Objective:To evaluate the long-term cost-effectiveness of different strategies for human papillomavirus (HPV) DNA testing combined with Pap smear for cervical cancer screening in Taiwan.Methods:This study adopts a perspective of Department of Health in cost-effectiveness analysis to compare a no-screening strategy with nine different screening strategies. These strategies comprise three screening tools (Pap smear alone, HPV DNA testing followed by Pap smear triage, and HPV DNA testing combined with Pap smear), and three screening intervals (annually, every 3 years, and every 5 years). Outcomes are life expectancy, quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs). Probabilistic sensitivity analyses (PSAs) were conducted to assess parameter uncertainty.Results:When three times gross domestic product per capita is used as the decision threshold, all nine screening strategies were cost-effective compared with the no-screening strategy. Compared with the current screening strategy (an annual Pap smear), HPV DNA testing followed by Pap smear triage every 5 years and every 3 years were cost-effective. Results of PSA also indicated that a HPV DNA testing followed by Pap smear triage every 5 or every 3 years achieved the highest expected net benefits.Conclusions:Possible economic advantages are associated with extending the cervical cancer screening interval from one Pap smear annually to HPV DNA testing followed by Pap smear triage every 5 years with an ICER $1 247 000 per QALY gained, especially in a country with a publicly financed health-care system.

BackgroundTranscatheter left atrial appendage occlusion (LAAO) is a promising therapy for stroke prophylaxis in non-valvular atrial fibrillation (NVAF) but its cost-effectiveness remains understudied. This study evaluated the cost-effectiveness of LAAO for stroke prophylaxis in NVAF.MethodsA Markov decision analytic model was used to compare the cost-effectiveness of LAAO with 7 pharmacological strategies: aspirin alone, clopidogrel plus aspirin, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban. Outcome measures included quality-adjusted life years (QALYs), lifetime costs and incremental cost-effectiveness ratios (ICERs). Base-case data were derived from ACTIVE, RE-LY, ARISTOTLE, ROCKET-AF, PROTECT-AF and PREVAIL trials. One-way sensitivity analysis varied by CHADS2 score, HAS-BLED score, time horizons, and LAAO costs; and probabilistic sensitivity analysis using 10,000 Monte Carlo simulations was conducted to assess parameter uncertainty.ResultsLAAO was considered cost-effective compared with aspirin, clopidogrel plus aspirin, and warfarin, with ICER of US$5,115, $2,447, and $6,298 per QALY gained, respectively. LAAO was dominant (i.e. less costly but more effective) compared to other strategies. Sensitivity analysis demonstrated favorable ICERs of LAAO against other strategies in varied CHADS2 score, HAS-BLED score, time horizons (5 to 15 years) and LAAO costs. LAAO was cost-effective in 86.24 % of 10,000 simulations using a threshold of US$50,000/QALY.ConclusionsTranscatheter LAAO is cost-effective for prevention of stroke in NVAF compared with 7 pharmacological strategies.Condensed abstractThe transcatheter left atrial appendage occlusion (LAAO) is considered cost-effective against the standard 7 oral pharmacological strategies including acetylsalicylic acid (ASA) alone, clopidogrel plus ASA, warfarin, dabigatran 110 mg, dabigatran 150 mg, apixaban, and rivaroxaban for stroke prophylaxis in non-valvular atrial fibrillation management.

The study results provided important evidences on the monetary value women placed on a HPV vaccine, and the differential benefits between vaccinating the women and their daughters.

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vs. warfarin), and apixaban (vs. aspirin) to be cost-effective; data on clopidogrelϩaspirin (vs. aspirin) to be conflicting, and genotyped-warfarin and ximelagtran not cost-effective. CONCLUSIONS: Cost-effectiveness models of pharmacologic SPAF have been extensively published; but none have estimated the comparative cost-effectiveness of newer agents. Models used similar structures and non-drug-specific inputs, and commonly find innovator strategies to be cost-effective. OBJECTIVES:To undertake an economic evaluation of rivaroxaban relative to the local standard of care, acenocoumarol, for stroke prevention in atrial fibrillation (AF) patients with one or more risk factors. METHODS: A Markov model designed to reflect the natural progression of AF patients through different health states was developed and adapted to the Greek setting. The analysis was undertaken from a payer perspective. Baseline event rates (adjusted to three month cycles) and relative treatment effects (RRs) were derived from the safety on treatment analysis of the ROCKET AF study. Utility values for events were based on literature. A treatment-related disutility of 0.05 was applied to acenocoumarol arm. Costs assigned to each health state reflect local drug acquisition, monitoring, event management and transportation costs and reflect the year 2012. An incremental cost effectiveness ratio (ICER) per quality-adjusted-life year (QALY) gained was calculated. Oneway sensitivity analyses were conducted to identify key model drivers. Probabilistic analysis was undertaken to deal with uncertainty. The horizon of analysis was over patient life time and both cost and outcomes were discounted at 3.5%. RESULTS:The average total cost of rivaroxaban-treated patients was €985 higher compared to acenocoumarol. Rivaroxaban was associated with additional drug acquisition costs (€5,275), however these were mainly offset by reduced monitoring (€3,947) and event costs (€343). Moreover, rivaroxaban was associated with a 0.22 increment in QALYs leading to an ICER of €4,517/QALY gained. Sensitivity analyses showed that the cost-effectiveness results are fairly robust with discontinuation rate of rivaroxaban, acenocoumarol monitoring visits, acenocoumarol-related utility decrement, RR for rivaroxaban versus acenocoumarol for stroke having the highest impact on results. Probabilistic analysis revealed a high probability of rivaroxaban being cost-effective at a threshold of €30,000 or €40,000/QALY. CONCLUSIONS: Rivaroxaban may represent a cost-effective option for the prevention of stroke in AF patients with one or more risk factors.