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Clinical Benefits, Costs, and Cost-Effectiveness of Neonatal Intensive Care in Mexico  [PDF]
Jochen Profit,Diana Lee,John A. Zupancic,LuAnn Papile,Cristina Gutierrez,Sue J. Goldie,Eduardo Gonzalez-Pier,Joshua A. Salomon
PLOS Medicine , 2010, DOI: 10.1371/journal.pmed.1000379
Abstract: Background Neonatal intensive care improves survival, but is associated with high costs and disability amongst survivors. Recent health reform in Mexico launched a new subsidized insurance program, necessitating informed choices on the different interventions that might be covered by the program, including neonatal intensive care. The purpose of this study was to estimate the clinical outcomes, costs, and cost-effectiveness of neonatal intensive care in Mexico. Methods and Findings A cost-effectiveness analysis was conducted using a decision analytic model of health and economic outcomes following preterm birth. Model parameters governing health outcomes were estimated from Mexican vital registration and hospital discharge databases, supplemented with meta-analyses and systematic reviews from the published literature. Costs were estimated on the basis of data provided by the Ministry of Health in Mexico and World Health Organization price lists, supplemented with published studies from other countries as needed. The model estimated changes in clinical outcomes, life expectancy, disability-free life expectancy, lifetime costs, disability-adjusted life years (DALYs), and incremental cost-effectiveness ratios (ICERs) for neonatal intensive care compared to no intensive care. Uncertainty around the results was characterized using one-way sensitivity analyses and a multivariate probabilistic sensitivity analysis. In the base-case analysis, neonatal intensive care for infants born at 24–26, 27–29, and 30–33 weeks gestational age prolonged life expectancy by 28, 43, and 34 years and averted 9, 15, and 12 DALYs, at incremental costs per infant of US$11,400, US$9,500, and US$3,000, respectively, compared to an alternative of no intensive care. The ICERs of neonatal intensive care at 24–26, 27–29, and 30–33 weeks were US$1,200, US$650, and US$240, per DALY averted, respectively. The findings were robust to variation in parameter values over wide ranges in sensitivity analyses. Conclusions Incremental cost-effectiveness ratios for neonatal intensive care imply very high value for money on the basis of conventional benchmarks for cost-effectiveness analysis. Please see later in the article for the Editors' Summary
Cost-effectiveness of candesartan versus losartan in the primary preventive treatment of hypertension  [cached]
Granström O,Levin LA,Henriksson M
ClinicoEconomics and Outcomes Research , 2012,
Abstract: Ola Granstr m,1 Lars- ke Levin,2 Martin Henriksson11AstraZeneca Nordic, S dert lje, 2Center for Medical Technology Assessment, Link ping University, Link ping, SwedenBackground: Although angiotensin receptor blockers have different receptor binding properties, no comparative randomized studies with cardiovascular event endpoints have been performed for this class of drugs. The aim of this study was to assess the long-term cost-effectiveness of candesartan (Atacand ) versus generic losartan in the primary preventive treatment of hypertension.Methods: A decision-analytic model was developed to estimate costs and health outcomes over a patient's lifetime. Data from a clinical registry study were used to estimate event rates for cardiovascular complications, such as myocardial infarction and heart failure. Costs and quality of life data were from published sources. Costs were in Swedish kronor and the outcome was quality-adjusted life-years (QALYs). Results: Due to reduced rates of cardiovascular complications, candesartan was associated with a QALY gain and lower health care costs compared with generic losartan (0.053 QALYs gained and reduced costs of approximately 4700 Swedish kronor for women; and 0.057 QALYs gained and reduced costs of approximately 4250 Swedish kronor for men). This result was robust in several sensitivity analyses.Conclusion: When modeling costs and health outcomes based on event rates for cardiovascular complications from a real-world registry study, candesartan appears to bring a QALY gain and a reduction in costs compared with generic losartan in the primary preventive treatment of hypertension in Sweden.Keywords: hypertension, angiotensin receptor blockers, cost-effectiveness, decision analysis
