scholarly journals Cost-effectiveness and value of information analysis of multiple frequency bioimpedance devices for fluid management in people with chronic kidney disease having dialysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Elisabet Jacobsen ◽  
Moira Cruickshank ◽  
David Cooper ◽  
Angharad Marks ◽  
Miriam Brazzelli ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cost Effectiveness ◽  
Kidney Disease ◽  
Value Of Information ◽  
Relative Effectiveness ◽  
Fluid Management ◽  
Base Case ◽  
Health State ◽  
Multiple Frequency ◽  
Life Years

Abstract Background Among people with chronic kidney disease (CKD) on dialysis, sub-optimal fluid management has been linked with hospitalisation, cardiovascular complications and death. This study assessed the cost-effectiveness using multiple-frequency bioimpedance guided fluid management versus standard fluid management based on clinical judgment. Methods A Markov model was developed to compare expected costs, outcomes and quality adjusted life years of the alternative management strategies. The relative effectiveness of the bioimpedance guided approach was informed by a systematic review of clinical trials, and focussed reviews were conducted to identify baseline event rates, costs and health state utility values for application in the model. The model was analysed probabilistically and a value of information (VOI) analysis was conducted to inform the value of conducting further research to reduce current uncertainties in the evidence base. Results For the base-case analysis, the incremental cost-effectiveness ratio (ICER) for bioimpedance guided fluid management versus standard management was £16,536 per QALY gained. There was a 59% chance of the ICER being below £20,000 per QALY. Form the VOI analysis, the theoretical upper bound on the value of further research was £53 million. The value of further research was highest for parameters relating to the relative effectiveness of bioimpedance guided management on final health outcomes. Conclusions Multiple frequency bioimpedance testing may offer a cost-effective approach to improve fluid management in patients with CKD on dialysis, but further research would be of value to reduce the current uncertainties.

The economic and clinical costs of chronic kidney disease following radical and partial nephrectomy in the management of small renal masses.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 353-353
Author(s):  
S. L. Chang ◽  
L. E. Cipriano ◽  
L. C. Harshman ◽  
B. I. Chung
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Health Outcomes ◽  
Partial Nephrectomy ◽  
Base Case ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Lifetime Horizon ◽  
Life Years ◽  
The Impact

353 Background: Postoperative chronic kidney disease (PCKD), defined as a glomerular filtration rate of < 60mL/min/1.73m2, is a recognized adverse outcome after extirpative therapy for small renal masses (SRM, ≤ 4cm). We quantified the long-term economic and clinical costs of PCKD following radical and partial nephrectomy for the management of SRM. Methods: Using a Markov model, we evaluated open and laparoscopic approaches for radical and partial nephrectomy in the treatment of SRMs. The base case was a 65-year old healthy individual with a unilateral SRM and normal renal function. We used a 3-month cycle length, lifetime horizon, societal perspective, and 3% discount rate. The costs, quality of life adjustments, and transition probabilities were estimated from the literature, Medicare, and expert opinion. Health outcomes were measured in quality-adjusted life-years (QALY) gained and costs in 2008 U.S. dollars. The model was tested with sensitivity analyses. Results: The average discounted lifetime outcomes are listed in the Table. There were minimal differences between the open and laparoscopic approaches. PCKD led to a substantial increase costs and decrease in health outcomes. The impact of PCKD was indirectly associated with age. Conclusions: Partial nephrectomy provides cost-savings and improved health outcomes compared to radical nephrectomy in the management of patients with SRMs. Both procedures incur significant economic and clinical costs due to the development of PCKD. A discussion about the potential for PCKD should be incorporated into the informed consent for surgical treatment of SRMs. [Table: see text] No significant financial relationships to disclose.

scholarly journals Cost-effectiveness analysis of a strategy to delay progression to dialysis and death among chronic kidney disease patients in Lima, Peru

