Anita J. Brogan

Cost-effectiveness of treating influenzalike illness with oseltamivir in the United States

PURPOSE The cost-effectiveness of treating influenzalike illness (ILI) with oseltamivir in the United States was assessed. METHODS A decision-analysis model was developed with a one-year time horizon to assess the cost-effectiveness of oseltamivir compared with usual care from societal and payer perspectives for four patient populations: high-risk adults, healthy adults, elderly adults, and children. The model used efficacy data from oseltamivir clinical trials and other published literature and assumed oseltamivir was effective only in individuals infected with influenza virus not resistant to oseltamivir and treated within 48 hours of symptom onset. Direct medical costs were based on resources used; indirect costs were estimated based on time lost from work due to illness and premature mortality. Base-case estimates were tested in one-way sensitivity and variability analyses. RESULTS From a societal perspective, oseltamivir was cost-effective across all populations modeled, with an incremental cost per quality-adjusted life-year gained of

Cost-effectiveness of Telaprevir Combination Therapy for Chronic Hepatitis C

5,388,

Cost Effectiveness of Darunavir/Ritonavir in Highly Treatment-Experienced, HIV-1-Infected Adults in the USA

6,317,

Cost-Effectiveness Model for Neovascular Age-Related Macular Degeneration: Comparing Early and Late Treatment with Pegaptanib Sodium Based on Visual Acuity

7,652, and

Comparative cost-efficacy analysis of darunavir/ritonavir and other ritonavir-boosted protease inhibitors for first-line treatment of HIV-1 infection in the United States.

16,176 for high-risk adults, children, elderly adults, and healthy adults, respectively. Results were similar from a payer perspective. When indirect costs were included (for all populations except elderly adults), oseltamivir was cost saving. In sensitivity analyses, oseltamivir remained cost-effective across all patient populations for all values tested, except the probability of developing influenza-related pneumonia. Variability analyses showed that oseltamivir remained cost-effective under most scenarios tested. CONCLUSION Base-case results and sensitivity analyses from a decision-analysis model found that treatment of ILI with oseltamivir was cost-effective compared with usual care from U.S. payer and societal perspectives in all patient populations studied when only direct costs were considered.

A note on separation in mean-lower-partial-moment portfolio optimization with fixed and moving targets

Objective To explore the expected long-term health and economic outcomes of telaprevir (TVR) plus peginterferon alfa-2a and ribavirin (PR), a regimen that demonstrated substantially increased sustained virologic response (SVR) compared with PR alone in adults with chronic genotype 1 hepatitis C virus (HCV) and compensated liver disease in the Phase III studies ADVANCE (treatment-naïve patients) and REALIZE (relapsers, partial responders, and null responders to previous PR treatment). Study Design A decision-analytic model was developed to assess the cost-effectiveness of TVR+PR vs. PR in the United States (US). Methods Patients first moved through the 72-week decision-tree treatment phase of the model and then entered the cyclic Markov post-treatment phase. Clinical data (patient characteristics, SVR rates, and adverse event rates and durations) were obtained from ADVANCE and REALIZE. Health-state transition probabilities, drug and other costs (in 2012/2013 US dollars), and utility values were obtained from the trials, published studies, and publicly available sources. Outcomes were discounted at 3% per year. Results Regardless of treatment history, patients receiving TVR+PR were projected to experience fewer liver-disease complications, more life-years, and more quality-adjusted life-years (QALYs) than patients receiving PR. In prior relapsers, TVR+PR was dominant, with lower total medical costs and more QALYs. For the other patient subgroups, incremental costs per QALY gained were between

Cost-effectiveness of combination therapy with etravirine in treatment-experienced adults with HIV-1 infection.

16,778 (treatment-naïve patients) and

US Cost Effectiveness of Darunavir/ Ritonavir 600/100 mg bid in Treatment- Experienced, HIV-Infected Adults with Evidence of Protease Inhibitor Resistance Included in the TITAN Trial

34,279 (prior null responders). Extensive sensitivity analyses confirmed robust model results. Conclusions At standard willingness-to-pay thresholds, TVR+PR represents a cost-effective treatment option compared with PR alone for patients with chronic genotype 1 HCV and compensated liver disease in the US. Future analyses are needed to compare TVR+PR with all existing HCV treatment options.

Cost-Effectiveness of Nucleoside Reverse Transcriptase Inhibitor Pairs in Efavirenz-Based Regimens for Treatment-Naïve Adults with HIV Infection in the United States

AbstractIntroduction: Darunavir is a new protease inhibitor (PI) that is co-administered with low-dose ritonavir and has demonstrated substantial efficacy in clinical trials of highly treatment-experienced patients when combined with an optimized background regimen (with or without enfuvirtide). This study estimates the cost effectiveness of darunavir with ritonavir (DRV/r) in this population over 5-year and lifetime time horizons in the USA. Methods: AMarkov model was used to follow a treatment-experienced HIV-1 cohort through six health states, based on CD4 cell count: greater than 500, 351–500, 201–350, 101–200, 51–100 and 0–50 cells/mm3, and death. The magnitude of the CD4 cell count increase and duration of increasing and stable periodswere derived fromweek 48DRV/r clinical trial results (POWER1 and 2). The treatment pathway assumed one regimen switch following treatment failure on the initial regimen. The use of antiretroviral drugs was based on usage in DRV/r clinical trials. US daily wholesale acquisition costs were calculated using the recommended daily doses. For each CD4 cell count range, utility values, HIV-1-related mortality rates and costs for medical resources (other than antiretroviral drug costs) were obtained from published literature. Non-HIV-1-related mortality rates were calculated by applying a relative risk value to theUS general population age and gender-specific mortality rates. Costs and outcomes were discounted at 3% per year. One-way and probabilistic sensitivity analyses and variability analysis were performed. Results: In a 5-year analysis, patients receivingDRV/r experienced 3.80 qualityadjusted life-years (QALYs) and incurred total medical costs of US

Cost-effectiveness of seasonal quadrivalent versus trivalent influenza vaccination in the United States: A dynamic transmission modeling approach.

217 288, while those receiving control PIs experienced 3.60QALYs and incurred costs of US