贵州省农村癫痫项目点防治管理的成本-效用分析

目的 了解贵州省内农村癫痫项目覆盖地区参与管理治疗和自行治疗的癫痫患者在治疗后,费用和生存质量改善方面的情况,为管理治疗癫痫的后期成本投入提供科学依据。方法 采用QOLIE-31量表收集2组癫痫患者的生存质量情况,并计算改善的QALY值,依据卫生经济学的分析方法,计算其成本效用。结果 经比较,项目组与非项目组的各项指标均无统计学差异,具有较好的比较性。项目组平均QALY为30.14,非项目组为17.62,QALY的改善主要集中在中青年癫痫患者;项目组平均改善1个QALY需要20 903.8元,非项目组为24 201.4元,项目组人均成本效用比为34.10,而非项目组为136.73。结论 农村癫痫防治管理项目在提高农村癫痫患者的生存质量方面具有经济优势,作为一项惠民政策,应该逐步推广综合干预模式,为其他农村综合防治项目提供参考。     

高强度聚焦超声和子宫切除手术治疗子宫腺肌瘤的有效性及其成本效用分析

目的探讨高强度聚焦超声（HIFU）和子宫切除手术治疗子宫腺肌瘤有效性,并进行成本效用分析。方法将40例子宫腺肌瘤的患者均分为HIFU组和子宫切除组,于治疗后1、3、6个月随访患者治疗前后生活质量（QOL）改善率,并采用等级尺度法提取效用值进行成本效用分析。结果两组治疗后各时间点的QOL评分差异无统计学意义（P〉0．05）;但各组内QOL在治疗6个月后均较前升高（P〈0．05）,HIFU组和手术组的质量调整生命年成本分别为20388．76元／年和34507．68元／年,增量成本效用分析和敏感性分析表明手术组的花费高于HIFU组。结论HIFU和手术治疗均可有效改善子宫腺肌瘤患者的生存质量,6个月内手术治疗成本较高。     

Adjuvant chemotherapy for breast cancer: a cost-utility analysis of FEC-D vs. FEC 100

Background Adjuvant 5-flurouracil, epirubicin and cyclophosphamide-docetaxel (FEC-D) has been shown to improve disease-free and overall survival (DFS and OS), compared to FEC 100, for node-positive breast cancer. An economic evaluation was undertaken to examine the cost-utility (CU) of FEC-D relative to FEC 100 given possible differences in cost between the two regimens. Methods A Markov model was developed to calculate the cumulative costs and quality-adjusted life years (QALY) gained over a 10-year horizon for a hypothetical cohort of 1,000 women with node-positive breast cancer treated with FEC 100 or FEC-D. Event rates, costs, and utilities were derived from the literature. Efficacy outcomes were based primarily on the hazard ratio of DFS for all patients, but separate analyses were also conducted according to age and menopausal status as per the PACS 01 subgroup analysis results. The model took a third-party direct payer perspective and reports results in 2006 Canadian dollars ($). Both costs and benefits were discounted at 3%. Results FEC-D is associated with 0.156 QALY gain and a $2,280 incremental cost compared to FEC 100, with a CU of $14,612/QALY gained. Results were robust to model assumptions and input parameters in a sensitivity analysis but were marginal in pre-menopausal and younger women. Conclusions Adjuvant FEC-D is a cost-effective alternative to FEC 100, with a cost-effectiveness ratio well below commonly employed thresholds. The CU according to age and menopausal status should be considered in view of the potential differences in efficacy in these subgroups, if any.     

难治性抑郁症文拉法辛与米氮平治疗的药物经济学分析

目的 比较文拉法辛和米氮平治疗难治性抑郁症的成本-效果和成本-效用.方法 研究纳入难治性抑郁症患者105例,按照计算机生成的随机数随机分为文拉法辛组50例和米氮平组55例.计算8周治疗药费成本,以临床治愈率和临床有效率为治疗效果,质量调整生命年为治疗效用.采用描述性分析及非参数检验比较两组的成本-效果和成本-效用.结果 治疗8周每位抑郁症患者治疗成本文拉法辛组1 396.44元,米氮平组1 206.90元,前者比后者成本高189.54元.成本-效果分析显示,两组每成功治愈或治疗有效1％患者的成本接近（临床治愈率成本相差0.06元,临床有效率成本相差1.08元）.成本-效用分析显示两组之间差异无统计学意义（生理机能Z=-0.15,P＞0.05;心理健康Z=-0.54,P＞0.05）.结论 文拉法辛和米氮平治疗难治性抑郁症的成本-效果、成本-效用相似.     

