The CEA Registry Blog

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.

By CEA Registry Team on 2/5/2015 10:07 AM

By Cayla Saret, BA and Peter Neumann, ScD

The costs of new treatments for hematologic malignancies (blood cancers) have provoked debate, such as the much-discussed piece in the journal Blood criticizing high prices for tyrosine kinase inhibitors for chronic myeloid leukemia. At times perspectives in this debate take into account only the cost of treatment or only the benefits, rather than both.

In a new paper also published in Blood, we and our colleagues investigated both the costs and benefits of innovative treatments across these cancers. We found that, though many of these treatments are associated with high costs, many are also associated with large benefits. Based on our analysis of the available literature, with some important caveats, many of these treatments may be cost-effective according to commonly used standards.

For our analysis, we included studies from the Tufts Cost-Effectiveness Analysis (CEA) Registry pertaining to innovative treatments for hematologic cancers. The CEA Registry includes studies that measure health benefits in quality-adjusted life years (QALYs), a measure that incorporates both length and quality of life. We found 29 studies (published 1996-2012) reporting 44 cost-effectiveness ratios, which we grouped into nine treatment agents and four cancer types. For each study, we extracted information about the study’s methodology, transparency, and a subjective quality rating. We examined cost-effectiveness ratios across the studies as well as within subgroups such as industry and non-industry-funded studies and studies that received a high quality rating.

Most cost-effectiveness ratios fell below (were more favorable than) the widely used $50,000/QALY or $100,000/QALY thresholds (73% and 86%, respectively). Industry-funded studies found a lower (more favorable) median ratio – $26,000/QALY – than non-industry-funded studies – $33,000/QALY.  This difference was not statistically significant. The distribution of cost-effectiveness ratios by value in the high quality studies (quality score ≥ 5 on a rating scale of 1-7, with 7 being the best) was similar to the overall distribution and not significantly different from the findings of the overall analysis.

Our study is limited by the small sample size of the studies. As with other studies based on published literature, findings may be subject to publication bias including selected conduct and reporting of studies. We limited our study to the cost-per-QALY literature and did not include other analyses such as cost-per-life year studies. In addition, cost-effectiveness ratios may have changed over time as associated costs or benefits have changed. For example, imatinib’s price increased to roughly three times its original price over about a decade.

In conclusion, our study suggests that many new treatments for these cancers may be cost-effective according to the published literature. Treatments appear to have both high prices and substantial health benefits in terms of quality-adjusted life years. Decision-makers may use cost-effectiveness as one factor among others (e.g. values, preferences, and affordability) when considering coverage for these and other interventions.

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 2/2/2015 4:11 PM

By James D. Chambers, Ph.D.

In a new paper published in Health Affairs, my colleagues and I examine whether Medicare coverage in national coverage determinations (NCDs) – the coverage pathway typically reserved for ‘big-ticket’ technologies – has become more restrictive over time.(1)

Using the Tufts Medical Center National Coverage Determination Database as our starting point, we developed a novel dataset of clinical evidence reviewed in NCDs and other factors known to influence decision making.(2)  We used logistic regression to examine whether coverage policy has changed over time when controlling for the quality of supporting clinical evidence and other factors. 

We found that when holding constant the level of supporting evidence, more recent coverage determinations (from mid-March 2008 through August 2012) were approximately twenty times less likely to be positive than earlier coverage determinations (from February 1999 through January 2002).  In other words, the evidentiary bar for medical intervention coverage under Medicare national coverage determinations became higher between 1999 and 2012.

We also found various characteristics of the clinical evidence and non-evidentiary decision inputs to be positively associated with coverage, including:

  • The number of patients in randomized controlled trials
  • The consistency of intervention-favorable findings among randomized controlled trials, among other clinical trials, and among clinical reviews
  • The consistency of favorable recommendations among clinical guidelines
  • The availability of alternative therapeutic approaches
  • The availability of cost-effectiveness evidence

Coverage policy is an important payer tool for promoting the appropriate use of medical interventions in the Medicare program.  However, rising evidence standards raise questions regarding patients’ access to new medical interventions and the challenges faced by manufacturers as they attempt to bring innovations to the market.

