The CEA Registry Blog

By CEA Registry Team on 4/17/2014 8:32 AM

By: Pei-Jung Lin, Ph.D.

Strategies to help improve memory and boost brain health have received a great deal of attention for preventing Alzheimer’s disease and related dementias (ADRD). But less attention has been given to how effectively managing the occurrence of chronic conditions that may underlie dementia could influence the disease burden and its associated health care costs.

Our recent paper in the journal Health Affairs evaluated the “unintended benefits” stemming from better managing four modifiable risk factors for ADRD – cardiovascular disease, hypertension, diabetes, and Body Mass Index (BMI) – in older adults. We chose these four risk factors because they have reasonably strong evidence to back them up.

Our model predicted substantial savings for both Medicare and Medicaid from controlling ADRD risk factors.  Our model also showed that a 10-percent reduction in prevalence rates from chronic conditions, such as cardiovascular diseases, could help delay the onset of ADRD and shorten its duration.

With health care costs for ADRD soaring and the projected number of cases climbing as Baby Boomers get older and live longer, there’s a greater need for successful strategies to prevent the disease or intervene early in its development.

But it’s extremely challenging to design clinical trials aimed at preventing ADRD. One reason is that the disease’s underlying mechanism remains unclear. A second is that it’s difficult to select a target population to participate in the research. And a third is that the trial would need to enroll a large number of participants and involve lengthy follow-up periods.

Thus, our simulation model provides an alternative approach for projecting the health and economic impacts of addressing risk factors linked with ADRD.  Our results could be used along with other economic evaluations to ultimately determine the most cost-effective strategies for addressing ADRD.

Our findings could serve as benchmarks to help government officials and policy makers evaluate potential future costs and health care needs, and conduct public health planning for ADRD. Restrained health care spending growth could also benefit employers and payers.

Lin PJ, Yang Z, Fillit HM, Cohen JT, Neumann PJ. Unintended benefits: the potential economic impact of addressing risk factors to prevent Alzheimer’s disease. Health Affairs. 2014; 33(4):547-554.

By CEA Registry Team on 4/8/2014 11:09 AM

By: Pei-Jung Lin, Ph.D.

Managing risk factors linked with preventing Alzheimer's disease and related dementias (ADRD) could substantially reduce its health care costs, according to a new analysis my colleagues and I have published in the April issue of the journal Health Affairs.

Our research found that addressing modifiable risk factors, such as cardiovascular diseases, hypertension, diabetes, and body mass index (BMI), could lessen the chances of developing ADRD, delay its onset, and shorten the duration. 

We also showed that managing these four risk factors could increase the amount of time that older adults lived without ADRD, and greatly reduce costs.

To our knowledge, the study is the first to look at the “unintended benefits” of addressing these modifiable risk factors for ADRD.

We examined data from a group of 65-year-old Medicare patients with ADRD. We also developed a simulation model to predict the impact of a 10 percent drop in the prevalence rates of cardiovascular diseases, diabetes, high blood pressure, and BMI among overweight or obese older adults.

In each of these four scenarios, we explored the potential health gains and saving opportunities from reducing the prevalence of these modifiable risks.

Our simulation showed that a 10 percent drop in the prevalence rates of cardiovascular diseases could save an estimated $20 billion for Medicare and $17 billion for Medicaid in Alzheimer's-related expenses. Similar reductions in hypertension could save approximately $12 billion each for Medicare and Medicaid; in diabetes, $7 billion for Medicare and $1 billion for Medicaid; and a 10 percent reduction in BMI among overweight or obese older adults, $6 billion for Medicare and $35 billion for Medicaid.

Knowing the health consequences and economic impact of addressing modifiable Alzheimer's risk factors is important given the lack of effective treatment for the disease, the high cost of new drug therapies, and the pressure to curb health spending.

In 2014, Alzheimer's disease will cost the United States an estimated $214 billion, including $150 billion in costs to Medicare ($113 billion) and Medicaid ($37 billion), according to the Alzheimer's Association.

Although more data are needed to support the control of risk factors as an effective way to prevent ADRD, our research demonstrates that efforts to better manage chronic conditions may have added benefits to managing the disease.

The research was funded by the Alzheimer's Drug Discovery Foundation and the Alzheimer's Foundation of America.

Lin PJ, Yang Z, Fillit HM, Cohen JT, Neumann PJ. Unintended benefits: the potential economic impact of addressing risk factors to prevent Alzheimer’s disease. Health Affairs. 2014; 33(4):547-554.

 

By CEA Registry Team on 3/27/2014 10:26 AM

By Teja Thorat, M.Sc., M.P.H, Peter Neumann, Sc.D., and Joshua T. Cohen, Ph.D.

When we recently updated the CEA Registry for 2012, it became apparent that there was a notable spike in the number of studies added that year. Roughly 45 percent more cost-utility analyses (CUAs) were published in PubMed in 2012 than 2011 (538 versus 372).



We have identified two potential explanations for the increase:

•    Journals that have published CUAs in the past, such as the Journal of Medical Economics, PLoS ONE, Clinical Therapeutics, Pharmacoeconomics, BMJ Open, International Journal of Technology Assessment in Health Care have increased the number of CUAs they are publishing. Between 2011 and 2012, these journals have more than doubled the number of CUAs they published.

•    There was a rise in the number of journals publishing CUAs for the first time in 2012, reflecting a growing interest in the field. The Registry included 60 journals that were first-time publishers of CUAs during 2012, such as Acta Ophthalmologica, Bulletin of the World Health Organization, Journal of the American Medical Informatics Association, Journal of Cancer, Clinical Rheumatology. These include existing journals that have started publishing CUAs, or brand-new journals, or journals newly indexed on PubMed. 

Journals

Number of CUAs

2012

2011

Change from previous year

Journal of Medical Economics

38

11

27

PLoS One

21

11

10

Clinical Therapeutics

15

7

8

Pharmacoeconomics

14

7

7

BMJ Open

8

2

6

International Journal of Technology Assessment in Health Care

9

4

5

Osteoporosis International

6

1

5

Heart

6

1

5

Applied Health Economics and Health Policy

7

3

4

BMC Health Services Research

7

3

4

Breast Cancer Research and Treatment

5

1

4

European Heart Journal

4

0

4

AIDS and Behavior

4

0

4

 

Our initial count of articles published in 2013 suggests that the number of CUAs published in 2013 will be comparable to the number published in 2012. As seen in recent years, we can also expect more CUAs from emerging market countries, such as China, Japan and South Korea. For example, the number of CUAs from China increased from 3 in 2011 to 10 in 2012.  

Although we still do not understand why there has been a dramatic increase in the publication of CUAs, it is possible that it reflects an increased interest in assessing economic value, a sense that cost-utility analysis is an effective way to address this issue and to communicate findings, or some combination of the two.

 

By CEA Registry Team on 3/11/2014 2:47 PM

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

On March 3rd, a Federal Register Notice said the Food and Drug Administration (FDA) is seeking input from the public on issues related to Section 114 of the Food and Drug Administration Modernization Act (FDAMA).

The Notice states that the agency is considering writing a draft guidance to clarify appropriate ways for pharmaceutical companies to discuss their products with payers and other audiences. Many people who work in the industry have found aspects of the law in this area vague.

To clarify its understanding of the law, the agency may specifically address FDAMA Section 114. The FDA may offer its interpretation of the regulation of health care economic information as a component of a drug’s promotional material.  

This development is notable on several fronts.  Elsewhere on this blog, we have noted that, despite the growing importance of health economic information, the FDA has not released guidance or taken regulatory action on Section 114 to date.  

We have also called attention to the limitations of Section 114 and called for an expansion of the Section to include comparative effectiveness information.  We believe the Notice of possible draft guidance is therefore a positive step by the FDA but it will be important to see how the agency addresses the provision, and how far they are willing to go to provide flexibility for drug company communications in the area.

 

By CEA Registry Team on 3/11/2014 9:02 AM

By: Teja Thorat, MPH

The CEA Registry has finished updating and revising its study database through 2012.

We added 158 new studies previously not included in the CEA Registry between 2004 and 2011.  This addition brings our total number of CUAs to 3,722 studies published through 2012. 

A revision was necessary to include some cost-utility analyses studies published between 2004 and 2011 that were inadvertently missed in our previous searches.

These omissions occurred because our PubMed search process had previously used a study’s publication date as a search criterion. This sometimes limited our search if a study was not indexed by MEDLINE, the National Library of Medicine database, until weeks or months after its date of publication, which delayed the study’s appearance in PubMed.

To avoid this problem, our new search method now includes all PubMed entries matching our search terms, regardless of their publication date. As a result, we pick up more CUAs for inclusion in the Registry. 

The table below shows the number of studies added to the Registry in our recent update.

Year Additional Studies Total Studies
2004 7 177
2005 8 226
2006 8 228
2007 2 300
2008 18 360
2009 49 400
2010 43 384
2011 23 372
2012 10 538

 

By CEA Registry Team on 2/27/2014 9:43 AM

By Cayla Saret, BA

In a commentary published online recently in Genetics in Medicine, Scott Grosse, a health economist at the CDC’s National Center on Birth Defects and Developmental Disabilities, suggests that researchers wait to conduct cost-utility analyses (CUAs) of personalized medicine tests until evidence of their clinical utility is more thoroughly validated.(1)

Grosse worries that in the relatively new field of personalized medicine tests, cost-effectiveness studies based on early evaluations of their clinical utility may later prove unreliable.

