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2.
Orthop Clin North Am ; 51(1): 1-5, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31739873

RESUMEN

Using an age- and comorbidity-matched cohort, we compared patients who underwent unicompartmental knee arthroplasty in an ambulatory surgery center with those who underwent the procedure in a traditional hospital inpatient setting. Postoperatively, the ambulatory surgery center cohort had fewer major complications than the inpatient cohort. No ambulatory surgery center patients required acute hospital admission and none had major complications. Four major complications occurred in the inpatient cohort. There was no difference in complication rates. Our results suggest that outpatient unicompartmental knee arthroplasty in a freestanding ambulatory surgery center is a safe and reasonable alternative to the traditional inpatient hospital setting.


Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/economía , Artroplastia de Reemplazo de Rodilla/economía , Análisis Costo-Beneficio/métodos , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Complicaciones Posoperatorias/epidemiología , Resultado del Tratamiento
3.
Expert Rev Pharmacoecon Outcomes Res ; 19(6): 619-626, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31721598

RESUMEN

Introduction: In recent decades, medical devices (MDs) have increasingly become an integral part of patient care. However, when it comes to designing and appraising economic models, researchers typically follow pharmaceutical templates (e.g. CHEERS) to assess their economic viability. This study evaluates the generalizability of four device-specific criteria, as recommended by the recent MedtechHTA project, of learning curve, incremental innovation, dynamic pricing, and organizational impact with a broader group of MDs including diagnostics and implantables. The purpose was to determine the applicability of these criteria to a broader range of MDs.Areas Covered: We determined the extent to which these criteria could be applied to each device type and attempted to identify common themes. We performed a literature search using PubMed and Google of a range of devices to understand the clinical significance, operation, and economic viability.Expert Opinion: Our findings suggest that the four characteristics are not applicable to all device types. Prior evaluation of a device's intrinsic properties (such as longevity and device location) and its FDA risk classification could help to indicate the applicability of the criteria. Documenting this process when assessing the additional four criteria on the CHEERS checklist would improve the transparency of future economic evaluations.


Asunto(s)
Equipos y Suministros/economía , Modelos Económicos , Evaluación de la Tecnología Biomédica/métodos , Lista de Verificación , Análisis Costo-Beneficio/métodos , Humanos , Evaluación de la Tecnología Biomédica/economía
4.
Afr J AIDS Res ; 18(4): 289-296, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31779574

RESUMEN

Sustaining HIV and AIDS responses depends on a mix of donor, government and private funders. Their decisions about investing in HIV treatment may be informed by various types of economic evaluations, which may be more or less useful for different contexts. This paper benchmarks methods against each other. Epidemiological and demographic impacts of HIV and antiretroviral therapy (ART) from 1996-2015 were quantified using country- specific spectrum files. The study compared societal benefits of ART using the full income (FI) methodology with "conventional" benefit, utility and effectiveness estimates produced with the same data. The FI estimates suggested $3.50 in benefits per dollar spent on ART globally, 2.6 times larger than productivity-related measures of benefits, of $1.33 in benefits per dollar. Higher benefit-cost ratios are mainly because FI reflects value of life beyond what people produce at work and in non-working age groups, and allocates the future stream of benefits in the year that death is avoided. ART costs were 0.78 times per capita GDP per quality-adjusted life-years gained globally. FI benefit-cost ratios are considerably higher in upper- and lower-middle-income countries than in low- or high-income countries. Productivity-based benefits also exceeded costs in all but one region but had smaller ratios and different regional patterns. Per capita GDP per quality-adjusted life-years ratios were below 1.2 for all regions and country income bands, suggesting cost effectiveness. The fact that FI returns of ART are higher than productivity returns, helps to quantify developmental benefits of interventions that directly extend life and its quality, arguably the objective of development. They provide an important argument to increase budget allocations to health sectors for ART scale-up, and not just reallocate existing health resources. Benchmarking FI returns against cost per quality- adjusted life-years may allow comparison to other "cost effective" health interventions. However, caution should be taken in extrapolations between measures, because they produce different rankings across country categories.


