scholarly journals Lowering drug prices and enhancing pharmaceutical affordability: an analysis of the national volume-based procurement (NVBP) effect in China

2021 ◽  
Vol 6 (9) ◽  
pp. e005519
Author(s):  
Jing Yuan ◽  
Z Kevin Lu ◽  
Xiaomo Xiong ◽  
Bin Jiang
Keyword(s):  
Multifaceted Approach ◽  
Pilot Programme ◽  
Drug Prices ◽  
Insurance Programme ◽  
The Mean ◽  
Lowering Drug ◽  
Daily Wage ◽  
The Cost ◽  
The Impact ◽  
Health Insurance Programme

To cope with the increasing healthcare costs brought about by the universal health insurance programme, national volume-based procurement (NVBP) was implemented in China to reduce drug prices. However, the impact of NVBP remains unknown. We reported the effects of the NVBP pilot programme on medication affordability and discussed the challenges and recommendations for further reforms. A total of 25 molecules won the bidding in the NVBP pilot programme, and price cuts ranged from 25% to 96%. Medication affordability was measured as the number of days’ wages needed to pay for a course of treatment, and the medication was identified as affordable if the cost of a treatment course was less than the average daily wage. After the NVBP, the proportion of affordable drugs increased from 33% to 67%, and the mean affordability improved from 8.2 days’ wages to 2.8 days’ wages. Specifically, for rural residents, the proportion of affordable drugs increased from 13% to 58%, and the mean affordability improved from 15.7 days’ wages to 5.3 days’ wages. For urban residents, the proportion of affordable drugs increased from 54% to 71%, and the mean affordability improved from 5.9 days’ wages to 2.0 days’ wages. Implementing the NVBP substantially improved medication affordability. In future reforms, a multifaceted approach addressing all issues in the health system is needed to enhance medicine access.

scholarly journals Addition of Flucytosine to Fluconazole for the Treatment of Cryptococcal Meningitis in Africa: A Multicountry Cost-effectiveness Analysis

2019 ◽  
Vol 70 (1) ◽  
pp. 26-29 ◽  
Author(s):  
Tinevimbo Shiri ◽  
Angela Loyse ◽  
Lawrence Mwenge ◽  
Tao Chen ◽  
Shabir Lakhi ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cryptococcal Meningitis ◽  
Cost Effective ◽  
Immunodeficiency Virus ◽  
The Mean ◽  
The Cost ◽  
The Impact ◽  
Costing Analysis ◽  
Very High

Abstract Background Mortality from cryptococcal meningitis remains very high in Africa. In the Advancing Cryptococcal Meningitis Treatment for Africa (ACTA) trial, 2 weeks of fluconazole (FLU) plus flucytosine (5FC) was as effective and less costly than 2 weeks of amphotericin-based regimens. However, many African settings treat with FLU monotherapy, and the cost-effectiveness of adding 5FC to FLU is uncertain. Methods The effectiveness and costs of FLU+5FC were taken from ACTA, which included a costing analysis at the Zambian site. The effectiveness of FLU was derived from cohorts of consecutively enrolled patients, managed in respects other than drug therapy, as were participants in ACTA. FLU costs were derived from costs of FLU+5FC in ACTA, by subtracting 5FC drug and monitoring costs. The cost-effectiveness of FLU+5FC vs FLU alone was measured as the incremental cost-effectiveness ratio (ICER). A probabilistic sensitivity analysis assessed uncertainties and a bivariate deterministic sensitivity analysis examined the impact of varying mortality and 5FC drug costs on the ICER. Results The mean costs per patient were US $847 (95% confidence interval [CI] $776–927) for FLU+5FC, and US $628 (95% CI $557–709) for FLU. The 10-week mortality rate was 35.1% (95% CI 28.9–41.7%) with FLU+5FC and 53.8% (95% CI 43.1–64.1%) with FLU. At the current 5FC price of US $1.30 per 500 mg tablet, the ICER of 5FC+FLU versus FLU alone was US $65 (95% CI $28–208) per life-year saved. Reducing the 5FC cost to between US $0.80 and US $0.40 per 500 mg resulted in an ICER between US $44 and US $28 per life-year saved. Conclusions The addition of 5FC to FLU is cost-effective for cryptococcal meningitis treatment in Africa and, if made available widely, could substantially reduce mortality rates among human immunodeficiency virus–infected persons in Africa.

