objeCtives: The aim of this study was to evaluate the long-term cost effectiveness of ticagrelor + aspirin versus clopidogrel + aspirin in patients with acute coronary syndrome (ACS) treated for 12 months in Spain. Methods: The cost effectiveness model consisted of a decision tree (1st year) based on the PLATO study and a long-term Markov model (2nd year onwards). This allowed estimation of cardiovascular events (death, myocardial infarction and non-fatal stroke), survival, health costs, and health related quality of life. A life time horizon was applied. The daily drug cost was € 0.60 and € 2.96 for generic clopidogrel and ticagrelor, respectively. Spanish unit costs and life tables were used; outcomes and costs were discounted at 3%. A sensitivity analysis across subgroups was carried out, and probabilistic sensitivity analysis was used to validate the robustness of the model. Results: Ticagrelor compared to clopidogrel was associated with a gain of 0.1586 life years and 0.1363 years of quality-adjusted life years (QALY), with an incremental cost of € 596. The incremental cost per life year and per QALY gained was € 3,760 and € 4,374, respectively. The probabilistic sensitivity analysis showed that ticagrelor was costeffective versus clopidogrel in > 99 % of the simulations given a willingness-to-pay threshold of € 15,000/QALY. The results were consistent across different subgroups of ACS patients. ConClusions: Ticagrelor + aspirin for 12 months is a cost effective treatment compared to generic clopidogrel + aspirin in patients with ACS treated invasively or conservatively, based on the findings of the PLATO study and Spanish health care costs.objeCtives: This study was conducted to determine the cost-effectiveness of carotid Artery stenting (CAS) versus carotid endarterectomy (CEA) in patients with symptomatic carotid stenosis (more than 50% stenosis) in Korean health care system perspective. Methods: We performed a cost-utility analysis. Costs were estimated from retrospective chart review (CAS= 346, CEA= 331), health insurance claims data, and other national resources and expressed in 2013 KRW. Transition probabilities were estimated from retrospective chart and systematic review. Health utility index was assessed for general population using Time Trade Off (TTO) with health scenario. We used a Markov model to project 15-year costs and quality-adjusted life years (QALYs) for the 2 treatment groups. Results: In the base case analysis, CAS produced 6.49 QALYs, compared with 6.71 QALYs for CEA. The incremental cost of stenting was 1,691,740 KRW. In the base case analysis, CEA for patients with symptomatic stenosis had a greater benefit than CAS, with lower costs. In subgroup for patients with stenosis more than 70% or patient with over 80 years old, CAS was cost-effective. Sensitivity analyses showed that the major stroke or mortality influenced the results. However the results were consistent with the base analysis. ConClusions: Under the current circumstances in Korea, CEA was dominated by CEA in symptomatic ...

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Caregiving hours spent per week, across groups of increasing severity, by a community nurse were 0.

the Health Assessment Questionnaire (HAQ) score, utility, and the effect of treatment on HAQ had large impacts on the iNMB. For example, models that use a latent class growth model to simulate HAQ progression for patients using cDMARDs were predicted to increase the iNMB by around $45,000 relative to models that assumed a linear rate of progression. Standardized input parameters with the largest coefficients in absolute value included the extent to which the HAQ score rebounded after treatment failure and the impact of changes in the HAQ score on mortality. ConClusions: Cost-effectiveness estimates for rheumatoid arthritis vary due to both parameter and structural uncertainty. New studies are needed to improve the quality of parameter estimates; consensus-driven approaches such as Delphi panels can help determine appropriate model structures. Research should prioritize the most sensitive model parameters and debates should focus on the structural assumptions most likely to influence results.