Nonadherence to antihypertensive medications is known to be a major health problem. Novel biochemical analyses using liquid chromatography-tandem mass spectrometry are becoming accepted as a clinically useful objective measure to manage (non)adherence in Hypertension Clinics. Discussion of results from such analyses with patients can significantly improve adherence and blood pressure control. Our objective was to model the cost-effectiveness of performing liquid chromatography-tandem mass spectrometry-based analyses in improving adherence in patients with hypertension. Lifetime cost-utility was assessed from a UK healthcare payer perspective, using a Markov model. Efficacy was based on study findings of lowering blood pressure because of improved adherence to drug treatment. Cost and utilities were derived from literature. The base case cohort consisted of males aged 65 years. Subgroup analyses included varying population sex and age and a subgroup of patients with apparent resistant hypertension. Additionally, univariate and probabilistic sensitivity analyses were performed. Our findings are reported after the Consolidated Health Economic Evaluation Reporting Standards checklist. Per patient, screening resulted in 0.020 incremental quality-adjusted life-years and a negative incremental cost of £495, suggesting the intervention to be dominant compared with care as usual. Targeting younger patients or patients with apparent resistant hypertension would further improve these outcomes. Modeling suggested that screening prevented 518 myocardial infarctions and 305 stroke events in a cohort of 10 000 male hypertensive patients. Using liquid chromatography-tandem mass spectrometry-based biochemical analyses to improve adherence in hypertensive patients is likely to be an effective and cost-saving strategy, especially in patients with apparent resistant hypertension.

Type 2 diabetes mellitus (T2DM) is an established risk factor for cardiovascular and nephropathic events. In the Netherlands, prevalence of T2DM is expected to be as high as 8% by 2025. This will result in significant clinical and economic impact, highlighting the need for well-informed reimbursement decisions for new treatments. However, availability and consistent use of costing methodologies is limited. We aimed to systematically review recent costing data for T2DM-related cardiovascular and nephropathic events in the Netherlands. A systematic literature review in PubMed and Embase was conducted to identify available Dutch cost data for T2DM-related events, published in the last decade. Information extracted included costs, source, study population, and costing perspective. Finally, papers were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Out of initially 570 papers, 36 agreed with the inclusion criteria. From these studies, 150 cost estimates for T2DM-related clinical events were identified. In total, 29 cost estimates were reported for myocardial infarction (range: €196-€27,038), 61 for stroke (€495-€54,678), fifteen for heart failure (€325-€16,561), 24 for renal failure (€2,438-€91,503), and seventeen for revascularisation (€3,000-€37,071). Only four estimates for transient ischaemic attack were available, ranging from €587 to €2,470. Adherence to CHEERS was generally high. The most expensive clinical events were related to renal failure, while TIA was the least expensive event. Generally, there was substantial variation in reported cost estimates for T2DM-related events. Costing of clinical events should be improved and preferably standardised, as accurate and consistent results in economic models are desired.

Rifaximin-α as an adjunct to lactulose is reimbursed in the Netherlands for prevention of the third and subsequent episodes of overt Hepatic Encephalopathy (HE) in cirrhotic patients. However, use ...

Introduction In 2021, breast cancer affected 75,619 women in Denmark. Approximately 50% of breast cancers are considered human epidermal growth factor receptor 2 (HER2)-low. The DESTINY-Breast04 (DB-04) trial led to European Medicines Agency (EMA) approval of trastuzumab deruxtecan (T-DXd) as a treatment for patients with unresectable or metastatic HER2-low breast cancer who have received prior chemotherapy in the metastatic setting or developed disease recurrence during or within 6 months of completing adjuvant chemotherapy. Moreover, the Danish Breast Cancer Group guidelines recently included T-DXd as a treatment for HER2-low metastatic breast cancer. This economic evaluation aims to estimate the cost-effectiveness of T-DXd for the approved EMA indication in Denmark. Methods A three-state—progression-free, post-progression, and death—partitioned survival model was developed to estimate the cost-effectiveness of T-DXd versus treatment of physician’s choice over a lifetime horizon following the Danish Medicines Council guidelines. Clinical data were gathered from the DB-04 trial, and cost and resource use data were sourced from the literature. Sensitivity and scenario analysis were conducted to explore uncertainty. Results T-DXd led to 0.78 incremental quality-adjusted life years (QALYs) gained and incurred DKK 621,325 in incremental costs compared to the treatment of physician’s choice. This resulted in an incremental cost-effectiveness ratio of DKK 795,181 per QALY gained, which falls below the willingness-to-pay threshold. Sensitivity and scenario analyses showed the robustness of the deterministic result, with T-DXd remaining cost-effective. Conclusion Our study demonstrates that T-DXd is a cost-effective treatment for patients with HER2-low unresectable or metastatic breast cancer who have received prior chemotherapy in Denmark.

Type-2 Diabetes Mellitus (T2DM) increases both the patient risk of cardiovascular disease (CVD) and renal outcomes, such as chronic kidney disease (CKD). Recent clinical trials of the glucose-lower...