Applied health economics and health policy, Jan 26, 2015
All 28 EU member states except Sweden and the UK apply international reference pricing (IRP), int... more All 28 EU member states except Sweden and the UK apply international reference pricing (IRP), international price comparison, external reference pricing or cross-reference pricing. The attractiveness of using prices of other countries as a benchmark for decisions within a national price control is obvious. Alternative models for price and reimbursement decision making such as value-based pricing (VBP), i.e. cost-effectiveness analyses, are more complicated. However, IRP provides incentives for stakeholders to take action not in line with optimal (welfare-maximizing) pricing. IRP is costly for two reasons. First, manufacturers are incentivised to limit or delay access to new innovative treatments in countries with small markets and/or a low income, which can be costly in terms of loss of health. Second, all countries also experience a loss of welfare (health) because IRP reduces the opportunities for differential pricing (Ramsey pricing), i.e. using the fact that the ability and will...
Background: the recent substantial increase in the number of obese surgeries performed in sweden ... more Background: the recent substantial increase in the number of obese surgeries performed in sweden has raised concerns about the budget impact. Objective: our aim in this paper is to present an assessment of the budgetary impact of different policies for surgical intervention for obese and overweight subjects from a healthcare perspective in sweden. Methods: the model simulates the annual expected treatment costs of obesity related diseases and surgery in patients of different sex, age and Body mass index (Bmi). costs evaluated are costs of surgery plus the excess treatment costs that an obese patient has over and above the treatment costs of a normal-weight patient. the diagnoses that are included for costs assessment are diabetes and cardiovascular disease since these diagnoses are the principal diagnoses associated with obesity. four different scenarios over the number of surgical operations performed each year are simulated and compared: (1) no surgical operation, (2) 3 000 surgical operations in persons with Bmi > 40, (3) 4 000 (Bmi > 40), and (4) 5 000 (expanded to Bmi > 38). Results: comparing scenario 2 with scenario 1 results in a net budget impact of on average seK 121 million per annum or seK 40 000 per patient. this implies that 55 percent of the cost of surgery, set equal to seK 90 000 for each patient, has been offset by a reduction in the excess treatment costs of obesity related diseases. expanding annual surgery from 3000 to 4000 the cost-offset increased to 58%. By expanding annual surgery further from 4000 to 5000 and at the same time expanding the indication for surgery from Bmi > 40 to Bmi > 38, no cost-offset is obtained. Conclusion: a cost-minimization strategy for bariatric surgery in sweden should not expand indication, but rather increase the number of surgeries within the currently accepted indication.
Background: Multiple myeloma (MM) patients who have progressed following treatment with both bort... more Background: Multiple myeloma (MM) patients who have progressed following treatment with both bortezomib and lenalidomide have a poor prognosis. In this late stage, other effective alternatives are limited, and patients in Sweden are often left with best supportive care. Pomalidomide is a new anti-angiogenic and immunomodulatory drug for the treatment of MM. Our objective was to evaluate the cost effectiveness of pomalidomide as an add-on to best supportive care in patients with relapsed and refractory MM in Sweden. Material and methods: We developed a health-economic discrete event simulation model of a patient's course through stable disease and progressive disease, until death. It estimates life expectancy, quality-adjusted life years (QALYs) and costs from a societal perspective. Effectiveness data and utilities were taken from the MM-003 trial comparing pomalidomide plus low-dose dexamethasone with high-dose dexamethasone (HIDEX). Cost data were taken from official Swedish price lists, government sources and literature. Results: The model estimates that, if a patient is treated with HIDEX, life expectancy is 1.12 years and the total cost is SEK 179 976 (E19 100), mainly indirect costs. With pomalidomide plus low-dose dexamethasone, life expectancy is 2.33 years, with a total cost of SEK 767 064 (E81 500), mainly in drug and indirect costs. Compared to HIDEX, pomalidomide treatment gives a QALY gain of 0.7351 and an incremental cost of SEK 587 088 (E62 400) consisting of increased drug costs (59%), incremental indirect costs (33%) and other healthcare costs (8%). The incremental costeffectiveness ratio is SEK 798 613 (E84 900) per QALY gained. Conclusion: In a model of late-stage MM patients with a poor prognosis in the Swedish setting, pomalidomide is associated with a relatively high incremental cost per QALY gained. This model was accepted by the national Swedish reimbursement authority TLV, and pomalidomide was granted reimbursement in Sweden.
