• Journal of Preventive Medicine and Public Health
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• 제55권5호
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• pp.415-423
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• 2022

Economic evaluations in the healthcare are used to assess economic efficiency of pharmaceuticals and medical interventions such as diagnoses and medical procedures. This study introduces the main concepts of economic evaluation across its key steps: planning, outcome and cost calculation, modeling, cost-effectiveness results, uncertainty analysis, and decision-making. When planning an economic evaluation, we determine the study population, intervention, comparators, perspectives, time horizon, discount rates, and type of economic evaluation. In healthcare economic evaluations, outcomes include changes in mortality, the survival rate, life years, and quality-adjusted life years, while costs include medical, non-medical, and productivity costs. Model-based economic evaluations, including decision tree and Markov models, are mainly used to calculate the total costs and total effects. In cost-effectiveness or costutility analyses, cost-effectiveness is evaluated using the incremental cost-effectiveness ratio, which is the additional cost per one additional unit of effectiveness gained by an intervention compared with a comparator. All outcomes have uncertainties owing to limited evidence, diverse methodologies, and unexplained variation. Thus, researchers should review these uncertainties and confirm their robustness. We hope to contribute to the establishment and dissemination of economic evaluation methodologies that reflect Korean clinical and research environment and ultimately improve the rationality of healthcare policies.

• Asian Pacific Journal of Cancer Prevention
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• 제17권2호
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• pp.799-805
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• 2016

Background: There is no standard treatment for patients with platinum-resistant or refractory epithelial ovarian cancer. Single agent chemotherapies have evidence of more efficacy and less toxicity than combination therapy. Most are very expensive, with appreciable toxicity and minimal survival. Since it is difficult to make comparison between outcomes, economic analysis of single-agent chemotherapy regimens and best supportive care may help to make decisions about an appropriate management for the affected patients. Objective: To evaluate the cost effectiveness of second-line chemotherapy compared with best supportive care for patients with platinum-resistant or refractory epithelial ovarian cancer. Materials and Methods: A Markov model was used to estimate the effectiveness and total costs associated with treatments. The hypothetical patient population comprised women aged 55 with platinum-resistant or refractory epithelial ovarian cancer. Four types of alternative treatment options were evaluated: 1) gemcitabine followed by BSC; 2) pegylated liposomal doxorubicin (PLD) followed by BSC; 3) gemcitabine followed by topotecan; and 4) PLD followed by topotecan. Baseline comparator of alternative treatments was BSC. Time horizon of the analysis was 2 years. Health care provider perspective and 3% discount rate were used to determine the costs of medical treatment in this study. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Treatment effectiveness data were derived from the literature. Costs were calculated from unit cost treatment of epithelial ovarian cancer patients at various stages of disease in King Chulalongkorn Memorial Hospital (KCMH) in the year 2011. Parameter uncertainty was tested in probabilistic sensitivity analysis by using Monte Carlo simulation. One-way sensitivity analysis was used to explore each variable's impact on the uncertainty of the results. Results: Approximated life expectancy of best supportive care was 0.182 years and its total cost was 26,862 Baht. All four alternative treatments increased life expectancy. Life expectancy of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 0.510, 0.513, 0.566, and 0.570 years, respectively. The total cost of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 113,000, 124,302, 139,788 and 151,135 Baht, respectively. PLD followed by topotecan had the highest expected quality-adjusted life-years but was the most expensive of all the above strategies. The incremental cost-effectiveness ratios (ICER) of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 344,643, 385,322, 385,856, and 420,299 Baht, respectively. Conclusions: All of the second-line chemotherapy strategies showed certain benefits due to an increased life-year gained compared with best supportive care. Moreover, gemcitabine as second-line chemotherapy followed by best supportive care in progressive disease case was likely to be more effective strategy with less cost from health care provider perspective. Gemcitabine was the most cost-effective treatment among all four alternative treatments. ICER is only an economic factor. Treatment decisions should be based on the patient benefit.