scholarly journals Cost Minimisation Study of the Impact of Generic Drugs on Glaucoma Management: 1-year Indian Experience

1970 ◽  
Vol 12 (4) ◽  
pp. 192-196
Author(s):  
Devindra Sood ◽  
Alka Pandey ◽  
Rajeev Sood ◽  
Nagesh Gupta ◽  
Ravinder Kumar Bajaj ◽  
...  
Keyword(s):  
Generic Drugs ◽  
Open Angle Glaucoma ◽  
Eye Drops ◽  
Brand Name ◽  
Cost Difference ◽  
Medication Costs ◽  
Generic Medications ◽  
The Mean ◽  
The Cost ◽  
The Impact

Aim: To study the medication costs of various topical glaucoma medications using data collected from real world use by patients.Methods: Patients with primary open angle glaucoma treated at glaucoma clinics in 5 hospitals (1 rural and 4 urban) in northern India from 1 January to 30 June 2008 were enrolled. The number of days each bottle of medication lasted was recorded, and the mean cost per day was computed from the maximum retail price and mean number of days each medication lasted.Results: 790 of 801 eligible patients completed the study. The mean number of days that a bottle of medication lasted was found to be highest for Xalatan® and Xalacom® at 35.23 days and 35.00 days, respectively. The brand name prostaglandin analogues all lasted for a mean of more than 30 days: Xalatan, 35.23 days (SD, 4.14 days); Lumigan®, 31.37 days (SD, 5.31 days); and Travatan®, 34.84 days (SD, 6.51 days), while the generic eye drops lasted for about 21 days: latanoprost, 20.69 days (SD, 3.69 days) and bimatoprost, 21.39 days (SD, 4.34 days). The cost of the generic medication was less than the brand name medication in all groups (for example, bimatoprost, Indian rupees 9.76 versus Indian rupees 12.33) except for brimonidine/timolol (Indian rupees 8.73 versus Indian rupees 8.66). Further analysis in 2009 showed that, for latanoprost, brimonidine and brimonidine/timolol, the difference between the brand name and generic medications decreased in 2009 over 2008 (in the latanoprost group, the cost difference over the year reduced from Indian rupees 592 in 2008 to Indian rupees 523 in 2009); the cost difference for bimatoprost increased from 2008 to 2009.Conclusion: When both cost and number of days a bottle lasts were considered over the long term, use of generic medications might not minimise the cost of glaucoma medical management by much when compared with the brand name medication.

Capturing the Financial Impact of Heparin-Induced Thrombocytopenia.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3127-3127 ◽  
Author(s):  
Maureen A. Smythe ◽  
John M. Koerber ◽  
Joan C. Mattson
Keyword(s):  
Control Patient ◽  
Hospital Cost ◽  
Financial Impact ◽  
Case Patient ◽  
Heparin Induced Thrombocytopenia ◽  
The Mean ◽  
Cost Calculations ◽  
The Cost ◽  
And Control ◽  
The Impact

Abstract Data evaluating the financial impact of heparin-induced thrombocytopenia (HIT) (a severe adverse drug reaction which can result in life threatening thrombosis) is lacking. The goal of this case-control study was to evaluate the financial impact of HIT. Case patients were those with a new diagnosis of HIT from April 2003 to March 2004 for whom matched controls were available. Controls for each case patient were matched for the DRG under which the hospital was reimbursed, the patient’s primary diagnosis code and their primary procedure code. Case patients required identification of >1 control for inclusion. The hospital’s financial database was queried for length of stay (LOS), total cost, and reimbursement. For each case patient, the cost and reimbursement were compared to the cost and reimbursement for each group of matched controls. In an effort to eliminate the impact of variable reimbursement, a subset of only Medicare case and control patients was also evaluated. Of 72 new HIT patients, matched controls were identified for 31. The mean LOS for the case and control patients was 22.8 and 11.6 days respectively (p=0.006). The mean hospital cost of case and control patients was $55,440 and $26,505 respectively. From reimbursement minus cost calculations, our institution lost an average of $13,429 per HIT patient compared to an average of $393 per control patient (p=0.005). The mean LOS for Medicare cases (n=21) and matched Medicare controls was 26 and 14.6 days respectively (p=0.041). The mean hospital cost of Medicare case and control patients was $58,842 and $30,210 respectively. From reimbursement minus cost calculations for the Medicare subset, our institution lost an average of $20,229 per HIT case compared to $1844 per control patient (p<0.0001). Assuming 72 new cases of HIT per year, our institution incurs a projected annual financial loss of $980,000 from HIT. The use of alternate anticoagulants, although having a higher acquisition cost, may offset this loss through HIT avoidance.

