Using a disease model, the current economic burden of stroke in the 2.3 million US patients with ... more Using a disease model, the current economic burden of stroke in the 2.3 million US patients with atrial fibrillation was estimated, and potential savings in direct costs obtainable by optimization of oral anticoagulation were projected using a disease model. Cost estimates were based on published epidemiologic data on risks in 3 main prevention scenarios (ie, none or aspirin alone, warfarin in routine care, and warfarin in anticoagulation clinic settings) and 2003 Medicare cost data. According to the model described, the approximately 1.265 million (55%) patients currently not receiving prophylaxis, suffer 58 382 strokes annually with an associated total direct cost to Medicare of dollar 4.8 billion. For the 1.035 million receiving warfarin, 38 468 strokes are predicted every year, costing an estimated dollar 3.1 billion. If 50% of those not receiving warfarin prophylaxis were optimally anticoagulated, 19 380 emboli would be prevented and dollar 1.1 billion would be saved. If 50% of...
OBJECTIVE: The UK Prospective Diabetes Study (UKPDS) has proven the relevance of an intensive glu... more OBJECTIVE: The UK Prospective Diabetes Study (UKPDS) has proven the relevance of an intensive glucose control policy in type 2 diabetes. UKPDS 35 has provided the evidence of a significant association between diabetes-related complications and level of HbA1c. We used the UKPDS findings to assess the cost-effectiveness of a new fixed-dose combination of metformin and glibenclamide, compared to the conventional strategy of the UKPDS. METHODS: We developed a Markov model reflecting the management of two diabetic cohorts. The follow-up of a cohort of newly diagnosed 50-year-old patients, similar to the conventional group of the UKPDS, was simulated to follow HbA1c progression over a 10-year period. The second cohort, treated with metformin-glibenclamide, had the same demographic and clinical characteristics at baseline. The reduction rate of HbA1c under metformin-glibenclamide was extracted from a 20-week randomized double-blind trial. The HbA1c level in the metformin-glibenclamide cohort was assumed to progressively converge with that in the conventional group. The occurrence of complications was modeled through risk functions linking HbA1c levels to a conditional probability using UKPDS 23 and 35 results. Results were computed in a French context using a payer perspective. Only medical costs were considered. A sensitivity analysis was performed on the reduction rate of HbA1c under metformin-glibenclamide between 0.8 (best case) and 1.5 (worst case). RESULTS: Cumulative medical costs amounted to EUR 7,240 in the conventional group versus EUR 7,759 in the metformin-glibenclamide group. A 6.1% decrease in the mean number of events per patient was obtained. The additional cost per life year saved was EUR 13,142 (9,924 (best case), 17,912 (worst case)) and the additional cost per complication-free year was EUR 5,736 (4,312 (worst case), 7,842 (best case)). CONCLUSION: These results suggest that metforminglibenclamide is cost-effective in the treatment of type 2 diabetes when compared with conventional therapy.
Pertussis continues to be a significant cause of morbidity and mortality among nonimmunized young... more Pertussis continues to be a significant cause of morbidity and mortality among nonimmunized young infants. Although the inception of childhood pertussis immunization programs has significantly reduced the occurrence of the disease in children, waning vaccine-induced immunity permits the disease to affect adolescents and adults, who in turn transmit the disease to unimmunized or incompletely immunized infants. The Global Pertussis Initiative brought together experts from 17 countries around the world to evaluate strategies to improve disease control. Seven strategies were considered: (1) universal adult immunization; (2) selective immunization of mothers and close family contacts of newborns; (3) selective immunization of health care workers; (4) selective immunization of child care workers; (5) universal immunization of adolescents; (6) preschool booster at 4-6 years of age; and (7) reinforcement and/or improvement of current infant and toddler immunization strategies. Because immunization programs vary widely from country to country, no single strategy is likely to be appropriate for all. Moreover it would be helpful to have additional data to support the strategies and provide a better understanding of the disease so that new approaches can be monitored effectively. However, certain steps can be taken now to reduce the incidence of pertussis.
