The CEA Registry Blog

By CEA Registry Team on 11/28/2016 4:26 PM

 Once each week we highlight findings from recently published cost-effectiveness studies:

Apixaban regarded as cost-effective treatment option for stroke prevention in Greece: Apixaban was found to be a cost-effective treatment option versus warfarin and aspirin for the prevention of stroke in patients with atrial fibrillation from a Greek healthcare payer perspective (2).
 
• Future prevalence and cost burden of Chronic Lymphocytic Leukemia (CLL) estimated to have large financial impact: The increased benefit of oral targeted therapies is projected to enhance CLL survivorship but higher costs can impose a substantial financial burden on both patients and payers in the U.S. (4).
 
• Cognitive screening tests for detecting dementia and mild cognitive impairment found to be cost-effective: Cognitive screening tests for use by General Practitioners considered a cost-effective strategy compared to standard of care in England (18).
 
See below for a full list of all cost-utility studies and selected reviews and editorials published November 21-25, 2016.  To discover more CEA articles or to dive in-depth on some of these topics, please visit the Tufts CEA Registry.  Follow us on Twitter (@TuftsCEVR) and Facebook.
 
1: Arefian H, Heublein S, Scherag A, Brunkhorst FM, Younis MZ, Moerer O, Fischer D, Hartmann M. Hospital-related cost of sepsis: A systematic review. J Infect. 2016 Nov 21. pii: S0163-4453(16)30288-2. PMID: 27884733.
 
2: Athanasakis K, Boubouchairopoulou N, Karampli E, Tarantilis F, Savvari P, Bilitou A, Kyriopoulos J. Cost Effectiveness of Apixaban versus Warfarin or Aspirin for Stroke Prevention in Patients with Atrial Fibrillation: A Greek Perspective. Am J Cardiovasc Drugs. 2016 Nov 23. PMID: 27882517.
 
3: Bozkaya D, Livingston T, Migliaccio-Walle K, Odom T. The cost-effectiveness of disease-modifying therapies for the treatment of relapsing-remitting multiple sclerosis. J Med Econ. 2016 Nov 21:1-6. PMID:27822961.
 
4: Chen Q, Jain N, Ayer T, Wierda WG, Flowers CR, O'Brien SM, Keating MJ, Kantarjian HM, Chhatwal J. Economic Burden of Chronic Lymphocytic Leukemia in the Era of Oral Targeted Therapies in the United States. J Clin Oncol. 2016 Nov 21:JCO2016682856. PMID: 27870563.
 
5: Chotai S, Parker SL, Sielatycki JA, Sivaganesan A, Kay HL, Wick JB, McGirt MJ, Devin CJ. Impact of old age on patient-report outcomes and cost utility for anterior cervical discectomy and fusion surgery for degenerative spine disease. Eur Spine J. 2016 Nov 24. PMID: 27885477.
 
6: Gama E, Were V, Ouma P, Desai M, Niessen L, Buff AM, Kariuki S. Large-scale implementation of disease control programmes: a cost-effectiveness analysis of long-lasting insecticide-treated bed net distribution channels in a malaria-endemic area of western Kenya-a study protocol. BMJ Open. 2016 Nov 21;6(11):e012776. PMID: 27872120.
 
7: Gu S, Zeng Y, Yu D, Hu X, Dong H. Cost-Effectiveness of Saxagliptin versus Acarbose as Second-Line Therapy in Type 2 Diabetes in China. PLoS One. 2016 Nov 22;11(11):e0167190. PMID: 27875596.
 
8: Hellard M, Pedrana A, Scott N. Targeted direct-acting antiviral treatment for chronic hepatitis C: a financial reality or an obstacle to elimination? J Hepatol. 2016 Nov 21. PMID: 27884764.
 
9: Klebanoff MJ, Corey KE, Chhatwal J, Kaplan LM, Chung RT, Hur C. Bariatric Surgery for Nonalcoholic Steatohepatitis: A Clinical and Cost-Effectiveness Analysis. Hepatology. 2016 Nov 23. PMID: 27880977.
 
10: Lam SW, Wai M, Lau JE, McNamara M, Earl M, Udeh B. Cost-Effectiveness Analysis of Second-Line Chemotherapy Agents for Advanced Gastric Cancer. Pharmacotherapy. 2016 Nov 21. PMID: 27870079.
 
11: Malet-Larrea A, García-Cárdenas V, Sáez-Benito L, Benrimoj SI, Calvo B, Goyenechea E. Cost-effectiveness of professional pharmacy services in community pharmacy: a systematic review. Expert Rev Pharmacoecon Outcomes Res. 2016 Dec;16(6):747-758. PMID: 27828725.
 
12: Maulsby C, Jain KM, Weir BW, Enobun B, Riordan M, Charles VE; RiC Intervention Team., Holtgrave DR. The Cost and Threshold Analysis of Retention in Care (RiC): A Multi-Site National HIV Care Program. AIDS Behav. 2016 Nov 21. PMID: 27873083.
 
13: Ong AA, Carroll WW, Nguyen SA, Gillespie MB. Cost-effectiveness of transfacial gland-preserving removal of parotid sialoliths. Laryngoscope. 2016 Nov 22. PMID: 27873327.
 
14: Patterson PD, Smith KJ, Hostler D. Cost-effectiveness of workplace wellness to prevent cardiovascular events among U.S. firefighters. BMC Cardiovasc Disord. 2016 Nov 21;16(1):229. PMID: 27871247.
 
15: Serra-Arbeloa P, Rabines-Juárez ÁO, Álvarez-Ruiz MS, Guillén-Grima F. Cost of cutaneous melanoma by tumor stage: A descriptive analysis. Actas Dermosifiliogr. 2016 Nov 22. pii: S0001-7310(16)30329-5.PubMed PMID: 27887672.
 
16: Shao H, Zhai S, Zou D, Mir MU, Zawadzki NK, Shi Q, Liu S, Shi L. Cost-effectiveness analysis of dapagliflozin versus glimepiride as monotherapy in a Chinese population with type 2 diabetes mellitus. Curr Med Res Opin. 2016 Nov 23:1-11. PMID: 27817216.
 
17: Sutherland CS, Stone CM, Steinmann P, Tanner M, Tediosi F. Seeing beyond 2020: an economic evaluation of contemporary and emerging strategies for elimination of Trypanosoma brucei gambiense. Lancet Glob Health. 2016 Nov 21. PMID: 27884709.
 
18: Tong T, Thokala P, McMillan B, Ghosh R, Brazier J. Cost effectiveness of using cognitive screening tests for detecting dementia and mild cognitive impairment in primary care. Int J Geriatr Psychiatry. 2016 Nov 22. PMID: 27874210.
 
19: Wera E, Mourits MC, Siko MM, Hogeveen H. Cost-Effectiveness of Mass Dog Vaccination Campaigns against Rabies in Flores Island, Indonesia. Transbound Emerg Dis. 2016 Nov 23. PMID: 27878980.
 
20: Winters D, Casten R, Rovner B, Murchison A, Leiby BE, Haller JA, Hark L, Weiss DM, Pizzi LT. Cost-Effectiveness of Behavior Activation Versus Supportive Therapy on Adherence to Eye Exams in Older African Americans With Diabetes. Am J  Med Qual. 2016 Nov 23. PMID: 27884979.
 
21: Yue WW, Li XL, Xu HX, Lu F, Sun LP, Guo LH, He YP, Wang D, Yin ZQ. Quality of Life and Cost-Effectiveness of Radiofrequency Ablation versus Open Surgery for Benign Thyroid Nodules: a retrospective cohort study. Sci Rep. 2016 Nov 24;6:37838. PMID: 27883069.
By CEA Registry Team on 11/22/2016 9:03 AM
Once each week we highlight findings from recently published cost-effectiveness studies
 
• Wait time reduction for behavioral intervention for autism spectrum disorder is cost-effective: A new study out of Canada projects that providing early access to behavior interventions for children with severe autism spectrum disorder is associated with improved outcomes and reduced costs (8)
 
• Therapy presents reasonable value in reducing cardiovascular outcomes: in patients with heart failure (NYHA class II to IV), sacubitril-valsartan therapy reduced cardiovascular mortality and morbidity for reasonable value (11)
 
 
See below for a full list of all cost-utility studies and selected reviews and editorials published November 14-18, 2016. To discover more CEA articles or to dive in-depth on some of these topics, please visit the Tufts CEA Registry. Follow us on Twitter (@TuftsCEVR) and Facebook.
 
 
1: Banerjee S, Jeon-Slaughter H, Tsai S, Mohammad A, Foteh M, Abu-Fadel M, Gigliotti OS, Cawich I, Rodriguez G, Kumbhani D, Addo T, Luna M, Das TS, Prasad A, Armstrong EJ, Shammas NW, Brilakis ES. Comparative Assessment of Procedure Cost and Outcomes Between Guidewire and Crossing Device Strategies to Cross Peripheral Artery Chronic Total Occlusions. JACC Cardiovasc Interv. 2016 Nov 14;9(21):2243-2252. PMID: 27832850.
 
2: Cui S, Tobe RG, Mo X, Liu X, Xu L, Li S. Cost-effectiveness analysis of rotavirus vaccination in China: Projected possibility of scale-up from the current domestic option. BMC Infect Dis. 2016 Nov 15;16(1):677. PMID: 27846803.
 
