Direct Cost of Depression: Analysis of Treatment Costs of Paroxetine versus Imipramine in Canada

1995 ◽  
Vol 40 (7) ◽  
pp. 370-377 ◽  
Author(s):  
Yvon Lapierre ◽  
Judith Bentkover ◽  
Sandra Schainbaum ◽  
Steven Manners
Keyword(s):  
Severe Depression ◽  
Cost Benefit ◽  
Cost Effective ◽  
Initial Therapy ◽  
Tricyclic Antidepressant ◽  
Cost Of Care ◽  
Continuation Rate ◽  
Cost Of Treatment ◽  
Physician Visits ◽  
Alternate Therapy

Objective To assess the potential economic impact of new and more expensive antidepressants on the overall cost of treatment using cost-effectiveness analysis. Method For this analysis, a computerized decision tree of clinical practice was developed to model the 12-month treatment of moderate to severe depression in Canada. To complete the model, data were obtained from physician panels, the Ontario Ministry of Health, and clinical comparative trials of paroxetine, a selective serotonin reuptake inhibitor, and Imipramine, a tricyclic antidepressant. Results The overall cost of treatment when paroxetine 30 mg per day was used first-line was found to be lower than when generic imipramine was used as the initial therapy ($1697 versus $1793). The higher drug cost of paroxetine ($1.69 per day) versus imipramine ($0.05 per day) was offset by a higher rate of treatment failures with the tricyclic necessitating an alternate therapy, additional physician visits and/or hospitalization. Sensitivity analysis of key variables determined that drug price and relapse rates after discontinuation were relatively insensitive predictors of the overall cost of care. More important was the continuation rate while on different therapies. Conclusion Paroxetine demonstrated a cost-benefit relative to Imipramine when the continuation rate was ≥ 47%. Clinical trials of paroxetine have reported continuation rates of 41% to 65%, suggesting that paroxetine is a cost-effective alternative to Imipramine in the 1-year management of patients with moderate to severe depression.

Cost-effective upgrading of the Arnsberg WWTP by post denitrification with a moving bed system

2000 ◽  
Vol 41 (9) ◽  
pp. 123-130
Author(s):  
N. Jardin ◽  
L. Rath ◽  
A. Sabin ◽  
F. Schmitt ◽  
D. Thöle ◽  
...  
Keyword(s):  
Carbon Source ◽  
Biological Process ◽  
Cost Benefit Analysis ◽  
Cost Benefit ◽  
Cost Effective ◽  
Benefit Analysis ◽  
Moving Bed ◽  
Trickling Filters ◽  
Sludge Hydrolysis ◽  
Effective Integration

On the basis of a cost-benefit analysis it was decided to expand the Arnsberg WWTP by a multistage biological process which allows for cost-effective integration of the existing facilities. Carbon removal will then be accomplished in a high-loaded activated sludge stage for which the existing primary clarifier is to be reconstructed. The existing trickling filters will be used for nitrification during a midterm period and will be replaced later on either by a moving bed system or by new trickling filters. Line 3 of the existing secondary clarifiers will be reconstructed and used for post denitrification in a moving bed system. The carbon needed for denitrification will be provided by means of sludge hydrolysis and the use of an external carbon source.

scholarly journals Environmental Engineering Techniques to Restore Degraded Posidonia oceanica Meadows

Water ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 661
Author(s):  
Luigi Piazzi ◽  
Stefano Acunto ◽  
Francesca Frau ◽  
Fabrizio Atzori ◽  
Maria Francesca Cinti ◽  
...  
Keyword(s):  
Large Scale ◽  
Natural Habitat ◽  
Cost Benefit ◽  
Cost Effective ◽  
Posidonia Oceanica ◽  
Environmental Engineering ◽  
Bottom Surface ◽  
Sessile Invertebrates ◽  
Set Up ◽  
Short Time