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
  2. Chambers JD, Morris S, Neumann PJ, Buxton MJ.  Factors Predicting Medicare National Coverage: An Empirical Analysis. Med Care 2012; 50:249–256

 

By CEA Registry Team on 1/22/2015 10:09 AM

The Social Security Act established the Medicare program in 1965 to cover services “reasonable and necessary for diagnosis or treatment.” The first coverage for a preventive service (pneumococcal inoculation) under the program did not occur until Congressional action in 1980. Today, Medicare covers 23 preventive services.

Figure 1: Timeline of Preventative Services Covered for Medicare Beneficiaries
 


 
Click to view a larger image.

Read more about Medicare coverage of preventive services and the use of cost-effectiveness analysis in the blog post and the Health Policy paper.

References

1.    Chambers, JD, Cangelosi, MJ, Neumann, PJ. Medicare’s use of cost-effectiveness analysis for prevention (but not for treatment). Health Policy 2014 Nov 22. [Epub ahead of print]

By CEA Registry Team on 1/20/2015 2:22 PM

By James Chambers, PhD

In a new paper published in Health Policy, my colleagues and I investigated the use of cost-effectiveness analysis (CEA) in Medicare coverage of prevention. We found that cost-effectiveness has played a longstanding role in coverage determinations for several preventive health services.  In contrast, no such consideration is used in coverage of treatments. While Medicare once dealt primarily with paying claims for treatments, preventative services have been gradually added to the program, with their addition becoming more commonplace over the past ten years. There has been little examination to date of the role CEA has played in coverage determinations for preventive measures.

When preventive services were initially added to the program, it was through Congressional action that required evidence of affordability. Of the 23 preventive services currently covered by Medicare, CEA played a role in coverage for nine. For example, CEA was used in coverage determinations for pneumococcal vaccine (1981), HIV screening (2010), and screening and behavioral counseling for alcohol misuse (2011). In addition, CEA was considered in multiple cases when Medicare decided not to cover a preventive service, e.g., screening computed tomography colonography (CTC) for colorectal cancer.

In other ways, the US has increasingly made efforts to promote preventive care – such as the addition of the annual wellness visit to the Medicare benefits package (2011).  However, by evaluating the cost-effectiveness of preventive services and not treatment, the government holds prevention to a stricter evidence standard.  Using CEA for prevention and not for treatment is a double standard. Expanding the role of CEA in Medicare coverage to include treatment would add balance and evidence to the process, and efficiency to the program.


References

1.    Chambers, JD, Cangelosi, MJ, Neumann, PJ. Medicare’s use of cost-effectiveness analysis for prevention (but not for treatment). Health Policy 2014 Nov 22. [Epub ahead of print]

By CEA Registry Team on 1/16/2015 1:32 PM

By Cayla Saret, B.A.

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

1: Lee BY, Bartsch SM, Brown ST, et. al. Quantifying the Economic Value and Quality of Life Impact of Earlier Influenza Vaccination. Med Care. 2015 Jan 14. [Epub ahead of print] PubMed PMID: 25590676.

2: 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 Jan 14. [Epub ahead of print] PubMed PMID: 25590606.

3: Looker KJ, Wallace LA, Turner KM. Impact and cost-effectiveness of chlamydia testing in Scotland: a mathematical modelling study. Theor Biol Med Model. 2015 Jan 15;12(1):2. [Epub ahead of print] PubMed PMID: 25588390.

4: Stoddart A, van der Pol M, Pinnock H, et. al. Telemonitoring for chronic obstructive pulmonary disease: a cost and cost-utility analysis of a randomised controlled trial. J Telemed Telecare. 2015 Jan 13. [Epub ahead of print] PubMed PMID: 25586810.

5: Huxley N, Jones-Hughes T, Coelho H, et. al. A systematic review and economic evaluation of intraoperative tests [RD-100i one-step nucleic acid amplification (OSNA) system and Metasin test] for detecting sentinel lymph node metastases in breast cancer. Health Technol Assess. 2015 Jan;19(2):1-216. PubMed PMID: 25586547.

6: Grosse SD, Chaugule SS, Hay JW. Estimates of utility weights in hemophilia: implications for cost-utility analysis of clotting factor prophylaxis. Expert Rev Pharmacoecon Outcomes Res. 2015 Jan 14:1-17. [Epub ahead of print] PubMed PMID: 25585817.

7: Ross EL, Weinstein MC, Schackman BR, et. al. The clinical role and cost-effectiveness of long-acting antiretroviral therapy. Clin Infect Dis. 2015 Jan 12. [Epub ahead of print] PubMed PMID: 25583979.