广东省社区美沙酮维持治疗的评价与决策分析

目的通过Markov模型进行MonteCarlo模拟,对广东省社区美沙酮维持治疗进行评价与决策分析。方法建立Markov决策模型,应用MonteCarlo模拟进行成本效用分析。结果平均每个吸毒者30年中不维持治疗与维持治疗的费用分别为114.4(101.2～129.6)万元与81.9(62.4～102.3)万元,效用值分别为9.7(8.9～10.7)QALY与12.3(10.4～14.2)QALY,C/E分别为11.8(10.3～13.0)万元/QALY与6.7(4.5～9.6)万元/QALY,ICUR为-12.5万元/QALY。结论MonteCarlo试验模拟能估计成本与效用的变异,并能进行统计学检验,对于结果的预测有积极意义。     

Modelling the cost-utility of bio‑electric stimulation therapy compared to standard care in the treatment of elderly patients with chronic non-healing wounds in the UK

ABSTRACT

Objective: To estimate the cost-utility of bio-electric stimulation therapy (Posifect^*) compared to standard care in elderly patients with chronic, non-healing wounds of > 6 months duration, from the perspective of the National Health Service (NHS) in the UK.

Methods: Clinical and resource use data from a 16 week clinical evaluation of bio-electric stimulation therapy among patients who had recalcitrant wounds were combined with utility data obtained from a standard gamble analysis to construct a 16 week Markov model. The model considers the decision by a clinician to continue with a patient's previous care plan or treat with bio-electric stimulation therapy. Unit resource costs at 2005/2006 prices were applied to the resource utilisation estimates within the model, enabling the cost-utility of bio-electric stimulation therapy compared to standard care to be estimated. The acquisition cost of Posifect had not been decided at the time of performing this study. Hence, the base case analysis used a cost of £50 per dressing.

Results: 33% of all wounds are expected to heal within 16 weeks after the start of bio-electric stimulation therapy. Consequently, using bio-electric stimulation therapy is expected to lead to a 51% decrease in the number of domiciliary clinician visits, from 4.7 to 2.3 per week. The model also showed that using bio-electric stimulation therapy instead of patients’ standard care is expected to reduce the NHS cost of managing them by 16% from £2287 (95% CI: £1838; £2735) to £1921 (95% CI: £1609; £2233) and result in a health gain of 0.023 QALYs over 16 weeks. Hence, bio-electric stimulation therapy was found to be a dominant treatment. Sensitivity analyses demonstrated that the cost-utility of using bio-electric stimulation therapy relative to standard care is very sensitive to the acquisition cost of the therapy, the acquisition cost of patients’ drugs and the number of clinician visits and less sensitive to utility values and the acquisition cost of other dressings.

Conclusion: Within the limitations of the model, bio-electric stimulation therapy is expected to afford the NHS a cost-effective dressing compared to standard care in the management of chronic non-healing wounds of > 6 months duration. Bio-electric stimulation therapy's acquisition cost is expected to be offset by a reduction in the requirement for domiciliary clinician visits, leading to a release of NHS resources for use elsewhere in the system, thereby generating an increase in NHS efficiency.     

A cost-effectiveness analysis of South Africa’s seasonal influenza vaccination programme

BackgroundSeasonal influenza imposes a significant health and economic burden in South Africa, particularly in populations vulnerable to severe consequences of influenza. This study assesses the cost-effectiveness of South Africa’s seasonal influenza vaccination strategy, which involves vaccinating vulnerable populations with trivalent inactivated influenza vaccine (TIV) during routine facility visits. Vulnerable populations included in our analysis are persons aged ≥ 65 years; pregnant women; persons living with HIV/AIDS (PLWHA), persons of any age with underlying medical conditions (UMC) and children aged 6–59 months.MethodWe employed the World Health Organisation’s (WHO) Cost Effectiveness Tool for Seasonal Influenza Vaccination (CETSIV), a decision tree model, to evaluate the 2018 seasonal influenza vaccination campaign from a public healthcare provider and societal perspective. CETSIV was populated with existing country-specific demographic, epidemiologic and coverage data to estimate incremental cost-effectiveness ratios (ICERs) by comparing costs and benefits of the influenza vaccination programme to no vaccination.ResultsThe highest number of clinical events (influenza cases, outpatient visits, hospitalisation and deaths) were averted in PLWHA and persons with other UMCs. Using a cost-effectiveness threshold of US$ 3 400 per quality-adjusted life year (QALY), our findings suggest that the vaccination programme is cost-effective for all vulnerable populations except for children aged 6–59 months. ICERs ranged from ~US$ 1 750 /QALY in PLWHA to ~US$ 7 500/QALY in children. In probabilistic sensitivity analyses, the vaccination programme was cost-effective in pregnant women, PLWHA, persons with UMCs and persons aged ≥65 years in >80% of simulations. These findings were robust to changes in many model inputs but were most sensitive to uncertainty in estimates of influenza-associated illness burden.ConclusionSouth Africa's seasonal influenza vaccination strategy of opportunistically targeting vulnerable populations during routine visits is cost-effective. A budget impact analysis will be useful for supporting future expansions of the programme.