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Análise da relação custo-efetividade do tratamento com DCI - Desfibrilador Cardioversor Implantável; Cost-effectiveness analysis of implantable cardioverter defibrillator therapy (ICD)

Matos, Afonso José de
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 23/03/2007 PT
Relevância na Pesquisa
66.31%
Objetivo: Análise da relação custo-efetividade do tratamento com o uso do DCI - Desfibrilador Cardioversor Implantável comparado com o tratamento clínico alternativo através de medicamentos. Revisão de literatura: O estudo contemplou a revisão da conceituação das técnicas de avaliação econômica e de apropriação de custos de procedimentos hospitalares, bem como experiências sobre a análise da relação custo-efetividade aplicadas às intervenções médicas consideradas na pesquisa. Métodos: O estudo utilizou a unidade de Custo por AVG - Ano de Vida Ganho, como expressão do indicador de custo-efetividade. A metodologia compreendeu a definição da perspectiva da pesquisa (Sistema Único de Saúde na qualidade de principal financiador do implante de DCIs, no Brasil), elaboração dos protocolos padrões de tratamento, cálculo dos custos totais dos tratamentos baseados em indicadores praticados por hospitais de referência, os quais encontram-se estimados para o período de dez anos e ajustados para valor presente à taxa de desconto de 6% ao ano. No âmbito da efetividade, foram utilizados parâmetros da literatura, os quais encontram-se baseados nos anos de vida ganhos do tratamento com o uso do DCI, em relação ao tratamento clínico. Resultados: O custo por AVG alcançado pelo estudo foi de R$ 20.530...

Estudo comparativo entre os métodos percutâneo e cirúrgico no tratamento da comunicação interatrial do tipo ostium secundum em crianças e adolescentes: análise da segurança e eficácia clínica e do custo-efetividade incremental; Comparative study of percutaneous vs surgical treatment of Ostium Secundum Atrial Septal Defects in children and adolescents: analysis of clinical safety and efficacy and incremental cost-effectiveness

Costa, Rodrigo Nieckel da
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 10/12/2014 PT
Relevância na Pesquisa
66.27%
Introdução: As comunicações interatriais do tipo ostium secundum (CIA-OS) são tratadas por fechamento percutâneo (FP) ou intervenção cirúrgica (IC). Estudos comparando ambos métodos são escassos e avaliações de custo-efetividade inexistem na literatura nacional. Objetivos: Realizar uma avaliação da segurança e eficácia (ASE) clínica seguida de uma análise de custo-efetividade (ACE) incremental comparando o FP e IC sob a perspectiva do Sistema Único de Saúde (SUS). Materiais e métodos: ASE - Estudo observacional, não randomizado de 2 coortes de crianças e adolescentes < 14 anos com CIA-OS tratadas por FP ou IC. A coleta dos dados foi prospectiva no FP e retrospectiva no IC. ACE - Realizada revisão sistemática de estudos clínicos disponíveis no MEDLINE e a Cochrane Central. Estudos com mais de 50 pacientes e com idade média abaixo de 14 anos foram incluídos. A análise foi baseada em uma árvore de decisão computando os custos e consequências no longo prazo de ambas as opções. Foi utilizado valor da prótese de R$ 16.000 e estipulado valor de honorário médico de R$ 2.355. A efetividade foi estimada em anos de vida. A avaliação utilizou uma taxa de desconto de 5% ao ano e uma disposição a pagar de 3 vezes o PIB per capita no Brasil (63.000). Análises de limiares também foram conduzidas. Resultados: ASE - De Abr/09 a Out/11 foram alocados 75 pacientes (pts) no FP e entre Jan/06 e Jan/11 105 pts na IC. A idade e o peso foram maiores no FP e o diâmetro da CIA foi semelhante entre os grupos. Sucesso técnico foi observado em todos os procedimentos e não houve óbitos. Complicações (a maioria menores) foram encontradas em 68% na IC e em 4% do FP (p<0...

Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)

Guedes,Ricardo Augusto Paletta; Guedes,Vanessa Maria Paletta; Chaoubah,Alfredo
Fonte: Conselho Brasileiro de Oftalmologia Publicador: Conselho Brasileiro de Oftalmologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2012 EN
Relevância na Pesquisa
66.3%
PURPOSE: Non-penetrating deep sclerectomy (NPDS) has emerged as a viable option in the surgical management of open-angle glaucoma. Our aim is to assess the cost-effectiveness of NPDS and to compare it to maximum medical treatment in a 5-year follow-up. METHODS: A decision analysis model was built. Surgical (NPDS) arm of the decision tree was observational (consecutive retrospective case series) and maximum medical treatment arm was hypothetical. Maximum medical therapy was considered a three-drug regimen (association of a fixed combination of timolol/dorzolamide [FCTD] and a prostaglandin analogue [bimatoprost, latanoprost or travoprost]). Cost-effectiveness ratio was defined as direct cost (US dollars) for each percentage of intraocular pressure (IOP) reduction. Horizon was 5 years and perspective is from the public health care service in Brazil (SUS). Incremental cost-effectiveness ratio (ICER) was calculated. RESULTS: Direct cost for each percentage of IOP reduction in 5 years (cost-effectiveness ratio) was US$ 10.19 for NPDS; US$ 37.45 for the association of a FCTD and bimatoprost; US$ 39.33 for FCTD and travoprost; and US$ 41.42 for FCTD and latanoprost. NPDS demonstrated a better cost-effectiveness ratio, compared to maximum medical therapy. The ICER was negative for all medical treatment options; therefore NPDS was dominant. CONCLUSIONS: Despite some limitations...

Different approaches to modelling the cost-effectiveness of schistosomiasis control

Guyatt,Helen
Fonte: Instituto Oswaldo Cruz, Ministério da Saúde Publicador: Instituto Oswaldo Cruz, Ministério da Saúde
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/1998 EN
Relevância na Pesquisa
66.27%
This paper reviews three different approaches to modelling the cost-effectiveness of schistosomiasis control. Although these approaches vary in their assessment of costs, the major focus of the paper is on the evaluation of effectiveness. The first model presented is a static economic model which assesses effectiveness in terms of the proportion of cases cured. This model is important in highlighting that the optimal choice of chemotherapy regime depends critically on the level of budget constraint, the unit costs of screening and treatment, the rates of compliance with screening and chemotherapy and the prevalence of infection. The limitations of this approach is that it models the cost-effectiveness of only one cycle of treatment, and effectiveness reflects only the immediate impact of treatment. The second model presented is a prevalence-based dynamic model which links prevalence rates from one year to the next, and assesses effectiveness as the proportion of cases prevented. This model was important as it introduced the concept of measuring the long-term impact of control by using a transmission model which can assess reduction in infection through time, but is limited to assessing the impact only on the prevalence of infection. The third approach presented is a theoretical framework which describes the dynamic relationships between infection and morbidity...

The Cost-Effectiveness of Tuberculosis Preventive Therapy for HIV-Infected Individuals in Southern India: A Trial-Based Analysis

Pho, Mai T.; Swaminathan, Soumya; Kumarasamy, Nagalingeswaran; Ponnuraja, C.; Uhler, Lauren M.; Scott, Callie A.; Losina, Elena; Mayer, Kenneth Hugh; Freedberg, Kenneth Alan; Walensky, Rochelle P.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
66.27%
Background: Regimens for isoniazid-based preventive therapy (IPT) for tuberculosis (TB) in HIV-infected individuals have not been widely adopted given concerns regarding efficacy, adherence and drug resistance. Further, the cost-effectiveness of IPT has not been studied in India. Methods We used an HIV/TB model to project TB incidence, life expectancy, cost and incremental cost-effectiveness of six months of isoniazid plus ethambutol (6EH), thirty-six months of isoniazid (36H) and no IPT for HIV-infected patients in India. Model input parameters included a median CD4 count of 324 cells/mm(^3), and a rate ratio of developing TB of 0.35 for 6EH and 0.22 for 36H at three years as compared to no IPT. Results of 6EH and 36H were also compared to six months of isoniazid (6H), three months of isoniazid plus rifampin (3RH) and three months of isoniazid plus rifapentine (3RPTH). Results: Projected TB incidence decreased in the 6EH and 36H regimens by 51% and 62% respectively at three-year follow-up compared to no IPT. Without IPT, projected life expectancy was 136.1 months at a lifetime per person cost of $5,630. 6EH increased life expectancy by 0.8 months at an additional per person cost of $100 (incremental cost-effectiveness ratio (ICER) of $1...

