Cost-Effectiveness Analysis of Combined Chemotherapy Regimen Containing Bedaquiline in the Treatment of Multidrug-Resistant Tuberculosis in China

Objective This study aims to estimate the cost-effectiveness of the combined chemotherapy regimen containing Bedaquiline(BR)and the conventional treatment regimen(CR,not containing Bedaquiline)for the treatment of adults with multidrug-resistant tuberculosis(MDR-TB)in China.Methods A combination of a decision tree and a Markov model was developed to estimate the cost and effects of MDR patients in BR and CR within ten years.The model parameter data were synthesized from the literature,the national TB surveillance information system,and consultation with experts.The incremental cost-effectiveness ratio(ICER)of BR vs.CR was determined.Results BR(vs.CR)had a higher sputum culture conversion rate and cure rate and prevented many premature deaths(decreased by 12.8%),thereby obtaining more quality-adjusted life years(QALYs)(increased by 2.31 years).The per capita cost in BR was as high as 138,000 yuan,roughly double that of CR.The ICER for BR was 33,700 yuan/QALY,which was lower than China's 1×per capita Gross Domestic Product(GDP)in 2020(72,400 yuan).Conclusion BR is shown to be cost effective.When the unit price of Bedaquiline reaches or falls below57.21 yuan per unit,BR is expected to be the dominant strategy in China over CR.

Cost-effectiveness of robotic-assisted spinal surgery:A single-center retrospective study

Objective:Robotic-assisted spine surgeries(RASS)have been shown to enhance precision,reduce operative time,prevent complications,facilitate minimally invasive spinal surgery,and decrease revision surgery rates,leading to improved patient outco mes This study aimed to compare the cost-effectiveness of RAs's and non-robotic-assisted surgery for degenerative spine disease at a single center.Me thods:This retrospective study,including 122 patients,was conducted at a single center from March 2015 to February 2022.Patients who underwent ro bot-assisted surgery were assigned to the robotgroup,and patients who underwent non-robotic-assisted surgery were assigned to the non-mmbot group.Various data,indluding demographic information,surgical details,outcomes,and cost-effectiveness,were colected for both groups.The cost-effectiveness was determined using the incremental cost-effectiveness ratio(ICER),and subgroup analysis was conducted for patients with 1 or 2 levels of spi-nal instrumentation.The analysis was performed using STATA SE version 15 and Tree.Age Pro 2020,with Monte Caro simulations for the cost-effectiveness acceptability curve.Results The owerallICER was$22,572,but it decreased to$16,980 when considering cases with only 1or 2 levels of instrumentation.RASS is deemed cost-effective when the willi ingness to pay is$3000-$4000 if less than 2 levels of the spine are instrumented.Conchsions:The cost-effectiveness of robot icassistance be comes apparent whenthere isa reduced need for open surgeries,leading to decreased d revision rates caused by complications such as misplaced screwsor infctions.Therefore,it is advisable to allocate healthcare budget resou Irces to spine robots,as RASS PIDves to be cost-effective,partic cularly when only two or Ewer spinal levels require instrumentation.

Cost-effectiveness of patient specific vs conventional instrumentation for total knee arthroplasty:A systematic review and meta-analysis

BACKGROUND Over the past years,patient specific instrumentation(PSI)for total knee arthroplasty(TKA)has been implemented and routinely used.No clear answer has been given on its associated cost and cost-effectiveness when compared to conventional instrumentation(CI)for TKA.AIM To compare the cost and cost-effectiveness of PSI TKA compared to CI TKA.METHODS A literature search was performed in healthcare,economical healthcare,and medical databases(MEDLINE,EMBASE,CINAHL,Web of Science,Cochrane Library,EconLit).It was conducted in April 2021 and again in January 2022.Relevant literature included randomised controlled trials,retrospective studies,prospective studies,observational studies,and case control studies.All studies were assessed on methodological quality.Relevant outcomes included incremental cost-effectiveness ratio,quality-adjusted life years,total costs,imaging costs,production costs,sterilization associated costs,surgery duration costs and readmission rate costs.All eligible studies were assessed for risk of bias.Meta-analysis was performed for outcomes with sufficient data.RESULTS Thirty-two studies were included into the systematic review.Two were included in the metaanalysis.3994 PSI TKAs and 13267 CI TKAs were included in the sample size.The methodological quality of the included studies,based on Consensus on Health Economic Criteria-scores and risk of bias,ranged from average to good.PSI TKA costs less than CI TKA when considering mean operating room time and its associated costs and tray sterilization per patient case.PSI TKA costs more compared to CI TKA when considering imaging and production costs.Considering total costs per patient case,PSI TKA is more expensive in comparison to CI TKA.Meta-analysis comparing total costs for PSI TKA,and CI TKA showed a significant higher cost for PSI TKA.CONCLUSION Cost for PSI and CI TKA can differ when considering distinct aspects of their implementation.Total costs per patient case are increased for PSI TKA when compared to CI TKA.

