The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Jan B Pietzsch - One of the best experts on this subject based on the ideXlab platform.
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gender differences in added benefit of catheter based renal denervation for resistant hypertension model based estimation of unAdjusted and quality Adjusted Life Year gains in males and females
European Heart Journal, 2013Co-Authors: Jan B Pietzsch, Benjamin P Geisler, Murray D EslerAbstract:Purpose: Our goal was to estimate, stratified by gender, the impact of catheter-based renal denervation plus standard of care (RDN) versus standard of care alone (SoC) on Life Year (LY) and quality-Adjusted Life Year (QALY) gain in simulated European resistant hypertension cohorts of different cardiovascular (CV) risk. Methods: A recently published simulation model based on multivariate risk equations for CHD, MI, stroke, CHF, and ESRD was populated with CV risk factors and Life tables for Germany. LY and QALY gain was estimated for male and female cohorts of age 58 defined by combinations of 1) pre-treatment SBP of 165 mmHg vs. 190 mmHg; and 2) low vs. high cardiovascular risk profile from the JNC 7 guidelines. All other input parameters, including the treatment effect based on a previously published linear regression model, were derived from the Symplicity HTN-2 randomized controlled trial. No discounting was applied. Results: Renal denervation was estimated to reduce a pre-treatment SBP of 165 by 30 mm Hg, and a SBP of 190 by 40 mm Hg, respectively. The projected Lifetime gains in LYs and QALYs for RDN vs. SoC were projected as follows for male/ female cohorts: 1) Low CV risk profile at 165 mmHg: 1.37/ 1.88 LYs, 1.13/ 1.54 QALYs; 2) Low CV risk profile at 190 mmHg: 1.21/ 1.70 LYs, 1.03/ 1.41 QALYs; 3) High CV risk profile at 165 mmHg: 1.93/ 2.29 LYs, 1.53/ 1.90 QALYs; 3) High CV risk profile at 190 mmHg: 1.55/ 1.83 LYs, 1.25/ 1.49 QALYs. Conclusions: Our results suggest gender is an important factor influencing patient-relevant outcomes in patients treated with catheter-based renal denervation. While renal denervation was associated with clinically meaningful gains in Life expectancy and quality-Adjusted Life expectancy across cardiovascular risk profiles and pre-treatment systolic blood pressure in both genders, females were projected to experience consistently higher gains than males. These model-based findings need to be confirmed in clinical trials.
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cost effectiveness and clinical effectiveness of catheter based renal denervation for resistant hypertension
Journal of the American College of Cardiology, 2012Co-Authors: Benjamin P Geisler, Brent M Egan, Joshua T Cohen, Abigail M Garner, Ron Akehurst, Murray D Esler, Jan B PietzschAbstract:Objectives The purpose of this study was to assess cost-effectiveness and long-term clinical benefits of renal denervation in resistant hypertensive patients. Background Resistant hypertension affects 12% of hypertensive persons. In the Symplicity HTN-2 randomized controlled trial, catheter-based renal denervation (RDN) lowered systolic blood pressure by 32 ± 23 mm Hg from 178 ± 18 mm Hg at baseline. Methods A state-transition model was used to predict the effect of RDN and standard of care on 10-Year and Lifetime probabilities of stroke, myocardial infarction, all coronary heart disease, heart failure, end-stage renal disease, and median survival. We adopted a societal perspective and estimated an incremental cost-effectiveness ratio in U.S. dollars per quality-Adjusted Life-Year, both discounted at 3% per Year. Robustness and uncertainty were evaluated using deterministic and probabilistic sensitivity analyses. Results Renal denervation substantially reduced event probabilities (10-Year/Lifetime relative risks: stroke 0.70/0.83; myocardial infarction 0.68/0.85; all coronary heart disease 0.78/0.90; heart failure 0.79/0.92; end-stage renal disease 0.72/0.81). Median survival was 18.4 Years for RDN versus 17.1 Years for standard of care. The discounted Lifetime incremental cost-effectiveness ratio was $3,071 per quality-Adjusted Life-Year. Findings were relatively insensitive to variations in input parameters except for systolic blood pressure reduction, baseline systolic blood pressure, and effect duration. The 95% credible interval for incremental cost-effectiveness ratio was cost-saving to $31,460 per quality-Adjusted Life-Year. Conclusions The model suggests that catheter-based renal denervation, over a wide range of assumptions, is a cost-effective strategy for resistant hypertension that might result in lower cardiovascular morbidity and mortality.
