In our propensity matched analysis, the results were similar. In the first year after treatment, the total costs among patients who received radiation were significantly lower than those who received surgery (RR=0.97, 95% CI 0.94-1.0, p=0.025). In Years 3 – 5, the total costs among patients who received radiation were significantly higher than those who received surgery (<0.05 for all, Table 5). Inpatient visits, same day surgeries and emergency department visit costs were significantly lower in men treated with radiation in Year 1 (p<0.0001 for all). In Years 2 to 5, these costs became significantly higher in the radiation group (p<0.0001 for all). Ontario Drug Benefit costs were higher for all years in the radiation group relative to the surgery group (Table 5). By Year 5, outpatient cancer management costs were significantly lower in men who received radiation compared to surgery (RR=0.78 (0.67 – 0.9, p<0.002).
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costs were first converted to USD based on official yearly average exchange rates for the period during which the costs were incurred and for purchasing power parity for International Dollar costs using the World Bank purchas- ing power parity index [19, 20]. All costs are reported in 2012 USD. Both financial and economic costs were esti- mated in order to calculate the value of donated inputs as well as the actual financial implications of the interven- tion. Financial costs represent purely monetary flows, while economic costs represent the value (opportunity cost) of all resources necessary to implement a given inter- vention. However, in the case of this study no substantial donated items were used and few capital goods were used and as such the differences between financial and eco- nomic costs were negligible and only economic costs are presented here. The provider perspective was used; travel or time costs to recipients of the intervention were not included, nor were other household-level costs or cost savings. Household-level cost-savings due to averted need for malaria case management among intervention bene- ficiaries may have occurred. Household costs for the intervention were believed to be negligible given that the intervention is provided at no charge directly at household level and the drugs administered have very low risk of ser- ious side effects that would require any medical interven- tion. Cost savings due to reduced treatment at the health facility were modelled based on existing literature on the cost of treatment of uncomplicated malaria cases at health
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Costs-to-charge ratios were used to calculate anesthesia, pathology, radiology, and laboratory charges. Average OR cost and average cost of hospitalization were calculated. The calculation of costs did not include fixed hospital costs, including the purchasing and amortization of the robot. The incremental cost-effectiveness ratio (ICER), which represents the cost to find each additional unknown primary, was cal- culated to be $8,619 for sequential tonsillectomy and TORS, and $5,774 for simultaneous EUA, tonsillectomy, and TORS. By identifying the primary tumor site, post-operative radia- tion may be avoided or at least limited in its field, further reducing the overall cost of treatment. 10
Rheumatoid arthritis imposes a considerable disease burden to the affected population. Patients with RA have substantially lower quality of life than the general population. In the absence of a cure for the disease and the use of potentially toxic drugs, quality-of-life assessment and economic evaluation of treatment seem to have an important place in treatment decision making. Since it is a non-curable disease, treatment of RA continues for a prolonged period of time, and it is very important to assess the direct medical cost of treatment of RA to get an idea about the economic burden imposed to the patients due to the disease and to optimize the treatment with respect to cost of treatment and effectiveness. Moreover, the medications used in the treatment of RA are potentially toxic and are liable to produce serious adverse effects. So evaluation of treatment outcome, both beneficial and adverse, will help physician in judicious prescribing of medicines to each patients that will be safe, effective and cost effective. RA is more prevalent in females than in males. In Countries like India, ladies are less often taking advantage of doing professional activities. So, it is not relevant in taking the indirect costs like absence from duties, early retirements etc.
BSC and hospice care are necessary in all strategies because of the lack of ideal replacement therapy after R/M HNSCC using ﬁ rst-line Pt-based chemotherapy and the high mortality of R/M HNSCC (>80%) over 2 years of treatment. BSC and hospice care costs were obtained from studies on immune checkpoint inhibitors for different diseases in the China and US. 7,8,11 Clinically, SAEs of grades III or IV degree mainly indicate neutropenia, and the cost of treatment for drug intervention must be considered. The cost of treatment for SAEs refers to the research of Joanne L. Yu et al in the US and Wu Bin et al in China. 7,12 The costs in the model are shown in US dollars based on the 2018 exchange rate (6.6174 yuan/US dollar) and discounted at a discount rate of 3%.