Asunto(s)
Fármacos Anti-VIH/economía , Análisis Costo-Beneficio/métodos , Infecciones por VIH/economía , Recursos en Salud , Fármacos Anti-VIH/uso terapéutico , Benchmarking , Infecciones por VIH/tratamiento farmacológico , Costos de la Atención en Salud , Humanos , Renta , Años de Vida Ajustados por Calidad de Vida
5.
Anticancer Res ; 39(10): 5559-5564, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31570450

RESUMEN

BACKGROUND/AIM: Tyrosine kinase inhibitors are important in the treatment of metastatic renal cell cancer (mRCC). The aim of the study was to evaluate the costs and effects of sunitinib in mRCC. PATIENTS AND METHODS: A total of 81 mRCC patients who received first-line sunitinib therapy between 2010 and 2014 were recruited. Drug doses, laboratory and imaging studies, outpatient visits and inpatient stays were recorded. Health-related quality of life (HRQoL) was measured (15D- and EQ-5D - 3L questionnaires). RESULTS: The cost of sunitinib (mean 22,268 €/patient range 274 € to 105,121 €) covered 73% of the total costs during the treatment period. The total treatment cost was 30,530 €/patient (range=1,661-111,516 €). The median overall survival was 17.9 months. HRQoL decreased during treatment. CONCLUSION: The main cost during sunitinib treatment of mRCC was the drug itself (73% of the total costs). Drug costs and HRQoL should be considered when choosing treatment for mRCC.


Asunto(s)
Carcinoma de Células Renales/tratamiento farmacológico , Carcinoma de Células Renales/economía , Neoplasias Renales/tratamiento farmacológico , Neoplasias Renales/economía , Sunitinib/economía , Sunitinib/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/economía , Antineoplásicos/uso terapéutico , Análisis Costo-Beneficio/métodos , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Calidad de Vida
6.
J Manag Care Spec Pharm ; 25(10): 1096-1101, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31556822

RESUMEN

Genetic testing technology is rapidly evolving with the growth of personalized medicine. While test evaluation typically relies on laboratory measures of performance, tests can be costly and analytically and ethically complex. A more fulsome consideration of value is warranted to inform adoption and appropriate use. Herein we describe a methodology for developing novel clinician- and patient-reported measures of clinical and personal utility, aiming to capture the informational value of genome diagnostic tests. Adhering to core measurement science principles and standards, our 4-step process includes (1) tool development through scoping reviews and stakeholder interviews and surveys; (2) tool validation through prospective cohort studies to establish construct validity, inter- and intra-rater reliability; (3) tool application using comparative effectiveness assessment to gauge the comparative value of different types of genetic tests; and (4) tool dissemination, leveraging existing partnerships with international stakeholders to spur additional validation studies, comparative effectiveness research, cost-effectiveness analysis, and evidence-informed policy. A scoping review of the clinical utility literature informed the development of a preliminary 25-item index. Qualitative interviews with 35 clinicians further informed the definition of our utility construct, item content, and item importance. Stakeholder surveys with 113 clinicians enabled further feedback on item content, importance, sensibility, response, and scoring options. An 18-item tool, the "Clinician-reported Genetic testing Utility InDEx" (C-GUIDE), is now undergoing validation, while development work on the patient-reported measure of utility is underway. A methodologically innovative approach to the development of stakeholder-informed and clinimetrically sound measures of value for personalized medicine tests will assist technology users and decision makers globally. DISCLOSURES: This work was supported by the Canadian Institutes of Health Research Operating Grant (#PJT-152880) and the PhRMA Foundation Challenge Award. Publication of the study methodology or findings generated therein was not contingent on the sponsor's approval or censorship of the manuscript. The authors have nothing to disclose. Results from this study were presented as a poster at the 40th Annual North American Meeting of the Society for Medical Decision Making; October 14, 2018; Montreal, QC; the Annual Meeting of the American Society of Human Genetics; October 18, 2018; San Diego, CA; and as an oral presentation at the Annual Meeting of the Canadian Association for Health Services and Policy Research; May 31, 2018; Montreal, QC.


