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181 records – page 1 of 19.

Cost-effectiveness of intravenous thrombolysis with alteplase within a 3-hour window after acute ischemic stroke.

https://arctichealth.org/en/permalink/ahliterature166388
Source
Stroke. 2007 Jan;38(1):85-9
Publication Type
Article
Date
Jan-2007
Author
Lars Ehlers
Grethe Andersen
Lone Beltoft Clausen
Merete Bech
Mette Kjølby
Author Affiliation
HTA Unit, Aarhus University Hospital, Olof Palmes Allé 17, 8200 Aarhus N, Denmark. le@ag.aaa.dk
Source
Stroke. 2007 Jan;38(1):85-9
Date
Jan-2007
Language
English
Publication Type
Article
Keywords
Acute Disease
Brain Ischemia - diagnosis - drug therapy
Clinical Protocols - standards
Cost-Benefit Analysis
Decision Trees
Denmark
Fibrinolytic Agents - economics - therapeutic use
Health Care Costs
Humans
Infusions, Intravenous
Magnetic Resonance Imaging - economics - utilization
Markov Chains
Models, Econometric
Monte Carlo Method
Patient Selection
Predictive value of tests
Preoperative Care - standards
Quality-Adjusted Life Years
Stroke - diagnosis - drug therapy
Thrombolytic Therapy - economics
Time
Time Factors
Tissue Plasminogen Activator - administration & dosage - economics - therapeutic use
Treatment Outcome
Abstract
The aim of this study was to assess the costs and cost-effectiveness of intravenous thrombolysis treatment with alteplase (Actilyse) of acute ischemic stroke with 24-hour in-house neurology coverage and use of magnetic resonance imaging.
A health economic model was designed to calculate the marginal cost-effectiveness ratios for time spans of 1, 2, 3 and 30 years. Effect data were extracted from a meta-analysis of six large-scale randomized and placebo-controlled studies of thrombolytic therapy with alteplase. Cost data were extracted from thrombolysis treatment at Aarhus Hospital, Denmark, and from previously published literature.
The calculated cost-effectiveness ratio after the first year was $55,591 US per quality-adjusted life-year (base case). After the second year, computation of the cost-effectiveness ratio showed that thrombolysis was cost-effective. The long-term computations (30 years) showed that thrombolysis was a dominant strategy compared with conservative treatment given the model premises.
A high-quality thrombolysis treatment with 24-hour in-house neurology coverage and magnetic resonance imaging might not be cost-effective in the short term compared with conservative treatment. In the long term, there are potentially large-scale health economic cost savings.
PubMed ID
17122430 View in PubMed
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Cost-effectiveness of combination therapy with etravirine in treatment-experienced adults with HIV-1 infection.

