A probabilistic cost-effectiveness analysis of enoxaparin versus unfractionated heparin for the prophylaxis of deep-vein thrombosis following major trauma.

Background: In the absence of major contraindications, treatment guidelines recommend that, following a major traumatic event, all patients receive low molecular weight heparin (e.g. enoxaparin) as thromboprophylaxis for the prevention of deep vein thrombosis (DVT).

A probabilistic cost-effectiveness analysis of enoxaparin versus unfractionated heparin for the prophylaxis of deep-vein thrombosis following major trauma.

Background: In the absence of major contraindications, treatment guidelines recommend that, following a major traumatic event, all patients receive low molecular weight heparin (e.g. enoxaparin) as thromboprophylaxis for the prevention of deep vein thrombosis (DVT).

Retrospective economic evaluation of a controlled trial of indomethacin prophylaxis for patent ductus arteriosus in premature infants.

Objective: To determine the incremental cost-effectiveness of indomethacin prophylaxis in extremely low birth weight infants enrolled in the Trial of Indomethacin Prophylaxis in Preterms (TIPP).

Study Design: Participants in this economic evaluation were 428 infants enrolled at 9 Canadian TIPP centres. The study took a third-party payer perspective.

Antiviral agents for influenza: a comparison of cost-effectiveness data.

The economic burden of influenza-related illness has been estimated to be 71.3-166 billion US dollars in the US, the majority of which is attributable to indirect costs as a result of lost productivity. There are currently four antiviral drugs available for the treatment of influenza: two ion channel blockers, amantadine and rimantadine; and two neuraminidase inhibitors, zanamivir and oseltamivir.

The impact of reference pricing of nonsteroidal anti-inflammatory agents on the use and costs of analgesic drugs.

Objective: To estimate the effect of reference pricing (RP) of nonsteroidal anti-inflammatory drugs (NSAIDs) on drug subsidy program and beneficiary expenditures on analgesic drugs.

Data Sources/study Setting: Monthly claims data from Pharmacare, the public drug subsidy program for seniors in British Columbia, Canada, over the period of February 1993 to June 2001.

Study Design: RP limits drug plan reimbursement of interchangeable medicines to a reference price, which is typically equal to the price of the lowest cost interchangeable drug; any cost above that is borne by the patient.

Conducting economic evaluations alongside multinational clinical trials: toward a research consensus.

Demand for economic evaluations in multinational clinical trials is increasing, but there is little consensus about how such studies should be conducted and reported. At a workshop in Durham, North Carolina, we sought to identify areas of agreement about how the primary findings of economic evaluations in multinational clinical trials should be generated and presented. In this paper, we propose a framework for classifying multinational economic evaluations according to (a) the sources of an analyst's estimates of resource use and clinical effectiveness and (b) the analyst's method of estimating costs.

Cost-effectiveness of physiologic pacing: results of the Canadian Health Economic Assessment of Physiologic Pacing.

Objectives: The purpose of this study was to determine the cost-effectiveness of physiologic pacemakers.

Background: The Canadian Trial of Physiologic Pacing (CTOPP) was a large randomized trial that evaluated the efficacy of physiologic pacing compared with ventricular pacing. CTOPP also included a prospective cost-effectiveness substudy.

Cost-effectiveness analysis for multinational clinical trials.

Clinical trials of cost-effectiveness are often conducted in more than one country. The two most common ways of dealing with the multinational nature of the data are either to calculate a pooled estimate or to stratify results by country. Since the between-country heterogeneity in costs is potentially substantial, pooled estimates may be difficult to interpret for any one country.

Analysis of a pharmaceutical risk sharing agreement based on the purchaser's total budget.

Many public and private healthcare payers use formularies as a tool for controlling drug costs and quality. Although the price per dose is often negotiated as part of the formulary listing, payers may still face unlimited financial risk if demand is much greater than expected at the time of listing. The requirement for drug manufacturers to submit a budget impact analysis as part of the drug approval process suggests that payers are concerned not only with the cost effectiveness of a proposed drug but also with the potential increase in total expenditures that may result from new formulary listings.

Country specific cost comparisons from multinational clinical trials using empirical Bayesian shrinkage estimation: the Canadian ASSENT-3 economic analysis.

The growing number of multinational clinical trials in which patient-level health care resource data are collected have raised the issue of which is the best approach for making inference for individual countries with respect to the between-treatment difference in mean cost. We describe and discuss the relative merits of three approaches. The first uses the random effects pooled estimate from all countries to estimate the difference for any particular country.

Cost-effectiveness of rhythm versus rate control in atrial fibrillation.

Background: Atrial fibrillation is the most common type of sustained cardiac arrhythmia, but recent trials have identified no clear advantage of rhythm control over rate control. Consequently, economic factors often play a role in guiding treatment selection.

Objective: To estimate the cost-effectiveness of rhythm-control versus rate-control strategies for atrial fibrillation in the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM).

Advances in risk-benefit evaluation using probabilistic simulation methods: an application to the prophylaxis of deep vein thrombosis.

