Correction: Framework for developing cost-effectiveness analysis threshold: the case of Egypt

Cost-effectiveness analyses in gynecologic oncology: methodological quality and trends

Background:Heart failure is a chronic condition that imposes a significant burden on healthcare systems worldwide. Effective management is crucial for improving patient outcomes and reducing costs. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are widely used to manage heart failure by reducing cardiac strain and preventing disease progression. Despite their common use, ACE inhibitors and ARBs differ in mechanisms, cost, and potential side effects. ACE inhibitors have long been the standard treatment, while ARBs are often prescribed to patients intolerant to ACE inhibitors, particularly due to side effects like cough. Given these differences, evaluating the cost-effectiveness of these treatments is essential. This study compares the cost-effectiveness of ACE inhibitors and ARBs from a healthcare system perspective, considering both direct medical costs and health outcomes.Methods:A cost-effectiveness analysis was conducted using a decision-analytic Markov model to simulate heart failure progression in a hypothetical cohort. Data inputs included clinical trial outcomes, real-world effectiveness data, direct medical costs (medications, hospitalizations, monitoring), and utility values for quality of life. The primary outcome measures were the cost per quality-adjusted life year gained and the incremental cost-effectiveness ratio. Sensitivity analyses tested the robustness of results, and subgroup analyses were conducted based on age and disease severity.Results:The base-case analysis showed that ACE inhibitors were associated with lower overall costs and slightly higher quality-adjusted life years than ARBs. Sensitivity analyses revealed that variations in key parameters, such as transition probabilities, mortality rates, and healthcare expenses, had limited impact on the overall cost-effectiveness conclusions. Subgroup analyses indicated that ACE inhibitors and ARBs exhibited similar cost-effectiveness profiles for patients aged <65 and ≥65 years. However, among patients with severe heart failure, ARBs demonstrated a higher incremental cost-effectiveness ratio compared with ACE inhibitors, suggesting reduced cost-effectiveness in this subgroup.Conclusion:ACE inhibitors are likely a more cost-effective option for managing heart failure than ARBs, particularly from a healthcare system perspective. The findings underscore the importance of tailoring treatment decisions to individual patient factors, preferences, and clinical conditions, providing valuable insights for healthcare policy and practice, particularly regarding cost-effectiveness across patient subgroups.

Cost effectiveness analysis (CEA) is a useful tool for allocation of constrained resources, yet CEA methodologies are rarely taught or implemented in developing nations. We aimed to assess exposure to, and interest in CEA, and identify barriers to implementation in Uganda. A cross-sectional survey was carried out in Uganda using a newly developed self-administered questionnaire (via online and paper based approaches), targeting the main health care actors as identified by a previous study. Overall, there was a 68% response rate, with a 92% (69/75) response rate among the paper-based respondents compared to a 40% (26/65) rate with the online respondents. Seventy eight percent (74/95) of the respondents had no exposure to CEA. None of those with a master of medicine degree had any CEA exposure, and 80% of technical officers, who are directly involved in policy formulation, had no CEA exposure. Barriers to CEA identified by more than 50% of the participants were: lack of information technology (IT) infrastructure (hardware and software); lack of local experts in the field of CEA; lack of or limited local data; limited CEA training in schools; equity or ethical issues; and lack of training grants incorporating CEA. 93% reported a lot of interest in learning to conduct CEA, and over 95% felt CEA was important for clinical decision making and policy formulation. Among health care actors in Uganda, there is very limited exposure to, but substantial interest in conducting CEA and including it in clinical decision making and health care policy formation. Capacity to undertake CEA needs to be built through incorporation into medical training and use of regional approaches.

