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Article ; Online: Optimal allocation of scarce PCR tests during the COVID-19 pandemic.

Afschin Gandjour

PLoS ONE, Vol 18, Iss 6, p e

2023 Volume 0285083

Abstract: Background/aim During the coronavirus disease (COVID-19) pandemic, Germany and various other countries experienced a shortage of polymerase chain reaction (PCR) laboratory tests due to the highly transmissible SARS-CoV-2 Omicron variant that drove an ... ...

Abstract	Background/aim During the coronavirus disease (COVID-19) pandemic, Germany and various other countries experienced a shortage of polymerase chain reaction (PCR) laboratory tests due to the highly transmissible SARS-CoV-2 Omicron variant that drove an unprecedented surge of infections. This study developed a mathematical model that optimizes diagnostic capacity with lab-based PCR testing. Methods A mathematical model was constructed to determine the value of PCR testing in relation to the pre-test probability of COVID-19. Furthermore, the model derives the lower and upper bounds for the threshold pre-test probability of the designated priority group. The model was applied in a German setting using the PCR test-positivity rate at the beginning of February 2022. Results The value function of PCR testing is bell-shaped with respect to the pre-test probability, reaching a maximum at a pre-test probability of 0.5. Based on a PCR test-positivity rate of 0.3 and assuming that at least two thirds of the tested population have a pre-test probability below, lower and higher pre-test probability thresholds are ≥ 0.1 and 0.7, respectively. Therefore, individuals who have a 25% likelihood of testing positive because they exhibit symptoms should be a higher priority for PCR testing. Furthermore, a positive rapid antigen test in asymptomatic individuals with no known exposure to COVID-19 should be confirmed using PCR. Yet, symptomatic individuals with a positive RAT should be excluded from PCR testing. Conclusion A mathematical model that allows for the optimal allocation of scarce PCR tests during the COVID-19 pandemic was developed.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Was EU’s COVID-19 vaccine procurement strategy irrational? A re-analysis based on cost-effectiveness considerations

Afschin Gandjour

BMC Health Services Research, Vol 22, Iss 1, Pp 1-

2022 Volume 9

Abstract: Abstract Aim The European Union (EU) has received criticism for being slow to secure coronavirus disease (COVID-19) vaccine contracts in 2020 before the approval of the first COVID-19 vaccine. This study aimed to retrospectively analyze the EU’s COVID-19 ...

Abstract	Abstract Aim The European Union (EU) has received criticism for being slow to secure coronavirus disease (COVID-19) vaccine contracts in 2020 before the approval of the first COVID-19 vaccine. This study aimed to retrospectively analyze the EU’s COVID-19 vaccine procurement strategy. To this end, the study retrospectively determined the minimum vaccine efficacy that made vaccination cost-effective from a societal perspective in Germany before clinical trial announcements in late 2020. The results were compared with the expected vaccine efficacy before the announcements. Methods Two strategies were analyzed: vaccination followed by the complete lifting of mitigation measures and a long-term mitigation strategy. A decision model was constructed using, for example, information on age-specific fatality rates, intensive care unit costs and outcomes, and herd protection thresholds. The base-case time horizon was 5 years. Cost-effectiveness of vaccination was determined in terms of the costs per life-year gained. The value of an additional life-year was borrowed from new, innovative oncological drugs, as cancer is a condition with a perceived threat similar to that of COVID-19. Results A vaccine with 50% efficacy against death due to COVID-19 was not clearly cost-effective compared with a long-term mitigation strategy if mitigation measures were planned to be lifted after vaccine rollout. The minimum vaccine efficacy required to achieve cost-effectiveness was 40% in the base case. The sensitivity analysis showed considerable variation around the minimum vaccine efficacy, extending above 50% for some of the input variables. Conclusions This study showed that vaccine efficacy levels expected before clinical trial announcements did not clearly justify lifting mitigation measures from a cost-effectiveness standpoint. Hence, the EU’s sluggish procurement strategy still appeared to be rational at the time of decision making.
Keywords	European Union ; COVID-19 ; Vaccine ; Procurement ; Cost-effectiveness ; Public aspects of medicine ; RA1-1270
Subject code	710
Language	English
Publishing date	2022-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Benefits, risks, and cost-effectiveness of COVID-19 self-tests from a consumer’s perspective