Cost-Effective Method of Gene Synthesis by Sequencing from Microchip-Derived Oligos for Droplet Cloning

Gene synthesis has provided important contributions in various fields including genomics and medicine. Current genes are 7 - 30 cents depending on the assembly and sequencing methods performed. Demand for gene synthesis has been increasing for the past few decades, yet available methods remain expensive. A solution to this problem involves microchip-derived oligonucleotides (oligos), an oligo pool with a substantial number of oligo fragments. Microchips have been proposed as a tool for gene synthesis, but this approach has been criticized for its high error rate during sequencing. This study tests a possible cost-effective method for gene synthesis utilizing fragment assembly and golden gate assembly, which can be employed for quicker manufacturing and efficient execution of genes in the near future. The droplet method was tested in two trials to determine the viability of the method through the accuracy of the oligos sequenced. A preliminary research experiment was performed to determine the efficacy of oligo lengths ranging from two to four overlapping oligos through Gibson assembly. Of the three oligo lengths tested, only two fragment oligos were correctly sequenced. Two fragment oligos were used for the second experiment, which determined the efficacy of the droplet method in reducing gene synthesis cost and speed. The first trial utilized a high-fidelity polymerase and resulted in 3% correctly sequenced oligos, so the second trial utilized a non-high-fidelity polymerase, resulting in 8% correctly sequenced oligos. After calculating, the cost of gene synthesis lowers down to 0.8 cents/base. The final calculated cost of 0.8 cents/base is significantly cheaper than other manufacturing costs of 7 - 30 cents/base. Reducing the cost of gene synthesis provides new insight into the cost-effectiveness of present technologies and protocols and has the potential to benefit the fields of bioengineering and gene therapy.

Cost-effectiveness Analysis of Insulin Degludec and Liraglutide Injection in the Treatment of Type 2 Diabetes

Objective To analyze the cost-effectiveness of insulin degludec and liraglutide injection(IDegLira)compared with insulin glargine plus insulin aspart(IGar plus IAsp)in the treatment of type 2 diabetes mellitus(T2DM)based on the price of IDegLira before and after it was successfully admitted to the National Reimbursable Drug List(NRDL).Methods Cost and effectiveness parameters were obtained through systematic retrieval from PubMed,ScienceDirect,CNKI,and Wanfang database.A cost-effectiveness analysis(CEA)model was established to analyze the economics using IDegLira for T2DM patients with 1 to 5 years of medication.Results and Conclusion Before IDegLira was admitted to NRDL,its economic advantages over the IGlar plus Iasp regimen became more significant as patients’medication time prolonged.After being admitted to NRDL,with 1 year of medication,the medical cost of IDegLira decreased by 2853.91 yuan and the quality adjusted life years(QALY)increased by 0.12055 than IGar plus IAsp.The sensitivity analysis was highly consistent with the results of the baseline result.After being admitted to NRDL,for patients with T2DM who have poor blood glucose control,IDegLira is absolutely an economic advantage scheme compared with IGar plus IAsp.

Investigation of cost-effectiveness of highway asphalt pavement maintenance treatments based on rutting development analysis

To investigate the cost-effectiveness of different maintenance treatments of highways in Jiangsu Province, the historical pavement maintenance records, traffic load information and pavement performance data in the pavement management system （PMS） are recorded and analyzed. Compared with the growth model, the linear model, the logarithm model and the exponential model, the cubic model has higher regression accuracy R2 and it can capture the sigmoid shape of the deterioration curve. So it is selected to simulate the pavement rotting development. The benefit over cost ratio is calculated to quantify the treatment cost- effectiveness. The analysis results show that thin hot mix asphalt （HMA） overlays and micro surfacing are more cost- effective than the. other two treatments on light and moderate traffic roads. Hot in-place recycling and thick HMA overlays have much longer service lives and greater cost-effectiveness under heavy or extra heavy traffic.

