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Igarashi A, Inoue S, Onishi Y. Cost-utility analysis of isavuconazole compared with the standard of care as a first-line therapy for patients with invasive fungal infection prior to differential pathogen diagnosis in Japan. J Med Econ 2025; 28:460-470. [PMID: 40126416 DOI: 10.1080/13696998.2025.2483098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Revised: 02/27/2025] [Accepted: 03/19/2025] [Indexed: 03/25/2025]
Abstract
AIMS This study aimed to evaluate the cost-effectiveness of isavuconazole compared with voriconazole as a first-line therapy for patients with invasive aspergillosis prior to differential pathogen diagnosis. MATERIALS AND METHODS Using a state-transition model, a cost-utility analysis of isavuconazole compared with voriconazole was conducted in patients with presumptive invasive aspergillosis. The study population consisted of patients with hematological malignancies undergoing hematopoietic stem cell transplantation (HSCT) or chemotherapy who developed invasive fungal infections. The incremental cost-effectiveness ratio (ICER) was analyzed from the perspective of public healthcare. In patients with presumptive invasive aspergillosis, 6.6% were assumed to have mucormycosis. Efficacy data were sourced from the SECURE and VITAL trials, which included patients with invasive aspergillosis and mucormycosis. Expected survival was based on data for acute myeloid leukemia. The cost of voriconazole was based on its generic price. Different parameters were set for quality of life, expected survival period, and hospitalization costs in the HSCT and chemotherapy models, and the robustness of the model was evaluated using probabilistic and deterministic sensitivity analyses. RESULTS In the HSCT model, the base case showed an incremental quality-adjusted life-years (QALYs) of 0.37 and an incremental cost of JPY 918,682 for isavuconazole compared with voriconazole, with an ICER of JPY 2,515,813. In the chemotherapy model, the incremental QALYs was 0.16, and the incremental cost was JPY 723,111, with an ICER of JPY 4,411,564. The probability sensitivity analysis showed that the proportion of ICERs below JPY 5 million was 100.0% in the HSCT model and 79.1% in the chemotherapy model. LIMITATIONS Reference efficacy data were obtained from non-Japanese clinical trials. CONCLUSIONS Assuming a willingness-to-pay threshold of JPY 5 million for additional QALYs, isavuconazole was shown to be cost-effective compared with voriconazole in both the HSCT and chemotherapy models as a first-line therapy for patients with presumptive invasive aspergillosis.
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Affiliation(s)
- Ataru Igarashi
- Department of Health Policy and Public Health, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Shun Inoue
- Asahi Kasei Pharma Corporation, Tokyo, Japan
| | - Yasushi Onishi
- Department of Hematology, Tohoku University Hospital, Sendai, Japan
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Yanagi Y, Tsujimura J, Ohno S, Higashi K, Sakashita N, Shoji A, Igarashi A. Cost-effectiveness analysis of bispecific antibody faricimab for treatment of neovascular age-related macular degeneration and diabetic macular edema in Japan. J Med Econ 2025; 28:448-459. [PMID: 40078048 DOI: 10.1080/13696998.2025.2478755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Revised: 03/07/2025] [Accepted: 03/10/2025] [Indexed: 03/14/2025]
Abstract
OBJECTIVE To assess the cost-effectiveness of faricimab vs. other anti-vascular endothelial growth factor (anti-VEGF) drugs for treatment of neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) in Japan, while considering societal burden associated with treatment. METHODS A Markov model for cost-effectiveness analysis of anti-VEGF treatment in patients with nAMD and DME was applied based on cost and utility value data from Japan. Faricimab administered through a treat-and-extend (T&E) regimen was compared with ranibizumab administered pro re nata (PRN) and T&E, aflibercept T&E, brolucizumab T&E, and best supportive care (BSC). Further to treatment costs (public payer perspective), the societal burden (societal perspective), including costs of travel, informal care, and productivity, was assessed. RESULTS In treatment of nAMD, lifetime quality-adjusted life years (QALYs) gained were highest with faricimab (faricimab T&E: 6.92, ranibizumab PRN: 6.88, ranibizumab T&E: 6.91, aflibercept T&E: 6.89, brolucizumab T&E: 6.89, BSC: 5.99). From the public payer perspective, the lifetime total cost for faricimab T&E was lower than those for ranibizumab (PRN, T&E) and brolucizumab (T&E), comparable to aflibercept T&E, and higher than BSC (incremental costs: 158,385 and 6,475,511 JPY, respectively). As a result, faricimab was cost-effective or dominant in the treatment of nAMD, excluding BSC. From the societal perspective, faricimab was dominant against all comparators in nAMD. In treatment of DME, QALYs gained were highest with faricimab (faricimab T&E: 8.51, ranibizumab PRN: 8.17, aflibercept PRN: 8.36, ranibizumab T&E: 8.13, BSC: 5.16). From both the public payer and societal perspectives, faricimab was dominant against all comparators in DME. CONCLUSIONS When societal burdens were considered, faricimab was dominant in both nAMD and DME against all comparators, suggesting that the extended dosing interval associated with faricimab treatment may alleviate societal burdens and consequently improve patient outcomes.
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Affiliation(s)
- Yasuo Yanagi
- Department of Ophthalmology and Micro-Technology, Yokohama City University, Yokohama, Japan
- Retina Research Group, Singapore Eye Research Institute, Singapore
- Singapore Eye-ACP, Duke-NUS Medical School, National University of Singapore, Singapore
| | | | - Shinya Ohno
- Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | | | | | - Ayako Shoji
- Medilead, Inc., Tokyo, Japan
- Healthcare Consulting, Inc., Tokyo, Japan
| | - Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
- Department of Public Health, School of Medicine, Yokohama City University, Kanagawa, Japan
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Liu N, Babazono A, Hayashida K, Jamal A, Ishihara R, Yamao R, Yoshida S, Matsuda S, Li Y. Cost-effectiveness analysis of tube feeding among older adults with advanced dementia in Japan: A net benefit regression approach. Arch Gerontol Geriatr 2025; 133:105812. [PMID: 40073797 DOI: 10.1016/j.archger.2025.105812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 02/11/2025] [Accepted: 03/02/2025] [Indexed: 03/14/2025]
Abstract
BACKGROUND This study aims to assess the cost-effectiveness of percutaneous endoscopic gastrostomy (PEG) and nasogastric tube (NGT) in older adults with advanced dementia, compared with non-artificial nutrition. METHODS Retrospective cohort study. Medical claims data and long-term care claims data from Fukuoka Prefecture, Japan, were used. We identified 3,882 older adults (≥75 years) with advanced dementia who were hospitalized between April 2016 and March 2019 due to dysphagia, malnutrition, or aspiration pneumonia. Using propensity score matching, we matched 192 patients in the PEG group with 192 in the non-artificial nutrition group, and 490 patients in the NGT group with 490 in the non-artificial nutrition group. We examined the survival years and total costs of each patient from the date of admission to March 31, 2020, and thereby estimated the cost-effectiveness of PEG and NGT, respectively, versus non-artificial nutrition. The net benefit regression model was employed to estimate the incremental net benefits (INB) with varying values of willingness-to-pay (WTP) for PEG and NGT. Furthermore, cost-effectiveness acceptability curve was used to present the probability of the cost-effectiveness of each intervention. RESULTS As WTP increased from JPY 7,747,909 (equivalent to US$51,546) to JPY 28,163,651 (equivalent to US$187,371), the probability of PEG being cost-effective increased from 50 % to nearly100 %. The NGT group had negative INB estimates. CONCLUSIONS Both PEG and NGT are less likely to provide economic values for patients with advanced dementia. However, this conclusion should be further refined through detailed cost-effectiveness analysis from multiple perspectives.
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Affiliation(s)
- Ning Liu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Kenshi Hayashida
- Department of Medical Informatics and Management, University Hospital, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Aziz Jamal
- Health Administration Program, Faculty of Business and Management, University Teknologi MARA, Selangor, Malaysia
| | - Reiko Ishihara
- Department of Human Sciences, Osaka University of Economics, Osaka, Japan
| | - Reiko Yamao
- Public Health Nursing, School of Nursing, Fukuoka University, Fukuoka,Japan
| | - Shinichiro Yoshida
- Department of Health Care Administration and Management, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yunfei Li
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Deshpande V, Simpson E, Caballero J, Haddad C, Smith J, Gardner V. Cost-utility of lumbar interbody fusion surgery: a systematic review. Spine J 2025; 25:1117-1138. [PMID: 39805471 DOI: 10.1016/j.spinee.2024.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 12/16/2024] [Accepted: 12/17/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND CONTEXT Lumbar interbody fusion (LIF) is a common surgical intervention for treating lumbar degenerative disorders. Increasing demand has contributed to ever-increasing healthcare expenditure and economic burden. To address this, cost-utility analyses (CUAs) compare value in the context of patient outcomes. CUAs quantify health improvements using quality-adjusted life years (QALYs), allowing decision-makers to determine procedure value. PURPOSE While there is a growing body of literature assessing LIF value, a comprehensive synthesis of LIF CUAs is lacking. This systematic review aims to address this gap by assessing all available CUAs of LIF techniques, to support evidence-based practices that improve outcomes and promote efficient resource use. STUDY DESIGN Systematic review. STUDY SAMPLE This study sample consisted of adult patients with lumbar degenerative conditions specifically treated with lumbar interbody fusion, including grade I or II degenerative spondylolisthesis, lumbar spinal stenosis, disc degeneration, and spondylosis, with or without low back and/or leg pain. OUTCOME MEASURES Direct (healthcare) and indirect (nonhealthcare) costs, cost sources and calculation methods, utility scores, QALY gain, cost-utility, incremental cost-effectiveness ratios, and willingness-to-pay thresholds. Outcomes were reported as median and interquartile ranges (IQR). METHODS A systematic review was conducted following PRISMA guidelines. PubMed, Web of Science, and Embase were searched from inception to October 23, 2023, for CUAs reporting QALYs and costs of LIF procedures. Relevant studies were selected and data extracted. Subgroup analyses compared minimally invasive versus open surgery and anterior versus posterior approaches. Study quality was assessed using the CHEC-Extended tool. Quantitative meta-analysis was not performed due to methodological heterogeneity. RESULTS Out of 2047 identified studies, 14 met inclusion criteria. The mean CHEC-Extended score was 72.1%. Most studies reported on TLIF (n=11) and utilized EQ-5D questionnaire to calculate utility (n=9). Direct costs were sourced from institutional databases, Medicare, DRGs, Redbook, and a variety of other sources. Most indirect costs were estimated from productivity loss. TLIF demonstrated the highest median QALY gain over 1 year (0.43, IQR 0.121-0.705), while PLIF was highest over 2 years (1.33). ALIF was most favorable over 1 year ($30,901/QALY) and OLIF was most favorable over 2 years ($11,187/QALY). PLIF, TLIF, and LLIF exhibited similar cost-utility over 2 years ($44,383, $45,628, $48,576/QALY). MIS was substantially favorable to OS at 1 year ($42,635 vs $226,304), though similar at 2 years ($48,576 vs $45,628/QALY). Anterior approach was favorable to posterior approach at 1 year ($30,901.5 vs $81,038) and 2 years ($29,881.9 vs $44,383). Cost-utility comparisons substantially varied and were sensitive to utility measures, study methodology, cost sourcing, and follow-up duration. CONCLUSIONS This is the first systematic review to comprehensively assess CUAs of all LIF approaches in the existing literature. While certain approaches, such as ALIF and OLIF, may demonstrate favorable outcomes, these conclusions are limited by high methodological heterogeneity and a limited study pool. By addressing existing gaps in study design and reporting, future comparative cost-utility research can better inform evidence-based decision-making and optimize the value of spinal surgical care.
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Affiliation(s)
- Viraj Deshpande
- Hoag Orthopedics, 16300 Sand Canyon Ave., Suite. 500, Irvine, CA 92618, USA.
| | - Evan Simpson
- Hoag Orthopedics, 16300 Sand Canyon Ave., Suite. 500, Irvine, CA 92618, USA
| | - Jesse Caballero
- Hoag Orthopedic Institute, 16250 Sand Canyon Avenue, Irvine, CA 92618, USA
| | - Chris Haddad
- Hoag Memorial Hospital Presbyterian, 1 Hoag Dr, Newport Beach, CA 92663, USA
| | - Jeremy Smith
- Hoag Orthopedic Institute, 16250 Sand Canyon Avenue, Irvine, CA 92618, USA
| | - Vance Gardner
- Hoag Orthopedics, 16300 Sand Canyon Ave., Suite. 500, Irvine, CA 92618, USA
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Khojaly R, Rowan FE, Shah V, Nagle M, Shahab M, Ahmad AS, Dahly D, Taylor C, Niocaill RM, Cleary M. Immediate Weight-Bearing Compared with Non-Weight-Bearing After Operative Ankle Fracture Fixation: Results of the INWN Pragmatic, Randomized, Multicenter Trial. J Bone Joint Surg Am 2025:00004623-990000000-01464. [PMID: 40408465 DOI: 10.2106/jbjs.24.00965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2025]
Abstract
BACKGROUND There has been weak consensus and a paucity of robust literature with regard to the best postoperative weight-bearing and immobilization regime for operatively treated ankle fractures. This trial compared immediate protected weight-bearing (IWB) with non-weight-bearing (NWB) with cast immobilization following ankle fracture fixation (open reduction and internal fixation [ORIF]), with a particular focus on functional outcomes, complication rates, and cost utility. METHODS This INWN (Is postoperative Non-Weight-bearing Necessary?) study was a prospective, pragmatic, randomized controlled trial (RCT), with participants allocated in a 1:1 ratio to 1 of 2 parallel groups. IWB from postoperative day 1 in a walking boot was compared with NWB and immobilization in a cast for 6 weeks, following ORIF of all standard types of unstable ankle fractures. Skeletally immature patients and patients with tibial plafond fractures were excluded. The type of surgical fixation was at the surgeon's discretion. Patients were randomized postoperatively by an operating room nurse using computerized block randomization (20 patients per block). Surgeons were blinded until after the operation. The study was multicenter and included 2 major orthopaedic centers in Ireland. Analysis was performed on an intention-to-treat basis. The primary outcome was the functional outcome assessed by the Olerud-Molander Ankle Score (OMAS) at 6 weeks. A cost-utility analysis via decision tree modeling was performed to derive an incremental cost-effectiveness ratio (ICER). RESULTS We recruited 160 patients between January 1, 2019, and June 30, 2020, with 80 patients per arm, who were 15 to 94 years of age (mean age, 45.5 years), and 54% of patients were female. The IWB group demonstrated a higher mean OMAS at 6 weeks (43 ± 24 for the IWB group and 35 ± 20 for the NWB group, with a mean difference of 10.4; p = 0.005). The complication rates were similar in both groups, including surgical site infection, wound dehiscence, implant removal, and further operations. Over a 1-year horizon, IWB was associated with a lower expected cost (€1,027.68) than NWB (€1,825.70) as well as a higher health benefit (0.741 quality-adjusted life-year [QALY]) than NWB (0.704 QALY). IWB dominated NWB, yielding cost savings of €798.02 and a QALY gain of 0.04. CONCLUSIONS IWB in a walking boot following ankle fracture fixation demonstrated superior functional outcomes, greater cost savings, earlier return to work, and similar complication rates compared with NWB in a cast for 6 weeks. These findings support the implementation of IWB as the routine mobilization protocol following ankle fracture fixation. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ramy Khojaly
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
- Department of Orthopaedic Surgery, University College Cork, Cork, Ireland
- Department of Orthopaedic Surgery, University Hospital of North Midlands, Stoke-on-Trent, England, United Kingdom
| | - Fiachra E Rowan
- Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
| | - Vinay Shah
- Department of Orthopaedic Surgery, University Hospital of North Midlands, Stoke-on-Trent, England, United Kingdom
- Royal National Orthopaedic Hospital Rotation, Stanmore, London, England, United Kingdom
| | - Matthew Nagle
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Cork, Ireland
| | - Muhammad Shahab
- Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
| | - Amir Sohaib Ahmad
- Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
| | - Darren Dahly
- HRB Clinical Research Facility - University College Cork, University Hospital Waterford, Waterford, Ireland
| | - Colm Taylor
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Cork, Ireland
| | - Ruairí Mac Niocaill
- Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
| | - May Cleary
- Department of Trauma and Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
- Department of Orthopaedic Surgery, University College Cork, Cork, Ireland
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Rehman F, Shahid MW, Riaz M, Umair MM, Azhar F, Amer M, Ahmed A. Willingness to pay for a quality-adjusted life year (QALY) in Pakistan: implications for health policy. Expert Rev Pharmacoecon Outcomes Res 2025:1-9. [PMID: 40347023 DOI: 10.1080/14737167.2025.2504945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 03/31/2025] [Accepted: 04/03/2025] [Indexed: 05/12/2025]
Abstract
OBJECTIVES Allocating healthcare resources in developing countries like Pakistan is constrained by economic limitations and uneven distribution. Therefore, in this study, we aimed to investigate the Willingness to Pay (WTP) for one additional Quality-Adjusted Life Year (QALY) among the general population in Pakistan to establish contextually relevant thresholds for health technology assessment (HTA). METHODS We conducted a cross-sectional survey using the convenient sampling technique to estimate the WTP for one additional QALY among the general population of Pakistan. The contingent valuation method (CVM) using the payment card technique was used to assess its monetary value. RESULTS A total of 600 participants participated in the survey and resulted in 1200 WTP responses for further analysis. The mean WTP/QALY was 114,006.4 Pakistani rupee (PKR) (United States Dollar 410.11), equivalent to 0.29 times Pakistan's GDP per capita. The WTP/QALY for the quality-of-life improvement scenario was lower than the life-extension scenario. The two-part regression model showed that higher education and income were positively associated with WTP value. CONCLUSION This study provides empirical evidence of the monetary value of one additional QALY from a sample of the Pakistani population. These findings highlight country-specific cost-effectiveness benchmarks, and incorporating WTP insights into the healthcare policy for better resource allocation, affordability, and long-term sustainability of the interventions.