Objective: To demonstrate the use of probabilistic simulation modeling to estimate the joint density of therapeutic risks and benefits. Published data are used to introduce the risk-benefit acceptability curve as a novel method of illustrating risk-benefit analysis.

Study Design And Setting: Using published data, we performed a second-order Monte Carlo simulation to estimate the joint density of major bleeding and deep vein thrombosis (DVT) secondary to enoxaparin or unfractionated heparin.

Cost-effectiveness acceptability curves--facts, fallacies and frequently asked questions.

Cost-effectiveness acceptability curves (CEACs) have been widely adopted as a method to quantify and graphically represent uncertainty in economic evaluation studies of health-care technologies. However, there remain some common fallacies regarding the nature and shape of CEACs that largely result from the 'textbook' illustration of the CEAC. This 'textbook' CEAC shows a smooth curve starting at probability 0, with an asymptote to 1 for higher money values of the health outcome (lambda).

Principles of good modeling practice in healthcare cost-effectiveness studies.

Decision analytic models are increasingly being used to present information on the costs and effects of both new and existing healthcare technologies. However, despite this increase, the literature on what constitutes 'quality' or 'good practice' in modeling is sparse, confusing and often conflicting. As a result there is a need to summarize these quality assurance and good practice principles into a framework that is useful for modelers and users of models alike.

A systematic review of economic analyses of low-molecular-weight heparin for the treatment of venous thromboembolism.

Introduction: Public concerns about the increase in health care expenditure have prompted investigators to analyze the costs and benefits of health care interventions. We conducted a systematic review of economic analyses of venous thromboembolism treatment focusing on studies evaluating low-molecular-weight heparin.

Materials And Methods: We identified studies by a MEDLINE search and a review of bibliographies of retrieved articles.

A methodological guide to performing a cost-utility study comparing surgical techniques.

Background: When recommending the adoption of a new surgical intervention as opposed to maintaining an old one, surgeons need to consider the opportunity cost, which is the value of the forgone benefits. To inform these decisions, surgeons can use economic analyses of surgical practices. Unfortunately, economic analyses conducted alongside randomized controlled trials in surgery are rare.

A view from the bridge: agreement between the SF-6D utility algorithm and the Health Utilities Index.

Background: The SF-6D is a new health state classification and utility scoring system based on 6 dimensions ('6D') of the Short Form 36, and permits a "bridging" transformation between SF-36 responses and utilities. The Health Utilities Index, mark 3 (HUI3) is a valid and reliable multi-attribute health utility scale that is widely used. We assessed within-subject agreement between SF-6D utilities and those from HUI3.

Review of economic evaluations of radiofrequency catheter ablation for cardiac arrhythmias.

A systematic review of current studies on the cost effectiveness of catheter ablation for treatment of tachycardia in adults was undertaken. The results are summarized based on a predefined framework of principles for economic evaluation. Of 192 abstracts identified, only three cost effectiveness studies were identified.

Measures of importance for economic analysis based on decision modeling.

In probabilistic economic analysis, the uncertainty concerning input parameters is quantified, and determines the level of uncertainty over the optimal decision. Researchers from a wide range of disciplines employ mathematical models to simulate complex processes. Common through many such disciplines is the conduct of importance analysis to determine those input parameters that contribute most to the uncertainty over the optimal decision based on the results of the analysis.

Economic considerations for health insurance coverage of emerging genetic tests.

Public and private health insurance plans face the question of whether to cover emerging genetic tests for cancer and other diseases. This paper outlines issues in the economic evaluation of new genetic tests, illustrating key methodological issues and policy implications with findings from a comprehensive and systematic review of the 14 full economic evaluations published over the past 5 years that have addressed both the costs and consequences of molecular genetic tests. Key questions for framing an evaluation include: whose viewpoint matters, which costs and consequences are relevant, and to which clinical alternatives should new genetic tests be compared? While economic evaluation research can inform coverage decisions about genetic tests, the coverage decision-making process must also inform economic researchers about the aims, context, and value systems within which genetic tests will be covered and practised.

Cost-effectiveness of the implantable cardioverter defibrillator: a review of current evidence.

Introduction: Implantable cardioverter defibrillator (ICD) therapy is indicated for patients at risk for sudden cardiac death (SCD) due to ventricular tachycardia (VT) or ventricular fibrillation (VF). The high relative cost of therapy with the ICD versus antiarrhythmic drugs has raised questions regarding its cost-effectiveness. To address these questions, we review the literature on ICD cost-effectiveness.

Coding accuracy of administrative drug claims in the Ontario Drug Benefit database.

Background: Every year in Ontario, the records of over 42 million prescriptions dispensed to persons eligible for Ontario Drug Benefit (ODB) benefits are transmitted to a central database. The ODB database is the second largest database of medications in Canada, containing records on almost half of all medications dispensed in Ontario. There is no information about the reliability of the coding on the ODB drug claims database and, therefore, the objective of this study was to estimate the reliability of coding of the Drug Identification Number, and the date, quantity and duration of the dispensation on claims sent to the ODB.