The Cost-effectiveness Analysis of Percutaneous Transhepatic Metal Versus Plastic Biliary Stent Implantation for Treating Malignant Biliary Obstruction (Multiple Center Investigation)

Objective: To compare metal versus plastic biliary stent implantation for treatment of malignant biliary obstruction in cost-effectiveness ratio (CER). Methods: Percutaneous transhepatic self-expandable metal stent (MS, n=61) or 10F plastic stent (PS, n=34) implantation was performed in 95 patients with malignant biliary obstruction in three hospitals of Guangdong province. All patients were followed up until death or at least one year after the procedure. Kaplan-Meier analysis was used to compare the survival and stent patency rates of the patients in the two groups. CERs of two groups were calculated. The main indexes were CERsurvival period (total cost/median survival period), CERpatency period (total cost/median patency period). Results: The total costs of treatment were 53177±3139 yuan (RMB) in MS group and 42564±4950 yuan (RMB) in PS group respectively (P>0.05). CER in MS group was superior to that in PS group (CERsurvival period was 237.4 yuan /d vs 452.6 yuan /d, respectively; CERpatency period was 231.2 yuan /d vs 472.9 yuan /d, respectively). Conclusion: The metal stent implantation is superior to the plastic stent in the CER for treatment of malignant biliary obstruction.

Cost-effectiveness analysis of chemotherapy for advancedgastric cancer in China

AIM： To assess the economics of various chemotherapeutic regimens for advanced gastric cancer （AGC）, and to select the best cost-effective regimen for the common Chinese patients. METHODS： Data source used in this study was the Chinese Biomedical Disk Database. Patients were diagnosed as AGC and any regimen was eligible. Outcome measures included median survival time （MST） and percentage of complete and partial response （CR＋PR）. Economic statistics was per capita direct medical cost （DMC） of a single cycle. TreeAge Pro Healthcare 2007 software was used to carry out costeffectiveness and incremental cost-effectiveness analysis. Sensitivity analyses were applied by altering willingness- to-pay and annual discount rate, and also re-analyzed by excluding the studies with apparent heterogeneity. RESULTS： Seven retrospective economics studies on 760 patients were included. S-fluorouracil-based regimens were universal, and also some new agents were involved, such as docetaxel, paclitaxel, andoxaliplatin. By processing analysis, we could recommend etoposide, leucovorin and 5-fluorouracil （ELF） regimen as preference, with a DMC/MST ratio of 2543 RBM/11.7 mo and a DMC/CR＋PR ratio of 2543 RMB/53.3%. Uraciltegafur, etoposide and cisplatin （FEP） or 5-fluorouracil, adrimycin/epirubin and mitomycin （FAM） regimens could be regarded as optional first-line chemotherapy for AGC in common Chinese patients. With no regard for willingness-to-pay, the docetaxel, cisplatin and 5-fluorouracil （DCF） regimen could be chosen as either a first- or a second-line chemotherapy, with a DMC/CR＋PR ratio of 9979 RMB/56.3%. CONCLUSION： 5-fluorouracial regimens are still considered the mainstream for AGC, while new agents such as taxanes are optional. More randomized clinical trials are required before any mandatory recommendation of certain regimens for patients with AGC in China is made.

High-resolution microendoscopy for esophageal cancer screening in China: A cost-effectiveness analysis

