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2 results on '"Ajeng V. Icanervilia"'

1. Cost-utility analysis of early reconstruction surgery versus conservative treatment for anterior cruciate ligament injury in a lower-middle income country

Author

Romy Deviandri, Hugo C. van der Veen, Abdul Khairul R. Purba, Ajeng V. Icanervilia, Andri MT. Lubis, Inge van den Akker-Scheek, and Maarten J. Postma

Subjects
ACL rupture, Rehabilitation, Reconstruction, Cost-effectiveness, LMIC, Public aspects of medicine, RA1-1270
Abstract

Abstract Background The ideal approach for treating anterior cruciate ligament (ACL) injury is still disputed. This study aimed to determine the more cost-effective strategy by comparing early ACL reconstruction (ACLR) surgery to conservative treatment (rehabilitation with optional delayed reconstruction) for ACL injury in a lower/middle-income country (LMIC), Indonesia. Methods A decision tree model was constructed for cost-utility analysis of early ACLR versus conservative treatment. The transition probabilities between states were obtained from the literature review. Utilities were measured by the EQ-5D-3 L from a prospective cohort study in a local hospital. The costs were obtained from a previous study that elaborated on the burden and cost of ACLR in Indonesia. Effectiveness was expressed in quality-adjusted life years gained (QALYs). Principal outcome measure was the incremental cost-effectiveness ratios (ICER). Willingness-to-pay was set at US$12,876 — three times the Indonesian GDP per capita in 2021 — the currently accepted standard in Indonesia as suggested by the World Health Organization Choosing Interventions that are Cost-Effective criterion (WHO-CHOICE). Results The early ACLR group showed an incremental gain of 0.05 QALYs over the conservative treatment group, with a higher overall cost to society of US$976. The ICER of ACLR surgery was US$19,524 per QALY, above the WTP threshold of US$12,876. The ICER was sensitive to cost of conservative treatment, cost of ACLR, and rate of cross-over to delayed ACLR numbers in the conservative treatment group. Using the WTP threshold of US$12,876, the probability of conservative treatment being preferred over early ACLR was 64%. Conclusions Based on the current model, early ACLR surgery does not seem more cost-effective compared to conservative treatment for ACL injury patients in Indonesia. Because the result was sensitive to the rate of cross-over probabilities from the conservative treatment alone to delayed ACLR, a future study with a long-term perspective is needed to further elucidate its impact.

Published
2024
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2. Economic evaluations of mammography to screen for breast cancer in low- and middle-income countries

Author

Ajeng V Icanervilia, Jurjen van der Schans, Qi Cao, Adriana C de Carvalho, Kathya Cordova-Pozo, Jarir At Thobari, Maarten J Postma, and Antoinette DI van Asselt

Subjects
RISK, STRATEGIES, Cost-Benefit Analysis, Health Policy, Public Health, Environmental and Occupational Health, WOMEN, Breast Neoplasms, POLICIES, COST-EFFECTIVENESS ANALYSIS, Middle Aged, HEALTH-CARE DECISIONS, SURVIVAL, PROGRAM, Humans, Mass Screening, Female, Developing Countries, Institute for Management Research, PREPARE, Mammography
Abstract

Background Low-and middle-income countries (LMICs) have limited resources compared to high-income countries (HICs). Therefore, it is critical that LMICs implement cost-effective strat-egies to reduce the burden of breast cancer. This study aimed to answer the question of whether mammography is a cost-effective breast cancer screening method in LMICs. Methods A systematic article search was conducted through Med -line, Embase, Web of Science, and Econlit. Studies were includ-ed only if they conducted a full economic evaluation and focused on mammography screening in LMICs. Two reviewers screened through the title and abstract of each article and continued with full-text selection. Data were extracted and synthesized narrative-ly. Quality assessment for each included study was conducted using the Consensus Health Economic Criteria (CHEC) extend-ed checklist. Results This review identified 21 studies economically evaluat-ing mammography as a breast cancer screening method in LMICs. Eighteen of these studies concluded that mammography screening was a cost-effective strategy. Most studies (71%) were conducted in upper-middle-income countries (Upper MICs). The quality of the studies varied from low to good. Important factors determin-ing cost-effectiveness are the target age group (eg, 50-59 years), the screening interval (eg, biennial or triennial), as well as any combi-nation with other breast cancer control strategies (eg, combination with treatment strategy for breast cancer patients). Conclusions Mammography screening appeared to be a cost-ef-fective strategy in LMICs, particularly in Upper MICs. More studies conducted in lower-middle-income and low-income countries are needed to better understand the cost-effectiveness of mammogra-phy screening in these regions.

Published
2022

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