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Risk Management Assessment Improves the Cost-Effectiveness of Invasive Species Prioritisation.

ABSTRACT: International agreements commit nations to control or eradicate invasive alien species. The scale of this challenge exceeds available resources and so it is essential to prioritise the management of invasive alien species. Species prioritisation for management typically involves a hierarchy of processes that consider the likelihood and scale of impact (risk assessment) and the feasibility, costs and effectiveness of management (risk management). Risk assessment processes are widely used, risk management less so, but are a crucial component of resource decision making. To assess the cost-effectiveness of prioritisation, we considered 26 high-risk species considered for eradication from Great Britain (GB) with pre-existing risk assessment and risk management outputs. We extracted scores to reflect the overall risk to GB posed by the species, together with the estimated cost and the overall feasibility of eradication. We used these to consider the relative reduction in risk per unit cost when managing prioritised species based on different criteria. We showed that the cost-effectiveness of prioritisation within our sample using risk assessment scores alone, performed no better than a random ranking of the species. In contrast, prioritisation including management feasibility produced nearly two orders of magnitude improvement compared to random. We conclude that basing management actions on priorities based solely on risk assessment without considering management feasibility risks the inefficient use of limited resources. In this study, the cost-effectiveness of species prioritisation for action was greatly increased by the inclusion of risk management assessment.

SUBMITTER: Robertson PA

PROVIDER: S-EPMC8698869 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Importance:Among high-risk patients with hypertension, targeting a systolic blood pressure of 120 mm Hg reduces cardiovascular morbidity and mortality compared with a higher target. However, intensive blood pressure management incurs additional costs from treatment and from adverse events. Objective:To evaluate the incremental cost-effectiveness of intensive blood pressure management compared with standard management. Design, Setting, and Participants:This cost-effectiveness analysis conducted from September 2015 to August 2016 used a Markov cohort model to estimate cost-effectiveness of intensive blood pressure management among 68-year-old high-risk adults with hypertension but not diabetes. We used the Systolic Blood Pressure Intervention Trial (SPRINT) to estimate treatment effects and adverse event rates. We used Centers for Disease Control and Prevention Life Tables to project age- and cause-specific mortality, calibrated to rates reported in SPRINT. We also used population-based observational data to model development of heart failure, myocardial infarction, stroke, and subsequent mortality. Costs were based on published sources, Medicare data, and the National Inpatient Sample. Interventions:Treatment of hypertension to a systolic blood pressure goal of 120 mm Hg (intensive management) or 140 mm Hg (standard management). Main Outcomes and Measures:Lifetime costs and quality-adjusted life-years (QALYs), discounted at 3% annually. Results:Standard management yielded 9.6 QALYs and accrued $155?261 in lifetime costs, while intensive management yielded 10.5 QALYs and accrued $176?584 in costs. Intensive blood pressure management cost $23?777 per QALY gained. In a sensitivity analysis, serious adverse events would need to occur at 3 times the rate observed in SPRINT and be 3 times more common in the intensive management arm to prefer standard management. Conclusions and Relevance:Intensive blood pressure management is cost-effective at typical thresholds for value in health care and remains so even with substantially higher adverse event rates.

Project description:BackgroundCardiovascular disease (CVD) is a major contributor to the burden from non-communicable diseases in Sub-Saharan Africa and hypertension is the leading risk factor for CVD. The objective of this modeling study is to assess the cost-effectiveness of a risk stratified approach to medication management in Kenya in order to achieve adequate blood pressure control to reduce CVD events.MethodsWe developed a microsimulation model to evaluate CVD risk over the lifetime of a cohort of individuals. Risk groups were assigned utilizing modified Framingham study distributions based on individual level risk factors from the Kenya STEPwise survey which collected details on blood pressure, blood glucose, tobacco and alcohol use and cholesterol levels. We stratified individuals into 4 risk groups: very low, low, moderate and high risk. Mortality could occur due to acute CVD events, subsequent future events (for individual who survive the initial event) and other causes. We present cost and DALYs gained due to medication management for men and women 25 to 69 years.ResultsTreating high risk individuals only was generally more cost-effective that treating high and moderate risk individuals. At the anticipated base levels of effectiveness, medication management was only cost-effective under the low cost scenario. The incremental cost per DALY gained with low cost ranged from $1,505 to $3,608, which is well under $4,785 (3 times GPD per capita) threshold for Kenya. Under the low cost scenario, even lower levels of effectiveness of medication management are likely to be cost-effective for high-risk men and women.ConclusionsIn Kenya, our results indicate that the risk stratified approach to treating hypertension may be cost-effective especially for men and women at a high risk for CVD events, but these results are highly sensitive to the cost of medications. Medication management would require significant financial investment and therefore other interventions, including lifestyle changes, should be evaluated especially for those with elevated blood pressure and overall 10-year risk that is less than 20%.

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Risk Management Assessment Improves the Cost-Effectiveness of Invasive Species Prioritisation.

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