The cost implication of primary prevention in the HOPE 3 trial

2019 ◽  
Vol 5 (3) ◽  
pp. 266-271
Author(s):  
Andre Lamy ◽  
Eva Lonn ◽  
Wesley Tong ◽  
Balakumar Swaminathan ◽  
Hyejung Jung ◽  
...  
Keyword(s):  
Developing Countries ◽  
Primary Prevention ◽  
Cost Saving ◽  
Developed Countries ◽  
Sensitivity Analyses ◽  
Clinical Trial Registration ◽  
Pressure Lowering ◽  
The Cost ◽  
Care Costs ◽  
Country Specific

Abstract Aims The Heart Outcomes Prevention Evaluation-3 (HOPE-3) found that rosuvastatin alone or with candesartan and hydrochlorothiazide (HCT) (in a subgroup with hypertension) significantly lowered cardiovascular events compared with placebo in 12 705 individuals from 21 countries at intermediate risk and without cardiovascular disease. We assessed the costs implications of implementation in primary prevention in countries at different economic levels. Methods and results Hospitalizations, procedures, study and non-study medications were documented. We applied country-specific costs to the healthcare resources consumed for each patient. We calculated the average cost per patient in US dollars for the duration of the study (5.6 years). Sensitivity analyses were also performed with cheapest equivalent substitutes. The combination of rosuvastatin with candesartan/HCT reduced total costs and was a cost-saving strategy in United States, Canada, Europe, and Australia. In contrast, the treatments were more expensive in developing countries even when cheapest equivalent substitutes were used. After adjustment for gross domestic product (GDP), the costs of cheapest equivalent substitutes in proportion to the health care costs were higher in developing countries in comparison to developed countries. Conclusion Rosuvastatin and candesartan/HCT in primary prevention is a cost-saving approach in developed countries, but not in developing countries as both drugs and their cheapest equivalent substitutes are relatively more expensive despite adjustment by GDP. Reductions in costs of these drugs in developing countries are essential to make statins and blood pressure lowering drugs affordable and ensure their use. Clinical trial registration HOPE-3 ClinicalTrials.gov number, NCT00468923.

scholarly journals Cost-effectiveness of zoledronic acid compared with sequential denosumab/alendronate for older osteoporotic women in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Mori ◽  
Carolyn J. Crandall ◽  
Tomoko Fujii ◽  
David A. Ganz
Keyword(s):  
Health Economic ◽  
Cost Effectiveness ◽  
Zoledronic Acid ◽  
Cost Saving ◽  
Fragility Fracture ◽  
Community Dwelling ◽  
Sensitivity Analyses ◽  
Term Care ◽  
Lifetime Horizon ◽  
The Cost

Abstract Summary Among hypothetical cohorts of older osteoporotic women without prior fragility fracture in Japan, we evaluated the cost-effectiveness of two treatment strategies using a simulation model. Annual intravenous zoledronic acid for 3 years was cost-saving compared with biannual subcutaneous denosumab for 3 years followed by weekly oral alendronate for 3 years. Purpose Osteoporosis constitutes a major medical and health economic burden to society worldwide. Injectable treatments for osteoporosis require less frequent administration than oral treatments and therefore have higher persistence and adherence with treatment, which could explain better efficacy for fracture prevention. Although annual intravenous zoledronic acid and biannual subcutaneous denosumab are available, it remains unclear which treatment strategy represents a better value from a health economic perspective. Accordingly, we examined the cost-effectiveness of zoledronic acid for 3 years compared with sequential denosumab/alendronate (i.e., denosumab for 3 years followed by oral weekly alendronate for 3 years, making the total treatment duration 6 years) among hypothetical cohorts of community-dwelling osteoporotic women without prior fragility fracture in Japan at ages 65, 70, 75, or 80 years. Methods Using a previously validated and updated Markov microsimulation model, we obtained incremental cost-effectiveness ratios (Japanese yen [¥] (or US dollars [$]) per quality-adjusted life-year [QALY]) from the public healthcare and long-term care payer’s perspective over a lifetime horizon with a willingness-to-pay of ¥5 million (or $47,500) per QALY. Results In the base case, zoledronic acid was cost-saving (i.e., more effective and less expensive) compared with sequential denosumab/alendronate. In deterministic sensitivity analyses, results were sensitive to changes in the efficacy of zoledronic acid or the cumulative persistence rate with zoledronic acid or denosumab. In probabilistic sensitivity analyses, the probabilities of zoledronic acid being cost-effective were 98–100%. Conclusions Among older osteoporotic women without prior fragility fracture in Japan, zoledronic acid was cost-saving compared with sequential denosumab/alendronate.

