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[null,null,"This Excel workbook contains the Evidence Map generated from heoro.com on\nCosts studies in cystic fibrosis since 2000. "]
[]
[]
[null,null,"How this Evidence Map was generated"]
[null,null,null,"We searched the heoro.com database on 17 May 2017 with the following field settings:"]
[null,null,null,"Disease: Cystic fibrosis AND Study type:  Costs and resource use studies: Direct costs OR Indirect costs "]
[null,null,null,"The search identified a total of 60 abstracts published since 1960 which were  segmented with the following standard heoro.com fields:"]
[null,null,null,null,"Locations - these are the geographical location of the study. "]
[null,null,null,null,"Interventions - the interventions assessed in each study, where relevant."]
[null,null,null,null,"Study types - whether the study reported direct costs or indirect costs"]
[null,null,null,"In addition the following publication date segmentations are used:"]
[null,null,null,null,"1960 to 1999, 2000 to 2004, 2005 to 2009, 2010 to 2014, 2015 to 2017"]
[]
[null,null,"All data in this Evidence Map is taken from the heoro.com database"]
[]
[null,null,"Details of the PubMed search strategy used to populate the heoro.com database can be found here."]
[]
[null,null,"Contact us:"]
[null,null,"Address: Crystallise Ltd. Unit 21, Thames Enterpise Centre, Thames Industrial Park, East Tilbury, Essex, UK RM18 8RH"]
[null,null,"Tel: +44 (0)1375 488020"]
[null,null,"Email: heoro@crystallise.com"]

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[{"$f":"COUNT(A2:A1701)","v":60},"Full citation","DOI","Authors","Title","Abstract","Citation","Locations","Year","Diseases","Interventions","Type of PRO tool","PROtools","Subpopulations","Study types","Study methodologies","LocationsTags","SubpopulationsTags","DiseaseTags","InterventionsTags","StudytypesTags","StudyMethodologyTags","PROtoolTags","DateBand","C1","C2","C3","C4","C5"]
[1,"Balaguer A,González de Dios J. Home versus hospital intravenous antibiotic therapy for cystic fibrosis. Cochrane Database Syst Rev. 2015 Dec 15;12():CD001917. doi: 10.1002/14651858.CD001917.pub4. Epub 2015 Dec 15. ","10.1002/14651858.CD001917.pub4. ","Balaguer A,González de Dios J."," Home versus hospital intravenous antibiotic therapy for cystic fibrosis.","Recurrent endobronchial infection in cystic fibrosis requires treatment with intravenous antibiotics for several weeks usually in hospital,affecting health costs and quality of life for patients and their families. This is an update of a previously published review. To determine whether home intravenous antibiotic therapy in cystic fibrosis is as effective as inpatient intravenous antibiotic therapy and if it is preferred by individuals or families or both. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Most recent search of the Group's Trials Register: 23 November 2015. Randomized and quasi-randomized controlled studies of intravenous antibiotic treatment for adults and children with cystic fibrosis at home compared to in hospital. The authors independently selected studies for inclusion in the review,assessed methodological quality of each study and extracted data using a standardised form. Eighteen studies were identified by the searches. Only one study could be included which reported results from 17 participants aged 10 to 41 years with an infective exacerbation of Pseudomonas aeruginosa. All their 31 admissions (18 hospital and 13 at home after two to four days of hospital treatment) were analysed as independent events. Outcomes were measured at 0,10 and 21 days after initiation of treatment. Home participants underwent fewer investigations than hospital participants (P < 0.002) and general activity was higher in the home group. No significant differences were found for clinical outcomes,adverse events,complications or change of intravenous lines,or time to next admission. Home participants received less low-dose home maintenance antibiotic.Quality of life measures showed no significant differences for dyspnoea and emotional state,but fatigue and mastery were worse for home participants,possibly due to a higher general activity and need of support. Personal,family,sleeping and eating disruptions were less important for home than hospital admissions.Home therapy was cheaper for families and the hospital. Indirect costs were not determined. Current evidence is restricted to a single randomized clinical trial. It suggests that,in the short term,home therapy does not harm individuals,entails fewer investigations,reduces social disruptions and can be cost-effective. There were both advantages and disadvantages in terms of quality of life. The decision to attempt home treatment should be based on the individual situation and appropriate local resources. More research is urgently required.","Cochrane Database Syst Rev. 2015 Dec 15;12():CD001917.","International",2015,null,"Antibiotics",null,null,null,"Direct costs"]
[2,"Moodie M,Lal A,Vidmar S,Armstrong DS,Byrnes CA,Carlin JB,Cheney J,Cooper PJ,Grimwood K,Robertson CF,Tiddens HA,Wainwright CE,Australasian Cystic Fibrosis Bronchoalveolar Lavage Study Investigators. Costs of bronchoalveolar lavage-directed therapy in the first 5 years of life for children with cystic fibrosis. J Pediatr. 2014 Sep;165(3):564-569.e5. doi: 10.1016/j.jpeds.2014.05.031. Epub 2014 Jul 1.",null,"Moodie M,Lal A,Vidmar S,Armstrong DS,Byrnes CA,Carlin JB,Cheney J,Cooper PJ,Grimwood K,Robertson CF,Tiddens HA,Wainwright CE,Australasian Cystic Fibrosis Bronchoalveolar Lavage Study Investigators.","Bronchoalveolar Lavage Study Investigators. Costs of bronchoalveolar lavage-directed therapy in the first 5 years of life for children with cystic fibrosis.","To determine whether bronchoalveolar lavage (BAL)-directed therapy for infants and young children with cystic fibrosis (CF),rather than standard therapy,was justified on the grounds of a decrease in average costs and whether the use of BAL reduced treatment costs associated with hospital admissions. Costs were assessed in a randomized controlled trial conducted in Australia and New Zealand on infants diagnosed with CF after newborn screening and assigned to receive either BAL-directed or standard therapy until they reached 5 years of age. A health care funder perspective was adopted. Resource use measurement was based on standardized data collection forms administered for patients across all sites. Unit costs were obtained primarily from government schedules. Mean costs per child during the study period were Australian dollars (AUD)92 860 in BAL-directed therapy group and AUD90 958 in standard therapy group (mean difference AUD1902,95% CI AUD-27 782 to 31 586,P = .90). Mean hospital costs per child during the study period were AUD57 302 in the BAL-directed therapy group and AUD66 590 in the standard therapy group (mean difference AUD-9288; 95% CI AUD-35 252 to 16 676,P = .48). BAL-directed therapy did not result in either lower mean hospital admission costs or mean costs overall compared with managing patients with CF by a standard protocol based upon clinical features and oropharyngeal culture results alone. Following on our previous findings that BAL-directed treatment offers no clinical advantage over standard therapy at age 5 years,flexible bronchoscopy with BAL cannot be recommended for the routine management of preschool children with CF on the basis of overall cost savings."," J Pediatr. 2014 Sep;165(3):564-569.e5.","Australia,New Zealand",2014,null,"Bronchiolar lavage",null,null,null,"Direct costs"]
[3,"Whiting P,Al M,Burgers L,Westwood M,Ryder S,Hoogendoorn M,Armstrong N,Allen A,Severens H,Kleijnen J. Ivacaftor for the treatment of patients with cystic fibrosis and the G551D mutation: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2014 Mar;18(18):1-106. doi: 10.3310/hta18180. ",null,"Whiting P,Al M,Burgers L,Westwood M,Ryder S,Hoogendoorn M,Armstrong N,Allen A,Severens H,Kleijnen J"," Ivacaftor for the treatment of patients with cystic fibrosis and the G551D mutation: a systematic review and cost-effectiveness analysis.","Ivacaftor (Kalydeco(®),Vertex Pharmaceuticals) is the first of a new class of drugs that target the underlying protein defect in cystic fibrosis (CF). It is aimed at patients with the G551D (glycine to aspartate change in nucleotide 1784 in exon 11) mutation; 5.7% of patients with CF in the UK have this mutation. To review the clinical effectiveness and cost-effectiveness of ivacaftor for the treatment of CF in patients aged ≥ 6 years who have the G551D mutation. Ten databases,including MEDLINE and EMBASE,were searched from inception to July 2012. Studies that evaluated ivacaftor for the treatment of adults and children (≥ 6 years) with at least one G551D mutation were eligible. There were insufficient data to conduct a formal meta-analysis. The manufacturer of ivacaftor,Vertex Pharmaceuticals,submitted a deterministic patient-level simulation model for the assessment of the lifetime cost-effectiveness of ivacaftor. We modified the model where values were not UK-specific or not recent,or where better estimates could be found. The only change to the model structure was the addition of lung transplantations. We changed utility values,annual decline in percentage predicted forced expiratory volume in 1 second (FEV1),and the baseline exacerbation rate,and used data from the CF Registry to estimate the relation between costs,age and percentage predicted FEV1. Estimates of treatment effect of ivacaftor came from the clinical effectiveness review. We modelled three scenarios for the longer-term effects of ivacaftor. We also modelled an 'optimistic' scenario for patients aged < 12 years with little lung damage. We conducted a budget impact analysis to estimate the total cost to the NHS of introducing ivacaftor in England. Three studies were included: a randomised controlled trial (RCT) in adults (n = 167) (≥ 12 years),a RCT in children (n = 26) (6-11 years),and an open-label extension study of the two RCTs. Both RCTs reported significantly greater changes from baseline in all measures of lung function in patients receiving ivacaftor than in those receiving placebo. The mean difference in change in percentage predicted FEV1 was 10.5 [95% confidence interval (CI) 8.5 to 12.5] percentage points in the adults' study and 10.0 (95% CI 4.5 to 15.5) percentage points in the children's study at 48 weeks. Improvements in lung function were seen across all subgroups investigated (age,sex,study region and lung function). There were significantly greater improvements in the ivacaftor group than in the placebo group for all outcomes assessed (exacerbations,quality of life,sweat chloride and weight) with the exception of quality of life in children. Improvements were maintained in the open-label trial. Adverse events were mainly minor and comparable across treatment groups. Both RCTs reported more withdrawals in the placebo group than in the ivacaftor group. The incremental cost-effectiveness ratio varied between £335,000 and £1,274,000 per quality-adjusted life-year gained. The total additional lifetime costs for all eligible CF patients in England ranged from £438M to £479M; the lifetime cost for standard care only was £72M. The available evidence suggests that ivacaftor is a clinically effective treatment for patients with CF and the G551D mutation; the high cost of ivacaftor may prove an obstacle in the uptake of this treatment. The main priority for further research is the long-term effectiveness of ivacaftor. This study is registered as PROSPERO CRD42012002516. The National Institute for Health Research Health Technology Assessment programme.",". Health Technol Assess. 2014 Mar;18(18):1-106.","UK",2014,null,"Ivacaftor",null,null,null,"Direct costs"]
[4,"Tappenden P,Harnan S,Uttley L,Mildred M,Walshaw M,Taylor C,Brownlee K. The cost effectiveness of dry powder antibiotics for the treatment of Pseudomonas aeruginosa in patients with cystic fibrosis. Pharmacoeconomics. 2014 Feb;32(2):159-72. doi: 10.1007/s40273-013-0122-x.",null,"Tappenden P,Harnan S,Uttley L,Mildred M,Walshaw M,Taylor C,Brownlee K. ","The cost effectiveness of dry powder antibiotics for the treatment of Pseudomonas aeruginosa in patients with cystic fibrosis","Cystic fibrosis (CF) affects over 9,000 people in the UK and limits life expectancy. CF patients are susceptible to lung infections,most commonly Pseudomonas aeruginosa. Once infection is established,patients require lifetime treatment using nebulised antibiotics. Newer dry powder formulations of antibiotics may reduce treatment burden and improve compliance. Our objective was to evaluate the cost effectiveness of (i) colistimethate sodium dry powder for inhalation (DPI) and (ii) tobramycin DPI versus nebulised tobramycin for the treatment of chronic P. aeruginosa lung infection in patients with CF from the perspective of the National Health Service (NHS) and Personal Social Services (PSS). We developed a state transition model based on transitions between three strata of lung function measured in terms of forced expiratory volume in 1 second (FEV1) % predicted. Additional health states representing post-lung transplantation and dead are also modelled. The model structure was informed by systematic reviews of evidence concerning the plausibility of potential relationships between intermediate endpoints and final outcomes. The model assumes that treatment impacts on FEV1 trajectory,which manifest as changes in health-related quality of life. No survival benefit is assumed due to the absence of robust quantifiable evidence. Model parameters were informed by patient-level and aggregate data from two randomised controlled trials together with the best available evidence from the literature. Resource use and costs associated with drug acquisition,the management of exacerbations and reduced nebuliser maintenance were drawn from reference sources and expert opinion. Costs were valued at 2011/2012 prices. Costs and health outcomes were discounted at a rate of 3.5 %. Simple and probabilistic sensitivity analyses were undertaken,including additional analyses of Patient Access Scheme (PAS) price discounts offered by the manufacturers of both DPI products. Colistimethate sodium DPI is expected to produce fewer quality-adjusted life-years (QALYs) than nebulised tobramycin. Based on its list price,colistimethate sodium DPI is expected to be dominated by nebulised tobramycin. When the PAS is incorporated,the incremental cost-effectiveness ratio (ICER) for colistimethate sodium DPI versus nebulised tobramycin is expected to be approximately £288,600 saved per QALY lost. Based on its current list price,the ICER for tobramycin DPI versus nebulised tobramycin is expected to be approximately £124,000 per QALY gained. When the proposed PAS is included,tobramycin DPI is expected to dominate nebulised tobramycin. Under their list prices,neither DPI product is likely to represent good value for money for the NHS given current cost-effectiveness thresholds. The PAS discounts have a significant impact upon the economic attractiveness of both DPI products compared against nebulised tobramycin. The clinical effectiveness and cost effectiveness of the DPIs against other nebulised antibiotics,such as aztreonam and inhaled colistimethate sodium,remains unclear.","Pharmacoeconomics. 2014 Feb;32(2):159-72. ","UK",2014,null,"Antibiotics",null,null,null,"Direct costs"]
[5,"Nshimyumukiza L,Bois A,Daigneault P,Lands L,Laberge AM,Fournier D,Duplantie J,Giguère Y,Gekas J,Gagné C,Rousseau F,Reinharz D. Cost effectiveness of newborn screening for cystic fibrosis: a simulation study. J Cyst Fibros. 2014 May;13(3):267-74. doi: 10.1016/j.jcf.2013.10.012. Epub 2013 Nov 12.",null,"Nshimyumukiza L,Bois A,Daigneault P,Lands L,Laberge AM,Fournier D,Duplantie J,Giguère Y,Gekas J,Gagné C,Rousseau F,Reinharz D.","Cost effectiveness of newborn screening for cystic fibrosis: a simulation study","Early detection of cystic fibrosis (CF) by newborn screening (NBS) reduces the rate of avoidable complications. NBS protocols vary by jurisdiction and the cost effectiveness of these different protocols is debated. To compare the cost effectiveness of various CF NBS options. A Markov model was built to simulate the cost effectiveness of various CF-NBS options for a hypothetical CF-NBS program over a 5-year time horizon assuming its integration into an existing universal NBS program. NBS simulated options were based on a combination of tests between the two commonly used immunoreactive trypsinogen (IRT) cutoffs (96th percentile and 99.5th percentile) as first tier tests,and,as a second tier test,either a second IRT,pancreatic-associated protein (PAP) or CFTR mutation panels. CFTR mutation panels were also considered as an eventual third tier test. Data input parameters used were retrieved from a thorough literature search. Outcomes considered were the direct costs borne by the Quebec public health care system and the number of cases of CF detected through each strategy,including the absence of screening option. IRT-PAP with an IRT cutoff at the 96th percentile is the most favorable option with a ratio of CAD$28,432 per CF case detected. The next most favorable alternative is the IRT1-IRT2 option with an IRT1 cutoff at the 96th percentile. The no-screening option is dominated by all NBS screening protocols considered. Results were robust in sensitivity analyses. This study suggests that NBS for cystic fibrosis is a cost-effective strategy compared to the absence of NBS. The IRT-PAP newborn screening algorithm with an IRT cutoff at the 96th percentile is the most cost effective NBS approach for Quebec.","J Cyst Fibros. 2014 May;13(3):267-74. ","Canada",2014,null,"Screening",null,null,null,"Direct costs,Indirect costs"]
[6,"Eidt-Koch D,Wagner TO,Mittendorf T,Reimann A,von der Schulenburg JM. Resource usage in outpatient care and reimbursement for cystic fibrosis in Germany. Pediatr Pulmonol. 2011 Mar;46(3):278-85. doi: 10.1002/ppul.21364. Epub 2010 Nov 17. ",null,"Eidt-Koch D,Wagner TO,Mittendorf T,Reimann A,von der Schulenburg JM. ","Resource usage in outpatient care and reimbursement for cystic fibrosis in Germany.","Objective of this study is to assess and evaluate resource use in outpatient treatment in Germany and to compare it with remuneration. Outpatient treatment was evaluated in seven different centers for pediatric and adult CF patients. Data were recorded during one representative month in 2006. A micro-costing approach was used to value resource use data. For outpatient treatment mean costs (excluding drugs) of 488 € per patient per quarter occurred. Correlation analyses identified significant cost drivers including age and co-morbidities (pancreatic insufficiency,hepatobiliary complications,lung function capacity,or bacterial lung colonization). Remuneration covered only 51% of the total costs (252 € per patient/quarter). As the human resources available to these centers today are already below the requirements set by the European consensus for standards of CF care it will be important for a high level of patient care to reach a cost-covering remuneration scheme.","Pediatr Pulmonol. 2011 Mar;46(3):278-85. ","Germany",2010,null,"Outpatient care",null,null,null,"Direct costs"]
[7,"Wells J,Rosenberg M,Hoffman G,Anstead M,Farrell PM. A decision-tree approach to cost comparison of newborn screening strategies for cystic fibrosis. Pediatrics. 2012 Feb;129(2):e339-47. doi: 10.1542/peds.2011-0096. Epub 2012 Jan 30.",null,"Wells J,Rosenberg M,Hoffman G,Anstead M,Farrell PM."," A decision-tree approach to cost comparison of newborn screening strategies for cystic fibrosis.","Because cystic fibrosis can be difficult to diagnose and treat early,newborn screening programs have rapidly developed nationwide but methods vary widely. We therefore investigated the costs and consequences or specific outcomes of the 2 most commonly used methods. With available data on screening and follow-up,we used a simulation approach with decision trees to compare immunoreactive trypsinogen (IRT) screening followed by a second IRT test against an IRT/DNA analysis. By using a Monte Carlo simulation program,variation in the model parameters for counts at various nodes of the decision trees,as well as for costs,are included and applied to fictional cohorts of 100 000 newborns. The outcome measures included the numbers of newborns given a diagnosis of cystic fibrosis and costs of screening strategy at each branch and cost per newborn. Simulations revealed a substantial number of potential missed diagnoses for the IRT/IRT system versus IRT/DNA. Although the IRT/IRT strategy with commonly used cutoff values offers an average overall cost savings of $2.30 per newborn,a breakdown of costs by societal segments demonstrated higher out-of-pocket costs for families. Two potential system failures causing delayed diagnoses were identified relating to the screening protocols and the follow-up system. The IRT/IRT screening algorithm reduces the costs to laboratories and insurance companies but has more system failures. IRT/DNA offers other advantages,including fewer delayed diagnoses and lower out-of-pocket costs to families."," Pediatrics. 2012 Feb;129(2):e339-47.","USA",2012,null,"Screening",null,null,null,"Direct costs"]
[8,"Kopp BT,Wang W,Chisolm DJ,Kelleher KJ,McCoy KS. Inpatient healthcare trends among adult cystic fibrosis patients in the U.S. Pediatr Pulmonol. 2012 Mar;47(3):245-51. doi: 10.1002/ppul.21535. Epub 2011 Sep 7. ",null,"Kopp BT,Wang W,Chisolm DJ,Kelleher KJ,McCoy KS"," Inpatient healthcare trends among adult cystic fibrosis patients in the U.S.","Adult cystic fibrosis (CF) patients are an expanding cohort that is taken care of in a variety of hospital settings including adult centers located within pediatric institutions. This study compared costs and discharge rates among adult CF patient hospitalizations in terms of location of hospitalization. The 2007 Nationwide Inpatient Sample was utilized to identify adult CF patient admission data on patients aged 18-44. Data were separated into pediatric and adult facilities based on percentage discharge rate for patients >18. Primary outcomes measures were length of stay (LOS) and total hospital charges. Secondary predictors were geographic,primary payer,and co-morbidity effects on LOS and total hospital charges. LOS was higher for adult CF patient admissions in pediatric facilities compared to adult facilities by a mean of 2.5 days. Mean total hospital charges were not significantly different. Adult hospitals in the Western U.S. had a mean total charge more than $50,000 greater than any region in the U.S. Self-pay patients had significantly fewer hospital days and charges across all hospital types. Adult facilities had 7% more CF patients discharged home with home healthcare use. Depressed CF patients had longer LOS by 1.5 days regardless of facility type. LOS for adult CF inpatient admissions was significantly lower in adult facilities compared to pediatric facilities without a significant difference in hospital charges and is influenced by geographic hospital location. Depressed patients had longer lengths of stay regardless of facility type. Self-insured adult CF patients have a significant reduction in LOS and hospital charges when compared to all other payers regardless of hospital type."," Pediatr Pulmonol. 2012 Mar;47(3):245-51.","USA",2011,null,"Inpatient care",null,null,null,"Direct costs"]
[9,"Antoñanzas F,Rodríguez-Ibeas R,Hutter MF,Lorente R,Juárez C,Pinillos M. Genetic testing in the European Union: does economic evaluation matter? Eur J Health Econ. 2012 Oct;13(5):651-61. doi: 10.1007/s10198-011-0319-x. Epub 2011 May 20.",null,"Antoñanzas F,Rodríguez-Ibeas R,Hutter MF,Lorente R,Juárez C,Pinillos M"," Genetic testing in the European Union: does economic evaluation matter?","We review the published economic evaluation studies applied to genetic technologies in the EU to know the main diseases addressed by these studies,the ways the studies were conducted and to assess the efficiency of these new technologies. The final aim of this review was to understand the possibilities of the economic evaluations performed up to date as a tool to contribute to decision making in this area. We have reviewed a set of articles found in several databases until March 2010. Literature searches were made in the following databases: PubMed; Euronheed; Centre for Reviews and Dissemination of the University of York-Health Technology Assessment,Database of Abstracts of Reviews of Effects,NHS Economic Evaluation Database; and Scopus. The algorithm was \"(screening or diagnosis) and genetic and (cost or economic) and (country EU27)\". We included studies if they met the following criteria: (1) a genetic technology was analysed; (2) human DNA must be tested for; (3) the analysis was a real economic evaluation or a cost study,and (4) the articles had to be related to any EU Member State. We initially found 3,559 papers on genetic testing but only 92 articles of economic analysis referred to a wide range of genetic diseases matched the inclusion criteria. The most studied diseases were as follows: cystic fibrosis (12),breast and ovarian cancer (8),hereditary hemochromatosis (6),Down's syndrome (7),colorectal cancer (5),familial hypercholesterolaemia (5),prostate cancer (4),and thrombophilia (4). Genetic tests were mostly used for screening purposes,and cost-effectiveness analysis is the most common type of economic study. The analysed gene technologies are deemed to be efficient for some specific population groups and screening algorithms according to the values of their cost-effectiveness ratios that were below the commonly accepted threshold of 30,000€. Economic evaluation of genetic technologies matters but the number of published studies is still rather low as to be widely used for most of the decisions in different jurisdictions across the EU. Further,the decision bodies across EU27 are fragmented and the responsibilities are located at different levels of the decision process for what it is difficult to find out whether a given decision on genetic tests was somehow supported by the economic evaluation results.","Eur J Health Econ. 2012 Oct;13(5):651-61.","International",2012,null,"Screening",null,null,null,"Direct costs"]
[10,"Lillquist YP,Cho E,Davidson AG. Economic effects of an eradication protocol for first appearance of Pseudomonas aeruginosa in cystic fibrosis patients: 1995 vs. 2009. J Cyst Fibros. 2011 May;10(3):175-80. doi: 10.1016/j.jcf.2011.01.002. Epub 2011 Feb 18. ",null,"Lillquist YP,Cho E,Davidson AG. ","Economic effects of an eradication protocol for first appearance of Pseudomonas aeruginosa in cystic fibrosis patients: 1995 vs. 2009.","Acquisition of Pseudomonas aeruginosa (Psa) and infection with mucoid strains is associated with repeated pulmonary exacerbations which often require intravenous and long-term nebulised antibiotic treatments,repeated hospitalizations and leads to a more precipitous decline in lung function. Anti-Psa antibiotic therapy early in the course of Psa infection in patients with cystic fibrosis (CF) may result in eradication of Psa and prevention or delay of colonization with the organism. From January 1995 to December 2009 our paediatric CF clinic has followed an early eradication protocol for the first appearance of Psa. In this paper we report on the economic effects after 15 years as reflected in hospitalization and antibiotic usage and cost. The Psa-eradication protocol includes 2 weeks of IV piperacillin and tobramycin,followed by oral ciprofloxacin for 3 weeks,and nebulised colistimethate for 6 months. The same protocol is used for newly diagnosed CF patients who grow Psa on their first visit or who grow a mucoid strain,multiresistant strain of Psa or whose Psa co-cultured with Burkholderia cepacia complex,and for patients in whom Psa recurs after initial clearance. 195 Psa eradication courses were completed from 1995 to 2009 with an overall Psa clearance rate of 90%. Patients that only cultured a Psa classic (non-mucoid) strain had a clearance rate was 96.5%. The percentage of children chronically infected with Psa has declined from 44% in 1994 to 15% in 2009.Total days spent in hospital for all reasons declined by 43%; chronic Psa hospital days declined by 75%; IV and nebulised anti-Psa antibiotic costs reduced by 44%. Results indicate that application of a Pseudomonas eradication protocol as described in this report has economic and resource utilization benefits in addition to clinical benefits."," J Cyst Fibros. 2011 May;10(3):175-80. ","Canada",2011,null,"Antibiotics",null,null,null,"Direct costs"]
[11,"Woodward TC,Brown R,Sacco P,Zhang J. Budget impact model of tobramycin inhalation solution for treatment of Pseudomonas aeruginosa in cystic fibrosis patients. J Med Econ. 2010;13(3):492-9. doi: 10.3111/13696998.2010.505863. ",null,"Woodward TC,Brown R,Sacco P,Zhang J.","Budget impact model of tobramycin inhalation solution for treatment of Pseudomonas aeruginosa in cystic fibrosis patients.","Pseudomonas aeruginosa (PA) is the most common airway pathogen in cystic fibrosis (CF) patients. The objective of this analysis was to determine the costs of managing PA infection in CF patients with a chronic regimen of tobramycin inhalation solution (TIS). A budget impact model of CF patients was developed to evaluate the costs of TIS from a US managed-care organization (MCO) perspective. The Microsoft Excel model compared TIS treatment plus standard care with standard care alone over a 4-year time horizon and included the cost of drugs,medical care,and annual probabilities of hospitalization and IV anti-pseudomonal (anti-PA) antibiotics administration. For an MCO with 5,000,000 members,389 members 6 years of age or older were estimated to have CF,and 218 (56%) had PA infection. Assuming that use of TIS increased from 20% to 25%,the 1-year budget increased $231,251 or from $0.049 to $0.053 per member per month (PMPM). The net drug budget increase was $243,919,while medical costs associated with exacerbation management decreased $12,669 over the first year. Increasing utilization of TIS,from 20% to 40% over 4 years resulted in an incremental overall budget increase of $925,002,a 3% decrease in hospitalizations,and a 4% decrease in administrations of IV anti-PA antibiotics. These reductions translated to a medical care cost saving of $50,676 over 4 years. Limitations of this study include that the clinical data for the model are from clinical trials conducted in 1996 and the estimation of TIS use for CF patients with chronic PA infections can be impacted by TIS adherence. Model results suggest that increasing the use of TIS decreases medical care costs due to decreased hospital admissions and the use of IV anti-PA antibiotics at the expense of higher drug costs."," J Med Econ. 2010;13(3):492-9. ","USA",2010,null,"Antibiotics",null,null,null,"Direct costs"]
[12,"Chandrasekharan S,Heaney C,James T,Conover C,Cook-Deegan R. Impact of gene patents and licensing practices on access to genetic testing for cystic fibrosis. Genet Med. 2010 Apr;12(4 Suppl):S194-211. doi: 10.1097/GIM.0b013e3181d7cf7d. ",null,"Chandrasekharan S,Heaney C,James T,Conover C,Cook-Deegan R.","Impact of gene patents and licensing practices on access to genetic testing for cystic fibrosis.","Cystic fibrosis is one of the most commonly tested autosomal recessive disorders in the United States. Clinical cystic fibrosis is associated with mutations in the CFTR gene,of which the most common mutation among Caucasians,DeltaF508,was identified in 1989. The University of Michigan,Johns Hopkins University,and the Hospital for Sick Children,where much of the initial research occurred,hold key patents on cystic fibrosis genetic sequences,mutations,and methods for detecting them. Several patents,including the one that covers detection of the DeltaF508 mutation,are jointly held by the University of Michigan and the Hospital for Sick Children in Toronto,with Michigan administering patent licensing in the United States. The University of Michigan broadly licenses the DeltaF508 patent for genetic testing with >60 providers of genetic testing to date. Genetic testing is now used in newborn screening,diagnosis,and for carrier screening. Interviews with key researchers and intellectual property managers,a survey of laboratories' prices for cystic fibrosis genetic testing,a review of literature on cystic fibrosis tests' cost-effectiveness,and a review of the developing market for cystic fibrosis testing provide no evidence that patents have significantly hindered access to genetic tests for cystic fibrosis or prevented financially cost-effective screening. Current licensing practices for cystic fibrosis genetic testing seem to facilitate both academic research and commercial testing. More than 1000 different CFTR mutations have been identified,and research continues to determine their clinical significance. Patents have been nonexclusively licensed for diagnostic use and have been variably licensed for gene transfer and other therapeutic applications. The Cystic Fibrosis Foundation has been engaged in licensing decisions,making cystic fibrosis a model of collaborative and cooperative patenting and licensing practice."," Genet Med. 2010 Apr;12(4 Suppl):S194-211.","USA",2010,null,"Screening",null,null,null,"Direct costs"]
[13,"Weiner JR,Toy EL,Sacco P,Duh MS. Costs,quality of life and treatment compliance associated with antibiotic therapies in patients with cystic fibrosis: a review of the literature. Expert Opin Pharmacother. 2008 Apr;9(5):751-66. doi: 10.1517/14656566.9.5.751. ",null,"Weiner JR,Toy EL,Sacco P,Duh MS. ","Costs,quality of life and treatment compliance associated with antibiotic therapies in patients with cystic fibrosis: a review of the literature","Cystic fibrosis is the most common incurable hereditary disease in the US. Persistent respiratory infection is the leading cause of morbidity and mortality in cystic fibrosis patients. This study aimed to review the literature on economic and quality of life outcomes and treatment compliance associated with antibiotic therapies for cystic fibrosis patients. A systematic literature review was conducted using keyword searches of the MEDLINE database and selected conference abstracts. The review covered studies published between January 1990 and May 2007. Evidence suggests that inhaled tobramycin,a key chronic suppressive therapy,can reduce other healthcare costs. The main determinants of the cost of care include disease severity and respiratory infection. Costs vary widely by country. There is evidence that inhaled tobramycin and oral azithromycin improve quality of life and that treatment setting and patient convenience may also impact on quality of life. Antibiotic treatment compliance varied significantly and depended on the method of measurement,with more subjective measures tending to be higher. This review concludes by offering directions for future research.","Expert Opin Pharmacother. 2008 Apr;9(5):751-66. ","International",2008,null,"Antibiotics",null,null,null,"Direct costs"]