Murray D Esler - One of the best experts on this subject based on the ideXlab platform.
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gender differences in added benefit of catheter based renal denervation for resistant hypertension model based estimation of unAdjusted and quality Adjusted Life Year gains in males and females
European Heart Journal, 2013Co-Authors: Jan B Pietzsch, Benjamin P Geisler, Murray D EslerAbstract:Purpose: Our goal was to estimate, stratified by gender, the impact of catheter-based renal denervation plus standard of care (RDN) versus standard of care alone (SoC) on Life Year (LY) and quality-Adjusted Life Year (QALY) gain in simulated European resistant hypertension cohorts of different cardiovascular (CV) risk. Methods: A recently published simulation model based on multivariate risk equations for CHD, MI, stroke, CHF, and ESRD was populated with CV risk factors and Life tables for Germany. LY and QALY gain was estimated for male and female cohorts of age 58 defined by combinations of 1) pre-treatment SBP of 165 mmHg vs. 190 mmHg; and 2) low vs. high cardiovascular risk profile from the JNC 7 guidelines. All other input parameters, including the treatment effect based on a previously published linear regression model, were derived from the Symplicity HTN-2 randomized controlled trial. No discounting was applied. Results: Renal denervation was estimated to reduce a pre-treatment SBP of 165 by 30 mm Hg, and a SBP of 190 by 40 mm Hg, respectively. The projected Lifetime gains in LYs and QALYs for RDN vs. SoC were projected as follows for male/ female cohorts: 1) Low CV risk profile at 165 mmHg: 1.37/ 1.88 LYs, 1.13/ 1.54 QALYs; 2) Low CV risk profile at 190 mmHg: 1.21/ 1.70 LYs, 1.03/ 1.41 QALYs; 3) High CV risk profile at 165 mmHg: 1.93/ 2.29 LYs, 1.53/ 1.90 QALYs; 3) High CV risk profile at 190 mmHg: 1.55/ 1.83 LYs, 1.25/ 1.49 QALYs. Conclusions: Our results suggest gender is an important factor influencing patient-relevant outcomes in patients treated with catheter-based renal denervation. While renal denervation was associated with clinically meaningful gains in Life expectancy and quality-Adjusted Life expectancy across cardiovascular risk profiles and pre-treatment systolic blood pressure in both genders, females were projected to experience consistently higher gains than males. These model-based findings need to be confirmed in clinical trials.
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cost effectiveness and clinical effectiveness of catheter based renal denervation for resistant hypertension
Journal of the American College of Cardiology, 2012Co-Authors: Benjamin P Geisler, Brent M Egan, Joshua T Cohen, Abigail M Garner, Ron Akehurst, Murray D Esler, Jan B PietzschAbstract:Objectives The purpose of this study was to assess cost-effectiveness and long-term clinical benefits of renal denervation in resistant hypertensive patients. Background Resistant hypertension affects 12% of hypertensive persons. In the Symplicity HTN-2 randomized controlled trial, catheter-based renal denervation (RDN) lowered systolic blood pressure by 32 ± 23 mm Hg from 178 ± 18 mm Hg at baseline. Methods A state-transition model was used to predict the effect of RDN and standard of care on 10-Year and Lifetime probabilities of stroke, myocardial infarction, all coronary heart disease, heart failure, end-stage renal disease, and median survival. We adopted a societal perspective and estimated an incremental cost-effectiveness ratio in U.S. dollars per quality-Adjusted Life-Year, both discounted at 3% per Year. Robustness and uncertainty were evaluated using deterministic and probabilistic sensitivity analyses. Results Renal denervation substantially reduced event probabilities (10-Year/Lifetime relative risks: stroke 0.70/0.83; myocardial infarction 0.68/0.85; all coronary heart disease 0.78/0.90; heart failure 0.79/0.92; end-stage renal disease 0.72/0.81). Median survival was 18.4 Years for RDN versus 17.1 Years for standard of care. The discounted Lifetime incremental cost-effectiveness ratio was $3,071 per quality-Adjusted Life-Year. Findings were relatively insensitive to variations in input parameters except for systolic blood pressure reduction, baseline systolic blood pressure, and effect duration. The 95% credible interval for incremental cost-effectiveness ratio was cost-saving to $31,460 per quality-Adjusted Life-Year. Conclusions The model suggests that catheter-based renal denervation, over a wide range of assumptions, is a cost-effective strategy for resistant hypertension that might result in lower cardiovascular morbidity and mortality.
