scholarly journals Cost-Effectiveness of Operative Versus Nonoperative Management of Acute Achilles Tendon Ruptures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Scott Ellis ◽  
Jayme Koltsov ◽  
Benedict Nwachukwu ◽  
Anca Marinescu ◽  
Caitlin Gribbin
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Achilles Tendon ◽  
Operative Treatment ◽  
Nonoperative Management ◽  
Cost Effective ◽  
Operative Management ◽  
Base Case ◽  
Tendon Ruptures

Category: Ankle, Sports Introduction/Purpose: The management of acute Achilles tendon ruptures remains controversial. Proponents of operative treatment cite lower rates of re-rupture, the potential for better functional outcomes and earlier return to activity. However, operative management incurs the added risks of surgical complications and the considerable cost of the surgical procedure. The goal of this study was to evaluate the cost-effectiveness of operative versus nonoperative management of acute Achilles tendon ruptures using the best available evidence regarding the costs and benefits of these two strategies. Methods: A Markov cost-utility analysis was conducted from the societal perspective to evaluate the cost-effectiveness of operative versus nonoperative management of acute Achilles tendon ruptures over a two-year time-period. Hospital costs were derived from New York SPARCS data, physician and rehabilitation costs were derived from Medicare physician fee schedules, and indirect costs of missed work were calculated using the average U.S. hourly earnings from the Bureau of Labor Statistics. Rates of re-rupture, major and minor complications, and the costs of managing these complications were obtained from the literature. For the base-case model, operative and non-operative patients were assumed to have the same utilities (quality of life) following surgery. The robustness of the model to uncertainty in the input parameters was examined through sensitivity analyses varying inputs over plausible ranges from the literature. Results are presented as costs (2014 US$), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios with 95% confidence intervals. Results: In the base-case model, nonoperative management of acute Achilles tendon ruptures dominated operative management, resulting in both lower costs and greater benefits. The total cost of operative management was $13,936 versus $13,430 for nonoperative management. The initial surgical cost for Achilles tendon repair, $3,145 ($3,045-$3,244), was largely offset through reduced indirect costs from fewer missed days of work, 19 (4-34) days). In sensitivity analyses, if surgical costs dropped below $2,621 or the hourly wage rose above $29, then operative treatment became a cost-effective strategy at the willingness-to-pay threshold of $50,000/QALY. The model results were highly sensitive to the relative utilities for operative versus nonoperative treatment. If nonoperative utilities decreased relative to operative utilities by just 1.6%, then operative management became the dominant treatment strategy. Conclusion: Surgical costs and the economic impact associated with return to work are important determinants of cost- effectiveness for Achilles tendon ruptures. These results suggest that operative treatment of Achilles tendon injury may be cost- effective at low-cost centers and for high wage earning individuals. Furthermore, operative treatment is cost-effective if it produces incrementally better function and quality of life relative to nonoperative management. The available literature is inconclusive regarding differences in function and quality of life between operative and nonoperative treatment. Further research is needed to evaluate the quality of life benefits associated with operative and non-operative treatment of Achilles tendon injury.

scholarly journals Determining the cost-effectiveness requirements of an exoskeleton preventing second hip fractures using value of information

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Stefania Manetti ◽  
Giuseppe Turchetti ◽  
Francesco Fusco
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Hip Fracture ◽  
Hip Fractures ◽  
Cost Effective ◽  
Future Research ◽  
Base Case ◽  
Secondary Analyses ◽  
The Cost

