Cost-effectiveness ratio

However, the most widely used materials are the zinc dialkyl-dithiophosphates that have an anti-wear effect in addition to their antioxidant power and, besides, offer an attractive cost/effectiveness ratio. 

If the two options have different costs and effects, what is the incremental cost-effectiveness ratio ... 

Because the costs for chronic preventative pharmacotherapy are the same for primary and secondary prevention, while the risk of events is higher with secondary prevention, secondary prevention is more cost effective than primary prevention of CHD. Pharmacotherapy demonstrating cost effectiveness to prevent death in the ACS and post-MI patient includes fibrinolytics ( 2,000 to 33,000 cost per year of life saved), aspirin, glycoprotein Ilb/IIIa receptor blockers ( 13,700 to 16,500 per year of life added), (3-blockers (less than 5,000 to 15,000 cost per year of life saved), ACE inhibitors ( 3,000 to 5,000 cost per year of life saved), eplerenone ( 15,300 to 32,400 per year of life gained), statins ( 4,500 to 9,500 per year of life saved) and gemfibrozil ( 17,000 per year of life saved).49-58 Because cost-effectiveness ratios of less than 50,000 per added life-year are considered economically attractive from a societal perspective,49 pharmacotherapy described above for ACS and secondary prevention are standards of care because of their efficacy and cost attractiveness to payors. 

Two mid-term objectives are closely related to the principal goal of RP. The first of them has to do with encouraging price competition, as it provides an incentive for companies to bring their prices close to the reference level. This is precisely one of the reasons why the European Commission5 recommends RP. The second mid-term objective concerns incentives, as it takes into account the cost-effectiveness ratio of prescription drags by increasing the financial responsibility of patients, which in turn may influence prescriber decisions. It is important to note that, unlike in traditional co-payment, under this system the patient s share of the cost of the product is avoidable if the patient and/or doctor select a product with a price that does not exceed the reference price. 

Drugs that are more (or equally) effective than the comparator drug (or service) and which have total costs that are either equal to or less than those of the comparator drug are generally considered to be a cost-effective option. It should be noted that if a drug is both more effective and has lower overall costs than the comparator, it is said to dominate the alternative. Readers should be aware that in cases of dominance some study authors will not provide the cost-effectiveness ratio rather, they will simply state that the comparator drug was dominated. 

Grade Description of incremental cost-effectiveness ratio Recommendations... 

Implantable cardioverter defibrillator implantation is expensive, with an estimated cost of 30,000- 50,000 per implant, not including the cost of follow-up. However, economic analysis of ICD studies has shown that ICD implantation compares favorably with such commonly accepted therapies as dialysis for end-stage renal failure [47]. It is estimated that the cost effectiveness ratio for ICDs is 27,000 per life year saved, comparable to those for other well-... 

Third, economic data are more important when there is substantial budgetary impact. In some jurisdictions, technologies are selected for appraisal only if they have a substantial impact on the (national) health service (e.g., in the United Kingdom), or if the manufacturer wants a premium price over other drugs to treat the given health condition (e.g., in the Netherlands). In addition, in several countries the authorities require an estimation of overall budgetary impact as well as the incremental cost-effectiveness ratio. 

Our results on benefits can be used with estimates of costs to calculate the incremental cost-effectiveness ratio (ICER). The ICER, which could be interpreted as cost per life year gained resulting from introduction of new drugs in this group of studies, provides a standard metric with which to compare the productivity of health care across different types of products and different countries. Thus, the calculation of ICER provides useful information for improving the efficiency of resource allocation in a country. In addition, international comparison of ICERs for the same product provides useful information for better understanding performance of health care systems in different countries. 

There are a number of sources of uncertainty surrounding the results of economic assessments. One source relates to sampling error (stochastic uncertainty). The point estimates are the result of a single sample from a population. If we ran the experiment many times, we would expect the point estimates to vary. One approach to addressing this uncertainty is to construct confidence intervals both for the separate estimates of costs and effects as well as for the resulting cost-effectiveness ratio. A substantial literature has developed related to construction of confidence intervals for cost-effectiveness ratios. 

One of the most dependably accurate methods for deriving 95% confidence intervals for cost-effectiveness ratios is the nonparametric bootstrap method. In this method, one resamples from the smdy sample and computes cost-effectiveness ratios in each of the multiple samples. To do so requires one to (1) draw a sample of size n with replacement from the empiric distribution and use it to compute a cost-effectiveness ratio (2) repeat this sampling and calculation of the ratio (by convention, at least 1000 times for confidence intervals) (3) order the repeated estimates of the ratio from lowest (best) to highest (worst) and (4) identify a 95% confidence interval from this rank-ordered distribution. The percentile method is one of the simplest means of identifying a confidence interval, but it may not be as accurate as other methods. When using 1,000... 

