Comparing the cost-per-QALYs gained and cost-per-DALYs averted literatures

Neumann, Peter J.; Anderson, J. Edgar; Panzer, Ari D; Pope, Elle; D’Cruz, Brittany; Kim, David D.; Cohen, Joshua T.

doi:10.12688/gatesopenres.12786.1

Cited by 22 publications

(13 citation statements)

References 16 publications

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“…In order to use WHO’s suggested threshold, the ICER should be in terms of cost per DALY (disability-adjusted life year) [7], however according to a study that reviewed the cost-effectiveness literature, it was found that cost-per quality adjusted life year (QALY) is used to address diseases in wealthier countries such as cancer, whereas cost-per DALY tend to address more prevalent diseases in low income countries such as HIV. Furthermore, QALYs tend to be used for interventions that evaluate pharmaceuticals, while DALYs are used to evaluate interventions that are more focused on immunizations [8]. Additionally, the use of a figure close to the GDP per capita as a cost-effectiveness threshold is widespread in many countries.…”

Section: Introductionmentioning

confidence: 99%

Cost effectiveness and affordability of trastuzumab in sub-Saharan Africa for early stage HER2-positive breast cancer

Gershon

Berchenko

Hall

et al. 2019

Cost Eff Resour Alloc

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Background Breast cancer is the second most common cancer worldwide, the most common among women, and the most frequent cause of death among women in less developed regions. Trastuzumab is a humanized monoclonal antibody that downregulates the extracellular domain of the HER2 protein. Using trastuzumab to treat women with localized HER2 -positive breast cancer has been shown to improve survival. The objective of this study is to explore the cost-effectiveness of adjuvant trastuzumab, from a societal perspective, in 11 African countries. In addition, we aimed to establish value-based prices for trastuzumab based on the gross domestic product per capita in each country. Methods We developed a Markov model in order to assess the costs and benefits associated with trastuzumab treatment over a lifetime horizon. A probabilistic sensitivity analysis was performed in order to estimate the impact of uncertainty of parameter-values on the results. Efficacy inputs were derived using clinical trial data from non-African countries. Results In the base case analysis, trastuzumab yielded a gain ranging from 0.92 LYs in Nigeria to 1.07 LYs in South Africa, and 0.9 QALYs in Nigeria to 1.02 QALYs in South Africa. The incremental cost ranged from 19,561 USD in Nigeria to 19,997 USD in Congo, and an incremental cost-effectiveness ratio ranging from 19,534 USD/QALY in South Africa to 21,697 USD/QALY in Nigeria. Using willingness to pay estimates based on World Health Organization recommendations, trastuzumab appear to not be cost-effective in all countries analyzed. Cost-effectiveness estimates were most sensitive to the discount rate, trastuzumab cost, and the hazard ratio. Conclusions Trastuzumab does not appear to be cost effective in the African countries analyzed. In order for trastuzumab to be cost-effective, the costs of treatment would require significant discounts. Electronic supplementary material The online version of this article (10.1186/s12962-019-0174-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Cost effectiveness and affordability of trastuzumab in sub-Saharan Africa for early stage HER2-positive breast cancer

Gershon

Berchenko

Hall

et al. 2019

Cost Eff Resour Alloc

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“…Meanwhile, CUA is the gold standard for economic evaluation, since it uses utility-based units as outcomes (such as cost per QALYs gained or DALYs averted), which enables the comparison of various type of interventions and disease conditions. A previous review indicated that QALYs were more popular in high income countries, while low and low-middle income countries mostly used DALYs averted [71]. A key benefit of the utility-based units CUA uses is that they consider both the patients’ quality of life/health and the effects of interventions on mortality, which are more important than purely clinical outcomes often used in CEA.…”

Section: Discussionmentioning

confidence: 99%

Economic evaluation studies in the field of HIV/AIDS: bibliometric analysis on research development and scopes (GAPRESEARCH)

