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A Systematic Review of Economic Evaluations of Pharmacogenetic Testing for Prevention of Adverse Drug Reactions.

BACKGROUND: Pharmacogenetics offers the potential to improve health outcomes by identifying individuals who are at greater risk of harm from certain medicines. Routine adoption of pharmacogenetic tests requires evidence of their cost effectiveness. OBJECTIVE: The present review aims to systematically review published economic evaluations of pharmacogenetic tests that aim to prevent or reduce the incidence of ADRs. METHODS: We conducted a systematic literature review of economic evaluations of pharmacogenetic tests aimed to reduce the incidence of adverse drug reactions. Literature was search

Cost-effectiveness of multitarget stool DNA testing for colorectal cancer screening in Chinese primary healthcare settings: a modelling study.

AIM: To evaluate the cost-effectiveness of a one-time mt-sDNA-based colorectal cancer screening program compared with no screening, using real-world data from a government-led population-based screening program in Harbin Municipality of China. METHODS: This modelling study was based on a real-world mt-sDNA CRC screening program in Chinese primary healthcare settings. The program targeted residents aged 45-64 years without a prior history of CRC. A decision analytic model was developed from the healthcare system perspective to compare mt-sDNA screening with a hypothetical no-screening scenario

Cost-Effectiveness of Insulin Degludec vs. Insulin Glargine U100 in Type 1 and Type 2 Diabetes Mellitus in a UK Setting.

BACKGROUND: Understanding which therapeutic innovations in diabetes represent the best value requires rigorous economic evaluation. Data from randomised controlled trials and observational studies indicate that insulin degludec has a hypoglycemia advantage versus insulin glargine 100 units/mL (glargine U100), the most widely prescribed basal insulin analogue in the UK. This analysis was done to more rigorously assess cost-effectiveness in a UK setting. METHODS: Data from two double-blinded, randomised, two-period crossover trials in type 1 (SWITCH 1) and type 2 (SWITCH 2) diabetes mellitus we

A cost-utility analysis of transcatheter versus surgical aortic valve replacement for the treatment of aortic stenosis in the population with intermediate surgical risk.

OBJECTIVE: Although transcatheter aortic valve implantation has been shown to be noninferior to surgical aortic valve replacement in patients with severe aortic stenosis at intermediate surgical risk, the cost-effectiveness of this strategy in this population is unknown. Our objective was to conduct a cost-utility analysis comparing transcatheter aortic valve implantation with surgical aortic valve replacement in the population with intermediate risk severe aortic stenosis. METHODS: A fully probabilistic Markov model with 30-day cycles was constructed from the Canadian third-party payer's per

Cost-effectiveness of RIMS1 methylation-guided gastric cancer surveillance after Helicobacter pylori eradication.

BACKGROUND: The cost-effectiveness of methylation-guided surveillance after Helicobacter pylori eradication remains uncertain. RESEARCH DESIGN AND METHODS: From a healthcare system perspective, a cohort model compared annual, biennial, and RIMS1 methylation-guided surveillance over 30 years in Japanese patients aged 50 years with open-type gastric atrophy. Differences in stage at diagnosis were calibrated from annual-surveillance data. Costs and quality-adjusted life-years (QALYs) were discounted at 3.0% annually. Sensitivity analyses examined uncertainty; an exploratory analysis used Korean

Cost-effectiveness of a proportionate universal offer of free exercise: Leeds Let's Get Active.

BACKGROUND: The purpose of this paper is to assess the cost-effectiveness of a proportionate universal programme to reduce physical inactivity (Leeds Let us Get Active (LLGA)) in adults. METHODS: A continuous-time Markov chain model was developed to assess the cost implications and QALY gains associated with increases in physical activity levels across the adult population. A parametric survival analysis approach was applied to estimate the decay of intervention effect over time. Baseline model data were obtained from previous economic models, population-based surveys and other published lite

Cost and cost-effectiveness of attractive targeted sugar baits (ATSB) in the context of a phase III cluster randomized control trial in Western Province, Zambia.

BACKGROUND: Vector control is the most important malaria prevention strategy in Zambia. Attractive Targeted Sugar Baits (ATSB) are a potential new tool for vector control in this setting, which, if efficacious, would be intended to supplement insecticide-treated bed nets (ITNs) and indoor residual spraying (IRS). ATSBs target and kill sugar feeding mosquitoes, potentially limiting the spread of malaria. No information on the cost or cost-effectiveness of deployment of ATSB stations is currently available. METHODS: A cluster randomized control trial (cRCT) was carried out in Western Province,

Cost-effectiveness of different exercise intensities during oncological treatment in the Phys-Can RCT.