Abstract Background Falls may lead to hip fractures, which have a detrimental effect on the prognosis of patients as well as a considerable impact on healthcare expenditures. Since a secondary hip fracture (SHF) may lead to even higher costs than primary fractures, the development of innovative services is crucial to limit falls and curb costs in high-risk patients. An early economic evaluation assessed which patients with a second hip fracture could benefit most from an exoskeleton preventing falls and whether its development is feasible. Methods The life-course of hip fractured patients presenting with dementia or cardiovascular diseases was simulated using a Markov model relying on the United Kingdom administrative data and complemented by published literature. A group of experts provided the exoskeleton parameters. Secondary analyses included a threshold analysis to identify the exoskeleton requirements (e.g. minimum impact of the exoskeleton on patients’ quality of life) leading to a reimbursable incremental cost-effectiveness ratio. Similarly, the uncertainty around these requirements was modelled by varying their standard errors and represented alongside population Expected Value of Perfect Information (EVPI). Results Our base-case found the exoskeleton cost-effective when providing a statistically significant reduction in SHF risk. The secondary analyses identified 286 cost-effective combinations of the exoskeleton requirements. The uncertainty around these requirements was explored producing further 22,880 scenarios, which showed that this significant reduction in SHF risk was not necessary to support the exoskeleton adoption in clinical practice. Conversely, a significant improvement in women quality of life was crucial to obtain an acceptable population EVPI regardless of the cost of the exoskeleton. Conclusions Our study identified the exoskeleton requisites to be cost-effective and the value of future research. Decision-makers could use our analyses to assess not only whether the exoskeleton could be cost-effective but also how much further research and development of the exoskeleton is worth to be pursued.

The Cost-effectiveness of Biannual Serum Urate (SU) Monitoring after Reaching Target in Gout: A Health Economic Analysis Comparing SU Monitoring

2018 ◽  
Vol 45 (5) ◽  
pp. 697-704 ◽  
Author(s):  
Philip C. Robinson ◽  
Nicola Dalbeth ◽  
Peter Donovan
Keyword(s):  
Quality Of Life ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Serum Urate ◽  
Base Case ◽  
Component Level ◽  
Health Economic Analysis ◽  
Lifetime Horizon

Objective.The 2012 American College of Rheumatology gout management guidelines recommend monitoring serum urate (SU) every 6 months after target SU has been achieved. Our objective was to determine through modeling whether this testing would be cost-effective, considering financial cost, quality of life, and estimated change in adherence.Methods.A cost-utility analysis was completed with a 3-arm model: (1) no regular urate monitoring; (2) annual urate monitoring; and (3) biannual urate monitoring. Inputs to the model for health-related quality of life, flare rate, and treatment location were drawn from the medical literature and modeled over a lifetime horizon.Results.No monitoring was the least costly (Australian$6974) but least effective [13.51 quality-adjusted life-yrs (QALY)], while annual urate monitoring [A$7117; 13.53 QALY; incremental cost-effectiveness ratio (ICER) A$13,678/QALY gained] and biannual monitoring [A$7298; 13.54 QALY; ICER A$15,420 per QALY gained] were both cost-effective alternatives in base case analysis. Sensitivity analysis on both an individual component level and a probabilistic sensitivity analysis (PSA) demonstrated that the result was robust to changes in input variables. An improvement in adherence of ≥ 3.5% with biannual monitoring was all that was required to demonstrate cost-effectiveness. In PSA, the probability of biannual monitoring was 78%, no monitoring was 20%, and annual monitoring was 2%.Conclusion.The results suggest that biannual SU monitoring after attaining target SU is the most cost-effective, compared with no testing and annual testing.

scholarly journals Cost-effectiveness of internet-delivered cognitive–behavioural therapy for adolescents with irritable bowel syndrome

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023881 ◽  
Author(s):  
Filipa Sampaio ◽  
Marianne Bonnert ◽  
Ola Olén ◽  
Erik Hedman ◽  
Maria Lalouni ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Irritable Bowel Syndrome ◽  
Cost Effectiveness ◽  
Resource Use ◽  
Cost Effective ◽  
Behavioural Therapy ◽  
Cognitive Behavioural ◽  
The Difference ◽  
Irritable Bowel

