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Canadian cost-utility analysis of initiation and maintenance treatment with anti-TNF-a drugs for refractory Crohn's disease.

https://arctichealth.org/en/permalink/ahliterature127813
Source
J Crohns Colitis. 2012 Feb;6(1):77-85
Publication Type
Article
Date
Feb-2012
Author
Gord Blackhouse
Nazila Assasi
Feng Xie
John Marshall
E Jan Irvine
Kathryn Gaebel
Kaitryn Campbell
Rob Hopkins
Daria O'Reilly
Jean-Eric Tarride
Ron Goeree
Author Affiliation
Programs for Assessment of Technology in Health Research Institute, McMaster University, Hamilton, ON, Canada. blackhou@mcmaster.ca
Source
J Crohns Colitis. 2012 Feb;6(1):77-85
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Anti-Inflammatory Agents - economics - therapeutic use
Antibodies, Monoclonal - economics - therapeutic use
Antibodies, Monoclonal, Humanized - economics - therapeutic use
Canada
Cost-Benefit Analysis
Crohn Disease - drug therapy - economics
Health Care Costs
Humans
Markov Chains
Quality-Adjusted Life Years
Abstract
Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. Symptoms include but are not limited to abdominal pain, nausea, emesis, and diarrhea. Anti-TNF-a drugs are increasingly being used in patients with CD who have inadequate response to conventional therapy. However, these medications are quite expensive. The objective of this study is to evaluate the cost-utility of two anti-TNF-a drugs (infliximab, adalimumab) for refractory CD.
A Markov model was used to estimate the costs and QALYs of three treatments (usual care, infliximab, adalimumab) over a 5 year time horizon. After initial treatment, patients achieve remission, achieve treatment response or remain in the drug refractory health state. Patients who achieve remission or treatment response are at risk of relapse each 3 month model cycle. Patients in the drug refractory health state either remain in the health state or have surgery in each cycle. Different costs and utility values were assigned to the various model health states. Model input parameters including initial response rates, relapse rates, utility values were derived from published literature.
Usual care had both the lowest expected costs ($17,017) and QALYs (2.555), while infliximab had both the highest expected costs ($54,084) and QALYs (2.721). The incremental cost per QALY moving from usual care to adalimumab and from adalimumab to infliximab was estimated to be to be $193,305 and $451,165, respectively.
Based on common willingness to pay thresholds, ant-TNF-a drugs would not be perceived as a cost effective treatment for refractory CD.
PubMed ID
22261531 View in PubMed
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Canadian cost- utility analysis of intravenous immunoglobulin for acute childhood idiopathic thrombocytopenic purpura.

https://arctichealth.org/en/permalink/ahliterature124449
Source
J Popul Ther Clin Pharmacol. 2012;19(2):e166-78
Publication Type
Article
Date
2012
Author
Gord Blackhouse
Feng Xie
Mitchell A H Levine
Kaitryn Campbell
Nazila Assasi
Kathryn Gaebel
Daria O'Reilly
Jean- Eric Tarride
Ron Goeree
Author Affiliation
Programs for Assessment of Technology in Health (PATH) Research Institute, McMaster University, Hamilton, Ontario, Canada. blackhou@mcmaster.ca
Source
J Popul Ther Clin Pharmacol. 2012;19(2):e166-78
Date
2012
Language
English
Publication Type
Article
Keywords
Acute Disease
Adrenal Cortex Hormones - economics - therapeutic use
Age Factors
Body Weight
Canada
Child
Cost-Benefit Analysis
Drug Costs
Hospital Costs
Hospitalization - economics
Humans
Immunoglobulins, Intravenous - economics - therapeutic use
Immunologic Factors - economics - therapeutic use
Intracranial Hemorrhages - economics - etiology - prevention & control
Markov Chains
Models, Economic
Platelet Count
Purpura, Thrombocytopenic, Idiopathic - blood - complications - drug therapy - economics
Quality-Adjusted Life Years
Time Factors
Treatment Outcome
Abstract
Idiopathic thrombocytopenic purpura (ITP) is a hematological disorder and can be classified as acute or chronic. The main goal of treatment for acute childhood ITP is the prevention of potentially fatal bleeding complications, the most serious of which is intracranial hemorrhage (ICH). Treatment options for acute childhood ITP include splenectomy, corticosteroids, and blood products such as intravenous immunoglobulin.
