Gregory F. Guzauskas

Cost-Effectiveness of Recombinant Tissue-Type Plasminogen Activator Within 3 Hours of Acute Ischemic Stroke Current Evidence

Background and Purpose— Despite the availability of results from multiple newer clinical trials and changing healthcare costs, the cost-effectiveness of recombinant tissue-type plasminogen activator (r-tPA) for treatment of acute ischemic stroke within 0 to 3 hours of symptom onset was last evaluated in 1998 for the United States Using current evidence, we evaluate the long-term cost-effectiveness of r-tPA administered 0 to 3 hours after acute ischemic stroke onset versus no r-tPA. Methods— A disease-based decision model to project lifetime outcomes of patients after acute ischemic stroke by r-tPA treatment status from the US payer perspective was developed. Model inputs were derived from a recent meta-analysis of r-tPA trials, cohort studies, and health state preference studies. Cost data, inflated to 2013 dollars, were based on drug wholesale acquisition cost and the literature. To compare r-tPA to no r-tPA, we calculated incremental total direct costs, incremental quality-adjusted life years, and incremental cost-effectiveness ratios. We performed 1-way and probabilistic sensitivity analyses to evaluate uncertainty in the results. Results— r-tPA resulted in a gain of 0.39 quality-adjusted life years (95% confidence range, 0.16–0.66) on average per patient and a lifetime cost-saving of

The Cost-Effectiveness of Primary Stroke Centers for Acute Stroke Care

25 000 (95% confidence range, −

A risk-benefit assessment of prasugrel, clopidogrel, and genotype-guided therapy in patients undergoing percutaneous coronary intervention.

42 500 to −

Clopidogrel-Proton Pump Inhibitor Drug-Drug Interaction and Risk of Adverse Clinical Outcomes Among PCI-Treated ACS Patients: A Meta-analysis

11 000) compared with no r-tPA. In probabilistic sensitivity analyses, r-tPA was dominant compared with no r-tPA in ≈100% of simulations. The model was sensitive to inputs for r-tPA efficacy, healthcare costs for disabled patients, mortality rates for disabled and nondisabled patients, and quality of life estimates. Conclusions— Our analysis supports earlier economic evaluations that r-tPA is a cost-effective method to treat stroke. Appropriate use of r-tPA should be prioritized nationally.

The budget impact and cost-effectiveness of defibrotide for treatment of veno-occlusive disease with multi-organ dysfunction in patients post-hematopoietic stem cell transplant

Background and Purpose— Primary stroke centers (PSC) have demonstrated improved survival in patients with acute ischemic stroke (AIS). The objective of this study was to evaluate the cost-effectiveness of treating AIS patients in a PSC compared with a nonPSC hospital setting. Methods— We developed a decision analytic model to project the lifetime outcomes and costs of 2 hypothetical cohorts of 75 AIS patients. Clinical data were derived from a recent observational study comparing PSC- and nonPSC-admitted patients, clinical trials, longitudinal cohort studies, and health state preference studies. Cost data were based on Medicare reimbursement and other published sources. We used a healthcare payer perspective, and the primary outcomes were incremental life expectancy, quality-adjusted life years, and healthcare costs. We performed sensitivity and scenario analyses to evaluate uncertainty in the results. Results— Admission to a PSC resulted in a gain of 0.22 years of life (95% credible range [CR], 0.12–0.33) and 0.15 quality-adjusted life years (95% CR, 0.08–0.23) per patient, at a cost of

Stakeholder perspectives on decision-analytic modeling frameworks to assess genetic services policy

3600 (95% CR,

Cost-effectiveness of Drugs to Treat Relapsed/Refractory Multiple Myeloma in the United States

2400–

Cost-effectiveness of obinutuzumab plus bendamustine followed by obinutuzumab monotherapy for the treatment of follicular lymphoma patients who relapse after or are refractory to a rituximab-containing regimen in the US

5000) per patient, compared with admission to a nonPSC hospital. The incremental cost/quality-adjusted life year gained was

Are Evidence Standards Different for Genomic‐ vs. Clinical‐Based Precision Medicine? A Quantitative Analysis of Individualized Warfarin Therapy

24 000, and all probabilistic simulation results were below the

Integrating value of research into NCI Clinical Trials Cooperative Group research review and prioritization: A pilot study

100 000/quality-adjusted life year threshold. In scenario analyses accounting for as few as 7 and as many as 500 AIS patients/year per PSC, cost-effectiveness improved as the number of AIS patients admitted per year increased. Conclusions— Our study indicates that care at a PSC for patients with AIS is cost-effective and improves outcomes across a wide range of possible scenarios.