ObjectiveTo assess whether exposure-based internet-delivered cognitive–behavioural therapy (internet-CBT) is a cost-effective treatment for adolescents with irritable bowel syndrome (IBS) compared with a waitlist control, from a societal perspective, based on data from a randomised trial.DesignWithin-trial cost-effectiveness analysis.SettingParticipants were recruited from the whole of Sweden via primary, secondary and tertiary care clinics reached through news media and advertising.ParticipantsAdolescents (aged 13–17) with a diagnosis of IBS.InterventionsParticipants were randomised to either an exposure-based internet-CBT, including 10 weekly modules for adolescents and five modules for parents, or a waitlist.Outcome measuresThe main health outcome was the quality-adjusted life-year (QALY) estimated by mapping Pediatric Quality-of-Life Inventory (PedsQL) scores onto EQ-5D-3L utilities. The secondary outcome was the point improvement on the PedsQL scale. Data on health outcomes and resource use were collected at baseline and 10 weeks post-treatment. Resource use was measured using the Trimbos and Institute of Medical Technology Assessment Cost Questionnaire for Psychiatry (TIC-P) . Incremental cost-effectiveness ratios (ICER) were calculated as the difference in average costs by the difference in average outcomes between groups.ResultsThe base-case results showed that internet-CBT costs were on average US$170.24 (95% CI 63.14 to 315.04) more per participant than the waitlist. Adolescents in the internet-CBT group showed small QALY gains (0.0031; 95% CI 0.0003 to 0.0061), and an average improvement of 5.647 points (95% CI 1.82 to 9.46) on the PedsQL compared with the waitlist. Internet-CBT yielded an ICER of $54 916/QALY gained and a probability of cost-effectiveness of 74% given the Swedish willingness-to-pay threshold. The ICER for the outcome PedsQL was US$85.29/point improvement.ConclusionsOffering internet-CBT to adolescents with IBS improves health-related quality of life and generates small QALY gains at a higher cost than a waitlist control. Internet-CBT is thus likely to be cost-effective given the strong efficacy evidence, small QALY gains and low cost.Trial registration numberNCT02306369; Results.

Palonosetron compared to ondansetron in the prevention of chemotherapy-induced nausea and vomiting: Activity, safety, and cost-effectiveness evaluation

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20573-e20573 ◽  
Author(s):  
G. Bernardo ◽  
R. Palumbo ◽  
M. Frascaroli ◽  
A. Bernardo ◽  
A. Losurdo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Positive Impact ◽  
Cost Effective ◽  
Complete Response ◽  
Pharmacoeconomic Evaluation ◽  
Nausea And Vomiting ◽  
Group A ◽  
Group B

e20573 Background: Chemotherapy(CT)-induced nausea and vomiting (CINV) are common adverse effects in cancer patients. The control of CINV is a relevant objective for the patient's quality of life and also aims to optimize cancer treatment. 5-HT3- receptor antagonists (RAs) are commonly used to prevent CINV. Palonosetron, the only second generation 5-HT3-RA, has a significantly longer half-life and a higher binding activity than the first generation of 5-HT3RAs. Methods: To evaluate the activity, safety and farmacoeconomic profile of palonosetron compared to ondansetron as antiemetic prophylaxis for highly (HEC) or moderately (MEC) emetogenic chemotherapy, 235 consecutive chemo-naïve patients (pts) were assigned (1:1) to receive palonosetron 250 mcg i.v. plus dexamethasone 8 mg i.v. 30 min before CT on day 1 (Group A) or ondansetron 8 mg i.v. plus dexamethasone 8 mg i.v. on day 1, followed by 8 mg os twice daily over 3 days (Group B). Results: The 2 treatment groups were comparable with respect to tumour type (breast 52%, lung 20%, colorectal cancer 11%, ovarian 8%, head & neck 5%, other 4%) and emetogenic potential of CT (HEC in 78 pts, AC-based chemotherapy in 123, MEC in 35). FLIE questionnaires were completed on days 2–5. Complete response (CR) rate for the acute period was 82% in pts given HEC in group A versus 63.2% in group B, 93.4 % versus 80.6% in pts given AC and 100% versus 94.4% in pts given MEC. For the delayed period: 74.4% in group A versus 63.2% in group B for pts receiving HEC, 90.2% versus 71% in pts given AC and 94% versus 88.9% in pts given MEC. FLIE analysis showed a reduced impact of CINV on daily life in group A (p<0.05). The pharmacoeconomic evaluation showed favourable cost effectiveness profiles for palonosetron, with a saving of about 50% per cycle/per patient over ondansetron. A not significant reduced incidence of headache and constipation was observed in group A. Conclusions: Palonosetron was effective in preventing CINV following HEC, AC and MEC in both acute and delayed phases, as well as being cost effective. The CR rates were maintained throughout subsequent cycles of CT, with a significant positive impact on daily functioning and quality of life. No significant financial relationships to disclose.

