Objective To evaluate the cost effectiveness of four different mechanisms clinical commonly used antidepressants, namely, amitriptyline, escitalopram, mirtazapine and venlafaxine in the treatment of moderate-severe depressive disorder in China and to provide clinicians with some advice. Methods We carried out the cost-effectiveness analysis of four antidepressants by establishing a decision tree model. The parameters uncertainty in the model was estimated through one-way sensitivity analysis. Results In terms of average cost-effectiveness ratio (CER), amitriptyline’s was 45.24 RMB, which was the lowest. And the CERs of mirtazapine, escitalopram and venlafaxine were 273.71 RMB, 332.00 RMB and 716.58 RMB, respectively. While in terms of incremental cost-effectiveness ratio (ICER), venlafaxine was excluded as the dominated strategy. When the threshold value of willingness to pay (WTP) was less than 3 420.92 RMB, amitriptyline was the most cost-effective; when the threshold value ranges between 3 420.92 RMB and 4 200 RMB, mirtazapine was the most cost-effective; and when the threshold value was over 4 200 RMB, escitalopram was the most cost-effective. In the one-way sensitivity analysis, when we changed the four kinds of drugs costs within a certain range, the results was not changed with the change of venlafaxine’s cost but changed with the other three drugs costs. Conclusion Clinicians may choose the most cost-effective therapy according to patients’ different WTP values. We suggests that health care institutions should encourage the use of escitalopram clinically and provide subsidies for patients so as to increase the overall society benefit.
Objective To evaluate the ambulatory surgery mode by using health economical mothods and provide reference for optimization and decision of surgical operation mode. Methods The patients who underwent unilateral flexible ureteroscopic holmium laser lithotriphy for ureteral calculi in Xiangya Hospital, Central South University between January 1st to December 31th, 2015 were selected in this study, including 59 with ambulatory surgery mode (the ambulatory group) and 65 with special in-hospital surgery mode (the special group). The differences in average bed occupancy time, cost, therapeutic effect, and satisfaction between the two operation modes were compared. Results The average bed occupancy time in the ambulatory group and the special group was (1.03±0.18) and (6.35±0.74) days, respectively, and the difference was statistically significant (P<0.05). The patients in both groups were followed up for one month after the operation, and the incidence of complications was 6.8% (4/59) in the ambulatory group and 6.2% (4/65) in the special group, without significant difference (P>0.05). The satisfaction score in the ambulatory group and the special group was 96.48±0.23vs. 96.53±0.18 without significant difference (P>0.05). The differences in direct medical cost [(17 738.28±1 027.85)vs. (21 307.67±554.41) yuan], direct non-medical cost [(103.39±18.25) vs. (630.76±78.90) yuan], indirect cost[ (266.93±47.12) vs. (1 640.44±190.55) yuan], and total cost [(18 128.10±1 037.76) vs. (23 558.29±619.20) yuan] between the ambulatory group and the special group were all statistically significant (P<0.05). The treatment effect index in the ambulatory group and the special group was 0.96 and 1.05, respectively; the cost-effect ratio was 18 883.44 and 22 436.47, respectively. Sensitivity analysis showed that the adjusted cost-effect ratio in the ambulatory group (16 629.64) was still lower than that in the special group (20 534.91). Conclusions The cost-effect ratio of ambulatory surgery mode is superior than that of special in-hospital surgery mode, and there is no obvious difference in patients satisfaction between the two modes. Ambulatory surgery mode can be recommended to patients who meet the indications of day surgery.
ObjectiveTo compare medical cost and utilization efficiency of medical resources between manual layered anastomosis with mechanical stapling technique in esophagectomy. MethodsClinical data of 132 patients who underwent surgical resection of esophageal carcinoma in the Department of Thoracic Surgery of Gansu Tumor Hospital between January and October 2011 were respectively analyzed. According to different anastomotic techniques, all the patients were divided into a manual layered anastomosis group (including 40 males and 20 females with their age of 36-72 (49.3±7.6) years) and a mechanical stapling technique group (including 50 males and 22 females with their age of 30-79 (51.0±8.6) years). Demographic data, operation data, postoperative complications, direct and indirect medical cost, and constitution of direct medical cost were compared between the 2 groups. ResultsMedical cost of esophagectomy was 14 505.03± 1 523.37 yuan in the manual layered anastomosis group and 19 891.05±1 634.58 yuan in the mechanical stapling technique group respectively, which were statistically different (P < 0.05). Material cost was 2 242.00±751.08 yuan in the manual layered anastomosis group and 5 424.00±1 876.22 yuan in the mechanical stapling technique group respectively, which were statistically different (P < 0.05). Cost-effectiveness analysis showed that cost-effectiveness ratio in the manual layered anastomosis group was lower, thus this anastomotic technique was more reasonable. ConclusionMedical cost of manual layered anastomosis is lower than that of mechanical stapling technique in esophagectomy, as the utilization efficiency of medical resources of manual layered anastomosis is higher than that of mechanical stapling technique.