scholarly journals Cost Analysis of Methylprednisolone Treatment of Multiple Sclerosis Patients

1998 ◽  
Vol 25 (3) ◽  
pp. 222-229 ◽  
Author(s):  
Lynda S. Robson ◽  
Charlene Bain ◽  
Shann Beck ◽  
Suzanne Guthrie ◽  
Peter C. Coyte ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cost Saving ◽  
Cost Analysis ◽  
Home Care ◽  
Care Program ◽  
Sensitivity Analyses ◽  
Patient Treatment ◽  
Fiscal Year ◽  
Multiple Sclerosis Patients ◽  
The Cost

ABSTRACT:Background:Intravenous methylprednisolone (IVMP) is the treatment of choice for multiple sclerosis (MS) patients undergoing acute exacerbation of disease symptoms and yet its cost has not been accurately determined. Determination of this cost in different settings is also pertinent to consideration of cost-saving alternatives to in-patient treatment.Methods:Cost analysis from the point of view of the health care system of IVMP treatment of MS patients receiving treatment in association with a selected Toronto teaching hospital in fiscal year 1994/95 was carried out. Costs of any concurrent treatments were excluded.Results:Total cost for 92 patients, based on a 4 dose regime, was estimated to be $78,527. The the cost per patient was $1,1181.84 for in-patients (IP), $714.64 for out-patients of the MS Clinic (OP) and $774.21 for patients whose treatment was initiated in the Clinic, but completed in the home (HC). Sensitivity analyses indicated: 1) IP treatment was in all cases more expensive than that of OP or HC; 2) the cost savings of OP vs. HC was sensitive to assumptions made regarding Clinic overhead, Clinic nursing costs and Home Care Program overhead.Conclusion:Alternatives to in-patient care must be considered carefully. In this study, both out-patient and in-home treatment were cost-saving alternatives to in-patient treatment, but large differences in the cost of hospital out-patient vs. in-home care could not be demonstrated.

scholarly journals Assessing the Potential Deployment of Biosensors for Point-of-Care Diagnostics in Developing Countries: Technological, Economic and Regulatory Aspects

Biosensors ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. 119 ◽  
Author(s):  
Daniel Migliozzi ◽  
Thomas Guibentif
Keyword(s):  
Developing Countries ◽  
Technological Development ◽  
Point Of Care ◽  
Medical Personnel ◽  
Developed Countries ◽  
Key Factors ◽  
Resource Limited ◽  
Point Of Care Diagnostics ◽  
Successful Case ◽  
The Cost

