Use of Cost-Effectiveness Analysis in Health-Care Resource Allocation Decision-Making: How Are Cost-Effectiveness Thresholds Expected to Emerge?

Eichler, Hans‐Georg; Kong, Sheldon X.; Gerth, William C.; Mavros, Panagiotis; Jönsson, Bengt

doi:10.1111/j.1524-4733.2004.75003.x

Cited by 682 publications

(483 citation statements)

References 48 publications

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“…Nevertheless, cost-effective scenarios were found for treatments other than alendronate, providing credible alternative options for patients unable to take alendronate. Similar conclusions have also been reached in separate studies for most second line treatments [106,[109][110][111][112][113][114]. There are differences, however, in the spectrum of efficacy of these alternatives across different fracture sites that will determine their suitability in the clinical management of individuals.…”

Section: Cost-effectiveness Of Pharmaceutical Interventionssupporting

confidence: 67%

Osteoporosis in the European Union: medical management, epidemiology and economic burden

Hernlund¹,

Svedbom²,

Ivergård³

et al. 2013

Arch Osteoporos

2,016

1,048

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Summary This report describes the epidemiology, burden, and treatment of osteoporosis in the 27 countries of the European Union (EU27). Introduction Osteoporosis is characterized by reduced bone mass and disruption of bone architecture, resulting in increased risk of fragility fractures which represent the main clinical consequence of the disease. Fragility fractures are associated with substantial pain and suffering, disability and even death for affected patients and substantial costs to society. The aim of this report was to characterize the burden of osteoporosis in the EU27 in 2010 and beyond. Methods The literature on fracture incidence and costs of fractures in the EU27 was reviewed and incorporated into a model estimating the clinical and economic burden of osteoporotic fractures in 2010.Results Twenty-two million women and 5.5 million men were estimated to have osteoporosis; and 3.5 million new fragility fractures were sustained, comprising 610,000 hip fractures, 520,000 vertebral fractures, 560,000 forearm fractures and 1,800,000 other fractures (i.e. fractures of the pelvis, rib, humerus, tibia, fibula, clavicle, scapula, sternum and other femoral fractures). The economic burden of incident and prior fragility fractures was estimated at € 37 billion. Incident fractures represented 66 % of this cost, long-term fracture care 29 % and pharmacological prevention 5 %. Previous and incident fractures also accounted for 1,180,000 quality-adjusted life years lost during 2010. The costs are expected to increase by 25 % in 2025. The majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are untreated and the number of patients on treatment is declining.

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Section: Cost-effectiveness Of Pharmaceutical Interventionssupporting

confidence: 67%

Osteoporosis in the European Union: medical management, epidemiology and economic burden

Hernlund¹,

Svedbom²,

Ivergård³

et al. 2013

Arch Osteoporos

2,016

1,048

View full text Add to dashboard Cite

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“…Because assumptions relating to key model parameters strongly depend on the intervention context, a direct comparison of ICERs is likely to be inappropriate to fully assess the cost-effectiveness of screening programs. 18 The classification process was made in five steps: (i) the structure of each program was summarized in terms of target population, diagnostic strategy (age cutoff, clinical criteria, tumor testing, gene sequencing), cascade testing of the relatives, and preventive strategy; (ii) the outlined 19,20 (iii) the ICERs extracted from each study were listed in the table according to the specific comparisons made between programs and were marked as accepted or not accepted according to the willingness-to-pay thresholds specified in their studies; (iv) based on their target population, programs were assigned to specific screening categories and were listed in different tables; and (v) programs were ranked in ascending order of ICER and divided into two sections: one for those with accepted ICERs, the other for those for which ICERs were not accepted.Because of the lack of a universally accepted ICER threshold and the different health-care resources and preferences among different countries, 21 we counted as cost-effective programs all those with an ICER under the willingness-to-pay threshold specified in their studies. When the ICER threshold was not stated in the study, we adopted a threshold we judged to be appropriate after considering either the economic literature or the institutional guidelines of the selected country.…”

mentioning

confidence: 99%

Which Lynch syndrome screening programs could be implemented in the “real world”? A systematic review of economic evaluations

