Cost–Utility Analysis of Topical Intranasal Steroids for Otitis Media with Effusion Based on Evidence from the GNOME Trial

Petrou, Stavros; Dakin, Helen; Abangma, Giselle; Benge, Sarah; Williamson, Ian

doi:10.1111/j.1524-4733.2010.00711.x

Cited by 23 publications

(11 citation statements)

References 32 publications

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“…Illustrates potential for differing conclusions between CMA and CEA 2 GNOME (Petrou et al, 2010;Williamson et al, 2009a): placebo-controlled RCT on intranasal steroids for otitis media (n = 217) Differences in costs and effectiveness are negligible and nonsignificant 3 10 simulated datasets Highlight situations where differences in uncertainty estimates between CMA and CEA are particularly large or small or when there may be a significant difference in net benefits despite no significant differences in costs or effects…”

Section: Empirical Studymentioning

confidence: 98%

“…Research Framework] Nasal steroids for Otitis Media with Effusion trial. The GNOME trial observed no significant differences between steroids and placebo for costs, QALYs, utilities, side effects or the primary clinical endpoint (cure at one month; Petrou et al, 2010;Williamson et al, 2009a). CUA showed steroids to be dominated by placebo, generating non-significantly fewer QALYs and non-significantly higher costs (Table III).…”

Section: Gprf [General Practicementioning

confidence: 99%

“…The GPRF [General Practice Research Framework] Nasal steroids for Otitis Media with Effusion (GNOME) trial comprised a randomised, double-blind, placebo-controlled trial evaluating topical intranasal corticosteroids with placebo in the treatment of 217 children with otitis media with effusion ('glue ear') in primary care (Petrou et al, 2010;Williamson et al, 2009aWilliamson et al, , 2009b. Cost-effectiveness was assessed using CUA and CEA that calculated the cost per additional child cured.…”

Section: Literature Search On Prevalence Of Cost-minimisation Analysismentioning

confidence: 99%

“…Future values were discounted at 3.5% per annum. For SUIT, we assumed that 16 950 couples in the UK could benefit from treatment each year (NCC-WCH, 2004), whereas for GNOME, we assumed that 16 068 children could benefit each year (Petrou et al, 2010).…”

Section: Literature Search On Prevalence Of Cost-minimisation Analysismentioning

confidence: 99%

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Cost‐minimisation Analysis Versus Cost‐effectiveness Analysis, Revisited

Dakin

Wordsworth

2011

Health Economics

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We aim to establish whether it is ever appropriate to conduct cost-minimisation analysis (CMA) rather than cost-effectiveness analysis.We perform a literature review to examine how the use of CMA has changed since Briggs & O'Brien announced its death in 2001. Examples of simulated and trial data are presented: firstly to illustrate the advantages and disadvantages of CMA in the context of non-inferiority trials and those finding no significant difference in efficacy and secondly to assess whether CMA gives biased results.We show that CMA is still used and will bias measures of uncertainty, causing overestimation or underestimation of the value of information and the probability that treatment is cost-effective. Although bias will be negligible for non-inferiority studies comparing treatments that differ enormously in cost, it is generally necessary to collect and analyse data on costs and efficacy (including utilities) to assess this bias. Cost-effectiveness analysis (including evaluation of the joint distribution of costs and benefits) is almost always required to avoid biased estimation of uncertainty. The remit of CMA in trial-based economic evaluation is therefore even narrower than previously thought, suggesting that CMA is not only dead but should also be buried.

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Section: Empirical Studymentioning

confidence: 98%

Section: Gprf [General Practicementioning

confidence: 99%

Section: Literature Search On Prevalence Of Cost-minimisation Analysismentioning

confidence: 99%

Section: Literature Search On Prevalence Of Cost-minimisation Analysismentioning

confidence: 99%

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Cost‐minimisation Analysis Versus Cost‐effectiveness Analysis, Revisited

Dakin

Wordsworth

2011

Health Economics

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“…Many studies have shown that there are considerable differences in ICERs over patient groups, in such diverse areas as children otitis media [26], tuberculosis screening [27], assertive community treatment for homeless people [28] and phosphate binders in end-stage renal disease [29]. The Swedish health economic evaluation recommendations state that “The purpose of a health economic evaluation is to identify for which patient groups or indications a drug is cost-effective –it is never the medication itself which is cost-effective, rather the use of it” ( [14], p. 1).…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity in cost-effectiveness of lifestyle counseling for metabolic syndrome risk groups -primary care patients in Sweden

Feldman

Hellström

Johansson

2013

Cost Eff Resour Alloc

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BackgroundClinical trials have indicated that lifestyle interventions for patients with lifestyle-related cardiovascular and diabetes risk factors (the metabolic syndrome) are cost-effective. However, patient characteristics in primary care practice vary considerably, i.e. they exhibit heterogeneity in risk factors. The cost-effectiveness of lifestyle interventions is likely to differ over heterogeneous patient groups.MethodsPatients (62 men, 80 women) in the Kalmar Metabolic Syndrome Program (KMSP) in primary care (Kalmar regional healthcare area, Sweden) were divided into three groups reflecting different profiles of metabolic risk factors (low, middle and high risk) and gender. A Markov model was used to predict future cardiovascular disease and diabetes, including complications (until age 85 years or death), with health effects measured as QALYs and costs from a societal perspective in Euro (EUR) 2012, discounted 3%. Simulations with risk factor levels at start and at 12 months follow-up were performed for each group, with an assumed 4-year sustainability of intervention effects.ResultsThe program was estimated cost-saving for middle and high risk men, while the incremental cost vs. do-nothing varied between EUR 3,500 – 18,000 per QALY for other groups. There is heterogeneity in the cost-effectiveness over the risk groups but this does not affect the overall conclusion on the cost-effectiveness of the KMSP. Even the highest ICER (for high risk women) is considered moderately cost-effective in Sweden. The base case result was not sensitive to alternative data and methodology but considerably affected by sustainability assumptions. Alternative risk stratifications did not change the overall conclusion that KMSP is cost-effective. However, simple grouping with average risk factor levels over gender groups overestimate the cost-effectiveness.ConclusionsLifestyle counseling to prevent metabolic diseases is cost-effective in Swedish standard primary care settings. The use of risk stratification in the cost-effectiveness analysis established that the program was cost-effective for all patient groups, even for those with very high levels of lifestyle-related risk factors for the metabolic syndrome diseases. Heterogeneity in the cost-effectiveness of lifestyle interventions in primary care patients is expected, and should be considered in health policy decisions.

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