In my thesis, in the theoretical part I deal with atrial fibrillation. I also deal with management of atrial fibrillation treatment. In the paper I explain the basic principles of pharmaco-economic evaluation in the Czech Republic, on the basis of which laws these pharmacological interventions are evaluated and who are in the Czech Republic. In the work I present cost breakdown and what are the most commonly used pharmaco-economic analyzes. In the practical part I will apply the theoretical knowledge. I have developed cost utility analysis based on available clinical evidence - randomized clinical trials ARISTOTLE (Granger, 2011), RE-LY (Connolly, 2009), ROCKET AF (Patel, 2011). I made an indirect comparison of the total benefits of NOACs. In the baseline scenario, I have calculated QALY to evaluate the benefits of effectiveness, safety and reduction of mortality. I have also dealt with a bleeding-related scenario. The ICER's greatest contribution to the public healthcare system has shown the active substance apixaban in both scenarios. I added the results and confirmed the clinical results of a recent, robust, retrospective study by Mayo Clinic (Yao, 2016).

This thesis investigated the cost-effectiveness of a 12-month supervised aerobic walking program with or without a behavioural intervention and an educational pamphlet, compared to an unsupervised/self-directed educational pamphlet intervention, among individuals with moderate osteoarthritis (OA) of the knee. Analyses included an economic evaluation to assess the cost effectiveness of the two walking interventions from both the societal and Canadian provincial/territorial health care payer perspectives. A value of information analysis exploring the potential value of future research was also performed. Results revealed that the unsupervised/self-directed intervention was the most cost-effective approach given that it cost the least to implement and participants had higher quality-adjusted life years (QALYs). Walking, either supervised in a community setting, or unsupervised in a setting such as the home, may be a favourable non-pharmacological option for the management of OA of the knee. The thesis concludes with a policy discussion relating to the funding of non-pharmacological therapies.

Background: Lung cancer was the fifth leading cause of mortality globally in 2010, and the leading cause of cancer mortality in Canada, representing 26% of all cancer deaths for both men and women in 2017. Radon is a very modifiable environmental exposure that is the second most important cause of lung cancer. Objectives: The objectives of this thesis are to quantify the lung cancer burden associated with residential radon and to identify the most cost effective mitigation options to reduce residential radon in Canada. Methods: The global burden of lung cancer mortality attributable to radon in 2012 was estimated from the 66 countries for which a representative national radon survey was available, using several different models for excess relative risk (ERR) of lung cancer from radon studies. Cost-utility analyses are conducted for 20 practical radon interventions scenarios to reduce residential radon exposures in new and existing housing in Canada, each province/territory and 17 census metropolitan areas. A societal perspective and a lifetime horizon are adopted. A Markov cohort model and a discrete event simulation are used to model residents by household, based on a period-life table analysis, at a discount rate of 1.5%. Results: The estimates of the global median PAR were consistent, ranging from 16.5% to 13.6% for the three ERR models based on miners, and the mean estimates of PAR for Canada ranged from 16.3% to 14.6%. It is very cost effective to install radon preventive measures in new construction compared to no radon control in all regions across Canada. At a radon mitigation threshold of 100 Bq/m3, the sequential analysis recommends the combination of the activation of preventive measures in new housing with the mitigation of existing housing at current testing and mitigation rates for cost effectiveness thresholds between 51,889 and 92,072 $/QALY for Canada, between 27,558 and 85,965 $/QALY for Manitoba, and between 15,801 and 36,547 $/QALY for the Yukon. The discounted ICER for screening and mitigation of existing housing at current rates relative to no radon control measures is 62,451 (66,421) $/QALY using a Markov cohort model (discrete event simulation model) for mitigation of housing above a threshold of 200 Bq/m3, and is 58,866 (59,556) $/QALY using a Markov cohort model (discrete event simulation model) for mitigation of housing above a threshold of 100 Bq/m3. Conclusions: Cost effective residential radon interventions should be implemented across Canada to reduce exposures to this very modifiable cause of lung cancer and to help reduce the increasing lung cancer burden in an ageing Canadian population.

This thesis investigated the cost-effectiveness of a 12-month supervised aerobic walking program with or without a behavioural intervention and an educational pamphlet, compared to an unsupervised/self-directed educational pamphlet intervention, among individuals with moderate osteoarthritis (OA) of the knee. Analyses included an economic evaluation to assess the cost effectiveness of the two walking interventions from both the societal and Canadian provincial/territorial health care payer perspectives. A value of information analysis exploring the potential value of future research was also performed. Results revealed that the unsupervised/self-directed intervention was the most cost-effective approach given that it cost the least to implement and participants had higher quality-adjusted life years (QALYs). Walking, either supervised in a community setting, or unsupervised in a setting such as the home, may be a favourable non-pharmacological option for the management of OA of the knee. The thesis concludes with a policy discussion relating to the funding of non-pharmacological therapies.

