes were incremental difference in effectiveness (survival probabilities), incremental difference in cost (US dollars) and incremental cost-effectiveness ratios (US dollars/deaths averted).ResultsThis model included 1708 patients who received consultation and 1273 patients who did not. In the base-case analysis, the cost associated with the infectious disease consult strategy was $54 137.4 and the associated probability of survival was 0.77. For the no consult strategy, the cost was $57 051.2, and the probability of survival was 0.72. The incremental difference in cost between strategies was $2913.8, and the incremental difference in effectiveness was 0.05. Overall, consultation was associated with estimated savings of $55 613.4/death averted (incremental cost-effectiveness ratio, −$55613.4/death averted). In the probabilistic analysis, at a willingness-to-pay threshold of $50 000, infectious disease consult was cost-effective compared with no consult in 54% of 10 000 simulations. In cost-effectiveness acceptability curves, the consult strategy was cost-effective in 58% to 73%) of simulations compared with no consult for a willingness-to-pay threshold ranging from $0 to $150 000.Conclusions and RelevanceThese findings suggest that infectious disease consultation may be a cost-effective strategy for management of Staphylococcus aureus bacteremia and that it is associated with health care cost-savings.
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Dirksen, Carmen D., André J. H. A. Ament, Eddy M. M. Adang, Geerard L. Beets, Peter M. N. Y. H. Go, Cor G. M. I. Baeten, and Gauke Kootstra. "Cost-Effectiveness of Open Versus Laparoscopic Repair for Primary Inguinal Hernia." International Journal of Technology Assessment in Health Care 14, no. 3 (1998): 472–83. http://dx.doi.org/10.1017/s0266462300011454.

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AbstractA cost-effectiveness (CE) analysis was performed of Bassini versus laparoscopic repair for primary inguinal hernia. Incremental costs per 1 -year recurrence-free patient were calculated for the societal and hospital perspective. From the hospital perspective, the incremental CE ratio of laparoscopic repair is 5.348 guilders. From the societal perspective, laparoscopic repair is both less costly and more effective than Bassini repair. Results were sensitive to assumptions about recurrence rates, laparoscopic operating time, and return to work. Laparoscopic repair should replace Bassini repair in order to benefit society. From the hospital perspective, the decision to accept laparoscopic repair depends on the willingness to pay.
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Aronsson, Mattias, Håkan Walfridsson, Magnus Janzon, Ulla Walfridsson, Jens Cosedis Nielsen, Peter Steen Hansen, Arne Johannessen, et al. "The cost-effectiveness of radiofrequency catheter ablation as first-line treatment for paroxysmal atrial fibrillation: results from a MANTRA-PAF substudy." EP Europace 17, no. 1 (October 23, 2014): 48–55. http://dx.doi.org/10.1093/europace/euu188.

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Aim The aim of this prospective substudy was to estimate the cost-effectiveness of treating paroxysmal atrial fibrillation (AF) with radiofrequency catheter ablation (RFA) compared with antiarrhythmic drugs (AADs) as first-line treatment. Methods and results A decision-analytic Markov model, based on MANTRA-PAF (Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) study data, was developed to study long-term effects and costs of RFA compared with AADs as first-line treatment. Positive clinical effects were found in the overall population, a gain of an average 0.06 quality-adjusted life years (QALYs) to an incremental cost of €3033, resulting in an incremental cost-effectiveness ratio of €50 570/QALY. However, the result of the subgroup analyses showed that RFA was less costly and more effective in younger patients. This implied an incremental cost-effectiveness ratio of €3434/QALY in ≤50-year-old patients respectively €108 937/QALY in >50-year-old patients. Conclusion Radiofrequency catheter ablation as first-line treatment is a cost-effective strategy for younger patients with paroxysmal AF. However, the cost-effectiveness of using RFA as first-line therapy in older patients is uncertain, and in most of these AADs should be attempted before RFA (MANTRA-PAF ClinicalTrials.gov number; NCT00133211).
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Chen, Huey-Fen, Angela M. Rose, Susan Waisbren, Ayesha Ahmad, and Lisa A. Prosser. "Newborn Screening and Treatment of Phenylketonuria: Projected Health Outcomes and Cost-Effectiveness." Children 8, no. 5 (May 12, 2021): 381. http://dx.doi.org/10.3390/children8050381.

