TY - JOUR T1 - Cost-utility and cost-benefit analysis of TAVR availability in the US severe symptomatic aortic stenosis patient population. JF - Journal of Medical Economics Y1 - 2022 A1 - Sevilla, J P A1 - Klusty, Jessica M A1 - Song, Younghwan A1 - Russo, Mark J A1 - Thompson, Christin A A1 - Jiao, Xiayu A1 - Clancy, Seth J A1 - Bloom, David E KW - Aortic Valve KW - Aortic Valve Stenosis KW - Cost-Benefit Analysis KW - Health Care Costs KW - Heart Valve Prosthesis Implantation KW - Risk Factors KW - Transcatheter Aortic Valve Replacement KW - Treatment Outcome AB -

AIMS: We evaluated the availability of transcatheter aortic valve replacement (TAVR) to determine its value across all severe symptomatic aortic stenosis (SSAS) patients, especially those untreated because of concerns regarding invasive surgical AVR (SAVR) and its impact on active aging.

METHODS: We performed payer perspective cost-utility analysis (CUA) and societal perspective cost-benefit analysis (CBA). The CBA's benefit measure is active time: salaried labor, unpaid work, and active leisure. The study population is a cohort of US elderly SSAS patients. We compared a "TAVR available" scenario in which SSAS patients distribute themselves across TAVR, SAVR, and medical management (MM); and a "TAVR not available" scenario with only SAVR and MM. We structured each scenario with a decision-tree model of SSAS patient treatment allocation. We measured the association between health and active time in the US Health and Retirement Study and used this association to impute active time to SSAS patients given their health.

RESULTS: The incremental cost-effectiveness ratio (ICER) and rate of return (RoR) of TAVR availability were $8,533 and 395%, respectively. CUA net monetary benefits (NMB) were $212,199 per patient and $43.4 billion population-wide. CBA NMB were $50,530 per patient and $10.3 billion population-wide.

LIMITATIONS: Among study limitations were scarcity of evidence regarding key parameters and the lack of long-term survival, health utility, and treatment cost data. Our analysis did not account for TAVR durability, retreatments, and valve-in-valve treatments.

CONCLUSION: Across risk-, age-, and treatment-eligibility groups, TAVR is the economically optimal treatment choice. It represents strong value-for-money per patient and population-wide. The vast majority of TAVR value involves raising treatment uptake among the untreated.

VL - 25 IS - 1 ER - TY - JOUR T1 - Brief interventions for older adults (BIO) delivered by non-specialist community health workers to reduce at-risk drinking in primary care: a study protocol for a randomised controlled trial. JF - BMJ Open Y1 - 2021 A1 - Paula, Tassiane Cristine Santos A1 - Chagas, Camila A1 - Noto, Ana Regina A1 - Formigoni, Maria Lucia Oliveira Souza A1 - Pereira, Tiago Veiga A1 - Ferri, Cleusa Pinheiro KW - Aged KW - Alcohol Drinking KW - Alcoholism KW - Brazil KW - Community Health Workers KW - Cost-Benefit Analysis KW - Crisis Intervention KW - Humans KW - Primary Health Care KW - Quality of Life KW - Randomized Controlled Trials as Topic AB -

INTRODUCTION: Evidence suggests that brief interventions are effective in reducing alcohol consumption among older adults. However, the effectiveness of these interventions when delivered by community health workers (non-specialists) in a primary healthcare setting is unknown. To our knowledge, this will be the first randomised trial to examine this.

METHODS AND ANALYSIS: Two hundred and forty-two individuals considered at-risk drinkers (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C score ≥4) will be recruited and randomly allocated to usual care (waiting-list) or usual care plus an intervention delivered by trained community health workers (non-specialists). Seven primary care units (PCUs) in Sao José dos Campos, Brazil. PCUs are part of the Brazilian public healthcare system (Sistema Único de Saúde).6 months.The primary outcome will be the proportion of participants considered at-risk drinkers (AUDIT-C score ≥4). Secondary outcomes will include alcohol consumption in a typical week in the last 30 days (in units per week) assessed by the AUDIT, service use questionnaire, cognitive performance-assessed by The Health and Retirement Study Harmonised Cognitive Assessment, physical activity-assessed by the International Physical Activity Questionnaire, depression-assessed by the Geriatric Depression Scale and quality of life-assessed by the Control, Autonomy, Self-realisation and Pleasure-16 instrument. The analysis will be based on intention-to-treat principle.

ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the Universidade Federal de São Paulo, CEP/UNIFESP Project n: 0690/2018; CAAE: 91648618.0.0000.5505. All eligible participants will provide informed consent prior to randomisation. The results of this study will be published in relevant peer-reviewed journals and in conference presentations.

TRIAL REGISTRATION NUMBER: RBR-8rcxkk.

VL - 11 IS - 5 ER - TY - JOUR T1 - Skin Cancer in U.S. Elderly Adults: Does Life Expectancy Play a Role in Treatment Decisions? JF - J Am Geriatr Soc Y1 - 2016 A1 - Linos, Eleni A1 - Chren, Mary-Margaret A1 - Irena Cenzer A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Carcinoma, Basal Cell KW - Carcinoma, Squamous Cell KW - Comorbidity KW - Cost-Benefit Analysis KW - Cross-Sectional Studies KW - Curettage KW - Decision Support Techniques KW - Disability Evaluation KW - Electrosurgery KW - Female KW - Humans KW - Keratinocytes KW - Life Expectancy KW - Male KW - Mohs Surgery KW - Prognosis KW - Skin Neoplasms AB -

OBJECTIVES: To examine whether life expectancy influences treatment pattern of nonmelanoma skin cancer, or keratinocyte carcinoma (KC), the most common malignancy and the fifth most costly cancer to Medicare.

DESIGN: Nationally representative cross-sectional study.

SETTING: Nationally representative Health and Retirement Study linked to Medicare claims.

PARTICIPANTS: Treatments (N = 9,653) from individuals aged 65 and older treated for basal or squamous cell carcinoma between 1992 and 2012 (N = 2,702) were included.

MEASUREMENTS: Limited life expectancy defined according to aged 85 and older, medical comorbidities, Charlson Comorbidity Index score of 3 or greater, difficulty in at least one activity of daily living (ADL), and a Lee index of 13 or greater. Treatment type (Mohs micrographic surgery (MMS) (most intensive, highest cost), excision, or electrodesiccation and curettage (ED&C) (least intensive, lowest cost)), according to procedure code.

RESULTS: Most KCs (61%) were treated surgically. Rates of MMS (19%), excision (42%), and ED&C (39%) were no different in participants with limited life expectancy and those with normal life expectancy. For example, 19% of participants with difficulty or dependence in ADLs, 20% of those with a Charlson comorbidity score greater than 3, and 15% of those in their last year of life underwent MMS; participants who died within 1 year of diagnosis were treated in the same way as those who lived longer.

CONCLUSION: A one-size-fits-all approach in which advanced age, health status, functional status, and prognosis are not associated with intensiveness of treatment appears to guide treatment for KC, a generally nonfatal condition. Although intensive treatment of skin cancer when it causes symptoms may be indicated regardless of life expectancy, persons with limited life expectancy should be given choices to ensure that the treatment matches their goals and preferences.

VL - 64 UR - http://www.ncbi.nlm.nih.gov/pubmed/27303932 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27303932?dopt=Abstract ER - TY - JOUR T1 - Do Statins Reduce the Health and Health Care Costs of Obesity? JF - Pharmacoeconomics Y1 - 2015 A1 - Gaudette, Étienne A1 - Dana P Goldman A1 - Messali, Andrew A1 - Sood, Neeraj KW - Aged KW - Computer Simulation KW - Cost-Benefit Analysis KW - Health Care Costs KW - Humans KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors KW - Life Expectancy KW - Markov chains KW - Models, Economic KW - Obesity KW - Quality-Adjusted Life Years AB -

CONTEXT: Obesity impacts both individual health and, given its high prevalence, total health care spending. However, as medical technology evolves, health outcomes for a number of obesity-related illnesses improve. This article examines whether medical innovation can mitigate the adverse health and spending associated with obesity, using statins as a case study. Because of the relationship between obesity and hypercholesterolaemia, statins play an important role in the medical management of obese individuals and the prevention of costly obesity-related sequelae.

