ObjectivesTo compare the common application methods of meta-analysis results used in economic evaluations so as to provide reference and suggestions for similar economic evaluations in future.MethodsFour methods were used to calculate the effectiveness deriving from meta-analysis of omeprazole and esomeprazole in the treatment of peptic ulcer, then substituted into the decision tree model to perform cost-effectiveness analysis.ResultsMethod 1 used the risk difference as the incremental effectiveness. The ICER was ￥2 420, and the equal probability point of the cost-effectiveness acceptability curve (CEAC) in the probability sensitivity analysis was approximately ￥2 600. Method 2 used the effective rate of the study group in high-quality literatures as the benchmark, calculated the effective rate of the control group according to the RR. The ICER was ￥2 016, and the equal probability point of the CEAC was approximately￥2 000. Method 3 was based on the effective rate of the control group in high-quality literatures to calculate the effective rate of the study group according to RR. The ICER was ￥2 420 and the equal probability point of the CEAC was approximately￥2 200; Method 4 used literature weights to calculate the effectiveness, the ICER is ￥2 420, and the equal probability point of the CEAC was about ￥2 400.ConclusionsThe results of the four methods share little difference, and the sensitivity analysis results show that the base case analysis results are more robust. However, in the application process, method 1 lacks specific effectiveness of the two groups and underestimate the variation range of the effectiveness difference when one-way sensitivity analysis was performed. Relevant assumptions are further required to limit the possibility of effectiveness calculated greater than 1 in sensitivity analysis among method 2 and 3. Comprehensively, method 4 can be recommended in the economic evaluations for fewer defects of calculating effectiveness.
ObjectivesTo evaluate the economic efficacy of nab-paclitaxel (NAB-P) combined with gemcitabine (GEM) versus GEM alone in the treatment of metastatic pancreatic cancer in China.MethodsA Markov model simulating the costs and health outcomes was developed to estimate quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). The impact of parameter uncertainty on the model was assessed by deterministic one-way sensitivity analysis.ResultsNAB-P combined with GEM was shown superior efficacy compared to gemcitabine monotherapy, however with higher costs. The ICER between the two groups was 964 780.79￥/QALY.ConclusionsCompared with gemcitabine monotherapy, NAB-P combined with GEM is not cost-effective. The conclusion is confirmed by deterministic one-way sensitivity analysis.
ObjectiveTo systematically review the status of economic evaluation of liver cancer screening in China, so as to provide reference for further studies.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were searched to collect economic evaluation studies of liver cancer screening in China from inception to December, 2017. Two reviewers independently screened literature, extracted data and conducted descriptive analysis of basic characteristics, methods of economic evaluation and main results as well as quality and uniformity of reporting.ResultsA total of 5 studies were included. Among them, the starting age of screening were found to be 35 to 45 years old; α-fetoprotein (AFP) testing and ultrasound examination combined procedure and screening interval of every 6 months were mostly evaluated. The quality of the 5 studies was satisfactory, and the uniformity of reporting was relatively acceptable, with a median score of 78% (range: 60% ~ 78%). Two population-based studies reported cost per liver cancer detected (44 thousand and 575 thousand yuan). Three studies reported cost-effectiveness ratio(CER) based on life year saved (LYS) and quality adjusted life year (QALY). Among these results, only 1 study from mainland China reported CER based on LYS (1 775 yuan), and the calculated ratio of CER to local GDP per capita was estimated as 0.1, while 2 studies from Taiwan province reported 4 CERs, and the ratios of CER to local GDP per capita ranged from 1.0 to 2.2.ConclusionsInformation from liver cancer endemic areas such as Taiwan province indicates promising cost-effectiveness to conduct liver cancer screening in local general population, while data from mainland suggests that conducting liver cancer screening combining AFP and ultrasound in high-risk population will be cost-effective, however only supported by 1 regional study. This needs to be verified by further economic evaluations based on randomized controlled trials or cohort studies as well as health economic evaluations.