Examining Methods Used to Evaluate the Cost-Effectiveness of Childhood Obesity Interventions

Wright, Davene
Fonte: Harvard University Publicador: Harvard University
Tipo: Thesis or Dissertation
EN_US
Relevância na Pesquisa
66.3%
This dissertation examines methods used to evaluate the cost-effectiveness of childhood obesity interventions in order to help decision-makers prioritize among competing health programs using standardized outcomes. Chapter 1 generates inputs for use in cost-effectiveness analyses (CEAs) of childhood obesity interventions. In Chapter 1.1, I use data from the Medical Expenditure Panel Survey to predict expenditures associated with obesity in childhood and adolescence. I found that obese children and adolescents have significantly different expenditures than their normal weight counterparts. I conclude that exclusion of obesity-related medical expenditures can potentially undervalue the cost-effectiveness of interventions. In Chapter 1.2, I use data from the Study of Early Child Care and Youth Development to examine the longitudinal trajectory of child weight. I derived probabilities of transitioning between weight classes that can be used in a decision-analytic model to extrapolate the effectiveness of childhood obesity interventions beyond childhood. I found that deviating from CDC BMI reference categories can more accurately capture the risk of future obesity. In Chapter 2, I evaluate the cost-effectiveness of a primary care-based obesity prevention program...

Cost-Effectiveness of Genotype Testing for Primary Resistance in Brazil

Luz, Paula M.; Morris, Bethany L.; Grinsztejn, Beatriz; Freedberg, Kenneth A.; Veloso, Valdilea G.; Walensky, Rochelle P.; Losina, Elena; Nakamura, Yoriko M.; Girouard, Michael P.; Sax, Paul E.; Struchiner, Claudio J.; Paltiel, A. David
Fonte: JAIDS Journal of Acquired Immune Deficiency Syndromes Publicador: JAIDS Journal of Acquired Immune Deficiency Syndromes
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
66.27%
Objective: HIV genotype-resistance testing can help identify more effective antiretroviral treatment (ART) regimens for patients, substantially increasing the likelihood of viral suppression and immune recovery. We sought to evaluate the cost-effectiveness of genotype-resistance testing before first-line ART initiation in Brazil. Design: We used a previously published microsimulation model of HIV disease (CEPAC-International) and data from Brazil to compare the clinical impact, costs, and cost-effectiveness of initial genotype testing (Genotype) with no initial genotype testing (No genotype). Methods: Model parameters were derived from the HIV Clinical Cohort at the Evandro Chagas Clinical Research Institute and from published data, using Brazilian sources whenever possible. Baseline patient characteristics included 69% male, mean age of 36 years (SD, 10 years), mean CD4 count of 347 per microliter (SD, 300/µL) at ART initiation, annual ART costs from 2012 US $1400 to US $13,400, genotype test cost of US $230, and primary resistance prevalence of 4.4%. Life expectancy and costs were discounted 3% per year. Genotype was defined as “cost-effective” compared with No Genotype if its incremental cost-effectiveness ratio was less than 3 times the 2012 Brazilian per capita GDP of US $12...