To quantify the quality of anticoagulation control in routine medical care in the US: Long-term o... more To quantify the quality of anticoagulation control in routine medical care in the US: Long-term oral anticoagulation reduces the risk of ischemic stroke in atrial fibrillation but only if the international normalized ratio (INR) is tightly controlled between two and three. METHODS: A cohort study was carried out in practices with no staff dedicated to anticoagulation in four states. Charts of patients 18 years or older with atrial fibrillation and on an anticoagulant at least 60 consecutive days between July 1, 2001 and June 30, 2002 were reviewed by trained abstractors based on a standard form that covered monitoring tests, results and patient outcomes. Data were entered via touch-tone telephone (IVRS) and sensitivity analyses were performed. RESULTS: Charts of 686 patients from 11 practices (most internal or family medicine) and 67 practitioners were reviewed. Mean age was 75 years; 53% male; 79% received warfarin and mean interval between INR tests was 25 ± 22 days; 52% of physicians gave occasional face-to-face consultations in connection with INR tests and 78% used clinical judgment alone to adjust anticoagulant dose. A total of 53% of charts specified a target INR of 2-3; patients spent 42% of the time with INRs out of this range, most (27%) too low, yet the anticoagulant dose was adjusted only a third of the times that INRs were out of range. CONCLUSION: Concerted efforts to improve anticoagulation have been made for more than a decade. Nevertheless, despite increasing costs with frequent INR testing, there remain severe deficiencies in the routine management of anticoagulation in the US.
To estimate the healing and relapse rates in the acute and maintenance treatment of gastroesophag... more To estimate the healing and relapse rates in the acute and maintenance treatment of gastroesophageal reflux disease (GERD) with the newer proton-pump inhibitors (PPIs) lansoprazole, rabeprazole and pantoprazole, compared with omeprazole, ranitidine and placebo.
Two hundred and seven large bowel cancer patients (93% of all cases diagnosed in a defined commun... more Two hundred and seven large bowel cancer patients (93% of all cases diagnosed in a defined community between 1965 and 1976) were matched at random with non-cancer subjects of same age, sex, and place of residence. Men with cancer, aged 75 years and younger than, had a more frequent history of work in a local factory handling synthetic fiber than controls (22 versus 10; P less than 0.025). In this factory 45% of cancers occurred before age 60, while this was true in only 24% of cancer cases outside the factory (P less than 0.05). There was a greater tendency for cancers in factory workers to occur in the colon than in the rectum. Heredity was not found to be a risk factor for large bowel cancer. The rate of prior appendectomy was higher in men with colon cancer (P less than 0.05) and the rate of prior cholecystectomy was lower in females with colonic cancer (P less than 0.05). A previous hemorroidectomy was also found more often in males with colonic cancer (P less than 0.05). Long-standing severe constipation was present more often in patients with cancer (P less than 0.01). There was some evidence for a compounding influence of different risk factors, as studied by relative risk ratio. This study confirms the existence of a high risk of large bowel cancer in a group of workers in a synthetic fiber factory and suggests other factors antecedent to large bowel cancer.
which permits unrestricted use, distribution, and reproduction in any medium, provided the origin... more which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: Pertussis, a highly contagious respiratory illness, affects people of all ages and can have serious clinical consequences. It has been reported that from 1997–2000, 20 % of all pertussis cases required hospitalization in the US. This analysis examined demographics, case fatality rate, resource use and costs of hospital care related to pertussis by age. Methods: ICD-9 codes (033.0, 033.9) were used to identify cases of pertussis in hospital discharge
Background: Standard of care (SoC) for transfusion-dependent β-thalassemia (TDT) requires lifelon... more Background: Standard of care (SoC) for transfusion-dependent β-thalassemia (TDT) requires lifelong, regular blood transfusions as well as chelation to reduce iron accumulation. Objective: This study investigates the cost-effectiveness of betibeglogene autotemcel ('beti-cel'; LentiGlobin for β-thalassemia) one-time, gene addition therapy compared to lifelong SoC for TDT. Study design: Microsimulation model simulated the lifetime course of TDT based on a causal sequence in which transfusion requirements determine tissue iron levels, which in turn determine risk of iron overload complications that increase mortality. Clinical trial data informed beti-cel clinical parameters; effects of SoC on iron levels came from real-world studies; iron overload complication rates and mortality were based on published literature. Setting: USA; commercial payer perspective Participants: TDT patients age 2-50 Interventions: Beti-cel is compared to SoC. Main outcome measure: Incremental cost-effectiveness ratio (ICER) utilizing quality-adjusted lifeyears (QALYs) Results: The model predicts beti-cel adds 3.8 discounted life years (LYs) or 6.9 QALYs versus SoC. Discounted lifetime costs were $2.28 M for beti-cel ($572,107 if excluding beti-cel cost) and $2.04 M for SoC, with a resulting ICER of $34,833 per QALY gained. Conclusion: Beti-cel is cost-effective for TDT patients compared to SoC. This is due to longer survival and cost offset of lifelong SoC.
