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Treatment evolution and new standards of care: implications for cost-effectiveness analysis.

https://arctichealth.org/en/permalink/ahliterature144568
Source
Med Decis Making. 2011 Jan-Feb;31(1):35-42
Publication Type
Article
Author
Steven M Shechter
Author Affiliation
Sauder School of Business, University of British Columbia, Vancouver, BC, Canada. steven.shechter@sauder.ubc.ca
Source
Med Decis Making. 2011 Jan-Feb;31(1):35-42
Language
English
Publication Type
Article
Keywords
British Columbia
Cost-Benefit Analysis
Humans
Markov Chains
Models, Statistical
Patient Care - economics - standards
Probability
Quality-Adjusted Life Years
Abstract
Traditional approaches to cost-effectiveness analysis have not considered the downstream possibility of a new standard of care coming out of the research and development pipeline. However, the treatment landscape for patients may change significantly over the course of their lifetimes.
To present a Markov modeling framework that incorporates the possibility of treatment evolution into the incremental cost-effectiveness ratio (ICER) that compares treatments available at the present time.
. Markov model evaluated by matrix algebra. Measurements. The author evaluates the difference between the new and traditional ICER calculations for patients with chronic diseases facing a lifetime of treatment.
The bias of the traditional ICER calculation may be substantial, with further testing revealing that it may be either positive or negative depending on the model parameters. The author also performs probabilistic sensitivity analyses with respect to the possible timing of a new treatment discovery and notes the increase in the magnitude of the bias when the new treatment is likely to appear sooner rather than later. Limitations. The modeling framework is intended as a proof of concept and therefore makes simplifying assumptions such as time stationarity of model parameters and consideration of a single new drug discovery.
For diseases with a more active research and development pipeline, the possibility of a new treatment paradigm may be at least as important to consider in sensitivity analysis as other parameters that are often considered.
PubMed ID
20354228 View in PubMed
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Chemoprevention: drug pricing and mortality: the case of tamoxifen.

https://arctichealth.org/en/permalink/ahliterature168200
Source
Cancer. 2006 Sep 1;107(5):950-8
Publication Type
Article
Date
Sep-1-2006
Author
Joy Melnikow
Christina Kuenneth
L Jay Helms
Amber Barnato
Miriam Kuppermann
Stephen Birch
James Nuovo
Author Affiliation
Department of Family and Community Medicine, University of California-Davis, Sacramento, California 95817, USA. jamelnikow@ucdavis.edu
Source
Cancer. 2006 Sep 1;107(5):950-8
Date
Sep-1-2006
Language
English
Publication Type
Article
Keywords
Anticarcinogenic Agents - economics - therapeutic use
Antineoplastic Agents, Hormonal - therapeutic use
Breast Neoplasms - drug therapy - economics - mortality - prevention & control
Canada
Cost-Benefit Analysis
Endometrial Neoplasms - chemically induced
Female
Humans
Markov Chains
Middle Aged
Monte Carlo Method
Neoplasms, Hormone-Dependent - economics
Risk
Tamoxifen - adverse effects - economics - therapeutic use
Time Factors
United States
Abstract
Tamoxifen is a prototypic cancer chemopreventive agent, yet clinical trials have not evaluated its effect on mortality or the impact of drug pricing on its cost-effectiveness.
A state-transition Markov model for a hypothetical cohort of women age 50 years was used to evaluate the effects of tamoxifen on mortality and tamoxifen price on cost-effectiveness. Incidence and mortality rates for breast and endometrial cancers were derived from Surveillance, Epidemiology and End Results statistics, and noncancer outcomes were obtained from published studies. Relative risks of outcomes were derived from the National Surgical Adjuvant Breast and Bowel Project P-1 trial. Costs were based on Medicare reimbursements.
Projected overall mortality for women at 1.67% 5-year breast cancer risk showed little difference with or without tamoxifen, resulting in a cost-effectiveness ratio of $1,335,690 per life-year saved as a result of tamoxifen use. Adjusting for the differential impact of estrogen receptor-negative cancers, tamoxifen increased mortality for women with a uterus until the 5-year breast cancer risk reached > or =2.1%. Assigning the Canadian price for tamoxifen dramatically reduced the incremental cost (to $123,780 per life-year saved). At that price, the use of tamoxifen was less costly and more effective for women with 5-year breast cancer risks >4%.