3: Fernández-García P, Marco-Doménech SF, Lizán-Tudela L, Ibáñez-Gual MV, Navarro-Ballester A, Casanovas-Feliu E. The cost effectiveness of vacuum-assisted versus core-needle versus surgical biopsy of breast lesions. Radiologia. 2016 Nov 16. pii: S0033-8338(16)30143-6. doi: 10.1016/j.rx.2016.09.006. PMID: 27865561.
 
4: Goranitis I, Coast J, Day E, Copello A, Freemantle N, Frew E. Maximizing Health or Sufficient Capability in Economic Evaluation? A Methodological Experiment of Treatment for Drug Addiction. Med Decis Making. 2016 Nov 17.  PubMed PMID: 27856827.
 
5: Griffin SO, Naavaal S, Scherrer C, Patel M, Chattopadhyay S; Community Preventive Services Task Force. Evaluation of School-Based Dental Sealant Programs: An Updated Community Guide Systematic Economic Review. Am J Prev Med. 2016 Nov 16. pii: S0749-3797(16)30510-4. doi: 10.1016/j.amepre.2016.10.004. PMID: 27865653.
 
6: Li N, Yang X, Fan L, Totev T, Guerin A, Chen L, Bhattacharyya S, Joseph G. Nilotinib versus dasatinib as second-line therapy in patients with Philadelphia chromosome-positive chronic myeloid leukemia in chronic phase who are resistant or intolerant to imatinib: a cost-effectiveness analysis based on real-world data. J Med Econ. 2016 Nov 14:1-24. PMID: 27841717.
 
7: Maru S, Byrnes JM, Carrington MJ, Stewart S, Scuffham PA. Long-term cost-effectiveness of home versus clinic-based management of chronic heart failure: The WHICH? study. J Med Econ. 2016 Nov 14:1-25. PMID: 27841726.
 
8: Piccininni C, Bisnaire L, Penner M. Cost-effectiveness of Wait Time Reduction for Intensive Behavioral Intervention Services in Ontario, Canada. JAMA Pediatr. 2016 Nov 14. doi: 10.1001/jamapediatrics.2016.2695. PMID: 27842183.
 
9: Ride J, Lorgelly P, Tran T, Wynter K, Rowe H, Fisher J. Preventing postnatal maternal mental health problems using a psychoeducational intervention: the cost-effectiveness of What Were We Thinking. BMJ Open. 2016 Nov 18;6(11):e012086. doi: 10.1136/bmjopen-2016-012086. PMID: 27864246.
 
10: Rykov K, Reininga IH, Knobben BA, Sietsma MS, Ten Have BL. The design of a randomised controlled trial to evaluate the (cost-) effectiveness of the posterolateral versus the direct anterior approach for THA (POLADA - trial). BMC Musculoskelet Disord. 2016 Nov 15;17(1):476. PMID: 27846875.
 
11: Sandhu AT, Ollendorf DA, Chapman RH, Pearson SD, Heidenreich PA. Cost-Effectiveness of Sacubitril-Valsartan in Patients With Heart Failure With Reduced Ejection Fraction. Ann Intern Med. 2016 Nov 15;165(10):681-689. PubMed PMID: 27571284.
 
12: Thommes EW, Kruse M, Kohli M, Sharma R, Noorduyn SG. Review of seasonal influenza in Canada: Burden of disease and the cost-effectiveness of quadrivalent inactivated influenza vaccines. Hum Vaccin Immunother. 2016 Nov 18:0. PMID: 27858509.
 
13: Tonmukayakul U, Arrow P. Cost-effectiveness analysis of the atraumatic restorative treatment-based approach to managing early childhood caries. Community Dent Oral Epidemiol. 2016 Nov 14. doi: 10.1111/cdoe.12265. PMID: 27859533.
By CEA Registry Team on 11/17/2016 1:25 PM

By Elle Pope

Once each week we highlight findings from recently published cost-effectiveness studies:
 • Postpartum depression screening and treatment is cost-effective: After new recommendations issued from the U.S. Preventive Services Task Force promoting screening for postpartum depression, a new study finds screening for and treating postpartum depression to be cost-effective and recommends this practice be considered as part of usual postnatal care (8)
 
Nutrition intervention effective at reducing childhood obesity: One study has determined a school-based nutrition education intervention to be extremely cost-effective in reducing childhood obesity among elementary school students (1)
 
Patient-Centered Care is good value: Incorporating patient preferences within practice-based guidelines has been found to have good value and is recommended as a priority for developing new guidelines (16)
 
See below for a full list all cost-utility studies and selected reviews and editorials published November 7-11, 2016.  To discover more CEA articles or to dive in-depth on some of these topics, please visit the Tufts CEA Registry.  Follow us on Twitter (@TuftsCEVR) and Facebook.
 
1: Graziose MM, Koch PA, Wang YC, Lee Gray H, Contento IR. Cost-effectiveness of a Nutrition Education Curriculum Intervention in Elementary Schools. J Nutr Educ Behav. 2016 Nov 11. pii: S14994046(16)30853-3. PubMed PMID: 27843129.
 
2: Venkatesh S, Pasternak JD, Beninato T, Drake FT, Kluijfhout WP, Liu C, Gosnell JE, Shen WT, Clark OH, Duh QY, Suh I. Cost-effectiveness of active surveillance versus hemithyroidectomy for micropapillary thyroid cancer. Surgery. 2016 Nov 10. pii: S0039-6060(16)30570-0. PubMed PMID: 27839930.
 
3: Ruder JA, Turvey B, Hsu JR, Scannell BP. Effectiveness of a Low-Cost Drilling Module in Orthopaedic Surgical Simulation. J Surg Educ. 2016 Nov 7. pii:S1931-7204(16)30229-X. PubMed PMID: 27839695.
 
4: Zhao D, Gai Tobe R, Cui M, He J, Wu B. Cost-effectiveness of a 23-valent pneumococcal polysaccharide vaccine immunization programme for the elderly in Shanghai, China. Vaccine. 2016 Nov 9. pii: S0264-410X(16)31025-8. PubMed PMID: 27838068.
 
5: Zanocco KA, Wu JX, Yeh MW. Parathyroidectomy for asymptomatic primary hyperparathyroidism: A revised cost-effectiveness analysis incorporating fracture risk reduction. Surgery. 2016 Nov 8. pii: S0039-6060(16)30493-7. PubMed PMID: 27836213.
 
6: Dowell JD, Shah SH, Cooper KJ, Yıldız V, Pan X. Cost-benefit analysis of establishing an inferior vena cava filter clinic. Diagn Interv Radiol. 2016 Nov 11. PubMed PMID: 27833068.
 
7: Bugiantella W, Rondelli F, Mariani L, Polistena A, Sanguinetti A, Avenia N, Mariani E. Cost-effectiveness analysis of the temporary percutaneous ileostomy for faecal diversion after colorectal resection in elderly. Aging Clin Exp Res. 2016 Nov 10. PubMed PMID: 27832466.
 
8: Wilkinson A, Anderson S, Wheeler SB. Screening for and Treating Postpartum Depression and Psychosis: A Cost-Effectiveness Analysis. Matern Child Health J. 2016 Nov 10. PubMed PMID: 27832444.
 
9: McEwan P, Selvapatt N, Brown A, Thursz M, Bennett H, Webster S, Kalsekar A, Yuan Y, Brenner M, Gordon J. A clinician's guide to the cost and health benefits  of hepatitis C cure assessed from the individual patient perspective. Eur J Gastroenterol Hepatol. 2016 Nov 9. PubMed PMID: 27832039.
 
10: Malet-Larrea A, García-Cárdenas V, Sáez-Benito L, Benrimoj SI, Calvo B, Goyenechea E. Cost-effectiveness of professional pharmacy services in community pharmacy: a systematic review. Expert Rev Pharmacoecon Outcomes Res. 2016 Nov 9. PubMed PMID: 27828725.
 
11: Hassan A, Shehata N, Wahba A. Cost effectiveness of letrozole and purified urinary FSH in treating women with clomiphene citrate-resistant polycystic ovarian syndrome: a randomized controlled trial. Hum Fertil (Camb). 2016 Nov 8:1-6. PubMed PMID: 27825272.
 
12: Wen F, Zheng H, Wu Y, Wheeler J, Zeng X, Fu P, Li Q. Cost-effectiveness Analysis of Fluorouracil, Leucovorin, and Irinotecan versus Epirubicin, Cisplatin, and Capecitabine in Patients with Advanced Gastric Adenocarcinoma. Sci Rep. 2016 Nov 8;6:36060. PubMed PMID: 27824060.
 
13: Bozkaya D, Livingston T, Migliaccio-Walle K, Odom T. The cost-effectiveness of disease-modifying therapies for the treatment of relapsing-remitting multiple sclerosis. J Med Econ. 2016 Nov 8:1-16. PubMed PMID:27822961.
 
14: Crossan C, Lord J, Ryan R, Nherera L, Marshall T. Cost effectiveness of case-finding strategies for primary prevention of cardiovascular disease: a modelling study. Br J Gen Pract. 2016 Nov 7. pii: bjgpjan-2017-67-654-marshall-fl-p. PubMed PMID: 27821671.
 
15: Reynolds MR, Baron SJ, Cohen DJ. Economic Implications of Transcatheter Aortic Valve Replacement in Patients at Intermediate Surgical Risk. Circulation. 2016 Nov 8;134(19):1416-1418. PubMed PMID: 27821418.
 
16: Padula WV, Millis MA, Worku AD, Pronovost PJ, Bridges JF, Meltzer DO. Individualized cost-effectiveness analysis of patient-centered care: a case series of hospitalized patient preferences departing from practice-based guidelines. J Med Econ. 2016 Nov 10:1-9. PubMed PMID: 27786569.
 
