17 research outputs found
Costs and benefits of early response in the Ebola virus disease outbreak in Sierra Leone
Background: The 2014-2016 Ebola virus disease (EVD) outbreak in West Africa was the largest EVD outbreak recorded, which has triggered calls for investments that would facilitate an even earlier response. This study aims to estimate the costs and health effects of earlier interventions in Sierra Leone. Methods: A deterministic and a stochastic compartment model describing the EVD outbreak was estimated using a variety of data sources. Costs and Disability-Adjusted Life Years were used to estimate and compare scenarios of earlier interventions. Results: Four weeks earlier interventions would have averted 10,257 (IQR 4353-18,813) cases and 8835 (IQR 3766-16,316) deaths. This implies 456 (IQR 194-841) thousand DALYs and 203 (IQR 87-374) million $US saved. The greatest losses occurred outside the healthcare sector. Conclusions: Earlier response in an Ebola outbreak saves lives and costs. Investments in healthcare system facilitating such responses are needed and can offer good value for money
Distributional consequences of including survivor costs in economic evaluations
Medical interventions that increase life expectancy of patients result in additional consumption of nonâmedical goods and services in âadded life yearsâ. This paper focuses on the distributional consequences across socioâeconomic groups of including these costs in cost effectiveness analysis. In that context, it also highlights the role of remaining quality of life and household economies of scale. Data from a Dutch household spending survey was used to estimate nonâmedical consumption and household size by age and educational attainment. Estimates of nonâmedical consumption and household size were combined with life tables to estimate what the impact of including nonâmedical survivor costs would be on the incremental cost effectiveness ratio (ICER) of preventing a death at a certain age. Results show that including nonâmedical survivor costs increases estimated ICERs most strongly when interventions are targeted at the higher educated. Adjusting for household size (lower educated people less often live additional life years in multiâperson households) and quality of life (lower educated people on average spend added life years in poorer health) mitigates this difference. Ignoring costs of nonâmedical consumption in economic evaluations implicitly favors interventions targeted at the higher educated and thus potentially amplifies socioâeconomic inequalities in health
Patient Utilities in Health States Based on Hoehn and Yahr and Off-Time in Parkinsonâs Disease : A Swedish Register-Based Study in 1823 Observations
Background: Cost-effectiveness models in Parkinsonâs disease often include health states based on Hoehn and Yahr (H&Y) and time in âoffâ. Few studies have investigated utilities in these health states. Objective: The aim of this study was firstly to explore utilities in health states based on H&Y and off-time, and secondly to investigate to what extent H&Y and off-time correlated with EQ-5D dimensions. Methods: Patients with idiopathic Parkinsonâs disease in the National Parkinsonâs Disease Patient Registry (PARKreg) in Sweden with observations of EQ-5D-3L, H&Y and off-time were included. Correlations with EQ-5D dimensions were analyzed. The relationship between the EQ-5D-3L and H&Y and off-time were estimated by a linear mixed-model with random intercept. Results: Among patients in PARKreg, 1823 observations fulfilled inclusion criteria. The dimensions âself-careâ, âmobilityâ and âusual activitiesâ correlated moderately with H&Y (rs = 0.45, rs = 0.46, rs = 0.45). Weak correlations were found for âanxiety/depressionâ and âpain/discomfortâ (rs = 0.24, rs = 0.22) (p values < 0.001). All dimensions correlated weakly with off-time. The fitted model included H&Y, time in âoffâ, and sex. All H&Y stages were found to be significant and had large and monotonous impact on EQ-5D. Off-time was not significant, but improved the model goodness of fit. Predicted values ranged from 0.733 to â 0.106. Conclusion: This study provides utilities for health states reflecting the current modeling practice of interventions targeting motor symptoms in Parkinsonâs disease. Future research should investigate patient utilities in health states that also capture non-motor symptoms of the disease, as the management of and options for treatments targeting these symptoms increases
The Relationship between PDQ-8 and Costs in Parkinson's DiseaseâA Swedish Register-Based Study