Cost-effectiveness of candesartan versus losartan in the primary preventive treatment of hypertension
Granstr m O, Levin LA, Henriksson M
ClinicoEconomics and Outcomes Research , 2012, DOI: http://dx.doi.org/10.2147/CEOR.S35824
Abstract: st-effectiveness of candesartan versus losartan in the primary preventive treatment of hypertension Original Research (1393) Total Article Views Authors: Granstr m O, Levin LA, Henriksson M Published Date November 2012 Volume 2012:4 Pages 313 - 322 DOI: http://dx.doi.org/10.2147/CEOR.S35824 Received: 11 July 2012 Accepted: 17 September 2012 Published: 01 November 2012 Ola Granstr m,1 Lars- ke Levin,2 Martin Henriksson1 1AstraZeneca Nordic, S dert lje, 2Center for Medical Technology Assessment, Link ping University, Link ping, Sweden Background: Although angiotensin receptor blockers have different receptor binding properties, no comparative randomized studies with cardiovascular event endpoints have been performed for this class of drugs. The aim of this study was to assess the long-term cost-effectiveness of candesartan (Atacand ) versus generic losartan in the primary preventive treatment of hypertension. Methods: A decision-analytic model was developed to estimate costs and health outcomes over a patient's lifetime. Data from a clinical registry study were used to estimate event rates for cardiovascular complications, such as myocardial infarction and heart failure. Costs and quality of life data were from published sources. Costs were in Swedish kronor and the outcome was quality-adjusted life-years (QALYs). Results: Due to reduced rates of cardiovascular complications, candesartan was associated with a QALY gain and lower health care costs compared with generic losartan (0.053 QALYs gained and reduced costs of approximately 4700 Swedish kronor for women; and 0.057 QALYs gained and reduced costs of approximately 4250 Swedish kronor for men). This result was robust in several sensitivity analyses. Conclusion: When modeling costs and health outcomes based on event rates for cardiovascular complications from a real-world registry study, candesartan appears to bring a QALY gain and a reduction in costs compared with generic losartan in the primary preventive treatment of hypertension in Sweden.
Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure  [PDF]
Pieter H. M van Baal ,Johan J Polder,G. Ardine de Wit,Rudolf T Hoogenveen,Talitha L Feenstra,Hendriek C Boshuizen,Peter M Engelfriet,Werner B. F Brouwer
PLOS Medicine , 2008, DOI: 10.1371/journal.pmed.0050029
Abstract: Background Obesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to compare those to similar costs attributable to smoking, and to discuss the implications for prevention. Methods and Findings With a simulation model, lifetime health-care costs were estimated for a cohort of obese people aged 20 y at baseline. To assess the impact of obesity, comparisons were made with similar cohorts of smokers and “healthy-living” persons (defined as nonsmokers with a body mass index between 18.5 and 25). Except for relative risk values, all input parameters of the simulation model were based on data from The Netherlands. In sensitivity analyses the effects of epidemiologic parameters and cost definitions were assessed. Until age 56 y, annual health expenditure was highest for obese people. At older ages, smokers incurred higher costs. Because of differences in life expectancy, however, lifetime health expenditure was highest among healthy-living people and lowest for smokers. Obese individuals held an intermediate position. Alternative values of epidemiologic parameters and cost definitions did not alter these conclusions. Conclusions Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.
Stochastic Perron's Method for the Probability of lifetime ruin problem under transaction costs  [PDF]
Erhan Bayraktar,Yuchong Zhang
Mathematics , 2014,
Abstract: We apply stochastic Perron's method to a singular control problem where an individual targets at a given consumption rate, invests in a risky financial market in which trading is subject to proportional transaction costs, and seeks to minimize her probability of lifetime ruin. Without relying on the dynamic programming principle (DPP), we characterize the value function as the unique viscosity solution of an associated Hamilton-Jacobi-Bellman (HJB) variational inequality. We also provide a complete proof of the comparison principle which is the main assumption of stochastic Perron's method.
Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach
Stefan A Baeten, N Job A van Exel, Maaike Dirks, Marc A Koopmanschap, Diederik WJ Dippel, Louis W Niessen
Cost Effectiveness and Resource Allocation , 2010, DOI: 10.1186/1478-7547-8-21
Abstract: The EDISSE study is a prospective non-randomized controlled cluster trial that compared stroke services (n = 151 patients) to usual care (n = 187 patients). Health status and cost trial-data were entered in multi-dimensional stroke life-tables. The tables distinguish four levels of disability which are defined by the modified Rankin scale. Quality-of-life scores (EuroQoL-5D), transition and survival probabilities are based on concurrent Dutch follow-up studies. Outcomes are quality-adjusted life years lived and lifetime medical cost by disability category. An economic analysis compares outcomes from a successful stroke service to usual care, by bootstrapping individual costs and effects data from patients in each arm.Lifetime costs and QALYs after stroke depend on age-of-onset of first-ever stroke. Lifetime QALYs after stroke are 2.42 (90% CI - 0.49 - 2.75) for male patients in usual care and 2.75 (-0.61; 6.26) for females. Lifetime costs for men in the usual care setting are €39,335 (15,951; 79,837) and €42,944 (14,081; 95,944) for women. A comparison with the stroke service results in an ICER of €11,685 saved per QALY gained (€14,211 and €7,745 for men and women respectively). This stroke service is with 90% certainty cost-effective.Our analysis shows the potential of large health benefits and cost savings of stroke services, taking a lifetime perspective, also in other European settings.In The Netherlands, as in most Western countries, stroke is a major contributor to the total burden of disease, in terms of morbidity, mortality and concomitant costs. In 2007, incidence of primary stroke was 2.12 per 1,000 men and 2.23 per 1,000 women, prevalence of stroke was 11.89 per 1,000 men and 11.48 per 1,000 women, and mortality from stroke was 46.50 per 100,000 men and 69.84 per 100,000 women [1]. The incidence rates in the Netherlands have only fluctuated around the same level since the early 1990 s. Yet, mortality has been steadily declining [1].The burden of stroke in
The Costs, Benefits, and Cost-Effectiveness of Interventions to Reduce Maternal Morbidity and Mortality in Mexico  [PDF]
Delphine Hu, Stefano M. Bertozzi, Emmanuela Gakidou, Steve Sweet, Sue J. Goldie
PLOS ONE , 2007, DOI: 10.1371/journal.pone.0000750
Abstract: Background In Mexico, the lifetime risk of dying from maternal causes is 1 in 370 compared to 1 in 2,500 in the U.S. Although national efforts have been made to improve maternal services in the last decade, it is unclear if Millennium Development Goal 5 - to reduce maternal mortality by three-quarters by 2015 - will be met. Methodology/Principal Findings We developed an empirically calibrated model that simulates the natural history of pregnancy and pregnancy-related complications in a cohort of 15-year-old women followed over their lifetime. After synthesizing national and sub-national trends in maternal mortality, the model was calibrated to current intervention-specific coverage levels and validated by comparing model-projected life expectancy, total fertility rate, crude birth rate and maternal mortality ratio with Mexico-specific data. Using both published and primary data, we assessed the comparative health and economic outcomes of alternative strategies to reduce maternal morbidity and mortality. A dual approach that increased coverage of family planning by 15%, and assured access to safe abortion for all women desiring elective termination of pregnancy, reduced mortality by 43% and was cost saving compared to current practice. The most effective strategy added a third component, enhanced access to comprehensive emergency obstetric care for at least 90% of women requiring referral. At a national level, this strategy reduced mortality by 75%, cost less than current practice, and had an incremental cost-effectiveness ratio of $300 per DALY relative to the next best strategy. Analyses conducted at the state level yielded similar results. Conclusions/Significance Increasing the provision of family planning and assuring access to safe abortion are feasible, complementary and cost-effective strategies that would provide the greatest benefit within a short-time frame. Incremental improvements in access to high-quality intrapartum and emergency obstetric care will further reduce maternal deaths and disability.
