scholarly journals Generic substitutions of antiepileptic drugs: Is it possible to put an end to the discussion?

2018 ◽  
Vol 10 (1S) ◽  
pp. 75-80
Author(s):  
E. A. Ushkalova ◽  
S. K. Zyryanov ◽  
K. E. Zatolochina
Keyword(s):  
Cost Effectiveness ◽  
Antiepileptic Drugs ◽  
Economic Benefits ◽  
Brand Name ◽  
Regulatory Requirements ◽  
The Cost ◽  
Generic Instability ◽  
The Impact ◽  
Brand Name Drugs

A policy on generic substitutions, which is aimed at reducing the cost-effectiveness of pharmacotherapy, was proposed by the WHO at the end of the 20th century; however, but the debate about their  economic benefits has continued until now. There have been the  most active discussions of whether an epileptic patient may be  switched from brand-name to generic antiepileptic drugs. The paper  gives data obtained in Russian and foreign studies of the therapeutic  efficacy and safety of anticonvulsant generics versus their brand- name drugs, as well as the impact of generic substitutions on the cost-effectiveness of  antiepileptic therapy. Emphasis is placed on the importance of the  quality of generic medicines, their dosage forms, and regulatory requirements for registration of generics. The problem of generic instability is under discussion.

Disease Management Programmes for Major Depression: Making the Financial Case

2009 ◽  
Vol 15 (3) ◽  
pp. 679-725
Author(s):  
J. Buckle
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Disease Management ◽  
Sickness Absence ◽  
Public Healthcare ◽  
Life Years ◽  
Disease Management Programmes ◽  
The Cost ◽  
The Impact

ABSTRACTDepression is a significant burden for the United Kingdom economy and despite conclusive evidence on the clinical efficacy of treatments and acknowledgements of the impact on quality of life, a high proportion still goes undiagnosed and untreated. The purpose of this paper is to present the economic case for a more structured approach to depression management, using techniques from the disciplines of health economics and actuarial science to demonstrate cost-effectiveness and return on investment. The results are presented first as an economic cost-effectiveness analysis, comparing the benefits of additional quality-adjusted life years (QALYs) with the costs, and secondly as a financial projection model of costs and savings, familiar to actuaries.The results of the model show that from a societal perspective, disease management programmes for depression are likely to both reduce costs and increase quality of life for patients in the overall adult population. This is also true from the perspective of an employer who has the cost burden of direct medical costs and sickness absence. For a healthcare payer who is not bearing the cost of sickness absence, such as a primary care trust (PCT) or private insurer, disease management programmes are likely to improve quality of life, but increase direct healthcare costs. However, the additional cost per QALY is well below the commonly used threshold in the U.K. of £30,000; therefore, most health economists would deem disease management programmes for severe and moderate depression to be a good use of public healthcare funds. The actuarial calculations, which show an internal rate of return for 45% to 50%, validate this conclusion.

scholarly journals A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 277-287 ◽  
Author(s):  
Hayley McBain ◽  
Chris Flood ◽  
Michael Shipley ◽  
Abigail Olaleye ◽  
Samantha Moore ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Short Form ◽  
Cost Effective ◽  
Self Monitoring ◽  
The Cost ◽  
Monitoring Service ◽  
The Impact