Infectious diseases and antimicrobial resistance are major burdens in developing countries, where very specific conditions impede the deployment of established medical infrastructures. Since biosensing devices are nowadays very common in developed countries, particularly in the field of diagnostics, they are at a stage of maturity at which other potential outcomes can be explored, especially on their possibilities for multiplexing and automation to reduce the time-to-results. However, the translation is far from being trivial. In order to understand the factors and barriers that can facilitate or hinder the application of biosensors in resource-limited settings, we analyze the context from several angles. First, the technology of the devices themselves has to be rethought to take into account the specific needs and the available means of these countries. For this, we describe the partition of a biosensor into its functional shells, which define the information flow from the analyte to the end-user, and by following this partition we assess the strengths and weaknesses of biosensing devices in view of their specific technological development and challenging deployment in low-resource environments. Then, we discuss the problem of cost reduction by pointing out transversal factors, such as throughput and cost of mistreatment, that need to be re-considered when analyzing the cost-effectiveness of biosensing devices. Beyond the technical landscape, the compliance with regulations is also a major aspect that is described with its link to the validation of the devices and to the acceptance from the local medical personnel. Finally, to learn from a successful case, we analyze a breakthrough inexpensive biosensor that is showing high potential with respect to many of the described aspects. We conclude by mentioning both some transversal benefits of deploying biosensors in developing countries, and the key factors that can drive such applications.

Design Exploration of Affordable Refreshable Braille Display Technology for Low-Income Visually Impaired Users

2017 ◽  
Author(s):  
Anthony S. Walker ◽  
Shraddha Sangelkar
Keyword(s):  
Developing Countries ◽  
Low Income ◽  
Visually Impaired ◽  
Developed Countries ◽  
Tactile Display ◽  
Influential Factor ◽  
High Price ◽  
Digital Information ◽  
The Cost ◽  
Braille Display

People with visual disability need assistance in reading and writing by converting text to braille. Braille allows tactile display of the information for the visually impaired. Refreshable braille displays are commonly available in developed countries for a high price with the number of cells the display contains being the most influential factor on that price. Low-income blind individuals from developing countries cannot afford an expensive refreshable braille display, which in turn limits their access to digital information. The purpose to this paper is to explore design options for reducing the cost of refreshable braille displays. The paper begins with a summary of currently available refreshable braille displays on the market and their features. Next, the design requirements are explored for developing a low-cost device for visually impaired users in the developing countries. The paper also explains the state-of-the-art technologies for actuating the braille dots that may reduce the cost of the device. Finally, the recommendations for reducing the cost of these displays are presented.

scholarly journals New International Economic Order (NIEO): Origin, Elements and Criticisms

2017 ◽  
Vol 4 (3) ◽  
pp. 22
Author(s):  
Fesseha Mulu Gebremariam
Keyword(s):  
Economic Growth ◽  
International Economic ◽  
Developing Countries ◽  
International Economic Order ◽  
Developed Countries ◽  
Economic Order ◽  
Poor Countries ◽  
Secondary Sources ◽  
The Cost ◽  
New System

Employing secondary sources of data this paper aims to assess the history, elements, and criticisms against New International Economic Order (NIEO). NIEO is mainly an economic movement happened after WWII with the aim of empowering developing countries politically through economic growth. It also criticizes the existing political and economic system as benefiting developed countries at the cost of developing countries so that a new system is needed that benefits poor countries. However, many criticize NIEO as hypothetical and unorganized movement. Clear division and disagreements among its members is evident. Developing countries failed to form unity, committed to meet the objectives of NIEO, and unable to compete in the market.

PP02 Cost Effectiveness Of Tamoxifen For Breast Cancer Treatment In Ghana

2018 ◽  
Vol 34 (S1) ◽  
pp. 66-66
Author(s):  
Rebecca Addo ◽  
Stephen Goodall ◽  
Jane Hall Marion Haas
Keyword(s):  
Breast Cancer ◽  
Developing Countries ◽  
Cost Effectiveness ◽  
Adjuvant Treatment ◽  
Developed Countries ◽  
African Countries ◽  
Treatment Protocols ◽  
Effective Measure ◽  
Menopausal Women ◽  
The Cost

