| 12. |
- Olofsson, Sara, et al.
(författare)
-
Preferences for improvements in attributes associated with basal insulin : a time trade-off and willingness-to-pay survey of a diabetic and non-diabetic population in Sweden
- 2016
-
Ingår i: Journal of Medical Economics. - : Informa UK Limited. - 1369-6998 .- 1941-837X. ; 19:10, s. 945-958
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Apart from improved health outcomes, treatment convenience per se may have a value to individuals. This is sometimes referred to as process utility and can be estimated in terms of willingness-to-pay (WTP) or quality-adjusted life-years (QALYs). Previous research has produced multiple studies on QALY gains and WTP estimates of insulin-related attributes. There are, however, significant variations between studies, and it is not clear to what extent the value is a reflection of the true preferences or a consequence of the methodological approach. The aim of this study is to estimate the preferences for treatment attributes associated with basal insulin (administration frequency, administration flexibility, and treatment-induced weight gain) using both QALYs—elicited using time trade-off (TTO) and WTP—among a sample of the Swedish general population and among a sample of the Swedish diabetes population. Methods: Data was collected using web-based surveys which were distributed to members of internet panels. The WTP survey presented five hypothetical scenarios with an offer to pay the incremental cost to receive basal insulin with improved attributes. The TTO survey presented six hypothetical scenarios where the respondent could choose between living for the rest of his/her life with diabetes and receiving treatment with a basal insulin with certain attributes or live for a shorter time with full health. The scenarios were combined with either a basal or a basal–bolus treatment regimen. Results from the TTO analysis were translated into monetary estimates using a threshold value of SEK500,000 per QALY. Results: In total, 2012 responses were included. The ratings of the attributes were almost identical, irrespective of method for the general population, while it differed to some extent for the diabetes population. The methods produced the same value for flexibility, but the estimates generated with the TTO approach were higher for one less injection and avoided weight gain. The general population assigned a higher utility gain to convenience attributes, while the diabetes population assigned a higher utility gain to avoiding weight gain. Limitations: About a quarter of the respondents did not accept the scenario in the WTP survey, i.e. protesters. Conclusions: The ranking of the attributes was generally independent of evaluation method, but the TTO method resulted in similar or higher values compared to the WTP method.
|
|
| 13. |
- Walter, Evelyn, et al.
(författare)
-
Cost-effectiveness of continuous subcutaneous apomorphine in the treatment of Parkinson's disease in the UK and Germany
- 2015
-
Ingår i: Journal of Medical Economics. - : Informa Healthcare. - 1941-837X .- 1369-6998. ; 18:2, s. 155-165
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Parkinson's disease (PD) is the second most common neurodegenerative disease, affecting similar to 5.2 million people worldwide. Continuous subcutaneous apomorphine (CSAI) represents an alternative treatment option for advanced PD with motor fluctuation. The purpose of this analysis was to estimate the cost-effectiveness of CSAI compared with Levodopa/carbidopa intestinal gel (LCIG), Deep-Brain-Stimulation (DBS) and Standard-of-care (SOC). Methods: A multi-country Markov-Model to simulate the long-term consequences, disease progression (Hoehn & Yahr stages 3-5, percentage of waking-time in the OFF-state), complications, and adverse events was developed. Monte-Carlo simulation accounted for uncertainty. Probabilities were derived from RCT and open-label studies. Costs were estimated from the UK and German healthcare provider's perspective. QALYs, life-years (LYs), and costs were projected over a life-time horizon. Results: UK lifetime costs associated with CSAI amounts to 78,251.49 pound and generates 2.85 QALYs and 6.28 LYs ((sic)104,500.08, 2.92 QALYs and 6.49 LYs for Germany). Costs associated with LCIG are 130,011.34 pound, achieves 3.06 QALYs and 6.93 LYs ((sic)175,004.43, 3.18 QALYs and 7.18 LYs for Germany). The incremental-cost per QALY gained (ICER) was 244,684.69 pound ((sic)272,914.58). Costs for DBS are 87,730.22 pound, associated with 2.75 QALYs and 6.38 LYs ((sic)105,737.08, 2.85 QALYs and 6.61 LYs for Germany). CSAI dominates DBS. SOC associated UK costs are 76,793.49; pound 2.62 QALYs and 5.76 LYs were reached ((sic)90,011.91, 2.73 QALYs and 6 LYs for Germany). Conclusions: From a health economic perspective, CSAI is a cost-effective therapy and could be seen as an alternative treatment to LCIG or DBS for patients with advanced PD.
|
|
