The CEA Registry Blog

By CEA Registry Team on 5/22/2015 2:47 PM

By Cayla Saret, B.A.

Twice each month we highlight recently published cost-utility studies and selected reviews and editorials.

1: Becerra V, Gracia A, Desai K, et. al. Cost-effectiveness and public health benefit of secondary cardiovascular disease prevention from improved adherence using a polypill in the UK. BMJ Open. 2015 May 9;5(5):e007111. PubMed PMID: 25991449.

2: Hur C, Choi SE, Kong CY, et. al. High-resolution microendoscopy for esophageal cancer screening in China: A cost-effectiveness analysis. World J Gastroenterol. 2015 May 14;21(18):5513-23. PubMed PMID: 25987774.

3: Jordan RE, Majothi S, Heneghan NR, et. al. Supported self-management for patients with moderate to severe chronic obstructive pulmonary disease (COPD): an evidence synthesis and economic analysis. Health Technol Assess. 2015 May;19(36):1-516. PubMed PMID: 25980984.

4: Donnay Candil S, Balsa Barro JA, Álvarez Hernández J, et. al. Cost-effectiveness analysis of universal screening for thyroid disease in pregnant women in Spain. Endocrinol Nutr. 2015 May 11. [Epub ahead of print] English, Spanish. PubMed PMID: 25977144.

5: Piñol C. Cost-effectiveness analysis of interferon beta-1b as treatment for patients with clinically isolated syndrome suggestive of multiple sclerosis in Spain. Neurologia. 2015 May 11. [Epub ahead of print] English, Spanish. PubMed PMID: 25976942.

6: Valente M, Cortesi PA, Lassandro G, et. al. Health economic models in hemophilia A and utility assumptions from a clinician's perspective. Pediatr Blood Cancer. 2015 May 14. [Epub ahead of print] PubMed PMID: 25976056.

7: Pfeil AM, Reich O, Guerra IM, et. al. Cost-effectiveness analysis of sofosbuvir compared to current standard treatment in swiss patients with chronic hepatitis C. PLoS One. 2015 May 14;10(5):e0126984. eCollection 2015. PubMed PMID: 25974722.

8: Deogan C, Zarabi N, Stenström N, et. al. Cost-Effectiveness of School-Based Prevention of Cannabis Use. Appl Health Econ Health Policy. 2015 May 14. [Epub ahead of print] PubMed PMID: 25972235.

9: Borisenko O, Haude M, Hoppe UC, et. al. Cost-utility analysis of percutaneous mitral valve repair in inoperable patients with functional mitral regurgitation in German settings. BMC Cardiovasc Disord. 2015 May 14;15(1):43. [Epub ahead of print] PubMed PMID: 25971307.

10: Zhang AY, Fu AZ. Cost-effectiveness of a behavioral intervention for persistent urinary incontinence in prostate cancer patients. Psychooncology. 2015 May 12. [Epub ahead of print] PubMed PMID: 25963381.

11: Wong WW, Hicks LK, Tu HA, et. al. Hepatitis B virus screening before adjuvant chemotherapy in patients with early-stage breast cancer: a cost-effectiveness analysis. Breast Cancer Res Treat. 2015 May 12. [Epub ahead of print] PubMed PMID: 25962692.

12: Roze S, Smith-Palmer J, Valentine W, et. al. Cost-effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections of insulin in Type 1 diabetes: a systematic review. Diabet Med. 2015 May 11. [Epub ahead of print] PubMed PMID: 25962621.

13: Isaranuwatchai W, Markle-Reid M, Hoch JS. Adjusting for Baseline Covariates in Net Benefit Regression: How You Adjust Matters. Pharmacoeconomics. 2015 May 10. [Epub ahead of print] PubMed PMID: 25957531.

14: Nazir J, Heemstra L, van Engen A, et. al. Cost-effectiveness of a fixed-dose combination of solifenacin and oral controlled adsorption system formulation of tamsulosin in men with lower urinary tract symptoms associated with benign prostatic hyperplasia. BMC Urol. 2015 May 9;15(1):41. [Epub ahead of print] PubMed PMID: 25956727.

15: Drobniewski F, Cooke M, Jordan J, et. al. Systematic review, meta-analysis and economic modelling of molecular diagnostic tests for antibiotic resistance in tuberculosis. Health Technol Assess. 2015 May;19(34):1-188. PubMed PMID: 25952553.

16: Norton G, McDonough CM, Cabral H, et. al. Cost-utility of cognitive behavioral therapy for low back pain from the commercial payer perspective. Spine (Phila Pa 1976). 2015 May 15;40(10):725-33. PubMed PMID: 25950282.

17: Gu S, Deng J, Shi L, et. al. Cost-effectiveness of saxagliptin versus glimepiride as a second-line therapy added to metformin in Type 2 diabetes in China. J Med Econ. 2015 May 7:1-40. [Epub ahead of print] PubMed PMID: 25950193.

18: Gillett M, Brennan A, Watson P, et. al. The cost-effectiveness of testing strategies for type 2 diabetes: a modelling study.  Health Technol Assess. 2015 May;19(33):1-80. PubMed PMID: 25947106.

19: Ito K, Avorn J, Shrank WH, et. al. Long-term cost-effectiveness of providing full coverage for preventive medications after myocardial infarction. Circ Cardiovasc Qual Outcomes. 2015 May;8(3):252-9. Epub 2015 May 5. PubMed PMID: 25944633.

20: Barnett PG, Jeffers A, Smith MW, et. al. Cost-effectiveness of integrating tobacco cessation into Post-Traumatic Stress Disorder treatment. Nicotine Tob Res. 2015 May 4. [Epub ahead of print] PubMed PMID: 25943761.

21: Vestergaard AS, Ehlers LH. A Health Economic Evaluation of Stroke Prevention in Atrial Fibrillation: Guideline Adherence Versus the Observed Treatment Strategy Prior to 2012 in Denmark. Pharmacoeconomics. 2015 May 6. [Epub ahead of print] PubMed PMID: 25943684.

22: Butt T, Lee A, Lee C, et. al. The cost-effectiveness of initiating ranibizumab therapy in eyes with neovascular AMD with good vision: an economic model using real-world outcomes. BMJ Open. 2015 May 5;5(5):e006535. PubMed PMID: 25943370.

23: Tanajewski L, Franklin M, Gkountouras G, et. al. Cost-Effectiveness of a Specialist Geriatric Medical Intervention for Frail Older People Discharged from Acute Medical Units: Economic Evaluation in a Two-Centre Randomised Controlled Trial (AMIGOS). PLoS One. 2015 May 5;10(5):e0121340. eCollection 2015. PubMed PMID: 25942421.

24: Pennington B, Akehurst R, Wasan H, et. al. Cost-effectiveness of selective internal radiation therapy using yttrium-90 resin microspheres in treating patients with inoperable colorectal liver metastases in the UK. J Med Econ. 2015 May 5:1-18. [Epub ahead of print] PubMed PMID: 25941769.

25: Gallego CJ, Shirts BH, Bennette CS, et. al. Next-Generation Sequencing Panels for the Diagnosis of Colorectal Cancer and Polyposis Syndromes: A Cost-Effectiveness Analysis. J Clin Oncol. 2015 May 4. [Epub ahead of print] PubMed PMID: 25940718.

26: Peng S, Tafazzoli A, Dorman E, et. al. Cost-effectiveness of DTG+ABC/3TC versus EFV/TDF/FTC for first-line treatment of HIV-1 in the United States. J Med Econ. 2015 May 1:1-36. [Epub ahead of print] PubMed PMID: 25934146.

27: Cure S, Guerra I, Cammà C, et. al. Cost-effectiveness of sofosbuvir plus ribavirin with or without pegylated interferon for the treatment of chronic hepatitis C in Italy. J Med Econ. 2015 May 7:1-13. [Epub ahead of print] PubMed PMID: 25891129.

28: Wu JX, Beni CE, Zanocco KA, et. al. Cost-Effectiveness of Long-Term Every Three-Year Versus Annual Postoperative Surveillance for Low-Risk  Papillary Thyroid Cancer. Thyroid. 2015 May 7. [Epub ahead of print] PubMed PMID: 25851702.

29: Linas BP, Barter DM, Morgan JR, et. al. The cost-effectiveness of sofosbuvir-based regimens for treatment of hepatitis C virus genotype 2 or 3 infection. Ann Intern Med. 2015 May 5;162(9):619-29. PubMed PMID: 25820703.

30: Bamrungsawad N, Chaiyakunapruk N, Upakdee N, et. al. Cost-utility analysis of intravenous immunoglobulin for the treatment of steroid-refractory dermatomyositis in Thailand. Pharmacoeconomics. 2015 May;33(5):521-31. PubMed PMID: 25774016.

31: Kaplan RI, De Moraes CG, Cioffi GA, et. al. Comparative Cost-effectiveness of the Baerveldt Implant, Trabeculectomy With Mitomycin, and Medical Treatment. JAMA Ophthalmol. 2015 May 1;133(5):560-7. PubMed PMID: 25741886.

32: Schawo S, van der Kolk A, Bouwmans C, et. al. Probabilistic Markov Model Estimating Cost Effectiveness of Methylphenidate Osmotic-Release Oral System Versus Immediate-Release Methylphenidate in Children and Adolescents: Which Information is Needed? Pharmacoeconomics. 2015 May;33(5):489-509. PubMed PMID: 25715975.

33: Esteves S, Alves M, Castel-Branco M, et. al. A pilot cost-effectiveness analysis of treatments in newly diagnosed high-grade gliomas: the example of 5-aminolevulinic Acid compared with white-light surgery. Neurosurgery. 2015 May;76(5):552-62. PubMed PMID: 25714513.

34: Von Bargen E, Patterson D. Cost utility of the treatment of stress urinary incontinence. Female Pelvic Med Reconstr Surg. 2015 May-Jun;21(3):150-3. PubMed PMID: 25679355.

35: Wade R, Duarte A, Simmonds M, et. al. The Clinical and Cost Effectiveness of Aflibercept in Combination with Irinotecan and Fluorouracil-Based Therapy (FOLFIRI) for the Treatment of Metastatic Colorectal Cancer Which has Progressed Following Prior Oxaliplatin-Based Chemotherapy: a Critique of the Evidence. Pharmacoeconomics. 2015 May;33(5):457-66. PubMed PMID: 25616671.

36: Pietzsch JB, Liu S, Garner AM, et. al. Long-Term Cost-Effectiveness of Upper Airway Stimulation for the Treatment of Obstructive Sleep Apnea: A Model-Based Projection Based on the STAR Trial. Sleep. 2015 May 1;38(5):735-44. PubMed PMID: 25348126.

By CEA Registry Team on 5/15/2015 9:34 AM

Come find the CEVR team at booth #309 at the ISPOR International Meeting. Our researchers will be giving the following presentations:

Monday, May 18th

James Chambers: Poster presentation- “A systematic review of the methodological quality of network meta-analyses” 8:30 AM-2:15 PM
Peter Neumann and Cayla Saret: Poster presentation- “When can pharmaceutical companies communicate health economic claims to payers? 10 Case Studies” 3:45-7:45 PM
Matthew Chenoweth: Poster presentation- “Coverage of medical devices: Is Medicare consistent with private payers?” 3:45-7:45 PM
Peter Neumann, Teja Thorat, Cayla Saret: Poster presentation- “The changing face of the cost-utility literature, 1990-2012” 3:45-7:45 PM
Natalia Olchanski: Poster presentation- “Who is spending where: Analysis of healthcare spending by Medicaid and private payers in Massachusetts” 3:45-7:45 PM

Tuesday May 19th

Teja Thorat: Poster presentation- “Understanding QALY gains across different types of cancers and cancer-related interventions” 3:45-7:45 PM
Peter Neumann: Issue Panel, Moderator- “How should the FDA regulate the communication of health economic data by pharmaceutical companies to payers?” 11:00 AM- 12:00 PM
Joshua Cohen: Workshop- “Design of bundled payment in the ambulatory setting of care” 3:45-4:45 PM
Wendy Zhong: Poster presentation- “Costs of treating skeletal-related events among prostate cancer patients with bone metastases in a commercial insured population in the US” 3:45-7:45 PM

Wednesday May 20th

Pallavi Rane: Poster presentation- “Potential savings in health care spending on ‘low-value’ interventions: Case study of arthroscopic knee surgery” 8:30 AM- 2:45 PM
Paige Lin: Poster presentation- “Willingness to pay for newborn genetic testing for Spinal Muscular Atrophy” 8:30 AM-2:45 PM

By CEA Registry Team on 5/15/2015 9:02 AM

By  Peter Neumann, Sc.D. and Cayla Saret, B.A.
 
