Cost-Effectiveness and Value-Based Pricing of Aducanumab for Patients With Early Alzheimer Disease

Neurology ◽  
2022 ◽  
pp. 10.1212/WNL.0000000000013314
Author(s):  
Melanie D. Whittington ◽  
Jonathan D. Campbell ◽  
David Rind ◽  
Noemi Fluetsch ◽  
Grace A. Lin ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Supportive Care ◽  
Incremental Cost ◽  
Health Care System ◽  
Societal Perspective ◽  
List Price ◽  
Lifetime Horizon ◽  
System Perspective ◽  
Care System

Introduction:Aducanumab was granted accelerated approval with a conflicting evidence base, near-unanimous FDA Advisory Committee vote to reject approval, and a widely criticized launch price of $56,000 per year. The objective of this analysis was to estimate its cost-effectiveness.Methods:We developed a Markov model to compare aducanumab in addition to supportive care to supportive care alone over a lifetime horizon. Results were presented from both the health system and modified societal perspective. The model tracked the severity of disease and the care setting. Incremental cost-effectiveness ratios were calculated, and a threshold analysis was conducted to estimate at what price aducanumab would meet commonly used cost-effectiveness thresholds.Results:Using estimates of effectiveness based on pooling of data from both pivotal trials, patients treated with aducanumab spent four more months in earlier stages of AD. Over the lifetime time horizon, treating a patient with aducanumab results in 0.154 more QALYs gained per patient and 0.201 evLYGs per patient from the health care system perspective, with additional costs of approximately $204,000 per patient. The incremental outcomes were similar for the modified societal perspective. At the list price of $56,000 per year, the cost-effectiveness ranged from $1.02 million per evLYG to $1.33 million per QALY gained from the health care system perspective; and from $938,000 per evLYG to $1.27 million per QALY gained in the modified societal perspective. The annual price to meet commonly used cost-effectiveness thresholds ranged from $2,950 to $8,360, which represents a discount of 85-95% off from the annual launch price set by the manufacturer. Using estimates of effectiveness based only on the trial that suggested a benefit, the mean incremental cost was greater than $400,000 per QALY gained.Discussion:Patients treated with aducanumab received minimal improvements in health outcomes at considerable cost. This resulted in incremental cost-effectiveness ratios that far exceeded commonly used value thresholds, even under optimistic treatment effectiveness assumptions. These findings are subject to the substantial uncertainty regarding whether aducanumab provides any true net health benefit, but evidence available currently suggests that an annual price of aducanumab of $56,000 is not in reasonable alignment with its clinical benefits.

scholarly journals Cost Effectiveness of Infant Vaccination for Rotavirus in Canada

2012 ◽  
Vol 23 (2) ◽  
pp. 71-77 ◽  
Author(s):  
Doug Coyle ◽  
Kathryn Coyle ◽  
Julie A Bettinger ◽  
Scott A Halperin ◽  
Wendy Vaudry ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Health Care System ◽  
Societal Perspective ◽  
Emergency Department Visits ◽  
System Perspective ◽  
The Cost ◽  
Care System

INTRODUCTION: Rotavirus is the main cause of gastroenteritis in Canadian children younger than five years of age, resulting in significant morbidity and cost. The present study provides evidence on the cost effectiveness of two alternative rotavirus vaccinations (RotaTeq [Merck Frosst Canada Ltd, Canada] and Rotarix [GlaxoSmithKline, Canada]) available in Canada.METHODS: Analysis was conducted through a Markov model that followed a cohort of children from birth to five years of age. Analysis used pertinent data on the natural history of rotavirus and the effects of vaccination. Estimates of heath care costs for children requiring hospitalizations and emergency department visits were derived from the Canadian Immunization Monitoring Program, Active (IMPACT) surveillance, emergency department studies, as well as other Canadian studies. The model estimated the effect of vaccination on costs and quality-adjusted life years (QALYs).RESULTS: The incremental cost per QALY gained from the health care system perspective was $122,000 for RotaTeq and $108,000 for Rotarix. From the societal perspective, both vaccination strategies were dominant – both cost saving and more effective. The cost-effectiveness of vaccination is dependent on the mode of administration, the perspective adopted and the cost of the vaccine.CONCLUSIONS: From a societal perspective, a universal vaccination program against rotavirus will be both cost saving and more effective than no vaccination. Becasue the majority of rotavirus infections do not require emergency department visits or hospital admission, from a health care system perspective, a program would not be considered cost effective.

PP138 Cost-Effectiveness Analysis Of Influenza A (H1N1) Chemoprophylaxis

2018 ◽  
Vol 34 (S1) ◽  
pp. 120-121
Author(s):  
Luisa Vecoso ◽  
Marcus Silva ◽  
Everton Silva ◽  
Mariangela Resende ◽  
Tais Galvao
Keyword(s):  
Health Care ◽  
Intensive Care ◽  
Cost Effectiveness ◽  
Adverse Events ◽  
Incremental Cost ◽  
Health Care System ◽  
Influenza A ◽  
System Perspective ◽  
Influenza A H1n1 ◽  
Care System

