Bhavani Shankara Bagepally
@nie.gov.in
Scientist-E
ICMR-National Institute of Epidemiology
A medical graduate has a Ph.D. in Clinical Neuroscience (ICMR MD-PhD Program) at NIMHANS, Bangalore, India, PhD work was on Structural Neuroimaging: MRI-Diffusion Tensor Imaging in Alzheimer's dementia. Trained in Health Technology Assessment with an MSc (Health Technology Assessment) degree from Mahidol University, Bangkok, Thailand. Currently working as Scientist in ICMR-National Institute of Epidemiology.
EDUCATION
MBBS, PhD(Clinical Neurosciences), MSc (Health Technology Assessment)
RESEARCH, TEACHING, or OTHER INTERESTS
Economics and Econometrics, Neuroscience, Public Health, Environmental and Occupational Health, Multidisciplinary
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Aniruddha Basu, Atanu Kumar Dutta, Bhavani Shankara Bagepally, Saibal Das, Jerin Jose Cherian, Sudipto Roy, Pawan Kumar Maurya, Indranil Saha, Deepasree Sukumaran, Kumari Rina,et al.
Public Library of Science (PLoS)
Objectives The response to antipsychotic therapy is highly variable. Pharmacogenomic (PGx) factors play a major role in deciding the effectiveness and safety of antipsychotic drugs. A hybrid type 2 effectiveness-implementation research will be conducted to evaluate the clinical utility (safety and efficacy), cost-effectiveness, and facilitators and barriers in implementing PGx-assisted management compared to standard of care in patients with schizophrenia attending a tertiary care hospital in eastern India. Methods In part 1, a randomized controlled trial will be conducted. Adult patients with schizophrenia will be randomized (2: 1) to receive PGx-assisted treatment (drug and regimen selection depending on the results of single-nucleotide polymorphisms in genes DRD2, HTR1A, HTR2C, ABCB1, CYP2D6, CYP3A5, and CYP1A2) or the standard of care. Serum drug levels will be measured. The patients will be followed up for 12 weeks. The primary endpoint is the difference in the Udvalg for Kliniske Undersøgelser Side-Effect Rating Scale score between the two arms. In part 2, the cost-effectiveness of PGx-assisted treatment will be evaluated. In part 3, the facilitators and barriers to implementing PGx-assisted treatment for schizophrenia will be explored using a qualitative design. Expected outcome The study findings will help in understanding whether PGx-assisted management has a clinical utility, whether it is cost-effective, and what are the facilitators and barriers to implementing it in the management of schizophrenia. Trial registration The study has been registered with the Clinical Trials Registry–India (CTRI/2023/08/056210).
Akhil Sasidharan, Bhavani Shankara Bagepally, and S Sajith Kumar
Springer Science and Business Media LLC
Raghu Bhanupriya, Madhumitha Haridoss, Goda Suchitra Lakshmi, and Bhavani Shankara Bagepally
Springer Science and Business Media LLC
Bhavani Shankara Bagepally, Sajith Kumar S, and Akhil Sasidharan
Informa UK Limited
Background Efficient allocation of healthcare resources requires a comprehensive evaluation of healthcare spending and its impact on disease burden. This study aims to estimate the costs-per disability-adjusted life years (DALY) in India. Data from 2010 to 2019 on DALYs and health expenditure per capita (HEp) for individual states in India were utilised. Design and Methods We followed the CHEERS statement 2022 to present our study’s methodology and outcomes. Pearson’s product-moment correlations were used to analyse associations between DALYs and HEp. A panel regression analysis was conducted using a log regression model to estimate changes in DALYs due to health expenditure changes. All costs are reported in Indian rupee (₹) along with its 95% CI, with a conversion factor of 1 US$ = ₹82.4 applied. Results The costs-per-DALY were estimated for each state and India. DALY was negatively correlated with HEp. The estimated mean cost-per-DALY for India was ₹82,112 (₹55,810 to ₹1,08,413) [$997 ($667 to $1316)]. The mean cost per-DALY varied across states, with value of ₹27,058 (₹22,250 to ₹31,866) [$328 ($270 to $387)] for states in the first quartile based on Human Development Index (HDI) and ₹2,69,175 (₹1,05,946 to ₹4,32,404) [$3267 ($1286 to $5248)] for those in fourth HDI quartile. States such as Gujarat (0.16), Karnataka (0.17) and Maharashtra (0.22) have lower, and Arunachal Pradesh has the highest cost-per-DALY to Gross state domestic product per-capita ratio (2.41), followed by Nagaland (1.45). Conclusion Higher healthcare investment has a lower disease burden; however, reduction in DALY varies across states. Study findings provide evidence to aid the setting up of differential willingness-to-pay thresholds across Indian states for efficient and equitable healthcare resource allocation.
