PRM97 – Evaluating the cost-effectiveness of multicomponent rehabilitation guidelines

Objectives: The Dutch guideline for cancer rehabilitation recommends patients to engage in multicomponent interventions, i.e. several single interventions combined into a rehabilitation programme. To perform a health economic evaluation of this guideline, data on the cost-effectiveness of these multicomponent interventions is required. However, to date, the interventions´ (cost-)effectiveness is almost exclusively assessed for the single interventions, rather than for the multicomponent intervention, which challenges the health economic analysis of the multicomponent interventions. The objective of this study was to identify or develop a method that allows to deduct the cost-effectiveness of multicomponent interventions from published data of the single interventions.Methods: We searched the literature for articles offering a method or ideas for the development of a method for assessing the cost-effectiveness of multicomponent interventions on the basis of data on the single interventions. The cost-effectiveness gap analysis method, which can be used for assessing the maximum cost of an intervention given a certain willingness-to-pay, was identified as suitable and was further developed to allow assessing if a multidimensional programmes is cost-effective, based on the (cost-)effectiveness data of the single interventions.Results: Cost-effectiveness gap analysis was identified in the literature as being a suitable method, with further refinement. We suggested to first calculate the costs of all interventions. Given the effectiveness of one intervention it is then possible to estimate how much additional effectiveness a second (or any subsequent) intervention would have to provide so that the multicomponent intervention remains cost-effective, given a range of ceiling ratios. Recommendations for methods for estimating the additional effect of subsequent interventions were deducted from the literature identified.Conclusions: We suggest estimating the cost-effectiveness of the combined interventions as recommended in clinical guidelines by performing a refined cost-effectiveness gap analysis metho

Return-to-work intervention for cancer survivors: budget impact and allocation of costs and returns in the Netherlands and six major EU-countries

Background Return-to-work (RTW)-interventions support cancer survivors in resuming work, but come at additional healthcare costs. The objective of this study was to assess the budget impact of a RTW-intervention, consisting of counselling sessions with an occupational physician and an exercise-programme. The secondary objective was to explore how the costs of RTW-interventions and its financial revenues are allocated among the involved stakeholders in several EU-countries. Methods The budget impact (BI) of a RTW-intervention versus usual care was analysed yearly for 2015–2020 from a Dutch societal- and from the perspective of a large cancer centre. The allocation of the expected costs and financial benefits for each of the stakeholders involved was compared between the Netherlands, Belgium, England, France, Germany, Italy, and Sweden. Results The average intervention costs in this case were €1,519/patient. The BI for the Netherlands was €-14.7 m in 2015, rising to €-71.1 m in 2020, thus the intervention is cost-saving as the productivity benefits outweigh the intervention costs. For cancer centres the BI amounts to €293 k in 2015, increasing to €1.1 m in 2020. Across European countries, we observed differences regarding the extent to which stakeholders either invest or receive a share of the benefits from offering a RTW-intervention. Conclusion The RTW-intervention is cost-saving from a societal perspective. Yet, the total intervention costs are considerable and, in many European countries, mainly covered by care providers that are not sufficiently reimbursed

PCN77 – Cost-effectiveness of cognitive-behavioral therapy and physical exercise for alleviating treatment-induced menopausal symptoms in breast cancer patients

Objectives Many breast cancer patients suffer from (severe) menopausal symptoms after an early onset of menopause caused by cancer treatment. The standard treatment for these complaints is hormone replacement therapy, which, however, is contraindicated for this group, as it may have tumor-promoting effects. The aim of this study was to assess the cost-effectiveness of three interventions aimed at alleviating these symptoms: cognitive-behavioral therapy (CBT), physical exercise (PE), and the combination of both (CBT+PE). Methods A cost-effectiveness analysis was performed from a health care system perspective. The primary outcome was incremental health care costs (IHCC) per patient with a clinically relevant improvement after six months of treatments. The secondary outcome was incremental costs per quality-adjusted life years (QALYs) gained over a five-year time period. This was assessed using a Markov model, populated with data from a recent randomized controlled trial evaluating the effectiveness of CBT, PE, and CBT+PE in the clinical setting and additional cost data. The robustness of the results was analyzed through one-way and probabilistic sensitivity analyses. Results IHCCs for alleviating one patient of the perceived symptom burden by a clinically relevant difference after six months of treatment were EUR€605 for CBT, EUR€1,847 for CBT+PT, and EUR€1,250 for PE alone, compared to the waiting list control group. CBT generated 0.009 additional QALYs at an additional cost of EUR€162, compared to the control group, leading to an Incremental Cost Utility Ratio (ICUR) of EUR€18,655 per QALY gained and The ICUR of CBT+PE was EUR€42,375 per QALY in comparison to the control group. CBT had a high probability (circa 61%) of being cost-effective at prevailing ceiling ratios. Conclusions CBT is likely the most cost-effective of the three interventions investigated for alleviating treatment-induced menopausal symptoms in breast cancer patient

