11 research outputs found

    The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England

    Get PDF
    Background: Parkinson’s disease is a progressive neurodegenerative disease, which significantly impacts patients’ quality of life and is associated with high treatment and direct healthcare costs. In England, levodopa/carbidopa intestinal gel (LCIG) is indicated for the treatment of levodopa-responsive advanced Parkinson’s disease with troublesome motor fluctuations when available combinations of medicinal products are unsatisfactory. Objective: We aimed to determine the cost effectiveness of LCIG compared to the standard of care for patients with advanced Parkinson’s disease in England, using real-world data. Methods: A Markov model was adapted from previous published studies, using the perspective of the English National Health System and Personal and Social Services to evaluate the cost effectiveness of LCIG compared to standard of care in patients with advanced Parkinson’s disease over a 20-year time horizon. The model comprised 25 health states, defined by a combination of the Hoehn and Yahr scale, and waking time spent in OFF-time. The base case considered an initial cohort of patients with an Hoehn and Yahr score of ≥ 3, and > 4 h OFF-time. Standard of care comprised standard oral therapies, and a proportion of patients were assumed to be treated with subcutaneous apomorphine infusion or injection in addition to oral therapies. Efficacy inputs were based on LCIG clinical trials where possible. Resource use and utility values were based on results of a large-scale observational study, and costs were derived from the latest published UK data, valued at 2017 prices. The EuroQol five-dimensions-3-level (EQ-5D-3L) instrument was used to measure utilities. Costs and quality-adjusted life-years were discounted at 3.5%. Both deterministic and probabilistic sensitivity analyses were conducted. Results: Total costs and quality-adjusted life-years gained for LCIG vs standard of care were £586,832 vs £554,022, and 2.82 vs 1.43, respectively. The incremental cost-effectiveness ratio for LCIG compared to standard of care was £23,649/quality-adjusted life-year. Results were sensitive to the healthcare resource utilisation based on real-world data, and long-term efficacy of LCIG. Conclusions: The base-case incremental cost-effectiveness ratio was estimated to be within the acceptable thresholds for cost effectiveness considered for England

    Benchmarking the Cost per Person of Mass Treatment for Selected Neglected Tropical Diseases: An Approach Based on Literature Review and Meta-regression with Web-Based Software Application

    No full text
    <div><p>Background</p><p>Advocacy around mass treatment for the elimination of selected Neglected Tropical Diseases (NTDs) has typically put the cost per person treated at less than US0.50.Whilstusefulforadvocacy,thefocusonasinglenumbermisrepresentsthecomplexityofdeliveringfreedonatedmedicinestoaboutabillionpeopleacrosstheworld.WeperformaliteraturereviewandmetaregressionofthecostperpersonperroundofmasstreatmentagainstNTDs.Wedevelopawebbasedsoftwareapplication(<ahref="https://healthy.shinyapps.io/benchmark/"target="blank">https://healthy.shinyapps.io/benchmark/</a>)tocalculatesettingspecificunitcostsagainstwhichprogrammebudgetsandexpendituresorresultsbasedpayoutscanbebenchmarked.</p><p>Methods</p><p>Wereviewedcostingstudiesofmasstreatmentforthecontrol,eliminationoreradicationoflymphaticfilariasis,schistosomiasis,soiltransmittedhelminthiasis,onchocerciasis,trachomaandyaws.Thesearethemain6NTDsforwhichmasstreatmentisrecommended.Weextractedfinancialandeconomicunitcosts,adjustedtoastandarddefinitionandbaseyear.Weregressedunitcostsonthenumberofpeopletreatedandotherexplanatoryvariables.Regressionresultswereusedtopredictcountryspecificunitcostbenchmarks.</p><p>Results</p><p>Wereviewed56costingstudiesandincludedinthemetaregression34studiesfrom23countriesand91sites.Unitcostswerefoundtobeverysensitivetoeconomiesofscale,andthedecisionofwhetherornottouselocalvolunteers.Financialunitcostsareexpectedtobelessthan2015US 0.50. Whilst useful for advocacy, the focus on a single number misrepresents the complexity of delivering “free” donated medicines to about a billion people across the world. We perform a literature review and meta-regression of the cost per person per round of mass treatment against NTDs. We develop a web-based software application (<a href="https://healthy.shinyapps.io/benchmark/" target="_blank">https://healthy.shinyapps.io/benchmark/</a>) to calculate setting-specific unit costs against which programme budgets and expenditures or results-based pay-outs can be benchmarked.</p><p>Methods</p><p>We reviewed costing studies of mass treatment for the control, elimination or eradication of lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, onchocerciasis, trachoma and yaws. These are the main 6 NTDs for which mass treatment is recommended. We extracted financial and economic unit costs, adjusted to a standard definition and base year. We regressed unit costs on the number of people treated and other explanatory variables. Regression results were used to “predict” country-specific unit cost benchmarks.</p><p>Results</p><p>We reviewed 56 costing studies and included in the meta-regression 34 studies from 23 countries and 91 sites. Unit costs were found to be very sensitive to economies of scale, and the decision of whether or not to use local volunteers. Financial unit costs are expected to be less than 2015 US 0.50 in most countries for programmes that treat 100 thousand people or more. However, for smaller programmes, including those in the “last mile”, or those that cannot rely on local volunteers, both economic and financial unit costs are expected to be higher.</p><p>Discussion</p><p>The available evidence confirms that mass treatment offers a low cost public health intervention on the path towards universal health coverage. However, more costing studies focussed on elimination are needed. Unit cost benchmarks can help in monitoring value for money in programme plans, budgets and accounts, or in setting a reasonable pay-out for results-based financing mechanisms.</p></div

    Economic unit costs (excluding volunteer time) and population treated, by study (across years, sites and comparators).

    No full text
    <p>Dots represent individual study results, and lines represent the least squares line of best fit for studies with more than two results. The horizontal line at US$ 0.50 marks the oft-cited unit cost typically used in advocacy.</p

    Financial unit cost and population treated, by study (across years, sites and comparators).

    No full text
    <p>Dots represent individual study results, and lines represent the least squares line of best fit for studies with more than two results. The horizontal line at US$ 0.50 marks the oft-cited unit cost typically used in advocacy.</p

    Classification of financial and economic unit costs (excluding medicines<sup>1</sup>)

    No full text
    <p>Classification of financial and economic unit costs (excluding medicines<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005037#t001fn001" target="_blank"><sup>1</sup></a>)</p
    corecore