Davene R. Wright

The Economic Costs of Chronic Pain Among a Cohort of Treatment-Seeking Adolescents in the United States

UNLABELLED The aim of this study was to assess the economic cost of chronic pain among adolescents receiving interdisciplinary pain treatment. Information was gathered from 149 adolescents (ages 10-17) presenting for evaluation and treatment at interdisciplinary pain clinics in the United States. Parents completed a validated measure of family economic attributes, the Client Service Receipt Inventory, to report on health service use and productivity losses due to their childs chronic pain retrospectively over 12 months. Health care costs were calculated by multiplying reported utilization estimates by unit visit costs from the 2010 Medical Expenditure Panel Survey. The estimated mean and median costs per participant were

Market uptake of new antiviral drugs for the treatment of hepatitis C.

11,787 and

Long-term effectiveness and cost-effectiveness of screening for Hepatitis C virus infection.

6,770, respectively. Costs were concentrated in a small group of participants; the top 5% of those patients incurring the highest costs accounted for 30% of total costs, whereas the lower 75% of participants accounted for only 34% of costs. Total costs to society for adolescents with moderate to severe chronic pain were extrapolated to

Long-term effectiveness and cost-effectiveness of antiviral treatment in hepatitis C.

19.5 billion annually in the United States. The cost of adolescent chronic pain presents a substantial economic burden to families and society. Future research should focus on predictors of increased health services use and costs in adolescents with chronic pain. PERSPECTIVE This cost of illness study comprehensively estimates the economic costs of chronic pain in a cohort of treatment-seeking adolescents. The primary driver of costs was direct medical costs followed by productivity losses. Because of its economic impact, policy makers should invest resources in the prevention, diagnosis, and treatment of chronic pediatric pain.

Cost Effectiveness of Childhood Obesity Interventions Evidence and Methods for CHOICES

BACKGROUND/AIMS Peginterferon plus ribavirin is the state-of-the-art antiviral therapy for prevention of serious complications of hepatitis C. Our aim was to compare market uptake of and access to these drugs across Europe. METHODS We collected launch and sales data for peginterferons for 21 countries in the WHO European region and compared country-specific sales rates. Additionally, we converted sales figures into patient numbers and related those to country-specific hepatitis C prevalence, taking into account genotype distribution, patient characteristics and practice patterns. RESULTS Peginterferon sales rates differed considerably across countries. The earliest, most rapid and highest adoption rates were in EU founder states, followed by EU members that joined after foundation, and EU non-member states. Most new member states showed a marked increase in sales. By the end of 2005, approximately 308,000 patients had been treated with peginterferons in the 21 countries evaluated. The number of patients ever treated ranged from 16% of prevalent cases in France to less than 1% of cases in Romania, Poland, Greece and Russia. CONCLUSIONS Peginterferon market uptake and access differed considerably across Europe, suggesting unequal access to optimised therapy. Besides budget restrictions, national surveillance and treatment policies should be considered as reasons for market access variation.

Methods for Measuring Temporary Health States for Cost-Utility Analyses

BACKGROUND Hepatitis C virus (HCV) infection is an emerging problem in public health. In most countries, the majority of HCV infected people are yet undiagnosed. Early detection and treatment may result in better health outcomes and save costs by preventing future advanced liver disease. The evidence for long-term effectiveness and cost-effectiveness of HCV screening was systematically reviewed. METHODS We performed a systematic literature search on long-term health-economic effects of HCV screening and included Health Technology Assessment (HTA) reports, systematic reviews, long-term clinical trials, full health economic and decision-analytic modelling studies with a sufficiently long time horizon and patient-relevant long-term outcomes such as life-years gained (LYG) or quality-adjusted life years (QALY) gained. Economic results were converted to 2005 Euros. RESULTS Seven studies were included. Target population, HCV prevalence, study perspective, discount rate, screening and antiviral treatment mode varied. The incremental effectiveness of HCV screening and early treatment compared to no screening and standard care varied from 0.0004 to 0.066 LYG, and from 0.0001 to 0.072 QALY. Incremental cost-effectiveness and cost-utility ratios of HCV screening vs. no screening were 3900-243,700 euro/LYG and 18,300-1,151,000 euro/QALY. HCV screening seems to be cost-effective in populations with high HCV prevalence, but not in low HCV prevalence populations. CONCLUSIONS HCV screening and early treatment have the potential to improve average life-expectancy, but should focus on populations with elevated HCV prevalence to be cost-effective. Further research on the long-term health-economic impact of HCV screening when combined with appropriate monitoring strategies in different European health care systems is needed.

The cost of a primary care-based childhood obesity prevention intervention.

Summary.  We systematically reviewed the evidence for long‐term effectiveness and cost‐effectiveness of antiviral treatment in patients with chronic hepatitis C. We performed a systematic literature search on the long‐term effectiveness and cost‐effectiveness of AVT in hepatitis C (1990–March 2007), and included health technology assessment (HTA) reports, systematic reviews, long‐term clinical trials, economic studies conducted alongside clinical trials and decision‐analytic modelling studies. All costs were converted to 2005€. Antiviral therapy with peginterferon plus ribavirin in treatment‐naïve patients with chronic hepatitis C was the most effective (3.6–4.7 life years gained [LYG]) treatment and was reasonably cost‐effective (cost‐saving to 84 700€/quality adjusted life years [QALY]) when compared to interferon plus ribavirin. Some results also suggest cost‐effectiveness (below 8400€/(QALY) of re‐treatment in nonresponders/relapsers. Results for patients with persistently normal alanine aminotransferase (ALT) levels or with special co‐morbidities (e.g. HIV) or risk profiles were rare. We conclude that antiviral therapy may prolong life, improve long‐term health‐related quality‐of‐life and be reasonably cost‐effective in treatment‐naïve patients with chronic hepatitis C as well as in former relapsers/nonresponders. Further research is needed in patients with specific co‐morbidities or risk profiles.

Standardized Clinical Pathways for Hospitalized Children and Outcomes

INTRODUCTION The childhood obesity epidemic continues in the U.S., and fiscal crises are leading policymakers to ask not only whether an intervention works but also whether it offers value for money. However, cost-effectiveness analyses have been limited. This paper discusses methods and outcomes of four childhood obesity interventions: (1) sugar-sweetened beverage excise tax (SSB); (2) eliminating tax subsidy of TV advertising to children (TV AD); (3) early care and education policy change (ECE); and (4) active physical education (Active PE). METHODS Cost-effectiveness models of nationwide implementation of interventions were estimated for a simulated cohort representative of the 2015 U.S. population over 10 years (2015-2025). A societal perspective was used; future outcomes were discounted at 3%. Data were analyzed in 2014. Effectiveness, implementation, and equity issues were reviewed. RESULTS Population reach varied widely, and cost per BMI change ranged from

The costs and cost-effectiveness of collaborative care for adolescents with depression in primary care settings: a randomized clinical trial

1.16 (TV AD) to

Modeling the Cost Effectiveness of Child Care Policy Changes in the U.S.

401 (Active PE). At 10 years, assuming maintenance of the intervention effect, three interventions would save net costs, with SSB and TV AD saving