Tamoxifen may increase mortality in women at the lower end of the "high-risk" range for breast cancer. If prices in the U.S. approximated Canadian prices, then tamoxifen use for breast cancer risk reduction in women with a 5-year risk >3% could be a reasonable strategy to reduce the incidence of breast cancer. Because they are used by many unaffected individuals, the price of chemopreventive agents has a major influence on their cost-effectiveness.
PubMed ID
16865680 View in PubMed
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Cost-effectiveness of alternative treatments for women with osteoporosis in Canada.

https://arctichealth.org/en/permalink/ahliterature168355
Source
Curr Med Res Opin. 2006 Jul;22(7):1425-36
Publication Type
Article
Date
Jul-2006
Author
Ron Goeree
Gord Blackhouse
Jonathan Adachi
Author Affiliation
Program for Assessment of Technology in Health (PATH), McMaster University, Ontario, Canada. goereer@mcmaster.ca
Source
Curr Med Res Opin. 2006 Jul;22(7):1425-36
Date
Jul-2006
Language
English
Publication Type
Article
Keywords
Aged
Alendronate - economics - therapeutic use
Bone Density Conservation Agents - economics - therapeutic use
Canada
Cost-Benefit Analysis
Decision Support Techniques
Etidronic Acid - analogs & derivatives - economics - therapeutic use
Female
Humans
Markov Chains
Osteoporosis, Postmenopausal - drug therapy - economics
Raloxifene - economics - therapeutic use
Abstract
During the years following menopause, estrogen levels decline leading to accelerated bone loss and an increased risk of osteoporosis and osteoporosis-related fractures.
Using a Markov model and decision analytic techniques, the long-term costs and outcomes of five treatment and secondary prevention strategies for osteoporosis were compared: 'no intervention', alendronate, etidronate, risedronate, and raloxifene. The base case analysis examined postmenopausal (65 year old) osteoporotic women without prior fracture. Probabilistic sensitivity analysis (PSA) was used to incorporate the impact of parameter uncertainty, and deterministic sensitivity analysis (DSA) was used to compare alternative patient populations and modeling assumptions. Life years and Quality Adjusted Life Years (QALYs) were used as measures of effectiveness.
In the base case analysis, risedronate was dominated by etidronate and alendronate. Alendronate and etidronate were projected to have similar costs and QALYs, and the efficiency frontier was represented by 'no intervention', etidronate, alendronate, and raloxifene (Can$32 571, Can$38 623 and Can$114 070 per QALY respectively). Alternative assumptions of raloxifene's impact on CHD and breast cancer, alternative discount rates and alternative patient risk factors (e.g., starting age of therapy, CHD risk, and prior fracture risk) had significant impacts on the overall cost-effectiveness results for both the bisphosphonates and raloxifene.
Using conventionally quoted benchmarks and compared to no therapy, alendronate, etidronate, and raloxifene would all be considered cost-effective alternatives for treating women with osteoporosis. Potential limitations of this study include the usual caveats and cautions associated with long-term projection models and the fact that not all inputs into the model are Canadian data sources.
PubMed ID
16834841 View in PubMed
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Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy.

https://arctichealth.org/en/permalink/ahliterature168750
Source
CMAJ. 2006 Jun 20;174(13):1847-52
Publication Type
Article
Date
Jun-20-2006
Author
Dean A Regier
Rubina Sunderji
Larry D Lynd
Kenneth Gin
Carlo A Marra
Author Affiliation
Collaboration for Outcomes Research and Evaluation, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC.
Source
CMAJ. 2006 Jun 20;174(13):1847-52
Date
Jun-20-2006
Language
English
Publication Type
Article
Keywords
Administration, Oral
Anticoagulants - administration & dosage - adverse effects - economics
Atrial Fibrillation - drug therapy - economics
Bayes Theorem
Canada
Cost of Illness
Cost-Benefit Analysis
Health Services Research
Heart Valve Prosthesis - economics
Humans
International Normalized Ratio
Markov Chains
National Health Programs
Outcome Assessment (Health Care)
Physician's Role
Quality-Adjusted Life Years
Self Administration - economics
Abstract
Patient self-management of long-term oral anticoagulation therapy is an effective strategy in a number of clinical situations, but it is currently not a funded option in the Canadian health care system. We sought to compare the incremental cost and health benefits of self-management with those of physician management from the perspective of the Canadian health care payer over a 5-year period.