AIM:To study the cost-effectiveness of high-resolution microendoscopy(HRME)in an esophageal squamous cell carcinoma(ESCC)screening program in China.METHODS:A decision analytic Markov model of ESCC was developed.Separate model analyses were conducted for cohorts consisting of an averagerisk population or a high-risk population in China.Hypothetical 50-year-old individuals were followed until age 80 or death.We compared three different strategies for both cohorts:(1)no screening;(2)standard endoscopic screening with Lugol’s iodine staining;and(3)endoscopic screening with Lugol’s iodine staining and an HRME.Model parameters were estimated from the literature as well as from GLOBOCAN,the Cancer Incidence and Mortality Worldwide cancer database.Health states in the model included non-neoplasia,mild dysplasia,moderate dysplasia,high-grade dysplasia,intramucosal carcinoma,operable cancer,inoperable cancer,and death.Separate ESCC incidence transition rates were generated for the average-risk and high-risk populations.Costs in Chinese currency were converted to international dollars(I$)and were adjusted to 2012dollars using the Consumer Price Index.RESULTS:The main outcome measurements for this study were quality-adjusted life years(QALYs)and incremental cost-effectiveness ratio(ICER).For the average-risk population,the HRME screening strategy produced 0.043 more QALYs than the no screening strategy at an additional cost of I$646,resulting in an ICER of I$11808 per QALY gained.Standard endoscopic screening was weakly dominated.Among the high-risk population,when the HRME screening strategy was compared with the standard screening strategy,the ICER was I$8173 per QALY.For both the high-risk and average-risk screening populations,the HRME screening strategy appeared to be the most cost-effective strategy,producing ICERs below the willingness-topay threshold,I$23500 per QALY.One-way sensitivity analysis showed that,for the average-risk population,higher specificity of Lugol’s iodine(>40%)and lower specificity of HRME(<70%)could make Lugol’s iodine screening cost-effective.For the high-risk population,the results of the model were not substantially affected by varying the follow-up rate after Lugol’s iodine screening,Lugol’s iodine test characteristics(sensitivity and specificity),or HRME specificity.CONCLUSION:The incorporation of HRME into an ESCC screening program could be cost-effective in China.Larger studies of HRME performance are needed to confirm these findings.

Cost-effectiveness analysis of early veno-venous hemofiltration for severe acute pancreatitis in China

AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were： continuous or long-term veno-venous hemofiltration （CVVH/LVVH）, short-term veno-venous hemofiltration （SVVH）, SVVH plus peritoneal dialysis （PD）, and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS： The SVVH only technique was the least costly modality, $5809 （44449 RMB）, and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION： The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.

Influenza vaccination in acute coronary syndromes patients in Thailand： the cost-effectiveness analysis of the prevention for cardiovascular events and pneumonia

Background Influenza vaccination has been clinically shown to reduce adverse cardiovascular outcomes in acute coronary syndrome （ACS） patients, but the economic perspectives can provide important data to make informed decisions. This study aimed to perform the economic evaluation of lifelong annual influenza vaccination for cardiovascular events and well-established pneumonia prevention. Methods Lifetime costs, life-expectancy, and quality-adjusted live years （QALYs） were estimated beyond one-year cycle length of a six-health states Markov model condition on whether a hospitalization for ACS, stroke, heart failure, pneumonia, no hospitalizations occurred, or death. The comparison of three age-groups of 40-49, 50-65, and 〉 65 years scenario was performed. Incremental cost-effectiveness ratio （ICER） and net monetary benefit （NMB） were presented as a societal perspective in 2016. The model robustness was determined by one-way and prob- abilistic sensitivity analyses. Results The influenza vaccination was cost-effective in all age-groups, by dominant ICERs （lower cost with higher effectiveness） which was completely lower than acceptable willingness-to-pay threshold of Thailand [160,000 THB （4,466.8 USD） per QALYs], with a great incremental value of NMB. Especially, the 50-year-old-and- above scenario was shown as the most benefit at 129,092 THB （3,603.9 USD） for each patient. Conclusions The annually additional influenza vaccination to standard treatment in ACS was cost-effective in all age-groups, which should be considered in clinical practice and health-policy making process.

Cost-effectiveness analysis of population-based screening of hepatocellular carcinoma: Comparing ultrasonography with two-stage screening

AIM: To assess the cost-effectiveness of two populationbased hepatocellular carcinoma(HCC) screening programs, two-stage biomarker-ultrasound method and mass screening using abdominal ultrasonography(AUS).METHODS: In this study, we applied a Markov decision model with a societal perspective and a lifetime horizon for the general population-based cohorts in an area with high HCC incidence, such as Taiwan. The accuracy of biomarkers and ultrasonography was estimated from published meta-analyses. The costs of surveillance, diagnosis, and treatment were based on a combination of published literature, Medicare payments, and medical expenditure at the National Taiwan University Hospital. The main outcome measure was cost per lifeyear gained with a 3% annual discount rate. RESULTS: The results show that the mass screening using AUS was associated with an incremental costeffectiveness ratio of USD39825 per life-year gained, whereas two-stage screening was associated with an incremental cost-effectiveness ratio of USD49733 per life-year gained, as compared with no screening. Screening programs with an initial screening age of 50 years old and biennial screening interval were the most cost-effective. These findings were sensitive to the costs of screening tools and the specificity of biomarker screening.CONCLUSION: Mass screening using AUS is more cost effective than two-stage biomarker-ultrasound screening. The most optimal strategy is an initial screening age at 50 years old with a 2-year inter-screening interval.