Where to Use Cost Effectiveness Techniques Rather Than Cost Benefit Analysis

Mackie, Peter; Nellthorp, John; Laird, James
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Relevância na Pesquisa
66.33%
Cost Benefit Analysis, and the measures of economic performance that can be derived from it (see Note 6: When and How to Use NPV, IRR and Adjusted IRR), is the preferred method for demonstrating the economic justification of transport investments. Such an approach, however, relies on the ability to be able to measure costs and benefits in monetary terms (see Note 5: Framework), which renders it problematic for projects where the majority of benefits cannot be readily monetised. Such a project could be a Low Volume Rural Road (see Note 21: Low Volume Rural Roads). In such situations consideration should be given to the use of measures derived from cost effectiveness or weighted cost effectiveness (also known as Multi Criteria Analysis) techniques as the basis for the decision regarding whether to invest or not. Cost effectiveness techniques are also a very useful tool for project screening or ranking. Such a screening process ensures that projects that are subjected to a more detailed analysis (including cost benefit analysis) are those that best fit with the objectives of the investment (e.g. poverty alleviation). Section 1 of this note outlines the situations in which cost effectiveness techniques should be used...

Cost-Effectiveness Measurement in Development : Accounting for Local Costs and Noisy Impacts

Evans, David K.; Popova, Anna
Fonte: World Bank Group, Washington, DC Publicador: World Bank Group, Washington, DC
EN_US
Relevância na Pesquisa
66.34%
As evidence from rigorous impact evaluations grows in development, there have been more calls to complement impact evaluation analysis with cost analysis, so that policy makers can make investment decisions based on costs as well as impacts. This paper discusses important considerations for implementing cost-effectiveness analysis in the policy making process. The analysis is applied in the context of education interventions, although the findings generalize to other areas. First, the paper demonstrates a systematic method for characterizing the sensitivity of impact estimates. Second, the concept of context-specificity is applied to cost measurement: program costs vary greatly across contexts -- both within and across countries -- and with program complexity. The paper shows how adapting a single cost ingredient across settings dramatically shifts cost-effectiveness measures. Third, the paper provides evidence that interventions with fewer beneficiaries tend to have higher per-beneficiary costs, resulting in potential cost overestimates when extrapolating to large-scale applications. At the same time...

Function after spinal treatment, exercise, and rehabilitation: Cost-effectiveness analysis based on a randomized controlled trial

Morris, Stephen; Morris, Tim P.; McGregor, Alison H.; Dore, Caroline J.; Jamrozik, Konrad
Fonte: Lippincott Williams & Wilkins Publicador: Lippincott Williams & Wilkins
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
Relevância na Pesquisa
66.27%
Study Design. Cost-effectiveness analysis alongside a factorial randomized controlled trial. Objective. To assess the cost-effectiveness of a rehabilitation program and/or an education booklet each compared with usual care for the postoperative management of patients undergoing discectomy or lateral nerve root decompression surgery. Summary of Background Data. There is little knowledge about the cost-effectiveness of postoperative management of patients after spinal surgery. Methods. A total of 338 patients were recruited into the study between June 2005 and March 2009. Patients were randomized to rehabilitation only, booklet only, rehabilitation plus booklet, or usual care only. Interactions between booklet and rehabilitation were nonsignificant; hence, we compare booklet versus no booklet and rehabilitation versus no rehabilitation. We adopt an English National Health Service and personal social services perspective. Data on outcomes and costs are based on patient level data from the trial. A 1-year time horizon was used. Outcomes were measured in terms of quality-adjusted life years. Health-related quality of life was reported by patients using the EuroQol-5D (EQ-5D). A comprehensive range of health service contacts were included in the cost analysis. Results. There were no significant differences in costs or outcomes associated with either intervention. Mean incremental costs and mean quality-adjusted life years gained per patient of booklet versus no booklet were -£87 (95% CI: -£1221 to £1047) and -0.023 (95% CI: -0.068 to 0.023)...

