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1.
BMC Health Serv Res ; 21(1): 909, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479565

RESUMO

BACKGROUND: To evaluate the cost-effectiveness of six diagnostic strategies involving magnetic resonance imaging (MRI) targeted biopsy for diagnosing prostate cancer in initial and repeat biopsy settings from the Singapore healthcare system perspective. METHODS: A combined decision tree and Markov model was developed. The starting model population was men with mean age of 65 years referred for a first prostate biopsy due to clinical suspicion of prostate cancer. The six diagnostic strategies were selected for their relevance to local clinical practice. They comprised MRI targeted biopsy following a positive pre-biopsy multiparametric MRI (mpMRI) [Prostate Imaging - Reporting and Data System (PI-RADS) score ≥ 3], systematic biopsy, or saturation biopsy employed in different testing combinations and sequences. Deterministic base case analyses with sensitivity analyses were performed using costs from the healthcare system perspective and quality-adjusted life years (QALY) gained as the outcome measure to yield incremental cost-effectiveness ratios (ICERs). RESULTS: Deterministic base case analyses showed that Strategy 1 (MRI targeted biopsy alone), Strategy 2 (MRI targeted biopsy ➔ systematic biopsy), and Strategy 4 (MRI targeted biopsy ➔ systematic biopsy ➔ saturation biopsy) were cost-effective options at a willingness-to-pay (WTP) threshold of US$20,000, with ICERs ranging from US$18,975 to US$19,458. Strategies involving MRI targeted biopsy in the repeat biopsy setting were dominated. Sensitivity analyses found the ICERs were affected mostly by changes to the annual discounting rate and prevalence of prostate cancer in men referred for first biopsy, ranging between US$15,755 to US$23,022. Probabilistic sensitivity analyses confirmed Strategy 1 to be the least costly, and Strategies 2 and 4 being the preferred strategies when WTP thresholds were US$20,000 and US$30,000, respectively. LIMITATIONS AND CONCLUSIONS: This study found MRI targeted biopsy to be cost-effective in diagnosing prostate cancer in the biopsy-naïve setting in Singapore.


Assuntos
Imageamento por Ressonância Magnética , Neoplasias da Próstata , Idoso , Biópsia , Análise Custo-Benefício , Humanos , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Singapura/epidemiologia
2.
Expert Rev Pharmacoecon Outcomes Res ; 21(3): 441-448, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33593205

RESUMO

Objectives: To determine whether olaparib maintenance therapy, used with and without restriction by BRCA1/2 mutation status, is cost-effective at the population level for platinum-sensitive relapsed ovarian cancer in Singapore.Methods: A partitioned survival model compared three management strategies: 1) treat all patients with olaparib; 2) test for germline BRCA1/2 mutation, followed by targeted olaparib use in mutation carriers only; 3) observe all patients. Mature overall survival (OS) data from Study 19 and a 15-year time horizon were used and direct medical costs were applied. Sensitivity analyses were conducted to explore uncertainties.Results: Treating all patients with olaparib was the most costly and effective strategy, followed by targeted olaparib use, and observation of all patients. Base-case incremental cost-effectiveness ratios (ICERs) for all-olaparib and targeted use strategies were SGD133,394 (USD100,926) and SGD115,736 (USD87,566) per quality-adjusted life year (QALY) gained, respectively, compared to observation. ICERs were most sensitive to the cost of olaparib, time horizon and discount rate for outcomes. When these parameters were varied, ICERs remained above SGD92,000 (USD69,607)/QALY.Conclusions: At the current price, olaparib is not cost-effective when used with or without restriction by BRCA1/2 mutation status in Singapore, despite taking into account potential OS improvement over a long time horizon.