Asunto(s)
Toma de Decisiones Clínicas/métodos , Investigación sobre la Eficacia Comparativa/métodos , Pruebas Genéticas/normas , Genoma Humano/genética , Medicina de Precisión/normas , Análisis Costo-Beneficio/métodos , Práctica Clínica Basada en la Evidencia/economía , Práctica Clínica Basada en la Evidencia/normas , Pruebas Genéticas/economía , Humanos , Medición de Resultados Informados por el Paciente , Reproducibilidad de los Resultados , Participación de los Interesados , Seguro de Salud Basado en Valor/economía
7.
Respir Res ; 20(1): 173, 2019 Aug 02.
Artículo en Inglés | MEDLINE | ID: mdl-31375102

RESUMEN

Despite the availability of treatment guidelines and inhaled medications for asthma and chronic obstructive pulmonary disease (COPD), much remains to be done to lessen the burden of these respiratory diseases for patients. The challenge of selecting effective and efficacious drugs for patients is a key focus area for healthcare professionals. Here we discuss the concept of "drivers of effectiveness"- features of a medicine which may increase or decrease its effectiveness in the presence of real-world factors - and highlight the importance of considering these drivers in the early stages of drug development, and exploring their impact in carefully designed pragmatic trials. Using the Salford Lung Studies (SLS) in asthma and COPD as an illustrative example, we discuss various features of the inhaled corticosteroid/long-acting ß2-agonist combination, fluticasone furoate/vilanterol (FF/VI), as potential drivers of effectiveness that may have contributed to the improved patient outcomes observed with initiation of FF/VI versus continuation of usual care in the UK primary care setting.


Asunto(s)
Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Manejo de la Enfermedad , Desarrollo de Medicamentos/tendencias , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Antiasmáticos/economía , Asma/diagnóstico , Asma/economía , Análisis Costo-Beneficio/métodos , Desarrollo de Medicamentos/economía , Humanos , Cumplimiento de la Medicación , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/economía , Resultado del Tratamiento
8.
Health Psychol ; 38(8): 669-671, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31368750

RESUMEN

Behavioral interventions can be offered within a wide range of contexts, including public health, medicine, surgery, physical rehabilitation, nutrition, and other health services. These differing services compete for the same resources and it is difficult to compare their value. Systematic standardized methodologies for valuing outcomes are available and are being applied by economists and health services researchers, but are not widely used in our field. With support from the Society for Health Psychology, the National Cancer Institute (NCI), and the Office for Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health, two working group meetings were held to consider the use of well-established cost-effectiveness methodologies for the evaluation of behavioral and public health interventions. In this special section, we acknowledge a wide range of variability in terms of behavioral interventions typically delivered in nonclinical versus more traditional clinical settings. Three articles address (1) standardizing methods for conducting cost-effectiveness and cost-utility analyses, (2) providing examples to illustrate progress in applying these methods to evaluate interventions delivered in whole or in part in clinical settings, and (3) providing nonclinical intervention examples selected to highlight the challenges and opportunities for evaluating the cost-effectiveness of interventions in more diverse settings. The ability of our field to communicate cost-effectiveness data to policy makers, employers, and insurers that incorporates implementation costs is central to the likelihood of our interventions being adopted by practitioners and reimbursed by payers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Terapia Conductista/economía , Terapia Conductista/métodos , Medicina de la Conducta/economía , Medicina de la Conducta/métodos , Análisis Costo-Beneficio/métodos , Humanos
9.
Health Psychol ; 38(8): 672-679, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31368751

