Spanish recommendations on economic evaluation of health technologies

BACKGROUND AND OBJECTIVES: There are conflicting views as to whether testing for biotinidase deficiency (BD) ought to be incorporated into universal newborn screening (NBS) programs. The aim of this study was to evaluate the cost-effectiveness of adding BD to the panel of conditions currently screened under the national NBS program in Spain. METHODS:We used information from the regional NBS program for BD that has been in place in the Spanish region of Galicia since 1987. These data, along with other sources, were used to develop a cost-effectiveness decision model that compared lifetime costs and health outcomes of a national birth cohort of newborns with and without an early detection program. The analysis took the perspective of the Spanish National Health Service. Effectiveness was measured in terms of quality-adjusted life years (QALYs). We undertook extensive sensitivity analyses around the main model assumptions, including a probabilistic sensitivity analysis. RESULTS:In the base case analysis, NBS for BD led to higher QALYs and higher health care costs, with an estimated incremental cost per QALY gained of $24 677. Lower costs per QALY gained were found when conservative assumptions were relaxed, yielding cost savings in some scenarios. The probability that BD screening was cost-effective was estimated to be .70% in the base case at a standard threshold value.CONCLUSIONS: This study indicates that NBS for BD is likely to be a cost-effective use of resources. WHAT'S KNOWN ON THIS SUBJECT:Biotinidase deficiency (BD) might cause severe and permanent consequences. Cases detected through newborn screening and under treatment are shown to remain asymptomatic. However, some countries, including Spain, do not provide universal BD screening within their national newborn screening programs. WHAT THIS STUDY ADDS:It provides a first estimate of the lifetime costs and health outcomes of a Spanish birth cohort with and without neonatal screening for BD. It shows that newborn screening for BD is likely to be a costeffective use of resources. Dr Vallejo-Torres participated in the concept and design of the study and in the collection, analysis, and interpretation of data and drafted and revised the manuscript; Dr Castilla participated in the design of the study and in the collection and interpretation of data and revised the manuscript; Drs Couce, Pérez-Cerdá, Martín-Hernández, Pineda, and Campistol participated in the concept and design of the study and in the collection and interpretation of data and revised the manuscript; Ms Arrospide and Dr Morris participated in the concept and design of the study and in the analysis and interpretation of data and revised the manuscript; Dr Serrano-Aguilar coordinated the research team and critically reviewed the manuscript; and all authors approved the final manuscript as submitted. In Spain, only 2 regions (Galicia, since 1987, and Murcia, since 2007) include BD in their regional newborn screening (NBS) programs. Currently, the Spanish Ministry of Health, Social Servi...

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“…The time horizon of the analysis was individuals' life expectancy, and we applied a 3% discount rate to future costs and QALYs. 20 …”

Section: Overviewmentioning

confidence: 99%

Cost-Effectiveness Analysis of a National Newborn Screening Program for Biotinidase Deficiency

et al. 2015

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“…As medical devices are used to provide symptomatic improvement, the number of QALY gained is the preferred assessment outcome. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 The methodology used by the majority of studies assessed satisfied most of the general methodological aspects considered to represent good practice in international recommendations [3,8,9,10,11]. Compared with previous reviews [1,4] the number and quality of published Spanish health economic evaluations seems to have improved over times, and some deficiencies found in previous reviews seem to have been solved.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, it should be expected that the recent publication of Spanish recommendations on the economic evaluation of health technologies [11] will reinforce this trend in the future." Page 11, line 6 And "Different thresholds have been stated in Spanish publications (ranging from 30,000€ to 50,000€/QALY) [12,21,22], but a recommendation of 30,000€/QALY gained is commonly considered as cost effective for most authors after the review by Sacristán et al in 2002[12]."…”

Section: Responsementioning

confidence: 99%

“…Different healthcare authorities have adopted a maximum ICER threshold to help decide whether a health technology is cost-effective or not and whether it should be adopted by the healthcare system. In Spain, there is no official threshold recommended by healthcare authorities as a "rule-of-thumb" for the economic evaluation of health technologies [11]. However, a review by Sacristán et al in 2002 found that most economic evaluations that recommended the adoption of a certain health intervention were based on ICER lower than 30,000 € per LYG [12].…”