Objective To evaluate the cost effectiveness of four different mechanisms clinical commonly used antidepressants, namely, amitriptyline, escitalopram, mirtazapine and venlafaxine in the treatment of moderate-severe depressive disorder in China and to provide clinicians with some advice. Methods We carried out the cost-effectiveness analysis of four antidepressants by establishing a decision tree model. The parameters uncertainty in the model was estimated through one-way sensitivity analysis. Results In terms of average cost-effectiveness ratio (CER), amitriptyline’s was 45.24 RMB, which was the lowest. And the CERs of mirtazapine, escitalopram and venlafaxine were 273.71 RMB, 332.00 RMB and 716.58 RMB, respectively. While in terms of incremental cost-effectiveness ratio (ICER), venlafaxine was excluded as the dominated strategy. When the threshold value of willingness to pay (WTP) was less than 3 420.92 RMB, amitriptyline was the most cost-effective; when the threshold value ranges between 3 420.92 RMB and 4 200 RMB, mirtazapine was the most cost-effective; and when the threshold value was over 4 200 RMB, escitalopram was the most cost-effective. In the one-way sensitivity analysis, when we changed the four kinds of drugs costs within a certain range, the results was not changed with the change of venlafaxine’s cost but changed with the other three drugs costs. Conclusion Clinicians may choose the most cost-effective therapy according to patients’ different WTP values. We suggests that health care institutions should encourage the use of escitalopram clinically and provide subsidies for patients so as to increase the overall society benefit.
Onehealth, an evidence-based decision-making software, is based on the United Nations' epidemiological reference modules to predict the effect of health services. Onehealth is a large database. The software is using activitybased costing, simulating investment costs of health system and changes of mortality in different coverage levels. By the cost of inputs/avoid deaths, it could quantify the cost of health services effectiveness and provide an intuitive basis for the rational allocation of health resources. This study introduces the relevant concepts, model structures and applications of Onehealth. We took the study of child nutrition interventions in Sudan for example and to present Onehealth tool's operating. As a new auxiliary and evidence-based decision-making software with scientific and rigorous theoretical approach, Onehealth has practical significance on the national or regional macro decision-making.
ObjectiveTo systematically review the pharmacoeconomics of hemodialysis and peritoneal dialysis in patients with end-stage renal disease. MethodsCRD, NICE, CADTH, HITAP, NECA, IWIQG, ISPOR, PubMed, EMbase, CNKI, and WanFang Data databases were electronically searched to collect pharmacoeconomic studies on the hemodialysis and peritoneal dialysis in the treatment of end-stage renal disease from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, the conclusions of research models, pharmacoeconomic evaluation results, and sensitivity analysis were summarized. ResultsA total of 15 pharmacoeconomic studies were included, among which 9 studies used the Markov state transition model, and 6 were observational studies. From the perspective of health outcomes, peritoneal dialysis had cost-effectiveness advantages over hemodialysis in the treatment of end-stage renal disease under the condition of a clear threshold. ConclusionsCurrent evidence shows that compared with hemodialysis, peritoneal dialysis has certain cost-effectiveness advantages in the treatment of end-stage renal disease. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo compare medical cost and utilization efficiency of medical resources between manual layered anastomosis with mechanical stapling technique in esophagectomy. MethodsClinical data of 132 patients who underwent surgical resection of esophageal carcinoma in the Department of Thoracic Surgery of Gansu Tumor Hospital between January and October 2011 were respectively analyzed. According to different anastomotic techniques, all the patients were divided into a manual layered anastomosis group (including 40 males and 20 females with their age of 36-72 (49.3±7.6) years) and a mechanical stapling technique group (including 50 males and 22 females with their age of 30-79 (51.0±8.6) years). Demographic data, operation data, postoperative complications, direct and indirect medical cost, and constitution of direct medical cost were compared between the 2 groups. ResultsMedical cost of esophagectomy was 14 505.03± 1 523.37 yuan in the manual layered anastomosis group and 19 891.05±1 634.58 yuan in the mechanical stapling technique group respectively, which were statistically different (P < 0.05). Material cost was 2 242.00±751.08 yuan in the manual layered anastomosis group and 5 424.00±1 876.22 yuan in the mechanical stapling technique group respectively, which were statistically different (P < 0.05). Cost-effectiveness analysis showed that cost-effectiveness ratio in the manual layered anastomosis group was lower, thus this anastomotic technique was more reasonable. ConclusionMedical cost of manual layered anastomosis is lower than that of mechanical stapling technique in esophagectomy, as the utilization efficiency of medical resources of manual layered anastomosis is higher than that of mechanical stapling technique.