RESUMEN

Health care remains the most expensive sector in the U.S. economy, now accounting for nearly 1 in every 5 dollars spent. The purpose of health care is to improve the health of populations. However, formal medical care is one of many alternatives for improving health. In order to make better use of scarce resources, cost-effectiveness methodologies have been developed to evaluate how to produce the most health within the constraints of available resources. Standardized cost-effectiveness methodologies are now commonly used in the evaluation of medical therapies and new technologies. However, these methods have rarely been employed for the evaluation of behavioral interventions. Behavioral interventions often use measures that are not generally applied in other areas of health outcomes research. A consequence of neglecting to employ standardized cost-effectiveness analysis is that behavioral, psychological, and environmental interventions may be left out of resource allocation discussions. The purpose of this paper is to review standardized approaches to cost-effectiveness analysis and to encourage their use for the evaluation of behavioral intervention programs. Application of standardized methods of cost-effectiveness analysis will allow direct comparisons between investing in behavioral interventions programs in comparison to a wide range of other alternatives. The methods are general and can be used to estimate the cost-effectiveness of social and environmental interventions in addition to traditional medical and surgical treatments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Terapia Conductista/economía , Análisis Costo-Beneficio/métodos , Humanos
10.
Health Psychol ; 38(8): 680-688, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31368752

RESUMEN

In this report, we offer three examples of how economic data could promote greater adoption of behavioral and psychosocial interventions in clinical settings where primary or specialty medical care is delivered to patients. The examples are collaborative care for depression, chronic pain management, and cognitive-behavioral therapy for insomnia. These interventions illustrate differences in the availability of cost and cost-effectiveness data and in the extent of intervention adoption and integration into routine delivery of medical care. Collaborative care has been widely studied from an economic perspective, with most studies demonstrating its relative cost-effectiveness per quality-adjusted life year (QALY) and some studies demonstrating its potential for cost neutrality or cost savings. The success of collaborative care for depression can be viewed as a model for how to promote greater adoption of other interventions, such as psychological therapies for chronic pain and insomnia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Terapia Cognitivo-Conductual/economía , Análisis Costo-Beneficio/métodos , Humanos
11.
Health Psychol ; 38(8): 689-700, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31368753

RESUMEN

This paper examines three distinct examples of interventions in nonclinical settings selected to highlight the challenges and opportunities for evaluating cost-effectiveness in the field of health psychology and behavioral medicine. Nonclinical settings are defined as those involving systems outside of traditional medical/clinical settings, and include interventions tested in clinical settings that can also be implemented in nonclinical settings. The examples in this paper reflect the use of a varying degree of existing cost-effectiveness data and previous health economic analyses. First, the Chronic Disease Self-Management Program model reflects an intervention protocol designed to increase patients' confidence and mastery in their ability to manage their conditions that has been shown to be cost effective for a variety of chronic disease conditions. Second, the cost and cost-effectiveness of tobacco quitlines (e.g., National Tobacco Quit Line) has been the subject of several preliminary cost-effectiveness examinations and has proven to have significant reach and impact on tobacco-related behaviors. Finally, environmental interventions for promoting walking and physical activity in community-based contexts (e.g., PATH trial) are presented and have been shown to be highly relevant for demonstrating cost-effectiveness. Overall, the disciplines of health psychology and behavioral medicine are in a unique position to develop, implement, and evaluate a broader range of interventions in more diverse environments than cost-effectiveness applications in more traditional, clinical settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Terapia Conductista/economía , Análisis Costo-Beneficio/métodos , /métodos , Humanos
12.
Health Psychol ; 38(8): 701-704, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31368754

RESUMEN

Founding figures in Western medicine both puzzled over and anticipated a day when demand for expensive treatments would outstrip financial wherewithal. In the United States, that day has arrived and, with it, the need for sound health care economic policy that selectively covers treatments of demonstrable effectiveness and efficiency. Standard cost-effectiveness methods exist to determine the value of alternative treatments, but they have rarely been applied to behavioral interventions in the United States. Cost-effectiveness analyses are one part of the solution to learning which treatment packages warrant coverage because they produce the most health for the most people. Another part of the solution involves applying novel multiphase optimize strategy methods to reengineer behavioral interventions so that they yield the maximum health benefit attainable for the least resource expenditure. Among the research designs in the multiphase optimize strategy toolkit are methods to derive algorithms that address naturally occurring population heterogeneity in the response to treatments. Such algorithms suggest a population-level protocol to adapt and prioritize treatment options once a patient has failed to respond to an evidence-based practice that was offered as first-line treatment. Developing sound health care economic policy for the population requires systematically figuring out who needs what care and how to provide them what they need-not less and not more. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Terapia Conductista/economía , Análisis Costo-Beneficio/métodos , Política de Salud/economía , Humanos
13.
Anesth Analg ; 129(3): 726-734, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31425213

