scholarly journals Nonsevere Hypoglycemia Episode Clinical and Economic Outcomes: A Comparison between Sulfonylurea and Sodium-Glucose Cotransporter 2 Inhibitor as Add-On to Metformin from a Canadian Perspective

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Pendar Farahani
Keyword(s):  
Sensitivity Analysis ◽  
Work Productivity ◽  
Indirect Costs ◽  
Risk Difference ◽  
Economic Outcomes ◽  
Economic Evaluations ◽  
Clinical Settings ◽  
Sodium Glucose Cotransporter ◽  
Number Of Patients ◽  
Out Of Pocket Costs

Background. Nonsevere hypoglycemia episodes (NSHEs) are associated with clinically adverse outcomes, lower health-related quality of life, increased burden of disease, and reduced work productivity. Objective. To estimate prevalence of NSHEs and associated economic outcomes attributable to sulfonylurea (SU) versus sodium-glucose cotransporter 2 inhibitor (SGLT2i) initiation after metformin over one year for Canadian patients with type 2 diabetes (T2DM). Methods. Risk difference for NSHEs was calculated for SU and SGLT2i from RCT data. Estimation of NSHEs attributable to SU utilization in Canada was calculated from published data. Both direct and indirect costs associated with NSHEs were obtained from previous published studies in literature. Results. The number of patients with T2DM and exposure to SU in Canada in 2016 was estimated to be 1,246,438. The average underreported NSHEs in clinical settings were estimated at 67.7%. Risk difference for NSHEs for SU versus SGLT2i was estimated at 26.7%. Estimation of excess NSHEs attributable to SU utilization versus SGLT2i in Canada was estimated at 130,434 events per year (sensitivity analysis: minimum 80,680 and maximum 624,465). Total indirect costs including loss-of-work productivity and out-of-pocket costs secondary to excess NSHEs due to SU utilization versus SGLT2i after metformin were estimated at CDN$8.6M (M = millions) for 2016 (sensitivity analysis: minimum CDN$5.3M and maximum CDN$81.2M). Conclusion. NSHE, which is a forgotten variable in economic evaluations for healthcare reimbursement models, occurs frequently in real-world clinical settings but is infrequently reported. NSHEs can lead to a significant loss-of-work productivity and out-of-pocket costs.

PP38 Productivity Loss In Patients With Chronic Diseases: A Pooled Analysis

2019 ◽  
Vol 35 (S1) ◽  
pp. 44-44
Author(s):  
Omar Rashdan ◽  
Valentin Brodszky
Keyword(s):  
Productivity Loss ◽  
Indirect Costs ◽  
Working Hours ◽  
Female Gender ◽  
Pooled Analysis ◽  
Economic Evaluations ◽  
Cross Sectional ◽  
Female Population ◽  
Number Of Patients ◽  
Lost Productivity

IntroductionDue to the unprecedented increase in medicine prices in recent years, the socio-economic perspective started gaining importance in health economic evaluations. Productivity loss evaluations provide a long-term economic impact visualization for a more informed reimbursed medicine decisions.MethodsA pooled analysis of patient-level data from 11 cross-sectional, retrospective, cost-of-illness studies was performed. SPSS software was used for our statistical analysis. Analysis of variance (ANOVA) and correlation analysis were utilized to measure the effect of different variables on lost productivity hours. All costs were recalculated to account for the cumulative inflation till 2018.ResultsThe sample size of included studies ranged between 68 (Multiple Sclerosis) and 480 (Diabetes), and the total number of patients enrolled in the analysis was 1,881 of which 956 were female. A total of 6,795 hours were reported as missed working hours per year. Overall, the female population reported a mean of 689.5 lost productive hours compared to 324.7 in males (p < 0.001). This translated into higher indirect costs at EUR 2,748 and EUR 1,530 for females and males, respectively. Patients with a college degree or higher reported lower yearly lost productive hours and indirect costs (358.4 hours and EUR 1,749) (p < 0.001) compared to patients with lower education level (845.6 hours and EUR 3,534) (p < 0.001). The average indirect cost as a percentage of gross domestic product per capita was highest in Schizophrenia patients at 97.5 percent and lowest in Benign Prostatic Hyperplasia at 1.9 percent. In patients below 65 years of age, a weak positive correlation was observed between age and lost productive hours with a Pearson value of 0.1 (p < 0.001).ConclusionsFemale gender and older age resulted in higher productivity loss, and Schizophrenia was the disease with the highest indirect costs per patient per year.