8: Wong WW, Tu HA, Feld JJ, et. al. Cost-effectiveness of screening for hepatitis C in Canada. CMAJ. 2015 Jan 12. [Epub ahead of print] PubMed PMID: 25583667.

9: Quartuccio L, Di Bidino R, Ruggeri M, et. al. Cost-effectiveness analysis of two Rituximab retreatment regimens for longstanding rheumatoid arthritis. Arthritis Care Res (Hoboken). 2015 Jan 7. [Epub ahead of print] PubMed PMID: 25581074.

10: Gaudette É, Goldman DP, Messali A, et. al. Do Statins Reduce the Health and Health Care Costs of Obesity? Pharmacoeconomics. 2015 Jan 10. [Epub ahead of print] PubMed PMID: 25576147.

11: Kvamme MK, Lie E, Uhlig T, et. al. Cost-effectiveness of TNF inhibitors vs synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: a Markov model study based on two longitudinal observational studies. Rheumatology (Oxford). 2015 Jan 7. [Epub ahead of print] PubMed PMID: 25573840.

12: Ang M, Nguyen HV, Kiew SY, et. al. Cost-effectiveness of alternative strategies for interferon-γ release assays and tuberculin skin test in tuberculous uveitis. Br J Ophthalmol. 2015 Jan 8. [Epub ahead of print] PubMed PMID: 25573149.

13: You JH, Lui G, Kam KM, et. al. Cost-effectiveness analysis of the Xpert MTB/RIF assay for rapid diagnosis of suspected tuberculosis in an intermediate burden area. J Infect. 2015 Jan 6. [Epub ahead of print] PubMed PMID: 25573001.

14: Zhang Z, Kolm P, Grau-Sepulveda MV, et. al. Cost-Effectiveness of Revascularization Strategies: The ASCERT Study. J Am Coll Cardiol. 2015 Jan 6;65(1):1-11. PubMed PMID: 25572503.

15: Stollenwerk B, Bartmus T, Klug F, et. al. Cost-effectiveness of hip protector use on a geriatric ward in Germany: a Markov model. Osteoporos Int.2015 Jan 9. [Epub ahead of print] PubMed PMID: 25572047.

16: Dick AW, Perencevich EN, Pogorzelska-Maziarz M, et. al. A decade of investment in infection prevention: A cost-effectiveness analysis. Am J Infect Control. 2015 Jan 1;43(1):4-9. PubMed PMID: 25564117.

17: Obreli-Neto PR, Marusic S, Guidoni CM, et. al. Economic evaluation of a pharmaceutical care program for elderly diabetic and hypertensive patients in primary health care: a 36-month randomized controlled clinical trial. J Manag Care Spec Pharm. 2015 Jan;21(1):66-75. PubMed PMID: 25562774.

18: Delea TE, Amdahl J, Diaz J, et. al. Cost-effectiveness of pazopanib versus sunitinib for renal cancer in the United States. J Manag Care Spec Pharm. 2015 Jan;21(1):46-54. PubMed PMID: 25562772.

19: Chen LA, Kim J, Boucher K, et. al. Toxicity and cost-effectiveness analysis of intensity modulated radiation therapy versus 3-dimensional conformal radiation therapy for postoperative treatment of gynecologic cancers. Gynecol Oncol. 2015 Jan 3. [Epub ahead of print] PubMed PMID: 25562668.

20: Shearer DW, Youm J, Bozic KJ. Short-term Complications Have More Effect on Cost-effectiveness of THA than Implant Longevity. Clin Orthop Relat Res. 2015 Jan 6. [Epub ahead of print] PubMed PMID: 25560958.

21: Minor T, Lasher A, Klontz K, et. al. The Per Case and Total Annual Costs of Foodborne Illness in the United States. Risk Anal. 2015 Jan 2. [Epub ahead of print] PubMed PMID: 25557397.

22: Hendriksen JM, Geersing GJ, van Voorthuizen SC, et. al. The cost-effectiveness of point-of-care D-dimer tests compared with a laboratory test to rule out deep venous thrombosis in primary care. Expert Rev Mol Diagn. 2015 Jan;15(1):125-36. PubMed PMID: 25537569.

23: D'Amico F, Rehill A, Knapp M, et. al. Maintenance cognitive stimulation therapy: an economic evaluation within a randomized controlled trial. J Am Med Dir Assoc. 2015 Jan 1;16(1):63-70. PubMed PMID: 25528281.