The objective was to evaluate, from a Canadian perspective, the cost-effectiveness of intravenous immunoglobulin (IVIG) compared to alternative inpatient treatments for acute childhood idiopathic thrombocytopenic purpura (ITP).
A Markov model with a lifelong time horizon was used to evaluate the costs and quality-adjusted life years (QALYs) for 5 treatments for children hospitalized for ITP: 1) no treatment; 2) IVIG; 3) Anti-D; 4) prednisone; and 5) methylprednisolone. The model predicted the probability of intracranial hemorrhage for each treatment strategy based on the time children spent with platelet counts
PubMed ID
22580389 View in PubMed
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Common Drug Review recommendations: an evidence base for expectations?

https://arctichealth.org/en/permalink/ahliterature127551
Source
Pharmacoeconomics. 2012 Mar;30(3):229-46
Publication Type
Article
Date
Mar-2012
Author
Angela Rocchi
Elizabeth Miller
Robert B Hopkins
Ron Goeree
Author Affiliation
Axia Research, Burlington, ON, Canada. angela@axiaresearch.com
Source
Pharmacoeconomics. 2012 Mar;30(3):229-46
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Canada
Cost-Benefit Analysis
Databases, Factual
Formularies as Topic
Humans
Insurance, Pharmaceutical Services - economics
Multivariate Analysis
Prescription Drugs - economics - therapeutic use
Regression Analysis
Abstract
The Common Drug Review (CDR) was created to provide a single process to review the comparative clinical efficacy and cost effectiveness of new drugs, and then to make formulary listing recommendations to Canadian publicly funded drug benefit plans.
The objective was to conduct an in-depth analysis of Canadian Expert Drug Advisory Committee (CEDAC) recommendations to date, to explore predictors and possible explanatory factors associated with negative recommendations.
Final recommendations were identified from inception (September 2003) to 31 December 2009. Using only publicly available information, recommendations were analysed under the following categories: submission specifics, drug characteristics, clinical factors and economic factors. Descriptive analyses were conducted, followed by statistical analyses, to determine which factors independently predicted a 'do not list' (DNL) recommendation.
The database consisted of 138 unique final recommendations. The overall DNL rate was 48%. Significant differences in DNL rates were observed between therapeutic areas, ranging from 0% for HIV antivirals up to 88% for analgesic drugs. In the univariate analysis, several factors were significantly associated with a DNL recommendation, including first-in-class drugs and use of clinical scales as an outcome. In the multivariate regression, four factors were significantly predictive of a DNL recommendation: clinical uncertainty (odds ratio [OR] 14), price higher than comparators (OR 9), request for reconsideration (OR 10) and price as the only economic evidence used (OR 18). Incremental cost-effectiveness thresholds were not predictive of recommendations. The hypothesis that economic factors did not impact recommendations when clinical factors were included first was supported by the analysis.
This analysis documented an evidence-driven process that simultaneously weighted multiple factors. Clinical uncertainty and price considerations, but not economic results, had a strong impact on the recommendations. Insufficiency of clinical evidence may have resulted from the gap in evidence available at the time of product launch and the absence of demonstrated benefits to support innovative drugs.
PubMed ID
22283689 View in PubMed
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Cost-effectiveness analysis of antiviral treatments for HBeAg-positive chronic hepatitis B in Canada.