We developed a Bayesian Markov model comparing the costs and quality-adjusted life years (QALYs) accrued to patients receiving oral anticoagulation therapy through self-management or physician management for atrial fibrillation or for a mechanical heart valve. Five health states were defined: no events, minor hemorrhagic events, major hemorrhagic events, thrombotic events and death. Data from published literature were used for transition probabilities. Canadian 2003 costs were used, and utility estimates were obtained from various published sources.
Self-management resulted in 3.50 fewer thrombotic events, 0.78 fewer major hemorrhagic events and 0.12 fewer deaths per 100 patients than physician management. The average discounted incremental cost of self-management over physician management was found to be 989 dollars (95% confidence interval [CI] 310 dollars-1655 dollars) per patient and the incremental QALYs gained was 0.07 (95% CI 0.06-0.08). The cost-effectiveness of self-management was 14,129 dollars per QALY gained. There was a 95% chance that self-management would be cost-effective at a willingness to pay of 23,800 dollars per QALY. Results were robust in probabilistic and deterministic sensitivity analyses.
This model suggests that self-management is a cost-effective strategy for those receiving long-term oral anticoagulation therapy for atrial fibrillation or for a mechanical heart valve.
Notes
Cites: J Thromb Thrombolysis. 2000 Apr;9(3):283-9210728029
Cites: Lancet. 2000 Mar 18;355(9208):956-6210768433
Cites: J Thromb Thrombolysis. 2000 Jun;9 Suppl 1:S13-910859580
Cites: J Thromb Thrombolysis. 2000 Jun;9 Suppl 1:S41-510859584
Cites: Lancet. 2000 Jul 8;356(9224):97-10210963245
Cites: Chest. 2001 Jan;119(1 Suppl):8S-21S11157640
Cites: Stroke. 2001 Jun;32(6):1425-911387509
Cites: Ann Thorac Surg. 2001 Nov;72(5):1523-711722037
Cites: Annu Rev Public Health. 2002;23:377-40111910068
Cites: Stroke. 2002 Apr;33(4):1034-4011935057
Cites: Stroke. 2002 Aug;33(8):2053-912154262
Cites: J Clin Pathol. 2002 Nov;55(11):845-912401823
Cites: Stroke. 2003 Feb;34(2):528-3612574571
Cites: Stroke. 2003 Apr;34(4):1056-8312677087
Cites: Med Decis Making. 2003 Jul-Aug;23(4):341-5012926584
Cites: Qual Life Res. 2004 Mar;13(2):427-3315085915
Cites: Chest. 2004 Sep;126(3 Suppl):204S-233S15383473
Cites: Can J Cardiol. 2004 Sep;20(11):1117-2315457308
Cites: Health Policy. 1990 Dec;16(3):199-20810109801
Cites: CMAJ. 1992 Feb 15;146(4):473-811306034
Cites: Thromb Haemost. 1993 Mar 1;69(3):236-98470047
Cites: N Engl J Med. 1995 Jul 6;333(1):11-77776988
Cites: Arch Intern Med. 1995 Nov 13;155(20):2185-97487240
Cites: Int J Technol Assess Health Care. 1995 Fall;11(4):796-78567213
Cites: Arch Intern Med. 1996 Jun 10;156(11):1197-2018639014
Cites: Lancet. 1996 Aug 17;348(9025):423-88709780
Cites: Eur J Cardiothorac Surg. 1997 May;11(5):935-429196312
Cites: JAMA. 1999 Jan 13;281(2):145-509917117
Cites: Semin Thromb Hemost. 1999;25(1):103-710327229
Cites: Disabil Rehabil. 1999 May-Jun;21(5-6):258-6810381238
Cites: Med Decis Making. 1999 Jul-Sep;19(3):265-7510424833
Cites: J Intern Med. 1999 Sep;246(3):309-1610475999
Cites: Ann Intern Med. 2005 Jan 4;142(1):1-1015630104
Cites: Int J Cardiol. 2005 Mar 10;99(1):37-4515721497
Cites: Z Kardiol. 2005 Mar;94(3):182-615747040
Cites: Lancet. 2006 Feb 4;367(9508):404-1116458764
Comment In: CMAJ. 2007 Mar 13;176(6):813; author reply 813-417353543
PubMed ID
16785459 View in PubMed
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Cost-effectiveness of C-leg compared with non-microprocessor-controlled knees: a modeling approach.