Background:The rising trend in the prevalence of obesity has during the past decades become a maj... more Background:The rising trend in the prevalence of obesity has during the past decades become a major public health concern in many countries, as obesity may lead to comorbidities and death. A frequent used marker for obesity is the Body Mass Index (BMI). The cost of treatment for obesity related diseases has become a heavy burden on national health care budget in many countries. While diet and exercise are the cornerstones of weight management, pharmacotherapy is often needed to achieve and maintain desired weight loss. In some cases of extreme obesity, bariatric surgery may be recommended. It is expected to increase by 50% in Sweden.Objective: The overall objective was to develop a cost-effectiveness model using the best available evidence to assess the cost-effectiveness of gastric bypass (GBP) surgical treatments for obesity in adult patients, in comparison with conventional treatment (CT), in Sweden from a healthcare perspective. With the model we also seeked to identify the lo...
The introduction of biologics has changed treatment patterns as well as costs in patients with ps... more The introduction of biologics has changed treatment patterns as well as costs in patients with psoriasis. This study was performed to estimate direct and indirect costs of the psoriasis population in Sweden, and to analyse changes in costs between 2006 and 2009. The study population was identified in national registers. Direct costs included health care visits with primary psoriasis diagnoses in specialist care and drugs relevant for treating psoriasis. Productivity loss, including costs of long-term sick leave and disability pension, was estimated as the difference between psoriasis patients and matched controls from the general population. Total direct cost increased from SEK 348 million (~ €39) in 2006 to SEK 459 million (~ €51) in 2009, whereas the total productivity loss decreased from SEK 1,646 (~ €183) to 1,618 million (~ €180) between 2006 and 2009. Although direct costs, especially for biologic agents, have increased for patients with psoriasis over time, this study indicat...
To evaluate the cost effectiveness of a multidisciplinary team including a pharmacist for systema... more To evaluate the cost effectiveness of a multidisciplinary team including a pharmacist for systematic medication review and reconciliation from admission to discharge at hospital among elderly patients (the Lund Integrated Medicines Management (LIMM)) in order to reduce drug-related readmissions and outpatient visits. Published data from the LIMM project group were used to design a probabilistic decision tree model for evaluating tools for (1) a systematic medication reconciliation and review process at initial hospital admission and during stay (admission part) and (2) a medication report for patients discharged from hospital to primary care (discharge part). The comparator was standard care. Inpatient, outpatient and staff time costs (Euros, 2009) were calculated during a 3-month period. Dis-utilities for hospital readmissions and outpatient visits due to medication errors were taken from the literature. The total cost for the LIMM model was €290 compared to €630 for standard care,...
This study aimed to estimate the cost-effectiveness of treating non-superficial diabetic foot ulc... more This study aimed to estimate the cost-effectiveness of treating non-superficial diabetic foot ulcers with Promogran plus good wound care (GWC) compared with GWC alone in four European countries (France, Germany, Switzerland and UK). An existing Markov-based health economic model of non-superficial diabetic foot ulcers was adapted to incorporate the relative efficacy of Promogran compared with GWC alone as demonstrated in a randomised controlled trial. Treatment with Promogran was modelled for a maximum of three months. Country-specific treatment costs were used to estimate the incremental cost per ulcer-free day gained over 12 months. Some parameter assumptions were changed to assess the sensitivity of the results. Within the first three months of treatment, 26% of ulcers in the Promogran cohort healed compared with 20.7% in the GWC cohort. Over the 12 months, the average number of months spent in the healed state was 3.41 (GWC) and 3.75 (Promogran). Promogran treatment was found to...