Assuntos
Terapia de Alvo Molecular , Neoplasias Ovarianas/tratamento farmacológico , Ftalazinas/administração & dosagem , Piperazinas/administração & dosagem , Inibidores de Poli(ADP-Ribose) Polimerases/administração & dosagem , Proteína BRCA1/genética , Proteína BRCA2/genética , Análise Custo-Benefício , Feminino , Humanos , Mutação , Recidiva Local de Neoplasia , Neoplasias Ovarianas/economia , Neoplasias Ovarianas/genética , Ftalazinas/economia , Piperazinas/economia , Inibidores de Poli(ADP-Ribose) Polimerases/economia , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Singapura , Análise de Sobrevida , Fatores de Tempo
3.
Expert Rev Pharmacoecon Outcomes Res ; 21(3): 449-456, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33595372

RESUMO

BACKGROUND: This study evaluates the cost-effectiveness of pertuzumab with trastuzumab biosimilar and docetaxel as initial treatment for HER2-positive metastatic breast cancer (MBC) in Singapore. METHODS: A partitioned survival model with three health states was developed to evaluate the cost-effectiveness of trastuzumab biosimilar and docetaxel with or without pertuzumab from a healthcare system perspective over a 15-year time horizon for patients with HER2-positive MBC. Key clinical inputs were derived from the CLEOPATRA trial. Health state utilities were derived from the literature and direct medical costs were obtained from local public healthcare institutions. RESULTS: The base-case resulted in an incremental cost-effectiveness ratio (ICER) of SGD366,658 (USD272,244) per quality-adjusted life-year (QALY) gained. One-way sensitivity analyses showed that the ICER was sensitive to utilities in the progression-free state, price of pertuzumab and time horizon. When the price for trastuzumab reference biologic (branded) was applied, the ICER was even higher (SGD426,996 [USD317,045]/QALY). CONCLUSION: Although trastuzumab biosimilar reduced the cost of the pertuzumab combination regimen, the ICER remained high and was not cost effective in Singapore's context. As pertuzumab contributed 80% of the overall combination treatment cost, price reductions for pertuzumab will be required to improve the cost-effectiveness of combination treatment to an acceptable level.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Medicamentos Biossimilares/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Anos de Vida Ajustados por Qualidade de Vida , Anticorpos Monoclonais Humanizados/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/economia , Medicamentos Biossimilares/economia , Neoplasias da Mama/economia , Neoplasias da Mama/patologia , Análise Custo-Benefício , Docetaxel/administração & dosagem , Feminino , Humanos , Metástase Neoplásica , Intervalo Livre de Progressão , Receptor ErbB-2/metabolismo , Singapura , Trastuzumab/administração & dosagem
4.
Int J Audiol ; 59(1): 39-44, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31498005

RESUMO

Objective: The value of cochlear implantation (CI) has not been established in Taiwan. The purpose of this study was to evaluate the cost-effectiveness of paediatric CI within the context of Taiwan's national health insurance (NHI) programme.Design: A Markov model-based cost-utility analysis (CUA) was conducted to evaluate the cost-effectiveness of a unilateral CI (UCI) with a contralateral acoustic hearing aid (UCI-HA) compared with a bilateral HA. We performed one-way sensitivity analyses to identify the cost variables that affected the incremental cost-effectiveness ratio (ICER) the most. Monte Carlo simulation was used to explore the simultaneous effect of all uncertain parameters on cost-effectiveness.Study sample: Not applicable.Results: Compared with bilateral HAs, the ICER for UCI-HA was $6487 per quality-adjusted life year (QALY) gained. The ICERs were consistently below $7000 per QALY gained and were most sensitive to the selling price of the external CI device. When this selling price increased by 10%, the ICER of UCI-HA would increase to $6954 per QALY gained. UCI-HA has a probability greater than 50% of being cost-effective if the cost-effectiveness threshold exceeds approximately $10,000 per QALY.Conclusions: Our analysis suggested that within the context of Taiwan's NHI programme, UCI is highly cost-effective for deaf children.


