Aim: To estimate the cost-effectiveness of atezolizumab compared with docetaxel and nivolumab for the treatment of advanced non-small cell lung cancer (NSCLC), as a second-line treatment, in a French setting. Materials and methods: A three-state partitioned-survival model was developed (progression-free survival, post-progression survival, death) based on the phase IIIOAK trial on a 10-year time horizon. The comparison between nivolumab and atezolizumab came from a network meta-analysis. Utilities were estimated from the OAK trial EQ-5D applying the French utility tariffs. Overall survival (OS), progression-free survival (PFS), and treatment duration were estimated using parametric models selected using Akaike and Bayesian information criterion. Extrapolation beyond the trial duration followed NICE DSU TSD 14. Economic perspective was the one of all payers, discount rate fixed at 4% on benefits and costs. This analysis was aligned with French Haute Autorit e de Sant e recommendations. Results were expressed in total cost (2019) and e/QALY (Quality Adjusted Life Year). Model robustness was checked through sensitivity analyses, and a probabilistic sensitivity analysis was conducted. Results: In comparison to docetaxel, atezolizumab costs 49,429e more and increased life expectancy by 8 months, generating 0.47 QALY. Incremental cost-effectiveness ratio was estimated at 104,835e/ QALY. When comparing nivolumab to atezolizumab, a cost minimization analysis was conducted since no clear evidence supporting a difference in terms of survival benefit was reported. Using list price, and the Market Access Authorization regimens, atezolizumab saved approximately 6,000e, 9.5% of its total costs. Sensitivity analyses confirmed the robustness of our findings. Conclusion: Atezolizumab is more efficient and more costly than docetaxel in the second-line treatment of NSCLC of stage IIIB or IV, in France, with results consistent to previous French authorities' evaluation of immunotherapies in similar indication. Lastly, atezolizumab is a cost saving alternative to nivolumab, based on list price.
ARTICLE HISTORY
test, Wilcoxon test, Chi-square test) were: number of patients exposed to allogeneic red cells, amount of blood transfusions, and the number of length of stay in hospital. An economic model was quantified the cost saving of EVICEL® in ICH. Results: preliminary results showed that application of EVICEL reduce number of transfused RBC, postoperative haemoglobin loss, and days of hospital stay. In the hospital cost. analysis EVICEL® predicts resource reduction with average cost-savings of € 1.227 per patient. ConClusions: Overall, the results suggest that EVICEL are efficacious in reducing both post-operative blood loss, and hospital stay The protocol with EVICEL® produce clinical appropriateness and important cost savings for hospital.
Objectives: The Pipeline Embolization Device (PED) is a flow diverter system designed to treat intracranial aneurysms. This study focuses on unruptured, wide neck, giant intracranial aneurysm, and aims at identifying the cost-effectiveness of PED compared with current standard therapies available in the Mexican public healthcare system. MethOds: To predict clinical endpoints and costs over a 15-year time horizon, a decision analytic model (Markov) was developed. The model has a short-term component with three health states based on major radiologic outcomes: complete occlusion, residual neck, and residual aneurysm; and a longterm component with three health states: reintervention, rupture and death. The endovascular procedures of coiling and stent assisted coiling were identified as comparators. Clinical efficacy was measured using radiological outcomes; all clinical trials used the same assessment tools facilitating comparison. Costs were taken from public available sources considering direct medical costs only. Results were presented as incremental cost per life years gained in national currency. Results: PED showed to have an ICER of $103,839.34 versus coiling, 117,043.87 when compared to stent-assisted coiling and $20,711.69 when compared with the no intervention strategy in a 15-year temporal horizon scenario. PED obtained an ICER below Mexican GDP threshold per life years gained, versus the rest of the competitors in the mentioned timeline. Other ICERs for different time horizons will be shown in the sensitivity analysis. cOnclusiOns: PED represents a cost-effective strategy for the treatment of this particular type of aneurysmal lesions when compared with the current available endovascular treatment options in the Mexican public healthcare system.
1527 to 6182) after surgery. There were, however, no differences in long-term costs to society between laparoscopic and open surgery ($684, 95% CI: -5799 to 7166). Results were sensitive to length of hospital stay, sick leave and the cost for stoma materials as demonstrated in one-way sensitivity analysis. ConClusions: The study found short and long-term cost differences for the health care sector. There was no significant difference in regards to long-term societal perspective. Future research is suggested to investigate the effects of sick leave costs using material from a greater number of patients.
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