Afschin Gandjour

BMC Health Services Research, Vol 22, Iss 1, Pp 1-

2022 Volume 8

Abstract: Abstract Background The aim of this study is to quantify the health benefits, risks, and cost-effectiveness of COVID-19 self-tests from a consumer’s perspective in Germany. Methods The analysis is based on a modelling approach using secondary data. The ... ...

Abstract	Abstract Background The aim of this study is to quantify the health benefits, risks, and cost-effectiveness of COVID-19 self-tests from a consumer’s perspective in Germany. Methods The analysis is based on a modelling approach using secondary data. The clinical endpoints considered in this analysis are avoided SARS-CoV-2 infections and secondary severe clinical events (death, intensive care unit (ICU) admission, and long COVID syndrome). The study determines the number of self-tests that need to be conducted under a 7-day incidence of 75 per 100,000 population to prevent one infection or severe clinical event. Furthermore, the study calculates the cost of testing per avoided clinical event and quality-adjusted life year (QALY) gained from a consumer perspective. Results Disregarding the rate of unreported COVID-19 cases, 4556 self-tests need to be conducted (over 12 years) in order to avoid one undesirable event (death, intensive care unit stay, or long COVID syndrome). Ninety percent of infections are not avoided among direct contacts but along the chain of infection. The costs per quality-adjusted life year gained from a consumer’s perspective are €5870. This ratio is particularly sensitive to the 7-day incidence, effective reproduction number, and the age of contacts. Conclusions The benefits of self-testing in the general population at a 7-day incidence rate of 75 per 100,000 appear to be minor. Nevertheless, cost-effectiveness may still be acceptable in the presence of higher-risk contacts given the low costs of self-test kits in Germany.
Keywords	COVID-19 ; Self-test ; Cost-effectiveness ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A parsimonious model to validate cost-effectiveness analyses on preventive health care

Afschin Gandjour

BMC Health Services Research, Vol 21, Iss 1, Pp 1-

2021 Volume 7

Abstract: Abstract Background The effect of preventive health care on health expenditures is ambiguous. On the one hand, prevention reduces the costs of future morbidity. On the other hand, prevention leads to costs of life extension. The purpose of this paper is ... ...

Abstract	Abstract Background The effect of preventive health care on health expenditures is ambiguous. On the one hand, prevention reduces the costs of future morbidity. On the other hand, prevention leads to costs of life extension. The purpose of this paper is to develop a parsimonious model that determines for a preventive measure of interest whether savings from preventing morbidity are more than offset by the costs of living longer, resulting in a net expenditure increase. Methods A theoretical model was built based on a Weibull survival function. It includes savings and life extension costs over the remaining lifetime. The model was applied to the example of obesity prevention. Results The model shows that the cost consequences of prevention are essentially driven by two factors: i) the relative reduction of morbidity-related costs, which determines the amount of savings from avoiding morbidity; and ii) the hazard ratio of death, which determines the amount of life extension costs. In the application example, the model is able to validate the results of a more complex cost-effectiveness model on obesity prevention. Conclusions This work provides new insight into the lifetime cost consequences of prevention. The model can be used both to check plausibility of the results of other models and to conduct an independent analysis.
Keywords	Cost-effectiveness analysis ; Model ; Validation ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2021-11-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The price of curing cancer

Afschin Gandjour

BMC Health Services Research, Vol 21, Iss 1, Pp 1-

2021 Volume 8

Abstract: Abstract Background Health care systems around the world struggle with high prices for new cancer drugs. The purpose of this study was to conduct a gedankenexperiment and calculate how much health expenditures would change if a cure for cancer through ... ...