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
E. M. Saldarriaga ◽  
J. Bravo-Zúñiga ◽  
Y. Hurtado-Roca ◽  
V. Suarez
Keyword(s):  
Chronic Kidney Disease ◽  
Cost Effectiveness ◽  
Kidney Disease ◽  
Usual Care ◽  
Lifetime Cost ◽  
Standard Of Care ◽  
Health Consequences ◽  
Lack Of Information ◽  
Payer Perspective ◽  
Life Years

Abstract Background The Renal Health Program (RHP) was implemented in 2013 as a secondary prevention strategy to reduce the incidence of patients initiating dialysis and overall mortality. A previous study found that adherent patients have 58% protection against progression to dialysis compared to non-adherent. The main objective of the study was to estimate the lifetime economic and health consequences of the RHP intervention to determine its cost-effectiveness in comparison with usual care. Methods We use a Markov model of three health stages to simulate disease progression among chronic kidney disease patients in Lima, Peru. The simulation time-horizon was 30 years to capture the lifetime cost and health consequences comparing the RHP to usual care. Costs were estimated from the payer perspective using institutional data. Health outcomes included years lived free of dialysis (YL) and quality adjusted life years (QALY). We conducted a probabilistic sensitivity analysis (PSA) to assess the robustness of our estimates against parameter uncertainty. Results We found that the RHP was dominant—cost-saving and more effective—compared to usual care. The RHP was 783USD cheaper than the standard of care and created 0.04 additional QALYs, per person. The Incremental Cost-Effectiveness Ratio (ICER) showed a cost per QALY gained of $21,660USD. In the PSA the RHP was dominant in 996 out of 1000 evaluated scenarios. Conclusions The RHP was cheaper than the standard of care and more effective due to a reduction in the incidence of patients progressing to dialysis, which is a very expensive treatment and many times inaccessible. We aim these results to help in the decision-making process of scaling-up and investment of similar strategies in Peru. Our results help to increase the evidence in Latin America where there is a lack of information in the long-term consequences of clinical-management-based prevention strategies for CKD patients.

scholarly journals Economic evaluation of brentuximab vedotin for persistent Hodgkin lymphoma

2017 ◽  
Vol 24 (1) ◽  
pp. 6 ◽  
Author(s):  
V. Babashov ◽  
M.A. Begen ◽  
J. Mangel ◽  
G.S. Zaric
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Hodgkin Lymphoma ◽  
Risk Sharing ◽  
Treatment Options ◽  
Brentuximab Vedotin ◽  
Base Case ◽  
Decision Analytic Model ◽  
Health State ◽  
Life Years

Background We conducted a cost-effectiveness analysis of brentuximab vedotin for the treatment of relapsed and refractory Hodgkin lymphoma (hl) in the post–autologous stem-cell transplantation (asct) failure period, from the perspective of the Canadian health care payer.Methods We developed a decision-analytic model to simulate lifetime costs and benefits of brentuximab vedotin compared with best supportive care for the treatment of patients with hl after failure of asct. Administrative data from Ontario were used to set the model parameters.Results In the base case, treatment with brentuximab vedotin resulted in incremental quality-adjusted life-years (qalys) of 0.544 and an incremental cost of $89,366 per patient, corresponding to an incremental cost-effectiveness ratio (icer) of $164,248 per qaly gained. The icer was sensitive to the cost of brentuximab vedotin, the hazard ratio used to assess the efficacy of brentuximab vedotin treatment, and health state utilities.Conclusions In light of the available information, brentuximab vedotin has an icer exceeding $100,000 per qaly gained, which is a level often classified as having “weak evidence for adoption and appropriate utilization” in Canada. However, it is worth noting that provincial cancer agencies take into account not only the costs and associated icer, but also other factors such as a lack of alternative treatment options and the clinical benefits of expensive cancer drugs. Pricing arrangements should be negotiated, and risk-sharing agreements or patient access schemes should be explored. 