Abstract Objective To determine whether a patient-initiated DMARD self-monitoring service for people on MTX is a cost-effective model of care for patients with RA or PsA. Methods An economic evaluation was undertaken alongside a randomized controlled trial involving 100 patients. Outcome measures were quality of life and ESR assessed at baseline and post-intervention. Costs were calculated for healthcare usage using a United Kingdom National Health Service economic perspective. Sensitivity analysis was performed to explore the impact of nurse-led telephone helplines. Uncertainty around the cost-effectiveness ratios was estimated by bootstrapping and analysing the cost-effectiveness planes. Results Fifty-two patients received the intervention and 48 usual care. The difference in mean cost per case indicated that the intervention was £263 more expensive (P < 0.001; 95% CI: £149.14, £375.86) when the helpline costs were accounted for and £94 cheaper (P = 0.08; 95% CI: –£199.26, £10.41) when these costs were absorbed by the usual service. There were, however, statistically significant savings for the patient (P = 0.02; 95% CI: −£28.98, £3.00). When costs and effectiveness measures of ESR and quality of life measured, using the Short Form-12v1, were combined this did not show the patient-initiated service to be cost-effective at a statistically significant level. Conclusion This patient-initiated service led to reductions in primary and secondary healthcare services that translated into reduced costs, in comparison with usual care, but were not cost-effective. Further work is needed to establish how nurse-led telephone triage services are integrated into rheumatology services and the associated costs of setting up and delivering them. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, ISRCTN21613721

scholarly journals Long-term cost-effectiveness of interventions for obesity: A mendelian randomisation study

PLoS Medicine ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. e1003725
Author(s):  
Sean Harrison ◽  
Padraig Dixon ◽  
Hayley E. Jones ◽  
Alisha R. Davies ◽  
Laura D. Howe ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Healthcare Costs ◽  
Mendelian Randomisation ◽  
Unit Increase ◽  
Related Quality ◽  
Health Related ◽  
The Cost ◽  
The Impact

Background The prevalence of obesity has increased in the United Kingdom, and reliably measuring the impact on quality of life and the total healthcare cost from obesity is key to informing the cost-effectiveness of interventions that target obesity, and determining healthcare funding. Current methods for estimating cost-effectiveness of interventions for obesity may be subject to confounding and reverse causation. The aim of this study is to apply a new approach using mendelian randomisation for estimating the cost-effectiveness of interventions that target body mass index (BMI), which may be less affected by confounding and reverse causation than previous approaches. Methods and findings We estimated health-related quality-adjusted life years (QALYs) and both primary and secondary healthcare costs for 310,913 men and women of white British ancestry aged between 39 and 72 years in UK Biobank between recruitment (2006 to 2010) and 31 March 2017. We then estimated the causal effect of differences in BMI on QALYs and total healthcare costs using mendelian randomisation. For this, we used instrumental variable regression with a polygenic risk score (PRS) for BMI, derived using a genome-wide association study (GWAS) of BMI, with age, sex, recruitment centre, and 40 genetic principal components as covariables to estimate the effect of a unit increase in BMI on QALYs and total healthcare costs. Finally, we used simulations to estimate the likely effect on BMI of policy relevant interventions for BMI, then used the mendelian randomisation estimates to estimate the cost-effectiveness of these interventions. A unit increase in BMI decreased QALYs by 0.65% of a QALY (95% confidence interval [CI]: 0.49% to 0.81%) per year and increased annual total healthcare costs by £42.23 (95% CI: £32.95 to £51.51) per person. When considering only health conditions usually considered in previous cost-effectiveness modelling studies (cancer, cardiovascular disease, cerebrovascular disease, and type 2 diabetes), we estimated that a unit increase in BMI decreased QALYs by only 0.16% of a QALY (95% CI: 0.10% to 0.22%) per year. We estimated that both laparoscopic bariatric surgery among individuals with BMI greater than 35 kg/m2, and restricting volume promotions for high fat, salt, and sugar products, would increase QALYs and decrease total healthcare costs, with net monetary benefits (at £20,000 per QALY) of £13,936 (95% CI: £8,112 to £20,658) per person over 20 years, and £546 million (95% CI: £435 million to £671 million) in total per year, respectively. The main limitations of this approach are that mendelian randomisation relies on assumptions that cannot be proven, including the absence of directional pleiotropy, and that genotypes are independent of confounders. Conclusions Mendelian randomisation can be used to estimate the impact of interventions on quality of life and healthcare costs. We observed that the effect of increasing BMI on health-related quality of life is much larger when accounting for 240 chronic health conditions, compared with only a limited selection. This means that previous cost-effectiveness studies have likely underestimated the effect of BMI on quality of life and, therefore, the potential cost-effectiveness of interventions to reduce BMI.