A new discussion draft of the 21st Century Cures Act, the bipartisan initiative to accelerate development of new medical treatments, includes a section entitled “Facilitating Dissemination of Health Care Economic Information.” A previous version of the bill included only a placeholder heading for these issues. The section makes changes to Section 114 of the Food and Drug Modernization Act of 1997 (FDAMA 114), which regulates promotion of health economic information by pharmaceutical companies to formulary committees, such as a claim that a drug reduces health care costs in a given population.

The Food and Drug Administration (FDA) has never commented on Section 114 and, as we note in a new paper in which we develop hypothetical case studies for Section 114, the lack of guidance about what the original statute allows has hampered the exchange of information. Together, the proposed changes would add clarity and flexibility for pharmaceutical companies to engage with health plans about the potential value of their products, though it will require careful ongoing monitoring by regulators.

Improved Communication

The discussion draft contains a number of changes that, in our view, would help foster better communication between drug companies and payers about the real-world impacts and economic consequences of using pharmaceuticals.

The existing language of Section 114, while vaguely worded, seems to restrict the promotion of health economic information only to information that drug companies collect in randomized clinical trials (RCTs), called “substantial evidence,” rather than information using “real-world” data. For example, it is unclear whether and in what circumstances a company could promote a study using an observational database that analyzes the costs of using the drug in real-world settings.

The new draft amends the clause requiring that a promotional claim “directly relate[s]” to the FDA-approved indication to the less restrictive term “relate[s].” The term, “relates,” would still require clarification, ideally in a future FDA guidance, but it suggests more flexibility around the type of health care economic information (e.g., from database analyses or economic models) that drug companies could provide proactively (as opposed to in responses to unsolicited requests) to health plan audiences.

For example, the “directly relates” language implies a strict standard — a company might not promote findings from a database study if the population differed, even in minor ways, from the population studied in the relevant randomized clinical trials. Under the proposed change, such an analysis might be deemed permissible, though again, the FDA will have to clarify the details.

The draft also adds a provision requiring, where applicable, pharmaceutical companies to provide “a conspicuous and prominent statement describing any differences between the information and the indication approved.” Such a disclosure (e.g., that a promotion is based on a database study, that the population under investigation might differ from those in RCTs, and that retrospective database analyses demonstrate associations but do not indicate causality) should increase transparency and help ensure that health plan audiences are informed and aware that the health care economic information being promoted is not necessarily based on substantial evidence from randomized clinical trials.

Furthermore, the existing statute provides a narrow definition of “health care economic information” regulated by the Section which limits the possible types of economic analyses permitted. The draft expands the definition to incorporate inputs and methods, including “clinical or other assumptions.” Because all health care economic analyses include clinical assumptions, this language would allow a much broader array of health economic analyses to be included, though again FDA clarity will be important.

Finally, the draft clarifies the permitted audience for health economic promotions. These promotions are currently limited to formulary committee members and the undefined phrase, “similar entities.” The draft includes “payor[s]” in addition to the “formulary committee[s], or other similar entit[ies]” covered by the existing statute. That is important because the original statutory language, from 1997, did not state whether payers would be included, although the draft still does not define what is meant by “similar entity” (e.g., does it include physicians working and making decisions for accountable care organizations?).

Preserving Guardrails For Public Health

Critically, the changes would continue to restrict these types of promotions to organizations (i.e., formulary committees and payers), not to general prescribers and consumers.

As we’ve argued before, that would “preserve key guardrails for public health. Promotion would be restricted to organizations that retain strong incentives to be informed and wary consumers of drug-company promotions and that increasingly employ their own experts, mine their own data, and request comparative effectiveness evidence from companies.”

It would confer upon health plans the responsibility to judge the usefulness and credibility of a wider range of health economic claims promulgated by drug companies, therefore providing more data to payers to inform coverage decisions.

As noted, several other conditions must hold if the new legislation is to be successful. First, FDA will need to clarify what types of clinical claims (either explicitly made or implied) are permissible in health care economic information.

An amendment posted to the discussion draft would require the Department of Health and Human Services (HHS) to “issue draft guidance on facilitating the dissemination of responsible, truthful, and non-misleading scientific and medical information not included on the label of drugs.”

Second, ongoing work is needed on standards for observational data and other real world studies. Third, it will be important for the FDA to monitor the field to ensure that health care economic promotions are not false and misleading.

This will be a challenging area for FDA to regulate. For one, various court cases surrounding drug companies’ promotion and First Amendment rights have raised issues about the FDA’s ability to regulate truthful, non-misleading claims. For another, it is challenging for FDA to know what types of promotional claims will be made under the new health economic promotion laws given that they are business-to-business communications.

The language in the Discussion Draft may continue to change as the bill works its way through the legislative process. Still, the proposal to date reflects a step in the right direction.

This piece was originally posted on the Health Affairs Blog.

By CEA Registry Team on 5/13/2015 9:09 AM

Health payers in the U.S. have often balked at using formal cost-effectiveness analysis in coverage and reimbursement decisions for medical technologies. The Medicare program, for example, does not consider cost or cost-effectiveness in its coverage decisions for new treatments, despite fiscal challenges and multiple initiatives to achieve better value.  Less well known, however, is that cost-effectiveness analysis has played a longstanding role in informing the addition of preventive services to Medicare.  It has provided Medicare officials information to help ensure that health gains are achieved at reasonable cost. Our new paper on the topic and other research highlights, as well as upcoming conferences and events, are described in our Spring 2015 newsletter: http://tinyurl.com/CEVR15S.

By CEA Registry Team on 5/6/2015 12:03 PM

By Cayla Saret, B.A.

Twice each month we highlight recently published cost-utility studies and selected reviews and editorials.

1: Bhanegaonkar AJ, Horodniceanu EG, Abdul Latiff AH, et. al. Economic value of atopic dermatitis prevention via infant formula use in high-risk Malaysian infants. Asia Pac Allergy. 2015 Apr;5(2):84-97. Epub 2015 Apr 29. PubMed PMID: 25938073.

2: Miquel-Cases A, Steuten LM, Retèl VP, et. al. Early stage cost-effectiveness analysis of a BRCA1-like test to detect triple negative breast cancers responsive to high dose alkylating chemotherapy. Breast. 2015 Apr 28. [Epub ahead of print] PubMed PMID: 25937263.

3: Brown GC, Brown MM, Turpcu A, et. al. The Cost-Effectiveness of Ranibizumab for the Treatment of Diabetic Macular Edema. Ophthalmology. 2015 Apr 29. [Epub ahead of print] PubMed PMID: 25935787.

4: Brusco NK, Watts JJ, Shields N, et. al. Is cost effectiveness sustained after weekend inpatient rehabilitation? 12 month follow up from a randomized controlled trial. BMC Health Serv Res. 2015 Apr 18;15(1):165. [Epub ahead of print] PubMed PMID: 25927870.

5: Goldhaber-Fiebert JD, Brandeau ML. Evaluating Cost-effectiveness of Interventions That Affect Fertility and Childbearing: How Health Effects Are Measured Matters. Med Decis Making. 2015 Apr 29. [Epub ahead of print] PubMed PMID: 25926281.

6: Burn E, Marshall AL, Miller YD, et. al. The cost-effectiveness of the MobileMums intervention to increase physical activity among mothers with young children: a Markov model informed by a randomised controlled trial. BMJ Open. 2015 Apr 29;5(4):e007226. PubMed PMID: 25926145.

7: Li Y, Bare LA, Bender RA, et. al. Cost Effectiveness of Sequencing 34 Cancer-Associated Genes as an Aid for Treatment Selection in Patients with Metastatic Melanoma. Mol Diagn Ther. 2015 Apr 30. [Epub ahead of print] PubMed PMID: 25926090.

8: Botteman M, Detzel P. Cost-effectiveness of partially hydrolyzed whey protein formula in the primary prevention of atopic dermatitis in high-risk urban infants in southeast Asia. Ann Nutr Metab. 2015;66 Suppl 1:26-32. Epub 2015 Apr 24. PubMed PMID: 25925338.

9: Lee JY, Kim Y, Lee TJ, et. al. Cost-effectiveness of para-aortic lymphadenectomy before chemoradiotherapy in locally advanced cervical cancer. J Gynecol Oncol. 2015 Apr 17. [Epub ahead of print] PubMed PMID: 25925292.

10: Zhang P, Yang Y, Wen F, et. al. Cost-effectiveness of sorafenib as a first-line treatment for advanced hepatocellular carcinoma. Eur J Gastroenterol Hepatol. 2015 Apr 22. [Epub ahead of print] PubMed PMID: 25919775.

11: Nghiem VT, Davies KR, Beck JR, et. al. Economic evaluation of DNA ploidy analysis vs liquid-based cytology for cervical screening. Br J Cancer. 2015 Apr 28. [Epub ahead of print] PubMed PMID: 25919612.

12: Imaz-Iglesia I, Miguel LG, Ayala-Morillas LE, et. al. Economic evaluation of Chagas disease screening in Spain. Acta Trop. 2015 Apr 25. [Epub ahead of print] PubMed PMID: 25917718.

13: Fox GJ, Oxlade O, Menzies D. Fluoroquinolone Therapy for the Prevention of Multi-drug Resistant Tuberculosis in Contacts: a Cost-effectiveness Analysis. Am J Respir Crit Care Med. 2015 Apr 27. [Epub ahead of print] PubMed PMID: 25915791.

14: Snowsill T, Huxley N, Hoyle M, et. al. A model-based assessment of the cost-utility of strategies to identify Lynch syndrome in early-onset colorectal cancer patients. BMC Cancer. 2015 Apr 25;15(1):313. [Epub ahead of print] PubMed PMID: 25910169.

15: Gustafson DH Sr, McTavish F, Gustafson DH Jr, et. al. The effect of an information and communication technology (ICT) on older adults' quality of life: study protocol for a randomized control trial. Trials. 2015 Apr 25;16(1):191. PubMed PMID: 25909465.

16: Fleeman N, Bagust A, Beale S, et. al. Dabrafenib for Treating Unresectable, Advanced or Metastatic BRAF V600 Mutation-Positive Melanoma: An Evidence Review Group Perspective. Pharmacoeconomics. 2015 Apr 24. [Epub ahead of print] PubMed PMID: 25906420.

17: Meier G, Gregg M, Poulsen Nautrup B. Cost-effectiveness analysis of quadrivalent influenza vaccination in at-risk adults and the elderly: an updated analysis in the United Kingdom. J Med Econ. 2015 Apr 23:1-40. [Epub ahead of print] PubMed PMID: 25903831.

18: Westerhout K, Treur M, Mehnert A, et. al. A cost utility analysis of simeprevir used with peginterferon + ribavirin in the management of genotype 1 hepatitis C virus infection, from the perspective of the UK National Health Service. J Med Econ. 2015 Apr 23:1-19. [Epub ahead of print] PubMed PMID: 25903830.

19: Troyer JL, Jones AE, Shapiro NI, et. al. Cost-effectiveness of Quantitative Pretest Probability Intended to Reduce Unnecessary Medical Radiation Exposure in Emergency Department Patients With Chest Pain and Dyspnea. Acad Emerg Med. 2015 Apr 21. [Epub ahead of print] PubMed PMID: 25899550.

20: Groot-Jensen S, Kiessling A, Zethraeus N, et. al. Cost-effectiveness of case-based training for primary care physicians in evidence-based medicine of patients with coronary heart disease. Eur J Prev Cardiol. 2015 Apr 20. [Epub ahead of print] PubMed PMID: 25896863.

21: Harvey MJ, Gaies MG, Prosser LA. US and International In-Hospital Costs of Extracorporeal Membrane Oxygenation: a Systematic Review. Appl Health Econ Health Policy. 2015 Apr 18. [Epub ahead of print] PubMed PMID: 25894740.

22: Blommestein HM, Verelst SG, de Groot S, et. al. A cost-effectiveness analysis of real-world treatment for elderly patients with multiple myeloma using a full disease model. Eur J Haematol. 2015 Apr 18. [Epub ahead of print] PubMed PMID: 25892333.

23: Picavet E, Cassiman D, Simoens S. What is known about the cost-effectiveness of orphan drugs? Evidence from cost-utility analyses. J Clin Pharm Ther. 2015 Jun;40(3):304-7. Epub 2015 Apr 20. PubMed PMID: 25891411.

24: Cure S, Guerra I, Cammà C, et. al. Cost-effectiveness of sofosbuvir plus ribavirin with or without pegylated interferon for the treatment of chronic hepatitis C in Italy. J Med Econ. 2015 Apr 20:1-26. [Epub ahead of print] PubMed PMID: 25891129.