Seagrass planting techniques have shown to be an effective tool for restoring degraded meadows and ecosystem function. In the Mediterranean Sea, most restoration efforts have been addressed to the endemic seagrass Posidonia oceanica, but cost-benefit analyses have shown unpromising results. This study aimed at evaluating the effectiveness of environmental engineering techniques generally employed in terrestrial systems to restore the P. oceanica meadows: two different restoration efforts were considered, either exploring non-degradable mats or, for the first time, degradable mats. Both of them provided encouraging results, as the loss of transplanting plots was null or very low and the survival of cuttings stabilized to about 50%. Data collected are to be considered positive as the survived cuttings are enough to allow the future spread of the patches. The utilized techniques provided a cost-effective restoration tool likely affordable for large-scale projects, as the methods allowed to set up a wide bottom surface to restore in a relatively short time without any particular expensive device. Moreover, the mats, comparing with other anchoring methods, enhanced the colonization of other organisms such as macroalgae and sessile invertebrates, contributing to generate a natural habitat.

scholarly journals ANN-Based Decision Making in Station Keeping for Geotechnical Drilling Vessel

2021 ◽  
Vol 9 (6) ◽  
pp. 596
Author(s):  
Murugan Ramasamy ◽  
Mohammed Abdul Hannan ◽  
Yaseen Adnan Ahmed ◽  
Arun Kr Dev
Keyword(s):  
Decision Making ◽  
Water Depth ◽  
Business Models ◽  
Cost Benefit ◽  
Cost Effective ◽  
Station Keeping ◽  
Operational Information ◽  
Effective Option ◽  
The Cost ◽  
Cost Factors

Offshore vessels (OVs) often require precise station-keeping and some vessels, for example, vessels involved in geotechnical drilling, generally use Spread Mooring (SM) or Dynamic Positioning (DP) systems. Most of these vessels are equipped with both systems to cover all ranges of water depths. However, determining which system to use for a particular operational scenario depends on many factors and requires significant balancing in terms of cost-benefit. Therefore, this research aims to develop a platform that will determine the cost factors for both the SM and DP station-keeping systems. Operational information and cost data are collected for several field operations, and Artificial Neural Networks (ANN) are trained using those data samples. After that, the trained ANN is used to predict the components of cost for any given environmental situation, fieldwork duration and water depth. Later, the total cost is investigated against water depth for both DP and SM systems to determine the most cost-effective option. The results are validated using two operational scenarios for a specific geotechnical vessel. This decision-making algorithm can be further developed by adding up more operational data for various vessels and can be applied in the development of sustainable decision-making business models for OVs operators.

Cost-Effectiveness: Cholinesterase Inhibitors and Memantine in Vascular Dementia

2009 ◽  
Vol 36 (6) ◽  
pp. 735-739 ◽  
Author(s):  
Camilla L. Wong ◽  
Nick Bansback ◽  
Philip E. Lee ◽  
Aslam H. Anis
Keyword(s):  
Cost Effectiveness ◽  
Adverse Events ◽  
Incremental Cost ◽  
Vascular Dementia ◽  
Standard Care ◽  
Cholinesterase Inhibitors ◽  
Cost Effective ◽  
Decision Analysis Model ◽  
Physician Visits ◽  
Cost Effective Treatment

Background:Several randomized controlled trials of cholinesterase inhibitors and memantine in mild to moderate vascular dementia have demonstrated the efficacy of these treatments. However, given these drugs incur considerable cost, the economic argument for their use is less clear.Objective:To determine the incremental cost-effectiveness of cholinesterase inhibitors and memantine for mild to moderate vascular dementia.Design:A decision analysis model using a 24-28 week time horizon was developed. Outcomes of cholinesterase inhibitors and memantine and probabilities of adverse events were extracted from a systematic review. Costs of adverse events, medications, and physician visits were obtained from local estimates. Robustness was tested with probabilistic sensitivity analysis using a Monte Carlo simulation.Interventions:Donepezil 5 mg daily, donepezil 10 mg daily, galantamine 16-24 mg daily, rivastigmine flexible dosing up to 6 mg twice daily, or memantine 10 mg twice daily versus standard care.Main Outcome Measures:Incremental cost-effectiveness ratio (ICER) expressed as cost per unit decrease in the Alzheimer's Disease Assessment Scale-cognitive (ADAS-cog) subscale.Results:Donepezil 10 mg daily was found to be the most cost-effective treatment with an ICER of $400.64 (95%CI, $281.10-$596.35) per unit decline in the ADAS-cog subscale. All other treatments were dominated by donepezil 10 mg, that is, more costly and less effective.Conclusion:From a societal perspective, treatment with cholinesterase inhibitors or memantine was more effective but also more costly than standard care for mild to moderate vascular dementia. The donepezil 10 mg strategy was the most cost-effective and also dominated the other alternatives.

