Cost Effectiveness Analysis

An economic analysis comparing the relative cost and impact of different medical treatments with the aim of directing health care spending more efficiently.

Regulating Prescription Drug Prices

Feb. 2, 2021

In the perennial debate over drug pricing, U.S. policymakers have proposed lowering domestic prices by tying them in some way to international prices. But policymakers seem less interested in understanding or adapting the regulatory frameworks that produce these lower prices in other countries.

Evaluating the Cost-Effectiveness of Maternal Pertussis Immunization in Low- and Middle-Income Countries: A Review of Lessons Learnt

Jan. 3, 2021

Louise B. Russell, Ajoke Sobanjo-ter Meulen, Cristiana M. Toscano

Abstract [from journal]

This issue of Vaccine is devoted to papers from a research project that developed two types of simulation models, static and dynamic transmission, to evaluate the cost-effectiveness of maternal immunization to prevent pertussis in infants in low- and middle-income countries (LMICs). The research was conducted by a multinational team of investigators and funded by the Bill & Melinda Gates Foundation to gain an understanding of when and where maternal immunization might be a good public health investment for LMICs. Here we


Cost-Effectiveness of Maternal Pertussis Immunization: Implications of a Dynamic Transmission Model for Low- and Middle-Income Countries

Jan. 3, 2021

Sun-Young Kim, Kyung-Duk Min, Sung-mok Jung, Louise B. Russell, Cristiana Toscano, Ruth Minamisava, Ana Lucia S. Andrade, Colin Sanderson, Anushua Sinha

Abstract [from journal]

Objective: This study evaluates the cost-effectiveness of maternal acellular pertussis (aP) immunization in low- and middle-income countries using a dynamic transmission model.

Methods: We developed a dynamic transmission model to simulate the impact of infant vaccination with whole-cell pertussis (wP) vaccine with and without maternal aP immunization. The model was calibrated to Brazilian surveillance data and then used to project health outcomes and costs under


Modeling the Cost-Effectiveness of Maternal Acellular Pertussis Immunization (aP) in Different Socioeconomic Settings: A Dynamic Transmission Model of Pertussis in Three Brazilian States

Jan. 3, 2021

Paula M. Luz, Claudio J. Struchiner, Sun-Young Kim, Ruth Minamisava, Ana Luci S. Andrade, Colin Sanderson, Louise B. Russell, Cristiana M. Toscano

Abstract [from journal]

Objectives: Using dynamic transmission models we evaluated the health and cost outcomes of adding acellular pertussis (aP) vaccination of pregnant women to infant vaccination in three Brazilian states that represent different socioeconomic conditions. The primary objective was to determine whether the same model structure could be used to represent pertussis disease dynamics in differing socioeconomic conditions.

Methods: We tested three model structures (SIR, SIRS


Comparison of Static and Dynamic Models of Maternal Immunization to Prevent Infant Pertussis in Brazil

Jan. 3, 2021

Louise B. Russell, Sun-Young Kim, Cristiana Toscano, Ben Cosgriff, Ruth Minamisava, Ana Lucia Andrade, Colin Sanderson, Anushua Sinha

Abstract [from journal] 

Background: This paper compares cost-effectiveness results from two models of maternal immunization to prevent pertussis in infants in Brazil, one static, one dynamic, to explore when static models are adequate for public health decisions and when the extra effort required by dynamic models is worthwhile.

Methods: We defined two scenarios to explore key differences between static and dynamic models, herd immunity and time horizon. Scenario 1 evaluates the


COVID-19 Screening Strategies for Repopulating College Campuses

Dec. 9, 2020

As some college and university leaders plan to resume in-person instruction this spring, it is critical to determine the best way to identify COVID-19 cases among students to safely repopulate campuses. However, there is a lack of consensus about the optimal testing strategy to identify the most infections.

A Rapid Pre-Implementation Evaluation To Inform a Family Engagement Navigator Program During COVID-19

Rinad Beidas, PhD, U of Penn
Dec. 9, 2020

Stephanie Parks Taylor, Robert T. Short, Anthony M. Asher, Brice Taylor, Rinad S. Beidas

Abstract [from journal]

Background: Innovative models of family engagement and support are needed in the intensive care unit (ICU) during times of restricted visitation such as the COVID-19 pandemic. Limited understanding of the factors affecting the uptake and outcomes of different family support models hinders the implementation of best practices. We aimed to conduct a rapid pre-implementation evaluation of stakeholder-perceived facilitators and barriers to design implementation strategies to support a novel program using medical students


Burden Of Parkinson's Disease By Severity: Health Care Costs In The U.S. Medicare Population

Nabila Dahodwala, MD, MS
Oct. 8, 2020

Nabila DahodwalaPengxiang Li, Jordan Jahnke, Vrushabh P. Ladage, Amy R. Pettit, Prasanna L. Kandukuri, Yanjun Bao, Jorge Zamudio, Yash J. Jalundhwala, Jalpa A. Doshi 

Abstract [from journal]

Background: Current understanding of the health care costs of Parkinson's disease (PD) and the incremental burden of advanced disease is incomplete.