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of becaplermin gel (a biotechnology product containing recombinant human platelet-derived grown factor), in combination with good wound care (GWC), for the treatment of diabetic foot ulcers. GWC consisted of sharp debridement to remove callus, fibrin and necrotic tissue, and a moist saline dressing. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population The study population comprised a hypothetical cohort of patients with diabetic ischaemia-free foot ulcers. Superficial ulcers were excluded. Setting The setting was secondary care. The economic study was carried out in France, the UK, Sweden and Switzerland.
Objectives. Quantify changes in hospital resource use in Finland following initiation of risperid... more Objectives. Quantify changes in hospital resource use in Finland following initiation of risperidone long-acting injection (RLAI). Materials and Methods. A retrospective multi-center chart review (naturalistic setting) was used to compare annual hospital bed-days and hospital episodes for 177 schizophrenia patients (mean age 47.1 years, 52% female, 72% hospitalized) before and after initiation of RLAI (between January 2004 and June 2005) using the within-patient "mirror-image" study design. The base case analytical approach allocated hospital episodes overlapping the start date entirely to the preinitiation period. In order to investigate the impact of inpatient care ongoing at baseline, the change in bed-days was also estimated using an alternative analytical approached related to economic modelling. Results. In the conventional analysis, the mean annual hospitalisation costs declined by €11,900 and the number of bed-days was reduced by 40%, corresponding to 0.19 fewer ho...
etc. The unit of measurement was cost per successful treatment. Differences in costs and effi cac... more etc. The unit of measurement was cost per successful treatment. Differences in costs and effi cacy rates were analyzed by the appropriate statistical tools. The study was performed from a government's perspective. RESULTS: A total of 44 patients were evenly randomised to receive LNG-IUS treatment and TBEA and evaluation was performed 1 year after treatment. Of these, 18 patients from the LNG-IUS group completed the study with 3 dropouts. Ten achieved menorrhagic control and 5 had to be converted to other therapies. In patients receiving TBEA therapy, 7 dropped out and 15 were deemed successful. The overall cost of treatment for LNG-IUS and TBEA groups was HKD140,000 (USD18,000; 1USD 7.8HKD) and HKD430,000 (USD55,000) respectively. The average cost per successful treatment per patient was therefore HKD14,000 (USD1,800) and HKD28,600 (USD3,660) for the LNG-IUS and TBEA patients respectively. CONCLUSIONS: From this small group of patients enrolled in a clinical trial to assess the outcomes of LNG-IUS and TBEA, it appears that the LNG-IUS therapy is more cost-effective. The major cost drivers appear to be the procedural and hospitalization costs arising from TBEA.
To compare the economic costs and benefits of eszopiclone co-administered with fluoxetine (ESZ+FL... more To compare the economic costs and benefits of eszopiclone co-administered with fluoxetine (ESZ+FLX) to that of placebo co-administered with fluoxetine (PBO+FLX) in patients with insomnia and co-morbid MDD. METHODS: Data from 422 patients enrolled in an 8-week, double-blind, placebo-controlled, trial were used to estimate the cost per quality-adjusted life-year (QALY) gained by treating patients' insomnia with ESZ along with FLX for MDD. The costs of medical care and time away from work were estimated using published algorithms based on scores of the Hamilton Depression Scale (HAM-D17). Cost of lost productivity while at work was based on responses to the Work Limitations Questionnaire collected during the trial. Utilities were estimated via the HAM-D17 scores or the SF-36 scores collected during the trial using published transformation methods. Drug costs were estimated based on average wholesale price, adjusted for standard discounts and dispensing fees. All costs (in 2007 US$) and QALYs were estimated using the 8-week trial data or the trial data extrapolated to 6 months using last observation carried forward. Treatment discontinuations before and after Week 8 were taken into consideration and sensitivity analysis of key parameters was performed. RESULTS: In the base case 8-week analysis using HAM-D17-derived utilities, the mean gains in QALYs were 0.