In addition to addressing stochastic uncertainty, one may want to address uncertainty related to parameters measured without variation (e.g., unit cost estimates, discount rates, etc.), whether or not the results are generalizable to settings other than those studied in the trial, and, for chronic therapies, whether the cost-effectiveness ratio observed within the trial is likely to be representative of the ratio that would have been observed if the trial had been conducted for a longer period. These sources of uncertainty are often addressed using sensitivity analysis. 

Chaudhary MA, Stearns SC. Estimating confidence intervals for cost-effectiveness ratios an example from a randomized trial. Stat Med 1996 15 1447-58. 

Polsky DP, Glick HA, Willke R, Schuknan K. Confidence intervals for cost-effectiveness ratios a comparison of four methods. Health Econ 1997 6 243-52. 

Willan AR, O Brien BJ. Confidence intervals for cost-effectiveness ratios an application of Fieller s theorem. Health Econ 1996 5 297-305. 

Cost-effectiveness is an economic evaluation in which both the costs and the consequences of treatments are examined. The denominator of the cost-effectiveness ratio can be an intermediate outcome, such as a delay in the progression of a disease, or a final outcome, such as life-years saved. Once the outcome is measured, the costs associated with attaining this outcome form the numerator of the ratio. For example, suppose our interest is determining the relative value of drug therapy for epilepsy versus epilepsy... 

These preferences for the different disease states, expressed as numbers, are called utilities, and are used to qualitv-adjust or to weight the additional years of survival. The result is a quality-adjusted life-year (QALY) gained. Quality-adjusted life-years gained are also used frequently as the denominator of a cost-effectiveness ratio, as in costs per QALYs gained. 

Returning to our example, we can now examine the costs per QALYs for treatment A and treatment B. Table 9.3 illustrates these calculations. As the table shows, when calculating the incremental cost per effect (cost-effectiveness ratio) using unadjusted life-years gained, treatment A costs 10000 for that additional year of life. But when we use the QALYs gained we see that this additional QALY actually costs 50 000. 

When it is assumed that the effectiveness of two therapies is equal, the effectiveness part of the cost-effectiveness ratio can be dropped from the analysis. In this situation, only the cost differences between the two therapies are examined. Usually this includes the cost of the drug, costs of administration, the treatment of side effects or adverse reactions and the incidence and prevalence of the condition. For example, Fenton et al. (1982) compared the costs of home versus hospital treatment of psychiatric patients when the outcomes of each were considered not to differ in any respect except that one requires a hospital stay and the other does not. The cost-minimization analysis simply looked at the differences in costs of the two treatments. The result is, not unexpectedly, that hospitalization was 64% more expensive than home-based treatment. 

Establishing the value of a new pharmaceutical can be done through a cost-effectiveness ratio, where the costs are compared with currently accepted therapy and the effect is expressed in natural units such as life-years gained or disability-free days. A cost-utility analysis uses QALYs as the expression of the drug s effect, which is a measure that incorporates all the outcomes as well as all the costs of the drug treatment. Such a broad-based measure captures how much improved the patient s life becomes as a result of the treatment and at what cost. Quality-adjusted life-years can be viewed as life-years gained,... 

Figure 6.14 Bar graph comparing the analysis All calculations were performed on a 2.5 GHz capacity, in number of ligands bite angles and desktop computer (analysis capacity will flexibility ranges calculated per hour, using improve with better computers and software, topological descriptors (2D), and 3D descriptors but the 2D/3D cost-effectiveness ratio will based on MM force fields, semi-empirical remain constant).

If an apphcation proves to be technically feasible, the choice of solvent-to-feed ratio is determined by identifying the most cost-effective ratio between the minimum and maximum limits. For most applications, the maximum solvent-to-feed ratio will be much larger than the ratio chosen for the commercial process however, the maximum ratio can be a real constraint when dealing with applications exhibiting high mutual solubility, especially for systems that involve high solute concentrations. Additional discussion is given by Seader and Henley [Chap. 8 in Separations Process Principles (Wiley, 1998)]. Solvent ratios are further constrained for a fractional extraction scheme, as discussed in Fractional Extraction Calculations. ... 

---