Early-stage cost-effectiveness analyses of new health care technologies

Mital, Shweta (2021) Early-stage cost-effectiveness analyses of new health care technologies. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

With the rapid pace of technological innovation in health care alongside rising health care costs, policymakers need to decide which innovations are worth adopting from an economic perspective. Cost-effectiveness analyses – especially those conducted at an early stage of the life cycle of a technology -- are useful tools to identify technologies which can yield better patient outcomes that justify the costs of these technologies. In this thesis, I provide the first evidence on cost-effectiveness of four new health care technologies. In chapter 2, I investigate the cost-effectiveness of Teplizumab, the first-ever drug to prevent or delay onset of Type 1 diabetes. A market price for this drug has not yet been established and there exist differences in the drug’s efficacy based on genetic and antibody characteristics of patients. Thus, in this study, I identify price ranges within which the drug will be cost-effective for different patient groups. In chapter 3, I examine the cost-effectiveness of a novel, but highly controversial, weight loss technique – aspiration therapy – versus bariatric surgery. I find that even though aspiration therapy is not cost-effective versus bariatric surgery, it is cost-effective for patients who do not have access to bariatric surgery. In chapter 4, I assess the cost-effectiveness of using Elipse – the first procedureless intragastric balloon – as a substitute or complement to bariatric surgery for treatment of obesity, and find that providing Elipse prior to sleeve gastrectomy is the most cost-effective treatment approach. In chapter 5, I examine the cost-effectiveness of using artificial intelligence (AI) or polygenic risk scores (PRS) to risk-stratify women aged between 40 and 49 years for mammography screening and find that AI-based screening is cost-effective compared with PRS-based screening and screening based exclusively on existing guidelines by the United States Preventive Services Task Force, the American College of Obstetricians and Gynecologists and the American College of Radiology. These four studies can serve to inform decision-making by manufacturers, policymakers, clinicians and other stakeholders with regard to these emerging technologies.

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