Automated Feedback After Internet-Based Depression Screening: Cost-Effectiveness Analysis of a Randomized Controlled Trial

Cost-effectiveness analysis in cardiac surgery: A review of its concepts and methodologies

<p> </p> <p><strong>Objective</strong></p> <p>To assess the cost-effectiveness of collaborative versus usual care in adults with poorly-controlled type 2 diabetes and depression in India.</p> <p><strong>Research Design and Methods</strong></p> <p>We performed a within-trial cost-effectiveness analysis of a 24-month parallel, open-label, pragmatic randomized clinical trial at four urban clinics in India from multipayer and societal perspectives. The trial randomized 404 patients with poorly-controlled type 2 diabetes (HbA1c≥8.0% or systolic BP≥140mmHg or LDL-c≥130mg/dl) and depressive symptoms (PHQ-9≥10) to collaborative care (support from non-physician care coordinators, electronic registers, and specialist-supported case review) for 12 months, followed by 12 months usual care or 24 months usual care. We calculated incremental cost-effectiveness ratios (ICER) in Indian rupees (INR) and international dollars (Int’l) and the probability of cost-effectiveness using quality-adjusted life years (QALYs) and depression-free days (DFDs).</p> <p><strong>Results</strong></p> <p>From a multipayer perspective, collaborative care costed additional INR309,558 (Int’l-$15,344) per QALY and additional INR290.2 (Int’l-$14.4) per DFD gained compared to usual care. The probability of cost-effectiveness was 56.4% using a willingness-to-pay of INR336,000 (Int’l-$16,654) per QALY (~3-times per-capita GDP). The willingness-to-pay per DFD to achieve a probability of cost-effectiveness >95% was INR401.6 (Int’l-$ 19.9). From a societal perspective, cost-effectiveness was marginally lower. In sensitivity analyses, integrating collaborative care in clinical workflows reduced incremental costs by ~47% (ICER: 162,689/QALY; cost-effectiveness probability: 89.4%) but cost-effectiveness decreased when adjusting for baseline values.</p> <p><strong>Conclusions</strong></p> <p>Collaborative care for patients with type 2 diabetes and depression in urban India can be cost-effective, especially when integrated in clinical workflows. Long-term cost-effectiveness might be more favorable. Scalability across lower- and middle-income country settings depends on heterogeneous contextual factors. </p>

Incremental cost-effectiveness analysis is critical to the efficient allocation of health care resources; however, the incremental cost-effectiveness ratio (ICER) of surgical versus nonsurgical treatment for adult spinal deformity (ASD) has eluded the literature, due in part to inherent empirical difficulties when comparing surgical and nonsurgical patients. Using observed preoperative health-related quality of life (HRQOL) for patients who later underwent surgery, this study builds a statistical model to predict hypothetical quality-adjusted life years (QALYs) without surgical treatment. The analysis compares predicted QALYs to observed postoperative QALYs and forms the resulting ICER. This was a single-center (Baylor Scoliosis Center) retrospective analysis of consecutive patients undergoing primary surgery for ASD. Total costs (expressed in 2010 dollars) incurred by the hospital for each episode of surgical care were collected from administrative data and QALYs were calculated from the 6-dimensional Short-Form Health Survey, each discounted at 3.5% per year. Regression analysis was used to predict hypothetical QALYs without surgery based on preoperative longitudinal data for 124 crossover surgical patients with similar diagnoses, baseline HRQOL, age, and sex compared with the surgical cohort. Results were projected through 10-year follow-up, and the cost-effectiveness acceptability curve (CEAC) was estimated using nonparametric bootstrap methods. Three-year follow-up was available for 120 (66%) of 181 eligible patients, who were predominantly female (89%) with average age of 50. With discounting, total costs averaged $125,407, including readmissions, with average QALYs of 1.93 at 3-year follow-up. Average QALYs without surgery were predicted to be 1.6 after 3 years. At 3- and 5-year follow-up, the ICER was $375,000 and $198,000, respectively. Projecting through 10-year follow-up, the ICER was $80,000. The 10-year CEAC revealed a 40% probability that the ICER was $80,000 or less, a 90% probability that the ICER was $90,000 or less, and a 100% probability that the ICER was less than $100,000. Based on the WHO's suggested upper threshold for cost-effectiveness (3 times per capita GDP, or $140,000 in 2010 dollars), the analysis reveals that surgical treatment for ASD is cost-effective after a 10-year period based on predicted deterioration in HRQOL without surgery. The ICER well exceeds the WHO threshold at earlier follow-up intervals, highlighting the importance of the durability of surgical treatment in assessing the value of surgical intervention. Due to the study's methodology, the results are dependent on the predicted deterioration in HRQOL without surgery. As such, the results may not extend to patients whose HRQOL would remain steady without surgery. Future research should therefore pursue a direct comparison of QALYs for surgical and nonsurgical patients to better understand the cost-effectiveness of surgery for the average ASD patient.