Pumping two dilute gas Bose-Einstein condensates with Raman light scattering

We propose an optical method for increasing the number of atoms in a pair of dilute gas Bose-Einstein condensates. The method uses laser-driven Raman transitions which scatter atoms between the condensate and non-condensate atom fractions. For a range of condensate phase differences there is destructive quantum interference of the amplitudes for scattering atoms out of the condensates. Because the total atom scattering rate into the condensates is unaffected the condensates grow. This mechanism is analogous to that responsible for optical lasing without inversion. Growth using macroscopic quantum interference may find application as a pump for an atom laser.Comment: 4 pages, no figure

Macroscopic superpositions of Bose-Einstein condensates

We consider two dilute gas Bose-Einstein condensates with opposite velocities from which a monochromatic light field detuned far from the resonance of the optical transition is coherently scattered. In the thermodynamic limit, when the relative fluctuations of the atom number difference between the two condensates vanish, the relative phase between the Bose-Einstein condensates may be established in a superposition state by detections of spontaneously scattered photons, even though the condensates have initially well-defined atom numbers. For a finite system, stochastic simulations show that the measurements of the scattered photons lead to a randomly drifting relative phase and drive the condensates into entangled superpositions of number states. This is because according to Bose-Einstein statistics the scattering to an already occupied state is enhanced.Comment: 18 pages, RevTex, 5 postscript figures, 1 MacBinary eps-figur

Rehabilitation for cancer survivors: cost-effectiveness and budget impact

As the incidence of cancer is rising and more patients survive their disease, the number of people within the population who have a history of cancer is rising. The expected number for the Netherlands was 690,000 for 2015 and is supposed to have doubled since the year 2000. Unfortunately, most cancer survivors experience bothersome late and long-term symptoms, such as fatigue, low physical functioning, low quality of life, depression, anxiety, cognitive limitations, and pain. These prevent many of them from returning to their previous daily lives and often from returning to work. In order to alleviate the symptoms, survivors can follow a rehabilitation programme. However, these\ud are not implemented widely. A major obstacle in the further implementation of cancer rehabilitation is the limited reimbursement by health insurance.\ud As the pressure on the health care budget is high, health services that are added to the Dutch health insurance scheme are assessed on their cost-effectiveness and affordability, next to the criteria of being necessary and effective. At the start of this research, the evidence base on the cost-effectiveness of cancer rehabilitation was very small. Therefore, the aim of this thesis was to increase the evidence base on the costeffectiveness and budget impact of cancer rehabilitation

Cost-effectiveness analysis of implementing screening on preterm pre-eclampsia at first trimester of pregnancy in Germany and Switzerland

ObjectiveTo assess the cost-effectiveness of preterm preeclampsia (PE) screening versus routine screening based on maternal characteristics in Germany and Switzerland.MethodsA health economic model was used to analyse the cost-effectiveness of PE screening versus routine screening based on maternal characteristics. The analysis was conducted from the healthcare perspective with a time horizon of one year from the start of pregnancy. The main outcome measures were incremental health care costs and incremental costs per PE case averted.ResultsThe incremental health care costs for PE screening versus routine screening per woman were €14 in Germany, and -CHF42 in Switzerland, the latter representing cost savings. In Germany, the incremental costs per PE case averted were €3,795. In Switzerland, PE screening was dominant. The most influential parameter in the one-way sensitivity analysis was the cost of PE screening (Germany) and the probability of preterm PE in routine screening (Switzerland). In Germany, at a willingness-to-pay for one PE case avoided of €4,200, PE screening had a probability of more than 50% of being cost-effective compared to routine screening. In Switzerland, at a willingness-to-pay of CHF0, PE screening had a 78% probability of being the most cost-effective screening strategy.ConclusionFor Switzerland, PE screening is expected to be cost saving in comparison to routine screening. For Germany, the additional health care costs per woman were expected to be €14. Future cost-effectiveness studies should be conducted with a longer time horizon

Is Procalcitonin Biomarker-Guided Antibiotic Therapy a Cost-Effective Approach to Reduce Antibiotic Resistant and Clostridium difficile Infections in Hospitalized Patients?

Antibiotics (AB) can reduce morbidity and mortality in the treatment of patients with sepsis and chronic obstructive pulmonary disease (COPD) exacerbations. Yet, AB overuse or misuse increases antibiotic resistance (ABR) and Clostridium difficile infections (CDI). This study projected the expected impact of a procalcitonin (PCT) biomarker testing strategy on incremental ABR cases and CDI, and costs of care in a population of patients hospitalized with suspected sepsis or a COPD exacerbation, in three European countries: the United Kingdom, Germany, and the Netherlands. Based on a systematic literature search and a decision model, we analyzed the number of ABR and CDI cases avoided and the incremental healthcare costs per patient from a societal perspective over the time horizon of a hospital stay. In the sepsis population, the PCT-guided antibiotic prescription strategy was projected to reduce the number of ABR cases with circa 6%, the number of CDI cases with 21%, and societal costs with circa Euro1300 per patient. In the COPD population, the number of ABR and CDI cases is reduced with circa 50%, and societal cost savings ranged Euro1701, Euro2473, and Euro2435 per patient in Germany, the Netherlands, and the United Kingdom, respectively. Model outcomes were most sensitive to the impact of the PCT-guided strategy on the number of intensive care unit days and general hospital ward days. Taken together, a PCT biomarker-guided antibiotic management strategy is likely to reduce the number of ABR and CDI cases and generate cost savings in a population of patients hospitalized with suspected sepsis or with a COPD exacerbation