Background
Inability to achieve primary fascial closure after damage control laparotomy is a frequently encountered problem by acute care and trauma surgeons. This study aims to compare the ...cost-effectiveness of Wittmann patch-assisted closure to the planned ventral hernia closure.
Methods
A literature review was performed to determine the probabilities and outcomes for Wittmann patch-assisted primary closure and planned ventral hernia closure techniques. Average utility scores were obtained by a patient-administered survey for the following: rate of successful surgeries (uncomplicated abdominal wall closure), surgical site infection, wound dehiscence, abdominal hernia and enterocutaneous fistula. A visual analogue scale (VAS) was utilized to assess the survey responses and then converted to quality-adjusted life years (QALYs). Total cost for each strategy was calculated using Medicare billing codes. A decision tree was generated with rollback and incremental cost-utility ratio (ICUR) analyses. Sensitivity analyses were performed to account for uncertainty.
Results
Wittmann patch-assisted closure was associated with higher clinical effectiveness of 19.43 QALYs compared to planned ventral hernia repair (19.38), with a relative cost reduction of US$7777. Rollback analysis supported Wittmann patch-assisted closure as the more cost-effective strategy. The resulting negative ICUR of −156,679.77 favored Wittmann patch-assisted closure. Monte Carlo analysis demonstrated a confidence of 96.8% that Wittmann patch-assisted closure was cost-effective.
Conclusions
This study demonstrates using the Wittmann patch-assisted closure strategy as a more cost-efficient management of the open abdomen compared to the planned ventral hernia approach.
Across the nation, patients with locally advanced gastric cancer (LAGC) are managed with modalities including upfront surgery (US) and perioperative chemotherapy (PCT). Preoperative therapies have ...demonstrated survival benefits over US and thus long-term outcomes are expected to vary between the options. However, as these 2 modalities continue to be regularly employed, we sought to perform a decision analysis comparing the costs and quality-of-life associated with the treatment of patients with LAGC to identify the most cost-effective option. We designed a decision tree model to investigate the survival and costs associated with the most commonly utilized management modalities for LAGC in the United States: US and PCT. The tree described costs and treatment strategies over a 6-month time horizon. Costs were derived from 2022 Medicare reimbursement rates using the third-party payer perspective for physicians and hospitals. Effectiveness was represented using quality-adjusted life-years (QALYs). One-way, two-way, and probabilistic sensitivity analyses were utilized to test the robustness of our findings. PCT was the most cost-effective treatment modality for patients with LAGC over US with a cost of $40,792.16 yielding 3.11 QALYs. US has a cost of $55,575.57 while yielding 3.15 QALYs; the incremental cost-effectiveness ratio (ICER) was $369,585.25. One-way and two-way sensitivity analyses favored PCT in all variations of variables across their standard deviations. Across 100,000 Monte Carlo simulations, 100% of trials favored PCT. In our model simulating patients with LAGC, the most cost-effective treatment strategy was PCT. While US demonstrated improved QALYs over PCT, the associated cost was too great to justify its use.
Background and Aim
Growing studies have demonstrated clinical benefits of fecal microbiota transplantation (FMT) therapy (administered by colonoscopy, enema, or both) for active ulcerative colitis ...(UC). This study aimed to evaluate the cost‐effectiveness of standard treatment with and without FMT therapy for mild‐to‐moderate active UC from the perspective of US healthcare provider.
Methods
A 10‐year Markov model was developed to evaluate the costs and quality‐adjusted life‐years (QALYs) of standard treatment plus FMT therapy versus standard treatment alone. Model inputs were retrieved from publish data in literature. Base‐case and sensitivity analyses were performed.
