11 research outputs found
The Cost Effectiveness of Levodopa-Carbidopa Intestinal Gel in the Treatment of Advanced Parkinson’s Disease in England
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
<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 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
Results from meta-regression of (log) unit costs in 2015 US$
<p>Results from meta-regression of (log) unit costs in 2015 US$</p
Summary statistics for 34 studies of 23 countries and 91 sites over 19 years
<p>Summary statistics for 34 studies of 23 countries and 91 sites over 19 years</p
Economic unit costs (excluding volunteer time) and population treated, by study (across years, sites and comparators).
<p>Dots represent individual study results, and lines represent the least squares line of best fit for studies with more than two results. The horizontal line at US$ 0.50 marks the oft-cited unit cost typically used in advocacy.</p
Availability of costing studies among low- and middle-income countries, by disease.
<p>Most recent year refers to the most recent year of study, not the most recent year of publication.</p
Financial unit cost benchmarks in low- and middle-income countries at different scales of implementation, using volunteers but excluding the (economic) cost of volunteer time.
<p>The legend excludes Vanuatu. See <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005037#pntd.0005037.s006" target="_blank">S5 Table</a> in the Supplemental Information for results for Vanuatu.</p
Financial unit cost and population treated, by study (across years, sites and comparators).
<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>)
<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