Cost-effectiveness analysis of colon cancer treatments from MOSIAC and No.16968 trials

AIM: To compare XELOX and FOLFOX4 as colon cancer adjuvant chemotherapy based on MOSAIC and No. 16968 trails from Chinese cost-effectiveness perspective. METHODS: A decision-analytic Markov model was developed to compare the FOLFOX4 and XELOX regimens based MOSAIC and No. 16968 trial. Five states were included in our Markov model: well (state 1), minor toxicity (state 2), major toxicity (state 3), quitting adjuvant chemotherapy (state 4), and death due to adjuvant chemotherapy (state 5). Transitions among the 5 states were assumed to be Markovian. Costs were calculated from the perspective of the Chinese health-care payer. The utility data were taken from published studies. Sensitivity analyses were used to explore the impact of uncertainty factors in this cost-effectiveness analysis. RESULTS: Total direct costs of FOLFOX4 and XELOX per patient were $ 19884.96 +/- 4280.30 and $ 18113.25 +/- 3122.20, respectively. The total fees related to adverse events per patient during the entire treatment were $ 204.75 +/- 16.80 for the XELOX group, and $ 873.72 +/- 27.60 for the FOLFOX4 group, and the costs for travel and absenteeism per patient were $ 18495.00 for the XELOX group and $ 21,352.68 for the FOLFOX4 group. The base-case analysis showed that FOLFOX4 was estimated to produce an additional 0.06 in quality adjusted life years (QALYs) at an additional cost of $ 3950.47 when compared to the XELOX regimen over the model time horizon. The cost per QALY gained was $ 8047.30 in the XELOX group, which was $ 900.98 less than in the FOLFOX4 group ($ 8948.28). The one way sensitivity analysis demonstrated that the utility for the well state and minor toxicity state greatly influenced the incremental cost-effectiveness ratio of FOLFOX4. CONCLUSION: In term of cost-comparison, XELOX is expected to dominate FOLFOX4 regimes; Therefore, XELOX provides a more cost-effective adjuvant chemotherapy for colon cancer patients in China. c 2014 Baishideng Publishing Group Inc. All rights reserved.

Real-world cost-effectiveness associated with infliximab maintenance therapy for moderate to severe Crohn's disease in China

BACKGROUND Infliximab was the first approved biologic treatment for moderate to severe Crohn's disease(MS-CD) in China. However, the cost-effectiveness of infliximab maintenance therapy(IMT) for MS-CD relative to conventional maintenance therapy remained unclarified.AIM To assess the cost-effectiveness of IMT for MS-CD in Chinese patients from the perspective of Chinese public insurance payer.METHODS A cohort of MS-CD patients managed in a Chinese tertiary care hospital was created to compare IMT with conventional maintenance therapy(CMT) for clinical outcomes and direct medical costs over a 1-year observation time using conventional regression analyses. A decision-analytic model with the generated evidence was constructed to assess the cost-effectiveness of IMT relative to CMT using reimbursed medical costs.RESULTS Based on the included 389 patients, IMT was associated with significantly higher disease remission chance [odds ratio: 4.060, P = 0.003], lower risk of developing new complications(odds ratio: 0.527, P = 0.010), higher utility value for quality of life(coefficient 0.822, P = 0.008), and lower total hospital costs related to disease management(coefficient-0.378, P = 0.008) than CMT. Base-case cost-effectiveness analysis estimated that IMT could cost Chinese health insurance payers $55260 to gain one quality-adjusted life year(QALY). The cost-effectiveness of IMT was mainly driven by the estimate of quality of life, treatment efficacy of maintenance therapy, mortality risk associated with active disease, and unit price of infliximab. The probability that IMT was cost-effective at a willingness-to-pay threshold of three times gross domestic product [2018 Chinese gross domestic product per capita(GDPPC)] was 86.4%.CONCLUSION IMT significantly improved real-world health outcomes and cost the Chinese public health insurance payers less than one GDPPC to gain one QALY in Chinese MS-CD patients.