METHODS: Using well-recognized estimates of the health impact of statins and the Future Elderly Model (FEM)-an established dynamic microsimulation model of the health of Americans aged over 50 years-we estimate the changes in life expectancy, functional status and health care costs of obesity due to the introduction and widespread use of statins.

RESULTS: Life expectancy gains of statins are estimated to be 5-6 % greater for obese individuals than for healthy-weight individuals, but most of these additional gains are associated with some level of disability. Considering both medical spending and the value of quality-adjusted life-years, statins do not significantly alter the costs of class 1 and 2 obesity (body mass index [BMI] ≥30 and ≥35 kg/m(2), respectively) and they increase the costs of class 3 obesity (BMI ≥40 kg/m(2)) by 1.2 %.

CONCLUSIONS: Although statins are very effective medications for lowering the risk of obesity-associated illnesses, they do not significantly reduce the costs of obesity.

VL - 33 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25576147?dopt=Abstract ER - TY - JOUR T1 - Reducing case ascertainment costs in U.S. population studies of Alzheimer's disease, dementia, and cognitive impairment-Part 1. JF - Alzheimers Dement Y1 - 2011 A1 - David R Weir A1 - Robert B Wallace A1 - Kenneth M. Langa A1 - Brenda L Plassman A1 - Robert S Wilson A1 - David A Bennett A1 - Duara, Ranjan A1 - Loewenstein, David A1 - Ganguli, Mary A1 - Sano, Mary KW - Aging KW - Algorithms KW - Alzheimer disease KW - Cognition Disorders KW - Community Health Planning KW - Cost-Benefit Analysis KW - Dementia KW - Health Surveys KW - Humans KW - Internet KW - Reproducibility of Results KW - United States AB -

Establishing methods for ascertainment of dementia and cognitive impairment that are accurate and also cost-effective is a challenging enterprise. Large population-based studies often using administrative data sets offer relatively inexpensive and reliable estimates of severe conditions including moderate to advanced dementia that are useful for public health planning, but they can miss less severe cognitive impairment which may be the most effective point for intervention. Clinical and epidemiological cohorts, intensively assessed, provide more sensitive detection of less severe cognitive impairment but are often costly. In this article, several approaches to ascertainment are evaluated for validity, reliability, and cost. In particular, the methods of ascertainment from the Health and Retirement Study are described briefly, along with those of the Aging, Demographics, and Memory Study (ADAMS). ADAMS, a resource-intense sub-study of the Health and Retirement Study, was designed to provide diagnostic accuracy among persons with more advanced dementia. A proposal to streamline future ADAMS assessments is offered. Also considered are algorithmic and Web-based approaches to diagnosis that can reduce the expense of clinical expertise and, in some contexts, can reduce the extent of data collection. These approaches are intended for intensively assessed epidemiological cohorts where goal is valid and reliable case detection with efficient and cost-effective tools.