17: Carter MJ, Gilligan AM, Waycaster CR, Schaum K, Fife CE. Cost effectiveness of adding clostridial collagenase ointment to selective debridement in individuals with stage IV pressure ulcers. J Med Econ. 2016 Nov 9:1-13. PubMed PMID: 27774840.
By CEA Registry Team on 11/4/2016 9:16 AM

The Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org) has been updated to include published cost-effectiveness analyses (CEAs) from 2015.  

New data collection process
Starting with studies published in 2015, the CEA Registry will continue to display detailed information only for select studies that undergo full article review. Detailed description for the selection process is provided here. CEAs not selected for full review will still be included in the CEA Registry, but with limited, descriptive information.

Why the change?
This change follows the rapidly growing publication rate of CEAs, with over 600 cost-utility analyses (CUAs) published in 2014 alone. The new process allows the CEA Registry to provide valuable ratio and preference weight information for a select group of important studies to our users while continuing to provide a comprehensive list of cost-effectiveness studies published annually across different disease areas and interventions.  

CEA Registry contents
For years 1976-2015, we catalogue all cost-effectiveness analyses publishing CUAs. For 2015, we will include limited information on CEAs exclusively reporting cost per life-year (LY) results.

The current upload adds the following to the database:
- 701 cost-effectiveness analyses articles published in 2015, including:
    > 654 CUAs (398 full review and 257 partial review)
    > 47 cost-per-LY studies (29 full review and 18 partial review)
- Among 397 full review $/QALY articles:
    > 1,108 cost-effectiveness ratios
    > 1,971 utility weights

The full Registry now includes:
- 5,702 cost-effectiveness analyses articles published from 1976 through 2015
    > 5,655 CUAs
    > 47 cost-per-LY studies
    > 14,570 cost-effectiveness ratios
    > 21,927 utility weights

Figure. Article Review Process for CEA Registry along with number of cost-effectiveness analyses reviewed

 

The CEA data dictionary provides a list of variables used for data extraction for cost-per-QALY and cost-per-LY studies. It also provides information on changes in the variables over time. [Click here]

 

CEA Registry website

Online search capabilities allow for public access to a select set of data from the registry, including utility weights and ratios.  CEVR’s premium access subscribers can access and download both the entire CEA Registry and the Tufts National Coverage Determination database, which provides detailed information on each national coverage decision.  Premium access subscribers can conduct advanced searches of the Registry data. 

If you are interested in becoming a sponsor, please contact Julie Lannon for more information.

Stay up-to-date on all the news from the CEA Registry by following us on Twitter @TuftsCEVR or Like Us on Facebook.

By CEA Registry Team on 10/27/2016 1:46 PM

Research suggests that private health care payers cover medical interventions inconsistently.  In a study published in the Journal of Managed Care and Specialty Pharmacy we examined the consistency of the largest private payers’ coverage decisions for rheumatoid arthritis drugs.3  We examined coverage policies for rheumatoid arthritis drugs issued by the largest 10 payers in terms of covered lives in three ways.

 

First, we compared how the payers covered the rheumatoid arthritis drugs relative to each drug’s corresponding FDA approval.  We found that 69% of the payers’ coverage determinations were more restrictive than the corresponding FDA approval, 15% were consistent; 3% were less restrictive; and 13% were mixed, i.e., were more restrictive than the label in one way but less restrictive in another.  

 

Second, we compared the coverage policies with the American College of Rheumatology (ACR) treatment recommendations.  We found that 34% of the payers’ coverage determinations were consistent with the ACR recommendations, 33% were more restrictive; 17% were less restrictive; and 17% were mixed.

 

Third, we reviewed the coverage policies to determine the evidence that the payers reported reviewing when making their determination.  We found that payers reported reviewing a different evidence base in their coverage determinations.  For instance, we found that only Aetna reported reviewing evidence from each considered evidence category.  This finding is consistent with other research that has examined the evidence base that payers report reviewing in their coverage policies.

 

While we expected some differences among the included payers, the identified variation across the payers’ was notable.  One reason for this variation could be that payers use different evidence and/or different criteria to make decisions.  Indeed, we found that the included payers reported reviewing a different evidence base in their decisions.  In future research we plan to examine the consistency between the payer coverage determination and the evidence they report reviewing when adjudicating the decision. 

By CEA Registry Team on 10/19/2016 11:23 AM
In a recent study published in the American Journal of Managed Care, researchers from the Center for the Evaluation of Value and Risk in Health analyzed findings from 26 empirical studies to examine how drug exclusion policies affect patients and healthcare costs.  The researchers found that although there were important exceptions, most studies found that drug exclusion policies reduced costs and did not negatively impact patients.    

An info-graphic based on this study can be found here–http://www.ajmc.com/newsroom/infographic-do-formulary-drug-exclusions-save-money-as-promised   

Dr. Chambers, the study’s lead author, participated on a podcast to discuss this...
By CEA Registry Team on 10/14/2016 8:19 AM

 By James D. Chambers, Ph.D.

 

In a study published in the American Journal of Managed Care we report on our research that sought to map the private health care payer coverage and reimbursement landscape.  We considered all publicly available coverage policies for medical interventions issued by the largest 20 private health care payers.  Two payers do not make their coverage determinations publicly available and were excluded from this research.  In total, we considered more than 7,000 coverage policies.

 

We found that the number of policies payers issued varied, ranging from 146 by UnitedHealthcare to 698 by Aetna.  We also found variation in the types of intervention for which payers issued coverage determinations for: 89% of payers issued the largest proportion of their coverage policies for medical devices; 11% issued the largest proportion for drugs.

 

Additionally, for a subset of interventions – the seven medical devices, pharmaceuticals, surgeries, and diagnostic tests/imaging procedures for which the payers most often issued coverage policies – we examined the payers’ coverage determinations and the evidence that the payers reported reviewing in their policy.

 

We found that how payers covered the interventions varied: for 9 of the 28 interventions some payers covered the intervention and others did not.  We also found variation with respect to the evidence that the payers reported reviewing in their coverage policies, some highlights are presented here:

 

  • Overall, payers reported reviewing clinical studies in 87% of policies.
  • Two payers did not report reviewing systematic reviews or meta-analyses in any policies; nine payers reported reviewing systematic reviews or meta-analyses in at least half of their policies.
  • Fourteen payers reported reviewing cost-effectiveness analyses at least some of the time
  • No payer reported receiving direct input from patients or patient advocates.

 

In summary, our research highlights variation in how US private payers cover medical interventions and in the evidence that payers report reviewing in their coverage policies.  This variation across private payers’ coverage policies may lead to unequal access to medical technology for patients and presents a challenge for manufacturers developing evidence for new technologies.

By CEA Registry Team on 9/27/2016 12:01 PM

 

The American Journal of Public Health has published our paper highlighting the paucity of recently published cost-utility analyses that address the leading health concerns in the US Department of Health and Human Services Healthy People 2020 report. 

Using the Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org), a database containing 5000 published cost-utility analyses published in the MEDLINE literature through 2014, two researchers at the Center for the Evaluation of Value and Risk in Health (CEVR) reviewed abstracts for articles published 2011 to 2014 (n=687) and subsequently categorized cost-utility analyses that addressed the specific priorities listed in the 12 Healthy People 2020 areas (n = 120). 

Key findings include:  7.3% of recently published cost-utility analyses addressed key clinical preventative services and only 2% of recently published cost-utility analyses covered each of the following Healthy People 2020 topics: reproductive and sexual health, nutrition/physical activity/obesity, maternal and infant health, and tobacco.  Fewer than 1% addressed priority interventions for injuries and violence, mental health, or substance abuse.  No recent cost-utility analyses addressed specific Healthy People 2020 priorities on oral health, environmental quality, or social determinants of health.  

The scarcity of cost-utility analyses on the government’s own priorities, including interventions addressing areas with substantial burdens of morbidity and mortality, is troubling.  The lack of evaluation of interventions that mitigate risks in these areas keeps the United States on the path of solving health problems largely through medical care rather than through changes in the built and social environment.  

By CEA Registry Team on 9/13/2016 11:00 AM


By Peter J. Neumann, Sc.D.

The Journal of the American Medical Association today published a special communications from the Second Panel on Cost Effectiveness in Health and Medicine.  The Panel updates 20-year-old guidelines and recommendations for evaluating cost-effectiveness in health and medicine.1

The field of cost-effectiveness analysis has advanced in important ways over the years and the need to deliver health care efficiently has only grown.  Updating the guidelines provides an opportunity to reflect on the evolution of cost-effectiveness analysis and to provide guidance for the next generation of practitioners and consumers.

Building on the original work of the 1996 Panel on Cost-Effectiveness in Health and Medicine, originally convened by the U.S. Public Health Service, the recommendations are intended to guide decision makers in using new methods for analyzing evidence, reporting standardized results, incorporating both healthcare system and societal perspectives, and weighing ethical issues in the use of cost-effectiveness analysis.

Primarily funded by grants from the Robert Wood Johnson Foundation and the Bill & Melinda Gates Foundation, the panel recommends several key changes to the guidelines, including:

•    Broadening the scope of the Reference Case, a standard set of methodology that should be followed to ensure quality analysis by creating comparable measurements.

•    Measuring health effects in terms of quality adjusted life years, a measure that includes both the quality and quantity of life lived.

•    Including both costs reimbursed by third-party payers and those paid for out-of-pocket by patients in healthcare sector analyses.