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Affiliation(s)
- Faizur Rehman
- Department of Pharmacy Practice, Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Muhammad Wasay Shahid
- Department of Pharmacy Practice, Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Mehran Riaz
- Department of Pharmacy Practice, Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | | | - Farah Azhar
- Department of Pharmacy Practice, Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| | - Muhammad Amer
- Department of Pharmacy, Abasyn University, Islamabad, Pakistan
| | - Ali Ahmed
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
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Takamoto N, Aso S, Ishida R, Konishi T, Fushimi K, Yasunaga H. Cost-effectiveness analysis of 9-valent human papillomavirus vaccine combined with screening for cervical cancer in Japan. Int J Gynaecol Obstet 2025; 169:788-801. [PMID: 39731455 PMCID: PMC12011068 DOI: 10.1002/ijgo.16125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 12/10/2024] [Accepted: 12/16/2024] [Indexed: 12/29/2024]
Abstract
OBJECTIVE In Japan, the current coverage rate of human papillomavirus (HPV) vaccination is only 30%, and the rate of biennial cervical screening is 40%. The Japanese Government has attempted to increase the coverage of HPV vaccination and cervical screening. We analyzed the cost-effectiveness of the 9-valent HPV vaccine and cervical screening in Japan. METHODS A yearly cycle Markov model with 15 health states was created to evaluate the cost-effectiveness of the 9-valent HPV vaccination and cervical screening in women aged 12-75 years. We considered four scenarios: 30% coverage of vaccination with 40% coverage of biennial screening (Scenario 1 representing the current Japanese situation), 70% (the highest proportion in 2013 in Japan) and 90% coverage of vaccination with 40% coverage of biennial screening (Scenarios 2 and 3, respectively), and 90% coverage of vaccination with 70% coverage of biennial screening (Scenarios 4). The incremental cost-effectiveness ratio (ICER) was calculated as costs per quality-adjusted life year (QALY) based on the perspective of the healthcare payer and compared with the benchmark for willingness to pay in Japan (41 700 USD per QALY). The cumulative morbidity and mortality in each scenario were analyzed using the Markov model. RESULTS Compared with Scenario 1, the ICERs of Scenarios 2, 3, and 4 were 5382, 5321, and 8524 USD/QALY, respectively, which were lower than the benchmark for willingness to pay. As the coverage of HPV vaccination and cervical screening increased, the cumulative morbidity and mortality decreased. CONCLUSION Increasing the coverage of the 9-valent HPV vaccination and cervical screening is cost-effective in Japan.
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Affiliation(s)
- Naohiro Takamoto
- Department of Pediatric Surgery, Graduate School of MedicineThe University of TokyoTokyoJapan
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
| | - Shotaro Aso
- Department of Health Services Research, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Risa Ishida
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
- Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
| | - Kiyohide Fushimi
- Department of Health Policy and InformaticsTokyo Medical and Dental University Graduate SchoolTokyoJapan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of TokyoTokyoJapan
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Mortimer D, Ymer L, McKay A, Wong D, Frencham K, Grima N, Roper M, Nguyen S, Murray J, Spitz G, Ponsford J. Cost-effectiveness of cognitive behavioural therapy versus health education for sleep disturbance and fatigue following stroke and traumatic brain injury. J Rehabil Med 2025; 57:jrm42770. [PMID: 40275692 PMCID: PMC12041795 DOI: 10.2340/jrm.v57.42770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 04/02/2025] [Indexed: 04/26/2025] Open
Abstract
OBJECTIVE Evaluate cost, effectiveness and cost-effectiveness of cognitive behavioural therapy for sleep and fatigue (CBT-SF) vs health education (HE) and of CBT-SF vs treatment as usual (TAU) for sleep disturbance and fatigue in acquired brain injury. DESIGN Economic evaluation from Australian health system and societal perspectives based on data from a June 2017 to October 2023 randomized controlled trial. SUBJECTS Community-dwelling Australian adults with sleep disturbance and fatigue following acquired brain injury (n = 126). METHODS Incremental health system costs based on cost of delivery and health service utilization since last follow-up. Incremental effectiveness based on participant-reported sleep quality, fatigue, and quality of life at each timepoint. Productivity gains/losses based on a 1-week activity diary at each timepoint. RESULTS Reductions in health service utilization from CBT-SF (-A$777, 95% CI: -A$4,232, A$2,678) offset higher delivery costs (A$333, 95% CI: A$109, A$556) relative to HE, with improvements in quality of life at 2 months post-treatment (0.02, 95% CI: -0.01, 0.05) and an additional 3.37 quality-adjusted life days per participant (95% CI: -4.18, 10.92). CBT-SF dominates HE (less costly and more effective) and is likely more cost-effective than HE (66-76%). CBT-SF is cost-effective relative to TAU under realistic assumptions. CONCLUSIONS CBT-SF after acquired brain injury improved clinical and economic outcomes and was more likely to be cost-effective than HE. Further research is required to precisely estimate the cost-effectiveness of CBT-SF vs TAU and to demonstrate generalizability to routine practice and other settings. ANZCTR Trial registration numbers: 1261700087830; 12617000879369.
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Affiliation(s)
- Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia.
| | - Lucy Ymer
- Monash Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Adam McKay
- Monash Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Epworth Healthcare, Melbourne, VIC, Australia
| | - Dana Wong
- Monash Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Kate Frencham
- Monash Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Natalie Grima
- Monash Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Monique Roper
- Monash Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | | | - Jade Murray
- Monash Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Gershon Spitz
- Monash Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Jennie Ponsford
- Monash Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia; Epworth Healthcare, Melbourne, VIC, Australia
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Hundal S, Cappelli J, Croitoru D, Drucker AM, Ingram JR, Goldberg SR, Netchiporouk E. Cost-utility analysis of clinic-based deroofing versus local excision for hidradenitis suppurativa. J Am Acad Dermatol 2025; 92:773-780. [PMID: 39657847 DOI: 10.1016/j.jaad.2024.11.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 10/27/2024] [Accepted: 11/12/2024] [Indexed: 12/12/2024]
Abstract
BACKGROUND Deroofing and local excision are common clinic-based surgical options for hidradenitis suppurativa. Evidence suggests deroofing may have lower rates of adverse events (AEs), defined as disease recurrence or postsurgical complications. OBJECTIVE This cost-utility analysis evaluates the economic and health-related impacts of clinic-based deroofing vs excision for hidradenitis suppurativa, comparing direct medical costs and quality-adjusted life-years (QALYs). METHODS A Markov model was developed based on a literature review of clinical outcomes, EQ-5D utilities, and resource utilization. Patients began in a preprocedural state and transitioned monthly among 3 health states: responders (no AEs), nonresponders (≥1 AE), and death. The model assessed cost-effectiveness over a 2-year horizon from the U.S. healthcare system perspective. RESULTS Deroofing provided an additional 0.19 QALYs at a cost of USD$311.39 per patient relative to excision, yielding a favorable incremental cost-effectiveness ratio of USD$1677.10/QALY, below the USD$50,000/QALY threshold. LIMITATIONS Methodological constraints from limited published data were addressed through multiple sensitivity analyses. Cost-effectiveness was sensitive to AE rates, secondary costs, and utility values. CONCLUSION When clinically appropriate, deroofing is more cost-effective than excision for clinic-based procedural management of HS, offering improved quality of life at a modest incremental cost.
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Affiliation(s)
- Sabrina Hundal
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Julian Cappelli
- Applied Policy Research Division, Strategic Policy Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - David Croitoru
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and Research and Innovation Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - John R Ingram
- Division of Infection and Immunity, Department of Dermatology & Academic Wound Healing, Cardiff University, Cardiff, UK
| | | | - Elena Netchiporouk
- Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada
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10
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Momoeda M, Ito K, Inoue S, Shibahara H, Mitobe Y, Komatsu N. Cost-effectiveness of ferric citrate hydrate in patients with iron deficiency anemia. Int J Hematol 2025; 121:467-475. [PMID: 39724235 PMCID: PMC11923001 DOI: 10.1007/s12185-024-03905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 12/08/2024] [Accepted: 12/15/2024] [Indexed: 12/28/2024]
Abstract
We investigated the cost-effectiveness of treating iron deficiency anemia (IDA) with ferric citrate hydrate (FC) in Japan. We employed four treatment strategies: switching from sodium ferrous citrate (SF) to FC at (1) 500 mg (approximately 120 mg of iron) per day or (2) 1000 mg (approximately 240 mg of iron) per day in patients with SF-induced nausea/vomiting, or starting treatment with FC at (3) 500 mg/day or (4) 1000 mg/day. We evaluated the cost-effectiveness of these strategies compared with SF 100 mg (100 mg of iron) per day. Incremental effects over 26 weeks relative to SF 100 mg were 0.0052 quality-adjusted life years (QALYs) for (1) and (2), and 0.0044 QALYs for (3) and (4). From the payer's perspective, incremental cost-effectiveness ratios (ICERs: JPY/QALY) against SF 100 mg were: (1) 1,107,780, (2) 2,257,477, (3) 5,588,430, and (4) 11,544,816. All four FC strategies were dominant (less costly and more effective) from a limited societal perspective. Treatment with FC for IDA was cost-effective (ICER ≤ JPY 5,000,000/QALY) when switching strategies from the payer perspective, and cost-saving (all FC strategies) from limited societal perspectives. Individual patients' characteristics and cost-effectiveness should be considered in treatment selection.
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Affiliation(s)
- Mikio Momoeda
- Aiiku Maternal and Child Health Center, Aiiku Hospital, 1-16-10 Shibaura, Minato-Ku, Tokyo, 105-8321, Japan
| | - Kyoko Ito
- Medical Affairs Department, Torii Pharmaceutical Co., Ltd., 3-4-1 Nihonbashi-Honcho, Chuo-Ku, Tokyo, 103-8439, Japan
| | - Sachie Inoue
- CRECON Medical Assessment Inc., The Pharmaceutical Society of Japan, Nagai Memorial Hall 2-12-15, Shibuya, Shibuya-Ku, Tokyo, 150-0002, Japan
| | - Hidetoshi Shibahara
- CRECON Medical Assessment Inc., The Pharmaceutical Society of Japan, Nagai Memorial Hall 2-12-15, Shibuya, Shibuya-Ku, Tokyo, 150-0002, Japan
| | - Yuko Mitobe
- Medical Affairs Department, Torii Pharmaceutical Co., Ltd., 3-4-1 Nihonbashi-Honcho, Chuo-Ku, Tokyo, 103-8439, Japan.
| | - Norio Komatsu
- Department of Hematology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
- Department of Advanced Hematology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
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11
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Imagawa N, Izumi S, Shimazaki T, Yamauchi T, Ikeda S, Noto S, Kojima H, Suka M. Evaluating the Cost-Effectiveness of Unilateral Cochlear Implants Versus Hearing Aids in Older Adults in Japan. Otol Neurotol 2025:00129492-990000000-00783. [PMID: 40165444 DOI: 10.1097/mao.0000000000004504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2025]
Abstract
OBJECTIVES This study aimed to evaluate the cost-effectiveness of cochlear implants in older adults with hearing impairment 65 years or older in Japan. In addition, this study aimed to establish a basis for making recommendations for cochlear implants in clinical practice for suitable patients. DESIGN We conducted a cost-utility analysis using the incremental cost-effectiveness ratio (ICER) to compare unilateral cochlear implants with hearing aids. The study involved participants 65 years or older with severe-to-profound hearing loss attending two cochlear implant surgery facilities in Japan. Costs were calculated from the participants' receipt data and standard clinical paths from medical care providers. Quality-adjusted life years (QALY) were assessed by patients using the Japanese version of the Health Utilities Index Mark 3 and by medical care providers using the visual analog scale (VAS). In addition, sensitivity analyses were performed by varying the utility value, discount rate, age at implantation, and costs to estimate the ICER under different scenarios. RESULTS Responses were received from 26 cochlear implant users and 8 hearing aid users. After applying the survival and discount rates to the utility values and costs, the ICER was $44,533, which falls within the acceptable willingness-to-pay threshold in Japan. Sensitivity analysis showed that the ICER was the most sensitive to the utility value, followed by the discount rate. CONCLUSIONS The findings indicate that providing cochlear implants to older adults with hearing impairment is not only beneficial in terms of improved hearing performance but also economically efficient.
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Affiliation(s)
| | - Shuji Izumi
- Department of Otolaryngology, Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takashi Shimazaki
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yamauchi
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunya Ikeda
- Department of Pharmaceutical Sciences, School of Pharmacy, International University of Health and Welfare, Tochigi, Japan
| | - Shinichi Noto
- Department of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | - Hiromi Kojima
- Department of Otolaryngology, The Jikei University School of Medicine, Tokyo, Japan
| | - Machi Suka
- Department of Public Health and Environmental Medicine, The Jikei University School of Medicine, Tokyo, Japan
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12
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Aranishi T, Igarashi A, Hara K, Osumili B, Cai Z, Mizogaki A, Sato M, Takeuchi M, Minghetti A, Hunt B, Kadowaki T. The Long-Term Cost-Effectiveness of Tirzepatide 5 mg versus Dulaglutide 0.75 mg for the Treatment of People with Type 2 Diabetes in Japan. Diabetes Ther 2025; 16:431-445. [PMID: 39708085 PMCID: PMC11868005 DOI: 10.1007/s13300-024-01675-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 11/20/2024] [Indexed: 12/23/2024] Open
Abstract
INTRODUCTION This analysis aimed to evaluate the long-term cost-effectiveness of tirzepatide 5 mg versus dulaglutide 0.75 mg (both administered once weekly) in people not achieving glycemic control on metformin, based on the results of the head-to-head SURPASS J-mono trial from a Japanese healthcare payer perspective. METHODS A cost-utility analysis was performed over a 50-year time horizon using an implementation of the UKPDS Outcomes Model 2 developed in Microsoft Excel. Baseline cohort characteristics, treatment effects and adverse event rates were sourced from the SURPASS J-mono trial. Simulated patients were assumed to receive either tirzepatide 5 mg or dulaglutide 0.75 mg until HbA1c exceeded 8.0%, at which point treatment was discontinued and basal insulin was initiated. Direct costs were derived from the Japan Medical Data Center claims database. Future costs and clinical benefits were discounted at 2% annually. RESULTS In this cost-utility modeling analysis, tirzepatide 5 mg was associated with lower diabetes-related complication rates, improved life expectancy, improved quality-adjusted life expectancy and higher direct costs versus dulaglutide 0.75 mg. This resulted in an incremental cost-effectiveness ratio (ICER) of JPY (Japanese yen) 1,302,240 per quality-adjusted life year (QALY) gained for tirzepatide 5 mg versus dulaglutide 0.75 mg (JPY 140 = USD 1). Tirzepatide remained cost-effective versus dulaglutide over a range of sensitivity analyses. CONCLUSIONS In this analysis, tirzepatide 5 mg was associated with an ICER below the commonly quoted willingness-to-pay threshold of JPY 5,000,000 per QALY gained, suggesting that tirzepatide is a cost-effective treatment option for adult patients with type 2 diabetes mellitus, compared with dulaglutide 0.75 mg.
