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Case 1 Description
You seek to explore different drug strategies to treat HIV infection. Single agent therapy with retrocyclovir at 200mg per day has a mean discounted lifetime cost of $20,000 and results in a quality-adjusted life expectancy of 70 years. Single agent therapy with retrocyclovir at 400mg per day has a mean discounted lifetime cost of $22,000 and a quality adjusted life expectancy of 65 years (given the increased incidence of side effects with the higher dose). Another drug, centroflexavir (which comes only in one dose of 250 mg/day) has a mean total lifetime cost of $10,000 and a quality-adjusted life expectancy of 50 years. The combination of centroflexavir with low-dose retrocyclovir has a mean-life time cost of $40,000 and an average quality adjusted life expectancy of 80 years, while the combination of centroflexavir with high-dose retrocyclovir has a mean lifetime cost of $35,000 and a quality-adjusted life expectancy of 75 years.
Newer ARTs are also available and their lifetime costs/QALYs are detailed below:
Cost and QALY Outcomes for ARTs
| ART 1/2 |
11,000 |
63.4 |
| ART 1 |
15,525 |
73.52 |
Instructions
Perform a cost-effectiveness analysis of the treatment options using QALYs as the measure of health effects. Which strategy would you choose and why, if the willingness-to-pay threshold is $50,000 per quality-adjusted life year?
| Do nothing |
36,000 |
43.8 |
| ART 1 |
15,525 |
73.52 |
| ART 1/2 |
11,000 |
63.4 |
| Retro 200 |
20,000 |
70.0 |
| Retro 400 |
22,000 |
65.0 |
| Centro |
10,000 |
50.0 |
| Centro / Retro 200 |
40,000 |
80.0 |
| Centro / Retro 400 |
35,000 |
75.0 |
Case 2 Description
You are interested in performing a cost-effectiveness analysis of different cancer screening recommendations for anal squamous intraepithelial lesions and anal cancer in men.
Below is a table of the costs and quality-adjusted life years gained associated with different screening strategies over a six-year time span.
Instructions
Calculate incremental cost-effectiveness ratios for each strategy and determine which screening strategy you would choose if, as a decision maker, you were prepared to pay $50,000/QALY (using discounted quality-adjusted life years)
Cost and QALY Outcomes, by Strategy
| No screening |
10.05 |
4,130 |
| Every 3 years |
10.798 |
5,178 |
| Every 2 years |
10.830 |
5,583 |
| Every 1 year |
10.973 |
6,417 |
| Every 6 months |
10.988 |
8,744 |