BACKGROUND: Cost-effectiveness is important in the prioritisation between interventions in health care. Exercise is cost-effective compared to usual care during oncological treatment; however, the significance of exercise intensity to the cost-effectiveness is unclear. In the present study, we aimed to evaluate the long-term cost-effectiveness of the randomised controlled trial Phys-Can, a six-month exercise programme of high (HI) or low-to-moderate intensity (LMI) during (neo)adjuvant oncological treatment. METHODS: A cost-effectiveness analysis was performed, based on 189 participants with …

Cost effectiveness of dietary interventions for individuals with mental disorders: A scoping review of experimental studies.

AIM: This scoping review aimed to explore the extent of the evidence of experimental studies evaluating the cost effectiveness of dietary interventions in individuals with mental disorders. METHODS: Five databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Scopus) were searched to October 2020 for cost-analysis studies of interventions aiming to improve dietary intake in people with mental disorders. No restriction was placed on participant age, mental disorder type or intervention design. Results are presented narratively. RESULTS: Of 2753 articles identified, 13 articles reporting on eight stu

Economic evaluation of fractional flow reserve-guided versus angiography-guided multivessel revascularisation in ST-segment elevation myocardial infarction patients in the FLOWER-MI randomised trial.

BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) who have multivessel disease, the FLOWER-MI trial found no significant clinical benefit to fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared to angiography-guided PCI. AIMS: Our aim was to estimate the cost-effectiveness and cost-utility of FFR-guided PCI, the secondary endpoint of the FLOWER-MI trial. METHODS: Costs, major adverse cardiovascular events (composite of all-cause death, non-fatal myocardial infarction [MI], and unplanned hospitalisation leading to urgent revascul

Cost-effectiveness of prenatal screening for postpartum thyroiditis.

Five percent of all pregnant women and 25% of pregnant women with insulin-dependent diabetes mellitus (IDDM) develop postpartum thyroiditis (PPT) during the first year after delivery. PPT has significant morbidity and can be predicted prenatally by the presence of thyroid peroxidase (TPO) antibody. Our objective was to estimate the cost-effectiveness of screening pregnant women for the TPO antibody versus the current strategy of no screening test or an alternative strategy of a thyroid-stimulating hormone (TSH) test 6 weeks postpartum. We performed cost-effectiveness analysis using a decision …

Cost-effectiveness of diagnostic imaging modalities in symptomatic patients with lower limb peripheral arterial disease: discrete event simulation model.

OBJECTIVE: Lower limb peripheral arterial disease in the symptomatic stage has a significant effect on patients´ functional disability. Befo … he health care payer, and the effects were calculated as quality-adjusted life year's (QALY's). The cost-effectiveness analysis was performed to pairwise compare CTA, MRA and DSA with DUS as the baseline diagnostic modality. A scenario analysis and probabilistic sensitivity analysis were carried out to evaluate the robustness of the results. RESULTS: In the basic case, the …

GDP Matters: Cost Effectiveness of Cochlear Implantation and Deaf Education in Sub-Saharan Africa.

HYPOTHESIS: Cochlear implantation and deaf education are cost effective in Sub-Saharan Africa. BACKGROUND: Cost effectiveness of pediatric cochlear implantation has been well established in developed countries but is unknown in low resource settings, where access to the technology has traditionally been limited. With incidence of severe-to-profound congenital sensorineural hearing loss 5 to 6 times higher in low/middle-income countries than the United States and Europe, developing cost-effective management strategies in these settings is critical. METHODS: Costs were obtained from experts in

(Cost-)effectiveness of personalised multimodal physiotherapy compared to surgery in patients with cervical radiculopathy: A systematic review.

RATIONALE: Cervical radiculopathy is initially typically managed conservatively. Surgery is indicated when conservative management fails or with severe/progressive neurological signs. Personalised multimodal physiotherapy could be a promising conservative strategy. However, aggregated evidence on the (cost-)effectiveness of personalised multimodal physiotherapy compared to surgery with/without post-operative physiotherapy is lacking. AIM/OBJECTIVES: To systematically summarise the literature on the (cost-)effectiveness of personalised multimodal physiotherapy compared to surgery with or witho

Cost-Effectiveness of Enfortumab Vedotin and Pembrolizumab for First-Line Metastatic Urothelial Cancer in the United States.