Background: Parkinson's disease (PD) is a progressive neurodegenerative disorder associated with substantial costs which increase with progression state. However, few studies have investigated the association between costs and health related quality of life. Objectives: To estimate the relationship between costs and health related quality of life, measured by the Parkinson's disease Quality of Life Questionnaire (PDQ)-8 from a societal perspective, partial societal perspective (excluding productivity loss), and a health care perspective. Methods: The Swedish Parkinson's Disease registry was linked to health care data registries to estimate annual costs. A generalized linear model was used to assess the relationship between instrument items and costs. Results: The results suggest that PDQ-8 captures the increase of costs by PD severity, particularly for costs within the broader societal perspective. From the best to worst PDQ-8 quartile, we observed approximately 7-fold increases within the societal perspective (39,400 to 274,300 SEK) and the partial societal perspective (31,800 to 219,400 SEK), and the increase within the health care perspective more than doubled (21,900 to 49,700 SEK). The PDQ-8 dimensions âmobility,â âactivities of daily livingâ and âsocial supportâ were associated with high costs in all perspectives. Conclusion: Using a disease-specific measure reflecting the patient's perspective, we found an increase of costs with worsening severity of PD, particularly for costs within the broader societal perspective. High costs were associated with not only motor symptoms, but also the dimension âSocial support.â
Costs and benefits of interventions aimed at major infectious disease threats: lessons from the literature
Pandemics and major outbreaks have the potential to cause large health losses and major economic costs. To prioritize between preventive and responsive interventions, it is important to understand the costs and health losses interventions may prevent. We review the literature, investigating the type of studies performed, the costs and benefits included, and the methods employed against perceived major outbreak threats. We searched PubMed and SCOPUS for studies concerning the outbreaks of SARS in 2003, H5N1 in 2003, H1N1 in 2009, Cholera in Haiti in 2010, MERS-CoV in 2013, H7N9 in 2013, and Ebola in West-Africa in 2014. We screened titles and abstracts of papers, and subsequently examined remaining full-text papers. Data were extracted according to a pre-constructed protocol. We included 34 studies of which the majority evaluated interventions related to the H1N1 outbreak in a high-income setting. Most interventions concerned pharmaceuticals. Included costs and benefits, as well as the methods applied, varied substantially between studies. Most studies used a short time horizon and did not include future costs and benefits. We found substantial variation in the included elements and methods used. Policymakers need to be aware of this and the bias toward high-income countries and pharmaceutical interventions, which hampers generalizability. More standardization of included elements, methodology, and reporting would improve economic evaluations and their usefulness for policy
Estimating the costs of non-medical consumption in life-years gained for economic evaluations
Including the costs of non-medical consumption in life years gained in economic evaluations of medical interventions has been controversial. This paper focuses on the estimation of these costs using Dutch data coming from cross-sectional household surveys consisting of 56,569 observations covering the years 1978â2004. We decomposed the costs of consumption into age, period and cohort effects and modelled the non-linear age and cohort patterns of consumption using P-splines. As consumption patterns depend on household composition, we also estimated household size using the same regression modeling strategy. Estimates of non-medical consumption and household size were combined with life tables to estimate the impact of including non-medical survivor costs on an incremental cost-effectiveness ratio (ICER). Results revealed that including non-medical survivor costs substantially increases the ICER, but the effect varies strongly with age. The impact of cohort effects is limited but ignoring household economies of scale results in a significant overestimation of non-medical costs. We conclude that a) ignoring the costs of non-medical consumption results in an underestimation of the costs of life prolonging interventions b) economies of scale within households with respect to consumption should be accounted for when estimating future costs
Costs and benefits of early response in the Ebola virus disease outbreak in Sierra Leone
Abstract Background The 2014â2016 Ebola virus disease (EVD) outbreak in West Africa was the largest EVD outbreak recorded, which has triggered calls for investments that would facilitate an even earlier response. This study aims to estimate the costs and health effects of earlier interventions in Sierra Leone. Methods A deterministic and a stochastic compartment model describing the EVD outbreak was estimated using a variety of data sources. Costs and Disability-Adjusted Life Years were used to estimate and compare scenarios of earlier interventions. Results Four weeks earlier interventions would have averted 10,257 (IQR 4353â18,813) cases and 8835 (IQR 3766â16,316) deaths. This implies 456 (IQR 194â841) thousand DALYs and 203 (IQR 87â374) million $US saved. The greatest losses occurred outside the healthcare sector. Conclusions Earlier response in an Ebola outbreak saves lives and costs. Investments in healthcare system facilitating such responses are needed and can offer good value for money