https://arctichealth.org/en/permalink/ahliterature129591
Source
AIDS. 2012 Jan 28;26(3):355-64
Publication Type
Article
Date
Jan-28-2012
Author
Josephine Mauskopf
Anita J Brogan
Sandra E Talbird
Silas Martin
Author Affiliation
RTI Health Solutions, Research Triangle Park, North Carolina, USA. jmauskopf@rti.org
Source
AIDS. 2012 Jan 28;26(3):355-64
Date
Jan-28-2012
Language
English
Publication Type
Article
Keywords
Acquired Immunodeficiency Syndrome - drug therapy - economics - epidemiology
Adolescent
Adult
Aged
Anti-HIV Agents - economics - therapeutic use
CD4 Lymphocyte Count
Canada - epidemiology
Cost-Benefit Analysis
Double-Blind Method
Drug Therapy, Combination
Female
HIV-1 - isolation & purification
Humans
Male
Markov Chains
Middle Aged
Models, Economic
Pyridazines - economics - therapeutic use
Quality-Adjusted Life Years
Ritonavir - economics - therapeutic use
Sulfonamides - economics - therapeutic use
Viral Load - drug effects
Young Adult
Abstract
To assess the cost-effectiveness of etravirine (INTELENCE), a novel nonnucleoside reverse transcriptase inhibitor, used in combination with a background regimen that included darunavir/ritonavir, from a Canadian Provincial Ministry of Health perspective.
A Markov model with a 3-month cycle time and six health states based on CD4 cell count ranges was developed to follow a hypothetical cohort of treatment-experienced adults with HIV-1 infection through initial and subsequent treatment regimens.
Costs (in 2009 Canadian dollars), utilities, and HIV-related mortality data for each health state as well as non-HIV-related mortality data were estimated from Canadian sources and published literature. Transition probabilities between health states and first-year hospitalization and mortality rates were derived from clinical trial data. Incremental 1-year costs per additional adult with viral load less than 50 copies/ml at 48 weeks and incremental lifetime costs per quality-adjusted life-year (QALY) gained were estimated using a 5% discount rate. Sensitivity and variability analyses and model validation were performed.
Etravirine was associated with an increased probability of achieving less than 50 copies/ml at 48 weeks of 0.205 and an estimated gain of 0.66 discounted (1.48 undiscounted) QALYs over a lifetime. The incremental 1-year cost per additional person with viral load less than 50 copies/ml was $23,862. The lifetime incremental cost per QALY gained was $49,120. For the uncertainty ranges and variability scenarios tested for the lifetime horizon, the cost-effectiveness ratio was between $28,859 and 66,249.
When compared with optimized standard of care including darunavir/ritonavir, adding etravirine represents a cost-effective option for treatment-experienced adults in Canada.
PubMed ID
22089378 View in PubMed
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Modeling and validating the cost and clinical pathway of colorectal cancer.

https://arctichealth.org/en/permalink/ahliterature266936
Source
Med Decis Making. 2015 Feb;35(2):255-65
Publication Type
Article
Date
Feb-2015
Author
Paal Joranger
Arild Nesbakken
Geir Hoff
Halfdan Sorbye
Arne Oshaug
Eline Aas
Source
Med Decis Making. 2015 Feb;35(2):255-65
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Biometry - methods
Colorectal Neoplasms - economics - mortality - therapy
Cost-Benefit Analysis
Health Care Costs
Humans
Markov Chains
Models, Biological
Models, Econometric
Neoplasm Staging
Norway
Registries
Survival Analysis
Abstract
Cancer is a major cause of morbidity and mortality, and colorectal cancer (CRC) is the third most common cancer in the world. The estimated costs of CRC treatment vary considerably, and if CRC costs in a model are based on empirically estimated total costs of stage I, II, III, or IV treatments, then they lack some flexibility to capture future changes in CRC treatment. The purpose was 1) to describe how to model CRC costs and survival and 2) to validate the model in a transparent and reproducible way.
We applied a semi-Markov model with 70 health states and tracked age and time since specific health states (using tunnels and 3-dimensional data matrix). The model parameters are based on an observational study at Oslo University Hospital (2049 CRC patients), the National Patient Register, literature, and expert opinion. The target population was patients diagnosed with CRC. The model followed the patients diagnosed with CRC from the age of 70 until death or 100 years. The study focused on the perspective of health care payers.
The model was validated for face validity, internal and external validity, and cross-validity. The validation showed a satisfactory match with other models and empirical estimates for both cost and survival time, without any preceding calibration of the model.
The model can be used to 1) address a range of CRC-related themes (general model) like survival and evaluation of the cost of treatment and prevention measures; 2) make predictions from intermediate to final outcomes; 3) estimate changes in resource use and costs due to changing guidelines; and 4) adjust for future changes in treatment and trends over time. The model is adaptable to other populations.
PubMed ID
25073464 View in PubMed
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A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke.