Abstract	Abstract Background Health care systems around the world struggle with high prices for new cancer drugs. The purpose of this study was to conduct a gedankenexperiment and calculate how much health expenditures would change if a cure for cancer through pharmaceutical treatment were made available. The cancer cure was conceived to eliminate both cancer deaths and the underlying morbidity burden of cancer. Furthermore, the cure was hypothesized to arrive in incremental steps but at infinitesimally small time intervals (resulting, effectively, in an immediate cure). Methods The analysis used secondary data and was conducted from the viewpoint of the German social health insurance. As its underlying method, it used a cause-elimination life-table approach. To account for the age distribution of the population, the study weighted age-specific increases in remaining life expectancy by age-specific population sizes. It considered drug acquisition costs as well as savings and life extension costs from eliminating cancer. All cancer drugs that underwent a mandatory early benefit assessment in Germany between 2011 and 2015/16 and were granted an added benefit were included. Data on age- and gender-specific probabilities of survival, population sizes, causes of death, and health expenditures, as well as data on cancer costs were taken from the German Federal Office of Statistics and the German Federal Social Insurance Office. Results Based on the cause-elimination life-table approach and accounting for the age structure of the German population, curing cancer in Germany yields an increase in average remaining life expectancy by 2.66 life years. Based on the current incremental cost-effectiveness ratio of new cancer drugs, which is on average €101,493 per life year gained (€39,751/0.39 life years), the German social health insurance would need to pay €280,497 per insuree to eliminate cancer. Dividing this figure by current average remaining lifetime health expenditures yields a ratio of 2.07, which represents a multiplier of ...
Keywords	Cancer ; Cure ; Health expenditure ; Public aspects of medicine ; RA1-1270
Subject code	300
Language	English
Publishing date	2021-12-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Cost-effectiveness of sofosbuvir in hepatitis C genotype 1 infection in Germany

Afschin Gandjour

PLoS ONE, Vol 15, Iss 10, p e

A reanalysis of published results.

2020 Volume 0236543

Abstract: Objectives Recently, the results of two economic evaluations were published both of which seemingly demonstrate the cost-effectiveness of sofosbuvir-based regimens for the treatment of chronic hepatitis C genotype 1 infection in Germany. Both analyses ... ...

Abstract	Objectives Recently, the results of two economic evaluations were published both of which seemingly demonstrate the cost-effectiveness of sofosbuvir-based regimens for the treatment of chronic hepatitis C genotype 1 infection in Germany. Both analyses were sponsored by the manufacturer of sofosbuvir and use a different methodology: Whereas one evaluation is based on a conventional cost-utility analysis, the other rests upon the efficiency-frontier method used by the German Institute for Quality and Efficiency in Health Care (IQWiG). The purpose of this study is to reanalysis the results of both economic evaluations in combination. Design Reanalysis of published decision modelling results. Setting Primary care in Germany. Participants Patients with chronic hepatitis C genotype 1 infection (treatment-naïve and -experienced, cirrhotic and non-cirrhotic). Interventions Sofosbuvir, other anti-hepatitis C virus drugs, and no treatment. Primary and secondary outcome measures Cost per unit of health benefit and cost per quality-adjusted life year. Results Reanalysis of the results of both economic evaluations in combination reveals an unclear rationale for choosing the selected cost-effectiveness methods as well as a potential publication bias, favoring the product of the manufacturer. Based on the reanalysis, sofosbuvir is not cost-effective in treatment-experienced non-cirrhotic patients, potentially lacks cost-effectiveness in treatment-experienced cirrhotic patients, and is only partially cost-effective in treatment-naïve non-cirrhotic patients. Taken together, these results indicate a lack of cost-effectiveness in three quarters of the German patient population. Conclusions Two economic evaluations on sofosbuvir suggest, in combination, that sofosbuvir cannot be considered a cost-effective treatment in three quarters of the German patient population.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Willingness to pay for new medicines

Afschin Gandjour

BMC Health Services Research, Vol 20, Iss 1, Pp 1-

a step towards narrowing the gap between NICE and IQWiG

2020 Volume 7

Abstract: Abstract Background The question of how to set the cost-effectiveness threshold for new, innovative medicines is a matter of ongoing controversy. One prominent proposal suggests that the cost-effectiveness threshold adopted by the U.K. National Institute ...