BACKGROUND: Pertussis, a highly contagious respiratory illness, affects people of all ages and ca... more BACKGROUND: Pertussis, a highly contagious respiratory illness, affects people of all ages and can have serious clinical consequences. It has been reported that from 1997–2000, 20% of all pertussis cases required hospitalization in the US. This analysis examined demographics, case fatality rate, resource use and costs of hospital care related to pertussis by age. METHODS: ICD-9 codes (033.0, 033.9) were
Background: Management of deep vein thrombosis (DVT) has evolved from hospitalisation for intrave... more Background: Management of deep vein thrombosis (DVT) has evolved from hospitalisation for intravenous heparin therapy to treatment options that include acute management as an outpatient. While efficacy and safety remain the principal basis for choosing a therapy, the economic consequences of that choice should be considered as well. Objective: To estimate the average cost of various DVT management options from
Objective: To consider the benefits and risks of large postmarketing outcomes studies, as demonst... more Objective: To consider the benefits and risks of large postmarketing outcomes studies, as demonstrated by studies of the statin drugs. Methods: Literature review. Results: The risks were that the statin studies had a strong coat-tail effect. Each new study was beneficial to all statins as well as the one studied. Economic analyses based on the results of the postmarketing studies concluded that the drugs were not cost-effective. Long-term postmarketing studies were slow to be put into perspective and did not immediately influence other researchers or clinicians. During that time, the sponsoring companies shouldered opportunity costs as well as the actual costs of the studies. The risk that one drug company would use another company's results instead of investing in their own research did not materialize. The benefits were that the studies definitively showed that the drugs and the lowering of lipids were safe and efficacious. The studies also expanded the indications for the drugs, generated goodwill in the medical and research communities for the sponsors, allowed sponsors to include specific claims in their advertisements, generated follow-up studies, spawned economic analyses that sparked interest in the medical and lay press, and had a major impact on clinicians' use of the drug. Conclusion: The risks and benefits of postmarketing studies may depend on the company's time perspective. In the short term, the risks may outweigh the benefits. Only companies that have a longer perspective may find it beneficial to undertake large postmarketing studies.
SIONS: Our model provides evidence than an effective AIDS intervention in a high-risk population ... more SIONS: Our model provides evidence than an effective AIDS intervention in a high-risk population of out-oftreatment substance abusers can avert significant numbers of new HIV infections, which may offset initial costs.
We recommend a framework for the BIA, provide guidance on the acquisition and use of data, and of... more We recommend a framework for the BIA, provide guidance on the acquisition and use of data, and offer a common reporting format that will promote standardization and transparency. Adherence to these good research practice principles would not necessarily supersede jurisdiction-specific BIA guidelines but may support and enhance local recommendations or serve as a starting point for payers wishing to promulgate methodology guidelines.
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 authors assessed pertussis immunisation given in a combined pertussis-diphtheria-tetanus vaccine as an additional adolescent acellular booster dose. The comparator was the existing vaccination strategy of no booster vaccination during adolescence. Type of intervention Primary prevention. Economic study type Cost-effectiveness analysis. Study population The study hypothetical population comprised four cohorts of individuals. Specifically, infants (0-1 year old), children (1-10 years old), adolescents (11-18 years old) and adults (older than 18 years). The vaccination cohort was the adolescents, while the other cohorts allowed an analysis of herd effects. Setting The setting was the community. The economic study was carried out in the USA and Canada.
