Optimizing formulary decisions.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 14-14
Author(s):  
Henry Jacob Conter
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Health System ◽  
Cost Utility ◽  
Mortality Data ◽  
Primary Concern ◽  
System Cost ◽  
Best Estimate ◽  
Health System Cost ◽  
Drug Review

14 Background: As medication prices rise, the sustainability of health care systems has been increasingly questioned. Health technology assessment (HTA) could be employed to maximize value when budgets are limited. Methods: The pan-Canadian Oncology Drug Review (pCODR) is an evidence-based, cancer drug review process that guides formulary decision-making. As of 10/30/16, data from all 93 reviews and economic guidances were abstracted for price of medication, total health care cost per patient, cost-utility provided by the submitter, and the re-analysis by pCODR. Regression analysis was employed to identify correlations. Expected use of therapy was estimated employing mortality data from the Canadian Cancer Society. An optimal formulary was then developed, with value for money as the primary concern. Results: Of the 93 reviews, 11 were not finalized, 3 were withdrawn, and 1 was suspended. 4 reviews were excluded since the base-case was ambiguous. Of included reviews, 13% were recommended for funding, 66% were recommended conditional on improved cost-effectiveness, and 22% were rejected. The median drug price per 28-day cycle was $7,567 (range $2,800-$18,435), with no annual difference from 2012-2016 (p=0.49). The median best-estimate of cost-utility was $188,537/QALY (IQR $127,399/QALY) with a median net increase in health system cost of $66,069/patient (IQR $90,466). The median difference between pCODR’s best estimate and the submitter’s was $61,240/QALY (IQR $73,656/QALY). The submitter’s estimate of cost effectiveness was correlated with pCODRs assessment (R² = 0.65, p<0.01). Cost per 28-day cycle was a weak predictor of value (R² = 0.01, p<0.01), and not of health system cost (R² = 0.17, p=0.11). In the Canadian context, funding all efficacious medications would require a total of $5.91 billion producing 31,705 QALYs, annually. Funding the system with $1.12 billion for new medicines by first-come-first-served principle, yields 5,966 QALYs over 16 drugs, annually. By prioritizing based on value, $1 billion allows for funding of 22 drugs producing 9,665 QALYs, annually. $2 billion would increase annual QALYs to 15,792 over 26 drugs. Conclusions: Price of medications should not be used as a heuristic for value. An optimized formulary requires practical deployment of HTA.

Market capitalism in cancer pharmaceuticals.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18295-e18295
Author(s):  
Henry Jacob Conter
Keyword(s):  
Health System ◽  
Health Care Cost ◽  
Health Benefit ◽  
Cost Utility ◽  
Cancer Drug ◽  
Base Case ◽  
Cancer Society ◽  
System Cost ◽  
Health System Cost ◽  
Drug Review

e18295 Background: How can health technology assessments be deployed in a market-based healthcare system to improve value and sustainability? Methods: The pan-Canadian Oncology Drug Review (pCODR) is an evidence-based, cancer drug review process that guides formulary decision-making. As of 1/1/17, data from all 98 reviews and economic guidances were abstracted for price of medication, total health care cost per patient, cost-utility provided by the submitter and re-analysis by pCODR. Regression analysis identified correlations. Expected use of therapy was estimated employing data from the Canadian Cancer Society. An optimal formulary was developed, optimizing value for money. Results: Of the 98 reviews, 13 were not finalized, 3 were withdrawn, 1 was suspended. 4 reviews were excluded since the base-case was ambiguous. The median drug price per 28-day cycle was $7,567 (range $2,800-$18,435), with no annual difference from 2012-2016 (p = 0.49). The median best-estimate of cost-utility was $190,858/QALY (IQR $125,585/QALY) with a median net increase in health system cost of $62,771/patient (IQR $89,260) and 0.48 LYG/patient (range 0.04-2.43). Cost per 28-day cycle was a weak predictor of value (R² = 0.02, p < 0.01), and not of health system cost (R² = 0.14, p = 0.06). Funding all efficacious medications by a single payer insurance plan in Canada would require $5.91 billion producing 31,705 QALYs, annually. 26% of the cumulative budget would buy 41% of the health benefit, 56% of the budget would buy 70% of the effect. Once a budget is determined, new medication would replace drugs of higher cost per QALY. Employing this method increased QALY yield of the budget by 67%, 21%, 15%, and 14% at $1B, $2B, $3B, and $4B, respectively. The formulary turnover would be 66%, 44%, 37%, and 22% at each respective budget level. Conclusions: An optimized formulary requires practical deployment of HTA, the ability to shift resources across budgets, and the ability to continuously renegotiate prices based on incremental value. Future work is needed on publically acceptable divestment methods for lower value pharmaceuticals.