https://arctichealth.org/en/permalink/ahliterature267230
Source
Europace. 2015 Feb;17(2):207-14
Publication Type
Article
Date
Feb-2015
Author
Lars-Åke Levin
Magnus Husberg
Piotr Doliwa Sobocinski
Viveka Frykman Kull
Leif Friberg
Mårten Rosenqvist
Thomas Davidson
Source
Europace. 2015 Feb;17(2):207-14
Date
Feb-2015
Language
English
Publication Type
Article
Keywords
Aged
Asymptomatic Diseases
Atrial Fibrillation - complications - diagnosis - economics
Brain Ischemia - diagnosis - etiology
Cost-Benefit Analysis
Electrocardiography - economics
Electrocardiography, Ambulatory - economics
Humans
Markov Chains
Mass Screening - economics
Quality-Adjusted Life Years
Secondary Prevention - economics
Stroke - diagnosis - economics - etiology
Sweden
Abstract
The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF, intermittent electrocardiogram (ECG) recordings using a handheld recording device, at regular time intervals for 30 days, and short-term 24 h continuous Holter ECG, in comparison with a no-screening alternative in 75-year-old patients with a recent ischaemic stroke.
The long-term (20-year) costs and effects of all alternatives were estimated with a decision analytic model combining the result of a clinical study and epidemiological data from Sweden. The structure of a cost-effectiveness analysis was used in this study. The short-term decision tree model analysed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model followed a Markov design, simulating the patients' health states for 20 years. Continuous 24 h ECG recording was inferior to intermittent ECG in terms of cost-effectiveness, due to both lower sensitivity and higher costs. The base-case analysis compared intermittent ECG screening with no screening of patients with recent stroke. The implementation of the screening programme on 1000 patients resulted over a 20-year period in 11 avoided strokes and the gain of 29 life-years, or 23 quality-adjusted life years, and cost savings of €55 400.
Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is a cost-effective use of health care resources saving costs and lives and improving the quality of life.
PubMed ID
25349228 View in PubMed
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Use of models to identify cost-effective interventions: pertussis vaccination for pediatric health care workers.

https://arctichealth.org/en/permalink/ahliterature132153
Source
Pediatrics. 2011 Sep;128(3):e591-9
Publication Type
Article
Date
Sep-2011
Author
Amy L Greer
David N Fisman
Author Affiliation
Public Health Agency of Canada, 180 Queen St W, 11th floor, Toronto, Ontario, Canada M5V 3L7. amy.greer@phac.aspc.gc.ca
Source
Pediatrics. 2011 Sep;128(3):e591-9
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Adult
Allied Health Personnel
Cost Savings
Cost-Benefit Analysis
Decision Support Techniques
Diphtheria-Tetanus-acellular Pertussis Vaccines - economics - therapeutic use
Female
Humans
Intensive Care Units, Neonatal
Life expectancy
Male
Markov Chains
Occupational Diseases - economics - prevention & control
Ontario
Quality-Adjusted Life Years
Stochastic Processes
Whooping Cough - economics - prevention & control
Abstract
Acellular pertussis vaccine is safe and effective in adults. An explicit recommendation for pertussis booster vaccination in pediatric health care workers is based on the importance of health care workers as a potential source of infection for patients. However, limited information is available on the economic attractiveness of this intervention. We sought to evaluate the health-economic attractiveness of a diphtheria-tetanus-acellular pertussis booster vaccination program for health care workers in a pediatric intensive care setting.
We developed a Markov model to calculate the cost-effectiveness of vaccinating NICU health care workers in different proportions ranging from the current strategy of no pertussis booster vaccination program to a vaccination program that achieves between 25% and 95% vaccine coverage.
Implementation of a vaccination program that achieves 25% coverage was projected to be cost-saving compared with no vaccine program. At all coverage levels the intervention reduced costs, increased life expectancy, and was cost-effective. Projections were most sensitive to the risk of a pertussis introduction via an infected health care worker. Once the monthly risk of an introduction exceeded ~0.3%, implementation of an immunization program with at least 25% coverage provided both greater health and greater economic benefits than having no vaccine program.
The implementation of a hospital-based and funded diphtheria-tetanus-acellular pertussis vaccine program administered through an occupational health program is cost-effective or cost-saving in the context of pediatric health care facilities in which many of the patients are at risk of serious morbidity and mortality should they acquire pertussis while hospitalized.
PubMed ID
21844056 View in PubMed
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Cost utility analysis based on a head-to-head Phase 3 trial comparing ustekinumab and etanercept in patients with moderate-to-severe plaque psoriasis: a Canadian perspective.