https://arctichealth.org/en/permalink/ahliterature120466
Source
Value Health. 2012 Sep-Oct;15(6):894-906
Publication Type
Article
Author
Jing He
James M Bowen
Feng Xie
Ron Goeree
Author Affiliation
Canadian Institute for Health Information, Toronto, ON, Canada. mail.jinghe@gmail.com
Source
Value Health. 2012 Sep-Oct;15(6):894-906
Language
English
Publication Type
Article
Keywords
Adult
Antiviral Agents - economics - therapeutic use
Canada
Cost-Benefit Analysis
Female
Hepatitis B e Antigens - blood
Hepatitis B, Chronic - drug therapy - immunology
Humans
Male
Markov Chains
Quality-Adjusted Life Years
Abstract
To conduct a cost-effectiveness analysis of currently available nucleos(t)ide antiviral treatments (lamivudine, telbivudine, entecavir, and tenofovir) for chronic hepatitis B in Canada.
Markov modeling was used to project the lifetime health benefits and costs associated with the antiviral treatments. The hypothetical patient population was hepatitis B e antigen-positive chronic hepatitis B-infected patients aged 34 years. Quality-adjusted life-years were used as a measure of effectiveness. Long-term cumulative incidence of liver complications was also projected. Treatment effectiveness data were derived from the literature; meta-analysis was conducted when there was a large variance in reported effectiveness data. Costs were obtained from a cost analysis of treating chronic hepatitis B-related complications in Canada. Stochastic parameter uncertainty was examined in probabilistic sensitivity analysis by using second-order Monte Carlo simulation. Alternative modeling assumptions were assessed in scenario analysis. One-way sensitivity analysis was used to explore each parameter's impact on the uncertainty of the results.
In the base-case analysis, telbivudine was dominated by entecavir and tenofovir. Tenofovir strictly dominated lamivudine, telbivudine, and entecavir. Over the 72-year period of the model, the expected life expectancy (undiscounted) of lamivudine, telbivudine, entecavir, and tenofovir was 35.71, 36.94, 37.65, and 37.99 years, respectively. Tenofovir had the highest expected quality-adjusted life-years at 11.86 (discounted) in all comparisons. Scenario and sensitivity analyses proved the robustness of the base-case results. The projected 10-year cumulative incidence of cirrhosis and hepatocellular carcinoma was 11.40% and 3.05%, respectively, for tenofovir, which is significantly lower than that for lamivudine.
Tenofovir generated the best results compared with all other therapies under evaluation.
PubMed ID
22999140 View in PubMed
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Cost-effectiveness analysis of a randomized trial comparing care models for chronic kidney disease.

https://arctichealth.org/en/permalink/ahliterature134145
Source
Clin J Am Soc Nephrol. 2011 Jun;6(6):1248-57
Publication Type
Article
Date
Jun-2011
Author
Robert B Hopkins
Amit X Garg
Adeera Levin
Anita Molzahn
Claudio Rigatto
Joel Singer
George Soltys
Steven Soroka
Patrick S Parfrey
Brendan J Barrett
Ron Goeree
Author Affiliation
PATH Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. hopkinr@mcmaster.ca
Source
Clin J Am Soc Nephrol. 2011 Jun;6(6):1248-57
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Aged
Biological Markers - blood
Canada
Cardiovascular Agents - economics - therapeutic use
Cardiovascular Diseases - economics - etiology - prevention & control
Chronic Disease
Cost Savings
Cost-Benefit Analysis
Creatinine - blood
Disease Progression
Drug Costs
Female
General Practice - economics - organization & administration
Glomerular Filtration Rate
Health Care Costs
Hematinics - economics - therapeutic use
Hospital Costs
Hospitalization - economics
Humans
Hypoglycemic Agents - economics - therapeutic use
Hypolipidemic Agents - economics - therapeutic use
Kidney - physiopathology
Kidney Diseases - complications - diagnosis - economics - nursing - physiopathology - therapy
Length of Stay - economics
Male
Middle Aged
Models, Economic
Nurse Clinicians - economics - organization & administration
Patient Care Team - economics - organization & administration
Platelet Aggregation Inhibitors - economics - therapeutic use
Preventive Health Services - economics - organization & administration
Prospective Studies
Quality-Adjusted Life Years
Risk assessment
Risk factors
Risk Reduction Behavior
Severity of Illness Index
Smoking Cessation
Time Factors
Treatment Outcome
Up-Regulation
Abstract
Potential cost and effectiveness of a nephrologist/nurse-based multifaceted intervention for stage 3 to 4 chronic kidney disease are not known. This study examines the cost-effectiveness of a chronic disease management model for chronic kidney disease.
