Search

Background: End-of-life care is a driver of increasing healthcare costs; however, palliative care interventions may significantly reduce these costs. Economic evaluations that measure the incremental cost per quality adjusted life years (QALY) are warranted to inform cost-effectiveness of the intervention relative to a comparator and permit evaluation of investment against other therapeutic interventions. Evidence from the literature up to 2011 indicates a scarcity of cost-utility studies in palliative care research. Aim: This literature review evaluates economic studies published between 2011 and 2019 to determine whether the methods of economic evaluations have evolved since 2011. Design and Data Sources: A literature search was completed using CENTRAL, OVID MEDLINE, EMBASE and other sources for publications between 2011 and 2019. Study characteristics, methodology and key findings of publications that met the inclusion criteria were reviewed. Quality of studies were assessed using indicators developed by authors of the previous literature review. Results: 46 papers were included for qualitative synthesis. Among them only 6 studies conducted formal cost-effectiveness evaluations-of these 5 measured QALYs and 1 employed probabilistic analyses. In addition, with the exception of 1 costing analysis, all other economic evaluations undertook a healthcare payer perspective. Quality of evidence were comparable to the previous literature review published in 2011. Conclusion: Despite the small increase in the number of cost-utility studies, the methods of palliative care economic evaluations have not evolved significantly since 2011. More probabilistic cost-utility analyses of palliative care interventions from a societal perspective are necessary to truly evaluate the value for money.

Background and Aims Chronic kidney disease (CKD) is a costly public health issue, which affects 13.4% of the population globally. Anaemia is a common complication in patients with CKD resulting in reduced health-related quality of life and high healthcare costs. The objective of this analysis was to estimate the direct medical care cost offsets of the investigational agent roxadustat for the treatment of anaemia in patients with dialysis-dependent (DD) CKD from a Canadian healthcare perspective. Method Data from the roxadustat global phase 3 program were used to estimate the incidence of rescue therapy or iron supplementation use (i.e. intravenous iron, erythropoiesis-stimulating agents [ESAs] or red blood cell transfusions) and major adverse cardiovascular events (MACE+) for roxadustat compared with ESAs in DD patients with anaemia of CKD. MACE+ included myocardial infarction, stroke, unstable angina requiring hospitalization, congestive heart failure (CHF) requiring hospitalization, cardiovascular death and other death. Published Canadian cost data were used to estimate event costs. Drug acquisition costs for roxadustat and ESAs were not considered. A hypothetical cohort of 10,000 Canadian adult DD patients (90% undergoing haemodialysis, 10% undergoing peritoneal dialysis) with treatable anaemia was modelled to determine net medical care cost offsets annually and cumulatively compared with ESAs over a 4-year time horizon. Results Preliminary results for patients with DD CKD show that, compared with ESAs, roxadustat could produce sizeable net medical care cost offsets resulting from reductions in rescue therapy or iron supplementation use, specifically red blood cell transfusions, and from reductions in MACE+, specifically CHF hospitalizations. For the entire cohort of patients with DD CKD, cumulative medical care cost offsets for roxadustat were an estimated $162,609 for rescue therapy or iron supplementation use and $1,027,070 for MACE+ compared with ESAs. Conclusion This analysis provides evidence that treatment with roxadustat in DD patients with anaemia of CKD could result in considerable medical care cost offsets for roxadustat compared with ESAs.

Background and Aims Anaemia is common in patients with chronic kidney disease (CKD) and is associated with increased mortality, cardiovascular complications, reduced quality of life and increased use of healthcare resources. Based on robust epidemiological and clinical data, mathematical modelling is a useful approach for predicting the future burden of disease and the effects of different intervention scenarios, which is essential for health service planning. This analysis uses a microsimulation model, Inside ANEMIA of CKD, to project the impact of a hypothetical intervention scenario that reduces the prevalence of anaemia of CKD on related healthcare costs in Canada from 2020 to 2025. Method A virtual cohort representing the Canadian population was created within the Inside ANEMIA of CKD microsimulation model framework using national demographics and epidemiological data drawn from Statistics Canada and a provincial renal database. In the cohort, virtual individuals were ascribed an age- and sex-stratified CKD status (defined by estimated glomerular filtration rate and albuminuria levels, as per international guidelines) and anaemia status (defined as mild, moderate or severe based on haemoglobin level, as per WHO criteria) based on Canadian prevalence data. Key comorbidities (type 2 diabetes, heart failure and hypertension) were also assigned, reflecting Canada-specific population statistics. Costs related to the treatment of CKD were taken from the published literature, and are shown in Canadian dollars (C$). This modelling analysis evaluated the effects on healthcare costs of a hypothetical intervention scenario in which the prevalence of moderate and severe anaemia is reduced by 20% per year from 2020 to 2025 compared with no intervention (baseline). In each scenario (i.e. intervention or baseline), the modelling analysis estimated CKD-related healthcare costs for patients with moderate or severe anaemia of CKD. The modelling analysis did not adjust for the potential costs of the intervention. Results Preliminary results predict that, with the hypothetical intervention, there could be approximately 435,000 fewer patients with moderate or severe anaemia of CKD in Canada in 2025 compared with no intervention (approximately 497,000 versus 932,000). The intervention is projected to lead to a reduction of C$4.4 billion in annual direct healthcare costs in 2025 for patients with moderate or severe anaemia of CKD compared with no intervention (C$9.1 billion versus C$13.5 billion), assuming that all eligible patients are diagnosed and treated. Conclusion The Inside ANEMIA of CKD microsimulation model predicts that a hypothetical intervention which reduces the prevalence of moderate and severe anaemia of CKD would produce reductions in direct healthcare costs. This suggests that interventions effective at reducing the prevalence of anaemia of CKD would help to reduce the economic burden on healthcare services.