Bloodstream infections are associated with considerable morbidity and health care costs. Molecular rapid diagnostic tests (mRDTs) are a promising complement to conventional laboratory methods for the diagnosis of bloodstream infections and may reduce the time to effective therapy among patients with bloodstream infections. The concurrent implementation of antimicrobial stewardship programs (ASPs) may reinforce these benefits. The aim of this study was to evaluate the cost-effectivenesses of competing strategies for the diagnosis of bloodstream infection alone or combined with an ASP. To this effect, we constructed a decision-analytic model comparing 12 strategies for the diagnosis of bloodstream infection. The main arms compared the use of mRDT and conventional laboratory methods with or without an ASP. The baseline strategy used as the standard was the use of conventional laboratory methods without an ASP, and our decision-analytic model assessed the cost-effectivenesses of 5 principal strategies: mRDT (with and without an ASP), mRDT with an ASP, mRDT without an ASP, conventional laboratory methods with an ASP, and conventional laboratory methods without an ASP. Furthermore, based on the availability of data in the literature, we assessed the cost-effectivenesses of 7 mRDT subcategories, as follows: PCR with an ASP, matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) analysis with an ASP, peptide nucleic acid fluorescent in situ hybridization (PNA-FISH) with an ASP, a blood culture nanotechnology microarray system for Gram-negative bacteria (BC-GP) with an ASP, a blood culture nanotechnology microarray system for Gram-positive bacteria (BC-GN) with an ASP, PCR without an ASP, and PNA-FISH without an ASP. Our patient population consisted of adult inpatients in U.S. hospitals with suspected bloodstream infection. The time horizon of the model was the projected life expectancy of the patients. In a base-case analysis, cost-effectiveness was determined by calculating the numbers of bloodstream infection deaths averted, the numbers of quality-adjusted life years gained, and incremental cost-effectiveness ratios (ICERs). In a probabilistic analysis, uncertainty was addressed by plotting cost-effectiveness planes and acceptability curves for various willingness-to-pay thresholds. In the base-case analysis, MALDI-TOF analysis with an ASP was the most cost-effective strategy, resulting in savings of $29,205 per quality-adjusted life year and preventing 1 death per 14 patients with suspected bloodstream infection tested compared to conventional laboratory methods without an ASP (ICER, -$29,205/quality-adjusted life year). BC-GN with an ASP (ICER, -$23,587/quality-adjusted life year), PCR with an ASP (ICER, -$19,833/quality-adjusted life year), and PCR without an ASP (ICER, -$21,039/quality-adjusted life year) were other cost-effective options. In the probabilistic analysis, mRDT was dominant and cost-effective in 85.1% of simulations. Importantly, mRDT with an ASP had an 80.0% chance of being cost-effective, while mRDT without an ASP had only a 41.1% chance. In conclusion, our findings suggest that mRDTs are cost-effective for the diagnosis of patients with suspected bloodstream infection and can reduce health care expenditures. Notably, the combination of mRDT and an ASP can result in substantial health care savings.

