Cost Effectiveness Analysis of Riluzole for ALS in Ontario Home Care Setting
Notice bibliographique
Résumé
Objective: To identify the factors associated with the prescription of riluzole and assess its cost-effectiveness for patients diagnosed with Amyotrophic Lateral Sclerosis (ALS) in long stay home care in Ontario, Canada. \n \nMethod: A retrospective cohort study was conducted using the Ontario Association of Community Care Access Centres – Home Care (OACCAC-HC) data. Assessment records of ALS patients admitted into home care between April 1st, 2005 and March 31st, 2013, who had information on whether or not they used riluzole, were reviewed. Univariate and multiple logistic regressions analysis were used to identify the predictors influencing the receipt of riluzole. Variables included in the analyses were chosen in correlation to the prognostic factors identified in the literature review. For the cost-effectiveness analysis, cost data were obtained from relevant literatures and published information on Canadian Institute for Health Information Patient Cost Estimator accounting for the cost of administration of riluzole, standard supportive home care services, and cost-savings from delay in hospitalization. Effectiveness was measured using time to discharge from home care due to death, placement into long-term care, and hospitalization, controlling for potential confounding variables using propensity score stratification. The incremental cost-effectiveness ratio was calculated based on time spent in different states and the associated utility scores using the stratified population and expressed as cost per life-year gained and quality-adjusted life-year gained. Sensitivity analyses included one-way deterministic sensitivity analysis to investigate the change in ICER due to variations in specific input parameters. Scenario analyses were developed to depict the ICERs in best and worst case scenarios. \n \nResuts: The total study population comprised of 1,351 patients diagnosed with ALS, of which 1,277 patients had information on the use of riluzole. In the multiple logistic regression analysis, older age, moderate – moderate severe impairment in cognitive functions, not being married and geographical locations across LHINs (Champlain, Erie St. Clair, Hamilton Niagara Haldimand Brant, Mississauga Halton, North East, South East, and South West) decreased the likelihood of riluzole prescription. Primary analysis showed that treatment with riluzole was associated with prolonged survival in home care [HR = 0.86; 95% confidence interval: 0.745 – 0.99; p=0.046]. Survival gain associated with riluzole was 1.5 months, while the incremental cost was approximately $5,000 per patient. Thus, the incremental cost-effectiveness ratio of riluzole versus standard supportive home care services was $41,128.85 per life-year gained or $55,579.53 per quality-adjusted life-year gained. One-way deterministic sensitivity analysis suggested an ICER ranging from $50,000 – 78,000 per QALY, while scenario analyses depicting best and worst case scenarios suggested an ICERs of $29,890.36 per QALY and $106,641.52 per QALY. \n \nConclusion: Patient characteristics such as age, cognitive score, geographical location and marital status markedly influenced drug utilization of riluzole. In addition, the findings of this study indicate that riluzole has a borderline or unfavorable cost-effectiveness for patients diagnosed with ALS in home care setting.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,022 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,004 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».