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High-cost healthcare users (HCUs) are a small proportion of the population who use a disproportionate amount of healthcare resources. Although the phenomenon occurs across the entire age spectrum, older adults represent the majority of HCUs. HCUs have drawn increasing attention internationally from clinicians, health policy-makers, and government administrators. Many experts have suggested that the short- and long-term sustainability of the healthcare system is threatened unless current approaches to the care and healthcare costs of this population are modified. Complex case management and care coordination models are being implemented internationally to address HCUs despite a lack of strong evidence to support their effectiveness in improving clinical outcomes or savings in costs of care. We review what is known about HCUs and the available evidence for the effectiveness of interventions designed to manage their high and costly healthcare use.

BackgroundBayesian hierarchical models have been proposed to combine evidence from different types of study designs. However, when combining evidence from randomised and non-randomised controlled studies, imbalances in patient characteristics between study arms may bias the results. The objective of this study was to assess the performance of a proposed Bayesian approach to adjust for imbalances in patient level covariates when combining evidence from both types of study designs.Methodology/Principal FindingsSimulation techniques, in which the truth is known, were used to generate sets of data for randomised and non-randomised studies. Covariate imbalances between study arms were introduced in the non-randomised studies. The performance of the Bayesian hierarchical model adjusted for imbalances was assessed in terms of bias. The data were also modelled using three other Bayesian approaches for synthesising evidence from randomised and non-randomised studies. The simulations considered six scenarios aimed at assessing the sensitivity of the results to changes in the impact of the imbalances and the relative number and size of studies of each type. For all six scenarios considered, the Bayesian hierarchical model adjusted for differences within studies gave results that were unbiased and closest to the true value compared to the other models.Conclusions/SignificanceWhere informed health care decision making requires the synthesis of evidence from randomised and non-randomised study designs, the proposed hierarchical Bayesian method adjusted for differences in patient characteristics between study arms may facilitate the optimal use of all available evidence leading to unbiased results compared to unadjusted analyses.

BackgroundOvarian cancer is a leading cause of cancer-related mortality. Although the disease is relatively rare, it carries a disproportionately large morbidity burden.ObjectiveWe conducted a cost-utility analysis from a Canadian public payer perspective to determine the cost effectiveness of bevacizumab, a newly available treatment option for recurrent ovarian cancer.MethodsUsing a 7-year time horizon, a three health-state cohort-based partitioned survival model was developed to assess the cost utility of bevacizumab plus chemotherapy (BEV) versus chemotherapy alone. We reconstructed individual patient data from published Kaplan–Meier curves. Clinical parameters, including progression-free survival and overall survival, were derived from the AURELIA phase III randomized controlled trial. Costs, resource utilization and utility values from recent Canadian sources were used to populate the model. Results were presented using incremental cost-utility ratios (ICURs). Uncertainty was examined through univariate and probabilistic sensitivity analyses.ResultsThe reconstructed individual patient data matched the AURELIA trial results. Total costs for the BEV and chemotherapy treatment arms were $Can79,086 and $Can54,982, respectively. Total estimated quality-adjusted life-years (QALYs) were 1.1055 and 0.9926 for the BEV and chemotherapy arms, respectively. The ICUR was estimated to be $Can213,424 per QALY gained. At a willingness-to-pay threshold of $Can100,000 per QALY gained, the probability of BEV being cost effective was 0.ConclusionsThe results of our analysis suggest that the addition of bevacizumab to single-agent chemotherapy treatment, while improving patient outcomes, is unlikely to be cost effective in this Canadian patient population. The results also provide some preliminary validation for use of individual patient data-reconstruction techniques in pharmacoeconomic evaluation.Electronic supplementary materialThe online version of this article (doi:10.1007/s41669-017-0030-7) contains supplementary material, which is available to authorized users.

OBJECTIVES: There has been a growing concern about the economic burden of work incapacity due to mental health problems; meanwhile studies examining the employer's perspective are still scarce. This study aims to propose a rationale to estimate the burden of mental health problems in Brazilian corporations. METHODS: Data from an observational study investigating absenteeism due to sick leaves in a Brazilian bank were used to build a costing estimation model (total number of employees, average number of sick days per employee, and proportion of sick days due to mental ill health). These data were combined with average wage and turnover rate national statistics and published data on presenteeism due to mental health problems. RESULTS: Based on nϭ7499 workers, 3.36 annual sick days per employee, a proportion of sick days attributable to mental health disorders of 15.58%, and a mean daily wage of 51.33BRL, the costing model projected annual costs due to absenteeism of 201,534BRL. If presenteeism is included in the costing estimation, using a previously published presenteeism/absenteeism ratio of 4.0 (for depressed workers), costs due to presenteeism would represent 806,138BRL per year. There is a lack of Brazilian observational studies assessing turnover rates and associated costs. National rates according to economic sector were employed to estimate the impact of turnover of mental ill workers (Service Industryϭ4.15% in 2010) and a turnover cost of 3 times the average monthly cost per employee were used as a proxy. Turnover costs would incur in additional 115,500BRL per year. The annual economic burden of mental health disorders under the employers perspective was estimated in 1,123,173BRL. CONCLUSIONS: The cost of mental ill health to employers, particularly the cost of productivity losses due to lower performance of employees at work (presenteeism), can represent a significant burden for companies and society. OBJECTIVES:The objective of this exploratory analysis was to assess the costeffectiveness of quetiapineXR as monotherapy compared to other key drug treatments in MDD patients, who have failed on previous therapy. METHODS: A Markov Model with one week cycles was used to assess the cost effectiveness of quetiap-ineXR treatment over 52 weeks. Key outcomes were: response rates, costs and Incremental Cost-Effectiveness Ratios (ICERs) for second line monotherapy. The