Objective: To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B, and estimate the willing to pay and budget impacts on the PMTCT. Methods: The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention. The parameters in the model were obtained from literatures of national surveys or Meta-analysis. The costs, cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives, respectively. The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization. One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results. In addition, cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy. Results: The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier, which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention. Due to the strategy, a total of 24.516 1 QALYs per person would be gained, which was higher than that in those receiving no intervention. From societal perspective, the ICER was -59 136.6 yuan (RMB) per additional QALYs gained, indicating that the PMTCT is cost effective. The results were reliable indicated by one-way, multi-way and probability sensitivity analyses. By the CEAC, the willing to pay was much lower than the cost-effectiveness threshold. From the affordability curve of the PMTCT strategy, the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB), which was lower than the financial ability. Based on the results of cost-effectiveness affordability curves, the higher annual budget was determined, the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state. Only when the annual budget reaches 688.8 million yuan (RMB), the goal of PMTCT would be fully realized. Conclusions: The PMTCT strategy in China was cost effective, and the cost is not beyond the financial budget needed and the willing to pay. The strategy, which is consistent with the global hepatitis B elimination efforts, should be conducted widely in China.

Is Dietetic Treatment for Undernutrition in Older Individuals in Primary Care Cost-Effective?

This study compares the five-level EuroQol five-dimension questionnaire (EQ-5D-5L) crosswalks and the 5L value sets for England, the Netherlands, and Spain and explores the implication of using one or the other for the results of cost-utility analyses. Data from two randomized controlled trials in depression and diabetes were used. Utility value distributions were compared, and mean differences in utility values between the EQ-5D-5L crosswalk and the 5L value set were described by country. Quality-adjusted life years (QALYs) were calculated using the area-under-the-curve method. Incremental cost-effectiveness ratios (ICERs) were calculated, and uncertainty around ICERs was estimated using bootstrapping and graphically shown in cost-effectiveness acceptability curves. For all countries investigated, utility value distributions differed between the EQ-5D-5L crosswalk and 5L value set. In both case studies, mean utility values were lower for the EQ-5D-5L crosswalk compared with the 5L value set in England and Spain, but higher in the Netherlands. However, these differences in utility values did not translate into relevant differences across utility estimation methods in incremental QALYs and the interventions' probability of cost-effectiveness. Thus, our results suggest that EQ-5D-5L crosswalks and 5L value sets can be used interchangeably in patients affected by mild or moderate conditions. Further research is needed to establish whether these findings are generalizable to economic evaluations among severely ill patients.

Cost-effectiveness of health coaching and financial incentives to promote physical activity after total knee replacement

PCN82 Cost-Effectiveness of Once Weekly Selinexor-Bortezomib-Dexamethasone (XVD) in Previously Treated Multiple Myeloma (MM)

The efficacy of automated feedback after internet-based depression screening (DISCOVER): an observer-masked, three-armed, randomised controlled trial in Germany

Particulated Juvenile Articular Cartilage and Matrix-Induced Autologous Chondrocyte Implantation Are Cost-Effective for Patellar Chondral Lesions

Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand

Objective: To evaluate the cost-effectiveness of government fully-funded quadrivalent influenza vaccination (QIV) program for older adults aged 60 and above in mainland China. Methods: Based on decision tree model in the previous research on the cost-effectiveness analysis of TIV immunization, we extended the structure of model and updated the key parameters such as influenza patients' healthcare seeking behavior, vaccine cost, vaccine coverage and vaccine efficacy/effectiveness to estimate influenza-associated outpatient consultations, hospitalizations, respiratory disease excess mortality and quality-adjusted life years (QALY) between the QIV and no vaccination or TIV program. And incremental cost and incremental cost-effectiveness ratio (ICER) were evaluated between the QIV and no vaccination or TIV program from the societal perspective. The time frame of the study is one year. All costs were adjusted to 2019 using the consumer price index. Results: Comparing the fully-funded QIV and no vaccination or TIV for older adults aged 60 and above is separately expected to prevent 45 070 or 2 718 influenza-associated influenza-like illness (ILI) outpatients, 21 451 or 1 294 influenza-associated severe acute respiratory infection (SARI) hospitalizations, 19 346 or 1 167 influenza-associated respiratory excess deaths and avoid 155 234 or 9 363 QALY loss each year. Compared with no vaccination, introducing QIV into National Immunization Program (NIP) is expected to increase the cost of 11.71 billion yuan from the societal perspective. The incremental cost per QALY gained between QIV and no vaccination was 75 325 yuan per QALY, which is higher than willingness-to-pay (WTP) threshold (one-fold gross domestic product per capita is considered as WTP: 70 892 yuan) and means no cost effective. Introducing QIV rather than TIV into NIP will cost 7.98 billion yuan from the societal perspective and the ICER was 852.54 thousand yuan per QALY which is much higher than WTP and means no cost effective as well. The threshold of vaccination cost between QIV and no vaccination or TIV should no more than 113.41 or 6.83 yuan when the two comparators' scenarios above are all cost effective. Conclusion: Under the condition of current vaccine effectiveness and vaccine cost, comparing fully-funded QIV with no or TIV vaccination program is not cost effective for people aged 60 years or older.