His comments come in response to the first review, also appearing in Genetics in Medicine, to evaluate the economic value of personalized medicine tests. This research, led by Kathryn Phillips of the University of San Francisco, examined 59 CUAs published between 1998 and 2011.(2) These studies were included in the Tufts Medical Center Cost-Effectiveness Analysis Registry, a database of CUAs of health interventions.

The analysis suggests that many personalized medicine tests are relatively cost-effective. It also found that 20 percent of genetic tests saved money. However, as Grosse points out, Phillips and colleagues were careful not to draw conclusions about the cost effectiveness of genetic tests in personalized medicine as a whole.

Grosse cautions against making generalizations about the cost effectiveness of genetic tests before there is strong medical evidence of their effectiveness in improving patient outcomes. For example, he is concerned that a CUA might help decide whether to invest time and resources in a test for a cancer mutation, even though the CUA was carried out using weak evidence about the test’s clinical value. 

Phillips and her research team acknowledged that many genetic tests lack firm evidence of their clinical value. They observe, however, that often by the time this information is available, payers may have already decided whether to adopt or reject the test. So an assessment of benefits, risks, and costs is valuable in part because it occurs early in the process.

“We constantly grapple with the uncertain nature of evidence surrounding these and other new technologies,” says study co-author Peter Neumann, director of the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center. “However, decisions about new technologies, such as personalized medicine testing, need to be made on an ongoing basis.  CUAs can help inform those decisions, though we need to do a better job of understanding and characterizing the uncertainty.”

As Grosse highlights, there is value in waiting for more evidence. But constructing too high a bar for it also has consequences. Ultimately, there is a need to weigh the costs and benefits of acquiring additional information. 


References

    1.     Grosse SD. Economic analyses of genetic tests in personalized medicine: clinical utility first, then cost utility. Genet Med e-pub ahead of print  14 Nov 2013.
    2.     Phillips KA, Sakowski JA, Trosman J, Douglas MP, Liang SY, Neumann P. The economic value of personalized medicine tests: what we know and what we need to know. Genet Med e-pub ahead of print  14 Nov 2013.


 

By CEA Registry Team on 2/18/2014 10:32 AM

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

1: Komenda P, Ferguson TW, Macdonald K, et al. Cost-effectiveness of Primary Screening for CKD: A Systematic Review. Am J Kidney Dis. 2014 Feb 12. [Epub ahead of print] PubMed PMID: 24529536.
 
2: Ament JD, Greene KR, Flores I, et al. Health impact and economic analysis of NGO-supported neurosurgery in Bolivia. J Neurosurg Spine. 2014 Feb 14. [Epub ahead of print] PubMed PMID: 24527825.
 
3: Ma Y, Ying X, Zou H, et al. Cost-utility Analysis of Rhegmatogenous Retinal Detachment Surgery in Shanghai, China. Ophthalmic Epidemiol. 2014 Feb 14. [Epub ahead of print] PubMed PMID: 24527711.
 
4: Achelrod D, Stargardt T. Cost-Utility Analysis Comparing Heavy-Weight and Light-Weight Mesh in Laparoscopic Surgery for Unilateral Inguinal Hernias. Appl Health Econ Health Policy. 2014 Feb 13. [Epub ahead of print] PubMed PMID: 24526592.
 
5: Attard CL, Brown S, Alloul K, et al. Cost-effectiveness of folfirinox for first-line treatment of metastatic pancreatic cancer. Curr Oncol. 2014 Feb;21(1):e41-51. PubMed PMID: 24523620.
 
6: Levy AR, Zou D, Risebrough N, et al. Cost-effectiveness in Canada of azacitidine for the treatment of higher-risk myelodysplastic syndromes. Curr Oncol. 2014 Feb;21(1):e29-40. PubMed PMID: 24523619; PubMed Central PMCID: PMC3921046.
 
7: Dorian P, Kongnakorn T, Phatak H, et al. Cost-effectiveness of apixaban vs. current standard of care for stroke prevention in patients with atrial fibrillation. Eur  Heart J. 2014 Feb 9. [Epub ahead of print] PubMed PMID: 24513791.
 
8: Kourlaba G, Maniadakis N, Andrikopoulos G, et al. Economic evaluation of rivaroxaban in stroke prevention for patients with atrial fibrillation in Greece. Cost Eff Resour Alloc. 2014 Feb 10;12(1):5. [Epub ahead of print] PubMed PMID: 24512351.
 
9: Hildebrandt T, Thiel FC, Fasching PA, et al. Health utilities in gynecological oncology and mastology in Germany. Anticancer Res. 2014 Feb;34(2):829-35. PubMed PMID: 24511019.
 
10: Obach D, Deuffic-Burban S, Esmat G, et al. Effectiveness and cost-effectiveness of immediate vs. delayed treatment of HCV-infected patients in a country with limited resources: the case of Egypt. Clin Infect Dis. 2014 Feb 7. [Epub ahead of print] PubMed PMID: 24510934.
 
11: Lip GY, Kongnakorn T, Phatak H, et al. Cost-effectiveness of apixaban versus other new oral anticoagulants for stroke prevention in atrial fibrillation. Clin Ther. 2014 Feb 1;36(2):192-210.e20. Epub 2014 Feb 6. PubMed PMID: 24508420.
 
12: Che D, Zhou H, He J, et al. Modeling the impact of the 7-valent pneumococcal conjugate vaccine in Chinese infants: an economic analysis of a compulsory vaccination. BMC Health Serv Res. 2014 Feb 7;14:56. PubMed PMID: 24507480.
 
13: Akunne A, Davis S, Westby M, et al. The cost-effectiveness of multi-component interventions to prevent delirium in older people undergoing surgical repair of hip fracture. Eur J Orthop Surg Traumatol. 2014 Feb;24(2):187-95. Epub 2013 Feb 15. PubMed PMID: 23412312.
 
14: Angus C, Scafato E, Ghirini S, et al. Cost-effectiveness of a programme of screening and brief interventions for alcohol in primary care in Italy. BMC Fam Pract. 2014 Feb 6;15(1):26. [Epub ahead of print] PubMed PMID: 24502342.
 
15: Wu B, Kun L, Liu X, et al. Cost-effectiveness of different strategies for stroke prevention in patients with atrial fibrillation in a health resource-limited setting. Cardiovasc Drugs Ther. 2014 Feb;28(1):87-98. PubMed PMID: 24048510.
 
16: Gulliford MC, Bhattarai N, Charlton J, et al. Cost-effectiveness of a universal strategy of brief dietary intervention for primary prevention in primary care: population-based cohort study and Markov model. Cost Eff Resour Alloc. 2014 Feb 2;12(1):4. PubMed PMID: 24485221.
 
17: Caughey AB, Burchfield DJ. Costs and cost-effectiveness of periviable care. Semin Perinatol. 2014 Feb;38(1):56-62. PubMed PMID: 24468571.
 
18: Garcia A, Liu TH, Victorino GP. Cost-utility analysis of prehospital spine immobilization recommendations for penetrating trauma. J Trauma Acute Care Surg.  2014 Feb;76(2):534-41. PubMed PMID: 24458063.
 
19: Herman PM, Szczurko O, Cooley K, et al. A naturopathic approach to the prevention of cardiovascular disease: cost-effectiveness analysis of a pragmatic multi-worksite randomized clinical trial. J Occup Environ Med. 2014 Feb;56(2):171-6. PubMed PMID: 24451612.
 
20: Adena M, Houltram J, Mulligan SP, et al. Modelling the cost effectiveness of rituximab in chronic lymphocytic leukaemia in first-line therapy and following relapse. Pharmacoeconomics. 2014 Feb;32(2):193-207. PubMed PMID: 24442832.
 
21: Clarke A, Pulikottil-Jacob R, Connock M, et al. Cost-effectiveness of left ventricular assist devices (LVADs) for patients with advanced heart failure: Analysis of the British NHS bridge to transplant (BTT) program. Int J Cardiol. 2014 Feb 15;171(3):338-45. PubMed PMID: 24424339.
 
22: Petrou PK, Talias MA. Cost-effectiveness of sorafenib compared to best supportive care in second line renal cell cancer from a payer perspective in Cyprus. Expert Rev Pharmacoecon Outcomes Res. 2014 Feb;14(1):131-8.  Epub 2014 Jan 7. PubMed PMID: 24397606.
 
23: Barbosa C, Smith EA, Hoerger TJ, et al. Cost-effectiveness Analysis of the National Perinatal Hepatitis B Prevention Program. Pediatrics. 2014 Feb;133(2):243-53. Epub 2014 Jan 6. PubMed PMID: 24394684.
 
24: Schneider K, Gray RT, Wilson DP. A Cost-effectiveness Analysis of HIV Preexposure Prophylaxis for Men Who Have Sex With Men in Australia. Clin Infect Dis. 2014 Feb 6. [Epub ahead of print] PubMed PMID: 24385445.
 
25: Penaloza-Ramos MC, Sheppard JP, Jowett S, et al. Cost-effectiveness of optimizing acute stroke care services for thrombolysis. Stroke. 2014 Feb;45(2):553-62. Epub 2014 Jan 2. PubMed PMID: 24385272.
 
26: van Haalen HG, Pompen M, Bergenheim K, et al. Cost effectiveness of adding dapagliflozin to insulin for the treatment of type 2 diabetes mellitus in the Netherlands. Clin Drug Investig. 2014 Feb;34(2):135-46. PubMed PMID: 24243529.
 
27: Hannouf MB, Xie B, Brackstone M, et al. Cost effectiveness of a 21-gene recurrence score assay versus canadian clinical practice in post-menopausal women with early-stage estrogen or progesterone-receptor-positive, axillary lymph-node positive breast cancer. Pharmacoeconomics. 2014 Feb;32(2):135-47. PubMed PMID: 24288208.
 