25: Capocci S, Smith C, Morris S, et. al. Decreasing cost effectiveness of testing for latent TB in HIV in a low TB incidence area. Eur Respir J. 2015 Apr 16. [Epub ahead of print] PubMed PMID: 25882810.

26: Mears J, Vynnycky E, Lord J, et. al. The prospective evaluation of the TB strain typing service in England: a mixed methods study. Thorax. 2015 Apr 16. [Epub ahead of print] PubMed PMID: 25882538.

27: Wu AC, Gay C, Rett MD, et. al. Pharmacogenomic test that predicts response to inhaled corticosteroids in adults with asthma likely to be cost-saving. Pharmacogenomics. 2015 Apr;16(6):591-600. Epub 2015 Apr 16. PubMed PMID: 25880024.

28: Zucco F, Ciampichini R, Lavano A, et. al. Cost-Effectiveness and Cost-Utility Analysis of Spinal Cord Stimulation in Patients With Failed Back Surgery Syndrome: Results From the PRECISE Study. Neuromodulation. 2015 Apr 16. [Epub ahead of print] PubMed PMID: 25879722.

By CEA Registry Team on 5/4/2015 11:20 AM

The Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org) has now been updated to include published cost-utility studies or CUAs (studies that report findings in the form of cost per quality-adjusted life years (QALYs) gained) through 2013.  The database contains information on cost-utility analyses on a wide range of health and medical interventions published from 1976-2013, including information on almost 12,000 standardized cost-effectiveness ratios.

The current upload adds the following to the database:

•    332 cost-utility analyses articles published in 2013
•    847 cost-effectiveness ratios
•    1,665 utility weights

The full Registry now includes:

•    4,339 cost-utility analyses articles published from 1976 through 2013
•    11,880 cost-effectiveness ratios
•    16,946 utility weights

CEVR’s premium access subscribers can access both the entire CEA Registry and the Tufts National Coverage Determination database, which provides detailed information on each national coverage decision.  Premium access subscribers can conduct advanced searches of the Registry data.

If you are interested in becoming a sponsor, please contact Julie Lannon for more information.

Stay up-to-date on all the news from the CEA Registry by following us on Twitter @TuftsCEVR or Like Us on Facebook.

-    The CEA Registry Team

By CEA Registry Team on 4/29/2015 3:53 PM

By James Chambers, Ph.D.

Clinical researchers and health care decision makers are increasingly using network meta-analysis to synthesize comparative effectiveness evidence of competing treatments that have not been studied in head-to-head clinical trials.  In a new paper published in PLOS ONE, my colleagues and I examine the methodological quality of the network meta-analysis literature.1

We systematically searched the medical literature for network meta-analyses evaluating pharmaceuticals, and identified 318 published papers through July 30th, 2014.  We assessed these network meta-analyses using objective criteria from the checklist of good research practices in the ISPOR guidance for interpreting and conducting network meta-analysis studies.2,3  Our assessment criteria pertained to the following:

1.    Methodological approach – for example, did the study report an assessment of the risk of bias in included trials, or an assessment of the consistency between direct and indirect evidence.
2.    Study transparency and reproducibility – for example, did the study report the search terms used, and were the extracted clinical trial data presented.
3.    Reporting of findings – for example, was a matrix of head-to-head comparisons presented.

To better understand the literature, we then used our assessment criteria to compare network meta-analyses published in journals with lower and higher impact factors, older and more recently published studies, and studies supported by the pharmaceutical industry and studies supported by non-industry sources or receiving no support.  The findings are presented in Table 1.

We found notable differences in the quality of network meta-analyses.  Studies published in higher impact factor journals and those that did not receive industry support performed better across our assessment criteria.  We found few differences between older studies and those published more recently.

Study findings highlight the variation in published network meta-analyses and underline the need for consensus among guidelines to guide their conduct and reporting. 

Click to view a larger image.


References:

1. Chambers JD, Naci H, Wouters OJ, Pyo J, Gunjal S, Kennedy IR, Hoey MG , Winn A, Neumann PJ. An assessment of the methodological quality of published network meta-analyses: A systematic review PLOS ONE 2015 

2. Jansen JP, Fleurence R, Devine B, Itzler R, Barrett A, Hawkins N, Lee K, Boersma C, Annemans L, Cappelleri JC. Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1. Value Health. 2011 Jun;14(4):417-28.

3. Hoaglin DC, Hawkins N, Jansen JP, Scott DA, Itzler R, Cappelleri JC, Boersma C, Thompson D, Larholt KM, Diaz M, Barrett A.Conducting indirect-treatment-comparison and network-meta-analysis studies: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 2. Value Health. 2011 Jun;14(4):429-37.
 

By CEA Registry Team on 4/17/2015 10:06 AM

By Cayla Saret, B.A.

Twice each month we highlight recently published cost-utility studies and selected reviews and editorials.

1: Murajda L, Aichinger E, Pfaff G, et. al. Public health management of invasive meningococcal disease in Baden-Wuerttemberg, Germany, 2012: adherence to guidance and estimation of resources required as determined in a survey of local health authorities. BMC Public Health. 2015 Apr 12;15(1):371. PubMed PMID: 25881238.

2: Ramallo-Fariña Y, García-Pérez L, Castilla-Rodríguez I, et. al. Effectiveness and cost-effectiveness of knowledge transfer and behavior modification interventions in type 2 diabetes mellitus patients-the INDICA study: a cluster randomized controlled trial. Implement Sci. 2015 Apr 9;10(1):47. PubMed PMID: 25880498.

3: Hannemann PF, Essers BA, Schots JP, et. al. Functional outcome and cost-effectiveness of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a cost-utility analysis. BMC Musculoskelet Disord. 2015 Apr 11;16(1):84. PubMed PMID: 25880388.

4: Michaud K, Strand V, Shadick NA, et. al. Outcomes and costs of incorporating a multibiomarker disease activity test in the management of patients with rheumatoid arthritis. Rheumatology (Oxford). 2015 Apr 15. [Epub ahead of print] PubMed PMID: 25877911.

5: Prica A, Chan K, Cheung M. Frontline rituximab monotherapy induction versus a watch and wait approach for asymptomatic advanced-stage follicular lymphoma: A cost-effectiveness analysis. Cancer. 2015 Apr 15. [Epub ahead of print] PubMed PMID: 25877511.

6: Tirani M, Meregaglia M, Melegaro A. Health and Economic Outcomes of Introducing the New MenB Vaccine (Bexsero) into the Italian Routine Infant Immunisation Programme. PLoS One. 2015 Apr 13;10(4):e0123383. eCollection 2015. PubMed PMID: 25874805.

7: Kip M, Monteban H, Steuten L. Long-term cost-effectiveness of Oncotype DX(®) versus current clinical practice from a Dutch cost perspective. J Comp Eff Res. 2015 Apr 15:1-13. [Epub ahead of print] PubMed PMID: 25872415.

8: Cheung MC, Hay AE, Crump M, et. al. Gemcitabine/Dexamethasone/Cisplatin vs Cytarabine/Dexamethasone/Cisplatin for Relapsed or Refractory Aggressive-Histology Lymphoma: Cost-Utility Analysis of NCIC CTG LY.12. J Natl Cancer Inst. 2015 Apr 13;107(7). Print 2015 Jul. PubMed PMID: 25868579.

9: Aronsson M, Svennberg E, Rosenqvist M, et. al. Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording. Europace. 2015 Apr 12. [Epub ahead of print] PubMed PMID: 25868469.

10: Graham DM, Isaranuwatchai W, Habbous S, et. al. A cost-effectiveness analysis of human papillomavirus vaccination of boys for the prevention of oropharyngeal cancer. Cancer. 2015 Apr 13. [Epub ahead of print] PubMed PMID: 25867018.

11: Forde GK, Chang J, Ziogas A, et. al. Costs of Treatment for Elderly Women with Advanced Ovarian Cancer in a Medicare Population. Gynecol Oncol. 2015 Apr 9. [Epub ahead of print] PubMed PMID: 25866323.

12: Vitale A, Spolverato G, Burra P, et. al. Cost-effectiveness of Pre-Transplant Sofosbuvir for Preventing Recurrent HCV Infection after Liver Transplantation. Transpl Int. 2015 Apr 11. [Epub ahead of print] PubMed PMID: 25865602.

13: Dewhurst E, Novakova B, Reuber M. A prospective service evaluation of acceptance and commitment therapy for patients with refractory epilepsy. Epilepsy Behav. 2015 Apr 10. [Epub ahead of print] PubMed PMID: 25864992.

14: Hirst A, Knight C, Hirst M, et. al. Tramadol and the risk of fracture in an elderly female population: a cost utility assessment with comparison to transdermal buprenorphine. Eur J Health Econ. 2015 Apr 11. [Epub ahead of print] PubMed PMID: 25861916.

15: Lin L, Teng M, Zhao YJ, et. al. Long-term Cost-effectiveness of Statin Treatment for Primary Prevention of Cardiovascular Disease in the Elderly. Cardiovasc Drugs Ther. 2015 Apr 11. [Epub ahead of print] PubMed PMID: 25860556.

16: Brittenden J, Cotton SC, Elders A, et. al. Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial. Health Technol Assess. 2015 Apr;19(27):1-342. PubMed PMID: 25858333.

17: Nimdet K, Chaiyakunapruk N, Vichansavakul K, et. al. A Systematic Review of Studies Eliciting Willingness-to-Pay per Quality-Adjusted Life Year: Does It Justify CE Threshold? PLoS One. 2015 Apr 9;10(4):e0122760. eCollection 2015. PubMed PMID: 25855971.

18: Grieve R, Gomes M, Sweeting MJ, et. al. Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial. Eur Heart J. 2015 Apr 7. [Epub ahead of print] PubMed PMID: 25855369.

19: Sturkenboom IH, Hendriks JC, Graff MJ, et. al. Economic evaluation of occupational therapy in Parkinson's disease: A randomized controlled trial. Mov Disord. 2015 Apr 8. [Epub ahead of print] PubMed PMID: 25854809.

20: Huetson P, Palmer JL, Levorsen A, et. al. Cost-effectiveness of once-daily GLP-1 receptor agonist lixisenatide compared to bolus insulin both in combination with basal insulin for the treatment of patients with Type 2 diabetes in Norway. J Med Econ. 2015 Apr 8:1-30. [Epub ahead of print] PubMed PMID: 25853868.

21: Wu JX, Beni CE, Zanocco K, et. al. Cost-Effectiveness of Long-Term Every Three-Year Versus Annual Postoperative Surveillance for Low Risk Papillary Thyroid Cancer. Thyroid. 2015 Apr 8. [Epub ahead of print] PubMed PMID: 25851702.

22: Stevenson M, Pandor A, Stevens JW, et. al. Nalmefene for Reducing Alcohol Consumption in People with Alcohol Dependence: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. Pharmacoeconomics. 2015 Apr 8. [Epub ahead of print] PubMed PMID: 25851485.

23: Letchumanan MG, Coyte PC, Loutfy M. An economic evaluation of conception strategies for heterosexual serodiscordant couples where the male partner is HIV-positive. Antivir Ther. 2015 Apr 7. [Epub ahead of print] PubMed PMID: 25849113.

24: Cure S, Guerra I, Dusheiko G. Cost-effectiveness of sofosbuvir for the treatment of chronic hepatitis C-infected patients. J Viral Hepat. 2015 Apr 7. [Epub ahead of print] PubMed PMID: 25847572.

25: Twigg MJ, Wright D, Barton GR, et. al. The four or more medicines (FOMM) support service: results from an evaluation of a new community pharmacy service aimed at over-65s. Int J Pharm Pract. 2015 Apr 6. [Epub ahead of print] PubMed PMID: 25847545.

26: Genders TS, Petersen SE, Pugliese F, et. al. The optimal imaging strategy for patients with stable chest pain: a cost-effectiveness analysis. Ann Intern Med. 2015 Apr 7;162(7):474-84. PubMed PMID: 25844996.

27: Palace J, Duddy M, Bregenzer T, et. al. Effectiveness and cost-effectiveness of interferon beta and glatiramer acetate in the UK Multiple Sclerosis Risk Sharing Scheme at 6 years: a clinical cohort study with natural history comparator. Lancet Neurol. 2015 Apr 1. [Epub ahead of print] PubMed PMID: 25841667.

28: Petrie J, Easton S, Naik V, et. al. Hospital costs of out-of-hospital cardiac arrest patients treated in intensive care; a single centre evaluation using the national tariff-based system. BMJ Open. 2015 Apr 2;5(4):e005797. PubMed PMID: 25838503.