Cost-effectiveness of tubal patency tests

Verhoeve, H.; Moolenaar, L.; Hompes, P.; van der Veen, F.; Mol, B.
Fonte: Wiley Publicador: Wiley
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
66.27%
Objective: Guidelines are not in agreement on the most effective diagnostic scenario for tubal patency testing; therefore, we evaluated the cost-effectiveness of invasive tubal testing in subfertile couples compared with no testing and treatment. Design: Cost-effectiveness analysis. Setting: Decision analytic framework. Population: Computer-simulated cohort of subfertile women. Methods: We evaluated six scenarios: (1) no tests and no treatment; (2) immediate treatment without tubal testing; (3) delayed treatment without tubal testing; (4) hysterosalpingogram (HSG), followed by immediate or delayed treatment, according to diagnosis (tailored treatment); (5) HSG and a diagnostic laparoscopy (DL) in case HSG does not prove tubal patency, followed by tailored treatment; and (6) DL followed by tailored treatment. Main outcome measures: Expected cumulative live births after 3 years. Secondary outcomes were cost per couple and the incremental cost-effectiveness ratio. Results: For a 30–year-old woman with otherwise unexplained subfertility for 12 months, 3–year cumulative live birth rates were 51.8, 78.1, 78.4, 78.4, 78.6 and 78.4%, and costs per couple were €0, €6968, €5063, €5410, €5405 and €6163 for scenarios 1, 2, 3, 4...

Cost-effectiveness of induction of labour at term with a Foley catheter compared to vaginal prostaglandin E₂ gel (PROBAAT trial); Cost-effectiveness of induction of labour at term with a Foley catheter compared to vaginal prostaglandin E(2) gel (PROBAAT trial)

van Baaren, G.J.; Jozwiak, M.; Opmeer, B.; Oude Rengerink, K.; Benthem, M.; Dijksterhuis, M.; van Huizen, M.; van der Salm, P.; Schuitemaker, N.; Papatsonis, D.; Perquin, D.; Porath, M.; van der Post, J.; Rijnders, R.; Scheepers, H.; Spaanderman, M.; van
Fonte: Wiley Publicador: Wiley
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
66.3%
Objective: To assess the economic consequences of labour induction with Foley catheter compared to prostaglandin E2 gel. Design: Economic evaluation alongside a randomised controlled trial. Setting: Obstetric departments of one university and 11 teaching hospitals in the Netherlands. Population: Women scheduled for labour induction with a singleton pregnancy in cephalic presentation at term, intact membranes and an unfavourable cervix; and without previous caesarean section. Methods: Cost-effectiveness analysis from a hospital perspective. Main outcome measures: We estimated direct medical costs associated with healthcare utilisation from randomisation to 6 weeks postpartum. For caesarean section rate, and maternal and neonatal morbidity we calculated the incremental cost-effectiveness ratios, which represent the costs to prevent one of these adverse outcomes. Results: Mean costs per woman in the Foley catheter group (n = 411) and in the prostaglandin E2 gel group (n = 408), were €3297 versus €3075, respectively, with an average difference of €222 (95% confidence interval −€157 to €633). In the Foley catheter group we observed higher costs due to longer labour ward occupation and less cost related to induction material and neonatal admissions. Foley catheter induction showed a comparable caesarean section rate compared with prostaglandin induction...

Economics of Chronic Diseases Protocol: Cost-effectiveness modelling and the future burden of non-communicable disease in Europe