Cost and cost-effectiveness were prospectively gathered alongside a multicenter trial. The Canadian Prevention of Renal and Cardiovascular Endpoints Trial (CanPREVENT) randomized 236 patients to receive usual care (controls) and another 238 patients to multifaceted nurse/nephrologist-supported care that targeted factors associated with development of kidney and cardiovascular disease (intervention). Cost and outcomes over 2 years were examined to determine the incremental cost-effectiveness of the intervention. Base-case analysis included disease-related costs, and sensitivity analysis included all costs.
Consideration of all costs produced statistically significant differences. A lower number of days in hospital explained most of the cost difference. For both base-case and sensitivity analyses with all costs included, the intervention group required fewer resources and had higher quality of life. The direction of the results was unchanged to inclusion of various types of costs, consideration of payer or societal perspective, changes to the discount rate, and levels of GFR.
The nephrologist/nurse-based multifaceted intervention represents good value for money because it reduces costs without reducing quality of life for patients with chronic kidney disease.
Notes
Cites: Health Qual Life Outcomes. 2003;1:5414613568
Cites: J Am Soc Nephrol. 2007 Nov;18(11):2953-917942955
Cites: BMJ. 2008 Mar 22;336(7645):645-5118299289
Cites: Am J Med Qual. 2008 May-Jun;23(3):184-9218539979
Cites: Health Technol Assess. 2010 Apr;14(21):1-18420441712
Cites: Clin J Am Soc Nephrol. 2011 Jun;6(6):1241-721617090
Cites: Clin Exp Nephrol. 2008 Feb;12(1):41-5218175059
Cites: Am J Kidney Dis. 2001 Mar;37(3):484-911228171
Cites: Ann Intern Med. 2001 Apr 17;134(8):629-3611304102
Cites: J Am Soc Nephrol. 2001 Aug;12(8):1713-2011461944
Cites: N Engl J Med. 2001 Sep 20;345(12):851-6011565517
Cites: Am J Kidney Dis. 2001 Nov;38(5):1122-811684571
Cites: JAMA. 2003 Dec 17;290(23):3101-1414679273
Cites: J Am Soc Nephrol. 2004 May;15(5):1300-615100370
Cites: J Am Soc Nephrol. 2005 May;16(5):1433-915800126
Cites: Clin Ther. 2006 Mar;28(3):432-4416750458
Cites: Nephrol Dial Transplant. 2006 Aug;21(8):2133-4316644779
Cites: Arch Intern Med. 2006 Sep 25;166(17):1884-9117000946
Comment In: Clin J Am Soc Nephrol. 2011 Jun;6(6):1229-3121617089
PubMed ID
21617091 View in PubMed
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Cost-effectiveness analysis of cast versus splint in children with acceptably angulated wrist fractures.

https://arctichealth.org/en/permalink/ahliterature135792
Source
Int J Technol Assess Health Care. 2011 Apr;27(2):101-7
Publication Type
Article
Date
Apr-2011
Author
Camilla von Keyserlingk
Kathy Boutis
Andrew R Willan
Robert Borden Hopkins
Ron Goeree
Author Affiliation
Programs PATH Research Institute, St. Joseph's Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada. vonkeys@mcmaster.ca
Source
Int J Technol Assess Health Care. 2011 Apr;27(2):101-7
Date
Apr-2011
Language
English
Publication Type
Article
Keywords
Casts, Surgical - economics
Child
Child, Preschool
Cost-Benefit Analysis
Female
Fractures, Bone - economics - rehabilitation
Health Care Costs
Humans
Male
Ontario
Pediatrics - economics
Questionnaires
Splints - economics
Treatment Outcome
Wrist Injuries - economics - rehabilitation
Abstract
In a practice setting where casting is considered the standard of care, the aim of this study was to assess the cost-effectiveness of wrist splints compared with routine casting in children with acceptably angulated distal radius greenstick or transverse fractures.
