This micro-simulation found that the utilization of olanzapine ODT for the treatment of schizophrenia is predicted to be more cost-effective than any other ODT or SOT formulations of the studied atypical antipsychotic medications.

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BackgroundThis paper presents the model and results to evaluate the use of teriparatide as a first-line treatment of severe postmenopausal osteoporosis (PMO) and Glucocorticoid-induced osteoporosis (GIOP). The study’s objective was to determine if teriparatide is cost effective against oral bisphosphonates for two large and high risk cohorts.MethodsA computer simulation model was created to model treatment, osteoporosis related fractures, and the remaining life of PMO and GIOP patients. Natural mortality and additional mortality from osteoporosis related fractures were included in the model. Costs for treatment with both teriparatide and oral bisphosphonates were included. Drug efficacy was modeled as a reduction to the relative fracture risk for subsequent osteoporosis related fractures. Patient health utilities associated with age, gender, and osteoporosis related fractures were included in the model. Patient costs and utilities were summarized and incremental cost-effectiveness ratios (ICERs) for teriparatide versus oral bisphosphonates and teriparatide versus no treatment were estimated.For each of the PMO and GIOP populations, two cohorts differentiated by fracture history were simulated. The first contained patients with both a historical vertebral fracture and an incident vertebral fracture. The second contained patients with only an incident vertebral fracture. The PMO cohorts simulated had an initial Bone Mineral Density (BMD) T-Score of −3.0. The GIOP cohorts simulated had an initial BMD T-Score of −2.5.ResultsThe ICERs for teriparatide versus bisphosphonate use for the one and two fracture PMO cohorts were €36,995 per QALY and €19,371 per QALY. The ICERs for teriparatide versus bisphosphonate use for the one and two fracture GIOP cohorts were €20,826 per QALY and €15,155 per QALY, respectively.ConclusionsThe selection of teriparatide versus oral bisphosphonates as a first-line treatment for the high risk PMO and GIOP cohorts evaluated is justified at a cost per QALY threshold of €50,000.

This analysis estimated that mirabegron is a cost-effective treatment for OAB from US commercial health plan and Medicare Advantage perspectives, due to fewer projected adverse events and comorbidities, and data suggesting better persistence.

Purpose The COV-BARRIER Phase 3 trial demonstrated that treatment with baricitinib, an oral selective Janus kinase 1/2 inhibitor, in addition to standard of care significantly reduced mortality over 28 days in hospitalized COVID-19 participants, with a similar safety profile to standard of care. We assessed the cost-effectiveness of baricitinib plus standard of care versus standard of care alone (which included systemic corticosteroids and remdesivir) in patients hospitalized in the United States with COVID-19. Methods An economic model was developed in Microsoft Excel to simulate the inpatient stay, discharge to post-acute care, and recovered patients. Costs modelled included payer costs, hospital costs, and indirect costs. Benefits modelled included life years, quality-adjusted life years, deaths avoided, and use of mechanical ventilation avoided. The primary analysis was performed from a payer perspective over a lifetime horizon; a secondary analysis was also performed from the hospital perspective. The base case analysis modelled the numerical differences in treatment effectiveness observed in the COV-BARRIER trial. Scenario analyses were also performed in which the clinical benefit of baricitinib was limited to the statistically significant reduction in mortality demonstrated in the trial. Findings In the base case payer perspective, combination treatment with baricitinib plus standard of care resulted in an incremental total cost of $17,276, a total quality-adjusted life year (QALY) gain of 0.6703, and a total life-year gain of 0.837 compared with standard of care alone. The addition of baricitinib also increased survival by 5.1% and reduced the use of mechanical ventilation by 1.6%. The base-case incremental cost-effectiveness ratios were $25,774 per QALY gained and $20,638 per life year gained; the “mortality only” scenario analysis yielded similar results of $26,862 per QALY gained and $21,433 per life year gained. For the hospital perspective, combination treatment with baricitinib plus standard of care was more effective and less costly than standard of care alone in the base case, and it resulted in an incremental cost of $38,964 per death avoided in the “mortality only” scenario. Implications Our study showed that adding baricitinib to standard of care is cost effective for hospitalized COVID-19 patients in the United States. Cost effectiveness was demonstrated for both payer and hospital perspectives. These findings were robust to sensitivity analyses and to conservative assumptions limiting the clinical benefits of baricitinib to the statistically significant reduction in mortality demonstrated in the COV-BARRIER trial.