Abstract:To review economic evaluations of genetic interventions published between 2004 and 2009 and assess the quality of the identified studies, we searched for economic evaluations of genetic testing and interventions published between 2004 and 2009. Studies that met inclusion criteria were reviewed and their quality then assessed using a validated instrument-the Quality of Health Economic Studies. Of 54 articles identified, 26 met study criteria and were included in the review. These studies span a number of clinical indications, genetic tests, and interventions, but the majority (92%) focuses on genetic interventions for preventive screening and increasing treatment efficacy. The mean quality score for the reviewed studies was 89.8. Comparison of the quality of different study types revealed that cost-utility studies and studies that used a combined decision tree and Markov model had the highest mean quality scores. Clear statements regarding bias, funding source, and study perspective were commonly lacking in the reviewed studies. Although the reviewed studies were of fairly high quality, we found Quality of Health Economic Studies methodology for grading the quality of economic evaluations challenging and observed no statistically significant improvement in quality of studies between the periods
to the WHO Commission on Macroeconomics and Health, RLAI is highly costeffective (Յ1xGDP per-capita/QALY gained) in patients with a BARR between 63% and 72.5% and cost-effective (Յ3xGDP per-capita /QALY gained) in patients with a BARR between 35% and 63%. CONCLUSIONS: In all published naturalistic studies comparing RLAI with oral medication, where the selection of patients to receive RLAI is left to the physicians, the BARR is greater than 0.71, which suggest that using RLAI in Mexico with similar criteria of patient selection would result in a cost-saving strategy. OBJECTIVES:Evaluate the effectiveness of quetiapine extended release (XR) versus quetiapine immediate release (IR) in Mexican Schizophrenic patients from a governmental perspective. METHODS: Effective measurements were taken from Meu-lien=s, et al, 2010 meta-analysis and a systematic review done for this analysis. Cost-effectiveness and a cost utility analysis were done. Effectiveness measurements were: percentage of patients adherent to treatment, reporting adverse events (AEs) and with relapse. Disease-specific utility values assigned to each of the 6 schizophrenia disease states, based in the possible combinations of adherence levels (full, partial, or nonadherence) and the relapse results, have been estimated by Furiak, 2009 using the Positive and Negative Syndrome Scale, and expert opinion. Costs considered are direct medical care, drug, AEs and relapse treatment. Analysis used a governmental perspective (Mexican Institute of Social Services costs), (published May 2012). A Markov model was performed considering a one year horizon with 3 month cycles simulating schizophrenic Mexican population with the proposed treatment alternatives. Finally a univariated probabilistic sensitivity analysis was done to validate consistency in the model. RESULTS: The use of quetiapine XR resulted in more adherent patients with 0.17846 compared with 0.05630 for quetiapine IR; less AEs reported with 0.13716 compared with 0.05462 respectively. In the cost-utility analysis quetiapine XR had an average QALYs of 0.14620 compared to quetiapine IR QALYS of 0.1256. Quetiapine XR generated a cost saving of USD 508.52 (conversion rate: USDϭ13.14 MxPesos. Average 2012). CONCLUSIONS: Based on the data from the review and meta-analysis, quetiapine XR had a similar efficacy and tolerability profile than quetiapine IR but with better results in effectiveness measures (adherence, adverse events and QALYs). It reduces direct treatment costs in Mexican public Institutions with a positive estimate impact. Based on these, quetiapine XR is a dominant alternative, more effective and with less costs tan quetiapine IR.
This analysis suggests a diagnostic technology capable of identifying whether men with biochemical recurrence after radical prostatectomy have localized versus metastatic disease would be a cost-effective alternative to current standard work-up. The results support additional investment in development and validation of such a diagnostic.
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