Milton C Weinstein - One of the best experts on this subject based on the ideXlab platform.
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updating cost effectiveness the curious resilience of the 50 000 per qaly threshold
The New England Journal of Medicine, 2014Co-Authors: Peter J Neumann, Joshua T Cohen, Milton C WeinsteinAbstract:The ratio of $50,000 per quality-Adjusted Life-Year (QALY) gained by using a given health care intervention has long served as a benchmark for the value of U.S. health care. But evidence suggests that it is too low and might best be thought of as an implied lower boundary.
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legislating against use of cost effectiveness information
The New England Journal of Medicine, 2010Co-Authors: Peter J Neumann, Milton C WeinsteinAbstract:The Patient-Centered Outcomes Research Institute . . . shall not develop or employ a dollars per quality Adjusted Life Year (or similar measure that discounts the value of a Life because of an individual's disability) as a threshold to establish what type of health care is cost effective or recommended. The Secretary shall not utilize such an Adjusted Life Year (or such a similar measure) as a threshold to determine coverage, reimbursement, or incentive programs under title XVIII. — The Patient Protection and Affordable Care Act1 In 1996, after 2 Years of deliberation, the U.S. Panel on Cost-Effectiveness in Health and Medicine, . . .
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how much are americans willing to pay for a quality Adjusted Life Year
Medical Care, 2008Co-Authors: Milton C WeinsteinAbstract:for coverage recommendations to the National Health Service 2 ; some observers have inferred that explicit criteria such as £30,000 per QALY may be used to guide these recommendations. 3 The World Health Organization has proposed that developing countries might use a cost-per-QALY threshold of 3 times the per-capita gross domestic product to guide their health care resource allocations. 4 Despite widespread use elsewhere in the world, cost-effectiveness analysis has gained only limited traction in the United States as an explicit guide to clinical practice, insurance coverage, and policy decisions. It seems that Americans do not have the inclination to focus on the fact that even in the wealthiest country in the world, resources are limited, and not all beneficial health services can be provided to everyone who might potentially benefit from them. Rationing among health services occurs largely by default and not by design. In the United States, cost per QALY is sometimes cited as part of the justification for guidelines for clinical practice or preventive services, and a decade ago a panel was convened by the US Public Health Service to provide guidance to practitioners of cost-effectiveness analysis. 5 However, despite the attention given to cost-effectiveness analysis in medical journals, The Centers for Medicare and Medicaid Services have avoided explicit use of cost-effectiveness criteria in coverage decisions, and it is unclear to what degree cost-effectiveness is used to guide coverage decisions in the private sector. 6 Because cost per QALY is not used in any systematic or consistent way in the United States, it should not be surprising that there is no consensus as to the appropriate value of cost per QALY that should guide health care decisions and policies. The number $50,000 per QALY has become a mythical benchmark for cost per QALY in this country, although it is impossible to trace its origins. Some authors of cost-effectiveness studies refer to this number when reporting subgroup analyses or sensitivity analyses 7 ; these kinds of statements should not be interpreted as endorsements of a $50,000 per QALY threshold, but rather as a convenient way of representing the conclusion that the intervention in question is good value for money even under pessimistic assumptions. With that interpretation, the reference to the $50,000 threshold could be interpreted as an implied lower bound on the value of a QALY. Braithwaite et al, in this issue of Medical Care, 8 set out to deduce lower and upper bounds on the value Americans place on quality-Adjusted Life Years by analyzing the implications of aggregate decisions that citizens of this country have made—to pay for the increase in the cost of medical care services since 1950; or have not made—to insure the uninsured. They argue that because the gains in Life expectancy since 1950 have been bought at an estimated average cost of $183,000 per Year of Life expectancy gained, on average Americans must be willing to pay at least that much for a Year of Life. When optimistic imputations of quality of Life gains are also considered, the implied lower bound on the value of a QALY drops to $109,000. The number drops below $100,000 when they
Benjamin P Geisler - One of the best experts on this subject based on the ideXlab platform.