https://arctichealth.org/en/permalink/ahliterature132237
Source
Value Health. 2011 Jul-Aug;14(5):652-6
Publication Type
Article
Author
Feng Pan
Nicole C Brazier
Neil H Shear
Farah Jivraj
Brad Schenkel
Ruth Brown
Author Affiliation
United BioSource Corporation, Bethesda, MD 20814, USA. feng.pan@unitedbiosource.com
Source
Value Health. 2011 Jul-Aug;14(5):652-6
Language
English
Publication Type
Article
Keywords
Antibodies, Monoclonal - economics - therapeutic use
Antibodies, Monoclonal, Humanized
Canada
Cost-Benefit Analysis
Decision Support Techniques
Double-Blind Method
Drug Costs
Health Resources - economics - utilization
Health Services Research
Humans
Immunoglobulin G - economics - therapeutic use
Immunosuppressive Agents - economics - therapeutic use
Insurance, Health, Reimbursement
Markov Chains
Models, Economic
Outcome and Process Assessment (Health Care) - economics
Psoriasis - diagnosis - drug therapy - economics
Receptors, Tumor Necrosis Factor - therapeutic use
Regression Analysis
Severity of Illness Index
Time Factors
Treatment Outcome
Abstract
A head-to-head comparator study has shown that the clinical efficacy of ustekinumab is superior to that of etanercept over a 12-week period in patients with psoriasis. Economic models are often hindered by the lack of trials directly comparing outcomes between relevant alternative therapies. The aim of this analysis was to evaluate the cost-effectiveness of ustekinumab versus etanercept among adults with moderate-to-severe plaque psoriasis based on a Phase 3 head-to-head trial.
The Markov model incorporates trial data from the Active Comparator (CNTO 1275/Enbrel) Psoriasis Trial study (ustekinumab 45 mg at Weeks 0 and 4; etanercept 50 mg biweekly) to follow patient response to initial treatment using the modeling approach developed by the Centre for Reviews and Dissemination, University of York, and often cited by others conducting economic analyses of psoriasis. Beyond the initial trial period, the Canadian model extrapolates results up to 10 years.
Over the 10-year time horizon of the model, the mean annual costs were $16,807 for ustekinumab (45 mg) and $19,525 for etanercept (50 mg). The incremental difference in costs and utilities remained in favour of ustekinumab across a range of sensitivity analyses.
This model highlights the advantage of having head-to-head comparative trial data relevant to the at-risk population. Our model shows that ustekinumab is more cost-effective than etanercept for patients with moderate-to-severe plaque psoriasis.
PubMed ID
21839402 View in PubMed
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Cost-effectiveness of memantine in moderate and severe Alzheimer's disease in Norway.

https://arctichealth.org/en/permalink/ahliterature132290
Source
Int J Geriatr Psychiatry. 2012 Jun;27(6):573-82
Publication Type
Article
Date
Jun-2012
Author
B. Rive
D. Aarsland
M. Grishchenko
J. Cochran
M. Lamure
M. Toumi
Author Affiliation
University of Lyon I, Lyon, France. berv@lundbeck.com
Source
Int J Geriatr Psychiatry. 2012 Jun;27(6):573-82
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy
Cost-Benefit Analysis
Disease Progression
Excitatory Amino Acid Antagonists - economics - therapeutic use
Female
Humans
Male
Markov Chains
Memantine - economics - therapeutic use
Norway
Quality-Adjusted Life Years
Abstract
The cost-effectiveness of memantine for the treatment of moderate and severe Alzheimer's disease has been assessed in several European countries. Objective of the study was to assess it in Norwegian settings.
This cost-utility analysis used a Markov modelling approach to simulate the evolution of patients until their need for full-time care (FTC) over a 5-year period. FTC was defined as a patient becoming either dependent or institutionalised. Transition probabilities were estimated using a newly developed predictive equation of time to FTC. Health resource use and utilities were obtained from the Scandinavian Study of Cost and Quality of Life in Alzheimer's Disease study, and mortality was obtained from the Oslo study. Memantine efficacy was based on a meta-analysis of six large trials. The model compared memantine with its alternative in this population, that is no pharmacological treatment or background therapy with acetylcholinesterase inhibitors. The model underwent extensive sensitivity analyses.
In Norway, memantine was found to delay the need for FTC by 4.4 weeks compared with standard care and was associated with increased quality-adjusted life years. Memantine was the dominant strategy with cost savings of €3739 (30?041 NOK) per patient. The probability of being the dominant strategy was 98.8%. This result was confirmed across multiple sensitivity analyses.
The model suggests that memantine prolongs time to FTC for no additional cost to the healthcare system and society. It can be regarded as a cost-effective choice in the management of moderate and severe Alzheimer's disease.
PubMed ID
21834130 View in PubMed
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Cost effectiveness of screening immigrants for hepatitis B.