•    Using an “Impact Inventory” that lists the health and non-health effects of a healthcare intervention to ensure that all consequences are considered, including those to patients, caregivers, social services and others outside the healthcare sector.  This tool also allows analysts to look at categories of impacts that may be most important to stakeholders.

•    A reporting checklist and guidelines for transparency that include assumptions in any analysis and the disclosure of potential conflicts of interest.
 
The panel was co-chaired by Gillian D. Sanders, professor in the Department of Medicine and a member of both the Duke Clinical Research Institute and the Duke-Margolis Center for Health Policy, and Peter J. Neumann, ScD, Director, Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center and Professor of Medicine at Tufts University.  The panel also included Anirban Basu (University of Washington), Dan W. Brock (Harvard Medical School), David Feeny (McMaster University), Murray Krahn (University of Toronto), Karen M. Kuntz (University of Minnesota), David O. Meltzer (University of Chicago), Douglas K. Owens (VA Palo Alto Health Care System and Stanford University), Lisa A. Prosser (University of Michigan), Joshua A. Salomon (Harvard T.H. Chan School of Public Health), Mark J. Sculpher (University of York, UK), Thomas A. Trikalinos (Brown University), Louise B. Russell (Rutgers University), Joanna E. Siegel, and Theodore G. Ganiats (University of California – San Diego School of Medicine).

1Sanders GD, Neumann PJ, Basu A, Brock DW, Feeny D, Krahn M, Kuntz KM, Meltzer DO, Owens DK, Prosser LA, Salomon JA, Sculpher MJ, Trikalinos TA, Russell LB, Siegel JE, Ganiats TG. Recommendations for Conduct, Methodological Practices, and Reporting of Cost-Effectiveness Analyses: Second Panel on Cost Effectiveness in Health and Medicine. JAMA. 2016;316(10):1093-1103

By CEA Registry Team on 8/15/2016 8:31 AM

By Pei-Jung Lin, PhD

People with multiple sclerosis (MS) may experience problems with the use of the arms and hands, walking, tiredness, eyesight, attention, and memory.  Our recent study in PharmacoEconomics suggests that not all symptoms are equally troubling to patients, however:  MS patients may value potential improvement in one symptom (e.g., improved arm and hand coordination) over another (e.g., less fatigue) [1].

Further, MS patients may rank the importance of treating various symptoms differently from the way neurologists rank them.  For example, our survey found that MS patients would be willing to pay $410-$520/month to improve their mobility alone—higher than neurologists believe their patients would pay ($216-$249/month, depending on the scenario).  For paired symptoms, our results showed that MS patients would pay the most to treat both mobility and upper limb function (US$525/month) and the least to treat mobility and fatigue (US$371/month) (Figure 1).  In contrast, neurologists believed MS patients would pay the most to treat both mobility and fatigue (US$263/month) and the least to treat mobility and upper limb function (US$177/month) (Figure 2).

Our findings may suggest a mismatch between what MS patients want and what neurologists assume their patients want.  Given this discrepancy, it is important for MS patients and their clinicians to discuss treatment priorities that take into account patient preferences.  As numerous studies have pointed out, understanding these preferences is crucial for effective patient-physician communication and improved patient outcomes and treatment adherence.  Additionally, a better understanding of patient-centered outcomes can guide the development of MS treatments.

In prior work, we have investigated patient preferences and patient-centered communications.  Through a population-based survey, we document that the way a doctor frames survival statistics can make a big difference in how the patient perceives the value of cancer therapy [2].  As patients are asked to shoulder more costs and make difficult decisions about their care, understanding when and why framing matters is essential for uncovering how patients evaluate the value of medical interventions.

Figure 1: Estimated mean monthly willingness-to-pay values among MS patient respondents

Figure 2: Estimated mean monthly patient willingness-to-pay values among neurologist respondents

This study was supported by research funding from Biogen to Tufts Medical Center.

[1] Lin PJ, Saret CJ, Neumann PJ, Sandberg EA, Cohen JT. Assessing the Value of Treatment to Address Various Symptoms Associated with Multiple Sclerosis: Results from a Contingent Valuation Study. Pharmacoeconomics. 2016 Jul 26. [Epub ahead of print] PubMed PMID: 27461538.

[2] Lin PJ, Concannon TW, Greenberg D, Cohen JT, Rossi G, Hille J, Auerbach HR, Fang CH, Nadler ES, Neumann PJ. Does framing of cancer survival affect perceived value of care? A willingness-to-pay survey of US residents. Expert Rev Pharmacoecon Outcomes Res. 2013 Aug;13(4):513-22. PubMed PMID: 23977977.

By CEA Registry Team on 6/15/2016 4:20 PM
 By Pei-Jung Lin, PhD.

Alzheimer’s disease and related dementias (ADRD) is a slow, progressive disease.  Many people with ADRD may live for years with the disease left unrecognized or untreated, in part because the early symptoms are mild and often mistaken as part of normal aging.  Our recent study1 in the Journal of the American Geriatrics Society (JAGS) found that ADRD patients may already use more health care services than those without dementia before they receive a formal diagnosis. Our findings suggest that ADRD patients’ Medicare expenditures may start to increase at least 12 months preceding their first diagnosis date (Figure 1).  We found that total Medicare expenditures are 42% higher among ADRD patients than matched controls during the year prior to diagnosis ($15,091 vs. $10,622), and 192% higher during the first year immediately following diagnosis ($27,126 vs. $9,274).  Our study also showed that ADRD patients’ Medicare expenditures increase substantially during the period...
By CEA Registry Team on 5/16/2016 8:41 AM

By CEA Registry Team

The Tufts Medical Center Cost-Effectiveness Analysis (CEA) Registry (www.cearegistry.org), will begin to display detailed information only for selected studies considered to be high impact economic evaluations. Starting with studies published in 2015, all CEA abstracts will be reviewed by two Tufts reviewers, who will make a determination by consensus on whether the study qualifies for an extended review based on: the study’s population, the medical intervention(s) being studied, novelty of treatment, as well as the generalizability of the study’s results, as inferred from the abstract. The selected studies will then be reviewed in full so the Registry team can collect detailed information on cost-effectiveness ratios, utility weights, and study methodology. The cost-utility studies not deemed to be high impact will continue to be included in the CEA Registry, but with limited information extracted only from the abstract, including country of study, intervention type, target population and interventions evaluated, without providing ratios, weights, or disaggregate cost and QALY data. Limited information on cost per life year studies will also be included in the Registry starting with studies published in 2015.

This change follows the rapidly growing publication rate of CUAs, with over 600 studies published in 2014 alone. The newer process allows the CEA Registry to provide valuable ratio and preference weight information for a select group of important studies to our users while continuing to provide a comprehensive list of cost per QALY and cost per life year studies published annually across different disease areas and interventions.  The Registry is currently updated through 2014 and contains 5,000 cost-utility studies with over 13,000 standardized cost-effectiveness ratios and 19,000 utility weights.

By CEA Registry Team on 2/12/2016 11:51 AM
By CEA Registry Team The Tufts Medical Center Cost-Effectiveness Analysis Registry (www.cearegistry.org) has now been updated to include published cost-utility studies or CUAs (studies that report findings in the form of cost per quality-adjusted life years (QALYs) gained) through 2014.  The database contains information on cost-utility analyses on a wide range of health and medical interventions published from 1976-2014, including over 13,000 standardized cost-effectiveness ratios. The current upload adds the following to the database: • 642 cost-utility analyses articles published in 2014 • 1,547 cost-effectiveness ratios • 2,964 utility weights The full Registry now includes: • 5,000 cost-utility analyses articles published from 1976 through 2014 • 13,462 cost-effectiveness ratios • 19,956 utility weights Online search capabilities allow for public access to a select set of data from the registry, including utility weights and ratios.  CEVR’s premium access subscribers can access and download both the entire CEA Registry and the Tufts National Coverage Determination database, which provides detailed information on each national coverage decision.  Premium access subscribers can conduct advanced searches of the Registry data....
By CEA Registry Team on 2/1/2016 9:59 AM

 

By Joshua Cohen, PhD, and Pei-Jung Lin, PhD

Newly approved cancer drugs in the U.S. now cost an average of $10,000 per month, with some therapies costing more than $30,000 per month.  Expensive oncology innovations present coverage and reimbursement challenges for payers who must contain costs while ensuring drug access.  High costs also pose substantial financial burdens on patients and families.  One of the most heated debates concerns treatment for chronic myeloid leukemia (CML). 

Our recent paper [1] in Medical Care found that, despite high costs, CML care may have provided reasonable value for money among older patients between 1995 and 2007.  This study, funded by The Leukemia & Lymphoma Society, analyzed how aggregate care costs and survival have changed over time based on real-world, population-level data from SEER-Medicare.  Our findings showed that for older adults, cancer care costs increased from $127,000 in 1995 to $278,000 in 2007 (2010 dollars), but that during the same period, survival increased from 2.2 years to 4.2 years.  The increase in CML care costs largely reflects the added cost of tyrosine kinase inhibitor (TKI) medications (see Figure below).  Dividing the added treatment costs between 1995 and 2007 of $151,000 by the corresponding survival gain of roughly 2 years yields an estimated incremental cost-effectiveness ratio (ICER) of $74,000/LY (2010 dollars) among Medicare patients with CML.  The clinical benefits of TKIs can also be described in more concrete terms: for many patients, these medications have transformed CML from a fatal disorder to a managed, chronic condition.