Introduction:Influenza A (H1N1) virus is the most relevant virus in death by flu complications. Oseltamivir and zanamivir are used for influenza prophylaxis in epidemics. We aimed to evaluate the efficacy of chemoprophylaxis for influenza A (H1N1) for the Brazilian health care system.Methods:We systematically searched the literature to identify efficacy results. Costs assessed from the system perspective were obtained from official Brazilian Ministry of Health systems, and completed from medical care at a university hospital of Campinas, Sao Paulo. Model outcomes were quality-adjusted life years (QALY) with willingness to pay BRL 30,000 (USD 8,212)/QALY and prevention of H1N1. A decision-tree model was used to calculate the incremental cost-effectiveness ratios for prophylaxis, compared to no prophylaxis. Deterministic and probabilistic sensitivity analyses were used to test robustness of the model.Results:Prophylaxis had 70 percent adherence to treatment, 9 percent adverse events, effectiveness in avoiding H1N1 (relative risk = 0.43; 95% confidence interval: 0.33, 0.57); no evidence of prophylaxis efficacy for complication, hospitalization and death was found. Both scenarios had 14 percent H1N1 attack rate, 67 percent of ambulatorial consult, 43 percent of inpatient care, 14 percent of deaths in hospital, 23 percent of intensive care where death was 40 percent. Utility was 0.50 during H1N1 infection, 0.23 with hospitalization, 0.195 less with adverse events, 0 for deaths and 0.885 for healthy. Cost was BRL39 (USD 11) for chemoprophylaxis; BRL 12 (USD 4) for outpatient care; BRL 5,728 (USD 1,568) for hospital admission; BRL 19,217 (USD 5,260) for intensive care; and BRL 292 (USD 80) for adverse events. Incremental cost of prophylaxis was BRL 40 (USD 11) and utility increased 0.004, which mean saving of BRL 2,921 (USD 780)/QALY. Prophylaxis saves BRL 338 (USD 92) per H1N1 case avoided. Univariate and probabilistic sensitivity analysis assure the robustness of results, with 43 percent probability of being of lower cost and higher effectiveness.Conclusions:Prophylaxis is cost-effective from the health care system perspective using utility and avoided H1N1 cases outcomes.

Cost-effectiveness of continuous positive airway pressure therapy for obstructive sleep apnea: health care system and societal perspectives

SLEEP ◽  
2019 ◽  
Vol 42 (12) ◽  
Author(s):  
Jared Streatfeild ◽  
David Hillman ◽  
Robert Adams ◽  
Scott Mitchell ◽  
Lynne Pezzullo
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Health System ◽  
Health Care System ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Cpap Therapy ◽  
System Perspective ◽  
Obstructive Sleep ◽  
Care System

Abstract Study Objectives To determine cost-effectiveness of continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) in Australia for 2017–2018 to facilitate public health decision-making. Methods Analysis was undertaken of direct per-person costs of CPAP therapy (according to 5-year care pathways), health system and other costs of OSA and its comorbidities averted by CPAP treatment (5-year adherence rate 56.7%) and incremental benefit of therapy (in terms of disability-adjusted life years [DALYs] averted) to determine cost-effectiveness of CPAP. This was expressed as the incremental cost-effectiveness ratio (= dollars per DALY averted). Direct costs of CPAP were estimated from government reimbursements for services and advertised equipment costs. Costs averted were calculated from both the health care system perspective (health system costs only) and societal perspective (health system plus other financial costs including informal care, productivity losses, nonmedical accident costs, deadweight taxation and welfare losses). These estimates of costs (expressed in US dollars) and DALYs averted were based on our recent analyses of costs of untreated OSA. Results From the health care system perspective, estimated cost of CPAP therapy to treat OSA was $12 495 per DALY averted while from a societal perspective the effect was dominant (−$10 688 per DALY averted) meaning it costs more not to treat the problem than to treat it. Conclusions These estimates suggest substantial community investment in measures to more systematically identify and treat OSA is justified. Apart from potential health and well-being benefits, it is financially prudent to do so.

scholarly journals Clinical and Economic Consequences of Vancomycin and Fidaxomicin for the Treatment ofClostridium difficileInfection in Canada

2014 ◽  
Vol 25 (2) ◽  
pp. 87-94 ◽  
Author(s):  
Monika Wagner ◽  
Louis Lavoie ◽  
Mireille Goetghebeur
Keyword(s):  
Health Care ◽  
Incremental Cost ◽  
Health Care System ◽  
Economic Consequences ◽  
Base Case ◽  
System Perspective ◽  
Canadian Health Care System ◽  
Canadian Health ◽  
Canadian Health Care ◽  
Care System

BACKGROUND:Clostridium difficileinfection (CDI) represents a public health problem with increasing incidence and severity.OBJECTIVE: To evaluate the clinical and economic consequences of vancomycin compared with fidaxomicin in the treatment of CDI from the Canadian health care system perspective.METHODS: A decision-tree model was developed to compare vancomycin and fidaxomicin for the treatment of severe CDI. The model assumed identical initial cure rates and included first recurrent episodes of CDI (base case). Treatment of patients presenting with recurrent CDI was examined as an alternative analysis. Costs included were for study medication, physician services and hospitalization. Cost effectiveness was measured as incremental cost per recurrence avoided. Sensitivity analyses of key input parameters were performed.RESULTS: In a cohort of 1000 patients with an initial episode of severe CDI, treatment with fidaxomicin led to 137 fewer recurrences at an incremental cost of $1.81 million, resulting in an incremental cost of $13,202 per recurrence avoided. Among 1000 patients with recurrent CDI, 113 second recurrences were avoided at an incremental cost of $18,190 per second recurrence avoided. Incremental costs per recurrence avoided increased with increasing proportion of cases caused by the NAP1/B1/027 strain. Results were sensitive to variations in recurrence rates and treatment duration but were robust to variations in other parameters.CONCLUSIONS: The use of fidaxomicin is associated with a cost increase for the Canadian health care system. Clinical benefits of fidaxomicin compared with vancomycin depend on the proportion of cases caused by the NAP1/B1/027 strain in patients with severe CDI.

Sign in / Sign up

Export Citation Format

Share Document