Cost-effectiveness of endoscopic ultrasound-guided coils plus cyanoacrylate injection compared to endoscopic cyanoacrylate injection in the management of gastric varices

BACKGROUND Cyanoacrylate(CYA)injection can be performed using a standard upper endoscopy technique or under endoscopic ultrasound(EUS)guidance alone or in combination with coils.There is little information available on the economic impact of these treatment methods.AIM To compare the cost-effectiveness of treating gastric varices by CYA injection via upper endoscopy vs coils plus CYA guided by EUS.METHODS This was an observational,descriptive,and retrospective study.Patients were allocated into two groups:A CYA group and coils plus CYA group.The baseline characteristics were compared,and a cost analysis was performed.RESULTS Overall,36 patients were included(19 in the CYA group and 17 in the coils+CYA group).All patients in the CYA group had acute bleeding.They underwent a higher mean number of procedures(1.47 vs 1,P=0.025),and the mean volume of glue used was 2.15 vs 1.65 mL,P=0.133.The coils+CYA group showed a higher technical success rate(100%vs 84.2%),with a complication rate similar to the CYA group.The majority of CYA patients required hospitalization,and although the mean total per procedure cost was lower(United States$1350.29 vs United States$2978),the mean total treatment cost was significantly different(United States$11060.89 for CYA vs United States$3007.13 for coils+CYA,P=0.03).CONCLUSION The use of EUS-guided coils plus cyanoacrylate is more cost-effective than cyanoacrylate injection when the total costs are evaluated.Larger,randomized trials are needed to validate the cost-effectiveness of the EUS-guided approach to treat gastric varices.

Cost-effectiveness analysis of transcatheter arterial chemoembolization with or without sorafenib for the treatment of unresectable hepatocellular carcinoma

BACKGROUND: Transcatheter arterial chemoembolization(TACE) and TACE in combination with sorafenib(TACEsorafenib) have shown a significant survival benefit for the treatment of unresectable hepatocellular carcinoma(HCC). Adopting either as a first-line therapy carries major cost and resource implications. The objective of this study was to estimate the relative cost-effectiveness of TACE against TACE-sorafenib for unresectable HCC using a decision analytic model.METHODS: A Markov cohort model was developed to compare TACE and TACE-sorafenib. Transition probabilities and utilities were obtained from systematic literature reviews, and costs were obtained from West China Hospital, Sichuan University, China. Survival benefits were reported in quality-adjusted life-years(QALYs). The incremental cost-effectiveness ratio(ICER) was calculated. Sensitive analysis was performed by varying potentially modifiable parameters of the model.RESULTS: The base-case analysis showed that TACE cost $26 951 and yielded survival of 0.71 QALYs, and TACE-sorafenib cost $44 542 and yielded survival of 1.02 QALYs in the entire treatment. The ICER of TACE-sorafenib versus TACE was $56 745 per QALY gained, which was above threshold for cost-effectiveness in China. Sensitivity analysis revealed that the major driver of ICER was the cost post TACE-sorafenib therapy with stable state.CONCLUSION: TACE is a more cost-effective strategy than TACE-sorafenib for the treatment of unresectable HCC.

Cost-Effectiveness Analysis of Neoadjuvant Chemotherapy with Zoledronic Acid for HER2-Negative Breast Cancer in Japan: The JONIE1 Study

Objective: Zoledronic acid (ZOL) is a nitrogen-containing bisphosphonate that induces osteoclast apoptosis and inhibits bone resorption. Adding ZOL to neoadjuvant chemotherapy has been shown to have potential anticancer benefits in women with HER2-negative breast cancer. The objective of the present study was to investigate ZOL’s cost-effectiveness from the perspective of health care payers in Japan. Methods: A Markov model was developed to evaluate the costs and effectiveness associated with ZOL + chemotherapy (CTZ) and chemotherapy (CT) alone over a 10-year time horizon. Monthly transition probabilities were estimated according to JONIE1 (Japan Organization of Neoadjuvant Innovative Expert) Study data and an extrapolated Weibull model. Health outcomes were measured in quality-adjusted life years (QALYs). Costs were calculated using year-2018 Japanese yen (JPY) (1.00 US dollars (USD) = 110.4 JPY). Model robustness was addressed through one-way and probabilistic sensitivity analysis. The costs and QALYs were discounted at a rate of 2% per year. Results: In the base case, the use of CTZ was associated with a gain of 3.94 QALYs. The incremental cost per QALY of the CTZ gain was 681,056.1 JPY (6168.99 USD) per QALY. Conclusion: It is convincing that neoadjuvant CTZ for patients with breast cancer would be expected to have statistically significant clinical efficacy. Addition of ZOL to CT might be a cost-effective option compared with CT alone.

