Pharmacoeconomic comparison of losartan and amlodipine in patients of hypertension in a tertiary care teaching hospital

Background: To conduct a pharmacoeconomic comparison (cost-effectiveness analysis) and to evaluate the overall safety and efficacy of Losartan and Amlodipine in reducing the Mean blood pressure per mm Hg in hypertensive patients.Methods: This was a prospective, randomized, open label, observational analysis of cost-effectiveness; into compare the cost of Losartan 50mg and Amlodipine 5mg in hypertensive patients using either of the two drugs. A total of 80 newly diagnosed drug naïve hypertensive patients were considered for the comparison, of which 40 patients were prescribed Losartan and the other 40 were prescribed Amlodipine as per the recommended dosage. Based on the data, statistical analysis was carried out using SPSS Software Version 21.Results: The two drugs were found to be equi-effective in reducing the blood pressure to the target goal, at their respective equivalent doses Moreover, the cost of reducing 1 mm of Hg mean blood pressure with Losartan was 103.42 INR, whereas that of Amlodipine was 57.11 INR. Hence the cost incurred in treating elevated BP was markedly lower with the Amlodipine group as compared to the Losartan group.Conclusions: This pharmacoeconomic analysis shows that Amlodipine is more cost-effective as compared to Losartan when the cost per mm Hg reduction in mean blood pressure is considered. Hence in India, where the cost of drug is a significant deterrant to patient compliance, cost-effective therapy of chronic disease like hypertension is of prime importance.

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Pharmacoeconomic Analysis of Using Sinemet CR over Standard Sinemet in Parkinsonian Patients with Motor Fluctuations

Annals of Pharmacotherapy ◽

10.1345/aph.16353 ◽

1998 ◽

Vol 32 (9) ◽

pp. 878-883 ◽

Cited By ~ 9

Author(s):

Alan G Hempel ◽

Mary L Wagner ◽

Mohamed A Maaty ◽

Jacob I Sage

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cost Effectiveness ◽

Pharmacoeconomic Analysis ◽

Tertiary Care ◽

Motor Fluctuations ◽

University Teaching ◽

Total Cost ◽

Medication Costs ◽

The Cost

OBJECTIVE: To compare the costs of pharmacotherapy in patients with Parkinson's disease before and after converting from standard Sinemet to extended-release Sinemet CR. DESIGN: Investigators retrospectively reviewed records of patients converting from Sinemet to Sinemet CR for efficacy and total drug costs. Cost-effectiveness was evaluated retrospectively from data collected in prospective Sinemet CR efficacy trials. SETTING: Parkinson's disease clinic at a tertiary care university teaching hospital. PATIENTS: 100 patients with motor fluctuations who had undergone an initial 6-month course of Sinemet therapy, followed by a 6-month course of Sinemet CR. MAIN OUTCOME MEASURES: Total cost was measured as the cost of Sinemet formulations plus the costs of other antiparkinson medications. Differences in pre- and postconversion costs were compared by using the paired, two-tailed Student's t-test. A substudy of 39 patients on the cost-effectiveness of conversion measured the ratio of daily medication costs to the daily hours “on” without chorea. RESULTS: While total daily medication costs after conversion increased by 21%, patients experienced either a comparable or an improved degree of disease control with Sinemet CR. Patients who were also taking selegiline were able to decrease selegiline expense by 20%. The costs of other adjunctive medications did not differ significantly after conversion. The cost-effectiveness analysis revealed an increase in postconversion on time by 2.2 hours (p = 0.0001), accompanied by a $2.85 decrease in total cost per hour on without chorea (p = 0.11). CONCLUSIONS: Although Sinemet CR is more costly, it may be more cost-effective in patients with motor fluctuations. Some patients may be able to reduce adjunctive medications.