scholarly journals Treatment options in moderate and severe depression: decision analysis supporting a clinical guideline

2006 ◽  
Vol 189 (6) ◽  
pp. 494-501 ◽  
Author(s):  
Judit Simon ◽  
Stephen Pilling ◽  
Rachel Burbeck ◽  
David Goldberg
Keyword(s):  
Combination Therapy ◽  
Decision Analysis ◽  
Secondary Care ◽  
Treatment Options ◽  
Severe Depression ◽  
Cost Effective ◽  
Current Evidence ◽  
Resource Utilisation ◽  
Moderate Depression ◽  
The Cost

BackgroundTreatment options for depression include antidepressants, psychological therapy and a combination of the two.AimsTo develop cost-effective clinical guidelines.MethodSystematic literature reviews were used to identify clinical, utility and cost data. A decision analysis was then conducted to compare the benefits and costs of antidepressants with combination therapy for moderate and severe depression in secondary care in the UK.ResultsOver the 15-month analysis period, combination therapy resulted in higher costs and an expected 0.16 increase per person in the probability of remission and no relapse compared with antidepressants. The cost per additional successfully treated patient was £4056 (95% CI 1400–18 300); the cost per quality-adjusted life year gained was £5777 (95% CI 1900–33 800) for severe depression and £14 540 (95% CI 4800–79 400) for moderate depression.ConclusionsCombination therapy is likely to be a cost-effective first-line secondary care treatment for severe depression. Its cost-effectiveness for moderate depression is more uncertain from current evidence. Targeted combination therapy could improve resource utilisation.

Medical readiness: evaluating the robustness of medical clinic staffing solutions

2016 ◽  
Vol 14 (4) ◽  
pp. 407-419
Author(s):  
Michael Q Corpuz ◽  
Christina F Rusnock ◽  
Vhance V Valencia ◽  
Kyle Oyama
Keyword(s):  
Negative Impact ◽  
Cost Benefit Analysis ◽  
Relative Effectiveness ◽  
Discrete Event ◽  
Cost Savings ◽  
Cost Benefit ◽  
Wait Time ◽  
Cost Effective ◽  
Wait Times ◽  
Staffing Mix

Medical readiness requires Department of Defense medical clinics to be robust to changes in patient demand. Minor fluctuations in patient demand occur on a regular basis, but major increases can also occur. Major demand increases can result from a number of occurrences, including mass military deployments, medical incidents, outbreaks, and overflow from Veterans’ Affairs clinics. This research evaluates a system of clinics at Wright-Patterson Air Force Base in order to determine its ability to handle a 200% surge in patient demand. In addition, this study evaluates the relative effectiveness of six different staffing mix options to minimize patient wait times, also under the surge demand conditions. This evaluation is conducted using discrete-event simulation to estimate patient wait times and includes a sensitivity analysis of the increased patient demand, as well as a cost–benefit analysis to determine the most cost-effective alternative scenario. The study finds that adjustments to staffing mix enable cost savings while meeting current demands. In addition, the study finds that adjusting the staffing mix will not have a negative impact on patient wait time in the surge conditions, relative to the current staffing mix.

scholarly journals Cost–effectiveness and cost-benefit analysis of oliceridine in the treatment of acute pain

