Cost-Effectiveness Analysis Of Primary HPV Screening With Dual-Stain Cytology Triage In The Cervical Cancer Screening Program Of Belgium

Abstract

Objectives: On-demand stimulation of the sphenopalatine ganglion (SPG) by means of an implantable neurostimulation system has been shown to be a safe and clinically promising therapy for the treatment of chronic cluster headache. Our objective was to estimate changes in cluster headache medication cost observed in patients treated with the ATI PULSANTE Neurostimulation System, using baseline and 12-month utilization data from the recent Pathway registry and United Kingdom drug costs for reference. MethOds: Detailed patient-level data of n= 71 chronic cluster headache patients followed through 12 months in Pathway R1 (NCT01677026) were analyzed to assess weekly utilization of acute cluster headache medications at baseline and 12 months. Cost estimates for all drug/dosage combinations were developed based on current 2017 pharmaceutical prices published in the British National Formulary (BNF 73, 2017), and used the lowest priced product and largest available package size in each instance to determine cost. Results: In the patients receiving SPG stimulation treatment, overall weekly medication costs per patient were reduced by 54.8% from £197.60 to £89.42 (-£108.20) from baseline to 12 months. Under a steady-state assumption, the observed drug cost reductions resulted in annualized acute drug cost savings to the U.K. National Health Service (NHS) of £5,626 (reduction from £10,276 to £4,650 per year). cOnclusiOns: Our analysis suggests that SPG stimulation for the treatment of chronic cluster headache is associated with pronounced reductions in acute cluster headache medication usage, leading to sizable annual savings in medication costs for the United Kingdom's NHS. On the basis of prior clinical studies investigating SPG therapy, these reductions stem from both effective treatment of attacks with stimulation, and also a reduction in attack frequency observed in stimulation-treated patients.