Minimally invasive surgery (MIS) has benefits over open surgery for lumbar decompression and/or fusion. Published literature on its cost-effectiveness vs open techniques is mixed. Systematically review the cost-effectiveness of minimally invasive vs open lumbar spinal surgical decompression, fusion, or discectomy using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic electronic search of databases (MEDLINE, Embase, and Cochrane Library) and a manual search from the cost-effectiveness analysis (CEA) database and National Health Service economic evaluation database was conducted. Studies that included adult populations undergoing surgery for degenerative changes in the lumbar spine (stenosis, radiculopathy, and spondylolisthesis) and reported outcomes of costing analysis, CEA, or incremental cost-effectiveness ratio were included. A total of 17 studies were included. Three studies assessed outcomes of MIS vs open discectomy. All 3 reported statistically significant lower total costs in the MIS, compared with the open group, with similar reported gains in quality-adjusted life years (QALYs). Two studies reported cost differences in MIS vs open laminectomy, with significantly lower total costs attributed to the MIS group. Twelve studies reported findings on the relative direct costs of MIS vs open lumbar fusion. Among those, 3 of the 4 studies comparing single-level MIS-transforaminal lumbar interbody fusion (TLIF) and open TLIF reported lower total costs associated with MIS procedures. Six studies reported cost evaluation of single- and 2-level TLIF procedures. Lower total costs were found in the MIS group compared with the open fusion group in all studies except for the subgroup analysis of 2-level fusions in a single study. Three of these 6 studies reported cost-effectiveness (cost/QALY). MIS fusion was found to be more cost-effective than open fusion in all 3 studies. The studies reviewed were of poor to moderate methodological quality. Generally, studies reported a reduced cost associated with MIS vs open surgery and suggested better cost-effectiveness, particularly in MIS vs open single- and 2-level TLIF procedure. Most studies had a high risk of bias. Therefore, this review was unable to conclusively recommend MIS over open surgery from a cost-effectiveness perspective. The incidence of spinal decompressive and fusion surgey and financial constraints on healthcare services continue to increase. This study aims to identify the cost and clinical effectiveness of common approaches to spinal surgery. 3a.

Objective To analyze the cost-effectiveness of transcatheter aortic valve implantation (TAVI) using the SAPIEN 3 (Edwards Lifesciences, Irvine, CA) compared to surgical aortic valve replacement (SAVR) in low- and intermediate-risk patients from a Japanese public healthcare payer perspective. Methods A Markov model cost-effectiveness analysis was developed. Clinical and utility data were extracted from a systematic literature review. Cost inputs were obtained from analysis of the Medical Data Vision claims database and supplemented with a targeted literature search. The robustness of the results was assessed using sensitivity analyses. Scenario analyses were performed to determine the impact of lower mean age (77.5 years) and the effect of two different long-term mortality hazard ratios (TAVI versus SAVR: 0.9–1.09) on both risk-level populations. This analysis was conducted according to the guidelines for cost-effectiveness evaluation in Japan from Core 2 Health. Results In intermediate-risk patients, TAVI was a dominant procedure (TAVI had lower cost and higher effectiveness). In low-risk patients, the incremental cost effectiveness ratio (ICER) for TAVI was ¥750,417/quality-adjusted-life-years (QALY), which was below the cost-effectiveness threshold of ¥5 million/QALY. The ICER for TAVI was robust to all tested sensitivity and scenario analyses. Conclusions TAVI was dominant and cost-effective compared to SAVR in intermediate- and low-risk patients, respectively. These results suggest that TAVI can provide meaningful value to Japanese patients relative to SAVR, at a reasonable incremental cost for patients at low surgical risk and potentially resulting in cost-savings in patients at intermediate surgical risk.

Telemedicine has great potential to overcome geographical barriers to providing access to equal health care services, particularly for people living in remote and rural areas in developing countries like Bangladesh. A number of telemedicine systems have been implemented in Bangladesh. However, no significant studies have been conducted to determine either their cost effectiveness or efficiency in reducing travel time required by patients. In addition, very few studies have analyzed the attitude and level of satisfaction of telemedicine service recipients in Bangladesh. The aim of this study was to analyze the cost and time effectiveness of a telemedicine service, implemented through locally developed PC based diagnostic equipment and software in Bangladesh, compared to conventional means of providing those services. The study revealed that the introduced telemedicine service reduced cost and travel time on average by 56% and 94% respectively compared to its counterpart conventional approach. The study also revealed that majority of users were highly satisfied with the newly introduced telemedicine service. Therefore, the introduced telemedicine service can be considered as a low cost and time efficient health service solution to improve health care facilities in the remote rural areas in Bangladesh.

Chapter 16 gives an overview of cost-effectiveness and cost-benefit analysis. Every year millions of dollars are spent on food and nutrition intervention programs that are designed to improve health. Given money can always be spent in many different ways leads to a natural question: How effective was the program, relative to how much it cost? There are two standard approaches to answering this question: a cost effectiveness analysis and a cost benefit analysis. The chapter covers the main questions that must be answered in doing either a cost effectiveness or cost benefit analysis. The main formulas in each approach are presented. The pros and cons of each approach are discussed. A hypothetical nutrition intervention program is carried throughout to provide context for the discussion.