https://arctichealth.org/en/permalink/ahliterature133053
Source
Liver Int. 2011 Sep;31(8):1179-90
Publication Type
Article
Date
Sep-2011
Author
William W L Wong
Gloria Woo
E. Jenny Heathcote
Murray Krahn
Author Affiliation
Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, ON, Canada. william.wong@theta.utoronto.ca
Source
Liver Int. 2011 Sep;31(8):1179-90
Date
Sep-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antiviral Agents - economics - therapeutic use
Canada - epidemiology
Cost-Benefit Analysis
Emigrants and Immigrants
Health Care Costs
Hepatitis B Vaccines - economics
Hepatitis B, Chronic - diagnosis - economics - mortality - prevention & control - therapy
Humans
Liver Transplantation - economics
Markov Chains
Mass Screening - economics
Middle Aged
Models, Economic
Predictive value of tests
Prevalence
Quality-Adjusted Life Years
Young Adult
Abstract
The prevalence of chronic hepatitis B (CHB) infection among the immigrants of North America ranges from 2 to 15%, among whom 40% develop advanced liver disease. Screening for hepatitis B surface antigen is not recommended for immigrants.
The objective of this study is to estimate the health and economic effects of screening strategies for CHB among immigrants.
We used the Markov model to examine the cost-effectiveness of three screening strategies: (i) 'No screening'; (ii) 'Screen and Treat' and (iii) 'Screen, Treat and Vaccinate' for 20-65 years old individuals who were born abroad but are currently living in Canada. Model data were obtained from the published literature. We measured predicted hepatitis B virus (HBV)-related deaths, costs (2008 Canadian Dollars), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER).
Our results show that screening all immigrants will prevent 59 HBV-related deaths per 10, 000 persons screened over the lifetime of the cohort. Screening was associated with an increase in quality-adjusted life expectancy (0.024 QALYs) and cost ($1665) per person with an ICER of $69, 209/QALY gained compared with 'No screening'. The 'Screen, Treat and Vaccinate' costs an additional $81, generates an additional 0.000022 QALYs per person, with an ICER of $3, 648,123/QALY compared with the 'Screen and Treat'. Sensitivity analyses suggested that the 'Screen and Treat' is likely to be moderately cost-effective.
We show that a selective hepatitis B screening programme targeted at all immigrants in Canada is likely to be moderately cost-effective. Identification of silent CHB infection with the offer of treatment when appropriate can extend the lives of immigrants at reasonable cost.
PubMed ID
21745300 View in PubMed
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Cost-utility of adjuvant high-dose interferon alpha therapy in stage III cutaneous melanoma in Quebec.