BACKGROUND: Documentation of the hospitalizations rates following a stroke provides the inputs re... more BACKGROUND: Documentation of the hospitalizations rates following a stroke provides the inputs required for planning health services and to evaluate the economic efficiency of any new therapies. METHODS: Hospitalization rates by cause were examined using administrative data on 18,695 patients diagnosed with ischemic stroke (first or subsequent, excluding transient ischemic attack) in Saskatchewan, Canada between 1990 and 1995. Medical history
Trust and confidence are critical to the success of health care models. There are two main method... more Trust and confidence are critical to the success of health care models. There are two main methods for achieving this: transparency (people can see how the model is built) and validation (how well it reproduces reality). This report describes recommendations for achieving transparency and validation, developed by a task force appointed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the Society for Medical Decision Making (SMDM). Recommendations were developed iteratively by the authors. A nontechnical description should be made available to anyone—including model type and intended applications; funding sources; structure; inputs, outputs, other components that determine function, and their relationships; data sources; validation methods and results; and limitations. Technical documentation, written in sufficient detail to enable a reader with necessary expertise to evaluate the model and potentially reproduce it, should be made available openly ...
Discrete event simulation (DES) is a form of computer-based modeling that provides an intuitive a... more Discrete event simulation (DES) is a form of computer-based modeling that provides an intuitive and flexible approach to representing complex systems. It has been used in a wide range of health care applications. Most early applications involved analyses of systems with constrained resources, where the general aim was to improve the organization of delivered services. More recently, DES has increasingly been applied to evaluate specific technologies in the context of health technology assessment. The aim of this article is to provide consensus-based guidelines on the application of DES in a health care setting, covering the range of issues to which DES can be applied. The article works through the different stages of the modeling process: structural development, parameter estimation, model implementation, model analysis, and representation and reporting. For each stage, a brief description is provided, followed by consideration of issues that are of particular relevance to the appli...
Using a disease model, the current economic burden of stroke in the 2.3 million US patients with ... more Using a disease model, the current economic burden of stroke in the 2.3 million US patients with atrial fibrillation was estimated, and potential savings in direct costs obtainable by optimization of oral anticoagulation were projected using a disease model. Cost estimates were based on published epidemiologic data on risks in 3 main prevention scenarios (ie, none or aspirin alone, warfarin in routine care, and warfarin in anticoagulation clinic settings) and 2003 Medicare cost data. According to the model described, the approximately 1.265 million (55%) patients currently not receiving prophylaxis, suffer 58 382 strokes annually with an associated total direct cost to Medicare of dollar 4.8 billion. For the 1.035 million receiving warfarin, 38 468 strokes are predicted every year, costing an estimated dollar 3.1 billion. If 50% of those not receiving warfarin prophylaxis were optimally anticoagulated, 19 380 emboli would be prevented and dollar 1.1 billion would be saved. If 50% of...
OBJECTIVE: The UK Prospective Diabetes Study (UKPDS) has proven the relevance of an intensive glu... more OBJECTIVE: The UK Prospective Diabetes Study (UKPDS) has proven the relevance of an intensive glucose control policy in type 2 diabetes. UKPDS 35 has provided the evidence of a significant association between diabetes-related complications and level of HbA1c. We used the UKPDS findings to assess the cost-effectiveness of a new fixed-dose combination of metformin and glibenclamide, compared to the conventional strategy of the UKPDS. METHODS: We developed a Markov model reflecting the management of two diabetic cohorts. The follow-up of a cohort of newly diagnosed 50-year-old patients, similar to the conventional group of the UKPDS, was simulated to follow HbA1c progression over a 10-year period. The second cohort, treated with metformin-glibenclamide, had the same demographic and clinical characteristics at baseline. The reduction rate of HbA1c under metformin-glibenclamide was extracted from a 20-week randomized double-blind trial. The HbA1c level in the metformin-glibenclamide cohort was assumed to progressively converge with that in the conventional group. The occurrence of complications was modeled through risk functions linking HbA1c levels to a conditional probability using UKPDS 23 and 35 results. Results were computed in a French context using a payer perspective. Only medical costs were considered. A sensitivity analysis was performed on the reduction rate of HbA1c under metformin-glibenclamide between 0.8 (best case) and 1.5 (worst case). RESULTS: Cumulative medical costs amounted to EUR 7,240 in the conventional group versus EUR 7,759 in the metformin-glibenclamide group. A 6.1% decrease in the mean number of events per patient was obtained. The additional cost per life year saved was EUR 13,142 (9,924 (best case), 17,912 (worst case)) and the additional cost per complication-free year was EUR 5,736 (4,312 (worst case), 7,842 (best case)). CONCLUSION: These results suggest that metforminglibenclamide is cost-effective in the treatment of type 2 diabetes when compared with conventional therapy.
