Reading a cost-effectiveness or decision analysis study

Young, Kate; Kelly, Adam G.; Holloway, Robert G.

doi:10.1212/cpj.0b013e3182a78fd8

Cited by 9 publications

(6 citation statements)

References 20 publications

(17 reference statements)

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“…34 QALYs are valued at €30 000 each, at the lower end of the range of €30 000–50 000 per QALY commonly applied in European healthcare systems. 35 36 …”

Section: Methodsmentioning

confidence: 99%

Economic study of the value of expanding HCV treatment capacity in Germany

Sbarigia

Wirth

Nuys³

et al. 2017

BMJ Open Gastroenterol

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BackgroundToday's highly efficacious, low-toxicity interferon-free treatment regimens for chronic hepatitis C virus (HCV) can cure most patients with HCV in 12–24 weeks. The aim of this study was to understand how the introduction of shorter duration treatment regimens for HCV will impact the capacity for treatment and value to society.MethodsA Markov model of HCV transmission and progression was constructed, incorporating nationally representative data on HCV prevalence, incidence and progression; mortality, treatment costs, medical expenditures, employment probabilities and disability payments in Germany. The model was stratified by HCV genotype and exposure route (1-time healthcare exposure, injection drug use and sexual activity). Treatment scenarios were based on German treatment guidelines and projected treatment capacity. The impact of different treatment scenarios on disease transmission and prevalence, quality-adjusted life years (QALYs), treatment costs, medical expenditures, employment and disability expenditures was calculated.ResultsDepending on their adoption profile, new treatment regimens and protocols introduced over the next several years will increase HCV treatment capacity in Germany by 8–30%, reducing disease transmission and prevalence, increasing QALYs and adding €94–310 million in discounted social value (QALYs plus medical savings net of treatment costs) over a 30-year horizon. Additional social value in the form of higher employment and lower disability would also result.ConclusionsThe introduction of shorter HCV treatment regimens and the resulting increased treatment capacity in Germany would result in large gains to society by reducing disease transmission and prevalence, resulting in longer, healthier, more productive lives for current and future generations.

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“…34 QALYs are valued at €30 000 each, at the lower end of the range of €30 000–50 000 per QALY commonly applied in European healthcare systems. 35 36 …”

Section: Methodsmentioning

confidence: 99%

Economic study of the value of expanding HCV treatment capacity in Germany

Sbarigia

Wirth

Nuys³

et al. 2017

BMJ Open Gastroenterol

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“…However the purpose of any cost-effectiveness model is to help frame questions and inform medical decision making. [44] …”

Section: Discussionmentioning

confidence: 99%

The Cost-Utility of CT Angiography and Conventional Angiography for People Presenting with Intracerebral Hemorrhage

et al. 2014

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ObjectiveTo determine the optimal imaging strategy for ICH incorporating CTA or DSA with and without a NCCT risk stratification algorithm.MethodsA Markov model included costs, outcomes, prevalence of a vascular lesion, and the sensitivity and specificity of a risk stratification algorithm from the literature. The four imaging strategies were: (a) CTA screening of the entire cohort; (b) CTA only in those where NCCT suggested a high or indeterminate likelihood of a lesion; (c) DSA screening of the entire cohort and (d) DSA only for those with a high or indeterminate suspicion of a lesion following NCCT. Branch d was the comparator.ResultsAge of the cohort and the probability of an underlying lesion influenced the choice of optimal imaging strategy. With a low suspicion for a lesion (<12%), branch (a) was the optimal strategy for a willingness-to-pay of $100,000/QALY. Branch (a) remained the optimal strategy in younger people (<35 years) with a risk below 15%. If the probability of a lesion was >15%, branch (b) became preferred strategy. The probabilistic sensitivity analysis showed that branch (b) was the optimal choice 70–72% of the time over varying willingness-to-pay values.ConclusionsCTA has a clear role in the evaluation of people presenting with ICH, though the choice of CTA everyone or CTA using risk stratification depends on age and likelihood of finding a lesion.

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“…At the same time, the outcome of the ambulance services needs to be improved or at least maintained. Therefore, a cost-effectiveness analysis of ambulance replacement is crucial and should be taken into account in making such an important decision [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Modelling cost-effectiveness of replacement strategies for ambulance services in the Ministry of Health Malaysia

Mohd Hassan,

Bahari,

Raman

et al. 2024

BMC Health Serv Res

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Background Emergency Medical Service (EMS) is a very crucial aspect of the healthcare system in providing urgent management and transportation of patients during emergencies. The sustainability of the services is however greatly impacted by the quality and age of ambulances. While this has led to numerous replacement policy recommendations, the implementations are often limited due to a lack of evidence and financial constraints. This study thus aims to develop a cost-effectiveness model and testing the model by evaluating the cost-effectiveness of 10-year and 15-year compulsory ambulance replacement strategies in public healthcare for the Malaysian Ministry of Health (MOH). Methods A Markov model was developed to estimate the cost and outcomes ambulance replacement strategies over a period of 20 years. The model was tested using two alternative strategies of 10-year and 15-year. Model inputs were derived from published literature and local study. Model development and economic analysis were accomplished using Microsoft Excel 2016. The outcomes generated were costs per year, the number of missed trips and the number of lives saved, in addition to the Incremental Cost-Effectiveness Ratio (ICER). One-Way Deterministic Sensitivity Analysis (DSA) and Probabilistic Sensitivity Analysis (PSA) were conducted to identify the key drivers and to assess the robustness of the model. Results Findings showed that the most expensive strategy, which is the implementation of 10 years replacement strategy was more cost-effective than 15 years ambulance replacement strategy, with an ICER of MYR 11,276.61 per life saved. While an additional MYR 13.0 million would be incurred by switching from a 15- to 10-year replacement strategy, this would result in 1,157 deaths averted or additional live saved per year. Sensitivity analysis showed that the utilization of ambulances and the mortality rate of cases unattended by ambulances were the key drivers for the cost-effectiveness of the replacement strategies. Conclusions The cost-effectiveness model developed suggests that an ambulance replacement strategy of every 10 years should be considered by the MOH in planning sustainable EMS. While this model may have its own limitation and may require some modifications to suit the local context, it can be used as a guide for future economic evaluations of ambulance replacement strategies and further exploration of alternative solutions.

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Reading a cost-effectiveness or decision analysis study

Cited by 9 publications

References 20 publications

Economic study of the value of expanding HCV treatment capacity in Germany

Economic study of the value of expanding HCV treatment capacity in Germany

The Cost-Utility of CT Angiography and Conventional Angiography for People Presenting with Intracerebral Hemorrhage

Modelling cost-effectiveness of replacement strategies for ambulance services in the Ministry of Health Malaysia

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