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Cost-effectiveness analysis approaches to compare clinical strategies

Singh, Ashima (2015) Cost-effectiveness analysis approaches to compare clinical strategies. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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This dissertation uses the concept of cost-effectiveness to compare interventions, procedures or treatment options in different clinical areas. This dissertation includes three manuscripts comparing specific strategies in the healthcare sector.
The first assesses the economic value of using antimicrobial-coated sutures (as compared to regular sutures) for abdominal incisions to prevent surgical site infections (SSI). We use decision tree analysis to evaluate the cost-effectiveness of antimicrobial sutures under a variety of circumstances. The results show that antimicrobial coated sutures can be a cost-effective measure for preventing SSIs if they have at least have an efficacy of preventing 10% of infections and are used for surgeries with 10% or higher SSI risk.
The second project compares the clinical outcomes, functional outcomes and costs between patients undergoing off-pump and on-pump coronary artery bypass grafting (CABG) using data from the Bypass Angioplasty Revascularization Investigation 2 Diabetes trial. The results show that the off-pump procedure is associated with significantly higher rates of major cardiovascular events (death/myocardial infarction/stroke) even though the short-term complication rate for the two types of CABG are comparable. From the hospital perspective the net health benefits (NHB) were significantly lower for the off-pump patients. From the third party payer perspective, the two strategies were comparable in terms of costs, effectiveness and NHB. Overall, we conclude that an off-pump procedure is not the favorable strategy as compared to on-pump for patients with diabetes.
The third manuscript compares the cost-effectiveness of three pharmacotherapy switch options for treating depression (bupropion, sertraline and venlafaxine), after failure of initial treatment with citalopram, that were assessed as part of Sequenced Treatment Alternatives to Relieve Depression trial. The calculated NHBs are comparable for the three switch options. This concludes that there is no evidence that any switch option is better/worse than the other in terms of cost-effectiveness.
From a public health perspective, it is essential to determine the cost-effective strategy given the limited resources available. Identification and adoption of cost-effective options can translate to considerable costs saved per effectiveness unit across the entire nation. Also, decisions based on comparing clinical outcomes are further strengthened in cases when strategies have similar cost-effectiveness.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Singh, Ashimaasi9@pitt.eduASI9
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBrooks, Maria M.mbrooks@pitt.eduMBROOKS
Committee MemberPotter, Margaret Amapotter@pitt.eduMAPOTTER
Committee MemberVoorhees, Ronald E. rev12@pitt.eduREV12
Committee MemberRoberts, Mark Smroberts@pitt.eduMROBERTS
Committee MemberWisniewski, Stephen Rwisniew@edc.pitt.eduSTEVEWIS
Date: 29 June 2015
Date Type: Publication
Defense Date: 30 January 2015
Approval Date: 29 June 2015
Submission Date: 11 February 2015
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 191
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: cost-effectiveness, comparison
Date Deposited: 29 Jun 2015 16:14
Last Modified: 15 Nov 2016 14:26


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