Estimated mean health care costs (simulation truncated at 15 years after diagnosis, 2010 dollars)


Despite the transformative impact of TKIs on CML and their arguably favorable cost-effectiveness (the value of a quality adjusted life year – a “QALY” – in the United States has been reported to range from $100,000 to $150,000 [2]), these medications remain tremendously controversial.  In 2013, an editorial signed by more than 100 CML experts argued that “prices of CML drugs are too high and unsustainable.”[3]  Why?

First, the prices of these drugs have increased substantially since their introduction in 2001.  At that time, the first TKI, imatinib, cost $30,000 per year for each patient.  By 2012, the price had tripled to $92,000 per year.  Indeed, our analysis has been criticized since it reflects drug price increases only through 2007. [4,5]

Second, there is a sense that the cost-effectiveness ratio alone is not a sufficient indicator for assessing whether the price for a drug is warranted. Payers and others feel that budget impact is also important.  They argue that the introduction of new, high priced drugs that are indicated for a large number of people (Sovaldi is a recent poster child) makes the health system “unsustainable”.  One notable drug valuation framework, developed by the Institute for Clinical and Economic Review (ICER), explicitly considers budget impact.[6]  In ICER’s framework, a highly cost-effective drug can be deemed too expensive if the population budget impact exceeds $904 million annually.

Our analysis of CML is limited by the fact that we have data only through 2007, and our work should be updated when new data become available.  But there are several points to keep in mind.  First, just as it makes sense to update prices for these drugs in our analysis, it also makes sense to take into account the fact that these drugs will likely become considerably less expensive in the not too distant future.  The patent for imatinib expired in 2015, and the patent for dasatinib is scheduled to expire in 2020.

Second, we would argue that if a (new) drug has a favorable cost-effectiveness ratio but an “unsustainable” impact on health care budgets, an advisable reaction is not necessarily rejection of coverage for that new drug.  Instead, it might make sense to look at whether resources should be diverted away from other, lower value therapies in order to fund access to the novel, higher value therapy. 

The response to this position might be that perhaps the government should instead limit the price of drugs or the duration of patent coverage.  How much innovation patent protection generates is not clear.  Then again, at some point (that must be better understood), cutting back on patent protection adversely affects innovation since it decreases the return on investment to drug manufacturers. 

It is critical to recognize that there will be tradeoffs, whether between a new treatment and a (lower value) existing treatment, or between more affordable treatment coverage now and possibly less innovation in the future.  We must better understand those tradeoffs and then consciously decide which benefits are most important to preserve.  Because these tradeoffs are so controversial, it is tempting to dismiss them.  But doing so does not make them go away.  On average, it just leads to worse outcomes.


1 Lin PJ, Winn AN, Parsons SK, Neumann PJ, Weiss ES, Cohen JT. Linking Costs and Survival in the Treatment of Older Adults with Chronic Myeloid Leukemia:  An Analysis of SEER-Medicare Data from 1995-2007. Medical Care 2016 Jan 12 [Epub ahead of print].
 
2 Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness—the curious resilience of the $50,000-per-QALY threshold. N Engl J Med 2014;371:796–797.

3 Experts in Chronic Myeloid Leukemia. The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts. Blood 2013;121:4439–4442.

4 Prasad V, Mailankody S. How should we assess the value of innovative drugs in oncology? Lessons from cost-effectiveness analyses. Blood. 2015;126(15):1860-1861.

5 Saret CJ, Cohen JT, Parsons SK, Neumann PJ. Price and value in cancer care. Cancer 2015;121(22):4097-4098.

6 Neumann PJ, Cohen JT. Measuring the Value of Prescription Drugs. N Engl J Med 2015;373(27):2595-7.

By CEA Registry Team on 11/18/2015 5:26 PM
By: Joshua T. Cohen and Peter J. Neumann Rising drug prices continue to frustrate payers, physicians, and the public.  They grab the attention of the media and leading presidential candidates.  In response, private US organizations have recently developed drug evaluation schemes, and by doing so, hope to promote rational drug pricing and purchase decisions. In this week’s New England Journal of Medicine, we examine how five notable actors evaluate drug prices according to their value-based framework:  

American College of Cardiology     (ACC)/American Heart Association (AHA), American Society of Clinical Oncology (ASCO), Institute for Clinical and Economic Review (ICER), Memorial Sloan Kettering Cancer Center (MSKCC), and The National Comprehensive Cancer Network (NCCN). Framework details are available in our commentary.  But here’s what we learned.  First, these frameworks emphasize a drug’s value – in terms of patient benefits and in some cases population impacts – rather than a drug’s development and production cost.  That’s good because it incentivizes development of drugs that improve health.  It’s also consistent with how consumers think about other products.  After all, when we visit Starbucks, we’re thinking about coffee taste and possibly shop ambiance.  We’re certainly not thinking about the cost of the coffee beans, hot water, and barista service.  Admittedly, medication and coffee markets differ.  But the salience of product benefits spans both....
By CEA Registry Team on 9/25/2015 2:14 PM

By James D. Chambers, Ph.D.

Conventional wisdom in the U.S. suggests that private payers look to Medicare’s lead in making coverage decisions. However, in a new paper published in Health Affairs, my colleagues and I found that Medicare national coverage determinations (NCDs) disagreed with private policies for roughly half of the technologies included in our study.(1)

The Medicare program issues NCDs for technologies seen as especially significant; the remainder of coverage decisions are made by regional contractors. We identified medical devices in NCDs between February 1999 and August 2013 using the Tufts Medical Center National Coverage Determination Database.(2)

For each device, we examined whether it was covered by Medicare and each of the 18 largest private payers (excluding two that did not publish formal coverage policies online). If both Medicare and a private payer covered the device, we classified the NCD as equivalent to, more restrictive than, or less restrictive than the private payer policy.

Of the forty-seven medical devices included in our study, twenty-seven had 510(k) clearance, nineteen had pre-market approval, and one had a humanitarian device example. Medicare covered thirty-five (74%) of the devices. The sixteen payers we examined issued coverage policies for varying proportions of the devices; only two issued policies for fewer than half the devices, while one payer (Aetna) issued policies for all forty-seven.

NCDs were equivalent with private coverage in 51% of comparisons, more restrictive tin 23%, and less restrictive in 22% of cases (Exhibit 1). Twenty devices were coverage by Medicare and all private payers, while seven devices were not covered by Medicare or any private payers. Private payer coverage policies were inconsistent for the other twenty devices.

Exhibit 1

Exhibit 1. Source: Health Affairs.

This research was limited to technologies present in NCDs during the study period. We could not include payers without available coverage policies. In addition, in cases without a policy it was possible that payers made coverage decisions on a case by case basis. The study excluded devices coverage through Medicare’s coverage with evidence development program, which requires study while an intervention is made available to a limited population. This program lacked an analogue for comparison among private payer policies.  

While some differences are expected amongst the many individual decisions made by Medicare and each of the private payers, we were surprised at the amount of variation among the payers in our study. One possible explanation is that the difference in age between the Medicare population and populations covered by private insurers leads to different policies; however, this difference would not explain the lack of agreement among private payers. It is possible that payers used different evidence and/or different criteria to make decisions. This variation in coverage policy can create a challenge for manufacturers developing evidence about new technology and may lead to unequal access to medical technology for patients.

References:

1. Chambers, JD, Chenoweth M, Thorat T, Neumann PJ. Private Payers Disagree with Medicare Over Medical Device Coverage About Half The Time. Health Affairs 2015;34(8):1376–1382.

By CEA Registry Team on 9/17/2015 9:33 AM

By Cayla Saret, B.A. 

Twice each month we highlight recently published cost-utility studies and selected reviews and editorials.
 
1: Xu X, Ma YY, Zou HD. Cost-Utility Analysis of Cataract Surgery in Advanced Glaucoma Patients. J Glaucoma. 2015 Sep 14. [Epub ahead of print] PubMed PMID: 26372156.
 
2: Puggina A, Broumas A, Ricciardi W, et. al. Cost-effectiveness of screening for lung cancer with low-dose computed tomography: a systematic literature review. Eur J Public Health. 2015 Sep 14. [Epub ahead of print] PubMed PMID: 26370440.
 
3: Polistena B, Calzavara-Pinton P, Altomare G, et. al. The impact of biologic therapy in chronic plaque psoriasis from a societal perspective: an analysis based on Italian actual clinical practice. J Eur Acad Dermatol Venereol. 2015 Sep 15. [Epub ahead of print] PubMed PMID: 26370321.
 
4: Boyd KA, Briggs AH, Bauld L, et. al. Are financial incentives cost-effective to support smoking cessation during pregnancy? Addiction. 2015 Sep 15. [Epub ahead of print] PubMed PMID: 26370095.
 
5: Juusola JL, Brandeau ML. HIV Treatment and Prevention: A Simple Model to Determine Optimal Investment. Med Decis Making. 2015 Sep 14. [Epub ahead of print] Review. PubMed PMID: 26369347.
 
6: Gooding S, Lau IJ, Sheikh M, et. al. Double Relapsed and/or Refractory Multiple Myeloma: Clinical Outcomes and Real World Healthcare Costs. PLoS One. 2015 Sep 14;10(9):e0136207. eCollection 2015. PubMed PMID: 26367874.
 
7: Pertile P, Poli A, Dominioni L, et. al. Is chest X-ray screening for lung cancer in smokers cost-effective? Evidence from a population-based study in Italy. Cost Eff Resour Alloc. 2015 Sep 12;13:15. eCollection 2015. PubMed PMID: 26366122.
 
8: Pei PP, Weinstein MC, Li XC, et. al. Prioritizing HIV comparative effectiveness trials based on value of information: generic versus brand-name ART in the US. HIV Clin Trials. 2015 Sep 14:1945577115Y0000000009. [Epub ahead of print] PubMed PMID: 26365741.
 