• Asian Pacific Journal of Cancer Prevention
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• 제13권6호
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• pp.2721-2728
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• 2012

Background: There are limited data evaluating the cost-effectiveness of gastric cancer screening using endoscopy or upper gastrointestinal x-ray in the general population. Objective: To evaluate the cost-effectiveness of population-based screening for gastric cancer in South Korea by decision analysis. Methods: A time-dependent Markov model for gastric cancer was constructed for healthy adults 30 years of age and older, and a deterministic sensitivity analysis was performed. Cost-utility analysis with multiple strategies was conducted to compare the costs and effects of 13 different screening alternatives with respect to the following eligibility criteria: age at the beginning of screening, screening interval, and screening method. The main outcome measurement was the incremental cost-effectiveness ratio. Results: The results revealed that annual endoscopic screening from ages 50-80 was the most cost-effective for the male population. In the females, biennial endoscopy screening from ages 50-80 was calculated as the most cost-effective strategy among the 12 screening alternatives. The most cost-effective screening strategy may be adjustable according to the screening costs and the distribution of cancer stage at screening. The limitation was that effectiveness data were obtained from published sources. Conclusions: Using the threshold of $19,162 per quality-adjusted life year on the basis of the Korean gross domestic product (2008), as suggested by the World Health Organization, endoscopic gastric cancer screening starting at the age of 50 years was highly cost-effective in the Korean population. The national recommendation for gastric cancer screening should consider the starting age of screening, the screening interval, and the screening modality.

• Journal of Korean Neurosurgical Society
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• 제62권1호
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• pp.83-89
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• 2019

Objective : This study is a retrospective cost-benefit analysis of cervical anterior interbody fusion and cervical artificial disc replacement, which are the main surgical methods to treat degenerative cervical disc disease. Methods : We analyzed 156 patients who underwent anterior cervical disc fusion and cervical artificial disc replacement from January 1, 2008 to December 31, 2009, diagnosed with degenerative cervical disc disorder. In this study, the costs and benefits were analyzed by using quality adjusted life year (QALY) as the outcome index for patients undergoing surgery, and a Markov model was used for the analysis. Only direct medical costs were included in the analysis; indirect medical costs were excluded. Data were analyzed with TreeAge Pro $2015^{TM}$ (TreeAge Software, Inc, Williamstown, MA, USA). Results : Patients who underwent cervical anterior fusion had a total cost of KRW 2501807/USD 2357 over 5 years and obtained a utility of 3.72 QALY. Patients who underwent cervical artificial disc replacement received 4.18 QALY for a total of KRW 3685949/USD 3473 over 5 years. The cumulative cost-effectiveness ratio of cervical spine replacement surgery was KRW 2549511/QALY (USD 2402/QALY), which was lower than the general Korean payment standard. Conclusion : Both cervical anterior fusion and cervical artificial disc replacement are cost-effective treatments for patients with degenerative cervical disc disease. Cervical artificial disc replacement may be an effective alternative to obtain more benefits.

• 한국치위생학회지
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• 제11권5호
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• pp.707-715
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• 2011

Objectives : The objective of this study was to assess a level of oral health related quality of life(OHRQoL) for rural communities elderly and to determine the association between OHRQoL and socio-economic position. Methods : The study population was elderly(60+year-old) residents of PyeongChang county, Jeongseon county, Yeongwol county, Gangwon province. A total of 171 people were invited to participate. Oral health related quality of life was measured using the GOHAI. The data were analyzed with Mann-Whitney U test or Kruskal-Wallis test and to assess socio-economic inequalities in OHRQoL(GOHAI), we used multi-variable logistic regression models. We used models adjusting for age, sex, family status factors(Model I) and compared them to models additionally adjusting for stress level(Model II). Results : There were significant differences in lower score of GOHAI at lower age group and live alone group. And we found that lower SES was significantly associated with lower score of OHRQoL. Social gradient in the score of OHRQoL persisted when adjusted for age, sex, family status, stress level. Conclusions : We recommend that oral health promotion program should be developed after due consideration SES for rural communities elderly because OHRQoL of rural communities elderly was low and association between SES and OHRQoL for rural communities elderly.