A cost-effectiveness analysis was conducted alongside a randomized controlled trial (RCT). One hundred children with acceptably angulated distal radius greenstick or transverse fractures received either a wrist splint or cast. Information on health care provider and patient and family resource use as well as productivity cost was collected. Resource use was costed using unit costs from local administrative data sources and expense diaries. Effectiveness was assessed at 6 weeks using the performance version of the Activities Scale for Kids (ASKp) questionnaire. Cost-effectiveness analysis related differential costs to differential ASKp scores.
Mean total cost was $877.58 in the splint group and $950.35 in the cast group, with a mean difference of $-72.76 (standard error [SE] 45.88). Mean total healthcare cost was $670.66 in the splint group and $768.22 in the cast group, with a mean difference of $-97.56 (SE 9.24). Mean (SE) ASKp was 92.8 in the splint group and 91.4 in the cast group, with a mean difference of 1.439 (SE 1.585). Therefore, splint management was more effective and cheaper. After accounting for uncertainty, the probability of splint being cost-effective compared with cast was 94 percent for a willingness-to-pay threshold value of $0 for one-unit gain in ASKp score and exceeded 82 percent for all threshold values.
In this RCT, splint management was cost-effective compared with casting in children with acceptably angulated distal radius greenstick or transverse fractures. This study challenges the existing standard of care for children with this type of fracture and provides justification on clinical and economic grounds for a change in routine practice.
PubMed ID
21447261 View in PubMed
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Cost-effectiveness analysis of elective endovascular repair compared with open surgical repair of abdominal aortic aneurysms for patients at a high surgical risk: A 1-year patient-level analysis conducted in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature156090
Source
J Vasc Surg. 2008 Oct;48(4):779-87
Publication Type
Article
Date
Oct-2008
Author
Jean-Eric Tarride
Gord Blackhouse
Guy De Rose
Teresa Novick
James M Bowen
Robert Hopkins
Daria O'Reilly
Ron Goeree
Author Affiliation
Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
Source
J Vasc Surg. 2008 Oct;48(4):779-87
Date
Oct-2008
Language
English
Publication Type
Article
Keywords
Aged
Angioplasty - economics
Aortic Aneurysm, Abdominal - economics - surgery
Cost-Benefit Analysis
Female
Humans
Male
Ontario
Risk factors
Time Factors
Vascular Surgical Procedures - economics - methods
Abstract
Abdominal aortic aneurysm (AAA) is a prevalent health condition affecting up to 14% of men and 6% of women. The objective of this study was to estimate the cost-effectiveness and cost-utility of elective endovascular aneurysm repair (EVAR) compared with open surgical repair (OSR) in patients at a high risk of surgical complications.
Patient-level cost and outcome data from a 1-year prospective observational study conducted at London Health Sciences Centre, London, Ontario, Canada, was used to determine the incremental cost per life-year gained and the incremental cost per quality-adjusted life year (QALY) gained of EVAR compared with OSR in patients with an AAA >5.5 cm and a high risk of surgical complications. The analysis was taken from a societal perspective and the time horizon was 1 year. To measure sampling uncertainty on costs and effects, nonparametric bootstrap techniques were applied. Uncertainty results were expressed using cost-effectiveness acceptability curves. Extrapolations of the 1-year results to a 5-year time horizon were conducted in sensitivity analyses.