Assuntos
Implante Coclear/economia , Implantes Cocleares/economia , Surdez/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Implante Coclear/métodos , Análise Custo-Benefício , Surdez/cirurgia , Feminino , Humanos , Lactente , Masculino , Anos de Vida Ajustados por Qualidade de Vida , Taiwan
5.
PLoS One ; 14(8): e0220439, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31415595

RESUMO

A cochlear implant is a small electronic device that provides a sense of sound for the user, which can be used unilaterally or bilaterally. Although there is advocacy for the benefits of binaural hearing, the high cost of cochlear implant raises the question of whether its additional benefits over the use of an acoustic hearing aid in the contralateral ear outweigh its costs. This cost-effectiveness analysis aimed to separately assess the cost-effectiveness of simultaneous and sequential bilateral cochlear implantations compared to bimodal hearing (use of unilateral cochlear implant combined with an acoustic hearing aid in the contralateral ear) in children with severe-to-profound sensorineural hearing loss in both ears from the Singapore healthcare payer perspective. Incremental quality-adjusted life year (QALYs) gained and costs associated with bilateral cochlear implants over the lifetime horizon were estimated based on a four-state Markov model. The analysis results showed that, at the 2017 mean cost, compared to bimodal hearing, patients receiving bilateral cochlear implants experienced more QALYs but incurred higher costs, resulting in an incremental cost-effectiveness ratio (ICER) of USD$60,607 per QALY gained for simultaneous bilateral cochlear implantation, and USD$81,782 per QALY gained for sequential bilateral cochlear implantation. The cost-effectiveness of bilateral cochlear implants is most sensitive to utility gain associated with second cochlear implant, and cost of bilateral cochlear implants. ICERs increased when the utility gain from bilateral cochlear implants decreased; ICERs exceeded USD$120,000 per QALY gained when the utility gain was halved from 0.03 to 0.015 in both simultaneous and sequential bilateral cochlear implantations. The choice of incremental utility gain associated with the second cochlear implant is an area of considerable uncertainty.


Assuntos
Implante Coclear/economia , Implantes Cocleares/economia , Análise Custo-Benefício , Perda Auditiva Neurossensorial/cirurgia , Modelos Teóricos , Criança , Implante Coclear/métodos , Custos de Cuidados de Saúde , Perda Auditiva Neurossensorial/economia , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Singapura
6.
PLoS One ; 13(6): e0198387, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29856821

RESUMO

Inadequate care of chronic kidney disease (CKD) is common and may be associated with adverse outcomes after dialysis. The nationwide pre-end-stage renal disease pay for performance program (P4P) has been implemented in Taiwan to improve quality of CKD care. However, the effectiveness of the P4P program in improving the outcomes of pre-dialysis care and dialysis is uncertain. We conducted a longitudinal cohort study. Patients who newly underwent long-term dialysis (≥3 mo) between 2007 and 2009 were identified from the Taiwan National Health Insurance Research Database. Based on the patient enrolment of the P4P program, they were categorized into P4P or non-P4P groups. We analysed pre-dialysis care, healthcare expenditures, and mortality between two groups. Among the 26 588 patients, 25.5% participated in the P4P program. The P4P group received significantly better quality of care, including a higher frequency of glomerular filtration rate measurement and CKD complications survey, a higher rate of vascular access preparation, and more frequent use of arteriovenous fistulas than the non-P4P group did. The P4P group had a 68.4% reduction of the 4-year total healthcare expenditure (excluding dialysis fee), which is equivalent to US$345.7 million, and a significant 22% reduction in three-year mortality after dialysis (hazard ratio 0.78, 95% confidence interval: 0.75-0.82, P < 0.001) compared with the non-P4P group. P4P program improves quality of pre-dialysis CKD care, and provide survival benefit and a long-term cost saving for dialysis patients.


