QALY

The purpose of this paper was to review the literature through a structured literature review and provide a grade of recommendation for patient safety, gait energy efficiency, and cost effectiveness of the C-Leg microprocessor-controlled prosthetic knee for transfemoral amputees. Medline (Ovid) and CINAHL (EBSCO) data bases were searched to identify potentially pertinent studies within the 1995–2009 time range. Studies were screened and sorted. Pertinent studies were rated for methodologic quality and for risk of bias. Following assessment of methodologic quality and bias risk, the level of evidence and a grade of recommendation was determined for each of three categories: Safety, energy efficiency, and cost effectiveness. A total of 18 articles were determined to be pertinent: seven for safety, eight for energy efficiency, and three for cost effectiveness. Methodologic quality was low with a moderate risk of bias in the safety and energy effectiveness categories. Studies in cost ef...

In order to avoid undue discrimination of disabled people, we have suggested that all life years gained by the disabled should count as 1 in QALY calculations as long as the health states in question are preferred to being dead by those concerned. Johannesson noted that such a convention could lead to inconsistencies between societal and individual preferences. We believe the problem derives from the structure of preferences in the real world, rather than from our specific choice of model. The inconsistency is at any rate a much smaller practical problem than Johannesson suggests. Johannesson's alternative model has some virtues, but it does not resolve the inconsistency problem. It also leads to counter intuitive results. Copyright © 2003 John Wiley & Sons, Ltd.

The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have developed clinical practice guidelines for the care of patients with varicose veins of the lower limbs and pelvis. The document also includes recommendations on the management of superficial and perforating vein incompetence in patients with associated, more advanced chronic venous diseases (CVDs), including edema, skin changes, or venous ulcers. Recommendations of the Venous Guideline Committee are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as strong (GRADE 1) if the benefits clearly outweigh the risks, burden, and costs. The suggestions are weak (GRADE 2) if the benefits are closely balanced with risks and burden. The level of available evidence to support the evaluation or treatment can be of high (A), medium (B), or low or very low (C) quality. The key recommendations of these guidelines are: We recommend that in patients with varicose veins or more...

High-cost, low-value care permeates much of the American health care system. Congress has begun attempting to address the issue by provisions in the Affordable Care Act encouraging a shift from pay-for-volume to pay-for-performance practices, and by funding clinical effectiveness research through the new Patient-Centered Outcomes Research Institute (PCORI). This short paper offers an overview of the background of PCORI’s formation, the politically-derived constraints within which it is required to operate, and the types of studies it is carrying out. The paper concludes that in addition to clinical effectiveness studies, well-designed cost-effectiveness studies are needed for the development of rationalized health care practices -- current congressional restrictions notwithstanding.

Das Wirtschaftlichkeitsgebot gehört zu den tragenden Grundsätzen des Krankenversicherungsrechts. Trotz seiner enormen Bedeutung sind nach wie vor viele Aspekte ungeklärt oder umstritten.

Das vorliegende Werk zeigt auf, wie das Wirtschaftlichkeitsgebot bei der Erbringung medizinischer Leistungen im Allgemeinen sowie bei der Tarifgestaltung, der Spitalplanung und der Arzneimittelvergütung angewandt und durchgesetzt wird. Es arbeitet dabei seinen Gehalt und seine Funktionsweise heraus und deckt gleichzeitig Defizite auf. Zudem bettet es das Gebot in den übergeordneten rechtsstaatlichen Rahmen ein.

Durch seine gesamtheitliche Untersuchung klärt das vorliegende Werk wissenschaftlich und praktisch relevante Fragen. Es dient daher insbesondere Behörden, Versicherern und Leistungserbringern auch als Nachschlagewerk zum Thema.

Objectives: We demonstrate the use of health economics to guide investment decisions in regenerative medicine. Our examples are based on proposed tissue engineering applications in the urinary tract. We show that health economics have a role in strengthening the supply side, not just the demand side of the health economy.Methods: We reviewed the epidemiology and treatment of the clinical conditions where TE of urothelium may be considered using literature identified from a range of sources including electronic databases, article bibliographies and references, online articles and expert opinion in the field.Results: Careful analysis of current best treatment suggested that urethral defects and bladder resection for cancer offered the most propitious applications of TE. The headroom for engineered urethral tissue was estimated at £186. This is unlikely to be large enough to support the launch of a TE product populated with viable cells. The headroom for TE bladder, on the other hand, was estimated at around £16 268. However, the market size is limited reducing potential profitability.Conclusions: The Headroom Method can help inform instrumental decisions concerning new treatments without having to build a complex model with very wide parameter uncertainty. Copyright © 2007 John Wiley & Sons, Ltd.

