Comparison of analytic approaches for the economic evaluation of new technologies alongside multicenter clinical trials

Taira, Deborah A.; Seto, Todd B.; Siegrist, Richard B.; Cosgrove, Roberta S.; Berezin, Ronna H.; Cohen, David J.

doi:10.1067/mhj.2003.3

Cited by 81 publications

(74 citation statements)

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“…After the exclusion of charges for care received before randomization and charges for the index TAVR procedure itself, all remaining hospital charges were converted to costs by use of costcenter-specific cost-to-charge ratios obtained from each enrolling hospital's Medicare cost report. 11 When bills were unavailable, the costs of hospital care were estimated with a linear regression model derived from the patients with complete billing data (model R 2 ϭ0.84). Covariates included in the model included total intensive care unit (ICU) and non-ICU length of stay, in-hospital death, in-hospital acute renal failure, and major vascular complication.…”

Section: Other Index Hospital Costsmentioning

confidence: 99%

Cost-Effectiveness of Transcatheter Aortic Valve Replacement Compared With Standard Care Among Inoperable Patients With Severe Aortic Stenosis

et al. 2012

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on behalf of the PARTNER InvestigatorsBackground-In patients with severe aortic stenosis who cannot have surgery, transcatheter aortic valve replacement (TAVR) has been shown to improve survival and quality of life compared with standard therapy, but the costs and cost-effectiveness of this strategy are not yet known. Methods and Results-The PARTNER trial randomized patients with symptomatic, severe aortic stenosis who were not candidates for surgery to TAVR (nϭ179) or standard therapy (nϭ179). Empirical data regarding survival, quality of life, medical resource use, and hospital costs were collected during the trial and used to project life expectancy, quality-adjusted life expectancy, and lifetime medical care costs to estimate the incremental cost-effectiveness of TAVR from a US perspective. For patients treated with TAVR, mean costs for the initial procedure and hospitalization were $42 806 and $78 542, respectively. Follow-up costs through 12 months were lower with TAVR ($29 289 versus $53 621) because of reduced hospitalization rates, but cumulative 1-year costs remained higher ($106 076 versus $53 621). We projected that over a patient's lifetime, TAVR would increase discounted life expectancy by 1.6 years (1.3 quality-adjusted life-years) at an incremental cost of $79 837. The incremental cost-effectiveness ratio for TAVR was thus estimated at $50 200 per year of life gained or $61 889 per quality-adjusted life-year gained. These results were stable across a broad range of uncertainty and sensitivity analyses. Conclusions-For patients with severe aortic stenosis who are not candidates for surgery, TAVR increases life expectancy at an incremental cost per life-year gained well within accepted values for commonly used cardiovascular technologies. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.

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Section: Other Index Hospital Costsmentioning

confidence: 99%

Cost-Effectiveness of Transcatheter Aortic Valve Replacement Compared With Standard Care Among Inoperable Patients With Severe Aortic Stenosis

et al. 2012

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“…We defi ned mortality as death during the index hospitalization, readmission as readmission to any acute care hospital within 30 days of discharge aft er the index hospitalization, and costs as the total reported hospital charges (adjusted for infl ation to 2010 dollars) multiplied by the hospital-specifi c all-payer cost-to-charge ratio for the year of hospitalization. 22 We calculated these outcomes among two populations: (1) all patients with PE and (2) the subset of these patients with ICU stays. Adjustment Variables: Adjustment variables included demographic data (age, sex, and payer); admission data (weekday or weekend, emergent or nonemergent, admission source); individual patient comorbidities (as defi ned by Elixhauser et al 24 ); presence of organ failure using ICD-9-CM codes corresponding to circulatory, renal, neurologic, hematologic, metabolic, and hepatic organ failure (as defined by Angus et al 25 ); use of ICU procedures (central line, arterial line, pulmonary artery catheterization, thrombolytics, invasive mechanical ventilation, and noninvasive positive pressure ventilation); hospital size; total hospital-wide patients with PE across the study period; ICU capacity (as a percentage of total beds); teaching status (defi ned by the ratio of resident full-time equivalents [FTEs] to beds); medical school affi liation; designation as a critical access hospital; and hospital type (for profi t, not for profi t, or government).…”