Abstract	Abstract Background The question of how to set the cost-effectiveness threshold for new, innovative medicines is a matter of ongoing controversy. One prominent proposal suggests that the cost-effectiveness threshold adopted by the U.K. National Institute for Health and Care Excellence (NICE) should represent the opportunity cost for the U.K. National Health Service resulting from the adoption of new medicines. The purpose of this article is to compare this proposal for the U.K. with the approach chosen by the Institute for Quality and Efficiency in Health Care (IQWiG) in Germany, which relies on indication-specific cost-effectiveness thresholds. Main text The ‘ideal’ NICE and IQWiG surprisingly share the fundamental principle of inferring the willingness to pay from existing care. For this and other reasons, indication-specific thresholds based on IQWiG’s methodology do not lead to more inefficiency at the health system’s level than a generic threshold based on the ‘ideal’ NICE (keeping other conditions the same). Also, applying either decision rule to one country will yield a similar long-term growth in population spending. Assuming that everything else is equal, both decision rules are predicted to decrease long-term expenditure growth. Convergence of the two decision rules would require, among others, ruling out waste in the ‘ideal’ NICE’s approach and, for IQWiG’s approach, using the same relative weights for life expectancy and health-related quality of life as the quality-adjusted-life-year model. Conclusion This article shows that both decision rules have notable commonalities in terms of inferring the willingness to pay from existing care and the projected impact on long-term growth in population spending.
Keywords	NICE ; IQWiG ; Cost-effectiveness ; Threshold ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2020-04-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A proportional rule for setting reimbursement prices of new drugs and its mathematical consistency

Afschin Gandjour

BMC Health Services Research, Vol 20, Iss 1, Pp 1-

2020 Volume 6

Abstract: Abstract Background Value-based pricing (VBP) of new drugs has been suggested both as a way to control health expenditures and to maximize health benefits based on the available resources. The purpose of this work is to present a simple mathematical ... ...

Abstract	Abstract Background Value-based pricing (VBP) of new drugs has been suggested both as a way to control health expenditures and to maximize health benefits based on the available resources. The purpose of this work is to present a simple mathematical proof showing that prices of new drugs are set in a mathematically consistent way when the sum of intervention and downstream costs is proportional to the size of health benefits. Such proportional relationship underlies the efficiency-frontier method used by the German Institute for Quality and Efficiency in Health Care (IQWiG). Methods A proof by contradiction is presented that is based upon the following three premises: 1) total costs (intervention plus downstream costs) of existing non-dominated drugs and interventions are acceptable to decision-making bodies; 2) new drugs with health benefits in-between those of the most and second most effective existing interventions are not automatically excluded from reimbursement and are acceptable if prices are sufficiently low; and 3) value is measured on a cardinal scale. Result The proof shows that a proportional rule sets reimbursement prices of new drugs in a mathematically consistent way. Conclusion Based on the proof and the underlying assumptions a proportional relationship between costs and health benefits ensures mathematical consistency in VBP of drugs.
Keywords	Cost-effectiveness ; Drugs ; Innovation ; Pricing ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2020-03-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Cost-effectiveness of sofosbuvir in hepatitis C genotype 1 infection in Germany