Use of alternative location to go to the published version of the article requires journal subscr... more Use of alternative location to go to the published version of the article requires journal subscription.
OBJECTIVE: To project the health and economic consequences associated with a prophylactic type-sp... more OBJECTIVE: To project the health and economic consequences associated with a prophylactic type-specific HPV-16/18 vaccine in the setting of a cervical cancer screening program. METHODS: A computer-based model of the natural history of cervical cancer that incorporates the type-specific HPV distribution within precancerous lesions and cancer was used to estimate cancer incidence and mortality, quality-adjusted life years (QALY), lifetime costs, and incremental cost-effectiveness ratios associated with different cancer prevention policies consisting of vaccination, screening, and combined vaccination/screening strategies. Strategies included (1) no vaccination and no screening; (2) no vaccination and cytology screening every 1, 2, 3, 4, and 5 years; (3) vaccination and cytology screening every 1, 2, 3, 4, and 5 years. Screening strategies included conventional and liquid-based cytology initiated at ages 18, 21, 25, or 30. We assumed vaccination occurred at age 12 and was 90% effective in reducing the probability of acquiring persistent infection with HPV 16/18, but evaluated the impact of alternative assumptions about vaccine efficacy and waning immunity. RESULTS: Vaccination at age 12 followed by triennial cytology screening beginning at age 30 provided reductions in cervical cancer mortality above those provided by annual conventional cytology and had an incremental cost-effectiveness ratio of below $50,000 per QALY compared to the next best strategy of vaccination and triennial cytology screening beginning at age 35. These results were stable over a range of vaccine efficacies (60% to 100%) but sensitive to the degree to which vaccination effect persists over time. CONCLUSIONS: A prophylactic vaccine that prevents persistent HPV 16/18 infection can be expected to significantly reduce HPV-16/18-associated high-grade lesions and cervical cancer even in a setting of cytology screening. A program of vaccination that permits a later age of screening initiation and a less frequent screening interval is likely to be a costeffective use of health care resources.
Applied health economics and health policy, Jan 26, 2015
All 28 EU member states except Sweden and the UK apply international reference pricing (IRP), int... more All 28 EU member states except Sweden and the UK apply international reference pricing (IRP), international price comparison, external reference pricing or cross-reference pricing. The attractiveness of using prices of other countries as a benchmark for decisions within a national price control is obvious. Alternative models for price and reimbursement decision making such as value-based pricing (VBP), i.e. cost-effectiveness analyses, are more complicated. However, IRP provides incentives for stakeholders to take action not in line with optimal (welfare-maximizing) pricing. IRP is costly for two reasons. First, manufacturers are incentivised to limit or delay access to new innovative treatments in countries with small markets and/or a low income, which can be costly in terms of loss of health. Second, all countries also experience a loss of welfare (health) because IRP reduces the opportunities for differential pricing (Ramsey pricing), i.e. using the fact that the ability and will...
Background: the recent substantial increase in the number of obese surgeries performed in sweden ... more Background: the recent substantial increase in the number of obese surgeries performed in sweden has raised concerns about the budget impact. Objective: our aim in this paper is to present an assessment of the budgetary impact of different policies for surgical intervention for obese and overweight subjects from a healthcare perspective in sweden. Methods: the model simulates the annual expected treatment costs of obesity related diseases and surgery in patients of different sex, age and Body mass index (Bmi). costs evaluated are costs of surgery plus the excess treatment costs that an obese patient has over and above the treatment costs of a normal-weight patient. the diagnoses that are included for costs assessment are diabetes and cardiovascular disease since these diagnoses are the principal diagnoses associated with obesity. four different scenarios over the number of surgical operations performed each year are simulated and compared: (1) no surgical operation, (2) 3 000 surgical operations in persons with Bmi > 40, (3) 4 000 (Bmi > 40), and (4) 5 000 (expanded to Bmi > 38). Results: comparing scenario 2 with scenario 1 results in a net budget impact of on average seK 121 million per annum or seK 40 000 per patient. this implies that 55 percent of the cost of surgery, set equal to seK 90 000 for each patient, has been offset by a reduction in the excess treatment costs of obesity related diseases. expanding annual surgery from 3000 to 4000 the cost-offset increased to 58%. By expanding annual surgery further from 4000 to 5000 and at the same time expanding the indication for surgery from Bmi > 40 to Bmi > 38, no cost-offset is obtained. Conclusion: a cost-minimization strategy for bariatric surgery in sweden should not expand indication, but rather increase the number of surgeries within the currently accepted indication.