[14,"Vasiliadis HM,Collet JP,Penrod JR,Ferraro P,Poirier C. A cost-effectiveness and cost-utility study of lung transplantation. J Heart Lung Transplant. 2005 Sep;24(9):1275-83. doi: 10.1016/j.healun.2004.10.012.",null,"Vasiliadis HM,Collet JP,Penrod JR,Ferraro P,Poirier C."," A cost-effectiveness and cost-utility study of lung transplantation.","Life-threatening complications and expensive posttransplantation medical care raises the issue whether lung transplantation (L-Tx) is cost effective. We studied,from a health care system perspective,the cost effectiveness (C/E) and cost utility (C/U) of L-Tx in a Canadian setting. An incremental C/E and C/U analysis of L-Tx,compared with the waiting list (WL),was carried out on 124 patients accepted into the Quebec L-Tx WL (1997-2001). Survival was presented in mean life-years (LYs). Utility,assessed with the standard gamble,was used in computing the quality-adjusted life-years (QALY). Different person-time experiences were simulated. Costs (95% confidence interval),in US dollars,were discounted at 5%. The mean LYs and QALYs gained were 0.57 (0.36-0.78) and 0.62 (0.36-0.78),respectively. The cost per patient without Tx was 1102 dollars (856 dollars-1348 dollars) per month. The L-Tx program induced a screening cost of 6208 dollars per patient. The cost of the L-Tx procedure (n = 91) was 31,815 dollars (25,301 dollars-44,816 dollars). The post-Tx cost per month in the first,second,third,and fourth year was 1809 dollars dollars (1187 dollars-2446 dollars),1060 dollars (703 dollars-1478 dollars),1128 dollars (519 dollars-1735 dollars),and 626 dollars (495 dollars-758 dollars),respectively. The projected C/E and C/U of the L-Tx program,assessed on the basis of pre- and post-Tx extrapolations,reached 40,048 dollars and 46,631 dollars,respectively. L-Tx in this Canadian setting yielded a benefit in mean LYs and QALYs gained. Although the program is expensive,the C/E and C/U ratios for some patient groups prove to be an acceptable cost for the benefits observed."," J Heart Lung Transplant. 2005 Sep;24(9):1275-83. ","Canada",2005,null,"Lung transplant",null,null,null,"Direct costs"]
[15,"Reams BD,Palmer SM. Sublingual tacrolimus for immunosuppression in lung transplantation: a potentially important therapeutic option in cystic fibrosis. Am J Respir Med. 2002;1(2):91-8. ",null,"Reams BD,Palmer SM"," Sublingual tacrolimus for immunosuppression in lung transplantation: a potentially important therapeutic option in cystic fibrosis.","Lung transplantation has emerged as an option to prolong and increase the quality of life in patients with end-stage pulmonary lung disease. In lung transplant recipients,because of the high potential for acute and chronic allograft rejection,optimal selection,dosage and delivery of immunosuppressive medications is critical. Cystic fibrosis (CF),a multi-organ system disease that often includes pulmonary and gastrointestinal manifestations,represents the leading indication for bilateral lung transplantation. The gastrointestinal manifestations of CF,however,confound post-transplant management by causing significant variation in the rate and extent of absorption of orally administered immunosuppressive medications. Tacrolimus,a new calcineurin inhibitor,is increasingly employed as the primary immunosuppressive agent in lung transplant recipients. Unfortunately,tacrolimus itself exhibits variable bioavailability,particularly in CF transplant recipients. A novel approach to the absorption dilemma is administration of tacrolimus via the sublingual (SL) route. Little published information exists concerning the use of SL immunosuppression in transplant recipients. However,emerging evidence suggests that SL tacrolimus provides is an effective means of drug delivery particularly for CF lung transplant recipients. Preliminary results from a pilot study,demonstrate that SL delivery of tacrolimus achieves therapeutic serum levels,in lung transplant recipients with CF,over the first few postoperative months. In addition,the early postoperative use of SL tacrolimus has been associated with acceptable rates of transplant rejection and normal renal function in a cohort of 22 lung transplant recipients that included CF and non-CF transplant recipients. Potential pharmacokinetic advantages of the SL route of delivery include good permeability,rapid absorption,acceptable bioavailability and easy accessibility. From an economic standpoint,considerable cost savings could be achieved by using the SL rather than the intravenous route of drug delivery for tacrolimus. Comparative,prospective randomized trials are necessary to evaluate the long-term safety and efficacy of SL tacrolimus in lung transplant patients. Until such data are available,the use of SL tacrolimus should be considered in situations where alternative routes of delivery are unavailable or as part of ongoing research studies. Ultimately,SL tacrolimus may prove efficacious for short-term use in the early postoperative lung transplant recipients,particularly in patients with malabsorption problems such as CF transplant recipients."," Am J Respir Med. 2002;1(2):91-8. ","International",2002,null,"Lung transplant",null,null,null,"Direct costs"]
[16,"Krauth C,Jalilvand N,Welte T,Busse R. Cystic fibrosis: cost of illness and considerations for the economic evaluation of potential therapies. Pharmacoeconomics. 2003;21(14):1001-24. ",null,"Krauth C,Jalilvand N,Welte T,Busse R. ","Cystic fibrosis: cost of illness and considerations for the economic evaluation of potential therapies.","Cystic fibrosis (CF) is the most common life-shortening inherited disease of the Caucasian race,with a prevalence of around 1 in 2500 live births. Advances in the treatment and management of respiratory and pancreatic disorders have dramatically increased the life expectancy of patients with CF. This article presents an overview of cost-of-illness studies of CF,identifies deficits in the available health economic analyses of CF and discusses which specific factors are essential for the economic evaluation of potential therapies,based on a critical review of the health economic literature on two main therapeutic strategies. Cost-of-illness studies of CF have predominantly been restricted to direct costs. According to the literature,direct costs amount to between 6200- 16300 US dollars (1996 values) per patient per year. As most studies likely underestimated the actual costs (e.g. by disregarding provision of certain healthcare services),real healthcare costs tend to be at the upper end of the cost range. Healthcare costs depend on the patient's age (for adults,costs are approximately twice as high as for children),the grade of severity (the cost relationship of severe to mild CF is between 4.5 and 7.1) and other factors. Lifetime direct costs of CF are estimated at 200 000-300000 US dollars (at 1996 values and a discount rate of 5%). Home intravenous (IV) antibacterial therapy and recombinant human DNase (rhDNase; dornase alfa) treatment are the two main therapeutic strategies most often evaluated in health economic studies of CF. While home IV antibacterial therapy (compared with inpatient IV antibacterial therapy) is assumed to be cost saving,rhDNase treatment is a very cost-intensive therapy intended to efficiently achieve health improvements. Health economic analyses of future CF therapeutic technologies should present explicit data regarding healthcare services provision,resource consumption and unit costs. Indirect costs and patient costs should be considered more often than they have to date,particularly when they are significantly influenced by novel CF technologies. The perspective of health economic studies should be stated explicitly and always include the societal perspective. More economic studies should be based on a controlled,and preferably randomised,design. The observation period must be long enough to identify long-term effects of interventions. A greater number of effectiveness studies should be performed to determine costs and outcomes of therapies applied under everyday life conditions for patients with CF. Finally,international comparison studies should identify the influence of different healthcare systems on the costs and outcomes of interventions.","Pharmacoeconomics. 2003;21(14):1001-24. ","International",2003,null,"All healthcare",null,null,null,"Direct costs"]
[17,"Hollin IL,Robinson KA. A Scoping Review of Healthcare Costs for Patients with Cystic Fibrosis. Appl Health Econ Health Policy. 2016 Apr;14(2):151-9. doi: 10.1007/s40258-015-0211-4. ",null,"Hollin IL,Robinson KA."," A Scoping Review of Healthcare Costs for Patients with Cystic Fibrosis. ","Cystic fibrosis (CF),one of the most common life-shortening genetic diseases,has no cure,but people living with it have seen improvements in their health and survival. The rising life expectancy and increased availability of treatment options has likely increased the lifetime costs of people living with CF. In addition,a recent drug approval for a therapy that targets the cause of the disease is one of the most expensive drugs worldwide. In light of these circumstances,it is important to have an updated understanding of the costs of CF therapy and management. This study aims to determine the extent of available literature that quantifies CF costs. We used a scoping review framework to identify the sources and types of evidence available to determine the costs of CF therapy and management compared to the general population or a comparable population of people with other complex chronic conditions. We searched 14 databases for peer-reviewed studies and grey literature published in English since 1998. The search was conducted in August 2013 and updated in October 2014. We identified 28 studies that estimated overall,general CF costs. Of these,three studies compare CF costs to healthcare costs of a general population and only one of those provides a direct comparison of CF costs to the general population in order to calculate the incremental cost associated with CF. We estimate there are 98 systematic reviews that quantify the costs of comparable conditions and potentially provide a comparison group for people with CF. There is evidence available that attempts to quantify overall,general healthcare costs of people with CF,although much of it is outdated. However,there is much less evidence available that provides a comparison of these costs with either the general population or people with comparable conditions.","Appl Health Econ Health Policy. 2016 Apr;14(2):151-9. ","International",2016,null,"All healthcare",null,null,null,"Direct costs"]
[18,"Schechter MS,Trueman D,Farquharson R,Higuchi K,Daines CL. Inhaled aztreonam lysine versus inhaled tobramycin in cystic fibrosis. An economic evaluation. Ann Am Thorac Soc. 2015 Jul;12(7):1030-8. doi: 10.1513/AnnalsATS.201312-453OC.",null,"Schechter MS,Trueman D,Farquharson R,Higuchi K,Daines CL. ","Inhaled aztreonam lysine versus inhaled tobramycin in cystic fibrosis. An economic evaluation.","Pseudomonas aeruginosa infection is a significant cause of morbidity and mortality in patients with cystic fibrosis and is associated with a high economic burden. A recently published comparator trial demonstrated that outcomes in patients with cystic fibrosis with chronic P. aeruginosa infections switched from tobramycin solution for inhalation to aztreonam lysine for inhalation were better than those of patients who continued on tobramycin. To compare overall costs of treatment of chronic inhaled tobramycin and aztreonam lysine in patient with cystic fibrosis who have chronic Pseudomonas infection,taking differences in outcomes into account. A cost-effectiveness analysis with a 3-year time horizon was performed to simulate the economic consequences of either treatment from the perspective of a third party payer in the United States. We extrapolated results from the comparator trial and used data regarding clinical outcomes,quality of life,and costs from published literature and proprietary databases. A Markov structure was used to consider transitions between health states,defined principally by levels of percent predicted of FEV1. Extensive scenario and probabilistic sensitivity analyses were performed. Use of aztreonam lysine for inhalation was associated with an average cost saving of $41,947 per patient over 3 years,as well as greater quality-adjusted life-years and total life-years. Scenario analyses demonstrated that these findings were robust to changes in key assumptions. It appears,with high likelihood,that the use of aztreonam solution for inhalation is associated with cost savings,an increase in quality-adjusted life-years,and improved clinical outcomes among patients with extensive prior use of tobramycin solution for inhalation who are naive to inhaled aztreonam lysine.","Ann Am Thorac Soc. 2015 Jul;12(7):1030-8.","USA",2015,null,"Antibiotics",null,null,null,"Direct costs"]
[19,"Hill M,Twiss P,Verhoef TI,Drury S,McKay F,Mason S,Jenkins L,Morris S,Chitty LS. Non-invasive prenatal diagnosis for cystic fibrosis: detection of paternal mutations,exploration of patient preferences and cost analysis. Prenat Diagn. 2015 Oct;35(10):950-8. doi: 10.1002/pd.4585. Epub 2015 Apr 5.",null,"Hill M,Twiss P,Verhoef TI,Drury S,McKay F,Mason S,Jenkins L,Morris S,Chitty LS.","Non-invasive prenatal diagnosis for cystic fibrosis: detection of paternal mutations,exploration of patient preferences and cost analysis.","We aim to develop non-invasive prenatal diagnosis (NIPD) for cystic fibrosis (CF) and determine costs and implications for implementation. A next-generation sequencing assay was developed to detect ten common CF mutations for exclusion of the paternal mutation in maternal plasma. Using uptake data from a study exploring views on NIPD for CF,total test-related costs were estimated for the current care pathway and compared with those incorporating NIPD. The assay reliably predicted mutation status in all control and maternal plasma samples. Of carrier or affected adults with CF (n = 142) surveyed,only 43.5% reported willingness to have invasive testing for CF with 94.4% saying they would have NIPD. Using these potential uptake data,the incremental costs of NIPD over invasive testing per 100 pregnancies at risk of CF are £9025 for paternal mutation exclusion,and £26,510 for direct diagnosis. We have developed NIPD for risk stratification in around a third of CF families. There are economic implications due to potential increased test demand to inform postnatal management rather than to inform decisions around termination of an affected pregnancy."," Prenat Diagn. 2015 Oct;35(10):950-8.","UK",2015,null,"Screening",null,null,null,"Direct costs"]
[20,"Angelis A,Tordrup D,Kanavos P. Socio-economic burden of rare diseases: A systematic review of cost of illness evidence. Health Policy. 2015 Jul;119(7):964-79. doi: 10.1016/j.healthpol.2014.12.016. Epub 2014 Dec 30.",null,"Angelis A,Tordrup D,Kanavos P. ","Socio-economic burden of rare diseases: A systematic review of cost of illness evidence","Cost-of-illness studies,the systematic quantification of the economic burden of diseases on the individual and on society,help illustrate direct budgetary consequences of diseases in the health system and indirect costs associated with patient or carer productivity losses. In the context of the BURQOL-RD project (\"Social Economic Burden and Health-Related Quality of Life in patients with Rare Diseases in Europe\") we studied the evidence on direct and indirect costs for 10 rare diseases (Cystic Fibrosis [CF],Duchenne Muscular Dystrophy [DMD],Fragile X Syndrome [FXS],Haemophilia,Juvenile Idiopathic Arthritis [JIA],Mucopolysaccharidosis [MPS],Scleroderma [SCL],Prader-Willi Syndrome [PWS],Histiocytosis [HIS] and Epidermolysis Bullosa [EB]). A systematic literature review of cost of illness studies was conducted using a keyword strategy in combination with the names of the 10 selected rare diseases. Available disease prevalence in Europe was found to range between 1 and 2 per 100,000 population (PWS,a sub-type of Histiocytosis,and EB) up to 42 per 100,000 population (Scleroderma). Overall,cost evidence on rare diseases appears to be very scarce (a total of 77 studies were identified across all diseases),with CF (n=29) and Haemophilia (n=22) being relatively well studied,compared to the other conditions,where very limited cost of illness information was available. In terms of data availability,total lifetime cost figures were found only across four diseases,and total annual costs (including indirect costs) across five diseases. Overall,data availability was found to correlate with the existence of a pharmaceutical treatment and indirect costs tended to account for a significant proportion of total costs. Although methodological variations prevent any detailed comparison between conditions and based on the evidence available,most of the rare diseases examined are associated with significant economic burden,both direct and indirect."," Health Policy. 2015 Jul;119(7):964-79.","International",2015,null,"All healthcare",null,null,null,"Direct costs"]
[21,"van der Ploeg CP,van den Akker-van Marle ME,Vernooij-van Langen AM,Elvers LH,Gille JJ,Verkerk PH,Dankert-Roelse JE,CHOPIN study group. Cost-effectiveness of newborn screening for cystic fibrosis determined with real-life data. J Cyst Fibros. 2015 Mar;14(2):194-202. doi: 10.1016/j.jcf.2014.08.007. Epub 2014 Sep 10. ",null,"van der Ploeg CP,van den Akker-van Marle ME,Vernooij-van Langen AM,Elvers LH,Gille JJ,Verkerk PH,Dankert-Roelse JE,CHOPIN study group"," Cost-effectiveness of newborn screening for cystic fibrosis determined with real-life data.","Previous cost-effectiveness studies using data from the literature showed that newborn screening for cystic fibrosis (NBSCF) is a good economic option with positive health effects and longer survival. We used primary data to compare cost-effectiveness of four screening strategies for NBSCF,i.e. immunoreactive trypsinogen-testing followed by pancreatitis-associated protein-testing (IRT-PAP),IRT-DNA,IRT-DNA-sequencing,and IRT-PAP-DNA-sequencing,each compared to no-screening. A previously developed decision analysis model for NBSCF was fed with model parameters mainly based on a study evaluating two novel screening strategies among 145,499 newborns in The Netherlands. The four screening strategies had cost-effectiveness ratios varying from €23,600 to €29,200 per life-year gained. IRT-PAP had the most favourable cost-effectiveness ratio. Additional life-years can be gained by IRT-DNA but against higher costs. When treatment costs reduce with 5% due to early diagnosis,screening will lead to financial savings. NBSCF is as an economically justifiable public health initiative. Of the four strategies tested IRT-PAP is the most economic and this finding should be included in any decision making model,when considering implementation of newborn screening for CF."," J Cyst Fibros. 2015 Mar;14(2):194-202.","Netherlands",2015,null,"Screening",null,null,null,"Direct costs,Indirect costs"]
[22,"Ference EH,Schroeder JW Jr,Qureshi H,Conley D,Chandra RK,Tan BK,Shintani Smith S. Current utilization of balloon dilation versus endoscopic techniques in pediatric sinus surgery. Otolaryngol Head Neck Surg. 2014 Nov;151(5):852-60. doi: 10.1177/0194599814545442. Epub 2014 Aug 4.",null,"Ference EH,Schroeder JW Jr,Qureshi H,Conley D,Chandra RK,Tan BK,Shintani Smith S"," Current utilization of balloon dilation versus endoscopic techniques in pediatric sinus surgery.","To study the utilization of balloon catheter dilation (BCD) compared to traditional endoscopic surgery (ESS) in pediatric patients. Cross-sectional analysis. Hospital and freestanding ambulatory surgery centers in California,Florida,Maryland,and New York Patients less than 18 years who underwent BCD(316) or ESS(2346),as identified by CPT codes from the State Ambulatory Surgery Databases 2011. Patient and facility demographics,mean charges,and operating room time were examined using bivariate and multivariate analyses. A total of 2662 children underwent surgery,with BCD used in 10.6% of maxillary,8.4% of sphenoid,and 11.8% of frontal procedures. Adjusted analysis found that children with asthma,allergic rhinitis (AR),GERD,or concomitant adenoidectomy were more likely to have BCD compared to patients without these comorbidities,asthma odds ratio (OR) = 1.94 (95% CI,1.84-3.41),AR OR = 1.77 (95% CI,1.03-3.07),GERD OR = 2.79 (95% CI,.59-4.90),or without adenoidectomy OR = 2.50 (95% CI,1.84-3.41). Patients with cystic fibrosis were less likely to have BCD,OR = 0.33 (95% CI,0.11-0.95). Median charges for patients undergoing maxillary antrostomy alone by BCD (P = .042) or with adenoidectomy (P < .001) were approximately $2100 and $4200 greater than the median of patients undergoing those procedures with ESS. However,operating room time was similar (P = .81) between patients undergoing maxillary antrostomy,regardless of whether BCD was used,but was longer (P < .001) in those undergoing maxillary antrostomy and adenoidectomy when BCD was utilized. BCD was used in 11.9% of pediatric sinus surgery and had higher average charges with no decrease in OR time compared to procedures that only utilized ESS. Future research is necessary to evaluate whether BCD may lead to improved outcomes and eventually decreased operating room time for pediatric patients with chronic rhinosinusitis."," Otolaryngol Head Neck Surg. 2014 Nov;151(5):852-60.","USA",2014,null,"Various",null,null,null,"Direct costs"]
[23,"Tappenden P,Harnan S,Uttley L,Mildred M,Carroll C,Cantrell A. Colistimethate sodium powder and tobramycin powder for inhalation for the treatment of chronic Pseudomonas aeruginosa lung infection in cystic fibrosis: systematic review and economic model. Health Technol Assess. 2013 Dec;17(56):v-xvii,1-181. doi: 10.3310/hta17560. ",null,"Tappenden P,Harnan S,Uttley L,Mildred M,Carroll C,Cantrell A.","Colistimethate sodium powder and tobramycin powder for inhalation for the treatment of chronic Pseudomonas aeruginosa lung infection in cystic fibrosis: systematic review and economic model. ","Cystic fibrosis (CF) is an inherited condition characterised by the abnormal transport of chloride ions across transporting epithelia. This leads to the production of thick sticky mucus in the lungs,pancreas,liver,intestine and reproductive tract,and an increase in the salt content in sweat. Among other problems,people with CF experience recurrent respiratory infections and have difficulties digesting food. CF affects over 9000 individuals in the UK. CF shortens life expectancy and adversely affects quality of life. In 2010,CF was recorded as the cause of 103 deaths in England and Wales. To evaluate the clinical effectiveness and cost-effectiveness of colistimethate sodium dry powder for inhalation (DPI) (Colobreathe(®),Forest Laboratories) and tobramycin DPI (TOBI Podhaler(®),Novartis Pharmaceuticals) for the treatment of Pseudomonas aeruginosa lung infection in CF. Electronic databases were searched in February and March 2011 [MEDLINE,MEDLINE In-Process & Other Non-Indexed citations,EMBASE,The Cochrane Library databases,Cumulative Index to Nursing and Allied Health Literature (CINAHL),Web of Science,Conference Proceedings Citation Index (CPCI) and Bioscience Information Service (BIOSIS) Previews]. Relevant databases were searched for ongoing and unpublished studies,and bibliographies of relevant systematic reviews and the manufacturers' submissions were also hand-searched. A systematic review of the clinical effectiveness and cost-effectiveness of colistimethate sodium DPI and tobramycin DPI for the treatment of chronic P. aeruginosa lung infection in CF was conducted. Existing economic evidence within the literature was reviewed and a de novo health economic model was also developed. Three randomised controlled trials (RCTs) were included in the clinical effectiveness review. Both colistimethate sodium DPI and tobramycin DPI were reported to be non-inferior to nebulised tobramycin for the outcome forced expiratory volume in first second percentage predicted (FEV1%). It was not possible to draw any firm conclusions as to the relative efficacy of colistimethate sodium DPI compared with tobramycin DPI. The economic analysis suggests that colistimethate sodium DPI produces fewer quality-adjusted life-years (QALYs) than nebulised tobramycin. Given the incremental discounted lifetime cost of tobramycin DPI compared with nebulised tobramycin,it highly unlikely that tobramycin DPI has an incremental cost-effectiveness ratio that is better than £30,000 per QALY gained. The uncertainty surrounding the short-term evidence base inevitably results in uncertainty surrounding the long-term clinical effectiveness and cost-effectiveness of colistimethate sodium DPI. Both DPI formulations have been shown to be non-inferior to nebulised tobramycin as measured by FEV1%. The results of these trials should be interpreted with caution owing to the means by which the results were analysed,the length of follow-up,and concerns about the ability of FEV1% to accurately represent changes in lung health. Although the increase in QALYs is expected to be lower with colistimethate sodium DPI than with nebulised tobramycin,a price for this intervention had not been agreed at the time of the assessment. Depending on the price of colistimethate sodium DPI,this results either in a situation whereby colistimethate sodium DPI is dominated by nebulised tobramycin or in one whereby the incremental cost-effectiveness of nebulised tobramycin compared with colistimethate sodium DPI is in the range of £24,000-277,000 per QALY gained. The economic analysis also suggests that,given its price,it is unlikely that tobramycin DPI has a cost-effectiveness ratio of < £30,000 per QALY gained when compared with nebulised tobramycin. A RCT to assess the longer-term (≥ 12 months) efficacy of colistimethate sodium DPI and tobramycin DPI in comparison with nebulised treatments would be beneficial. Such a study should include the direct assessment of HRQoL using a relevant preference-based instrument. Future studies should ensure that the European Medicines Agency guidelines are adhered to. In addition,high-quality research concerning the relationship between forced expiratory volume in first second % (FEV1%) predicted or other measures of lung function and survival/health-related quality of life (HRQoL) would be useful. PROSPERO CRD42011001350. The National Institute for Health Research Health Technology Assessment programme."," Health Technol Assess. 2013 Dec;17(56):v-xvii,1-181.","UK",2013,null,"Antibiotics",null,null,null,"Direct costs"]
[24,"Ledger SJ,Owen E,Prasad SA,Goldman A,Willams J,Aurora P. A pilot outreach physiotherapy and dietetic quality improvement initiative reduces IV antibiotic requirements in children with moderate-severe cystic fibrosis. J Cyst Fibros. 2013 Dec;12(6):766-72. doi: 10.1016/j.jcf.2013.01.003. Epub 2013 Feb 17. ",null,"Ledger SJ,Owen E,Prasad SA,Goldman A,Willams J,Aurora P.","A pilot outreach physiotherapy and dietetic quality improvement initiative reduces IV antibiotic requirements in children with moderate-severe cystic fibrosis.","At our hospital the current model of care for children with moderate-severe CF is focused on intensive inpatient intervention,regular outpatient clinic review and specialist outreach care as required. An alternative model providing more regular physiotherapy and dietetic outreach support,in addition to these specialist services,may be more effective. 16 children (4 male; 12 female; mean age 10.9±2.93; range 4-15 years) who required >40days of IV antibiotics in the 12-months pre-intervention were enrolled. Physiotherapy included weekly-supervised exercise sessions,alongside regular review of home physiotherapy regimens. Dietetic management included 1-2 monthly monitoring of growth,appetite,intake and absorption,and nutrition education sessions. There was a 23% reduction in inpatient IV antibiotic requirement and 20% reduction in home IV antibiotic requirement during the intervention year. Cost-benefit analyses showed savings of £113,570. VO(2Peak) increased by 4.9 ml·kg·min(-1) (95%CI 1.01 to 8.71; p=0.02),and 10 m-MSWT distance and increment achieved increased by 229 m (95%CI 109 to 350; p<0.001) and 2 levels (95%CI 1 to 3; p<0.002) respectively. No significant differences in physiological and patient reported outcomes were demonstrated,although there was a possible trend towards improvement in outcomes when compared to the pre-intervention year. This pilot programme demonstrated a reduction in IV and admission requirements with a cost benefit in a small group of children with moderate-severe CF. A fully powered clinical trial is now warranted."," J Cyst Fibros. 2013 Dec;12(6):766-72.","UK",2013,null,"Physical therapy,Diet",null,null,null,"Direct costs"]
[25,"Urquhart D,Sell Z,Dhouieb E,Bell G,Oliver S,Black R,Tallis M. Effects of a supervised,outpatient exercise and physiotherapy programme in children with cystic fibrosis. Pediatr Pulmonol. 2012 Dec;47(12):1235-41. doi: 10.1002/ppul.22587. Epub 2012 May 2.",null,"Urquhart D,Sell Z,Dhouieb E,Bell G,Oliver S,Black R,Tallis M. "," Effects of a supervised,outpatient exercise and physiotherapy programme in children with cystic fibrosis.","Previous work suggests benefit from outpatient exercise and physiotherapy in children with cystic fibrosis (CF),namely improved exercise capacity and lung function measures,as well reduced intravenous (IV) antibiotic needs. Our study aim was to investigate the effect of a year-long supervised outpatient exercise and physiotherapy programme in children with CF. Subjects with CF aged ≥10 years who had received ≥4 courses of IV antibiotics in 2009 were enrolled and seen fortnightly for supervised exercise and physiotherapy throughout 2010. In addition,they were expected to exercise three times weekly,and if unwell complete additional physiotherapy sessions extra to usual chest physiotherapy. Assessments of exercise capacity using the Modified Shuttle Test (MST) and quality of life (QOL; CFQ-UK) were recorded at baseline and after 1 year. Regular spirometry was performed before and throughout the study. Data were collected on IV antibiotic days. 12 subjects (6 female) were enrolled with mean (95% CI) age of 13.3 (11.8-14.6) years at study entry. A significant reduction in IV antibiotic days from 60 (56-64) days in 2009 to 50 (44-56) in 2010 (P = 0.02) was noted,along with improved MST distance (m) [735 (603-867) vs. 943 (725-1,161),P = 0.04] and level attained [9.4 (8.4-10.5) vs. 11.1 (9.6-12.6),P = 0.04]. Significant improvements in CFQ-UK scores for physical [59 (47-72) vs. 83 (74-92),P = 0.001],emotional [63 (55-72) vs. 84 (74-93),P < 0.001],treatment [41 (30-51) vs. 61 (48-73),P = 0.002],and respiratory [54 (42-66) vs. 76 (70-82),P = 0.002] domains were noted. The mean (95% CI) rate of change of FEV(1) was -4 (-18,+10)% in 2009,but was +6 (-2,+13)% in 2010,although this did not reach statistical significance. Supervised,outpatient exercise and physiotherapy are associated with improvements in QOL and exercise tolerance,a reduction in IV antibiotic days,and a trend towards reducing lung function decline in children with CF. The cost of IV antibiotics was reduced by £66,384 ($104,000) in 2010 when compared with 2009. Such cost-benefit may have implications for workforce planning and service provision."," Pediatr Pulmonol. 2012 Dec;47(12):1235-41. ","UK",2012,null,"Physical therapy",null,null,null,"Direct costs"]
[26,"Dewitt EM,Grussemeyer CA,Friedman JY,Dinan MA,Lin L,Schulman KA,Reed SD. Resource use,costs,and utility estimates for patients with cystic fibrosis with mild impairment in lung function: analysis of data collected alongside a 48-week multicenter clinical trial. Value Health. 2012 Mar-Apr;15(2):277-83. doi: 10.1016/j.jval.2011.11.027. Epub 2012 Jan 27. ",null,"Dewitt EM,Grussemeyer CA,Friedman JY,Dinan MA,Lin L,Schulman KA,Reed SD"," Resource use,costs,and utility estimates for patients with cystic fibrosis with mild impairment in lung function: analysis of data collected alongside a 48-week multicenter clinical trial.","Transport of ions to generate epithelial rehydration (TIGER)-1 was a randomized trial conducted to evaluate the safety and efficacy of denufosol versus placebo in patients with cystic fibrosis with mild impairment in lung function. The trial met its primary end point at 24 weeks,but a subsequent trial did not show a sustained effect of denufosol at 48 weeks. By using the 48-week data,we characterized resource use,direct medical costs,indirect costs,and utility estimates. Data on medications,outpatient and emergency visits,hospital admissions,tests,procedures,and home nursing were captured on study case report forms. Sources for unit costs included the Medicare Physician Fee Schedule,the Nationwide Inpatient Sample,and the Red Book. Health utilities were derived from the Health Utilities Index Mark 2/3. We used multivariable regression to evaluate the impact of baseline covariates on costs. Characteristics of the 352 participants at enrollment included mean age of 14.6 years,history of Pseudomonas aeruginosa colonization in 45.2%,use of dornase alfa in 77.0%,and long-term use of inhaled antibiotics in 37.2%. Over 48 weeks,22.4% of participants were hospitalized and,on average,participants missed 7.4 days of school or work. Mean total costs (excluding denufosol) were $39,673 (SD $26,842),of which 85% were attributable to medications. Female sex and P. aeruginosa colonization were independently associated with higher costs. Prospective economic data collection alongside a clinical trial allows for robust estimates of cost of illness. The mean annual cost of care for patients with cystic fibrosis with mild impairment in lung function exceeds $43,000 and is driven by medication costs.","Value Health. 2012 Mar-Apr;15(2):277-83. ","USA",2012,null,"Denufosol",null,null,null,"Direct costs"]
[27,"Norman R,van Gool K,Hall J,Delatycki M,Massie J. Cost-effectiveness of carrier screening for cystic fibrosis in Australia. J Cyst Fibros. 2012 Jul;11(4):281-7. doi: 10.1016/j.jcf.2012.02.007. Epub 2012 Mar 16. ",null,"Norman R,van Gool K,Hall J,Delatycki M,Massie J.","Cost-effectiveness of carrier screening for cystic fibrosis in Australia.","Carrier screening for cystic fibrosis is not widely available in Australia,partly due to concerns regarding its cost-effectiveness. The benefit of information from pregnancy to pregnancy has not been widely considered in existing cost-effectiveness analyses. A decision tree was constructed estimating costs and outcomes from screening,including both initial and subsequent pregnancies. Effectiveness was expressed in terms of CF births averted. Costs were collected using a health service perspective. All costs and outcomes were discounted at 5% per annum. Screening reduced the annual incidence of CF births from 34 to 14/100,000 births (an aggregate number of CF births of 100.9 and 41.9 respectively). In initial pregnancies,costs in the screening arm (A$16.6 million/100,000 births) exceed those in the non-screening arm (A$13.4 million/100,000 births). The incremental cost per CF birth in initial pregnancies is therefore approximately A$150,000. However,this was reversed for subsequent pregnancies,in that the pre-collected information reduces the incidence of CF in subsequent pregnancies at low additional costs. When aggregated,the results suggest screening is likely to be cost-saving. The introduction of national carrier screening for cystic fibrosis should be considered,as it is likely to reduce CF incidence at an acceptable (potentially negative) cost.",". J Cyst Fibros. 2012 Jul;11(4):281-7. ","Australia",2012,null,"Screening",null,null,null,"Direct costs,Indirect costs"]