Patients Costs And Health System Cost-Effectiveness Of Tuberculosis Treatment Supervision In Three Brazilian States

2011 ◽  
Author(s):  
Ricardo E. Steffen ◽  
Caroline S.S. Cyriaco ◽  
Margareth M. Sá ◽  
Ninarosa Cardoso ◽  
Betina M.A. Gabardo ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health System ◽  
Tuberculosis Treatment ◽  
System Cost ◽  
Health System Cost

Cost-effectiveness of continuous positive airway pressure therapy for obstructive sleep apnea: health care system and societal perspectives

SLEEP ◽  
2019 ◽  
Vol 42 (12) ◽  
Author(s):  
Jared Streatfeild ◽  
David Hillman ◽  
Robert Adams ◽  
Scott Mitchell ◽  
Lynne Pezzullo
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Health System ◽  
Health Care System ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Cpap Therapy ◽  
System Perspective ◽  
Obstructive Sleep ◽  
Care System

Abstract Study Objectives To determine cost-effectiveness of continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) in Australia for 2017–2018 to facilitate public health decision-making. Methods Analysis was undertaken of direct per-person costs of CPAP therapy (according to 5-year care pathways), health system and other costs of OSA and its comorbidities averted by CPAP treatment (5-year adherence rate 56.7%) and incremental benefit of therapy (in terms of disability-adjusted life years [DALYs] averted) to determine cost-effectiveness of CPAP. This was expressed as the incremental cost-effectiveness ratio (= dollars per DALY averted). Direct costs of CPAP were estimated from government reimbursements for services and advertised equipment costs. Costs averted were calculated from both the health care system perspective (health system costs only) and societal perspective (health system plus other financial costs including informal care, productivity losses, nonmedical accident costs, deadweight taxation and welfare losses). These estimates of costs (expressed in US dollars) and DALYs averted were based on our recent analyses of costs of untreated OSA. Results From the health care system perspective, estimated cost of CPAP therapy to treat OSA was $12 495 per DALY averted while from a societal perspective the effect was dominant (−$10 688 per DALY averted) meaning it costs more not to treat the problem than to treat it. Conclusions These estimates suggest substantial community investment in measures to more systematically identify and treat OSA is justified. Apart from potential health and well-being benefits, it is financially prudent to do so.

scholarly journals Implementing standard antenatal care interventions: health system cost at primary health facilities in Tanzania

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Amisa Tindamanyile Chamani ◽  
Amani Thomas Mori ◽  
Bjarne Robberstad
Keyword(s):  
Standard Model ◽  
Antenatal Care ◽  
Health System ◽  
Health Facilities ◽  
System Cost ◽  
Primary Health ◽  
Health System Cost ◽  
The Standard Model ◽  
Health Centres ◽  
Primary Health Facilities

