Health care system decision makers face challenges in allocating resources for screening, diagnosis and treatment of hepatitis C. Approximately 240,000 individuals are infected with the hepatitis C virus (HCV) in Canada. Populations most affected by HCV include Indigenous people, people who inject drugs, immigrants and homeless or incarcerated populations as well as those born…
Although probabilistic analysis has become the accepted standard for decision analytic cost-effectiveness models, deterministic one-way sensitivity analysis continues to be used to meet the need of decision makers to understand the impact that changing the value taken by one specific parameter has on the results of the analysis. The value of a probabilistic form of one-way sensitivity…
Enzalutamide (Enza) is an effective treatment for metastatic castrate-resistant prostate cancer (mCPRC). However, Enza is not cost-effective (CE) at willingness to pay (WTP) thresholds from $0-$125 000/quality adjusted life years (QALYs) and is therefore a strain on valuable health care dollars. Metformin (Met) is inexpensive (~$8.00/month) and is thought to improve prostate cancer…
Acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML) are both hematological malignancies characterized by rapid onset. While AML is more common than ALL, both typically receive cytotoxic chemotherapy in first line. Upon complete remission, patients will be considered for allogeneic hematopoietic stem cell transplant (HSCT). The economic burden of malignant blood disorders…
CADTH Horizon Scanning bulletins present an overview of the technology and available evidence. They are not systematic reviews and do not involve critical appraisal, nor do they include a detailed summary of study findings. Therefore, they are not intended to provide recommendations for or against a particular technology.
| Jane Nixon, Sarah Brown, Isabelle Smith, Elizabeth McGinnis, Armando Vargas-Palacios, E Andrea Nelson, Julia Brown, Susanne Coleman, Howard Collier, Catherine Fernandez, Rachael Gilberts, Valerie Henderson, Christopher McCabe, Delia Muir, Claudia Rutherford, Nikki Stubbs, Benjamin Thorpe, Klemens Wallner, Kay Walker, Lyn Wilson, Claire Hulme
Pressure ulcers (PUs) are a burden to patients, carers and health-care providers. Specialist mattresses minimise the intensity and duration of pressure on vulnerable skin sites in at-risk patients.
Health Technology Assessment (HTA) has always sought to incorporate the evidence of all patients affected in the decision-making process. While health system budgets could increase to cover costs of new technologies, the relevant patients are those benefitting from access to the technology being appraised. More recently, with health system budgets effectively fixed, costs of new…
This analysis, published in BMC Psychiatry, aimed to determine cost-effectiveness of a stepped-care pathway for depression in adults in primary care versus standard care (SC), treatment-as-usual (TAU), and online cognitive behavioural therapy (CBT).
The authors aimed to determine the cost effectiveness of initiating treatment early in the disease course (within 2 years of CD diagnosis) vs later in the disease course (more than 2 years after diagnosis). To do so, the authors constructed a Markov model of a hypothetical cohort of patients with CD in Canada to simulate disease progression after initiation of infliximab or adalimumab…
Low-density lipoprotein cholesterol (LDL-C) is an important indicator in the development and management of atherosclerotic cardiovascular disease (ASCVD). Herein, we describe the management of LDL-C with lipid-lowering therapy, among patients diagnosed with clinical ASCVD in Alberta, Canada.
| Helena Earl, Louise Hiller, Anne-Laure Vallier, Shrushma Loi, Karen McAdam, Luke Hughes-Davies, Adrian Harnett, Mei-Lin Ah-See, Richard Simcock, Daniel Rea, Sanjay Raj, Pamela Woodings, Mark Harries, Donna Howe, Kerry Raynes, Helen Higgins, Maggie Wilcox, Chris Plummer, Janine Mansi, Ioannis Gounaris, Betania Mahler–Araujo, Elena Provenzano, Anita Chhabra, Jean Abraham, Carlos Caldas, Peter Hall, Christopher McCabe, Claire Hulme, David Miles, Andrew Wardley, David Cameron, Janet Dunn
The authors aimed to investigate whether 6-month adjuvant trastuzumab treatment is non-inferior to the standard 12-month treatment regarding disease-free survival.
The treatment landscape of multiple myeloma (MM) is rapidly evolving with the availability of new therapeutic options leading to improved responses and survival rates. The INFORMM study, an ongoing, province-wide study in Alberta, Canada (population of 4.3 million in 2018), is examining treatment patterns in a real-world setting using population-based administrative data to better…
| Malek Hannouf, Gregory Zaric, Phillip Blanchette, Christine Brezden-Masley, Mike Paulden, Christopher McCabe, Jacques Raphael, Muriel Brackstone
The authors examined the cost-effectiveness of incorporating these assays into standard practice. A decision model was built to project lifetime clinical and economic consequences of different adjuvant treatment-guiding strategies. The model was parameterized using follow-up data from a secondary analysis of the Anastrozole or Tamoxifen Alone or Combined randomized trial, cost…
The clinical outcomes of patients with newly diagnosed multiple myeloma (NDMM) have improved. However, early mortality (EM) post-diagnosis remains a concern, with incidence ranging from 13% at 2 months to 29% at 1 year after diagnosis. EM can be influenced by patient age, comorbidities, performance status, therapy, and disease biology. Our aim is to examine EM incidence in patients…
| Christopher McCabe
Comment in: The Inclusion of Spillover Effects in Economic Evaluation: A Public Health Economics Perspective
| David Birnie, Jeff Healey, George Wells, Felix Ayala-Paredes, Benoit Coutu, Glen Sumner, Giuliano Becker, Atul Verma, François Philippon, Eli Kalfon, John Eikelboom, Roopinder Sandhu, Pablo Nery, Nicholas Lellouche, Stuart Connolly, John Sapp, Vidal Essebag
Guidelines recommend warfarin continuation rather than heparin bridging for pacemaker and defibrillator surgery, after the BRUISE CONTROL trial demonstrated an 80% reduction in device pocket haematoma with this approach. However, direct oral anticoagulants (DOACs) are now used to treat the majority of patients with atrial fibrillation. We sought to understand the best strategy…
| Léon Nshimyumukiza, Jean-Alexandre Beaumont, Julie Duplantie, Sylvie Langlois, Julian Little, François Audibert, Christopher McCabe, Jean Gekas, Yves Giguère, Christian Gagné, Daniel Reinharz, François Rousseau
Yearly, 450 000 pregnant Canadians are eligible for voluntary prenatal screening for trisomy 21. Different screening strategies select approximately 4% of women for invasive fetal chromosome testing. Non-invasive prenatal testing (NIPT) using maternal blood cell-free DNA could reduce those invasive procedures but is expensive. This study evaluated the cost-effectiveness…
The cost-effectiveness threshold in health care systems with a constrained budget should be determined by the cost-effectiveness of displacing health care services to fund new interventions. Using comparative statics, we review some potential determinants of the threshold, including the budget for health care, the demand for existing health care interventions, the technical efficiency…