Pertussis continues to be a significant cause of morbidity and mortality among nonimmunized young... more Pertussis continues to be a significant cause of morbidity and mortality among nonimmunized young infants. Although the inception of childhood pertussis immunization programs has significantly reduced the occurrence of the disease in children, waning vaccine-induced immunity permits the disease to affect adolescents and adults, who in turn transmit the disease to unimmunized or incompletely immunized infants. The Global Pertussis Initiative brought together experts from 17 countries around the world to evaluate strategies to improve disease control. Seven strategies were considered: (1) universal adult immunization; (2) selective immunization of mothers and close family contacts of newborns; (3) selective immunization of health care workers; (4) selective immunization of child care workers; (5) universal immunization of adolescents; (6) preschool booster at 4-6 years of age; and (7) reinforcement and/or improvement of current infant and toddler immunization strategies. Because immunization programs vary widely from country to country, no single strategy is likely to be appropriate for all. Moreover it would be helpful to have additional data to support the strategies and provide a better understanding of the disease so that new approaches can be monitored effectively. However, certain steps can be taken now to reduce the incidence of pertussis.
To quantify the quality of anticoagulation control in routine medical care in the US: Long-term o... more To quantify the quality of anticoagulation control in routine medical care in the US: Long-term oral anticoagulation reduces the risk of ischemic stroke in atrial fibrillation but only if the international normalized ratio (INR) is tightly controlled between two and three. METHODS: A cohort study was carried out in practices with no staff dedicated to anticoagulation in four states. Charts of patients 18 years or older with atrial fibrillation and on an anticoagulant at least 60 consecutive days between July 1, 2001 and June 30, 2002 were reviewed by trained abstractors based on a standard form that covered monitoring tests, results and patient outcomes. Data were entered via touch-tone telephone (IVRS) and sensitivity analyses were performed. RESULTS: Charts of 686 patients from 11 practices (most internal or family medicine) and 67 practitioners were reviewed. Mean age was 75 years; 53% male; 79% received warfarin and mean interval between INR tests was 25 ± 22 days; 52% of physicians gave occasional face-to-face consultations in connection with INR tests and 78% used clinical judgment alone to adjust anticoagulant dose. A total of 53% of charts specified a target INR of 2-3; patients spent 42% of the time with INRs out of this range, most (27%) too low, yet the anticoagulant dose was adjusted only a third of the times that INRs were out of range. CONCLUSION: Concerted efforts to improve anticoagulation have been made for more than a decade. Nevertheless, despite increasing costs with frequent INR testing, there remain severe deficiencies in the routine management of anticoagulation in the US.
To estimate the healing and relapse rates in the acute and maintenance treatment of gastroesophag... more To estimate the healing and relapse rates in the acute and maintenance treatment of gastroesophageal reflux disease (GERD) with the newer proton-pump inhibitors (PPIs) lansoprazole, rabeprazole and pantoprazole, compared with omeprazole, ranitidine and placebo.