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Affiliation(s)
| | - Ataru Igarashi
- Department of Health Policy and Public Health, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 13-0033, Japan
| | - Kazuo Hara
- Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Beatrice Osumili
- Eli Lilly and Company Limited, 8 Arlington Square West, Downshire Way, Bracknell, RG12, 1PU, UK
| | - Zhihong Cai
- Eli Lilly Japan K.K., 5-1-28 Isogami-dori, Chuo-Ku, Kobe, Japan
| | - Aska Mizogaki
- Eli Lilly Japan K.K., 5-1-28 Isogami-dori, Chuo-Ku, Kobe, Japan
| | - Manaka Sato
- Eli Lilly Japan K.K., 5-1-28 Isogami-dori, Chuo-Ku, Kobe, Japan
| | | | - Alice Minghetti
- Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051, Basel, Switzerland
| | - Barnaby Hunt
- Ossian Health Economics and Communications GmbH, Bäumleingasse 20, 4051, Basel, Switzerland.
| | - Takashi Kadowaki
- Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan
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13
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Matsunaga K, Harada-Shiba M, Yamashita S, Tada H, Uda A, Mori K, Yoshimura M, Inoue S, Kamae I, Yokoyama S, Minamino T. A Cost-Effectiveness Analysis for the Combination of Universal Screening at 9-10 Years Old and Reverse Cascade Screening of Relatives for Familial Hypercholesterolemia in Japan. J Atheroscler Thromb 2025:65181. [PMID: 39956559 DOI: 10.5551/jat.65181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2025] Open
Abstract
AIM Screening for familial hypercholesterolemia (FH) is important for reducing the incidence of cardiovascular diseases (CVDs). Cost-effectiveness was evaluated using the Kagawa FH screening model, which is a combination of universal screening (US) in the universal health examination for children 9-10 years old conducted in Kagawa Prefecture, and reverse cascade screening (RCS) of the probands' relatives. METHODS A lifetime simulation was conducted using mathematical models (decision tree and Markov model) to determine the cost-effectiveness of introducing a series of FH screenings (US in children + RCS in adult relatives). Only screening-related costs and direct medical costs were included, using quality-adjusted life years (QALYs) as an outcome. The costs of statins were estimated using the public health insurance claims database DeSC Healthcare, Inc. The risk of each CVD event was estimated using the same claims data and adjusted for age. We hypothesized that standard statin treatment decreases CVD risk by reducing plasma low-density lipoprotein cholesterol levels. RESULTS A series of FH screenings (US in children + RCS in adult relatives) was cost-effective compared to no screening, with an incremental cost-effectiveness ratio (ICER) of approximately JPY 150,000 (USD 1,042)/QALY, which was below the willingness-to-pay threshold of JPY 5,000,000 (USD 34,722)/QALY for medical technology in Japan (USD 1 = JPY 144). The ICER for the US without RCS was also acceptable at approximately JPY 2,720,000 (USD 18,889)/QALY. CONCLUSION The cost-effectiveness analysis revealed that a series of FH screenings (US in children + RCS in adult relatives) based on the Kagawa model was cost-effective.
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Affiliation(s)
- Keiji Matsunaga
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University
| | | | | | - Hayato Tada
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University
| | | | | | | | | | - Isao Kamae
- Graduate School of Public Policy, The University of Tokyo
| | | | - Tetsuo Minamino
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University
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14
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Inano H, Morimoto Y, Kitagawa K, Shibuya A, Nakagomi K, Ota T, Anzo Y, Miyauchi R, Shono A, Watanabe K, Otori K. Cost-effectiveness analysis of fosnetupitant in patients receiving cisplatin in Japan: analysis based on real-world data. Support Care Cancer 2025; 33:149. [PMID: 39904775 DOI: 10.1007/s00520-025-09210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 01/25/2025] [Indexed: 02/06/2025]
Abstract
PURPOSE Our previous study showed that the preventive effects of fosnetupitant (F-NTP) against chemotherapy-induced nausea and vomiting (CINV) were superior to those of fosaprepitant (F-APR) or aprepitant (APR). To evaluate the cost-effectiveness of F-NTP compared with F-APR or APR in Japan, a cost-utility analysis was performed. METHODS A decision tree model was developed based on real-world data to compare the CINV prevention ability of each neurokinin-1 receptor antagonist (NK1 RA) in Japanese patients receiving cisplatin-based regimens. We evaluated the patients 7 days after the first course of treatment. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated to examine the cost-effectiveness of the antiemetic therapy. The probabilities of health states and medical costs were derived from the results of our previous study. These cost-utility analyses were performed from the perspective of the payers. RESULTS The incremental QALYs of F-NTP relative to F-APR and APR were 0.00180 and 0.00153, respectively. The ICER of F-NTP relative to F-APR was 22,802.21 US dollars (USD) per QALY gained, which was lower than the willingness-to-pay (WTP) threshold (38,043.06 USD: 5 million Japanese Yen/QALY). Contrastingly, the ICER of F-NTP relative to APR was 40,119.64 USD/QALY, which was slightly above the WTP threshold, indicating that F-NTP may be slightly less cost-effective. CONCLUSION F-NTP is more cost-effective than F-APR, but slightly less cost-effective than APR.
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Affiliation(s)
- Hiroshi Inano
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
| | - Yoshihito Morimoto
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan.
| | - Kanata Kitagawa
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
| | - Akito Shibuya
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
| | - Kozue Nakagomi
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
| | - Tomohiro Ota
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
| | - Yuri Anzo
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
| | - Rika Miyauchi
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan
| | - Aiko Shono
- Laboratory of Public Health, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan
| | - Kazuhiro Watanabe
- Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo, 194-8543, Japan
| | - Katsuya Otori
- Department of Pharmacy, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
- Laboratory of Pharmacy Practice and Science I, Research and Education Center for Clinical Pharmacy, School of Pharmacy, Kitasato University, 1-15-1, Kitasato, Sagamihara, Minami, 252-0375, Japan
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15
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Yanagaki S, Omata K, Oguro S, Ota H, Sato T, Kamada H, Tannai H, Tezuka Y, Ono Y, Sato M, Ohbe H, Takase K. Cost-effectiveness analysis of segmental adrenal venous sampling with radiofrequency ablation for primary aldosteronism in Japan. Jpn J Radiol 2025; 43:290-300. [PMID: 39317867 PMCID: PMC11790736 DOI: 10.1007/s11604-024-01665-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 09/12/2024] [Indexed: 09/26/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the cost-effectiveness of comprehensive treatment strategy, including segmental adrenal venous sampling (sAVS) and radiofrequency ablation (RFA), versus medication-only strategy for primary aldosteronism. MATERIALS AND METHODS A Markov decision model was developed to compare the cost-effectiveness of a comprehensive treatment strategy and a medication-only strategy for 50-year-old men and women with stage I-III hypertension. The comprehensive treatment strategy included aldosterone/renin ratio measurement, two loading tests, computed tomography, sAVS, drugs, surgery, and RFA. We built a model with a yearly cycle over 32- and 38-year time horizons for men and women, respectively, and four health states: hypertension, heart failure, stroke, and death. The incremental cost-effectiveness ratio (ICER), expressed as Japanese yen per quality-adjusted life-years (QALYs), was estimated, and strategy preference was determined on the basis of 5 million Japanese yen per QALY societal willingness-to-pay threshold. RESULTS The ICERs of the comprehensive treatment strategy over the medication-only strategy were 201,482 and 3,399 JPY per QALY for men and women, respectively. The resultant ICER was less than the 5 million JPY societal willingness-to-pay threshold. Deterministic sensitivity analysis and probabilistic sensitivity analysis revealed that the results varied with the input values, but the comprehensive strategy was likely to be more cost-effective than the medication-only strategy. CONCLUSION This cost-effectiveness study revealed that a comprehensive treatment strategy including sAVS and RFA was favorable compared with the medication-only strategy for managing stage I-III hypertension in 50-year-old men and women, with acceptable willingness-to-pay thresholds. This cost-effectiveness study revealed that a comprehensive treatment strategy for primary aldosteronism that included segmental adrenal sampling and radiofrequency ablation was favorable compared with the medication-only strategy for managing stage I-III hypertension in 50-year-old men and women, with acceptable willingness-to-pay thresholds.
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Affiliation(s)
- Satoru Yanagaki
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
- Department of Diagnostic Radiology, Tohoku Medical Pharmaceutical University Hospital, Sendai, Miyagi, Japan.
| | - Kei Omata
- Department of Diabetes, Metabolism and Endocrinology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Division of Nephrology, Rheumatology and Endocrinology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Sota Oguro
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tomomi Sato
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Diagnostic Radiology, Tohoku Medical Pharmaceutical University Hospital, Sendai, Miyagi, Japan
| | - Hiroki Kamada
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiromitsu Tannai
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yuta Tezuka
- Department of Diabetes, Metabolism and Endocrinology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Division of Nephrology, Rheumatology and Endocrinology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoshikiyo Ono
- Department of Diabetes, Metabolism and Endocrinology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Division of Nephrology, Rheumatology and Endocrinology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Miho Sato
- Division of Radiological Examinations and Technology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiroyuki Ohbe
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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16
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Walsh TP, Swalwell C, Merlo GB, Wearing SC, Jacob W, Doherty D, Vandermost M, Platt S. Podiatric Clinical Triage in a Foot and Ankle Orthopaedic Clinic: A Randomised Trial. J Eval Clin Pract 2025; 31:e14249. [PMID: 39785105 DOI: 10.1111/jep.14249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 10/02/2024] [Accepted: 10/20/2024] [Indexed: 01/12/2025]
Abstract
RATIONALE Hospitals are increasingly utilising allied-health professionals to provide clinical triage to patients. While these positions are routinely implemented, and several observational studies have reported positive outcomes, the effectiveness of this intervention has been rarely tested in a clinical trial. AIMS AND OBJECTIVES The objectives of this study were to (i) evaluate a podiatry-led orthopaedic triage service using patient-reported outcome measures (PROMs), and (ii) determine if it is cost-effective in terms of incremental cost/quality-adjusted life years (QALYs). METHODS This pragmatic, randomised, wait-list-control trial recruited participants referred to an orthopaedic foot and ankle clinic at a tertiary-level health service. Trial registration was 31 March 2020. Participants were randomised to either immediate clinical triage (intervention) or to remain on the waiting-list (control). The primary outcome measure was change in foot pain as measured by the Manchester-Oxford Foot and Ankle Questionnaire (MOxFQ) at 6-months. Core outcome measures for chronic musculoskeletal pain were also measured and cost-effectiveness calculated. RESULTS One hundred and forty-eight participants were recruited, randomising 73 people to the intervention and 75 people to the control. No between-group differences in pain or demographics were detected at baseline. Foot pain as measured by the MOxFQ improved in both groups at 6-months follow-up, but no significant between-group differences were identified. Significant between-group differences, however, were detected in the patient global impression of change. Additionally, the intervention resulted in a 30% discharge rate, and is considered cost-effective, with each QALY gain costing < $30,000 in real-world scenarios. CONCLUSION A clinical triage service has minimal impact on PROMS for foot and ankle pain or chronic musculoskeletal pain, but it is generally well-received, is cost-effective, and participants were more likely to report global improvement if they attended.
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Affiliation(s)
- Tom P Walsh
- Research Office, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Caitlin Swalwell
- Research Office, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Greg B Merlo
- Healthcare Improvement Unit, Clinical Excellence Queensland, Herston, Queensland, Australia
| | - Scott C Wearing
- School of Medicine and Health, Technical University of Munich, Munich, Bavaria, Germany
- Basel Academy for Quality and Research in Medicine, Basel, Switzerland
| | - Warren Jacob
- Department of Orthopaedics, Mackay Hospital and Health Service, West Mackay, Queensland, Australia
| | - Darren Doherty
- Interdisciplinary Persistent Pain Centre, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Margaret Vandermost
- Interdisciplinary Persistent Pain Centre, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Simon Platt
- Department of Orthopaedics and Trauma, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
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17
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Nakagawa N, Ono R, Odanaka K, Ohara H, Kisara S, Ito K. A Pharmacoeconomic Study of Post-Exposure Prophylaxis Strategies for Influenza Virus Infections in Japan. Adv Ther 2025; 42:772-787. [PMID: 39636568 DOI: 10.1007/s12325-024-02988-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 09/02/2024] [Indexed: 12/07/2024]
Abstract
INTRODUCTION Vaccines can prevent influenza (flu) infections and are cost-effective for society and healthcare. However, the cost-effectiveness of post-exposure prophylaxis as a follow-up strategy is unclear. This study aims to evaluate the cost utility of post-exposure prophylaxis and treatment strategies with neuraminidase inhibitors and a cap-dependent endonuclease inhibitor for flu infections from the perspective of healthcare costs in Japan. METHODS A base-case analysis was used to compare oseltamivir, zanamivir, and laninamivir for neuraminidase inhibitors and baloxavir marboxil for the endonuclease inhibitor. The costs of the first visit to a physician and pharmacy were excluded because of the policy on out-of-pocket expenses for post-exposure prophylaxis in Japan. Direct medical costs include the second physician visit, pharmacy and hospital admission expenses, and drug prices, based on the 2020 Japanese Medical Fee Index. The EuroQol-5Dimention-5Level was utilized to measure healthy participants' quality of life scores, with a time horizon of 14 days. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS We have found baloxavir marboxil as the post-exposure prophylaxis agent and laninamivir as the treatment agent to be the most cost-effective strategy in Japan, followed by oseltamivir as the post-exposure prophylaxis agent and zanamivir as the treatment agent. CONCLUSIONS Baloxavir marboxil and oseltamivir are cost-effective prophylactic agents for flu from the perspective of healthcare costs in Japan. This strategy to select baloxavir marboxil or oseltamivir would be helpful to manage a formulary for post-exposure prophylaxis in Japan.
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Affiliation(s)
- Naoto Nakagawa
- School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomita-machi, Koriyama, Fukushima, 963-8611, Japan.
| | - Runa Ono
- School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomita-machi, Koriyama, Fukushima, 963-8611, Japan
| | - Keita Odanaka
- School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomita-machi, Koriyama, Fukushima, 963-8611, Japan
| | - Hiroshi Ohara
- School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomita-machi, Koriyama, Fukushima, 963-8611, Japan
| | - Shigeki Kisara
- School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomita-machi, Koriyama, Fukushima, 963-8611, Japan
| | - Kitae Ito
- School of Pharmaceutical Sciences, Ohu University, 31-1 Misumido, Tomita-machi, Koriyama, Fukushima, 963-8611, Japan
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Lysholm S, Chaters GL, Di Bari C, Hughes EC, Huntington B, Rushton J, Thomas L. A framework for quantifying the multisectoral burden of animal disease to support decision making. Front Vet Sci 2025; 12:1476505. [PMID: 39917311 PMCID: PMC11799246 DOI: 10.3389/fvets.2025.1476505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 01/07/2025] [Indexed: 02/09/2025] Open
Abstract
Animal diseases have wide-ranging impacts in multiple societal arenas, including agriculture, public health and the environment. These diseases cause significant economic losses for farmers, disrupt food security and present zoonotic risks to human populations. Additionally, they contribute to antimicrobial resistance and a range of environmental issues such as greenhouse gas emissions. The societal and ecological costs of livestock diseases are frequently underrepresented or unaddressed in policy decisions and resource allocations. Social cost-benefit analysis (SCBA) offers a comprehensive framework to evaluate the broad impacts of animal diseases across different sectors. This approach aligns with the One Health concept, which seeks to integrate and optimize the health of humans, animals and the environment. Traditional economic evaluations often focus narrowly on profit maximization within the livestock sector, neglecting wider externalities such as public health and environmental impacts. In contrast, SCBA takes a multi-sectoral whole-system view, considering multiple factors to guide public and private sector investments toward maximizing societal benefits. This paper discusses three separate sector specific (Animal health, Human health, Environmental health) methodologies for quantifying the burden of animal diseases. It then discusses how these estimates can be combined to generate multisectoral estimates of the impacts of animal diseases on human societies and the environment using monetary values. Finally this paper explores how this framework can support the evaluation of interventions from a One Health perspective though SCBA. This integrated assessment framework supports informed decision-making and resource allocation, ultimately contributing to improved public health outcomes, enhanced animal welfare, and greater environmental sustainability.
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Affiliation(s)
- Sara Lysholm
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
- Animal and Human Health Program, Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya
| | - Gemma L. Chaters
- Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Bailrigg, United Kingdom
- Lancaster Medical School, University of Lancaster, Lancaster, United Kingdom
| | - Carlotta Di Bari
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology, and Public Health, Ghent University, Merelbeke, Belgium
| | - Ellen C. Hughes
- Global Burden of Animal Diseases (GBADs) Programme, Liverpool, United Kingdom
- Department of Livestock and One Health, University of Liverpool, Liverpool, United Kingdom
| | - Ben Huntington
- Global Burden of Animal Diseases (GBADs) Programme, Liverpool, United Kingdom
- Department of Livestock and One Health, University of Liverpool, Liverpool, United Kingdom
| | - Jonathan Rushton
- Global Burden of Animal Diseases (GBADs) Programme, Liverpool, United Kingdom
- Department of Livestock and One Health, University of Liverpool, Liverpool, United Kingdom
| | - Lian Thomas
- Animal and Human Health Program, Department of Biosciences, International Livestock Research Institute, Nairobi, Kenya
- Royal (Dick) School of Veterinary Studies (R(D)SVS), University of Edinburgh, Edinburgh, United Kingdom
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Shinohara A, Takumoto Y, Tauchi J, Morishita K, Kawasaki T, Akazawa M. Cost-effectiveness of systematic chemotherapy for metastatic pancreatic cancer: a retrospective study using Japanese clinical data. Sci Rep 2025; 15:267. [PMID: 39747263 PMCID: PMC11696500 DOI: 10.1038/s41598-024-80549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 11/19/2024] [Indexed: 01/04/2025] Open
Abstract
We compared the cost-effectiveness of gemcitabine plus nab-paclitaxel (GnP) and modified FOLFIRINOX (mFFX)-standard first-line treatments for metastatic pancreatic cancer in Japan. This retrospective cohort study included patients with metastatic pancreatic cancer treated at the National Cancer Center Hospital East in Japan between December 2013 and February 2017. A partitioned survival model, featuring five mutually exclusive health states, was developed. A cost-effectiveness analysis was performed to obtain total costs and quality-adjusted life-years (QALYs). A 2% annual discount rate was applied to costs and outcomes. Parameter uncertainty effect was assessed using a one-way sensitivity analysis. mFFX treatment involved intravenous infusions of oxaliplatin, levofolinate, and irinotecan, whereas GnP treatment involved weekly intravenous administration of nab-paclitaxel and gemcitabine. Dosages were adjusted based on observed adverse events. The total costs of the mFFX and GnP arms were JPY 3,193,597 (USD 31,006) and JPY 3,913,171 (USD 37,992), respectively. Incremental total costs of JPY 719,574 (USD 6,986) were associated with GnP compared to mFFX. Total QALYs were 0.427 and 0.435 for mFFX and GnP, respectively. Therefore, GnP has slightly higher QALYs than mFFX in Japanese real-world clinical practice, suggesting it has a potentially better safety profile, although the impact on healthcare costs persists.