28: Tappenden P, Harnan S, Uttley L, et al. The Cost Effectiveness of Dry Powder Antibiotics for the Treatment of Pseudomonas aeruginosa in Patients with Cystic Fibrosis. Pharmacoeconomics. 2014  Feb;32(2):159-72. PubMed PMID: 24338264.
 
29: Dewilde S, Woods B, Castaigne JG, et al. Bendamustine-rituximab: a cost-utility analysis in first-line treatment of indolent non-Hodgkin's lymphoma in England and Wales. J Med Econ. 2014 Feb;17(2):111-24. Epub 2014 Jan 13. PubMed PMID: 24308372.
 
By Teja Thorat, MPH
By CEA Registry Team on 2/6/2014 10:45 AM

April in Boston means the return of the World Champion Red Sox to Fenway Park and the annual running of the Boston Marathon. It’s also the month when our Center for the Evaluation of Value and Risk in Health (CEVR) will hold its annual meeting.

Open exclusively to Center sponsors, this year’s by-invitation-only event will be held on Wednesday, April 9th at the Mandarin Oriental Hotel in Boston.

“At the meeting, attendees will learn cutting-edge research methods and gain insights on the latest policy developments,” said Peter Neumann, director of the Center for the Evaluation of Value and Risk in Health.

Some program highlights will include:

Is Innovation in Cancer Worthwhile? Our new study offers the latest empirical evidence on whether new drugs for blood-borne cancers improved patient survival rates at reasonable value for the money.

Does CER Influence Payer Coverage? We are quantifying the relationship between the clinical evidence base and Medicare coverage, giving a unique insight into the role of comparative-effectiveness research in coverage policy.

Thinking about Risk:  Donuts, Dioxin, and Drugs.  Life is full of trade-offs, whether they come from the food we put into our mouths or the drugs we put into our bodies. Using FDA’s proposed ban on trans fats as a starting point, this session will explore different ways of putting risks – like those posed by medical treatments – into perspective by comparing them to a range of benchmarks related to jobs, transportation, and recreation.

 

When Does FDAMA Section 114 Apply?  Special guest Laurie Burke, formerly of the FDA’s Office of New Drugs, will be part of a thought-provoking and engaging panel discussion, moderated by CEVR director, Peter Neumann, on when FDAMA 114 regulations apply to the promotion of drugs. This interactive session will focus on case studies that highlight key issues surrounding interpretation of the law.

We’ll present several drug case studies, attendees will vote on whether the law applies in each case, and a panel of experts will weigh in on the decision-making process from a governmental, legal, and health economics perspective.

A post-lunch walk. Stretch your legs along the Boston Marathon route and even cross the finish line -- without covering 26.2 miles!

Take advantage of this unique opportunity to learn from CEVR’s top researchers about their latest findings. To register for the meeting, Center sponsors can contact Julie Lannon at jlannon@tuftsmedicalcenter.org.
 

By CEA Registry Team on 11/11/2013 10:00 AM

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

1: Gomez JA, Tirado JC, Navarro Rojas AA, et al. Cost-effectiveness and cost utility analysis of three pneumococcal conjugate vaccines in children of Peru. BMC Public Health. 2013 Oct 30;13(1):1025. [Epub ahead of print] PubMed PMID: 24171921.

2: You JH. Pharmacogenetic-guided selection of warfarin versus novel oral anticoagulants for stroke prevention in patients with atrial fibrillation: a cost-effectiveness analysis. Pharmacogenet Genomics. 2013 Oct 28. [Epub ahead of  print] PubMed PMID: 24168919.

3: Edwards RT, Linck P, Hounsome N, et al. Cost-effectiveness of a national exercise referral programme for primary care patients in Wales: results of a randomised controlled trial. BMC Public Health. 2013 Oct 29;13(1):1021. [Epub ahead of print] PubMed PMID: 24164697.

4: Knapp M, King D, Romeo R, et al. Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial. BMJ. 2013 Oct 25;347:f6342. PubMed PMID: 24162943.

5: Nee R, Parker AL, Little DJ, et al. Cost-effectiveness of antiplatelet therapy to prolong primary patency of hemodialysis graft. Clin Nephrol. 2013 Oct 28. [Epub ahead of print] PubMed PMID: 24161074.

6: Cure S, Bianic F, Gavart S, et al. Cost-effectiveness of Telaprevir in Combination with Pegylated Interferon Alpha and Ribavirin in Previously Untreated Chronic Hepatitis C Genotype 1 Patients. J Med Econ. 2013 Oct 28. [Epub ahead of print] PubMed PMID: 24160335.

7: Barnieh L, Gill JS, Klarenbach S, et al. The Cost-Effectiveness of Using Payment to Increase Living Donor Kidneys for Transplantation. Clin J Am Soc Nephrol. 2013 Oct 31. [Epub ahead of print] PubMed PMID: 24158797.

8: Eggington S, Valldeoriola F, Chaudhuri KR, et al. The  cost-effectiveness of deep brain stimulation in combination with best medical therapy, versus best medical therapy alone, in advanced Parkinson's disease. J Neurol. 2013 Oct 25. [Epub ahead of print] PubMed PMID: 24158271.

9: Lefebvre P, Coleman CI, Bookhart BK, et al. Cost-effectiveness of rivaroxaban compared with enoxaparin plus a vitamin K antagonist for the treatment of venous thromboembolism. J Med Econ. 2013 Oct 25. [Epub ahead of print] PubMed PMID: 24156243.

10: Monreal M, Folkerts K, Diamantopoulos A, et al. Cost-effectiveness impact of rivaroxaban versus new and existing prophylaxis for  the prevention of venous thromboembolism after total hip or knee replacement surgery in France, Italy and Spain. Thromb Haemost. 2013 Oct 31;110(5):987-94. Epub 2013 Aug 22. PubMed PMID: 23965805.

11: Johnsen LG, Hellum C, Storheim K et al. Cost-Effectiveness of Total Disc Replacement Vs. Multidisciplinary Rehabilitation in Patients With Chronic Low Back Pain: A Norwegian Multicenter RCT. Spine (Phila Pa 1976). 2013 Oct 21. [Epub ahead of print] PubMed PMID: 24150435.

12: Meijboom MJ, Pouwels K, Luytjes W, et al. RSV vaccine in development: Assessing the potential cost-effectiveness in the Dutch elderly population. Vaccine. 2013 Oct 19. [Epub ahead of print] PubMed PMID: 24148573.

13: Cho BH, Stoecker C, Link-Gelles R, et al. Cost-effectiveness of administering 13-valent pneumococcal conjugate vaccine in addition to 23-valent pneumococcal polysaccharide vaccine to adults with immunocompromising conditions. Vaccine. 2013 Oct 19. [Epub ahead of print] PubMed PMID: 24148572.

14: Ericsson A, Pollock RF, Hunt B, et al. Evaluation of the cost-utility  of insulin degludec vs insulin glargine in Sweden. J Med Econ. 2013 Oct 25. [Epub ahead of print] PubMed PMID: 24147661.

15: Noritomi DT, Ranzani OT, Monteiro MB, et al. Implementation of a multifaceted sepsis education program in an emerging country setting: clinical outcomes and cost-effectiveness in a long-term follow-up study. Intensive Care Med. 2013 Oct 22. [Epub ahead of print] PubMed PMID: 24146003.

16: Labopin M, Ruggeri A, Gorin NC, et al. Cost-effectiveness and clinical outcomes of double versus single cord blood transplantation in adults with acute leukemia in France. Haematologica. 2013 Oct 18. [Epub ahead of print] PubMed PMID: 24143000.

17: Takura T, Yoshimatsu M, Sugimori H, et al. Cost-Effectiveness Analysis of Percutaneous Vertebroplasty for Osteoporotic Compression Fractures. J Spinal Disord Tech. 2013 Oct 16. [Epub ahead of print] PubMed PMID: 24141337.

18: Taylor P, Pezzullo L, Grant SJ, Bensoussan A. Cost-effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain. Pain Pract. 2013 Oct 21. [Epub ahead of print] PubMed PMID: 24138020.

19: Coleman CI, Limone BL. Universal versus platelet reactivity assay- driven use of P2Y12 inhibitors in acute coronary syndrome patients. Cost-effectiveness analyses for six European perspectives. Thromb Haemost. 2013 Oct 17;111(1). [Epub ahead of print] PubMed PMID: 24136466.

20: Rognoni C, Marchetti M, Quaglini S, et al. Apixaban, Dabigatran, and Rivaroxaban Versus Warfarin for Stroke Prevention in Non-Valvular Atrial Fibrillation: A Cost-Effectiveness Analysis. Clin Drug Investig. 2013 Oct 18. [Epub ahead of print] PubMed PMID: 24135964.

21: Zhuo X, Zhang P, Kahn HS, et al. Cost-Effectiveness of Alternative Thresholds of the Fasting Plasma Glucose Test to Identify the Target Population for Type 2 Diabetes Prevention in Adults Aged >=45 Years. Diabetes Care. 2013 Oct 17. [Epub ahead of print] PubMed PMID: 24135386.

22: You JH. Novel Oral Anticoagulants Versus Warfarin Therapy at Various Levels of Anticoagulation Control in Atrial Fibrillation-A Cost-Effectiveness Analysis.  J Gen Intern Med. 2013 Oct 17. [Epub ahead of print] PubMed PMID: 24132628.