Introduction:In recent years, unlike developing countries, developed countries have seen an increase in the survival of women diagnosed with breast cancer and this has been attributed to early detection through screening and best treatments such as adjuvant systemic therapies with medications like Tamoxifen. The burden of breast cancer in Africa, including Ghana, lies among premenopausal women, with mean age of diagnosis being 46 years. However, survival among these women is low due to reasons such as inability to afford treatment including Tamoxifen, an older but cheaper and effective adjuvant therapy. This study therefore sought to assess the cost effectiveness of Tamoxifen compared to nothing for the adjuvant treatment of early breast cancer among pre- and peri-menopausal women in Ghana to inform funding decisions.Methods:A Markov model was developed using TreeAge pro to incorporate effectiveness, costs and utility data. Effectiveness of Tamoxifen, rate of events and utility weights were derived from published literature. Resource utilization and costs were estimated from Ghanaian clinical expert, national health insurance scheme tariffs and medicines. The analysis was conducted from the perspective of the payer.Results:Patients on Tamoxifen incurred additional costs compared to those who received nothing. The key driver of costs was the cost of Tamoxifen. However, these costs were offset by the QALY gained: 3.51. The incremental cost effectiveness ratio (ICER) was GHC 666.15 (USD 150) per QALY gained. In line with the effective measure commonly used in developing countries, the ICER per DALYs averted was GHC 219.96 (USD 50). The results were sensitive to variations in the utility weights and the cost of Tamoxifen. There were no significant differences between the ICERs of premenopausal and peri-menopausal women in a subgroup analysis.Conclusions:Compared to no treatment, Tamoxifen therapy is highly cost-effective for the adjuvant treatment of breast cancer among pre- and peri-menopausal women in Ghana. The results can be applied to other African countries with similar resource use and treatment protocols

IS THE LIFE BOAT ETHIC APPROPRIATE?

PEDIATRICS ◽  
1975 ◽  
Vol 56 (1) ◽  
pp. 81-81
Keyword(s):  
Developing Countries ◽  
Raw Materials ◽  
Developed Countries ◽  
The Rich ◽  
The Developed Countries ◽  
The Cost ◽  
Moral Legacy

Recent statements argue that we in the developed countries are in effect in a lifeboat, well supplied with resources, while many other countries are in other lifeboats without resources such as food. They argue that we should withhold these resources or risk future destruction from depletion of our own resources. As grim as this policy seems, it has many advocates today. What should the passengers on the rich lifeboat do? In answer Callahan argues that we cannot turn away from the needs of the developing countries no matter how seductive that course may seem now. For one thing, we are dependent on raw materials from them. But, more important, he points out that to bequeath a civilization of morality to our children is an even greater need, and we cannot do that by selfish isolation. "If we are to worry about our duty to posterity, it would not hurt to ask what kind of moral legacy we should bequeath. One in which we won our own survival at the cost of outright cruelty and callousness would be tawdry and vile."

scholarly journals Impact of Dispensing Services in an Independent Community Pharmacy

Pharmacy ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 44
Author(s):  
Kaleb Payne ◽  
Elizabeth J. Unni ◽  
Benjamin Jolley
Keyword(s):  
Cost Saving ◽  
Community Pharmacy ◽  
Adverse Drug Events ◽  
Minimum Cost ◽  
Improve Medication Adherence ◽  
Potential Harm ◽  
Medication Therapy ◽  
The Cost ◽  
The Impact ◽  
Care Costs

With approximately 300 prescriptions dispensed per day in a typical community pharmacy, several activities take place to ensure the safe dispensing of medicines. While some of these activities are common for all prescriptions, others need further activities such as prescription clarification. These activities are important to avoid any potential harm to the patient and improve medication adherence. The objective of this study was to measure the impact of these additional dispensing services in a community pharmacy by evaluating the documented patient notes. Two-hundred patients with annotations on their profiles between 1 July and 31 August 2018 were randomly selected and 322 notes were analyzed. The average number of notes per patient was 1.6. The majority of the notes were about contacting the patient/caregiver for prescription clarification (86.8%). When analyzed based on Medication Therapy Problems, 54.7% were related to adherence and 35.4% to safety. Using the cost saving estimate from the literature for each averted adverse event, these activities resulted in a minimum cost saving of $10,458. This study was able to show the positive impacts that everyday dispensing services in an independent community pharmacy have on ensuring the safe use of medication, thus potentially preventing adverse drug events and reducing health care costs.