Background: Multiple myeloma (MM) patients who have progressed following treatment with both bort... more Background: Multiple myeloma (MM) patients who have progressed following treatment with both bortezomib and lenalidomide have a poor prognosis. In this late stage, other effective alternatives are limited, and patients in Sweden are often left with best supportive care. Pomalidomide is a new anti-angiogenic and immunomodulatory drug for the treatment of MM. Our objective was to evaluate the cost effectiveness of pomalidomide as an add-on to best supportive care in patients with relapsed and refractory MM in Sweden. Material and methods: We developed a health-economic discrete event simulation model of a patient's course through stable disease and progressive disease, until death. It estimates life expectancy, quality-adjusted life years (QALYs) and costs from a societal perspective. Effectiveness data and utilities were taken from the MM-003 trial comparing pomalidomide plus low-dose dexamethasone with high-dose dexamethasone (HIDEX). Cost data were taken from official Swedish price lists, government sources and literature. Results: The model estimates that, if a patient is treated with HIDEX, life expectancy is 1.12 years and the total cost is SEK 179 976 (E19 100), mainly indirect costs. With pomalidomide plus low-dose dexamethasone, life expectancy is 2.33 years, with a total cost of SEK 767 064 (E81 500), mainly in drug and indirect costs. Compared to HIDEX, pomalidomide treatment gives a QALY gain of 0.7351 and an incremental cost of SEK 587 088 (E62 400) consisting of increased drug costs (59%), incremental indirect costs (33%) and other healthcare costs (8%). The incremental costeffectiveness ratio is SEK 798 613 (E84 900) per QALY gained. Conclusion: In a model of late-stage MM patients with a poor prognosis in the Swedish setting, pomalidomide is associated with a relatively high incremental cost per QALY gained. This model was accepted by the national Swedish reimbursement authority TLV, and pomalidomide was granted reimbursement in Sweden.
Background:The rising trend in the prevalence of obesity has during the past decades become a maj... more Background:The rising trend in the prevalence of obesity has during the past decades become a major public health concern in many countries, as obesity may lead to comorbidities and death. A frequent used marker for obesity is the Body Mass Index (BMI). The cost of treatment for obesity related diseases has become a heavy burden on national health care budget in many countries. While diet and exercise are the cornerstones of weight management, pharmacotherapy is often needed to achieve and maintain desired weight loss. In some cases of extreme obesity, bariatric surgery may be recommended. It is expected to increase by 50% in Sweden.Objective: The overall objective was to develop a cost-effectiveness model using the best available evidence to assess the cost-effectiveness of gastric bypass (GBP) surgical treatments for obesity in adult patients, in comparison with conventional treatment (CT), in Sweden from a healthcare perspective. With the model we also seeked to identify the lo...
The introduction of biologics has changed treatment patterns as well as costs in patients with ps... more The introduction of biologics has changed treatment patterns as well as costs in patients with psoriasis. This study was performed to estimate direct and indirect costs of the psoriasis population in Sweden, and to analyse changes in costs between 2006 and 2009. The study population was identified in national registers. Direct costs included health care visits with primary psoriasis diagnoses in specialist care and drugs relevant for treating psoriasis. Productivity loss, including costs of long-term sick leave and disability pension, was estimated as the difference between psoriasis patients and matched controls from the general population. Total direct cost increased from SEK 348 million (~ €39) in 2006 to SEK 459 million (~ €51) in 2009, whereas the total productivity loss decreased from SEK 1,646 (~ €183) to 1,618 million (~ €180) between 2006 and 2009. Although direct costs, especially for biologic agents, have increased for patients with psoriasis over time, this study indicat...