Between August 11, 2003, and April 3, 2005, 192 patients at a high risk of surgical complications were enrolled: 140 received EVAR and 52 OSR. Point estimates during a 1-year period showed that EVAR dominated OSR for high-risk patients in terms of incremental cost per life-year gained and incremental cost per QALYs. However, bootstrap estimates for the two cost-effectiveness measures indicated there was a great deal of uncertainty regarding the costs and the QALYs and less uncertainty regarding life-years gained. If society was willing to pay $50,000 per life-year gained or per QALY gained, the probability of EVAR being cost-effective was found to be 0.76 and 0.55, respectively. Five-year extrapolations indicated that EVAR was cost-effective compared with OSR.
According to this 1-year observational study, EVAR may be a cost-effective strategy compared with OSR for high-risk patients. Longer-term data are needed to decrease the uncertainty associated with the results.
Notes
Comment In: J Vasc Surg. 2009 Jan;49(1):277; author reply 277-819174269
PubMed ID
18639421 View in PubMed
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Cost-effectiveness and cost-utility of long-term management strategies for heartburn.

https://arctichealth.org/en/permalink/ahliterature189441
Source
Value Health. 2002 Jul-Aug;5(4):312-28
Publication Type
Article
Author
Ron Goeree
Bernie J O'Brien
Gordon Blackhouse
John Marshall
Andrew Briggs
Rameeta Lad
Author Affiliation
Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario L8N 1G6, Canada. goereer@mcmaster.ca
Source
Value Health. 2002 Jul-Aug;5(4):312-28
Language
English
Publication Type
Article
Keywords
Canada
Cost-Benefit Analysis
Enzyme Inhibitors - economics - therapeutic use
Heartburn - economics - therapy
Histamine H2 Antagonists - economics - therapeutic use
Humans
Long-Term Care - economics
Models, Econometric
Monte Carlo Method
Outcome and Process Assessment (Health Care)
Primary Health Care - economics - methods - utilization
Proton Pump Inhibitors
Quality-Adjusted Life Years
Recurrence - prevention & control
Abstract
To compare the expected costs and outcomes of seven alternative long-term primary care strategies for the management of patients with moderate-to-severe heartburn over a 1-year period.
A decision-analytic model was developed to estimate costs and effects (weeks with heartburn symptoms and quality adjusted life years [QALYs]) for each strategy. Meta-analyses were used to synthesize acute treatment and maintenance studies and physician surveys to collect information on patient management. The impact of uncertainty on the base case results was assessed using probabilistic sensitivity analysis. Probability distributions were defined for key model parameters and techniques of Monte Carlo simulation were used to draw values from these distributions. Cost-effectiveness acceptability curves (CEACs) conditional on the monetary value decision makers are willing to pay for a symptom-free day or QALY were created for each strategy.
In the base case, no strategy was strictly dominated by any other strategy. However, two strategies (maintenance H2-receptor antagonists H2RA] and step-down proton pump inhibitor PPI]) were dominated through principles of extended dominance. The least costly and least effective strategy was intermittent H2RA, while maintenance PPI was the most costly and most effective.
This analysis showed that the best way of managing patients with heartburn depends on how much society is willing to pay to achieve health improvements. Based on the commonly quoted threshold of US 50,000 dollars per QALY, the optimal primary care strategy for managing patients with moderate-to-severe heartburn symptoms is to treat the symptoms with a PPI followed by maintenance therapy with an H2RA to prevent symptomatic recurrence.
PubMed ID
12102694 View in PubMed
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A cost-effectiveness model comparing endovascular repair to open surgical repair of abdominal aortic aneurysms in Canada.