Objectives: The aim of this study was to assess the direct economic burden associated with advanced versus mild/moderate PD in a prevalent national sample of elderly U.S. Medicare beneficiaries with a PD diagnosis.

Methods: Analyzing 100% fee-for-service Medicare claims from 2013, we defined advanced PD with a medication-


The Effects Of Market Competition On Cardiologists' Adoption Of Transcatheter Aortic Valve Replacement

Sep. 17, 2020

Peter W. Groeneveld, Lin Yang, Andrea G. Segal, Pinar Karaca-Mandic, Genevieve P. Kanter

Abstract [from jorunal]

Background: For decades, the prevailing assumption regarding the diffusion of high-cost medical technologies has been that competitive markets favor more aggressive adoption of new treatments by health care providers (ie, the "Medical Arms Race"). However, novel regulations governing the adoption of transcatheter aortic valve replacement (TAVR) may have disrupted this paradigm when TAVR was introduced.

Objective: The objective of this study was to assess the relationship between the market


FDA Restrictions on Mifepristone: Time for a Change?

Issue Brief
Sep. 10, 2020

Mifepristone, a drug used to manage early miscarriage or end an early pregnancy, carries unique restrictions imposed by the U.S. Food and Drug Administration (FDA). Patients are required to pick up the drug in person
from a doctor or a clinic, even though they can take the drug at home. In July, a federal court ruled that the FDA must suspend these restrictions during the COVID-19 pandemic, for patients seeking an early abortion,
although the ruling did not apply to women with an early pregnancy loss. But the challenges to FDA restrictions on mifepristone predate the pandemic. This Issue Brief provides the context for this ongoing controversy, and
reviews recent evidence on the clinical and cost effectiveness of mifepristone for the medical management of first trimester miscarriage.

Association Of Medicare Advantage Penetration With Per Capita Spending, Emergency Department Visits, And Readmission Rates Among Fee-for-Service Medicare Beneficiaries With High Comorbidity Burden

Norma Coe, PhD
Aug. 26, 2020

Sungchul Park, Brent A. Langellier, Robert E. Burke, Jose F. Figueroa, Norma B. Coe

Abstract [from journal]

Rapid growth of Medicare Advantage (MA) plans has the potential to change clinical practice for both MA and fee-for-service (FFS) beneficiaries, particularly for high-need, high-cost beneficiaries with multiple chronic conditions or a costly single condition. We assessed whether MA growth from 2010 to 2017 spilled over to county-level per capita spending, emergency department visits, and readmission rates among FFS beneficiaries, and how much this varied by the comorbidity burden of the beneficiary. We also examined whether the


Health Care Costs of Alzheimer and Related Dementias Within A Medicare Managed Care Provider

Jul. 23, 2020

Paul A. Fishman, Lindsay White, Bailey Ingraham, Sungchul Park, Eric B. Larson, Paul Crane, Norma B. Coe

Abstract [from journal]

Background: Although one third of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, there is limited information about the cost of treating Alzheimer disease and related dementias (ADRD) in these settings.

Objective: The objective of this study was to estimate direct health care costs attributable to ADRD among older adults within a large MA plan.

Research design: A retrospective cohort design was used to estimate direct total, outpatient, inpatient


The Effect Of Increased Cost-Sharing On Low-Value Service Use

Jul. 20, 2020

Jonathan Gruber, Johanna Catherine Maclean, Bill Wright, Eric Wilkinson, Kevin G Volpp

Abstract [from journal]

We examine the effect of a value-based insurance design (VBID) program implemented at a large public employer in the state of Oregon. The program substantially increased cost-sharing for several healthcare services likely to be of low value for most patients: diagnostic services (e.g., imaging services) and surgeries (e.g., spinal surgeries for pain). Using a difference-in-differences design coupled with granular, administrative health insurance claims data over the period 2008-2012, we estimate the change in low-value service use


Cost-Effectiveness of Mifepristone Pretreatment for the Medical Management of Nonviable Early Pregnancy: Secondary Analysis of a Randomized Clinical Trial

Mar. 2, 2020

Divyah Nagendra, Nathanael Koelper, Sandra E. Loza-Avalos, Sarita Sonalkar, Melissa Chen, Jessica Atrio, Courtney A. SchreiberHeidi S. Harvie

Abstract [from journal]

Importance: Early pregnancy loss (EPL) is the most common complication of pregnancy. A multicenter randomized clinical trial compared 2 strategies for medical management and found that mifepristone pretreatment is 25% more effective than the standard of care, misoprostol alone. The cost of mifepristone may be a barrier to implementation of the regimen.

Objective: To assess the cost-effectiveness of medical management of EPL with mifepristone pretreatment plus misoprostol vs misoprostol alone in the United