scholarly journals Paricalcitol versus Calcitriol + Cinacalcet for the Treatment of Secondary Hyperparathyroidism in Chronic Kidney Disease in China: A Cost-Effectiveness Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Zhuolin Zhang ◽  
Lele Cai ◽  
Hong Wu ◽  
Xinglu Xu ◽  
Wenqing Fang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Cost Effectiveness Analysis ◽  
Effectiveness Analysis ◽  
Life Years ◽  
Ckd Stage ◽  
Hospitalization Costs

Background: Chronic Kidney Disease (CKD) is a global chronic disease with increasing prevalence in recent years, particularly CKD accompanied by Secondary Hyperparathyroidism (SHPT) leads to reduced quality of life, increased mortality, a considerable economic burden for patients and society. The aim of this study was to investigate the cost-effectiveness analysis of paricalcitol vs. calcitriol + cinacalcet for CKD patients with SHPT in China in 2020.Methods: A Markov model was conducted employing data derived from published literature, clinical trials, official sources, and tertiary public hospital data in China, based on a 10-year horizon from the perspective of the healthcare system. Calcitriol + Cinacalcet was used as the reference group. CKD stage 5 (CKD-5) dialysis patients suffering from SHPT were included in the study. Effectiveness was measured in quality-adjusted life years (QALYs). The discount rate (5%) was applied to costs and effectiveness. Sensitivity analysis was performed to confirm the robustness of the findings.Results: The base case analysis demonstrated that Patients treated with paricalcitol could gain an increase in utility (0.183 QALYs) and require fewer expenditures (6925.612 yuan). One-way sensitivity analysis was performed to showed that impact factors were the price of cinacalcet, the hospitalization costs of patients with paricalcitol and calcitriol, the costs and utilities of hemodialysis and the costs of calcitriol, the costs of paricalcitol regardless of period. Probabilistic simulation analysis displayed when willingness-to-pay was ¥217113, the probability that Paricalcitol was dominant is 96.20%.Conclusion: The results showed that paricalcitol administrated to treat patients diagnosed with Secondary hyperparathyroidism in Chronic Kidney Disease, compared to calcitriol and cinacalcet, might be dominant in China.

scholarly journals Cost‐Effectiveness of Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Patients With Chronic Kidney Disease and Acute Coronary Syndromes in the US Medicare Program

2021 ◽  
Author(s):  
Matthew R. Reynolds ◽  
Tingting Gong ◽  
Shuling Li ◽  
Charles A. Herzog ◽  
David M. Charytan
Keyword(s):  
Chronic Kidney Disease ◽  
Cost Effectiveness ◽  
Coronary Artery ◽  
Kidney Disease ◽  
Medical Therapy ◽  
Artery Bypass ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Quality Adjusted Life

Background Coronary revascularization provides important long‐term clinical benefits to patients with high‐risk presentations of coronary artery disease, including those with chronic kidney disease. The cost‐effectiveness of coronary interventions in this setting is not known. Methods and Results We developed a Markov cohort simulation model to assess the cost‐effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with chronic kidney disease who were hospitalized with acute myocardial infarction or unstable angina. Model inputs were primarily drawn from a sample of 14 300 patients identified using the Medicare 20% sample. Survival, quality‐adjusted life‐years, costs, and cost‐effectiveness were projected over a 20‐year time horizon. Multivariable models indicated higher 30‐day mortality and end‐stage renal disease with both PCI and CABG, and higher stroke with CABG, relative to medical therapy. However, the model projected long‐term gains of 0.72 quality‐adjusted life‐years (0.97 life‐years) for PCI compared with medical therapy, and 0.93 quality‐adjusted life‐years (1.32 life‐years) for CABG compared with PCI. Incorporation of long‐term costs resulted in incremental cost‐effectiveness ratios of $65 326 per quality‐adjusted life‐year gained for PCI versus medical therapy, and $101 565 for CABG versus PCI. Results were robust to changes in input parameters but strongly influenced by the background costs of the population, and the time horizon. Conclusions For patients with chronic kidney disease and high‐risk coronary artery disease presentations, PCI and CABG were both associated with markedly increased costs as well as gains in quality‐adjusted life expectancy, with incremental cost‐effectiveness ratios indicating intermediate value in health economic terms.

