Cost-Effectiveness Analysis Of Using Levonorgestrel-Releasing Intrauterine System In Long-Term Contraception In Colombia

Abstract

A first-order Markov decision-analytic model was developed to compare cost-effectiveness of vaccination with PCV13, PPSV23 and no vaccination in the Czech Republic. PPSV23 effectiveness was derived from literature and PCV13 was extrapolated from impact in children adjusting for immunosenescence in older persons. Pneumonia, bacteremia and meningitis hospitalization and cost data were acquired from health authorities and DRG system in CR; outpatient data were based on retrospective patient survey. The model used a lifetime time horizon and 3% discount rate. RESULTS: Used according to Czech guidelines, PCV13 vaccination is associated with 0.0002 life-years gained for an additional EUR 1.002 on average (EUR 3,812,478 in total) compared to no vaccination and 0.0004 life-years gained for additional EUR 0.97 on average (EUR 3,704,061 in total) compared to PPSV23. This leads to an ICER of EUR/LYG 4,950 and 2,265 under current reimbursement. If all moderate and high risk people were vaccinated, the ICER would increase to EUR/LYG 5,582 and 6,691, respectively, under current reimbursement and to ICER of EUR/LYG 8,676 and 7,057 under full reimbursement. CONCLUSIONS: Confronting the national GDP per capita with the WHO recommendation on health care spending per QALY gained, PCV13 national immunization program in the Czech Republic can be considered cost-effective even under a full reimbursement policy. OBJECTIVES:The Women's Health Initiative (WHI) estrogen+progestin (E+P) clinical trial provides a large sample to estimate health state utility values for post-menopausal women with an intact uterus in the United States. To facilitate future health economic evaluations in this large population sub-group, we estimated utilities for trial participants stratified by age group (50-59, 60-69, 70-79) and randomization assignment (E+P or placebo). METHODS: We measured health state utility values for all 16,608 trial participants with the Short Form-6D (SF-6D) utility index using a validated Bayesian mapping algorithm and U.S. weights. We calculated cross-sectional mean baseline and 1-year utilities, and mean within-patient utility change from baseline to 1-year. Patients included in the baseline analysis completed the SF-36 within 7 days of randomization, and