scholarly journals Model of Short and Long-Term Outcomes of Emicizumab Prophylaxis Treatment for Persons with Hemophilia Α

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3511-3511 ◽  
Author(s):  
Arash Mahajerin ◽  
Zheng-Yi Zhou ◽  
Karina Raimundo ◽  
Anisha Patel ◽  
Simeng Han ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Societal Perspective ◽  
Research Funding ◽  
Hemophilia A ◽  
Indirect Costs ◽  
Economic Outcomes ◽  
Inhibitor Development ◽  
Time Horizons ◽  
The Us

Abstract Introduction: Persons with hemophilia A (PwHA) can experience bleeds that result in pain, disability, and a decrease in quality of life over time. Emicizumab is a Food and Drug Administration-approved bispecific antibody to factors IXa/X for prophylaxis of PwHA with inhibitors. Emicizumab was evaluated for the treatment of PwHA without inhibitors in the HAVEN 3 trial. However, its long-term impact is still unknown. This model aimed to estimate the lifetime clinical and economic outcomes of prophylaxis with emicizumab versus factor VIII (FVIII) replacement in persons with severe hemophilia A (HA). Methods: An Excel-based Markov model was developed to predict long-term clinical and economic outcomes associated with HA treatment options from the US societal perspective. In the model base-case, a hypothetical cohort of patients aged 1 year with severe HA without inhibitors were assigned to prophylaxis with emicizumab or FVIII. Patients in both arms could receive FVIII episodic treatment for breakthrough bleeds. In the model, patients could experience serious adverse events, develop FVIII inhibitors (based on FVIII exposure days), undergo immune therapy induction, develop arthropathy (conditional on number of joint bleeds and Pettersson score), and undergo orthopedic surgery (based on achieving a Pettersson score of 28). Indirect costs associated with productivity loss due to missed work or disabilities were also estimated and applied when patients would be in working age (18-65 years). Patients were assumed to receive life-long treatment. Model inputs were obtained from the HAVEN trials, published literature, and expert opinion. One-way sensitivity analysis was performed to assess inputs that were influential on the model outcomes. We report number of treated bleeds, mean age at inhibitor development, mean age at arthropathy onset, number of orthopedic surgeries, and total direct medical and indirect productivity costs. Outcomes are reported over 1 year, 5 years and lifetime time horizons. Cost results were inflation-adjusted to 2017 USD. Scenario analysis of moderate and severe PwHA was also performed. Results: The number of treated bleeds and joint bleeds was consistently lower for patients in the emicizumab arm across all time horizons (emicizumab vs. FVIII treated bleeds 1 year: 1.5 vs. 5.8; 5 years: 7.4 vs. 29.1; lifetime: 125.7 vs. 444.0; Joint bleeds 1 year: 1.1 vs. 3.6; 5 years: 5.4 vs. 17.8; lifetime: 92.2 vs. 273.3). Consequently, arthropathy onset (defined as Pettersson score ≥1) was postponed for patients receiving emicizumab versus FVIII prophylaxis (mean age at arthropathy onset: 12.9 vs. 5.4 years). Orthopedic surgeries were rare events in both emicizumab and FVIII arms (0.0 vs. 0.2). FVIII inhibitor development was also delayed in the emicizumab arm (mean age at inhibitor development: 13.9 vs. 1.1 years). Total cumulative direct and indirect costs were lower for emicizumab prophylaxis compared with FVIII prophylaxis for all time horizons (1 year: $97,127 vs. $312,020; 5 years: $603,057 vs. $1,281,059; lifetime: $15,373,443 vs. $20,134,246). Sensitivity analysis indicated that results were driven by drug list price, dosing schedule, and differences in efficacy rate. Results for moderate and severe PwHA were consistent with findings in the severe HA-only population. Conclusions: The model suggests that prophylaxis treatment of HA with emicizumab can result in a lower number of bleeding events as well as delayed onset of arthropathy and inhibitor development. Findings indicate that prophylaxis with emicizumab leads to better patient outcomes and has a lower financial impact from the US societal perspective. Disclosures Mahajerin: Genentech Inc.: Consultancy. Zhou:Analysis Group, Inc.: Employment; Celgene Corporation: Research Funding. Raimundo:Genentech Inc: Employment, Other: Ownership interests PLC. Patel:Genentech Inc: Employment. Han:Analysis Group Inc.: Research Funding. Ji:Analysis Group Inc.: Research Funding. Zhong:Analysis Group Inc.: Research Funding. Betts:Analysis Group Inc.: Research Funding.