Background and Aims Anaemia is a common complication in patients with chronic kidney disease (CKD). Prevalence of anaemia increases with CKD severity and ranges from 17% in patients with stage 3 disease to over 50% in patients with stage 5 CKD who are not on dialysis. Anaemia of CKD is associated with increased mortality, cardiovascular complications, reduced quality of life and increased use of healthcare resources. Mathematical modelling based on robust epidemiological and clinical data is a useful approach for predicting the future burden of disease, which is important for health service planning. This analysis uses a microsimulation model, Inside ANEMIA of CKD, to project the economic burden of anaemia of CKD in Canada from 2020 to 2025. Method A virtual cohort representing the Canadian population was created within the Inside ANEMIA of CKD microsimulation model framework, using Canadian demographics and epidemiological data drawn from Statistics Canada and a provincial renal database. In the cohort, virtual individuals were ascribed an age–sex-stratified CKD status (defined by estimated glomerular filtration rate and albuminuria levels, as per international guidelines) and anaemia status (defined as mild, moderate or severe based on haemoglobin level, as per WHO criteria) based on Canadian prevalence data. Key comorbidities (type 2 diabetes, heart failure and hypertension) were also assigned, reflecting Canada-specific population statistics. Incidence rates for acute kidney injury and cardiovascular complications (heart failure, myocardial infarction and stroke) were drawn from the literature. Costs related to CKD, anaemia of CKD and associated complications were taken from Canadian government sources and the literature, and are shown in Canadian dollars (C$). Results Preliminary results show that, in Canada, the number of individuals with anaemia of CKD is projected to increase by approximately 0.8 million between 2020 and 2025 (from 1.8 million to 2.6 million). Annual healthcare costs for patients with anaemia of CKD are projected to increase by 17% by 2025 (from C$19.3 billion to C$22.5 billion). Between 2020 and 2025, the costs associated with cardiovascular complications in patients with anaemia of CKD are projected to increase by 28% for heart failure (from C$1.13 billion to C$1.45 billion), 26% for myocardial infarction (from C$0.83 billion to C$1.05 billion) and 29% for stroke (from C$0.99 billion to C$1.29 billion). Conclusion Inside ANEMIA of CKD is the first microsimulation model to project the economic burden of anaemia of CKD in Canada. Based on the modelling projections, the increase in the number of individuals with anaemia of CKD over the next 5 years will be accompanied by a parallel increase in associated healthcare costs and a marked rise in the cost of cardiovascular complications. Evidence-based therapies for anaemia of CKD that lower cardiovascular complications are needed to reduce the economic burden on healthcare services.