G. Srimathi, R. Revathy, B. Bagepally and Beena Joshi
BACKGROUND OBJECTIVES
Iron deficiency anaemia (IDA) during pregnancy is treated with oral and parenteral iron. The objective of this review was to compare the clinical effectiveness, safety, pregnancy and neonatal outcomes of intravenous (iv) ferric carboxymaltose (FCM) and iv iron sucrose (IS) in treating IDA in pregnancy.
METHODS
The Department of Health Research funded this study. PubMed, Cochrane Library, EMBASE and Scopus were searched to include studies published till November 2022. The protocol was registered in PROSPERO (CRD42022306092). Pregnant women (15-49 yr) in second and third trimesters, diagnosed with moderate-to-severe iron deficiency anaemia, treated with either of the drugs were included. The included studies were critically assessed using appropriate tools. We conducted a qualitative synthesis of the studies and meta-analysis for improvement in haematological parameters and incidence of adverse events.
RESULTS
A total of 18 studies were included. The risk of bias was low to moderate. A rise in haemoglobin up to four weeks was higher with FCM than IS by 0.57 (0.24, 0.9) g/dl. Intravenous FCM is associated with fewer adverse events than IS [pooled odds ratio: 0.5 (0.32, 0.79)]. The included studies had limited evidence on pregnancy and neonatal outcomes after iv iron treatment.
INTERPRETATION CONCLUSIONS
Intravenous FCM is effective and safer than intravenous IS in terms of haematological parameters, in treating IDA in pregnancy. Further research is required on the effects of iv FCM and iv IS on the pregnancy and neonatal outcomes when used for treating IDA in pregnancy.
Bhavani Shankara Bagepally, S. Sajith Kumar, Akhil Sasidharan, Madhumitha Haridoss, and Krishnamurthy Venkataraman
Springer Science and Business Media LLC
AbstractRheumatoid arthritis (RA) not only has a physical and emotional toll but also has a substantial economic impact. This study aims to estimate the burden of catastrophic health expenditure (CHE) on households due to RA in Tamil Nadu, India. We conducted cross-sectional descriptive hospital-based single-centre study at a tertiary care private multispecialty hospital in Tamil Nadu, India. The study comprised 320 RA patients who visited the outpatient clinic from April to October 2022. Demographic and baseline descriptive characteristics were reported. Multivariable logistic regression analyses were performed to identify major determinants associated with CHE. We also examined the inequality in household annual income and CHE. Most study participants were females (88.1%) with a mean age (SD) of 55.57 ± 12.29 years. About 93% of RA patients were from urban areas, and 89.4% were literate. Only 8.1% of respondents reported having health insurance. Households experiencing CHE owing to RA were 51.4% (n = 162). The mean (95% CI) annual health expenditure for treating RA is ₹44,700 (₹41,710 to 47,690) with a median (IQR) of ₹39,210 (₹25,500) [$476 ($310)]. The corresponding mean (95% CI) and median (IQR) Out of pocket expenditure among RA patients per household were ₹40,698 (₹38,249 to 43,148) [$494 ($464 to $524)] and ₹36,450 (23,070) [$442 ($280)] respectively. Nearly half of the households with RA patients had a financial catastrophe due to healthcare costs being paid out-of-pocket and limited health insurance coverage. The results underscore the need for comprehensive approaches to strengthening public health policies along with financial risk protection and quality care in India.