scholarly journals Comparison of the EQ-5D 3L and the SF-6D (SF-36) contemporaneous utility scores in patients with chronic kidney disease in Sri Lanka: a cross-sectional survey

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024854
Author(s):  
Sanjeewa Kularatna ◽  
Sameera Senanayake ◽  
Nalika Gunawardena ◽  
Nicholas Graves
Keyword(s):  
Chronic Kidney Disease ◽  
Sri Lanka ◽  
Kidney Disease ◽  
Short Form ◽  
Classification Systems ◽  
Health State ◽  
Cross Sectional ◽  
Life Years ◽  
Sf 36 ◽  
Utility Scores

ObjectivesThe aim of this study was to compare utility weights of EuroQoL-five-dimension-3 levels (EQ-5D-3L) and Short-Form six-dimension (SF-6D) in a representative cohort of patients with chronic kidney disease (CKD). A cost–utility analysis (CUA) is designed to report the change to costs required to achieve an estimated change to quality-adjusted life years (QALYs). The quality component of a QALY is measured by utility. Utility represents the preference of general population for a given health state. Classification systems of the multi-attribute utility instruments (MAUIs) are used to define these health states. Utility weights developed from different classification systems can vary and may affect the conclusions from CUAs.DesignA community-based cross-sectional study.SettingAnuradhapura, a rural district in Sri Lanka.ParticipantsA representative sample of 1096 patients with CKD, selected using the population-based CKD register, completed the EQ-5D-3L and SF-36. SF-6D was constructed from the SF-36 according to the published algorithm. The study assessed discrimination, correlation and differences across the two instruments.ResultsStudy participants were predominantly male (62.6%). Mean EQ-5D-3L utility score was 0.540 (SD 0.35) compared with 0.534 (SD 0.09) for the SF-6D (p=0.588). The correlation (r) between the scores was 0.40 (p<0.001). Utility scores were significantly different in both males and females between the two tools, but there was no difference in age and educational categories. Both MAUI scores were significantly lower (p<0.001) among those who were in more advanced stages of the disease and the corresponding utility scores of the two instruments in different CKD stages were also significantly different (p<0.05). The largest effect size was seen among the patients on dialysis.ConclusionsThe correlation between the scores was moderate. SF-6D had the lowest floor and ceiling effect and was better at detecting different stages of the disease. Thus, based on the evidence presented in this study, SF-6D appears to be more appropriate to be used among patients with CKD.

A Cost-Effectiveness Analysis of Adjuvant Trastuzumab Regimens in Early HER2/neu–Positive Breast Cancer

2007 ◽  
Vol 25 (6) ◽  
pp. 634-641 ◽  
Author(s):  
Allison W. Kurian ◽  
Rebecca Newton Thompson ◽  
Allison F. Gaw ◽  
Sally Arai ◽  
Rafael Ortiz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Randomized Clinical Trials ◽  
Early Stage ◽  
Base Case ◽  
Health State ◽  
Adjuvant Trastuzumab ◽  
Life Years ◽  
International Research Group ◽  
Positive Breast Cancer