Results
In the base‐case analysis, standard treatment plus FMT therapy was more effective than standard treatment alone (by 0.068 QALYs). Comparing to standard treatment alone, standard treatment plus FMT therapy varied from cost‐saving to incremental cost, subject to the number of FMT administrations. One‐way sensitivity analysis identified the relative risk of achieving remission with FMT therapy to be the most influential factor on the incremental cost‐effectiveness ratio of standard treatment plus FMT therapy. Monte‐Carlo simulations showed that standard treatment plus FMT therapy with 3 and 6 administrations per FMT course was cost‐effective (at willingness‐to‐pay threshold = 50 000 USD/QALY) in 90.77% and 67.03% of time, respectively.
Conclusions
Standard treatment plus FMT therapy appears to be more effective in gaining higher QALYs than standard therapy alone for patients with mild‐to‐moderate active UC. Cost‐effectiveness of standard treatment plus FMT therapy is highly subject to the relative improvement in achieving remission with standard therapy plus FMT therapy and number of FMT administrations per FMT course.
Objectives
To assess the cost‐effectiveness, resource use implications, quality‐adjusted life‐years (QALYs) and cost per QALY of care pathways starting with either extracorporeal shockwave ...lithotripsy (SWL) or with ureteroscopic retrieval (ureteroscopy URS) for the management of ureteric stones.
Patients and Methods
Data on quality of life and resource use for 613 patients, collected prospectively in the Therapeutic Interventions for Stones of the Ureter (TISU) randomized controlled trial (ISRCTN 92289221), were used to assess the cost‐effectiveness of two care pathways, SWL and URS. A health provider (UK National Health Service) perspective was adopted to estimate the costs of the interventions and subsequent resource use. Quality‐of‐life data were calculated using a generic instrument, the EuroQol EQ‐5D‐3L. Results are expressed as incremental cost‐effectiveness ratios and cost‐effectiveness acceptability curves.
Results
The mean QALY difference (SWL vs URS) was −0.021 (95% confidence interval CI −0.033 to −0.010) and the mean cost difference was −£809 (95% CI −£1061 to −£551). The QALY difference translated into approximately 10 more healthy days over the 6‐month period for the patients on the URS care pathway. The probabaility that SWL is cost‐effective is 79% at a society's willingness to pay (WTP) threshold for 1 QALY of £30,000 and 98% at a WTP threshold of £20,000.
Conclusion
The SWL pathway results in lower QALYs than URS but costs less. The incremental cost per QALY is £39 118 cost saving per QALY lost, with a 79% probability that SWL would be considered cost‐effective at a WTP threshold for 1 QALY of £30 000 and 98% at a WTP threshold of £20 000. Decision‐makers need to determine if costs saved justify the loss in QALYs.
Objective
To evaluate the cost‐effectiveness of spinal cord stimulation (SCS) and conventional medical management (CMM) compared with CMM alone for patients with failed back surgery syndrome (FBSS), ...complex regional pain syndrome (CRPS), peripheral arterial disease (PAD), and refractory angina pectoris (RAP).
Design
Markov models were developed to evaluate the cost‐effectiveness of SCS vs CMM alone from the perspective of a Canadian provincial Ministry of Health. Each model followed costs and outcomes in 6‐month cycles. Health effects were expressed as quality‐adjusted life years (QALYs). Costs were gathered from public sources and expressed in 2012 Canadian dollars (CAN$). Costs and effects were calculated over a 20‐year time horizon and discounted at 3.5% annually, as suggested by the National Institute of Clinical Excellence. Cost‐effectiveness was identified by deterministic and probabilistic sensitivity analysis (50,000 Monte‐Carlo iterations). Outcome measures were: cost, QALY, incremental net monetary benefit (INMB), incremental cost‐effectiveness ratio (ICER), expected value of perfect information (EVPI), and strategy selection frequency.
Results
The ICER for SCS was: CAN$ 9,293 (FBSS), CAN$ 11,216 (CRPS), CAN$ 9,319 (PAD), CAN$ 9,984 (RAP) per QALY gained, respectively. SCS provided the optimal economic path. The probability of SCS being cost‐effective compared with CMM was 75–95% depending on pathology. SCS generates a positive INMB for treatment of pain syndromes. Sensitivity analyses demonstrated that results were robust to plausible variations in model costs and effectiveness inputs. Per‐patient EVPI was low, indicating that gathering additional information for model parameters would not significantly impact results.