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The objective of this study was to evaluate the cost-effectiveness of newborn screening and treatment for phenylketonuria (PKU) in the context of new data on adherence to recommended diet treatment and a newly available drug treatment (sapropterin dihydrochloride). A computer simulation model was developed to project outcomes for a hypothetical cohort of newborns with PKU. Four strategies were compared: (1) clinical identification (CI) with diet treatment; (2) newborn screening (NBS) with diet treatment; (3) CI with diet and medication (sapropterin dihydrochloride); and (4) NBS with diet and medication. Data sources included published literature, primary data, and expert opinion. From a societal perspective, newborn screening with diet treatment had an incremental cost-effectiveness ratio of $6400/QALY compared to clinical identification with diet treatment. Adding medication to NBS with diet treatment resulted in an incremental cost-effectiveness ratio of more than $16,000,000/QALY. Uncertainty analyses did not substantially alter the cost-effectiveness results. Newborn screening for PKU with diet treatment yields a cost-effectiveness ratio lower than many other recommended childhood prevention programs even if adherence is lower than previously assumed. Adding medication yields cost-effectiveness results unlikely to be considered favorable. Future research should consider conditions under which sapropterin dihydrochloride would be more economically attractive.
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Chew, Derek S., Yanhong Li, Patricia A. Cowper, Kevin J. Anstrom, Jonathan P. Piccini, Jeanne E. Poole, Melanie R. Daniels, et al. "Cost-Effectiveness of Catheter Ablation Versus Antiarrhythmic Drug Therapy in Atrial Fibrillation: The CABANA Randomized Clinical Trial." Circulation 146, no. 7 (August 16, 2022): 535–47. http://dx.doi.org/10.1161/circulationaha.122.058575.

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Background: In the CABANA trial (Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation), catheter ablation did not significantly reduce the primary end point of death, disabling stroke, serious bleeding, or cardiac arrest compared with drug therapy by intention-to-treat, but did improve the quality of life and freedom from atrial fibrillation recurrence. In the heart failure subgroup, ablation improved both survival and quality of life. Cost-effectiveness was a prespecified CABANA secondary end point. Methods: Medical resource use data were collected for all CABANA patients (N=2204). Costs for hospital-based care were assigned using prospectively collected bills from US patients (n=1171); physician and medication costs were assigned using the Medicare Fee Schedule and National Average Drug Acquisition Costs, respectively. Extrapolated life expectancies were estimated using age-based survival models. Quality-of-life adjustments were based on EQ-5D–based utilities measured during the trial. The primary outcome was the incremental cost-effectiveness ratio, comparing ablation with drug therapy on the basis of intention-to-treat, and assessed from the US health care sector perspective. Results: Costs in the first 3 months averaged $20 794±SD 1069 higher with ablation compared with drug therapy. The cumulative within-trial 5-year cost difference was $19 245 (95% CI, $11 360–$27 170) and the lifetime mean cost difference was $15 516 (95% CI, –$2963 to $35,512) higher with ablation than with drug therapy. The drug therapy arm accrued an average of 12.5 life-years (LYs) and 10.7 quality-adjusted life-years (QALYs). For the ablation arm, the corresponding estimates were 12.6 LYs and 11.0 QALYs. The incremental cost-effectiveness ratio was $57 893 per QALY gained, with 75% of bootstrap replications yielding an incremental cost-effectiveness ratio < $100 000 per QALY gained. With no quality-of-life/utility adjustments, the incremental cost-effectiveness ratio was $183 318 per LY gained. Conclusions: Catheter ablation of atrial fibrillation was economically attractive compared with drug therapy in the CABANA Trial overall at present benchmarks for health care value in the United States on the basis of projected incremental QALYs but not LYs alone.
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Ramirez, Nicolas, Jorge Eduardo Herrera, Jose Fortino Chavez, and Horacio Astudillo. "Cost-effectiveness analysis of neoadjuvant chemotherapy with intensive dose of epirubicin and different cycles in patients with locally advanced breast cancer: 4 FE100C versus 6 FE100C." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e11565-e11565. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e11565.