RESUMEN

The convergence of multiple recent developments in health care information technology and monitoring devices has made possible the creation of remote patient surveillance systems that increase the timeliness and quality of patient care. More convenient, less invasive monitoring devices, including patches, wearables, and biosensors, now allow for continuous physiological data to be gleaned from patients in a variety of care settings across the perioperative experience. These data can be bound into a single data repository, creating so-called data lakes. The high volume and diversity of data in these repositories must be processed into standard formats that can be queried in real time. These data can then be used by sophisticated prediction algorithms currently under development, enabling the early recognition of patterns of clinical deterioration otherwise undetectable to humans. Improved predictions can reduce alarm fatigue. In addition, data are now automatically queriable on a real-time basis such that they can be fed back to clinicians in a time frame that allows for meaningful intervention. These advancements are key components of successful remote surveillance systems. Anesthesiologists have the opportunity to be at the forefront of remote surveillance in the care they provide in the operating room, postanesthesia care unit, and intensive care unit, while also expanding their scope to include high-risk preoperative and postoperative patients on the general care wards. These systems hold the promise of enabling anesthesiologists to detect and intervene upon changes in the clinical status of the patient before adverse events have occurred. Importantly, however, significant barriers still exist to the effective deployment of these technologies and their study in impacting patient outcomes. Studies demonstrating the impact of remote surveillance on patient outcomes are limited. Critical to the impact of the technology are strategies of implementation, including who should receive and respond to alerts and how they should respond. Moreover, the lack of cost-effectiveness data and the uncertainty of whether clinical activities surrounding these technologies will be financially reimbursed remain significant challenges to future scale and sustainability. This narrative review will discuss the evolving technical components of remote surveillance systems, the clinical use cases relevant to the anesthesiologist's practice, the existing evidence for their impact on patients, the barriers that exist to their effective implementation and study, and important considerations regarding sustainability and cost-effectiveness.


Asunto(s)
Anestesiología/métodos , Informática Médica/métodos , Calidad de la Atención de Salud , Tecnología de Sensores Remotos/métodos , Anestesiología/economía , Anestesiología/normas , Análisis Costo-Beneficio/métodos , Análisis Costo-Beneficio/normas , /normas , Humanos , Informática Médica/economía , Informática Médica/normas , Calidad de la Atención de Salud/economía , Calidad de la Atención de Salud/normas , Tecnología de Sensores Remotos/economía , Tecnología de Sensores Remotos/normas , Factores de Tiempo
14.
Int J Technol Assess Health Care ; 35(4): 291-297, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31337452

RESUMEN

BACKGROUND: Traditional decision rules have limitations when a new technology is less effective and less costly than a comparator. We propose a new probabilistic decision framework to examine non-inferiority in effectiveness and net monetary benefit (NMB) simultaneously. We illustrate this framework using the example of repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT) for treatment-resistant depression. METHODS: We modeled the quality-adjusted life-years (QALYs) associated with the new intervention (rTMS), an active control (ECT), and a placebo control, and we estimated the fraction of effectiveness preserved by the new intervention through probabilistic sensitivity analysis (PSA). We then assessed the probability of cost-effectiveness using a traditional cost-effectiveness acceptability curve (CEAC) and our new decision-making framework. In our new framework, we considered the new intervention cost-effective in each simulation of the PSA if it preserved at least 75 percent of the effectiveness of the active control (thus demonstrating non-inferiority) and had a positive NMB at a given willingness-to-pay threshold (WTP). RESULTS: rTMS was less effective (i.e., associated with fewer QALYs) and less costly than ECT. The traditional CEAC approach showed that the probabilities of rTMS being cost-effective were 100 percent, 39 percent, and 14 percent at WTPs of $0, $50,000, and $100,000 per QALY gained, respectively. In the new decision framework, the probabilities of rTMS being cost-effective were reduced to 23 percent, 21 percent, and 13 percent at WTPs of $0, $50,000, and $100,000 per QALY, respectively. CONCLUSIONS: This new framework provides a different perspective for decision making with considerations of both non-inferiority and WTP thresholds.