Ankit Viramgami, Ankit Sheth, Bhavani Shankara Bagepally, and Rakesh Balachandar
Springer Science and Business Media LLC
Elumalai Rajalakshmi, Akhil Sasidharan, Bhavani Shankara Bagepally, Muthusamy Santhosh Kumar, Ponnaiah Manickam, T. S. Selva Vinayagam, P. Sampath, and K Parthipan
Springer Science and Business Media LLC
Abstract Background The Coronavirus disease 2019 (COVID-19) pandemic increased the utilisation of healthcare services. Such utilization could lead to higher out-of-pocket expenditure (OOPE) and catastrophic health expenditures (CHE). We estimated OOPE and the proportion of households that experienced CHE by conducting a cross-sectional survey of 1200 randomly selected confirmed COVID-19 cases. Methods A cross-sectional survey was conducted by telephonic interviews of 1200 randomly selected COVID-19 patients who tested positive between 1 March and 31 August 2021. We collected household-level information on demographics, income, expenditure, insurance coverage, direct medical and non-medical costs incurred toward COVID-19 management. We estimated the proportion of CHE with a 95% confidence interval. We examined the association of household characteristics; COVID-19 cases, severity, and hospitalisation status with CHE. A multivariable logistic regression analysis was conducted to ascertain the effects of variables of interest on the likelihood that households face CHE due to COVID-19. Results The mean (95%CI) OOPE per household was INR 122,221 (92,744–1,51,698) [US$1,643 (1,247–2,040)]. Among households, 61.7% faced OOPE, and 25.8% experienced CHE due to COVID-19. The odds of facing CHE were high among the households; with a family member over 65 years [OR = 2.89 (2.03–4.12)], with a comorbid individual [OR = 3.38 (2.41–4.75)], in the lowest income quintile [OR = 1.82 (1.12–2.95)], any member visited private hospital [OR = 11.85 (7.68–18.27)]. The odds of having CHE in a household who have received insurance claims [OR = 5.8 (2.81- 11.97)] were high. Households with one and more than one severe COVID-19 increased the risk of CHE by more than two-times and three-times respectively [AOR = 2.67 (1.27–5.58); AOR = 3.18 (1.49–6.81)]. Conclusion COVID-19 severity increases household OOPE and CHE. Strengthening the public healthcare and health insurance with higher health financing is indispensable for financial risk protection of households with severe COVID-19 from CHE.
Indranil Saha, Joydeep Majumder, Bhavani Shankara Bagepally, Sujoy Ray, Asim Saha, and Amit Chakrabarti
Elsevier BV
Shravan Venkatraman, Saibal Das, Madhavi Eerike, Jerin Jose Cherian, and Bhavani Shankara Bagepally
Springer Science and Business Media LLC
Rakesh Balachandar, Ankit Viramgami, Bhavani Shankara Bagepally, and Kuldip Upadhyay
Springer Science and Business Media LLC
Purushothaman Rajamani Asish, Sauvik Dasgupta, Gladys Rachel, Bhavani Shankara Bagepally, and Chethrapilly Purushothaman Girish Kumar
Elsevier BV
Madhumitha Haridoss, Lavanya Ayyasamy, and Bhavani Shankara Bagepally
Springer Science and Business Media LLC
Lavanya Ayyasamy and Bhavani Shankara Bagepally
Elsevier BV
Rajalakshmi Elumalai, Bhavani Shankara Bagepally, Manickam Ponnaiah, Tarun Bhatnagar, Suganya Barani, Poornima Kannan, Lakshmi Kantham, P. Sathiyarajeswaran, and Sasikumar D
Elsevier BV
S Sajith Kumar, Bhavani Shankara Bagepally, and Akhil Sasidharan
Springer Science and Business Media LLC
Sajith Kumar and Bhavani Shankara Bagepally
Informa UK Limited
OBJECTIVE
To systematically review cost-utility evidence of TNF-a-i treatment for Rheumatoid arthritis (RA) and to estimate the pooled incremental net benefit (INBp).