29: Sowa PM, Downes MJ, Gordon LG. Cost-effectiveness of dual energy X-ray absorptiometry (DXA) plus anti-resorptive treatment in Australian women with breast cancer who receive aromatase inhibitors. J Bone Miner Metab. 2015 Apr 3. [Epub ahead of print] PubMed PMID: 25837431.

30: Neilson AR, Bruhn H, Bond CM, et. al. Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial. BMJ Open. 2015 Apr 1;5(4):e006874. PubMed PMID: 25833666.

31: Retèl VP, van den Boer C, Steuten LM, et. al. Cost-effectiveness of heat and moisture exchangers compared to usual care for pulmonary rehabilitation after total laryngectomy in Poland. Eur Arch Otorhinolaryngol. 2015 Apr 2. [Epub ahead of print] PubMed PMID: 25832966.

32: Tannenbaum C, Diaby V, Singh D, et. al. Sedative-Hypnotic Medicines and Falls in Community-Dwelling Older Adults: A Cost-Effectiveness (Decision-Tree) Analysis from a US Medicare Perspective. Drugs Aging. 2015 Apr;32(4):305-14. PubMed PMID: 25825121.

33: Pulikottil-Jacob R, Connock M, Kandala NB, et. al. Cost effectiveness of total hip arthroplasty in osteoarthritis: comparison of devices with differing bearing surfaces and modes of fixation. Bone Joint J. 2015 Apr;97-B(4):449-57. PubMed PMID: 25820881.

34: Krishnan NM, Purnell C, Nahabedian MY, et. al. The Cost Effectiveness of the DIEP Flap Relative to the Muscle-Sparing TRAM Flap in Postmastectomy Breast Reconstruction. Plast Reconstr Surg. 2015 Apr;135(4):948-58. PubMed PMID: 25811560.

35: Barzi A, Sadeghi S, Kattan MW, et. al. Comparative effectiveness of screening strategies for Lynch syndrome. J Natl Cancer Inst. 2015 Mar 20;107(4). Print 2015 Apr. PubMed PMID: 25794514.

36: Laires PA, Ejzykowicz F, Hsu TY, et. al. Cost-effectiveness of adding ezetimibe to atorvastatin vs switching to rosuvastatin therapy in Portugal. J Med Econ. 2015 Apr 10:1-8. [Epub ahead of print] PubMed PMID: 25788039.

37: Varier RU, Biltaji E, Smith KJ, et. al. Cost-Effectiveness Analysis of Fecal Microbiota Transplantation for Recurrent Clostridium difficile Infection. Infect Control Hosp Epidemiol. 2015 Apr;36(4):438-44. PubMed PMID: 25782899.

38: Nuijten M, Roggeri DP, Roggeri A, et. al. Health economic evaluation of paricalcitol(®) versus cincalcet + calcitriol (oral) in Italy. Clin Drug Investig. 2015 Apr;35(4):229-38. PubMed PMID: 25724153.

39: Slaman J, van den Berg-Emons R, Tan SS, et. al. Cost-utility of a lifestyle intervention in adolescents and young adults with spastic cerebral palsy. J Rehabil Med. 2015 Apr 7;47(4):338-45. PubMed PMID: 25678311.

40: Rubio-Terrés C, Soria JM, Morange PE, et. al. Economic Analysis of Thrombo inCode, a Clinical-Genetic Function for Assessing the Risk of Venous Thromboembolism. Appl Health Econ Health Policy. 2015 Apr;13(2):233-42. PubMed PMID: 25652150.

41: Tuffaha HW, Roberts S, Chaboyer W, et. al. Cost-Effectiveness and Value of Information Analysis of Nutritional Support for Preventing Pressure Ulcers in High-risk Patients: Implement Now, Research Later. Appl Health Econ Health Policy. 2015 Apr;13(2):167-79. PubMed PMID: 25650349.

42: Lønne G, Johnsen LG, Aas E, et. al. Comparing Cost-effectiveness of X-Stop With Minimally Invasive Decompression in Lumbar Spinal Stenosis: A Randomized Controlled Trial. Spine (Phila Pa 1976). 2015 Apr 15;40(8):514-20. PubMed PMID: 25608246.

43: Romanus D, Cardarella S, Cutler D, et. al. Cost-effectiveness of multiplexed predictive biomarker screening in non-small-cell lung cancer. J Thorac Oncol. 2015 Apr;10(4):586-94. PubMed PMID: 25590606.

44: Huang YL, Lasry A, Hutchinson AB, et. al. A Systematic Review on Cost Effectiveness of HIV Prevention Interventions in the United States. Appl Health Econ Health Policy. 2015 Apr;13(2):149-56. PubMed PMID: 25536927.

45: Hamid R, Loveman C, Millen J, et. al. Cost-Effectiveness Analysis of OnabotulinumtoxinA (BOTOX(®)) for the Management of Urinary Incontinence in Adults with Neurogenic Detrusor Overactivity: A UK Perspective. Pharmacoeconomics. 2015 Apr;33(4):381-93. PubMed PMID: 25526842.

46: Matros E, Albornoz CR, Razdan SN, et. al. Cost-Effectiveness Analysis of Implants versus Autologous Perforator Flaps Using the BREAST-Q. Plast Reconstr Surg. 2015 Apr;135(4):937-46. PubMed PMID: 25517411.

47: Offodile AC 2nd, Chatterjee A, Vallejo S, et. al. A cost-utility analysis of the use of preoperative computed tomographic angiography in abdomen-based perforator flap breast reconstruction. Plast Reconstr Surg. 2015 Apr;135(4):662e-9e. PubMed PMID: 25517410.

48: Janzic A, Kos M. Cost effectiveness of novel oral anticoagulants for stroke prevention in atrial fibrillation depending on the quality of warfarin anticoagulation control. Pharmacoeconomics. 2015 Apr;33(4):395-408. PubMed PMID: 25512096.

49: Delea TE, Amdahl J, Wang A, et. al. Cost Effectiveness of Dabrafenib as a First-Line Treatment in Patients with BRAF V600 Mutation-Positive Unresectable or Metastatic Melanoma in Canada. Pharmacoeconomics. 2015 Apr;33(4):367-80. PubMed PMID: 25488880.

50: Zhang W, Islam N, Ma C, et. al. Systematic review of cost-effectiveness analyses of treatments for psoriasis. Pharmacoeconomics. 2015 Apr;33(4):327-40. PubMed PMID: 25475964.

51: Huang H, Taylor DC, Carson RT, et. al. Economic evaluation of linaclotide for the treatment of adult patients with irritable bowel syndrome with constipation in the United States. J Med Econ. 2015 Apr;18(4):283-294. PubMed PMID: 25333331.

52: Adogwa O, Parker SL, Shau D, et. al. Cost Per Quality-adjusted Life Year Gained of Revision Fusion for Lumbar Pseudoarthrosis: Defining the Value of Surgery. J Spinal Disord Tech. 2015 Apr;28(3):101-5. PubMed PMID: 24999554.

53: Chatterjee A, Krishnan NM, Rosen JM. Complex ventral hernia repair using components separation with or without biologic mesh: a cost-utility analysis. Ann Plast Surg. 2015 Apr;74(4):471-8. PubMed PMID: 24051454.

By CEA Registry Team on 4/6/2015 12:52 PM

By Teja Thorat, MSc, MPH

In our recently published paper in Value in Health Regional Issues, “The State of Cost-Utility Analyses in Asia: A Systematic Review,” my colleagues and I review and evaluate published, English-language, cost-utility analyses (CUAs) targeting populations in Asia.(1)

We analyzed data from the Tufts Medical Center Cost-Effectiveness Analysis Registry to summarize study features from these CUAs, such as country of study, disease area researched, study funder, and type of intervention. We also compared the Asian CUAs to CUAs focusing on non-Asian population across study features, methodological characteristics, and reporting practices, such as study perspective, discounting of costs and health benefits, time horizon, funding source, acceptability curves, and sensitivity analyses.

Asian CUAs account for 5.1% (n=175) of the total CUAs present in the CEA Registry from 2000-2012 (n=3,414). The number of Asian CUAs has steadily grown over the past years from 19 CUAs published in 2000-2004 to 107 CUAs in 2009-2012. Asian CUAs were most often set in Japan (33.1%), followed by Taiwan (15.4%), China (14.9%), Thailand (8.0%), and South Korea (6.9%).

Figure 1. Asian cost-utility analyses by country of study, 2000-2012.
 

Figure 1. Asian cost-utility analyses by country of study, 2000-2012.

The most common diseases researched were cancer (24.6%) followed by infectious diseases (13.7%) and cardiovascular disease (8.6%). Most studies were funded by government agencies (29.1%) followed by pharmaceutical and device companies (21.7%). Asian CUAs focused mainly on pharmaceutical treatments (56%) followed by screening programs (19.4%) and immunizations (12.0%). Furthermore, a higher proportion of Asian CUAs evaluated primary prevention practices such as immunizations and screenings compared to non-Asian CUAs (21.7% vs. 16.5%, p=0.07). Also, fewer Asian CUAs were sponsored by pharmaceutical companies compared to non-Asian CUAs (p=0.001). In comparing the methodological and reporting practices between the two groups, we found that the majority of Asian CUAs adhered to good reporting practices; however, they lagged in reporting sensitivity analyses, disclosing funding status, and stating the currency year.  A full description of the CEA Registry and other recent trends can be found here.(2)

References

1.    Thorat T, Lin PJ, Neumann PJ. The State of Cost-Utility Analyses in Asia: A Systematic Review. Value Health Regional Issues. 2015 May 7–13.
2.    Neumann PJ, Thorat T, Shi J, et. al. The Changing Face of the Cost Utility Literature, 1990-2012. Value in Health 2015. 18(2):271-277.
 

By CEA Registry Team on 4/3/2015 12:52 PM

By Cayla Saret, B.A.

Twice each month we highlight recently published cost-utility studies and selected reviews and editorials.

1: Moran PS, Teljeur C, Masterson S, et. al. Cost-effectiveness of a national public access defibrillation programme. Resuscitation. 2015 Mar 28. [Epub ahead of print] PubMed PMID: 25828922.

2: Hogendoorn W, Lavida A, Hunink MG, et. al. Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms. J Vasc Surg. 2015 Mar 28. [Epub ahead of print] PubMed PMID: 25827968.

3: Bortoletto P, Einerson BD, Miller ES, et. al. A Cost-Effectiveness Analysis Of Morcellation Hysterectomy For Fibroids. J Minim Invasive Gynecol. 2015 Mar 28. [Epub ahead of print] PubMed PMID: 25827327.

4: Huntington SF, Svoboda J, Doshi JA. Cost-Effectiveness Analysis of Routine Surveillance Imaging of Patients With Diffuse Large B-Cell Lymphoma in First Remission. J Clin Oncol. 2015 Mar 30. [Epub ahead of print] PubMed PMID: 25823735.

5: Linas BP, Barter DM, Morgan JR, et. al. The Cost-Effectiveness of Sofosbuvir-Based Regimens for Treatment of Hepatitis C Virus Genotype 2 or 3 Infection. Ann Intern Med. 2015 Mar 30. [Epub ahead of print] PubMed PMID: 25820703.

6: Plumpton CO, Brown I, Reuber M, et. al. Economic evaluation of a behavior-modifying intervention to enhance antiepileptic drug adherence. Epilepsy Behav. 2015 Mar 26. [Epub ahead of print] PubMed PMID: 25819948.

7: Yang JJ, Thanataveerat A, Green PH, et. al. Cost Effectiveness of Routine Duodenal Biopsy Analysis for Celiac Disease During Endoscopy for Gastroesophageal Reflux. Clin Gastroenterol Hepatol. 2015 Mar 25. [Epub ahead of print] PubMed PMID: 25818076.

8: Charokopou M, McEwan P, Lister S, et. al. The cost-effectiveness of dapagliflozin versus sulfonylurea as an add-on to metformin in the treatment of Type 2 diabetes mellitus. Diabet Med. 2015 Mar 28. [Epub ahead of print] PubMed PMID: 25817050.

9: Zhang S, Rust G, Cardarelli K, et. al. Adherence to highly active antiretroviral therapy impact on clinical and economic outcomes for Medicaid enrollees with human immunodeficiency virus and hepatitis C coinfection. AIDS Care. 2015 Mar 27:1-7. [Epub ahead of print] PubMed PMID: 25814041.

10: Ito K, Leslie WD. Cost-effectiveness of fracture prevention in rural women with limited access to dual-energy X-ray absorptiometry. Osteoporos Int. 2015 Mar 26. [Epub ahead of print] PubMed PMID: 25807913.