[28,"Al-Saleh S,Dell SD,Grasemann H,Yau YC,Waters V,Martin S,Ratjen F. Sputum induction in routine clinical care of children with cystic fibrosis. J Pediatr. 2010 Dec;157(6):1006-1011.e1. doi: 10.1016/j.jpeds.2010.06.001. Epub 2010 Jul 14.",null,"Al-Saleh S,Dell SD,Grasemann H,Yau YC,Waters V,Martin S,Ratjen F. ","Sputum induction in routine clinical care of children with cystic fibrosis.","To determine the microbiological yield of induced sputum (IS) samples compared with conventional airway samples,spontaneously expectorated sputum and throat swabs,in children with cystic fibrosis (CF) attending an outpatient clinic. Ninety-five children with CF (75 able to spontaneously expectorate sputum) were included in this prospective cross-sectional comparative study. After obtaining expectorated sputum or throat swabs samples,IS was obtained by performing the sputum induction procedure using an eFlow device (PARI,Starnberg,Germany). CF bacterial culture results were compared between the two procedures. Differences in culture results between samples were observed in 25 of 94 (27%) patients. IS had a significantly higher yield for CF pathogens,with 80% of the differences being due to detection of additional organisms in IS samples. Overall,SI was well tolerated,but 12 of 95 cases had a >20% postinduction decline in forced expiratory volume in 1 second. The whole SI procedure took 30 to 85 minutes of clinic time,and its estimated additional cost was $150 (US)/patient. Induced sputum has a higher microbiological yield compared with the conventional samples in children with CF,even in patients capable of expectorating sputum spontaneously. Although sputum induction is safe and tolerable,it is time-consuming and expensive in routine clinical settings."," J Pediatr. 2010 Dec;157(6):1006-1011.e1.","Canada",2010,null,"Various",null,null,null,"Direct costs"]
[29,"Maxwell S,Brameld K,Youngs L,Geelhoed E,O'Leary P. Informing policy for the Australian context - Costs,outcomes and cost savings of prenatal carrier screening for cystic fibrosis. Aust N Z J Obstet Gynaecol. 2010 Feb;50(1):51-9. doi: 10.1111/j.1479-828X.2009.01111.x. ",null,"Maxwell S,Brameld K,Youngs L,Geelhoed E,O'Leary P","Informing policy for the Australian context - Costs,outcomes and cost savings of prenatal carrier screening for cystic fibrosis.","To examine the costs,outcomes and cost savings of three models of prenatal cystic fibrosis (CF) carrier screening compared to no screening from a public health sector perspective. A decision tree was generated to estimate costs and outcomes for each screening model for a hypothetical cohort of 38 000 pregnancies. Sensitivity analysis assessed the impact of model parameter variation. Under baseline assumptions,the initial annual cost to provide a prenatal CF carrier-screening programme is Au$5.32 million,Au$3.35 million and $2.93 million for one-step,two-step simultaneous and two-step sequential screening respectively. Annual costs are significantly lower for an established programme. No screening model provides a net saving over a lifetime horizon; however,the results were sensitive to variation in lifetime cost of care,screening test costs and number of pregnancies per carrier couple. Under some scenarios,prenatal CF carrier screening is cost saving to the health system; however,this is not conclusive and depends on several factors. Cost remains a potential barrier due to the substantial level of funding required in the short term. Feasibility and psychosocial,ethical and legal implications of screening need to be considered. Additionally,consultation is required with the Australian community on the acceptability and/or desire for prenatal CF carrier screening."," Aust N Z J Obstet Gynaecol. 2010 Feb;50(1):51-9.","Australia",2010,null,"Screening",null,null,null,"Direct costs"]
[30,"Rodrigues R,Magalhaes PK,Fernandes MI,Gabetta CS,Ribeiro AF,Pedro KP,Valdetaro F,Santos JL,Souza RM,Pazin Filho A,Maciel LM. Neonatal screening for cystic fibrosis in São Paulo State,Brazil: a pilot study. Braz J Med Biol Res. 2009 Oct;42(10):973-8. doi: . Epub 2009 Sep 4.",null,"Rodrigues R,Magalhaes PK,Fernandes MI,Gabetta CS,Ribeiro AF,Pedro KP,Valdetaro F,Santos JL,Souza RM,Pazin Filho A,Maciel LM. ","Neonatal screening for cystic fibrosis in São Paulo State,Brazil: a pilot study.","Cystic fibrosis is one of the most common autosomal recessive hereditary diseases in the Caucasian population,with an incidence of 1:2000 to 1:3500 liveborns. More than 1000 mutations have been described with the most common being F508del. It has a prevalence of 23-55% within the Brazilian population. The lack of population-based studies evaluating the incidence of cystic fibrosis in São Paulo State,Brazil,and an analysis concerning the costs of implantation of a screening program motivated the present study. A total of 60,000 dried blood samples from Guthrie cards obtained from April 2005 to January 2006 for neonatal screening at 4 reference centers in São Paulo State were analyzed. The immunoreactive trypsinogen (IRT)/IRT protocol was used with the cut-off value being 70 ng/mL. A total of 532 children (0.9%) showed IRT >70 ng/mL and a 2nd sample was collected from 418 (80.3%) of these patients. Four affected children were detected at two centers,corresponding to an incidence of 1:8403. The average age at diagnosis was 69 days,and 3 of the children already showed severe symptoms of the disease. The rate of false-positive results was 95.2% and the positive predictive value for the test was 8%. The cost of detecting an affected subject was approximately US$8,000.00 when this cystic fibrosis program was added to an existing neonatal screening program. The present study clearly shows the difficulties involved in cystic fibrosis screening using the IRT/IRT protocol,particularly in a population with no long-term tradition of neonatal screening.","Braz J Med Biol Res. 2009 Oct;42(10):973-8.","Brazil",2009,null,"Screening",null,null,null,"Direct costs"]
[31,"Davis LB,Champion SJ,Fair SO,Baker VL,Garber AM. A cost-benefit analysis of preimplantation genetic diagnosis for carrier couples of cystic fibrosis. Fertil Steril. 2010 Apr;93(6):1793-804. doi: 10.1016/j.fertnstert.2008.12.053. Epub 2009 May 12. ",null,"Davis LB,Champion SJ,Fair SO,Baker VL,Garber AM"," A cost-benefit analysis of preimplantation genetic diagnosis for carrier couples of cystic fibrosis. ","To perform a cost-benefit analysis of preimplantation genetic diagnosis (PGD) for carrier couples of cystic fibrosis (CF) compared with the alternative of natural conception (NC) followed by prenatal testing and termination of affected pregnancies. Cost-benefit analysis using a decision analytic model. Outpatient reproductive health practices. A simulated cohort of 1,000 female patients. We calculated the net benefit of giving birth to a child as the present value of lifetime earnings minus lifetime medical costs. Net benefits in dollars. When used for women younger than 35 years of age,the net benefit of PGD over NC was $182,000 ($715,000 vs. $532,000,respectively). For women aged 35-40 years,the net benefit of PGD over NC was $114,000 ($634,000 vs. $520,000,respectively). For women older than 40 years,however,the net benefit of PGD over NC was -$148,000 ($302,000 vs. $450,000,respectively). Preimplantation genetic diagnosis provides net economic benefits when used by carrier couples of CF. Although there is an upper limit of maternal age at which economic benefit can be demonstrated,carrier couples of CF should be offered PGD for prevention of an affected child.","Fertil Steril. 2010 Apr;93(6):1793-804. ","USA",2010,null,"Screening",null,null,null,"Direct costs"]
[32,"Huot L,Durieu I,Bourdy S,Ganne C,Bellon G,Colin C,Touzet S,REMU study. Evolution of costs of care for cystic fibrosis patients after clinical guidelines implementation in a French network. J Cyst Fibros. 2008 Sep;7(5):403-8. doi: 10.1016/j.jcf.2008.02.004. Epub 2008 Mar 20.",null,"Huot L,Durieu I,Bourdy S,Ganne C,Bellon G,Colin C,Touzet S,REMU study"," Evolution of costs of care for cystic fibrosis patients after clinical guidelines implementation in a French network.","The aim of this study was to evaluate how advances in CF management in France between 2000 and 2003 impacted CF-related costs. The analysis of direct medical costs was done in 2000 and 2003 from the perspective of the French national healthcare insurance system. The patients,65 in 2000 and 64 in 2003,were followed-up in one pediatric and one adult CF reference center (CFRC). We quantified and valued CF-related home and hospital care costs. We found an average cost of euro16474/patient/year in 2000,and euro22725 in 2003 (based on the 2003 euro value). Hospital care increased from 15% of the total cost in 2000 to 22% in 2003. Medications accounted for 45% of the total cost for the two periods,with an average cost of euro7229/patient/year in 2000 and euro10336 in 2003. Home intravenous antibiotic therapy accounted for 20% of the total cost for the two periods. We highlighted an increase in CF care costs between 2000 and 2003,which might be related to the changes in practice patterns that followed guidelines implementation,such as the use of new medications (dornase alpha and tobramycin) and more frequent follow-up in the CFRC."," J Cyst Fibros. 2008 Sep;7(5):403-8. ","France",2008,null,"All healthcare",null,null,null,"Direct costs,Indirect costs"]
[33,"Guerriere DN,Tranmer JE,Ungar WJ,Manoharan V,Coyte PC. Valuing care recipient and family caregiver time: a comparison of methods. Int J Technol Assess Health Care. 2008 Winter;24(1):52-9. doi: 10.1017/S0266462307080075. ",null,"Guerriere DN,Tranmer JE,Ungar WJ,Manoharan V,Coyte PC"," Valuing care recipient and family caregiver time: a comparison of methods. ","The purpose of this study is to compare the approaches used for valuing family caregiver and care recipient time devoted to providing and receiving care. Valuation approaches were operationalized within a cohort of cystic fibrosis care recipients (n = 110). Base-case analyses,grounded in human capital theory,applied earnings estimates to caregiving time to impute the market value of time lost from labor. Unpaid labor and leisure time was valued with a replacement cost (homemaker's wage rate). Total time costs were computed and sensitivity analyses were conducted to describe the effects of alternative valuation methods on total costs. The mean time cost per care recipient-caregiver dyad over 28 days was $2,026CAD. The majority (76 percent) of time costs were due to losses from unpaid labor and leisure time. Varying the valuation of paid labor time did not result in significantly different total time costs (p = .0877). However,varying the method of valuing unpaid labor and leisure time did significantly affect total costs (p < .0001). Care recipients and caregivers primarily lost time from unpaid labor and leisure in the treatment of cystic fibrosis. Moreover,when the above losses were aggregated,the method of valuation greatly influenced overall results. The findings clearly indicate that omitting caregiver and unpaid labor and leisure costs may result in an inaccurate assessment of ambulatory and home-based healthcare programs.","Int J Technol Assess Health Care. 2008 Winter;24(1):52-9. ","Canada",2008,null,"None or unclear",null,null,null,"Direct costs"]
[34,"Veenstra DL,Harris J,Gibson RL,Rosenfeld M,Burke W,Watts C. Pharmacogenomic testing to prevent aminoglycoside-induced hearing loss in cystic fibrosis patients: potential impact on clinical,patient,and economic outcomes. Genet Med. 2007 Oct;9(10):695-704. doi: 10.1097GIM.0b013e318156dd07. ",null,"Veenstra DL,Harris J,Gibson RL,Rosenfeld M,Burke W,Watts C. ","Pharmacogenomic testing to prevent aminoglycoside-induced hearing loss in cystic fibrosis patients: potential impact on clinical,patient,and economic outcomes","Aminoglycosides are commonly used in cystic fibrosis patients to treat Pseudomonas aeruginosa respiratory infections. Aminoglycoside-induced hearing loss may occur in 1%-15% of patients with cystic fibrosis,ranging from mild to severe. Recently,a genetic test to identify patients with a mitochondrial mutation (A1555G) that may predispose patients to this adverse event has become available. Although the A1555G variant is very rare,it seems to confer a high risk of severe hearing loss in patients exposed to aminoglycosides. The objective was to evaluate the potential clinical,patient,and economic outcomes associated with the use of A1555G testing in a cystic fibrosis population,and explore data gaps and uncertainty in its clinical implementation. We developed a decision-analytic model to evaluate a hypothetical cohort of patients with cystic fibrosis from a societal perspective. Clinical and economic data were derived primarily from a critical literature review. The incidence of aminoglycoside-induced severe hearing loss,quality-adjusted life-years,and total health care costs were evaluated. Sensitivity analyses were conducted to evaluate uncertainty in our results. In the base-case analysis,A1555G testing decreased the risk of severe aminoglycoside-induced hearing loss by 0.12% in the cystic fibrosis population. The discounted incremental cost per quality-adjusted life-years gained was $79,300,but varied widely from $33,000 to testing being dominated by the no testing strategy (higher costs and lower quality-adjusted life-years with testing) in sensitivity analyses. If avoidance of aminoglycosides in patients testing positive leads to an absolute increase in the lifetime risk of death from Pseudomonas infection of 0.8% or greater,A1555G testing would lead to a decrease in quality-adjusted life-years. The results of our analysis suggest that there are significant data gaps and uncertainty in the outcomes with A1555G testing,but it is not likely cost-effective,and could lead to worse patient outcomes due to avoidance of first-line therapy in the >95% of patients who are false-positives. Additional research is needed before pharmacogenetic testing for the A1555G mitochondrial mutation can be recommended,even in a population with a high likelihood of exposure to aminoglycosides.","Genet Med. 2007 Oct;9(10):695-704","USA",2007,null,"Antibiotics",null,null,null,"Indirect costs"]
[35,"Radhakrishnan M, van Gool K, Hall J, Delatycki M, Massie J. Economic evaluation of cystic fibrosis screening: a review of the literature. Health Policy. 2008 Feb;85(2):133-47. doi: 10.1016/j.healthpol.2007.07.007. Epub 2007 Aug 28. ",null,"Radhakrishnan M, van Gool K, Hall J, Delatycki M, Massie J. "," Economic evaluation of cystic fibrosis screening: a review of the literature. ","To critically examine the economic evidence regarding cystic fibrosis (CF) carrier screening and to understand issues relating to the transferability of international findings to any national context for policy decisions. A systematic literature search identified 14 studies (out of 29 economic studies on CF) focusing on preconception or prenatal screening between 1990 and 2006. These studies were then assessed against international benchmarks on conducting and reporting of economic evaluations, costing methodology used and focusing on the transferability of the evidence to national contexts. The primary outcome measures varied considerably between studies and there was considerable ambiguity and variation on how costs were estimated. The Incremental Cost Effectiveness Ratio (ICER) and net savings, for preconception and prenatal screening were inconsistent and varied significantly, even after adjusting for timing and exchange rates. Differences in screening participation rates, reproductive choices, test sensitivity, cost of test and lifetime cost of care make up a large part of the ICER variations. The heterogeneity in study design, model inputs and reporting of economic evaluations of CF carrier screening makes comparability and transferability across countries and even within countries difficult. This reinforces the need to assess any technology within the relevant context, and to not simply generalize from reported studies. In turn, this adds to the complex task of making efficient resource allocation decisions in the area of CF carrier screening. Our evaluation adds weight to the calls for revisiting the way economic studies are conducted and reported.","Health Policy. 2008 Feb;85(2):133-47.","International",2008,null,"Screening",null,null,null,"Direct costs"]
[36,"Wei S, Quigg MH, Monaghan KG. Is cystic fibrosis carrier screening cost effective? Community Genet. 2007;10(2):103-9. doi: 10.1159/000099088.",null,"Wei S, Quigg MH, Monaghan KG","Is cystic fibrosis carrier screening cost effective?","Between 2001 and 2005, 6,166 females underwent cystic fibrosis (CF) carrier screening at our institution. Only 36% were Caucasian. We identified 143 carrier females and subsequently tested 85 of their partners. The observed carrier frequency was not significantly different than expected for any racial or ethnic group tested. We identified 6 positive couples (5 Caucasian, 1 Arab American) and 1 affected fetus. In just under 4 years, our institution spent approximately $334,000 on CF population screening. Comparing this to the lifetime medical cost for a CF patient, CF population-based carrier screening is cost effective at our institution, despite the high number of non-Caucasians being screened."," Community Genet. 2007;10(2):103-9.","USA",2007,null,"Screening",null,null,null,"Direct costs"]
[37,"Horvais V, Touzet S, François S, Bourdy S, Bellon G, Colin C, Durieu I. Cost of home and hospital care for patients with cystic fibrosis followed up in two reference medical centers in France. Int J Technol Assess Health Care. 2006 Fall;22(4):525-31. doi: 10.1017/S0266462306051476. ",null,"Horvais V, Touzet S, François S, Bourdy S, Bellon G, Colin C, Durieu I.","Cost of home and hospital care for patients with cystic fibrosis followed up in two reference medical centers in France. ","In France, new guidelines for clinical practices concerning cystic fibrosis came out in 2002, underscoring the need for early and intensive management of this disease. Because no recent health economic studies on cystic fibrosis in France were available, we conducted a cost-analysis study before the new guidelines were put into practice, with a view to a later study on the medical and economic impact of these guidelines. A cost-analysis study was performed of the inpatient and outpatient costs of patients with cystic fibrosis for the 2000-2001 period. The various direct costs were estimated on a sample of sixty-five adult and pediatric patients managed for cystic fibrosis in two reference medical centers. Data were obtained from medical records, and questionnaires were filled out by the patients. Analysis was made from the perspective of the French healthcare system. We studied sixty-five patients, 54 percent male patients and 72 percent children under 18 years of age. The total cost of cystic fibrosis care totaled 16,189 euros per year and per patient. Outpatient costs accounted for 88 percent of the total cost versus 12 percent for inpatient costs; medication costs were the highest with 21 percent of the total cost for home intravenous antibiotic treatments and 49 percent of the total cost for chronic medications. The results show that outpatient costs were higher than inpatient costs, which could be related to the importance granted to home health care in France, notably for intravenous antibiotic treatments given for pulmonary complications.","Int J Technol Assess Health Care. 2006 Fall;22(4):525-31.","France",2006,null,"All healthcare",null,null,null,"Direct costs"]
[38,"van den Akker-van Marle ME, Dankert HM, Verkerk PH, Dankert-Roelse JE. Cost-effectiveness of 4 neonatal screening strategies for cystic fibrosis. Pediatrics. 2006 Sep;118(3):896-905. doi: 10.1542/peds.2005-2782. ",null,"van den Akker-van Marle ME, Dankert HM, Verkerk PH, Dankert-Roelse JE. ","Cost-effectiveness of 4 neonatal screening strategies for cystic fibrosis.","The purpose of this work was to assess the costs of 4 neonatal screening strategies for cystic fibrosis in relation to health effects. In each strategy, the first test was the measurement of serum concentration of immunoreactive trypsin. The second step consisted of either a second immunoreactive trypsin test (strategy 1) or a multiple mutation analysis (strategy 2). In strategies 3 and 4, a third step was added to strategy 2: a second immunoreactive trypsin test (strategy 3) or an extended mutation analysis of the cystic fibrosis gene, that is, a denaturing gradient gel electrophoresis analysis (strategy 4). We conducted an economic-modeling exercise in the Netherlands based on published data and expert opinions. Subjects were a hypothetical cohort of 200 000 neonates, the approximate number of children born annually in the Netherlands, and we assessed the costs and number of life-years gained as a result of neonatal screening for cystic fibrosis. The costs and effects of changes in reproductive decisions because of neonatal screening were also assessed. Immunoreactive trypsin + immunoreactive trypsin had the most favorable cost-effectiveness ratio of 24,800 euro per life-year gained. Immunoreactive trypsin + DNA + denaturing gradient gel electrophoresis achieved more health effects than immunoreactive trypsin + DNA + immunoreactive trypsin at lower cost. The incremental costs per life-year gained of the immunoreactive trypsin + DNA + denaturing gradient gel electrophoresis strategy compared with the immunoreactive trypsin + immunoreactive trypsin strategy were 130,700 euro, whereas the incremental costs of the immunoreactive trypsin + DNA strategy compared with the immunoreactive trypsin + DNA + denaturing gradient gel electrophoresis strategy were 2,154,300 euro. When changes in reproductive decisions as a result of neonatal screening are also taken into account, neonatal screening for cystic fibrosis may lead to financial savings of approximately 1.8 million euro annually, depending on the screening strategy used. Cystic fibrosis screening for neonates is a good economic option, and positive health effects can also be expected. Immunoreactive trypsin + immunoreactive trypsin and immunoreactive trypsin + DNA + denaturing gradient gel electrophoresis are the most cost-effective strategies."," Pediatrics. 2006 Sep;118(3):896-905. ","Netherlands",2006,null,"Screening",null,null,null,"Direct costs"]
[39,"Glanville AR, Scott AI, Morton JM, Aboyoun CL, Plit ML, Carter IW, Malouf MA. Intravenous ribavirin is a safe and cost-effective treatment for respiratory syncytial virus infection after lung transplantation. J Heart Lung Transplant. 2005 Dec;24(12):2114-9. doi: 10.1016/j.healun.2005.06.027. Epub 2005 Sep 6.",null,"Glanville AR, Scott AI, Morton JM, Aboyoun CL, Plit ML, Carter IW, Malouf MA.","Intravenous ribavirin is a safe and cost-effective treatment for respiratory syncytial virus infection after lung transplantation","Community-acquired viral infections, such as respiratory syncytial virus (RSV), represent a risk factor for bronchiolitis obliterans syndrome (BOS), the major limiting factor for long-term survival after lung transplantation (LTx). RSV often presents with acute bronchiolitis and may be fatal in 10% to 20% of patients. Standard therapies for RSV include nebulized ribavirin with or without steroids, but are costly and inconvenient. We investigated the utility of intravenous (IV) ribavirin with steroids for the treatment of RSV infection after LTx. RSV was identified in nasopharyngeal and throat swabs (NPS) using indirect fluorescent antibody (IFA) testing in 18 symptomatic patients, which was confirmed by viral culture in 14. Data were collected for the period between April 2002 and October 2004. The study included 10 men and 8 women, mean age 42 +/- 15 (range 18 to 63) years. Transplant procedures were 5 single LTx and 13 bilateral LTx. RSV diagnosis was made on Day 1,374 +/- 1,270 (range 61 to 4,598, median 935) post-operatively. Underlying diagnoses included cystic fibrosis (n = 9), emphysema (n = 7) and pulmonary fibrosis (n = 2). All 18 patients received intravenous (IV) ribavirin (33 mg/kg on Day 1 and 20 mg/kg/day thereafter in 3 divided doses) with oral prednisolone (1 mg/kg) until repeat NPS were negative for RSV on IFA. Median therapy was 8 days (6 to 15). The mortality rate was 0%. Mean FEV1 fell from 2.1 +/- 1.0 liter (0.7 to 3.7 liters) to 1.8 +/- 0.9 liter (0.5 to 3.6 liters) (p < 0.001), but recovered to 2.1 +/- 0.9 (0.7 to 3.7 liters) within 3 months and was maintained at follow-up of 521 +/- 328 days (141 to 1,023 days, median 302). Only 1 patient developed bronchiolitis obliterans syndrome (BOS). Complications included mild hemolytic anemia (blood hemoglobin fell from 122 +/- 22 [84 to 154] g/liter to 107 +/- 18 [75 to 138] g/liter, p = 0.02). Cost savings per 8-day course were $US15,913 when compared with nebulized therapy at 6 g/day (p < 0.001). This is the largest reported series of treated RSV cases after LTx and the first to show that therapy with IV ribavirin and oral corticosteroids is well tolerated and effective. Cost utility vs nebulized therapy has been established. Early diagnosis and management are essential to prevent airway epithelial injury and subsequent BOS."," J Heart Lung Transplant. 2005 Dec;24(12):2114-9. ","Australia",2005,null,"Lung transplant",null,null,null,"Direct costs"]
[40,"Thornton J, Elliott RA, Tully MP, Dodd M, Webb AK. Clinical and economic choices in the treatment of respiratory infections in cystic fibrosis: comparing hospital and home care. J Cyst Fibros. 2005 Dec;4(4):239-47. doi: 10.1016/j.jcf.2005.08.003. Epub 2005 Oct 19. ",null,"Thornton J, Elliott RA, Tully MP, Dodd M, Webb AK"," Clinical and economic choices in the treatment of respiratory infections in cystic fibrosis: comparing hospital and home care.","A cost-effectiveness evaluation comparing home-based and hospital-based treatment with intravenous antibiotics for respiratory exacerbations in adults with cystic fibrosis (CF) has not been previously undertaken. The study was conducted in a UK adult CF centre from a health service perspective. Clinical outcome and resource use data were obtained from a retrospective one-year study and combined with unit cost data in an incremental economic analysis. The primary outcome measure was percentage change in FEV(1); \"effectiveness\" was defined as maintenance of baseline average FEV(1) over the one-year study period. 116 patients received 454 courses of intravenous antibiotics. At the end of 1 year, there had been a mean percentage decline in FEV(1) compared with baseline average for home-treated patients but an improvement for hospital-treated patients (Tukey's HSD mean difference 10.1%, 95% CI 2.9 to 17.2, p = 0.003). Treatment was deemed \"effective\" in more hospital (58.8%) than home (42.6%) patients. The cost of hospital treatment was higher than home treatment (mean difference 9,005 pounds, 95% CI 3,507 to 14,700, p<0.001). The mean ICER was 46,098 pounds (2.5th and 97.5th percentiles -374,044 and 362,472). Hospital treatment was more effective but more expensive than home treatment. Potential methods to improve outcome at home should be considered but these may have resource implications."," J Cyst Fibros. 2005 Dec;4(4):239-47.","UK",2005,null,"Antibiotics",null,null,null,"Direct costs"]
[41,"Rosenberg MA, Farrell PM. Assessing the cost of cystic fibrosis diagnosis and treatment. J Pediatr. 2005 Sep;147(3 Suppl):S101-5. doi: 10.1016/j.jpeds.2005.08.018.",null,"Rosenberg MA, Farrell PM.","Assessing the cost of cystic fibrosis diagnosis and treatment.","To extend previous evaluations of costs of cystic fibrosis (CF) diagnosis and examine key issues in assessing the CF cost of care. Costs for CF newborn screening (NBS) including CF multi-mutation testing are analyzed by using data from the Wisconsin State Laboratory of Hygiene. Electronic data from 2 Wisconsin CF centers are used to illustrate the complexity of analyzing CF health care utilization and costs. The current cost-per-newborn of a CF multi-mutation test is 50% higher than testing for a single mutation. Data collection for the cost-of-care study requires a combination of electronic and manual data collection; modeling of cost data requires consideration of any censoring. Hospitalizations are shown to have a large impact on costs and show high variability at the individual level. Sixty-nine percent of children with meconium ileus had some hospitalization versus 56% of children without meconium ileus. A cost-benefit analysis of CF multi-mutation testing is warranted. The study of health care cost data is complex and utilization varies between children. Individual-level modeling of CF costs must include factors contributing to the severity of the disease and allow for consideration of individual-level utilization, such as the number of hospitalizations."," J Pediatr. 2005 Sep;147(3 Suppl):S101-5. ","USA",2005,null,"All healthcare",null,null,null,"Direct costs"]
[42,"Warren E, Anderson R, Proos AL, Burnett LB, Barlow-Stewart K, Hall J. Cost-effectiveness of a school-based Tay-Sachs and cystic fibrosis genetic carrier screening program. Genet Med. 2005 Sep;7(7):484-94. doi: 10.109701.gim.0000178496.91670.3b. ",null,"Warren E, Anderson R, Proos AL, Burnett LB, Barlow-Stewart K, Hall J. ","Cost-effectiveness of a school-based Tay-Sachs and cystic fibrosis genetic carrier screening program. ","To explore the cost-effectiveness of school-based multi-disease genetic carrier screening. Decision analysis of the cost-effectiveness of a school-based Tay-Sachs disease and cystic fibrosis genetic carrier screening program, relative to no screening. Data relating to ethnicity profile, test-accepting behavior, and screening program cost were sourced from an existing program in Sydney, Australia. Compared to no screening, the incremental cost-effectiveness of the screening program is A dollar 5,834 per additional carrier detected. This cost-effectiveness ratio is most sensitive to changes in genetic test accuracy, and the cost of laboratory assays. The results imply a cost per affected birth avoided of approximately A dollar 530,000 (approximately US dollar 371,000). This preconceptional genetic carrier screening program offers comparable cost-effectiveness to prenatal screening programs for cystic fibrosis.","Genet Med. 2005 Sep;7(7):484-94.","Australia",2005,null,"Screening",null,null,null,"Direct costs"]
[43,"Taccetti G, Campana S, Festini F, Mascherini M, Döring G. Early eradication therapy against Pseudomonas aeruginosa in cystic fibrosis patients. Eur Respir J. 2005 Sep;26(3):458-61. Doi: 10.1183/09031936.05.00009605.",null,"Taccetti G, Campana S, Festini F, Mascherini M, Döring G.","Early eradication therapy against Pseudomonas aeruginosa in cystic fibrosis patients. ","In cystic fibrosis (CF) patients early antibiotic treatment of lung infection has been shown to lead to Pseudomonas aeruginosa eradication. The present study determined: 1) the time period from eradication to new P. aeruginosa acquisition; 2) P. aeruginosa re-growth and new acquisition; and 3) the impact of eradication therapy on lung function, antimicrobial resistance, emergence of other pathogens and treatment costs. Ciprofloxacin and colistin were used to eradicate P. aeruginosa in 47 CF patients. Bacterial pathogens, lung function decline, P. aeruginosa antimicrobial resistance and anti-pseudomonal serum antibodies were assessed quarterly and compared with an age-matched CF control group. Additionally, costs of antibiotic therapy in both groups were assessed. Early antibiotic therapy leads to a P. aeruginosa free-period of a median (range) of 18 (4-80) months. New acquisition with different P. aeruginosa genotypes occurs in 73% of episodes. It also delays the decline of lung function compared with chronically infected patients, prevents the occurrence of antibiotic resistant P. aeruginosa strains, does not lead to emergence of other pathogens, and significantly reduces treatment costs. The treatment substantially lowers P. aeruginosa prevalence in CF. In conclusion, early antibiotic therapy exerts beneficial effects on the patient's clinical status and is cost-effective compared with conventional antibiotic therapy for chronically infected cystic fibrosis patients.","Eur Respir J. 2005 Sep;26(3):458-61","Germany",2005,null,"Antibiotics",null,null,null,"Direct costs"]
[44,"Iles R, Legh-Smith J, Drummond M, Prevost A, Vowler S. Economic evaluation of Tobramycin nebuliser solution in cystic fibrosis. J Cyst Fibros. 2003 Sep;2(3):120-8. doi: 10.1016/S1569-1993(03)00064-X. ",null,"Iles R, Legh-Smith J, Drummond M, Prevost A, Vowler S."," Economic evaluation of Tobramycin nebuliser solution in cystic fibrosis.","The cost effectiveness of inhaled TOBIR tobramycin nebuliser solution (TNS) in CF and chronic pulmonary Pseudomonas aeruginosa infection has been shown in US but not in European studies. An economic evaluation of TNS was undertaken in children and adults. Lung function and resource utilisation were recorded for 24 months before and during TNS therapy. Interventions were costed. Forty-one patients received TNS; 30 of them matched with a paired control on usual therapy. TNS cases received more inhaled and IV antibiotics in the year before TNS than controls, and were hospitalised more. In the TNS treated group mean days in hospital before and after (change) were 32.0, 24.2 (-7.8); days on IV antibiotics 55.4, 38.9 (-16.4); total cost 22,102 pounds, 28,394 pounds (+ 6292 pounds), composed of cost of TNS 0 pounds, 10,010 pounds (+ 10,010 pounds), cost of hospitalisation 10,897 pounds, 8552 pounds (- 2345 pounds), cost of drugs 11,205 pounds, 9832 pounds (- 1374 pounds). In 19 patients aged < 18 the change in days hospitalised was -10.7 and days on IVs -20.2. Incremental cost was 3830 pounds. TNS was associated with clinically and socially important reductions of hospital attendances and parenteral antibiotics. This would improve patients' quality of life and reduce interference with work and schooling. Its maximal acquisition cost of 10,010 pounds may be reduced by delays in prescribing and dispensing, and was offset by savings of approximately 3500-6200 pounds."," J Cyst Fibros. 2003 Sep;2(3):120-8.","UK",2003,null,"Antibiotics",null,null,null,"Direct costs"]
[45,"Baumann U, Stocklossa C, Greiner W, von der Schulenburg JM, von der Hardt H. Cost of care and clinical condition in paediatric cystic fibrosis patients. J Cyst Fibros. 2003 Jun;2(2):84-90. doi: 10.1016/S1569-1993(03)00024-9.",null,"Baumann U, Stocklossa C, Greiner W, von der Schulenburg JM, von der Hardt H"," Cost of care and clinical condition in paediatric cystic fibrosis patients. ","The clinical course of cystic fibrosis (CF) shows considerable variation resulting in differences in health care utilisation. We investigated important clinical parameters and their relation to costs. We collected clinical parameters together with health care utilisation of a representative paediatric CF population (n=138 patients) attending Hanover Medical School over a period of 1 year. 49% of the patients were chronically infected with Pseudomonas aeruginosa. Costs were calculated on the basis of the annual individual health care utilisation from the perspective of health insurance. Total annual expenditure per patient amounted to 23,989 euro (S.D. 18,026), with home drug treatment representing the most important single cost factor (47% of total costs). While costs rose with age and doubled in the first 18 years, they correlated foremost with P. aeruginosa airway colonisation status and lung function expressed as FEV(1). Costs of patients with chronic P. aeruginosa infection were more than three times higher than of uninfected patients. Health care expenditures for patients with CF vary with the clinical course. The variation can be explained to a large extend by clinical parameters."," J Cyst Fibros. 2003 Jun;2(2):84-90. ","Germany",2003,null,"All healthcare",null,null,null,"Direct costs"]