Marco

D’Andrea

Panić

et al. 2018

Genetics in Medicine

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Purpose: Lynch syndrome (LS) screening can significantly reduce cancer morbidity and mortality in mutation carriers. Our aim was to identify cost-effective LS screening programs that can be implemented in the "real world."Methods: We performed a systematic review of full economic evaluations of genetic screening for LS in different target populations; health outcomes were estimated in life-years gained or quality-adjusted life-years.Results: Overall, 20 studies were included in the systematic review. Based on the study populations, we identified six categories of LS screening program: colorectal cancer (CRC)-based, endometrial cancer-based, general population-based, LS family registry-based, cascade testing-based, and genetics clinic-based screening programs. We performed an in-depth analysis of CRC-based LS programs, classifying them into three additional subcategories: universal, age-targeted, and selective. In five studies, universal programs based on immunohistochemistry, either alone or in combination with the BRAF test, were cost-effective compared with no screening, while in two studies age-targeted programs with a cutoff of 70 years were cost-effective when compared with agetargeted programs with lower age thresholds.Conclusion: Universal or o70 years-age-targeted CRC-based LS screening programs are cost-effective and should be implemented in the "real world." Genet Med advance online publication 4 January 2018Key Words: colorectal cancer; cost-effectiveness; Lynch syndrome; screening program; systematic review INTRODUCTIONLynch syndrome (LS) is the most common cause of inherited colorectal cancer (CRC), accounting for about 3% of newly diagnosed cases, and results from a mutation in one of the DNA mismatch repair (MMR) genes (MLH1, MSH2, MSH6, and PMS2). As LS is associated with an increased risk of colorectal, endometrial, and other cancers, it is important to identify both the probands and their family members. 1 In 2009, the Evaluation of Genomic Applications in Practice and Prevention Working Group recommended testing for LS in individuals with newly diagnosed CRC to reduce cancer morbidity and mortality in relatives. 2 The working group declared that there is a moderate certainty that this would provide moderate population benefit, but it did not recommend a specific genetic testing strategy among the several examined, nor did it deal with implementation issues. 2 Thereafter the US Department of Health and Human Services adopted the following as a Healthy People 2020 developmental objective: 3 "Increase the proportion of persons with newly diagnosed colorectal cancer who receive genetic testing to identify Lynch syndrome (or familial colorectal cancer syndromes)."Although genomic information has the potential to improve the delivery of patient-centered care through tailored preventive, diagnostic, and treatment strategies, there is a considerable gap between discoveries in genomics research and the translation of these findings into genetic services that benefit patients. 4,5 A previous study highl...

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“…Everything is focussed on the individual. The financial value of the health gain for the individual patient as a result of treatment has been estimated at a maximum cost of between 20,000 and 50,000 monetary units /effect gained or 54–137 monetary units for a perfectly healthy day [10]. All new treatment options that enter the current healthcare market and are available for a doctor to choose have been evaluated within that scheme of extra payment for extra health gain, to a maximum level.…”

Section: Organisation Of Treatment Versus Preventionmentioning

confidence: 99%

2. How is the economic assessment of vaccines performed today?

Standaert

Rappuoli²

2017

Journal of Market Access & Health Policy

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This paper describes how the economic assessment of vaccines is performed today. It discusses why it may be incomplete and explores potential approaches to adjust the analysis to be more comprehensive. Besides helping protect against serious disease, vaccines also help avoid mild disease episodes that may not receive medical attention but which have important societal consequences. They also benefit unvaccinated individuals by reducing disease transmission. Wider societal benefits may extend beyond a decrease in disease incidence, as lower transmission rates reduce the risk of epidemics, which in turn reduces the pressure on healthcare providers, and may improve the quality of care for patients with unrelated diseases. Vaccines also lower the use of antibiotics leading to less pressure on anti-microbial resistance. Conventional ICUA focuses on individual health benefits, like increased survival. Therefore, this approach may not adequately capture the wider vaccination benefits. We discuss differences between treatment and vaccine prevention in the economic assessment, and how ICUA has been adapted to cope with the inconsistencies. Although such adaptations may fulfil the demand of one specific stakeholder, they may not meet the needs of other stakeholders who operate at the societal level, such as ministries other than healthcare, employers, caregivers, and insurers.

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Use of Cost-Effectiveness Analysis in Health-Care Resource Allocation Decision-Making: How Are Cost-Effectiveness Thresholds Expected to Emerge?

Cited by 682 publications

References 48 publications

Osteoporosis in the European Union: medical management, epidemiology and economic burden

Osteoporosis in the European Union: medical management, epidemiology and economic burden

Which Lynch syndrome screening programs could be implemented in the “real world”? A systematic review of economic evaluations

2. How is the economic assessment of vaccines performed today?

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