scholarly journals Cost-effectiveness of teduglutide in adult patients with short bowel syndrome: Markov modeling using traditional cost-effectiveness criteria

2019 ◽  
Vol 111 (1) ◽  
pp. 141-148 ◽  
Author(s):  
Vikram K Raghu ◽  
David G Binion ◽  
Kenneth J Smith
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Short Bowel Syndrome ◽  
Adult Patients ◽  
Sensitivity Analyses ◽  
Published Data ◽  
Model Parameters ◽  
Short Bowel ◽  
Life Years ◽  
The Cost

ABSTRACT Background Adults with short bowel syndrome have a high mortality and significant morbidity due to unsuccessful attempts at rehabilitation that necessitate chronic use of parenteral nutrition (PN). Teduglutide is a novel therapy that promotes intestinal adaptation to improve rehabilitation but with a price >$400,000/y. Objective The current study evaluated the cost-effectiveness of using teduglutide in US adult patients with short bowel syndrome. Methods A Markov model evaluated the costs (in US dollars) and effectiveness (in quality-adjusted life years, or QALYs) of treatment compared with no teduglutide use, with a presumed starting age of 40 y. Parameters were obtained from published data or estimation. The primary effect modeled was the increased likelihood of reduced PN days per week when using teduglutide, leading to greater quality of life and lower PN costs. Sensitivity analyses were performed on all model parameters. Results In the base scenario, teduglutide cost $949,910/QALY gained. In 1-way sensitivity analyses, only reducing teduglutide cost decreased the cost/QALY gained to below the typical threshold of $100,000/QALY gained. Specifically, teduglutide cost would need to be reduced by >65% for it to reach the threshold value. Probabilistic sensitivity analysis favored no teduglutide use in 80% of iterations at a $100,000/QALY threshold. However, teduglutide therapy was cost-saving in 13% of model iterations. Conclusions Teduglutide does not meet a traditional cost-effectiveness threshold as treatment for PN reduction in adult patients with short bowel syndrome compared with standard intestinal rehabilitation. Subpopulations that demonstrate maximum benefit could be cost-saving, and complete nonuse could lead to financial loss. Teduglutide becomes economically reasonable only if its cost is substantially reduced.

scholarly journals Building Information Modelling in Cameroon

2016 ◽  
pp. 145-172
Author(s):  
F. H. Abanda ◽  
M. B. Manjia ◽  
C. Pettang ◽  
Joseph H. M. Tah ◽  
G. E. Nkeng
Keyword(s):  
Developing Countries ◽  
Pilot Study ◽  
Research Methods ◽  
Developed Countries ◽  
African Countries ◽  
Building Information Modelling ◽  
Francophone Africa ◽  
Information Modelling ◽  
Building Information ◽  
The Cost

BIM has recently gained ground in developed countries. However, the use of BIM in developing countries including Cameroon is not well-known. In this study, BIM implementation in Cameroon is explored. The research methods used are a pilot study, electronic email surveys and in-depth phone interviews. Altogether, 179 professionals having at least a Master's Degree in Civil Engineering from the National Advanced School of Engineering Yaoundé I - Cameroon, a leading engineering institution in Francophone Africa, were sampled. Forty six provided feedback yielding a response rate of 25.7%. It emerged that some BIM software are already being used in Cameroon. However, major barriers hindering BIM uptake are high license fee and lack of huge projects that can pay off the cost of investment in BIM. Perhaps, partly because the respondents were highly skilled, it emerged that the lack of expertise was/is not a major problem to use BIM in projects. Although this study is limited to Cameroon, many recommendations could be relevant to other African countries.

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