Lars Holger Ehlers

Analysis of cost effectiveness of screening Danish men aged 65 for abdominal aortic aneurysm

Objective To assess the cost effectiveness of screening men aged 65 for abdominal aortic aneurysm. Design Cost effectiveness analysis based on a probabilistic, enhanced economic decision analytical model from screening to death. Population and setting Hypothetical population of men aged 65 invited (or not invited) for ultrasound screening in the Danish healthcare system. Data sources Published results from randomised trials and observational epidemiological studies retrieved from electronic bibliographic databases, and supplementary data obtained from the Danish Vascular Registry. Data synthesis A hybrid decision tree and Markov model was developed to simulate the short term and long term effects of screening for abdominal aortic aneurysm compared with no systematic screening on clinical and cost effectiveness outcomes. Probabilistic sensitivity analyses using Monte Carlo simulation were carried out. Results were presented in a cost effectiveness acceptability curve, an expected value of perfect information curve, and a curve showing the expected (net) number of avoided deaths from abdominal aortic aneurysm over time after the introduction of screening. The model was validated by calibrating base case health outcomes and expected activity levels against evidence from the recent Cochrane review of screening for abdominal aortic aneurysm. Results The estimated costs per quality adjusted life year (QALY) gained discounted at 3% per year over a lifetime for costs and QALYs was £43 485 (€54 852;

Cost-Effectiveness of Intravenous Thrombolysis With Alteplase Within a 3-Hour Window After Acute Ischemic Stroke

71 160). At a willingness to pay threshold of £30 000 the probability of screening for abdominal aortic aneurysm being cost effective was less than 30%. One way sensitivity analyses showed the incremental cost effectiveness ratio varying from £32 640 to £66 001 per QALY. Conclusion Screening for abdominal aortic aneurysm does not seem to be cost effective. Further research is needed on long term quality of life outcomes and costs.

Doing mini–health technology assessments in hospitals: A new concept of decision support in health care?

Background and Purpose— The aim of this study was to assess the costs and cost-effectiveness of intravenous thrombolysis treatment with alteplase (Actilyse) of acute ischemic stroke with 24-hour in-house neurology coverage and use of magnetic resonance imaging. Methods— A health economic model was designed to calculate the marginal cost-effectiveness ratios for time spans of 1, 2, 3 and 30 years. Effect data were extracted from a meta-analysis of six large-scale randomized and placebo-controlled studies of thrombolytic therapy with alteplase. Cost data were extracted from thrombolysis treatment at Aarhus Hospital, Denmark, and from previously published literature. Results— The calculated cost-effectiveness ratio after the first year was

Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients

55 591 US per quality-adjusted life-year (base case). After the second year, computation of the cost-effectiveness ratio showed that thrombolysis was cost-effective. The long-term computations (30 years) showed that thrombolysis was a dominant strategy compared with conservative treatment given the model premises. Conclusions— A high-quality thrombolysis treatment with 24-hour in-house neurology coverage and magnetic resonance imaging might not be cost-effective in the short term compared with conservative treatment. In the long term, there are potentially large-scale health economic cost savings.

A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy.

OBJECTIVES The purpose of this project was to evaluate local decision support tools used in the Danish hospital sector from a theoretical and an empirical point of view. METHODS The use of local decision support was evaluated through questionnaires sent to all county health directors, all hospital managers, and all heads of clinical departments in cardiology, orthopedic surgery, and intensive care. In addition, respondents were asked to submit whatever decision support tools they were using (including mini-HTAs, other forms or checklists, and special procedures for decision making concerning new health technologies). A theoretical analysis of the decision support tools (decision theory) was performed as well as a comparison with the business case method used in private companies. Finally, the Danish mini-HTA was compared with foreign production and use of HTA and HTA-like assessments as local decision support. RESULTS The response rate was high (87 percent, 94 percent, 85 percent, respectively). We collected sixty different forms (of which forty-nine were mini-HTAs) and twenty variants of written procedures. We found theoretical and empirical evidence that local involvement in the process of making the HTA could be important for the use of the results from the HTA and for the process of implementing the new technology. CONCLUSIONS Doing mini-HTA in hospitals seems to balance the need for quality and depth with the limited time and resources for assessment.