9: Shah M, Risher K, Berry SA, et. al. The epidemiologic and economic impact of improving HIV testing, linkage, and retention in care in the United States. Clin Infect Dis. 2015 Sep 11. [Epub ahead of print] PubMed PMID: 26362321.
 
10: Chit A, Becker DL, DiazGranados CA, et. al. Cost-effectiveness of high-dose versus standard-dose inactivated influenza vaccine in adults aged 65 years and older: an economic evaluation of data from a randomised controlled trial. Lancet Infect Dis. 2015 Sep 8. [Epub ahead of print] PubMed PMID: 26362172.
 
11: Tosanguan J, Chaiyakunapruk N. Cost-effectiveness analysis of clinical smoking cessation interventions in Thailand. Addiction. 2015 Sep 11. [Epub ahead of print] PubMed PMID: 26360507.
 
12: Svedbom A, Paech D, Leonard C, et. al. Is dibotermin alfa a cost-effective substitute for autologous iliac crest bone graft in single level lumbar interbody spine fusion? Curr Med Res Opin. 2015 Sep 11:1-32. [Epub ahead of print] PubMed PMID: 26359326.
 
13: Durkee BY, Qian Y, Pollom EL, et. al. Cost-Effectiveness of Pertuzumab in Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer. J Clin Oncol. 2015 Sep 8. [Epub ahead of print] PubMed PMID: 26351332.
 
14: Mullikin M, Tan L, Jansen JP, et. al. A Novel Dynamic Model for Health Economic Analysis of Influenza Vaccination in the Elderly. Infect Dis Ther. 2015 Sep 9. [Epub ahead of print] PubMed PMID: 26350238.
 
15: Kaimal AJ, Norton ME, Kuppermann M. Prenatal Testing in the Genomic Age: Clinical Outcomes, Quality of Life, and Costs. Obstet Gynecol. 2015 Sep 3. [Epub ahead of print] PubMed PMID: 26348190.
 
16: Burns DK, Wilson EC, Browne P, et. al. The Cost Effectiveness of Maintenance Schedules Following Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: An Economic Evaluation Alongside a Randomised Controlled Trial. Appl Health Econ Health Policy. 2015 Sep 7. [Epub ahead of print] PubMed PMID: 26346590.
 
17: Johnson MJ, Kanaan M, Richardson G, et. al. A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease. BMC Med. 2015 Sep 7;13(1):213. PubMed PMID: 26345362.
 
18: McBain RK, Salhi C, Hann K, et. al. Costs and cost-effectiveness of a mental health intervention for war-affected young persons: decision analysis based on a randomized controlled trial. Health Policy Plan. 2015 Sep 7. [Epub ahead of print] PubMed PMID: 26345320.
 
19: Le P, Rothberg MB. Cost-Effectiveness of Herpes Zoster Vaccine for Persons Aged 50 Years. Ann Intern Med. 2015 Sep 8. [Epub ahead of print] PubMed PMID: 26344036.
 
20: Nair SC, Welsing PM, Jacobs JW, et. al. Economic evaluation of a tight-control treatment strategy using an imaging device (handscan) for monitoring joint inflammation in early rheumatoid arthritis. Clin Exp Rheumatol. 2015 Sep 7. [Epub ahead of print] PubMed PMID: 26343274.
 
21: Lichtenberg FR. The impact of pharmaceutical innovation on premature cancer mortality in Switzerland, 1995-2012. Eur J Health Econ. 2015 Sep 5. [Epub ahead of print] PubMed PMID: 26342826.
 
22: Siribumrungwong B, Noorit P, Wilasrusmee C, et. al. Cost-utility analysis of great saphenous vein ablation withradiofrequency, foam and surgery in the emerging health-care setting of Thailand. Phlebology. 2015 Sep 4. [Epub ahead of print] PubMed PMID: 26341394.
 
23: Meads DM, Marshall A, Hulme CT, et. al. The Cost Effectiveness of Docetaxel and Active Symptom Control versus Active Symptom Control Alone for Refractory Oesophagogastric Adenocarcinoma: Economic Analysis of the COUGAR-02 Trial. Pharmacoeconomics. 2015 Sep 4. [Epub ahead of print] PubMed PMID: 26340940.
 
24: Valencia WM, Florez HJ. A new angle for glp-1 receptor agonist: the medical economics argument Editorial on: Huetson P, Palmer JL, Levorsen A, et al. Cost-effectiveness of the once-daily glp-1 receptor agonist lixisenatide compared to bolus insulin both in combination with basal insulin for the treatment of patients with type 2 diabetes in Norway. J Med Econ 2015: 1-13 [Epub ahead of print]. J Med Econ. 2015 Sep 4:1-3. [Epub ahead of print] PubMed PMID: 26337323.
 
25: Gutzwiller FS, Pfeil AM, Ademi Z, et. al. Cost Effectiveness of Sucroferric Oxyhydroxide Compared with Sevelamer Carbonate in the Treatment of Hyperphosphataemia in Patients Receiving Dialysis, from the Perspective of the National Health Service in Scotland. Pharmacoeconomics. 2015 Sep 3. [Epub ahead of print] PubMed PMID: 26334991.
 
26: Matter-Walstra K, Braun R, Kolb C, et. al. A cost-effectiveness analysis of trametinib plus dabrafenib as first-line therapy for metastatic BRAF V600-positive melanoma in the Swiss setting. Br J Dermatol. 2015 Sep 2. [Epub ahead of print] PubMed PMID: 26332527.
 
27: Karantana A, Scammell BE, Davis TR, et. al. Cost-effectiveness of volar locking plate versus percutaneous fixation for distal radial fractures: Economic evaluation alongside a randomised clinical trial. Bone Joint J. 2015 Sep;97-B(9):1264-70. PubMed PMID: 26330595.
 
28: Gimeno-Ballester V, Mar J, San Miguel R. Cost-effectiveness analysis of simeprevir with daclatasvir for non-cirrhotic genotype-1b-naïve patients plus chronic hepatitis C. Expert Rev Pharmacoecon Outcomes Res. 2015 Sep 1:1-10. [Epub ahead of print] PubMed PMID: 26327360.
 
29: Woo CY, Strandberg EJ, Schmiegelow MD, et. al. Cost-Effectiveness of Adding Cardiac Resynchronization Therapy to an Implantable Cardioverter-Defibrillator Among Patients With Mild Heart Failure. Ann Intern Med. 2015 Sep 15;163(6):417-26. PubMed PMID: 26301323.
 
30: Suen SC, Bendavid E, Goldhaber-Fiebert JD. Cost-effectiveness of improvements in diagnosis and treatment accessibility for tuberculosis control in India. Int J Tuberc Lung Dis. 2015 Sep;19(9):1115-24. PubMed PMID: 26260835.
 
31: Goffin JR, Flanagan WM, Miller AB, et. al. Cost-effectiveness of Lung Cancer Screening in Canada. JAMA Oncol. 2015 Sep 1;1(6):807-13. PubMed PMID: 26226181.
 
32: Li R, Qu S, Zhang P, et. al. Economic Evaluation of Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force. Ann Intern Med. 2015 Sep 15;163(6):452-60. PubMed PMID: 26167962.
 
33: Li M, Dick A, Montenovo M, et. al. Cost-effectiveness of liver transplantation in methylmalonic and propionic acidemias. Liver Transpl. 2015 Sep;21(9):1208-18. PubMed PMID: 25990417.
 
34: Vestergaard AS, Ehlers LH. A Health Economic Evaluation of Stroke Prevention  in Atrial Fibrillation: Guideline Adherence Versus the Observed Treatment Strategy Prior to 2012 in Denmark. Pharmacoeconomics. 2015 Sep;33(9):967-79. PubMed PMID: 25943684.
 
35: Fleeman N, Bagust A, Beale S, et. al. Dabrafenib for Treating Unresectable, Advanced or Metastatic BRAF V600 Mutation-Positive Melanoma: An Evidence Review Group Perspective. Pharmacoeconomics. 2015 Sep;33(9):893-904. PubMed PMID: 25906420.
 
36: Borisenko O, Adam D, Funch-Jensen P, et. al. Bariatric Surgery can Lead to Net Cost Savings to Health Care Systems: Results from a Comprehensive European Decision Analytic Model. Obes Surg. 2015 Sep;25(9):1559-68. PubMed PMID: 25639648.
By CEA Registry Team on 8/6/2015 3:00 PM

By Joshua T. Cohen, PhD

The New York Times writes that wider access to health insurance under the Affordable Care Act will drive up health care spending – despite claims to the contrary.  CEVR’s Josh Cohen comments in the article that greater access to screening often fails to save money because a large number of people must be screened to prevent one case of expensive disease.  That said, greater access to health care (and to prevention) can deliver good value.  But that’s not the same thing reducing overall health care costs.  Knowing which measures deliver good value depends on analyzing the options.  Generalizations about saving money are unhelpful.

By CEA Registry Team on 7/17/2015 3:27 PM

By Cayla Saret, B.A.

Twice each month we highlight recently published cost-utility studies and selected reviews and editorials.

1: Nwachukwu BU, McLawhorn AS, Simon MS, et. al. Management of End-Stage Ankle Arthritis: Cost-Utility Analysis Using Direct and Indirect Costs. J Bone Joint Surg Am. 2015 Jul 15;97(14):1159-72. PubMed PMID: 26178891.