[46,"Sawyer SM, Glazner JA. What follows newborn screening? An evaluation of a residential education program for parents of infants with newly diagnosed cystic fibrosis. Pediatrics. 2004 Aug;114(2):411-6. ",null,"Sawyer SM, Glazner JA.","What follows newborn screening? An evaluation of a residential education program for parents of infants with newly diagnosed cystic fibrosis.","The diagnosis of a severe life-limiting condition, such as cystic fibrosis (CF), is generally followed by assessment and treatment of the child and education and counseling for parents. The introduction of newborn screening for CF provides an opportunity for standardized assessment and education. The aim of this study was to evaluate a 5-day residential assessment and education program for parents of infants who receive a diagnosis of CF after newborn screening. Eligible parents had a 6- to 30-month-old infant with CF diagnosed by newborn screening. Parents were interviewed by telephone using a structured questionnaire that addressed 3 main themes: 1) initial communication of the diagnosis of CF, 2) the perceived value of the 5-day assessment and education program, and 3) the perceived advantages and disadvantages of the residential component (Care-By-Parent unit) of the program. Fifteen of 17 eligible families took part in the 5-day assessment and education program, 12 of whom used the residential Care-By-Parent unit. At the end of the program, parents believed that they had the knowledge and skills required to manage their child's CF at home. One hundred percent endorsed the timing of the assessment and education program immediately after the child's diagnosis and would recommend it to other families in the same situation. Perceived advantages of the residential program were not having to travel (89%), being able to concentrate on CF (50%), and the benefit of a \"home base\" at the hospital (39%). Twenty-two percent reported that financial costs related to participation (paternal time off work) were a disadvantage, 17% reported additional strain on family members caring for siblings, and 17% mentioned lack of comfort within the unit. This time-intensive residential program was evaluated positively by parents of children with newly diagnosed CF. It provides a model for education programs after the diagnosis of CF by newborn screening, as well as for other pediatric conditions that require intensive parent education.","Pediatrics. 2004 Aug;114(2):411-6. ","Australia",2004,null,"Various",null,null,null,"Direct costs"]
[47,"Balinsky W, Zhu CW. Pediatric cystic fibrosis: evaluating costs and genetic testing. J Pediatr Health Care. 2004 Jan-Feb;18(1):30-4. ",null,"Balinsky W, Zhu CW."," Pediatric cystic fibrosis: evaluating costs and genetic testing. ","The purpose of this article is to present a systematic, critical review of literature and data sources pertaining to pediatric cystic fibrosis, emphasizing and evaluating factors of costs and genetic testing. Cystic fibrosis is the most common fatal genetic disease in the United States. Therefore, its cause, prevalence, cost, and prevention make it important for review. Furthermore, the recent National Institutes of Health Consensus Statement on Genetic Testing for Cystic Fibrosis, the laboratory standards and guidelines published by the American College of Medical Genetics, the American College of Obstetricians and Gynecologists, and the National Human Genome Research Institute, and the increasing interest in genetic testing make it timely to discuss this major pediatric health topic. A broad educational effort, particularly among health care professionals, and genetic screening are advocated."," J Pediatr Health Care. 2004 Jan-Feb;18(1):30-4. ","International",2004,null,"Screening,All healthcare",null,null,null,"Indirect costs"]
[48,"Lee DS, Rosenberg MA, Peterson A, Makholm L, Hoffman G, Laessig RH, Farrell PM. Analysis of the costs of diagnosing cystic fibrosis with a newborn screening program. J Pediatr. 2003 Jun;142(6):617-23. doi: 10.1067/mpd.2003.209. ",null,"Lee DS, Rosenberg MA, Peterson A, Makholm L, Hoffman G, Laessig RH, Farrell PM.","Analysis of the costs of diagnosing cystic fibrosis with a newborn screening program","To compare the cost of diagnosing cystic fibrosis (CF) through a newborn screening program with the traditional method and to estimate the cost of CF diagnosis if a national newborn screening program is implemented. Surveys were conducted to determine the annual number of sweat tests in 1991 and in 2000 after implementation of statewide screening. A national survey of sweat test costs was used to estimate the annual expense for diagnosing CF in the United States through newborn screening. Since the introduction of newborn screening for CF, the numbers of sweat tests ordered annually have decreased from 1670 to 804 (including 134 follow-up tests from screening). The current estimated annual cost of Wisconsin CF newborn screening and diagnosis is $4.58 per newborn infant. The estimated annual cost per newly diagnosed CF infant using the traditional method is $4.97 per newborn infant. If no additional sweat tests were ordered outside of the newborn screening program, the estimated annual cost of a Wisconsin CF newborn screening and diagnosis is $2.66 per newborn and $2.47 per newborn for a national CF newborn screening program. A CF newborn screening program provides a potentially cost-saving alternative to the traditional method of diagnosis of CF."," J Pediatr. 2003 Jun;142(6):617-23.","USA",2003,null,"Screening",null,null,null,"Direct costs"]
[49,"Grieve R, Thompson S, Normand C, Suri R, Bush A, Wallis C. A cost-effectiveness analysis of rhDNase in children with cystic fibrosis. Int J Technol Assess Health Care. 2003 Winter;19(1):71-9.",null,"Grieve R, Thompson S, Normand C, Suri R, Bush A, Wallis C."," A cost-effectiveness analysis of rhDNase in children with cystic fibrosis.","This study compared the relative cost-effectiveness of daily recombinant human deoxyribonuclease (rhDNase), with alternate day rhDNase and hypertonic saline (HS) for treating children with cystic fibrosis (CF). A randomized controlled trial with a crossover design allocated 40 CF children consecutively to 12 weeks of daily rhDNase, alternate day rhDNase, or HS. The primary outcome measure was forced expiratory volume in 1 second (FEV1), a measure of lung function. All health resource use was prospectively documented for each patient and multiplied by unit costs to give a total health service cost for each 12-week treatment period. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics for each treatment comparison, for various hypothetical levels of the decision maker's ceiling ratio. Compared with HS, there was a 14% improvement in FEV1 for daily rhDNase (95% Cl, 5% to 23%), and a 12% improvement (95% Cl, 2% to 22%) for alternate day rhDNase. For a ceiling ratio of 200 pounds sterling per 1% gain in FEV1, the mean net benefits of daily and alternate day rhDNase compared with HS were 1,158 pounds sterling (95% Cl, -621pounds sterling to 2,842) and 1,188 pounds sterling (95% Cl, -847 to 3,343), respectively; the mean net benefit of daily compared with alternate day rhDNase was -30 pounds sterling (95% Cl, -2,091 pounds sterling to 1,576). If decision makers are prepared to pay 200 pounds sterling for a 1% gain in FEV1 over a 12-week period, then on average either rhDNase strategy is cost-effective.","Int J Technol Assess Health Care. 2003 Winter;19(1):71-9.","UK",2003,null,"RhDNAse",null,null,null,"Direct costs"]
[50,"Chung F, Barnes N, Allen M, Angus R, Corris P, Knox A, Miles J, Morice A, O'Reilly J, Richardson M. Assessing the burden of respiratory disease in the UK. Respir Med. 2002 Dec;96(12):963-75. ",null,"Chung F, Barnes N, Allen M, Angus R, Corris P, Knox A, Miles J, Morice A, O'Reilly J, Richardson M.","Assessing the burden of respiratory disease in the UK.","This review explores the health and social burden of some of the main respiratory diseases (asthma, chronic obstructive pulmonary disease, cryptogenic fibrosing alveolitis, cystic fibrosis, lung cancer, mesothelioma, obstructive sleep apnoea and tuberculosis) in order to increase awareness of these diseases and highlight areas where improvements in care are required. The overall impact of respiratory diseases in the U.K. in terms of prevalence, mortality, morbidity and economic costs, with particular reference to secondary care has been considered and comparisons made with the rest of Europe where data are available. Respiratory diseases are responsible for a significant proportion of serious morbidity and premature death among the population of the U.K. and they will continue to present a growing challenge; special support is needed to tackle this burden.","Respir Med. 2002 Dec;96(12):963-75. ","UK",2002,null,"All healthcare",null,null,null,"Direct costs"]
[51,"Suri R, Grieve R, Normand C, Metcalfe C, Thompson S, Wallis C, Bush A. Effects of hypertonic saline, alternate day and daily rhDNase on healthcare use, costs and outcomes in children with cystic fibrosis. Thorax. 2002 Oct;57(10):841-6.",null,"Suri R, Grieve R, Normand C, Metcalfe C, Thompson S, Wallis C, Bush A. ","Effects of hypertonic saline, alternate day and daily rhDNase on healthcare use, costs and outcomes in children with cystic fibrosis.","Daily recombinant human deoxyribonuclease (rhDNase) is an established but expensive treatment in cystic fibrosis (CF). An alternative lower cost therapy is hypertonic saline (HS), which has been shown to improve lung function in short term studies. This study compares the costs and consequences of daily rhDNase with alternate day rhDNase and HS in children with CF. In an open, randomised, crossover trial, 48 children with CF were allocated consecutively to 12 weeks of once daily 2.5 mg rhDNase, alternate day 2.5 mg rhDNase, and twice daily 5 ml 7% HS. Outcomes assessed included forced expiratory volume in 1 second (FEV(1)) and quality of life. All healthcare resource use was prospectively recorded for each patient. Unit costs were collected and combined with resource use data to give the total health service costs per patient for each treatment strategy. Daily rhDNase resulted in a significantly greater increase in mean FEV(1) than HS (8%, 95% CI 2 to 14) but there was no significant difference in FEV(1) between daily and alternate day rhDNase (2%, 95% CI -4 to 9). Over a 12 week period the mean incremental costs of daily rhDNase compared with HS was pound 1409 (95% CI pound 440 to pound 2318), and the incremental cost of using daily rather than alternate day rhDNase was pound 513 (95% CI - pound 546 to pound 1510). Daily rhDNase is more effective than 5 ml 7% HS twice daily delivered by jet nebuliser, but significantly increases healthcare costs. Administering rhDNase on an alternate day rather than a daily basis is as effective, with a potential for cost savings.","Thorax. 2002 Oct;57(10):841-6.","UK",2002,null,"RhDNAse",null,null,null,"Direct costs"]
[52,"Goodman DM, Mendez E, Throop C, Ogata ES. Adult survivors of pediatric illness: the impact on pediatric hospitals. Pediatrics. 2002 Sep;110(3):583-9.",null,"Goodman DM, Mendez E, Throop C, Ogata ES."," Adult survivors of pediatric illness: the impact on pediatric hospitals.","Patients now live well into adulthood surviving diseases with pediatric onset. The size and financial impact of this growing population is unknown. To describe the demographics of adult inpatients in pediatric facilities and to assess the financial impact of providing care for these patients on freestanding children's hospitals. An observational study using the Pediatric Health Information System, a proprietary database available to Child Health Corporation of America member hospitals, covering years 1994-1999. These data reflect inpatient services and exclude outpatient encounters and adult patients transitioned to adult providers. National estimates of the number of adult survivors of pediatric illness and the financial impact of care were calculated. Hospitals with >100 discharge events for patients > or =age 21 in 1999, and having both clinical and financial data in the dataset, assured an adequate sample size to discern resource utilization. Both 18 and 21 were used as lower limits of adult age to reflect common definitions of legal majority (age 18) and common pediatric practice (age 21). We truncated the data at age 64 to exclude patients eligible for Medicare. Ten hospitals representing all geographic regions of the United States were used for an in-depth analysis of financial impact during 1999. Six of 10 had data for 1994-1999 to describe trends over time. The number of patients admitted over the 6-year period increased, as did average and total adjusted charges. In 1999, 3863 patients 18 to 64 years old incurred 5051 discharge episodes and total charges of $134.5 million. Of these, about half (1785) were > or =21 with charges of $66 million. Of the hospitals' total discharges and financial charges, on average 2.1% and 3.1%, respectively, were from the inpatient care of patients 21 to 64 years old. Forty percent of patients receive public aid. Extrapolating from census data, up to 15 000 patients > or =21 years annually may seek inpatient care in part at children's hospitals, with charges exceeding $500 million. The 3 most common diagnostic groups to be admitted were those with cystic fibrosis, mental retardation or cerebral palsy, and congenital heart disease. We describe a subset of adults who have survived diseases of pediatric onset. We focused on the portion of that population that obtains at least some inpatient care at a children's hospital. The data reported here can be used to set a lower boundary for the size of this population, and thereby provide valuable data for health planners as well as clinicians. If one includes estimates of expenses across the continuum of care, the financial impact of this growing population is substantial. Public policy discussions should include the medical, psychological, social, and financial needs of this population.","Pediatrics. 2002 Sep;110(3):583-9.","USA",2002,null,"Inpatient care",null,null,null,"Direct costs"]
[53,"Nielsen R, Gyrd-Hansen D. Prenatal screening for cystic fibrosis: an economic analysis. Health Econ. 2002 Jun;11(4):285-99. doi: 10.1002/hec.652. ",null,"Nielsen R, Gyrd-Hansen D.","Prenatal screening for cystic fibrosis: an economic analysis.","Cystic fibrosis (CF) is the most common life-shortening genetically transmitted disease in Denmark with a birth prevalence of 1 in 4700, resulting in 12-15 new cases of cystic fibroses annually. The aim of this study is to disclose the societal resource implications of introducing a population wide prenatal screening programme for cystic fibrosis in Denmark. The present analysis is limited to the monetary consequences of introducing a screening programme, where costs of screening are compared to the potential benefits measured in cost savings involved if births of CF patients are avoided. Screening costs in a Danish setting were estimated at DKK 2 771 262 ( pound sterlings 231 438) per aborted affected fetus in the first screening round, stabilising at DKK 1 864 594 ( pound sterlings 155 383) per aborted affected fetus at subsequent screening rounds. Comparing this figure with the estimated benefits of avoiding a CF case (DKK 2.1-4.4 million; pound sterlings 175 000-366 667) suggests that introducing a screening programme for cystic fibrosis will be net cost saving irrespective of the perspective of the analysis, assumptions on replacement children and method of estimating long-term production gains/losses.","Health Econ. 2002 Jun;11(4):285-99.","Denmark",2002,null,"Screening",null,null,null,"Direct costs"]
[54,"Suri R, Metcalfe C, Lees B, Grieve R, Flather M, Normand C, Thompson S, Bush A, Wallis C. Comparison of hypertonic saline and alternate-day or daily recombinant human deoxyribonuclease in children with cystic fibrosis: a randomised trial. Lancet. 2001 Oct 20;358(9290):1316-21. doi: 10.1016/S0140-6736(01)06412-1.",null,"Suri R, Metcalfe C, Lees B, Grieve R, Flather M, Normand C, Thompson S, Bush A, Wallis C.","Comparison of hypertonic saline and alternate-day or daily recombinant human deoxyribonuclease in children with cystic fibrosis: a randomised trial. ","Daily recombinant human deoxyribonuclease (rhDNase) is an established but expensive treatment in cystic fibrosis. Alternate-day treatment, if equally effective, would reduce the drug cost. Hypertonic saline improved lung function to the same degree as rhDNase in short-term studies. We compared the effectiveness of daily rhDNase, hypertonic saline, and alternate-day rhDNase in children with cystic fibrosis. In an open cross-over trial, 48 children were allocated in random order to 12 weeks of once-daily rhDNase (2.5 mg), alternate-day rhDNase (2.5 mg), and twice-daily 5 mL 7% hypertonic saline. The primary outcome was forced expiratory volume in 1 s (FEV(1)). Secondary outcomes were forced vital capacity, number of pulmonary exacerbations, weight gain, quality of life, exercise tolerance, and the total costs of hospital and community care. Mean FEV(1) increased by 16% (SD 25%), 14% (22%), and 3% (21%) with daily rhDNase, alternate-day rhDNase, and hypertonic saline, respectively. There was no difference between daily and alternate-day rhDNase (2% [95% CI -4 to 9], p=0.55). However, daily rhDNase showed a significantly greater increase in FEV(1) than hypertonic saline (8% [2 to 14], p=0.01). The average difference in 12-week cost between daily and alternate-day rhDNase was pound513 (95% CI -546 to 1510) and that between daily rhDNase and hypertonic saline was pound1409 (440 to 2318). None of the secondary clinical outcomes showed significant differences between treatments. Hypertonic saline, delivered by jet nebuliser, is not as effective as daily rhDNase, although there is variation in individual response. There is no evidence of a difference between daily and alternate-day rhDNase.","Lancet. 2001 Oct 20;358(9290):1316-21.","UK",2001,null,"RhDNAse",null,null,null,"Direct costs,Indirect costs"]
[55,"Antioch K, Walsh M. Funding issues for Victorian hospitals: the risk-adjusted vision beyond casemix funding. Aust Health Rev. 2000;23(3):145-53.",null,"Antioch K, Walsh M.","Funding issues for Victorian hospitals: the risk-adjusted vision beyond casemix funding.","This paper discusses casemix funding issues in Victoria impacting on teaching hospitals. For casemix payments to be acceptable, the average price and cost weights must be set at an appropriate standard. The average price is based on a normative, policy basis rather than benchmarking. The 'averaging principle' inherent in cost weights has resulted in some AN-DRG weights being too low for teaching hospitals that are key State-wide providers of high complexity services such as neurosurgery and trauma. Casemix data have been analysed using international risk adjustment methodologies to successfully negotiate with the Victorian State Government for specified grants for several high complexity AN-DRGs. A risk-adjusted capitation funding model has also been developed for cystic fibrosis patients treated by The Alfred, called an Australian Health Maintenance Organisation (AHMO). This will facilitate the development of similar models by both the Victorian and Federal governments."," Aust Health Rev. 2000;23(3):145-53.","Australia",2000,null,"Inpatient care",null,null,null,"Direct costs"]
[56,"Knower MT, Labella-Walker K, McFadden PM, Kantrow SP, Valentine VG. Clarithromycin for safe and cost-effective reduction of cyclosporine doses in lung allograft recipients. South Med J. 2000 Nov;93(11):1087-92.",null,"Knower MT, Labella-Walker K, McFadden PM, Kantrow SP, Valentine VG."," Clarithromycin for safe and cost-effective reduction of cyclosporine doses in lung allograft recipients. ","This study was done to analyze the economic effect of clarithromycin on the daily dosing of cyclosporine in lung transplantation. Nine consecutive patients (mean age +/- SEM, 34.6 +/- 5.2 years) had transplantation from June 1995 to June 1996. Median follow-up time was 649 days (range, 431 to 799 days). Preoperative diagnoses were cystic fibrosis (n = 4), idiopathic pulmonary fibrosis (n = 2), emphysema, bronchiectasis, and obliterative bronchiolitis. Median time from transplantation to addition of clarithromycin to a standard immunosuppressive regimen was 86 days (range, 14 to 181 days). Baseline cyclosporine dose (9.9 +/- 2.2 mg/kg/day) was reduced to 5.8 +/- 1.0 mg/kg/day and 4.1 +/- 0.8 mg/kg/day at 1 month and 1 year, respectively, after initiation of clarithromycin therapy. Estimated annual savings were $3,400 per patient. There was no increase in infection or rejection episodes. Clarithromycin safely reduced the dose and cost of cyclosporine in this series.\n","South Med J. 2000 Nov;93(11):1087-92","USA",2000,null,"Lung transplant",null,null,null,"Direct costs"]
[57,"Scotet V, de Braekeleer M, Roussey M, Rault G, Parent P, Dagorne M, Journel H, Lemoigne A, Codet JP, Catheline M, David V, Chaventré A, Duguépéroux I, Verlingue C, Quéré I, Mercier B, Audrézet MP, Férec C. Neonatal screening for cystic fibrosis in Brittany, France: assessment of 10 years' experience and impact on prenatal diagnosis. Lancet. 2000 Sep 2;356(9232):789-94. doi: 10.1016/S0140-6736(00)02652-0.",null,"Scotet V, de Braekeleer M, Roussey M, Rault G, Parent P, Dagorne M, Journel H, Lemoigne A, Codet JP, Catheline M, David V, Chaventré A, Duguépéroux I, Verlingue C, Quéré I, Mercier B, Audrézet MP, Férec C.","Neonatal screening for cystic fibrosis in Brittany, France: assessment of 10 years' experience and impact on prenatal diagnosis.","Neonatal screening for cystic fibrosis has been a subject of debate over the past few years. This study assesses 10 years of neonatal screening in Brittany, France, and examines its impact on prenatal screening of subsequent pregnancies in couples with an affected child. The study included all the neonates screened for cystic fibrosis in Brittany from Jan 1, 1989, to Dec 31, 1998. The screening consisted of an immunoreactive trypsinogen assay from dried blood spots, plus, from 1993, mutation analysis. Data were collected on incidence of cystic fibrosis, and genotypic and biochemical characteristics. The use of prenatal screening of subsequent pregnancies in affected families was also investigated. Of the 343,756 neonates screened, 118 children with cystic fibrosis were identified, giving an incidence of one in 2913. All mutated alleles were characterised: 34 different mutations resulting in 36 genotypes were detected. The introduction of DNA analysis into the protocol greatly reduced the recall rate and increased the sensitivity of the test. The mean cost of the screening programme was US$2.32 per screened child. 39 (34%) of the families identified by neonatal screening opted for subsequent prenatal diagnosis at least once. 12 couples would have benefited from this procedure while their first child was still symptom-free. 42 healthy children were born, and 18 pregnancies were terminated (therapeutic abortion rate of 100%). We have shown the feasibility of neonatal screening for cystic fibrosis in Brittany. Through the detection of a large range of mutations, neonatal screening provides the opportunity for more reliable prenatal diagnosis and cascade screening. The neonatal screening programme described here could provide a good model for other countries intending to initiate such a scheme.","Lancet. 2000 Sep 2;356(9232):789-94. ","France",2000,null,"Screening",null,null,null,"Direct costs"]
[58,"Ollendorf DA, McGarry LJ, Watrous ML, Oster G. Use of rhDNase therapy and costs of respiratory-related care in patients with cystic fibrosis. Ann Pharmacother. 2000 Mar;34(3):304-8.",null,"Ollendorf DA, McGarry LJ, Watrous ML, Oster G.","Use of rhDNase therapy and costs of respiratory-related care in patients with cystic fibrosis.","To assess the relationship between level of use of recombinant deoxyribonuclease I (rhDNase) therapy and costs of respiratory-related care in patients with cystic fibrosis. Retrospective, cohort study using healthcare claims data from a large New England health insurer. All cystic fibrosis patients five years of age and older who began therapy with rhDNase in 1994 (the year it was first marketed in the US). Healthcare claims were compiled for six months prior to first receipt of rhDNase (pretreatment) and for 30 months subsequently (follow-up). Patients were stratified according to their level of rhDNase use during follow-up, based on whether it was above or below the median number of therapy days for the sample. Costs of rhDNase, all antibiotics, and all respiratory-related outpatient (physician, home health, hospital outpatient) and inpatient care were included. All costs were expressed on an annualized basis. Twenty-four patients with cystic fibrosis who began treatment with rhDNase in 1994 met all entry criteria; the median number of therapy days over a 30-month period was 355. Among patients with low (i.e., below the median) rhDNase use (n = 12), mean +/- SD annualized costs of respiratory-related care increased by almost $17,000 between pretreatment and follow-up, from $29,251 +/- $37,919 to $46,109 +/- $40,944. Among high-use patients (n = 12), costs decreased by approximately $2500, from $37,178 +/- $48,476 to $34,592 +/- $22,591. The change in both groups was accounted for primarily by a change in the number of respiratory-related hospitalizations. Prolonged use of rhDNase may reduce costs of respiratory-related care in patients with cystic fibrosis; further study is required, however, to confirm these findings.","Ann Pharmacother. 2000 Mar;34(3):304-8.","USA",2000,null,"RhDNAse",null,null,null,"Direct costs"]
[59,"LeLorier J, Perreault S, Birnbaum H, Greenberg P, Sheehy O. Savings in direct medical costs from the use of tobramycin solution for inhalation in patients with cystic fibrosis. Clin Ther. 2000 Jan;22(1):140-51.",null,"LeLorier J, Perreault S, Birnbaum H, Greenberg P, Sheehy O. "," Savings in direct medical costs from the use of tobramycin solution for inhalation in patients with cystic fibrosis.","Two identical 24-week, double-blind, placebo-controlled trials of tobramycin solution for inhalation (TOBI [PathoGenesis Corporation, Seattle, Washington]) in cystic fibrosis patients with chronic Pseudomonas aeruginosa infection were conducted in the United States. The aim of the present study was to extrapolate the US trial data to a Canadian setting, using Canadian costs to estimate the savings in direct medical costs that might result from use of a similar 24-week TOBI regimen versus usual care in 2 Canadian provinces. Cystic fibrosis is a genetic disease in which persistent respiratory infection, usually due to P. aeruginosa infection, is the major cause of morbidity and mortality. The US trials demonstrated that TOBI produced significant improvements in pulmonary function test results, reduced sputum levels of P. aeruginosa, and resulted in a 26% reduction in the probability of hospitalization (95% CI, 2%-43% vs placebo in the clinical trials). Individual patient data from the US trials were used to calculate the mean number of days in hospital as well as the mean number of days of home intravenous or oral antibiotic therapy. To adjust for Canadian pricing, pertinent economic data were obtained from Statistics Canada and the Ontario and Quebec health ministries. Demographic and baseline data were obtained from health surveys conducted by the Canadian Cystic Fibrosis Foundation. Economic analysis showed that the use of TOBI for 24 weeks would result in estimated mean per-patient savings in direct medical costs (in Canadian dollars) of $4055 in Ontario and $4916 in Quebec, which would substantially offset the Canadian acquisition price of $8602 for the same 24-week period. Assuming that the percentage of reduction in hospital days observed in the US trials would also occur in the Canadian clinical setting, use of TOBI would reduce the use of health care services, particularly hospital days, and lead to substantial savings in direct medical costs that would offset its acquisition price. Whether this reduction actually occurs after TOBI enters the Canadian market is a subject for future investigation."," Clin Ther. 2000 Jan;22(1):140-51.","Canada",2000,null,"All healthcare",null,null,null,"Direct costs"]
[60,"Elliott RA, Thornton J, Webb AK, Dodd M, Tully MP. Comparing costs of home- versus hospital-based treatment of infections in adults in a specialist cystic fibrosis center. Int J Technol Assess Health Care. 2005 Fall;21(4):506-10. doi: 10.1017/S0266462305050701.",null,"Elliott RA, Thornton J, Webb AK, Dodd M, Tully MP","Comparing costs of home- versus hospital-based treatment of infections in adults in a specialist cystic fibrosis center. ","This study aimed to produce valid patient-based UK National Health Service (NHS) costs for adults with cystic fibrosis to identify differences between hospital- and home-based treatments for infections. A costing study was carried out in adults with cystic fibrosis (CF) in the United Kingdom, who required intravenous antibiotic treatments for respiratory infections, administered either at home or in the hospital. The perspective was that of the NHS hospital trust. Data were collected retrospectively for each patient for 1 year using clinical records. Data were collected for 116 adults with CF between 2000 and 2001, when 42,382 treatment days (454 courses) of intravenous antibiotics were administered; 213 courses with intention-to-treat at home and 241 courses with intention-to-treat in the hospital. The mean length of a course was 15.3 days. Patients who had >60 percent of courses at home over 1 year had a mean cost of 13,528 UK pounds, compared with 22,609 pounds for patients who had > 60 percent of courses in the hospital, and a mean cost of 19,927 UK pounds for patients who had an equal mix of home and hospital care (p = .0001). The key cost-generating events in CF respiratory infections are hospital admissions. Future studies assessing costs should concentrate on factors affecting admissions, length of stay, staff input, and alternative methods of home-care provision, rather than marginal effects, such as using different antibiotics."," Int J Technol Assess Health Care. 2005 Fall;21(4):506-10. ","UK",2005,null,"Antibiotics",null,null,null,"Direct costs"]

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[1,"Balaguer A,González de Dios J. Home versus hospital intravenous antibiotic therapy for cystic fibrosis. Cochrane Database Syst Rev. 2015 Dec 15;12():CD001917. doi: 10.1002/14651858.CD001917.pub4. Epub 2015 Dec 15. ","10.1002/14651858.CD001917.pub4. ","Balaguer A,González de Dios J."," Home versus hospital intravenous antibiotic therapy for cystic fibrosis.","Recurrent endobronchial infection in cystic fibrosis requires treatment with intravenous antibiotics for several weeks usually in hospital,affecting health costs and quality of life for patients and their families. This is an update of a previously published review. To determine whether home intravenous antibiotic therapy in cystic fibrosis is as effective as inpatient intravenous antibiotic therapy and if it is preferred by individuals or families or both. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.Most recent search of the Group's Trials Register: 23 November 2015. Randomized and quasi-randomized controlled studies of intravenous antibiotic treatment for adults and children with cystic fibrosis at home compared to in hospital. The authors independently selected studies for inclusion in the review,assessed methodological quality of each study and extracted data using a standardised form. Eighteen studies were identified by the searches. Only one study could be included which reported results from 17 participants aged 10 to 41 years with an infective exacerbation of Pseudomonas aeruginosa. All their 31 admissions (18 hospital and 13 at home after two to four days of hospital treatment) were analysed as independent events. Outcomes were measured at 0,10 and 21 days after initiation of treatment. Home participants underwent fewer investigations than hospital participants (P < 0.002) and general activity was higher in the home group. No significant differences were found for clinical outcomes,adverse events,complications or change of intravenous lines,or time to next admission. Home participants received less low-dose home maintenance antibiotic.Quality of life measures showed no significant differences for dyspnoea and emotional state,but fatigue and mastery were worse for home participants,possibly due to a higher general activity and need of support. Personal,family,sleeping and eating disruptions were less important for home than hospital admissions.Home therapy was cheaper for families and the hospital. Indirect costs were not determined. Current evidence is restricted to a single randomized clinical trial. It suggests that,in the short term,home therapy does not harm individuals,entails fewer investigations,reduces social disruptions and can be cost-effective. There were both advantages and disadvantages in terms of quality of life. The decision to attempt home treatment should be based on the individual situation and appropriate local resources. More research is urgently required.","Cochrane Database Syst Rev. 2015 Dec 15;12():CD001917.","International",2015,null,"Antibiotics",null,null,null,"Direct costs",null,"International",null,null,"Antibiotics","Direct costs",null,null,"2015:2017"]