Purpose One-year adjuvant trastuzumab (AT) therapy, with or without anthracyclines, increases disease-free and overall survival in early-stage HER2/neu-positive breast cancer. We sought to evaluate the cost effectiveness of these regimens, which are expensive and potentially toxic. Methods We used a Markov health-state transition model to simulate three adjuvant therapy options for a cohort of 49-year-old women with HER2/neu-positive early-stage breast cancer: conventional chemotherapy without trastuzumab; anthracycline-based AT regimens used in the National Surgical Adjuvant Breast and Bowel Project B-31 and North Central Cancer Treatment Group N9831 trials; and the nonanthracycline AT regimen used in the Breast Cancer International Research group 006 trial. The base case used treatment efficacy measures reported in the randomized clinical trials of AT. We measured health outcomes in quality-adjusted life-years (QALYs) and costs in 2005 United States dollars (US$) and subjected results to probabilistic sensitivity analysis. Results In the base case, the anthracycline-based AT arm has an incremental cost-effectiveness ratio (ICER) of $39,982/QALY, whereas the nonanthracycline AT arm is more expensive and less effective; this result is insensitive to changes in recurrence rates, but if there is no benefit after 4 years, ICERs exceed $100,000/QALY for both AT arms. Results are moderately sensitive to variation in breast cancer survival rates and trastuzumab cost, and less sensitive to variations in cardiac toxicity. Conclusion AT has an ICER comparable to those for other widely used interventions. Longer clinical follow-up is warranted to evaluate the long-term efficacy and toxicity of different AT regimens.

scholarly journals Health related quality of life utility weights for economic evaluation through different stages of chronic kidney disease: a systematic literature review

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Jacie T. Cooper ◽  
Andrew Lloyd ◽  
Juan Jose Garcia Sanchez ◽  
Elisabeth Sörstadius ◽  
Andrew Briggs ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Cost Effectiveness ◽  
Kidney Disease ◽  
Task Force ◽  
Health State ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Abstract Background A Task Force from the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) provides recommendations on how to systematically identify and appraise health state utility (HSU) weights for cost-effectiveness analyses. We applied these recommendations to conduct a systematic review (SR) to identify HSU weights for different stages of chronic kidney disease (CKD), renal replacement therapy (RRT) and complications. Methods MEDLINE® and Embase were searched for interventional and non-interventional studies reporting HSU weights for patients with CKD stages 1–5 or RRT. As per ISPOR Task Force Guidance, study quality criteria, applicability for Health Technology Assessment (HTA) and generalisability to a broad CKD population were used to grade studies as either 1 (recommended), 2 (to be considered if there are no data from grade 1 studies) or 3 (not recommended). Results A total of 17 grade 1 studies were included in this SR with 51 to 1767 participants, conducted in the UK, USA, Canada, China, Spain, and multiple-countries. Health related quality of life (HRQL) instruments used in the studies included were EQ-5D-3L (10 studies), SF-6D (4 studies), HUI2/HUI3 (1 study), and combinations (2 studies). Although absolute values for HSU weights varied among instruments, HSU weights decreased with CKD severity in a consistent manner across all instruments. Conclusions This SR identified HSU weights for a range of CKD states and showed that HRQL decreases with CKD progression. Data were available to inform cost-effectiveness analysis in CKD in a number of geographies using instruments acceptable by HTA agencies.

scholarly journals Cost-Effectiveness Analysis for the Treatment of Hyperphosphatemia in Predialysis Patients: Calcium-Based versus Noncalcium-Based Phosphate Binders

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
B. L. Goh ◽  
A. Soraya ◽  
A. Goh ◽  
K. L. Ang
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Sensitivity Analyses ◽  
Phosphate Binders ◽  
Base Case ◽  
Health State ◽  
Life Years ◽  
High Calcium ◽  
Calcium Load ◽  
Markov Decision Model