Asunto(s)
Análisis Costo-Beneficio/métodos , Trastorno Depresivo Mayor/terapia , Terapia Electroconvulsiva/economía , Evaluación de la Tecnología Biomédica/métodos , Estimulación Magnética Transcraneal/economía , Terapia Electroconvulsiva/efectos adversos , Terapia Electroconvulsiva/métodos , Estudios de Equivalencia como Asunto , Humanos , Método de Montecarlo , Años de Vida Ajustados por Calidad de Vida , Proyectos de Investigación , Estimulación Magnética Transcraneal/efectos adversos , Estimulación Magnética Transcraneal/métodos
15.
Clin Drug Investig ; 39(10): 979-990, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31302899

RESUMEN

BACKGROUND: Migraine is a common, chronic neurovascular brain disorder with non-negligible multifaceted economic costs. Existing preventive treatments involve the selective use of onabotulinumtoxinA, which aims at migraine morbidity reduction for patients who have failed initial preventive treatment with oral agents. Erenumab is a new preventive treatment for migraines. OBJECTIVE: To evaluate the differences in costs and outcomes of the preventive treatment with erenumab versus onabotulinumtoxinA in patients with chronic migraines (CM) in Greece to assess the economic value of this treatment. METHODS: We conducted a cost-effectiveness analysis from both the payer and the societal perspective using a decision-tree analytic model. Outcomes were expressed in migraines avoided and in quality-adjusted life-years (QALYs). We obtained model inputs from the existing literature. The decision path adjusted for variation in the probability of adherence and the resulting differential effectiveness between the two treatments. Direct costs included the cost of the two drugs and administration costs, the costs of acute drugs used under usual care, and the costs of hospitalization, physician, and emergency department visits. Indirect costs for the societal perspective analyses included wages lost on workdays. The time-horizon of the analysis was 1 year and all costs were calculated in 2019 euros (€). Sensitivity analyses were conducted to control for parameter uncertainty and to evaluate the robustness of the findings. RESULTS: Our results indicate that treatment of CM with erenumab compared to onabotulinumtoxinA resulted in incremental cost-effectiveness ratios (ICERs) of €218,870 and €231,554 per QALY gained and €620 and €656 per migraine avoided, from the societal and the payer's perspective, respectively. Using a common cost-effectiveness threshold equal to three times the local gross domestic product (GDP) per capita (€49,000), for the erenumab ICERs to fall below this threshold, the erenumab price would have to be no more than €192 (societal perspective) or €173 (payer perspective). CONCLUSION: The prophylactic treatment of CM with erenumab in Greece might be cost effective compared to the existing alternative of onabotulinumtoxinA from both the payer and the societal perspective, but only at a highly discounted price. Nevertheless, erenumab could be considered a therapeutic option for patients who fail treatment with onabotulinumtoxinA.


Asunto(s)
Anticuerpos Monoclonales Humanizados/economía , Toxinas Botulínicas Tipo A/economía , Antagonistas del Receptor Peptídico Relacionado con el Gen de la Calcitonina/economía , Análisis Costo-Beneficio/métodos , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/economía , Adulto , Anticuerpos Monoclonales Humanizados/administración & dosificación , Toxinas Botulínicas Tipo A/administración & dosificación , Antagonistas del Receptor Peptídico Relacionado con el Gen de la Calcitonina/administración & dosificación , Enfermedad Crónica , Árboles de Decisión , Método Doble Ciego , Femenino , Grecia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Trastornos Migrañosos/epidemiología , Años de Vida Ajustados por Calidad de Vida
16.
Otolaryngol Head Neck Surg ; 161(3): 375-387, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31184254

RESUMEN

Clinicians seek to pursue the most clinically effective treatment strategies, but costs have also become a key determinant in contemporary health care. Economic analyses have thus emerged as a valuable resource to both quantify and qualify the value of existing and emerging interventions and programs. Cost-effectiveness analyses estimate the benefits gained per monetary unit, providing insights to guide resource allocation. Herein, we delineate the related concepts and considerations to facilitate understanding and appraisal of these analyses, so as to better inform the stakeholders in our otolaryngology community.