Assuntos
Falência Renal Crônica/economia , Falência Renal Crônica/mortalidade , Falência Renal Crônica/prevenção & controle , Programas Nacionais de Saúde , Serviços Preventivos de Saúde , Diálise Renal , Adulto , Idoso , Feminino , Taxa de Filtração Glomerular , Gastos em Saúde/estatística & dados numéricos , Humanos , Falência Renal Crônica/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/estatística & dados numéricos , Diálise Renal/economia , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Taiwan/epidemiologia
7.
Sci Rep ; 5: 15687, 2015 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-26507664

RESUMO

This retrospective cohort study investigated the progression risk of sequential complication in Asian type 2 diabetes (T2D) patients using the Taiwan Pay-for-Performance Diabetes Registry and claim data from November 2003 to February 2009. 226,310 adult T2D patients without complication were followed from diagnosis to complications, including myocardial infarction (MI), other ischemic heart disease (IHD), congestive heart failure (CHF), stroke, chronic kidney disease (CKD), retinopathy, amputation, death or to the end of study. Cumulative incidences (CIs) of first and second complications were analyzed in 30 and 4 years using the cumulative incidence competing risk method. IHD (29.8%), CKD (24.5%) and stroke (16.0%) are the most common first complications. The further development of T2D complications depends on a patient's existing complication profiles. Patients who initially developed cardiovascular complications had a higher risk (9.2% to 24.4%) of developing IHD or CKD, respectively. All-cause mortality was the most likely consequence for patients with a prior MI (12.0%), so as stroke in patients with a prior MI (10.8%) or IHD (8.9%). Patients with CKD had higher risk of developing IHD (16.3%), stroke (8.9%) and all-cause mortality (8.7%) than end-stage renal disease (4.0%). Following an amputation, patients had a considerable risk of all-cause mortality (42.1%).


Assuntos
Complicações do Diabetes/patologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Complicações do Diabetes/etiologia , Progressão da Doença , Feminino , Seguimentos , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/patologia , Humanos , Incidência , Falência Renal Crônica/etiologia , Falência Renal Crônica/patologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/patologia , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/patologia , Insuficiência Renal Crônica/etiologia , Insuficiência Renal Crônica/patologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/patologia , Taiwan , Adulto Jovem
8.
PLoS One ; 10(5): e0126912, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26020251

RESUMO

Acupuncture is a popular but controversial treatment option for low back pain. In China, it is practised as traditional Chinese medicine; other treatment strategies for low back pain are commonly practised as Western medicine. Research on patient preference for low back-pain treatment options has been mainly conducted in Western countries and is limited to a willingness-to-pay approach. A stated-preference, discrete choice experiment was conducted to determine Chinese patient preferences and trade-offs for acupuncture and low frequency infrared treatment in low back pain from September 2011 to August 2012 after approval from the Department of Scientific Research in the study settings. Eight-six adult outpatients who visited the 'traditional medicine department' at a traditional Chinese medicine hospital and the 'rehabilitation department' at a Western medicine hospital in Guangdong Province of China for chronic low back pain during study period participated in an interview survey. A questionnaire containing 10 scenarios (5 attributes in each scenario) was used to ask participants' preference for acupuncture, low frequency infrared treatment or neither option. Validated responses were analysed using a nested-logit model. The decision on whether to receive a therapy was not associated with the expected utility of receiving therapy, female gender and higher out-of-pocket payment significantly decreased chance to receive treatments. Of the utility of receiving either acupuncture or low frequency infrared treatment, the treatment sensation was the most important attribute as an indicator of treatment efficacy, followed by the maximum efficacy, maintenance duration and onset of efficacy, and the out-of-pocket payment. The willingness-to-pay for acupuncture and low frequency infrared treatment were about $618.6 and $592.4 USD per course respectively, demonstrated patients' demand of pain management. The treatment sensation was regarded as an indicator of treatment efficacy and the most important attribute for choosing acupuncture or low frequency infrared treatment. The high willingness-to-pay demonstrated patients' demand of pain management. However, there may be other factors influencing patients' preference to receive treatments.


Assuntos
Analgesia por Acupuntura , Raios Infravermelhos/uso terapêutico , Dor Lombar/terapia , Preferência do Paciente , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
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