Wex-Wechowski J.,PharmArchitecture |
Abou-Setta A.M.,PharmArchitecture |
Kildegaard Nielsen S.,Ferring International Center |
Kennedy R.,Coventry University
Reproductive BioMedicine Online | Year: 2010
The economic implications of the choice of gonadotrophin influence decision making but their cost-effectiveness in frozen-embryo transfer cycles has not been adequately studied. An economic evaluation was performed comparing highly purified human menopausal gonadotrophin (HP-HMG) and recombinant FSH (rFSH) using individual patient data (n = 986) from two large randomized controlled trials using a long agonist IVF protocol. The simulation model incorporated live birth data and published UK costs of IVF-related medical resources. After treatment for up-to-three cycles (one fresh and up to two subsequent fresh or frozen cycles conditional on availability of cryopreserved embryos), the cumulative live birth rate was 53.7% (95% CI 49.3-58.1%) for HP-HMG and 44.6% (40.2-49.0%) for rFSH (OR 1.44, 95% CI 1.12-1.85; P < 0.005). The mean costs per IVF treatment for HP-HMG and rFSH were £5393 (£5341-5449) and £6269 (£6210-6324), respectively (number needed to treat to fund one additional treatment was seven; P < 0.001). With maternal and neonatal costs applied, the median cost per IVF baby delivered with HP-HMG was £11,157 (£11,089-11,129) and £14,227 (£14,183-14,222) with rFSH (P < 0.001). The cost saving using HP-HMG remained after varying model parameters in a probabilistic sensitivity analysis. © 2010, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
Connolly M.P.,University of Groningen |
Kuyvenhoven J.P.,Kennemer Gasthuis |
Postma M.J.,University of Groningen |
Nielsen S.K.,Ferring International Center
Journal of Crohn's and Colitis | Year: 2014
Background: Improved compliance in active ulcerative colitis (UC) is likely to improve healthcare efficiency by reducing time spent in active mild to moderate UC state. To establish whether once daily (OD) mesalazine offers economic advantages over twice daily (BD) dosing in active UC, we evaluated the outcomes and costs of a recently published randomized study. Methods: A cost-effectiveness model with four week Markov cycles was developed to reflect current treatment practices in the Netherlands with OD and BD mesalazine for active UC. The health service perspective of the Netherlands was reflected in the model and considered a 32. week time horizon with 4 weekly Markov cycles. Outcomes evaluated in the model were time spent in active and remission UC and the corresponding health-related quality of life associated with different clinical states. This was then used to derive quality adjusted life-years (QALYs) at each treatment stage. Results: A greater proportion of subjects on 4. g OD achieved remission at weeks 4 and 8 compared with 2. g BD. After 32. weeks the average costs per patient with active UC were €3097 and €3548 for those treated with OD and BD mesalazine respectively, with an average saving of €451 per patient treated with OD mesalazine. The average costs per QALY for OD and BD mesalazine were €5433 and €6324 for OD and BD, respectively. Conclusions: Based on the results from a single randomized study, OD dosing resulted in a shorter time spent in active UC which resulted in lower healthcare costs. © 2013 European Crohn's and Colitis Organisation.
Lee D.,BresMed |
Porter J.,BresMed |
Gladwell D.,BresMed |
Brereton N.,BresMed |
Nielsen S.K.,Ferring International Center
Journal of Medical Economics | Year: 2014
Objective: To determine the cost-effectiveness of the treatment of advanced hormone-dependent prostate cancer with degarelix compared to luteinizing hormone-releasing hormone (LHRH) agonists in the UK using the latest available evidence and the model submitted to AWMSG. Methods: A cost-effectiveness model was developed from the perspective of the UK National Health Service evaluating monthly injection of degarelix against 3-monthly leuprorelin therapy plus anti-androgen flare cover for the first-line treatment of patients with advanced (locally advanced or metastatic) hormone-dependent prostate cancer. A Markov process model was constructed using the patient population characteristics and efficacy information from the CS21 Phase III clinical trial and associated extension study (CS21A). The intentionto-treat (ITT) population and a high-risk sub-group with a PSA level420 ng/mL were modeled. Results: In the base-case analysis using the patient access scheme (PAS) price, degarelix was dominant compared to leuprorelin with cost savings of £3633 in the ITT population and £4310 in the PSA420 ng/mL sub-group. The chance of being cost-effective was 95% in the ITT population and 96% in the PSA420 ng/mL subgroup at a threshold of £20,000 per quality-adjusted life-year (QALY). In addition, degarelix remained dominant when PSA progression was assumed equal and only the benefits of preventing testosterone flare were taken into account. Treatment with degarelix also remained dominant in both populations when the list price was used. The additional investment required to treat patients with degarelix could be offset in 19 months for the ITT population and 13 months for the PSA420 ng/mL population. The model was most sensitive to the hazard ratio assumed for PSA progression between degarelix and leuprorelin and the qualityof-life (utility) of patients receiving palliative care. Conclusion: Degarelix is likely to be cost-effective compared to leuprorelin plus anti-androgen flare cover in the first-line treatment of advanced hormone-dependent prostate cancer. © 2014 Informa UK Ltd.