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Affiliation(s)
- Akira Shinohara
- Department of Pharmacy, National Cancer Center Hospital East, Chiba, Japan
| | - Yuki Takumoto
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588, Japan
| | - Junko Tauchi
- Department of Pharmacy, National Cancer Center Hospital East, Chiba, Japan
| | - Koki Morishita
- Department of Pharmacy, National Cancer Center Hospital East, Chiba, Japan
| | | | - Manabu Akazawa
- Department of Public Health and Epidemiology, Meiji Pharmaceutical University, 2-522-1 Noshio, Kiyose, Tokyo, 204-8588, Japan.
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Odawara M, Nishi H, Kodera S, Kondo M, Nangaku M. Cost-Effectiveness of Empagliflozin in CKD with or without Albuminuria. Clin J Am Soc Nephrol 2025; 20:50-61. [PMID: 39792538 PMCID: PMC11737442 DOI: 10.2215/cjn.0000000582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 09/17/2024] [Indexed: 12/31/2024]
Abstract
Key Points Empagliflozin is cost-effective for the treatment of CKD in patients with an urine albumin-to-creatinine ratio of 30 mg/g or more. Empagliflozin is not cost-effective for the treatment of CKD in patients with an urine albumin-to-creatinine ratio <30 mg/g. Background The Study of Heart and Kidney Protection with Empagliflozin (EMPA-KIDNEY) expanded the CKD population that may benefit from sodium-glucose cotransporter 2 inhibitors in terms of eGFR and urine albumin-to-creatinine ratio. This enables a cost-effectiveness analysis of empagliflozin in subgroups stratified by these two parameters. Methods A cost–utility analysis using the Markov model was performed to evaluate the cost-effectiveness of adding empagliflozin to the standard treatment for CKD in Japan over 20 years of observation. Each cohort with the initial eGFR (≥45 but <60 ml/min per 1.73 m2, ≥30 but <45 ml/min per 1.73 m2, or ≥20 but <30 ml/min per 1.73 m2) and urine albumin-to-creatinine ratio (<30 mg/g, ≥30 but <300 mg/g, or ≥300 mg/g) within the defined ranges was analyzed. The changes in eGFR were determined on the basis of the EMPA-KIDNEY study. An incremental cost-effectiveness ratio of <¥5,000,000 (approximately $35,500) per quality-adjusted life-year (QALY) was considered cost-effective. One-way deterministic analyses, probabilistic sensitivity analyses, and scenario analyses were conducted to ensure the robustness of the results. Results The addition of empagliflozin to the standard treatment was associated with lower costs and higher QALYs in the macroalbuminuria or microalbuminuria cohorts while the incremental cost-effectiveness ratios in the negative albuminuria cohorts were >¥5,000,000 per QALY, regardless of the initial eGFR. The probabilities of empagliflozin being cost-effective were >84% in the macroalbuminuria or microalbuminuria cohorts but <30% in the negative albuminuria cohorts. Scenario analyses where empagliflozin suppressed the eGFR decline in the negative albuminuria cohorts showed that the drug was cost-effective in CKD stage G3b and G4 cohorts. Empagliflozin was not cost-effective in patients with CKD stage G3a and microalbuminuria with the observation period of 10 years. Conclusions In patients meeting the enrollment criteria for the EMPA-KIDNEY trial, the addition of empagliflozin to the standard treatment of CKD was judged as cost-effective for patients with albuminuria but not for those without albuminuria in the Japanese health care system.
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Affiliation(s)
- Motoki Odawara
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Nishi
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Kodera
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masahide Kondo
- Department of Health Care Policy and Management, Graduate School of Comprehensive Sciences, University of Tsukuba, Tsukuba, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Sakane N, Matsuhisa M, Kuroda A, Miura J, Hirota Y, Kato K, Toyoda M, Kouyama R, Kouyama K, Shimada A, Kawashima S, Matoba Y, Meguro S, Kusunoki Y, Hida K, Tanaka T, Domichi M, Suganuma A, Suzuki S, Tone A, Hosoda K, Murata T, For the ISCHIA Study Group. Cost-effective analysis focused on hypoglycemia of intermittent-scanning continuous glucose monitoring in type 1 diabetes adults: a ISCHIA randomized clinical trial. Diabetol Int 2025; 16:78-85. [PMID: 39877450 PMCID: PMC11769919 DOI: 10.1007/s13340-024-00762-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 09/10/2024] [Indexed: 01/31/2025]
Abstract
Background This study aimed to compare the economic value of intermittent-scanning continuous glucose monitoring (isCGM) with self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes (T1D). Methods Participants were placed on either an isCGM or SMBG arm for 84 days, in a randomized, crossover setup with a 28-day washout period. Clinically relevant hypoglycemia (<54 mg/dL) and severe hypoglycemia (SH) risks were calculated by analyzing the data from isCGM. The effectiveness variable was quality-adjusted life years (QALYs), and costs included medical costs related to the SMBG device. In addition, we performed a sensitivity analysis using a tornado diagram to confirm the robustness of the results. Patients A total of 93 Japanese T1D adults (51.4 ± 15.3 years old, male 47.3%, and HbA1c 7.3 ± 0.7%) treated with multiple daily insulin injection (MDI). Results Compared to the SMBG arm, clinically relevant hypoglycemia and SH risks over daytime (2.7 ± 1.7 vs. 2.4 ± 1.6 times; P = 0.008 and 3.1 ± 3.2 vs. 2.2 ± 2.7; P = 0.001) and night-time periods (2.1 ± 1.6 → 1.7 ± 1.2; P < 0.001 and 5.1 ± 4.0 → 4.2 ± 3.8; P = 0.013) were reduced with isCGM treatment. The isCGM system was associated with an incremental gain in quality-adjusted life expectancy (QALE) of 0.8 QALYs compared with the SMBG arm (74.6 vs. 73.8 QALYs). The resulting incremental cost-effectiveness ratio was JPY 4,398,932 (US$41,212) per QALY gained, which is well below the generally accepted cost-effectiveness threshold. SH during the daytime period was the primary driver of the incremental QALE. Conclusion The findings suggest that isCGM use for Japanese T1D adults treated with MDI is cost saving relative to SMBG.
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramotocho, Tokushima, Tokushima 770-8503 Japan
| | - Akio Kuroda
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramotocho, Tokushima, Tokushima 770-8503 Japan
| | - Junnosuke Miura
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women’s Medical University School of Medicine, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666 Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, The Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho Chuo-ku, Kobe, Hyogo 650-0017 Japan
| | - Ken Kato
- Diabetes Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006 Japan
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193 Japan
| | - Ryuji Kouyama
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki 300-0028 Japan
| | - Kunichi Kouyama
- Department of Diabetes and Metabolism, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, Hyogo 669-1515 Japan
| | - Akira Shimada
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma, Saitama 350-0495 Japan
| | - Satoshi Kawashima
- Kanda Naika Clinic, 5-21-3 Hannancho Abeno-ku, Osaka, Osaka 545-0021 Japan
| | - Yuka Matoba
- Department of Diabetes, Endocrinology and Metabolism, National Hospital Organization Kokura Medical Center, 10-1 Harugaoka, Kitakyushu Kokuraminami-ku, Fukuoka, 802-0803 Japan
| | - Shu Meguro
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-0016 Japan
| | - Yoshiki Kusunoki
- Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo Medical University, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501 Japan
| | - Kazuyuki Hida
- Department of Diabetology and Metabolism, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Okayama Kita-ku, Okayama, 701-1192 Japan
| | - Tsuyoshi Tanaka
- Department of Internal Medicine, National Hospital Organization Mie Chuo Medical Center, 2158-5 Hisai Myojincho, Tsu, Mie 514-1101 Japan
| | - Masayuki Domichi
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Akiko Suganuma
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - Shota Suzuki
- Department of Social & Community Pharmacy, School of Pharmaceutical Sciences, Wakayama Medical University, 25-1 Shichiban-cho, Wakayama, Wakayama 640-8156 Japan
| | - Atsuhito Tone
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutaicho Kita-ku, Okayama, Okayama 700-0021 Japan
| | - Kiminori Hosoda
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565 Japan
| | - Takashi Murata
- Department of Clinical Nutrition, National Hospital Organization Kyoto Medical Center, 1-1Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
- Diabetes Center, National Hospital Organization Kyoto Medical Center, 1-1Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
| | - For the ISCHIA Study Group
- Division of Preventive Medicine, Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramotocho, Tokushima, Tokushima 770-8503 Japan
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women’s Medical University School of Medicine, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162-8666 Japan
- Division of Diabetes and Endocrinology, The Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho Chuo-ku, Kobe, Hyogo 650-0017 Japan
- Diabetes Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 540-0006 Japan
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193 Japan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura, Ibaraki 300-0028 Japan
- Department of Diabetes and Metabolism, National Hospital Organization Hyogo-Chuo National Hospital, 1314 Ohara, Sanda, Hyogo 669-1515 Japan
- Department of Endocrinology and Diabetes, Saitama Medical University, 38 Morohongo Moroyama-machi, Iruma, Saitama 350-0495 Japan
- Kanda Naika Clinic, 5-21-3 Hannancho Abeno-ku, Osaka, Osaka 545-0021 Japan
- Department of Diabetes, Endocrinology and Metabolism, National Hospital Organization Kokura Medical Center, 10-1 Harugaoka, Kitakyushu Kokuraminami-ku, Fukuoka, 802-0803 Japan
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-0016 Japan
- Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo Medical University, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501 Japan
- Department of Diabetology and Metabolism, National Hospital Organization Okayama Medical Center, 1711-1 Tamasu, Okayama Kita-ku, Okayama, 701-1192 Japan
- Department of Internal Medicine, National Hospital Organization Mie Chuo Medical Center, 2158-5 Hisai Myojincho, Tsu, Mie 514-1101 Japan
- Department of Social & Community Pharmacy, School of Pharmaceutical Sciences, Wakayama Medical University, 25-1 Shichiban-cho, Wakayama, Wakayama 640-8156 Japan
- Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutaicho Kita-ku, Okayama, Okayama 700-0021 Japan
- Division of Diabetes and Lipid Metabolism, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565 Japan
- Department of Clinical Nutrition, National Hospital Organization Kyoto Medical Center, 1-1Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
- Diabetes Center, National Hospital Organization Kyoto Medical Center, 1-1Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555 Japan
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Wakao N, Furuya T, Yoshii T, Arima H, Yamato Y, Nakashima H, Imagama S, Imajo Y, Miyamoto H, Inoue G, Miyagi M, Kanbara S, Iizuka Y, Chikuda H, Watanabe K, Kobayashi K, Tsushima M, Miyazaki M, Yagi M, Suzuki S, Takahata M, Hongo M, Koda M, Nagata K, Mori K, Suzuki A, Kaito T, Murotani K, Miyakoshi N, Hashizume H, Matsuyama Y, Kawakami M, Haro H. A nationwide multicenter study of the cost effectiveness of five leading drugs for pharmacological management of cervicobrachial symptoms. J Orthop Sci 2025; 30:18-24. [PMID: 38151393 DOI: 10.1016/j.jos.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/24/2023] [Accepted: 12/15/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Cervicobrachial pain frequently affects the quality of life (QOL) of the general public and has a significant economic impact on the health care systems of various countries. There are a number of treatment options for this disease, including widely-used drug therapy, but the effectiveness of each option is indeterminate, and there have been no published cost-effectiveness analysis studies so far. This prospective observational study aimed to examine the cost-effectiveness of drug treatment for cervicobrachial symptoms. METHODS A 6-month medication regimen for each of five frequently-prescribed drugs for cervicobrachial symptoms was administered to 322 patients at 24 centers in Japan. Outcome measures, including of the EuroQol Group 5D, Short Form-8, and Visual Analog Scale (VAS), were investigated at baseline and every month thereafter. Incremental cost-effectiveness ratios (ICERs) of the drug cost to quality-adjusted life years (QALYs) were calculated. A stratified analysis of patient characteristics was also performed to identify baseline factors potentially affecting cost-effectiveness. RESULTS The ICER of entire drug treatment for cervicobrachial symptoms was 7,491,640 yen. Compared with the reference willingness-to-pay, the ICER was assumed to not be cost-effective. A certain number of QALYs were gained during the first 3 months after the treatment intervention, but almost no QALYs were gained during the following 3 months. Stratified analysis showed that cost-effectiveness was extremely low for patients with high baseline VAS and high QOL. CONCLUSIONS The available medications for cervicobrachial symptoms did not have excellent cost-effectiveness. Although a certain number of QALYs were gained during the first 3 months after medication, no QALYs were gained in the latter half of the study period, suggesting that it is not advisable to continue the medication needlessly. LEVEL OF EVIDENCE II, prospective cohort study.
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Affiliation(s)
- Norimitsu Wakao
- Departments of Orthopaedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
| | - Toshitaka Yoshii
- Section of Orthopaedic Surgery; and Spinal Surgery, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan.
| | - Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University, School of Medicine, Hamamatsu, Japan.
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University, School of Medicine, Hamamatsu, Japan.
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yasuaki Imajo
- Department of Orthopaedic Surgery, Tokuyama Central Hospital, Shunan, Japan.
| | - Hiroshi Miyamoto
- Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan.
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Sagamihara, Japan.
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Sagamihara, Japan.
| | - Shunsuke Kanbara
- Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Japan.
| | - Yoichi Iizuka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan.
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan.
| | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan.
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
| | - Mikito Tsushima
- Department of Orthopaedic Surgery, Konan Kosei Hospital, Konan, Japan.
| | - Masashi Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan.
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan.
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University, Tokyo, Japan.
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University, Graduate School of Medicine, Sapporo, Japan.
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Masao Koda
- Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
| | - Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan.
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan.
| | | | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University, School of Medicine, Hamamatsu, Japan.
| | - Mamoru Kawakami
- Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan.
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Kofu, Japan.
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Shirota G, Sato S, Yasunaga H, Aso S, Akahane M, Itoh D, Abe O. Transarterial radioembolization vs transarterial chemoembolization with drug-eluting beads for treating hepatocellular carcinoma: a cost-effectiveness analysis in Japanese healthcare system. Jpn J Radiol 2024; 42:1501-1515. [PMID: 39325293 PMCID: PMC11588955 DOI: 10.1007/s11604-024-01640-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/01/2024] [Indexed: 09/27/2024]
Abstract
PURPOSE Transarterial radioembolization (TARE) is effective for unresectable hepatocellular carcinoma; however, it awaits approval in Japan. This study aimed to simulate the cost-effectiveness of TARE over chemoembolization when TARE is approved in Japan and identify the requirements for cost-effectiveness. MATERIALS AND METHODS A Markov model was constructed to analyze the costs and effectiveness associated with TARE and transarterial chemoembolization with drug-eluting beads (DEB-TACE) for 2-month cycles over 5 years. In the primary analysis, the intention-to-treat survival data were used to calculate transition probabilities, whereas the ancillary analysis assessed the per-protocol survival data. DEB-TACE costs were calculated using the Japanese nationwide claims Diagnosis Procedure Combination database between April 2018 and March 2022, whereas TARE costs were estimated using database and international sources. The incremental cost-effectiveness ratio (ICER) was determined based on the payer's perspective and compared with the Japanese willingness-to-pay threshold of 5 million Japanese yen (JPY) (31,250 USD) per quality-adjusted life years (QALY). RESULTS From the claims database, 6,986 patients with hepatocellular carcinoma who received DEB-TACE were identified. In the primary analysis, the ICER was 5,173,591 JPY (32,334 USD)/QALY, surpassing the Japanese willingness-to-pay threshold. However, the ancillary analysis showed a lower ICER of 4,156,533 JPY (25,978 USD)/QALY, falling below the threshold. The one-way deterministic sensitivity analysis identified progression-free survival associated with TARE and DEB-TACE, DEB-TACE costs, and radioactive microsphere reimbursement price as key ICER influencers. The primary analysis suggested that setting the reimbursement price of radioactive microspheres below 1.399 million JPY (8,744 USD), approximately 2.8% lower than the price in the United Kingdom, would place the ICER below the Japanese willingness-to-pay threshold. CONCLUSIONS Under specific conditions, TARE can be a more cost-effective treatment than DEB-TACE. If the reimbursement price of radioactive microspheres is set approximately 2.8% lower than that in the United Kingdom, TARE could be cost-effective compared with DEB-TACE.