Return on Invesment (ROI) of Software Product: A Systematic Literature Review

2015 ◽  
Vol 6 (1) ◽  
pp. 50-57
Author(s):  
Rizqa Raaiqa Bintana ◽  
Putri Aisyiyah Rakhma Devi ◽  
Umi Laili Yuhana
Keyword(s):  
Return On Investment ◽  
Assessment Criteria ◽  
Software Product ◽  
And Performance ◽  
Rational Consideration ◽  
Actual Return ◽  
The Cost ◽  
Investment Models ◽  
The Impact

The quality of the software can be measured by its return on investment. Factors which may affect the return on investment (ROI) is the tangible factors (such as the cost) dan intangible factors (such as the impact of software to the users or stakeholder). The factor of the software itself are assessed through reviewing, testing, process audit, and performance of software. This paper discusses the consideration of return on investment (ROI) assessment criteria derived from the software and its users. These criteria indicate that the approach may support a rational consideration of all relevant criteria when evaluating software, and shows examples of actual return on investment models. Conducted an analysis of the assessment criteria that affect the return on investment if these criteria have a disproportionate effort that resulted in a return on investment of a software decreased. Index Terms - Assessment criteria, Quality assurance, Return on Investment, Software product

ECONOMIC SUBSTANTIATION OF TRANSITION TO PERSONNEL OUTSOURCING IN THE ORGANIZATIONS OF THE CONSTRUCTION INDUSTRY

2020 ◽  
pp. 70-79
Author(s):  
V.V. Verna
Keyword(s):  
Cost Effectiveness ◽  
Construction Industry ◽  
Methodological Approaches ◽  
Construction Organization ◽  
The Cost ◽  
The Impact

The article provides a rationale for methodological approaches to assessing the effectiveness of outsourcing in organizations of the construction industry using the example of outsourcing schemes to perform personnel functions. The conditional example shows the impact of the use of outsourcing on reducing the costs of a construction organization. The main prerequisites for the use of outsourcing in the activities of enterprises in the construction industry are identified, methodological approaches to assessing the cost-effectiveness of personnel outsourcing in the construction industry enterprises are substantiated.

scholarly journals Cost-effectiveness and feasibility of conditional economic incentives and motivational interviewing to improve HIV health outcomes of adolescents living with HIV in Anambra State, Nigeria

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Obinna Ikechukwu Ekwunife ◽  
Chinelo Janefrances Ofomata ◽  
Charles Ebuka Okafor ◽  
Maureen Ugonwa Anetoh ◽  
Stephen Okorafor Kalu ◽  
...  
Keyword(s):  
Viral Load ◽  
Cost Effectiveness ◽  
Service Delivery ◽  
Motivational Interviewing ◽  
Cost Effective ◽  
Economic Incentives ◽  
Additional Patient ◽  
Incentive Scheme ◽  
The Cost ◽  
The Impact

Abstract Background In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. Method A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. Result The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients’ acceptance of the intervention was very high. Conclusion The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1–3 times per annum. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. Trial registration This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (PACTR201806003040425).

447 Cost-Effectiveness of a 3-Year Tele-OSA Intervention

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A177-A177
Author(s):  
Jaejin An ◽  
Dennis Hwang ◽  
Jiaxiao Shi ◽  
Amy Sawyer ◽  
Aiyu Chen ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Willingness To Pay ◽  
Incremental Cost ◽  
Economic Benefits ◽  
Small Sample ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Group 2 ◽  
The Cost