Wastage of conserved fodder when feeding livestock

2010 ◽  
Vol 50 (6) ◽  
pp. 400 ◽  
Author(s):  
C. R. Stockdale
Keyword(s):  
Beef Cattle ◽  
Dairy Cattle ◽  
Present Review ◽  
Factors Affecting ◽  
Storage Method ◽  
The Mean ◽  
Main Factors ◽  
Wet Weather ◽  
The Cost ◽  
The Impact

The objective of the present review was to establish levels of conserved fodder wastage when feeding livestock (sheep, beef cattle, dairy cattle) under various conditions and using various feed-out systems, and to determine the factors affecting wastage. The mean wastage of hay recorded in the literature reviewed was 17% of the DM offered, but the range was from 4 to 77%. The main factors affecting the degree of wastage were storage method, packaging method, method of feeding out, amount of fodder on offer and its palatability and/or quality and the impact of wet weather. Although the emphasis was on hay, the principles should also apply to silage. If wastage was 40% rather than 5%, the cost of feeding conserved fodder to livestock would be a third greater than producers might expect or budget on.

Understanding the impacts of NPM and proposed solutions to the healthcare system reforms in Indonesia: the case of BPJS

2020 ◽  
Vol 35 (3) ◽  
pp. 346-353
Author(s):  
Erniaty Erniaty ◽  
Harun Harun
Keyword(s):  
Health Insurance ◽  
Healthcare System ◽  
New Public Management ◽  
Healthcare Services ◽  
Unintended Consequences ◽  
Healthcare Sector ◽  
Social Security Administration ◽  
Insurance Programme ◽  
The Impact ◽  
Health Insurance Programme

Abstract This study critically evaluates the adoption of a universal healthcare system recently introduced by the Indonesian government in 2014. Our study is driven by the lack of critical analysis of social and political factors and unintended consequences of New Public Management, which is evident in the healthcare sector reforms in emerging economies. This study not only examines the impact of economic and political forces surrounding the introduction of a universal health insurance programme in the country but also offers insights into the critical challenges and undesirable outcomes of a fundamental reform of the healthcare sector in Indonesia. Through a systematic and detailed review of prior studies, legal sources and reports from government and media organizations about the implementation and progress of an UHC health insurance programme in Indonesia, the authors find that a more democratic political system that emerged in 1998 created the opportunity for politicians and international financial aid agencies to introduce a universal social security administration agency called Badan Penyelenggara Jaminan Sosial (BPJS). Despite the introduction of BPJS to expand the health services’ coverage, this effort faces critical challenges and unintended outcomes including: (1) increased financial deficits, (2) resistance from medical professionals and (3) politicians’ tendency to blame BPJS’s management for failing to pay healthcare services costs. We argue that the adoption of the insurance system was primarily motivated by politicians’ own interests and those of international agencies at the expense of a sustainable national healthcare system. This study contributes to the healthcare industry policy literature by showing that a poorly designed UHC system could and will undermine the core values of healthcare services. It will also threaten the sustainability of the medical profession in Indonesia. The authors offer several suggestions for devising better policies in this sector in the developing nations.

scholarly journals Paying for convenience: comparing the cost of takeaway meals with their healthier home-cooked counterparts in New Zealand

2017 ◽  
Vol 20 (13) ◽  
pp. 2269-2276 ◽  
Author(s):  
Sally Mackay ◽  
Stefanie Vandevijvere ◽  
Pei Xie ◽  
Amanda Lee ◽  
Boyd Swinburn
Keyword(s):  
New Zealand ◽  
Saturated Fat ◽  
Preparation Time ◽  
Cost Impact ◽  
The Mean ◽  
Cost Of Time ◽  
The Cost ◽  
Mean Cost ◽  
The Impact ◽  
Cost Differences