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Affiliation(s)
- Go Shirota
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - So Sato
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Shotaro Aso
- Department of Real-World Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaaki Akahane
- Department of Radiology, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Daisuke Itoh
- Department of Diagnostic Radiology, Toranomon Hospital, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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Nusawat C, Sato S, Watanabe H, Konishi T, Yamana H, Yasunaga H. Cost-Effectiveness Analysis of Adjuvant Pertuzumab and Trastuzumab in Human Epidermal Growth Factor Receptor 2-Positive Early Breast Cancer in Japan. Clin Drug Investig 2024; 44:927-938. [PMID: 39511130 PMCID: PMC11638282 DOI: 10.1007/s40261-024-01399-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2024] [Indexed: 11/15/2024]
Abstract
BACKGROUND AND OBJECTIVE Human epidermal growth factor receptor 2 (HER2)-positive breast cancer presents considerable treatment challenges owing to its aggressive nature. Global guidelines have endorsed a full year of HER2-targeted therapy for early-stage breast cancer. However, previous cost-effectiveness analyses of dual HER2-targeted therapies have been limited. This study aimed to examine the cost effectiveness of dual HER2-targeted therapy for early-stage breast cancer within the Japanese healthcare system context. METHODS In the Markov model-based study, the cost effectiveness of dual anti-HER2 therapy, combining pertuzumab and trastuzumab, was assessed in comparison to trastuzumab monotherapy. Patients in whom treatment was initiated at a median age of 51 years were included. The study utilized quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) as comparison units. Subgroup analyses were conducted to explore variations in cost effectiveness, focusing on node-positive and node-negative patients. Both one-way deterministic and broader probabilistic sensitivity analyses using Monte Carlo simulations with 10,000 samples were performed from the Japanese healthcare payers perspective. RESULTS Dual HER2-targeted therapy led to 0.17 QALYs increment at an additional cost of $US15,289, resulting in an ICER of $US92,232 per QALY. In the subgroup of node-positive patients, the benefit of the dual HER2-targeted therapy was more pronounced, with an increase of 0.64 QALYs and an ICER of $US24,561 per QALY. Sensitivity analyses revealed the model's susceptibility to changes in the transition probabilities from invasive disease-free survival to death, from invasive disease-free survival to first-line metastatic breast cancer, and to costs associated with pertuzumab. Probabilistic sensitivity analysis suggests that for node-positive patients, dual HER2-targeted therapy may be a cost-effective option. CONCLUSIONS The economic viability of dual HER2-targeted therapy was most pronounced in patients with node-positive high-risk early breast cancer. This study highlights the potential of dual HER2-targeted therapy as a cost-effective addition for these cases.
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MESH Headings
- Humans
- Trastuzumab/economics
- Trastuzumab/administration & dosage
- Trastuzumab/therapeutic use
- Cost-Benefit Analysis
- Receptor, ErbB-2/metabolism
- Breast Neoplasms/drug therapy
- Breast Neoplasms/economics
- Breast Neoplasms/pathology
- Female
- Antibodies, Monoclonal, Humanized/economics
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/therapeutic use
- Japan
- Middle Aged
- Quality-Adjusted Life Years
- Markov Chains
- Antineoplastic Combined Chemotherapy Protocols/economics
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Chemotherapy, Adjuvant/economics
- Chemotherapy, Adjuvant/methods
- Adult
- Antineoplastic Agents, Immunological/economics
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/therapeutic use
- Monte Carlo Method
- Aged
- Cost-Effectiveness Analysis
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Affiliation(s)
- Chanon Nusawat
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 1130033, Japan.
| | - So Sato
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
| | - Hideaki Watanabe
- Department of Eat-loss Medicine, The University of Tokyo, Tokyo, Japan
| | - Takaaki Konishi
- Department of Breast and Endocrine Surgery, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Data Science Center, Jichi Medical University, Tochigi, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 1130033, Japan
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25
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Kagami Y, Nakashima H, Segi N, Ito S, Ouchida J, Ogura K, Shinjo R, Imagama S. Incremental cost-effectiveness ratio between titanium plate and hydroxyapatite block spacers in cervical laminoplasty for degenerative cervical myelopathy. J Orthop Sci 2024:S0949-2658(24)00196-9. [PMID: 39537525 DOI: 10.1016/j.jos.2024.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 08/22/2024] [Accepted: 10/08/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION Laminoplasty is a widely used surgical procedure to decompress the cervical spinal cord. Recently, titanium plates (TPs) have been used instead of conventional hydroxyapatite block (HA) spacers to prevent laminar reclosure. However, no study has compared the cost-effectiveness of TP and HA. Therefore, this study aimed to compare the cost-effectiveness and postoperative outcomes of laminoplasty using TP or HA. METHODS A total of 167 patients who underwent cervical laminoplasty at our institution were included in this study. Patients with cervical spinal cord injury, epidural hematoma, or follow-up of <1 year were excluded. Of the 167 patients, 69 underwent laminoplasty using TP (the TP group), and 98 underwent laminoplasty using HA (the HA group). The surgical costs and incremental cost-effectiveness ratio (ICER) were compared between the two groups. Additionally, the operation time, complications, Japanese Orthopaedic Association score, Hirabayashi recovery rate, and pre and postoperative cervical alignment on X-ray images were investigated. RESULTS The surgical costs were significantly higher in the TP group than in the HA group (HA, 7255 ± 1504 USD vs. TP, 11,642 ± 2492 USD, p < 0.01). The ICER was 21,935 USD per quality-adjusted life year in the TP group. The operation time was shorter in the TP group than in the HA group (HA, 70.0 ± 22.5 min vs. TP, 63.6 ± 19.3 min, p = 0.06). The Hirabayashi recovery rate and radiographic parameters were similar between the two groups. Implant displacements were significantly more common in the HA group than in the TP group (HA, 11.2 % vs. TP, 0 %, p < 0.01). CONCLUSIONS The surgical costs and ICER with TPs were higher than those with HA spacers. However, no difference in the Hirabayashi recovery rate and postoperative radiological parameters was observed between the two groups, although the HA group had more implant displacements.
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Affiliation(s)
- Yujiro Kagami
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Naoki Segi
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan; Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Jun Ouchida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Keisuke Ogura
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Ryuichi Shinjo
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Sato S, Konishi T, Ohbe H, Yasunaga H. Retraction notice to Cost-effectiveness of the Recombinant Zoster Vaccine among People Living with Human Immunodeficiency Virus in Japan: [VHRI Volume 44, November 2024, 101025]. Value Health Reg Issues 2024; 44:101025. [PMID: 38970854 DOI: 10.1016/j.vhri.2024.101025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 05/15/2024] [Accepted: 05/31/2024] [Indexed: 07/08/2024]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/policies/article-withdrawal). This article has been retracted at the request of the authors due to an error in the study discovered after the paper was published. In this study, the cost-effectiveness of the recombinant zoster vaccine (RZV) (Shingrix®) for people living with HIV (PLWHIV) aged ≥50 years was analyzed, comparing a 2-dose RZV strategy to no RZV strategy. The initial model indicated that the no RZV strategy was more cost-effective than the 2-dose RZV strategy (Erratum to Table 2). However, an error occurred in the model, where the cost parameter for the 2-dose RZV strategy was mistakenly applied as if PLWHIV individuals received the 2-dose vaccine in every cycle, significantly inflating the cost of this strategy. Upon correcting the model to reflect that the 2-dose RZV is administered only at cycle 0, the revised results indicate that the 2-dose RZV strategy is dominant over the no RZV strategy (Erratum to Table 2). Given that this error leads to a completely reversed conclusion, this paper has been retracted.
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Affiliation(s)
- So Sato
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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27
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Yokoyama K, Wasano K, Sasaki K, Machida R, Nakahira M, Kitamura K, Sakagami T, Takeshita N, Ohkoshi A, Suzuki M, Tateya I, Morishita Y, Sekimizu M, Nakayama M, Koyama T, Shibata H, Miyamaru S, Kiyota N, Hanai N, Homma A. Frequency of use and cost in Japan of first-line palliative chemotherapies for recurrent or metastatic squamous cell carcinoma of the head and neck. Jpn J Clin Oncol 2024; 54:1115-1122. [PMID: 39206595 DOI: 10.1093/jjco/hyae117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 08/10/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Over the last decade, novel anticancer drugs have improved the prognosis for recurrent or metastatic squamous cell carcinoma of the head and neck (RM-SCCHN). However, this has increased healthcare expenditures and placed a heavy burden on patients and society. This study investigated the frequency of use and costs of select palliative chemotherapy regimens in Japan. METHODS From July 2021 to June 2022 in 54 healthcare facilities, we gathered data of patients diagnosed with RM-SCCHN and who had started first-line palliative chemotherapy with one of eight commonly used regimens. Patients with nasopharyngeal carcinomas were excluded. The number of patients receiving each regimen and the costs of each regimen for the first month and per year were tallied. RESULTS The sample comprised 907 patients (674 were < 75 years old, 233 were ≥ 75 years old). 330 (36.4%) received Pembrolizumab monotherapy, and 202 (22.3%) received Nivolumab monotherapy. Over 90% of patients were treated with immune checkpoint inhibitors as monotherapy or in combination with chemotherapy. Treatment regimens' first-month costs were 612 851-849 241 Japanese yen (JPY). The cost of standard palliative chemotherapy until 2012 was about 20 000 JPY per month. The incremental cost over the past decade is approximately 600 000-800 000 JPY per month, a 30- to 40-fold increase in the cost of palliative chemotherapy for RM-SCCHN. CONCLUSION First-line palliative chemotherapy for RM-SCCHN exceeds 600 000 JPY monthly. Over the last decade, the prognosis for RM-SCCHN has improved, but the costs of palliative chemotherapy have surged, placing a heavy burden on patients and society.
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Affiliation(s)
- Kazuki Yokoyama
- Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Koichiro Wasano
- Department of Otolaryngology-Head and Neck Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Keita Sasaki
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Ryunosuke Machida
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Mitsuhiko Nakahira
- Department of Otolaryngology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Koji Kitamura
- Department of Head and Neck Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Tomofumi Sakagami
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University, Osaka, Japan
| | - Naohiro Takeshita
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
- Department of Otorhinolaryngology, Head and Neck Surgery, Jikei University Hospital, Tokyo, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan
| | - Motoyuki Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ichiro Tateya
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yohei Morishita
- Department of Otorhinolaryngology, Head and Neck Surgery, Jikei University Hospital, Tokyo, Japan
| | - Mariko Sekimizu
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Nakayama
- Department of Otolaryngology, Head and Neck Surgery, University of Tsukuba, Tsukuba, Japan
| | - Taiji Koyama
- Department of Medical Oncology and Hematology, Cancer Center, Kobe University Hospital, Kobe, Japan
| | - Hirofumi Shibata
- Department of Otolaryngology, Head and Neck Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Satoru Miyamaru
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Cancer Center, Kobe University Hospital, Kobe, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Whittaker SL, Brusco NK, Hill KD, Taylor NF. Self-management Programs Within Rehabilitation Yield Positive Health Outcomes at a Small Increased Cost Compared With Usual Care: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:1946-1960. [PMID: 38729404 DOI: 10.1016/j.apmr.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 04/09/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE To determine if self-management programs, supported by a health professional, in rehabilitation are cost effective. DATA SOURCES Six databases were searched until December 2023. STUDY SELECTION Randomized controlled trials with adults completing a supported self-management program while participating in rehabilitation or receiving health professional input in the hospital or community settings were included. Self-management programs were completed outside the structured, supervised therapy and health professional sessions. Included trials had a cost measure and an effectiveness outcome reported, such as health-related quality of life or function. Grading of Recommendations, Assessment, Development, and Evaluations was used to determine the certainty of evidence across trials included in each meta-analysis. Incremental cost-effectiveness ratios were calculated based on the mean difference from the meta-analyses of contributing health care costs and quality of life. DATA EXTRACTION After application of the search strategy, two independent reviewers determined eligibility of identified literature, initially by reviewing the title and/or abstract before full-text review. Using a customized form, data were extracted by one reviewer and checked by a second reviewer. DATA SYNTHESIS Forty-three trials were included, and 27 had data included in meta-analyses. Where self-management was a primary intervention, there was moderate certainty of a meaningful positive difference in quality-of-life utility index of 0.03 units (95% confidence interval, 0.01-0.06). The cost difference between self-management as the primary intervention and usual care (comprising usual intervention/therapy, minimal intervention [including education only], or no intervention) potentially favored the comparison group (mean difference=Australian dollar [AUD]90; 95% confidence interval, -AUD130 to AUD310). The cost per quality-adjusted life year (QALY) gained for self-management programs as a stand-alone intervention was AUD3000, which was below the acceptable willingness-to-pay threshold in Australia per QALY gained (AUD50,000/QALY gained). CONCLUSIONS Self-management as an intervention is low cost and could improve health-related quality of life.
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Affiliation(s)
- Sara L Whittaker
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria.
| | - Natasha K Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Melbourne, Victoria
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria; Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
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Bloom JA, Wareham C, Chahine E, Singhal D, Lin SJ, Lee BT, Nardello S, Homsy C, Persing SM, Chatterjee A. A Cost-Utility Analysis of the Use of -125 mm Hg Closed-incision Negative Pressure Therapy in Oncoplastic Breast Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6163. [PMID: 39359700 PMCID: PMC11444648 DOI: 10.1097/gox.0000000000006163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/24/2024] [Indexed: 10/04/2024]
Abstract
Background Closed-incision negative pressure therapy (ciNPT) decreases the rate of wound complications in oncoplastic breast surgery (OBS) but at a fiscal cost. Our aim was to examine the cost-utility of ciNPT in OBS. Methods A literature review was performed to obtain the probabilities and outcomes for the treatment of unilateral breast cancer with OBS with ciNPT versus without. Reported utility scores in the literature were used to calculate quality-adjusted life years (QALYs) for each health state. A decision analysis tree was constructed with rollback analysis to determine the more cost-effective strategy. An incremental cost-utility ratio was calculated. Sensitivity analyses were performed. Results OBS with ciNPT is associated with a higher clinical effectiveness (QALY) of 33.43 compared to without (33.42), and relative cost increase of $667.89. The resulting incremental cost-utility ratio of $57432.93/QALY favored ciNPT. In one-way sensitivity analysis, ciNPT was the more cost-effective strategy if the cost of ciNPT was less than $1347.02 or if the probability of wound dehiscence without was greater than 8.2%. Monte Carlo analysis showed a confidence of 75.39% that surgery with ciNPT is more cost effective. Conclusion Despite the added cost, surgery with ciNPT is cost-effective. This finding is a direct result of decreased overall wound complications with ciNPT.
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Affiliation(s)
- Joshua A Bloom
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Carly Wareham
- Department of Surgery, Tufts Medical Center, Boston, Mass
| | - Elsa Chahine
- Department of Surgery, Tufts Medical Center, Boston, Mass
| | - Dhruv Singhal
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Samuel J Lin
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Bernard T Lee
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Salvatore Nardello
- Division of Surgical Oncology and Breast Surgery, Department of Surgery, Tufts Medical Center, Boston, Mass
| | - Christopher Homsy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Mass
| | - Sarah M Persing
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Mass
- Division of Surgical Oncology and Breast Surgery, Department of Surgery, Tufts Medical Center, Boston, Mass
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Mass
- Division of Surgical Oncology and Breast Surgery, Department of Surgery, Tufts Medical Center, Boston, Mass
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30
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Nakagawa N, Konno M, Kashiwabara M, Shimoji S, Mochimaru J, Inoue T, Lai L. A Pilot Study on the Drug Price Revision Strategy in Japan: A Comparison Among Fiscal Years 2018, 2020, and 2022. Hosp Pharm 2024; 60:00185787241267738. [PMID: 39558939 PMCID: PMC11569764 DOI: 10.1177/00185787241267738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2024]
Abstract
Objective: Japan has resumed its health technology assessment to decide how to reduce high-cost drug prices. While drug price rules in Japan are comprehensive, they do not necessarily capture differences in product characteristics. This study examined the drug price revision strategy in Japan using migraine treatment with triptans as an example. Cost data from fiscal years (FY) 2018, 2020, and 2022 were utilized. Methods: A cost-utility analysis was conducted from the perspective of healthcare payers, focusing on Japanese patients aged over 18 years experiencing migraines. The study employed a base-case model with probabilities derived from a network meta-analysis. Direct costs included medical and drug costs. Effectiveness was assessed using the European Quality of Life 5-dimensions-3-level questionnaire. Deterministic and probabilistic sensitivity analyses were conducted to examine the level of uncertainty. Results: In FY2018, sumatriptan and eletriptan were cost-effective; however, the other triptans were dominated by sumatriptan. In FY2020, sumatriptan and eletriptan were cost-effective, and rizatriptan was extended-dominated; nevertheless, the other triptans were dominated by sumatriptan. In FY2022, naratriptan and eletriptan were cost-effective; however, the other triptans were dominated by naratriptan. The hierarchy of triptan strategies varied in each fiscal year. Conclusions: This study provides valuable insights into the drug price revision strategy in Japan. The variations could be problematic because in Japan, formulary management of triptans, for example, those for migraine, may face revaluation every other year. Discussions regarding this issue will be further explored in the future.