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gender differences in added benefit of catheter based renal denervation for resistant hypertension model based estimation of unAdjusted and quality Adjusted Life Year gains in males and females
European Heart Journal, 2013Co-Authors: Jan B Pietzsch, Benjamin P Geisler, Murray D EslerAbstract:Purpose: Our goal was to estimate, stratified by gender, the impact of catheter-based renal denervation plus standard of care (RDN) versus standard of care alone (SoC) on Life Year (LY) and quality-Adjusted Life Year (QALY) gain in simulated European resistant hypertension cohorts of different cardiovascular (CV) risk. Methods: A recently published simulation model based on multivariate risk equations for CHD, MI, stroke, CHF, and ESRD was populated with CV risk factors and Life tables for Germany. LY and QALY gain was estimated for male and female cohorts of age 58 defined by combinations of 1) pre-treatment SBP of 165 mmHg vs. 190 mmHg; and 2) low vs. high cardiovascular risk profile from the JNC 7 guidelines. All other input parameters, including the treatment effect based on a previously published linear regression model, were derived from the Symplicity HTN-2 randomized controlled trial. No discounting was applied. Results: Renal denervation was estimated to reduce a pre-treatment SBP of 165 by 30 mm Hg, and a SBP of 190 by 40 mm Hg, respectively. The projected Lifetime gains in LYs and QALYs for RDN vs. SoC were projected as follows for male/ female cohorts: 1) Low CV risk profile at 165 mmHg: 1.37/ 1.88 LYs, 1.13/ 1.54 QALYs; 2) Low CV risk profile at 190 mmHg: 1.21/ 1.70 LYs, 1.03/ 1.41 QALYs; 3) High CV risk profile at 165 mmHg: 1.93/ 2.29 LYs, 1.53/ 1.90 QALYs; 3) High CV risk profile at 190 mmHg: 1.55/ 1.83 LYs, 1.25/ 1.49 QALYs. Conclusions: Our results suggest gender is an important factor influencing patient-relevant outcomes in patients treated with catheter-based renal denervation. While renal denervation was associated with clinically meaningful gains in Life expectancy and quality-Adjusted Life expectancy across cardiovascular risk profiles and pre-treatment systolic blood pressure in both genders, females were projected to experience consistently higher gains than males. These model-based findings need to be confirmed in clinical trials.
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cost effectiveness and clinical effectiveness of catheter based renal denervation for resistant hypertension
Journal of the American College of Cardiology, 2012Co-Authors: Benjamin P Geisler, Brent M Egan, Joshua T Cohen, Abigail M Garner, Ron Akehurst, Murray D Esler, Jan B PietzschAbstract:Objectives The purpose of this study was to assess cost-effectiveness and long-term clinical benefits of renal denervation in resistant hypertensive patients. Background Resistant hypertension affects 12% of hypertensive persons. In the Symplicity HTN-2 randomized controlled trial, catheter-based renal denervation (RDN) lowered systolic blood pressure by 32 ± 23 mm Hg from 178 ± 18 mm Hg at baseline. Methods A state-transition model was used to predict the effect of RDN and standard of care on 10-Year and Lifetime probabilities of stroke, myocardial infarction, all coronary heart disease, heart failure, end-stage renal disease, and median survival. We adopted a societal perspective and estimated an incremental cost-effectiveness ratio in U.S. dollars per quality-Adjusted Life-Year, both discounted at 3% per Year. Robustness and uncertainty were evaluated using deterministic and probabilistic sensitivity analyses. Results Renal denervation substantially reduced event probabilities (10-Year/Lifetime relative risks: stroke 0.70/0.83; myocardial infarction 0.68/0.85; all coronary heart disease 0.78/0.90; heart failure 0.79/0.92; end-stage renal disease 0.72/0.81). Median survival was 18.4 Years for RDN versus 17.1 Years for standard of care. The discounted Lifetime incremental cost-effectiveness ratio was $3,071 per quality-Adjusted Life-Year. Findings were relatively insensitive to variations in input parameters except for systolic blood pressure reduction, baseline systolic blood pressure, and effect duration. The 95% credible interval for incremental cost-effectiveness ratio was cost-saving to $31,460 per quality-Adjusted Life-Year. Conclusions The model suggests that catheter-based renal denervation, over a wide range of assumptions, is a cost-effective strategy for resistant hypertension that might result in lower cardiovascular morbidity and mortality.