To evaluate the cost effectiveness of a multidisciplinary team including a pharmacist for systema... more To evaluate the cost effectiveness of a multidisciplinary team including a pharmacist for systematic medication review and reconciliation from admission to discharge at hospital among elderly patients (the Lund Integrated Medicines Management (LIMM)) in order to reduce drug-related readmissions and outpatient visits. Published data from the LIMM project group were used to design a probabilistic decision tree model for evaluating tools for (1) a systematic medication reconciliation and review process at initial hospital admission and during stay (admission part) and (2) a medication report for patients discharged from hospital to primary care (discharge part). The comparator was standard care. Inpatient, outpatient and staff time costs (Euros, 2009) were calculated during a 3-month period. Dis-utilities for hospital readmissions and outpatient visits due to medication errors were taken from the literature. The total cost for the LIMM model was €290 compared to €630 for standard care,...
This study aimed to estimate the cost-effectiveness of treating non-superficial diabetic foot ulc... more This study aimed to estimate the cost-effectiveness of treating non-superficial diabetic foot ulcers with Promogran plus good wound care (GWC) compared with GWC alone in four European countries (France, Germany, Switzerland and UK). An existing Markov-based health economic model of non-superficial diabetic foot ulcers was adapted to incorporate the relative efficacy of Promogran compared with GWC alone as demonstrated in a randomised controlled trial. Treatment with Promogran was modelled for a maximum of three months. Country-specific treatment costs were used to estimate the incremental cost per ulcer-free day gained over 12 months. Some parameter assumptions were changed to assess the sensitivity of the results. Within the first three months of treatment, 26% of ulcers in the Promogran cohort healed compared with 20.7% in the GWC cohort. Over the 12 months, the average number of months spent in the healed state was 3.41 (GWC) and 3.75 (Promogran). Promogran treatment was found to...
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The use of becaplermin gel (a biotechnology product containing recombinant human platelet-derived grown factor), in combination with good wound care (GWC), for the treatment of diabetic foot ulcers. GWC consisted of sharp debridement to remove callus, fibrin and necrotic tissue, and a moist saline dressing. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population The study population comprised a hypothetical cohort of patients with diabetic ischaemia-free foot ulcers. Superficial ulcers were excluded. Setting The setting was secondary care. The economic study was carried out in France, the UK, Sweden and Switzerland.
Objectives. Quantify changes in hospital resource use in Finland following initiation of risperid... more Objectives. Quantify changes in hospital resource use in Finland following initiation of risperidone long-acting injection (RLAI). Materials and Methods. A retrospective multi-center chart review (naturalistic setting) was used to compare annual hospital bed-days and hospital episodes for 177 schizophrenia patients (mean age 47.1 years, 52% female, 72% hospitalized) before and after initiation of RLAI (between January 2004 and June 2005) using the within-patient "mirror-image" study design. The base case analytical approach allocated hospital episodes overlapping the start date entirely to the preinitiation period. In order to investigate the impact of inpatient care ongoing at baseline, the change in bed-days was also estimated using an alternative analytical approached related to economic modelling. Results. In the conventional analysis, the mean annual hospitalisation costs declined by €11,900 and the number of bed-days was reduced by 40%, corresponding to 0.19 fewer ho...