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e11565 Background: There are different combinations of neoadjuvant chemotherapy (NCT) to treat locally advanced breast cancer (LABC); treatment with cytostatics drugs make it a costly concern, by establishing economic differences in the consumption of healthcare resources. To compare the cost-effectiveness of two NCT strategies (4FE100C vs. 6FE100C). Methods: It was made a cost-effectiveness analysis (CEA) of two treatment schemes (4FE100C vs. 6FE100C) in patients with clinical stage III breast cancer, each cohort included 48 patients. Effectiveness parameter: pathologic complete response (pCR). Differential cost: incremental cost-effectiveness ratio (ICER) using a Markov’s model. Results are expressed in terms of incremental cost per extra unit of effectiveness. Costs were expressed in Mexican (MXN) pesos ($) as of 2005; these were calculated under the perspective of public healthcare system (SSP, for its acronym in Spanish) denominated IMSS, with a 3 to 4 years analytical horizon. In order to determine the robustness of the results, a sensitivity analysis was carried out by modifying only the medical direct costs with a 3% discount rate. Results: The use of 6FE100C offered greater effectiveness compared against 4FE100C; the medical direct cost of only the cytostatic drugs for NCT with 6 FE100C and 4 E100C generated a cost per case of $30,467.00 MXN (€ 2,343.61) and $18,004.00 MXN (€ 1,384.92), respectively. The greatest unit price was given by epirubicin. The CEA demonstrated that the cost-effectiveness (C/E) was greater with 6 FE100C and the incremental cost-effectiveness ratio (ICER) showed that it was necessary to pay $11,765,925.42 MXN (€ 905,071.20) because it tells us how much it is paid additionally for every extra unit of effectiveness (pCR) which assumes 6 FE100C in front of 4 FE100C. The sensitivity analysis performed shows the robustness of the results. Conclusions: The6 FE100C scheme is the chemotherapeutic strategy with better cost-effectiveness ratio and is the most efficient in the short run for treating LABC.
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Hernández, Miguel Angel Negrín, Francisco José Vázquez-Polo, Francisco Javier Girón González-Torre, and Elías Moreno Bas. "Complementing the net benefit approach: A new framework for Bayesian cost-effectiveness analysis." International Journal of Technology Assessment in Health Care 25, no. 4 (October 2009): 537–45. http://dx.doi.org/10.1017/s0266462309990444.

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Objectives: The aim of cost-effectiveness analysis is to maximize health benefits from a given budget, taking a societal perspective. Consequently, the comparison of alternative treatments or technologies is solely based on their expected effectiveness and cost. However, the expectation, or mean, poses important limitations as it might be a poor summary of the underlying distribution, for instance when the effectiveness is a categorical variable, or when the distributions of either effectiveness or cost present a high degree of asymmetry. Clinical variables often present these characteristics.Methods: In this study, we present a framework for cost-effectiveness analysis based on the whole posterior distribution of effectiveness and cost.Results: An application with real data is included to illustrate the analysis. Decision-making measures such as the incremental cost-effectiveness ratio, incremental net-benefit, and cost-effectiveness acceptability curves, can also be defined under the new framework.Conclusions: This framework overcomes limitations of the mean and offers complementary information for the decision maker.
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Banjar, Ayman A., and Hani M. Nassar. "Universal Dental Adhesives: Cost-Effectiveness and Duration of Use." Applied Sciences 12, no. 1 (January 4, 2022): 487. http://dx.doi.org/10.3390/app12010487.

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The purpose of this study was to conduct a cost-effectiveness analysis (CEA) of different brands of universal dental adhesives used for composite restorations. Four adhesive brands were included: Single-Bond Universal (SB), Tetric N-Bond Universal VivaPen (TN), OptiBond All-In-One (OB), and G-Premio Bond (GP). Adhesives were applied 5 times daily in a standardized class II cavity onto a plastic tooth. A precision-analysis scale was used to measure all of the following parameters before and after use: adhesive bottle, applicator, dosing plate, and plastic tooth. CEA was done by measuring the amount of material utilized/day, waste/day, efficacy, efficiency, average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER). Data were analyzed using Kruskal–Wallis and Dunn’s tests with Bonferroni correction at 0.05 significance level. CEA tested parameters were significantly different between groups (p < 0.001) except for ICER (p = 0.112). GP was the least effective (median = 0.062), and SB was the least efficient (median = 0.366). The highest and lowest ACER values were associated with TN (median cost ≈ USD 317) and SB (median cost ≈ USD 317), respectively. ICER analysis reported an incremental cost for extra material utilized per milliliter of ≈USD 208 for TN, USD 3.8 for GP, and USD −38 for OB, compared to SB. TN seems to be the most efficient and cost-effective dental adhesive.
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Perovic, Sasa, and Slobodan Jankovic. "Renal transplantation vs hemodialysis: Cost-effectiveness analysis." Vojnosanitetski pregled 66, no. 8 (2009): 639–44. http://dx.doi.org/10.2298/vsp0908639p.