[2,"Moodie M,Lal A,Vidmar S,Armstrong DS,Byrnes CA,Carlin JB,Cheney J,Cooper PJ,Grimwood K,Robertson CF,Tiddens HA,Wainwright CE,Australasian Cystic Fibrosis Bronchoalveolar Lavage Study Investigators. Costs of bronchoalveolar lavage-directed therapy in the first 5 years of life for children with cystic fibrosis. J Pediatr. 2014 Sep;165(3):564-569.e5. doi: 10.1016/j.jpeds.2014.05.031. Epub 2014 Jul 1.",null,"Moodie M,Lal A,Vidmar S,Armstrong DS,Byrnes CA,Carlin JB,Cheney J,Cooper PJ,Grimwood K,Robertson CF,Tiddens HA,Wainwright CE,Australasian Cystic Fibrosis Bronchoalveolar Lavage Study Investigators.","Bronchoalveolar Lavage Study Investigators. Costs of bronchoalveolar lavage-directed therapy in the first 5 years of life for children with cystic fibrosis.","To determine whether bronchoalveolar lavage (BAL)-directed therapy for infants and young children with cystic fibrosis (CF),rather than standard therapy,was justified on the grounds of a decrease in average costs and whether the use of BAL reduced treatment costs associated with hospital admissions. Costs were assessed in a randomized controlled trial conducted in Australia and New Zealand on infants diagnosed with CF after newborn screening and assigned to receive either BAL-directed or standard therapy until they reached 5 years of age. A health care funder perspective was adopted. Resource use measurement was based on standardized data collection forms administered for patients across all sites. Unit costs were obtained primarily from government schedules. Mean costs per child during the study period were Australian dollars (AUD)92 860 in BAL-directed therapy group and AUD90 958 in standard therapy group (mean difference AUD1902,95% CI AUD-27 782 to 31 586,P = .90). Mean hospital costs per child during the study period were AUD57 302 in the BAL-directed therapy group and AUD66 590 in the standard therapy group (mean difference AUD-9288; 95% CI AUD-35 252 to 16 676,P = .48). BAL-directed therapy did not result in either lower mean hospital admission costs or mean costs overall compared with managing patients with CF by a standard protocol based upon clinical features and oropharyngeal culture results alone. Following on our previous findings that BAL-directed treatment offers no clinical advantage over standard therapy at age 5 years,flexible bronchoscopy with BAL cannot be recommended for the routine management of preschool children with CF on the basis of overall cost savings."," J Pediatr. 2014 Sep;165(3):564-569.e5.","Australia,New Zealand",2014,null,"Bronchiolar lavage",null,null,null,"Direct costs",null,"Australia,New Zealand",null,null,"Bronchiolar lavage","Direct costs",null,null,"2010:2014"]
[3,"Whiting P,Al M,Burgers L,Westwood M,Ryder S,Hoogendoorn M,Armstrong N,Allen A,Severens H,Kleijnen J. Ivacaftor for the treatment of patients with cystic fibrosis and the G551D mutation: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2014 Mar;18(18):1-106. doi: 10.3310/hta18180. ",null,"Whiting P,Al M,Burgers L,Westwood M,Ryder S,Hoogendoorn M,Armstrong N,Allen A,Severens H,Kleijnen J"," Ivacaftor for the treatment of patients with cystic fibrosis and the G551D mutation: a systematic review and cost-effectiveness analysis.","Ivacaftor (Kalydeco(®),Vertex Pharmaceuticals) is the first of a new class of drugs that target the underlying protein defect in cystic fibrosis (CF). It is aimed at patients with the G551D (glycine to aspartate change in nucleotide 1784 in exon 11) mutation; 5.7% of patients with CF in the UK have this mutation. To review the clinical effectiveness and cost-effectiveness of ivacaftor for the treatment of CF in patients aged ≥ 6 years who have the G551D mutation. Ten databases,including MEDLINE and EMBASE,were searched from inception to July 2012. Studies that evaluated ivacaftor for the treatment of adults and children (≥ 6 years) with at least one G551D mutation were eligible. There were insufficient data to conduct a formal meta-analysis. The manufacturer of ivacaftor,Vertex Pharmaceuticals,submitted a deterministic patient-level simulation model for the assessment of the lifetime cost-effectiveness of ivacaftor. We modified the model where values were not UK-specific or not recent,or where better estimates could be found. The only change to the model structure was the addition of lung transplantations. We changed utility values,annual decline in percentage predicted forced expiratory volume in 1 second (FEV1),and the baseline exacerbation rate,and used data from the CF Registry to estimate the relation between costs,age and percentage predicted FEV1. Estimates of treatment effect of ivacaftor came from the clinical effectiveness review. We modelled three scenarios for the longer-term effects of ivacaftor. We also modelled an 'optimistic' scenario for patients aged < 12 years with little lung damage. We conducted a budget impact analysis to estimate the total cost to the NHS of introducing ivacaftor in England. Three studies were included: a randomised controlled trial (RCT) in adults (n = 167) (≥ 12 years),a RCT in children (n = 26) (6-11 years),and an open-label extension study of the two RCTs. Both RCTs reported significantly greater changes from baseline in all measures of lung function in patients receiving ivacaftor than in those receiving placebo. The mean difference in change in percentage predicted FEV1 was 10.5 [95% confidence interval (CI) 8.5 to 12.5] percentage points in the adults' study and 10.0 (95% CI 4.5 to 15.5) percentage points in the children's study at 48 weeks. Improvements in lung function were seen across all subgroups investigated (age,sex,study region and lung function). There were significantly greater improvements in the ivacaftor group than in the placebo group for all outcomes assessed (exacerbations,quality of life,sweat chloride and weight) with the exception of quality of life in children. Improvements were maintained in the open-label trial. Adverse events were mainly minor and comparable across treatment groups. Both RCTs reported more withdrawals in the placebo group than in the ivacaftor group. The incremental cost-effectiveness ratio varied between £335,000 and £1,274,000 per quality-adjusted life-year gained. The total additional lifetime costs for all eligible CF patients in England ranged from £438M to £479M; the lifetime cost for standard care only was £72M. The available evidence suggests that ivacaftor is a clinically effective treatment for patients with CF and the G551D mutation; the high cost of ivacaftor may prove an obstacle in the uptake of this treatment. The main priority for further research is the long-term effectiveness of ivacaftor. This study is registered as PROSPERO CRD42012002516. The National Institute for Health Research Health Technology Assessment programme.",". Health Technol Assess. 2014 Mar;18(18):1-106.","UK",2014,null,"Ivacaftor",null,null,null,"Direct costs",null,"UK",null,null,"Ivacaftor","Direct costs",null,null,"2010:2014"]
[4,"Tappenden P,Harnan S,Uttley L,Mildred M,Walshaw M,Taylor C,Brownlee K. The cost effectiveness of dry powder antibiotics for the treatment of Pseudomonas aeruginosa in patients with cystic fibrosis. Pharmacoeconomics. 2014 Feb;32(2):159-72. doi: 10.1007/s40273-013-0122-x.",null,"Tappenden P,Harnan S,Uttley L,Mildred M,Walshaw M,Taylor C,Brownlee K. ","The cost effectiveness of dry powder antibiotics for the treatment of Pseudomonas aeruginosa in patients with cystic fibrosis","Cystic fibrosis (CF) affects over 9,000 people in the UK and limits life expectancy. CF patients are susceptible to lung infections,most commonly Pseudomonas aeruginosa. Once infection is established,patients require lifetime treatment using nebulised antibiotics. Newer dry powder formulations of antibiotics may reduce treatment burden and improve compliance. Our objective was to evaluate the cost effectiveness of (i) colistimethate sodium dry powder for inhalation (DPI) and (ii) tobramycin DPI versus nebulised tobramycin for the treatment of chronic P. aeruginosa lung infection in patients with CF from the perspective of the National Health Service (NHS) and Personal Social Services (PSS). We developed a state transition model based on transitions between three strata of lung function measured in terms of forced expiratory volume in 1 second (FEV1) % predicted. Additional health states representing post-lung transplantation and dead are also modelled. The model structure was informed by systematic reviews of evidence concerning the plausibility of potential relationships between intermediate endpoints and final outcomes. The model assumes that treatment impacts on FEV1 trajectory,which manifest as changes in health-related quality of life. No survival benefit is assumed due to the absence of robust quantifiable evidence. Model parameters were informed by patient-level and aggregate data from two randomised controlled trials together with the best available evidence from the literature. Resource use and costs associated with drug acquisition,the management of exacerbations and reduced nebuliser maintenance were drawn from reference sources and expert opinion. Costs were valued at 2011/2012 prices. Costs and health outcomes were discounted at a rate of 3.5 %. Simple and probabilistic sensitivity analyses were undertaken,including additional analyses of Patient Access Scheme (PAS) price discounts offered by the manufacturers of both DPI products. Colistimethate sodium DPI is expected to produce fewer quality-adjusted life-years (QALYs) than nebulised tobramycin. Based on its list price,colistimethate sodium DPI is expected to be dominated by nebulised tobramycin. When the PAS is incorporated,the incremental cost-effectiveness ratio (ICER) for colistimethate sodium DPI versus nebulised tobramycin is expected to be approximately £288,600 saved per QALY lost. Based on its current list price,the ICER for tobramycin DPI versus nebulised tobramycin is expected to be approximately £124,000 per QALY gained. When the proposed PAS is included,tobramycin DPI is expected to dominate nebulised tobramycin. Under their list prices,neither DPI product is likely to represent good value for money for the NHS given current cost-effectiveness thresholds. The PAS discounts have a significant impact upon the economic attractiveness of both DPI products compared against nebulised tobramycin. The clinical effectiveness and cost effectiveness of the DPIs against other nebulised antibiotics,such as aztreonam and inhaled colistimethate sodium,remains unclear.","Pharmacoeconomics. 2014 Feb;32(2):159-72. ","UK",2014,null,"Antibiotics",null,null,null,"Direct costs",null,"UK",null,null,"Antibiotics","Direct costs",null,null,"2010:2014"]
[5,"Nshimyumukiza L,Bois A,Daigneault P,Lands L,Laberge AM,Fournier D,Duplantie J,Giguère Y,Gekas J,Gagné C,Rousseau F,Reinharz D. Cost effectiveness of newborn screening for cystic fibrosis: a simulation study. J Cyst Fibros. 2014 May;13(3):267-74. doi: 10.1016/j.jcf.2013.10.012. Epub 2013 Nov 12.",null,"Nshimyumukiza L,Bois A,Daigneault P,Lands L,Laberge AM,Fournier D,Duplantie J,Giguère Y,Gekas J,Gagné C,Rousseau F,Reinharz D.","Cost effectiveness of newborn screening for cystic fibrosis: a simulation study","Early detection of cystic fibrosis (CF) by newborn screening (NBS) reduces the rate of avoidable complications. NBS protocols vary by jurisdiction and the cost effectiveness of these different protocols is debated. To compare the cost effectiveness of various CF NBS options. A Markov model was built to simulate the cost effectiveness of various CF-NBS options for a hypothetical CF-NBS program over a 5-year time horizon assuming its integration into an existing universal NBS program. NBS simulated options were based on a combination of tests between the two commonly used immunoreactive trypsinogen (IRT) cutoffs (96th percentile and 99.5th percentile) as first tier tests,and,as a second tier test,either a second IRT,pancreatic-associated protein (PAP) or CFTR mutation panels. CFTR mutation panels were also considered as an eventual third tier test. Data input parameters used were retrieved from a thorough literature search. Outcomes considered were the direct costs borne by the Quebec public health care system and the number of cases of CF detected through each strategy,including the absence of screening option. IRT-PAP with an IRT cutoff at the 96th percentile is the most favorable option with a ratio of CAD$28,432 per CF case detected. The next most favorable alternative is the IRT1-IRT2 option with an IRT1 cutoff at the 96th percentile. The no-screening option is dominated by all NBS screening protocols considered. Results were robust in sensitivity analyses. This study suggests that NBS for cystic fibrosis is a cost-effective strategy compared to the absence of NBS. The IRT-PAP newborn screening algorithm with an IRT cutoff at the 96th percentile is the most cost effective NBS approach for Quebec.","J Cyst Fibros. 2014 May;13(3):267-74. ","Canada",2014,null,"Screening",null,null,null,"Direct costs,Indirect costs",null,"Canada",null,null,"Screening","Direct costs,Indirect costs",null,null,"2010:2014"]
[6,"Eidt-Koch D,Wagner TO,Mittendorf T,Reimann A,von der Schulenburg JM. Resource usage in outpatient care and reimbursement for cystic fibrosis in Germany. Pediatr Pulmonol. 2011 Mar;46(3):278-85. doi: 10.1002/ppul.21364. Epub 2010 Nov 17. ",null,"Eidt-Koch D,Wagner TO,Mittendorf T,Reimann A,von der Schulenburg JM. ","Resource usage in outpatient care and reimbursement for cystic fibrosis in Germany.","Objective of this study is to assess and evaluate resource use in outpatient treatment in Germany and to compare it with remuneration. Outpatient treatment was evaluated in seven different centers for pediatric and adult CF patients. Data were recorded during one representative month in 2006. A micro-costing approach was used to value resource use data. For outpatient treatment mean costs (excluding drugs) of 488 € per patient per quarter occurred. Correlation analyses identified significant cost drivers including age and co-morbidities (pancreatic insufficiency,hepatobiliary complications,lung function capacity,or bacterial lung colonization). Remuneration covered only 51% of the total costs (252 € per patient/quarter). As the human resources available to these centers today are already below the requirements set by the European consensus for standards of CF care it will be important for a high level of patient care to reach a cost-covering remuneration scheme.","Pediatr Pulmonol. 2011 Mar;46(3):278-85. ","Germany",2010,null,"Outpatient care",null,null,null,"Direct costs",null,"Germany",null,null,"Outpatient care","Direct costs",null,null,"2010:2014"]
[7,"Wells J,Rosenberg M,Hoffman G,Anstead M,Farrell PM. A decision-tree approach to cost comparison of newborn screening strategies for cystic fibrosis. Pediatrics. 2012 Feb;129(2):e339-47. doi: 10.1542/peds.2011-0096. Epub 2012 Jan 30.",null,"Wells J,Rosenberg M,Hoffman G,Anstead M,Farrell PM."," A decision-tree approach to cost comparison of newborn screening strategies for cystic fibrosis.","Because cystic fibrosis can be difficult to diagnose and treat early,newborn screening programs have rapidly developed nationwide but methods vary widely. We therefore investigated the costs and consequences or specific outcomes of the 2 most commonly used methods. With available data on screening and follow-up,we used a simulation approach with decision trees to compare immunoreactive trypsinogen (IRT) screening followed by a second IRT test against an IRT/DNA analysis. By using a Monte Carlo simulation program,variation in the model parameters for counts at various nodes of the decision trees,as well as for costs,are included and applied to fictional cohorts of 100 000 newborns. The outcome measures included the numbers of newborns given a diagnosis of cystic fibrosis and costs of screening strategy at each branch and cost per newborn. Simulations revealed a substantial number of potential missed diagnoses for the IRT/IRT system versus IRT/DNA. Although the IRT/IRT strategy with commonly used cutoff values offers an average overall cost savings of $2.30 per newborn,a breakdown of costs by societal segments demonstrated higher out-of-pocket costs for families. Two potential system failures causing delayed diagnoses were identified relating to the screening protocols and the follow-up system. The IRT/IRT screening algorithm reduces the costs to laboratories and insurance companies but has more system failures. IRT/DNA offers other advantages,including fewer delayed diagnoses and lower out-of-pocket costs to families."," Pediatrics. 2012 Feb;129(2):e339-47.","USA",2012,null,"Screening",null,null,null,"Direct costs",null,"USA",null,null,"Screening","Direct costs",null,null,"2010:2014"]
[8,"Kopp BT,Wang W,Chisolm DJ,Kelleher KJ,McCoy KS. Inpatient healthcare trends among adult cystic fibrosis patients in the U.S. Pediatr Pulmonol. 2012 Mar;47(3):245-51. doi: 10.1002/ppul.21535. Epub 2011 Sep 7. ",null,"Kopp BT,Wang W,Chisolm DJ,Kelleher KJ,McCoy KS"," Inpatient healthcare trends among adult cystic fibrosis patients in the U.S.","Adult cystic fibrosis (CF) patients are an expanding cohort that is taken care of in a variety of hospital settings including adult centers located within pediatric institutions. This study compared costs and discharge rates among adult CF patient hospitalizations in terms of location of hospitalization. The 2007 Nationwide Inpatient Sample was utilized to identify adult CF patient admission data on patients aged 18-44. Data were separated into pediatric and adult facilities based on percentage discharge rate for patients >18. Primary outcomes measures were length of stay (LOS) and total hospital charges. Secondary predictors were geographic,primary payer,and co-morbidity effects on LOS and total hospital charges. LOS was higher for adult CF patient admissions in pediatric facilities compared to adult facilities by a mean of 2.5 days. Mean total hospital charges were not significantly different. Adult hospitals in the Western U.S. had a mean total charge more than $50,000 greater than any region in the U.S. Self-pay patients had significantly fewer hospital days and charges across all hospital types. Adult facilities had 7% more CF patients discharged home with home healthcare use. Depressed CF patients had longer LOS by 1.5 days regardless of facility type. LOS for adult CF inpatient admissions was significantly lower in adult facilities compared to pediatric facilities without a significant difference in hospital charges and is influenced by geographic hospital location. Depressed patients had longer lengths of stay regardless of facility type. Self-insured adult CF patients have a significant reduction in LOS and hospital charges when compared to all other payers regardless of hospital type."," Pediatr Pulmonol. 2012 Mar;47(3):245-51.","USA",2011,null,"Inpatient care",null,null,null,"Direct costs",null,"USA",null,null,"Inpatient care","Direct costs",null,null,"2010:2014"]
[9,"Antoñanzas F,Rodríguez-Ibeas R,Hutter MF,Lorente R,Juárez C,Pinillos M. Genetic testing in the European Union: does economic evaluation matter? Eur J Health Econ. 2012 Oct;13(5):651-61. doi: 10.1007/s10198-011-0319-x. Epub 2011 May 20.",null,"Antoñanzas F,Rodríguez-Ibeas R,Hutter MF,Lorente R,Juárez C,Pinillos M"," Genetic testing in the European Union: does economic evaluation matter?","We review the published economic evaluation studies applied to genetic technologies in the EU to know the main diseases addressed by these studies,the ways the studies were conducted and to assess the efficiency of these new technologies. The final aim of this review was to understand the possibilities of the economic evaluations performed up to date as a tool to contribute to decision making in this area. We have reviewed a set of articles found in several databases until March 2010. Literature searches were made in the following databases: PubMed; Euronheed; Centre for Reviews and Dissemination of the University of York-Health Technology Assessment,Database of Abstracts of Reviews of Effects,NHS Economic Evaluation Database; and Scopus. The algorithm was \"(screening or diagnosis) and genetic and (cost or economic) and (country EU27)\". We included studies if they met the following criteria: (1) a genetic technology was analysed; (2) human DNA must be tested for; (3) the analysis was a real economic evaluation or a cost study,and (4) the articles had to be related to any EU Member State. We initially found 3,559 papers on genetic testing but only 92 articles of economic analysis referred to a wide range of genetic diseases matched the inclusion criteria. The most studied diseases were as follows: cystic fibrosis (12),breast and ovarian cancer (8),hereditary hemochromatosis (6),Down's syndrome (7),colorectal cancer (5),familial hypercholesterolaemia (5),prostate cancer (4),and thrombophilia (4). Genetic tests were mostly used for screening purposes,and cost-effectiveness analysis is the most common type of economic study. The analysed gene technologies are deemed to be efficient for some specific population groups and screening algorithms according to the values of their cost-effectiveness ratios that were below the commonly accepted threshold of 30,000€. Economic evaluation of genetic technologies matters but the number of published studies is still rather low as to be widely used for most of the decisions in different jurisdictions across the EU. Further,the decision bodies across EU27 are fragmented and the responsibilities are located at different levels of the decision process for what it is difficult to find out whether a given decision on genetic tests was somehow supported by the economic evaluation results.","Eur J Health Econ. 2012 Oct;13(5):651-61.","International",2012,null,"Screening",null,null,null,"Direct costs",null,"International",null,null,"Screening","Direct costs",null,null,"2010:2014"]
[10,"Lillquist YP,Cho E,Davidson AG. Economic effects of an eradication protocol for first appearance of Pseudomonas aeruginosa in cystic fibrosis patients: 1995 vs. 2009. J Cyst Fibros. 2011 May;10(3):175-80. doi: 10.1016/j.jcf.2011.01.002. Epub 2011 Feb 18. ",null,"Lillquist YP,Cho E,Davidson AG. ","Economic effects of an eradication protocol for first appearance of Pseudomonas aeruginosa in cystic fibrosis patients: 1995 vs. 2009.","Acquisition of Pseudomonas aeruginosa (Psa) and infection with mucoid strains is associated with repeated pulmonary exacerbations which often require intravenous and long-term nebulised antibiotic treatments,repeated hospitalizations and leads to a more precipitous decline in lung function. Anti-Psa antibiotic therapy early in the course of Psa infection in patients with cystic fibrosis (CF) may result in eradication of Psa and prevention or delay of colonization with the organism. From January 1995 to December 2009 our paediatric CF clinic has followed an early eradication protocol for the first appearance of Psa. In this paper we report on the economic effects after 15 years as reflected in hospitalization and antibiotic usage and cost. The Psa-eradication protocol includes 2 weeks of IV piperacillin and tobramycin,followed by oral ciprofloxacin for 3 weeks,and nebulised colistimethate for 6 months. The same protocol is used for newly diagnosed CF patients who grow Psa on their first visit or who grow a mucoid strain,multiresistant strain of Psa or whose Psa co-cultured with Burkholderia cepacia complex,and for patients in whom Psa recurs after initial clearance. 195 Psa eradication courses were completed from 1995 to 2009 with an overall Psa clearance rate of 90%. Patients that only cultured a Psa classic (non-mucoid) strain had a clearance rate was 96.5%. The percentage of children chronically infected with Psa has declined from 44% in 1994 to 15% in 2009.Total days spent in hospital for all reasons declined by 43%; chronic Psa hospital days declined by 75%; IV and nebulised anti-Psa antibiotic costs reduced by 44%. Results indicate that application of a Pseudomonas eradication protocol as described in this report has economic and resource utilization benefits in addition to clinical benefits."," J Cyst Fibros. 2011 May;10(3):175-80. ","Canada",2011,null,"Antibiotics",null,null,null,"Direct costs",null,"Canada",null,null,"Antibiotics","Direct costs",null,null,"2010:2014"]
[11,"Woodward TC,Brown R,Sacco P,Zhang J. Budget impact model of tobramycin inhalation solution for treatment of Pseudomonas aeruginosa in cystic fibrosis patients. J Med Econ. 2010;13(3):492-9. doi: 10.3111/13696998.2010.505863. ",null,"Woodward TC,Brown R,Sacco P,Zhang J.","Budget impact model of tobramycin inhalation solution for treatment of Pseudomonas aeruginosa in cystic fibrosis patients.","Pseudomonas aeruginosa (PA) is the most common airway pathogen in cystic fibrosis (CF) patients. The objective of this analysis was to determine the costs of managing PA infection in CF patients with a chronic regimen of tobramycin inhalation solution (TIS). A budget impact model of CF patients was developed to evaluate the costs of TIS from a US managed-care organization (MCO) perspective. The Microsoft Excel model compared TIS treatment plus standard care with standard care alone over a 4-year time horizon and included the cost of drugs,medical care,and annual probabilities of hospitalization and IV anti-pseudomonal (anti-PA) antibiotics administration. For an MCO with 5,000,000 members,389 members 6 years of age or older were estimated to have CF,and 218 (56%) had PA infection. Assuming that use of TIS increased from 20% to 25%,the 1-year budget increased $231,251 or from $0.049 to $0.053 per member per month (PMPM). The net drug budget increase was $243,919,while medical costs associated with exacerbation management decreased $12,669 over the first year. Increasing utilization of TIS,from 20% to 40% over 4 years resulted in an incremental overall budget increase of $925,002,a 3% decrease in hospitalizations,and a 4% decrease in administrations of IV anti-PA antibiotics. These reductions translated to a medical care cost saving of $50,676 over 4 years. Limitations of this study include that the clinical data for the model are from clinical trials conducted in 1996 and the estimation of TIS use for CF patients with chronic PA infections can be impacted by TIS adherence. Model results suggest that increasing the use of TIS decreases medical care costs due to decreased hospital admissions and the use of IV anti-PA antibiotics at the expense of higher drug costs."," J Med Econ. 2010;13(3):492-9. ","USA",2010,null,"Antibiotics",null,null,null,"Direct costs",null,"USA",null,null,"Antibiotics","Direct costs",null,null,"2010:2014"]
[12,"Chandrasekharan S,Heaney C,James T,Conover C,Cook-Deegan R. Impact of gene patents and licensing practices on access to genetic testing for cystic fibrosis. Genet Med. 2010 Apr;12(4 Suppl):S194-211. doi: 10.1097/GIM.0b013e3181d7cf7d. ",null,"Chandrasekharan S,Heaney C,James T,Conover C,Cook-Deegan R.","Impact of gene patents and licensing practices on access to genetic testing for cystic fibrosis.","Cystic fibrosis is one of the most commonly tested autosomal recessive disorders in the United States. Clinical cystic fibrosis is associated with mutations in the CFTR gene,of which the most common mutation among Caucasians,DeltaF508,was identified in 1989. The University of Michigan,Johns Hopkins University,and the Hospital for Sick Children,where much of the initial research occurred,hold key patents on cystic fibrosis genetic sequences,mutations,and methods for detecting them. Several patents,including the one that covers detection of the DeltaF508 mutation,are jointly held by the University of Michigan and the Hospital for Sick Children in Toronto,with Michigan administering patent licensing in the United States. The University of Michigan broadly licenses the DeltaF508 patent for genetic testing with >60 providers of genetic testing to date. Genetic testing is now used in newborn screening,diagnosis,and for carrier screening. Interviews with key researchers and intellectual property managers,a survey of laboratories' prices for cystic fibrosis genetic testing,a review of literature on cystic fibrosis tests' cost-effectiveness,and a review of the developing market for cystic fibrosis testing provide no evidence that patents have significantly hindered access to genetic tests for cystic fibrosis or prevented financially cost-effective screening. Current licensing practices for cystic fibrosis genetic testing seem to facilitate both academic research and commercial testing. More than 1000 different CFTR mutations have been identified,and research continues to determine their clinical significance. Patents have been nonexclusively licensed for diagnostic use and have been variably licensed for gene transfer and other therapeutic applications. The Cystic Fibrosis Foundation has been engaged in licensing decisions,making cystic fibrosis a model of collaborative and cooperative patenting and licensing practice."," Genet Med. 2010 Apr;12(4 Suppl):S194-211.","USA",2010,null,"Screening",null,null,null,"Direct costs",null,"USA",null,null,"Screening","Direct costs",null,null,"2010:2014"]
[13,"Weiner JR,Toy EL,Sacco P,Duh MS. Costs,quality of life and treatment compliance associated with antibiotic therapies in patients with cystic fibrosis: a review of the literature. Expert Opin Pharmacother. 2008 Apr;9(5):751-66. doi: 10.1517/14656566.9.5.751. ",null,"Weiner JR,Toy EL,Sacco P,Duh MS. ","Costs,quality of life and treatment compliance associated with antibiotic therapies in patients with cystic fibrosis: a review of the literature","Cystic fibrosis is the most common incurable hereditary disease in the US. Persistent respiratory infection is the leading cause of morbidity and mortality in cystic fibrosis patients. This study aimed to review the literature on economic and quality of life outcomes and treatment compliance associated with antibiotic therapies for cystic fibrosis patients. A systematic literature review was conducted using keyword searches of the MEDLINE database and selected conference abstracts. The review covered studies published between January 1990 and May 2007. Evidence suggests that inhaled tobramycin,a key chronic suppressive therapy,can reduce other healthcare costs. The main determinants of the cost of care include disease severity and respiratory infection. Costs vary widely by country. There is evidence that inhaled tobramycin and oral azithromycin improve quality of life and that treatment setting and patient convenience may also impact on quality of life. Antibiotic treatment compliance varied significantly and depended on the method of measurement,with more subjective measures tending to be higher. This review concludes by offering directions for future research.","Expert Opin Pharmacother. 2008 Apr;9(5):751-66. ","International",2008,null,"Antibiotics",null,null,null,"Direct costs",null,"International",null,null,"Antibiotics","Direct costs",null,null,"2005:2009"]
[14,"Vasiliadis HM,Collet JP,Penrod JR,Ferraro P,Poirier C. A cost-effectiveness and cost-utility study of lung transplantation. J Heart Lung Transplant. 2005 Sep;24(9):1275-83. doi: 10.1016/j.healun.2004.10.012.",null,"Vasiliadis HM,Collet JP,Penrod JR,Ferraro P,Poirier C."," A cost-effectiveness and cost-utility study of lung transplantation.","Life-threatening complications and expensive posttransplantation medical care raises the issue whether lung transplantation (L-Tx) is cost effective. We studied,from a health care system perspective,the cost effectiveness (C/E) and cost utility (C/U) of L-Tx in a Canadian setting. An incremental C/E and C/U analysis of L-Tx,compared with the waiting list (WL),was carried out on 124 patients accepted into the Quebec L-Tx WL (1997-2001). Survival was presented in mean life-years (LYs). Utility,assessed with the standard gamble,was used in computing the quality-adjusted life-years (QALY). Different person-time experiences were simulated. Costs (95% confidence interval),in US dollars,were discounted at 5%. The mean LYs and QALYs gained were 0.57 (0.36-0.78) and 0.62 (0.36-0.78),respectively. The cost per patient without Tx was 1102 dollars (856 dollars-1348 dollars) per month. The L-Tx program induced a screening cost of 6208 dollars per patient. The cost of the L-Tx procedure (n = 91) was 31,815 dollars (25,301 dollars-44,816 dollars). The post-Tx cost per month in the first,second,third,and fourth year was 1809 dollars dollars (1187 dollars-2446 dollars),1060 dollars (703 dollars-1478 dollars),1128 dollars (519 dollars-1735 dollars),and 626 dollars (495 dollars-758 dollars),respectively. The projected C/E and C/U of the L-Tx program,assessed on the basis of pre- and post-Tx extrapolations,reached 40,048 dollars and 46,631 dollars,respectively. L-Tx in this Canadian setting yielded a benefit in mean LYs and QALYs gained. Although the program is expensive,the C/E and C/U ratios for some patient groups prove to be an acceptable cost for the benefits observed."," J Heart Lung Transplant. 2005 Sep;24(9):1275-83. ","Canada",2005,null,"Lung transplant",null,null,null,"Direct costs",null,"Canada",null,null,"Lung transplant","Direct costs",null,null,"2005:2009"]
[15,"Reams BD,Palmer SM. Sublingual tacrolimus for immunosuppression in lung transplantation: a potentially important therapeutic option in cystic fibrosis. Am J Respir Med. 2002;1(2):91-8. ",null,"Reams BD,Palmer SM"," Sublingual tacrolimus for immunosuppression in lung transplantation: a potentially important therapeutic option in cystic fibrosis.","Lung transplantation has emerged as an option to prolong and increase the quality of life in patients with end-stage pulmonary lung disease. In lung transplant recipients,because of the high potential for acute and chronic allograft rejection,optimal selection,dosage and delivery of immunosuppressive medications is critical. Cystic fibrosis (CF),a multi-organ system disease that often includes pulmonary and gastrointestinal manifestations,represents the leading indication for bilateral lung transplantation. The gastrointestinal manifestations of CF,however,confound post-transplant management by causing significant variation in the rate and extent of absorption of orally administered immunosuppressive medications. Tacrolimus,a new calcineurin inhibitor,is increasingly employed as the primary immunosuppressive agent in lung transplant recipients. Unfortunately,tacrolimus itself exhibits variable bioavailability,particularly in CF transplant recipients. A novel approach to the absorption dilemma is administration of tacrolimus via the sublingual (SL) route. Little published information exists concerning the use of SL immunosuppression in transplant recipients. However,emerging evidence suggests that SL tacrolimus provides is an effective means of drug delivery particularly for CF lung transplant recipients. Preliminary results from a pilot study,demonstrate that SL delivery of tacrolimus achieves therapeutic serum levels,in lung transplant recipients with CF,over the first few postoperative months. In addition,the early postoperative use of SL tacrolimus has been associated with acceptable rates of transplant rejection and normal renal function in a cohort of 22 lung transplant recipients that included CF and non-CF transplant recipients. Potential pharmacokinetic advantages of the SL route of delivery include good permeability,rapid absorption,acceptable bioavailability and easy accessibility. From an economic standpoint,considerable cost savings could be achieved by using the SL rather than the intravenous route of drug delivery for tacrolimus. Comparative,prospective randomized trials are necessary to evaluate the long-term safety and efficacy of SL tacrolimus in lung transplant patients. Until such data are available,the use of SL tacrolimus should be considered in situations where alternative routes of delivery are unavailable or as part of ongoing research studies. Ultimately,SL tacrolimus may prove efficacious for short-term use in the early postoperative lung transplant recipients,particularly in patients with malabsorption problems such as CF transplant recipients."," Am J Respir Med. 2002;1(2):91-8. ","International",2002,null,"Lung transplant",null,null,null,"Direct costs",null,"International",null,null,"Lung transplant","Direct costs",null,null,"2000:2004"]