Conclusion
SCS with CMM is cost‐effective compared with CMM alone in the management of FBSS, CRPS, PAD, and RAP.
Schizophrenia is a serious mental disorder characterized by impaired thinking, hallucinations and social behavior. Yogyakarta Special Region (DIY) ranks 2nd with a prevalence of schizophrenia ...reaching 10.4 per 1,000 population. The high number of people suffering from mental disorders can lead to increasingly expensive costs. To reduce the problem of health financing, a cost-effectiveness analysis is needed by calculating the cost of antipsychotic drugs and calculating the Average Cost Effectiveness Ratio value. The aim of this study was to determine the cost-effectiveness of using atypical antipsychotic monotherapy with atypical and typical combinations in schizophrenia patients at RSJ Grhasia Yogyakarta. The research method was carried out descriptively and retrospectively using medical record data for the period January-December 2022, with a proportional sampling technique. Results: research shows that atypical monotherapy antipsychotics are more cost-effective with an Average Cost Effectiveness Ratio value of IDR 204.4/week of therapeutic treatment compared to atypical-typical combination antipsychotics with a greater value of IDR 343.2/week of therapeutic treatment. Conclusion: The antipsychotics used by inpatient schizophrenia patients at RSJ Grhasia Yogyakarta had the highest effectiveness, namely in the atypical monotherapy therapy group, amounting to (93.02%).
The absence of a rigorous mechanism for prioritizing investment in endangered species management is a major implementation hurdle affecting recovery. Here, we present a method for prioritizing ...strategies for endangered species management based on the likelihood of achieving species’ recovery goals per dollar invested. We demonstrate our approach for 15 species listed under Canada's Species at Risk Act that co‐occur in Southwestern Saskatchewan. Without management, only two species have >50% probability of meeting recovery objectives; whereas, with management, 13 species exceed the >50% threshold with the implementation of just five complementary strategies at a cost of $126m over 20 years. The likelihood of meeting recovery objectives rarely exceeded 70% and two species failed to reach the >50% threshold. Our findings underscore the need to consider the cost, benefit, and feasibility of management strategies when developing recovery plans in order to prioritize implementation in a timely and cost‐effective manner.
This systematic review aims to catalogue and describe published applications of equity-informative cost-effectiveness analysis (CEAs).
Following PRISMA guidelines, we searched Medline for ...English-language, peer-reviewed CEAs published on or before August 2019. We included CEAs that evaluated 2 or more alternatives; explicitly mentioned equity as a consideration or decision-making principle; and applied an equity-informative CEA method to analyze or examine at least 1 equity criterion in an applied CEA. We extracted data on selected characteristics and analyzed reporting quality using the CHEERS checklist.
Fifty-four articles identified through a search and bibliography reviews met the inclusion criteria. All articles were published on or after 2010, with 80% published after 2015. Most studies evaluated primary prevention interventions in disease areas such as cancer, infectious diseases, and cardiovascular disease. Equity impact analysis alone was the most common equity-informative CEA (56%), followed by equity impact analysis with financial protection effects (30%). At least 11 different equity criteria have been used in equity-informative CEAs; socioeconomic status and race/ethnicity were used most frequently. Seventy-eight percent of studies reported finding “greater value” in an intervention after examining its distributional effects.
The number of equity-informative CEAs is increasing, and the wide range of equity criteria, diseases, interventions, settings, and populations represented suggests that broad application of these methods is feasible but will require further refinement. Inclusion of equity into CEAs may shift the value of evaluated interventions and can provide crucial additional information for decision makers.