AbstractObjectiveConvenience and cost impact on people’s meal decisions. Takeaway and pre-prepared foods save preparation time but may contribute to poorer-quality diets. Analysing the impact of time on relative cost differences between meals of varying convenience contributes to understanding the barrier of time to selecting healthy meals.DesignSix popular New Zealand takeaway meals were identified from two large national surveys and compared with similar, but healthier, home-made and home-assembled meals that met nutrition targets consistent with New Zealand Eating and Activity Guidelines. The cost of each complete meal, cost per kilogram, and confidence intervals of the cost of each meal type were calculated. The time-inclusive cost was calculated by adding waiting or preparation time cost at the minimum wage.SettingA large urban area in New Zealand.ResultsFor five of six popular meals, the mean cost of the home-made and home-assembled meals was cheaper than the takeaway meals. When the cost of time was added, all home-assembled meal options were the cheapest and half of the home-made meals were at least as expensive as the takeaway meals. The home-prepared meals were designed to provide less saturated fat and Na and more vegetables than their takeaway counterparts; however, the home-assembled meals provided more Na than the home-made meals.ConclusionsHealthier home-made and home-assembled meals were, except one, cheaper options than takeaways. When the cost of time was added, either the home-made or the takeaway meal was the most expensive. This research questions whether takeaways are better value than home-prepared meals.

Cost of depression: effect of adherence and treatment response

2006 ◽  
Vol 21 (6) ◽  
pp. 349-354 ◽  
Author(s):  
L. von Knorring ◽  
A.-C. Åkerblad ◽  
F. Bengtsson ◽  
Å. Carlsson ◽  
L. Ekselius
Keyword(s):  
Quality Of Life ◽  
Major Depression ◽  
Treatment Response ◽  
Controlled Trial ◽  
Indirect Costs ◽  
The Mean ◽  
Cost Of Drugs ◽  
The Cost ◽  
The Impact

AbstractObjectives:The purpose of the present study has been to assess the societal cost of major depression and the distribution into different cost components. The impact of adherence and treatment response was also explored.Method:Data were collected from a randomized controlled trial of patients with major depressive disorder who were treated in a naturalistic primary care setting. Resource use and quality of life were followed during the two-year trial.Results:The mean total cost per patient during two years was KSEK 363 (EUR 38 953). Indirect costs were the most important component (87%), whereas the cost of drugs was minor (4.5%). No significant differences in costs or quality of life between treatment arms or between adherent and non-adherent patients were demonstrated. However, treatment responders had 39% lower total costs per patient and experienced a larger increase in quality of life compared to non-responders.Conclusions:Major depression has high costs for society, primarily due to indirect costs. Treatment responders have considerably lower costs per patient and higher quality of life than non-responders. This indicates that measures to increase response rates are also important from an economic perspective.

Routine Use of Platelet Components Prepared with Photochemical Treatment (INTERCEPT Platelets) : Impact on Clinical Outcomes and Costs.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3629-3629 ◽  
Author(s):  
Jean Claude Osselaer ◽  
Chantal Doyen ◽  
Anne Sonet ◽  
Maryse Van Hooydonk ◽  
Edith Goossenaerts ◽  
...  
Keyword(s):  
Gamma Irradiation ◽  
Average Dose ◽  
Before And After ◽  
Integrated Processing ◽  
Component C ◽  
The Mean ◽  
The Cost ◽  
The Impact ◽  
Care Costs ◽  
Donor Recruitment