Measuring Effectiveness

2018 ◽  
Author(s):  
Jacob Stegenga
Keyword(s):  
Outcome Measures ◽  
Relative Risk Reduction ◽  
Drug Approval ◽  
Target Population ◽  
Risk Difference ◽  
General Context ◽  
Measuring Instruments ◽  
Clinical Settings ◽  
Medical Interventions ◽  
Regulatory Standards

There are three methodological challenges to measuring the effectiveness of medical interventions: the choice of good measuring instruments, the use of appropriate analytic measures, and the use of a reliable method of extrapolating measures from an experimental context to a more general context. In practice each of these challenges contributes to overestimating the effectiveness of medical interventions. These challenges suggest corrective principles. The instruments employed in clinical research should measure patient-relevant and disease-specific parameters. Effectiveness always should be measured and reported using absolute outcome measures (such as ‘risk difference’), and we should employ caution when interpreting relative outcome measures (such as ‘relative risk reduction’). Extrapolating from research settings to clinical settings should more rigorously take into account possible ways in which interventions can fail to be effective in a target population. Current regulatory standards for drug approval are insufficient to manage these problems of measurement.

Out-of-Pocket Costs and Importance of Nonmedical and Indirect Costs of Inpatients

2021 ◽  
Vol 24 ◽  
pp. 141-147
Author(s):  
Asma Sabermahani ◽  
Mohammad Jafari Sirizi ◽  
Farzaneh Zolala ◽  
Sonia Nazari
Keyword(s):  
Indirect Costs ◽  
Out Of Pocket Costs

Effectiveness of antimicrobial hospital curtains on reducing bacterial contamination—A multicenter study

2018 ◽  
Vol 40 (2) ◽  
pp. 164-170 ◽  
Author(s):  
Shik Luk ◽  
Viola Chi Ying Chow ◽  
Kelvin Chung Ho Yu ◽  
Enoch Know Hsu ◽  
Ngai Chong Tsang ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Bacterial Contamination ◽  
Indirect Costs ◽  
Multidrug Resistant ◽  
Clinical Settings ◽  
Carbapenem Resistant ◽  
Colony Forming Units ◽  
Multidrug Resistant Organisms ◽  
Bed Days

AbstractObjectiveTo determine the efficacy of 2 types of antimicrobial privacy curtains in clinical settings and the costs involved in replacing standard curtains with antimicrobial curtains.DesignA prospective, open-labeled, multicenter study with a follow-up duration of 6 months.SettingThis study included 12 rooms of patients with multidrug-resistant organisms (MDROs) (668 patient bed days) and 10 cubicles (8,839 patient bed days) in the medical, surgical, neurosurgical, orthopedics, and rehabilitation units of 10 hospitals.MethodCulture samples were collected from curtain surfaces twice a week for 2 weeks, followed by weekly intervals.ResultsWith a median hanging time of 173 days, antimicrobial curtain B (quaternary ammonium chlorides [QAC] plus polyorganosiloxane) was highly effective in reducing the bioburden (colony-forming units/100 cm2, 1 vs 57; P < .001) compared with the standard curtain. The percentages of MDRO contamination were also significantly lower on antimicrobial curtain B than the standard curtain: methicillin-resistant Staphylococcus aureus, 0.5% vs 24% (P < .001); carbapenem-resistant Acinetobacter spp, 0.2% vs 22.1% (P < .001); multidrug-resistant Acinetobacter spp, 0% vs 13.2% (P < .001). Notably, the median time to first contamination by MDROs was 27.6 times longer for antimicrobial curtain B than for the standard curtain (138 days vs 5 days; P = .001).ConclusionsAntimicrobial curtain B (QAC plus polyorganosiloxane) but not antimicrobial curtain A (built-in silver) effectively reduced the microbial burden and MDRO contamination compared with the standard curtain, even after extended use in an active clinical setting. The antimicrobial curtain provided an opportunity to avert indirect costs related to curtain changing and laundering in addition to improving patient safety.