11: Shen HJ, Hsu CT, Tung TH. Economic and medical benefits of ultrasound screenings for gallstone disease. World J Gastroenterol. 2015 Mar 21;21(11):3337-43. PubMed PMID: 25805942.

12: Morris S, Gurusamy KS, Sheringham J, et. al. Cost-Effectiveness Analysis of Endoscopic Ultrasound versus Magnetic Resonance Cholangiopancreatography in Patients with Suspected Common Bile Duct Stones. PLoS One. 2015 Mar 23;10(3):e0121699. eCollection 2015. PubMed PMID: 25799113.

13: Yates CJ, Chauchard MA, Liew D, et. al. Bridging the Osteoporosis Treatment Gap: Performance and Cost-Effectiveness of a Fracture Liaison Service. J Clin Densitom. 2015 Mar 18. [Epub ahead of print] PubMed PMID: 25797867.

14: Berndt N, Bolman C, Lechner L, et. al. Economic evaluation of a telephone- and face-to-face-delivered counseling intervention for smoking cessation in patients with coronary heart disease. Eur J Health Econ. 2015 Mar 22. [Epub ahead of print] PubMed PMID: 25796578.

15: Tolley K, Kemmett D, Thybo S, et. al. A cost-utility analysis of ingenol mebutate gel for the treatment of actinic keratosis: a Scottish perspective. Eur J Health Econ. 2015 Mar 21. [Epub ahead of print] PubMed PMID: 25795391.

16: Athanasakis K, Tarantilis F, Tsalapati K, et. al. Cost-utility analysis of tocilizumab monotherapy in first line versus standard of care for the treatment of rheumatoid arthritis in Greece. Rheumatol Int. 2015 Mar 21. [Epub ahead of print] PubMed PMID: 25794569.

17: Wolfson LJ, Walker A, Hettle R, et. al. Cost-Effectiveness of Adding Bedaquiline to Drug Regimens for the Treatment of Multidrug-Resistant Tuberculosis in the UK. PLoS One. 2015 Mar 20;10(3):e0120763. eCollection 2015. PubMed PMID: 25794045.

18: Gharaibeh M, McBride A, Bootman JL, et. al. Economic evaluation for the UK of nab-paclitaxel plus gemcitabine in the treatment of metastatic pancreas cancer. Br J Cancer. 2015 Mar 19. [Epub ahead of print] PubMed PMID: 25791875.

19: Muennig PA, Quan R, Chiuzan C, et. al. Considering Whether Medicaid Is Worth the Cost: Revisiting the Oregon Health Study. Am J Public Health. 2015 Mar 19:e1-e5. [Epub ahead of print] PubMed PMID: 25790389.

20: Laires PA, Ejzykowicz F, Hsu TY, et. al. Cost-effectiveness of adding ezetimibe to atorvastatin versus switching to rosuvastatin therapy in Portugal. J Med Econ. 2015 Mar 19:1-24. [Epub ahead of print] PubMed PMID: 25788039.

21: Zhou J, Zhao R, Wen F, et. al. Cost-effectiveness analysis of gemcitabine, S-1 and gemcitabine plus S-1 for treatment of advanced pancreatic cancer based on GEST study. Med Oncol. 2015 Apr;32(4):580. Epub 2015 Mar 19. PubMed PMID: 25788034.

22: Roberts ET, Horne A, Martin SS, et. al. Cost-Effectiveness of Coronary Artery Calcium Testing for Coronary Heart and Cardiovascular Disease Risk Prediction to Guide Statin Allocation: The Multi-Ethnic Study of Atherosclerosis (MESA). PLoS One. 2015 Mar 18;10(3):e0116377. eCollection 2015. PubMed PMID: 25786208.

23: Joensuu JT, Huoponen S, Aaltonen KJ, et. al. The cost-effectiveness of biologics for the treatment of rheumatoid arthritis: a systematic review. PLoS One. 2015 Mar 17;10(3):e0119683. eCollection 2015. PubMed PMID: 25781999.

24: Yeh JM, Hur C, Ward Z, et. al. Gastric adenocarcinoma screening and prevention in the era of new biomarker and endoscopic technologies: a cost-effectiveness analysis. Gut. 2015 Mar 16. [Epub ahead of print] PubMed PMID: 25779597.

25: Rein DB, Wittenborn JS, Smith BD, et. al. The Cost-effectiveness, Health Benefits, and Financial Costs of New Antiviral Treatments for Hepatitis C Virus. Clin Infect Dis. 2015 Mar 16. [Epub ahead of print] PubMed PMID: 25778747.

26: Najafzadeh M, Andersson K, Shrank WH, et. al. Cost-effectiveness of novel regimens for the treatment of hepatitis C virus. Ann Intern Med. 2015 Mar 17;162(6):407-19. PubMed PMID: 25775313.

27: Chhatwal J, Kanwal F, Roberts MS, et. al. Cost-effectiveness and budget impact of hepatitis C virus treatment with sofosbuvir and ledipasvir in the United States. Ann Intern Med. 2015 Mar 17;162(6):397-406. PubMed PMID: 25775312.

28: Lacasse Y, Bernard S, Martin S, et. al. Utility Scores In Patients With Oxygen-Dependent COPD: A Case-Control Study. COPD. 2015 Mar 16. [Epub ahead of print] PubMed PMID: 25774981.

29: Nelson RE, Angelovic AW, Nelson SD, et. al. An Economic Analysis of Adherence Engineering to Improve Use of Best Practices During Central Line Maintenance Procedures. Infect Control Hosp Epidemiol. 2015 Mar 16:1-7. [Epub ahead of print] PubMed PMID: 25772996.

30: Slof J, Ruiz L, Vila C. Cost-effectiveness of Sativex in multiple sclerosis spasticity: new data and application to Italy. Expert Rev Pharmacoecon Outcomes Res. 2015 Mar 16:1-13. [Epub ahead of print] PubMed PMID: 25771713.

31: Hofmarcher T, Borg S. Cost-effectiveness analysis of ferric carboxymaltose in iron-deficient patients with chronic heart failure in Sweden. J Med Econ. 2015 Mar 31:1-10. [Epub ahead of print] PubMed PMID: 25766863.

By CEA Registry Team on 3/23/2015 8:55 AM

By Cayla Saret, B.A. and Peter Neumann, Sc.D.

In our newly published paper in Value in Health, we (along with colleagues) investigated trends in the cost-utility literature.(1) Cost-utility analyses (CUAs) measure the incremental costs and health benefits of interventions compared with alternatives. Our review reveals considerable growth and some change in the cost-utility literature in recent years.

The number of CUAs published soared over the time period we studied, from 34 per year from 1990 to 1999 to 431 per year from 2010 to 2012. We examined the changing characteristics of these analyses.

“The number of CUAs published has soared from 34 per year (1990-1999) to 431 per year (2010-2012).” [Tweet this]

 Figure 1. Growth in the number of CUAs. Source: Neumann et. al. 2015.

Figure 1. Growth in the number of CUAs. Source: Neumann et. al. 2015.

We analyzed data from the Tufts Medical Center Cost-Effectiveness Analysis Registry, a database containing more than 3,700 English-language CUAs published in peer-reviewed journals through 2012 at the time of the study (updates are provided regularly).

The number of studies from the United States fell from 61% of the literature during 1990 to 1999 to 35% during 2010 to 2012. The number of studies focused on low- and middle-income countries increased, although still small compared with those focused on higher-income countries.  The number of journals publishing CUAs increased from 58 in 2000 to 251 in 2012. In 2012, 60 journals published CUAs for the first time. (See here for the complete list of journals publishing CUAs.)

Fig. 3. Distribution of CUAs by income of country (2000–2012), using 2012 World Bank income groups. Source: Neumann et. al. 2015. 


Fig. 3. Distribution of CUAs by income of country (2000–2012), using 2012 World Bank income groups.(2) High-income countries; middle-income countries; low-income countries. Source: Neumann et. al. 2015.

The most common disease areas examined by CUAs include cardiovascular diseases (18%), cancer (15%), and infectious diseases (15%). The field continues to focus in large part on pharmaceuticals (47%). The majority of CUAs have focused on treatments (65%), followed by secondary (19%) and primary (16%) prevention. Burden of disease and number of CUAs published vary by region; however, in all regions, injuries have a high burden but relatively few CUAs.


References

1.    Neumann PJ, Thorat T, Shi J, et. al. The Changing Face of the Cost Utility Literature, 1990-2012. Value in Health 2015. 18(2):271-277.
2.    Drummond MF, Sculpher MJ, Torrance GW, et. al. Methods for the Economic Evaluation of Health Care Programmes (3rd ed). Oxford University Press, Oxford, UK. 2014.

By CEA Registry Team on 3/18/2015 9:21 AM

By Yue Zhong, MD, PhD

In our new Value in Health paper, “Cost-Utility Analyses in Diabetes: A Systematic Review and Implications from Real-World Evidence,” my colleagues and I assess the opportunities for better investing health care resources for diabetes in the United States.(1) We found that most diabetes interventions with available cost-utility analyses (CUAs) may offer good value. Increased use of these interventions could potentially improve health outcomes while reducing costs.

First, we reviewed all diabetes-related CUAs catalogued in the Tufts Cost Effectiveness Analysis Registry.  The review included 196 diabetes CUAs published through the end of 2012 that reported 497 cost-effectiveness ratios. Most (73%) of the interventions were cost-saving or achieved health improvements at a cost of less than $50,000 per quality-adjusted life year (QALY), a commonly used threshold for cost-effectiveness. The median cost-effectiveness ratio was $15,400 per QALY (2012 $US).

Next, we used Humedica electronic medical records (EMRs) to explore possible gains from reallocating resources from low-value interventions for diabetes (those that increase costs and make health worse) to high-value interventions (those that improve health and reduce costs). We identified four high value interventions (e.g., intensive hypertension control among diabetes patients with hypertension) with utilization data available. The results indicate there is substantial opportunity to shift spending to these high value interventions.

Of 400,000 diabetic patients in the Humedica EMR database, we identified 7,907 eligible patients using the low-value interventions. In this population, up to 7,117 diabetes patients could move from low- to high-value treatments, saving more than $12 million and gaining more than 1,900 QALYs.

We acknowledge at the outset that this is an exploratory analysis, and that the results may not be readily scaled to the national level. Our main objective was to demonstrate the principle of using real-world data to identify opportunities for saving money and improving health by reinvesting.  Both patients and the overall health care system could potentially benefit from shifting to the greater use of services that have demonstrated greater health benefits and lower costs.


References

1.    Yue Z, Lin P-J, Cohen JT, et. al. Cost-Utility Analyses in Diabetes: A Systematic Review and Implications from Real-World Evidence. Value in Health 2015;18(2):308-314.

By CEA Registry Team on 3/16/2015 2:12 PM

By Cayla Saret, B.A.

Twice each month we highlight recently published cost-utility studies and selected reviews and editorials.

1: Vavken P, Sadoghi P, Palmer M, et. al. Platelet-Rich Plasma Reduces Retear Rates After Arthroscopic Repair of Small- and Medium-Sized Rotator Cuff Tears but Is Not Cost-Effective. Am J Sports Med. 2015 Mar 12. [Epub ahead of print] PubMed PMID: 25767267.

2: Bogosian A, Chadwick P, Windgassen S, et. al. Distress improves after mindfulness training for progressive MS: A pilot randomised trial. Mult Scler. 2015 Mar 12. [Epub ahead of print] PubMed PMID: 25767124.

3: Hofmarcher T, Borg S. Cost-effectiveness analysis of ferric carboxymaltose in iron-deficient patients with chronic heart failure in Sweden. J Med Econ. 2015 Mar 12:1-20. [Epub ahead of print] PubMed PMID: 25766863.

4: Minion LE, Bai J, Monk BJ, et. al. A markov model to evaluate cost-effectiveness of antiangiogenesis therapy using bevacizumab in advanced cervical cancer. Gynecol Oncol. 2015 Mar 9. [Epub ahead of print] PubMed PMID: 25766118.

5: de Wit GA, Over EA, Schmid BV, et. al. Chlamydia screening is not cost-effective at low participation rates: evidence from a repeated register-based implementation study in the Netherlands. Sex Transm Infect. 2015 Mar 10. [Epub ahead of print] PubMed PMID: 25759475.

6: Bongers ML, Coupé VM, De Ruysscher D, et. al. Individualized positron emission tomography-based isotoxic accelerated radiation  therapy is cost-effective compared with conventional radiation therapy: a model-based evaluation. Int J Radiat Oncol Biol Phys. 2015 Mar 15;91(4):857-65. PubMed PMID: 25752401.