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Background/Aim. Chronic renal insufficiency (CRI), diabetes, hypertension, autosomal dominant polycystic kidney disease (ADPKD) are the main reasons for starting dialysis treatment in patients having kidney function failure. At present, dialysis treatments are performed in about 4,100 patients at 46 institutions in Serbia, out of which 90% are hemodialyses. At end-stage renal disease (ESRD) the only correct selection is kidney transplatation. The basic aim of the planned research was to compare ratio of costs and effects (Cost Effectiveness Analysis - CEA) of hemodialysis and kidney transplantation in patients at ESRD. Methods. As the main issue of treatment in patients from both groups the life quality measured by the validated McGill Questionary, was used. The study included 150 patients totally, divided into two groups. The study group consisted of 50 patients with kidney transplantation performed at the Clinical Center of Serbia and the control group consisted of 100 patients on hemodialysis at Clinical Center of Serbia, Clinical Hospital Center Zemun, Clinical Hospital Center 'Zvezdara', Clinical Center Kragujevac and Health Center 'Studenica', Kraljevo, comparable with respect to sex, age and length of treatment with the study group. Results. Effect of kidney transplantation in relation to hemodialysis being selection of treatment is expressed in the form of incremental ratio of costs and effects (Incremental Cost-Effectiveness Ratio - ICER). It is clear from the enclosed tables that the strategy of kidney transplantation is far more profitable considering the fact that it represents saving of EUR 132,256.25 per one year of contribution Quality Adjusted Life Years (QALY) within the period of 10 years. According to all aspects of live quality (physical symptoms and problems, physical well-being, psychological symptoms, existential well-being and support), difference is statistically important in favor of transplant patents. Conclusion. The costs of patient therapy by hemodialysis at end-stage renal disease is far greater than by performing therapy of transplantation and maintenance, by almost three and a half times. Difference in total quality aspects of human life (physical, emotional, social, spiritual and financial) between dialyzed and transplant patients is statistically significant and by 18.12% greater in transplant patients than in patients on hemodialysis.
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Zeng, Xiaohui, Xiaomin Wan, Liubao Peng, Ye Peng, Fang Ma, Qiao Liu, and Chongqing Tan. "Cost-effectiveness analysis of pembrolizumab plus chemotherapy for previously untreated metastatic non-small cell lung cancer in the USA." BMJ Open 9, no. 12 (December 2019): e031019. http://dx.doi.org/10.1136/bmjopen-2019-031019.

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ObjectivesEvaluating the cost-effectiveness of pembrolizumab plus standard chemotherapy in the first-line setting for patients with metastatic non-small cell lung cancer (NSCLC) from the US payer perspective.DesignA Markov model was constructed to analyse the cost-effectiveness of pembrolizumab plus chemotherapy in the first-line treatment of metastatic NSCLC. Health outcomes were estimated in quality-adjusted life-years (QALYs). The cost information was from Medicare in 2018. One-way and probabilistic sensitivity analyses examined the impact of uncertainty and assumptions on the results.SettingThe US payer perspective.ParticipantsA hypothetical US cohort of patients with previously untreated metastatic nonsquamous NSCLC without EGFR or ALK mutations.InterventionsPembrolizumab plus chemotherapy versus chemotherapy.Primary outcome measuresCosts, QALYs, incremental cost-effectiveness ratio (ICER) of pembrolizumab plus chemotherapy expressed as cost per QALY gained compared with chemotherapyResultsThe base case analysis demonstrated that pembrolizumab plus chemotherapy provided an additional 0.78 QALYs at incremental cost of $151 409, resulting in an ICER of $194 372/QALY. ICER for pembrolizumab plus chemotherapy was >$149 680/QALY in all of our univariable and probabilistic sensitivity analyses.ConclusionsPembrolizumab in addition to chemotherapy provides modest incremental benefit at high incremental cost per QALY for the treatment of previously untreated metastatic NSCLC.
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Vaezi, Atefeh, and Alipasha Meysamie. "COVID-19 Vaccines Cost-Effectiveness Analysis: A Scenario for Iran." Vaccines 10, no. 1 (December 29, 2021): 37. http://dx.doi.org/10.3390/vaccines10010037.

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COVID-19 vaccines are supposed to be critical measure for ending the pandemic. Governments had to decide on the type of vaccine to provide for their population. In this decision-making process, cost-effectiveness analysis is considered a helpful tool. This study is a cost-effectiveness analysis utilized to calculate the incremental cost per averted disability-adjusted life year (DALY) by vaccination compared to no vaccination for different COVID-19 vaccines. The incremental cost-effectiveness ratio (ICER) for a vaccination with COVID-19 vaccines was estimated at 6.2 to 121.2 USD to avert one DALY and 566.8 to 10,957.7 USD per one death. The lowest and highest ICERs belong to Ad26.COV2.S and CoronaVac, respectively. Considering the scenario of Iran, vaccines that are recommended include ad26.cov2.s, chadox1-S, rAd26-S + rAd5-S, and BNT162b2 in the order of recommendation.
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49

Ruiz Vargas, Estefanía, Luciano A. Sposato, Spencer A. W. Lee, Vladimir Hachinski, and Lauren E. Cipriano. "Anticoagulation Therapy for Atrial Fibrillation in Patients With Alzheimer’s Disease." Stroke 49, no. 12 (December 2018): 2844–50. http://dx.doi.org/10.1161/strokeaha.118.022596.