Abstract Background: In 2003 the Blood Transfusion Ctr (BTC), Cliniques Universitaires Mont Godinne (CU-MG) initiated routine use of INTERCEPT Platelets (I-P) for transfusion support of thrombocytopenia. To examine the impact of I-P on patient outcomes and costs, the rate of acute transfusion reactions (ATR) for platelet (PLT) and red cell (RBC) transfusions (txn) were compared for 285 days (d) before I-P adoption, when only conventional platelets (C-P) were used, and for 255 d after adoption of I-P for routine use. Since preparation of RBC did not change, the relative rates of PLT-ATR and RBC-ATR in the 2 periods were used to assess the impact of I-P on ATR. Methods: In both periods, PLT were collected on the Amicus Cell Separator (Baxter) with process leuko-reduction. For C-P, T-Sol (Baxter) with a ratio to plasma of ~ 70:30 % was used; and for I-P, Intersol (Baxter)with a ratio to plasma of ~ 65:35 % was used. I-P containing 2.5 to 6.0 x 1011 plts in ~ 300 mL were prepared with an integrated processing set using amotosalen (S-59, 150 uM) and UVA (3 J/cm2) to inactivate pathogens and leukocytes. As for C-P, I-P were issued the d after collection and were stored for up to 5 d. The Hematology Service reported PLT and RBC ATR (febrile and non-febrile ATR occurring within 24 hr of txn) to the BTC. HLA and PLT antibodies (AB+/AB−) were determined by the BTC in pts with suspected alloimmunization. Factors impacting costs for PLT, before and after adoption of I-P, were assessed by the BTC. Results: Days of observation before and after adoption of I-P were similar (Table). More pts received I-P, due to an increase of CV surgery pts after I-P adoption. The mean plt dose was 2% lower with I-P (4.06 vs 4.15 x 1011), and the number of PLT txn/pt was 8% higher for I-P. The rate of ATR to PLT txn with I-P showed a declining trend (p =0.08) , while the rate of ATR to RBC txn was similar in the 2 periods (p = 0.55). Before and after I-P, 16.5 and 9.3 % of pts receiving plt had PLT ATR, respectively. The decrease was largely due to fewer ATR in pts without AB detected (AB-). Adoption of I-P did not require addition of personnel to the BTC, nor delay time of PLT issue. I-P did not affect the number of plt donors required to support the CU-MG patient population. I-P replaced gamma irradiation for prevention of txn-associated GVHD and avoided use of routine bacterial testing for PLT. Conclusions: Use of I-P resulted in a trend of decreased incidence for ATR to PLT txn on a per txn and per pt basis compared to RBC ATR. The average dose of I-P was minimally lower than C-P, and the number of PLT txn/pt was slightly increased. Adoption of I-P did not adversely impact the cost of donor recruitment or donor utilization nor the cost of BTC personnel. I-P avoided the cost of gamma irradiation and routine bacterial cultures. I-P offer the potential to reduce patient care costs due to reduced ATR. Impact of I-P Adoption Component C-P C-RBC I-P C-RBC Period Before Before After After na = not available Days 285 285 255 255 Patients 103 na 129 na Hem-Onc 47% na 44% na CV Surgery 35% na 47% na TXN (units) 1466 5110 1990 4895 ATR : No. TXN (%) 23 (1.57%) 18 (0.35%) 18 (0.90%) 21 (0.42%) AB+/AB- 6/13 3/15 6/7 4/17 TXN/Patient 14.2 na 15.4 na

Multicentric descriptive study of the lung cancer treatment

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 20109-20109
Author(s):  
M. Quintana ◽  
C. Pallares ◽  
I. Martinez ◽  
I. Gich ◽  
X. Bonfill
Keyword(s):  
Lung Cancer ◽  
Cancer Treatment ◽  
Clinical Characteristics ◽  
Descriptive Study ◽  
Small Cell ◽  
Lung Cancer Treatment ◽  
The Mean ◽  
Clinical Records ◽  
The Cost ◽  
The Impact

20109 Background: Given the insufficient available information on the clinical characteristics and the results of the lung cancer treatment at a population level, we performed a large multicentric descriptive study in the main hospitals in our city. Methods: We analyzed the patients diagnosed and treated for lung cancer during 1999 in five University Hospitals in Barcelona (Spain). We performed a retrospective analysis of the individual data obtained from the clinical records using a specifically validated questionnaire. A descriptive analysis was performed, stratifying for type of tumor, stage, and institution. The follow-up for the complete population was 5 years. Results: We included 836 patients (94.6% male, 5.4% female) with an average age of 64 years. Karnofsky was ≥ 70% in 85% of patients. Histologic distribution was non-small cell (NSCLC) 85.5%, small-cell (SCLC) 14.5%. 42% of cases were stage IV (38% NSCLC, 67.8% SCLC). First treatment was performed in 82% of cases with therapeutic intention (52% was chemotherapy). Pulmonary resection with lobectomy and platinum-based chemotherapy were the more frequent treatments. Complete remission was obtained in 25% of cases. Survival was 42.0, 17.9 and 12.6% at 1, 3 and 5 years respectively (NSCLC: 43.8, 19.4, 13.1%; SCLC: 31.9, 9.5, 9.5%). The mean interval first visit - treatment start was 2 months. The mean of direct costs per patient was 9000 €. The cost per life-year gained was 5200 € for NSCLC and 7600 € for SCLC patients. Conclusions: The obtained results allow to describe the clinical characteristics of a wide cohort of patients diagnosed of lung cancer and their survival to 5 years. Globally, these results are similar to those who have been published in our country and others, and constitute a very thorough referent for assessing the impact of future therapeutic advances. The comparison among hospitals can also be the matter of further analysis for identifying the causes of the observed differences. Equally, specific strategies for some patients’ subgroups could be designed in order to improve the cost-effectiveness of their treatment. No significant financial relationships to disclose.

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