The cost-effectiveness of routine HIV screening in health care settings, even in relatively low-prevalence populations, is similar to that of commonly accepted interventions, and such programs should be expanded.

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BackgroundInformation on costs of managing adverse events (AEs) associated with current treatments in metastatic melanoma is limited. This study estimates costs of AEs in eight countries: Australia (AU), Canada (CA), France (FR), Germany (GE), Italy (IT), the Netherlands (NL), Spain (ES), and the UK.MethodsA literature search was conducted to identify grade 3/4 AEs from product label, published trials, conference abstracts, and treatment guidelines. Resource utilization for the management of each type of AE was determined via interviews with 5 melanoma clinicians in each country. Outpatient and inpatient costs were estimated for each type of AE using country-specific tariffs or government/published sources.ResultsIn outpatient settings, the most costly AEs per incident included cutaneous squamous cell carcinoma (CSCC) (€1063, £720; NL/UK), anemia (€1443, €1329, €1285; ES/IT/FR), peripheral neuropathy (€1289; ES), and immune-related diarrhea (AUS$1,121; AU). In inpatient settings, the most costly AEs per hospitalization included hypophysitis (€10,265; €5316; CAN$9735; AUS$7231: ES/FR/CA/AU), dyspnea (€9077; GE), elevated liver enzymes (€6913, CAN$8030, AUS$6594; FR/CA/AU), CSCC (CAN$8934; CA), peripheral neuropathy (€6977, €4144, CAN$9472; NL/ES/CA), and diarrhea (£4284, €4113; UK/ES).ConclusionsCosts of managing AEs can be significant, and thus effective treatments with lower rates of severe AEs would be valuable.Electronic supplementary materialThe online version of this article (doi:10.1007/s10198-015-0757-y) contains supplementary material, which is available to authorized users.

Objectives: Prostate cancer (PCA) is the most common cancer in men worldwide. However, there is disagreement about the benefits of existing screening programs. This is mainly due to low specificity of currently utilized biomarkers. This can lead to both inappropriate medical treatment and increasing costs of care. For the future, many biotechnological developments are promising, but not all will be affordable for routine screening. The question is how much a complementary biomarker to prostate-specific antigen (PSA)-test may cost which would be applied to avoid falsepositive results. MethOds: Conduct of a hybrid discrete-event and system-dynamics simulation by applying AnyLogic. Based on clinical guidelines and expert knowledge, a hypothetical PCA screening workflow was developed and supplemented by a proposed innovative biomarker. Demographic and patient behavior information, disease related data on incidence as well as sensitivity and specificity of PSA, digitalrectal examination and prostate biopsy were further implemented in the model. Economic consequences were calculated by considering costs for examinations, biopsy diagnosis and complications. Results: In Germany, annual screening would be recommended for 18.8 million men aged ≥ 45 years. Assuming a biomarker specificity of 80%, approximately 70% of prostate biopsies could be avoided. This could lead to a reduction of biopsy caused complications. Regarding the latter, mean costs of 204.17€ were calculated. Due to prevented check-ups and biopsy-complications, cost neutrality for the supposed biomarker will be reached when applying a price of 48.50€ . cOnclusiOns: A complementary biomarker could lead to more precise diagnosis and additional value for patients and health insurance funds. Although the price may not be high, an implementation may nevertheless be feasible for companies due to the high number of examinations.