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Background and Purpose— Direct oral anticoagulants (DOACs) are safer, at least equally efficacious, and cost-effective compared to warfarin for stroke prevention in atrial fibrillation (AF) but they remain underused, particularly in demented patients. We estimated the cost-effectiveness of DOACs compared with warfarin in patients with AF and Alzheimer’s disease (AD). Methods— We constructed a microsimulation model to estimate the lifetime costs, quality-adjusted life-years (QALYs), and cost-effectiveness of anticoagulation therapy (adjusted-dose warfarin and various DOACs) in 70-year-old patients with AF and AD from a US societal perspective. We stratified patient cohorts based on stage of AD and care setting. Model parameters were estimated from secondary sources. Health benefits were measured in the number of acute health events, life-years, and QALYs gained. We classified alternatives as cost-effective using a willingness-to-pay threshold of $100 000 per QALY gained. Results— For patients with AF and AD, compared with warfarin, DOACs increase costs but also increase QALYs by reducing the risk of stroke. For mild-AD patients living in the community, edoxaban increased lifetime costs by $6603 and increased QALYs by 0.076 compared to warfarin, yielding an incremental cost-effectiveness ratio of $86 882/QALY gained. Even though DOACs increased QALYs compared with warfarin for all patient groups (ranging from 0.019 to 0.085 additional QALYs), no DOAC treatment alternative had an incremental cost-effectiveness ratio <$150 000/QALY gained for patients with moderate to severe AD. For patients living in a long-term care facility with mild AD, the DOAC with the lowest incremental cost-effectiveness ratio (rivaroxaban) costs $150 169 per QALY gained; for patients with more severe AD, the incremental cost-effectiveness ratios were higher. Conclusions— For patients with AF and mild AD living in the community, edoxaban is cost-effective compared with warfarin. Even though patients with moderate and severe AD living in the community and patients with any stage of AD living in a long-term care setting may obtain positive clinical benefits from anticoagulation treatment, DOACs are not cost-effective compared with warfarin for these populations. Compared to aspirin, no oral anticoagulation (warfarin or any DOAC) is cost effective in patients with AF and AD.
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50

Schuetz, Philipp, Suela Sulo, Stefan Walzer, Sebastian Krenberger, Zeno Stagna, Filomena Gomes, Beat Mueller, and Cory Brunton. "Economic Evaluation of Individualized Nutritional Support for Hospitalized Patients with Chronic Heart Failure." Nutrients 14, no. 9 (April 20, 2022): 1703. http://dx.doi.org/10.3390/nu14091703.

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Background Malnutrition is a highly prevalent risk factor in hospitalized patients with chronic heart failure (CHF). A recent randomized trial found lower mortality and improved health outcomes when CHF patients with nutritional risk received individualized nutritional treatment. Objective To estimate the cost-effectiveness of individualized nutritional support in hospitalized patients with CHF. Methods This analysis used data from CHF patients at risk of malnutrition (N = 645) who were part of the Effect of Early Nutritional Therapy on Frailty, Functional Outcomes and Recovery of Undernourished Medical Inpatients Trial (EFFORT). Study patients with CHF were randomized into (i) an intervention group (individualized nutritional support to reach energy, protein, and micronutrient goals) or (ii) a control group (receiving standard hospital food). We used a Markov model with daily cycles (over a 6-month interval) to estimate hospital costs and health outcomes in the comparator groups, thus modeling cost-effectiveness ratios of nutritional interventions. Results With nutritional support, the modeled total additional cost over the 6-month interval was 15,159 Swiss Francs (SF). With an additional 5.77 life days, the overall incremental cost-effectiveness ratio for nutritional support vs. no nutritional support was 2625 SF per life day gained. In terms of complications, patients receiving nutritional support had a cost savings of 6214 SF and an additional 4.11 life days without complications, yielding an incremental cost-effectiveness ratio for avoided complications of 1513 SF per life day gained. Conclusions On the basis of a Markov model, this economic analysis found that in-hospital nutritional support for CHF patients increased life expectancy at an acceptable incremental cost-effectiveness ratio.
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