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The cost estimate for each treatment strategy was calculated by the episode of care. In this study, the episode of care was defined as an estimate of the direct medical cost that was required for different treatment modalities, plus the cost of EUAs until the patient reached clinical remission. Estimates are meant to represent the direct hospital charge for the average patient within each treatment category. Cost data for each procedure was collected from the Department of Revenue Cycle Services at Jackson Memorial Hospital and Department of Billing and Collections at Bascom Palmer Eye Institute. The cost of treatment by planned enucleation includes the cost of surgery and hospital visits; focal laser therapy includes the cost of EUAs with focal laser treatment and hospital visits; chemotherapy includes the cost of hospital visits as well as therapy; chemotherapy and planned enucleation includes chemotherapy, surgery, and hospital visits; intra-arterial melphalan treatment includes one EUA and unilateral and bilateral melphalan treatments (including one, three, and six cycles of melphalan).
The cost of pharmaceutical treatment for a given disease/patient in general comprises of an obvious part, i.e. the cost of the medication per se, or in simple words, the “price on the box”, as well as of a less obvious part, which refers to the costs of administration of the drug and the management of potential side ef- fects. The issue of non-drug costs of pharmaceutical treatments is more pro- nounced in a number of severe and life-threatening diseases, such as neoplasms or autoimmune diseases, where the administration of medications follows an in- travenous pathway. In such cases, the need of healthcare resource use, such as the time spent within the facility, the time of the staff to overview the procedure the required capital costs to build and maintain infusion facilities and other sig- nificant parameters (healthcare professional time, waiting times, productivity loss, patient time in the hospital, duration of the treatment) can result to signifi- cant costs for the patients, healthcare system and providers  . As a result, it is important to take into consideration the drug administration costs to ration- alize resource allocation decisions and improve cost-effectiveness .
Comparing our results with a previous parallel cost- effectiveness analysis of pregabalin for chronic low back pain with a NeP component 16 implied a difference in potential treatments between the two pain conditions. Despite similar QALYs of the pregabalin groups in two analyses (cervical pain: 0.763 versus low back pain: 0.766), the incremental QALYs gained by pregabalin-con- taining treatments were larger in the present analysis than in the low back pain analysis (0.036 versus 0.014, respec- tively), re ﬂ ecting the slightly lower QALYs in the usual care group in the present analysis (0.727 versus 0.752, respectively). These results suggest that patients with chronic cervical pain with a NeP component may be more dif ﬁ cult to manage without pregabalin, compared with those with low back pain with a NeP component. One possible explanation is that relative to chronic low back pain, which often involves both nociceptive and neuropathic pain mechanisms (that is, mixed pain 37 ) for which a combination of medications for both pain types is suggested, 38,39 mixed pain may be less likely among patients with chronic cervical pain, and thus there may have been fewer patients who bene ﬁ ted from medications for nociceptive pain such as NSAIDs. Considering these, once the involvement of NeP is identi ﬁ ed in patients with chronic neck pain, physicians may ﬁ rst need to consider prescribing pregabalin because otherwise, pain control may be dif ﬁ cult to achieve.
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requirements of one of the main European health technol- ogy agencies. However, the study has some limitations. One limitation is that only the direct costs of the disease and its treatment were analyzed, since the associated indir- ect costs should be taken into account in patients with FLT3-AML, especially those who relapse or receive HSCT. Although, according to economic evaluation guide- lines, the social perspective is the most appropriate, 7 the perspective most commonly used in GENESIS reports 8 and in the cost-effectiveness analyses published for other drugs indicated for hematologic neoplasms in Spain 29,30 is that of the Spanish National Health System. Another lim- itation is the lack of quality of life results in patients treated with midostaurin or the comparator, which forced us to use utility values collected from the literature. However, in a sensitivity analysis in which the utility associated with relapse was reduced, the results of the ICUR were more favorable than those observed in the base case. Finally, our analysis considered that the toxicity pro ﬁ le of midostaurin was similar to that of the compara- tor. Therefore, data on adverse events were not included. However, NICE considered it important to take into account the adverse events derived from HSCT, given that certain events, such as graft-versus-host disease, could have a signi ﬁ cant impact on the results. Further research on this area is needed to ascertain the economic implications of HSCT-related adverse events.
