Julia E. Aledort

Reducing the Global Burden of Tuberculosis: The Contribution of Improved Diagnostics

We estimated the impact of hypothetical new diagnostic tests for tuberculosis (TB) in patients with persistent cough in developing countries. We found that a variety of new tests could help better identify TB cases and target treatment, thereby reducing the burden of disease.

Developing and Interpreting Models to Improve Diagnostics in Developing Countries

Developing a strategy for investment in diagnostic technologies requires an understanding of the need for, and the health impact of, potential new tools, as well as the necessary performance characteristics and user requirements. In this paper, we outline an approach for modelling the health benefits of new diagnostic tools.

Reducing the burden of sexually transmitted infections in resource-limited settings: the role of improved diagnostics.

There is a great need for improved diagnosis of curable bacterial sexually transmitted infections among women in developing countries. We found that wider access to new diagnostic tests has a greater overall impact on health outcomes than improvements in test sensitivity or specificity.

Cost-effectiveness of peginterferon α-2a compared with lamivudine treatment in patients with HBe-antigen-positive chronic hepatitis B in the United Kingdom

Background Peginterferon &agr;-2a (40 kDa), a new treatment for chronic hepatitis B, produces seroconversion within 48 weeks in approximately 32% of HBeAg-positive patients. Over a defined treatment duration it offers improved efficacy over lamivudine, but at higher cost. We assessed the clinical outcomes and costs, from the perspective of the UK National Health Service, of 48 weeks of peginterferon &agr;-2a (40 kDa) vs. 4 years of lamivudine. Methods Cost-effectiveness was analysed using a state-transition Markov model simulating HBeAg-positive chronic hepatitis B natural history. Efficacy data were obtained from a large randomized trial comparing peginterferon &agr;-2a (40 kDa) with lamivudine over 48 weeks. Use of adefovir salvage treatment for lamivudine-resistant patients was also evaluated. Long-term lamivudine efficacy, treatment durability, disease progression, cost, and quality-of-life estimates were derived from the literature. One-way and probabilistic sensitivity analyses evaluated uncertainty. Results Treatment with peginterferon &agr;-2a (40 kDa) for 48 weeks resulted in higher discounted total healthcare costs (£3100), but an increase of 0.3 discounted quality-adjusted life years compared with long-term lamivudine, giving an incremental cost-effectiveness ratio of £10 400 per quality-adjusted life year gained (£8300–£15 400 in one-way sensitivity analyses). The cost-effectiveness acceptability curve showed intervention was below the £30 000/QALY threshold in over 95% of the simulations. When adefovir was included for patients with lamivudine resistance, peginterferon &agr;-2a (40 kDa) had an incremental cost of £6100/QALY gained. Conclusions Treatment with peginterferon &agr;-2a (40 kDa) for a defined duration of 48 weeks, although more expensive than lamivudine therapy, provides improvement in health outcomes, with a cost-effectiveness ratio well below the current UK cost-effectiveness threshold.

Cost Implications to Health Care Payers of Improving Glucose Management among Adults with Type 2 Diabetes

Objective. To assess the cost implications to payers of improving glucose management among adults with type 2 diabetes. Data Source/Study Setting. Medical-record data from the Community Quality Index (CQI) study (1996-2002), pharmaceutical claims from four Massachusetts health plans (2004-2006), Medicare Fee Schedule (2009), published literature. Study Design. Probability tree depicting glucose management over 1 year. Data Collection/Extraction Methods. We determined how frequently CQI study subjects received recommended care processes and attained Health Care Effectiveness Data and Information Set (HEDIS) treatment goals, estimated utilization of visits and medications associated with recommended care, assigned costs based on utilization, and then modeled how hospitalization rates, costs, and goal attainment would change if all recommended care was provided. Principal Findings. Relative to current care, improved glucose management would cost U.S.

Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base

327 (U.S.

Tabletop Exercise for Pandemic Influenza Preparedness in Local Public Health Agencies

192-711 in sensitivity analyses) more per person with diabetes annually, largely due to antihyperglycemic medications. Cost-effectiveness to payers, defined as incremental annual cost per patient newly attaining any one of three HEDIS goals, would be U.S.

Facilitated look backs: a new quality improvement tool for management of routine annual and pandemic influenza

1,128; including glycemic crises reduces this to U.S.

Determining the Priority Global Health Needs and Quantifying the Health Benefits Resulting From the Introduction of New Diagnostics in the Developing World

555-1,021. Conclusions. The cost of improving glucose management appears modest relative to diabetes-related health care expenditures. The incremental cost per patient newly attaining HEDIS goals enables payers to consider costs as well as outcomes that are linked to future profitability.