https://arctichealth.org/en/permalink/ahliterature87731
Source
Arch Phys Med Rehabil. 2008 Jan;89(1):24-30
Publication Type
Article
Date
Jan-2008
Author
Brodtkorb Thor-Henrik
Henriksson Martin
Johannesen-Munk Kasper
Thidell Fredrik
Author Affiliation
Center for Medical Technology Assessment, Department of Medicine and Health Sciences, Linköpings Universitet, Linköping, Sweden. Thor-Henrik.Brodtkorb@ihs.liu.se
Source
Arch Phys Med Rehabil. 2008 Jan;89(1):24-30
Date
Jan-2008
Language
English
Publication Type
Article
Keywords
Adult
Artificial Limbs - economics
Cost-Benefit Analysis
Decision Support Techniques
Denmark
Female
Humans
Knee Prosthesis - economics
Leg
Male
Markov Chains
Outcome Assessment (Health Care)
Quality-Adjusted Life Years
Sweden
Abstract
OBJECTIVE: To estimate the costs and health outcomes of C-Leg and non-microprocessor-controlled (NMC) knees using a decision-analytic model. DESIGN: Data on costs, rates and duration of problems, knee survival, and health-related quality of life were obtained from interviews with patients and prosthetists with experience of both C-Leg and NMC knees. Interview data were assessed in a decision-analytic Markov model to estimate cost-effectiveness from a health care perspective. SETTING: Outpatient. PARTICIPANTS: A population sample of 20 patients currently using the C-Leg and prior experience of nonmicroprocessor knees, and 5 prosthetists. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Incremental cost per quality-adjusted life year (QALY). RESULTS: The mean incremental cost (in 2006 Euros) and QALYs for the C-Leg was 7657 euros and 2.38, respectively, yielding a cost per QALY gained of 3218 euros. CONCLUSIONS: It is important to provide decision-makers with relevant information on costs and health outcomes of different treatment strategies on actual decision problems despite limited evidence. The results of the study, taking into account both costs and a broadly defined health outcome in terms of QALY, show that given existing albeit limited evidence the C-Leg appears to yield positive health outcomes at an acceptable cost.
PubMed ID
18164326 View in PubMed
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Costs and cost-effectiveness of a universal, school-based hepatitis B vaccination program.

https://arctichealth.org/en/permalink/ahliterature204008
Source
Am J Public Health. 1998 Nov;88(11):1638-44
Publication Type
Article
Date
Nov-1998
Author
M. Krahn
R. Guasparini
M. Sherman
A S Detsky
Author Affiliation
Department of Medicine, University of Toronto, Ontario, Canada. murray.krahn@utoronto.ca
Source
Am J Public Health. 1998 Nov;88(11):1638-44
Date
Nov-1998
Language
English
Publication Type
Article
Keywords
British Columbia
Child
Cost-Benefit Analysis
Health Care Costs - statistics & numerical data
Health Services Research
Health status
Hepatitis B - economics - prevention & control
Humans
Incidence
Markov Chains
Program Evaluation
Public health nursing
School Health Services - economics
Sensitivity and specificity
Vaccination - economics
Abstract
This study evaluated the costs and cost-effectiveness of a school-based grade 6 universal vaccination program against hepatitis B.
We performed a descriptive cost study and cost-effectiveness analysis of British Columbia's vaccination program for 1994 and 1995. Since 1992, public health nurses have administered hepatitis B vaccine to grade 6 students in schools. We measured costs of vaccine, vaccine administration, and net program costs and used a validated Markov model to calculate the cost-effectiveness of the program.