• 보건행정학회지
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• 제29권3호
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• pp.357-367
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• 2019

Background: This study evaluated the cost-effectiveness of 21 different national dyslipidemia screening strategies according to total cholesterol (TC) cutoff and screening interval among 40 years or more for the primary prevention of coronary heart disease over a lifetime in Korea, from a societal perspective. Methods: A decision tree was used to estimate disease detection with the 21 different screening strategies, while a Markov model was used to model disease progression until death, quality-adjusted life years (QALYs) and costs from a Korea societal perspective. Results: The results showed that the strategy with TC 200 mg/dL and 4-year interval cost \4,625,446 for 16.65105 QALYs per person and strategy with TC 200 mg/dL and 3-year interval cost \4,691,771 for 16.65164 QALYs compared with \3,061,371 for 16.59877 QALYs for strategy with no screening. The incremental cost-effectiveness ratio of strategy with TC 200 mg/dL and 4-year interval versus strategy with no screening was \29,916,271/QALY. At a Korea willingness-to-pay threshold of \30,500,000/QALY, strategy with TC 200 mg/dL and 4-year interval is cost-effective compared with strategy with no screening. Sensitivity analyses showed that results were robust to reasonable variations in model parameters. Conclusion: In this study, revised national dyslipidemia screening strategy with TC 200 mg/dL and 4-year interval could be a cost-effective option. A better understanding of the Korean dyslipidemia population may be necessary to aid in future efforts to improve dyslipidemia diagnosis and management.

• Asian Pacific Journal of Cancer Prevention
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• 제15권19호
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• pp.8229-8237
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• 2014

Background: Organized cervical screening has decreased the incidence of cervical cancer. However, screening strategies vary in different countries. Objectives: We performed a systematic review to evaluate the economic aspects of different screening methods. Materials and Methods: We searched databases and then data were abstracted from each study. We evaluated articles based on different types of screening tests as well as screening age and intervals, and using incremental cost effectiveness ratio via calculating quality adjusted life years (QALY), or life years gained (LYG) per cost. We compared the incremental cost-effectiveness ratio (ICER) of each study using GDP per capita. Furthermore, we compared national guidelines with recommendations of cost-effectiveness studies in different countries. Results: A total of 21 articles met our criteria, of which 19 studies showed that HPV DNA testing, 13 suggested an age of 30 years or more, and 10 papers concluded that at least a 5-year or longer interval were the most cost-effective strategies. In some countries, the national guidelines did not match the recommendations of the cost-effectiveness studies. Conclusions: HPV testing, starting at age 30 years or older and repeated at 5-year or longer intervals, is the most cost-effective strategy in any setting. Closer collaboration with health economists is required during guideline development.

• 원예과학기술지
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• 제33권3호
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• pp.375-382
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• 2015

곰취의 수확 후 품질 유지와 출하시기 연장을 위한 MAP 저장의 기초 연구로서 3년에 걸쳐 CA 환경 최적화 연구를 수행하였다. 4월과 5월에 수확한 곰취는 차압통풍 예냉 방식으로 $4^{\circ}C$까지 품온을 낮춘 후 펀치 홀 MAP(일반 공기 조성과 같은 대조구) 및 CA 환경을 조성하였다. 대조구로서 MA 포장은 펀치 홀 천공 처리한 PP 필름 봉지를 활용하였다. CA 환경은 1년차에는 $O_2$ 1, 3% 2개 농도에 각각 $CO_2$ 5, 10%를 조합한 $2{\times}2$ 요인 처리, 2년차에는 $O_2$ 3% 고정에 $CO_2$ 0, 2.5, 5% 3개 처리, 3년차에는 $O_2$ 3%와 $CO_2$ 2.5, 5% 2개 처리를 설정하여 단계적인 최적화 과정을 거쳤다. 1년차 실험 결과, $O_2$ 1, 3%와 무관하게 $CO_2$ 10% 조합 CA 조건에서는 호흡속도의 감소와 함께 흑변 증상이 심하게 발생하였다. 2, 3년차에는 CA 저장에서도 장해 발생률이 뚜렷하게 나타나지 않았으나 4주 이상 저장 + 유통 후에는 대조구에 비해 다소 높은 경향이었다. 저장 4주 + 유통 5일 후에 조사한 조직감과 외관 상품성은 $O_2$ 3% + $CO_2$ 2.5% CA 저장에서 우수하였으나 CA 조성에 따른 저장기간 연장 효과는 크지 않았다. 연구 결과를 종합해 보면, 곰취는 이산화탄소 장해에 민감한 작물로서 상품성 유지를 위한 안전하고 효과적인 MAP 또는 CA 저장을 위한 $CO_2$ 농도 조성은 2.5% 수준이 적합한 것으로 판단되었다.