2: Rosselli D, Rueda JD, Diaz CE. Cost-effectiveness of kidney transplantation compared with chronic dialysis in end-stage renal disease. Saudi J Kidney Dis Transpl. 2015 Jul-Aug;26(4):733-738. PubMed PMID: 26178546.

3: Sharma M, Sy S, Kim JJ. The value of male human papillomavirus vaccination in preventing cervical cancer and genital warts in a low-resource setting. BJOG. 2015 Jul 14. [Epub ahead of print] PubMed PMID: 26176301.

4: Hsieh HM, Gu SM, Shin SJ, et. al. Cost-Effectiveness of a Diabetes Pay-For-Performance Program in Diabetes Patients with Multiple Chronic Conditions. PLoS One. 2015 Jul 14;10(7):e0133163. eCollection 2015. PubMed PMID: 26173086.

5: Pandya A, Sy S, Cho S, et. al. Cost-effectiveness of 10-Year Risk Thresholds for Initiation of Statin Therapy for Primary Prevention of Cardiovascular Disease. JAMA. 2015 Jul 14;314(2):142-50. doi: 10.1001/jama.2015.6822. PubMed PMID: 26172894.

6: Rudmik L, An W, Livingstone D, et. al. Making a case for high-volume robotic surgery centers: A cost-effectiveness analysis of transoral robotic surgery. J Surg Oncol. 2015 Jul 14. [Epub ahead of print] PubMed PMID: 26171771.

7: Babović I, Arandjelović M, Plešinac S, et. al. "Vaginal delivery or caesarean section at term breech delivery-chance or risk?" J Matern Fetal Neonatal Med. 2015 Jul 14:1-10. [Epub ahead of print] PubMed PMID: 26169706.

8: Vallejo-Torres L, Castilla I, Couce ML, et. al. Cost-Effectiveness Analysis of a National Newborn Screening Program for Biotinidase Deficiency. Pediatrics. 2015 Jul 13. [Epub ahead of print] PubMed PMID: 26169436.

9: Simpson SA, McNamara R, Shaw C, et. al. A feasibility randomised controlled trial of a motivational interviewing-based intervention for weight loss maintenance in adults. Health Technol Assess. 2015 Jul;19(50):1-378. doi: 10.3310/hta19500. PubMed PMID: 26168409.

10: Li R, Qu S, Zhang P, Chattopadhyay S, et. al. Economic Evaluation of Combined Diet and Physical Activity Promotion Programs to Prevent Type 2 Diabetes Among Persons at Increased Risk: A Systematic Review for the Community Preventive Services Task Force. Ann Intern Med. 2015 Jul 14. [Epub ahead of print] PubMed PMID: 26167962.

11: Shafiq M, Frick KD, Lee H, et. al. Management of Malignant Pleural Effusion: A Cost-Utility Analysis. J Bronchology Interv Pulmonol. 2015 Jul;22(3):215-25. PubMed PMID: 26165892.

12: Rosenthal VD, Udwadia FE, Kumar S, et. al. Clinical impact and cost-effectiveness of split-septum and single-use prefilled flushing device vs 3-way stopcock on central line-associated bloodstream infection rates in India: a randomized clinical trial conducted by the International Nosocomial Infection Control Consortium (INICC). Am J Infect Control. 2015 Jul 8. pii: S0196-6553(15)00655-0. [Epub ahead of print] PubMed PMID: 26164769.

13: Reilly CM, Butler J, Culler SD, et. al. An Economic Evaluation of a Self-Care Intervention in Persons with Heart Failure and Diabetes. J Card Fail. 2015 Jul 8. [Epub ahead of print] PubMed PMID: 26164214.

14: Mangen MJ, Rozenbaum MH, Huijts SM, et. al. Cost-effectiveness of adult pneumococcal conjugate vaccination in the Netherlands. Eur Respir J. 2015 Jul 9. pii: ERJ-00325-2015. [Epub ahead of print] PubMed PMID: 26160871.

15: Banz K, Delnoy PP, Billuart JR. Exploratory cost-effectiveness analysis of cardiac resynchronization therapy with systematic device optimization vs. standard (non-systematic) optimization: a multinational economic evaluation. Health Econ Rev. 2015 Dec;5(1):57. Epub 2015 Jul 11. PubMed PMID: 26160650.

16: Kvizhinadze G, Wilson N, Nair N, et. al. How much might a society spend on life-saving interventions at different ages while remaining cost-effective? A case study in a country with detailed data. Popul Health Metr. 2015 Jul 8;13:15. eCollection 2015. PubMed PMID:  26155199; PubMed Central PMCID: PMC4493819.

17: Forster A, Young J, Chapman K, et. al. Cluster Randomized Controlled Trial: Clinical and Cost-Effectiveness of a System of Longer-Term Stroke Care. Stroke. 2015 Jul 7. [Epub ahead of print] PubMed PMID: 26152298.

18: van den Akker-van Marle ME, van Sorge AJ, Schalij-Delfos NE. Cost and effects of risk factor guided screening strategies for retinopathy of prematurity for different treatment strategies. Acta Ophthalmol. 2015 Jul 6. doi: 10.1111/aos.12798. [Epub ahead of print] PubMed PMID: 26149829.

19: Leggett LE, Hauer T, Martin BJ, et. al. Optimizing Value From Cardiac Rehabilitation: A Cost-Utility Analysis Comparing Age, Sex, and Clinical Subgroups. Mayo Clin Proc. 2015 Jul 3. pii: S0025-6196(15)00466-8. [Epub ahead of print] PubMed PMID: 26149321.

20: Schauwvlieghe AM, Dijkman G, Hooymans JM, et. al. Comparing the effectiveness and costs of Bevacizumab to Ranibizumab in patients with Diabetic Macular Edema: a randomized clinical trial (the BRDME study). BMC Ophthalmol. 2015 Jul 7;15(1):71. PubMed PMID: 26149170; PubMed Central PMCID: PMC4491889.

21: Cillo U, Spolverato G, Vitale A, et. al. Liver Resection for Advanced Intrahepatic Cholangiocarcinoma: A Cost-Utility Analysis. World J Surg. 2015 Jul 7. [Epub ahead of print] PubMed PMID: 26148521.

22: Foster Page LA, Beckett DM, Cameron CM, et. al. Can the Child Health Utility 9D measure be useful in oral health research? Int J Paediatr Dent. 2015 Jul 4. [Epub ahead of print] PubMed PMID: 26146798.

23: ESHRE Capri Workshop Group. Economic aspects of infertility care: a challenge for researchers and clinicians. Hum Reprod. 2015 Jul 3. [Epub ahead  of print] Review. PubMed PMID: 26141712.

24: Ledwidge MT, O'Connell E, Gallagher J, et. al. Cost-effectiveness of natriuretic peptide-based screening and collaborative care: a report from the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) study. Eur J Heart Fail. 2015 Jul;17(7):672-9. PubMed PMID: 26139583.

25: Micieli A, Wijeysundera HC, Qiu F, et. al. A Decision Analysis of Percutaneous Left Atrial Appendage Occlusion Relative to Novel and Traditional Oral Anticoagulation for Stroke Prevention in Patients with New-Onset Atrial Fibrillation. Med Decis Making. 2015 Jul 2. [Epub ahead of print] PubMed PMID: 26139448.

26: Khan I, Morris S, Hackshaw A, et. al. Cost-effectiveness of first-line erlotinib in patients with advanced non-small-cell lung cancer unsuitable for chemotherapy. BMJ Open. 2015 Jul 2;5(7):e006733. PubMed PMID: 26137881.

27: Schurer JM, Rafferty E, Farag M, et. al. Echinococcosis: An Economic Evaluation of a Veterinary Public Health Intervention in Rural Canada. PLoS Negl Trop Dis. 2015 Jul 2;9(7):e0003883. eCollection 2015 Jul. PubMed PMID: 26135476.

28: Deng J, Gu S, Shao H, et. al. Cost-effectiveness analysis of exenatide twice daily (BID) versus insulin glargine once daily (QD) as add-on therapy in Chinese patients with Type 2 diabetes mellitus inadequately controlled by oral therapies. J Med Econ. 2015 Jul 2:1-32. [Epub ahead of print] PubMed PMID: 26134916.

29: Haasis MA, Ceria JA, Kulpeng W, et. al. Do Pneumococcal Conjugate Vaccines Represent Good Value for Money in a Lower-Middle  Income Country? A Cost-Utility Analysis in the Philippines. PLoS One. 2015 Jul 1;10(7):e0131156. eCollection 2015. PubMed PMID: 26131961.

30: Campbell JR, Sasitharan T, Marra F. A Systematic Review of Studies Evaluating the Cost Utility of Screening High-Risk Populations for Latent Tuberculosis Infection. Appl Health Econ Health Policy. 2015 Jul 1. [Epub ahead of print] PubMed PMID: 26129810.

31: Sonneville KR, Long MW, Ward ZJ, et. al. BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth. Am J Prev Med. 2015 Jul;49(1):124-34. PubMed PMID: 26094233.

32: Long MW, Gortmaker SL, Ward ZJ, et. al. Cost Effectiveness of a Sugar-Sweetened Beverage Excise Tax in the U.S. Am J Prev Med. 2015 Jul;49(1):112-23. Review. PubMed PMID: 26094232.

33: Gortmaker SL, Long MW, Resch SC, et. al. Cost Effectiveness of Childhood Obesity Interventions: Evidence and Methods for CHOICES. Am J Prev Med. 2015 Jul;49(1):102-11. PubMed PMID: 26094231.