2021 ◽  
Author(s):  
Kit N Simpson ◽  
Michael J Fossler ◽  
Linda Wase ◽  
Mark A Demitrack
Keyword(s):  
Cost Benefit Analysis ◽  
Cost Savings ◽  
Cost Benefit ◽  
Cost Effective ◽  
Adverse Outcomes ◽  
Protein Signaling ◽  
Opioid Receptor Agonist ◽  
Cost Effective Alternative ◽  
Μ Opioid Receptor ◽  
The Cost

Aim: Oliceridine, a new class of μ-opioid receptor agonist, is selective for G-protein signaling (analgesia) with limited recruitment of β-arrestin (associated with adverse outcomes) and may provide a cost-effective alternative versus conventional opioid morphine for postoperative pain. Patients & methods: Using a decision tree with a 24-h time horizon, we calculated costs for medication and management of three most common adverse events (AEs; oxygen saturation <90%, vomiting and somnolence) following postoperative oliceridine or morphine use. Results: Using oliceridine, the cost for managing AEs was US$528,424 versus $852,429 for morphine, with a net cost savings of $324,005. Conclusion: Oliceridine has a favorable overall impact on the total cost of postoperative care compared with the use of the conventional opioid morphine.

scholarly journals Evaluation of the cost-effectiveness of buprenorphine in treatment of chronic pain using competing EQ-5D weights

2015 ◽  
Vol 6 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Hanna Norrlid ◽  
Peter Dahm ◽  
Gunnel Ragnarson Tennvall
Keyword(s):  
Chronic Pain ◽  
Cost Effectiveness ◽  
Treatment Cost ◽  
Cost Effective ◽  
Elderly Persons ◽  
Physician Visits ◽  
Annual Treatment ◽  
The Uk ◽  
The Cost ◽  
Annual Treatment Cost

AbstractBackground and aimsChronic pain is a life altering condition and common among elderly persons. The 7-day buprenorphine patch could be a suitable treatment for managing chronic pain of moderate severity in elderly patients in Sweden.The objective of this analysis was to investigate the cost-effectiveness of the 7-day buprenorphine patch, versus no treatment, in patients >50 years old who suffer from moderate pain in a health economic perspective. An additional aim was to evaluate how the cost-effectiveness is affected by the choice of EQ-5D weights.MethodsThe annual treatment cost and the potential gains in health-related quality of life (HRQoL) of buprenorphine, compared to no treatment, were evaluated. Original EQ-5D data were collected from four clinical reference studies at baseline and at the final visit. Treatment effects on HRQoL were then assessed using both UK and Swedish EQ-5D weights. Annual treatment costs were calculated based on costs of physician visits and pharmaceuticals.The optimal treatment dose was 10-15 μg/h and the analysis was hence performed on both a 10- and a 15 μg/h buprenorphine patch.ResultsThe analysis of buprenorphine treatment resulted in improved HRQoL in all reference studies, irrespective of choice of EQ-5D weight set. The change in quality adjusted life years (QALYs) varied with a gain of 0.042-0.118 using the UK weights and 0.020-0.051 with the Swedish weights. The average annual treatment cost was SEK14454 for the 10μg/h patch and SEK17 017 for the 15 μg/h patch, while cost for the no-treatment alternative was SEK 9 960. The base case incremental cost-effectiveness ratios (ICER) with the UK weights were SEK 40000-SEK 170000 and SEK 90000-SEK 350000 when applying the Swedish weights. The corresponding ICER-span in the sensitivity analysis was SEK 15 000-SEK 400 000 when applying the UK weights and SEK 30 000-SEK 840 000 with the Swedish weights (SEK 100 is about €11).ConclusionsThe results imply that the 7-day buprenorphine patch may be a cost-effective treatment of moderate chronic pain in patients over 50 years of age. The UK and the Swedish EQ-5D weights generated vastly different HRQoL estimates but buprenorphine remains cost-effective regardless choice of weight set.

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