Cost-utility evaluation of vortioxetine in patients with Major Depressive Disorder experiencing inadequate response to alternative antidepressants in the United Kingdom.

BACKGROUND: Patients frequently require several lines of therapy for treatment of major depressive episodes. This economic analysis details the management of patients who responded inadequately due to lack of efficacy or intolerability to two previous antidepressants in the UK. METHODS: The model included a decision tree and a Markov component. Health states considered in the decision tree were remission, response, no response, withdrawal due to adverse events, relapse, recovery, and recurrence. The time horizon was 24 months. Patients were on third-line treatment for up to a 3-month acute phase and a 6-month maintenance phase. As third-line efficacy data were not available, inputs were calculated by adjusting original second-line data to third-line based on proportionate reductions observed in STAR*D. Equivalent efficacy was assumed for all comparators. Healthcare resource use and utilities were based on UK estimates. RESULTS: Vortioxetine was a cost-effective treatment option at a threshold of £20,000/QALY vs. escitalopram, citalopram, sertraline, and was associated with more health benefits, less costs (was dominant) versus relevant third-line comparators venlafaxine and duloxetine. Agomelatine was found not to be a cost-effective option. The 22-month maintenance phase treatment scenario results were similar to the 6-month base case. LIMITATIONS: Third-line efficacy data were not available. This highlights the need for studies in patients receiving third-line treatment. CONCLUSION: This model provides an overview for the management of patients receiving third-line treatment where limited evidence currently exists. Vortioxetine, with its novel mechanism of action, is expected to be a dominant treatment option versus relevant comparators in the UK.

Cost-effectiveness of QuantiFERON-TB test vs. tuberculin skin test in the diagnosis of latent tuberculosis infection.

OBJECTIVE: To evaluate the cost-effectiveness of the tuberculin skin test (TST), the QuantiFERON-TB Gold test (QFT) and a combination of TST and QFT (TST+QFT) for diagnosing latent tuberculosis infection (LTBI) in France in a bacille Calmette-Guérin (BCG) vaccinated population. METHODS: A decision analysis model evaluated three strategies among simulated adults in close contact with tuberculosis (TB). We calculated direct lifetime medical costs, life expectancies and incremental cost-effectiveness ratios (ICERs). RESULTS: The discounted direct medical costs of care per patient of no testing, TST, QFT and TST+QFT were respectively euro417, euro476, euro443 and euro435, while discounted life expectancies were respectively 25.030, 25.071, 25.073 and 25.062 years. TST had higher costs and lower efficacy than QFT; TST+QFT was associated with an ICER of euro560 per year of life gained (YLG) compared to no testing, and QFT was associated with an ICER of euro730/YLG compared to TST+QFT. The only scenario where QFT was associated with an ICER of >euro75 000/YLG was when the prevalence of LTBI around TB was low (<5%) and TST specificity high (>90%). CONCLUSIONS: In France, for the diagnosis of LTBI after close contact with TB, the TST is more expensive and less effective than QFT. Although it is more expensive, QFT is more effective and cost-effective than TST+QFT under a wide range of realistic test performance scenarios.

[Stage IV NSCLC. Economic analysis in lung cancers]. / Les analyses économiques des cancers bronchopulmonaires (CBP).

OBJECTIVE: To explain the help of economic analyses in the understanding of lung cancer (LC) management with a description of the quality of selected papers. METHODS: In the first part, quality criteria of economic analyses are depicted with the key words for the literature selection. RESULTS: The global costs of LC through literature review are depicted; then, in a second part, the costs of each stage of the disease. Finally, costs of chemotherapeutic drugs and target molecules are also discussed. CONCLUSION: Economic analyses are unavoidable to assess the burden of the disease but also the cost of each management strategy for LC.

[Inhaled corticosteroids in asthma: a medico-economic analysis of clinical trials]. / Les corticoïdes inhalés dans l'asthme: analyse médico-économique des essais cliniques.

BACKGROUND: Asthma is a chronic disease with a heavy economic burden in terms of public health on account of its clinical impact and consequences on quality of life and costs. Its management is based on pharmacological measures with inhaled corticosteroids playing a large role. The objective of this study was to undertake an analysis of the published literature of medico-economic trials of the use of inhaled corticosteroids. METHODS: A review of the literature from 1990 to 2007 was undertaken with separate analyses of studies of inhaled steroids alone and those looking at combined preparations. RESULTS: The costs of asthma vary greatly depending on the clinical management. Analysis of the published clinical trials showed that the addition of inhaled steroids increased the total cost. When efficacy is taken into account the economic results are acceptable for developed societies. The use of inhaled steroids as maintenance therapy, or maintenance and symptomatic therapy, was always cost effective. CONCLUSION: These results are based on data from clinical trials. They need to be confirmed by large scale observational studies using validated criteria of effectiveness.