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Figure 1 presents the model structure for the BoNT-A and BSC arms, which was informed by consultation with clinical experts. In the BoNT-A arm, patients with CD starting active treatment are divided into two health states: “no response” or “response.” Response was defined as an improvement in TWSTRS from baseline of at least 20% at week 4 or 8 or 12, in the base case (higher improvement in TWSTRS from baseline ( ≥ 30%) has been tested as part of alternative scenario analysis). Owing to unavailability of data, it was assumed that patients not responding to the initial injection do not achieve response in subsequent injection cycles. Similarly, patients who respond to the initial injection are assumed not to develop secondary nonresponse. Accordingly, only the first injection cycle determines the number of responding and nonresponding patients throughout the model. In an alternative scenario, the model assumed that nonresponders could achieve response with subsequent reinjections given at higher doses. Before treatment discontinuation, nonre- sponders are allowed up to six BoNT-A reinjections (with electromyographic or ultrasound guidance) before moving to BSC. Initial responders were allowed to receive up to
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Notes: simulated patients can transit between disease states in the direction shown by the arrow. “Fractured” is a temporary state and denotes patients with an existing osteoporotic hip, vertebral, or wrist fracture. All patients were simulated until “Death”. Osteoporos int. screening for and treat ment of osteoporosis: construction and validation of a state-transition microsimulation cost-effectiveness model. 26 (5) 2015:1477–1489. © international Osteoporosis Foundation and national Osteoporosis Foundation 2014. With permission of springer. 14
This study used data from the U.S. Schizophrenia Care and Assessment Program (US-SCAP), a large, nonrand- omized, naturalistic, 3-year prospective, multi-site study conducted between July 1997 and September 2003. The goal of US-SCAP was to understand the treatment of patients with schizophrenia in usual care settings. Briefly, participants were enrolled from 6 regional sites (Califor- nia, Colorado, Connecticut, Florida, Maryland, and North Carolina) and diverse systems of care, including commu- nity mental health centers, university health care systems, the Department of Veterans Affairs Health Services (VA), and community and state hospitals. Participants were diagnosed with schizophrenia, or schizoaffective or schiz- ophreniform disorder, based on DSM-IV criteria and were at least 18 years of age. Individuals were excluded from the study if they were unable to provide informed consent or had participated in a clinical drug trial within 30 days prior to enrollment. Further details regarding US-SCAP are available elsewhere [15,27,28].
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The major part of the cost of treatment is that of alpha inteferon, whilst the standard chemotherapy costs are very small at between £100 and £200 and have been ignored for this analysis. Using the MRC dosages, theoretical costs of alpha interferon would be £6,666; one Trust has reported actual costs to average about £10,000 per annum, which is an ongoing annual cost. This actual figure of £10,000 per annum has been used in the analysis presented in this Guidance Note.
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The total economic cost of alcohol-related accident and injuries in Indonesia 2016 was estimated at approximately IDR 895 billion or US$ 67 million as shown in Table 3. This represents 0.01% of GDP Indonesia. In this finding we highlighted that the indirect cost outweigh the direct cost, representing as amount as IDR 661 million (74%) of the total cost. The largest proportion was cost of premature mortality, IDR 660,090 million (73.8% of the total cost), and the rest of indirect cost was loss income due to disability, accounted for IDR 925 million (0.1%). In term of direct cost, treatment costs were shown to be the largest portion of direct cost with the estimated value was IDR174,309 million (19.5%), followed by estimation of material losses was IDR 19,812 million (2.2%) and transportation cost IDR 1,887 million (0.2%) (Table 4).