34: Cortesi PA, Mantovani LG, Ciaccio A, et. al. Cost-Effectiveness of New Direct-Acting Antivirals to Prevent Post-Liver Transplant Recurrent Hepatitis. Am J Transplant. 2015 Jul;15(7):1817-26. PubMed PMID: 26086300.

35: Kowada A. Cost-effectiveness of tobacco cessation support combined with tuberculosis screening among contacts who smoke. Int J Tuberc Lung Dis. 2015 Jul;19(7):857-63. PubMed PMID: 26056114.

36: Gu S, Deng J, Shi L, et. al. Cost-effectiveness of saxagliptin vs glimepiride as a second-line therapy added to metformin in Type 2 diabetes in China. J Med Econ. 2015 Jul 1:1-13. [Epub ahead of print] PubMed PMID: 25950193.

37: Zhang P, Yang Y, Wen F, et. al. Cost-effectiveness of sorafenib as a first-line treatment for advanced hepatocellular carcinoma. Eur J Gastroenterol Hepatol. 2015 Jul;27(7):853-9. PubMed PMID: 25919775.

38: Fox GJ, Oxlade O, Menzies D. Fluoroquinolone Therapy for the Prevention of Multidrug-Resistant Tuberculosis in Contacts. A Cost-Effectiveness Analysis. Am J Respir Crit Care Med. 2015 Jul 15;192(2):229-37. PubMed PMID: 25915791.

39: Cheung MC, Hay AE, Crump M, et. al. Gemcitabine/Dexamethasone/Cisplatin vs Cytarabine/Dexamethasone/Cisplatin for Relapsed or Refractory Aggressive-Histology Lymphoma: Cost-Utility Analysis of NCIC CTG LY.12. J Natl Cancer Inst. 2015 Apr 13;107(7). Print 2015 Jul. PubMed PMID: 25868579.

40: Fergenbaum J, Bermingham S, Krahn M, et. al. Care in the Home for the Management of Chronic Heart Failure: Systematic Review and Cost-Effectiveness Analysis. J Cardiovasc Nurs. 2015 Jul-Aug;30(4 Suppl 1):S44-51. PubMed PMID: 25658188.

41: Quartuccio L, di Bidino R, Ruggeri M, et. al. Cost-Effectiveness Analysis of Two Rituximab Retreatment Regimens for Longstanding Rheumatoid Arthritis. Arthritis Care Res (Hoboken). 2015 Jul;67(7):947-55. PubMed PMID: 25581074.

42: Gaudette É, Goldman DP, Messali A, et. al. Do Statins Reduce the Health and Health Care Costs of Obesity? Pharmacoeconomics. 2015 Jul;33(7):723-34. PubMed PMID: 25576147; PubMed Central PMCID:PMC4490078.

43: Finkelstein EA, Kruger E, Karnawat S. Cost-Effectiveness Analysis of Qsymia for Weight Loss. Pharmacoeconomics. 2015 Jul;33(7):699-706. PubMed PMID: 24986038; PubMed Central PMCID: PMC4486409.

By CEA Registry Team on 7/2/2015 11:13 AM

By Cayla Saret, B.A.

Twice each month we highlight recently published cost-utility studies and selected reviews and editorials.

1: Shih YT, Chien CR, Moguel R, et. al. Cost-Effectiveness Analysis of a Capitated Patient Navigation Program for Medicare Beneficiaries with Lung Cancer. Health Serv Res. 2015 Jun 26. [Epub ahead of print] PubMed PMID: 26119569.

2: Marques EM, Blom AW, Lenguerrand E, et. al. Local anaesthetic wound infiltration in addition to standard anaesthetic regimen in total hip and knee replacement: long-term cost-effectiveness analyses alongside the APEX randomised  controlled trials. BMC Med. 2015 Jun 26;13(1):151. [Epub ahead of print] PubMed PMID: 26116078.

3: Sharma P, Scotland G, Cruickshank M, et. al. Is self-monitoring an effective option for people receiving long-term vitamin K antagonist therapy? A systematic review and economic evaluation. BMJ Open. 2015 Jun 25;5(6):e007758. PubMed PMID: 26112222.

4: Giorgi MA, Caroli C, Giglio ND, et. al. Estimation of the cost-effectiveness of apixaban versus vitamin K antagonists in the management of atrial fibrillation in Argentina. Health Econ Rev. 2015 Dec;5(1):52. Epub 2015 Jun  26. PubMed PMID: 26112219.

5: Chen W, Krahn M. Disease burden of chronic hepatitis C among immigrants in Canada. J Viral Hepat. 2015 Jun 25. [Epub ahead of print] PubMed PMID: 26110922.

6: Koh R, Pukallus M, Kularatna S, et. al. Relative cost-effectiveness of home visits and telephone contacts in preventing early childhood caries. Community Dent Oral Epidemiol. 2015 Jun 25. [Epub ahead of print] PubMed PMID: 26110399.

7: Lang B, Wong CK. A cost-effectiveness comparison between early surgery and non-surgical approach for incidental papillary thyroid microcarcinoma (PTMC). Eur J Endocrinol. 2015 Jun 23. [Epub ahead of print] PubMed PMID: 26104754.

8: Chhatwal J, Mathisen M, Kantarjian H. Are high drug prices for hematologic malignancies justified? A critical analysis. Cancer. 2015 Jun 23. [Epub ahead of print] PubMed PMID: 26102457.

9: Painter JT, Fortney JC, Gifford AL, et. al. Cost-effectiveness of Collaborative Care for Depression in Human Immunodeficiency Virus Clinics. J Acquir Immune Defic Syndr. 2015 Jun 20. [Epub ahead of print] PubMed PMID: 26102447.

10: Karnon J, Partington A. Cost-Value Analysis and the SAVE: A Work in Progress, But an Option for Localised Decision Making? Pharmacoeconomics. 2015 Jun 23. [Epub ahead of print] PubMed PMID: 26100285.

11: Despiégel N, Anger D, Martin M, et. al. Cost-Effectiveness of Dolutegravir in HIV-1 Treatment-Naive and Treatment-Experienced Patients in Canada. Infect Dis Ther. 2015 Jun 23. [Epub ahead of print] PubMed PMID: 26099626.

12: Begum N, Stephens S, Schoeman O, et. al. Cost-effectiveness Analysis of Rivaroxaban in the Secondary Prevention of Acute Coronary Syndromes in Sweden. Cardiol Ther. 2015 Jun 23. [Epub ahead of print] PubMed PMID: 26099515.

13: Butzke B, Oduncu FS, Severin F, et. al. The cost-effectiveness of UGT1A1 genotyping before colorectal cancer treatment with irinotecan from the perspective of the German statutory health insurance. Acta Oncol. 2015 Jun 22:1-11. [Epub ahead of print] PubMed PMID: 26098842.

14: Gupta A, Mushlin AI, Kamel H, et. al. Cost-Effectiveness of Carotid Plaque MR Imaging as a Stroke Risk Stratification Tool in Asymptomatic Carotid Artery Stenosis. Radiology. 2015 Jun 17:142843. [Epub ahead of print] PubMed PMID: 26098459.

15: Tilden EL, Lee VR, Allen AJ, et. al. Cost-Effectiveness Analysis of Latent versus Active Labor Hospital Admission for Medically Low-Risk, Term Women. Birth. 2015 Jun 22. [Epub ahead of print] PubMed PMID: 26095829.

16: Svensson M, Nilsson FO, Arnberg K. Reimbursement Decisions for Pharmaceuticals in Sweden: The Impact of Disease Severity and Cost Effectiveness. Pharmacoeconomics. 2015 Jun 21. [Epub ahead of print] PubMed PMID: 26093889.

17: Katz G, Romano O, Foa C, et. al. Economic Impact of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in France. PLoS One. 2015 Jun 18;10(6):e0128880. eCollection 2015. PubMed PMID: 26086912.

18: Losina E, Dervan EE, Paltiel AD, et. al. Defining the Value of Future Research to Identify the Preferred Treatment of Meniscal Tear in the Presence of Knee Osteoarthritis. PLoS One. 2015 Jun 18;10(6):e0130256. eCollection 2015. PubMed PMID: 26086246.

19: Feingold B, Webber SA, Bryce CL, et. al. Cost-Effectiveness of Pediatric Heart Transplantation Across a Positive Crossmatch for High Waitlist Urgency Candidates. Am J Transplant. 2015 Jun 16. [Epub ahead of print] PubMed PMID: 26082322.

20: Skedgel C, Rayson D, Younis T. Is febrile neutropenia prophylaxis with granulocyte-colony stimulating factors economically justified for adjuvant TC chemotherapy in breast cancer? Support Care Cancer. 2015 Jun 17. [Epub ahead of print] PubMed PMID: 26081595.

21: Schremser K, Rogowski WH, Adler-Reichel S, et. al. Cost-Effectiveness of an Individualized First-Line Treatment Strategy Offering Erlotinib Based on EGFR Mutation Testing in Advanced Lung Adenocarcinoma Patients in Germany. Pharmacoeconomics. 2015 Jun 17. [Epub ahead of print] PubMed PMID: 26081300.

22: Beikler T, Flemmig TF. EAO consensus conference: economic evaluation of implant-supported prostheses. Clin Oral Implants Res. 2015 Jun 15. [Epub ahead of print] PubMed PMID: 26077930.

23: Spolverato G, Vitale A, Ejaz A, et. al. Hepatic Resection for Disappearing Liver Metastasis: a Cost-Utility Analysis. J Gastrointest Surg. 2015 Jun 16. [Epub ahead of print] PubMed PMID: 26077902.

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