Daria O’Reilly

A review of the cost of cardiovascular disease

In Canada, 74,255 deaths (33% of all deaths) in 2003 were due to cardio-vascular disease (CVD). As one of the most costly diseases, CVD represents a major economic burden on health care systems. The purpose of the present study was to review the literature on the economic costs of CVD in Canada and other developed countries (United States, Europe and Australia) published from 1998 to 2006, with a focus on Canada. Of 1656 screened titles and abstracts, 34 articles were reviewed including six Canadian studies and 17 American studies. While considerable variation was observed among studies, all studies indicated that the costs of treating CVD-related conditions are significant, outlining a convincing case for CVD prevention programs.

Canadian cost-utility analysis of initiation and maintenance treatment with anti-TNF-α drugs for refractory Crohn's disease

OBJECTIVES Crohns disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. Symptoms include but are not limited to abdominal pain, nausea, emesis, and diarrhea. Anti-TNF-α drugs are increasingly being used in patients with CD who have inadequate response to conventional therapy. However, these medications are quite expensive. The objective of this study is to evaluate the cost-utility of two anti-TNF-α drugs (infliximab, adalimumab) for refractory CD. METHODS A Markov model was used to estimate the costs and QALYs of three treatments (usual care, infliximab, adalimumab) over a 5 year time horizon. After initial treatment, patients achieve remission, achieve treatment response or remain in the drug refractory health state. Patients who achieve remission or treatment response are at risk of relapse each 3 month model cycle. Patients in the drug refractory health state either remain in the health state or have surgery in each cycle. Different costs and utility values were assigned to the various model health states. Model input parameters including initial response rates, relapse rates, utility values were derived from published literature. RESULTS Usual care had both the lowest expected costs (

Harmonization of reimbursement and regulatory approval processes: a systematic review of international experiences

17,017) and QALYs (2.555), while infliximab had both the highest expected costs (

Effects of study design and trends for EVAR versus OSR

54,084) and QALYs (2.721). The incremental cost per QALY moving from usual care to adalimumab and from adalimumab to infliximab was estimated to be to be

Cost-effectiveness of reducing wait times for cataract surgery in Ontario

193,305 and

Health economic evaluations help inform payers of the best use of scarce health care resources

451,165, respectively. CONCLUSIONS Based on common willingness to pay thresholds, ant-TNF-α drugs would not be perceived as a cost effective treatment for refractory CD.

Effect of computer-generated tailored feedback on glycemic control in people with diabetes in the community: a randomized controlled trial.

A considerable degree of overlap exists between reimbursement and regulatory approval of health technologies, and harmonization of certain aspects is both possible and feasible. Various models to harmonization have been suggested in which a number of practical attempts have been drawn from. Based on a review of the literature, approaches can be categorized into those focused on reducing uncertainty and developing economies of scale in the evidentiary requirements; and/or aligning timeframes and logistical aspects of the review process. These strategies can further be classified based on the expected level of structural and organizational change required to implement them into the existing processes. Passive processes require less modification, whereas active processes are associated with greater restructuring. Attempts so far at harmonization have raised numerous legal and practical issues and these must be considered when introducing a more harmonized framework into the existing regulatory and reimbursement arrangements.

Sentinel Lymph Node Biopsy in Vulvar Cancer: A Health Technology Assessment for the Canadian Health Care Context

Purpose: To investigate if study design factors such as randomization, multi-center versus single center evidence, institutional surgical volume, and patient selection affect the outcomes for endovascular repair (EVAR) versus open surgical repair (OSR). Finally, we investigate trends over time in EVAR versus OSR outcomes. Methods: Search strategies for comparative studies were performed individually for: OVID’s MEDLINE, EMBASE, CINAHL, HAPI, and Evidence Based Medicine (EBM) Reviews (including Cochrane DSR, ACP Journal Club, DARE and CCTR), limited to 1990 and November 2006. Results: Identified literature: 84 comparative studies pertaining to 57,645 patients. These include 4 randomized controlled trials (RCTs), plus 2 RCTs with long-term follow-up. The other 78 comparative studies were nonrandomized with 75 reporting perioperative outcomes, of which 16 were multi-center, and 59 single-center studies. Of the single-center studies 31 were low-volume and 28 were high-volume centers. In addition, 5 studies had all patients anatomically eligible for EVAR, and 8 studies included high-risk patients only. Finally, 25 long term observational studies reported outcomes up to 3 years. Outcomes: Lower perioperative mortality and rates of complications for EVAR versus OSR varied across study designs and patient populations. EVAR adverse outcomes have decreased in recent times. Conclusion: EVAR highlights the problem of performing meta-analysis when the experience evolves over time.

BARRIERS AND FACILITATORS INFLUENCING ETHICAL EVALUATION IN HEALTH TECHNOLOGY ASSESSMENT

BACKGROUND Reducing wait times for cataract surgery is a priority in Ontario. However, no previous analysis has determined whether the extra treatment volumes required to reduce wait times are of good monetary value when compared with allocating those same financial resources to new programs, drugs, or technologies. The objective of the study was to use queuing models to determine the cost-effectiveness of reducing, to target levels, wait times for cataract surgery at the provincial level within 1 to 10 years by increasing treatment volumes. METHODS A cost-effectiveness analysis was performed by estimating the extra treatment volume required to reduce wait times using queuing model methodology. The cost of these extra treatments was obtained from Ontario provincial data. The incremental benefits of surgery are improvements in quality-adjusted life years (QALYs), and these values were obtained from the clinical literature. Incremental costs were compared with incremental benefits to determine an incremental cost-effectiveness ratio. RESULTS To reach the publicly stated target wait times, annual treatment volumes must increase by 4%. An extra increase in treatment volumes of 25,660 must also be provided for the transition period from the current wait time. The incremental cost-effectiveness ratio is

General population versus disease-specific event rate and cost estimates: potential bias for economic appraisals.

17,829 per QALY if the target wait time is achieved in 5 years, and this ratio is less than the common threshold for approval of new interventions, of