PurposeMetastatic breast cancer (MBC) patients are treated with a variety of regimens with differing side effects that can reduce the patients’ quality of life. This study assessed the willingness to pay (WTP) to avoid side effects related to MBC treatment using conjoint analysis.MethodsAn online, self-administered conjoint analysis survey of US adult female MBC patients was conducted to elicit preferences for MBC treatment side effects. Attributes included in the analysis were hair loss, diarrhea, fatigue, nausea, tingling in hands and feet, pain, risk of infection, and out-of-pocket costs. Fifteen choice-based conjoint questions were presented where patients selected the most preferred therapy. A partial profile design was used to allow for each treatment description to be made with 3 instead of all 8 attributes. The attribute choices for each question included 2 side effects and a yearly out-of-pocket price.ResultsThere were 298 respondents. MBC patients were willing to pay (US$) $3,894 to avoid severe diarrhea, $3,479 to avoid being hospitalized due to infection, $3,211 to avoid severe nausea, $2,764 to avoid severe tingling in hands and feet, $2,652 to avoid severe fatigue, $1,853 to avoid obvious hair loss, and $1,458 to avoid severe pain. The most important attributes when selecting a therapy for MBC in terms of average utility were risk of infection, diarrhea, and nausea.ConclusionsMBC patients were willing to pay significant amounts to avoid side effects associated with MBC treatment, with patients willing to pay the most to avoid diarrhea, risk of infection, and nausea.
A109 (AF). Methods: We collected a sequential, prospective, convenience sample of patients 50 years of age or older, admitted between December 2010 and March 2013 diagnosed with ischemic stroke, excluding lacunar infarct, transitory cerebral ischemia, recurrent stroke or modified Rankin index greater than 2 prior to this episode. The presence of AF was sought with electrocardiogram and in some cases was studied with Holter. For a separate analysis, we matched for age and admission NIHSS score, in a 1:1 ratio, patients with and without AF. Variables measured in all cases were: age, gender, admission and discharge NIHSS, modified Rankin index, and CHA2DS2VASC score. Prospectively, we collected in-hospital resource use and costs incurred during the acute event. Exchange rate 1805 Colombian pesos = 1 American dollar (USD). Results: 166 patients were analyzed, 125 without and 41 with nonvalvular AF. For the paired analysis, we considered 37 patients with and 37 without AF. The average total cost of acute care for all stroke patients was USD$4,163
BACKGROUND: Age-related macular degeneration (AMD) is a leading cause of blindness worldwide and is the most common cause of blindness in developed countries. Despite antivascular endothelial growth factor (anti-VEGF) therapy demonstrating improvements in visual and anatomical outcomes, unmet needs remain. Brolucizumab-dbll (ie, brolucizumab), a VEGF inhibitor for treatment of neovascular (wet) AMD and recently approved by the FDA for its treatment of wet AMD, attempts to mitigate treatment burden through less frequent injections. OBJECTIVE: To assess the incremental costeffectiveness of brolucizumab compared with aflibercept and ranibizumab, given similar costs per injection and the potential for longer dosing intervals based on phase 3 clinical trial data. METHODS: A Markov model was developed to model the treatment of wet AMD patients with brolucizumab vs aflibercept and vs ranibizumab over a lifetime time horizon (base case) and 5-year time horizon (scenario analysis). The Markov model consisted of 3 primary health states: on treatment, off treatment, and death. Markov substates (5 total) described visual acuity (VA) ranging from no vision impairment to blindness. These VA-based substates were defined by best-corrected visual acuity (BCVA) values measured using Early Treatment Diabetic Retinopathy Study letters. Fixed-dosing regimens for each therapy were included in the model: dosing every 4 weeks (q4w) for the first 3 months followed by dosing q8w/q12w
BackgroundAlbumin is frequently prescribed in cirrhotic patients with acute decompensation. However, the true cost effectiveness of albumin use in cirrhotic patients is still under debate.ObjectiveTo evaluate the cost-effectiveness of albumin in the treatment of decompensated cirrhosis in Germany, Italy, and Spain.MethodsA decision-tree economic model was developed to evaluate treatments for decompensated cirrhosis from the hospital perspective over a typical inpatient admission. The treatments for large volume paracentesis (LVP) were albumin vs saline, gelatin, or no fluid. The treatments for spontaneous bacterial peritonitis (SBP) were albumin plus antibiotics vs antibiotics alone. The treatments for hepatorenal syndrome (HRS) were albumin plus a vasoconstrictor vs a vasoconstrictor alone. Effectiveness inputs were literature-based. Cost inputs included pharmacy costs and medical complication costs of decompensated cirrhosis. The primary model assessments were incremental cost-effectiveness ratios (ICERs) per life saved and per quality-adjusted life-year (QALY).ResultsAlbumin was found to be both less costly and more effective relative to saline, gelatin, and no fluid for the treatment of LVP across all 3 countries. For SBP, albumin plus antibiotics was more clinically effective than antibiotics alone in all 3 countries. The combination of albumin plus antibiotics was less costly than antibiotics alone in Germany and Italy, making albumin a dominant treatment (ie, less costly and more effective). In the management of SBP in Spain, albumin plus antibiotics compared to antibiotics alone resulted in ICERs of €1516 per life saved and €3369 per QALY gained. Albumin plus a vasoconstrictor was both less costly and more effective than vasoconstrictor alone in the treatment of HRS across all 3 countries.ConclusionThis analysis demonstrates that albumin is cost-effective in terms of lives saved and QALYs gained in the management of decompensated cirrhosis associated with LVP, SBP, or HRS.
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