Background and Aims Anaemia is a common complication of chronic kidney disease (CKD) and is associated with reduced quality of life, cardiovascular complications, early mortality and a high economic burden for patients. Current treatment options for anaemia of CKD include subcutaneous (SC) or intravenous (IV) erythropoiesis-stimulating agents (ESAs) with or without supplementary iron and blood transfusions. New oral therapies for anaemia, such as hypoxia-inducible factor prolyl hydroxylase inhibitors, are in development and may have advantages for patients compared with ESAs. It is therefore crucial to understand the treatment attributes that patients consider most important. This study aimed to investigate patient preferences for potential anaemia of CKD treatments in adults with dialysis-dependent (DD) CKD in Australia and Canada. Method Adult patients with DD CKD completed a discrete choice experiment (DCE) online survey. In each scenario, patients were asked to choose between three hypothetical treatment alternatives (‘oral pill’, ‘subcutaneous injection’ and ‘intravenous injection’) with differing levels of attributes and an opt-out option (none of these treatments/current treatment) to treat anaemia of CKD. Treatment attributes focused on administration (where, how often and by whom), purchasing (where it is collected and the cost per month), additional benefits (e.g. whether it reduces ‘bad’/LDL cholesterol), side effects (chance of hospitalization from a heart attack or stroke due to the medicine) and the need for rescue therapy (IV iron or blood transfusion). The attributes and their levels were derived from existing market research, the literature and expert opinion. A mixed multinomial logit model, which allows for preference heterogeneity, was used to quantify the overall value of such treatments and the relative importance of each of the defining attributes. Australian patients were divided into those who were eligible for reduced prescription charges under the Pharmaceutical Benefits Scheme, such as the elderly or those on low incomes (referred to as concessions), and those who were not (general patients). Prescription charge concessions did not apply for Canadian patients. Results This preliminary analysis included 61 patients with DD CKD from Australia (n = 22) and Canada (n = 39). The majority of patients were receiving haemodialysis (Australia, 72.7%; Canada, 61.5%), and more than half received their dialysis in a clinic or hospital (Australia, 54.5%; Canada, 76.9%); 50% of the Australian patients were concessions. In both countries, patients were likely to choose a new treatment alternative over the opt-out, with the greatest preference for oral treatment among Australian general and Canadian patients, all else being equal. For Australian concession patients, cost per month was the most important attribute across all treatment options; the risk of side effects (i.e. hospitalization from a heart attack or stroke) was the second most important attribute, with patients preferring treatments with the lowest possible risk. For Australian general and Canadian patients, the risk of side effects and the cost per month were the two most important attributes, and had similar levels of importance. Patients in both countries were also concerned about the risk of needing rescue therapy, and valued reductions in the amount of ‘bad’/LDL cholesterol. Conclusion Results from this DCE study showed that the risk of side effects and the costs of treatment are the most important attributes for hypothetical anaemia of CKD treatment for patients with DD CKD. Australian general and Canadian patients showed a preference for oral therapy over SC or IV injection, all other factors being equal. These findings may help to guide clinicians when selecting treatments for anaemia of CKD for their patients, and may provide useful information when assessing the value of new or future treatments.

Objective The efficacy of the novel interleukin (IL)-23p19 inhibitor guselkumab for psoriatic arthritis (PsA) has recently been demonstrated in two phase 3 trials (DISCOVER-1 & -2) but has not been evaluated vs other targeted therapies for PsA. The objective was to compare guselkumab to targeted therapies for PsA for safety and joint and skin efficacy through network meta-analysis (NMA). Methods A systematic literature review was conducted in January 2020 to identify randomized controlled trials. Bayesian NMAs were performed to compare treatments on American College of Rheumatology (ACR) 20/50/70 response, mean change from baseline in van der Heijde-Sharp (vdH-S) score, Psoriasis Area Severity Index (PASI) 75/90/100 response, adverse events (AEs) and serious adverse events (SAEs). Results Twenty-six phase 3 studies evaluating 13 targeted therapies for PsA were included. For ACR 20 response, guselkumab 100 mg every 8 weeks (Q8W) was comparable to IL-17A inhibitors and subcutaneous tumor necrosis factor (TNF) inhibitors. Similar findings were observed for ACR 50 and 70. For vdH-S score, guselkumab Q8W was comparable to other agents except intravenous TNF therapies. Results for PASI 75 and PASI 90 response suggested guselkumab Q8W was better than most other agents. For PASI 100, guselkumab Q8W was comparable to other active agents. For AEs and SAEs, guselkumab Q8W ranked highly but comparative conclusions were uncertain. Similar results were observed for all outcomes for guselkumab 100 mg every four weeks. Conclusions In this NMA, guselkumab demonstrated favorable arthritis efficacy comparable to IL-17A and subcutaneous TNF inhibitors while offering better PASI response relative to many other treatments.

Introduction: Recent health technology assessments (HTAs) of robot-assisted radical prostatectomy (RARP) in Ontario and Alberta, Canada, resulted in opposite recommendations, calling into question whether benefits of RARP offset the upfront investment. Therefore, the study objectives were to conduct a cost-utility analysis from a Canadian public payer perspective to determine the cost-effectiveness of RARP. Methods: Using a 10-year time horizon, a five-state Markov model was developed to compare RARP to open radical prostatectomy (ORP). Clinical parameters were derived from Canadian observational studies and a recently published systematic review. Costs, resource utilization, and utility values from recent Canadian sources were used to populate the model. Results were presented in terms of increment costs per quality-adjusted life years (QALYs) gained. A probabilistic analysis was conducted, and uncertainty was represented using cost-effectiveness acceptability curves (CEACs). One-way sensitivity analyses were also conducted. Future costs and QALYs were discounted at 1.5%. Results: Total cost of RARP and ORP were $47 033 and $45 332, respectively. Total estimated QALYs were 7.2047 and 7.1385 for RARP and ORP, respectively. The estimated incremental cost-utility ratio (ICUR) was $25 704 in the base-case analysis. At a willingness-to-pay threshold of $50 000 and $100 000 per QALY gained, the probability of RARP being cost-effective was 0.65 and 0.85, respectively. The model was most sensitive to the time horizon. Conclusions: The results of this analysis suggest that RARP is likely to be cost-effective in this Canadian patient population. The results are consistent with Alberta’s HTA recommendation and other economic evaluations, but challenges Ontario’s reimbursement decision.