Divajeva, D.; Marsh, T.; Logstrup, S.; Kestens, M.; Vemer, P.; Kriaucioniene, V.; Peresson, S.; O’Kelly, S.; Rito, A.; Webber, L.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em 16/05/2014 ENG
Relevância na Pesquisa
66.3%
Background: The majority of chronic disease is caused by risk factors which are mostly preventable. Effective interventions to reduce these risks are known and proven to be applicable to a variety of settings. Chronic disease is generally developed long before the fatal outcome, meaning that a lot of people spend a number of years in poor health. Effective prevention measures can prolong lives of individuals and significantly improve their quality of life. However, the methods to measure cost-effectiveness are a subject to much debate. The Economics of Chronic Diseases project aims to establish the best possible methods of measuring cost-effectiveness as well as develop micro-simulation models apt at projecting future burden of chronic diseases, their costs and potential savings after implementation of cost-effective interventions. Method: This research project will involve eight European countries: Bulgaria, Finland, Greece, Lithuania, The Netherlands, Poland, Portugal and the United Kingdom (UK). A literature review will be conducted to identify scientific articles which critically review the methods of cost-effectiveness. Contact will be made health economists to inform and enrich this review. This evidence will be used as a springboard for discussion at a meeting with key European stakeholders and experts with the aim of reaching a consensus on recommendations for cost-effectiveness methodology. Epidemiological data for coronary heart disease...

Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTB/RIF: A Dynamic Simulation and Economic Evaluation

Cohen, Ted; Lin, Hsien-Ho; Menzies, Nicolas Alan; Murray, Megan Blanche; Salomon, Joshua A.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
66.3%
Background: The Xpert MTB/RIF test enables rapid detection of tuberculosis (TB) and rifampicin resistance. The World Health Organization recommends Xpert for initial diagnosis in individuals suspected of having multidrug-resistant TB (MDR-TB) or HIV-associated TB, and many countries are moving quickly toward adopting Xpert. As roll-out proceeds, it is essential to understand the potential health impact and cost-effectiveness of diagnostic strategies based on Xpert. Methods and findings: We evaluated potential health and economic consequences of implementing Xpert in five southern African countries—Botswana, Lesotho, Namibia, South Africa, and Swaziland—where drug resistance and TB-HIV coinfection are prevalent. Using a calibrated, dynamic mathematical model, we compared the status quo diagnostic algorithm, emphasizing sputum smear, against an algorithm incorporating Xpert for initial diagnosis. Results were projected over 10- and 20-y time periods starting from 2012. Compared to status quo, implementation of Xpert would avert 132,000 (95% CI: 55,000–284,000) TB cases and 182,000 (97,000–302,000) TB deaths in southern Africa over the 10 y following introduction, and would reduce prevalence by 28% (14%–40%) by 2022, with more modest reductions in incidence. Health system costs are projected to increase substantially with Xpert...

Mobile HIV Screening in Cape Town, South Africa: Clinical Impact, Cost and Cost-Effectiveness

Bassett, Ingrid V.; Govindasamy, Darshini; Erlwanger, Alison S.; Hyle, Emily P.; Kranzer, Katharina; van Schaik, Nienke; Noubary, Farzad; Paltiel, A. David; Wood, Robin; Walensky, Rochelle P.; Losina, Elena; Bekker, Linda-Gail; Freedberg, Kenneth A.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
66.28%
Background: Mobile HIV screening may facilitate early HIV diagnosis. Our objective was to examine the cost-effectiveness of adding a mobile screening unit to current medical facility-based HIV testing in Cape Town, South Africa. Methods and Findings: We used the Cost Effectiveness of Preventing AIDS Complications International (CEPAC-I) computer simulation model to evaluate two HIV screening strategies in Cape Town: 1) medical facility-based testing (the current standard of care) and 2) addition of a mobile HIV-testing unit intervention in the same community. Baseline input parameters were derived from a Cape Town-based mobile unit that tested 18,870 individuals over 2 years: prevalence of previously undiagnosed HIV (6.6%), mean CD4 count at diagnosis (males 423/µL, females 516/µL), CD4 count-dependent linkage to care rates (males 31%–58%, females 49%–58%), mobile unit intervention cost (includes acquisition, operation and HIV test costs, $29.30 per negative result and $31.30 per positive result). We conducted extensive sensitivity analyses to evaluate input uncertainty. Model outcomes included site of HIV diagnosis, life expectancy, medical costs, and the incremental cost-effectiveness ratio (ICER) of the intervention compared to medical facility-based testing. We considered the intervention to be “very cost-effective” when the ICER was less than South Africa's annual per capita Gross Domestic Product (GDP) ($8...