Cost-effectiveness of enhanced liver fibrosis test to assess liver fibrosis in chronic hepatitis C virus and alcoholic liver disease patients

AIM To assess liver fibrosis(LF) in hepatitis C virus(HCV) and alcoholic liver disease(ALD), estimate health outcomes and costs of new noninvasive testing strategies METHODS A Markov model was developed to simulate LF progression in HCV and ALD for a cohort of 40-yearold men with abnormal levels of transaminases. Three different testing alternatives were studied: a single liver biopsy; annual Enhanced liver fibrosis(ELF?) followed by liver stiffness measurement(LSM) imaging as a confirmation test if the ELF test is positive; and annual ELF test without LSM. The analysis was performed from the perspective of a university hospital in Spain.Clinical data were obtained from published literature. Costs were sourced from administrative databases of the hospital. Deterministic and probabilistic sensitivity analyses were performed.RESULTS In HCV patients, annual sequential ELF test/LSM and annual ELF test alone prevented respectively 12.9 and 13.3 liver fibrosis-related deaths per 100 persons tested, compared to biopsy. The incremental costeffectiveness ratios(ICERs) were respectively €13400 and €11500 per quality-adjusted life year(QALY). In ALD, fibrosis-related deaths decreased by 11.7 and 22.1 per 100 persons tested respectively with sequential ELF test/LSM and annual ELF test alone. ICERs were €280 and €190 per QALY, respectively.CONCLUSION The use of the ELF test with or without a confirmation LSM are cost-effective options compared to a single liver biopsy for testing liver fibrosis in HCV and ALD patients in Spain.

Cost-effectiveness modelling of percutaneous coronary interventions in stable coronary artery disease

The objective of this study is to develop a cost-effectiveness model comparing drug eluting stents(DES) vs bare metal stent(BMS) in patients suffering of stable coronary artery disease. Using a 2-years time horizon, two simulation models have been developed: BMS first line strategy and DES first line strategy. Direct medical costs were estimated considering ambulatory and hospital costs. The effectiveness endpoint was defined as treatment success, which is the absence of major adverse cardiac events. Probabilistic sensitivity analyses were carried out using 10000 Monte-Carlo simulations. DES appeared slightly more efficacious over 2 years(60% of success) when compared to BMS(58% of success). Total costs over 2 years were estimated at 9303 € for the DES and at 8926 € for bare metal stent. Hence, corresponding mean cost-effectiveness ratios showed slightly lower costs(P < 0.05) per success for the BMS strategy(15520 €/success), as compared to the DES strategy(15588 €/success). Incremental costeffectiveness ratio is 18850 € for one additional percent of success. The sequential strategy including BMS as the first option appears to be slightly less efficacious but more cost-effective compared to the strategy including DES as first option. Future modelling approaches should confirm these results as further comparative data in stable coronary artery disease and long-term evidence become available.

Cost-effectiveness in Clostridium difficile treatment decision-making

AIM: To develop a framework for the clinical and health economic assessment for management of Clostridium difficile infection(CDI).METHODS: CDI has vast economic consequences emphasizing the need for innovative and cost effective solutions, which were aim of this study. A guidance model was developed for coverage decisions and guideline development in CDI. The model included pharmacotherapy with oral metronidazole or oral vancomycin, which is the mainstay for pharmacological treatment of CDI and is recommended by most treatment guidelines.RESULTS: A design for a patient-based cost-effectiveness model was developed, which can be used to estimate the cost-effectiveness of current and future treatment strategies in CDI. Patient-based outcomes were extrapolated to the population by including factors like, e.g., person-to-person transmission, isolation precautions and closing and cleaning wards of hospitals. CONCLUSION: The proposed framework for a population-based CDI model may be used for clinical and health economic assessments of CDI guidelines and coverage decisions for emerging treatments for CDI.