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Affiliation(s)
- Naoto Nakagawa
- Ohu University School of Pharmaceutical Sciences, Koriyama, Fukushima, Japan
| | - Mizuha Konno
- Ohu University School of Pharmaceutical Sciences, Koriyama, Fukushima, Japan
| | | | | | | | - Tadao Inoue
- Yamagata University Yamagata city, Yamagata, Japan
| | - Leanne Lai
- Kaohsiung Medical University, Kaohsiung city, Taiwan
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Kato M, Ono T, Deguchi H, Ohmagari N, Igarashi A. Cost-effectiveness analysis of NVX-CoV2373 COVID-19 vaccination for elderly people in Japan. Vaccine X 2024; 19:100514. [PMID: 39108420 PMCID: PMC11300936 DOI: 10.1016/j.jvacx.2024.100514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/19/2024] [Indexed: 01/27/2025] Open
Abstract
BACKGROUND NVX-CoV2373 is one of the vaccines marketed for COVID-19 prevention in Japan. Information on its cost-effectiveness is important for making well-informed decisions on the future of Japan's COVID-19 vaccination programme from the public healthcare payer's perspective. The aim of this study was to evaluate the cost-effectiveness of NVX-CoV2373 vaccination in the elderly Japanese population. METHODS Two analysis populations that included elderly Japanese individuals (aged ≥ 65 years) were defined in this study: those who had not received a COVID-19 vaccine or had not completed a primary vaccination series (i.e., first two vaccinations) with an approved COVID-19 vaccine (analysis population 1), and those who had received two primary vaccinations with an approved COVID-19 vaccine (analysis population 2). A literature-informed Markov model for each analysis population was developed to evaluate the cost-effectiveness of vaccination with NVX-CoV2373 against no vaccination with NVX-CoV2373 from the public healthcare payer's perspective as a base-case analysis and from the societal perspective as a scenario analysis. Vaccine efficacy was estimated from a phase 3 study of NVX-CoV2373 (EudraCT number: 2020-004123-16). Cost-effectiveness was assessed using a willingness-to-pay threshold of Japanese yen (JPY) 5 million per quality-adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses were also performed. RESULTS For analysis population 1, NVX-CoV2373 primary and booster vaccinations would reduce costs by JPY 37,647 and prolong QALYs by 0.01601. Therefore, NVX-CoV2373 primary and booster vaccinations were considered to be dominant over no vaccination. For analysis population 2, an NVX-CoV2373 booster vaccination would increase costs by JPY 5010 and prolong QALYs by 0.00550, with the incremental cost-effectiveness ratio of JPY 910,566 per QALY gained. CONCLUSIONS Our analyses suggest that a vaccination strategy with NVX-CoV2373 is cost-effective in the elderly population (aged ≥ 65 years) of Japan.
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Affiliation(s)
- Masafumi Kato
- Market Access, Public Affairs & Patient Experience, Japan Pharma Business Unit, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Takayori Ono
- Medical Franchise Vaccine, Japan Medical Office, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Hisato Deguchi
- Market Access, Public Affairs & Patient Experience, Japan Pharma Business Unit, Takeda Pharmaceutical Company Limited, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Ataru Igarashi
- Department of Public Health, School of Medicine, Yokohama City University, Yokohama, Japan
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Mizuno T, Kondo Y, Sakai M, Saneyasu K, Kojima R, Miyake Y. Cost-effectiveness of nirmatrelvir/ritonavir for high-risk adult outpatients with COVID-19 in Japan. J Infect Chemother 2024; 30:716-724. [PMID: 38325626 DOI: 10.1016/j.jiac.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 02/09/2024]
Abstract
INTRODUCTION This study aimed to evaluate the cost-effectiveness of nirmatrelvir/ritonavir (Nir/Rit) for adult outpatients with COVID-19 from the perspective of a Japanese public healthcare payer. METHODS A cost-effectiveness simulation was conducted comparing Nir/Rit for the outpatient treatment of high-risk COVID-19 patients to best supportive care (BSC) without antiviral or antibody drugs. The analytical model was divided into two phases: the treatment phase, lasting 35 days from the start of COVID-19 treatment, and the post-treatment phase. Patients who survived the treatment phase were assumed to follow a general population survival curve. Expected costs and expected quality-adjusted life years (QALYs) for both BSC and Nir/Rit were calculated for ages 40 to 80 to obtain the incremental cost-effectiveness ratio (ICER). The robustness of the results was evaluated through deterministic and probabilistic sensitivity analysis (PSA). RESULTS The ICERs for patients aged 40, 50, 60, 70, and 80 were 18,854,276 Japanese Yen (JPY)/QALY, 8,482,034 JPY/QALY, 4,976,612 JPY/QALY, 2,636,096 JPY/QALY, and 1,597,783 JPY/QALY, respectively. In the deterministic sensitivity analysis, both the mortality risk during the treatment phase and the relative mortality risk with Nir/Rit had a high impact on ICER across all ages. In the PSA, when the willingness-to-pay (WTP) threshold was set at 5 million JPY/QALY, the probability of the ICER being below the WTP threshold was 0%, 0.2%, 45.4%, 99.9%, and 100% at ages 40, 50, 60, 70, and 80, respectively. CONCLUSION Nir/Rit is cost-effective for older individuals aged 60 and over but not for younger age groups.
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Affiliation(s)
- Takahito Mizuno
- Department of Pharmacy, Toyota Kosei Hospital: 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Yu Kondo
- Department of Pharmacy, Toyota Kosei Hospital: 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan.
| | - Mikiyasu Sakai
- Department of Pharmacy, Toyota Kosei Hospital: 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Kenichi Saneyasu
- Department of Pharmacy, Toyota Kosei Hospital: 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Ryota Kojima
- Department of Pharmacy, Toyota Kosei Hospital: 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
| | - Yoshio Miyake
- Department of Pharmacy, Toyota Kosei Hospital: 500-1, Ibobara, Jousui-cho, Toyota, 470-0396, Japan
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Nakagawa N, Kashiwabara M, Egawa K, Sasaki A. Cost-effectiveness Analysis of Second-Generation Antihistamine 1 Receptor Blockers and Japanese Kampo Shoseiryuto for Treating Perennial Allergic Rhinitis in Outpatient Settings in Japan. Hosp Pharm 2024; 59:436-443. [PMID: 38919765 PMCID: PMC11195846 DOI: 10.1177/00185787241229152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Objectives: Perennial allergic rhinitis (PAR) is common in Japan. Second-generation antihistamines (SGAs) are commonly used for its treatment; however, it remains unclear which SGA is the most cost-effective. Additionally, the pharmacoeconomics of Japanese Kampo shoseiryuto (which was traditionally prescribed to treat PAR in Japan) remains poorly understood. In this study, we aimed to investigate the effectiveness of various SGAs and shoseiryuto for the treatment of PAR in Japanese outpatients, from the healthcare payer's perspective. Methods: The most cost- and clinically effective SGAs were determined from a list of 6 SGAs (bepotastine, 10 mg; cetirizine, 10 mg; ebastine, 10 mg; epinastine, 20 mg; loratadine, 10 mg; and olopatadine, 5 mg) together with shoseiryuto, using the overall improvement rate through a model-based analysis. The time horizon was 28 days. Costs were determined based on the Medical Fee Index in 2020. Deterministic and probabilistic sensitivity analyses were conducted to address the uncertainty of the base-case results. Results: Overall, bepotastine (10 mg) and ebastine (10 mg) were cost-effective. Shoseiryuto was less cost-effective than ebastine (10 mg) (dominated). Ebastine (10 mg) was the most cost-effective option based on deterministic and probabilistic sensitivity analyses. Conclusions: Ebastine (10 mg) was the most cost-effective treatment strategy for PAR among the agents evaluated in this study. This insight could aid in establishing an appropriate formulary for treating PAR in hospitals and communities.
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Affiliation(s)
| | | | - Kei Egawa
- Ohu University, Koriyama, Fukushima, Japan
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Kim S, Choi JK, Suh J, Park SH, Lee J. The epidemiologic and economic impact of varicella and herpes zoster vaccination in South Korea: A mathematical modelling study. Vaccine 2024; 42:4046-4055. [PMID: 38762358 DOI: 10.1016/j.vaccine.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND In South Korea, the National Immunization Program has included one-dose varicella vaccination for 1-year-olds since 2005. This study examines the potential impact of introducing a two-dose varicella vaccination for children, along with zoster vaccination for adults, using either the zoster vaccine live (ZVL) or recombinant zoster vaccine (RZV). METHODS The investigation considered four strategies in a base case scenario. The first involved introducing zoster vaccination for 60-year-olds, with a 60 % coverage. The second strategy combined zoster vaccination with a second-dose varicella vaccination for 4-year-olds, with a 90 % coverage. An age-structured model spanning 50 years was employed, assuming a zoster vaccine catch-up campaign over the initial 5 years. Cost-effectiveness analyses were conducted, assessing incremental cost-effectiveness ratios (ICERs), incremental net monetary benefits (INMBs), and net loss under different ages at zoster vaccination (50, 60, 65, and 70 years) and varying willingness-to-pay (WTP) levels from ₩40 million ($34,998) to ₩84 million ($74,000). RESULTS All strategies were cost-effective and significantly reduced herpes zoster (HZ) incidence, preventing approximately 3,077,000 to 7,609,000 cases, depending on the chosen strategy. The combined strategy prevented around 4,950,000 varicella and 653,000 HZ cases additionally. RZV outperformed ZVL by preventing twice as many HZ cases and offering greater QALY gains. However, ZVL was more cost-effective due to its lower cost. Probabilistic sensitivity analyses revealed that RZV became more cost-effective at higher WTP thresholds, exceeding ₩60.9 million ($53,193) in terms of ICER and ₩62.5 million ($54,591) for INMBs and net loss. The optimal age for zoster vaccination was 60 years concerning ICER but 50 years regarding INMB. CONCLUSIONS Combining RZV with a two-dose varicella vaccination strategy reduced the disease burden and improved QALY more effectively, though ZVL remained more cost-effective at lower WTP levels. Decisions regarding vaccination policies should be balanced between the public health needs and WTP levels.
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Affiliation(s)
- Sol Kim
- School of Mathematics and Computing (Mathematics), Yonsei University, Seoul, Republic of Korea
| | - Jae-Ki Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jiyeon Suh
- School of Mathematics and Computing (Computational Science and Engineering), Yonsei University, Seoul, Republic of Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Jeehyun Lee
- School of Mathematics and Computing (Mathematics), Yonsei University, Seoul, Republic of Korea.
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Cost-effectiveness of enoxaparin versus aspirin in the prevention of venous thromboembolism after total hip or knee arthroplasty: an analysis from the CRISTAL cluster-randomized trial. Bone Joint J 2024; 106-B:589-595. [PMID: 38821513 DOI: 10.1302/0301-620x.106b6.bjj-2023-0783.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Aims The aim of this study was to evaluate the healthcare costs and benefits of enoxaparin compared to aspirin in the prevention of symptomatic venous thromboembolism (VTE) after total hip arthroplasty (THA) or total knee arthroplasty (TKA) using data from the CRISTAL trial. Methods This trial-based economic analysis reports value for money as incremental cost per quality-adjusted life-year (QALY) gained in 2022 Australian dollars, compared to a single threshold value of AUD$70,000 per QALY. Event costs were estimated based on occurrence of VTEs and bleeds, and on published guidelines for treatment. Unit costs were taken from Australian sources. QALYs were estimated using CRISTAL six-month follow-up data. Sensitivity analyses are presented that vary the cost of VTE treatment, and extend the analyses to two years. Results The CRISTAL trial found that enoxaparin was more effective than aspirin in preventing symptomatic VTE within 90 days of THA or TKA (risk difference 1.97% (95% confidence interval (CI) 0.54% to 3.41%; p = 0.007)). The additional cost after a THA or TKA was AUD$83 (95% CI 68 to 97) for enoxaparin, and enoxaparin resulted in an additional 0.002 QALYs (95% CI -0.002 to 0.005). Incremental cost per QALY gained was AUD$50,567 (95% CI 15,513, dominated) for enoxaparin. We can be 60% confident that the incremental cost per QALY does not exceed the willingness-to-pay threshold of AUD$70,000. Increasing the cost of VTE treatment and extension of costs and consequences to two years suggested greater confidence that enoxaparin is good value for money (70% and 63% confidence, respectively). Conclusion This analysis provides strong evidence that enoxaparin thromboprophylaxis following THA or TKA reduced VTEs, but weak evidence of net economic benefits over aspirin. If the value of avoiding VTEs is high, and there is a strong likelihood of VTE-related health impairments, we can be more confident that enoxaparin is cost-effective compared to aspirin.
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Takayama Y, Tsukamoto S, Kudose Y, Takamizawa Y, Moritani K, Esaki M, Kanemitsu Y, Igarashi A. Cost-effectiveness of surveillance intervals after curative resection of colorectal cancer. Jpn J Clin Oncol 2024; 54:637-646. [PMID: 38376792 DOI: 10.1093/jjco/hyae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 01/25/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Major guidelines consistently recommend 5 years of postoperative surveillance for patients with colorectal cancer. However, they differ in their recommendations for examination intervals and whether they should vary according to disease stage. Furthermore, there are no reports on the cost-effectiveness of the different surveillance schedules. The objective of this study is to identify the most cost-effective surveillance intervals after curative resection of colorectal cancer. METHODS A total of 3701 patients who underwent curative surgery for colorectal cancer at the National Cancer Center Hospital were included. A cost-effectiveness analysis was conducted for the five surveillance strategies with reference to the guidelines. Expected medical costs and quality-adjusted life years after colorectal cancer resection were calculated using a state-transition model by Monte Carlo simulation. The incremental cost-effectiveness ratio per quality-adjusted life years gained was calculated for each strategy, with a maximum acceptable value of 43 500-52 200 USD (5-6 million JPY). RESULTS Stages I, II and III included 1316, 1082 and 1303 patients, respectively, with 45, 140 and 338 relapsed cases. For patients with stage I disease, strategy 4 (incremental cost-effectiveness ratio $26 555/quality-adjusted life year) was considered to be the most cost-effective, while strategies 3 ($83 071/quality-adjusted life year) and 2 ($289 642/quality-adjusted life year) exceeded the threshold value. In stages II and III, the incremental cost-effectiveness ratio for strategy 3 was the most cost-effective option, with an incremental cost-effectiveness ratio of $18 358-22 230/quality-adjusted life year. CONCLUSIONS In stage I, the cost-effectiveness of intensive surveillance is very poor and strategy 4 is the most cost-effective. Strategy 3 is the most cost-effective in stages II and III.
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Affiliation(s)
- Yuji Takayama
- Department of Colorectal Surgery, National Cancer Center, Tokyo, Japan
| | | | - Yozo Kudose
- Department of Colorectal Surgery, National Cancer Center, Tokyo, Japan
| | | | - Konosuke Moritani
- Department of Colorectal Surgery, National Cancer Center, Tokyo, Japan
| | - Minoru Esaki
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center, Tokyo, Japan
| | | | - Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
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Arima H, Hasegawa T, Yamato Y, Kato M, Yoshida G, Banno T, Oe S, Ide K, Yamada T, Nakai K, Kurosu K, Matsuyama Y. Cost-Effectiveness of Corrective Fusion Surgeries for Adult Spinal Deformities: Does Unexpected Revision Surgery Affect Cost-Effectiveness? Spine Surg Relat Res 2024; 8:306-314. [PMID: 38868785 PMCID: PMC11165507 DOI: 10.22603/ssrr.2023-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/10/2023] [Indexed: 06/14/2024] Open
Abstract
Introduction Previous research has demonstrated that mid- to long-term health-related quality of life following corrective fusion surgery for adult spinal deformity (ASD) can be improved by appropriate revision surgery. In this study, we aim to compare the cost-effectiveness of corrective fusion surgery for ASD with and without unexpected revision surgery 5 years postoperatively. Methods In total, 79 patients with ASD (mean age, 68.7 years) who underwent corrective fusion surgery between 2013 and 2015 were included in this study. Cost-effectiveness was evaluated based on the cost of obtaining 1 quality-adjusted life year (QALY). Patients were divided into two groups according to the presence or absence of unexpected revision surgery following corrective fusion and were subjected for comparison. Results As per our study findings, 26 (33%) of the 79 ASD patients underwent unexpected revision surgery during the first 5 years following surgery. Although there was no significant difference in terms of inpatient medical costs at the time of initial surgery for 5 years after surgery between the two groups (no-revision group, revision group; inpatient medical costs at the time of initial surgery: USD 69,854 vs. USD 72,685, P=0.344), the total medical expenses up to 5 years after surgery were found to be higher in the revision group (USD 72,704 vs. USD 104,287, P<0.001). The medical expenses required to improve 1 QALY 5 years after surgery were USD 178,476 in the no-revision group, whereas it was USD 222,081 in the revision group. Conclusions Although the total medical expenses were higher in the revision group, no significant difference was observed in the cumulative QALY improvement between the revision and no-revision groups. Moreover, the medical expenses required to improve 1 QALY were higher in the revision group, with a difference of approximately 20%.
