Does a Standard Cost-Effectiveness Threshold Exist? The Case of Greece

Tzanetakos, C.; Gourzoulidis, George

doi:10.1016/j.vhri.2023.02.006

Cited by 14 publications

(6 citation statements)

References 127 publications

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“…An incremental cost-effectiveness analysis was performed to identify the most cost-effective strategy. Despite the fact that, there is no official willingness-to-pay (WTP) threshold for Greece for a health intervention to be considered cost-effective, a WTP threshold of €34,000 per QALY/LY was used in the current analysis based on the recommendation that a health intervention should be considered cost-effective if the ICER is between one to three times the GDP per capita of that country (48)(49)(50)(51). This formula for WTP threshold has been widely used in cost-effectiveness studies within global health (48)(49)(50)(51).…”

Section: Discussionmentioning

confidence: 99%

Health and economic outcomes of 20-valent pneumococcal conjugate vaccine compared to 15-valent pneumococcal conjugate vaccine strategies for adults in Greece

Gourzoulidis,

Barmpouni,

Kossyvaki

et al. 2023

Front. Public Health

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ObjectiveHigher valency pneumococcal conjugate vaccines (PCVs) are expected to improve protection against pneumococcal disease through coverage of additional serotypes. The aim of the present study was to evaluate the cost-effectiveness of 20-valent pneumococcal conjugate vaccine (PCV20) compared to 15-valent pneumococcal conjugate vaccine (PCV15) alone or followed by 23-valent polysaccharide vaccine (PPV23) for adults in Greece.MethodsA published Markov model was adapted to simulate lifetime risk of clinical and economic outcomes from the public payer’s perspective. The model population was stratified based on age and risk profile (i.e., low, moderate, or high-risk of developing pneumococcal disease). Epidemiologic parameters, serotype coverage and vaccines’ effectiveness were based on published literature, while direct medical costs (prices €, 2022) were obtained from official sources. Main model outcomes were projected number of invasive pneumococcal disease (IPD) and all-cause non-bacteremic pneumonia (NBP) cases and attributable deaths, costs and quality-adjusted life-years (QALY) for each vaccination strategy. Sensitivity analyses were performed to ascertain the robustness of model results.ResultsOver the modeled time horizon, vaccination with PCV20 compared to PCV15 alone or PCV15 followed by PPV23 prevents an additional 747 and 646 cases of IPD, 10,334 and 10,342 cases of NBP and 468 and 455 deaths respectively, resulting in incremental gain of 1,594 and 1,536 QALYs and cost savings of €11,183 and €48,858, respectively. PSA revealed that the probability of PCV20 being cost-effective at the predetermined threshold of €34,000 per QALY gained was 100% compared to either PCV15 alone or the combination of PCV15 followed by PPV23.ConclusionPCV20 is estimated to improve public health by averting additional pneumococcal disease cases and deaths relative to PCV15 alone or followed by PPV23, and therefore translates to cost-savings for the public payer. Overall results showed that vaccination with PCV20 was estimated to be a dominant vaccination strategy (improved health outcomes with reduced costs) over PCV15 alone or followed by PPV23 for prevention of pneumococcal disease in adults in Greece.

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Section: Discussionmentioning

confidence: 99%

Health and economic outcomes of 20-valent pneumococcal conjugate vaccine compared to 15-valent pneumococcal conjugate vaccine strategies for adults in Greece

Gourzoulidis,

Barmpouni,

Kossyvaki

et al. 2023

Front. Public Health

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“…For an intervention to be considered cost-effective, a willingness-to-pay (WTP) threshold of $37,863.56 per QALY (three times the GDP per capita of China) was used in the current analysis. This threshold is based on the China Guidelines for Pharmacoeconomics Evaluation 2020 ( 20 ), as well as published studies ( 25 , 26 , 27 ), which state that a treatment should be considered cost-effective if the ICER is between one and three times the GDP per capita of that country. The GDP per capita in China was.…”

Section: Methodsmentioning

confidence: 99%

The cost-effectiveness of iruplinalkib versus alectinib in anaplastic lymphoma kinase-positive crizotinib-resistant advanced non-small-cell lung cancer patients in China