23: Mezquita Raya P, Pérez A, et al. Incretin Therapy for Type 2 Diabetes in Spain: A Cost-Effectiveness Analysis  of Liraglutide Versus Sitagliptin. Diabetes Ther. 2013 Oct 17. [Epub ahead of print] PubMed PMID: 24132613.

24: Hill G, Barron R, Fust K, et al. Primary vs secondary prophylaxis with pegfilgrastim for the reduction of febrile  neutropenia risk in patients receiving chemotherapy for non-Hodgkin's lymphoma: cost-effectiveness analyses. J Med Econ. 2013 Oct 18. [Epub ahead of print] PubMed PMID: 24028444.

25: Lawrence D, Maschio M, Leahy KJ, et al. Economic analysis of bevacizumab, cetuximab, and panitumumab with fluoropyrimidine-based chemotherapy in the first-line treatment of KRAS wild-type metastatic colorectal  cancer (mCRC). J Med Econ. 2013 Oct 25. [Epub ahead of print] PubMed PMID: 24102083.

- Teja Thorat, MPH

By CEA Registry Team on 10/28/2013 9:09 AM

Leaders in drug companies’ health economics and outcomes research (HEOR) groups say senior management in pharmaceutical companies view HEOR work as critical to success, and express optimism about the future for their function, according to a new survey from the Center for Evaluation of Value and Risk in Health at Tufts Medical Center. 

Health economics and outcomes research (HEOR) departments have existed in the pharmaceutical industry for at least two decades. They play an important role in the development and generation of evidence, and their work can influence company decisions regarding evidence generation and the pricing and positioning of products. However, little is known about the attitudes of individuals working in HEOR departments. Understanding the views of the people in these departments can shed light on prospects for the field and the prognosis for important policy changes.

Of 123 senior-level HEOR representatives who received the survey, 74 (60%) completed it, contributing to a diverse sample of individuals who belong to departments of varying sizes at 41 pharmaceutical companies and device manufacturers.

We asked questions about several key areas, including internal HEOR work, the usefulness of current policy tools in the field, and the role of cost-effectiveness analysis in decision-making by the U.S. government.  The findings appear in the October issue of the Expert Review of Pharmacoeconomics & Outcomes Research.(1)

Among the key results:

92% of respondents said they expect that HEOR will be used more frequently by their company in the future.
80% said senior management at their company view the work of the internal HEOR group as critical.
55% said FDAMA Section 114 has been a useful channel for promotion of health economics information.
49% said the U.S. government should use cost-effectiveness analysis in coverage and reimbursement decisions.
31% said they expect the U.S. government to explicitly begin using cost-effectiveness information in the next three years.

The findings suggest strong support for HEOR at senior management levels and optimism about the field. We plan to conduct an HEOR “tracking poll” such as this one on a regular basis. Let us know if you have suggestions for future survey questions on Facebook or Twitter.

By Cayla Saret, B.A. and Peter Neumann, Sc.D.
(1) Neumann J., Saret C. A survey of individuals in US-based pharmaceutical industry HEOR departments: attitudes on policy topics. Oct. 2013, Expert Review of Pharmacoeconomics & Outcomes Research. 13(5):657-661.

 

By CEA Registry Team on 10/17/2013 8:45 AM
Twice each month we highlight recently published cost utility studies and selected reviews and editorials.

1: Billings ME, Kapur VK. Medicare Long-Term CPAP Coverage Policy: A Cost-Utility Analysis. J Clin Sleep Med. 2013 Oct 15;9(10):1023-1029. PubMed PMID: 24127146.

2: Mavranezouli I, Megnin-Viggars O, Cheema N, et al. The cost-effectiveness of supported employment for adults with autism in the United Kingdom. Autism. 2013 Oct 14. [Epub ahead of print] PubMed PMID: 24126866.

3: Candon D, Healy J, Crown J. Modelling the cost-effectiveness of adjuvant lapatinib for early-stage breast cancer. Acta Oncol. 2013 Oct 14. [Epub ahead of print] PubMed PMID: 24125103.

4: Colombo GL, Di Matteo S, Antinori A, et al. Economic evaluation of initial antiretroviral therapy for HIV-infected patients: an update of Italian guidelines. Clinicoecon Outcomes Res. 2013 Oct 3;5:489-496. Review. PubMed PMID: 24124383.

5: Hidalgo-Vega A, Ramos-Goñi JM, Villoro R. Cost-utility of ranolazine for the symptomatic treatment of patients with chronic angina pectoris in Spain. Eur J Health Econ. 2013 Oct 12. [Epub ahead of print] PubMed PMID: 24122303.

6: Zulliger R, Black S, Holtgrave DR, et al. Cost-Effectiveness of a Package of Interventions for Expedited Antiretroviral Therapy Initiation During Pregnancy in Cape Town, South Africa. AIDS Behav. 2013 Oct 13. [Epub ahead of print] PubMed PMID: 24122044.

7: Sheckter C, Van Vliet MM, Krishnan NM, et al. Cost-Effectiveness Comparison Between Topical Silver Sulfadiazine and Enclosed Silver Dressing for Partial-Thickness Burn Treatment. J Burn Care Res. 2013 Oct 11. [Epub ahead of print] PubMed PMID: 24121806.

8: Abell RG, Vote BJ. Cost-Effectiveness of Femtosecond Laser-Assisted Cataract Surgery versus Phacoemulsification Cataract Surgery. Ophthalmology. 2013 Oct 10. [Epub ahead of print] PubMed PMID: 24120324.

9: Turnes J, Romero-Gómez M, Planas R, et al. Pharmacoeconomic analysis of the treatment of chronic hepatitis C with peginterferon alfa-2a or peginterferon alfa-2b plus ribavirin in Spain. Gastroenterol Hepatol. 2013 Oct 9. [Epub ahead of print] PubMed PMID: 24119723.

10: Beale S, Dickson R, Bagust Aet al. Vemurafenib for the Treatment of Locally Advanced or Metastatic BRAF V600 Mutation-Positive Malignant Melanoma: A NICE Single Technology Appraisal. Pharmacoeconomics. 2013 Oct 10. [Epub ahead of print] PubMed PMID: 24114739.

11: Hisashige A, Sasako M, Nakajima T. Cost-effectiveness of adjuvant chemotherapy for curatively resected gastric cancer with S-1. BMC Cancer. 2013 Oct 1;13(1):443. [Epub ahead of print] PubMed PMID: 24079752.

12: Wu Q, Parrott S, Godfrey C, et al. Cost-Effectiveness of Computer-Tailored Smoking Cessation Advice in Primary Care: A Randomized Trial (ESCAPE). Nicotine Tob Res. 2013 Oct 1. [Epub ahead of print] PubMed PMID: 24084467. Dec;8(1-2):136. Epub 2013 Oct 11. PubMed PMID: 24113837.

13: Dallat MA, Hunter RF, Tully MA, Cairns KJ, Kee F. A lesson in business: cost-effectiveness analysis of a novel financial incentive intervention for increasing physical activity in the workplace. BMC Public Health. 2013 Oct 10;13(1):953. [Epub ahead of print] PubMed PMID: 24112295.

14: Kastenberg ZJ, Hurley MP, Luan A, et al. Cost-Effectiveness of Preoperative Imaging for Appendicitis After Indeterminate Ultrasonography in the Second or Third Trimester of Pregnancy. Obstet Gynecol. 2013 Oct;122(4):821-829. PubMed PMID: 24084540.

15: Barros FM, Cheinquer H, Tsuchiya CT, et al. Cost-effectiveness analysis of treatment with peginterferon-alfa-2a versus peginterferon-alfa-2b for patients with chronic hepatitis C under the public payer perspective in Brazil. Cost Eff Resour Alloc. 2013 Oct 8;11(1):25. [Epub ahead of print] PubMed PMID: 24103591.

16: Lawrence D, Maschio M, Leahy KJ, et al. Economic Analysis of Bevacizumab, Cetuximab, and Panitumumab with Fluoropyrimidine Based Chemotherapy in the First Line Treatment of KRAS Wild-Type Metastatic Colorectal Cancer (mCRC). J Med Econ. 2013 Oct 9. [Epub ahead of print] PubMed PMID: 24102083.

17: Iannuzzi JC, Rickles AS, Kelly KN, et al. Defining High Risk: Cost-Effectiveness of Extended-Duration Thromboprophylaxis Following Major Oncologic Abdominal Surgery. J Gastrointest Surg. 2013 Oct 8. [Epub ahead of print] PubMed PMID: 24101450.

18: Grimes CE, Henry JA, Maraka J, et al. Cost-effectiveness of Surgery in Low- and Middle-income Countries: A Systematic Review. World J Surg. 2013 Oct 8. [Epub ahead of print] PubMed PMID: 24101020.

19: Mohara A, Pérez Velasco R, Praditsitthikorn N, et al. A cost-utility analysis of alternative drug regimens for newly diagnosed severe lupus nephritis patients in Thailand. Rheumatology (Oxford). 2013 Oct 4. [Epub ahead of print] PubMed PMID: 24097289.

20: Watkins KE, Cuellar AE, Hepner KA, et al. The cost-effectiveness of depression treatment for co-occurring disorders: A clinical trial. J Subst Abuse Treat. 2013 Oct 2. [Epub ahead of print] PubMed PMID: 24094613.

21: Connolly MP, Kuyvenhoven JP, Postma MJ, et al. Cost and quality-adjusted life year differences in the treatment of active ulcerative colitis using once-daily 4g or twice-daily 2g mesalazine dosing. J Crohns Colitis. 2013 Oct 2. [Epub ahead of print] PubMed PMID: 24094599.