Robotic transabdominal preperitoneal (r-TAPP) inguinal hernia repair is increasingly performed, but its economic value relative to laparoscopic TAPP (l-TAPP) remains uncertain, particularly in publicly funded health systems. A monthly state-transition (Markov) model was developed over a 24-month period from the perspective of the Italian National Health Service (SSN). A 90-day hospital/provider perspective was explored in scenario analyses. Costs were valued in 2023 euros, combining micro-costing data from a Spanish comparative study adjusted with OECD purchasing-power parities and Eurostat inflation indices, alongside Italian tariffs. Transition probabilities were derived from randomized trials and meta-analyses. Health-state utilities were obtained from EQ-5D studies in hernia populations and applied to model states. Deterministic one-way and probabilistic sensitivity analyses (10,000 iterations) were performed. Outcomes included incremental costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and probabilities of cost-effectiveness at willingness-to-pay thresholds of €20,000-30,000 per QALY. In the SSN base case, r-TAPP generated an incremental cost of €2,224 and a gain of 0.05 QALYs versus l-TAPP, yielding an ICER of €44,480/QALY. At a €30,000/QALY threshold, the probability of cost-effectiveness was less than 25%. Scenario analyses incorporating Italian inputs or regional tariffs further reduced the cost-effectiveness. Exploratory model-based scenario analyses (bilateral repair, elevated BMI) also yielded ICERs ≥ €30,000/QALY, confirming limited probability of cost-effectiveness. Recurrence and reoperation rates were assumed equal between r-TAPP and l-TAPP, consistent with current evidence; however, potential differences over longer horizons could alter cost-effectiveness estimates. r-TAPP is associated with substantially higher costs and only marginal health gains compared with l-TAPP. The incremental QALY gain was small and not clinically meaningful, resulting in a probability of cost-effectiveness below 25% at a €30,000/QALY threshold. Routine adoption cannot be justified under current cost and reimbursement conditions, and its role should be confined to structured training programs or prospective research protocols.

Background:Studies on the immunotherapy for Alzheimer’s disease (AD) have increasingly gained attention since 1990s. However, there are pros (preventing of AD) and cons (incurred cost and side effects) regarding the administration of immunotherapy. Up to date, there has been lacking of economic evaluation for immunotherapy of AD. We aimed to assess the cost-effectiveness analysis of the vaccination for AD.Methods:A meta-analysis of randomized control trials after systemic review was conducted to evaluate the efficacy of the vaccine. A Markov decision model was constructed and applied to a 120,000-Taiwanese cohort aged ≥65 years. Person years and quality-adjusted life years (QALY) were computed between the vaccinated group and the the unvaccinated group. Economic evaluation was performed to calculate the incremental cost-effectiveness ratio (ICER) and cost-effectiveness acceptability curve (CEAC).Results:Vaccinated group gained an additional 0.84 life years and 0.56 QALYs over 10-years and an additional 0.35 life years and 0.282 QALYs over 5-years of follow-up. The vaccinated group dominated the unvaccinated group by ICER over 5-years of follow-up. The ICERs of 10-year follow-up for the vaccinated group against the unvaccinated group were $13,850 per QALY and $9,038 per life year gained. Given the threshold of $20,000 of willingness to pay (WTP), the CEAC showed the probability of being cost-effective for vaccination with QALY was 70.7% and 92% for life years gained after 10-years of follow-up. The corresponding figures were 87.3% for QALY and 93.5% for life years gained over 5-years follow-up.Conclusion:The vaccination for AD was cost-effective in gaining QALY and life years compared with no vaccination, under the condition of a reasonable threshold of WTP.