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Affiliation(s)
- Hideyuki Arima
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Next Generation Creative Education Center for Medicine, Engineering, and Informatics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiko Hasegawa
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yu Yamato
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masashi Kato
- Division of Medical Profession, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Go Yoshida
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Banno
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Koichiro Ide
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Yamada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keiichi Nakai
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kenta Kurosu
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Fujita A, Konishi T, Sakata R, Hashimoto Y, Yasunaga H, Aihara M. Cost-effectiveness analysis of prophylactic laser peripheral iridotomy for primary angle-closure suspect in Japan. Eye (Lond) 2024; 38:930-936. [PMID: 37898717 PMCID: PMC10966023 DOI: 10.1038/s41433-023-02806-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND/OBJECTIVES This study aimed to compare the cost-effectiveness of prophylactic laser peripheral iridotomy (LPI) with that of observation for primary angle-closure suspect (PACS) in Japan. SUBJECTS/METHODS A Markov model was developed to compare the costs and utilities of prophylactic LPI with those of observation of 40-year-old patients with PACS. In the model with a yearly cycle over a 20-year time horizon, the disease was postulated to irreversibly progress from PACS to primary angle closure, followed by primary angle-closure glaucoma, unilateral blindness, and bilateral blindness. The parameters were estimated mainly based on a recent randomised controlled trial and analyses of Japanese claims data. The incremental cost-effectiveness ratio was estimated from the healthcare payer's perspective and evaluated at the willingness-to-pay 5 million Japanese Yen per quality-adjusted life-year. The observation period and the age at entry into the cohort was changed to account for a variety of clinical courses in sensitivity analyses. We conducted one-way deterministic sensitivity analysis and probabilistic sensitivity analysis with Monte Carlo simulations with 10 000 iterations. RESULTS The incremental cost-effectiveness ratio of LPI was 2,287,662 Japanese Yen (14,298 pounds sterling) per quality-adjusted life-year, which was below the willingness-to-pay threshold. The ratios were approximately 4 and 8 million in the 15-year and 10-year time horizons, respectively. Increasing the age at entry had little influence on the incremental cost-effectiveness ratio. The deterministic and probabilistic sensitivity analyses indicated that the results were robust. CONCLUSIONS Our results indicate that prophylactic LPI for middle-aged patients with PACS is cost-effective in Japan.
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Affiliation(s)
- Asahi Fujita
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Rei Sakata
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yohei Hashimoto
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Okazaki S, Shibuya K, Shiba S, Takura T, Ohno T. Cost-Effectiveness Comparison of Carbon-Ion Radiation Therapy and Transarterial Chemoembolization for Hepatocellular Carcinoma. Adv Radiat Oncol 2024; 9:101441. [PMID: 38778825 PMCID: PMC11110039 DOI: 10.1016/j.adro.2024.101441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/03/2024] [Indexed: 05/25/2024] Open
Abstract
PURPOSE Carbon-ion radiation therapy (CIRT) is a treatment option for patients with hepatocellular carcinoma (HCC) that results in better outcomes with fewer side effects despite its high cost. This study aimed to evaluate the cost-effectiveness of CIRT for HCC from medical and economic perspectives by comparing CIRT and transarterial chemoembolization (TACE) in patients with localized HCC who were ineligible for surgery or radiofrequency ablation. METHODS AND MATERIALS This study included 34 patients with HCC who underwent either CIRT or TACE at Gunma University between 2007 and 2016. Patient characteristics were employed to select each treatment group using the propensity score matching method. Life years were used as the outcome indicator. The CIRT technical fee was ¥3,140,000; however, a second CIRT treatment on the same organ within 2 years was performed for free. RESULTS Our study showed that CIRT was dominant over TACE, as the CIRT group had a higher life year (point estimate, 2.75 vs 2.41) and lower total cost (mean, ¥4,974,278 vs ¥5,284,524). We conducted a sensitivity analysis to validate the results because of the higher variance in medical costs in the TACE group, which demonstrated that CIRT maintained its cost effectiveness with a high acceptability rate. CONCLUSIONS CIRT is a cost-effective treatment option for localized HCC cases unsuitable for surgical resection.
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Affiliation(s)
- Shohei Okazaki
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
- Department of Radiology, Gunma Prefectural Cancer Center, Ota, Japan
| | - Kei Shibuya
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shintaro Shiba
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
- Department of Radiation Oncology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Tomoyuki Takura
- Department of Health Care Services Management, Nihon University School of Medicine, Tokyo, Japan
- Department of Healthcare Economics and Health Policy, University of Tokyo, Tokyo, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
- Gunma University Heavy Ion Medical Center, Showa-machi, Maebashi, Japan
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Yonazu S, Ozawa T, Nakanishi T, Ochiai K, Shibata J, Osawa H, Hirasawa T, Kato Y, Tajiri H, Tada T. Cost-effectiveness analysis of the artificial intelligence diagnosis support system for early gastric cancers. DEN OPEN 2024; 4:e289. [PMID: 37644958 PMCID: PMC10461711 DOI: 10.1002/deo2.289] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/24/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
Objectives The introduction of artificial intelligence into the medical field has improved the diagnostic capabilities of physicians. However, few studies have analyzed the economic impact of employing artificial intelligence technologies in the clinical environment. This study evaluated the cost-effectiveness of a computer-assisted diagnosis (CADx) system designed to support clinicians in differentiating early gastric cancers from non-cancerous lesions in Japan, where the universal health insurance system was introduced. Methods The target population to be used for the CADx was estimated as those with moderate to severe gastritis caused by Helicobacter pylori infection. Decision trees with Markov models were built to analyze the cumulative cost-effectiveness of using CADx relative to the pre-artificial intelligence status quo, a condition reconstructed from data in published reports. After conducting a base-case analysis, we performed sensitivity analyses by modifying several parameters. The primary outcome was the incremental cost-effectiveness ratio. Results Compared with the status quo as represented in the base-case analysis, the incremental cost-effectiveness ratio of CADx in the Japanese market was forecasted to be 11,093 USD per quality-adjusted life year. The sensitivity analyses demonstrated that the expected incremental cost-effectiveness ratios were within the willingness-to-pay threshold of 50,000 USD per quality-adjusted life year when the cost of the CAD was less than 104 USD. Conclusions Using CADx for EGCs may decrease their misdiagnosis, contributing to improved cost-effectiveness in Japan.
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Affiliation(s)
- Shion Yonazu
- Faculty of MedicineThe University of TokyoTokyoJapan
- AI Medical Service Inc.TokyoJapan
| | - Tsuyoshi Ozawa
- AI Medical Service Inc.TokyoJapan
- Tada Tomohiro Institute of Gastroenterology and ProctologySaitamaJapan
| | | | - Kentaro Ochiai
- AI Medical Service Inc.TokyoJapan
- Department of Surgical Oncology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Junichi Shibata
- AI Medical Service Inc.TokyoJapan
- Tada Tomohiro Institute of Gastroenterology and ProctologySaitamaJapan
| | - Hiroyuki Osawa
- Departments of Medicine and GastroenterologyDivision of Gastroenterology, Jichi Medical UniversityTochigiJapan
| | - Toshiaki Hirasawa
- Department of GastroenterologyCancer Institute Hospital of the Japanese Foundation for Cancer ResearchTokyoJapan
| | | | - Hisao Tajiri
- Department of Innovative Interventional Endoscopy ResearchThe Jikei University School of MedicineTokyoJapan
| | - Tomohiro Tada
- AI Medical Service Inc.TokyoJapan
- Tada Tomohiro Institute of Gastroenterology and ProctologySaitamaJapan
- Department of Surgical Oncology, Graduate School of MedicineThe University of TokyoTokyoJapan
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Tanaka M, Okubo R, Hoshi SL, Kondo M. Cost-effectiveness analysis of pertussis booster vaccination for adolescents in Japan. Vaccine 2024; 42:2081-2088. [PMID: 38418340 DOI: 10.1016/j.vaccine.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION In Japan, the introduction of a fifth diphtheria-tetanus-acellular pertussis (DTaP) vaccination has been considered, and adolescents aged 11-12 years old who are currently receiving the diphtheria-tetanus (DT) vaccine are one candidate group. We analyze the cost-effectiveness of replacing the DT vaccine with the DTaP vaccine for 11-year-old adolescents and investigate the indirect effect of vaccinated adolescents on unvaccinated infant siblings. We undertake two analyses using high- and low-morbidity pertussis cases, and based on the results, present suggestions for pertussis prevention in the post-COVID-19 pandemic era. METHOD We used the number of pertussis cases in 2019 as the high-morbidity case and the average number of cases in 2020-2021 as the low-morbidity case, and evaluated the incremental cost-effectiveness ratio (ICER) of the DTaP strategy to the DT strategy based on quality-adjusted life years (QALYs). The economic model contained adolescent and infant sub-models. The indirect effect for infants was considered as the probability of unvaccinated infants avoiding pertussis infection from their vaccinated siblings. RESULTS The ICER from the payers' perspective was Japanese yen (JPY) 4,254,515 per QALY gained in the high-morbidity case and JPY 62,546,776 per QALY gained in the low-morbidity case. The sensitivity analysis showed that the utility of pertussis had the greatest impact on the ICER, with a 60.58% and 0% probability that the ICER was less than JPY 5 million per QALY gained in the high-morbidity case and low-morbidity case, respectively. CONCLUSION The cost-effectiveness of replacing the DT vaccine with the DTaP vaccine is affected by the level of pertussis morbidity, with the ICER becoming more favorable in the high-morbidity case. The indirect effect has little impact on the ICER. Thus, policy-makers should continue to monitor the pertussis epidemic in the post-COVID-19 era, and determine the need to introduce a booster based on perceived trends.
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Affiliation(s)
- Motoko Tanaka
- Department of Health Care Policy and Management, Doctoral Program in Public Health, Degree Programs in Comprehensive Human Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki 3058577, Japan.
| | - Reiko Okubo
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki 3058577, Japan; Department of Clinical Laboratory Medicine, University of Tsukuba Hospital, 2-1-1, Amakubo, Tsukuba, Ibaraki 3058576, Japan
| | - Shu-Ling Hoshi
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki 3058577, Japan
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Institute of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki 3058577, Japan
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Lim EH, Lim A, Khara JS, Cheong J, Fong J, Sivanesan S, Griffiths M, New E, Lee SC. Cost-effectiveness analysis of add-on pertuzumab to trastuzumab biosimilar and chemotherapy as neoadjuvant treatment for human epidermal growth receptor 2-positive early breast cancer patients in Singapore. Expert Rev Pharmacoecon Outcomes Res 2024; 24:413-426. [PMID: 38289042 DOI: 10.1080/14737167.2023.2295474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/10/2023] [Indexed: 02/16/2024]
Abstract
OBJECTIVES The Asian PEONY trial showed that add-on pertuzumab to trastuzumab and chemotherapy significantly improved pathological complete response in the neoadjuvant treatment of patients with human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (EBC). This study evaluated the cost-effectiveness of pertuzumab as an add-on therapy to trastuzumab and chemotherapy for neoadjuvant treatment of patients with HER2+ EBC in Singapore. METHODS A six-state Markov model was developed from the Singapore healthcare system perspective, with a lifetime time horizon. Model outputs were: costs; life-years (LYs); quality-adjusted LYs (QALYs); incremental cost-effectiveness ratios (ICERs). Sensitivity/scenario analyses explored model uncertainties. RESULTS The base case projected the addition of pertuzumab to be associated with improved outcomes by 0.277 LYs and 0.271 QALYs, increased costs by S$1,387, and an ICER of S$5,121/QALY. The ICER was most sensitive to the pCR rate, and the probabilistic sensitivity analysis showed that add-on pertuzumab had an 81.3% probability of being cost-effective at a willingness-to-pay threshold of S$45,000/QALY gained. CONCLUSIONS This model demonstrated that the long-term clinical impact of early pertuzumab use, particularly the avoidance of metastatic disease and thus avoidance of higher costs and mortality rates, make neoadjuvant pertuzumab a cost-effective option in the management of patients with HER2+ breast cancer in Singapore.
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Affiliation(s)
- Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Andrew Lim
- Asia-Pacific Evidence Development, Costello Medical Singapore Pte Ltd, Singapore, Singapore
| | | | - John Cheong
- Market Access, Roche Singapore Pte Ltd, Singapore, Singapore
| | - Jek Fong
- Market Access, Roche Singapore Pte Ltd, Singapore, Singapore
| | | | | | - Emma New
- Health Economics, Costello Medical Consulting Ltd, London, UK
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
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Orman Z, Olaiya MT, Thrift AG, Cadilhac DA, Phan T, Nelson MR, Ung D, Srikanth VK, Bladin CF, Gerraty RP, Phillipos J, Kim J. Cost-Effectiveness of an Individualised Management Program after Stroke: A Trial-Based Economic Evaluation. Neuroepidemiology 2024; 58:156-165. [PMID: 38359812 PMCID: PMC11152005 DOI: 10.1159/000535638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/20/2023] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Evidence on the cost-effectiveness of comprehensive post-stroke programs is limited. We assessed the cost-effectiveness of an individualised management program (IMP) for stroke or transient ischaemic attack (TIA). METHODS A cost-utility analysis alongside a randomised controlled trial with a 24-month follow-up, from both societal and health system perspectives, was conducted. Adults with stroke/TIA discharged from hospitals were randomised by primary care practice to receive either usual care (UC) or an IMP in addition to UC (intervention). An IMP included stroke-specific nurse-led education and a specialist review of care plans at baseline, 3 months, and 12 months, and telephone reviews by nurses at 6 months and 18 months. Costs were expressed in 2021 Australian dollars (AUD). Costs and quality-adjusted life years (QALYs) beyond 12 months were discounted by 5%. The probability of cost-effectiveness of the intervention was determined by quantifying 10,000 bootstrapped iterations of incremental costs and QALYs below the threshold of AUD 50,000/QALY. RESULTS Among the 502 participants (65% male, median age 69 years), 251 (50%) were in the intervention group. From a health system perspective, the incremental cost per QALY gained was AUD 53,175 in the intervention compared to the UC group, and the intervention was cost-effective in 46.7% of iterations. From a societal perspective, the intervention was dominant in 52.7% of iterations, with mean per-person costs of AUD 49,045 and 1.352 QALYs compared to mean per-person costs of AUD 51,394 and 1.324 QALYs in the UC group. The probability of the cost-effectiveness of the intervention, from a societal perspective, was 60.5%. CONCLUSIONS Care for people with stroke/TIA using an IMP was cost-effective from a societal perspective over 24 months. Economic evaluations of prevention programs need sufficient time horizons and consideration of costs beyond direct healthcare utilisation to demonstrate their value to society.