Jungder Wang - One of the best experts on this subject based on the ideXlab platform.
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impact of work related cancers in taiwan estimation with qaly quality Adjusted Life Year and healthcare costs
Preventive medicine reports, 2016Co-Authors: Lukas Jyuhnhsiarn Lee, Mei Chuan Hung, Chengkuan Lin, Jungder WangAbstract:This study estimates the annual numbers of eight work-related cancers, total losses of quality-Adjusted Life Years (QALYs), and Lifetime healthcare expenditures that possibly could be saved by improving occupational health in Taiwan. Three databases were interlinked: the Taiwan Cancer Registry, the National Mortality Registry, and the National Health Insurance Research Database. Annual numbers of work-related cancers were estimated based on attributable fractions (AFs) abstracted from a literature review. The survival functions for eight cancers were estimated and extrapolated to Lifetime using a semi-parametric method. A convenience sample of 8846 measurements of patients' quality of Life with EQ-5D was collected for utility values and multiplied by survival functions to estimate quality-Adjusted Life expectancies (QALEs). The loss-of-QALE was obtained by subtracting the QALE of cancer from age- and sex-matched referents simulated from national vital statistics. The Lifetime healthcare expenditures were estimated by multiplying the survival probability with mean monthly costs paid by the National Health Insurance for cancer diagnosis and treatment and summing this for the expected Lifetime. A total of 3010 males and 726 females with eight work-related cancers were estimated in 2010. Among them, lung cancer ranked first in terms of QALY loss, with an annual total loss-of-QALE of 28,463 QALYs and total Lifetime healthcare expenditures of US$36.6 million. Successful prevention of eight work-related cancers would not only avoid the occurrence of 3736 cases of cancer, but would also save more than US$70 million in healthcare costs and 46,750 QALYs for the Taiwan society in 2010.
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cost per qaly quality Adjusted Life Year and Lifetime cost of prolonged mechanical ventilation in taiwan
PLOS ONE, 2012Co-Authors: Mei Chuan Hung, Likwang Chen, Ming Shian Lin, Cheng Ren Chen, Jungder WangAbstract:Introduction Patients who require prolonged mechanical ventilation (PMV) are increasing and producing financial burdens worldwide. This study determines the cost per QALY (quality-Adjusted Life Year), out-of-pocket expenses, and Lifetime costs for PMV patients stratified by underlying diseases and cognition levels.
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estimation of burden of lead for offspring of female lead workers a quality Adjusted Life Year qaly assessment
Journal of Toxicology and Environmental Health, 2005Co-Authors: Hungyi Chuang, Kun Yu Chao, Jungder WangAbstract:This study demonstrates an empirical example that uses quality-Adjusted Life Year (QALY) as a common metric for occupational health assessment to measure the utility loss of potential lead-exposed children delivered by female lead-battery-exposed workers. A set of nationwide health examination data was used for 1726 lead workers. Among them, there were 649 female workers. The numbers of offspring from female lead workers were estimated by multiplying the age-specific fertility rate (ASFR) by the number of workers in each age stratum. The quality of Life assessment for these offspring was assumed impaired by increased absorption of lead using a measure of utility for quality of Life that was adapted from Rosser’s index of health-related quality of Life. The total utility loss was calculated by summing up the loss of QALY for these expected offspring. Dose-response and exposure assessments were based on their mothers’ blood lead levels. It was estimated that more than 38 babies were delivered in 1 yr. There...