A Systematic and Critical Review of Model-Based Economic Evaluations of Pharmacotherapeutics in Patients with Bipolar Disorder

Abstract

Objectives The main objective of this study was to derive cost estimates of five major foodborne illnesses (campylobacteriosis, salmonellosis, enterohemorrhagic Escherichia coli (EHEC), yersiniosis and shigellosis) in Sweden. These estimates provide a necessary contribution to perform future cost-benefit analyses aimed at reducing the burden of foodborne disease. A secondary aim was to obtain estimates of the true number of cases that occur in the community, thus providing necessary ground for calculating costs. Methods The true number of cases for each foodborne illness was simulated by multiplying the reported number of cases by sequential multipliers, one for each potential source of information loss about a case. This assessment of the true number of cases was then used to estimate the number of cases of sequelae for each illness. An incidence-based analysis was then used to calculate direct medical and non-medical costs, as well as indirect costs. Data for estimating the true number of cases for each illness were primarily based on an expert panel, while the derivation of costs mainly utilized national registries, databases and published literature. Results The estimated number of cases was between 7-and 11-fold higher than the reported number of cases, indicating the importance of taking information loss into account when calculating costs. By far the most common pathogen of the five was campylobacter, with an estimated 101,719 (90% credibility interval [CI] 59,640-158,025) human cases occurring annually. For salmonella, 19,678 (90% CI 8394-40,456) cases were estimated to occur each year, while the other three pathogens were less common, with a yearly incidence of approximately 2500-5500 cases each. The total cost for the five pathogens (including sequelae) amounted to €142 million annually. Campylobacter was the most costly pathogen, representing 69% of the total costs. Salmonellosis and EHEC constituted 18 and 9% of these costs, respectively, while yersiniosis and shigellosis represented approximately 2% each. Costs for sequelae were significant and accounted for approximately 50% of the total costs. Conclusions Our simulations indicated that campylobacter infection was more common and more costly than salmonella, EHEC, yersinia and shigella combined. Estimated costs for all illnesses were highly influenced by (1) considering potential information losses about cases in the population (which increased costs 7-to 11-fold), and (2) taking account of postinfection sequelae (which doubled the costs). Key Points for Decision MakersThis study estimates the difference between registered and actual number of cases in the community for five major foodborne diseases. Potential post-infection sequelae are included in the analysis. These considerations are crucial in order to assess the actual societal burden of the five pathogens.The study also estimates total societal costs and costs per case for the five pathogens, results that can be utilized in future cost-benefit or cost-effectiveness studies.

A Systematic Review and Critical Appraisal of Economic Evaluations of Pharmacological Interventions for People with Bipolar Disorder

“…Each individual is assigned personal characteristics defined at the start of the simulation and is allowed to move from one event to another with probabilities that are determined over time by these baseline characteristics, as well as by changes in these characteristics through events experienced by the individual within the model [56;59]. DES models can accommodate differing cycle lengths more easily than Markov models, are not limited by the Markovian assumption, and therefore may be more appropriate (though more time-consuming) for use in the area of BD [60].…”

“…Lithium is the only known drug in the treatment of bipolar disorder with a preventative effect against suicide [69]. Omission of the death state from BD economic models has been criticised [60], however, the 6 modelling studies that did not consider mortality had short time horizons ranging from 3 weeks to 2 years [19;26-29], and therefore it is unlikely that this omission has had a significant impact on their results. Moreover, given that the risk of mortality in people with BD appears to be equal across drug treatments with the exception of lithium, omission of the death state is likely to have affected results in an even lesser degree in the models that did not include lithium.…”

Cost-Effectiveness of Routine Monitoring of Long-Term Conditions in Primary Care: Informing Decision Modelling with a Systematic Review in Hypertension, Type 2 Diabetes and Chronic Kidney Disease

“…Different techniques, structures and input parameters may yield very different outputs, and therefore different policy decisions [ 27 – 29 ]. The choice of model type and structure is rarely discussed in published model-based cost-effectiveness studies of healthcare interventions [ 24 , 30 ]. A systematic review can provide rigorous and comprehensive evidence to aid us in the development of our comorbidity model, and more widely benefit decision makers who consider cost effectiveness of monitoring in these three LTCs.…”