[16,"Krauth C,Jalilvand N,Welte T,Busse R. Cystic fibrosis: cost of illness and considerations for the economic evaluation of potential therapies. Pharmacoeconomics. 2003;21(14):1001-24. ",null,"Krauth C,Jalilvand N,Welte T,Busse R. ","Cystic fibrosis: cost of illness and considerations for the economic evaluation of potential therapies.","Cystic fibrosis (CF) is the most common life-shortening inherited disease of the Caucasian race,with a prevalence of around 1 in 2500 live births. Advances in the treatment and management of respiratory and pancreatic disorders have dramatically increased the life expectancy of patients with CF. This article presents an overview of cost-of-illness studies of CF,identifies deficits in the available health economic analyses of CF and discusses which specific factors are essential for the economic evaluation of potential therapies,based on a critical review of the health economic literature on two main therapeutic strategies. Cost-of-illness studies of CF have predominantly been restricted to direct costs. According to the literature,direct costs amount to between 6200- 16300 US dollars (1996 values) per patient per year. As most studies likely underestimated the actual costs (e.g. by disregarding provision of certain healthcare services),real healthcare costs tend to be at the upper end of the cost range. Healthcare costs depend on the patient's age (for adults,costs are approximately twice as high as for children),the grade of severity (the cost relationship of severe to mild CF is between 4.5 and 7.1) and other factors. Lifetime direct costs of CF are estimated at 200 000-300000 US dollars (at 1996 values and a discount rate of 5%). Home intravenous (IV) antibacterial therapy and recombinant human DNase (rhDNase; dornase alfa) treatment are the two main therapeutic strategies most often evaluated in health economic studies of CF. While home IV antibacterial therapy (compared with inpatient IV antibacterial therapy) is assumed to be cost saving,rhDNase treatment is a very cost-intensive therapy intended to efficiently achieve health improvements. Health economic analyses of future CF therapeutic technologies should present explicit data regarding healthcare services provision,resource consumption and unit costs. Indirect costs and patient costs should be considered more often than they have to date,particularly when they are significantly influenced by novel CF technologies. The perspective of health economic studies should be stated explicitly and always include the societal perspective. More economic studies should be based on a controlled,and preferably randomised,design. The observation period must be long enough to identify long-term effects of interventions. A greater number of effectiveness studies should be performed to determine costs and outcomes of therapies applied under everyday life conditions for patients with CF. Finally,international comparison studies should identify the influence of different healthcare systems on the costs and outcomes of interventions.","Pharmacoeconomics. 2003;21(14):1001-24. ","International",2003,null,"All healthcare",null,null,null,"Direct costs",null,"International",null,null,"All healthcare","Direct costs",null,null,"2000:2004"]
[17,"Hollin IL,Robinson KA. A Scoping Review of Healthcare Costs for Patients with Cystic Fibrosis. Appl Health Econ Health Policy. 2016 Apr;14(2):151-9. doi: 10.1007/s40258-015-0211-4. ",null,"Hollin IL,Robinson KA."," A Scoping Review of Healthcare Costs for Patients with Cystic Fibrosis. ","Cystic fibrosis (CF),one of the most common life-shortening genetic diseases,has no cure,but people living with it have seen improvements in their health and survival. The rising life expectancy and increased availability of treatment options has likely increased the lifetime costs of people living with CF. In addition,a recent drug approval for a therapy that targets the cause of the disease is one of the most expensive drugs worldwide. In light of these circumstances,it is important to have an updated understanding of the costs of CF therapy and management. This study aims to determine the extent of available literature that quantifies CF costs. We used a scoping review framework to identify the sources and types of evidence available to determine the costs of CF therapy and management compared to the general population or a comparable population of people with other complex chronic conditions. We searched 14 databases for peer-reviewed studies and grey literature published in English since 1998. The search was conducted in August 2013 and updated in October 2014. We identified 28 studies that estimated overall,general CF costs. Of these,three studies compare CF costs to healthcare costs of a general population and only one of those provides a direct comparison of CF costs to the general population in order to calculate the incremental cost associated with CF. We estimate there are 98 systematic reviews that quantify the costs of comparable conditions and potentially provide a comparison group for people with CF. There is evidence available that attempts to quantify overall,general healthcare costs of people with CF,although much of it is outdated. However,there is much less evidence available that provides a comparison of these costs with either the general population or people with comparable conditions.","Appl Health Econ Health Policy. 2016 Apr;14(2):151-9. ","International",2016,null,"All healthcare",null,null,null,"Direct costs",null,"International",null,null,"All healthcare","Direct costs",null,null,"2015:2017"]
[18,"Schechter MS,Trueman D,Farquharson R,Higuchi K,Daines CL. Inhaled aztreonam lysine versus inhaled tobramycin in cystic fibrosis. An economic evaluation. Ann Am Thorac Soc. 2015 Jul;12(7):1030-8. doi: 10.1513/AnnalsATS.201312-453OC.",null,"Schechter MS,Trueman D,Farquharson R,Higuchi K,Daines CL. ","Inhaled aztreonam lysine versus inhaled tobramycin in cystic fibrosis. An economic evaluation.","Pseudomonas aeruginosa infection is a significant cause of morbidity and mortality in patients with cystic fibrosis and is associated with a high economic burden. A recently published comparator trial demonstrated that outcomes in patients with cystic fibrosis with chronic P. aeruginosa infections switched from tobramycin solution for inhalation to aztreonam lysine for inhalation were better than those of patients who continued on tobramycin. To compare overall costs of treatment of chronic inhaled tobramycin and aztreonam lysine in patient with cystic fibrosis who have chronic Pseudomonas infection,taking differences in outcomes into account. A cost-effectiveness analysis with a 3-year time horizon was performed to simulate the economic consequences of either treatment from the perspective of a third party payer in the United States. We extrapolated results from the comparator trial and used data regarding clinical outcomes,quality of life,and costs from published literature and proprietary databases. A Markov structure was used to consider transitions between health states,defined principally by levels of percent predicted of FEV1. Extensive scenario and probabilistic sensitivity analyses were performed. Use of aztreonam lysine for inhalation was associated with an average cost saving of $41,947 per patient over 3 years,as well as greater quality-adjusted life-years and total life-years. Scenario analyses demonstrated that these findings were robust to changes in key assumptions. It appears,with high likelihood,that the use of aztreonam solution for inhalation is associated with cost savings,an increase in quality-adjusted life-years,and improved clinical outcomes among patients with extensive prior use of tobramycin solution for inhalation who are naive to inhaled aztreonam lysine.","Ann Am Thorac Soc. 2015 Jul;12(7):1030-8.","USA",2015,null,"Antibiotics",null,null,null,"Direct costs",null,"USA",null,null,"Antibiotics","Direct costs",null,null,"2015:2017"]
[19,"Hill M,Twiss P,Verhoef TI,Drury S,McKay F,Mason S,Jenkins L,Morris S,Chitty LS. Non-invasive prenatal diagnosis for cystic fibrosis: detection of paternal mutations,exploration of patient preferences and cost analysis. Prenat Diagn. 2015 Oct;35(10):950-8. doi: 10.1002/pd.4585. Epub 2015 Apr 5.",null,"Hill M,Twiss P,Verhoef TI,Drury S,McKay F,Mason S,Jenkins L,Morris S,Chitty LS.","Non-invasive prenatal diagnosis for cystic fibrosis: detection of paternal mutations,exploration of patient preferences and cost analysis.","We aim to develop non-invasive prenatal diagnosis (NIPD) for cystic fibrosis (CF) and determine costs and implications for implementation. A next-generation sequencing assay was developed to detect ten common CF mutations for exclusion of the paternal mutation in maternal plasma. Using uptake data from a study exploring views on NIPD for CF,total test-related costs were estimated for the current care pathway and compared with those incorporating NIPD. The assay reliably predicted mutation status in all control and maternal plasma samples. Of carrier or affected adults with CF (n = 142) surveyed,only 43.5% reported willingness to have invasive testing for CF with 94.4% saying they would have NIPD. Using these potential uptake data,the incremental costs of NIPD over invasive testing per 100 pregnancies at risk of CF are £9025 for paternal mutation exclusion,and £26,510 for direct diagnosis. We have developed NIPD for risk stratification in around a third of CF families. There are economic implications due to potential increased test demand to inform postnatal management rather than to inform decisions around termination of an affected pregnancy."," Prenat Diagn. 2015 Oct;35(10):950-8.","UK",2015,null,"Screening",null,null,null,"Direct costs",null,"UK",null,null,"Screening","Direct costs",null,null,"2015:2017"]
[20,"Angelis A,Tordrup D,Kanavos P. Socio-economic burden of rare diseases: A systematic review of cost of illness evidence. Health Policy. 2015 Jul;119(7):964-79. doi: 10.1016/j.healthpol.2014.12.016. Epub 2014 Dec 30.",null,"Angelis A,Tordrup D,Kanavos P. ","Socio-economic burden of rare diseases: A systematic review of cost of illness evidence","Cost-of-illness studies,the systematic quantification of the economic burden of diseases on the individual and on society,help illustrate direct budgetary consequences of diseases in the health system and indirect costs associated with patient or carer productivity losses. In the context of the BURQOL-RD project (\"Social Economic Burden and Health-Related Quality of Life in patients with Rare Diseases in Europe\") we studied the evidence on direct and indirect costs for 10 rare diseases (Cystic Fibrosis [CF],Duchenne Muscular Dystrophy [DMD],Fragile X Syndrome [FXS],Haemophilia,Juvenile Idiopathic Arthritis [JIA],Mucopolysaccharidosis [MPS],Scleroderma [SCL],Prader-Willi Syndrome [PWS],Histiocytosis [HIS] and Epidermolysis Bullosa [EB]). A systematic literature review of cost of illness studies was conducted using a keyword strategy in combination with the names of the 10 selected rare diseases. Available disease prevalence in Europe was found to range between 1 and 2 per 100,000 population (PWS,a sub-type of Histiocytosis,and EB) up to 42 per 100,000 population (Scleroderma). Overall,cost evidence on rare diseases appears to be very scarce (a total of 77 studies were identified across all diseases),with CF (n=29) and Haemophilia (n=22) being relatively well studied,compared to the other conditions,where very limited cost of illness information was available. In terms of data availability,total lifetime cost figures were found only across four diseases,and total annual costs (including indirect costs) across five diseases. Overall,data availability was found to correlate with the existence of a pharmaceutical treatment and indirect costs tended to account for a significant proportion of total costs. Although methodological variations prevent any detailed comparison between conditions and based on the evidence available,most of the rare diseases examined are associated with significant economic burden,both direct and indirect."," Health Policy. 2015 Jul;119(7):964-79.","International",2015,null,"All healthcare",null,null,null,"Direct costs",null,"International",null,null,"All healthcare","Direct costs",null,null,"2015:2017"]
[21,"van der Ploeg CP,van den Akker-van Marle ME,Vernooij-van Langen AM,Elvers LH,Gille JJ,Verkerk PH,Dankert-Roelse JE,CHOPIN study group. Cost-effectiveness of newborn screening for cystic fibrosis determined with real-life data. J Cyst Fibros. 2015 Mar;14(2):194-202. doi: 10.1016/j.jcf.2014.08.007. Epub 2014 Sep 10. ",null,"van der Ploeg CP,van den Akker-van Marle ME,Vernooij-van Langen AM,Elvers LH,Gille JJ,Verkerk PH,Dankert-Roelse JE,CHOPIN study group"," Cost-effectiveness of newborn screening for cystic fibrosis determined with real-life data.","Previous cost-effectiveness studies using data from the literature showed that newborn screening for cystic fibrosis (NBSCF) is a good economic option with positive health effects and longer survival. We used primary data to compare cost-effectiveness of four screening strategies for NBSCF,i.e. immunoreactive trypsinogen-testing followed by pancreatitis-associated protein-testing (IRT-PAP),IRT-DNA,IRT-DNA-sequencing,and IRT-PAP-DNA-sequencing,each compared to no-screening. A previously developed decision analysis model for NBSCF was fed with model parameters mainly based on a study evaluating two novel screening strategies among 145,499 newborns in The Netherlands. The four screening strategies had cost-effectiveness ratios varying from €23,600 to €29,200 per life-year gained. IRT-PAP had the most favourable cost-effectiveness ratio. Additional life-years can be gained by IRT-DNA but against higher costs. When treatment costs reduce with 5% due to early diagnosis,screening will lead to financial savings. NBSCF is as an economically justifiable public health initiative. Of the four strategies tested IRT-PAP is the most economic and this finding should be included in any decision making model,when considering implementation of newborn screening for CF."," J Cyst Fibros. 2015 Mar;14(2):194-202.","Netherlands",2015,null,"Screening",null,null,null,"Direct costs,Indirect costs",null,"Netherlands",null,null,"Screening","Direct costs,Indirect costs",null,null,"2015:2017"]
[22,"Ference EH,Schroeder JW Jr,Qureshi H,Conley D,Chandra RK,Tan BK,Shintani Smith S. Current utilization of balloon dilation versus endoscopic techniques in pediatric sinus surgery. Otolaryngol Head Neck Surg. 2014 Nov;151(5):852-60. doi: 10.1177/0194599814545442. Epub 2014 Aug 4.",null,"Ference EH,Schroeder JW Jr,Qureshi H,Conley D,Chandra RK,Tan BK,Shintani Smith S"," Current utilization of balloon dilation versus endoscopic techniques in pediatric sinus surgery.","To study the utilization of balloon catheter dilation (BCD) compared to traditional endoscopic surgery (ESS) in pediatric patients. Cross-sectional analysis. Hospital and freestanding ambulatory surgery centers in California,Florida,Maryland,and New York Patients less than 18 years who underwent BCD(316) or ESS(2346),as identified by CPT codes from the State Ambulatory Surgery Databases 2011. Patient and facility demographics,mean charges,and operating room time were examined using bivariate and multivariate analyses. A total of 2662 children underwent surgery,with BCD used in 10.6% of maxillary,8.4% of sphenoid,and 11.8% of frontal procedures. Adjusted analysis found that children with asthma,allergic rhinitis (AR),GERD,or concomitant adenoidectomy were more likely to have BCD compared to patients without these comorbidities,asthma odds ratio (OR) = 1.94 (95% CI,1.84-3.41),AR OR = 1.77 (95% CI,1.03-3.07),GERD OR = 2.79 (95% CI,.59-4.90),or without adenoidectomy OR = 2.50 (95% CI,1.84-3.41). Patients with cystic fibrosis were less likely to have BCD,OR = 0.33 (95% CI,0.11-0.95). Median charges for patients undergoing maxillary antrostomy alone by BCD (P = .042) or with adenoidectomy (P < .001) were approximately $2100 and $4200 greater than the median of patients undergoing those procedures with ESS. However,operating room time was similar (P = .81) between patients undergoing maxillary antrostomy,regardless of whether BCD was used,but was longer (P < .001) in those undergoing maxillary antrostomy and adenoidectomy when BCD was utilized. BCD was used in 11.9% of pediatric sinus surgery and had higher average charges with no decrease in OR time compared to procedures that only utilized ESS. Future research is necessary to evaluate whether BCD may lead to improved outcomes and eventually decreased operating room time for pediatric patients with chronic rhinosinusitis."," Otolaryngol Head Neck Surg. 2014 Nov;151(5):852-60.","USA",2014,null,"Various",null,null,null,"Direct costs",null,"USA",null,null,"Various","Direct costs",null,null,"2010:2014"]
[23,"Tappenden P,Harnan S,Uttley L,Mildred M,Carroll C,Cantrell A. Colistimethate sodium powder and tobramycin powder for inhalation for the treatment of chronic Pseudomonas aeruginosa lung infection in cystic fibrosis: systematic review and economic model. Health Technol Assess. 2013 Dec;17(56):v-xvii,1-181. doi: 10.3310/hta17560. ",null,"Tappenden P,Harnan S,Uttley L,Mildred M,Carroll C,Cantrell A.","Colistimethate sodium powder and tobramycin powder for inhalation for the treatment of chronic Pseudomonas aeruginosa lung infection in cystic fibrosis: systematic review and economic model. ","Cystic fibrosis (CF) is an inherited condition characterised by the abnormal transport of chloride ions across transporting epithelia. This leads to the production of thick sticky mucus in the lungs,pancreas,liver,intestine and reproductive tract,and an increase in the salt content in sweat. Among other problems,people with CF experience recurrent respiratory infections and have difficulties digesting food. CF affects over 9000 individuals in the UK. CF shortens life expectancy and adversely affects quality of life. In 2010,CF was recorded as the cause of 103 deaths in England and Wales. To evaluate the clinical effectiveness and cost-effectiveness of colistimethate sodium dry powder for inhalation (DPI) (Colobreathe(®),Forest Laboratories) and tobramycin DPI (TOBI Podhaler(®),Novartis Pharmaceuticals) for the treatment of Pseudomonas aeruginosa lung infection in CF. Electronic databases were searched in February and March 2011 [MEDLINE,MEDLINE In-Process & Other Non-Indexed citations,EMBASE,The Cochrane Library databases,Cumulative Index to Nursing and Allied Health Literature (CINAHL),Web of Science,Conference Proceedings Citation Index (CPCI) and Bioscience Information Service (BIOSIS) Previews]. Relevant databases were searched for ongoing and unpublished studies,and bibliographies of relevant systematic reviews and the manufacturers' submissions were also hand-searched. A systematic review of the clinical effectiveness and cost-effectiveness of colistimethate sodium DPI and tobramycin DPI for the treatment of chronic P. aeruginosa lung infection in CF was conducted. Existing economic evidence within the literature was reviewed and a de novo health economic model was also developed. Three randomised controlled trials (RCTs) were included in the clinical effectiveness review. Both colistimethate sodium DPI and tobramycin DPI were reported to be non-inferior to nebulised tobramycin for the outcome forced expiratory volume in first second percentage predicted (FEV1%). It was not possible to draw any firm conclusions as to the relative efficacy of colistimethate sodium DPI compared with tobramycin DPI. The economic analysis suggests that colistimethate sodium DPI produces fewer quality-adjusted life-years (QALYs) than nebulised tobramycin. Given the incremental discounted lifetime cost of tobramycin DPI compared with nebulised tobramycin,it highly unlikely that tobramycin DPI has an incremental cost-effectiveness ratio that is better than £30,000 per QALY gained. The uncertainty surrounding the short-term evidence base inevitably results in uncertainty surrounding the long-term clinical effectiveness and cost-effectiveness of colistimethate sodium DPI. Both DPI formulations have been shown to be non-inferior to nebulised tobramycin as measured by FEV1%. The results of these trials should be interpreted with caution owing to the means by which the results were analysed,the length of follow-up,and concerns about the ability of FEV1% to accurately represent changes in lung health. Although the increase in QALYs is expected to be lower with colistimethate sodium DPI than with nebulised tobramycin,a price for this intervention had not been agreed at the time of the assessment. Depending on the price of colistimethate sodium DPI,this results either in a situation whereby colistimethate sodium DPI is dominated by nebulised tobramycin or in one whereby the incremental cost-effectiveness of nebulised tobramycin compared with colistimethate sodium DPI is in the range of £24,000-277,000 per QALY gained. The economic analysis also suggests that,given its price,it is unlikely that tobramycin DPI has a cost-effectiveness ratio of < £30,000 per QALY gained when compared with nebulised tobramycin. A RCT to assess the longer-term (≥ 12 months) efficacy of colistimethate sodium DPI and tobramycin DPI in comparison with nebulised treatments would be beneficial. Such a study should include the direct assessment of HRQoL using a relevant preference-based instrument. Future studies should ensure that the European Medicines Agency guidelines are adhered to. In addition,high-quality research concerning the relationship between forced expiratory volume in first second % (FEV1%) predicted or other measures of lung function and survival/health-related quality of life (HRQoL) would be useful. PROSPERO CRD42011001350. The National Institute for Health Research Health Technology Assessment programme."," Health Technol Assess. 2013 Dec;17(56):v-xvii,1-181.","UK",2013,null,"Antibiotics",null,null,null,"Direct costs",null,"UK",null,null,"Antibiotics","Direct costs",null,null,"2010:2014"]
[24,"Ledger SJ,Owen E,Prasad SA,Goldman A,Willams J,Aurora P. A pilot outreach physiotherapy and dietetic quality improvement initiative reduces IV antibiotic requirements in children with moderate-severe cystic fibrosis. J Cyst Fibros. 2013 Dec;12(6):766-72. doi: 10.1016/j.jcf.2013.01.003. Epub 2013 Feb 17. ",null,"Ledger SJ,Owen E,Prasad SA,Goldman A,Willams J,Aurora P.","A pilot outreach physiotherapy and dietetic quality improvement initiative reduces IV antibiotic requirements in children with moderate-severe cystic fibrosis.","At our hospital the current model of care for children with moderate-severe CF is focused on intensive inpatient intervention,regular outpatient clinic review and specialist outreach care as required. An alternative model providing more regular physiotherapy and dietetic outreach support,in addition to these specialist services,may be more effective. 16 children (4 male; 12 female; mean age 10.9±2.93; range 4-15 years) who required >40days of IV antibiotics in the 12-months pre-intervention were enrolled. Physiotherapy included weekly-supervised exercise sessions,alongside regular review of home physiotherapy regimens. Dietetic management included 1-2 monthly monitoring of growth,appetite,intake and absorption,and nutrition education sessions. There was a 23% reduction in inpatient IV antibiotic requirement and 20% reduction in home IV antibiotic requirement during the intervention year. Cost-benefit analyses showed savings of £113,570. VO(2Peak) increased by 4.9 ml·kg·min(-1) (95%CI 1.01 to 8.71; p=0.02),and 10 m-MSWT distance and increment achieved increased by 229 m (95%CI 109 to 350; p<0.001) and 2 levels (95%CI 1 to 3; p<0.002) respectively. No significant differences in physiological and patient reported outcomes were demonstrated,although there was a possible trend towards improvement in outcomes when compared to the pre-intervention year. This pilot programme demonstrated a reduction in IV and admission requirements with a cost benefit in a small group of children with moderate-severe CF. A fully powered clinical trial is now warranted."," J Cyst Fibros. 2013 Dec;12(6):766-72.","UK",2013,null,"Physical therapy,Diet",null,null,null,"Direct costs",null,"UK",null,null,"Physical therapy,Diet","Direct costs",null,null,"2010:2014"]
[25,"Urquhart D,Sell Z,Dhouieb E,Bell G,Oliver S,Black R,Tallis M. Effects of a supervised,outpatient exercise and physiotherapy programme in children with cystic fibrosis. Pediatr Pulmonol. 2012 Dec;47(12):1235-41. doi: 10.1002/ppul.22587. Epub 2012 May 2.",null,"Urquhart D,Sell Z,Dhouieb E,Bell G,Oliver S,Black R,Tallis M. "," Effects of a supervised,outpatient exercise and physiotherapy programme in children with cystic fibrosis.","Previous work suggests benefit from outpatient exercise and physiotherapy in children with cystic fibrosis (CF),namely improved exercise capacity and lung function measures,as well reduced intravenous (IV) antibiotic needs. Our study aim was to investigate the effect of a year-long supervised outpatient exercise and physiotherapy programme in children with CF. Subjects with CF aged ≥10 years who had received ≥4 courses of IV antibiotics in 2009 were enrolled and seen fortnightly for supervised exercise and physiotherapy throughout 2010. In addition,they were expected to exercise three times weekly,and if unwell complete additional physiotherapy sessions extra to usual chest physiotherapy. Assessments of exercise capacity using the Modified Shuttle Test (MST) and quality of life (QOL; CFQ-UK) were recorded at baseline and after 1 year. Regular spirometry was performed before and throughout the study. Data were collected on IV antibiotic days. 12 subjects (6 female) were enrolled with mean (95% CI) age of 13.3 (11.8-14.6) years at study entry. A significant reduction in IV antibiotic days from 60 (56-64) days in 2009 to 50 (44-56) in 2010 (P = 0.02) was noted,along with improved MST distance (m) [735 (603-867) vs. 943 (725-1,161),P = 0.04] and level attained [9.4 (8.4-10.5) vs. 11.1 (9.6-12.6),P = 0.04]. Significant improvements in CFQ-UK scores for physical [59 (47-72) vs. 83 (74-92),P = 0.001],emotional [63 (55-72) vs. 84 (74-93),P < 0.001],treatment [41 (30-51) vs. 61 (48-73),P = 0.002],and respiratory [54 (42-66) vs. 76 (70-82),P = 0.002] domains were noted. The mean (95% CI) rate of change of FEV(1) was -4 (-18,+10)% in 2009,but was +6 (-2,+13)% in 2010,although this did not reach statistical significance. Supervised,outpatient exercise and physiotherapy are associated with improvements in QOL and exercise tolerance,a reduction in IV antibiotic days,and a trend towards reducing lung function decline in children with CF. The cost of IV antibiotics was reduced by £66,384 ($104,000) in 2010 when compared with 2009. Such cost-benefit may have implications for workforce planning and service provision."," Pediatr Pulmonol. 2012 Dec;47(12):1235-41. ","UK",2012,null,"Physical therapy",null,null,null,"Direct costs",null,"UK",null,null,"Physical therapy","Direct costs",null,null,"2010:2014"]
[26,"Dewitt EM,Grussemeyer CA,Friedman JY,Dinan MA,Lin L,Schulman KA,Reed SD. Resource use,costs,and utility estimates for patients with cystic fibrosis with mild impairment in lung function: analysis of data collected alongside a 48-week multicenter clinical trial. Value Health. 2012 Mar-Apr;15(2):277-83. doi: 10.1016/j.jval.2011.11.027. Epub 2012 Jan 27. ",null,"Dewitt EM,Grussemeyer CA,Friedman JY,Dinan MA,Lin L,Schulman KA,Reed SD"," Resource use,costs,and utility estimates for patients with cystic fibrosis with mild impairment in lung function: analysis of data collected alongside a 48-week multicenter clinical trial.","Transport of ions to generate epithelial rehydration (TIGER)-1 was a randomized trial conducted to evaluate the safety and efficacy of denufosol versus placebo in patients with cystic fibrosis with mild impairment in lung function. The trial met its primary end point at 24 weeks,but a subsequent trial did not show a sustained effect of denufosol at 48 weeks. By using the 48-week data,we characterized resource use,direct medical costs,indirect costs,and utility estimates. Data on medications,outpatient and emergency visits,hospital admissions,tests,procedures,and home nursing were captured on study case report forms. Sources for unit costs included the Medicare Physician Fee Schedule,the Nationwide Inpatient Sample,and the Red Book. Health utilities were derived from the Health Utilities Index Mark 2/3. We used multivariable regression to evaluate the impact of baseline covariates on costs. Characteristics of the 352 participants at enrollment included mean age of 14.6 years,history of Pseudomonas aeruginosa colonization in 45.2%,use of dornase alfa in 77.0%,and long-term use of inhaled antibiotics in 37.2%. Over 48 weeks,22.4% of participants were hospitalized and,on average,participants missed 7.4 days of school or work. Mean total costs (excluding denufosol) were $39,673 (SD $26,842),of which 85% were attributable to medications. Female sex and P. aeruginosa colonization were independently associated with higher costs. Prospective economic data collection alongside a clinical trial allows for robust estimates of cost of illness. The mean annual cost of care for patients with cystic fibrosis with mild impairment in lung function exceeds $43,000 and is driven by medication costs.","Value Health. 2012 Mar-Apr;15(2):277-83. ","USA",2012,null,"Denufosol",null,null,null,"Direct costs",null,"USA",null,null,"Denufosol","Direct costs",null,null,"2010:2014"]
[27,"Norman R,van Gool K,Hall J,Delatycki M,Massie J. Cost-effectiveness of carrier screening for cystic fibrosis in Australia. J Cyst Fibros. 2012 Jul;11(4):281-7. doi: 10.1016/j.jcf.2012.02.007. Epub 2012 Mar 16. ",null,"Norman R,van Gool K,Hall J,Delatycki M,Massie J.","Cost-effectiveness of carrier screening for cystic fibrosis in Australia.","Carrier screening for cystic fibrosis is not widely available in Australia,partly due to concerns regarding its cost-effectiveness. The benefit of information from pregnancy to pregnancy has not been widely considered in existing cost-effectiveness analyses. A decision tree was constructed estimating costs and outcomes from screening,including both initial and subsequent pregnancies. Effectiveness was expressed in terms of CF births averted. Costs were collected using a health service perspective. All costs and outcomes were discounted at 5% per annum. Screening reduced the annual incidence of CF births from 34 to 14/100,000 births (an aggregate number of CF births of 100.9 and 41.9 respectively). In initial pregnancies,costs in the screening arm (A$16.6 million/100,000 births) exceed those in the non-screening arm (A$13.4 million/100,000 births). The incremental cost per CF birth in initial pregnancies is therefore approximately A$150,000. However,this was reversed for subsequent pregnancies,in that the pre-collected information reduces the incidence of CF in subsequent pregnancies at low additional costs. When aggregated,the results suggest screening is likely to be cost-saving. The introduction of national carrier screening for cystic fibrosis should be considered,as it is likely to reduce CF incidence at an acceptable (potentially negative) cost.",". J Cyst Fibros. 2012 Jul;11(4):281-7. ","Australia",2012,null,"Screening",null,null,null,"Direct costs,Indirect costs",null,"Australia",null,null,"Screening","Direct costs,Indirect costs",null,null,"2010:2014"]
[28,"Al-Saleh S,Dell SD,Grasemann H,Yau YC,Waters V,Martin S,Ratjen F. Sputum induction in routine clinical care of children with cystic fibrosis. J Pediatr. 2010 Dec;157(6):1006-1011.e1. doi: 10.1016/j.jpeds.2010.06.001. Epub 2010 Jul 14.",null,"Al-Saleh S,Dell SD,Grasemann H,Yau YC,Waters V,Martin S,Ratjen F. ","Sputum induction in routine clinical care of children with cystic fibrosis.","To determine the microbiological yield of induced sputum (IS) samples compared with conventional airway samples,spontaneously expectorated sputum and throat swabs,in children with cystic fibrosis (CF) attending an outpatient clinic. Ninety-five children with CF (75 able to spontaneously expectorate sputum) were included in this prospective cross-sectional comparative study. After obtaining expectorated sputum or throat swabs samples,IS was obtained by performing the sputum induction procedure using an eFlow device (PARI,Starnberg,Germany). CF bacterial culture results were compared between the two procedures. Differences in culture results between samples were observed in 25 of 94 (27%) patients. IS had a significantly higher yield for CF pathogens,with 80% of the differences being due to detection of additional organisms in IS samples. Overall,SI was well tolerated,but 12 of 95 cases had a >20% postinduction decline in forced expiratory volume in 1 second. The whole SI procedure took 30 to 85 minutes of clinic time,and its estimated additional cost was $150 (US)/patient. Induced sputum has a higher microbiological yield compared with the conventional samples in children with CF,even in patients capable of expectorating sputum spontaneously. Although sputum induction is safe and tolerable,it is time-consuming and expensive in routine clinical settings."," J Pediatr. 2010 Dec;157(6):1006-1011.e1.","Canada",2010,null,"Various",null,null,null,"Direct costs",null,"Canada",null,null,"Various","Direct costs",null,null,"2010:2014"]
[29,"Maxwell S,Brameld K,Youngs L,Geelhoed E,O'Leary P. Informing policy for the Australian context - Costs,outcomes and cost savings of prenatal carrier screening for cystic fibrosis. Aust N Z J Obstet Gynaecol. 2010 Feb;50(1):51-9. doi: 10.1111/j.1479-828X.2009.01111.x. ",null,"Maxwell S,Brameld K,Youngs L,Geelhoed E,O'Leary P","Informing policy for the Australian context - Costs,outcomes and cost savings of prenatal carrier screening for cystic fibrosis.","To examine the costs,outcomes and cost savings of three models of prenatal cystic fibrosis (CF) carrier screening compared to no screening from a public health sector perspective. A decision tree was generated to estimate costs and outcomes for each screening model for a hypothetical cohort of 38 000 pregnancies. Sensitivity analysis assessed the impact of model parameter variation. Under baseline assumptions,the initial annual cost to provide a prenatal CF carrier-screening programme is Au$5.32 million,Au$3.35 million and $2.93 million for one-step,two-step simultaneous and two-step sequential screening respectively. Annual costs are significantly lower for an established programme. No screening model provides a net saving over a lifetime horizon; however,the results were sensitive to variation in lifetime cost of care,screening test costs and number of pregnancies per carrier couple. Under some scenarios,prenatal CF carrier screening is cost saving to the health system; however,this is not conclusive and depends on several factors. Cost remains a potential barrier due to the substantial level of funding required in the short term. Feasibility and psychosocial,ethical and legal implications of screening need to be considered. Additionally,consultation is required with the Australian community on the acceptability and/or desire for prenatal CF carrier screening."," Aust N Z J Obstet Gynaecol. 2010 Feb;50(1):51-9.","Australia",2010,null,"Screening",null,null,null,"Direct costs",null,"Australia",null,null,"Screening","Direct costs",null,null,"2010:2014"]