National use of thrombolysis with alteplase for acute ischaemic stroke via telemedicine in Denmark: a model of budgetary impact and cost effectiveness.

We studied whether preventive home monitoring of patients with chronic obstructive pulmonary disease (COPD) could reduce the frequency of hospital admissions and lower the cost of hospitalization. Patients were recruited from a health centre, general practitioner (GP) or the pulmonary hospital ward. They were randomized to usual care or tele-rehabilitation with a telehealth monitoring device installed in their home for four months. A total of 111 patients were suitable for inclusion and consented to be randomized: 60 patients were allocated to intervention and three were lost to follow-up. In the control group 51 patients were allocated to usual care and three patients were lost to follow-up. In the tele-rehabilitation group, the mean hospital admission rate was 0.49 per patient per 10 months compared to the control group rate of 1.17; this difference was significant (P = 0.041). The mean cost of admissions was €3461 per patient in the intervention group and €4576 in the control group; this difference was not significant. The Kaplan-Meier estimates for time to hospital admission were longer for the intervention group than the controls, but the difference was not significant. Future work requires large-scale studies of prolonged home monitoring with more extended follow-up.

Cost-effectiveness of transanal irrigation versus conservative bowel management for spinal cord injury patients.

Abstract Objective: To evaluate cost effectiveness and cost utility comparing robot-assisted laparoscopic prostatectomy (RALP) versus retropubic radical prostatectomy (RRP). Methods: In a retrospective cohort study a total of 231 men between the age of 50 and 69 years and with clinically localised prostate cancer underwent radical prostatectomy (RP) at the Department of Urology, Aarhus University Hospital, Skejby from 1 January 2004 to 31 December 2007, were included. The RALP and RRP patients were matched 1:2 on the basis of age and the D’Amico Risk Classification of Prostate Cancer; 77 RALP and 154 RRP. An economic evaluation was made to estimate direct costs of the first postoperative year and an incremental cost-effectiveness ratio (ICER) per successful surgical treatment and per quality-adjusted life-year (QALY). A successful RP was defined as: no residual cancer (PSA <0.2 ng/ml, preserved urinary continence and erectile function. A one-way sensitivity analysis was made to investigate the impact of changing one variable at a time. Results: The ICER per extra successful treatment was €64,343 using RALP. For indirect costs, the ICER per extra successful treatment was €13,514 using RALP. The difference in effectiveness between RALP and RRP procedures was 7% in favour of RALP. In the present study no QALY was gained 1 year after RALP, however this result is uncertain due to a high degree of missing data. The sensitivity analysis did not change the results noticeably. Limitations: The study was limited by the design resulting in a low percentage of information on the effect of medication for erectile dysfunction and only short-term quality of life was measured at 1 year postoperatively. Conclusion: RALP was more effective and more costly. A way to improve the cost effectiveness may be to perform RALP at fewer high volume urology centres and utilise the full potential of each robot.

Higher Stroke Unit Volume Associated With Improved Quality of Early Stroke Care and Reduced Length of Stay

AbstractAim: The purpose of this analysis was to assess the budgetary impact and cost effectiveness of the national use of thrombolysis with alteplase (recombinant tissue plasminogen activator; rt-PA) for acute ischaemic stroke via telemedicine in Denmark. Methods: Computations were based on a Danish health economic model of thrombolysis treatment of acute ischaemic stroke via telemedicine. Cost data for stroke units and satellite clinics were taken from the first practical experiences in Denmark with implementing thrombolysis via telemedical linkage to the Stroke Department at Aarhus University Hospital. Effectiveness data were taken from a published pooled analysis of results from randomized controlled trials of alteplase. Results: The calculations showed that the additional total costs to the hospitals of implementing thrombolysis with alteplase for acute ischaemic stroke via telemedicine were approximately

Quality of Care and Length of Hospital Stay Among Patients With Stroke

US3.0 (range 2.0–5.8) million per year in the case of five centres and five satellite clinics, or

Cost Effectiveness of Treatments for Stroke Prevention in Atrial Fibrillation: Focus on the Novel Oral Anticoagulants

US3.6 (range 2.4–7.0) million per year based on seven centres and seven satellite clinics. The incremental cost-effectiveness ratio was calculated to be approximately