scholarly journals Cost-effectiveness of a Transdiagnostic Psychotherapy Program for Youth With Common Mental Health Problems

2021 ◽  
Author(s):  
Rasmus Trap Wolf ◽  
Pia Jeppesen ◽  
Mette Maria Agner Pedersen ◽  
Louise Berg Puggaard ◽  
Mikael Thastum ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Mental Health Problems ◽  
Base Case ◽  
Trial Period ◽  
Common Mental Health Problems ◽  
One Year ◽  
Psychotherapy Program ◽  
Preference Weights

Abstract Objectives: Our objective was to evaluate the cost-effectiveness of the transdiagnostic psychotherapy program Mind My Mind (MMM) for youth with common mental health problems using a cost-utility analysis (CUA) framework and data from a randomized controlled trial. Furthermore, we analyzed the impact of choice of informant with respect to both quality-of-life reporting and preference weights on the Incremental Cost Effectiveness Ratio (ICER). Methods: A total of 396 school-aged youth took part in the 6-month trial. CUAs were carried out for the trial-period and for four one-year extrapolation scenarios. Costs were based on a combination of budget and self-reported costs. Youths and parents were asked to report on the youth’s quality-of-life three times during the trial using the Child Health Utility 9D (CHU9D). Parental-reported CHU9D was used in the base case together with preference weights of a youth population. Analyses using self-reported CHU9D and preference weights of an adult population were also carried out. Results: The analysis of the trial period resulted in an ICER of €170,465. The analyses of the one-year scenarios resulted in ICERs between €23,653 and €50,480. The ICER increased by 24% and 71% compared to the base case when using self-reported CHU9D and adult preference weights, respectively. Conclusion: The MMM intervention has the potential to be cost-effective, but the ICER is dependent on the duration of the treatment effects. Results varied significantly with the choice of respondent and the choice of preference weights indicating that both factors should be considered when assessing CUA involving youth.

scholarly journals A multicentre randomised controlled trial and economic evaluation of continuous positive airway pressure for the treatment of obstructive sleep apnoea syndrome in older people: PREDICT

2015 ◽  
Vol 19 (40) ◽  
pp. 1-188 ◽  
Author(s):  
Alison McMillan ◽  
Daniel J Bratton ◽  
Rita Faria ◽  
Magda Laskawiec-Szkonter ◽  
Susan Griffin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Practice ◽  
Cost Effectiveness ◽  
Older People ◽  
Positive Airway Pressure ◽  
Cost Effective ◽  
Sleep Apnoea ◽  
Obstructive Sleep Apnoea Syndrome ◽  
Obstructive Sleep

