Sixteen economic analyses were included; all studies used decision-tree structures to model acute prophylaxis, and 13 included a chronic-phase Markov module to capture long-term complications and recurrent VTE events. The model structures generally captured the important events needed to accurately estimate differences in costs and outcomes between different treatment strategies. Eleven studies included rivaroxaban, 9 studies included dabigatran, 3 studies included apixaban, and no studies included edoxaban. The analyses that compared a NOAC with low molecular-weight heparin (LMWH) predominantly resulted in the NOAC dominating LMWH for patients with both THR and TKR. The results of analyses that compared NOACs with each other suggested that dabigatran is the least cost-effective option. There is limited evidence directly comparing rivaroxaban with apixaban, but our results suggested that rivaroxaban dominates apixaban for patients with TKR in the United Kingdom. ConClusions: Economic analyses of NOACs for primary VTE prophylaxis following THR and TKR surgeries show reasonable consistency in the model structures used and events captured. The results strongly suggest that NOACs are cost-effective alternatives to LMWH. Dabigatran appears to be the least cost-effective NOAC. However, more research is needed to assess the cost-effectiveness of apixaban and edoxaban.
A865of the Mexican population, that is the reason why the institution must consider alternatives that bring not only effectiveness, instead "value for money" due to cost cuttings and containment issues experienced during the last years. Methods: The cost model considered population covered by the Mexican Institute of Social Security (IMSS), in this sense the target population (base case scenario) was chosen based on those patients with DT1 diagnosed and treated, in order to model the budget impact with and without the intervention. We conducted a pragmatic literature review and treatment comparison to find out hypoglycemic events frequency (event rate and event/patient/year). The time horizon was 12 months and the model only considered the medical direct costs. Results: After split the population (based on coverage pop at IMSS, very uncontrolled patients, diagnosed and treated), the cost model considered 40,439 DT1 patients. Without intervention, it was modelled 15,468 hypoglycemic events ($6.9 million dollars. Every treatment scenario was weighted according to literature review inputs). With intervention on base case scenario and best case (77.81% and 90.24% reduction on severe events) the frequency of severe events were 3,432 and 1,509, respectively (which it means a total costs that oscillate between $1.5 million and $675k dollars) ConClusions: The savings due to intervention (SAP) were described between $5.4 to 6.2 million of dollars. The analysis just account for those avoided acute events, we did not simulate those mid-term or long-term complications avoided neither indirect costs, items that could increase the effect size and costs savings due to SAP therapy on very uncontrolled DT1 patients.
Objectives: To conduct a cost-effectiveness analysis between Coblation and mechanical debridement with a shaver (MD) in a patient population presenting with chronic pain due to medial meniscus tear and an International Cartilage Research Society (ICRS) grade III focal chondral lesion. This analysis was conducted from the UK National Health Service (NHS) perspective. MethOds: A decisionanalytic model was developed to compare the net costs and clinical outcomes up to 4 years following surgery between patients whose knee chondroplasty procedure was carried out with Coblation or MD. Costs were obtained from the 2015-2016 UK NHS National schedule of reference costs and an annual 3% discount rate was applied to future costs. Clinical trial outcomes data included in the analysis were physiotherapy service utilization (6.4 units vs. 9.8 units; p= 0.04) and revision rates at 4 years (14% vs. 48%; p< 0.006) for both Coblation and MD respectively. Threshold analysis was used to determine the point at which the model conclusion changed while the robustness of the conclusions were assessed through deterministic sensitivity analyses. Results: Over a 4-year period following surgery, the use of Coblation vs. MD resulted in a £1,550 net savings per patient. The cost-saving realized with Coblation was robust to sensitivity analyses. Threshold analysis estimated that Coblation remained the dominant alternative when it was assumed that Coblation revision rate increased from the initially reported rate of 14% up to 68%. cOnclusiOns: The use of Coblation vs. MD in the treatment of cartilage lesions in a patient population with medial meniscus tear and ICRS grade III chondral lesion is cost-saving as a result of better clinical outcomes over a 4-year period following surgery.
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