https://arctichealth.org/en/permalink/ahliterature178215
Source
Value Health. 2004 Jul-Aug;7(4):423-32
Publication Type
Article
Author
R. Crott
F. Ali
S. Burdette-Radoux
Author Affiliation
Faculty of Pharmacy, University of Montreal, Canada. Ralph.crott@skyne.be
Source
Value Health. 2004 Jul-Aug;7(4):423-32
Language
English
Publication Type
Article
Keywords
Adult
Algorithms
Antineoplastic Agents - administration & dosage - economics
Chemotherapy, Adjuvant
Clinical Trials as Topic
Cohort Studies
Computer simulation
Cost of Illness
Cost-Benefit Analysis
Disease-Free Survival
Follow-Up Studies
Health status
Humans
Interferon-alpha - administration & dosage - economics
Markov Chains
Melanoma - drug therapy - economics - mortality
Middle Aged
Monte Carlo Method
Neoplasm Recurrence, Local - economics
Quality of Life
Quebec
Risk
Skin Neoplasms - drug therapy - economics - mortality
Software
Survival Analysis
Terminal Care - economics
Time Factors
Abstract
To estimate the cost-utility of adjuvant high-dose interferon in high-risk melanoma patients in Quebec compared to a watchful waiting strategy.
A Markov model was developed that replicates the findings of the pivotal E1684 trial. It was then used to extrapolate survival over a period of 35 years. Costs of medical resources used during the first year were derived through a detailed analysis of a sample (n = 13) of patients treated in a leading academic hospital. Follow-up costs were assessed through a medical decision algorithm. Utilities were derived from a population-based survey (n = 104) in different locations in Quebec using the time trade-off method.
The mean incremental cost per quality-adjusted life-year of adjuvant Interferon therapy is equal to 55,090 CAN dollars over a follow-up of 7 years but drops down to 14,003 CAN dollars when extrapolated over 35 years.
Estimates of the cost-effectiveness of high-dose interferon in melanoma patients show an acceptable cost-effectiveness ratio if long-term survival is taken into account. Estimates are, however, strongly influenced by the observed trial differences in survival, the utility associated to health states, and the discount rate.
PubMed ID
15449634 View in PubMed
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Cost-utility analysis of nt-probnp-guided multidisciplinary care in chronic heart failure.

https://arctichealth.org/en/permalink/ahliterature117882
Source
Int J Technol Assess Health Care. 2013 Jan;29(1):3-11
Publication Type
Article
Date
Jan-2013
Author
Deddo Moertl
Sabine Steiner
Doug Coyle
Rudolf Berger
Author Affiliation
Department of Internal Medicine III (Cardiology and Emergency Medicine), Landesklinikum St. Poelten, St. Poelten, Austria. deddo.moertl@stpoelten.lknoe.at
Source
Int J Technol Assess Health Care. 2013 Jan;29(1):3-11
Date
Jan-2013
Language
English
Publication Type
Article
Keywords
Austria
Biological Markers - blood
Canada
Cause of Death
Cost-Benefit Analysis
Health Expenditures - statistics & numerical data
Heart Failure - blood - mortality - therapy
Hospital Costs - statistics & numerical data
Humans
Interdisciplinary Communication
Markov Chains
Natriuretic Peptide, Brain - blood
Nurse's Practice Patterns - economics
Peptide Fragments - blood
Quality of Life
Questionnaires
Survival Analysis
Treatment Outcome
Abstract
A recent randomized, controlled trial in chronic heart failure patients showed that NT-proBNP-guided, intensive patient management (BMC) on top of multidisciplinary care reduced all-cause mortality and heart failure hospitalizations compared with multidisciplinary care (MC) or usual care (UC). We now performed a cost-utility analysis of these interventions from a payer's perspective.
Costs related to hospitalizations, ambulatory physician and nurse visits, and NT-proBNP testing for the three management strategies were acquired for both Austria (€) and Canada ($) and combined with the survival and quality of life data from the clinical trial for cost-effectiveness analysis. Data on long-term survival, costs, and quality-adjusted life-years (QALY) were extrapolated for a 20-year time horizon using a Markov model, which simulated the progression of disease through beta-blocker use, hospitalizations, and mortality.
BMC was the most cost-effective strategy as it was dominant (cost-saving with improved health outcome) over both MC and UC based on both Austrian and Canadian costs. Incremental cost-effectiveness ratios for MC relative to UC were €3,746 and $5,554 per QALY gained for Austrian and Canadian costs, respectively. The probabilities for BMC being the most cost-effective strategy were 92 percent at a threshold value of Austrian €40,000 and 93 percent at a threshold value of Canadian $50,000.
NT-proBNP-guided, intensive HF patient management in addition to multidisciplinary care not only reduces death and hospitalization but also proves to be cost-effective.
PubMed ID
23257208 View in PubMed
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181 records – page 1 of 19.