Section: Icer Analysismentioning

confidence: 99%

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The use of cost per life year gained as a measurement of cost-effectiveness in Spain: a systematic review of recent publications

et al. 2011

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Objectives: The objective of this study was to evaluate the methodological characteristics of cost-effectiveness evaluations carried out in Spain since 1990 which include LYG as an outcome to measure the incremental cost-effectiveness ratio. Methods: A systematic review of published studies was conducted describing their characteristics and methodological quality. We analyze the cost per LYG results in relation with a commonly-accepted Spanish cost effectiveness threshold and the possible relation with the cost per quality adjusted life year (QALY) gained when they were both calculated for the same economic evaluation. Results: A total of 62 economic evaluations fulfilled the selection criteria, 24 of them including the cost per QALY gained result as well. The methodological quality of the studies was good (55%) or very good (26%). A total of 124 cost per LYG results were obtained with a mean ratio of 49,529€ and a median of 11,490€ (standard deviation of 183,080). Since 2003, a commonly-accepted Spanish threshold has been referenced by 66% of studies. A significant correlation was found between the cost per LYG and cost per QALY gained results (0.89 Spearman-Rho, 0.91 Pearson). Conclusions: There is an increasing interest for economic healthcare evaluations in Spain and the quality of the studies is also improving. Although a commonly-accepted threshold exists, further information is needed for decision making as well as to identify the relationship between the costs per LYG and per QALY gained.Response to Reviewers: We decided to give response to specific reviewer and editor comments in this box and uploading the corresponding attachment file as well.

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“…The model has been designed to enable customization within the interface to provide estimates of costs and outcomes at various time‐points, including 2, 5 and 10 years and a life‐time (until an individual is 100 years of age). The model adopts country‐specific discounting rates 8, 9, 10, 11, 12.…”

Section: Methodsmentioning

confidence: 99%

Development and application of an economic model (EQUIPTMOD) to assess the impact of smoking cessation

Coyle

Lester‐George

et al. 2017

Addiction

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Background and AimsAlthough clear benefits are associated with reducing smoking, there is increasing pressure on public health providers to justify investment in tobacco control measures. Decision‐makers need tools to assess the Return on Investment (ROI)/cost‐effectiveness of programmes. The EQUIPT project adapted an ROI tool for England to four European countries (Germany, the Netherlands, Spain and Hungary). EQUIPTMOD, the economic model at the core of the ROI tool, is designed to assess the efficiency of packages of smoking cessation interventions. The objective of this paper is to describe the methods for EQUIPTMOD and identify key outcomes associated with continued and cessation of smoking.MethodsEQUIPTMOD uses a Markov model to estimate life‐time costs, quality‐adjusted life years (QALYs) and life years associated with a current and former smoker. It uses population data on smoking prevalence, disease prevalence, mortality and the impact of smoking combined with associated costs and utility effects of disease. To illustrate the tool's potential, costs, QALYs and life expectancy were estimated for the average current smoker for five countries based on the assumptions that they continue and that they cease smoking over the next 12 months. Costs and effects were discounted at country‐specific rates.ResultsFor illustration, over a life‐time horizon, not quitting smoking within the next 12 months in England will reduce life expectancy by 0.66, reduce QALYs by 1.09 and result in £4961 higher disease‐related health care costs than if the smoker ceased smoking in the next 12 months. For all age–sex categories, costs were lower and QALYs higher for those who quit smoking in the 12 months than those who continued.ConclusionsEQUIPTMOD facilitates assessment of the cost effectiveness of smoking cessation strategies. The demonstrated results indicate large potential benefits from smoking cessation at both an individual and population level.

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Spanish recommendations on economic evaluation of health technologies

Cited by 226 publications

References 1 publication

Cost-Effectiveness Analysis of a National Newborn Screening Program for Biotinidase Deficiency

Cost-Effectiveness Analysis of a National Newborn Screening Program for Biotinidase Deficiency

The use of cost per life year gained as a measurement of cost-effectiveness in Spain: a systematic review of recent publications

Development and application of an economic model (EQUIPTMOD) to assess the impact of smoking cessation

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