Vaccinating each student cost $44, $24 of which was the cost of vaccine administration. The net cost was $9 per person; considering productivity costs, net savings were $75 per person. Marginal cost per life year gained was $2100. Universal adolescent vaccination is also economically attractive in the United States but less attractive in regions with incidence rates below 3 cases per 100,000 per year.
Hepatitis B vaccine can be delivered in North American schools at a reasonable cost. Adolescent vaccination is economically attractive in North American regions of high and average incidence rates. Our analysis supports vaccination in adolescents who remain at risk for hepatitis B virus infection.
Notes
Cites: Bull World Health Organ. 1980;58(4):621-86969134
Cites: Hepatology. 1995 Aug;22(2):432-87543434
Cites: JAMA. 1988 Jan 15;259(3):365-92961895
Cites: Cancer. 1988 May 15;61(10):1942-562834034
Cites: Am J Med. 1989 Sep 4;87(3A):5S-10S2773982
Cites: Inquiry. 1990 Winter;27(4):332-432148306
Cites: Ann Intern Med. 1993 Feb 15;118(4):298-3068420448
Cites: JAMA. 1995 Oct 18;274(15):1201-87563509
Cites: JAMA. 1995 Oct 18;274(15):1209-137563510
Cites: Med Decis Making. 1993 Jan-Mar;13(1):4-208433635
Cites: CMAJ. 1993 Mar 15;148(6):921-48448706
Cites: Med Care. 1993 May;31(5):403-188501989
Cites: Clin Infect Dis. 1993 May;16(5):709-138507764
Cites: Scand J Infect Dis. 1994;26(1):19-228191235
Cites: Gastroenterol Clin North Am. 1994 Sep;23(3):437-557989088
Cites: Ann Intern Med. 1995 May 1;122(9):664-757702228
Cites: N Engl J Med. 1982 Sep 9;307(11):644-526810170
PubMed ID
9807529 View in PubMed
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Cost-effectiveness of clopidogrel in acute coronary syndromes in Sweden: a long-term model based on the CURE trial.

https://arctichealth.org/en/permalink/ahliterature53367
Source
J Intern Med. 2004 May;255(5):562-70
Publication Type
Article
Date
May-2004
Author
P. Lindgren
B. Jönsson
S. Yusuf
Author Affiliation
Department of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. peter.lindgren@imm.ki.se
Source
J Intern Med. 2004 May;255(5):562-70
Date
May-2004
Language
English
Publication Type
Article
Keywords
Acute Disease
Aged
Aged, 80 and over
Coronary Disease - drug therapy - economics
Cost of Illness
Cost-Benefit Analysis
Drug Costs
Epidemiologic Methods
Female
Health Care Costs
Humans
Male
Markov Chains
Middle Aged
Models, Econometric
Platelet Aggregation Inhibitors - economics - therapeutic use
Quality-Adjusted Life Years
Research Support, Non-U.S. Gov't
Sweden
Ticlopidine - analogs & derivatives - economics - therapeutic use
Abstract
OBJECTIVES: The purpose of this study was to evaluate the long-term cost-effectiveness of clopidogrel on top of standard therapy (including ASA) in patients with acute coronary syndromes without ST-segment elevation in Sweden. METHODS AND RESULTS: Incremental cost-effectiveness ratios (ICER) were assessed using a Markov model with transition probabilities estimated from the Swedish hospital discharge and cause of death registers. Patients were assumed to be treated for 1 year, with treatment effects (RR = 0.8) and costs taken from the Clopidogrel in Unstable Angina to prevent Recurrent ischaemic Events Trial. Two scenarios were analysed: with patients similar to those in the trial and with patients similar to those from the register. In the first scenario, the predicted net direct cost was 160 euro and the net total cost -54 euro, which with an incremental survival of 0.12 years give the ICER of 1365 euro per life-year gained from the health care payer perspective (including direct costs) and cost savings from the societal perspective (also including indirect costs). The net costs in the second scenario were 149 euro, giving an ICER of 1009 euro for both perspectives. CONCLUSIONS: Adding clopidogrel to standard therapy including ASA is cost-effective in the studied setting and compares favourably with other cardiovascular treatment and prevention strategies.