Dai,

Xu,

Chang

et al. 2024

Front. Public Health

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BackgroundIruplinalkib is a second-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI) with efficacy in patients with ALK-positive crizotinib-resistant advanced non-small cell lung cancer (NSCLC), which is independently developed by a Chinese pharmaceutical company. This study examined the cost-effectiveness of iruplinalkib versus alectinib in the Chinese healthcare setting.MethodsA partitioned survival model was developed to project the economic and health outcomes. Efficacy was derived using unanchored matching-adjusted indirect comparison (MAIC). Cost and utility values were obtained from the literature and experts’ opinions. Deterministic and probabilistic sensitivity analyses (PSA) were carried out to evaluate the model’s robustness.ResultsTreatment with iruplinalkib versus alectinib resulted in a gain of 0.843 quality-adjusted life years (QALYs) with incremental costs of $20,493.27, resulting in an incremental cost-effectiveness ratio (ICER) of $24,313.95/QALY. Parameters related to relative efficacy and drug costs were the main drivers of the model outcomes. From the PSA, iruplinalkib had a 90% probability of being cost-effective at a willingness-to-pay threshold of $37,863.56/QALY.ConclusionCompared to alectinib, iruplinalkib is a cost-effective therapy for patients with ALK-positive crizotinib-resistant advanced NSCLC.

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“… 32 – 34 This threshold has been widely used in cost-effectiveness studies within global health. 35 In the present study, a range of WTP thresholds, ranging from $12,039.07 to $36,117.22, were employed to explore the probability that treatment alternatives would be the most cost-effective.…”

Section: Methodsmentioning

confidence: 99%

Immune checkpoint inhibitors versus chemotherapy as second-line therapy for advanced oesophageal squamous cell carcinoma: a systematic review and economic evaluation

Liu,

Dou,

2024

Therap Adv Gastroenterol

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Background: Recently, several novel programmed cell death protein 1 (PD-1) inhibitors have been approved for second-line treating advanced or metastatic oesophageal squamous cell carcinoma (OSCC), including camrelizumab, nivolumab, pembrolizumab, sintilimab and tislelizumab. However, the optimal treatment regimen remained ambiguous. Objectives: The purpose of this study was to investigate the efficacy, safety and economy of available PD-1 inhibitors to determine the optimal treatment from the Chinese healthcare system perspective. Design: A systematic review and economic evaluation. Data sources and methods: A systematic review was undertaken utilizing PubMed, Web of Science, Cochrane Library, Embase and Scopus databases to identify eligible studies until 31 August 2023. Primary outcomes were progression-free survival (PFS), overall survival (OS) and adverse events (AEs). We also developed a partitioned survival model at 3-week intervals based on five clinical trials to predict long-term costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios for various treatment options. Direct medical costs and utility values were obtained from public drug bidding databases, clinical trials or published literature. The parameter uncertainties within the model were determined via one-way and probabilistic sensitivity analyses. Results: Five randomized controlled trials involving 2837 patients were included in the analysis. Compared with other treatments examined, camrelizumab provided the best PFS benefits [hazard ratio (HR): 0.69, 95% confidence interval (CI): 0.56–0.86], and pembrolizumab provided the best OS benefits (HR: 0.55, 95% CI: 0.37–0.82). Nivolumab caused a relatively lower incidence of treatment-related AEs (HR: 0.10, 95% CI: 0.05–0.20) and grade 3–5 AEs (HR: 0.13, 95% CI: 0.08–0.21) than other immunotherapy regimens. In the economic evaluation, average 10-year costs ranged from $5,433.86 (chemotherapy) to $50,617.95 (nivolumab) and mean QALYs ranged from 0.55 (chemotherapy) to 0.82 (camrelizumab). Pembrolizumab was eliminated because of dominance. Of the remaining strategies, when the willingness-to-pay thresholds were 1, 2 and 3 times GDP per capita in 2022, sintilimab, tislelizumab and camrelizumab were the most cost-effective treatment options, respectively. Conclusion: Sintilimab might be the optimal treatment alternative for second-line therapy of advanced OSCC in China, followed by tislelizumab and camrelizumab. Trial registration: This study has been registered on the PROSPERO database with the registration number CRD42023495204.

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Does a Standard Cost-Effectiveness Threshold Exist? The Case of Greece

Cited by 14 publications

References 127 publications

Health and economic outcomes of 20-valent pneumococcal conjugate vaccine compared to 15-valent pneumococcal conjugate vaccine strategies for adults in Greece

Health and economic outcomes of 20-valent pneumococcal conjugate vaccine compared to 15-valent pneumococcal conjugate vaccine strategies for adults in Greece

The cost-effectiveness of iruplinalkib versus alectinib in anaplastic lymphoma kinase-positive crizotinib-resistant advanced non-small-cell lung cancer patients in China

Immune checkpoint inhibitors versus chemotherapy as second-line therapy for advanced oesophageal squamous cell carcinoma: a systematic review and economic evaluation

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