•Equity-informative cost-effectiveness analysis (CEA) methods have been proposed to formally examine the equity effects of different interventions. Equity-informative CEAs quantify the distributional impacts of health interventions based on different equity criteria.•Since equity-informative CEAs were developed and proposed, their applications have not been systematically assessed to understand what conditions and interventions they have been used for, as well as their reporting quality. This systematic review aims to fill that gap by cataloguing and describing peer-reviewed applications of equity-informative CEAs to date.•Equity-informative CEAs are not only increasing but have been applied to a range of equity criteria, disease areas, intervention types, and populations, which suggests that broad application of these methods is feasible but will require further refinement.
A recent phase III clinical trial (NCT03981796) evaluated the efficacy and safety of dostarlimab combined with carboplatin-paclitaxel (DOS-CP) compared to placebo combined with carboplatin-paclitaxel ...(PLB-CP) as a first-line treatment for advanced endometrial cancer (EC). The NCT03981796 trial demonstrated that DOS-CP significantly improved progression-free survival and overall survival of patients with advanced EC while maintaining an acceptable safety profile. However, DOS-CP is expensive and its cost-effectiveness has not been evaluated. This study aims to evaluate the cost-effectiveness of DOS-CP compared to PLB-CP as a first-line treatment for advanced EC from the perspective of the Chinese healthcare system.
A Markov model with three health states was developed to evaluate the cost-effectiveness of DOS-CP as a first-line treatment for advanced EC. Clinical efficacy data were derived from the NCT03981796 trial, and drug costs were determined based on national tender prices. Other costs and utility values were obtained from published literature. The outcomes assessed included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). The robustness of the model was assessed through one-way sensitivity analysis and probabilistic sensitivity analysis.
In comparison to PLB-CP, the ICER of DOS-CP was $98,276.61/QALY for the overall population, $53,063.61/QALY for the dMMR subgroup, and $124,088.56/QALY for the pMMR subgroup. All of these ICER values were higher than the willingness-to-pay threshold of $38,201 per QALY. The most important variable that affected the results of the model was the discount rate, the cost of dostarlimab, and the utility value for progressive disease.
From the perspective of the Chinese healthcare system, DOS-CP is unlikely to be a cost-effective first-line treatment option for advanced EC.
Background
Secondary fracture prevention intervention such as fracture liaison services are effective for increasing osteoporosis treatment rates, but are not currently widely used in the United ...States. We evaluated the cost‐effectiveness of secondary fracture prevention intervention after osteoporotic fracture for Medicare beneficiaries.
Methods
An individual‐level state‐transition microsimulation model was developed to evaluate the cost‐effectiveness of secondary fracture prevention intervention compared with usual care for U.S. Medicare patients aged 65 and older who experience a new osteoporotic fracture. Patients who initiated pharmacotherapy and remained adherent were assumed to be treated for 5 years. Outcome measures included subsequent fractures, average lifetime costs, quality‐adjusted life‐years (QALYs), and incremental cost‐effectiveness ratios in 2020 U.S. dollars per QALY gained. The model time horizon was lifetime, and analysis perspective was payer.
Results
Base‐case analysis results showed that the secondary fracture prevention intervention strategy was both more effective and less expensive than usual care—thus, it was cost‐saving. Model findings indicated that the intervention would reduce the number of expected fractures by approximately 5% over a 5‐year period, preventing approximately 30,000 fractures for 1 million patients. Secondary fracture prevention intervention resulted in an average cost savings of $418 and an increase in QALYs of 0.0299 per patient over the lifetime; for 1 million patients who receive the intervention instead of usual care, expected cost savings for Medicare would be $418 million dollars. One‐way and probabilistic sensitivity analyses supported base‐case findings of cost savings.
Conclusion
Secondary fracture prevention intervention for Medicare beneficiaries after a new osteoporotic fracture is very likely to both improve health outcomes and reduce healthcare costs compared with usual care. Expansion of its use for this population is strongly recommended.
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