BackgroundThe therapeutic and economic benefits of continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnoea syndrome (OSAS) have been established in middle-aged people. In older people there is a lack of evidence.ObjectiveTo determine the clinical efficacy of CPAP in older people with OSAS and to establish its cost-effectiveness.DesignA randomised, parallel, investigator-blinded multicentre trial with within-trial and model-based cost-effectiveness analysis.MethodsTwo hundred and seventy-eight patients, aged ≥ 65 years with newly diagnosed OSAS [defined as oxygen desaturation index at ≥ 4% desaturation threshold level for > 7.5 events/hour and Epworth Sleepiness Scale (ESS) score of ≥ 9] recruited from 14 hospital-based sleep services across the UK.InterventionsCPAP with best supportive care (BSC) or BSC alone. Autotitrating CPAP was initiated using standard clinical practice. BSC was structured advice on minimising sleepiness.Coprimary outcomesSubjective sleepiness at 3 months, as measured by the ESS (ESS mean score: months 3 and 4) and cost-effectiveness over 12 months, as measured in quality-adjusted life-years (QALYs) calculated using the European Quality of Life-5 Dimensions (EQ-5D) and health-care resource use, information on which was collected monthly from patient diaries.Secondary outcomesSubjective sleepiness at 12 months (ESS mean score: months 10, 11 and 12) and objective sleepiness, disease-specific and generic quality of life, mood, functionality, nocturia, mobility, accidents, cognitive function, cardiovascular risk factors and events at 3 and 12 months.ResultsTwo hundred and seventy-eight patients were randomised to CPAP (n = 140) or BSC (n = 138) over 27 months and 231 (83%) patients completed the trial. Baseline ESS score was similar in both groups [mean (standard deviation; SD) CPAP 11.5 (3.3), BSC 11.4 (4.2)]; groups were well balanced for other characteristics. The mean (SD) in ESS score at 3 months was –3.8 (0.4) in the CPAP group and –1.6 (0.3) in the BSC group. The adjusted treatment effect of CPAP compared with BSC was –2.1 points [95% confidence interval (CI) –3.0 to –1.3 points;p < 0.001]. At 12 months the effect was –2.0 points (95% CI –2.8 to –1.2 points;p < 0.001). The effect was greater in patients with increased CPAP use or higher baseline ESS score. The number of QALYs calculated using the EQ-5D was marginally (0.005) higher with CPAP than with BSC (95% CI –0.034 to 0.044). The average cost per patient was £1363 (95% CI £1121 to £1606) for those allocated to CPAP and £1389 (95% CI £1116 to £1662) for those allocated to BSC. On average, costs were lower in the CPAP group (mean –£35; 95% CI –£390 to £321). The probability that CPAP was cost-effective at thresholds conventionally used by the NHS (£20,000 per QALY gained) was 0.61. QALYs calculated using the Short Form questionnaire-6 Dimensions were 0.018 higher in the CPAP group (95% CI 0.003 to 0.034 QALYs) and the probability that CPAP was cost-effective was 0.96. CPAP decreased objective sleepiness (p = 0.02), increased mobility (p = 0.03) and reduced total and low-density lipoprotein cholesterol (p = 0.05,p = 0.04, respectively) at 3 months but not at 12 months. In the BSC group, there was a fall in systolic blood pressure of 3.7 mmHg at 12 months, which was not seen in the CPAP group (p = 0.04). Mood, functionality, nocturia, accidents, cognitive function and cardiovascular events were unchanged. There were no medically significant harms attributable to CPAP.ConclusionIn older people with OSAS, CPAP reduces sleepiness and is marginally more cost-effective than BSC over 12 months. Further work is required in the identification of potential biomarkers of sleepiness and those patients at increased risk of cognitive impairment. Early detection of which could be used to inform the clinician when in the disease cycle treatment is needed to avert central nervous system sequelae and to assist patients decision-making regarding treatment and compliance. Treatment adherence is also a challenge in clinical trials generally, and adherence to CPAP therapy in particular is a recognised concern in both research studies and clinical practice. Suggested research priorities would include a focus on optimisation of CPAP delivery or support and embracing the technological advances currently available. Finally, the improvements in quality of life in trials do not appear to reflect the dramatic changes noted in clinical practice. There should be a greater focus on patient centred outcomes which would better capture the symptomatic improvement with CPAP treatment and translate these improvements into outcomes which could be used in health economic analysis.Trial registrationCurrent Controlled Trials ISRCTN90464927.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 40. See the NIHR Journals Library website for further project information.

scholarly journals Cost-Effectiveness of Particulated Juvenile Articular Cartilage Versus Matrix-Induced Autologous Chondrocyte Implantation for Patellar Chondral Lesions (176)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0029
Author(s):  
Drake LeBrun ◽  
Jake Feingold ◽  
Stephanie Swenson-Buza ◽  
Simone Gruber ◽  
Elizabeth Dennis ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Nonoperative Management ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Cartilage Defects ◽  
Base Case ◽  
Patellar Cartilage ◽  
Chondrocyte Implantation ◽  
The Cost ◽  
Autologous Chondrocyte