Asunto(s)
Análisis Costo-Beneficio , Medicina Basada en la Evidencia , Otolaringología/economía , Análisis Costo-Beneficio/clasificación , Análisis Costo-Beneficio/métodos , Árboles de Decisión , Pérdida Auditiva/diagnóstico , Pérdida Auditiva/terapia , Humanos , Enfermedades Otorrinolaringológicas/diagnóstico , Enfermedades Otorrinolaringológicas/terapia
17.
Value Health ; 22(6): 656-660, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31198182

RESUMEN

Evaluating different approaches to assessing the clinical effectiveness and value of potential cures will be essential to arm the policymaker, payer, and manufacturer communities with a platform that can reward innovation while supporting a sustainable health insurance system. Potential cures will accentuate concerns about substantial uncertainty in long-term outcomes. They will also focus attention on whether broader elements of value need to be incorporated and whether specific social values have a special place in evaluations of potential cures. In addition, the large magnitudes of potential health gain and cost offsets may require new methods before translation into value-based price recommendations. This article analyzes the challenges and presents several options to modify the conduct and presentation of cost-effectiveness analyses to ensure they provide policy-relevant assessments of the value of potential cures.


Asunto(s)
Análisis Costo-Beneficio/métodos , Seguro de Salud Basado en Valor/economía , Análisis Costo-Beneficio/tendencias , Humanos , Estados Unidos
18.
Value Health ; 22(6): 684-692, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31198186

RESUMEN

BACKGROUND: The popularity of quality-adjusted life years (QALYs) has been resistant to concerns about validity and reliability. Utility-theoretic outcome equivalents are widely used in other areas of applied economics. Equivalence values can be derived for time, money, risk, and other metrics. These equivalence measures preserve all available information about individual preferences and are valid measures of individual welfare changes. OBJECTIVE: The objective of this study was to derive alternative generalized equivalence measures from first principles and illustrate their application in an empirical comparative-effectiveness example. METHODS: We specify a general-equilibrium model incorporating neoclassical utility functions, health production function, severity-duration preferences, and labor-market tradeoff function. The empirical implementation takes advantage of discrete-choice experiment methods that are widely accepted in other areas of applied economics and increasingly in health economics. We illustrate the practical significance of restrictive QALY assumptions using comparative-effectiveness results based on both QALYs and estimates of welfare-theoretic time-equivalent values for anti-tumor necrosis factor and prolonged corticosteroid treatments for Crohn's disease in three distinct preference classes. RESULTS: The QALY difference between the two treatments is 0.2 months, while time-equivalent values range between 0.5 and 1.3 months for aggregate and class-specific differences. Thus, the QALY-based analysis understates welfare-theoretic values by 60%-85%. CONCLUSION: These results suggest that using disease-specific equivalence values offer a meaningful alternative to QALYs to compare global outcomes across treatments. The equivalence values approach is consistent with principles of welfare economics and offers several features not represented in QALYs, including accounting for preference nonlinearities in disease severity and duration, inclusion of preference-relevant nonclinical healthcare factors, representing preferences of clinically-relevant patient subpopulations, and including utility losses related to risk aversion.


