Background: Ipilimumab, a fully human monoclonal antibody that blocks CTLA-4 to promote anti-tumour immunity, was the first treatment in metastatic melanoma to show a significant survival benefit. Methods: A three-health-state partitioned survival model was developed to assess ipilimumab 3 mg/kg compared to dacarbazine and vemurafenib in first line therapy of advanced melanoma treatment-naive patients in Italy. The outcomes considered were costs, life years (LYs) and quality-adjusted life years (QALYs). Given the lack of trials assessing ipilimumab 3 mg/kg in this subgroup of patients, the efficacy was derived from a dataset of chemo-naive patients. Patient's management costs were estimated based on a micro-costing approach and the cost of adverse events based on both outpatient and inpatient care. Utilities considered were elicited from ipilimumab's clinical trials. Results: Basecase results showed that ipilimumab was both more costly and more effective than dacarbazine, with ratios of €38,345/LYs and €49,466/QALYs. By contrast, results vs. vemurafenib showed a marginal increase in health outcomes accompanied by a saving of €32,999, thus making ipilimumab the dominant strategy over vemurafenib in the base-case analysis. Sensitivity analysis showed overall robustness of the model. Conclusions: Treatment with ipilimumab showed better results in terms of LYs and QALYs against both comparators. Moreover, ipilimumab was the dominant strategy compared to vemurafenib, thus highly likely to bring both health benefits and cost savings in the Italian setting.

The cost-effectiveness evaluations showed that dabigatran can be considered the dominant treatment strategy compared to rivaroxaban in the patients' sub-groups considered, given the projected marginally higher clinical benefits and lower treatment costs.

India’s rapid economic growth has been accompanied by slower improvements in population health. Given the need to reconcile the ambitious goal of achieving Universal Coverage with limited resources, a robust priority-setting mechanism is required to ensure that the right trade-offs are made and the impact on health is maximised. Health Technology Assessment (HTA) is endorsed by the World Health Assembly as the gold standard approach to synthesizing evidence systematically for evidence-informed priority setting (EIPS). India is formally committed to institutionalising HTA as an integral component of the EIPS process. The effective conduct and uptake of HTA depends on a well-functioning ecosystem of stakeholders adept at commissioning and generating policy-relevant HTA research, developing and utilising rigorous technical, transparent, and inclusive methods and processes, and a strong multisectoral and transnational appetite for the use of evidence to inform policy. These all require myriad complex and complementary capacities to be built at each level of the health system . In this paper we describe how a framework for targeted and locally-tailored capacity building for EIPS, and specifically HTA, was collaboratively developed and implemented by an international network of priority-setting expertise, and the Government of India.

Aim In patients with chronic kidney disease (CKD), hyperkalaemia (HK) (potassium level ≥ 5.0 mEq/L) is associated with poor clinical outcomes. This study provides novel insights by comparing management costs of CKD patients with normokalaemia vs those with persistent HK regularly followed in renal clinics in Italy. Methods To this aim, a Markov model over life‐time horizon was developed. Time to end‐stage renal disease (ESRD) and time to death in CKD patients were derived from an observational multi‐centre database including 1665 patients with non‐dialysis CKD stage 1‐5 under nephrology care in Italy (15 years follow‐up). Resource use for CKD and HK management was obtained from the observational database, KDIGO international guidelines, and clinical expert opinion. Results Results showed that patients with normokalaemia vs persistent HK brought an average per patient lifetime cost‐saving of €16 059 besides delayed onset of ESRD by 2.29 years and increased survival by 1.79 years with increment in total survival and dialysis‐free survival in normokalaemia that decreased from early to advanced disease. Cost‐saving related to normokalaemia increased at more advanced CKD; however, it was already evident at early stage (3388.97€ at stage 1‐3a). OWSA confirmed cost‐saving associated with normokalaemia across all parameter variations. Discussion and conclusion This model is the first to simulate the impact of HK in non‐dialysis CKD patients on economic and clinical outcomes using real‐world data from nephrology clinics. In these patients, persistent HK results into higher lifetime costs, besides poorer clinical outcomes, that are evident since the early stages of CKD. Maintaining normokalaemia should therefore be of main concern in CKD treatment planning to improve long‐term economic and clinical outcomes.

Rheumatoid arthritis (RA) is an autoimmune chronic disease which is associated with an increasing disability in patients and high socioeconomic burden. Given the large number of economic evaluations considered by national health technology assessments (HTAs), this review attempts to clarify whether results from biologic disease-modifying antirheumatic drugs (DMARDs) economic evaluations form the basis of official recommendation by national HTA agencies in Australia, Canada, Scotland and England. The results show that evidence of cost-effectiveness was not equally perceived by decision makers and did not have equal weightage in defining the official listing of biologic DMARDs for the treatment of RA. As it has been demonstrated in previous studies, major barriers exist for the integration of cost-effectiveness and cost-utility results with national HTA activity. In fact, as shown in this review, even when such analysis are available, cost-minimization and comparative effectiveness studies seemed to be preferred by some HTA agencies as tools to inform allocation of healthcare resources.