https://arctichealth.org/en/permalink/ahliterature155259
Source
Value Health. 2009 Mar-Apr;12(2):245-52
Publication Type
Article
Author
Gord Blackhouse
Robert Hopkins
James M Bowen
Guy De Rose
Teresa Novick
Jean-Eric Tarride
Daria O'Reilly
Feng Xie
Ron Goeree
Author Affiliation
Program for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton, Ontario, Canada. blackhou@mcmaster.ca
Source
Value Health. 2009 Mar-Apr;12(2):245-52
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - economics - mortality - surgery
Blood Vessel Prosthesis - economics
Canada
Cohort Studies
Cost-Benefit Analysis
Decision Support Techniques
Humans
Male
Markov Chains
Middle Aged
Models, Economic
Models, Statistical
Probability
Quality-Adjusted Life Years
Risk assessment
Risk factors
Vascular Surgical Procedures - economics - methods - statistics & numerical data
Abstract
The primary risk of abdominal aortic aneurysms (AAAs) is rupture, which is associated with a high mortality rate. Elective surgical options for AAA include open repair (OR) and endovascular aneurysm repair (EVAR). EVAR is less invasive than OR, and therefore may have less surgical risk than OR. However, the graft used for EVAR is much more expensive then the graft used for OR.
A decision model with a 10-year time horizon was used to assess the cost-effectiveness of EVAR versus OR. The primary outcome measure was quality-adjusted life-years (QALYs). The model incorporated the costs and benefits of both perioperative outcomes and postoperative outcomes. A systematic review was conducted to derive clinical outcome rates. Cost and utility model variables were based on various literature sources and data from a recent Canadian observational study. Parameter uncertainty was assessed using probabilistic sensitivity analysis.
In the base-case model, the incremental cost per QALY of EVAR was estimated to be $268,337, whereas the incremental cost per life-year was found to be $444,129. The incremental cost per QALY of EVAR remained above $295,715 under different assumptions of cohort age and model time horizon.
Based on commonly quoted willingness-to-pay thresholds, EVAR was not found to be cost-effective compared to OR.
PubMed ID
18783394 View in PubMed
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Cost-effectiveness of 64-slice CT angiography compared to conventional coronary angiography based on a coverage with evidence development study in Ontario.

https://arctichealth.org/en/permalink/ahliterature106617
Source
Expert Rev Pharmacoecon Outcomes Res. 2013 Oct;13(5):675-90
Publication Type
Article
Date
Oct-2013
Author
Ron Goeree
Gord Blackhouse
James M Bowen
Daria O'Reilly
Simone Sutherland
Robert Hopkins
Benjamin Chow
Michael Freeman
Yves Provost
Carole Dennie
Eric Cohen
Dan Marcuzzi
Robert Iwanochko
Alan Moody
Narinder Paul
John D Parker
Author Affiliation
Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, ON L8P 1H1, Canada.
Source
Expert Rev Pharmacoecon Outcomes Res. 2013 Oct;13(5):675-90
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Coronary Angiography - economics - methods
Coronary Artery Disease - diagnosis - economics - radiography
Cost-Benefit Analysis
Female
Humans
Male
Middle Aged
Models, Economic
Multidetector Computed Tomography - economics - methods
Ontario
Probability
Sensitivity and specificity
Sex Factors
Abstract
Conventional coronary angiography (CCA) is the standard diagnostic for coronary artery disease (CAD), but multi-detector computed tomography coronary angiography (CTCA) is a non-invasive alternative.
A multi-center coverage with evidence development study was undertaken and combined with an economic model to estimate the cost-effectiveness of CTCA followed by CCA vs CCA alone. Alternative assumptions were tested in patient scenario and sensitivity analyses.
CCA was found to dominate CTCA, however, CTCA was relatively more cost-effective in females, in advancing age, in patients with lower pre-test probabilities of CAD, the higher the sensitivity of CTCA and the lower the probability of undergoing a confirmatory CCA following a positive CTCA.
RESULTS were very sensitive to alternative patient populations and modeling assumptions. Careful consideration of patient characteristics, procedures to improve the diagnostic yield of CTCA and selective use of CCA following CTCA will impact whether CTCA is cost-effective or dominates CCA.
PubMed ID
24138652 View in PubMed
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26 records – page 1 of 3.