Background. Hyperphosphatemia in chronic kidney disease (CKD) patients is often treated with calcium carbonate (CaCO3) despite the fact that CaCO3 is associated with increased calcium load and potentially increased cardiovascular risk. Alternative treatments with noncalcium-based phosphate binders do not increase the calcium load but are more costly. This study analyzes the cost-effectiveness of sevelamer versus CaCO3 for the treatment of hyperphosphatemia in stage III-V predialysis CKD patients in Malaysia. Methods. A Markov decision model was adapted to simulate a hypothetical cohort of CKD patients requiring treatment for hyperphosphatemia. Survival was estimated by using efficacy data from the INDEPENDENT-CKD clinical trial. Cost data was obtained from Malaysian studies while health state utilities were derived from literature. Analysis was performed over lifetime duration from the perspective of the Ministry of Health Malaysia with 2013 as reference year. Results. In the base case analysis, sevelamer treatment gained 6.37 life years (5.27 QALY) compared to 4.25 life years (3.54 QALY) with CaCO3. At 3% discount, lifetime costs were RM159,901 ($48,750) and RM77,139 ($23,518) on sevelamer and CaCO3, respectively. Incremental cost-effectiveness (ICER) of sevelamer versus CaCO3 was RM47,679 ($14,536) per QALY, which is less than the WHO threshold of three times GDP per capita (RM99,395) per QALY. Sensitivity analyses, both using scenario sensitivity analysis and probabilistic sensitivity analysis, showed the result to be robust. Conclusions. Our study finds that sevelamer is potentially cost-effective compared to CaCO3, for the treatment of hyperphosphatemia in predialysis CKD III-V. We propose that sevelamer should be an option in the treatment of Malaysian predialysis patients with hyperphosphatemia, particularly those with high calcium load.

Cost-effectiveness of FOLFIRI + cetuximab vs FOLFIRI + bevacizumab in the first-line (1L) treatment of RAS wild-type (wt) metastatic colorectal cancer (mCRC) in Germany: Data from the FIRE-3 (AIO KRK-0306) study.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 800-800 ◽  
Author(s):  
Sebastian Stintzing ◽  
Ilse van Oostrum ◽  
Chris Pescott ◽  
Alma Katharina Steinbach-Buechert ◽  
Bart Heeg ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Health State ◽  
Primary Tumors ◽  
Payer Perspective ◽  
Life Years ◽  
The Cost

800 Background: The randomized, phase 3 FIRE-3 trial evaluated 1L FOLFIRI + cetuximab or bevacizumab in patients with RAS wt mCRC; overall survival favored FOLFIRI + cetuximab by > 8 months. The purpose of this analysis was to evaluate the cost-effectiveness of FOLFIRI + cetuximab vs that of FOLFIRI + bevacizumab as 1L treatment for patients in Germany with RAS wt mCRC (including the patient subgroup with RAS wt, left-sided [LS] primary tumors, as LS is a predictive factor). Methods: A standard oncology 3–health-state partitioned survival cost-utility model was developed to analyze the costs and health benefits of FOLFIRI + cetuximab vs those of FOLFIRI + bevacizumab from a German payer perspective based on data from FIRE-3 and the literature. Health outcomes were reported in life-years (LYs) and quality-adjusted life-years (QALYs) gained. A 3.5% discounting rate was applied to the modeled costs and outcomes. Results: Discounted costs, health gains, and incremental cost-effectiveness ratios (ICERs) for patients with RAS wt (base case) and patients with RAS wt, LS (subgroup) mCRC are summarized in the Table. Probabilistic sensitivity analyses showed that at relevant European willingness-to-pay (WTP) thresholds of €55,000 and €80,000, FOLFIRI + cetuximab had a 64.0% and 81.6% (base case) and 80.5% and 92.4% (subgroup) probability of being cost-effective vs FOLFIRI + bevacizumab, respectively. Clinical trial information: NCT00433927. Conclusions: Based on our analyses, FOLFIRI + cetuximab is cost-effective compared with FOLFIRI + bevacizumab in patients in Germany with RAS wt mCRC at official WTP thresholds applied by relevant European health technology assessment agencies. The cost-effectiveness of FOLFIRI + cetuximab is more pronounced in the subgroup of patients with RAS wt, LS tumors.[Table: see text]

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