24: Gupta V, Baabbad R, Hammerby E, et. al. An analysis of the cost-effectiveness of switching from biphasic human insulin 30, insulin glargine, or neutral protamine Hagedorn to biphasic insulin aspart 30 in people with type 2 diabetes. J Med Econ. 2015 Jan 2:1-10. [Epub ahead of print] PubMed PMID: 25426701.

25: Revill PA, Walker S, Mabugu T, et. al. Opportunities for improving the efficiency of paediatric HIV treatment programmes. AIDS. 2015 Jan 14;29(2):201-10. PubMed PMID: 25396263.

26: Rochau U, Sroczynski G, Wolf D, et. al. Cost-effectiveness of the sequential application of tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia. Leuk Lymphoma. 2015 Jan 14:1-11. [Epub ahead of print] PubMed PMID: 25393806.

27: Schackman BR, Leff JA, Barter DM, et. al. Cost-effectiveness of rapid hepatitis C virus (HCV) testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs. Addiction. 2015 Jan;110(1):129-43. PubMed PMID: 25291977.

28: Beresniak A, Medina-Lara A, Auray JP, et. al. Validation of the Underlying Assumptions of the Quality-Adjusted Life-Years Outcome: Results from the ECHOUTCOME European Project. Pharmacoeconomics. 2015 Jan;33(1):61-9. PubMed PMID: 25230587.

29: Yu SY, Lee TJ, Jang SH, et. al. Cost-effectiveness of nationwide opportunistic screening program for dementia in South Korea. J Alzheimers Dis. 2015 Jan 1;44(1):195-204. PubMed PMID: 25208621.

30: Fleeman N, Bagust A, Beale S, et. al. Pertuzumab in Combination with Trastuzumab and Docetaxel for the Treatment of HER2-Positive Metastatic or Locally Recurrent Unresectable Breast Cancer. Pharmacoeconomics. 2015 Jan;33(1):13-23. PubMed PMID: 25138171.

31: King CH. Health metrics for helminth infections. Acta Trop. 2015 Jan;141(PtB):150-60. Epub 2013 Dec 12. PubMed PMID: 24333545.

By CEA Registry Team on 1/5/2015 1:13 PM

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

Cost-effectiveness thresholds, healthcare spending, quality-adjusted life years (QALYs)…we covered these topics and more in 2014. Here are some of our most popular posts of the past year. Follow us on Twitter and Facebook for updates.

1.       FDA considers draft guidance on FDAMA Section 114 (March 11): The Food and Drug Administration may offer further guidance on legislation that governs pharmaceutical companies’ promotion of health economic information.

2.       The curious resilience of the $50,000-per-QALY threshold (Aug 27): Researchers argue that multiple cost-effectiveness thresholds should replace the outdated $50,000-per-QALY metric.

3.       Cost-effectiveness analysis of personalized medicine: How much uncertainty is acceptable?: (Feb 27): Researchers debate the use of cost-effectiveness analysis for new genetic tests that may lack firm evidence of clinical effectiveness.

4.       Do specialty drugs offer value for money? (Oct 6): Specialty drugs may, in many cases, offer good value despite higher costs.

5.       Photo highlights from the CEVR symposium and celebratory dinner (Sept 22): In September, CEVR held a Symposium on Innovation and Cost-Effectiveness Research and a dinner to celebrate the CEA Registry’s 15th Anniversary.

6.       What are the returns of cancer research? Using QALYs to calculate IRR (Jul 16): One of the few papers to qualify the overall returns of medical research suggests “substantial” return for development of cancer-related interventions.

7.       Do PBM’s recent formulary restrictions point to an increased role for cost-effectiveness analysis in the US? (Aug 5): Changes in coverage policy by Express Scripts and CVS Caremark suggest that cost-effectiveness analysis may play a greater role in decisions by U.S. payers.

8.       Why the spike in new cost utility analyses in 2012? (March 27): Two possible explanations may illuminate why about 45% more cost-utility analyses were published in 2012 than 2011.

9.       What cost-effectiveness thresholds do US health economics cite most often? (Aug 28): While the $50,000-per-QALY threshold is commonly used, use of the $100,000-per-QALY benchmark is also increasing.

10.   A half century of US healthcare spending (Jul 24): A report by the California HealthCare Foundation provided insight into changes in healthcare spending in the last 50 years.

 

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