QALY based decision-making in health care does not seem to encompass any broad-scale increase in utility to the community. Given that a properly formed Utilitarian response should base the cost-effectiveness of health care distributions upon the total increase in utility it follows that the increase in utility to the individual should be considered in conjunction with the increase in utility to the society or community. Consequently, the QALY cannot be a strict Utilitarian response to issues of healthcare distribution nor is it able to evaluate such distributions in terms of the benefit (increase in utility) to the community.

Chronic pain is a costly and debilitating condition that has proven difficult to treat, solely with medical interventions, due to the complex interplay of biological, psychological, and social factors in its onset and persistence. Many studies have demonstrated the effectiveness of interdisciplinary treatment that includes psychosocial interventions for low back pain. Nevertheless, these interventions continue to be under-utilized due to concerns of cost and applicability. The present study utilized a cost utility analysis to evaluate effectiveness and associated costs of interdisciplinary early intervention for individuals with acute low back pain that was identified as high-risk for becoming chronic. Treatment effectiveness was evaluated using a standard pain measure and quality-adjusted life years, and associated medical and employment costs were gathered for 1 year. Results indicated that subjects improved significantly from pretreatment to 1-year follow-up, and that the early intervention group reported fewer health-care visits and missed workdays than the treatment as usual group. The majority of 1,000 bootstrapped samples demonstrated the dominance of the early intervention program as being both more effective and less costly from a societal perspective. The early intervention treatment was the preferred option in over 85% of samples within an established range of acceptable costs. These results are encouraging evidence for the cost-effectiveness of interdisciplinary intervention and the benefits of targeted early treatment.

Objectives: The objective of this study was to develop a model to assess the cost-effectiveness of a new treatment for patients with depression.Methods: A Markov simulation model was constructed to evaluate standard care for depression as performed in clinical practice compared with a new treatment for depression. Costs and effects were estimated for time horizons of 6 months to 5 years. A naturalistic longitudinal observational study provided data on costs, quality of life, and transition probabilities. Data on long-term consequences of depression and mortality risks were collected from the literature. Cost-effectiveness was quantified as quality-adjusted life-years (QALYs) gained from the new treatment compared with standard care, and the societal perspective was taken. Probabilistic analyses were conducted to present the uncertainty in the results, and sensitivity analyses were conducted on key parameters used in the model.Results: Compared with standard care, the new hypothetica...

VNS (Vagus Nerve Stimulation Therapy) is approved in the USA to treat refractory epilepsy as adjunctive to antiepileptic drugs (AEDs) in patients ≥12 years with complex partial seizures. To evaluate clinical outcomes, quality-adjusted life years (QALY), and costs associated with VNS in pediatric patients with drug-resistant epilepsy in a real-world setting. A retrospective analysis was conducted using Medicaid data (USA). Patients had ≥1 neurologist visits with epilepsy diagnosis (ICD-9 345.xx, 780.3x), ≥1 procedure claims for VNS implantation, ≥1 AEDs, ≥6-months of Pre- and Post-VNS continuous enrollment. Pre-VNS period was 6-months and Post-VNS period extended from implantation until device removal, death, Medicaid disenrollment, or study end (up to 3 years). Incidence rate ratios (IRR) and costs ($2010) were estimated. QALYs were estimated using number of seizure-related events. For patients 1-11 years old (N = 238), hospitalizations and emergency room visits were reduced Post-VNS vs. Pre-VNS (adjusted IRR = 0.73 [95% CI: 0.61-0.88] and 0.74 [95% CI: 0.65-0.83], respectively). Average total healthcare costs were lower Post-VNS vs. Pre-VNS ($18,437 vs. $18,839 quarterly [adjusted p = 0.052]). For patients 12-17 years old (N = 207), hospitalizations and status epilepticus events were reduced Post-VNS vs. Pre-VNS (adjusted IRR = 0.43 [95% CI: 0.34-0.54] and 0.25 [95% CI: 0.16-0.39], respectively). Average total healthcare costs were lower Post-VNS vs. Pre-VNS period ($14,546 vs. $19,695 quarterly [adjusted p = 0.002]). Lifetime QALY gain after VNS was 5.96 (patients 1-11 years) and 4.82 years (patients 12-17 years). VNS in pediatric patients is associated with decreased resource use and epilepsy-related events, cost savings, and QALY gain.