7: Williams MA, Williamson EM, Heine PJ, et. al. Strengthening And stretching for Rheumatoid Arthritis of the Hand (SARAH). A randomised controlled trial and economic evaluation. Health Technol Assess. 2015 Mar;19(19):1-222. PubMed PMID: 25748549.

8: Thampi N, Gurol-Urganci I, Crowcroft NS, et. al. Pertussis Post-Exposure Prophylaxis among Household Contacts: A Cost-Utility Analysis. PLoS One. 2015 Mar 6;10(3):e0119271. eCollection 2015. PubMed PMID: 25747269.

9: Snarski E, Szmurło D, Hałaburda K, et. al. An economic analysis of autologous hematopoietic stem cell transplantation (AHSCT) in the treatment of new onset type 1 diabetes. Acta Diabetol. 2015 Mar 6. [Epub ahead of print] PubMed PMID: 25744552.

10: Pérez A, Mezquita Raya P, Ramírez de Arellano A, et. al. Cost-Effectiveness Analysis of Incretin Therapy for Type 2 Diabetes in Spain: 1.8 mg Liraglutide Versus Sitagliptin. Diabetes Ther. 2015 Mar 6. [Epub ahead of print] PubMed PMID: 25742705.

11: Kaplan RI, De Moraes CG, Cioffi GA, et. al. Comparative Cost-effectiveness of the Baerveldt Implant, Trabeculectomy With Mitomycin, and Medical Treatment. JAMA Ophthalmol. 2015 Mar 5. [Epub ahead of print] PubMed PMID: 25741886.

12: Mirsaeedi-Farahani K, Halpern CH, Baltuch GH, et. al. Deep brain stimulation for Alzheimer disease: a decision and cost-effectiveness analysis. J Neurol. 2015 Mar 6. [Epub ahead of print] PubMed PMID: 25740662.

13: Makras P, Athanasakis K, Boubouchairopoulou N, et. al. Cost-effective osteoporosis treatment thresholds in Greece. Osteoporos Int. 2015 Mar 5. [Epub ahead of print] PubMed PMID: 25740208.

14: Ghomrawi HM, Eggman AA, Pearle AD. Effect of age on cost-effectiveness of unicompartmental knee arthroplasty compared with total knee arthroplasty in the u.s. J Bone Joint Surg Am. 2015 Mar 4;97(5):396-402. PubMed PMID: 25740030.

15: Chowdhury EK, Ademi Z, Moss JR, et. al; Second Australian National Blood Pressure Study Management Committee. Cost-utility of Angiotensin-converting enzyme inhibitor-based treatment compared with thiazide diuretic-based treatment for hypertension in elderly australians considering diabetes as comorbidity. Medicine (Baltimore). 2015 Mar;94(9):e590. PubMed PMID: 25738481.

16: Soneji S, Yang J. New analysis reexamines the value of cancer care in the United States compared to Western europe. Health Aff (Millwood). 2015 Mar 1;34(3):390-7. PubMed PMID: 25732488.

17: Chatterjee A, Ramkumar DB, Dawli TB, et. al. The Use of Mesh versus Primary Fascial Closure of the Abdominal Donor Site When Using a Transverse Rectus Abdominis Myocutaneous Flap for Breast Reconstruction: A Cost-Utility Analysis. Plast Reconstr Surg. 2015 Mar;135(3):682-9. PubMed PMID: 25719690.

18: Harrison M, Collins CD. Is procalcitonin-guided antimicrobial use cost-effective in adult patients with suspected bacterial infection and sepsis? Infect Control Hosp Epidemiol. 2015 Mar;36(3):265-72. PubMed PMID: 25695167.

19: Parker SL, McGirt MJ. Determination of the minimum improvement in pain, disability, and health state associated with cost-effectiveness: introduction of the concept of minimum cost-effective difference. Neurosurgery. 2015 Mar;76 Suppl 1:S64-70. PubMed PMID: 25692370.

20: Zhang C, Ke W, Gao Y, et. al. Cost-Effectiveness Analysis of Antiviral Therapies for Hepatitis B e Antigen-Positive Chronic Hepatitis B Patients in China. Clin Drug Investig. 2015 Mar;35(3):197-209. PubMed PMID: 25672930.

21: Black WC. Computed Tomography Screening for Lung Cancer in the National Lung Screening Trial: A Cost-effectiveness Analysis. J Thorac Imaging. 2015 Mar;30(2):79-87. PubMed PMID: 25635704.

22: Lee BY, Bartsch SM, Brown ST, et. al. Quantifying the economic value and quality of life impact of earlier influenza vaccination. Med Care. 2015 Mar;53(3):218-29. PubMed PMID: 25590676.

23: Mensch A, Stock S, Stollenwerk B, et. al. Cost effectiveness of rivaroxaban for stroke prevention in german patients with atrial fibrillation. Pharmacoeconomics. 2015 Mar;33(3):271-83. PubMed PMID: 25404426.

By CEA Registry Team on 3/5/2015 9:57 AM

By James Chambers, Ph.D. and Peter Neumann, Sc.D.

In our new Health Affairs paper, “Medicare is scrutinizing evidence more tightly for national coverage determinations,” we analyzed the evidence base CMS reviewed in each national coverage determination (NCD) from 1999-2012.(1)  We used regression analysis to examine the relationship between the quality and volume of the evidence with the likelihood of a favorable coverage determination. 

Some of the feedback we have received on the paper has focused on our approach for accommodating “coverage with evidence development (CED)” decisions in our analysis.  CMS utilizes a CED policy when they judge an intervention’s supporting evidence base insufficient to meet their conventional coverage standard, but sufficiently promising to warrant coverage for beneficiaries enrolled in approved registries or clinical studies.  Through CED policies, CMS collects additional information that allows revision of the coverage policy at a later date.

Our dataset included all coverage decisions made in NCDs from 1999 through 2012, and included 126 positive decisions, 74 non-coverage decisions, and 13 CED policies.

We considered several potential approaches to evaluating the data, each of which had advantages and disadvantages.  A limitation of our dataset was that the small number of CED policies prevented us from analyzing them meaningfully as a separate outcome category, and we were faced with the decision of how to handle these observations in the study. 

A primary study objective was to examine the evidence standard necessary to achieve Medicare coverage.  As CED policies are not equivalent to conventional coverage policies – coverage is only conditional on beneficiary enrollment in a clinical trial or registry – we included them with non-coverage decisions in the base case analysis.

We judged this to be the best approach given the limited access patients have to technologies in CED decisions, and after considering peer reviewer comments on earlier versions of the manuscript and our interaction with the editor over the matter during the pre-publication review process.   To examine the impact of this choice, in sensitivity analyses we reanalyzed the dataset first when excluding CED policies altogether, and second when including them along with positive coverage decisions.  The findings for the base case analysis and each sensitivity analysis are presented in Table 1 below, and were included in an online appendix to the paper.  In the base case analysis, when holding quality of evidence constant, the most recent coverage decisions (2008-2012) were roughly twenty times less likely to be positive than earlier coverage determinations (p<0.01) (1999-2002).  When excluding CED policies from the dataset, the most recent coverage decisions were roughly fourteen times less likely to be positive than earlier coverage determinations (p<0.01).  When including CED as positive coverage, the most recent coverage decisions were two times less likely (p<0.01).

In other words, across each analysis, we found that, after we adjusted for the strength of evidence and other factors known to influence coverage determinations, the evidentiary bar for coverage has risen; however, the magnitude does vary depending on how CED decisions are categorized. 

Table 1. Multivariate logistic regression model comparison:  Alternative approaches to including CED decisions

 

Odds Ratio

 

Base-case:

Positive coverage vs. noncoverage/CED

Sensitivity analysis 1: Positive coverage vs. noncoverage (excluding CED policies)

Sensitivity analysis 2: Positive coverage/CED vs. noncoverage

February 1999-January 2002

Ref.

Ref.

Ref.

February 2002-December 2003

0.245***

0.241***

0.245***

January 200-mid-March 2008

0.287**

0.290**

0.267**

Mid-March 2008-August 2012

0.046***

0.075***

0.462***

N.B. Ref. = Reference category; **p<0.05 ***p<0.01.  Variables controlled for in the analysis include:  Number of patients in randomized controlled trials (RCTs); Consistency of findings among RCTs; Consistency of findings among non RCT clinical trials; Consistency of findings among clinical reviews; Consistency of recommendations among clinical guidelines.

References

 1.      Chambers, JD, Chenoweth M, Cangelosi MJ, et. al. Medicare Is Scrutinizing Evidence More Tightly For National Coverage Determinations. Health Affairs 2015;34(2):253–260.

By CEA Registry Team on 3/3/2015 1:22 PM

By Paige Lin, Ph.D.

In a new paper published the American Journal of Managed Care, my colleagues and I found that many diabetes patients with multiple chronic comorbidities (MCCs) may have poor diabetes outcomes and excess emergency department (ED) visits and 30-day hospital readmissions.(1)

This study is the first to our knowledge to examine a large number of the most common MCC combinations in diabetes. Although previous studies have shown that the type and severity of comorbidities, not just the number of conditions, matter, it is unclear which MCC clusters are most prevalent in diabetes and how MCCs impact patient outcomes.

In our research, funded by the West Health Institute, we found that one in five type 2 diabetes patients had the combination of hypertension, hyperlipidemia and obesity and no other diagnosed comorbidities.  The top 10 MCC clusters accounted for roughly 70% of all type 2 diabetes patients.  However, MCC cluster patterns vary substantially across patients, especially those age 65 and older.

In addition, we found that diabetes patients with certain comorbidity profiles, such as those with obesity only, were less likely to have diabetes-related face-to-face visits and to meet A1C treatment goals, and were more likely to have ED visits and readmissions. We also reported that reducing ED visits and 30-day readmissions in patients with diabetes could yield substantial savings nationally- roughly $15 billion annually.

The analysis was based on more than 160,000 type 2 diabetes patients in Optum’s Humedica datasets, which link de-identified electronic health records, encounter files, prescribed medications, and lab values supplied by many large U.S. providers. Analyzing distinct MCC combinations as we have done is only possible using big data.

MCCs are highly prevalent in diabetes patients.  Having MCCs can complicate treatment and increase disease burden and health care costs.   Our findings indicate that diabetes guidelines and disease management programs should explicitly address common comorbidity clusters, such as hypertension-hyperlipidemia-obesity, commonly referred to as “metabolic syndrome.”  Appropriate management of individual disease in isolation may not be optimal for diabetes patients with MCCs.

References

1.    Lin P-J, Kent DM, Winn A, Cohen JT, Neumann PJ. Multiple Chronic Conditions in Type 2 Diabetes Mellitus: Prevalence and Consequences. AJMC 2015 February 27. [Epub ahead of print].

By CEA Registry Team on 3/2/2015 3:19 PM

By Cayla Saret, B.A.

Twice each month we highlight recently published cost-utility studies and selected reviews and editorials.

1: Nuijten M, Roggeri DP, Roggeri A, et. al. Health Economic Evaluation of Paricalcitol(®) Versus Cincalcet + Calcitriol (Oral) in Italy. Clin Drug Investig. 2015 Feb 28. [Epub ahead of print] PubMed PMID: 25724153.

2: Ferguson T, Xu Y, Gunasekara R, et. al. The Cost Effectiveness of Erythropoietin-Stimulating Agents for Treating Anemia in Patients on Dialysis: A Systematic Review. Am J Nephrol. 2015  Feb 26;41(2):89-97. [Epub ahead of print] PubMed PMID: 25721696.

3: Littlewood KJ, Ouwens MJ, Sauboin C, et. al. Cost-Effectiveness of Routine Varicella Vaccination Using the Measles, Mumps, Rubella and Varicella Vaccine in France: An Economic Analysis Based on a Dynamic Transmission Model for Varicella and Herpes Zoster. Clin Ther. 2015 Feb 23. [Epub ahead of print] PubMed PMID: 25721380.

4: Leung RM, Smith TL, Rudmik L. Developing a Laddered Algorithm for the Management of Intractable Epistaxis: A Risk Analysis. JAMA Otolaryngol Head Neck Surg. 2015 Feb 26. [Epub ahead of print] PubMed PMID: 25719360.

5: Schawo S, van der Kolk A, Bouwmans C, et. al. Probabilistic Markov Model Estimating Cost Effectiveness of Methylphenidate Osmotic-Release Oral System Versus Immediate-Release Methylphenidate in Children and Adolescents: Which Information is Needed? Pharmacoeconomics. 2015 Feb 26. [Epub ahead of print] PubMed PMID: 25715975.