Abstract Background Since 2002, Tanzania has been implementing the focused Antenatal Care (ANC) model that recommended four antenatal care visits. In 2016, the World Health Organization (WHO) reintroduced the standard ANC model with more interventions including a minimum of eight contacts. However, cost-implications of these changes to the health system are unknown, particularly in countries like Tanzania, that failed to optimally implement the simpler focused ANC model. We compared the health system cost of providing ANC under the focused and the standard models at primary health facilities in Tanzania. Methods We used a micro-costing approach to identify and quantify resources used to implement the focused ANC model at six primary health facilities in Tanzania from July 2018 to June 2019. We also used the standard ANC implementation manual to identify and quantify additional resources required. We used basic salary and allowances to value personnel time while the Medical Store Department price catalogue and local market prices were used for other resources. Costs were collected in Tanzanian shillings and converted to 2018 US$. Results The health system cost of providing ANC services at six facilities (2 health centres and 4 dispensaries) was US$185,282 under the focused model. We estimated that the cost would increase by about 90% at health centres and 97% at dispensaries to US$358,290 by introducing the standard model. Personnel cost accounted for more than one third of the total cost, and more than two additional nurses are required per facility for the standard model. The costs per pregnancy increased from about US$33 to US$63 at health centres and from about US$37 to US$72 at dispensaries. Conclusion Introduction of a standard ANC model at primary health facilities in Tanzania may double resources requirement compared to current practice. Resources availability has been one of the challenges to effective implementation of the current focused ANC model. More research is required, to consider whether the additional costs are reasonable compared to the additional value for maternal and child health.

scholarly journals Cost Analysis of Pediatric Intensive Care: A Low-Middle Income Country Perspective

2020 ◽  
Author(s):  
Amrit Kaur ◽  
Muralidharan Jayashree ◽  
Shankar Prinja ◽  
Ranjana Singh ◽  
Arun K. Baranwal
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Health System ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Severe Illness ◽  
Annual Data ◽  
System Cost ◽  
Health System Cost ◽  
State Of Art

Abstract Background: Globally, Pediatric Intensive Care Unit (PICU) admissions are amongst the most expensive. This makes it important to gain insights into the cost of pediatric intensive care units. We undertook this study to calculate the health system cost and out of pocket expenditure incurred per patient during Pediatric Intensive Care Unit (PICU) stayMethods: Prospective study conducted in a state of art tertiary level PICU of a teaching and referral hospital. Bottom-up micro costing methods were used to assess the health system cost. Annual data regarding hospital resources used for PICU care was collected from January 2018 to December 2018. Data regarding out of pocket expenditure (OOP) was collected from 299 patients who were admitted from July 2017 to December 2018. The study period was divided into four intervals, each of 4 and a half months duration and data was collected for 1 month in each interval. Per patient and per bed day costs for treatment were estimated both from health system and patient’s perspective. Results: The median (inter-quartile range, IQR) length of PICU stay was 5(3–8) days. Mean ± SD PRISM score of the study cohort was 22.23 ± 7.3. Of the total patients, 55.9% (167) were ventilated. Mean cost per patient treated was US$ 2,078(₹ 144,566). Of this, health system cost and OOP expenditure per patient were US$ 1,731 (₹ 120,425) and 352 (₹ 24,535) respectively. OOP expenditure of a ventilated child was twice that of a non‐ ventilated child. Conclusions: The fixed cost of PICU care were 3.5 times more than variable costs. Major portion of cost is borne by hospital. Severe illness, longer ICU stay and ventilation were associated with increased costs. This study can be used to set the reimbursement package rates under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Tertiary care state of art intensive care in a public sector teaching hospital in India is far less expensive than developed countries.

scholarly journals Efficacy and cost-effectiveness of a Transdiagnostic group-based exercise intervention: study protocol for a pragmatic multi-site randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sebastian Wolf ◽  
Britta Seiffer ◽  
Johanna-Marie Zeibig ◽  
Jana Welkerling ◽  
Leonie Louisa Bauer ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Cost Effectiveness ◽  
Depressive Disorders ◽  
Exercise Intervention ◽  
Controlled Trial ◽  
Cost Utility ◽  
Major Depressive ◽  
Outpatient Mental Health ◽  
Major Depressive Disorders