ObjectiveTo evaluate the comparative cost-effectiveness of thrombolysis treatment of ischemic stroke based on outcomes of CT perfusion (CTP). MethodsWe applied the methods of systematic review to evaluate the studies abroad about the cost effectiveness of CTP diagnosis outcomes used for selecting stroke patients for thrombolysis treatment. We also evaluated the domestic studies about the cost-effectiveness of CTP in China by establishing a decision tree model. ResultsA total of 2 economics studies were included. The results showed that, the cost-effectiveness ratios of CT, CTP and MRI for selecting stroke patients for thrombolysis treatment were 2 983.7 ￡/QALY, 2 951.4 ￡/QALY and 2 982.9 ￡/ QALY, respectively, in the UK; 100 483.5＄/QALY and 99 406.1＄/QALY just for CT and CTP, respectively, in the US; and the evaluation outcomes by establishing the decision tree model showed that, 113 492.4 ￥/QALY, 113 615￥/QALY and 120 831.9 ￥/QALY, respectively, in China. ConclusionAll international and domestic studies' results show that CTP is more cost-effective than CT/MRI in selecting stroke patients for thrombolysis treatment.
Objective To investigate cost-effectiveness of no indwelling urinary catheter in pulmonary lobectomy patients and to confirm the advances of no indwelling urinary catheter. Methods We recruited 148 lung cancer patients who were scheduled for pulmonary lobectomy under general anesthesia in West China Hospital from July through December 2015. These patients were divided into two groups including an indwelling urinary catheter group (74 patients, 45 males and 29 females, at age of 52.55±19.87 years) and a no indwelling urinary catheter group (74 patients, 42 males and 32 females, at age of 54.03±16.66 years). Indexes of cost-effectiveness of the two groups were compared. Results There was no statistical difference between the two groups in duration of indwelling catheter (1.56±0.0.65 d versus 1.68±0.91 d, P=0.077). Material expense(4 811.48 yuan versus 296.74 yuan, P=0.045), cost of nursing care (7 413.32 yuan versus 457.32 yuan, P=0.013), and total expense (12 224.8 yuan versus 754.06 yuan, P=0.000) in the indwelling catheter group were higher than those in the no indwelling catheter group. Material expense per patient (65.02±5.62 yuan/patient-time versus 4.01±0.00 yuan/patient-time, P=0.000), cost of nursing care per patient (100.18±7.19 yuan/patient-time versus 6.18±1.22 yuan/patient-time, P=0.000), and total cost per patient (165.20±12.81 yuan/patienttime versus 10.19±1.22 yuan/patient-time, P=0.000) in the indwelling catheter group were higher than those in the no indwelling catheter group. Conclusion Both costs and labor of nurse can be cut down for appropriate lung cancer patients undergoing lobectomy without routine indwelling urinary catheter.
ObjectiveTo evaluate the efficacy and cost-effectiveness of thymalfasin (Tα1) as an adjuvant therapy for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) after surgery.MethodsPatients with HBV-related HCC who underwent hepatectomy from February 2007 to December 2015 in West China Hospital of Sichuan University, Chengdu Military General Hospital, or the Third Affiliated Hospital of Sun Yat-sen University were retrospectively collected and divided into the Tα1 group and the observation group. Log-rank test and Kaplan-Meier curve were used to assess the overall survival, recurrence-free survival, and safety of patients. A Markov model was used to calculate the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) of the Tα1 group compared with the observation group. Cost data was from the hospital information system of the three hospitals. Utility scores mainly came from published data. Sensitivity analyses were applied to explore the impact of essential variables.ResultsA total of 208 patients with HCC after liver resection were enrolled, among them 48 received Tα1 treatment (the Tα1 group) and 160 were only followed up (the observation group). There was no significant difference between the two groups in the baseline characteristics. The median overall survival of the Tα1 group and the observation group was 102.0 months [95% confidence interval (CI) (74.8, 129.2) months] and 81.6 months [95%CI (65.7, 97.6) months], respectively, and the difference was statisitically significant (P=0.047); the median recurrence-free survival was 66.7 months [95%CI (17.3, 116.1) months] and 37.4 months [95%CI (28.7, 46.2) months], respectively, and the difference was statistically significant (P=0.044). There were no grade Ⅲ-Ⅳ adverse events and no treatment-related death occurred. The ICER of Tα1 group was ￥108 050.02/QALY, which was less than the willingness to pay (￥177 785.25/QALY).ConclusionsTα1, as an adjuvant therapy for HBV-related HCC patients, can improve the prognosis of the patients, and the cost is within the acceptable level in our country, so this strategy is likely to be a cost-effective option compared with the observation group.