6: You JH, Ming WK, Chan PK. Cost-effectiveness of Quadrivalent Influenza Vaccine in Hong Kong - A decision analysis. Hum Vaccin Immunother. 2015 Feb 25:0. [Epub ahead of print] PubMed PMID: 25714506.

7: Hu Y, Shah P, Stukenborg GJ, et. al. Utility of sentinel lymph node biopsy for solitary dermal melanomas. J Surg Oncol. 2015 Feb 24. [Epub ahead of print] PubMed PMID: 25712273.

8: Farag I, Howard K, Hayes AJ, et. al. Cost-effectiveness of a Home-Exercise Program Among Older People After Hospitalization. J Am Med Dir Assoc. 2015 Feb 18. [Epub ahead of print] PubMed PMID: 25703448.

9: Hoerger TJ, Crouse WL, Zhuo X, et. al. Medicare's Intensive Behavioral Therapy for Obesity: An Exploratory Cost-Effectiveness Analysis. Am J Prev Med. 2015 Feb 19. [Epub ahead of print] PubMed PMID: 25703178.

10: Lee EK, Wong WW, Trudeau ME, et. al. Cost-effectiveness of prophylactic granulocyte colony-stimulating factor for febrile neutropenia in breast cancer patients receiving FEC-D. Breast Cancer Res Treat. 2015 Feb;150(1):169-80. Epub 2015 Feb 19. PubMed PMID: 25694355.

11: Naing C, Poovorawan Y, Mak JW, et. al. Cost-utility analysis of an adjunctive recombinant activated factor VIIa for on-demand treatment of bleeding episodes in dengue haemorrhagic fever. Blood Coagul Fibrinolysis. 2015  Feb 16. [Epub ahead of print] PubMed PMID: 25692521.

12: Goldstein DA, Chen Q, Ayer T, et. al. First- and Second-Line Bevacizumab in Addition to Chemotherapy for Metastatic Colorectal Cancer: A United States-Based Cost-Effectiveness Analysis. J Clin Oncol. 2015 Feb 17. [Epub ahead of print] PubMed PMID: 25691669.

13: Earnshaw SR, Graham CN, McDade CL, et. al. Factor VIII alloantibody inhibitors: cost analysis of immune tolerance induction vs. prophylaxis and on-demand with bypass treatment. Haemophilia. 2015 Feb 16. [Epub ahead of print] PubMed PMID: 25688580.

14: Pyne JM, Fortney JC, Mouden S, et. al. Cost-Effectiveness of On-Site Versus Off-Site Collaborative Care for Depression in Rural FQHCs. Psychiatr Serv. 2015 Feb 17:appips201400186. [Epub ahead of print] PubMed PMID: 25686811.

15: Domínguez-Ortega J, Phillips-Anglés E, Barranco P, Quirce S. Cost-effectiveness of asthma therapy: a comprehensive review. J Asthma. 2015 Feb 20:1-9. [Epub ahead of print] PubMed PMID: 25539023.

By CEA Registry Team on 2/24/2015 12:02 PM

By James Chambers, Ph.D.

US payers make coverage and reimbursement decisions for drugs upon their FDA approval.  These decisions are made before the supporting evidence has fully matured, and typically before cost-effectiveness evidence is available.  This lag between FDA approval and publication of cost-effectiveness evidence can hamper payers from accounting for value in coverage and reimbursement decisions. 

In a new paper, published as a special report in Expert Review of Pharmacoeconomics and Outcomes Research, we examined this lag, and whether it has changed over time.(1)  For drugs approved for the first time by the FDA from 2000 through 2010, we searched the CEA Registry (www.cearegistry.org) for relevant cost-utility analyses (CUAs), and for each identified study we determined the date of first publication.  Then, for each drug, we determined whether a CUA was published in the three years following FDA approval.  We used a 3-year period as this was the maximum interval between the most recently approved drug in the dataset and the end of the search period.

Of all drugs approved in our time period, 23% (62/274) were associated with a CUA within the three years following approval.  The lag before CUA publication has decreased over time, and compared with drugs approved from 2000 to 2003, the lag was shorter for drugs approved from 2004 to 2006 (p=0.06), and from 2007 to 2010 (p<0.01) (Figure 1).

Our findings are encouraging, and illustrate that payers now have somewhat more rapid access to evidence of value than they did previously.  Nevertheless, we found that many drugs did not have an accompanying CUA, and of those that did, there was still a lengthy delay for several before the study was available.  We are hopeful that, as demand for evidence of value grows, the lag between FDA approval and publication of a CUA will decrease further.  



1.    Chambers JD, Thorat T, Pyo J, Neumann PJ. The lag from FDA approval to published cost-utility evidence. Expert Rev Pharmacoecon Outcomes Res. 2015 Jan 12:1-4

By CEA Registry Team on 2/18/2015 2:53 PM

By Cayla Saret, B.A.

Twice each month we highlight recently published cost-utility studies and selected reviews and editorials

1: Slaman J, van den Berg-Emons R, Tan SS, et. al. Cost-utility of a lifestyle intervention in adolescents and young adults with spastic cerebral palsy. J Rehabil Med. 2015 Feb 12. [Epub ahead of print] PubMed PMID: 25678311.

2: Leidner AJ, Chesson HW, Xu F, et. al. Cost-effectiveness of hepatitis C treatment for patients in early stages of liver disease. Hepatology. 2015 Feb 11. [Epub ahead of print] PubMed PMID: 25677072.

3: Ball S, Vickery J, Hobart J, et. al. The Cannabinoid Use in Progressive Inflammatory brain Disease (CUPID) trial: a randomised double-blind placebo-controlled parallel-group multicentre trial and economic evaluation of cannabinoids to slow progression in multiple sclerosis. Health Technol Assess. 2015 Feb;19(12):1-188. PubMed PMID: 25676540.

4: Lao C, Brown C, Rouse P, et. al. Economic evaluation of prostate cancer screening: a systematic review. Future Oncol. 2015 Feb;11(3):467-77. PubMed PMID: 25675126.

5: Zhang C, Ke W, Gao Y, et. al. Cost-Effectiveness Analysis of Antiviral Therapies for Hepatitis B e Antigen-Positive Chronic Hepatitis B Patients in China. Clin Drug Investig. 2015 Feb 12. [Epub ahead of print] PubMed PMID: 25672930.

6: Gyrd-Hansen D, Olsen KR, Bollweg K, et. al. Cost-effectiveness estimate of prehospital thrombolysis: Results of the PHANTOM-S Study. Neurology. 2015 Feb 11. [Epub ahead of print] PubMed PMID: 25672925.

7: Alberti A, Giudice P, Gelera A, et. al. Understanding the economic impact of intravascular ultrasound (IVUS). Eur J Health Econ. 2015 Feb 11. [Epub ahead of print] PubMed PMID: 25669755.

8: Retèl VP, van der Molen L, Steuten LM, et. al. A cost-effectiveness analysis of using TheraBite in a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy. Eur Arch Otorhinolaryngol. 2015 Feb 11. [Epub ahead of print] PubMed PMID: 25666587.

9: Spolverato G, Vitale A, Ejaz A, et. al. The Relative Net Health Benefit of Liver Resection, Ablation, and Transplantation for Early Hepatocellular Carcinoma. World J Surg. 2015 Feb 10. [Epub ahead of print] PubMed PMID: 25665675.

10: Bouland AJ, Risko N, Lawner BJ, et. al. The Price of a Helping Hand: Modeling the Outcomes and Costs of Bystander CPR. Prehosp Emerg Care. 2015 Feb 9. [Epub ahead of print] PubMed PMID: 25665010.

11: Stevens KJ. How Well Do the Generic Multi-attribute Utility Instruments Incorporate Patient and Public Views Into Their Descriptive Systems? Patient. 2015 Feb 8. [Epub ahead of print] PubMed PMID: 25663152.

12: Tao L, Wilson EC, Wareham NJ, et. al. Cost-effectiveness of intensive multifactorial treatment compared with routine care for individuals with screen-detected Type 2 diabetes: analysis of the ADDITION-UK cluster-randomized controlled trial. Diabet Med. 2015 Feb 6. [Epub ahead of print] PubMed PMID: 25661661.

13: Cowper PA, Pan W, Anstrom KJ, et. al. Economic Analysis of Ticagrelor Therapy From a U.S. Perspective: Results From the PLATO Study. J Am Coll Cardiol. 2015 Feb 10;65(5):465-76. PubMed PMID: 25660925.

14: Song DL, Altice FL, Copenhaver MM, et. al. Cost-Effectiveness Analysis of Brief and Expanded Evidence-Based Risk Reduction Interventions for HIV-Infected People Who Inject Drugs in the United States. PLoS One. 2015 Feb 6;10(2):e0116694. eCollection 2015. PubMed PMID: 25658949.

15: Fergenbaum J, Bermingham S, Krahn M, et. al. Care in the Home for the Management of Chronic Heart Failure: Systematic Review and Cost-Effectiveness Analysis. J Cardiovasc Nurs. 2015 Feb 5. [Epub ahead of print] PubMed PMID: 25658188.

16: Saret CJ, Winn A, Shah G, et. al. Value of innovation in hematologic malignancies: a systematic review of published cost-effectiveness analyses. Blood. 2015 Feb 5. [Epub ahead of print] PubMed PMID: 25655601.

17: Rubio-Terrés C, Soria JM, Morange PE, et. al. Economic Analysis of Thrombo inCode, a Clinical-Genetic Function for Assessing the Risk of Venous Thromboembolism. Appl Health Econ Health Policy. 2015 Feb 5. [Epub ahead of print] PubMed PMID: 25652150.

18: Tuffaha HW, Roberts S, Chaboyer W, et. al. Cost-Effectiveness and Value of Information Analysis of Nutritional Support for Preventing Pressure Ulcers in High-risk Patients: Implement Now, Research Later. Appl Health Econ Health Policy. 2015 Feb 4. [Epub ahead of print] PubMed PMID: 25650349.

19: Chandra A, Snider JT, Wu Y, et. al. Robot-assisted surgery for kidney cancer increased access to a procedure that can reduce mortality and renal failure. Health Aff (Millwood). 2015 Feb 1;34(2):220-8. PubMed PMID: 25646101.

20: Okubo R, Kondo M, Hoshi SL, et. al. Cost-effectiveness of obstructive sleep apnea screening for patients with diabetes or chronic kidney disease. Sleep Breath. 2015 Feb 3. [Epub ahead of print] PubMed PMID: 25643768.

21: Borisenko O, Adam D, Funch-Jensen P, et. al. Bariatric Surgery can Lead to Net Cost Savings to Health Care Systems: Results from a Comprehensive European Decision Analytic Model. Obes Surg. 2015 Feb 2. [Epub ahead of print] PubMed PMID: 25639648.

22: Scalone L, Cortesi PA. Cost-utility analysis of biologic therapies to treat chronic plaque psoriasis in Italy: the importance of using updated and adequate social tariffs to calculate quality-adjusted life-years. BioDrugs. 2015 Feb;29(1):69. PubMed PMID: 25633571.

23: Kazerooni R, Broadhead C. Cost-utility analysis of botulinum toxin type A products for the treatment of cervical dystonia. Am J Health Syst Pharm. 2015 Feb 15;72(4):301-7. PubMed PMID: 25631837.

24: Zachariah JP, Samnaliev M. Echo-based screening of rheumatic heart disease in children: a cost-effectiveness Markov model. J Med Econ. 2015 Feb 9:1-10. [Epub ahead of print] PubMed PMID: 25629653.

25: Al Hussein Al Awamlh B, Lee R, Chughtai B, et. al. A Cost-effectiveness Analysis of Management of Low-risk Non-muscle-invasive Bladder Cancer Using Office-based Fulguration. Urology. 2015 Feb;85(2):381-7. PubMed PMID: 25623694.

26: Tanaka E, Inoue E, Hoshi D, et. al. Cost-effectiveness of tocilizumab, a humanized anti-interleukin-6 receptor monoclonal antibody, versus methotrexate in patients with rheumatoid arthritis using real-world data from the IORRA observational cohort study. Mod Rheumatol. 2015 Feb 11:1-11. [Epub ahead of print] PubMed PMID: 25547018.

27: Sawyer LM, Wonderling D, Jackson K, et. al. Biological therapies for the treatment of severe psoriasis in patients with previous exposure to biological therapy: a cost-effectiveness analysis. Pharmacoeconomics. 2015 Feb;33(2):163-77. PubMed PMID: 25526841.