22: Aspinall SL, Smith KJ, Good CB, et al. Incremental Cost Effectiveness of Pharmacist-Managed Erythropoiesis-Stimulating Agent Clinics for Non-Dialysis-Dependent Chronic Kidney Disease Patients. Appl Health Econ Health Policy. 2013 Oct 5. [Epub ahead of print] PubMed PMID: 24092553.

23: Hollinghurst S, Coast J, Busby J, et al. A pragmatic randomized controlled trial of 'PhysioDirect' telephone assessment and advice services for patients with musculoskeletal problems: economic evaluation. BMJ Open. 2013 Oct 3;3(10):e003406. PubMed PMID: 24091423.

24: Mather RC 3rd, Koenig L, Kocher MS, et al. Societal and Economic Impact of Anterior Cruciate Ligament Tears. J Bone Joint Surg Am. 2013 Oct 2;95(19):1751-1759. PubMed PMID: 24088967.

25: Burr J, Hernández R, Ramsay C, et al. Is it worthwhile to conduct a randomized controlled trial of glaucoma screening in the United Kingdom? J Health Serv Res Policy. 2013 Oct 2. [Epub ahead of print] PubMed PMID: 24088295.

26: Goorden M, Vlasveld MC, Anema JR, et al. Cost-Utility Analysis of a Collaborative Care Intervention for Major Depressive Disorder in an Occupational Healthcare Setting. J Occup Rehabil. 2013 Oct 2. [Epub ahead of print] PubMed PMID: 24085535.

- Teja Thorat, MPH
By CEA Registry Team on 10/8/2013 9:15 AM

At age 18, James Chambers had to choose a specialty to continue his education in Northern Ireland where he grew up. He chose pharmacy school. “But I wasn’t entirely convinced that I wanted to be a pharmacist,” he said, “I didn’t know exactly what I wanted to be.” 

Nevertheless, it was his early experience filling prescriptions behind a pharmacy counter that led him to the current focus of his work:  Making sense of the coverage and reimbursement decisions made by health care payers. 

“I wondered why some people with high cholesterol, for example, were given the low-end generic drugs, and others got the more expensive drugs. Who was making that decision and why?” asked Chambers, now an assistant professor with a doctorate in health economics with the Center for Evaluation of Value and Risk in Health (CEVR) at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center. 

While studying and working in the UK, he learned that the UK’s National Institute for Health and Clinical Excellence (NICE) used a cost-effectiveness threshold when deciding which treatments to cover for which patients. Would the cost of the treatment lead to access for some patients, but not for others? Chambers wondered. “To allocate scarce resources efficiently, you had to accept that it sometimes necessary to put a value on life,” he said.

Then he became aware that in the United States, cost effectiveness did not play the same role in decisions. In fact, Medicare explicitly excludes the consideration of cost from its coverage decisions.
“So that made me wonder how they make their coverage determinations. If it’s not cost, is it high quality evidence or other criteria?” Chambers asked, “Is there some reason they don’t cover some things and they do cover others.” So far as he could discern, the track record of Medicare coverage and reimbursement decisions was largely unstudied.

Armed with his doctorate in health economics, he joined CEVR in Boston, MA and set out to find answers. He published a first paper on the topic in Medical Decision Making in 2010 entitled, “Does Medicare have an implicit cost effectiveness threshold?” Chambers and his colleagues found no real evidence of an implied cost effectiveness threshold, although he did show that Medicare covers multiple cost-ineffective technologies. 

Going forward, Chambers is looking more closely at how Medicare and private payers make coverage decisions. Ultimately, it’s important to know the answer to help drive innovation in medical technology, he said. “Such decisions have huge implications in health care. They may influence how manufacturers choose to invest in research and development, and most importantly,” he noted, “which patients get access to these medical advances.”
 

By CEA Registry Team on 10/7/2013 10:39 AM
Twice each month we highlight recently published cost utility studies and selected reviews and editorials.

1: Gasche D, Ulle T, Meier B, et al. Cost-effectiveness of ticagrelor and generic clopidogrel in patients with acute coronary syndrome in Switzerland. Swiss Med Wkly. 2013 Sep 19;143:w13851. PubMed PMID:24089294.

2: Kirkizlar E, Serban N, Sisson JA, Swann JL, Barnes CS, Williams MD. Evaluation of Telemedicine for Screening of Diabetic Retinopathy in the Veterans Health Administration. Ophthalmology. 2013 Sep 28. [Epub ahead of print] PubMed PMID: 24084501.

3: Dong D, Tan A, Mehta JS, et al. Cost-Effectiveness of Osteo-Odonto Keratoprosthesis in Singapore. Am J Ophthalmol. 2013 Sep 28 [Epub ahead of print] PubMed PMID: 24083686.

4: Hakkaart-van Roijen L, Bakker TJ, Al M, et al. Economic evaluation alongside a single RCT of an integrative psychotherapeutic nursing home programme. BMC Health Serv Res. 2013 Sep 30;13(1):370. [Epub ahead of print] PubMed PMID: 24079838.

5: Bolin K, Sandin R, Koltowska-Häggström M, et al. The cost-effectiveness of growth hormone replacement therapy (Genotropin(R)) in hypopituitary adults in Sweden. Cost Eff Resour Alloc. 2013 Sep 30;11(1):24. [Epub ahead of print] PubMed PMID: 24079522.

6: Gordon LG, Mayne GC, Hirst NG, et al. Cost-effectiveness of endoscopic surveillance of non-dysplastic Barrett's esophagus. Gastrointest Endosc. 2013 Sep 27. [Epub ahead of print] PubMed PMID: 24079411.

7: Ramírez de Arellano A, Coca A, de la Figuera M, et al. Economic Evaluation of Cardio inCode(®), a Clinical-Genetic Function for Coronary Heart Disease Risk Assessment. Appl Health Econ Health Policy. 2013 Sep 28. [Epub ahead of print] PubMed PMID: 24078223.

8: Lugnér AK, van der Maas N, van Boven M, et al. Cost-effectiveness of targeted vaccination to protect new-borns against pertussis: Comparing neonatal, maternal, and cocooning vaccination strategies. Vaccine. 2013 Sep 26. [Epub ahead of print] PubMed PMID: 24075918.

9: Ultsch B, Weidemann F, Reinhold T, et al. Health economic evaluation of vaccination strategies for the prevention of herpes zoster and postherpetic neuralgia in Germany. BMC Health Serv Res. 2013 Sep 26;13(1):359. [Epub ahead of print] PubMed PMID: 24070414.

10: Pink J, Pirmohamed M, Lane S, et al. Cost-effectiveness of pharmacogenetic guided warfarin therapy versus alternative anticoagulation in atrial fibrillation. Clin Pharmacol Ther. 2013 Sep 25. [Epub ahead of print] PubMed PMID: 24067746.

11: Laramée P, Wonderling D, Cahen DL, et al. Trial-based cost-effectiveness analysis comparing surgical and endoscopic drainage in patients with obstructive chronic pancreatitis. BMJ Open. 2013 Sep 23;3(9):e003676. PubMed PMID: 24065699.

12: Eells SJ, Bharadwa K, McKinnell JA, et al. Recurrent Urinary Tract Infections Among Adult Women: Comparative Effectiveness of Five Prevention and Management Strategies Using A Markov Chain Monte Carlo Model. Clin Infect Dis. 2013 Sep 24. [Epub ahead of print] PubMed PMID: 24065333.

13: Rintoul RC, Glover MJ, Jackson C, et al. Cost effectiveness of endosonography versus surgical staging in potentially resectable lung cancer: a health economics analysis of the ASTER trial from a European perspective. Thorax. 2013 Sep 24. [Epub ahead of print] PubMed PMID: 24064440.

14: van den Hurk CJ, van den Akker-van Marle ME, Breed WP, et al. Cost-effectiveness analysis of scalp cooling to reduce chemotherapy-induced alopecia. Acta Oncol. 2013 Sep 23. [Epub ahead of print] PubMed PMID: 24059270.

15: Forster A, Dickerson J, Young J, et al. A structured training programme for caregivers of inpatients after stroke (TRACS): a cluster randomised controlled trial and cost-effectiveness analysis. Lancet. 2013 Sep 17. [Epub ahead of print] PubMed PMID: 24054816.

16: Joling KJ, Bosmans JE, van Marwijk HW, et al. The cost-effectiveness of a family meetings intervention to prevent depression and anxiety in family caregivers of patients with dementia: a randomized trial. Trials. 2013 Sep 22;14(1):305. [Epub ahead of print] PubMed PMID: 24053631.

17: Masterton RG, Casamayor M, Musingarimi P, et al. De-escalation from micafungin is a cost-effective alternative to traditional escalation from fluconazole in the treatment of patients with systemic Candida infections. J Med Econ. 2013 Sep 25. [Epub ahead of print] PubMed PMID: 24003830.

18: 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. 2013 Sep 18. [Epub ahead of print] PubMed PMID: 24051454.

19: Thokala P, Baalbaki H, Brennan A, et al. Telemonitoring after discharge from hospital with heart failure: cost-effectiveness modelling of alternative service designs. BMJ Open. 2013 Sep 18;3(9):e003250. PubMed PMID: 24048626.

20: Wu B, Kun L, Liu X, et al. Cost-Effectiveness of Different Strategies for Stroke Prevention in Patients with Atrial Fibrillation in a Health Resource-Limited Setting. Cardiovasc Drugs Ther. 2013 Sep 19. [Epub ahead of print] PubMed PMID: 24048510.