PubMed ID
15078498 View in PubMed
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A cost-effectiveness evaluation of amlodipine usage in patients with coronary artery disease in Sweden.

https://arctichealth.org/en/permalink/ahliterature53763
Source
Int J Clin Pract. 2002 Mar;56(2):76-81
Publication Type
Article
Date
Mar-2002
Author
J J Doyle
A. McGuire
R. Arocho
S. Arikian
J. Casciano
P. Svangren
R. Casciano
R. Kim
H. Kugel
Author Affiliation
The Analytica Group, New York, NY 10016, USA.
Source
Int J Clin Pract. 2002 Mar;56(2):76-81
Date
Mar-2002
Language
English
Publication Type
Article
Keywords
Amlodipine - economics - therapeutic use
Analysis of Variance
Calcium Channel Blockers - economics - therapeutic use
Cohort Studies
Coronary Arteriosclerosis - drug therapy - economics
Cost-Benefit Analysis
Humans
Markov Chains
Models, Econometric
Prospective Studies
Research Support, Non-U.S. Gov't
Sensitivity and specificity
Sweden
Abstract
The objective of this analysis was to calculate the cost-effectiveness of amlodipine therapy in patients with coronary artery disease in Sweden. It is hypothesised that treatment with amlodipine will have an impact on overall cardiovascular disease treatment costs, resulting in a positive cost-effectiveness profile. A Markov cohort simulation model was constructed to simulate event-related and procedure-related health economic outcomes of coronary artery disease populations on amlodipine versus those on placebo. Patient level data from the Prospective Evaluation of the Vascular Effects of Norvasc Trial was used to populate the model. The total number of adverse cardiovascular clinical outcomes experienced over a three-year period was lower for patient on amlodipine than for those on placebo. The rate of hospitalisation per patient due to angina, coronary artery bypass graft, percutaneous transluminal coronary angioplasty, congestive heart failure, and myocardial infarction in the placebo cohort was 64.7%, while the rate in the amlodipine cohort was 46.9%. The cost per patient was Swedish kroner (SEK)26,600 for amlodipine patients and SEK27,400 for placebo patients. The use of amlodipine resulted in improved clinical outcomes as well as a slight savings in cost over a three-year period.
PubMed ID
11926709 View in PubMed
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Comparison of cost-effectiveness of tuberculosis screening of close contacts and foreign-born populations.

https://arctichealth.org/en/permalink/ahliterature196361
Source
Am J Respir Crit Care Med. 2000 Dec;162(6):2079-86
Publication Type
Article
Date
Dec-2000
Author
K. Dasgupta
K. Schwartzman
R. Marchand
T N Tennenbaum
P. Brassard
D. Menzies
Author Affiliation
Respiratory Epidemiology Unit, McGill University, Montreal, QC, Canada.
Source
Am J Respir Crit Care Med. 2000 Dec;162(6):2079-86
Date
Dec-2000
Language
English
Publication Type
Article
Keywords
Cohort Studies
Contact Tracing - economics - methods - statistics & numerical data
Cost-Benefit Analysis - economics - statistics & numerical data
Emigration and Immigration - statistics & numerical data
Humans
Markov Chains
Mass Screening - economics - methods - statistics & numerical data
Population Surveillance - methods
Prospective Studies
Quebec
Sensitivity and specificity
Treatment Outcome
Tuberculosis, Pulmonary - diagnosis - drug therapy - economics - transmission
Abstract
Although tuberculosis (TB) screening of immigrants has been conducted for over 50 yr in many industrialized countries, its cost- effectiveness has never been evaluated. We prospectively compared the yield and cost-effectiveness of two immigrant TB screening programs, using close-contact investigation and passive case detection. Study subjects included all immigration applicants undergoing radiographic screening, already arrived immigrants requiring surveillance for inactive TB, and close contacts of active cases resident in Montreal, Quebec, Canada, who were referred from June 1996 to June 1997 to the Montreal Chest Institute (MCI), a referral center specializing in respiratory diseases. For all subjects seen, demographic data, investigations, diagnoses, and therapy were abstracted from administrative data bases and medical charts. Estimated costs of detecting and treating each prevalent active case and preventing future active cases, based on federal and provincial health reimbursement schedules, were compared with the costs for passively diagnosed cases of active TB. Over a period of 1 yr, the three programs detected 27 cases of prevalent active TB and prevented 14 future cases. As compared with passive case detection, close-contact investigation resulted in net savings of $815 for each prevalent active case detected and treated and of $2,186 for each future active case prevented. The incremental cost to treat each case of prevalent active TB was $39,409 for applicant screening and $24,225 for surveillance, and the cost of preventing each case was $33,275 for applicants and $65,126 for surveillance. Close-contact investigation was highly cost effective and resulted in net savings. Immigrant applicant screening and surveillance programs had a significant impact but were much less cost effective, in large part because of substantial operational problems.
