Scaling up cost-effective physical activity interventions in a culturally diverse setting

Before this PhD project started, evidence showed that physical inactivity causes a substantial health and economic burden globally. For Switzerland, there was research available investigating the burden of physical inactivity. However, this research estimated the burden for the entire country without differentiating between sub regions although the prevalence of physical inactivity varies significantly between the French-, German- and Italian-speaking regions. Therefore, this thesis had three aims: 1. Estimating the health and economic burden of physical inactivity in Switzerland and for the French-, German- and Italian-speaking language regions separately 2. Systematically reviewing trial-based economic evaluations of interventions to reduce physical inactivity 3. Developing a health economic model that investigates the cost-effectiveness of physical activity interventions in Switzerland and its three language regions The thesis showed that the burden of physical inactivity in Switzerland is substantial and that the French- and Italian-speaking regions are over-proportionally affected. These two regions distinguish themselves from the German-speaking region by having a higher prevalence of physical inactivity, higher per capita health care spending, and higher disease prevalence. Due to the substantial burden of physical inactivity, interventions aiming to increase physical activity should be considered. In the systematic review we conducted, we found evidence from randomized controlled trials indicating the cost-effectiveness of some physical activity interventions for primary prevention in adults. These interventions were then further evaluated in a cost-effectiveness model built for the Swiss setting. This model showed that Swiss policy makers have cost-effective options of physical activity promotion. We recommend that individualized advice and general practitioner referral be further evaluated as interventions and that decision-making considers the specifics of the Swiss language regions. Furthermore, we judge the cost-effectiveness model to be not only relevant for Switzerland but also for other multicultural countries. Based on similar data availability, our model has the potential to be applied beyond Switzerland, primarily to high-income countries with a comparable background, as a tool to guide societal efforts in primary prevention of physical-inactivity-related diseases

Digitale Lebensstil-Intervention im Alter

Lebensstil-Interventionen sollen helfen, ungesunde Gewohnheiten zu durchbrechen. Um tatsächlich Verhaltensänderung zu bewirken, sind je nach Zielgruppe jedoch spezifische Ansätze gefragt. In einem neuen Projekt erforschen wir deshalb, wie wir ältere Menschen durch eine digitale Applikation erreichen können

Inpatient hospital costs of febrile neutropenia as a consequence of chemotherapy for breast cancer and non-Hodgkin lymphoma in Switzerland

Febrile neutropenia (FN) can be a serious complication of chemotherapy (CHT), increasing mortality risk and healthcare costs. Incidence and inpatient hospital costs of FN in Switzerland are currently not reported. The study aimed to: 1. Estimate the number of CHT induced FN-related hospitalizations. 2. Assess inpatient hospital costs per FN event in Switzerland

Biosimilars helfen sparen

Sie sind gleichwertig und kostengünstiger. Dennoch werden Biosimilars – die Nachahmerprodukte von Biologika – in der Schweiz bisher selten verordnet. Was sind die Gründe dafür? Ein im Auftrag des BAG durchgeführtes Health Technology Assessment (HTA) liefert Antworten anhand des Biologikums Infliximab und dessen Biosimilars bei der Behandlung von rheumatoider Arthritis

Economic evaluation of oral versus parenteral iron therapy for iron deficiency without anemia

The Swiss Federal Office of Public Health (SFOPH) commissioned a Health Technology Assessment (HTA) regarding iron therapy in symptomatic patients with iron deficiency without anemia (iron deficiency no anemia, IDNA) to the Basel Institute for Clinical Epidemiology and Biostatistics (CEB) and the Winterthur Institute of Health Economics (WIG). The scope, which describes the background of the HTA and elucidates the general approach, has been published on the SFOPH homepage. This HTA followed a step-wise approach. The aim of the first step was to assess the clinical effectiveness of iron therapy in symptomatic patients with IDNA, and to identify symptomatic populations that benefit from the therapy. In this first step, the clinical effectiveness of iron therapy was assessed in comparison to any other non-iron treatment or placebo, irrespective of the route of iron administration. This step was conducted by CEB, and the results are summarized in chapter 2 of this document. In the second step, which will be conducted by WIG, the economic evaluation shall compare parenteral versus oral iron therapy for those populations, for which a significant treatment effect of iron therapy (parenteral or oral) versus control could be identified during the first step. Based on the effectiveness results, the scope of the economic evaluation is outlined in chapter 4. Section 4.1 defines the objective of the economic evaluation. Section 4.2 defines the population, the intervention, the comparator, and the outcome (PICO) which will be evaluated. A screening of health economic literature and publicly available HTAs for economic studies comparing parenteral with oral iron therapy is presented in section 4.3, and section 4.4 concludes with the outline of the research methodology of the economic evaluation

Cost-effectiveness, burden of disease and budget impact of inclisiran : dynamic cohort modelling of a real-world population with cardiovascular disease

Objective: We aimed to estimate the cost-effectiveness, burden of disease and budget impact of inclisiran added to standard-of-care lipid-lowering therapy in the real-world secondary cardiovascular prevention population in Switzerland. Methods: An open-cohort Markov model captured event risks by sex, age and low-density lipoprotein cholesterol based on epidemiological and real-world data. Low-density lipoprotein cholesterol reduction with add-on inclisiran was based on trial results and translated to meta-analysis-based relative risks of cardiovascular events. Unit costs for 2018 were based on publicly available sources, adopting a Swiss healthcare system perspective. Price assumptions of Swiss francs (CHF) 500 and CHF 3,000 per dose of inclisiran were evaluated, combined with uptake assumptions for burden of disease and budget impact. The assessment of cost-effectiveness used a discount rate of 3% per year. We performed deterministic and probabilistic sensitivity analyses, and extensive scenario analyses. Results: Patients treated with inclisiran gained a 0.291 qualityadjusted life-year at an incremental cost per QALY gained of CHF 21,107/228,040 (life-long time horizon, discount rate 3%) under the lower/higher price. Inclisiran prevented 1025 cardiovascular deaths, 3425 acute coronary syndrome episodes, and 1961 strokes in 48,823 patients ever treated during 10 years; the 5-year budget impact was CHF 49.3/573.4 million under the lower/higher price. Estimates were sensitive to calibration targets and treatment eligibility; burden of disease/budget impact results also to uptake. Limitations included uncertainties about model assumptions and the size and characteristics of the population modelled. Conclusions: Inclisiran may be cost-effective at a willingness to pay of CHF 30,000 if priced at CHF 500; a threshold upwards of CHF 250,000 will be required if priced at CHF 3000. Inclisiran could enable important reductions in cardiovascular burden particularly under broader eligibility with a budget impact range from moderate to high depending on price