21: Smith SM, Campbell JD. Cost-Effectiveness of Renin-Guided Treatment of Hypertension. Am J Hypertens. 2013 Sep 18. [Epub ahead of print] PubMed PMID: 24048147.

22: Erickson KF, Chertow GM, Goldhaber-Fiebert JD. Cost-effectiveness of tolvaptan in autosomal dominant polycystic kidney disease. Ann Intern Med. 2013 Sep 17;159(6):382-9. PubMed PMID: 24042366.

23: Lilje SC, Persson UB, Tangen ST, et al. Costs and Utilities of Manual Therapy and Orthopedic Standard Care for Low Prioritized Orthopedic Outpatients of Working Age: A Cost Consequence Analysis. Clin J Pain. 2013 Sep 21. [Epub ahead of print] PubMed PMID: 24042345.

24: Mealing S, Feldman T, Eaton J, et al. EVEREST II high risk study based UK cost-effectiveness analysis of MitraClip® in patients with severe mitral regurgitation ineligible for conventional repair/replacement surgery. J Med Econ. 2013 Sep 24. [Epub ahead of print] PubMed PMID: 24040937.

- Teja Thorat, MPH
By CEA Registry Team on 9/23/2013 12:13 PM

The Tufts Cost-Effectiveness Analysis Registry (www.cearegistry.org) is now updated to include published 2012 cost-effectiveness articles entered into PubMed through June 2013. All 2012 articles have been reviewed and placed in the Registry. 

 The CEA Registry now includes:
 

 

New entries

2012

Total*

Cost-utility analyses articles

116

528

3,604

Cost-effectiveness ratios

318

1,535

9,845

Utility weights

475

2,165

13,572

* The CEA Registry contents will be revised over the coming year to include articles published through 2011 that were inadvertently missed in our previous searches. More details available here.

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

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 @CEARegistry or Like Us on Facebook.

- CEA Registry Team

By CEA Registry Team on 9/23/2013 12:02 PM
By CEA Registry Team
 
The CEA Registry is in the process of being revised to include some missing articles for the years 2005 through 2011. The year 2012 is now complete. This revision is necessary because of a limitation in our PubMed search process that did not account for the somewhat delayed process of journal indexing by MEDLINE, the National Library of Medicine database. MEDLINE sometimes does not index articles until weeks or months following the date of publication, thereby delaying their appearance in PubMed.
 
To avoid this problem in the future, we will not use the publication date as a search criterion. Instead, our search will include all entries in PubMed corresponding to our search terms, regardless of publication date. This new search method will identify all CEA articles, regardless of indexing date and ensure that the CEA Registry has no omissions. Using this method, however, we will not be able to identify the point at which we have completed reviewing articles for a particular publication year because we will not be using publication date as a search criterion. 
 
The addition of missing articles to the Registry will, to some extent, alter the article counts and Registry content. For the year 2011, for example, we have identified 40 new articles that are currently being reviewed; the final number of reviewed articles will be added to the 349 articles already present in the Registry. We will report how many new articles we identify for each publication year as we complete those searches. We expect the counts for each of those years will be similar or a bit smaller (because the size of the cost-effectiveness analysis literature was smaller). We regret the error and are working to resolve it.
By CEA Registry Team on 9/19/2013 9:09 AM

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

 1: Lilje SC, Persson UB, Tangen ST, et al. Costs and Utilities  of Manual Therapy and Orthopedic Standard Care for Low Prioritized Orthopedic Outpatients of Working Age: A Cost Consequence Analysis. Clin J Pain. 2013 Sep 13. [Epub ahead of print] PubMed PMID: 24042345.
 
2: Fonseca AJ, Ferreira LC, Neto GB. Cost-effectiveness of the vaccine against human papillomavirus in the Brazilian Amazon region. Rev Assoc Med Bras. 2013 Sep 13. [Epub ahead of print] English, Portuguese. PubMed PMID: 24041909.
 
3: Saokaew S, Permsuwan U, Chaiyakunapruk N, et al. Cost-Effectiveness of Pharmacist-Participated Warfarin Therapy Management in Thailand. Thromb Res. 2013 Sep 1. [Epub ahead of print] PubMed PMID: 24041634.
 
4: Kularatna S, Whitty JA, Johnson NW, et al. Health state valuation in low- and middle-income countries: a systematic review of the literature. Value Health. 2013 Sep-Oct;16(6):1091-9. Epub 2013 Jul 16. PubMed PMID: 24041360.
 
5: Chhatwal J, Ferrante SA, Brass C, et al. Cost-effectiveness of boceprevir in patients previously treated for chronic hepatitis C genotype 1 infection in the United States. Value Health. 2013 Sep-Oct;16(6):973-86. PubMed PMID: 24041347.
 
6: Ruggeri M, Coretti S, Gasbarrini A, et al. Economic Assessment of an Anti-HCV Screening Program in Italy. Value Health. 2013 Sep-Oct;16(6):965-72. PubMed PMID: 24041346.
 
7: Gilbert SA, Grobman WA, Landon MB, et al. Lifetime cost-effectiveness of trial of labor after cesarean in the United States. Value Health. 2013 Sep-Oct;16(6):953-64. PubMed PMID: 24041345.
 
8: Heintzbergen S, Kulin NA, Ijzerman MJ, et al Cost-Utility of Metal-on-Metal Hip Resurfacing Compared to Conventional Total Hip Replacement in Young Active Patients with Osteoarthritis. Value Health. 2013  Sep-Oct;16(6):942-52. PubMed PMID: 24041344.
 
9: Shmueli A, Fraifeld S, Peretz T, et al. Cost-effectiveness of baseline low-dose computed tomography screening for lung cancer: the israeli experience. Value Health. 2013 Sep-Oct;16(6):922-31. Epub 2013 Jul 20. PubMed PMID: 24041342.
 
10: Compagni A, Melegaro A, Tarricone R. Genetic screening for the predisposition to venous thromboembolism: a cost-utility analysis of clinical practice in the italian health care system. Value Health. 2013 Sep-Oct;16(6):909-21. Epub 2013 Jul 16. PubMed PMID: 24041341.
 
11: Juday T, Correll T, Anene A, et al. Cost-effectiveness of the once-daily efavirenz/emtricitabine/tenofovir tablet compared with the once-daily elvitegravir/cobicistat/emtricitabine/tenofovir tablet as first-line antiretroviral therapy in HIV-infected adults in the US. Clinicoecon Outcomes Res. 2013 Sep 2;5:437-45. PubMed PMID: 24039438.
 
12: Evers PD. Pre-emptive virology screening in the pediatrichematopoietic stem cell transplant population: A cost effectiveness analysis. Hematol Oncol Stem Cell Ther. 2013 Sep 11. [Epub ahead of print] PubMed PMID: 24036002.
 
13: Russell I, Edwards R, Gliddon A, et al. Cancer of Oesophagus or Gastricus - New Assessment of Technology of Endosonography (COGNATE): report of pragmatic randomised trial. Health Technol Assess. 2013 Sep;17(39):1-170. PubMed PMID: 24034150.
 
14: Cure S, Bianic F, Gavart S, et al. Cost-effectiveness of Telaprevir in Combination with Pegylated Interferon Alpha and Ribavirin in Treatment-experienced Chronic Hepatitis C Genotype 1 Patients. J Med Econ. 2013 Sep 13. [Epub ahead of print] PubMed PMID: 24032626.
 
15: Kleintjens J, Li X, Simoens S, et al. Cost-Effectiveness of Rivaroxaban Versus Warfarin for Stroke Prevention in Atrial Fibrillation in the Belgian Healthcare Setting. Pharmacoeconomics. 2013 Sep 13. [Epub ahead of print] PubMed PMID: 24030788.
 
16: Byford S, Barrett B, Metrebian N, et al. Cost-effectiveness of injectable opioid treatment v. oral methadone for chronic heroin addiction. Br J Psychiatry. 2013 Sep 12. [Epub ahead of print] PubMed PMID: 24029536.
 
17: Hill G, Barron R, Fust K, et al. Primary versus Secondary Prophylaxis with Pegfilgrastim for the Reduction of Febrile Neutropenia Risk in Patients Receiving Chemotherapy for Non-Hodgkin's Lymphoma: Cost-Effectiveness Analyses. J Med Econ. 2013 Sep 12. [Epub ahead of print] PubMed PMID: 24028444.
 
18: Hart WM, Abrams P, Munro V, et al. Cost-effectiveness analysis of solifenacin versus oxybutynin immediate-release in the treatment of patients with overactive bladder in the United Kingdom. J Med Econ. 2013 Sep 11. [Epub ahead of print] PubMed PMID: 23885660.
 
19: Naylor RN, John PM, Winn AN, et al. The Cost-Effectiveness of Maturity-Onset Diabetes of the Young Genetic  Testing - Translating Genomic Advances into Practical Health Applications. Diabetes Care. 2013 Sep 11. [Epub ahead of print] PubMed PMID: 24026547.
 
20: Nguyen GC, Sharma S. Feasibility of venous thromboembolism prophylaxis during inflammatory bowel disease flares in the outpatient setting: a decision analysis. Inflamm Bowel Dis. 2013 Sep;19(10):2182-9. PubMed PMID: 23883960.
 
21: McGarry LJ, Krishnarajah G, Hill G, et al. Cost-effectiveness analysis of tdap in the  prevention of pertussis in the elderly. PLoS One. 2013 Sep 3;8(9):e67260.  PubMed PMID: 24019859.
 
22: Qureshi SA, McAnany S, Goz V, et al. Cost-effectiveness analysis: comparing single-level cervical disc replacement and single-level anterior cervical discectomy and fusion. J Neurosurg Spine. 2013 Sep 6. [Epub ahead of print] PubMed PMID: 24010896.
 
