Michele Wilson

Cost-effectiveness of fluticasone propionate/salmeterol (500/50 μg) in the treatment of COPD

OBJECTIVE We examine the lifetime cost-effectiveness of treatment with fluticasone propionate/salmeterol (500/50 microg) compared with no maintenance treatment in COPD in the US. METHODS A decision-analytic model was developed to estimate lifetime costs and outcomes associated with fluticasone propionate/salmeterol 500/50 microg treatment, salmeterol 50 microg, and fluticasone propionate 500 microg compared to no maintenance treatment in treating COPD from a third-party US payer perspective. The patient population was similar to that of the TORCH clinical trial. Model structure and inputs were obtained from published literature and clinical trial data. All costs are presented in 2006 US dollars. Outcomes included cost per life year (LY) saved and cost per quality-adjusted life year (QALY) gained. Costs and outcomes were discounted at 3% annually. Univariate and multivariate sensitivity analyses were conducted to assess model robustness. RESULTS Compared to no maintenance treatment, treatment with fluticasone propionate/salmeterol 500/50mug results in a lifetime incremental cost-effectiveness ratio (ICER) of

Cost-Effectiveness of Recombinant Activated Factor VII in the Treatment of Intracerebral Hemorrhage

33,865/QALY. Treatment with salmeterol 50 microg was found to have an ICER of

Model-based cost-effectiveness analyses for the treatment of acute stroke events: a review and summary of challenges.

20,797/QALY. These results are robust to changes in input parameters. Fluticasone propionate 500 microg was dominated by no treatment, though the results were not robust to changes in parameters. CONCLUSIONS Treatment of COPD with fluticasone propionate/salmeterol 500/50 microg appears to be cost-effective (<or=

Cost-effectiveness analysis of umeclidinium/vilanterol for the management of patients with moderate to very severe COPD using an economic model

50,000/QALY) compared to no maintenance treatment. Similarly, salmeterol 50 microg may be cost-effective compared to no maintenance treatment. Compared with no maintenance treatment, fluticasone propionate 500 microg was effective in reducing number of exacerbations, but failure to differentiate from no maintenance treatment in mortality resulted in it being dominated in the base case.

Modeling the sustained use of the 13-valent pneumococcal conjugate vaccine compared to switching to the 10-valent vaccine in Mexico

Background and Purpose— Intracerebral hemorrhage (ICH) is among the most costly and debilitating forms of stroke. Results from a recent Phase IIb clinical trial demonstrate that administration of recombinant activated factor VII (rFVIIa) reduces ICH mortality and improves functional outcome. In the current analysis, we examine the cost-effectiveness of early treatment with rFVIIa for ICH in the United States. Methods— A decision-analytic model was developed to estimate the lifetime costs and outcomes associated with rFVIIa treatment at doses of 40, 80 and 160 &mgr;g/kg compared with current standard of care in treating ICH, from a US third-party payer perspective. The patient population was similar to that of the Phase IIb clinical trial. Model structure and inputs were obtained from published literature, clinical trial data, claims databases, and expert opinion. All costs are presented in 2005 US dollars. Outcomes included incremental cost per life-year (LY) saved and incremental cost per quality-adjusted life-year (QALY) gained. Costs and outcomes were discounted at 3% annually. Univariate and multivariate sensitivity analyses were conducted to assess model robustness. Results— Compared with standard care, treatment with rFVIIa 40 &mgr;g/kg, and 160 &mgr;g/kg results in total lifetime cost-effectiveness ratios of

Pneumococcal Vaccination Provides Substantial Value for Money for Canadians

6308/QALY and

Inpatient resource use and costs associated with switching from oral antipsychotics to aripiprazole once-monthly for the treatment of schizophrenia

3152/QALY, respectively. Treatment with rFVIIa 80 &mgr;g/kg was found to be cost saving and a gain of 1.67 QALYs is achieved over a patient’s lifetime. These results are robust to changes in input parameters. Conclusions— Treatment of ICH with rFVIIa 40 &mgr;g/kg and 160 &mgr;g/kg appears to be cost-effective (≤

COST-EFFECTIVENESS OF SALMETEROL/FLUTICASONE PROPIONATE IN THE TREATMENT OF COPD

50 000/QALY). At the 80 &mgr;g/kg dose, rFVIIa was not only cost-effective, but also cost saving.

Clinical and Economic Impact of a Potential Switch from 13-Valent to 10-Valent Pneumococcal Conjugate Infant Vaccination in Canada

OBJECTIVE To summarize the methodological approaches used in published decision-analytic models evaluating interventions for acute stroke treatment, to highlight key components of decision-analytic models of stroke treatment, and to discuss challenges for developing stroke decision models. METHODS A review of the published literature was performed using Medline, to identify studies involving mathematical decision models to evaluate interventions for acute stroke treatment. Articles were analyzed to determine key components of a stroke model and to note areas in which data are lacking. RESULTS We identified 13 published models of acute stroke treatment. These models typically possessed a short-term treatment module and a long-term post-treatment module. The following aspects of economic modeling were found to be relevant for developing a stroke model: modeling approach and health state; health state transition probabilities; estimation of short-term, long-term, and indirect costs; health state utilities; poststroke mortality; time horizon; model validation; and estimation of parameter uncertainty. CONCLUSIONS Data gaps have limited the development of economic models in stroke to date. In order to more accurately assess the long-term incremental impact of a new treatment of stroke, future research is needed to address these data gaps. We recommend that the complexity of models for examining the cost-effectiveness of an acute stroke treatment be kept to a minimum such that it can incorporate the currently available data without making a large number of assumptions around the data.

Estimating the Clinical and Economic Impact of Maintaining use of 13-valent Pneumococcal Conjugate Vaccine (PCV13) in Mexico

Background Bronchodilators such as long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) are central to the pharmacological management of COPD. Dual bronchodilation with umeclidinium/vilanterol (UMEC/VI; 62.5/25 μg) is a novel LAMA/LABA combination approved for maintenance treatment for patients with COPD. Objective The objective of this study was to assess the cost-effectiveness of maintenance treatment with UMEC/VI compared with tiotropium (TIO) 18 μg, open dual LAMA + LABA treatment, or no long-acting bronchodilator treatment in patients with moderate to very severe COPD. Methods A Markov model was developed to estimate the costs and outcomes associated with UMEC/VI treatment in patients with moderate to very severe COPD (GSK study number: HO-13-13411). Clinical efficacy, costs, utilities, and mortality obtained from the published literature were used as the model inputs. Costs are presented in US dollars based on 2015 prices. The model outputs are total costs, drug costs, other medical costs, number of COPD exacerbations, and quality-adjusted life-years (QALYs). Costs and outcomes were discounted at a 3% annual rate. Incremental cost-effectiveness ratios were calculated. One-way and probabilistic sensitivity analyses were conducted to assess the effects of changing parameters on the uncertainty of the results. Results UMEC/VI treatment for moderate to very severe COPD was associated with lower lifetime medical costs (