Cost-effectiveness estimates of the Mwanza sexually transmitted diseases intervention

3131 Background: Neurotrophic tyrosine receptor kinase (NTRK) gene fusions are oncogenic drivers in many solid tumors. With the inclusion of the targeted drug Entrectinib in China's national reimbursement drug list, the demand for NTRK testing has also increased. This study evaluates the cost-effectiveness of a two-step testing strategy (initial pan-TRK IHC testing followed by next-generation sequencing (NGS) confirmation for positive results) compared to directly conducting NGS testing, with treatment of positive cases using Entrectinib. Methods: A decision tree model was established from a health system perspective, based on clinical practices in China. The study included 17 cancer types as reported in the latest clinical trial of Entrectinib (n = 194). Diagnostic performance data were sourced from literature and validated by pathologists and clinicians. Clinical efficacy, treatment phase costs, and utility for progression-free survival (PFS) were obtained from open databases and literature. Turnaround time and costs for testing was gathered from expert interviews. The time horizon was set to include the duration of NTRK testing and the period of PFS associated with the medication. A one-way sensitivity analysis was conducted to assess the model's robustness. Results: In China, the NGS testing alone produced 0.55507 life years (LY) and 0.42646 quality-adjusted life years (QALY) at a total cost of $5932.57，whereas the pan-TRK IHC + NGS testing strategy yielded 0.55530 LY and 0.42665 QALY at a total cost of $4176.67. The pan-TRK IHC+NGS testing strategy was dominant, offering higher QALY at lower costs than NGS testing alone. Additionally, the average wait time for pan-TRK IHC + NGS testing was reduced by 10 days. The robustness of the base case results was confirmed through sensitivity analysis. Conclusions: Initial pan-TRK IHC testing, followed by NGS confirmation for positive results, is the optimal strategy for NTRK fusion detection in patients with locally advanced or metastatic solid tumors in China, providing superior cost-effectiveness compared to NGS testing alone. Cost-effectiveness analysis results. Testing Total Cost(USD$) Effectiveness (LYs) Effectiveness(QALY) Incremental cost ($) Incremental QALYs ICER (Cost/QALY) NGS $5932.57 0.55507 0.42646 pan-TRK IHC +NGS was dominant pan-TRK IHC+NGS $4176.67 0.55530 0.42665 -$1755.90 0.000187 ICER: Incremental cost-effectiveness ratio.

Cost effectiveness of midwifery care for women with complex pregnancy – a structured review of the extant literature

Análise de Custo-Efetividade da Sinvastatina versus Atorvastatina na Prevenção Secundária de Eventos Cardiovasculares no Sistema Único de Saúde Brasileiro

Age-related macular degeneration (AMD) is a leading cause of blindness in people aged ≥50 years. Wet AMD in particular has a major impact on patient quality of life and imposes substantial burdens on healthcare systems. This systematic review examined the cost-effectiveness data for current therapeutic options for wet AMD. PubMed and EMBASE databases were searched for all articles reporting original cost-effectiveness analyses of wet AMD treatments. The Centre for Reviews and Dissemination and Cochrane Library databases were searched for all wet AMD health technology assessments (HTAs). Overall, 44 publications were evaluated in full and included in this review. A broad range of cost-effectiveness analyses were identified for the most commonly used therapies for wet AMD (pegaptanib, ranibizumab and photodynamic therapy [PDT] with verteporfin). Three studies evaluated the cost effectiveness of bevacizumab in wet AMD. A small number of analyses of other treatments, such as laser photocoagulation and antioxidant vitamins, were also found. Ranibizumab was consistently shown to be cost effective for wet AMD in comparison with all the approved wet AMD therapies (four of the five studies identified showed ranibizumab was cost effective vs usual care, PDT or pegaptanib); however, there was considerable variation in the methodology for cost-effectiveness modelling between studies. Findings from the HTAs supported those from the PubMed and EMBASE searches; of the seven HTAs that included ranibizumab, six (including HTAs for Australia, Canada and the UK) concluded that ranibizumab was cost effective for the treatment of wet AMD; most compared ranibizumab with PDT and/or pegaptanib. By contrast, HTAs at best generally recommended pegaptanib or PDT for restricted use in subsets of patients with wet AMD. In the literature analyses, pegaptanib was found to be cost effective versus usual/best supportive care (including PDT) or no treatment in one of five studies; the other four studies found pegaptanib was of borderline cost effectiveness depending on the stage of disease and time horizon. PDT was shown to be cost effective versus usual/best supportive care or no treatment in five of nine studies; two studies showed that PDT was of borderline cost effectiveness depending on baseline visual acuity, and two showed that PDT was not cost effective. We identified no robust studies that properly evaluated the cost effectiveness of bevacizumab in wet AMD.

Prescribing and cost analysis of treatments of cutaneous fungalinfections

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

Recommendations on the Use of Open Surgical and Endovascular Aneurysm Repair for the Management of Unruptured Abdominal Aortic Aneurysm from the Guideline Development Committee Appointed by the UK National Institute for Health and Care Excellence