Section: Icu Admission Ratesmentioning

confidence: 99%

Hospital-Level Variation in ICU Admission and Critical Care Procedures for Patients Hospitalized for Pulmonary Embolism

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Seymour

Gershengorn

et al. 2014

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“…Hospital charges were converted into costs using hospital-and cost center-specific cost-to-charge ratios. 17,18 Linear regression models were then developed, with total hospitalization costs used as the outcome and sociodemographic factors, comorbidities, and in-hospital complications (identified on the basis of International Classification of Diseases, Ninth Revision codes) as predictors ( Table I in the onlineonly Data Supplement). Because of substantial variability in length of stay for revascularization procedures across the enrolling countries, length of stay was not included as a predictor in these models.…”

Section: Postprocedural Hospitalization Costsmentioning

confidence: 99%

Cost-Effectiveness of Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Bypass Surgery for Patients With 3-Vessel or Left Main Coronary Artery Disease

et al. 2014

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A pproximately 6% of all American adults suffer from coronary artery disease (CAD), with estimated total annual costs in excess of $200 billion.1 Coronary revascularization procedures, including percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG), account for nearly $12 billion per year in direct costs alone.Background-The Synergy Between Percutaneous Coronary Intervention With TAXUS and Cardiac Surgery (SYNTAX) trial demonstrated that in patients with 3-vessel or left main coronary artery disease, coronary artery bypass graft surgery (CABG) was associated with a lower rate of cardiovascular death, myocardial infarction, stroke, or repeat revascularization compared with percutaneous coronary revascularization with drug-eluting stents (DES-PCI)). The longterm cost-effectiveness of these strategies is unknown. Methods and Results-Between 2005 and 2007, 1800 patients with left main or 3-vessel coronary artery disease were randomized to CABG (n=897) or DES-PCI (n=903). Costs were assessed from a US perspective, and health state utilities were evaluated with the EuroQOL questionnaire. A patient-level microsimulation model based on the 5-year in-trial data was used to extrapolate costs, life expectancy, and quality-adjusted life expectancy over a lifetime horizon. Although initial procedural costs were $3415 per patient lower with CABG, total hospitalization costs were $10 036 per patient higher. Over the next 5 years, follow-up costs were higher with DES-PCI as a result of more frequent hospitalizations, revascularization procedures, and higher medication costs. Over a lifetime horizon, CABG remained more costly than DES-PCI, but the incremental cost-effectiveness ratio was favorable ($16 537 per quality-adjusted life-year gained) and remained <$20 000 per quality-adjusted life-year in most bootstrap replicates. Results were consistent across a wide range of assumptions about the long-term effect of CABG versus DES-PCI on events and costs. In patients with left main disease or a SYNTAX score ≤22, however, DES-PCI was economically dominant compared with CABG, although these findings were less certain. Conclusions-For most patients with 3-vessel or left main coronary artery disease, CABG is a clinically and economically attractive revascularization strategy compared with DES-PCI. However, among patients with less complex disease, DES-PCI may be preferred on both clinical and economic grounds.

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Comparison of analytic approaches for the economic evaluation of new technologies alongside multicenter clinical trials

Cited by 81 publications

References 0 publications

Cost-Effectiveness of Transcatheter Aortic Valve Replacement Compared With Standard Care Among Inoperable Patients With Severe Aortic Stenosis

Cost-Effectiveness of Transcatheter Aortic Valve Replacement Compared With Standard Care Among Inoperable Patients With Severe Aortic Stenosis

Hospital-Level Variation in ICU Admission and Critical Care Procedures for Patients Hospitalized for Pulmonary Embolism

Cost-Effectiveness of Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Bypass Surgery for Patients With 3-Vessel or Left Main Coronary Artery Disease

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