[30,"Rodrigues R,Magalhaes PK,Fernandes MI,Gabetta CS,Ribeiro AF,Pedro KP,Valdetaro F,Santos JL,Souza RM,Pazin Filho A,Maciel LM. Neonatal screening for cystic fibrosis in São Paulo State,Brazil: a pilot study. Braz J Med Biol Res. 2009 Oct;42(10):973-8. doi: . Epub 2009 Sep 4.",null,"Rodrigues R,Magalhaes PK,Fernandes MI,Gabetta CS,Ribeiro AF,Pedro KP,Valdetaro F,Santos JL,Souza RM,Pazin Filho A,Maciel LM. ","Neonatal screening for cystic fibrosis in São Paulo State,Brazil: a pilot study.","Cystic fibrosis is one of the most common autosomal recessive hereditary diseases in the Caucasian population,with an incidence of 1:2000 to 1:3500 liveborns. More than 1000 mutations have been described with the most common being F508del. It has a prevalence of 23-55% within the Brazilian population. The lack of population-based studies evaluating the incidence of cystic fibrosis in São Paulo State,Brazil,and an analysis concerning the costs of implantation of a screening program motivated the present study. A total of 60,000 dried blood samples from Guthrie cards obtained from April 2005 to January 2006 for neonatal screening at 4 reference centers in São Paulo State were analyzed. The immunoreactive trypsinogen (IRT)/IRT protocol was used with the cut-off value being 70 ng/mL. A total of 532 children (0.9%) showed IRT >70 ng/mL and a 2nd sample was collected from 418 (80.3%) of these patients. Four affected children were detected at two centers,corresponding to an incidence of 1:8403. The average age at diagnosis was 69 days,and 3 of the children already showed severe symptoms of the disease. The rate of false-positive results was 95.2% and the positive predictive value for the test was 8%. The cost of detecting an affected subject was approximately US$8,000.00 when this cystic fibrosis program was added to an existing neonatal screening program. The present study clearly shows the difficulties involved in cystic fibrosis screening using the IRT/IRT protocol,particularly in a population with no long-term tradition of neonatal screening.","Braz J Med Biol Res. 2009 Oct;42(10):973-8.","Brazil",2009,null,"Screening",null,null,null,"Direct costs",null,"Brazil",null,null,"Screening","Direct costs",null,null,"2005:2009"]
[31,"Davis LB,Champion SJ,Fair SO,Baker VL,Garber AM. A cost-benefit analysis of preimplantation genetic diagnosis for carrier couples of cystic fibrosis. Fertil Steril. 2010 Apr;93(6):1793-804. doi: 10.1016/j.fertnstert.2008.12.053. Epub 2009 May 12. ",null,"Davis LB,Champion SJ,Fair SO,Baker VL,Garber AM"," A cost-benefit analysis of preimplantation genetic diagnosis for carrier couples of cystic fibrosis. ","To perform a cost-benefit analysis of preimplantation genetic diagnosis (PGD) for carrier couples of cystic fibrosis (CF) compared with the alternative of natural conception (NC) followed by prenatal testing and termination of affected pregnancies. Cost-benefit analysis using a decision analytic model. Outpatient reproductive health practices. A simulated cohort of 1,000 female patients. We calculated the net benefit of giving birth to a child as the present value of lifetime earnings minus lifetime medical costs. Net benefits in dollars. When used for women younger than 35 years of age,the net benefit of PGD over NC was $182,000 ($715,000 vs. $532,000,respectively). For women aged 35-40 years,the net benefit of PGD over NC was $114,000 ($634,000 vs. $520,000,respectively). For women older than 40 years,however,the net benefit of PGD over NC was -$148,000 ($302,000 vs. $450,000,respectively). Preimplantation genetic diagnosis provides net economic benefits when used by carrier couples of CF. Although there is an upper limit of maternal age at which economic benefit can be demonstrated,carrier couples of CF should be offered PGD for prevention of an affected child.","Fertil Steril. 2010 Apr;93(6):1793-804. ","USA",2010,null,"Screening",null,null,null,"Direct costs",null,"USA",null,null,"Screening","Direct costs",null,null,"2010:2014"]
[32,"Huot L,Durieu I,Bourdy S,Ganne C,Bellon G,Colin C,Touzet S,REMU study. Evolution of costs of care for cystic fibrosis patients after clinical guidelines implementation in a French network. J Cyst Fibros. 2008 Sep;7(5):403-8. doi: 10.1016/j.jcf.2008.02.004. Epub 2008 Mar 20.",null,"Huot L,Durieu I,Bourdy S,Ganne C,Bellon G,Colin C,Touzet S,REMU study"," Evolution of costs of care for cystic fibrosis patients after clinical guidelines implementation in a French network.","The aim of this study was to evaluate how advances in CF management in France between 2000 and 2003 impacted CF-related costs. The analysis of direct medical costs was done in 2000 and 2003 from the perspective of the French national healthcare insurance system. The patients,65 in 2000 and 64 in 2003,were followed-up in one pediatric and one adult CF reference center (CFRC). We quantified and valued CF-related home and hospital care costs. We found an average cost of euro16474/patient/year in 2000,and euro22725 in 2003 (based on the 2003 euro value). Hospital care increased from 15% of the total cost in 2000 to 22% in 2003. Medications accounted for 45% of the total cost for the two periods,with an average cost of euro7229/patient/year in 2000 and euro10336 in 2003. Home intravenous antibiotic therapy accounted for 20% of the total cost for the two periods. We highlighted an increase in CF care costs between 2000 and 2003,which might be related to the changes in practice patterns that followed guidelines implementation,such as the use of new medications (dornase alpha and tobramycin) and more frequent follow-up in the CFRC."," J Cyst Fibros. 2008 Sep;7(5):403-8. ","France",2008,null,"All healthcare",null,null,null,"Direct costs,Indirect costs",null,"France",null,null,"All healthcare","Direct costs,Indirect costs",null,null,"2005:2009"]
[33,"Guerriere DN,Tranmer JE,Ungar WJ,Manoharan V,Coyte PC. Valuing care recipient and family caregiver time: a comparison of methods. Int J Technol Assess Health Care. 2008 Winter;24(1):52-9. doi: 10.1017/S0266462307080075. ",null,"Guerriere DN,Tranmer JE,Ungar WJ,Manoharan V,Coyte PC"," Valuing care recipient and family caregiver time: a comparison of methods. ","The purpose of this study is to compare the approaches used for valuing family caregiver and care recipient time devoted to providing and receiving care. Valuation approaches were operationalized within a cohort of cystic fibrosis care recipients (n = 110). Base-case analyses,grounded in human capital theory,applied earnings estimates to caregiving time to impute the market value of time lost from labor. Unpaid labor and leisure time was valued with a replacement cost (homemaker's wage rate). Total time costs were computed and sensitivity analyses were conducted to describe the effects of alternative valuation methods on total costs. The mean time cost per care recipient-caregiver dyad over 28 days was $2,026CAD. The majority (76 percent) of time costs were due to losses from unpaid labor and leisure time. Varying the valuation of paid labor time did not result in significantly different total time costs (p = .0877). However,varying the method of valuing unpaid labor and leisure time did significantly affect total costs (p < .0001). Care recipients and caregivers primarily lost time from unpaid labor and leisure in the treatment of cystic fibrosis. Moreover,when the above losses were aggregated,the method of valuation greatly influenced overall results. The findings clearly indicate that omitting caregiver and unpaid labor and leisure costs may result in an inaccurate assessment of ambulatory and home-based healthcare programs.","Int J Technol Assess Health Care. 2008 Winter;24(1):52-9. ","Canada",2008,null,"None or unclear",null,null,null,"Direct costs",null,"Canada",null,null,"None or unclear","Direct costs",null,null,"2005:2009"]
[34,"Veenstra DL,Harris J,Gibson RL,Rosenfeld M,Burke W,Watts C. Pharmacogenomic testing to prevent aminoglycoside-induced hearing loss in cystic fibrosis patients: potential impact on clinical,patient,and economic outcomes. Genet Med. 2007 Oct;9(10):695-704. doi: 10.1097GIM.0b013e318156dd07. ",null,"Veenstra DL,Harris J,Gibson RL,Rosenfeld M,Burke W,Watts C. ","Pharmacogenomic testing to prevent aminoglycoside-induced hearing loss in cystic fibrosis patients: potential impact on clinical,patient,and economic outcomes","Aminoglycosides are commonly used in cystic fibrosis patients to treat Pseudomonas aeruginosa respiratory infections. Aminoglycoside-induced hearing loss may occur in 1%-15% of patients with cystic fibrosis,ranging from mild to severe. Recently,a genetic test to identify patients with a mitochondrial mutation (A1555G) that may predispose patients to this adverse event has become available. Although the A1555G variant is very rare,it seems to confer a high risk of severe hearing loss in patients exposed to aminoglycosides. The objective was to evaluate the potential clinical,patient,and economic outcomes associated with the use of A1555G testing in a cystic fibrosis population,and explore data gaps and uncertainty in its clinical implementation. We developed a decision-analytic model to evaluate a hypothetical cohort of patients with cystic fibrosis from a societal perspective. Clinical and economic data were derived primarily from a critical literature review. The incidence of aminoglycoside-induced severe hearing loss,quality-adjusted life-years,and total health care costs were evaluated. Sensitivity analyses were conducted to evaluate uncertainty in our results. In the base-case analysis,A1555G testing decreased the risk of severe aminoglycoside-induced hearing loss by 0.12% in the cystic fibrosis population. The discounted incremental cost per quality-adjusted life-years gained was $79,300,but varied widely from $33,000 to testing being dominated by the no testing strategy (higher costs and lower quality-adjusted life-years with testing) in sensitivity analyses. If avoidance of aminoglycosides in patients testing positive leads to an absolute increase in the lifetime risk of death from Pseudomonas infection of 0.8% or greater,A1555G testing would lead to a decrease in quality-adjusted life-years. The results of our analysis suggest that there are significant data gaps and uncertainty in the outcomes with A1555G testing,but it is not likely cost-effective,and could lead to worse patient outcomes due to avoidance of first-line therapy in the >95% of patients who are false-positives. Additional research is needed before pharmacogenetic testing for the A1555G mitochondrial mutation can be recommended,even in a population with a high likelihood of exposure to aminoglycosides.","Genet Med. 2007 Oct;9(10):695-704","USA",2007,null,"Antibiotics",null,null,null,"Indirect costs",null,"USA",null,null,"Antibiotics","Indirect costs",null,null,"2005:2009"]
[35,"Radhakrishnan M, van Gool K, Hall J, Delatycki M, Massie J. Economic evaluation of cystic fibrosis screening: a review of the literature. Health Policy. 2008 Feb;85(2):133-47. doi: 10.1016/j.healthpol.2007.07.007. Epub 2007 Aug 28. ",null,"Radhakrishnan M, van Gool K, Hall J, Delatycki M, Massie J. "," Economic evaluation of cystic fibrosis screening: a review of the literature. ","To critically examine the economic evidence regarding cystic fibrosis (CF) carrier screening and to understand issues relating to the transferability of international findings to any national context for policy decisions. A systematic literature search identified 14 studies (out of 29 economic studies on CF) focusing on preconception or prenatal screening between 1990 and 2006. These studies were then assessed against international benchmarks on conducting and reporting of economic evaluations, costing methodology used and focusing on the transferability of the evidence to national contexts. The primary outcome measures varied considerably between studies and there was considerable ambiguity and variation on how costs were estimated. The Incremental Cost Effectiveness Ratio (ICER) and net savings, for preconception and prenatal screening were inconsistent and varied significantly, even after adjusting for timing and exchange rates. Differences in screening participation rates, reproductive choices, test sensitivity, cost of test and lifetime cost of care make up a large part of the ICER variations. The heterogeneity in study design, model inputs and reporting of economic evaluations of CF carrier screening makes comparability and transferability across countries and even within countries difficult. This reinforces the need to assess any technology within the relevant context, and to not simply generalize from reported studies. In turn, this adds to the complex task of making efficient resource allocation decisions in the area of CF carrier screening. Our evaluation adds weight to the calls for revisiting the way economic studies are conducted and reported.","Health Policy. 2008 Feb;85(2):133-47.","International",2008,null,"Screening",null,null,null,"Direct costs",null,"International",null,null,"Screening","Direct costs",null,null,"2005:2009"]
[36,"Wei S, Quigg MH, Monaghan KG. Is cystic fibrosis carrier screening cost effective? Community Genet. 2007;10(2):103-9. doi: 10.1159/000099088.",null,"Wei S, Quigg MH, Monaghan KG","Is cystic fibrosis carrier screening cost effective?","Between 2001 and 2005, 6,166 females underwent cystic fibrosis (CF) carrier screening at our institution. Only 36% were Caucasian. We identified 143 carrier females and subsequently tested 85 of their partners. The observed carrier frequency was not significantly different than expected for any racial or ethnic group tested. We identified 6 positive couples (5 Caucasian, 1 Arab American) and 1 affected fetus. In just under 4 years, our institution spent approximately $334,000 on CF population screening. Comparing this to the lifetime medical cost for a CF patient, CF population-based carrier screening is cost effective at our institution, despite the high number of non-Caucasians being screened."," Community Genet. 2007;10(2):103-9.","USA",2007,null,"Screening",null,null,null,"Direct costs",null,"USA",null,null,"Screening","Direct costs",null,null,"2005:2009"]
[37,"Horvais V, Touzet S, François S, Bourdy S, Bellon G, Colin C, Durieu I. Cost of home and hospital care for patients with cystic fibrosis followed up in two reference medical centers in France. Int J Technol Assess Health Care. 2006 Fall;22(4):525-31. doi: 10.1017/S0266462306051476. ",null,"Horvais V, Touzet S, François S, Bourdy S, Bellon G, Colin C, Durieu I.","Cost of home and hospital care for patients with cystic fibrosis followed up in two reference medical centers in France. ","In France, new guidelines for clinical practices concerning cystic fibrosis came out in 2002, underscoring the need for early and intensive management of this disease. Because no recent health economic studies on cystic fibrosis in France were available, we conducted a cost-analysis study before the new guidelines were put into practice, with a view to a later study on the medical and economic impact of these guidelines. A cost-analysis study was performed of the inpatient and outpatient costs of patients with cystic fibrosis for the 2000-2001 period. The various direct costs were estimated on a sample of sixty-five adult and pediatric patients managed for cystic fibrosis in two reference medical centers. Data were obtained from medical records, and questionnaires were filled out by the patients. Analysis was made from the perspective of the French healthcare system. We studied sixty-five patients, 54 percent male patients and 72 percent children under 18 years of age. The total cost of cystic fibrosis care totaled 16,189 euros per year and per patient. Outpatient costs accounted for 88 percent of the total cost versus 12 percent for inpatient costs; medication costs were the highest with 21 percent of the total cost for home intravenous antibiotic treatments and 49 percent of the total cost for chronic medications. The results show that outpatient costs were higher than inpatient costs, which could be related to the importance granted to home health care in France, notably for intravenous antibiotic treatments given for pulmonary complications.","Int J Technol Assess Health Care. 2006 Fall;22(4):525-31.","France",2006,null,"All healthcare",null,null,null,"Direct costs",null,"France",null,null,"All healthcare","Direct costs",null,null,"2005:2009"]
[38,"van den Akker-van Marle ME, Dankert HM, Verkerk PH, Dankert-Roelse JE. Cost-effectiveness of 4 neonatal screening strategies for cystic fibrosis. Pediatrics. 2006 Sep;118(3):896-905. doi: 10.1542/peds.2005-2782. ",null,"van den Akker-van Marle ME, Dankert HM, Verkerk PH, Dankert-Roelse JE. ","Cost-effectiveness of 4 neonatal screening strategies for cystic fibrosis.","The purpose of this work was to assess the costs of 4 neonatal screening strategies for cystic fibrosis in relation to health effects. In each strategy, the first test was the measurement of serum concentration of immunoreactive trypsin. The second step consisted of either a second immunoreactive trypsin test (strategy 1) or a multiple mutation analysis (strategy 2). In strategies 3 and 4, a third step was added to strategy 2: a second immunoreactive trypsin test (strategy 3) or an extended mutation analysis of the cystic fibrosis gene, that is, a denaturing gradient gel electrophoresis analysis (strategy 4). We conducted an economic-modeling exercise in the Netherlands based on published data and expert opinions. Subjects were a hypothetical cohort of 200 000 neonates, the approximate number of children born annually in the Netherlands, and we assessed the costs and number of life-years gained as a result of neonatal screening for cystic fibrosis. The costs and effects of changes in reproductive decisions because of neonatal screening were also assessed. Immunoreactive trypsin + immunoreactive trypsin had the most favorable cost-effectiveness ratio of 24,800 euro per life-year gained. Immunoreactive trypsin + DNA + denaturing gradient gel electrophoresis achieved more health effects than immunoreactive trypsin + DNA + immunoreactive trypsin at lower cost. The incremental costs per life-year gained of the immunoreactive trypsin + DNA + denaturing gradient gel electrophoresis strategy compared with the immunoreactive trypsin + immunoreactive trypsin strategy were 130,700 euro, whereas the incremental costs of the immunoreactive trypsin + DNA strategy compared with the immunoreactive trypsin + DNA + denaturing gradient gel electrophoresis strategy were 2,154,300 euro. When changes in reproductive decisions as a result of neonatal screening are also taken into account, neonatal screening for cystic fibrosis may lead to financial savings of approximately 1.8 million euro annually, depending on the screening strategy used. Cystic fibrosis screening for neonates is a good economic option, and positive health effects can also be expected. Immunoreactive trypsin + immunoreactive trypsin and immunoreactive trypsin + DNA + denaturing gradient gel electrophoresis are the most cost-effective strategies."," Pediatrics. 2006 Sep;118(3):896-905. ","Netherlands",2006,null,"Screening",null,null,null,"Direct costs",null,"Netherlands",null,null,"Screening","Direct costs",null,null,"2005:2009"]
[39,"Glanville AR, Scott AI, Morton JM, Aboyoun CL, Plit ML, Carter IW, Malouf MA. Intravenous ribavirin is a safe and cost-effective treatment for respiratory syncytial virus infection after lung transplantation. J Heart Lung Transplant. 2005 Dec;24(12):2114-9. doi: 10.1016/j.healun.2005.06.027. Epub 2005 Sep 6.",null,"Glanville AR, Scott AI, Morton JM, Aboyoun CL, Plit ML, Carter IW, Malouf MA.","Intravenous ribavirin is a safe and cost-effective treatment for respiratory syncytial virus infection after lung transplantation","Community-acquired viral infections, such as respiratory syncytial virus (RSV), represent a risk factor for bronchiolitis obliterans syndrome (BOS), the major limiting factor for long-term survival after lung transplantation (LTx). RSV often presents with acute bronchiolitis and may be fatal in 10% to 20% of patients. Standard therapies for RSV include nebulized ribavirin with or without steroids, but are costly and inconvenient. We investigated the utility of intravenous (IV) ribavirin with steroids for the treatment of RSV infection after LTx. RSV was identified in nasopharyngeal and throat swabs (NPS) using indirect fluorescent antibody (IFA) testing in 18 symptomatic patients, which was confirmed by viral culture in 14. Data were collected for the period between April 2002 and October 2004. The study included 10 men and 8 women, mean age 42 +/- 15 (range 18 to 63) years. Transplant procedures were 5 single LTx and 13 bilateral LTx. RSV diagnosis was made on Day 1,374 +/- 1,270 (range 61 to 4,598, median 935) post-operatively. Underlying diagnoses included cystic fibrosis (n = 9), emphysema (n = 7) and pulmonary fibrosis (n = 2). All 18 patients received intravenous (IV) ribavirin (33 mg/kg on Day 1 and 20 mg/kg/day thereafter in 3 divided doses) with oral prednisolone (1 mg/kg) until repeat NPS were negative for RSV on IFA. Median therapy was 8 days (6 to 15). The mortality rate was 0%. Mean FEV1 fell from 2.1 +/- 1.0 liter (0.7 to 3.7 liters) to 1.8 +/- 0.9 liter (0.5 to 3.6 liters) (p < 0.001), but recovered to 2.1 +/- 0.9 (0.7 to 3.7 liters) within 3 months and was maintained at follow-up of 521 +/- 328 days (141 to 1,023 days, median 302). Only 1 patient developed bronchiolitis obliterans syndrome (BOS). Complications included mild hemolytic anemia (blood hemoglobin fell from 122 +/- 22 [84 to 154] g/liter to 107 +/- 18 [75 to 138] g/liter, p = 0.02). Cost savings per 8-day course were $US15,913 when compared with nebulized therapy at 6 g/day (p < 0.001). This is the largest reported series of treated RSV cases after LTx and the first to show that therapy with IV ribavirin and oral corticosteroids is well tolerated and effective. Cost utility vs nebulized therapy has been established. Early diagnosis and management are essential to prevent airway epithelial injury and subsequent BOS."," J Heart Lung Transplant. 2005 Dec;24(12):2114-9. ","Australia",2005,null,"Lung transplant",null,null,null,"Direct costs",null,"Australia",null,null,"Lung transplant","Direct costs",null,null,"2005:2009"]
[40,"Thornton J, Elliott RA, Tully MP, Dodd M, Webb AK. Clinical and economic choices in the treatment of respiratory infections in cystic fibrosis: comparing hospital and home care. J Cyst Fibros. 2005 Dec;4(4):239-47. doi: 10.1016/j.jcf.2005.08.003. Epub 2005 Oct 19. ",null,"Thornton J, Elliott RA, Tully MP, Dodd M, Webb AK"," Clinical and economic choices in the treatment of respiratory infections in cystic fibrosis: comparing hospital and home care.","A cost-effectiveness evaluation comparing home-based and hospital-based treatment with intravenous antibiotics for respiratory exacerbations in adults with cystic fibrosis (CF) has not been previously undertaken. The study was conducted in a UK adult CF centre from a health service perspective. Clinical outcome and resource use data were obtained from a retrospective one-year study and combined with unit cost data in an incremental economic analysis. The primary outcome measure was percentage change in FEV(1); \"effectiveness\" was defined as maintenance of baseline average FEV(1) over the one-year study period. 116 patients received 454 courses of intravenous antibiotics. At the end of 1 year, there had been a mean percentage decline in FEV(1) compared with baseline average for home-treated patients but an improvement for hospital-treated patients (Tukey's HSD mean difference 10.1%, 95% CI 2.9 to 17.2, p = 0.003). Treatment was deemed \"effective\" in more hospital (58.8%) than home (42.6%) patients. The cost of hospital treatment was higher than home treatment (mean difference 9,005 pounds, 95% CI 3,507 to 14,700, p<0.001). The mean ICER was 46,098 pounds (2.5th and 97.5th percentiles -374,044 and 362,472). Hospital treatment was more effective but more expensive than home treatment. Potential methods to improve outcome at home should be considered but these may have resource implications."," J Cyst Fibros. 2005 Dec;4(4):239-47.","UK",2005,null,"Antibiotics",null,null,null,"Direct costs",null,"UK",null,null,"Antibiotics","Direct costs",null,null,"2005:2009"]
[41,"Rosenberg MA, Farrell PM. Assessing the cost of cystic fibrosis diagnosis and treatment. J Pediatr. 2005 Sep;147(3 Suppl):S101-5. doi: 10.1016/j.jpeds.2005.08.018.",null,"Rosenberg MA, Farrell PM.","Assessing the cost of cystic fibrosis diagnosis and treatment.","To extend previous evaluations of costs of cystic fibrosis (CF) diagnosis and examine key issues in assessing the CF cost of care. Costs for CF newborn screening (NBS) including CF multi-mutation testing are analyzed by using data from the Wisconsin State Laboratory of Hygiene. Electronic data from 2 Wisconsin CF centers are used to illustrate the complexity of analyzing CF health care utilization and costs. The current cost-per-newborn of a CF multi-mutation test is 50% higher than testing for a single mutation. Data collection for the cost-of-care study requires a combination of electronic and manual data collection; modeling of cost data requires consideration of any censoring. Hospitalizations are shown to have a large impact on costs and show high variability at the individual level. Sixty-nine percent of children with meconium ileus had some hospitalization versus 56% of children without meconium ileus. A cost-benefit analysis of CF multi-mutation testing is warranted. The study of health care cost data is complex and utilization varies between children. Individual-level modeling of CF costs must include factors contributing to the severity of the disease and allow for consideration of individual-level utilization, such as the number of hospitalizations."," J Pediatr. 2005 Sep;147(3 Suppl):S101-5. ","USA",2005,null,"All healthcare",null,null,null,"Direct costs",null,"USA",null,null,"All healthcare","Direct costs",null,null,"2005:2009"]
[42,"Warren E, Anderson R, Proos AL, Burnett LB, Barlow-Stewart K, Hall J. Cost-effectiveness of a school-based Tay-Sachs and cystic fibrosis genetic carrier screening program. Genet Med. 2005 Sep;7(7):484-94. doi: 10.109701.gim.0000178496.91670.3b. ",null,"Warren E, Anderson R, Proos AL, Burnett LB, Barlow-Stewart K, Hall J. ","Cost-effectiveness of a school-based Tay-Sachs and cystic fibrosis genetic carrier screening program. ","To explore the cost-effectiveness of school-based multi-disease genetic carrier screening. Decision analysis of the cost-effectiveness of a school-based Tay-Sachs disease and cystic fibrosis genetic carrier screening program, relative to no screening. Data relating to ethnicity profile, test-accepting behavior, and screening program cost were sourced from an existing program in Sydney, Australia. Compared to no screening, the incremental cost-effectiveness of the screening program is A dollar 5,834 per additional carrier detected. This cost-effectiveness ratio is most sensitive to changes in genetic test accuracy, and the cost of laboratory assays. The results imply a cost per affected birth avoided of approximately A dollar 530,000 (approximately US dollar 371,000). This preconceptional genetic carrier screening program offers comparable cost-effectiveness to prenatal screening programs for cystic fibrosis.","Genet Med. 2005 Sep;7(7):484-94.","Australia",2005,null,"Screening",null,null,null,"Direct costs",null,"Australia",null,null,"Screening","Direct costs",null,null,"2005:2009"]
[43,"Taccetti G, Campana S, Festini F, Mascherini M, Döring G. Early eradication therapy against Pseudomonas aeruginosa in cystic fibrosis patients. Eur Respir J. 2005 Sep;26(3):458-61. Doi: 10.1183/09031936.05.00009605.",null,"Taccetti G, Campana S, Festini F, Mascherini M, Döring G.","Early eradication therapy against Pseudomonas aeruginosa in cystic fibrosis patients. ","In cystic fibrosis (CF) patients early antibiotic treatment of lung infection has been shown to lead to Pseudomonas aeruginosa eradication. The present study determined: 1) the time period from eradication to new P. aeruginosa acquisition; 2) P. aeruginosa re-growth and new acquisition; and 3) the impact of eradication therapy on lung function, antimicrobial resistance, emergence of other pathogens and treatment costs. Ciprofloxacin and colistin were used to eradicate P. aeruginosa in 47 CF patients. Bacterial pathogens, lung function decline, P. aeruginosa antimicrobial resistance and anti-pseudomonal serum antibodies were assessed quarterly and compared with an age-matched CF control group. Additionally, costs of antibiotic therapy in both groups were assessed. Early antibiotic therapy leads to a P. aeruginosa free-period of a median (range) of 18 (4-80) months. New acquisition with different P. aeruginosa genotypes occurs in 73% of episodes. It also delays the decline of lung function compared with chronically infected patients, prevents the occurrence of antibiotic resistant P. aeruginosa strains, does not lead to emergence of other pathogens, and significantly reduces treatment costs. The treatment substantially lowers P. aeruginosa prevalence in CF. In conclusion, early antibiotic therapy exerts beneficial effects on the patient's clinical status and is cost-effective compared with conventional antibiotic therapy for chronically infected cystic fibrosis patients.","Eur Respir J. 2005 Sep;26(3):458-61","Germany",2005,null,"Antibiotics",null,null,null,"Direct costs",null,"Germany",null,null,"Antibiotics","Direct costs",null,null,"2005:2009"]
[44,"Iles R, Legh-Smith J, Drummond M, Prevost A, Vowler S. Economic evaluation of Tobramycin nebuliser solution in cystic fibrosis. J Cyst Fibros. 2003 Sep;2(3):120-8. doi: 10.1016/S1569-1993(03)00064-X. ",null,"Iles R, Legh-Smith J, Drummond M, Prevost A, Vowler S."," Economic evaluation of Tobramycin nebuliser solution in cystic fibrosis.","The cost effectiveness of inhaled TOBIR tobramycin nebuliser solution (TNS) in CF and chronic pulmonary Pseudomonas aeruginosa infection has been shown in US but not in European studies. An economic evaluation of TNS was undertaken in children and adults. Lung function and resource utilisation were recorded for 24 months before and during TNS therapy. Interventions were costed. Forty-one patients received TNS; 30 of them matched with a paired control on usual therapy. TNS cases received more inhaled and IV antibiotics in the year before TNS than controls, and were hospitalised more. In the TNS treated group mean days in hospital before and after (change) were 32.0, 24.2 (-7.8); days on IV antibiotics 55.4, 38.9 (-16.4); total cost 22,102 pounds, 28,394 pounds (+ 6292 pounds), composed of cost of TNS 0 pounds, 10,010 pounds (+ 10,010 pounds), cost of hospitalisation 10,897 pounds, 8552 pounds (- 2345 pounds), cost of drugs 11,205 pounds, 9832 pounds (- 1374 pounds). In 19 patients aged < 18 the change in days hospitalised was -10.7 and days on IVs -20.2. Incremental cost was 3830 pounds. TNS was associated with clinically and socially important reductions of hospital attendances and parenteral antibiotics. This would improve patients' quality of life and reduce interference with work and schooling. Its maximal acquisition cost of 10,010 pounds may be reduced by delays in prescribing and dispensing, and was offset by savings of approximately 3500-6200 pounds."," J Cyst Fibros. 2003 Sep;2(3):120-8.","UK",2003,null,"Antibiotics",null,null,null,"Direct costs",null,"UK",null,null,"Antibiotics","Direct costs",null,null,"2000:2004"]
[45,"Baumann U, Stocklossa C, Greiner W, von der Schulenburg JM, von der Hardt H. Cost of care and clinical condition in paediatric cystic fibrosis patients. J Cyst Fibros. 2003 Jun;2(2):84-90. doi: 10.1016/S1569-1993(03)00024-9.",null,"Baumann U, Stocklossa C, Greiner W, von der Schulenburg JM, von der Hardt H"," Cost of care and clinical condition in paediatric cystic fibrosis patients. ","The clinical course of cystic fibrosis (CF) shows considerable variation resulting in differences in health care utilisation. We investigated important clinical parameters and their relation to costs. We collected clinical parameters together with health care utilisation of a representative paediatric CF population (n=138 patients) attending Hanover Medical School over a period of 1 year. 49% of the patients were chronically infected with Pseudomonas aeruginosa. Costs were calculated on the basis of the annual individual health care utilisation from the perspective of health insurance. Total annual expenditure per patient amounted to 23,989 euro (S.D. 18,026), with home drug treatment representing the most important single cost factor (47% of total costs). While costs rose with age and doubled in the first 18 years, they correlated foremost with P. aeruginosa airway colonisation status and lung function expressed as FEV(1). Costs of patients with chronic P. aeruginosa infection were more than three times higher than of uninfected patients. Health care expenditures for patients with CF vary with the clinical course. The variation can be explained to a large extend by clinical parameters."," J Cyst Fibros. 2003 Jun;2(2):84-90. ","Germany",2003,null,"All healthcare",null,null,null,"Direct costs",null,"Germany",null,null,"All healthcare","Direct costs",null,null,"2000:2004"]
[46,"Sawyer SM, Glazner JA. What follows newborn screening? An evaluation of a residential education program for parents of infants with newly diagnosed cystic fibrosis. Pediatrics. 2004 Aug;114(2):411-6. ",null,"Sawyer SM, Glazner JA.","What follows newborn screening? An evaluation of a residential education program for parents of infants with newly diagnosed cystic fibrosis.","The diagnosis of a severe life-limiting condition, such as cystic fibrosis (CF), is generally followed by assessment and treatment of the child and education and counseling for parents. The introduction of newborn screening for CF provides an opportunity for standardized assessment and education. The aim of this study was to evaluate a 5-day residential assessment and education program for parents of infants who receive a diagnosis of CF after newborn screening. Eligible parents had a 6- to 30-month-old infant with CF diagnosed by newborn screening. Parents were interviewed by telephone using a structured questionnaire that addressed 3 main themes: 1) initial communication of the diagnosis of CF, 2) the perceived value of the 5-day assessment and education program, and 3) the perceived advantages and disadvantages of the residential component (Care-By-Parent unit) of the program. Fifteen of 17 eligible families took part in the 5-day assessment and education program, 12 of whom used the residential Care-By-Parent unit. At the end of the program, parents believed that they had the knowledge and skills required to manage their child's CF at home. One hundred percent endorsed the timing of the assessment and education program immediately after the child's diagnosis and would recommend it to other families in the same situation. Perceived advantages of the residential program were not having to travel (89%), being able to concentrate on CF (50%), and the benefit of a \"home base\" at the hospital (39%). Twenty-two percent reported that financial costs related to participation (paternal time off work) were a disadvantage, 17% reported additional strain on family members caring for siblings, and 17% mentioned lack of comfort within the unit. This time-intensive residential program was evaluated positively by parents of children with newly diagnosed CF. It provides a model for education programs after the diagnosis of CF by newborn screening, as well as for other pediatric conditions that require intensive parent education.","Pediatrics. 2004 Aug;114(2):411-6. ","Australia",2004,null,"Various",null,null,null,"Direct costs",null,"Australia",null,null,"Various","Direct costs",null,null,"2000:2004"]