Notes
Comment In: Am J Respir Crit Care Med. 2001 Jan;163(1):1-211208612
PubMed ID
11112118 View in PubMed
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The cost effectiveness of ACE inhibitors as first-line antihypertensive therapy.

https://arctichealth.org/en/permalink/ahliterature185346
Source
Pharmacoeconomics. 2003;21(8):573-85
Publication Type
Article
Date
2003
Author
Alain J Nordmann
Murray Krahn
Alexander G Logan
Gary Naglie
Allan S Detsky
Author Affiliation
The Programme in Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, Ontario, Canada. nordmanna@uhbs.ch
Source
Pharmacoeconomics. 2003;21(8):573-85
Date
2003
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - economics - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - economics - therapeutic use
Canada - epidemiology
Cohort Studies
Cost-Benefit Analysis
Diuretics - economics - therapeutic use
Drug Utilization - economics - statistics & numerical data
Humans
Hypertension - complications - drug therapy
Hypertrophy, Left Ventricular - complications - drug therapy - economics
Markov Chains
Practice Guidelines as Topic
Quality-Adjusted Life Years
Randomized Controlled Trials as Topic
Abstract
Current hypertension guidelines differ in their recommendations for first-line antihypertensive therapy.
To evaluate the cost effectiveness of ACE inhibitor therapy as antihypertensive first-line therapy as compared with conventional antihypertensive therapy with beta-adrenoceptor antagonists or diuretics.
Cost-effectiveness analysis based on data from randomised trials and observational studies comparing the effectiveness of ACE inhibitor and conventional antihypertensive therapy, we constructed a Markov model to compare four strategies in the management of uncomplicated hypertension: (i) prescribing ACE inhibitor therapy to all patients; (ii) prescribing conventional therapy to all patients; (iii) individualised antihypertensive therapy based on the presence or absence of left ventricular hypertrophy on electrocardiography (ECG); or (iv) individualised antihypertensive therapy based on the presence or absence of left ventricular hypertrophy on echocardiography.
Cost data were derived from the medical literature and focus groups, and utility values were derived from patients on antihypertensive monotherapy. All costs were calculated in 1999 Canadian dollars, but are reported in US dollars according to the 1999 purchasing power parity rate for medical and healthcare. The effectiveness of ACE inhibitor therapy in the presence of left ventricular hypertrophy was derived from observational studies. The time horizon was over a lifetime.
Third-party payer.
A cohort of men aged 40 years without cardiovascular comorbidity requiring antihypertensive drug therapy.
In the baseline analysis, all four strategies resulted in expected discounted QALYs that differed from each other only at the third decimal point (i.e. less than 0.003). Given the uncertainties in the variable estimates and the small size of the differences, these differences are extremely small and unlikely to represent real differences. Even accepting the small gains as real, the resulting cost-effectiveness ratios are unattractively high: $US 200,000 per QALY gained for the echocardiography strategy (compared with ECG), and $US 700,000 for the "ACE inhibitor for all" strategy (compared with ECG). The incremental cost effectiveness of prescribing ACE inhibitor therapy to everybody was never less than $US 100,000/QALY in the sensitivity analysis.
Prescribing ACE inhibitors as antihypertensive first-line therapy in patients without cardiovascular morbidity cannot be recommended at the present time unless the acquisition costs of ACE inhibitors become substantially more attractive.
PubMed ID
12751915 View in PubMed
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181 records – page 1 of 19.