Asunto(s)
Análisis Costo-Beneficio/normas , Años de Vida Ajustados por Calidad de Vida , Análisis Costo-Beneficio/métodos , Análisis Costo-Beneficio/estadística & datos numéricos , Humanos , Modelos Económicos , Reproducibilidad de los Resultados , Factores de Tiempo
19.
Acta Neurol Scand ; 140(4): 244-251, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31165476

RESUMEN

OBJECTIVES: The medical and social care of drug-resistant epilepsy (DRE) entails significant costs. Approximately 30 to 40 percent of patients with DRE who underwent vagus nerve stimulator (VNS) implantation achieve an above 50 percent reduction in seizure frequency. The study objective was to analyze the effect of VNS on clinical effects improvement and therapy cost reduction in patients with DRE over a 2-year follow-up period. The second purpose of the study was to compare average costs of VNS treatment of patients with DRE in selected countries, taking into account the purchasing power parity. MATERIALS AND METHODS: The study included all the patients who had VNS implanted at our department between 2014 and 2018. Data on clinical events and medical costs were collected prospectively and obtained from medical documentation. We also reviewed relevant literature on costs of VNS therapy in patients with DRE from the last 18 years. RESULTS: Resource utilization and epilepsy-related events were reduced during the follow-up period compared to the baseline. Average total cost was estimated at EUR 7703.59 in year 1 and at EUR 7108.38 in year 2 following VNS implantation. Average direct costs of VNS treatment of patients with DRE over the last 18 years varied between the countries and ranged from EUR 24 790.43 in the United States to EUR 64.84 in the United Kingdom. CONCLUSION: Vagus nerve stimulator is a cost-effective therapy yielding measurable clinical and therapeutic outcomes over the long term. Moreover, the analysis contained in this review highlights the poor consensus of methodological approaches.


Asunto(s)
Análisis Costo-Beneficio/métodos , Epilepsia Refractaria/economía , Epilepsia Refractaria/terapia , Estimulación del Nervio Vago/economía , Adolescente , Adulto , Epilepsia Refractaria/epidemiología , Europa (Continente)/epidemiología , Femenino , Recursos en Salud/economía , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto Joven
20.
Clin Drug Investig ; 39(10): 931-938, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31250401

RESUMEN

BACKGROUND AND OBJECTIVES: In first-line treatment of advanced renal cell carcinoma (aRCC), the KEYNOTE-426 study demonstrated a significant progression-free survival and overall survival for pembrolizumab plus axitinib in comparison with sunitinib. The objective of the current study was to evaluate the cost effectiveness of pembrolizumab plus axitinib versus sunitinib for previously untreated patients with aRCC in China. METHODS: A Markov model was used to estimate the costs and health outcomes of treatment of aRCC with sunitinib or pembrolizumab plus axitinib. Univariable and probabilistic sensitivity analyses were performed to determine the robustness of the model outcomes. Additional subgroup analyses were also performed. The primary outputs of the model included the total cost, life-years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratio (ICER). RESULTS: Pembrolizumab plus axitinib provided an additional 2.461 LYs (1.650 QALYs). The total cost per patient was US$178,725 for pembrolizumab plus axitinib and US$87,693 for sunitinib. The ICER for pembrolizumab plus axitinib was US$55,185/QALY versus sunitinib. Sensitivity analyses found the results to be most sensitive to pembrolizumab cost and overall hazard ratio. The results of subgroup analyses showed that the ICER remained greater than US$32,000/QALY across the all patient subgroups. CONCLUSIONS: Pembrolizumab plus axitinib is not likely to be cost effective versus sunitinib for patients with previously untreated aRCC at a threshold value of US$29,306/QALY.


Asunto(s)
Anticuerpos Monoclonales Humanizados/economía , Antineoplásicos Inmunológicos/economía , Axitinib/economía , Carcinoma de Células Renales/economía , Análisis Costo-Beneficio/métodos , Neoplasias Renales/economía , Sunitinib/economía , Anticuerpos Monoclonales Humanizados/administración & dosificación , Antineoplásicos Inmunológicos/administración & dosificación , Axitinib/administración & dosificación , Carcinoma de Células Renales/tratamiento farmacológico , Carcinoma de Células Renales/epidemiología , China/epidemiología , Quimioterapia Combinada , Humanos , Neoplasias Renales/tratamiento farmacológico , Neoplasias Renales/epidemiología , Años de Vida Ajustados por Calidad de Vida , Sunitinib/administración & dosificación
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