[47,"Balinsky W, Zhu CW. Pediatric cystic fibrosis: evaluating costs and genetic testing. J Pediatr Health Care. 2004 Jan-Feb;18(1):30-4. ",null,"Balinsky W, Zhu CW."," Pediatric cystic fibrosis: evaluating costs and genetic testing. ","The purpose of this article is to present a systematic, critical review of literature and data sources pertaining to pediatric cystic fibrosis, emphasizing and evaluating factors of costs and genetic testing. Cystic fibrosis is the most common fatal genetic disease in the United States. Therefore, its cause, prevalence, cost, and prevention make it important for review. Furthermore, the recent National Institutes of Health Consensus Statement on Genetic Testing for Cystic Fibrosis, the laboratory standards and guidelines published by the American College of Medical Genetics, the American College of Obstetricians and Gynecologists, and the National Human Genome Research Institute, and the increasing interest in genetic testing make it timely to discuss this major pediatric health topic. A broad educational effort, particularly among health care professionals, and genetic screening are advocated."," J Pediatr Health Care. 2004 Jan-Feb;18(1):30-4. ","International",2004,null,"Screening,All healthcare",null,null,null,"Indirect costs",null,"International",null,null,"Screening,All healthcare","Indirect costs",null,null,"2000:2004"]
[48,"Lee DS, Rosenberg MA, Peterson A, Makholm L, Hoffman G, Laessig RH, Farrell PM. Analysis of the costs of diagnosing cystic fibrosis with a newborn screening program. J Pediatr. 2003 Jun;142(6):617-23. doi: 10.1067/mpd.2003.209. ",null,"Lee DS, Rosenberg MA, Peterson A, Makholm L, Hoffman G, Laessig RH, Farrell PM.","Analysis of the costs of diagnosing cystic fibrosis with a newborn screening program","To compare the cost of diagnosing cystic fibrosis (CF) through a newborn screening program with the traditional method and to estimate the cost of CF diagnosis if a national newborn screening program is implemented. Surveys were conducted to determine the annual number of sweat tests in 1991 and in 2000 after implementation of statewide screening. A national survey of sweat test costs was used to estimate the annual expense for diagnosing CF in the United States through newborn screening. Since the introduction of newborn screening for CF, the numbers of sweat tests ordered annually have decreased from 1670 to 804 (including 134 follow-up tests from screening). The current estimated annual cost of Wisconsin CF newborn screening and diagnosis is $4.58 per newborn infant. The estimated annual cost per newly diagnosed CF infant using the traditional method is $4.97 per newborn infant. If no additional sweat tests were ordered outside of the newborn screening program, the estimated annual cost of a Wisconsin CF newborn screening and diagnosis is $2.66 per newborn and $2.47 per newborn for a national CF newborn screening program. A CF newborn screening program provides a potentially cost-saving alternative to the traditional method of diagnosis of CF."," J Pediatr. 2003 Jun;142(6):617-23.","USA",2003,null,"Screening",null,null,null,"Direct costs",null,"USA",null,null,"Screening","Direct costs",null,null,"2000:2004"]
[49,"Grieve R, Thompson S, Normand C, Suri R, Bush A, Wallis C. A cost-effectiveness analysis of rhDNase in children with cystic fibrosis. Int J Technol Assess Health Care. 2003 Winter;19(1):71-9.",null,"Grieve R, Thompson S, Normand C, Suri R, Bush A, Wallis C."," A cost-effectiveness analysis of rhDNase in children with cystic fibrosis.","This study compared the relative cost-effectiveness of daily recombinant human deoxyribonuclease (rhDNase), with alternate day rhDNase and hypertonic saline (HS) for treating children with cystic fibrosis (CF). A randomized controlled trial with a crossover design allocated 40 CF children consecutively to 12 weeks of daily rhDNase, alternate day rhDNase, or HS. The primary outcome measure was forced expiratory volume in 1 second (FEV1), a measure of lung function. All health resource use was prospectively documented for each patient and multiplied by unit costs to give a total health service cost for each 12-week treatment period. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics for each treatment comparison, for various hypothetical levels of the decision maker's ceiling ratio. Compared with HS, there was a 14% improvement in FEV1 for daily rhDNase (95% Cl, 5% to 23%), and a 12% improvement (95% Cl, 2% to 22%) for alternate day rhDNase. For a ceiling ratio of 200 pounds sterling per 1% gain in FEV1, the mean net benefits of daily and alternate day rhDNase compared with HS were 1,158 pounds sterling (95% Cl, -621pounds sterling to 2,842) and 1,188 pounds sterling (95% Cl, -847 to 3,343), respectively; the mean net benefit of daily compared with alternate day rhDNase was -30 pounds sterling (95% Cl, -2,091 pounds sterling to 1,576). If decision makers are prepared to pay 200 pounds sterling for a 1% gain in FEV1 over a 12-week period, then on average either rhDNase strategy is cost-effective.","Int J Technol Assess Health Care. 2003 Winter;19(1):71-9.","UK",2003,null,"RhDNAse",null,null,null,"Direct costs",null,"UK",null,null,"RhDNAse","Direct costs",null,null,"2000:2004"]
[50,"Chung F, Barnes N, Allen M, Angus R, Corris P, Knox A, Miles J, Morice A, O'Reilly J, Richardson M. Assessing the burden of respiratory disease in the UK. Respir Med. 2002 Dec;96(12):963-75. ",null,"Chung F, Barnes N, Allen M, Angus R, Corris P, Knox A, Miles J, Morice A, O'Reilly J, Richardson M.","Assessing the burden of respiratory disease in the UK.","This review explores the health and social burden of some of the main respiratory diseases (asthma, chronic obstructive pulmonary disease, cryptogenic fibrosing alveolitis, cystic fibrosis, lung cancer, mesothelioma, obstructive sleep apnoea and tuberculosis) in order to increase awareness of these diseases and highlight areas where improvements in care are required. The overall impact of respiratory diseases in the U.K. in terms of prevalence, mortality, morbidity and economic costs, with particular reference to secondary care has been considered and comparisons made with the rest of Europe where data are available. Respiratory diseases are responsible for a significant proportion of serious morbidity and premature death among the population of the U.K. and they will continue to present a growing challenge; special support is needed to tackle this burden.","Respir Med. 2002 Dec;96(12):963-75. ","UK",2002,null,"All healthcare",null,null,null,"Direct costs",null,"UK",null,null,"All healthcare","Direct costs",null,null,"2000:2004"]
[51,"Suri R, Grieve R, Normand C, Metcalfe C, Thompson S, Wallis C, Bush A. Effects of hypertonic saline, alternate day and daily rhDNase on healthcare use, costs and outcomes in children with cystic fibrosis. Thorax. 2002 Oct;57(10):841-6.",null,"Suri R, Grieve R, Normand C, Metcalfe C, Thompson S, Wallis C, Bush A. ","Effects of hypertonic saline, alternate day and daily rhDNase on healthcare use, costs and outcomes in children with cystic fibrosis.","Daily recombinant human deoxyribonuclease (rhDNase) is an established but expensive treatment in cystic fibrosis (CF). An alternative lower cost therapy is hypertonic saline (HS), which has been shown to improve lung function in short term studies. This study compares the costs and consequences of daily rhDNase with alternate day rhDNase and HS in children with CF. In an open, randomised, crossover trial, 48 children with CF were allocated consecutively to 12 weeks of once daily 2.5 mg rhDNase, alternate day 2.5 mg rhDNase, and twice daily 5 ml 7% HS. Outcomes assessed included forced expiratory volume in 1 second (FEV(1)) and quality of life. All healthcare resource use was prospectively recorded for each patient. Unit costs were collected and combined with resource use data to give the total health service costs per patient for each treatment strategy. Daily rhDNase resulted in a significantly greater increase in mean FEV(1) than HS (8%, 95% CI 2 to 14) but there was no significant difference in FEV(1) between daily and alternate day rhDNase (2%, 95% CI -4 to 9). Over a 12 week period the mean incremental costs of daily rhDNase compared with HS was pound 1409 (95% CI pound 440 to pound 2318), and the incremental cost of using daily rather than alternate day rhDNase was pound 513 (95% CI - pound 546 to pound 1510). Daily rhDNase is more effective than 5 ml 7% HS twice daily delivered by jet nebuliser, but significantly increases healthcare costs. Administering rhDNase on an alternate day rather than a daily basis is as effective, with a potential for cost savings.","Thorax. 2002 Oct;57(10):841-6.","UK",2002,null,"RhDNAse",null,null,null,"Direct costs",null,"UK",null,null,"RhDNAse","Direct costs",null,null,"2000:2004"]
[52,"Goodman DM, Mendez E, Throop C, Ogata ES. Adult survivors of pediatric illness: the impact on pediatric hospitals. Pediatrics. 2002 Sep;110(3):583-9.",null,"Goodman DM, Mendez E, Throop C, Ogata ES."," Adult survivors of pediatric illness: the impact on pediatric hospitals.","Patients now live well into adulthood surviving diseases with pediatric onset. The size and financial impact of this growing population is unknown. To describe the demographics of adult inpatients in pediatric facilities and to assess the financial impact of providing care for these patients on freestanding children's hospitals. An observational study using the Pediatric Health Information System, a proprietary database available to Child Health Corporation of America member hospitals, covering years 1994-1999. These data reflect inpatient services and exclude outpatient encounters and adult patients transitioned to adult providers. National estimates of the number of adult survivors of pediatric illness and the financial impact of care were calculated. Hospitals with >100 discharge events for patients > or =age 21 in 1999, and having both clinical and financial data in the dataset, assured an adequate sample size to discern resource utilization. Both 18 and 21 were used as lower limits of adult age to reflect common definitions of legal majority (age 18) and common pediatric practice (age 21). We truncated the data at age 64 to exclude patients eligible for Medicare. Ten hospitals representing all geographic regions of the United States were used for an in-depth analysis of financial impact during 1999. Six of 10 had data for 1994-1999 to describe trends over time. The number of patients admitted over the 6-year period increased, as did average and total adjusted charges. In 1999, 3863 patients 18 to 64 years old incurred 5051 discharge episodes and total charges of $134.5 million. Of these, about half (1785) were > or =21 with charges of $66 million. Of the hospitals' total discharges and financial charges, on average 2.1% and 3.1%, respectively, were from the inpatient care of patients 21 to 64 years old. Forty percent of patients receive public aid. Extrapolating from census data, up to 15 000 patients > or =21 years annually may seek inpatient care in part at children's hospitals, with charges exceeding $500 million. The 3 most common diagnostic groups to be admitted were those with cystic fibrosis, mental retardation or cerebral palsy, and congenital heart disease. We describe a subset of adults who have survived diseases of pediatric onset. We focused on the portion of that population that obtains at least some inpatient care at a children's hospital. The data reported here can be used to set a lower boundary for the size of this population, and thereby provide valuable data for health planners as well as clinicians. If one includes estimates of expenses across the continuum of care, the financial impact of this growing population is substantial. Public policy discussions should include the medical, psychological, social, and financial needs of this population.","Pediatrics. 2002 Sep;110(3):583-9.","USA",2002,null,"Inpatient care",null,null,null,"Direct costs",null,"USA",null,null,"Inpatient care","Direct costs",null,null,"2000:2004"]
[53,"Nielsen R, Gyrd-Hansen D. Prenatal screening for cystic fibrosis: an economic analysis. Health Econ. 2002 Jun;11(4):285-99. doi: 10.1002/hec.652. ",null,"Nielsen R, Gyrd-Hansen D.","Prenatal screening for cystic fibrosis: an economic analysis.","Cystic fibrosis (CF) is the most common life-shortening genetically transmitted disease in Denmark with a birth prevalence of 1 in 4700, resulting in 12-15 new cases of cystic fibroses annually. The aim of this study is to disclose the societal resource implications of introducing a population wide prenatal screening programme for cystic fibrosis in Denmark. The present analysis is limited to the monetary consequences of introducing a screening programme, where costs of screening are compared to the potential benefits measured in cost savings involved if births of CF patients are avoided. Screening costs in a Danish setting were estimated at DKK 2 771 262 ( pound sterlings 231 438) per aborted affected fetus in the first screening round, stabilising at DKK 1 864 594 ( pound sterlings 155 383) per aborted affected fetus at subsequent screening rounds. Comparing this figure with the estimated benefits of avoiding a CF case (DKK 2.1-4.4 million; pound sterlings 175 000-366 667) suggests that introducing a screening programme for cystic fibrosis will be net cost saving irrespective of the perspective of the analysis, assumptions on replacement children and method of estimating long-term production gains/losses.","Health Econ. 2002 Jun;11(4):285-99.","Denmark",2002,null,"Screening",null,null,null,"Direct costs",null,"Denmark",null,null,"Screening","Direct costs",null,null,"2000:2004"]
[54,"Suri R, Metcalfe C, Lees B, Grieve R, Flather M, Normand C, Thompson S, Bush A, Wallis C. Comparison of hypertonic saline and alternate-day or daily recombinant human deoxyribonuclease in children with cystic fibrosis: a randomised trial. Lancet. 2001 Oct 20;358(9290):1316-21. doi: 10.1016/S0140-6736(01)06412-1.",null,"Suri R, Metcalfe C, Lees B, Grieve R, Flather M, Normand C, Thompson S, Bush A, Wallis C.","Comparison of hypertonic saline and alternate-day or daily recombinant human deoxyribonuclease in children with cystic fibrosis: a randomised trial. ","Daily recombinant human deoxyribonuclease (rhDNase) is an established but expensive treatment in cystic fibrosis. Alternate-day treatment, if equally effective, would reduce the drug cost. Hypertonic saline improved lung function to the same degree as rhDNase in short-term studies. We compared the effectiveness of daily rhDNase, hypertonic saline, and alternate-day rhDNase in children with cystic fibrosis. In an open cross-over trial, 48 children were allocated in random order to 12 weeks of once-daily rhDNase (2.5 mg), alternate-day rhDNase (2.5 mg), and twice-daily 5 mL 7% hypertonic saline. The primary outcome was forced expiratory volume in 1 s (FEV(1)). Secondary outcomes were forced vital capacity, number of pulmonary exacerbations, weight gain, quality of life, exercise tolerance, and the total costs of hospital and community care. Mean FEV(1) increased by 16% (SD 25%), 14% (22%), and 3% (21%) with daily rhDNase, alternate-day rhDNase, and hypertonic saline, respectively. There was no difference between daily and alternate-day rhDNase (2% [95% CI -4 to 9], p=0.55). However, daily rhDNase showed a significantly greater increase in FEV(1) than hypertonic saline (8% [2 to 14], p=0.01). The average difference in 12-week cost between daily and alternate-day rhDNase was pound513 (95% CI -546 to 1510) and that between daily rhDNase and hypertonic saline was pound1409 (440 to 2318). None of the secondary clinical outcomes showed significant differences between treatments. Hypertonic saline, delivered by jet nebuliser, is not as effective as daily rhDNase, although there is variation in individual response. There is no evidence of a difference between daily and alternate-day rhDNase.","Lancet. 2001 Oct 20;358(9290):1316-21.","UK",2001,null,"RhDNAse",null,null,null,"Direct costs,Indirect costs",null,"UK",null,null,"RhDNAse","Direct costs,Indirect costs",null,null,"2000:2004"]
[55,"Antioch K, Walsh M. Funding issues for Victorian hospitals: the risk-adjusted vision beyond casemix funding. Aust Health Rev. 2000;23(3):145-53.",null,"Antioch K, Walsh M.","Funding issues for Victorian hospitals: the risk-adjusted vision beyond casemix funding.","This paper discusses casemix funding issues in Victoria impacting on teaching hospitals. For casemix payments to be acceptable, the average price and cost weights must be set at an appropriate standard. The average price is based on a normative, policy basis rather than benchmarking. The 'averaging principle' inherent in cost weights has resulted in some AN-DRG weights being too low for teaching hospitals that are key State-wide providers of high complexity services such as neurosurgery and trauma. Casemix data have been analysed using international risk adjustment methodologies to successfully negotiate with the Victorian State Government for specified grants for several high complexity AN-DRGs. A risk-adjusted capitation funding model has also been developed for cystic fibrosis patients treated by The Alfred, called an Australian Health Maintenance Organisation (AHMO). This will facilitate the development of similar models by both the Victorian and Federal governments."," Aust Health Rev. 2000;23(3):145-53.","Australia",2000,null,"Inpatient care",null,null,null,"Direct costs",null,"Australia",null,null,"Inpatient care","Direct costs",null,null,"2000:2004"]
[56,"Knower MT, Labella-Walker K, McFadden PM, Kantrow SP, Valentine VG. Clarithromycin for safe and cost-effective reduction of cyclosporine doses in lung allograft recipients. South Med J. 2000 Nov;93(11):1087-92.",null,"Knower MT, Labella-Walker K, McFadden PM, Kantrow SP, Valentine VG."," Clarithromycin for safe and cost-effective reduction of cyclosporine doses in lung allograft recipients. ","This study was done to analyze the economic effect of clarithromycin on the daily dosing of cyclosporine in lung transplantation. Nine consecutive patients (mean age +/- SEM, 34.6 +/- 5.2 years) had transplantation from June 1995 to June 1996. Median follow-up time was 649 days (range, 431 to 799 days). Preoperative diagnoses were cystic fibrosis (n = 4), idiopathic pulmonary fibrosis (n = 2), emphysema, bronchiectasis, and obliterative bronchiolitis. Median time from transplantation to addition of clarithromycin to a standard immunosuppressive regimen was 86 days (range, 14 to 181 days). Baseline cyclosporine dose (9.9 +/- 2.2 mg/kg/day) was reduced to 5.8 +/- 1.0 mg/kg/day and 4.1 +/- 0.8 mg/kg/day at 1 month and 1 year, respectively, after initiation of clarithromycin therapy. Estimated annual savings were $3,400 per patient. There was no increase in infection or rejection episodes. Clarithromycin safely reduced the dose and cost of cyclosporine in this series.\n","South Med J. 2000 Nov;93(11):1087-92","USA",2000,null,"Lung transplant",null,null,null,"Direct costs",null,"USA",null,null,"Lung transplant","Direct costs",null,null,"2000:2004"]
[57,"Scotet V, de Braekeleer M, Roussey M, Rault G, Parent P, Dagorne M, Journel H, Lemoigne A, Codet JP, Catheline M, David V, Chaventré A, Duguépéroux I, Verlingue C, Quéré I, Mercier B, Audrézet MP, Férec C. Neonatal screening for cystic fibrosis in Brittany, France: assessment of 10 years' experience and impact on prenatal diagnosis. Lancet. 2000 Sep 2;356(9232):789-94. doi: 10.1016/S0140-6736(00)02652-0.",null,"Scotet V, de Braekeleer M, Roussey M, Rault G, Parent P, Dagorne M, Journel H, Lemoigne A, Codet JP, Catheline M, David V, Chaventré A, Duguépéroux I, Verlingue C, Quéré I, Mercier B, Audrézet MP, Férec C.","Neonatal screening for cystic fibrosis in Brittany, France: assessment of 10 years' experience and impact on prenatal diagnosis.","Neonatal screening for cystic fibrosis has been a subject of debate over the past few years. This study assesses 10 years of neonatal screening in Brittany, France, and examines its impact on prenatal screening of subsequent pregnancies in couples with an affected child. The study included all the neonates screened for cystic fibrosis in Brittany from Jan 1, 1989, to Dec 31, 1998. The screening consisted of an immunoreactive trypsinogen assay from dried blood spots, plus, from 1993, mutation analysis. Data were collected on incidence of cystic fibrosis, and genotypic and biochemical characteristics. The use of prenatal screening of subsequent pregnancies in affected families was also investigated. Of the 343,756 neonates screened, 118 children with cystic fibrosis were identified, giving an incidence of one in 2913. All mutated alleles were characterised: 34 different mutations resulting in 36 genotypes were detected. The introduction of DNA analysis into the protocol greatly reduced the recall rate and increased the sensitivity of the test. The mean cost of the screening programme was US$2.32 per screened child. 39 (34%) of the families identified by neonatal screening opted for subsequent prenatal diagnosis at least once. 12 couples would have benefited from this procedure while their first child was still symptom-free. 42 healthy children were born, and 18 pregnancies were terminated (therapeutic abortion rate of 100%). We have shown the feasibility of neonatal screening for cystic fibrosis in Brittany. Through the detection of a large range of mutations, neonatal screening provides the opportunity for more reliable prenatal diagnosis and cascade screening. The neonatal screening programme described here could provide a good model for other countries intending to initiate such a scheme.","Lancet. 2000 Sep 2;356(9232):789-94. ","France",2000,null,"Screening",null,null,null,"Direct costs",null,"France",null,null,"Screening","Direct costs",null,null,"2000:2004"]
[58,"Ollendorf DA, McGarry LJ, Watrous ML, Oster G. Use of rhDNase therapy and costs of respiratory-related care in patients with cystic fibrosis. Ann Pharmacother. 2000 Mar;34(3):304-8.",null,"Ollendorf DA, McGarry LJ, Watrous ML, Oster G.","Use of rhDNase therapy and costs of respiratory-related care in patients with cystic fibrosis.","To assess the relationship between level of use of recombinant deoxyribonuclease I (rhDNase) therapy and costs of respiratory-related care in patients with cystic fibrosis. Retrospective, cohort study using healthcare claims data from a large New England health insurer. All cystic fibrosis patients five years of age and older who began therapy with rhDNase in 1994 (the year it was first marketed in the US). Healthcare claims were compiled for six months prior to first receipt of rhDNase (pretreatment) and for 30 months subsequently (follow-up). Patients were stratified according to their level of rhDNase use during follow-up, based on whether it was above or below the median number of therapy days for the sample. Costs of rhDNase, all antibiotics, and all respiratory-related outpatient (physician, home health, hospital outpatient) and inpatient care were included. All costs were expressed on an annualized basis. Twenty-four patients with cystic fibrosis who began treatment with rhDNase in 1994 met all entry criteria; the median number of therapy days over a 30-month period was 355. Among patients with low (i.e., below the median) rhDNase use (n = 12), mean +/- SD annualized costs of respiratory-related care increased by almost $17,000 between pretreatment and follow-up, from $29,251 +/- $37,919 to $46,109 +/- $40,944. Among high-use patients (n = 12), costs decreased by approximately $2500, from $37,178 +/- $48,476 to $34,592 +/- $22,591. The change in both groups was accounted for primarily by a change in the number of respiratory-related hospitalizations. Prolonged use of rhDNase may reduce costs of respiratory-related care in patients with cystic fibrosis; further study is required, however, to confirm these findings.","Ann Pharmacother. 2000 Mar;34(3):304-8.","USA",2000,null,"RhDNAse",null,null,null,"Direct costs",null,"USA",null,null,"RhDNAse","Direct costs",null,null,"2000:2004"]
[59,"LeLorier J, Perreault S, Birnbaum H, Greenberg P, Sheehy O. Savings in direct medical costs from the use of tobramycin solution for inhalation in patients with cystic fibrosis. Clin Ther. 2000 Jan;22(1):140-51.",null,"LeLorier J, Perreault S, Birnbaum H, Greenberg P, Sheehy O. "," Savings in direct medical costs from the use of tobramycin solution for inhalation in patients with cystic fibrosis.","Two identical 24-week, double-blind, placebo-controlled trials of tobramycin solution for inhalation (TOBI [PathoGenesis Corporation, Seattle, Washington]) in cystic fibrosis patients with chronic Pseudomonas aeruginosa infection were conducted in the United States. The aim of the present study was to extrapolate the US trial data to a Canadian setting, using Canadian costs to estimate the savings in direct medical costs that might result from use of a similar 24-week TOBI regimen versus usual care in 2 Canadian provinces. Cystic fibrosis is a genetic disease in which persistent respiratory infection, usually due to P. aeruginosa infection, is the major cause of morbidity and mortality. The US trials demonstrated that TOBI produced significant improvements in pulmonary function test results, reduced sputum levels of P. aeruginosa, and resulted in a 26% reduction in the probability of hospitalization (95% CI, 2%-43% vs placebo in the clinical trials). Individual patient data from the US trials were used to calculate the mean number of days in hospital as well as the mean number of days of home intravenous or oral antibiotic therapy. To adjust for Canadian pricing, pertinent economic data were obtained from Statistics Canada and the Ontario and Quebec health ministries. Demographic and baseline data were obtained from health surveys conducted by the Canadian Cystic Fibrosis Foundation. Economic analysis showed that the use of TOBI for 24 weeks would result in estimated mean per-patient savings in direct medical costs (in Canadian dollars) of $4055 in Ontario and $4916 in Quebec, which would substantially offset the Canadian acquisition price of $8602 for the same 24-week period. Assuming that the percentage of reduction in hospital days observed in the US trials would also occur in the Canadian clinical setting, use of TOBI would reduce the use of health care services, particularly hospital days, and lead to substantial savings in direct medical costs that would offset its acquisition price. Whether this reduction actually occurs after TOBI enters the Canadian market is a subject for future investigation."," Clin Ther. 2000 Jan;22(1):140-51.","Canada",2000,null,"All healthcare",null,null,null,"Direct costs",null,"Canada",null,null,"All healthcare","Direct costs",null,null,"2000:2004"]
[60,"Elliott RA, Thornton J, Webb AK, Dodd M, Tully MP. Comparing costs of home- versus hospital-based treatment of infections in adults in a specialist cystic fibrosis center. Int J Technol Assess Health Care. 2005 Fall;21(4):506-10. doi: 10.1017/S0266462305050701.",null,"Elliott RA, Thornton J, Webb AK, Dodd M, Tully MP","Comparing costs of home- versus hospital-based treatment of infections in adults in a specialist cystic fibrosis center. ","This study aimed to produce valid patient-based UK National Health Service (NHS) costs for adults with cystic fibrosis to identify differences between hospital- and home-based treatments for infections. A costing study was carried out in adults with cystic fibrosis (CF) in the United Kingdom, who required intravenous antibiotic treatments for respiratory infections, administered either at home or in the hospital. The perspective was that of the NHS hospital trust. Data were collected retrospectively for each patient for 1 year using clinical records. Data were collected for 116 adults with CF between 2000 and 2001, when 42,382 treatment days (454 courses) of intravenous antibiotics were administered; 213 courses with intention-to-treat at home and 241 courses with intention-to-treat in the hospital. The mean length of a course was 15.3 days. Patients who had >60 percent of courses at home over 1 year had a mean cost of 13,528 UK pounds, compared with 22,609 pounds for patients who had > 60 percent of courses in the hospital, and a mean cost of 19,927 UK pounds for patients who had an equal mix of home and hospital care (p = .0001). The key cost-generating events in CF respiratory infections are hospital admissions. Future studies assessing costs should concentrate on factors affecting admissions, length of stay, staff input, and alternative methods of home-care provision, rather than marginal effects, such as using different antibiotics."," Int J Technol Assess Health Care. 2005 Fall;21(4):506-10. ","UK",2005,null,"Antibiotics",null,null,null,"Direct costs",null,"UK",null,null,"Antibiotics","Direct costs",null,null,"2005:2009"]

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[null,"Toggle age cut-offs",null,null,null,null,null,null,6,1,null,null,null,null,null,null,null,null,null,1,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"This year =",{"$f":"YEAR(NOW())","v":2017},null,"Years","Cut","Selected cut state","Start","End",{"$f":"COUNTA(CF3:CF58)","v":5},{"$f":"OFFSET($CI$2,0,domainChoice)","v":"Study types"},"Locations","Interventions","Diseases","PRO tools","subPopulations","Study types","Study methodologies",null,null,null,null,"selected categories"]
[null,null,56,null,null,null,null,null,"Other","Direct costs",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1960,false,true,1960,1999,{"$f":"IF(CF3<>\"\",_xlfn.CONCAT(CF3,\":\",CG3),\"\")","v":"1960:1999"},{"$f":"OFFSET($CJ$2,0,ROW()-3)","v":"Locations"},"Australia","All healthcare",null,null,null,"Direct costs",null,null,null,null,null,{"$f":"OFFSET(INDIRECT($CU$1),ROW()-3,0)","v":"Other"}]
[null,"From",null,null,"To",null,null,null,null,"Direct costs",null,null,null,null,null,null,null,null,null,null,null,"C1",null,"Locations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"OFFSET($BY$5,domainChoice,0)","v":"studytypeCategories"},null,null,null,1961,false,null,2000,2004,{"$f":"IF(CF4<>\"\",_xlfn.CONCAT(CF4,\":\",CG4),\"\")","v":"2000:2004"},{"$f":"OFFSET($CJ$2,0,ROW()-3)","v":"Interventions"},"Brazil","Antibiotics",null,null,null,"Indirect costs",null,null,null,null,null,{"$f":"OFFSET(INDIRECT($CU$1),ROW()-3,0)","v":"Direct costs"}]
[null,{"$f":"IF(CF3=\"\",\"\",CF3)","v":1960},null,null,{"$f":"IF(CG3=\"\",\"\",CG3)","v":1999},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C2",null,"Interventions",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1962,false,"Segment count",2005,2009,"2005:2009","Diseases","Canada","Bronchiolar lavage",null,null,null,null,null,null,null,null,null,"Indirect costs"]
[null,{"$f":"IF(CF4=\"\",\"\",CF4)","v":2000},null,null,{"$f":"IF(CG4=\"\",\"\",CG4)","v":2004},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C3",null,"Diseases",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"locationCategories",null,null,null,1963,false,null,2010,2014,"2010:2014","PRO tools","Denmark","Denufosol",null,null,null,null,null,null,null,null,null,""]
[null,2005,null,null,2009,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C4",null,"Sub-populations",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"interventionCategories",null,null,null,1964,false,null,2015,2017,"2015:2017","subPopulations","France","Diet",null,null,null,null,null,null,null,null,null,""]
[null,2010,null,null,2014,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"C5",null,"PRO tools",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"diseaseCategories",null,null,null,1965,false,null,null,null,"","Study types","Germany","Inpatient care",null,null,null,null,null,null,null,null,null,""]
[null,2015,null,null,2017,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study types",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"protoolCategories",null,null,null,1966,false,null,null,null,"","Study methodologies","International","Ivacaftor",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study methodologies",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"subpopulationCategories",null,null,null,1967,false,null,null,null,"",null,"Netherlands","Lung transplant",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Location categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"studytypeCategories",null,null,null,1968,false,null,null,null,"",null,"New Zealand","None or unclear",null,null,null,null,null,null,null,null,null,""]
[null,{"$f":"IF(CF10=\"\",\"\",CF10)","v":""},null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Intervention categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"studymethodCategories",null,null,null,1969,false,null,null,null,"",null,"UK","Outpatient care",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Disease categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1970,false,null,null,null,"",null,"USA","Physical therapy",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sub-populations categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1971,false,null,null,null,"",null,null,"RhDNAse",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"PRO tool categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1972,false,null,null,null,"",null,null,"Screening",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,{"$f":"IF(CG14=\"\",\"\",CG14)","v":""},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study type categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1973,false,null,null,null,"",null,null,"Various",null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Study methodology categorised",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1974,false,null,null,null,"",{"$f":"COLUMN()","v":87},null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1975,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1976,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1977,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1978,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1979,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1980,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",22,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1981,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1982,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1983,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1984,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1985,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1986,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1987,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1988,false,null,null,null,{"$f":"IF(CF31<>\"\",_xlfn.CONCAT(CF31,\":\",CG31),\"\")","v":""},null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"",null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1989,false,null,null,null,"",null,null,null,null,null,null,null,null,null,null,null,null,""]
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