Analgesics use and ESRD in younger age: a case-control study
Fokke J van der Woude, Lothar AJ Heinemann, Helmut Graf, Michael Lewis, Sabine Moehner, Anita Assmann, Doerthe Kühl-Habich
BMC Nephrology , 2007, DOI: 10.1186/1471-2369-8-15
Abstract: We performed a population-based case-control study with incident cases of end-stage renal disease (ESRD) under the age of 50 years and four age and sex-matched neighborhood controls in 170 dialysis centers (153 in Germany, and 17 in Austria) from January 1, 2001 to December 31, 2004. Data on lifetime medical history, risk factors, treatment, job exposure and intake of analgesics were obtained in a standardized face-to-face interview using memory aids to enhance accuracy. Study design, study performance, analysis plan, and study report were approved by an independent international advisory committee and by the Drug Authorities involved. Unconditional logistic regression analyses were performed.The analysis included 907 cases and 3,622 controls who had never used phenacetin-containing analgesics in their lifetime. The use of high cumulative lifetime dose (3rd tertile) of analgesics in the period up to five years before dialysis was not associated with later ESRD. Adjusted odds ratios with 95% confidence intervals were 0.8 (0.7 – 1.0) and 1.0 (0.8 – 1.3) for ever- compared with no or low use and high use compared with low use, respectively. The same results were found for all analgesics and for mono-, and combination preparations with and without caffeine. No increased risk was shown in analyses stratifying for dose and duration. Dose-response analyses showed that analgesic use was not associated with an increased risk for ESRD up to 3.5 kg cumulative lifetime dose (98 % of the cases with ESRD). While the large subgroup of users with a lifetime dose up to 0.5 kg (278 cases and 1365 controls) showed a significantly decreased risk, a tiny subgroup of extreme users with over 3.5 kg lifetime use (19 cases and 11 controls) showed a significant risk increase. The detailed evaluation of 22 cases and 19 controls with over 2.5 kg lifetime use recommended by the regulatory advisors showed an impressive excess of other conditions than analgesics triggering the evolution of ESRD i
Health and economic impact of combining metformin with nateglinide to achieve glycemic control: Comparison of the lifetime costs of complications in the U.K
Alexandra J Ward, Maribel Salas, J Jaime Caro, David Owens
Cost Effectiveness and Resource Allocation , 2004, DOI: 10.1186/1478-7547-2-2
Abstract: An existing model that simulates the long-term course of type 2 diabetes in relation to glycosylated haemoglobin (HbA1c) and post-prandial glucose (PPG) was used to compare the combination of nateglinide with metformin to monotherapy with metformin. Complication rates were estimated for major diabetes-related complications (macrovascular and microvascular) based on existing epidemiologic studies and clinical trial data. Utilities and costs were estimated using data collected in the United Kingdom Prospective Diabetes Study (UKPDS). Survival, life years gained (LYG), quality-adjusted life years (QALY), complication rates and associated costs were estimated. Costs were discounted at 6% and benefits at 1.5% per year.Combination therapy was predicted to reduce complication rates and associated costs compared with metformin. Survival increased by 0.39 (0.32 discounted) and QALY by 0.46 years (0.37 discounted) implying costs of £6,772 per discounted LYG and £5,609 per discounted QALY. Sensitivity analyses showed the results to be consistent over broad ranges.Although drug treatment costs are increased by combination therapy, this cost is expected to be partially offset by a reduction in the costs of treating long-term diabetes complications.Type 2 diabetes is a prevalent disease with complications that cause substantial financial burden [1]. Improving glycemic control can influence the prognosis for patients with type 2 diabetes as it reduces the risk of developing microvascular complications (nephropathy, neuropathy and retinopathy) [2]. Recent guidelines from the National Institute of Clinical Excellence (NICE) recommend the initial use of diet and exercise and, when these fail to maintain glycemic control, metformin should be prescribed [3]. Monotherapy with any treatment, however, is often unable to sustain target HbA1c levels of 6.5–7.5% in the majority of patients. They are therefore expected to require additional therapy within six years [4].Sulphonylureas have bee
Comparisons of Production Costs and Profit of Three Different Technology Levels of Papaya Production in Tabasco, Mexico  [PDF]
E. Guzmán-Ramón,R. Gómez-álvarez,H. A. Jürgen Pohlan,J. C. Alvarez-Rivero
Journal of Agriculture and Rural Development in the Tropics and Subtropics , 2008,
Abstract: The survey was carried out from September 2006 to January 2007 in three papaya production sites located in main papaya production zones in Tabasco; SE Mexico. There are differences in size of the cultivated area, in the yield of the papaya as well as in production costs and profit, according to the different technology levels in the farming systems: low, medium and high technology cultivation level. The financial evaluations were carried out in three sites with different productive technologies. The comparison of the agronomic and economic traits results for low technology level in: V AN of 2359.00 USD, BCR in 1.9 and an equilibrium point of 3750.00 USD, TIR of 0.25. In order to avoid loses, a quantity of 10714 kg papaya should be sold. In medium technology VAN is 1605.10 USD, BCR is 1.7, TIR 0.20 and the equilibrium point is 12800.00 USD. 36571 kg of papaya should be yearly sold. In high technology level VAN is 11749.40, BCR is 2.73, TIR 0.43 and the equilibrium point is 12187.50 USD, 34821 kg papaya should be sold yearly. The indicators showed that all three levels are profitable and economically viable.
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