福建省消除麻疹免疫策略实施的成本-效益分析

[目的]为评价福建省加速麻疹控制目标的卫生经济学效益,对福建省1982—2002年的资料进行分析。[方法]采用标准期望寿命年损失计算法,计算伤残调整生命年(DALYs),并用EPi Info软件和Excel软件进行分析。[结果]福建省实施消除麻疹免疫策略时期,如不考虑无形效益的影响,按消除麻疹免疫策略实施时期(1998—2002年)和计划免疫时期(1982—1997年)相比,产生效益114 318 250元(人民币),成本效益比为1∶2.96。[结论]福建省消除麻疹免疫策略取得了良好的经济效益。     

Cost-benefit of stockpiling drugs for influenza pandemic

We analyzed strategies for the use of stockpiled antiviral drugs in the context of a future influenza pandemic and estimated cost-benefit ratios. Current stockpiling of oseltamivir appears to be cost-saving to the economy under several treatment strategies, including therapeutic treatment of patients and postexposure prophylactic treatment of patients' close contacts.     

Cost-Effectiveness Analysis of Adding Low Dose Ribavirin to Peginterferon Alfa-2a for Treatment of Chronic Hepatitis C Infected Thalassemia Major Patients in Iran

Background

The prevalence of hepatitis C in Iran is 1% and 18% in general population and thalassemia patients respectively. The cost effectiveness analysis of adding Ribavirin to Peginterferon alfa-2a (PEG IFN alfa-2a) as a combination treatment strategy of chronic hepatitis C in thalassemia patients in comparison with monotherapy could help clinicians and policy makers to provide the best treatment for the patients.

Objectives

In this study we aimed to assess whether adding Ribavirin to PEG IFN alfa-2a is a cost effective strategy in different genotypes and different subgroups of 280 patients with chronic hepatitis C infection from the perspective of society in Iranian setting.

Patients and Methods

A cost effectiveness analysis including all costs and outcomes of treatments for chronic hepatitis C infected thalassemia major patients was conducted. We constructed a decision tree of treatment course in which a hypothetical cohort of 100 patients received “PEG IFN alfa-2a” or “Peg IFN alfa-2a plus Ribavirin.” The cost analysis was based on cost data for 2008 and we used 9300 Iranian Rials (IR Rial) as exchange rate declared by the Iranian Central Bank on that time to calculating costs by US Dollar (USD). To evaluate whether a strategy is cost effective, one time and three times of GDP per capita were used as threshold based on recommendation of the World Health Organization.

Results

The Incremental Cost Effectiveness Ratio (ICER) for combination therapy in genotype-1 and genotypes non-1 subgroups was 2,673 and 19,211 US dollars (USD) per one Sustain Virological Response (SVR), respectively. In low viral load and high viral load subgroups, the ICER was 5,233 and 14,976 USD per SVR, respectively. The calculated ICER for combination therapy in subgroup of patients with previously resistant to monotherapy was 13,006 USD per SVR. Combination therapy in previously resistant patients to combination therapy was a dominant strategy.

Conclusions

Adding low dose of Ribavirin to PEG IFN alfa-2a for treatment of chronic hepatitis C patients with genotype-1 was “highly cost effective” and in patients with low viral load and in previous monotherapy resistant patients was “cost effective.”     

基于Markov模型的纳武利尤单抗治疗化疗后失败的进展期胃癌的成本效果分析

目的:评价近期在国内批准上市的纳武利尤单抗治疗化疗后失败的进展期胃癌的成本效果。方法:采用ATTRACTION-2临床试验所获数据(纳武利尤单抗组330例,安慰剂组163例),建立Markov模型模拟化疗失败后进展期胃癌的疾病过程。分析每组的成本、生命年(LY)以及质量调整生命年(QALY),然后计算增量成本效果比(ICER),并根据程序性细胞死亡配体1(PD-L1)的表达进行了亚组分析。运用敏感度分析对参数进一步评估,评价模型的稳定性。结果:PD-L1阳性的患者中,纳武利尤单抗组总健康产出值0.357QALY(0.526LY),总成本221171元;安慰剂组总健康产值0.251QALY(0.368LY),总成本40866元,纳武利尤单抗组相比安慰剂组的ICER为1700991元/QALY。PD-L1阴性的患者中,纳武利尤单抗组总健康产出值0.545QALY(0.845LY),总成本333195元;安慰剂组总健康产出值为0.403QALY(0.63LY),总成本为90285元,纳武利尤单抗组相比安慰剂组的ICER为1710634元/QALY。两亚组中纳武利尤单抗的ICER均大于意愿支付值(178980元)。概率敏感度分析显示,纳武利尤单抗具有成本效果性的概率为0。一元敏感度分析提示纳武利尤单抗的价格对结果影响最大。结论:在当前中国医疗保障角度下,纳武利尤单抗对比安慰剂在化疗失败的晚期胃癌患者治疗中不具有成本效果性,但是纳武利尤单抗可以为这些患者带来生存获益,通过开展慈善援助计划、纳入医保等措施可以提高其经济性。     