Tran

Nguyen

Turner

et al. 2019

BMC Health Serv Res

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BackgroundThe rapid decrease in international funding for HIV/AIDS has been challenging for many nations to effectively mobilize and allocate their limited resources for HIV/AIDS programs. Economic evaluations can help inform decisions and strategic planning. This study aims to examine the trends and patterns in economic evaluation studies in the field of HIV/AIDS and determine their research landscapes.MethodsUsing the Web of Science databases, we synthesized the number of papers and citations on HIV/AIDS and economic evaluation from 1990 to 2017. Collaborations between authors and countries, networks of keywords and research topics were visualized using frequency of co-occurrence and Jaccards’ similarity index. A Latent Dirichlet Allocation (LDA) analysis to categorize papers into different topics/themes.ResultsA total of 372 economic evaluation papers were selected, including 351 cost-effectiveness analyses (CEA), 11 cost-utility analyses (CUA), 12 cost-benefit analyses (CBA). The growth of publications, their citations and usages have increased remarkably over the years. Major research topics in economic evaluation studies consisted of antiretroviral therapy (ART) initiation and treatment; drug use prevention interventions and prevention of mother-to-child transmission interventions. Moreover, lack of contextualized evidence was found in specific settings with high burden HIV epidemics, as well as emerging most-at-risk populations such as trans-genders or migrants.ConclusionThis study highlights the knowledge and geographical discrepancies in HIV/AIDS economic evaluation literature. Future research directions are also informed for advancing economic evaluation in HIV/AIDS research.

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“…There is no clear explanation for these inconsistencies. As we have noted elsewhere, decisions to fund or conduct economic evaluations reflect not just the disease burden imposed by the targeted condition, but also the number of promising interventions or programs 19 , 20 . Because specialty drugs for diseases such as cancer represent important new interventions in high-income countries, and because pharmaceutical companies have the resources and incentive to characterize value for those interventions, much of the cost-per-QALY literature has recently focused on specialty drug therapies.…”

Section: Discussionmentioning

confidence: 99%

Comparing the cost-per-QALYs gained and cost-per-DALYs averted literatures

et al. 2018

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We examined the similarities and differences between Background studies using two common metrics used in cost-effectiveness analyses (CEAs): cost per quality-adjusted life year (QALY) gained and cost per disability-adjusted life year (DALY) averted.: We used the Tufts Medical Center CEA Registry, which contains Methods English-language cost-per-QALY gained studies, and the Global Cost-Effectiveness Analysis (GHCEA) Registry, which contains cost-per-DALY averted studies. We examined study characteristics, including intervention type, sponsor, country, and primary disease, and also compared the number of published CEAs to disease burden for major diseases and conditions across geographic regions.: We identified 6,438 cost-per-QALY and 543 cost-per-DALY Results studies published through 2016 and observed rapid growth for both literatures. Cost-per-QALY studies most often examined pharmaceuticals and interventions in high-income countries. Cost-per-DALY studies predominantly focused on infectious disease interventions and interventions in low and lower-middle income countries. We found that while diseases imposing a larger burden tend to receive more attention in the cost-effectiveness analysis literature, the number of publications for some diseases and conditions deviates from this pattern, suggesting "under-studied" conditions (e.g., neonatal disorders) and "over-studied" conditions (e.g., HIV and TB).: The CEA literature has grown rapidly, with applications to Conclusions diverse interventions and diseases. The publication of fewer studies than expected for some diseases given their imposed burden suggests funding opportunities for future cost-effectiveness research.

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Comparing the cost-per-QALYs gained and cost-per-DALYs averted literatures

Cited by 22 publications

References 16 publications

Cost effectiveness and affordability of trastuzumab in sub-Saharan Africa for early stage HER2-positive breast cancer

Cost effectiveness and affordability of trastuzumab in sub-Saharan Africa for early stage HER2-positive breast cancer

Economic evaluation studies in the field of HIV/AIDS: bibliometric analysis on research development and scopes (GAPRESEARCH)

Comparing the cost-per-QALYs gained and cost-per-DALYs averted literatures

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