Abstract Introduction Trial-based tele-obstructive sleep apnea (OSA) cost-effectiveness analyses have often been inconclusive due to small sample sizes and short follow-up. In this study, we report the cost-effectiveness of Tele-OSA using a larger sample from a 3-month trial that was augmented with 2.75 additional years of epidemiologic follow-up. Methods The Tele-OSA study was a 3-month randomized trial conducted in Kaiser Permanente Southern California that demonstrated improved adherence in patients receiving automated feedback messaging regarding their positive airway pressure (PAP) use when compared to usual care. At the end of the 3 months, participants in the intervention group pseudo-randomly either stopped or continued receiving messaging. This analysis included those participants who had moderate-severe OSA (Apnea Hypopnea Index >=15) and compared the cost-effectiveness of 3 groups: 1) no messaging, 2) messaging for 3 months only, and 3) messaging for 3 years. Costs were derived by multiplying medical service use from electronic medical records times costs from Federal fee schedules. Effects were average nightly hours of PAP use. We report the incremental cost per incremental hour of PAP use as well as the fraction acceptable. Results We included 256 patients with moderate-severe OSA (Group 1, n=132; Group 2, n=79; Group 3, n=45). Group 2, which received the intervention for 3 months only, had the highest costs and fewest hours of use and was dominated by the other two groups. Average 1-year costs for groups 1 and 3 were $6035 (SE, $477) and $6154 (SE, $575), respectively; average nightly hours of PAP use were 3.07 (SE, 0.23) and 4.09 (SE, 0.42). Compared to no messaging, messaging for 3 years had an incremental cost ($119, p=0.86) per incremental hour of use (1.02, p=0.03) of $117. For a willingness-to-pay (WTP) of $500 per year ($1.37/night), 3-year messaging has a 70% chance of being acceptable. Conclusion Long-term Tele-OSA messaging was more effective than no messaging for PAP use outcomes but also highly likely cost-effective with an acceptable willingness-to-pay threshold. Epidemiologic evidence suggests that this greater use will yield both clinical and additional economic benefits. Support (if any) Tele-OSA study was supported by the AASM Foundation SRA Grant #: 104-SR-13

scholarly journals Impact and cost-effectiveness evaluation of a community-based rehabilitation intervention on quality of life among Chinese adults with hearing loss: study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xin Ye ◽  
Dawei Zhu ◽  
Siyuan Chen ◽  
Xuefeng Shi ◽  
Rui Gong ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hearing Loss ◽  
Cost Effectiveness ◽  
Treatment Group ◽  
Hearing Aids ◽  
Control Group ◽  
Chinese Adults ◽  
Community Based ◽  
The Impact

Abstract Background Hearing loss is quite prevalent and can be related to people’s quality of life. To our knowledge, there are limited studies assessing the efficacy of hearing interventions on quality of life in adults. Therefore, we aim to conduct a randomized controlled trial (RCT) to determine the impact and cost-effectiveness of community-based hearing rehabilitation on quality of life among Chinese adults with hearing loss. Methods/design In this two-arm feasibility study, participants aged 16 and above with some degree of hearing loss (n = 464) will be recruited from Linyi City, Shandong Province. They are randomly assigned to the treatment group or the control group. Those in the treatment group are prescribed with hearing aids, while those in the control group receive no intervention. Reinstruction in use of devices is provided for the treatment group during booster visits held 12 months post-randomization or unscheduled interim visits when necessary. Data are collected at baseline and the follow-up 20 months later. The primary outcome is changes in quality of life over a 20-month study period. Secondary outcomes include sub-dimensions in quality of life, physical functioning, chronic diseases, cognitive function, depression, social support, hospitalizations, falls, and healthcare costs. Finally, we will evaluate whether hearing aids intervention is cost-effective to apply in a large scale. Discussion The trial is designed to evaluate the impact and cost-effectiveness of a community-based rehabilitation intervention on quality of life among Chinese adults with hearing loss. We hope that it would help improve the well-being for Chinese adults and provide references in policy and practice for China and other countries. Trial registration Chinese Clinical Trial Registry ChiCTR1900024739. Registered on 26 July 2019.

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