Afschin Gandjour / George Vousden

PLoS ONE, Vol 15, Iss

A reanalysis of published results

2020 Volume 10

Abstract	Objectives Recently, the results of two economic evaluations were published both of which seemingly demonstrate the cost-effectiveness of sofosbuvir-based regimens for the treatment of chronic hepatitis C genotype 1 infection in Germany. Both analyses were sponsored by the manufacturer of sofosbuvir and use a different methodology: Whereas one evaluation is based on a conventional cost-utility analysis, the other rests upon the efficiency-frontier method used by the German Institute for Quality and Efficiency in Health Care (IQWiG). The purpose of this study is to reanalysis the results of both economic evaluations in combination. Design Reanalysis of published decision modelling results. Setting Primary care in Germany. Participants Patients with chronic hepatitis C genotype 1 infection (treatment-naïve and -experienced, cirrhotic and non-cirrhotic). Interventions Sofosbuvir, other anti-hepatitis C virus drugs, and no treatment. Primary and secondary outcome measures Cost per unit of health benefit and cost per quality-adjusted life year. Results Reanalysis of the results of both economic evaluations in combination reveals an unclear rationale for choosing the selected cost-effectiveness methods as well as a potential publication bias, favoring the product of the manufacturer. Based on the reanalysis, sofosbuvir is not cost-effective in treatment-experienced non-cirrhotic patients, potentially lacks cost-effectiveness in treatment-experienced cirrhotic patients, and is only partially cost-effective in treatment-naïve non-cirrhotic patients. Taken together, these results indicate a lack of cost-effectiveness in three quarters of the German patient population. Conclusions Two economic evaluations on sofosbuvir suggest, in combination, that sofosbuvir cannot be considered a cost-effective treatment in three quarters of the German patient population.
Keywords	Medicine ; R ; Science ; Q
Subject code	360
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Costs of patients with chronic kidney disease in Germany.

Afschin Gandjour / Wencke Armsen / Wolfgang Wehmeyer / Jan Multmeier / Ulrich Tschulena

PLoS ONE, Vol 15, Iss 4, p e

2020 Volume 0231375

Abstract: Background This study aimed to determine the costs and distribution of healthcare spending of patients with chronic kidney disease (CKD) at stages 3 and 4 and on dialysis both at the individual and population level in Germany. Methods The study took the ... ...

Abstract	Background This study aimed to determine the costs and distribution of healthcare spending of patients with chronic kidney disease (CKD) at stages 3 and 4 and on dialysis both at the individual and population level in Germany. Methods The study took the perspective of the German statutory health insurance (SHI) system and analyzed claims data on 3,687,015 insurees from the year 2014. To extrapolate costs to the whole SHI population, a literature search on the prevalence of CKD was conducted. Results Average costs per person per year in an age- and gender-matched control group of the normal population were €2,876 (95% confidence interval [CI], €2,798 to €2,955) and ≥2.8-fold higher in CKD patients (€8,030 [95% CI, €7,848 to €8,212] at CKD stage 3, €9,760 [95% CI, €9,266 to €10,255] at CKD stage 4, and €44,374 [95% CI, €43,608 to €45,139] on dialysis). At CKD stages 3 and 4 the major cost driver was hospitalizations, contributing to more than 50% of total expenditures. Among dialysis patients, hospitalizations and dialysis-treatment costs contributed to 23% and 53% of total healthcare spending, respectively. At CKD stages 3 and 4, patients with the highest 20% of healthcare spending showed a considerable increase in per-patient costs over the reference population, while the bottom 80% of patients generated only moderately higher per-patient costs (p < 0.001). Comparing total CKD costs to total SHI expenditures yields that 10.2% of SHI expenditures was driven by patients at CKD stages 3 and 4 and 1.6% by dialysis patients. Conclusions Healthcare spending of patients with CKD at stages 3 and 4 and on dialysis is concentrated among a small number of high-need patients. As hospitalizations and dialysis treatment are key drivers of total expenditures, strategies that lead to a reduction in hospitalizations, delay in dialysis onset, or increase in the availability of kidney donors should become important considerations by policymakers.
Keywords	Medicine ; R ; Science ; Q
Subject code	616
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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