Two hundred and seven large bowel cancer patients (93% of all cases diagnosed in a defined commun... more Two hundred and seven large bowel cancer patients (93% of all cases diagnosed in a defined community between 1965 and 1976) were matched at random with non-cancer subjects of same age, sex, and place of residence. Men with cancer, aged 75 years and younger than, had a more frequent history of work in a local factory handling synthetic fiber than controls (22 versus 10; P less than 0.025). In this factory 45% of cancers occurred before age 60, while this was true in only 24% of cancer cases outside the factory (P less than 0.05). There was a greater tendency for cancers in factory workers to occur in the colon than in the rectum. Heredity was not found to be a risk factor for large bowel cancer. The rate of prior appendectomy was higher in men with colon cancer (P less than 0.05) and the rate of prior cholecystectomy was lower in females with colonic cancer (P less than 0.05). A previous hemorroidectomy was also found more often in males with colonic cancer (P less than 0.05). Long-standing severe constipation was present more often in patients with cancer (P less than 0.01). There was some evidence for a compounding influence of different risk factors, as studied by relative risk ratio. This study confirms the existence of a high risk of large bowel cancer in a group of workers in a synthetic fiber factory and suggests other factors antecedent to large bowel cancer.
which permits unrestricted use, distribution, and reproduction in any medium, provided the origin... more which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: Pertussis, a highly contagious respiratory illness, affects people of all ages and can have serious clinical consequences. It has been reported that from 1997–2000, 20 % of all pertussis cases required hospitalization in the US. This analysis examined demographics, case fatality rate, resource use and costs of hospital care related to pertussis by age. Methods: ICD-9 codes (033.0, 033.9) were used to identify cases of pertussis in hospital discharge
Background: Standard of care (SoC) for transfusion-dependent β-thalassemia (TDT) requires lifelon... more Background: Standard of care (SoC) for transfusion-dependent β-thalassemia (TDT) requires lifelong, regular blood transfusions as well as chelation to reduce iron accumulation. Objective: This study investigates the cost-effectiveness of betibeglogene autotemcel ('beti-cel'; LentiGlobin for β-thalassemia) one-time, gene addition therapy compared to lifelong SoC for TDT. Study design: Microsimulation model simulated the lifetime course of TDT based on a causal sequence in which transfusion requirements determine tissue iron levels, which in turn determine risk of iron overload complications that increase mortality. Clinical trial data informed beti-cel clinical parameters; effects of SoC on iron levels came from real-world studies; iron overload complication rates and mortality were based on published literature. Setting: USA; commercial payer perspective Participants: TDT patients age 2-50 Interventions: Beti-cel is compared to SoC. Main outcome measure: Incremental cost-effectiveness ratio (ICER) utilizing quality-adjusted lifeyears (QALYs) Results: The model predicts beti-cel adds 3.8 discounted life years (LYs) or 6.9 QALYs versus SoC. Discounted lifetime costs were $2.28 M for beti-cel ($572,107 if excluding beti-cel cost) and $2.04 M for SoC, with a resulting ICER of $34,833 per QALY gained. Conclusion: Beti-cel is cost-effective for TDT patients compared to SoC. This is due to longer survival and cost offset of lifelong SoC.
BACKGROUND: Pertussis, a highly contagious respiratory illness, affects people of all ages and ca... more BACKGROUND: Pertussis, a highly contagious respiratory illness, affects people of all ages and can have serious clinical consequences. It has been reported that from 1997–2000, 20% of all pertussis cases required hospitalization in the US. This analysis examined demographics, case fatality rate, resource use and costs of hospital care related to pertussis by age. METHODS: ICD-9 codes (033.0, 033.9) were
Background: Management of deep vein thrombosis (DVT) has evolved from hospitalisation for intrave... more Background: Management of deep vein thrombosis (DVT) has evolved from hospitalisation for intravenous heparin therapy to treatment options that include acute management as an outpatient. While efficacy and safety remain the principal basis for choosing a therapy, the economic consequences of that choice should be considered as well. Objective: To estimate the average cost of various DVT management options from
Objective: To consider the benefits and risks of large postmarketing outcomes studies, as demonst... more Objective: To consider the benefits and risks of large postmarketing outcomes studies, as demonstrated by studies of the statin drugs. Methods: Literature review. Results: The risks were that the statin studies had a strong coat-tail effect. Each new study was beneficial to all statins as well as the one studied. Economic analyses based on the results of the postmarketing studies concluded that the drugs were not cost-effective. Long-term postmarketing studies were slow to be put into perspective and did not immediately influence other researchers or clinicians. During that time, the sponsoring companies shouldered opportunity costs as well as the actual costs of the studies. The risk that one drug company would use another company's results instead of investing in their own research did not materialize. The benefits were that the studies definitively showed that the drugs and the lowering of lipids were safe and efficacious. The studies also expanded the indications for the drugs, generated goodwill in the medical and research communities for the sponsors, allowed sponsors to include specific claims in their advertisements, generated follow-up studies, spawned economic analyses that sparked interest in the medical and lay press, and had a major impact on clinicians' use of the drug. Conclusion: The risks and benefits of postmarketing studies may depend on the company's time perspective. In the short term, the risks may outweigh the benefits. Only companies that have a longer perspective may find it beneficial to undertake large postmarketing studies.
