The AFSPP effectively prevented suicides in the US Air Force. The long-term effectiveness of this program depends upon extensive implementation and effective monitoring of implementation. Suicides can be reduced through a multilayered, overlapping approach that encompasses key prevention domains and tracks implementation of program activities.
Objective: To evaluate the cost-effectiveness of disease-modifying therapies (DMTs) in the United States compared to basic supportive therapy without DMT for patients with relapsing multiple sclerosis (MS).
Methods:Using data from a longitudinal MS survey, we generated 10-year disease progression paths for an MS cohort. We used first-order annual Markov models to estimate transitional probabilities. Costs associated with losses of employment were obtained from the Bureau of Labor Statistics. Medical costs were estimated using the Centers for Medicare and Medicaid Services reimbursement rates and other sources. Outcomes were measured as gains in quality-adjusted life-years (QALY) and relapse-free years. Monte Carlo simulations, resampling methods, and sensitivity analyses were conducted to evaluate model uncertainty.Results: Using DMT for 10 years resulted in modest health gains for all DMTs compared to treatment without DMT (0.082 QALY or Ͻ1 quality-adjusted month gain for glatiramer acetate, and 0.126-0.192 QALY gain for interferons). The cost-effectiveness of all DMTs far exceeded $800,000/QALY. Reducing the cost of DMTs had by far the greatest impact on the costeffectiveness of these treatments (e.g., cost reduction by 67% would improve the probability of Avonex being cost-effective at $164,000/QALY to 50%). Compared to treating patients with all levels of disease, starting DMT earlier was associated with a lower (more favorable) incremental cost-effectiveness ratio compared to initiating treatment at any disease state.
Conclusion:
GLOSSARYCE ϭ cost-effectiveness; CEAC ϭ cost-effectiveness acceptability curve; CI ϭ confidence interval; DMT ϭ disease-modifying therapy; EDSS ϭ Expanded Disability Status Scale; FDA ϭ Food and Drug Administration; HRQOL ϭ health-related quality of life; ICER ϭ incremental cost-effectiveness ratio; ICD-9-CM ϭ International Classification of Diseases-9-Clinical Modification; MC ϭ Monte Carlo; MEPS ϭ Medical Expenditure Panel Survey; MS ϭ multiple sclerosis; QALY ϭ quality-adjusted life-year; RRMS ϭ relapsing-remitting multiple sclerosis; RFY ϭ relapse-free year; SC ϭ subcutaneous; SF-36 ϭ Short Form-36; SPMS ϭ secondary progressive multiple sclerosis.
The variation in end-of-life practices across PACE program sites, which are not attributed to differences in individual characteristics, raises two important questions: what are the causes for these variations; and are these variations desirable? Further research is required to answer both questions.
Enrollment in New York's SCHIP was associated with improvements in access to asthma care, quality of asthma care, and asthma-specific outcomes. These findings suggest that health insurance improves the health of children with asthma.
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