PB - 7 VL - 7 UR - http://mgetit.lib.umich.edu/sfx_local?ctx_enc=info 3Aofi 2Fenc 3AUTF-8;ctx_id=10_1;ctx_tim=2011-03-28T16 3A26 3A0EDT;ctx_ver=Z39.88-2004;rfr_id=info 3Asid 2Fsfxit.com 3Acitation;rft.genre=article;rft_id=info 3Apmid 2F21255747;rft_val_fmt=info 3Aofi 2Ffmt IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21255747?dopt=Abstract U2 - PMC3044596 U4 - Alzheimers disease/Dementia/Mild cognitive impairment/Cognitive impairment not dementia/Diagnostic algorithms/Cognition/Epidemiology/Screening/Technology/Education/Ethnicity ER - TY - JOUR T1 - Risk of nursing home admission among older americans: does states' spending on home- and community-based services matter? JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Muramatsu, Naoko A1 - yin, Hongjun A1 - Richard T. Campbell A1 - Ruby L Hoyem A1 - Martha A. Jacob A1 - Christopher Ross KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Cohort Studies KW - Cost Savings KW - Cost-Benefit Analysis KW - Female KW - Financing, Government KW - Health Expenditures KW - Home Care Services KW - Homes for the Aged KW - Humans KW - Insurance Coverage KW - Long-term Care KW - Male KW - Medicaid KW - Medicare KW - Nursing homes KW - Patient Admission KW - Patient Readmission KW - Risk Assessment KW - Risk Factors KW - State Health Plans KW - United States AB -

OBJECTIVE: States vary greatly in their support for home- and community-based services (HCBS) that are intended to help disabled seniors live in the community. This article examines how states' generosity in providing HCBS affects the risk of nursing home admission among older Americans and how family availability moderates such effects.

METHODS: We conducted discrete time survival analysis of first long-term (90 or more days) nursing home admissions that occurred between 1995 and 2002, using Health and Retirement Study panel data from respondents born in 1923 or earlier.

RESULT: State HCBS effects were conditional on child availability among older Americans. Living in a state with higher HCBS expenditures was associated with lower risk of nursing home admission among childless seniors (p <.001). However, the association was not statistically significant among seniors with living children. Doubling state HCBS expenditures per person aged 65 or older would reduce the risk of nursing home admission among childless seniors by 35%.

DISCUSSION: Results provided modest but important evidence supportive of increasing state investment in HCBS. Within-state allocation of HCBS resources, however, requires further research and careful consideration about fairness for individual seniors and their families as well as cost effectiveness.

PB - 62B VL - 62 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17507592?dopt=Abstract U4 - Home Care Services/Nursing Homes/Health Policy/Elderly ER - TY - JOUR T1 - Screening mammography and Pap tests among older American women 1996-2000: results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD). JF - Ann Fam Med Y1 - 2003 A1 - Truls Ostbye A1 - Gary N. Greenberg A1 - Donald H. Taylor Jr. A1 - Lee, Ann Marie M. KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Breast Neoplasms KW - Cost-Benefit Analysis KW - Female KW - Health Services for the Aged KW - Humans KW - Longitudinal Studies KW - Mammography KW - Middle Aged KW - Multivariate Analysis KW - Papanicolaou Test KW - Patient Acceptance of Health Care KW - Risk KW - United States KW - Uterine Cervical Neoplasms KW - Vaginal Smears AB -

BACKGROUND: We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys.

METHODS: This cohort study includes participants from 4 waves (1994-2000) of the Health and Retirement Study (HRS)--5,942 women aged 50 to 61 years, and 4 waves (1993-2000) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey--4,543 women aged 70 years and older. The self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1996 and 2000 for HRS, with predictors of receipt measured in 1994 and 1998. In AHEAD, the self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1995 and 2000, with predictors of receipt measured in 1993 and 1998.

RESULTS: Receipt of mammography is stable at 70% to 80% among women aged 50 to 64 years, then declines to around 40% among those aged 85 to 90 years. For Pap tests there is a decline from 75% among women aged 50 to 54 years to 25% in those aged 85 to 90 years. For both mammography and Pap tests, the rates increased in all groups from 1995/1996 to 2000. Higher education, being married, higher income, not smoking, and vigorous exercise were consistently associated with higher rates of receipt.

CONCLUSIONS: Although the use of mammography and Pap tests for screening declines into old age, use has been increasing recently. The large and increasing number of tests performed might not be justified given the lack of evidence of effect in older age-groups.

PB - 1 VL - 1 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15055410?dopt=Abstract U4 - Womens Health/Mammography/Pap Test ER -