Sandra E. Talbird

Cost-effectiveness of treating influenzalike illness with oseltamivir in the United States

PURPOSE The cost-effectiveness of treating influenzalike illness (ILI) with oseltamivir in the United States was assessed. METHODS A decision-analysis model was developed with a one-year time horizon to assess the cost-effectiveness of oseltamivir compared with usual care from societal and payer perspectives for four patient populations: high-risk adults, healthy adults, elderly adults, and children. The model used efficacy data from oseltamivir clinical trials and other published literature and assumed oseltamivir was effective only in individuals infected with influenza virus not resistant to oseltamivir and treated within 48 hours of symptom onset. Direct medical costs were based on resources used; indirect costs were estimated based on time lost from work due to illness and premature mortality. Base-case estimates were tested in one-way sensitivity and variability analyses. RESULTS From a societal perspective, oseltamivir was cost-effective across all populations modeled, with an incremental cost per quality-adjusted life-year gained of

Outcomes and costs associated with PHiD-CV, a new protein D conjugate pneumococcal vaccine, in four countries.

5,388,

Cost-effectiveness of Telaprevir Combination Therapy for Chronic Hepatitis C

6,317,

Residual economic burden of Streptococcus pneumoniae- and nontypeable Haemophilus influenzae-associated disease following vaccination with PCV-7: a multicountry analysis.

7,652, and

Modelling the effect of conjugate vaccines in pneumococcal disease: Cohort or population models?:

16,176 for high-risk adults, children, elderly adults, and healthy adults, respectively. Results were similar from a payer perspective. When indirect costs were included (for all populations except elderly adults), oseltamivir was cost saving. In sensitivity analyses, oseltamivir remained cost-effective across all patient populations for all values tested, except the probability of developing influenza-related pneumonia. Variability analyses showed that oseltamivir remained cost-effective under most scenarios tested. CONCLUSION Base-case results and sensitivity analyses from a decision-analysis model found that treatment of ILI with oseltamivir was cost-effective compared with usual care from U.S. payer and societal perspectives in all patient populations studied when only direct costs were considered.

Cost-effectiveness of combination therapy with etravirine in treatment-experienced adults with HIV-1 infection.

This study estimated the impact of routine vaccination of infants with a new 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on health outcomes and costs across the entire population in Canada, Germany, Mexico, and Norway. A compartmental, static model with a 1-year time period for a steady-state population that allowed for the incorporation of direct and indirect (i.e., herd immunity and serotype replacement) vaccine effects across all age groups was used. Cases of disease prevented, deaths prevented, life-years gained, quality-adjusted life-years gained, and incremental costs in the steady-state year were calculated for PHiD-CV compared with 7-valent pneumococcal conjugate vaccine (PCV-7). A short-term analysis was also conducted to estimate the incremental difference in disease and cost outcomes for the two vaccines within the first 10 years. All costs were in 2008 local currency. In all four countries, the model estimated that PHiD-CV prevented more cases of disease, prevented more deaths, and resulted in more life-years and quality-adjusted life-years compared with PCV-7 in both the short term and the steady-state year. Assuming price parity for the vaccines, the model projected that routine vaccination with PHiD-CV resulted in lower costs compared with PCV-7 in both the short term and the steady-state year. Scenario analysis showed the incremental cost savings for PHiD-CV compared with PCV-7 in the steady-state year were sensitive to assumptions regarding duration of vaccine efficacy.

A steady-state, population-based model to estimate the direct and indirect effects of pneumococcal vaccines.

Objective To explore the expected long-term health and economic outcomes of telaprevir (TVR) plus peginterferon alfa-2a and ribavirin (PR), a regimen that demonstrated substantially increased sustained virologic response (SVR) compared with PR alone in adults with chronic genotype 1 hepatitis C virus (HCV) and compensated liver disease in the Phase III studies ADVANCE (treatment-naïve patients) and REALIZE (relapsers, partial responders, and null responders to previous PR treatment). Study Design A decision-analytic model was developed to assess the cost-effectiveness of TVR+PR vs. PR in the United States (US). Methods Patients first moved through the 72-week decision-tree treatment phase of the model and then entered the cyclic Markov post-treatment phase. Clinical data (patient characteristics, SVR rates, and adverse event rates and durations) were obtained from ADVANCE and REALIZE. Health-state transition probabilities, drug and other costs (in 2012/2013 US dollars), and utility values were obtained from the trials, published studies, and publicly available sources. Outcomes were discounted at 3% per year. Results Regardless of treatment history, patients receiving TVR+PR were projected to experience fewer liver-disease complications, more life-years, and more quality-adjusted life-years (QALYs) than patients receiving PR. In prior relapsers, TVR+PR was dominant, with lower total medical costs and more QALYs. For the other patient subgroups, incremental costs per QALY gained were between

US Cost Effectiveness of Darunavir/ Ritonavir 600/100 mg bid in Treatment- Experienced, HIV-Infected Adults with Evidence of Protease Inhibitor Resistance Included in the TITAN Trial

16,778 (treatment-naïve patients) and

Cost-Effectiveness of Nucleoside Reverse Transcriptase Inhibitor Pairs in Efavirenz-Based Regimens for Treatment-Naïve Adults with HIV Infection in the United States

34,279 (prior null responders). Extensive sensitivity analyses confirmed robust model results. Conclusions At standard willingness-to-pay thresholds, TVR+PR represents a cost-effective treatment option compared with PR alone for patients with chronic genotype 1 HCV and compensated liver disease in the US. Future analyses are needed to compare TVR+PR with all existing HCV treatment options.

Categorization of methods used in cost-effectiveness analyses of vaccination programs based on outcomes from dynamic transmission models.

This paper estimates the annual direct medical and caregiver costs of Streptococcus pneumoniae (Sp) and nontypeable Haemophilus influenzae (NTHi)-associated diseases in children younger than 10 years in Canada, Germany, Mexico, and Norway after vaccination with the 7-valent pneumococcal conjugate vaccine (PCV-7). Per-episode direct medical costs for treating Sp- and NTHi-associated diseases were summarised from the literature for three countries, and a Delphi panel was used to estimate resource use and the per-episode costs for Mexico. Per-episode or annual costs were inflated to 2008 local currency and converted to 2008 United States (US) dollars using purchasing power parities. The analysis was for 1 year; therefore, costs were not discounted. Sp- and NTHi-associated diseases resulted in current annual national costs of