METHODS
We selected economic evaluation studies reporting the cost-utility of TNF-a-i compared to other disease-modifying anti-rheumatic drugs (DMARDs) after a systematic search in PubMed, Embase, Scopus, and Tufts Medical Centers' cost-effective analysis registry. The results were reported as pooled INB in purchasing power parity-adjusted US dollars, along with 95% confidence intervals. We used GRADE quality assessment to present summaries of evidence and random-effects meta-analysis to synthesise cost-utility of TNF-a-i.
RESULTS
We included 86 studies for systematic review, of which 27 for meta-analysis. TNF-a-i is not cost-effective [$ -4,129(-6,789 to -1,469)] compared to other DMARDs but with high heterogeneity. There was no evidence of publication bias (p=0.447). On separate analysis, TNF-a-i is not cost-effective [$-4,805(-7,882 to -1,728)] compared to conventional synthetic DMARDs for RA treatment. GRADE assessment indicated very low confidence in pooled cost-utility results and likely presence of risk of bias on overall ECOBIAS checklist in studies.
CONCLUSION
Based on the available evidence during the study period, TNF-a-i is not a cost-effective option for treating RA compared to other DMARDs. However, high heterogeneity and low confidence in GRADE quality assessment preclude the results from being generalizable.
S. Sajith Kumar, Akhil Sasidharan, and Bhavani Shankara Bagepally
Elsevier BV
Madhumitha Haridoss, Sajith Kumar, Meenakumari Natarajan, Akhil Sasidharan, Kavitha Rajsekar, Nikhil Kumar Oswal, and Bhavani Shankara Bagepally
Informa UK Limited
OBJECTIVES
Gallstone diseases impose a significant economic burden on the health care system; thus, determining cost-effective management for gallstones is essential. We aim to estimate the cost-effectiveness of cholecystectomy compared with conservative management in individuals with uncomplicated symptomatic gallstones or cholecystitis in India.
METHODS
A decision-analytic Markov model was used to compare the costs and QALY of early laparoscopic cholecystectomy (ELC), delayed laparoscopic cholecystectomy (DLC), and conservative management (CM) in patients with symptomatic uncomplicated gallstone/cholecystitis from an Indian health system perspective. Incremental cost-effectiveness ratio (ICER) was calculated. One-way and probabilistic sensitivity analyses were performed to test parameter uncertainties.
RESULTS
ELC and DLC, compared to CM, incurred an incremental cost of -₹10,948 ($146) and ₹1,054 ($14) for the 0.032 QALYs gained. The ICER was -₹3,42,758 ($4577) for ELC vs. CM, and ₹33,183 ($443) for DLC vs. CM, suggesting ELC and DLC are cost-effective. ELC saved ₹12,001 ($160) for 0.0002 QALYs gained compared to DLC, resulting in an ICER of -₹6,43,89,441 ($8,59,733). The results were robust to changes in the input parameters in sensitivity analyses.
CONCLUSION
ELC is dominant compared to both DLC and CM, and DLC is more cost-effective than CM. Thus, ELC may be preferable to other gallstone disease managements.