SIONS: Our model provides evidence than an effective AIDS intervention in a high-risk population ... more SIONS: Our model provides evidence than an effective AIDS intervention in a high-risk population of out-oftreatment substance abusers can avert significant numbers of new HIV infections, which may offset initial costs.
We recommend a framework for the BIA, provide guidance on the acquisition and use of data, and of... more We recommend a framework for the BIA, provide guidance on the acquisition and use of data, and offer a common reporting format that will promote standardization and transparency. Adherence to these good research practice principles would not necessarily supersede jurisdiction-specific BIA guidelines but may support and enhance local recommendations or serve as a starting point for payers wishing to promulgate methodology guidelines.
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 authors assessed pertussis immunisation given in a combined pertussis-diphtheria-tetanus vaccine as an additional adolescent acellular booster dose. The comparator was the existing vaccination strategy of no booster vaccination during adolescence. Type of intervention Primary prevention. Economic study type Cost-effectiveness analysis. Study population The study hypothetical population comprised four cohorts of individuals. Specifically, infants (0-1 year old), children (1-10 years old), adolescents (11-18 years old) and adults (older than 18 years). The vaccination cohort was the adolescents, while the other cohorts allowed an analysis of herd effects. Setting The setting was the community. The economic study was carried out in the USA and Canada.
BACKGROUND: Documentation of the hospitalizations rates following a stroke provides the inputs re... more BACKGROUND: Documentation of the hospitalizations rates following a stroke provides the inputs required for planning health services and to evaluate the economic efficiency of any new therapies. METHODS: Hospitalization rates by cause were examined using administrative data on 18,695 patients diagnosed with ischemic stroke (first or subsequent, excluding transient ischemic attack) in Saskatchewan, Canada between 1990 and 1995. Medical history
Trust and confidence are critical to the success of health care models. There are two main method... more Trust and confidence are critical to the success of health care models. There are two main methods for achieving this: transparency (people can see how the model is built) and validation (how well it reproduces reality). This report describes recommendations for achieving transparency and validation, developed by a task force appointed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the Society for Medical Decision Making (SMDM). Recommendations were developed iteratively by the authors. A nontechnical description should be made available to anyone—including model type and intended applications; funding sources; structure; inputs, outputs, other components that determine function, and their relationships; data sources; validation methods and results; and limitations. Technical documentation, written in sufficient detail to enable a reader with necessary expertise to evaluate the model and potentially reproduce it, should be made available openly ...
Discrete event simulation (DES) is a form of computer-based modeling that provides an intuitive a... more Discrete event simulation (DES) is a form of computer-based modeling that provides an intuitive and flexible approach to representing complex systems. It has been used in a wide range of health care applications. Most early applications involved analyses of systems with constrained resources, where the general aim was to improve the organization of delivered services. More recently, DES has increasingly been applied to evaluate specific technologies in the context of health technology assessment. The aim of this article is to provide consensus-based guidelines on the application of DES in a health care setting, covering the range of issues to which DES can be applied. The article works through the different stages of the modeling process: structural development, parameter estimation, model implementation, model analysis, and representation and reporting. For each stage, a brief description is provided, followed by consideration of issues that are of particular relevance to the appli...
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