The most cost-effective treatment pathway for WSD patients was NASHA/Dx followed by SNS, with a maximum ICUR of 5,928 GBP/ QALY vs the other treatment pathways analysed. In comparison with treatment pathway excluding SNS, 0.55 QALY are gained. ConClusions: SNS is a relevant treatment for FI in patients who have failed conservative management. Including SNS into the treatment pathway for refractory FI may provide value-for-money in the UK NHS perspective.
Capsaicin 8% patch is cost-effective compared to pregabalin for patients who have failed one or more previous systemic treatments for PNP.Objectives: Multiple regimens are used in the treatment of severe haemophilia A in the Netherlands. Most patients receive clotting factors intravenously 2-3 times weekly to prevent bleedings: intermediate dose prophylaxis. Given the high utilization of prophylaxis treatment, budget restraints might hinder the availability of prophylaxis for patients in the nearby future. Other treatment regimens are ondemand (OD) treatment, administering clotting factors in case of bleedings, and prophylaxis treatment with a switch to OD at 18 years. This analysis estimates the cost-effectiveness of Dutch prophylaxis treatment for severe haemophilia A patients compared to other treatment regimens. MethOds: A Markov model is developed with the health stages 'Alive', 'Severe joint damage' and 'Death'. Bleeding rates of individual patients are simulated over lifetime, including a probability of inhibitor development. A higher joint bleed rate is accompanied by increased joint damage, increasing the chance of joint surgery. Disease progression, within the Alive health state, is modeled with the Pettersson Score (PS). The PS indicates the radiographic arthropathy. Increased joint damage is associated with physical limitations and decreased QoL. Because the chosen treatment regimen affects both the joint bleed rate and inhibitor development, it also affects the HRQoL. The analysis was performed from a societal perspective. Results: Prophylaxis treatment was associated with the greatest QoL. The cost-effectiveness acceptability curve shows a probability of 90% for prophylaxis treatment to be cost-effective at a threshold of € 0, -compared to OD treatment. Compared to prophylaxis with a switch to OD at 18 years, prophylaxis treatment has a 50% probability of being cost-effective at a € 80.000, -threshold. The model outcome is sensitive for variations in bleeding rate, prophylaxis dosage, inhibitor development and utilities. cOnclusiOns: Based on our model, treatment of severe haemophilia A patients with lifetime prophylaxis is cost-effective compared to OD treatment.
We propose a methodology framework for evaluating complex intervention programs on connected care platforms such as remote patient monitoring for populations with long-term conditions in their potential in ROI for health care organizations and in their cost effectiveness for pending market introduction by health systems or payers. Methods: We built a probabilistic decision-analytic model to compare patient-reported costs and outcomes on QALYs of remote patient monitoring in addition to usual care given the published evidence and uncertainty from the Whole Systems Demonstrator Study which was setup in the United Kingdom from 2008 to 2009 [1]. The model was populated with as-reported survivor-specific QALYs distribution and compared to adjusted QALYs to compensate the effect of different mortality rates among the control and intervention group. We computed metrics such as, net monetary benefit, incremental cost effectiveness ratio and acceptability, expected value of perfect information and ROI. Results: The WSD reported an ICER of £92,000 and an CEA of 11% at willingness to pay threshold of £30 000 [1]. Our unadjusted model produced an ICER of £52,300 with an CEA of 38%. The adjusted QALY model produced an ICER of £24,800. At this level, the probability of cost effectiveness increased to 56%. Conclusions: Single-point measurements of QALY in an end-of-life population can cause bias which in turn can influence decision making on cost effectiveness of interventions. We suggest program effectiveness measurements to be taken repeatedly over time, covering the whole cohort at baseline and adjusting for non-survivors during follow-up, by collecting information on defined outcome measures from patients, clinicians, and administrative sources. The selected measures can be translated in the quadruple aim around lowered cost, improved staff experience, improved health outcomes and patient experience. [1] Cost effectiveness of telehealth for patient with long term conditions (Whole Systems Demonstrator study). Henderson et al. BMJ 2013
To identify published cost-effectiveness analyses and health technology assessment (HTA) submissions for treatments in chronic heart failure (CHF) to inform future cost-effectiveness modeling in CHF. MethOds: A systematic review was performed. Literature searches were conducted in MEDLINE, EMBASE, EconLit, and the Cochrane Library, with supplementary hand searching of conferences and HTA websites. Eligible studies had to report on cost-effectiveness outcomes in adults with CHF and/or heart failure with reduced ejection fraction, treated with angiotensin-converting enzyme inhibitors, beta-blockers, mineralocorticoid receptor antagonists, angiotensin receptor blockers, or ivabradine. Results: Sixty-six publications met the inclusion criteria, representing 63 distinct analyses. Of these, 53 reported their MethOds: 20 were statistical analyses of individual patient data, while 33 used decision-analytic modeling. Structures were most commonly described as being Markov (n= 27) but the methods were heterogeneous. The health states most frequently employed were 'alive' or 'dead', with outcomes such as hospitalization or New York Heart Association (NYHA) class distribution most commonly considered as a partition of the 'alive' state. Other health states considered were often based on NYHA class, hospitalizations, and major CV events. Different approaches to modeling the effects of interventions on mortality were used; treatment effects were applied to cardiovascular (CV) mortality and all-cause mortality in nine and 20 studies (among the 33 decision-analytic models), respectively. Across included studies, the time horizon ranged from within-trial to lifetime. Outcomes were frequently sensitive to baseline risks of mortality and hospitalization, relative efficacy of interventions, and unit costs of interventions. cOnclusiOns: The studies identified were heterogeneous with respect to their approaches; this may be due to the preference of payers in different jurisdictions. However, the identified literature suggests mortality and hospitalization are the key determinants of the cost-effectiveness of treatment for CHF.
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