Abstract Background Mental disorders are prevalent and cause considerable burden of disease. Exercise has been shown to be efficacious to treat major depressive disorders, insomnia, panic disorder with and without agoraphobia and post traumatic stress disorder (PTSD). Methods This pragmatic, two arm, multi-site randomised controlled trial will evaluate the efficacy and cost-effectiveness of the manualized, group-based six-months exercise intervention “ImPuls”, among physically inactive patients with major depressive disorders, insomnia, panic disorder, agoraphobia and PTSD within a naturalistic outpatient context in Germany. A minimum of 375 eligible outpatients from 10 different study sites will be block-randomized to either ImPuls in addition to treatment as usual (TAU) or TAU only. ImPuls will be conducted by trained exercise therapists and delivered in groups of six patients. The program will combine (a) moderate to vigorous aerobic exercise carried out two-three times a week for at least 30 min with (b) behavior change techniques for sustained exercise behavior change. All outcomes will be assessed pre-treatment, post-treatment (six months after randomization) and at follow-up (12 months after randomization). Primary outcome will be self-reported global symptom severity assessed with the Brief Symptom Inventory (BSI-18). Secondary outcomes will be accelerometry-based moderate to vigorous physical activity, self-reported exercise, disorder-specific symptoms, quality-adjusted life years (QALY) and healthcare costs. Intention-to-treat analyses will be conducted using mixed models. Cost-effectiveness and cost-utility analysis will be conducted using incremental cost-effectiveness and cost-utility ratios. Discussion Despite its promising therapeutic effects, exercise programs are currently not provided within the outpatient mental health care system in Germany. This trial will inform service providers and policy makers about the efficacy and cost-effectiveness of the group-based exercise intervention ImPuls within a naturalistic outpatient health care setting. Group-based exercise interventions might provide an option to close the treatment gap within outpatient mental health care settings. Trial registration The study was registered in the German Clinical Trials Register (ID: DRKS00024152, 05/02/2021).

scholarly journals Health System Cost of Post-Abortion Care (PAC): A Systematic Review

2021 ◽  
Author(s):  
Estro Dariatno Sihaloho ◽  
Ibnu Habibie ◽  
Fariza Zahra Kamilah ◽  
Yodi Christiani
Keyword(s):  
Systematic Review ◽  
Health System ◽  
Direct Cost ◽  
Medical Cost ◽  
Cochrane Library ◽  
System Cost ◽  
Abortion Care ◽  
Post Abortion Care ◽  
Health System Cost ◽  
Post Abortion

Abstract Background: Despite the increasing trend of Post Abortion Care (PAC) needs and provision, the evidence related to its health system cost is lacking. The study aims to review the health system costs of Post-Abortion Care (PAC) per patient at a national level.Methods: A systematic review of literatures related to PAC cost published in 1994 – October 2020 was performed. Electronic databases such as PubMed, Medline, The Cochrane Library, CINAHL, and PsycINFO were used to search the literature. Following the title and abstract screening, reporting quality was appraised using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. PAC costs were extrapolated into, US dollars ($US) and international dollars ($I), both in 2019. Content analysis was also conducted to synthesize the qualitative findings.Results: Twelve studies met the inclusion criteria. All studies reported direct medical cost per patient in accessing PAC, but only three of them included indirect medical cost. All studies reported either average or range of cost. In terms of range, The highest direct cost of PAC with MVA (Medical Vacuum Aspiration) services can be found in Colombia, between $US50.58-212.47, while the lowest is in Malawi ($US15.2-139.19). The highest direct cost of PAC with D&C (Dilatation and Curettage), services was in El Salvador ($US65.22-240.75), while the lowest is in Bangladesh ($US15.71-103.85). Among two studies providing average indirect cost data, Uganda with $US105.04 is the highest average indirect medical cost, while Rwanda with $US51.44 is the lowest on the cost of indirect medical.Conclusions: Our review shows variability in cost of PAC across countries. This study depicts a clearer picture of how costly it is for women to access PAC service, although it is still seemingly underestimated. When a study compared the use of UE method between MVA and D&C, it is confirmed that MVA treatments tend to have lower costs and potentially reduce a significant cost. Therefore, by looking at both clinical and economic perspective, improving and strengthening the quality and accessibility of PAC with MVA is a priority.

Sign in / Sign up

Export Citation Format

Share Document