28: Kongnakorn T, Lanitis T, Annemans L, et. al. Stroke and systemic embolism prevention in patients with atrial fibrillation in belgium: comparative cost effectiveness of new oral anticoagulants and warfarin. Clin Drug Investig. 2015 Feb;35(2):109-19. PubMed PMID: 25511639.

29: Aballéa S, Maman K, Thokagevistk K, et. al. Cost effectiveness of mirabegron compared with tolterodine extended release for the treatment of adults with overactive bladder in the United kingdom. Clin Drug Investig. 2015 Feb;35(2):83-93. PubMed PMID: 25491433.

30: Nord E. Cost-value analysis of health interventions: introduction and update on methods and preference data. Pharmacoeconomics. 2015 Feb;33(2):89-95. PubMed PMID: 25488879.

31: Sprague BL, Stout NK, Schechter C, et. al. Benefits, harms, and cost-effectiveness of supplemental ultrasonography screening for women with dense breasts. Ann Intern Med. 2015 Feb 3;162(3):157-66. PubMed PMID: 25486550.

32: Rajan S, Baraniuk S, Parker S, et. al. Implementing a mobile stroke unit program in the United States: why, how, and how much? JAMA Neurol. 2015 Feb 1;72(2):229-34. PubMed PMID: 25485723.

33: Blank PR, Filipits M, Dubsky P, et. al. Cost-effectiveness analysis of prognostic gene expression signature-based stratification of early breast cancer patients. Pharmacoeconomics. 2015 Feb;33(2):179-90. PubMed PMID: 25404424.

34: Hsieh HM, Tsai SL, Shin SJ, et. al. Cost-Effectiveness of Diabetes Pay-for-Performance Incentive Designs. Med Care. 2015 Feb;53(2):106-15. PubMed PMID: 25397966.

35: Huh WK, Williams E, Huang J, et. al. Cost effectiveness of human papillomavirus-16/18 genotyping in cervical cancer screening. Appl Health Econ Health Policy. 2015 Feb;13(1):95-107. PubMed PMID: 25385310.

36: Ziakas PD, Zacharioudakis IM, Zervou FN, et. al. Methicillin-Resistant Staphylococcus aureus Prevention Strategies in the ICU: A Clinical Decision Analysis*. Crit Care Med. 2015 Feb;43(2):382-93. PubMed PMID: 25377019.

37: McEwan P, Bennett H, Ward T, et. al. Refitting of the UKPDS 68 Risk Equations to Contemporary Routine Clinical Practice Data in the UK. Pharmacoeconomics. 2015 Feb;33(2):149-61. PubMed PMID: 25344660.

38: Greenhalgh J, Bagust A, Boland A, et. al. Eribulin for the Treatment of Advanced or Metastatic Breast Cancer: A NICE Single Technology Appraisal. Pharmacoeconomics. 2015 Feb;33(2):137-48. PubMed PMID: 25213036.

39: Rognoni C, Marchetti M, Quaglini S, et. al. Edoxaban versus warfarin for stroke prevention in non-valvular atrial fibrillation: a cost-effectiveness analysis. J Thromb Thrombolysis. 2015 Feb;39(2):149-54. PubMed PMID: 24973057.

40: Ma Y, Ying X, Zou H, et. al. Cost-utility Analysis of Rhegmatogenous Retinal Detachment Surgery in Shanghai, China. Ophthalmic Epidemiol. 2015 Feb;22(1):13-9. Epub 2014 Feb 14. PubMed PMID: 24527711.

By CEA Registry Team on 2/10/2015 9:58 AM
By Peter Neumann, ScD, Joshua Cohen, PhD, Susan Parsons, MD, MRP, and Cayla Saret, BA
 
As discussed in a recent blog post, our new paper (1) in the journal Blood examined the cost-effectiveness of treatments for hematologic malignancies (blood cancers). The paper has received some media attention, including coverage in the Boston Business Journal, Healio HemOnc today, and Medical Xpress. The press coverage has emphasized that treatments for blood cancer provide “good value for money.”
 
It is important to emphasize several points as we do in the paper:
 
• This paper is a review of the existing peer-reviewed medical literature. The estimates come from published cost-effectiveness analyses. Moreover, the data are limited to studies cataloged in the Tufts Medical Center Cost-Effectiveness Analysis (CEA) Registry, a repository of studies in the form of cost/quality-adjusted life years (QALYs).  We selected studies examining innovative treatments and excluded hematopoietic stem cell transplant, symptom management, and supportive care. These findings are limited by the small sample size. In addition, the literature may be subject to methodological issues or publication bias. For example, researchers conducting industry-funded studies may be more inclined to investigate interventions that are likely to demonstrate higher value and to report more favorable findings. We conducted a sub-analysis of non-industry funded studies, of which there were only seven. The non-industry funded studies reported a higher (less favorable) median ratio than industry funded studies. 
 
• Given the widespread discussion about the high prices of some of these interventions, we were somewhat surprised to find that many of the treatments appeared to be relatively cost-effective, even when we limited the sample to studies not funded by the pharmaceutical industry.
 
• Cost-effectiveness studies serve as one input for policymakers and stakeholders making decisions about investment, coverage, reimbursement, and so on. Other factors come into play, including but not limited to affordability, access, health impact, overall budget, and preferences. By reporting these results, we hope to encourage the consideration of value, in terms of the ratio of cost to effectiveness, as one tool in the decision-making process.
 
An appendix to the paper listing the 29 studies included in our review will be made available on the Blood web site shortly when the paper is published in its final form (subsequent to the currently available First Edition).
 
References
 
1.    Saret CJ, Winn A, Shah G, et. al. Value of Innovation in Hematologic Malignancies: A Systematic Review of Published Cost-Effectiveness Analyses. Blood 2015 First Edition.

 

By CEA Registry Team on 2/6/2015 9:39 AM

By Cayla Saret, B.A.

Twice each month we highlight recently published cost-utility studies and selected reviews and editorials.

1: Rowland MR, Lesnock JL, Farris C, et. al. Cost-utility comparison of neoadjuvant chemotherapy versus primary debulking surgery for treatment of advanced stage ovarian cancer in patients = 65 years old. Am J Obstet Gynecol. 2015 Jan 30. [Epub ahead of print] PubMed PMID: 25644442.

2: Mash R, Kroukamp R, Gaziano T, et. al. Cost-effectiveness of a diabetes group education program delivered by health promoters with a guiding style in underserved communities in Cape Town, South Africa. Patient Educ Couns. 2015 Jan  20. [Epub ahead of print] PubMed PMID: 25641665.

3: Mailhot Vega R, Kim J, Hollander A, et. al. Cost effectiveness of proton versus photon radiation therapy with respect to the risk of growth hormone deficiency in children. Cancer. 2015 Jan 29. [Epub ahead of print] PubMed PMID: 25641407.

4: Schuster A, Faulkner M, Zeymer U, et. al. Economic implications of intra-aortic balloon support for myocardial infarction with cardiogenic shock: an analysis from the IABP-SHOCK II-trial. Clin Res Cardiol. 2015 Jan 31. [Epub ahead of print] PubMed PMID: 25637294.

5: McEwan P, Ward T, Bennett H, et. al. Estimating the clinical and economic benefit associated with incremental improvements in sustained virologic response in chronic hepatitis C. PLoS One. 2015 Jan 30;10(1):e0117334. eCollection 2015. PubMed PMID: 25635922.

6: Black WC. Computed Tomography Screening for Lung Cancer in the National Lung Screening Trial: A Cost-effectiveness Analysis. J Thorac Imaging. 2015 Jan 29. [Epub ahead of print] PubMed PMID: 25635704.

7: Hagberg L, Hermansson L, Fredriksson C, et. al. Cost-effectiveness of powered mobility devices for elderly people with disability. Disabil Rehabil Assist Technol. 2015 Jan 30:1-6. [Epub ahead of print] PubMed PMID: 25634493.

8: Scalone L, Cortesi PA. Cost-Utility Analysis of Biologic Therapies to Treat Chronic Plaque Psoriasis in Italy: The Importance of Using Updated and Adequate Social Tariffs to Calculate Quality-Adjusted Life-Years. BioDrugs. 2015 Jan 30. [Epub ahead of print] PubMed PMID: 25633571.

9: Moran AE, Odden MC, Thanataveerat A, et. al. Cost-effectiveness of hypertension therapy according to 2014 guidelines. N Engl J Med. 2015 Jan 29;372(5):447-55. PubMed PMID: 25629742.

10: Zachariah JP, Samnaliev M. Echo-based screening of rheumatic heart disease in children: a cost-effectiveness Markov model. J Med Econ. 2015 Jan 28:1-30. [Epub ahead of print] PubMed PMID: 25629653.

11: Roberts KJ, Sutton AJ, Prasad KR, et. al. Cost-utility analysis of operative versus non-operative treatment for colorectal liver metastases. Br J Surg. 2015 Jan 26. [Epub ahead of print] PubMed PMID: 25624168.

12: Palmer R, Cooper C, Enderby P, et. al. Clinical and cost effectiveness of computer treatment for aphasia post stroke (Big CACTUS): study protocol for a randomised controlled trial. Trials. 2015 Jan 27;16(1):18. [Epub ahead of print] PubMed PMID: 25623162.

13: Hunter R. Cost-Effectiveness of Point-of-Care C-Reactive Protein Tests for Respiratory Tract Infection in Primary Care in England. Adv Ther. 2015 Jan;32(1):69-85. Epub 2015 Jan 27. PubMed PMID: 25620538.

14: Younossi ZM, Park H, Saab S, et. al. Cost-effectiveness of all-oral ledipasvir/sofosbuvir regimens in patients with chronic hepatitis C virus genotype 1 infection. Aliment Pharmacol Ther. 2015 Jan 26. [Epub ahead of print] PubMed PMID: 25619871.

15: Wade R, Duarte A, Simmonds M, et. al. The Clinical and Cost Effectiveness of Aflibercept in Combination with Irinotecan and Fluorouracil-Based Therapy (FOLFIRI) for the Treatment of Metastatic Colorectal Cancer Which has Progressed Following Prior Oxaliplatin-Based Chemotherapy: a Critique of the Evidence. Pharmacoeconomics. 2015 Jan 24. [Epub ahead of print] PubMed PMID: 25616671.

16: Vanneste BG, Pijls-Johannesma M, Van De Voorde L, et. al. Spacers in radiotherapy treatment of prostate cancer: Is reduction of toxicity cost-effective? Radiother Oncol. 2015 Jan 20. [Epub ahead of print] PubMed PMID: 25616537.

17: Lønne G, Johnsen LG, Aas E, et. al. Comparing cost-effectiveness of X-stop to minimally Invasive Decompression in Lumbar Spinal Stenosis: A Randomized Controlled Trial. Spine (Phila Pa 1976). 2015 Jan 20. [Epub ahead of print] PubMed PMID: 25608246.

18: Tierney WM. Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med. 2015 Jan 22;372(4):387-8. PubMed PMID: 25607439.

19: Pinsky PF. Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med. 2015 Jan 22;372(4):387. PubMed PMID: 25607438.

20: Black WC, Keeler EB, Soneji SS. Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med. 2015 Jan 22;372(4):388. PubMed PMID: 25607437.

21: Haas M, De Abreu Lourenco R. Pharmacological Management of Chronic Lower Back Pain: A Review of Cost Effectiveness. Pharmacoeconomics. 2015 Jan 22. [Epub ahead of print] PubMed PMID: 25604096.

22: Kirsch F. A systematic review of quality and cost-effectiveness derived from Markov models evaluating smoking cessation interventions in patients with chronic obstructive pulmonary disease. Expert Rev Pharmacoecon Outcomes Res. 2015 Jan 20:1-16. [Epub ahead of print] PubMed PMID: 25600470.

23: Whitehurst DG, Bryan S, Lewis M, et. al. Implementing Stratified Primary care Management for low Back Pain: Cost Utility Analysis alongside a Prospective, Population-based, Sequential Comparison Study. Spine (Phila Pa 1976). 2015 Jan 16. [Epub ahead of print] PubMed PMID: 25599287.

24: Hansson E, Ekman I, Swedberg K, et. al. Person-centred care for patients with chronic heart failure - a cost-utility analysis. Eur J Cardiovasc Nurs. 2015 Jan 16. [Epub ahead of print] PubMed PMID: 25595358.

25: Aboagye E, Karlsson ML, Hagberg J, et. al. Cost-effectiveness of early interventions for non-specific low back pain: A randomized controlled study investigating medical yoga, exercise therapy and self-care advice. J Rehabil Med. 2015 Jan 27;47(2):167-73. PubMed PMID: 25403347.

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