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Affiliation(s)
- Zhomart Orman
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia,
| | - Muideen T Olaiya
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Thanh Phan
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Department of Neurology, Monash Medical Centre, Clayton, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Ung
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Velandai K Srikanth
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Christopher F Bladin
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
- Victorian Stroke Telemedicine, Ambulance Victoria, Melbourne, Victoria, Australia
| | - Richard P Gerraty
- Department of Medicine, Epworth Healthcare, Richmond, Victoria, Australia
| | - Joseph Phillipos
- Department of General Surgery, Alfred Hospital, Melbourne, Victoria, Australia
| | - Joosup Kim
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Department of Neurology, Monash Medical Centre, Clayton, Victoria, Australia
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Crosland P, Ho N, Hosseini SH, Vacher C, Skinner A, Natsky AN, Rosenberg S, Hasudungan R, Huntley S, Song YJC, Lee GY, Marshall DA, Occhipinti JA, Hickie IB. Cost-effectiveness of system-level mental health strategies for young people in the Australian Capital Territory: a dynamic simulation modelling study. Lancet Psychiatry 2024; 11:123-133. [PMID: 38245017 DOI: 10.1016/s2215-0366(23)00396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Regional mental health planning is a key challenge for decision makers because mental health care is a complex, dynamic system. Economic evaluation using a system dynamics modelling approach presents an opportunity for more sophisticated planning and important evidence on the value of alternative investments. We aimed to investigate the cost-effectiveness of eight systems-based interventions targeted at improving the mental health and wellbeing of children, adolescents, and young adults in the Australian Capital Territory (ACT). METHODS We assessed eight interventions for children and young people (aged ≤25 years) with low, moderate, and high-to-very-high psychological distress: technology-enabled integrated care, emergency department-based suicide prevention, crisis response service, family education programme, online parenting programme, school-based suicide prevention programme, trauma service for youths, and multicultural-informed care. We developed a system dynamics model for the ACT through a participatory process and calibrated the model with historical data, including population demographics, the prevalence of psychological distress, and mental health services provision. We calculated incremental cost-effectiveness ratios compared with business as usual for cost (AU$) per: quality-adjusted life-year (QALY), suicide death avoided, self-harm related hospital admissions avoided, and mental health-related emergency department presentation, using a 10-year time horizon for health-care and societal perspectives. We investigated uncertainty through probabilistic sensitivity analysis and deterministic sensitivity analysis, including using a 30-year timeframe. FINDINGS From a societal perspective, increased investment in technology-enabled integrated care, family education, an online parenting programme, and multicultural-informed care were expected to improve health outcomes (incremental QALYs 4517 [95% UI -3135 to 14 507] for technology-enabled integrated care; 339 [91 to 661] for family education; 724 [114 to 1149] for the online parenting programme; and 137 [88 to 194] for multicultural-informed care) and reduce costs ($-91·4 million [-382·7 to 100·7]; $-12·8 million [-21·0 to -6·6]; $-3·6 million [-6·3 to 0·2]; and $-3·1 million [-4·5 to -1·8], respectively) compared with business as usual using a 10-year time horizon. The incremental net monetary benefit for the societal perspective for these four interventions was $452 million (-351 to 1555), $40 million (14 to 74), $61 million (9 to 98), and $14 million (9 to 20), respectively, compared with business as usual, when QALYs were monetised using a willingness to pay of $79 930 per QALY. Synergistic effects are anticipated if these interventions were to be implemented concurrently. The univariate and probabilistic sensitivity analyses indicated a high level of certainty in the results. Although emergency department-based suicide prevention and school-based suicide prevention were not cost effective in the base case (41 QALYs [0 to 48], incremental cost $4·1 million [1·2 to 8·2] for emergency department-based suicide prevention; -234 QALYs [-764 to 12], incremental cost $90·3 million [72·2 to 111·0] for school-based suicide prevention) compared with business as usual, there were scenarios for which these interventions could be considered cost effective. A dedicated trauma service for young people (9 QALYs gained [4 to 16], incremental cost $8·3 million [6·8 to 10·0]) and a crisis response service (-11 QALYs gained [-12 to -10], incremental cost $7·8 million [5·1 to 11·0]) were unlikely to be cost effective in terms of QALYs. INTERPRETATION Synergistic effects were identified, supporting the combined implementation of technology-enabled integrated care, family education, an online parenting programme, and multicultural-informed care. Synergistic effects, emergent outcomes in the form of unintended consequences, the capability to account for service capacity constraints, and ease of use by stakeholders are unique attributes of a system dynamics modelling approach to economic evaluation. FUNDING BHP Foundation.
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Affiliation(s)
- Paul Crosland
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia.
| | - Nicholas Ho
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Seyed Hossein Hosseini
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Catherine Vacher
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Adam Skinner
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Andrea N Natsky
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Sebastian Rosenberg
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Raphael Hasudungan
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Sam Huntley
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Yun Ju Christine Song
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Grace Yeeun Lee
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Deborah A Marshall
- Cumming School of Medicine, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Jo-An Occhipinti
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, NSW, Australia
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Sarnaik KS, Hoenig SM, Bakir NH, Hammoud MS, Mahboubi R, Vervoort D, McCrindle BW, Welke KF, Karamlou T. Ross procedure or mechanical aortic valve, which is the best lifetime option for an 18-year-old? A decision analysis. JTCVS OPEN 2024; 17:185-214. [PMID: 38420529 PMCID: PMC10897596 DOI: 10.1016/j.xjon.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/22/2023] [Accepted: 10/23/2023] [Indexed: 03/02/2024]
Abstract
Objectives Identifying the optimal solution for young adults requiring aortic valve replacement (AVR) is challenging, given the variety of options and their lifetime complication risks, impacts on quality of life, and costs. Decision analytic techniques make comparisons incorporating these measures. We evaluated lifetime valve-related outcomes of mechanical aortic valve replacement (mAVR) versus the Ross procedure (Ross) using decision tree microsimulations modeling. Methods Transition probabilities, utilities, and costs derived from published reports were entered into a Markov model decision tree to explore progression between health states for hypothetical 18-year-old patients. In total, 20,000 Monte Carlo microsimulations were performed to model mortality, quality-adjusted-life-years (QALYs), and health care costs. The incremental cost-effectiveness ratio (ICER) was calculated. Sensitivity analyses was performed to identify transition probabilities at which the preferred strategy switched from baseline. Results From modeling, average 20-year mortality was 16.3% and 23.2% for Ross and mAVR, respectively. Average 20-year freedom from stroke and major bleeding was 98.6% and 94.6% for Ross, and 90.0% and 82.2% for mAVR, respectively. Average individual lifetime (60 postoperative years) utility (28.3 vs 23.5 QALYs) and cost ($54,233 vs $507,240) favored Ross over mAVR. The average ICER demonstrated that each QALY would cost $95,345 more for mAVR. Sensitivity analysis revealed late annual probabilities of autograft/left ventricular outflow tract disease and homograft/right ventricular outflow tract disease after Ross, and late death after mAVR, to be important ICER determinants. Conclusions Our modeling suggests that Ross is preferred to mAVR, with superior freedom from valve-related morbidity and mortality, and improved cost-utility for young adults requiring aortic valve surgery.
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Affiliation(s)
- Kunaal S Sarnaik
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Samuel M Hoenig
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Nadia H Bakir
- Department of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Miza Salim Hammoud
- Department of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Rashed Mahboubi
- Department of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karl F Welke
- Division of Pediatric Cardiothoracic Surgery, Atrium Health Levine Children's Hospital, Charlotte, NC
| | - Tara Karamlou
- Department of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
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Xu L, Chen M, Angell B, Jiang Y, Howard K, Jan S, Si L. Establishing cost-effectiveness threshold in China: a community survey of willingness to pay for a healthylife year. BMJ Glob Health 2024; 9:e013070. [PMID: 38195152 PMCID: PMC10806867 DOI: 10.1136/bmjgh-2023-013070] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION The willingness to pay per quality-adjusted life year gained (WTP/Q) is commonly used to determine whether an intervention is cost-effective in health technology assessment. This study aimed to evaluate the WTP/Q for different disease scenarios in a Chinese population. METHODS The study employed a quadruple-bounded dichotomous choice contingent valuation method to estimate the WTP/Q in the general public. The estimation was conducted across chronic, terminal and rare disease scenarios. Face-to-face interviews were conducted in a Chinese general population recruited from Jiangsu province using a convenience sampling method. Interval regression analysis was performed to determine the relationship between respondents' demographic and socioeconomic conditions and WTP/Q. Sensitivity analyses of removing protest responses and open question analyses were conducted. RESULTS A total of 896 individuals participated in the study. The WTP/Q thresholds were 128 000 Chinese renminbi (RMB) ($36 364) for chronic diseases, 149 500 RMB ($42 472) for rare diseases and 140 800 RMB ($40 000) for terminal diseases, equivalent to 1.76, 2.06 and 1.94 times the gross domestic product per capita in China, respectively. The starting bid value had a positive influence on participants' WTP/Q. Additionally, residing in an urban area (p<0.01), and higher household expenditure (p<0.01), educational attainment (p<0.02) and quality of life (p<0.02) were significantly associated with higher WTP/Q. Sensitivity analyses demonstrated the robustness of the results. CONCLUSION This study implies that tailored or varied rather than a single cost-effectiveness threshold could better reflect community preferences for the value of a healthy year. Our estimates hold significance in informing reimbursement decision-making in health technology assessment in China.
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Affiliation(s)
- Lizheng Xu
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Blake Angell
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yawen Jiang
- Sun Yat-Sen University School of Public Health Shenzhen, Shenzhen, Guangdong, China
| | - Kirsten Howard
- Menzies Centre for Health Policy and Economics, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Stephen Jan
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lei Si
- School of Health Science, Western Sydney University, Penrith South, New South Wales, Australia
- Translational Health Research Institute, Western Sydney University, Penrith South, New South Wales, Australia
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Sra MS, Ganguly S, Naik RD, Sasi A, Sharma P, Giri RK, Abdul Rasheed A, Bakhshi S. Olanzapine cost-effectiveness in vomiting and nausea from highly emetogenic chemotherapy in children and adolescents. BMJ Support Palliat Care 2024; 13:e1272-e1279. [PMID: 36813535 DOI: 10.1136/spcare-2022-004069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness of addition of olanzapine to a prophylactic antiemetic regimen containing aprepitant, dexamethasone and ondansetron among children receiving highly emetogenic chemotherapy (HEC) in India, Bangladesh, Indonesia, the UK and the USA. METHODS Health states were estimated using individual patient-level outcome data from a randomised trial. The incremental cost-utility ratio (ICUR), incremental cost-effectiveness ratio and net monetary benefit (NMB) were calculated from the patient perspective for India, Bangladesh, Indonesia, the UK and the USA. One-way sensitivity analysis was done by varying the cost of olanzapine, cost of hospitalisation and utility values by ±25%. RESULTS The olanzapine arm had an increment of 0.0018 quality-adjusted life-years (QALY) over the control arm. The mean total expenditure in the olanzapine arm was greater by US$0.51, US$0.43, US$6.73, US$11.05 and US$12.35 in India, Bangladesh, Indonesia, the UK and the USA, respectively. The ICUR($/QALY) was US$282.60 in India, US$241.42 in Bangladesh, US$3755.93 in Indonesia, US$6161.83 in the UK and US$6887.41 in the USA. The NMB was US$9.86, US$10.12, US$14.08, US$44.74 and US$98.79 for India, Bangladesh, Indonesia, the UK and the USA, respectively. The ICUR estimates of the base case and sensitivity analysis were below the willingness-to-pay threshold in all scenarios. CONCLUSION The addition of olanzapine as a fourth agent for antiemetic prophylaxis is cost-effective despite an increase in overall expenditure. Olanzapine should be uniformly considered for children receiving HEC.
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Affiliation(s)
- Manraj Singh Sra
- Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Shuvadeep Ganguly
- Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ramavath Devendra Naik
- Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Archana Sasi
- Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Sharma
- Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rupak Kumar Giri
- Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Azgar Abdul Rasheed
- Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Bakhshi
- Medical Oncology, Dr. B. R. A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Choi W, Shim E. Evaluating the cost-effectiveness of HPV vaccination for adolescent girls in Japan: A comparison of 2-valent, 4-valent, and 9-valent HPV vaccines with consideration of cross-protection. Prev Med 2024; 178:107743. [PMID: 37866695 DOI: 10.1016/j.ypmed.2023.107743] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE In April 2023, the Japanese Health Ministry panel approved the inclusion of the 9-valent human papillomavirus (9vHPV) vaccine in the National Immunization Program, alongside the 2-valent (2vHPV) and 4-valent HPV (4vHPV) vaccines. In response to this, we evaluated the cost-effectiveness of these three vaccines for routine immunization of girls aged 12-16 in Japan, considering the cross-protection of 2vHPV and 4vHPV vaccines. METHODS We constructed an age-structured mathematical model for HPV transmission, aiming to quantify the economic and epidemiological effects of various HPV vaccination strategies over a 70-year period in Japan. We determined incremental costs and quality-adjusted life years (QALYs) for each strategy, applying a 3% annual discount. Univariate and probabilistic sensitivity analyses were conducted to assess the uncertainty of our model results, with all evaluations done in 2023. RESULTS Our projections indicate that the HPV vaccination program in Japan will significantly reduce the incidence of HPV-related diseases. All HPV vaccination strategies, using the 2vHPV, 4vHPV, and 9vHPV vaccines, were found to be cost-effective compared to no vaccination, with incremental cost-effectiveness ratios of ¥971,447/QALY, ¥1,237,297/QALY, and ¥742,084/QALY, respectively. Direct comparisons between vaccines demonstrated that the 9vHPV vaccination was more cost-effective than the 2vHPV vaccination, whereas 4vHPV vaccination was dominated by 2vHPV vaccination. CONCLUSIONS Our study validates the cost-effectiveness of implementing the 9vHPV vaccine as the primary option over the 2vHPV or 4vHPV vaccine for girls in Japan. These findings underscore the need to improve the acceptance rate and coverage of HPV vaccinations in the country.
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Affiliation(s)
- Wongyeong Choi
- Department of Mathematics, Soongsil University, 369 Sangdoro, Dongjak-gu, Seoul 06978, Republic of Korea.
| | - Eunha Shim
- Department of Mathematics, Soongsil University, 369 Sangdoro, Dongjak-gu, Seoul 06978, Republic of Korea.
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Nagano M, Kamei K, Matsuda H, Takahashi C, Yang J, Wada K, Yonemoto N. Cost-effectiveness analysis of COVID-19 booster vaccination with BNT162b2 in Japan. Expert Rev Vaccines 2024; 23:349-361. [PMID: 38411109 DOI: 10.1080/14760584.2024.2323133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND The aim of this study was to evaluate the public health and economic impact of the COVID-19 booster vaccination with BNT162b2 in Japan during an Omicron-dominant period from early 2022. RESEARCH DESIGN AND METHODS A combined cohort Markov decision tree model estimated the cost-effectiveness of annual or biannual booster vaccination strategies compared to no booster vaccination for those aged 65 years and above, and those aged 60-64 years at high risk as the base case. The societal perspective was primarily considered. We also examined other target populations with different age and risk groups. Sensitivity and scenario analyses with alternative inputs were performed. RESULTS Annual and biannual vaccination strategies were dominant from the societal perspective in the base case. Incremental Cost Effectiveness Ratios (ICERs) from the payer perspective were JPY 1,752,499/Quality Adjusted Life Year (QALY) for annual vaccination and JPY 2,831,878/QALY for biannual vaccination, both less than the threshold value in Japan (JPY 5 million/QALY). The results were consistent even when examining other target age and risk groups. All sensitivity and scenario analyses indicated that ICERs were below JPY 5 million/QALY. CONCLUSIONS Booster vaccination with the COVID-19 vaccine BNT162b2 is a dominant strategy and beneficial to public health in Japan.
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Affiliation(s)
| | | | | | | | - Jingyan Yang
- Global Access and Value, Pfizer Inc., New York, NY, USA
- Institute for Social and Economic Research and Policy, Columbia University, New York, NY, USA
| | - Koji Wada
- mRNA & Antiviral Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
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Ikumi S, Shiga T, Ueda T, Takaya E, Iwasaki Y, Kaiho Y, Tarasawa K, Fushimi K, Ito Y, Fujimori K, Yamauchi M. Intensive care unit mortality and cost-effectiveness associated with intensivist staffing: a Japanese nationwide observational study. J Intensive Care 2023; 11:60. [PMID: 38049894 PMCID: PMC10694900 DOI: 10.1186/s40560-023-00708-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Japan has four types of intensive care units (ICUs) that are divided into two categories according to the management fee charged per day: ICU management fees 1 and 2 (ICU1/2) (equivalent to high-intensity staffing) and 3 and 4 (ICU3/4) (equivalent to low-intensity staffing). Although ICU1/2 charges a higher rate than ICU3/4, no cost-effectiveness analysis has been performed for ICU1/2. This study evaluated the clinical outcomes and cost-effectiveness of ICU1/2 compared with those of ICU3/4. METHODS This retrospective observational study used a nationwide Japanese administrative database to identify patients admitted to ICUs between April 2020 and March 2021 and divided them into the ICU1/2 and ICU3/4 groups. The ICU mortality rates and in-hospital mortality rates were determined, and the incremental cost-effectiveness ratio (ICER) (Japanese Yen (JPY)/QALY), defined as the difference between quality-adjusted life year (QALY) and medical costs, was compared between ICU1/2 and ICU3/4. Data analysis was performed using the Chi-squared test; an ICER of < 5 million JPY/QALY was considered cost-effective. RESULTS The ICU1/2 group (n = 71,412; 60.7%) had lower ICU mortality rates (ICU 1/2: 2.6% vs. ICU 3/4: 4.3%, p < 0.001) and lower in-hospital mortality rates (ICU 1/2: 6.1% vs. ICU 3/4: 8.9%, p < 0.001) than the ICU3/4 group (n = 46,330; 39.3%). The average cost per patient of ICU1/2 and ICU3/4 was 2,249,270 ± 1,955,953 JPY and 1,682,546 ± 1,588,928 JPY, respectively, with a difference of 566,724. The ICER was 718,659 JPY/QALY, which was below the cost-effectiveness threshold. CONCLUSIONS ICU1/2 is associated with lower ICU patient mortality than ICU3/4. Treatments under ICU1/2 are more cost-effective than those under ICU3/4, with an ICER of < 5 million JPY/QALY.
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Affiliation(s)
- Saori Ikumi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- AI Lab, Tohoku University Hospital, Sendai, Japan
| | - Takuya Shiga
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
- Experience Design and Alliance Section, Tohoku University Hospital, Sendai, Japan.
- Department of Biodesign, Center for Research, Education, and Innovation, Tohoku University Hospital, Sendai, Japan.
- Department of Intensive Care Unit, Tohoku University Hospital, Sendai, Japan.
| | - Takuya Ueda
- AI Lab, Tohoku University Hospital, Sendai, Japan
- Department of Clinical Imaging, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eichi Takaya
- AI Lab, Tohoku University Hospital, Sendai, Japan
| | - Yudai Iwasaki
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Kaiho
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Yukiko Ito
- College of Policy Studies, Tsuda University, Tokyo, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masanori Yamauchi
- Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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