scholarly journals Economic Evaluations of Cabazitaxel for Treatment of Post-docetaxel Metastatic Castration-resistant Prostate Cancer: Evidence from a Systematic Review

2019 ◽  
pp. 1-8
Author(s):  
Nikinaz Ashrafi Shahmirzadi ◽  
Pardis Zaboli ◽  
Monireh Afzali ◽  
Bereket Molla Tigabu ◽  
Mirhamed Hajimiri ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Cost Effective ◽  
Bibliographic Databases ◽  
Economic Evaluations ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Radium 223 ◽  
Number Of Patients ◽  
Effective Option

Background and Objectives: Prostate cancer is an ever-increasing global incidence and has become the fifth leading cause of cancer-related mortality in men. A significant number of patients with prostate cancer develop metastatic castration-resistant prostate cancer (mCRPC). There are a few second-line treatment options for patients with post-docetaxel mCRPC. This systematic review aimed to assess the cost-effectiveness of cabazitaxel for the treatment of mCRPC. Materials and Methods: Electronic bibliographic databases including: PubMed/Medline, NICE, CRD, and Scopus were searched in January 2018 for identifying full economic evaluations published in English and Persian. The risk of assessment bias and descriptive analyses of individual studies’ findings were presented. Results: Three articles that fulfilled the inclusion criteria were included in the current study. All the included records had a reasonable quality. Cabazitaxel was not recommended as the most cost-effective option for the treatment of docetaxel-refractory mCRPC. Abiraterone acetate and radium-223 were the recommended cost-effective treatments for mCRPC treatment. Conclusion: We found that, in general, while cabazitaxel had equal or slightly higher improvement in Quality-adjusted Life Year (QALY) as compared to the alternatives, it incurred a high cost. Despite the inclusion of a few studies in this review, cabazitaxel was not found to be a cost-effective option. Therefore, we recommend full economic evaluations to be conducted in this area.

Budget impact analysis of trastuzumab in early breast cancer: A hospital district perspective

2010 ◽  
Vol 26 (2) ◽  
pp. 163-169 ◽  
Author(s):  
Timo T. Purmonen ◽  
Päivi K. Auvinen ◽  
Janne A. Martikainen
Keyword(s):  
Breast Cancer ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Early Breast Cancer ◽  
Probabilistic Sensitivity Analysis ◽  
Budget Impact ◽  
Base Case ◽  
Adjuvant Trastuzumab ◽  
Hospital District ◽  
Number Of Patients

Objectives:Adjuvant trastuzumab is widely used in HER2-positive (HER2+) early breast cancer, and despite its cost-effectiveness, it causes substantial costs for health care. The purpose of the study was to develop a tool for estimating the budget impact of new cancer treatments. With this tool, we were able to estimate the budget impact of adjuvant trastuzumab, as well as the probability of staying within a given budget constraint.Methods:The created model-based evaluation tool was used to explore the budget impact of trastuzumab in early breast cancer in a single Finnish hospital district with 250,000 inhabitants. The used model took into account the number of patients, HER2+ prevalence, length and cost of treatment, and the effectiveness of the therapy. Probabilistic sensitivity analysis and alternative case scenarios were performed to ensure the robustness of the results.Results:Introduction of adjuvant trastuzumab caused substantial costs for a relatively small hospital district. In base-case analysis the 4-year net budget impact was €1.3 million. The trastuzumab acquisition costs were partially offset by the reduction in costs associated with the treatment of cancer recurrence and metastatic disease.Conclusions:Budget impact analyses provide important information about the overall economic impact of new treatments, and thus offer complementary information to cost-effectiveness analyses. Inclusion of treatment outcomes and probabilistic sensitivity analysis provides more realistic estimates of the net budget impact. The length of trastuzumab treatment has a strong effect on the budget impact.

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