ObjectiveTo compare the cost-effectiveness of warfarin and enoxaparin overlapping treatment for the prevention of venous thromboembolism (VTE) or pulmonary embolism (PE) in patients with nephrotic syndrome (NS). MethodsA decision tree model was constructed. The efficacy data applied in our decision tree were from clinical data, and the cost data was based on the hospitalization cost of 103 patients with nephrotic syndrome in Guangdong Provincial People's Hospital from 2013 to 2014, State Development and Reform Commission pricing and literature report. The one-way sensitivity analyses was conducted to analyze the stability of test. ResultsIn base case, the cost and cost-effective ratio of warfarin and enoxaparin overlapped treatment for 3 days were 10305.49 yuan and 31607.15, respectively. While those overlapped treatment for 4 days were 8849.36 yuan and 20896.46, overlapped treatment for 5 days and above were 9494.29 yuan and 21659.95, respectively. The incremental cost-effectiveness ratio of 4 days versus 5 days and above was 5600.96. The cost-effective ratio of 4 days was lower but the incremental cost-effectiveness ratio of it was higher. The sensitivity analysis showed the test result was stable. ConclusionCost-effectiveness analysis shows that warfarin and enoxaparin overlapping treatment for 4 days in patients with nephrotic syndrome has cost-effective advantage. Due to the limited sample size of our study, the above conclusion should be proved by more large-scale high-quality clinical studies.
Onehealth, an evidence-based decision-making software, is based on the United Nations' epidemiological reference modules to predict the effect of health services. Onehealth is a large database. The software is using activitybased costing, simulating investment costs of health system and changes of mortality in different coverage levels. By the cost of inputs/avoid deaths, it could quantify the cost of health services effectiveness and provide an intuitive basis for the rational allocation of health resources. This study introduces the relevant concepts, model structures and applications of Onehealth. We took the study of child nutrition interventions in Sudan for example and to present Onehealth tool's operating. As a new auxiliary and evidence-based decision-making software with scientific and rigorous theoretical approach, Onehealth has practical significance on the national or regional macro decision-making.
Objective To retrospectively analyze the analgesic effect and cost-effectiveness of combined analgesia versus intermittent analgesia for patients underwent retroperitoneal laparoscopic surgery. Methods We retrospectively collected clinical parameters and outcomes of analgesic effect from patients who underwent retroperitoneal laparoscopic surgery. Included patients were divided into two groups: local injection of ropivacaine combined with intermittent administration with analgesic via intravenous injection and intermittent administration with analgesic via intravenous injection only. Visual analogue scale (VAS) at different time points (2 h, 4 h, 6 h, 12 h, 24 h), usage of postoperative non-steroidal anti-inflammatory drugs (NSAIDs), adverse events, costs and other information were collected and assessed for further analysis of analgesic effect and cost-effectiveness. Results A total of 80 patients were enrolled in this study, each group consists of 40 patients. The results of this study found that VAS scores at 2 h and 4 h after operation in the combined analgesic group were significantly lower than that in the intermittent intravenous analgesia group (P<0.05), while there were no significant differences between the two groups in VAS scores at 6, 12 and 24 h after operation. The usage of NSAIDs were significantly lower in the combined group than intermittent group (P<0.05). The effective rate in the combined group was significantly higher than that in the intermittent group (P<0.05). The average cost of postoperative hospitalization and postoperative analgesic of the two groups were similar (allP values >0.05), and cost-effectiveness evaluation of the combined analgesia group was better than that of intermittent group. Conclusion Compared to intermittent administration with analgesic via intravenous injection, subcutaneous injection of ropivacaine hydrochloride combined with intermittent intravenous injection of parecoxib in patients underwent retroperitoneal laparoscopic surgery significantly could alleviate patients' painful complaints and reduce the postoperative usage of NSAIDs without increasing adverse events. Furthermore, the combination strategy has a lower cost-effectiveness ratio than intermittent group, which represents economic advantages.