• Asian-Australasian Journal of Animal Sciences
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• 제17권1호
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• pp.7-12
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• 2004

Real time ultrasonic measurements for 13th rib fat thickness (LBF), longissimus muscle area (LEMA) and marbling score (LMS) of live animal at pre-harvest and subsequent carcass measurements for fat thickness (BF), longissimus muscle area (EMA), marbling score (MS) as well as body weight of live animal, carcass weight (CW), dressing percentage (DP), and total merit index (TMI) on 755 Korean beef steers were analyzed to estimate genetic parameters. Data were analyzed using multivariate animal models with an EM-REML algorithm. Models included fixed effects for year-season of birth, location of birth, test station, age of dam, linear and quadratic covariates for age or body weight at slaughter and random animal and residual effects. The heritability estimates for LEMA, LBF and LMS on RTU scans were 0.17, 0.41 and 0.55 in the age-adjusted model (Model 1) and 0.20, 0.52 and 0.55 in the weight-adjusted model (Model 2), respectively. The Heritability estimates for subsequent traits on carcass measures were 0.20, 0.38 and 0.54 in Model 1 and 0.23, 0.46 and 0.55 in Model 2, respectively. Genetic correlation estimate between LEMA and EMA was 0.81 and 0.79 in Model 1 and Model 2, respectively. Genetic correlation estimate between LBF and BF were high as 0.97 in Model 1 and 0.98 in Model 2. Real time ultrasonic marbling score were highly genetically correlated to carcass MS of 0.89 in Model 1 and 0.92 in Model 2. These results indicate that RTU scans would be alterative to carcass measurement for genetic evaluation of meat quality in a designed progeny-testing program in Korean beef cattle.

• Clinical and Experimental Pediatrics
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• 제52권11호
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• pp.1249-1259
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• 2009

목 적:소아 성장호르몬결핍증의 저신장 치료에 사용되는 성장호르몬 생물학적 제제인 서방형 주사제의 비용-효과성을 사회적 관점에서 기존 매일 주사제와 비교하여 평가하고자 한다. 방 법:성장 호르몬 치료를 받는 환아를 대상으로 시각화 척도 방법에 의해 건강 관련 효용을 측정하였다. 2008년 7월, 이 연구에 참여한 2개 병원에서 저성장증 치료를 받고 있는 149명의 환아 보호자에게 매일 주사제에 대한 효용과 주 1회 주사제를 사용할 경우 기대되는 효용을 인터넷을 통해 설문조사 하였다. 성장호르몬 주사요법 중 매일 주사제와 주 1회 주사제 투여에 소요되는 직․간접 비용은 차이가 없으므로, 두 제형의 의약품비만을 비교하였다. 결 과:매일 주사제에서 주 1회 주사제로 전환할 경우 예상되는 효용값은 0.584에서 0.784로 증가하며, 연평균 추가비용은 4,060,811원이 발생한다. 점증적 비용-효용비는 20,304,555원/QALY (quality-adjusted life year gained)로 계산되었다. 시나리오 분석 결과, 점증적 비용-효용비는 최소 15,751,198원/QALY에서 최대 25,489,929원/QALY이다. 결 론:Base case 및 시나리오 분석결과에서 제시하는 점증적 비용-효용비는 우리 나라 1인당 GDP의 0.85-1.37배 범위 내에 있으므로 매우 안정적으로 비용-효과성이 있는 것으로 판단된다. 따라서, 매일 주사제에서 주1회 주사제로의 투약방법 변경은 비용-효과적이라 할 수 있으며, 주 1회 주사제가 추가 비용을 부담하더라도 경제성이 우수하다고 결론지을 수 있다.