Objectives: Treatment options for articular cartilage lesions of the patella have evolved over the past several years due to the development of novel cell-based cartilage restoration techniques, including particulated juvenile allograft cartilage (PJAC) and matrix-induced autologous chondrocyte implantation (MACI). The objective of this study was to evaluate the cost -effectiveness of these modalities in the management of patellar cartilage defects. Methods: A Markov state-transition model was utilized to evaluate the cost-effectiveness of three strategies for patients with patellar chondral lesions: (1) nonoperative management, (2) PJAC, and (3) MACI. Probabilities, health utilities, and costs of surgical procedures and rehabilitation protocols were derived from institutional data and literature review. Effectiveness was assessed using quality-adjusted life-year (QALY). Cost-effectiveness was evaluated from societal and payer perspectives over a 15-year time horizon. The principal outcome measure was the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed on pertinent model parameters to assess their effect on base case conclusions. Results: From a societal perspective, nonoperative management, PJAC, and MACI cost $4,140, $52,683, and $83,073 respectively. Nonoperative management, PJAC, and MACI were associated with 4.91, 7.07, and 7.79 QALYs gained, respectively. Therefore, PJAC and MACI were cost-effective relative to nonoperative management (ICERs $22,527/QALY and $27,456/QALY, respectively; Figure 1). Although MACI was more cost-effective than PJAC in the base case, this was strongly sensitive to the estimated probabilities of full versus intermediate benefit following PJAC and MACI (Table 1). If the probabilities of full and intermediate benefit following PJAC were assumed to be the same as those following MACI (i.e., PJAC and MACI were equally effective), then PJAC dominated MACI by being cheaper and more effective. At a $100,000/QALY willingness-to-pay threshold, MACI, PJAC, and nonoperative management were the preferred strategies in 63%, 33%, and 4% of the Monte Carlo probabilistic sensitivity analyses, respectively (Figures 2 and 3). Similar results were seen from a payer perspective. Conclusions: In the management of symptomatic patellar cartilage defects, PJAC and MACI were both cost-effective compared to nonoperative treatment in the management of symptomatic patellar cartilage defects; however, MACI was the preferred strategy in our base-case analysis. The cost-effectiveness of PJAC compared to MACI depended heavily on the probability of achieving full versus intermediate benefit after PJAC and MACI.

scholarly journals Understanding the Cost-Effectiveness of Hearing Aids and Surgery for the Treatment of Otosclerosis

2022 ◽  
Author(s):  
Danielle M. Gillard ◽  
Jeffrey D. Sharon
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Hearing Aids ◽  
Cost Effective ◽  
Stapes Surgery ◽  
Cost Effective Method ◽  
Patient Reported ◽  
Complications Of Surgery ◽  
The Cost

Abstract Purpose of Review To summarize and critically review recent literature on the relative cost-effectiveness of hearing augmentation versus stapes surgery for the treatment of otosclerosis. Recent Findings Otosclerosis leads to reduced patient quality of life, which can be ameliorated by either stapes surgery, or hearing aid usage. The success of stapes surgery is high, and the risks of serious postoperative complications are low. Hearing aids don’t have the complications of surgery but are associated with long-term costs. Cost-effectiveness models have shown that stapes surgery is a cost-effective method for treating otosclerosis. Summary Both stapes surgery and hearing aids can improve patient-reported quality of life in otosclerosis. Stapes surgery has larger upfront costs and surgical risks, but hearing aids are associated with longer lifetime costs. Stapes surgery is cost-effective for the treatment of otosclerosis.

scholarly journals Cost-effectiveness analysis of initial nonoperative management versus emergency laparoscopic appendectomy for acute complicated appendicitis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kiyoaki Sugiura ◽  
Keiichi Suzuki ◽  
Tomoshige Umeyama ◽  
Kenshi Omagari ◽  
Takeo Hashimoto ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Laparoscopic Appendectomy ◽  
Nonoperative Management ◽  
Treatment Strategies ◽  
Cost Effective ◽  
Operative Management ◽  
Complicated Appendicitis ◽  
Effective Strategy ◽  
Threshold Analysis