etc. The unit of measurement was cost per successful treatment. Differences in costs and effi cac... more etc. The unit of measurement was cost per successful treatment. Differences in costs and effi cacy rates were analyzed by the appropriate statistical tools. The study was performed from a government's perspective. RESULTS: A total of 44 patients were evenly randomised to receive LNG-IUS treatment and TBEA and evaluation was performed 1 year after treatment. Of these, 18 patients from the LNG-IUS group completed the study with 3 dropouts. Ten achieved menorrhagic control and 5 had to be converted to other therapies. In patients receiving TBEA therapy, 7 dropped out and 15 were deemed successful. The overall cost of treatment for LNG-IUS and TBEA groups was HKD140,000 (USD18,000; 1USD 7.8HKD) and HKD430,000 (USD55,000) respectively. The average cost per successful treatment per patient was therefore HKD14,000 (USD1,800) and HKD28,600 (USD3,660) for the LNG-IUS and TBEA patients respectively. CONCLUSIONS: From this small group of patients enrolled in a clinical trial to assess the outcomes of LNG-IUS and TBEA, it appears that the LNG-IUS therapy is more cost-effective. The major cost drivers appear to be the procedural and hospitalization costs arising from TBEA.
To compare the economic costs and benefits of eszopiclone co-administered with fluoxetine (ESZ+FL... more To compare the economic costs and benefits of eszopiclone co-administered with fluoxetine (ESZ+FLX) to that of placebo co-administered with fluoxetine (PBO+FLX) in patients with insomnia and co-morbid MDD. METHODS: Data from 422 patients enrolled in an 8-week, double-blind, placebo-controlled, trial were used to estimate the cost per quality-adjusted life-year (QALY) gained by treating patients' insomnia with ESZ along with FLX for MDD. The costs of medical care and time away from work were estimated using published algorithms based on scores of the Hamilton Depression Scale (HAM-D17). Cost of lost productivity while at work was based on responses to the Work Limitations Questionnaire collected during the trial. Utilities were estimated via the HAM-D17 scores or the SF-36 scores collected during the trial using published transformation methods. Drug costs were estimated based on average wholesale price, adjusted for standard discounts and dispensing fees. All costs (in 2007 US$) and QALYs were estimated using the 8-week trial data or the trial data extrapolated to 6 months using last observation carried forward. Treatment discontinuations before and after Week 8 were taken into consideration and sensitivity analysis of key parameters was performed. RESULTS: In the base case 8-week analysis using HAM-D17-derived utilities, the mean gains in QALYs were 0.
Use of alternative location to go to the published version of the article requires journal subscr... more Use of alternative location to go to the published version of the article requires journal subscription.
OBJECTIVE: To project the health and economic consequences associated with a prophylactic type-sp... more OBJECTIVE: To project the health and economic consequences associated with a prophylactic type-specific HPV-16/18 vaccine in the setting of a cervical cancer screening program. METHODS: A computer-based model of the natural history of cervical cancer that incorporates the type-specific HPV distribution within precancerous lesions and cancer was used to estimate cancer incidence and mortality, quality-adjusted life years (QALY), lifetime costs, and incremental cost-effectiveness ratios associated with different cancer prevention policies consisting of vaccination, screening, and combined vaccination/screening strategies. Strategies included (1) no vaccination and no screening; (2) no vaccination and cytology screening every 1, 2, 3, 4, and 5 years; (3) vaccination and cytology screening every 1, 2, 3, 4, and 5 years. Screening strategies included conventional and liquid-based cytology initiated at ages 18, 21, 25, or 30. We assumed vaccination occurred at age 12 and was 90% effective in reducing the probability of acquiring persistent infection with HPV 16/18, but evaluated the impact of alternative assumptions about vaccine efficacy and waning immunity. RESULTS: Vaccination at age 12 followed by triennial cytology screening beginning at age 30 provided reductions in cervical cancer mortality above those provided by annual conventional cytology and had an incremental cost-effectiveness ratio of below $50,000 per QALY compared to the next best strategy of vaccination and triennial cytology screening beginning at age 35. These results were stable over a range of vaccine efficacies (60% to 100%) but sensitive to the degree to which vaccination effect persists over time. CONCLUSIONS: A prophylactic vaccine that prevents persistent HPV 16/18 infection can be expected to significantly reduce HPV-16/18-associated high-grade lesions and cervical cancer even in a setting of cytology screening. A program of vaccination that permits a later age of screening initiation and a less frequent screening interval is likely to be a costeffective use of health care resources.
Uploads
Papers by Ulf Persson