scholarly journals Price versus clinical guidelines in primary care statin prescribing: a retrospective cohort study and cost simulation model

2021 ◽  
pp. 014107682110517
Author(s):  
Matias Ortiz De Zarate ◽  
Emmanouil Mentzakis ◽  
Simon DS Fraser ◽  
Paul Roderick ◽  
Paul Rutter ◽  
...  
Keyword(s):  
Primary Care ◽  
Simulation Model ◽  
Clinical Guidelines ◽  
Cost Effective ◽  
Similar Efficacy ◽  
Significant Heterogeneity ◽  
Therapeutic Class ◽  
Cost Effective Treatment ◽  
Acquisition Costs ◽  
Cost Simulation

Objective To investigate the relative impact of generic entry and National Institute for Health and Care Excellence clinical guidelines on prescribing using statins as an exemplar. Design Retrospective analysis of statin prescribing in primary care and cost simulation model. Setting Royal College of General Practitioners Research and Surveillance Centre (RCGP R&SC) database and Prescription Cost Analysis (PCA) database. Participants New patients prescribed statins for the first time between July 2003 and September 2018. Results General trends of statin’ prescriptions were largely driven by a decrease in acquisition costs triggered by patent expiration, preceding NICE guidelines which themselves did not seem to affect prescription trends. Significant heterogeneity is observed in the prescription of the most cost-effective statin across GPs. A cost simulation shows that, between 2004 and 2018, the NHS could have saved £2.8bn (around 40% of the £6.3bn spent on statins during this time) if all GP practices had prescribed only the most cost-effective treatment. Conclusions There is potential for large savings for the NHS if new and, whenever possible, ongoing patients are promptly switched to the first medicine that becomes available as generic within a therapeutic class as long as it has similar efficacy to still-patented medicines.

scholarly journals Cost-Effectiveness Analysis of the Use of Point-of-Care C-Reactive Protein Testing to Reduce Antibiotic Prescribing in Primary Care

Antibiotics ◽  
2018 ◽  
Vol 7 (4) ◽  
pp. 106 ◽  
Author(s):  
Emily Holmes ◽  
Sharman Harris ◽  
Alison Hughes ◽  
Noel Craine ◽  
Dyfrig Hughes
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Respiratory Tract ◽  
Clinical Guidelines ◽  
Antibiotic Prescription ◽  
Point Of Care ◽  
Cost Effective ◽  
Routine Practice ◽  
C Reactive Protein ◽  
Reactive Protein

More appropriate and measured use of antibiotics may be achieved using point-of-care (POC) C-reactive protein (CRP) testing, but there is limited evidence of cost-effectiveness in routine practice. A decision analytic model was developed to estimate the cost-effectiveness of testing, compared with standard care, in adults presenting in primary care with symptoms of acute respiratory tract infection (ARTI). Analyses considered (1) pragmatic use of testing, reflective of routine clinical practice, and (2) testing according to clinical guidelines. Threshold and scenario analysis were performed to identify cost-effective scenarios. In patients with symptoms of ARTI and based on routine practice, the incremental cost-effectiveness ratios of CRP testing were £19,705 per quality-adjusted-life-year (QALY) gained and £16.07 per antibiotic prescription avoided. Following clinical guideline, CRP testing in patients with lower respiratory tract infections (LRTIs) cost £4390 per QALY gained and £9.31 per antibiotic prescription avoided. At a threshold of £20,000 per QALY, the probabilities of POC CRP testing being cost-effective were 0.49 (ARTI) and 0.84 (LRTI). POC CRP testing as implemented in routine practice is appreciably less cost-effective than when adhering to clinical guidelines. The implications for antibiotic resistance and Clostridium difficile infection warrant further investigation.

scholarly journals Cost-effectiveness of antibiotic treatment of uncomplicated urinary tract infection in women: a comparison of four antibiotics

BJGP Open ◽  
2017 ◽  
Vol 1 (3) ◽  
pp. bjgpopen17X101097
Author(s):  
Susannah Sadler ◽  
Michael Holmes ◽  
Shijie Ren ◽  
Stephen Holden ◽  
Swati Jha ◽  
...  
Keyword(s):  
Primary Care ◽  
Urinary Tract ◽  
Cost Effectiveness ◽  
Effective Treatment ◽  
Cost Effective ◽  
Uncomplicated Urinary Tract Infection ◽  
Adult Women ◽  
Effective Treatment Option ◽  
Cost Effective Treatment ◽  
Tract Infections

BackgroundUrinary tract infections (UTIs) are one of the most common reasons for women to attend primary care. There are four different antibiotics currently recommended in England for treatment of uncomplicated UTI but little evidence on their comparative cost-effectiveness.AimTo assess the relative cost-effectiveness of the four antibiotics currently recommended in England for treatment of uncomplicated UTI in adult women.Design & settingA cost-effectiveness model in adult women with signs and symptoms of uncomplicated UTI in primary care in England treated with fosfomycin, nitrofurantoin, pivmecillinam, or trimethoprim.MethodA decision tree economic model of the treatment pathway encompassed up to two rounds of treatment, accounting for different resistance levels. End points included recovery, persistence, pyelonephritis, and/or hospitalisation. Prescription, primary and secondary care treatment, and diagnostic testing costs were aggregated. Cost-effectiveness was assessed as cost per UTI resolved.ResultsTrimethoprim 200 mg twice daily (for 3 or 7 days) was estimated to be the most cost-effective treatment (£70 per UTI resolved) when resistance was <30%. However, if resistance to trimethoprim was ≥30%, fosfomycin 3 g once became more cost-effective; at resistance levels of ≥35% for trimethoprim, both fosfomycin 3 g once and nitrofurantoin 100 mg twice daily for 7 days were shown to be more cost-effective.ConclusionKnowing local resistance levels is key to effective and cost-effective empirical prescribing. Recent estimates of trimethoprim resistance rates are close to 50%, in which case a single 3 g dose of fosfomycin is likely to be the most cost-effective treatment option.