Objective To investigate the clinical effectiveness of the total Flavones of Hippophae Rhamnoides L. (TFH) and compare its cost-effectiveness ratio with enalapril in patients with essential hypertension. Methods Among 3 971 staff members in two universities, 155 eligible patients with blood pressure (BP) ≥160/100 mmHg were screened and included in this study. By using a random number table, the patients were randomized to the two groups: TFH was given to the treatment group while enalapril in the control group. At the end of the six week, BP, total cost and cost-effectiveness ratio were measured in both TFH and enalapril groups. Results After six weeks, blood pressures in the TFH and enalapril groups decreased by 12.7±11.6/8.1±5.1 mmHg and 15.2±9.7/10.1±7.3 mmHg respectively, while the improvement rates of BP were 73.24% (52/71) and 74.65% (53/71) respectively. There were no differences between TFH and enalapril groups in lowering BP amplitude and total effectiveness rate. The incidence of side effect in TFH group was 11.27% (8/71), which was significantly lower than that of enalapril 29.6% (21/71). The total cost of TFH group was 9 294.6 RMB with the cost effectiveness ratio of 732/1 147 RMB per mmHg and 179 RMB per case. In the enalapril group, the total cost added up to 13 236 RMB with cost effectiveness ratio of 870/1 310 per mmHg and 250 RMB per case. Sensitivity analysis indicated that TFH was better than enalapril with respect to clinical economic value even when enalapril price dropped to 1.8 RMB for tablet (5 mg). Conclusion Compared with enalapril, TFH is an effective and economic drug in treating patients with hypertension.
ObjectivesTo evaluate the economic efficacy of nab-paclitaxel (NAB-P) combined with gemcitabine (GEM) versus GEM alone in the treatment of metastatic pancreatic cancer in China.MethodsA Markov model simulating the costs and health outcomes was developed to estimate quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). The impact of parameter uncertainty on the model was assessed by deterministic one-way sensitivity analysis.ResultsNAB-P combined with GEM was shown superior efficacy compared to gemcitabine monotherapy, however with higher costs. The ICER between the two groups was 964 780.79￥/QALY.ConclusionsCompared with gemcitabine monotherapy, NAB-P combined with GEM is not cost-effective. The conclusion is confirmed by deterministic one-way sensitivity analysis.
ObjectiveTo systematically review the economics evaluation studies on the early screening or diagnosis of primary immunodeficiency diseases (PID). MethodsWeb of Science, CRD, PubMed, The Cochrane Library, CNKI and WanFang Data databases were electronically searched to collect the economics evaluation studies on the early screening or diagnosis of PID from inception to July 1st, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, a descriptive systematic review was performed. ResultsA total of 10 studies focusing on SCID were included. The results showed that under a relatively high threshold, the early screening and diagnosis of SCID were cost-effective, which can reduce severe infections in patients and treatment costs while improving patient’s survival. ConclusionCurrent evidence shows that early diagnosis of PID can reduce costs and improve benefits. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify above conclusion.
Objective To compare the cost-effectiveness of Baofukang and Xinfuning in the treatment of HPV infection, and to provide references for reasonable clinical prescription, pricing drugs and the cognition product value. Methods Decision tree model was developed to estimate the cost-effectiveness of Baofukang and Xinfuning from the perspective of the cost payer. In the model, the effectiveness was mainly measured by the clearance rate of HPV based on meta-analysis. The cost data was mainly based on the published price data from the websites of the Development and Reform Commission, Bidding Center, the Health Department and so on. The single factor sensitivity analysis was performed based on the change of effectiveness and price. Results The effective rate of Baofukang treatment for 48 days was 61.89%, and the effective rate for 42 days was 63.05%, while Xinfuning’s effective rate for 30 days was 46.58%. The total cost were 668.61 yuan, 630.09 yuan and 850.83 yuan, respectively. Baofukang users had lower costs yet higher clearance rates of HPV compared to Xinfuning at different treatment time. In sensitivity analysis, the evaluation results would not been affected. Conclusion The current study suggests that Baofukang is more cost-effective than Xinfuning in the treatment of HPV infection.