S. Sajith Kumar, Madhumitha Haridoss, Krishnamurthy Venkataraman, and Bhavani Shankara Bagepally
Frontiers Media SA
Introduction: Janus kinase inhibitors (JAK-i), a class of targeted synthetic disease-modifying antirheumatic drugs (tDMARDs), are suggested as second or third-line therapies in rheumatoid arthritis (RA). Synthesized cost-effective evidence would aid in informed decision-making given the similar clinical effectiveness of JAKi, but incongruent cost-effectiveness reports.Methods: Literature search was conducted in PubMed, Embase, Scopus, and Tufts Medical Centers’ cost-effective analysis registry. We pooled the incremental net benefit (INB) with 95% confidence interval (CI) using random-effects model and the heterogeneity was assessed using Cochrane-Q test and I2 statistic. Modified economic evaluation bias checklist was used to assess the quality of selected studies. Publication bias was assessed using a funnel plot and Egger’s test. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) assessment was performed to assess the certainty of outcomes presented.Results: We included seventeen relevant studies for systematic review, of which fifteen were eligible for meta-analysis. The meta-analysis results showed that JAK-i is cost-effective compared to csDMARDS/bDMARDs with a pooled INB (INBp) of $19,886 (95% CI, 1,635 to 38,137) but with considerable heterogeneity (I2 = 99.14). As a second-line treatment for csDMARD failed RA, JAK-i is cost-effective than csDMARD/bDMARD with a pooled INB of $23,144 (74.1–46,214) and high heterogeneity (I2 = 99.67). But on a separate analysis JAK-i as second-line treatment is not cost-effective than TNF-a-i (INBp = $25,813, -5,714 to 57,340). However, leave-one-out analysis found that omitting a single outlier makes JAK-i cost-effective. Further, JAK-i is not cost-effective as a third-line treatment for csDMARD-TNF-a-I failed RA, compared to csDMARDs/bDMARDs with INBp $26,157 (-7,284 to 59,598).Conclusion: Meta-analysis suggests that JAK-i is cost-effective when used after csDMARD failure but not cost-effective when used after csDMARD-TNF-a-i failure with low certainty of evidence.Clinical Trial Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021222541, identifier CRD42021222541
Sajith Kumar S, Bhavani Shankara Bagepally, and Balachandar Rakesh
Elsevier BV
S Sajith Kumar, Bhavani Shankara Bagepally, and Balachandar Rakesh
Elsevier BV
Bhavani Shankara Bagepally, Usa Chaikledkaew, Nathorn Chaiyakunapruk, John Attia, and Ammarin Thakkinstian
Springer Science and Business Media LLC
Abstract Background In the context of ever-growing health expenditure and limited resources, economic evaluations aid in making evidence-informed policy decisions. Cost-utility analysis (CUA) is often used, and CUA data synthesis is also desirable, but methodological issues are challenged. Hence, we aim to provide a step-by-step process to prepare the CUA data for meta-analysis. Methods Data harmonisation methods were constructed specifically considering CUA methodology, including inconsistent reports, economic parameters, heterogeneity (i.e., country’s income, time horizon, perspective, modelling approaches, currency, willingness to pay). An incremental net benefit (INB) and its variance were estimated and pooled across studies using a basic meta-analysis by COMER. Results Five scenarios show how to obtain INB and variance with various reported data: Study reports the mean and variance (Scenario 1) or 95% confidence interval (Scenario 2) of ΔC, ΔE, and ICER for INB/variance calculations. Scenario 3: ΔC, ΔE, and variances are available, but not for the ICER; a Monte Carlo was used to simulate ΔC and ΔE data, variance and covariance can be then estimated leading INB calculation. Scenario-4: Only the CE plane was available, ΔC and ΔE data can be extracted; means of ΔC, ΔE, and variance/covariance can be estimated accordingly, leading to INB/variance estimates. Scenario-5: Only mean cost/outcomes and ICER are available but not for variance and the CE-plane. A variance INB can be borrowed from other studies which are similar characteristics, including country income, ICERs, intervention-comparator, time period, country region, and model type and inputs (i.e., discounting, time horizon). Conclusion Out data harmonisation and meta-analytic methods should be useful for researchers for the synthesis of economic evidence to aid policymakers in decision making.