OBJECTIVES: The EV-302 trial demonstrated that the combination of enfortumab vedotin and pembrolizumab (EV+P) significantly improved progression-free and overall survival in patients with metastatic urothelial cancer. However, the economic value of this regimen remains uncertain. Our study aims to evaluate the cost-effectiveness of EV+P versus platinum-based chemotherapy as first-line treatment for metastatic urothelial cancer from the US payer perspective. METHODS: We developed a cohort state-transition model to simulate the lifetime costs and effectiveness of a cohort of 69-year-olds with m

Pharmacoeconomic Profiles of Advanced Therapy Medicinal Products in Rare Diseases: A Systematic Review.

Background and aim: Advanced Therapy Medicinal Products (ATMPs) are innovative drugs based on genes, tissues, or cells that target rare and severe diseases. ATMPs have shown promising clinical outcomes but are associated with high costs, raising questions about cost-effectiveness. Hence, this systematic review aims to analyze the cost-effectiveness and cost-utility profiles of the European Medicines Agency-authorized ATMPs for treating rare diseases. Methods: A systematic review was conducted following PRISMA guidelines. Studies were identified by searching PubMed, Embase, Web of Science, and

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… Furthermore, the quality of the evidence itself was affected by the lack of information about the comparator and reference year in the cost-effectiveness analysis; these factors can impact the conclusion. … Assessing the value of orphan drugs using conventional cost-effectiveness analysis: Is it fit for purpose? Orphanet J. Rare Dis. 2022 17 157 10.1186/s13023-022-02283-z 35382853 PMC8981887 101. Longo C.J. …

Cost-benefit analysis of a tracking program for arteriovenous fistula maturation.

OBJECTIVES: Fail-to-mature (FTM) of arteriovenous fistula (AVF) imposes suffering onto hemodialysis patients and increases cost burden to the healthcare system. FTM may result from delayed maturation-assisting procedures, patients' non-compliance or interdisciplinary miscommunication. A tracking program for AVF maturation was shown to improve clinical outcomes, however, extra manpower was required. This study aimed to evaluate the economic sustainability of the program. METHOD: Data from two cohorts of patients (without tracking and with tracking) was collected retrospectively. A decision tre

Endoscopic Ultrasonography-Guided Gastroenterostomy Is More Cost Effective Than Surgical Gastrojejunostomy: A Health-Economic Evaluation Alongside a Randomized Trial.

BACKGROUND: There is a paucity of data on the cost-utility of endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) compared with surgical gastrojejunostomy (SGJ) as palliative treatment of malignant gastric outlet obstruction. METHODS: In the ENDURO trial, 98 patients with malignant gastric outlet obstruction from 12 Dutch hospitals were randomized between EUS-GE (N = 48) and SGJ (N = 50). Cost utility was evaluated from a healthcare perspective with a time horizon of 1 month. A bottom-up approach was used to calculate the costs of each intervention, including the per-minute price of

Cost-utility analysis of robotic and conventional total knee arthroplasty: A 200-patient micro-costing study in a public sector institution.

Robotic-arm assisted total knee arthroplasty (RO TKA) has been developed to improve surgical precision and reproducibility compared with conventional techniques. However, the economic implications of adopting robotic technology remain uncertain, particularly within publicly funded healthcare systems. This study aimed to evaluate the in-hospital costs and health-related quality of life outcomes associated with RO TKA compared with conventional TKA (CO TKA) using a cost-utility framework within a UK National Health Service (NHS) institution. A propensity-matched cohort cost-utility analysis was

Cost-Effectiveness of Donanemab for Early Alzheimer Disease in Australia.

OBJECTIVES: To evaluate the cost-effectiveness of donanemab, an anti-amyloid-β monoclonal antibody recently approved in Australia, for treating early-stage Alzheimer disease with confirmed amyloid-β pathology from healthcare system and societal perspectives. DESIGN: A Markov microsimulation model simulating long-term Alzheimer disease progression, treatment costs and health outcomes for donanemab compared with standard care. SETTING, PARTICIPANTS: Australian healthcare context, applying published clinical and economic inputs. A hypothetical cohort of people with early symptomatic Alzheimer d