Managing febrile respiratory illnesses during a hypothetical SARS outbreak

Since the World Health Organization declared the global outbreak of severe acute respiratory syndrome (SARS) contained in July 2003, new cases have periodically reemerged in Asia. This situation has placed hospitals and health officials worldwide on heightened alert. In a future outbreak, rapidly and accurately distinguishing SARS from other common febrile respiratory illnesses (FRIs) could be difficult. We constructed a decision-analysis model to identify the most efficient strategies for managing undifferentiated FRIs within a hypothetical SARS outbreak in New York City during the season of respiratory infections. If establishing reliable epidemiologic links were not possible, societal costs would exceed 2.0 billion US dollars per month. SARS testing with existing polymerase chain reaction assays would have harmful public health and economic consequences if SARS made up <0.1% of circulating FRIs. Increasing influenza vaccination rates among the general population before the onset of respiratory season would save both money and lives.     

Ⅱ型HFRS疫苗预防接种的成本--效益分析

对莒南县１９９４年底完成Ⅱ型ＨＦＲＳ疫苗接种的人群进行了４个流行年度的观察,结果显示疫苗保护率为１００％,通过成本－分析发现,该批疫苗成本－效益比值为１．５０,４年来所取得的净效益为７６４０６元,并且随时间的推移,效益也随之增大。建议在高发病村尽快集中接种Ⅱ型ＨＦＲＳ疫苗,以控制该县持续高发的出血热疫情,取得更大的效益。     

Cost-benefit analysis of haemophilus influenzae type B immunization in Korea

An economic evaluation of Haemophilus influenzae type b (Hib) immunization was conducted to examine whether Hib immunization should be included in Korea's national immunization program. The costs and benefits included direct and indirect values and an estimation of the economic efficiency. We determined that a universal Hib immunization program in Korea would prevent 17 deaths and 280 invasive Hib cases. When we assumed the one Hib immunization cost as 26,000 won, the national Hib immunization would cost 34.6 billion won. Costs for various Hib diseases were estimated at 26.8 billion won (11.8 billion won from direct costs and 14.9 billion won from indirect costs). A benefit-cost ratio of 0.77 showed that the economic efficiency of the integration of Hib immunization in Korea is low because of the low incidence rate of Hib disease and high price of vaccine. However, if the Hib immunization cost decrease to less than 20,000 won, a benefit-cost ratio increase to 1.0 and above, integrating Hib immunization into the national immunization program with economic efficiency can be considered.     

Cost-benefit analysis of a new alcohol biomarker, carbohydrate deficient transferrin, in a chronic illness primary care sample

BACKGROUND: Carbohydrate Deficient Transferrin (CDT) is a new alcohol biomarker recently approved by the Food and Drug Administration for alcohol screening. Limited information is available on the economic benefits of alcohol biomarkers. Our objective was to conduct a cost-benefit analysis (CBA) of the CDT test in a primary care sample of patients being treated for diabetes and hypertension. METHODS: A decision tree was created using data from national surveys, published literature, and two brief intervention trials conducted in primary care settings. The decision tree was used to estimate the costs and benefits of CDT under different scenarios. RESULTS: For the base case, utilizing CDT in addition to patient self-report resulted in an increase from 28 to 53 problem drinking cases identified out of 70 cases screened. With increased detection and subsequent intervention, the average medical and legal costs were far lower in the CDT arm of the study. When these avoided costs were incorporated into the model, an overall savings of $212.30 per patient was realized with CDT testing. Monte Carlo analysis also indicated a trend toward cost savings, with a mean cost savings of approximately $353 and a range of $1,619 in savings to $450 in costs for 1,000 simulations of the decision tree model. CONCLUSION: This CBA suggests that the addition of routine CDT screening to patient self-report may provide positive net economic benefits in primary care settings.