as follows: costs for the general practitioner (GP), mental health care institute, psychiatrist/psychologist at an outpatient center or hospital, occupational health care, medical special- ist, paramedic care provider, social worker, consultation for alcohol/drugs, alternative treatment, self-help care, admis- sion to part-time day care, (psychiatric) hospital admission, and medication. These costs were taken into account as they are part of the validated instrument. The CPN was the care manager in the CC group and was therefore important for our analysis. The unit price estimation was based on gross wages per year, working hours, session length of 1 hour, prepara- tion of written reports, overheads, bonuses, and training. The amount of care provided by the CPN was recorded using a separate question about resource use. The indirect costs con- sidered were household and informal costs. The inclusion of productivity costs related to paid work is especially relevant when the intervention is targeted at patients of working age. Due to the high age of the study population, we could reason- ably expect cost-effectiveness outcomes to be unaffected by productivity costs, and therefore they could be ignored even when adopting a societal perspective. 44 However, the costs
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A four-month non-inferior first-line TB regimen is likely to be cost saving or cost-effective in many country settings. This benefit is more marked in middle income countries, like South Africa and Brazil, where health service delivery costs are higher. Adherence to TB treatment guidelines is a key determinant of cost-effectiveness when considering the introduction of shortened regimens. In low income countries, like Tanzania and Bangladesh, drug price is likely to be critical for cost-effectiveness. In terms of the post- 2015 global TB targets, the most notable benefit of short- ened regimens is to reduce the economic burden on households. In reaching these conclusions, we adopted an approach that considers individual and health service util- isation characteristics as well as societal costs using country-specific information, allowing us to tailor the ana- lysis and conclusions to specific ‘real world’ settings.
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and AE) are varied simultaneously, the result is –£81,885, with racecadotril remaining the dominant treatment strategy. Varying deterministic base case estimates by 20% (constrained by maximum and minimum values) shows that the model is most sensitive to the QoL estimate of a “well” person. The value is taken from a UK national survey com- missioned by the Department of Health and published as a working paper by the Centre for Health Economics, York University. 39 A total of 3395 adults in the UK were inter-
Methods: This study assessed the cost-effectiveness of entecavir versus adefovir, from a US payer perspective, in CHB patients with decompensated cirrhosis, using a health-state transition Markov model with four health states: hepatocellular carcinoma (HCC), HCC-free survival, post- liver transplant, and death. The model considered a hypothetical patient population similar to that included in a randomized controlled trial in the target population (ETV-048): predominantly male (74%), Asian (54%), mean age 52 years, hepatic decompensation (Child–Pugh score $ seven), hepatitis B e antigen-positive or -negative, treatment-naïve or lamivudine-experienced, and no liver transplant history. Clinical inputs were based on cumulative safety results for ETV-048 and published literature. Costs were obtained from published literature. Costs and outcomes were discounted at 3% per annum.
BPH. It is important to understand the trends in utilization that impact the treatment patterns for BPH and the conse- quent cost-effectiveness. While medical therapy is a common first-line treatment option for mild-to-moderate voiding symptoms, TURP had been the main form of BPH surgi- cal treatment for many years and remained a standard for improvements in urinary function to which other therapies were compared. Both pharmacological and technical inter- ventions for BPH have continued to evolve as clinicians learn more about the disease. The thermal therapies (transurethral microwave thermotherapy [microwave-generated] and TUNA [RF-generated conductive heating; e.g., Prostiva]) and laser procedures (e.g., Greenlight PVP) as less morbid alternatives to TURP were associated with significant revival of interest in BPH interventions. Laser procedures have similar efficacy in symptom relief to TURP. As reported in several sources, the consequence of the newer therapeutic options was a steady decline in TURP procedures while laser vaporization increased steadily. 69–71 PVP serves as an alternative to TURP
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Currently, in Spain, patients with r/r ALL receive sal- vage chemotherapy in order to achieve a CR that allows HSCT and, therefore, this therapeutic intervention has been considered as the comparator. However, in clinical practice, a high proportion of patients treated with salvage chemotherapy do not achieve CR, do not have a compa- tible donor, die before being able to receive HSCT or develop complications during salvage chemotherapy that contraindicate the HSCT realization. For this reason, in the cost estimates of the comparator, the proportion of patients receiving HSCT observed in the same study that was used as a source of effectiveness data was considered. 22 Likewise, as the rate of transplantation observed in the clinical trials of tisagenlecleucel (16.58%) was considered, the present study provides a view closer to real clinical practice than previous reports. 37,38 In any case, the sensi- tivity analysis of the present study showed that neither variations in the proportion of transplanted patients or the cost of HSCT had a signi ﬁ cant impact on the results.
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