Costs and Cost-Effectiveness of 9-Valent Human Papillomavirus (HPV) Vaccination in Two East African Countries

Kiatpongsan, Sorapop; Kim, Jane J.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
66.29%
Background: Current prophylactic vaccines against human papillomavirus (HPV) target two of the most oncogenic types, HPV-16 and -18, which contribute to roughly 70% of cervical cancers worldwide. Second-generation HPV vaccines include a 9-valent vaccine, which targets five additional oncogenic HPV types (i.e., 31, 33, 45, 52, and 58) that contribute to another 15–30% of cervical cancer cases. The objective of this study was to determine a range of vaccine costs for which the 9-valent vaccine would be cost-effective in comparison to the current vaccines in two less developed countries (i.e., Kenya and Uganda). Methods and Findings: The analysis was performed using a natural history disease simulation model of HPV and cervical cancer. The mathematical model simulates individual women from an early age and tracks health events and resource use as they transition through clinically-relevant health states over their lifetime. Epidemiological data on HPV prevalence and cancer incidence were used to adapt the model to Kenya and Uganda. Health benefit, or effectiveness, from HPV vaccination was measured in terms of life expectancy, and costs were measured in international dollars (I$). The incremental cost of the 9-valent vaccine included the added cost of the vaccine counterbalanced by costs averted from additional cancer cases prevented. All future costs and health benefits were discounted at an annual rate of 3% in the base case analysis. We conducted sensitivity analyses to investigate how infection with multiple HPV types...

Incorporating patients' characteristics in cost-effectiveness studies with clinical trial data : a flexible Bayesian approach

Vázquez Polo, Francisco José; Negrín Hernández, Miguel Ángel
Fonte: Universidade Autônoma de Barcelona Publicador: Universidade Autônoma de Barcelona
Tipo: Artigo de Revista Científica Formato: application/pdf
Publicado em //2004 ENG
Relevância na Pesquisa
66.29%
Most published research on the comparison between medical treatment options merely compares the results (effectiveness and cost) obtained for each treatment group. The present work proposes the incorporation of other patient characteristics into the analysis. Most of the studies carried out in this context assume normality of both costs and effectiveness. In practice, however, the data are not always distributed according to this assumption. Altervative models have to be developed. In this paper, we present a general model of cost-effectiveness, incorporating both binary effectiveness and skewed cost. In a practical application, we compare two highly active antiretroviral treatments applied to asymptomatic HIV patients. We propose a logit model when the effectiveness is measured depending on whether an initial purpose is achieved. For this model, the measure to compare treatments is the difference in the probability of success. Besides, the cost data usually present a right skewing. We propose the use of the logtransformation to carry out the regression model. The three models are fitted demonstrating the advantages of this modelling. The cost-effectiveness acceptability curve is used as a measure for decision-making.

Cost-effectiveness of self-management of blood pressure in hypertensive patients over 70 years with sub-optimal control and established cardiovascular disease or additional CV risk diseases (TASMIN-SR)

Pe?aloza Ramos, Maria Cristina; Jowett, Sue; Mant, Jonathan; Schwartz, Claire; Bray, Emma P.; Haque, M. Sayeed; Hobbs, F. D. Richard; Little, Paul; Bryan, Stirling; Williams, Bryan; McManus, Richard J.
Fonte: SAGE Publicador: SAGE
Tipo: Article; accepted version
EN
Relevância na Pesquisa
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This is the author accepted manuscript. The final version is available from SAGE via http://dx.doi.org/10.1177/2047487315618784; Background: A previous economic analysis of self-management, that is, self-monitoring with self-titration of antihypertensive mediation evaluated cost-effectiveness among patients with uncomplicated hypertension. This study considered cost-effectiveness of self-management in those with raised blood pressure plus diabetes, chronic kidney disease (CKD) and/or previous cardiovascular disease. Design and methods: A Markov model-based economic evaluation was undertaken to estimate the long-term cost-effectiveness of self-management of blood pressure in a cohort of 70-year old ?high risk? patients, compared with usual care. The model used the results of the TASMIN-SR trial. A cost-utility analysis was undertaken from a UK health and social care perspective, taking into account lifetime costs of treatment, cardiovascular events and quality adjusted life years (QALYs). A sub-group analysis ran the model separately for men and women. Deterministic sensitivity analyses examined the effect of different time horizons and reduced effectiveness of self-management. Results: Base-case results indicated that self-management was cost-effective compared with usual care...

