Cedar Associates LLC provides state-of-the-art analyses of the economic implications of medical technologies (pharmaceuticals, devices, and diagnostics) and services. Based on a strong foundation in decision analyses, epidemiology, statistics, and econometrics combined with more than a decade of experience working in and with life sciences companies, we generate analyses that are useful for a diverse array of stakeholders, including patients, physicians, senior management, and third-party payers.

We have extensive experience with decision trees, Markov processes, simulation analyses, Markov-chain Monte Carlo methods, and Bayesian analyses. Results of our analyses are published in core clinical and policy journals and presented at numerous international congresses. Companies also use the analyses in early-stage projects to facilitate discussions on design of clinical trials, need for supplementary studies to support reimbursement, and to test messages with key opinion leaders.

Recent Projects

Cost-effectiveness of Herpes Zoster Vaccine

Published in the Annals of Internal Medicine (Oct 2006, we examined the outcomes and cost-effectiveness of novel vaccine to prevent herpes zoster in patients age 60 and older. We found that the vaccination would increase overall survival adjusted for quality of life compared with no vaccination. Resolution of uncertainties about the average quality-of-life effects of acute zoster and the duration of vaccine efficacy is needed to better determine the cost-effectiveness of zoster vaccination. The results of our analyses played a key role in deliberations by government agencies (e.g., CDC) in determining coverage and funding of the vaccine.

Long-term prognosis and cost-effectiveness of novel HIV medicines

This project was designed to (1) model long-term outcomes of patients with HIV in the era of Highly Active Anti-Retroviral Therapy (HAART), (2) project costs of HIV care, and (3) determine the incremental effectiveness and costs of novel HIV medicines. We developed interactive computer models for use by managed care organizations and AIDS Drug Assistance Program (ADAP) managers to better understand the economic implications of the adoption of novel HIV medicines in their settings.

Economics of the treatment of patients with persistently normal aminotransferase (PNALT) and chronic hepatitis C (CHC)

This project’s goals are to (1) assess the risk of disease progression to liver cirrhosis and its complications associated with PNALT and CHC, and (2) determine the long-term societal effectiveness, costs, and cost-effectiveness of the treatment of patients with PNALT and CHC.

Cost-effectiveness of the treatment of HIV/HCV co-infected patients

Recent studies have demonstrated the substantially increased risk of liver cirrhosis among patients who are co-infected with HIV and the Hepatitis C virus (HCV). This study uses decision- analytic methods to estimate the impact of treatments on time to cirrhosis, costs, and associated cost-effectiveness.

Economic analysis of targeting chemotherapy using a 21 gene RT-PCR assay in lymph node negative, estrogen receptor positive early-stage breast cancer

Recent innovations in genomic technologies may more accurately predict the risk of recurrence of breast cancer (Paik et al, SABCS 2003). In this project, we evaluated the implications of greater prognostic accuracy on the risk of recurrence and the costs associated with administering adjuvant chemotherapy.

Cost-effectiveness of novel regimens using biologic agents in the treatment of diffuse large, B-cell non-Hodgkin’s lymphoma (DLBCL)

For more than 30 years, DLBCL has been treated with systemic chemotherapy. In the late 1990s, novel biologic agents were tested in randomized trials and shown to be more effective in achieving a complete response, delaying time until progression of disease, and increasing overall survival. We conducted a series of studies to determine the potential long-term cost- effectiveness of these new regimens.

International Working Group on the Recognition, Diagnosis, and Treatment of Primary Focal Hyperhidrosis

Primary focal hyperhidrosis is a disorder of excessive, bilateral, and relatively symmetric sweating in the axillae, palms, soles, or craniofacial region. The condition results in occupational, psychological, and physical impairment and potential social stigmatization. No formal appraisal exists summarizing the evidence on the treatment of primary focal hyperhidrosis. We chaired and faciliated a systematic review and development of recommendations based on the professional opinion of 26 internationally renowned experts in the management of this condition. Findings and recommendations of the working group are being presented at international congresses and will be in press in 2004.

Epidemiology and Evaluation of Moderate-to-Severe Psoriasis

In 2003, key reports were published on findings of phase III clinical trials of novel agents for the treatment of severe psoriasis. The societal and economic implications for these, and other agents currently under development, remain uncertain. We are involved in a series of analyses to better characterize the epidemiology of psoriasis, design more precise methods for measuring the impact of psoriasis, and assess the economic implications of psoriasis.

Economics of anemia correction in cancer

Anemia is common in cancer, affecting more than 50% of patients undergoing chemotherapy. A number of strategies are available for preventing and treating cancer-related anemia. Most recently, once weekly regimens using human recombinant erythropoeitin have been found to be as effective as thrice weekly regimens in achieving anemia correction and maintenance goals. In this project, we assessed the most economical means for the use of such regimens.