This paper analysis the cost-utility, measured in cost per QALY gained, of impact absorbent flooring that reduce hip fractures among institutionalized elderly in comparison to standard flooring. The study is based on experimental data from an elderly institution, where the absorbing floor was installed in 2010. Using a decision tree, the costs and benefits related to the new flooring are calculated on a one year basis, resulting in an incremental cost per QALY of 713327 SEK for the base case. Although the experimental data shows that there is an impact of the new flooring in reducing hip fractures a conclusion whether the policy is cost-effective or not can hardly be drawn. Sensitivity analysis based on a simulation of 5000 cases suggests that the result is robust. / Effektsamband i Samhället

Chronic Kidney Disease (CKD) is a risk factor for cardiovascular disease, early mortality, and kidney failure. There is a substantial burden of CKD in Manitoba’s rural and remote First Nations. Early detection and treatment of CKD in this population may be cost-effective. We constructed a Markov model comparing screening for CKD, by both estimated glomerular filtration rate and albuminuria, to usual care using the perspective of the health care payer. Patients were classified into initial risk groups based on results from the First Nations Community Based Screening to Improve Kidney Health and Prevent Dialysis initiative. Screening in Manitoba’s rural and remote First Nations was associated with a $33,500/QALY incremental cost-effectiveness ratio in comparison to usual care. Restricting to communities accessible primarily by air travel, this ratio fell to $16,180/QALY. In conclusion, at a willingness-to-pay threshold of $50,000/QALY, screening for CKD in Manitoba’s rural and remote First Nations is likely cost-effective.

Introduction: Facial lipoatrophy is a stigmatizing hallmark for HIV-positive status, and can lead to poor social functioning. Information gleaned from an economic evaluation of facial lipoatrophy treatments would inform policy decision making concerning potential public insurance coverage. Methods: A decision-analytic model was used to estimate the lifetime costs and Quality Adjusted Life Years (QALYs) gained from treatments using either poly-l-lactic or and polyalkylimide gel for HIV positive patients. Disease progression probabilities and utilities were derived from the literature. Costs were obtained from interviews with physicians and product distributors. Findings: Incremental costs per QALY were $66,409 CAD/$57,352 CAD for poly-l-lactic acid, and $48,715 CAD/$45,457 CAD for polyalkylimide gel® (Societal perspective/Ministry of Health perspective). Sensitivity analysis did not have a significant effect on the lower incremental costs per QALY reported for polyalkylimide gel. Conclusion: Our base-case analysis revealed that treatments using polyalkylimide gel offers lower ICUR than treatments using poly-l-lactic acid.

Introduction: Facial lipoatrophy is a stigmatizing hallmark for HIV-positive status, and can lead to poor social functioning. Information gleaned from an economic evaluation of facial lipoatrophy treatments would inform policy decision making concerning potential public insurance coverage. Methods: A decision-analytic model was used to estimate the lifetime costs and Quality Adjusted Life Years (QALYs) gained from treatments using either poly-l-lactic or and polyalkylimide gel for HIV positive patients. Disease progression probabilities and utilities were derived from the literature. Costs were obtained from interviews with physicians and product distributors. Findings: Incremental costs per QALY were $66,409 CAD/$57,352 CAD for poly-l-lactic acid, and $48,715 CAD/$45,457 CAD for polyalkylimide gel® (Societal perspective/Ministry of Health perspective). Sensitivity analysis did not have a significant effect on the lower incremental costs per QALY reported for polyalkylimide gel. Conclusion: Our base-case analysis revealed that treatments using polyalkylimide gel offers lower ICUR than treatments using poly-l-lactic acid.

This thesis investigated the cost-effectiveness of a 12-month supervised aerobic walking program with or without a behavioural intervention and an educational pamphlet, compared to an unsupervised/self-directed educational pamphlet intervention, among individuals with moderate osteoarthritis (OA) of the knee. Analyses included an economic evaluation to assess the cost effectiveness of the two walking interventions from both the societal and Canadian provincial/territorial health care payer perspectives. A value of information analysis exploring the potential value of future research was also performed. Results revealed that the unsupervised/self-directed intervention was the most cost-effective approach given that it cost the least to implement and participants had higher quality-adjusted life years (QALYs). Walking, either supervised in a community setting, or unsupervised in a setting such as the home, may be a favourable non-pharmacological option for the management of OA of the knee. The thesis concludes with a policy discussion relating to the funding of non-pharmacological therapies.

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