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Cost-effectiveness of gargling for the prevention of upper respiratory tract infections.

Sakai M, Shimbo T, Omata K, Takahashi Y, Satomura K, Kitamura T, Kawamura T, Baba H, Yoshihara M, Itoh H, Great Cold Investigators - BMC Health Serv Res (2008)

Bottom Line: Incremental cost-effectiveness ratio (ICER) was converted to dollars per quality-adjusted life years (QALY).The 95% confidence interval (95%CI) and probability of gargling being cost-effective were estimated by bootstrapping.ICER of the gargling group was $31,800/QALY (95%CI, $1,900-$248,100).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Research and Informatics, Research Institute, International Medical Center of Japan, Tokyo, Japan. sakai.michi1@gmail.com

ABSTRACT

Background: In Japan, gargling is a generally accepted way of preventing upper respiratory tract infection (URTI). The effectiveness of gargling for preventing URTI has been shown in a randomized controlled trial that compared incidences of URTI between gargling and control groups. From the perspective of the third-party payer, gargling is dominant due to the fact that the costs of gargling are borne by the participant. However, the cost-effectiveness of gargling from a societal perspective should be considered. In this study, economic evaluation alongside a randomized controlled trial was performed to evaluate the cost-effectiveness of gargling for preventing URTI from a societal perspective.

Methods: Among participants in the gargling trial, 122 water-gargling and 130 control subjects were involved in the economic analysis. Sixty-day cumulative follow-up costs and effectiveness measured by quality-adjusted life days (QALD) were compared between groups on an intention-to-treat basis. Incremental cost-effectiveness ratio (ICER) was converted to dollars per quality-adjusted life years (QALY). The 95% confidence interval (95%CI) and probability of gargling being cost-effective were estimated by bootstrapping.

Results: After 60 days, QALD was increased by 0.43 and costs were $37.1 higher in the gargling group than in the control group. ICER of the gargling group was $31,800/QALY (95%CI, $1,900-$248,100). Although this resembles many acceptable forms of medical intervention, including URTI preventive measures such as influenza vaccination, the broad confidence interval indicates uncertainty surrounding our results. In addition, one-way sensitivity analysis also indicated that careful evaluation is required for the cost of gargling and the utility of moderate URTI. The major limitation of this study was that this trial was conducted in winter, at a time when URTI is prevalent. Care must be taken when applying the results to a season when URTI is not prevalent, since the ICER will increase due to decreases in incidence.

Conclusion: This study suggests gargling as a cost-effective preventive strategy for URTI that is acceptable from perspectives of both the third-party payer and society.

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Related in: MedlinePlus

Acceptability curve. The curve indicates the probability of gargling being preferable to the control for potential maximum amounts that a decision-maker is willing to pay for an additional increase in QALY. WTP, willingness to pay.
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Figure 2: Acceptability curve. The curve indicates the probability of gargling being preferable to the control for potential maximum amounts that a decision-maker is willing to pay for an additional increase in QALY. WTP, willingness to pay.

Mentions: The incremental cost per QALY gained associated with gargling was $31,800 (95%CI, $1,900–$248,100). Bootstrapped estimates of the incremental costs and incremental QALD are shown in Figure 1 using the cost-effectiveness plane. Figure 2 shows that, given a willingness-to-pay threshold of $50,000/QALY, the probability of gargling being cost-effective compared with control is 69.8%. If the threshold is increased to $100,000, then the probability increases to 89.9%.


Cost-effectiveness of gargling for the prevention of upper respiratory tract infections.

Sakai M, Shimbo T, Omata K, Takahashi Y, Satomura K, Kitamura T, Kawamura T, Baba H, Yoshihara M, Itoh H, Great Cold Investigators - BMC Health Serv Res (2008)

Acceptability curve. The curve indicates the probability of gargling being preferable to the control for potential maximum amounts that a decision-maker is willing to pay for an additional increase in QALY. WTP, willingness to pay.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2651874&req=5

Figure 2: Acceptability curve. The curve indicates the probability of gargling being preferable to the control for potential maximum amounts that a decision-maker is willing to pay for an additional increase in QALY. WTP, willingness to pay.
Mentions: The incremental cost per QALY gained associated with gargling was $31,800 (95%CI, $1,900–$248,100). Bootstrapped estimates of the incremental costs and incremental QALD are shown in Figure 1 using the cost-effectiveness plane. Figure 2 shows that, given a willingness-to-pay threshold of $50,000/QALY, the probability of gargling being cost-effective compared with control is 69.8%. If the threshold is increased to $100,000, then the probability increases to 89.9%.

Bottom Line: Incremental cost-effectiveness ratio (ICER) was converted to dollars per quality-adjusted life years (QALY).The 95% confidence interval (95%CI) and probability of gargling being cost-effective were estimated by bootstrapping.ICER of the gargling group was $31,800/QALY (95%CI, $1,900-$248,100).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Clinical Research and Informatics, Research Institute, International Medical Center of Japan, Tokyo, Japan. sakai.michi1@gmail.com

ABSTRACT

Background: In Japan, gargling is a generally accepted way of preventing upper respiratory tract infection (URTI). The effectiveness of gargling for preventing URTI has been shown in a randomized controlled trial that compared incidences of URTI between gargling and control groups. From the perspective of the third-party payer, gargling is dominant due to the fact that the costs of gargling are borne by the participant. However, the cost-effectiveness of gargling from a societal perspective should be considered. In this study, economic evaluation alongside a randomized controlled trial was performed to evaluate the cost-effectiveness of gargling for preventing URTI from a societal perspective.

Methods: Among participants in the gargling trial, 122 water-gargling and 130 control subjects were involved in the economic analysis. Sixty-day cumulative follow-up costs and effectiveness measured by quality-adjusted life days (QALD) were compared between groups on an intention-to-treat basis. Incremental cost-effectiveness ratio (ICER) was converted to dollars per quality-adjusted life years (QALY). The 95% confidence interval (95%CI) and probability of gargling being cost-effective were estimated by bootstrapping.

Results: After 60 days, QALD was increased by 0.43 and costs were $37.1 higher in the gargling group than in the control group. ICER of the gargling group was $31,800/QALY (95%CI, $1,900-$248,100). Although this resembles many acceptable forms of medical intervention, including URTI preventive measures such as influenza vaccination, the broad confidence interval indicates uncertainty surrounding our results. In addition, one-way sensitivity analysis also indicated that careful evaluation is required for the cost of gargling and the utility of moderate URTI. The major limitation of this study was that this trial was conducted in winter, at a time when URTI is prevalent. Care must be taken when applying the results to a season when URTI is not prevalent, since the ICER will increase due to decreases in incidence.

Conclusion: This study suggests gargling as a cost-effective preventive strategy for URTI that is acceptable from perspectives of both the third-party payer and society.

Show MeSH
Related in: MedlinePlus