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Cost Effectiveness
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.
Current and
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.
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