23: Masterton RG, Casamayor M, Musingarimi P, et al. De-escalation from micafungin is a cost effective alternative to traditional escalation from fluconazole in the treatment of patients with systemic Candida infections. J Med Econ. 2013 Sep 4. [Epub ahead of print] PubMed PMID: 24003830.
 
24: Blázquez-Pérez A, San Miguel R, Mar J. Cost-Effectiveness Analysis of Triple Therapy with Protease Inhibitors in Treatment-Naive Hepatitis C Patients. Pharmacoeconomics. 2013 Sep 3. [Epub ahead of print] PubMed PMID: 24000086.
 
25: Thijssen J, VAN DEN Akker VAN Marle ME, et al. Cost-Effectiveness of Primary Prevention Implantable Cardioverter Defibrillator Treatment: Data from a Large Clinical Registry. Pacing Clin Electrophysiol. 2013 Sep 2. [Epub ahead of print] PubMed PMID: 23998638.
 
26: Bentley A, Gillard S, Spino M, et al. Cost-Utility Analysis of Deferiprone for the Treatment of β-Thalassaemia Patients with Chronic Iron Overload: A UK Perspective. Pharmacoeconomics. 2013 Sep;31(9):807-22. PubMed PMID: 23868464.
 
27: Villacorta R, Hay JW, Messali A. Cost effectiveness of moderate to severe psoriasis therapy with etanercept and ustekinumab in the United States. Pharmacoeconomics. 2013 Sep;31(9):823-39. PubMed PMID: 23975739.
 
28: van Wier MF, Verweij LM, Proper KI, et al. Economic Evaluation of an Occupational Health Care Guideline for Prevention of Weight Gain Among Employees. J Occup Environ Med. 2013 Sep;55(9):1100-1109. PubMed PMID: 23969508.
 
29: Smith KJ, Wateska A, Nowalk MPet al. Cost-effectiveness of procalcitonin-guided antibiotic use in community acquired pneumonia. J Gen Intern Med. 2013 Sep;28(9):1157-64. PubMed PMID: 23463457. 
 
30: Dougherty CP, Howard T. PPD-QALY-An Index for Cost-Effectiveness in Orthopedics: Providing Essential Information to Both Physicians and Health Care Policy Makers for Appropriate Allocation of Medical Resources. Sports Med Arthrosc. 2013 Sep;21(3):169-73. PubMed PMID: 23924750.
 
31: Dougherty CP, Howard T. Cost-effectiveness in Orthopedics: Providing Essential Information to Both Physicians and Health Care Policy Makers for Appropriate Allocation of Medical Resources. Sports Med Arthrosc. 2013 Sep;21(3):166-8. PubMed PMID: 23924749.
 
- Teja Thorat, MPH
By CEA Registry Team on 9/9/2013 9:42 AM

By Pei-Jung Lin, Ph.D.

 
When a physician describes a cancer treatment to a patient, the patient is likely to ask how the treatment will improve his or her “prognosis.” The way a doctor frames the answer to this question can make a big difference in how the patient perceives the value of the therapy, according to the analysis my colleagues and I have published  in
Expert Review of Pharmacoeconomics & Outcomes Research.(1)

In our survey of 2,040 U.S. adults, we randomized respondents to one of two sets of hypothetical scenarios a doctor might use to frame survival rates:  In the first scenario, a new treatment increases a patient’s median survival time by a specific number of months or years (median survival). In the second, a new treatment increases the patient’s chance of survival to a specific point such as 4 years (landmark survival). We found a consistent and significant difference in people’s willingness to pay (WTP) for a novel cancer treatment depending on how the survival benefit was described to them.

For example, 88% of people said they would pay for the new treatment if survival was framed as a landmark—improving 2-year survival from 20% to 30% (mean WTP=$92,045). But only 76% would pay for the treatment if survival was framed as a median rate—increasing survival time from 1 year to 1.5 years (mean WTP=$62,431), even though both scenarios are just different ways of saying the same thing: they correspond to a 50% improvement in survival.

Despite common usage of terms such as “survival,” “mortality,” “risk,” and “benefit,” converting these concepts into a patient-friendly language remains a challenge for health care professionals. Our empirical analysis provides unique data on how alternative methods of expressing survival benefits may influence preferences for cancer care. As patients are asked to shoulder more costs and make difficult decisions about their care, understanding when and why framing matters is essential for uncovering how patients evaluate the value of medical interventions.
This study was funded by Genentech.


(1) Lin PJ, Concannon T, Greenberg D, Cohen J, Rossi G, Hille J, Auerbach H, Fang CH, Nadler E, Neumann PJ. Does Framing of Cancer Survival Affect Perceived Value of Care? A Willingness-to-Pay Survey of U.S. Residents. 2013.
Expert Rev Pharmacoecon Outcomes Res (13); 513-522, doi:10.1586/14737167.2013.814948.

By CEA Registry Team on 8/28/2013 2:30 PM

By Michael J. Cangelosi, MA MPH

Does cost-effectiveness analysis matter? The evolution of Britain’s National Health Service is a case in point. Sixty-five years ago, after war had changed the world, British hospitals were changing as well. During WWII, and via the Emergency Medical Service, the British government employed formerly privately paid doctors and nurses to care for those injured by enemy action.
 
Forged from these war-weary origins, Britain’s National Health Service was officially formed in July of 1948 to provide a complete health service to be available to every member of the community. From these collectivist beginnings, the NHS has grown and continued to heal Britons. More recently, it was celebrated at the opening of the 2012 Olympic games by former Chancellor of the Exchequer Nigel Lawson as “…the nearest thing the English have to a religion.”
 
Nevertheless, the increasingly complex and expensive nature of contemporary health care, combined with an aging population, make it difficult to shepherd the resources necessary to provide unlimited healthcare to everyone. Thus, in the 1990’s through today, the NHS has slowly reformed to acknowledge explicitly its resource constraints and to use formal economic analysis to help improve population health within its limited budget. A noteworthy step was the creation of the National Institute for Clinical Effectiveness (NICE) in 1999 to provide the NHS with a determination of the clinical effectiveness and cost-effectiveness of treatments. In other words, to determine what works and whether the incremental gains are worthwhile. NICE has done much to help the efficiency of the NHS by highlighting, through cost-utility analyses, those treatments which provide large health gains relative to increases in costs. These sorts of cost-utility analyses form the basis of Tufts CEA Registry.
 
With this in mind, it’s worth pausing to mark the 65th anniversary of the NHS, one of the most active users of cost-effectiveness research in the world.
 
By CEA Registry Team on 8/21/2013 12:19 PM

It wouldn’t be easy, says CEVR Director Peter Neumann, Sc.D., but a change in legislation to allow drug companies to promote comparative effectiveness research (CER) with sufficient “public health guardrails” may be possible if interested parties begin a dialogue now. Dr. Neumann discusses the issue in a video interview on the National Pharmaceutical Council website.  

“The FDA, the payer community, the pharmaceutical industry, academic researchers, people who think about methodological standards, and ideally patient groups,” need to come together to address the issue, Dr. Neumann says in the video. Existing legislation, Section 114 of the Food and Drug Administration Modernization Act (FDAMA), prohibits drug companies from promoting their products based on the findings from most comparative effectiveness research. At the same time, there has been increased dissemination of CER by government, payers, and academic and other medical researchers to compare the results of alternative approaches for managing diseases. 
While Section 114 was originally intended to allow flexibility in drug promotions by permitting pharmaceutical companies to promote health economic information, it does not allow them to promote comparative effectiveness research, thereby inhibiting the exchange of potentially useful information. 
A possible option, Neumann says, is new legislation which would allow drug companies to promote cost effectiveness research, but only to health plans and other payers, not to individual doctors and patients. To make that happen, he said, people from all sides of the discussion need to work together. “I think change will be possible,” he said, “if we have this kind of dialogue and buy-in.” Neumann Sc.D. published a Perspective on this topic in the July 18, 2013 issue of the New England Journal of Medicine. (1)
 
By Kay Cahill, CEVR Medical Writer
 
 
By CEA Registry Team on 8/16/2013 11:16 AM

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

1. Fearon WF, Shilane D, Pijls NH, et al. Cost-Effectiveness of Percutaneous Coronary Intervention in Patients with Stable Coronary Disease and Abnormal Fractional Flow Reserve. Circulation. 2013 Aug 14. [Epub ahead of print] PubMed PMID: 23946263.
 
2. Seklehner S, Laudano MA, Te AE, et al. A cost-effectiveness analysis of retropubic midurethral sling versus transobturator midurethral sling for female stress urinary incontinence. Neurourol Urodyn. 2013  Aug 14. [Epub ahead of print] PubMed PMID: 23946119.
 
3. Tsai AG, Wadden TA, Volger S, et al. Cost-effectiveness of a primary care intervention to treat obesity. Int J Obes (Lond). 2013 Aug;37 Suppl  1:S31-7. PubMed PMID: 23921780.
 
4. Martin NK, Hickman M, Miners A, et al. Cost-effectiveness of HCV case-finding for people who inject drugs via dried blood spot testing in specialist addiction services and prisons. BMJ Open. 2013 Aug 13;3(8). PMID: 23943776.
 
5. Meacock R, Kristensen SR, Sutton M. THE COST-EFFECTIVENESS OF USING FINANCIAL  INCENTIVES TO IMPROVE PROVIDER QUALITY: A FRAMEWORK AND APPLICATION. Health Econ. 2013 Aug 14. [Epub ahead of print] PubMed PMID: 23943496.
 