Rhinosinusitis Treatment Protocol: Changing Provider Habits in Primary Care

2002 ◽  
Vol 126 (6) ◽  
pp. 614-622 ◽  
Author(s):  
William C. Kinney
Keyword(s):  
Primary Care ◽  
Chart Review ◽  
Practice Patterns ◽  
Treatment Protocol ◽  
Treatment Strategies ◽  
Primary Caregivers ◽  
Cost Effective ◽  
Clinical Protocols ◽  
Cost Effective Treatment ◽  
Provider Practice

OBJECTIVE: Sinus infections are common and represent a high cost to the health care industry. Clinical protocols can be used to develop cost-effective treatment strategies. Our objective was to show that a protocol for rhinosinusitis can change provider practice patterns in primary care. STUDY DESIGN AND SETTING: We used a literature search, survey of primary caregivers, and chart review from an academic health center to define and document current patterns. A protocol was developed and evaluated using the Rhinosinusitis Disability Index. RESULTS: Survey and chart review identified that primary caregivers do not elicit a detailed history for rhinosinusitis. Protocol use increased this to 100%. First-line antibiotic therapy was used for only 49.4% of the patients before protocol use and for 68.5% after protocol use. Patients felt better after treatment 84.1% of the time; the Rhinosinusitis Disability Index could not measure improvement. CONCLUSION: Provider practice patterns were positively influenced by use of the protocol. SIGNIFICANCE: Clinical protocols should be developed to direct provider treatment practices.

Cost Analysis of Two Clindamycin Dosing Regimens

DICP ◽  
1989 ◽  
Vol 23 (12) ◽  
pp. 980-983
Author(s):  
Alfred Chin ◽  
Mark A. Gill ◽  
Matthew K. Ito ◽  
Albert E. Yellin ◽  
Thomas V. Berne ◽  
...  
Keyword(s):  
Group Versus ◽  
Cost Effective ◽  
Similar Efficacy ◽  
Manufacturing Cost ◽  
Nursing Administration ◽  
Cost Effective Method ◽  
Dosing Regimens ◽  
Therapy Costs ◽  
Acquisition Costs ◽  
The Mean

A clinical trial of clindamycin 900 mg q8h admixed with gentamicin 1.5 mg/kg (eight-hourly group) versus clindamycin 600 mg q6h with gentamicin 1.5 mg/kg given separately (six-hourly group) was analyzed for relative cost containment. Acquisition costs were significantly higher for the six-hourly group for intravenous supplies ($181.5 ± 47.8) when compared with the eight-hourly group ($67.6 ± 21.6) (p<0.05). Nursing administration costs were greater for the six-hourly group ($28.6 ± 7.5) compared with ($10.7 ± 3.4) for the eight-hourly group (p<0.05). Also, significantly higher cost (p<0.05) was noted for pharmacist and technician manufacturing cost for the six-hourly group ($15.4 ± 4.0) compared with the eight-hourly group ($13.3 ± 4.3). Incorporating all appropriate costs, the mean total drug therapy costs were significantly greater (p<0.05) for clindamycin 600 mg q6h ($527.4 ± 143.0) compared with clindamycin 900 mg q8h ($433.3 ± 99.2). The dosing of clindamycin 900 mg q8h admixed with gentamicin 1.5 mg/kg is a more cost-effective method of drug delivery with similar efficacy and safety when compared with clindamycin 600 mg q6h with gentamicin given separately.

Physical and Psychological Benefits of Written Emotional Expression

2015 ◽  
Vol 20 (4) ◽  
pp. 242-251 ◽  
Author(s):  
Éva Kállay
Keyword(s):  
Mental Health ◽  
Expressive Writing ◽  
Mental Health Problems ◽  
Cost Effective ◽  
Health Problems ◽  
Future Research ◽  
Psychological Benefits ◽  
Cost Effective Treatment ◽  
Meta Analyses

Abstract. The last several decades have witnessed a substantial increase in the number of individuals suffering from both diagnosable and subsyndromal mental health problems. Consequently, the development of cost-effective treatment methods, accessible to large populations suffering from different forms of mental health problems, became imperative. A very promising intervention is the method of expressive writing (EW), which may be used in both clinically diagnosable cases and subthreshold symptomatology. This method, in which people express their feelings and thoughts related to stressful situations in writing, has been found to improve participants’ long-term psychological, physiological, behavioral, and social functioning. Based on a thorough analysis and synthesis of the published literature (also including most recent meta-analyses), the present paper presents the expressive writing method, its short- and long-term, intra-and interpersonal effects, different situations and conditions in which it has been proven to be effective, the most important mechanisms implied in the process of recovery, advantages, disadvantages, and possible pitfalls of the method, as well as variants of the original technique and future research directions.

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