Abstract Background The evidence regarding the safety and efficacy of nonoperative management is growing. However, the best treatment strategy for acute complicated appendicitis remains controversial. We aimed to evaluate the cost-effectiveness of treatment strategies for complicated appendicitis patients. This study sought to determine the most cost-effective strategy from the health care-payer’s perspective. Methods The primary outcome was an incremental cost effectiveness ratio (ICER) using nonoperative management with or without interval laparoscopic appendectomy (ILA) as the intervention compared with operative management with emergency laparoscopic appendectomy (ELA) alone as the control. Model variables were abstracted from a literature review, and from data obtained from the hospital records of Tochigi Medical Center. Cost-effectiveness was evaluated using an ICER. We constructed a Markov model to compare treatment strategies for complicated appendicitis in otherwise-healthy adults, over a time horizon of a single year. Uncertainty surrounding model parameters was assessed via one-way- and probabilistic-sensitivity analyses. Threshold analysis was performed using the willingness-to-pay threshold set at the World Health Organization’s criterion of $107,690. Results Three meta-analysis were included in our analysis. Operative management cost $6075 per patient. Nonoperative management with interval laparoscopic appendectomy (ILA) cost $984 more than operative management and produced only 0.005 more QALYs, resulting in an ICER of $182,587. Nonoperative management without ILA cost $235 more than operative management, and also yielded only 0.005 additional QALYs resulting in an ICER of $45,123 per QALY. Probabilistic sensitivity analysis with 1000 draws resulted in average ICER of $172,992 in nonoperative management with ILA and $462,843 in Nonoperative management without ILA. The threshold analysis demonstrated that regardless of willingness-to-pay, nonoperative management without ILA would not be most cost-effective strategy. Conclusions Nonoperative management with ILA and Nonoperative management without ILA were not cost-effective strategies compared with operative management to treat complicated appendicitis. Based on our findings, operative management remains the standard of care and nonoperative management would be reconsidered as a treatment option in complicated appendicitis from economic perspective.

scholarly journals Economic evaluation alongside a randomised controlled trial to assess the effectiveness and cost-effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy

2020 ◽  
pp. 096452842092028
Author(s):  
Alex Molassiotis ◽  
Bryony Dawkins ◽  
Roberta Longo ◽  
Lorna KP Suen ◽  
Hui Lin Cheng ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Peripheral Neuropathy ◽  
Usual Care ◽  
Base Case ◽  
Cost Effective Treatment ◽  
The Cost

Objective To assess the cost-effectiveness of acupuncture in the management of chemotherapy-induced peripheral neuropathy (CIPN) in Hong Kong. Methods A within trial cost-utility analysis with the primary endpoint for the economic evaluation being the Quality Adjusted Life Year (QALY) and associated Incremental Cost Effectiveness Ratio (ICER) over 14 weeks of treatment. A secondary cost-effectiveness analysis was undertaken with the endpoint being change in pain as measured on the Brief Pain Inventory (BPI). Results Eighty-seven patients were randomised to acupuncture or usual care. Acupuncture resulted in significant improvements in pain intensity (8- and 14-week mean changes compared to usual care of −1.8 and −1.8, respectively), pain interference (8- and 14-week mean changes compared to usual care of −1.5 and −0.9, respectively) and indicators of quality of life and neurotoxicity-related symptoms. However, in the economic evaluation there was little difference in QALYs between the two arms (mean change 0.209 and 0.200 in the acupuncture and usual care arms, respectively). Also, costs yielded deterministic ICERs of HK$616,965.62, HK$824,083.44 and HK$540,727.56 per QALY gained from the health care provider perspective, the societal perspective and the patient perspective, respectively. These costs are significantly higher than the cost-effectiveness threshold of HK$180,450 that was used for the base case analysis. Conclusion While acupuncture can improve symptoms and quality of life indicators related to CIPN, it is unlikely to be a cost-effective treatment for CIPN-related pain in health care systems with limited resources. Trial registration number NCT02553863 (ClinicalTrials.gov) post-results.

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