6. Hofmeijer J, van der Worp HB, Kappelle LJ, et al. Cost-Effectiveness of Surgical Decompression for Space-Occupying Hemispheric Infarction. Stroke. 2013 Aug 13. [Epub ahead of print] PubMed PMID: 23943217.
 
7. Comans T, Visser V, Scuffham P. Cost Effectiveness of a Community-Based Crisis Intervention Program for People Bereaved by Suicide. Crisis. 2013 Aug 13:1-8. [Epub ahead of print] PubMed PMID: 23942387.
 
8. Morphew T, Scott L, Li M, et al. Mobile health care operations and return on investment in predominantly underserved children with asthma: the breathmobile program. Popul Health Manag. 2013 Aug;16(4):261-9. PubMed PMID: 23941048.
 
9. Villanti AC, Jiang Y, Abrams DB, et al. A cost-utility analysis of lung cancer screening and the additional benefits of incorporating smoking cessation interventions. PLoS One. 2013 Aug 7;8(8):e71379. Print 2013. PubMed PMID: 23940744.
 
10. Arver S, Luong B, Fraschke A, et al. Is Testosterone Replacement Therapy in Males with Hypogonadism Cost-Effective? An Analysis in Sweden. J Sex Med. 2013 Aug 12. [Epub ahead of print] PubMed PMID: 23937088.
 
11. Messali A, Hay JW, Villacorta R. The cost-effectiveness of temozolomide in the adjuvant treatment of newly diagnosed glioblastoma in the United States. Neuro Oncol. 2013 Aug 9. [Epub ahead of print] PubMed PMID: 23935155.
 
12. Ginsberg G, Adunsky A, Rasooly I. A cost-utility analysis of a comprehensive orthogeriatric care for hip fracture patients, compared with standard of care treatment. Hip Int. 2013 Aug 9:0. [Epub ahead of print] PubMed PMID: 23934901.
 
13. Mencacci C, Aguglia E, Biggio G, et al: Cost and Quality-of-Life Pharmacoeconomic Analysis of Antidepressants in Major Depressive Disorder in Italy. Adv Ther. 2013 Aug 9. [Epub ahead of print] PubMed PMID: 23929174.
 
14. Touchon J, Lachaine J, Beauchemin C, et al. The impact of memantine in combination with acetylcholinesterase inhibitors on admission of patients with Alzheimer's disease to nursing homes: cost-effectiveness analysis in France. Eur J Health Econ. 2013 Aug 9. [Epub ahead of print] PubMed PMID: 23928827.
 
15. Oestergaard LG, Christensen FB, Nielsen CV, et al. Early Versus Late Initiation of Rehabilitation After Lumbar Spinal Fusion: Economic Evaluation Alongside a Randomized Controlled Trial. Spine (Phila Pa 1976). 2013 Aug 7. [Epub ahead of print] PubMed PMID: 23928716.
 
16. Almekhlafi MA, Hill MD, Wiebe S, et al. When Is Carotid Angioplasty and Stenting the Cost-Effective Alternative for Revascularization of Symptomatic Carotid Stenosis? A Canadian Health System Perspective. AJNR Am J Neuroradiol. 2013 Aug 8. [Epub ahead of print] PubMed PMID: 23928136.
 
17. Pandor A, Thokala P, Gomersall T, et al. Home telemonitoring or structured telephone support programmes after recent discharge in patients with heart failure: systematic review and economic evaluation. Health Technol Assess. 2013 Aug;17(32):1-208. PubMed PMID: 23927840.
 
18. Baltzer H, Binhammer PA. Cost-effectiveness in the management of Dupuytren's  contracture: A Canadian cost-utility analysis of current and future management strategies. Bone Joint J. 2013 Aug;95-B(8):1094-100. PubMed PMID: 23908426.
 
19. Barnett JC, Alvarez Secord A, Cohn DE, et al. Cost effectiveness of alternative strategies for incorporating bevacizumab into the primary treatment of ovarian cancer. Cancer. 2013 Aug 6. [Epub ahead of print] PubMed PMID: 23921967.
 
20. Liu X, Li C, Gong H, et al. An economic evaluation for prevention of diabetes mellitus in a developing country: a modelling study. BMC Public Health. 2013 Aug 7;13(1):729. [Epub ahead of print] PubMed PMID: 23919839.
 
21. Itzler R, O'Brien MA, Yamabe K, et al. Cost-effectiveness of a Pentavalent Rotavirus Vaccine in Japan. J Med Econ. 2013 Aug 6. [Epub ahead of print] PubMed PMID: 23919721.
 
22. Bentley A, Filipovic I, Gooch K, et al. A cost-effectiveness analysis of respiratory syncytial virus (RSV) prophylaxis in infants in the United Kingdom. Health Econ Rev. 2013 Aug 6;3(1):18. PubMed PMID: 23919494; PubMed Central PMCID: PMC3735492.
 
23. Wagner TH, Hattler B, Bishawi M, et al. On-Pump versus Off-Pump Coronary Artery Bypass Surgery: Cost-Effectiveness Analysis Alongside a  Multisite Trial. Ann Thorac Surg. 2013 Aug 2. [Epub ahead of print] PubMed PMID: 23916805.
 
24. Paggiaro P, Patel S, Nicolini G, et al. Stepping down from high dose fluticasone/salmeterol to extrafine BDP/F in asthma is cost-effective. Respir Med. 2013 Aug 2. [Epub ahead of print] PubMed PMID: 23916740.
 
25. Mendonça L, Perelman J, Rodrigues V, et al. Cost-effectiveness of lung transplantation and its evolution: the Portuguese case. Eur J Health Econ. 2013 Aug 3. [Epub ahead of print] PubMed PMID: 23913127.
 
26. Luciano JV, Sabes-Figuera R, Cardeñosa E, et al. Cost-Utility of a Psychoeducational Intervention in Fibromyalgia Patients Compared With Usual Care: An Economic Evaluation Alongside a 12-Month Randomized Controlled Trial. Clin J Pain. 2013 Aug;29(8):702-711. PubMed PMID: 23328339.
 
27. Valle-Mercado C, Cubides MF, Parra-Torrado M, et al. Cost-effectiveness of biological therapy compared with methotrexate in the treatment for rheumatoid arthritis in Colombia. Rheumatol Int. 2013 Aug 2. [Epub ahead of print] PubMed PMID: 23907586.
 
28. Simkiss DE, Snooks HA, Stallard N, et al. Effectiveness and cost-effectiveness of a universal parenting skills programme in deprived communities: multicentre randomised controlled trial. BMJ Open. 2013 Aug 1;3(8). PubMed PMID: 23906953..
 
29. Mayer F, Stahrenberg R, Gröschel K, et al. Cost-effectiveness of 7-day-Holter monitoring alone or in combination with transthoracic echocardiography in patients with cerebral ischemia. Clin Res Cardiol. 2013 Aug 2. [Epub ahead of print] PubMed PMID: 23904073.
 
30. Lathia N, Isogai PK, Angelis CD, et al. Cost-Effectiveness of Filgrastim and Pegfilgrastim as Primary Prophylaxis Against Febrile Neutropenia in Lymphoma Patients. J Natl Cancer Inst. 2013 Aug 7;105(15):1078-1085. Epub 2013 Jul 19. PubMed PMID: 23873405.
 
31. Parker SL, Godil SS, Mendenhall S, et al. 153 Cost-Utility and Comparative Effectiveness Analyses of Surgery vs Comprehensive Medical Management for Lumbar Spondylosis in Elderly. Neurosurgery. 2013 Aug;60 Suppl 1:170-1. PubMed PMID: 23839420.
 
32. Alvin MD, Lubelski D, Abdullah KG, et al. Cost-Utility Analysis of Anterior Cervical Discectomy and Fusion With Plating (ACDFP) vs Posterior Cervical Foraminotomy (PCF) for Patients With Single-Level Cervical Radiculopathy. Neurosurgery. 2013 Aug;60 Suppl 1:159. PubMed PMID: 23839386.
 
33. Kearns BC, Michaels JA, Stevenson MD, et al. Cost-effectiveness analysis of enhancements to angioplasty for infrainguinal arterial disease. Br J Surg. 2013 Aug;100(9):1180-8. PubMed PMID: 23842832.
 
34. Mazari FA, Khan JA, Carradice D, et al. Economic analysis of a randomized trial of percutaneous angioplasty, supervised exercise or combined treatment for intermittent claudication due to femoropopliteal arterial disease. Br J Surg. 2013 Aug;100(9):1172-9. PubMed PMID: 23842831.
 
35. Agren S, S Evangelista L, Davidson T, et al. Cost-effectiveness of a nurse-led education and psychosocial programme for patients with chronic heart failure and their partners. J Clin Nurs. 2013 Aug;22(15-16):2347-2353. PubMed PMID: 23829407.
 
36. Ljungman D, Hyltander A, Lundholm K. Cost-utility estimations of palliative care in patients with pancreatic adenocarcinoma: a retrospective analysis. World  J Surg. 2013 Aug;37(8):1883-91. doi: 10.1007/s00268-013-2003-z. PubMed PMID: 23519293.
 
37. de Groot NL, van Haalen HG, Spiegel BM, et al. Gastroprotection in Low-Dose Aspirin Users for Primary and Secondary Prevention of ACS: Results of a Cost-Effectiveness Analysis Including Compliance. Cardiovasc Drugs Ther. 2013 Aug;27(4):341-57. PubMed PMID: 23417566.
 
- Teja Thorat, MPH

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