Cost-effectiveness of Interferon Gamma Release Assay (QFT-IT) as a Diagnostic Test for Intraocular Tuberculosis

Chen, Shu
Fonte: Universidade Duke Publicador: Universidade Duke
Tipo: Tese de Doutorado
Publicado em //2014
Relevância na Pesquisa
66.29%

Background:

Interferon Gamma Release Assays (IGRAs) have proven to be potential replacement of tuberculin skin test (TST) in screening and diagnosing tuberculosis as shown by previous health economic studies. Given that these studies all center on pulmonary tuberculosis, we sought to examine the cost-effectiveness of IGRAs, specifically QFT-IT, as a diagnostic test for intraocular tuberculosis among uveitis patients in Singapore.

Method:

A decision tree was constructed to evaluate the cost-effectiveness of the QFT-IT for diagnosing intraocular tuberculosis among uveitis patients over a 30-year horizon. The input data were based on a cohort of 102 patients who presented with symptoms of uveitis and underwent relevant treatment and follow-up visits from 2009 to 2010 at Singapore National Eye Center (SNEC). By calculating their incremental cost-effectiveness ratio, we compared the cost-effectiveness of three strategies: TST alone, QFT-IT alone and TST followed by QFT-IT as a confirmatory test.

Results:

Our results show that in cost terms alone, QFT-IT alone strategy is the most expensive one (889 SGD per person), followed by TST alone (850 SGD per person) and finally the dual strategy (789 SGD per person). While examining effectiveness alone...

Análise custo-efetividade e índice de qualidade da refeição aplicados à Estratégia Global da OMS; Cost-effectiveness analysis and diet quality index applied to the WHO Global Strategy

Machado, Flávia Mori Sarti; Simões, Arlete Naresse
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf
Publicado em 01/02/2008 POR
Relevância na Pesquisa
66.33%
OBJETIVO: Testar o uso da metodologia de análise custo-efetividade como instrumento de decisão na produção de refeições para inclusão das recomendações proferidas na Estratégia Global da Organização Mundial da Saúde. MÉTODOS: Cinco opções alternativas de cardápio de café da manhã foram analisadas previamente à implementação da refeição em unidade de alimentação e nutrição de uma universidade do estado de São Paulo, no ano de 2006. O custo de cada opção baseou-se em preços de mercado dos componentes de custo direto. Os benefícios em saúde foram calculados com base em adaptação do Índice de Qualidade da Refeição (IQR). Foram calculadas a razão custo-efetividade dos cardápios pela divisão dos benefícios pelos custos e a razão custo-efetividade incremental pelo diferencial de custo por unidade de benefício adicional. A escolha considerou unidades de benefício à saúde em relação ao custo direto de produção, assim como a efetividade incremental por unidade de custo diferencial. RESULTADOS: A análise resultou na opção mais simples com adição de uma fruta (IQR=64 e custo=R$1,58) como melhor alternativa. Observou-se maior efetividade das alternativas com uma porção de fruta (IQR1=64 / IQR3=58 / IQR5=72) sobre as demais (IQR2=48 / IQR4=58). CONCLUSÕES: O cálculo da razão custo-efetividade permitiu identificar a melhor opção de café da manhã com base na análise custo-efetividade e Índice de Qualidade da Refeição. Tais instrumentos agregam características de facilidade de aplicação e objetividade de avaliação...