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Cost Effectiveness Analysis of Candesartan Therapy in Comparison to Candesartan-Amlodipine Therapy on Hypertensive Outpatients

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.515 ◽

2019 ◽

Vol 7 (22) ◽

pp. 3837-3840

Author(s):

Faridah Baroroh ◽

Andriana Sari ◽

Noviana Masruroh

Keyword(s):

Blood Pressure ◽

Cost Effectiveness ◽

Cost Effective ◽

Cost Effectiveness Analysis ◽

Effectiveness Analysis ◽

Significant Difference ◽

Hypertension Therapy ◽

The Mean ◽

The Cost

BACKGROUND: he achievement of optimal hypertension therapy requires cost-effective medicine. The treatment of hypertensive patients needs for long-term medication have made medical costs a prime issue in health economics. AIM: This study aims to determine the cost effectiveness of candesartan therapy compared to candesartan-amlodipine therapy on hypertensive outpatients. METHODS: This is a prospective cohort study that compares candesartan therapy to candesartan-amlodipine therapy at a public hospital from payers’ perspective. The outcome is the percentage of targeted blood pressure decrease after three months of therapy. The cost effectiveness analysis uses the Incremental Cost Effectiveness Ratio (ICER) based on the ratio of cost difference to the outcome in both therapy groups. RESULTS: As many as 111 patients participated in this research, comprising 40 candesartan therapy patients and 71 patients with the combination of candesartan-amlodipine. Of the participants, 63.96% were female, 57.66% were aged 60 or older, and 56.32% had diabetes mellitus as the most common complication. Results show that the average direct medical cost per patient for a therapy of three months with candesartan was IDR 1,050,536 ± 730,007 and IDR 760,040 ± 614,290 for a candesartan-amlodipine therapy. The mean decline of systolic and diastolic blood pressure under candesartan therapy is less than that of candesartan-amlodipine, although without any significant difference (p > 0.05). It follows that the effectiveness of candesartan (85%) is greater than that of the candesartan-amlodipine combination (84.50%). Candesartan therapy is thereby more cost-effective with an ICER value of IDR 580,993/%. CONCLUSION: Hypertension therapy by candesartan is more cost-effective than candesartan-amlodipine therapy with a cost addition of IDR 580,993.

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Analisis Efektivitas Biaya Kombinasi Obat Antihipertensi Pada Pasien Rawat Inap Di RS PKU Muhammadiyah Yogyakarta Tahun 2020

Indonesian Journal of Pharmacy and Natural Product ◽

10.35473/ijpnp.v4i2.1296 ◽

2021 ◽

Vol 4 (2) ◽

Author(s):

Assyifa Septiani Putri ◽

Niken Dyahariesti

Keyword(s):

Cost Effectiveness ◽

Standard Therapy ◽

Pharmacoeconomic Analysis ◽

Sampling Technique ◽

Cost Effective ◽

Cost Effectiveness Analysis ◽

Medical Expenses ◽

Drug Combination Therapy ◽

Effectiveness Analysis ◽

The Cost

Terapi kombinasi disarankan pada pasien hipertensi yang memiliki tekanan darah tidak terkontrol dengan terapi tunggal. Biaya pengobatan semakin meningkat setiap tahunnya. Penelitian ini bertujuan untuk mengetahui terapi kombinasi obat antihipertensi yang paling cost effective pada pasien rawat inap RS PKU Muhammadiyah Yogyakarta tahun 2020. Penelitian ini merupakan penelitian deskriptif dengan pendekatan analisis farmakoekonomi metode Cost Effectiveness Analysis (CEA) yang dilakukan secara retrospektif. Teknik pengambilan sampel yang digunakan adalah total sampling. Data dikelompokkan berdasarkan pola terapi pasien kemudian dilakukan analisis berdasarkan ACER dan ICER. Jenis pola terapi kombinasi antihipertensi yang paling banyak digunakan adalah kombinasi dua obat (53%). Terapi dengan ACER terendah yaitu Diuretika + ARB + β Bloker (Rp. 15.257). Hasil ICER kombinasi ACEI + CCB + β Bloker + Diuretikb + Agonis α2 Sentral + ACEI memiliki nilai yang terendah dengan Rp. 25.353 jika dibandingkan dengan terapi standar. Namun, terapi CCB + β Bloker, Diuretika + ACEI + CCB, Diuretika + ARB + β Bloker, ARB + CCB + β Bloker + Agonis α2 Sentral bersifat dominan terhadap terapi standar pada cost effectiveness grid. Sehingga, terapi yang paling cost effective berdasarkan ACER dan ICER adalah Diuretika + ARB + β Bloker.Combination therapy is recommended in hypertensive patients whose blood pressure is not controlled by monotherapy. Medical expenses are increasing every year. This study aims to determine the most cost-effective antihypertensive drug combination therapy for inpatients at PKU Muhammadiyah Yogyakarta Hospital in 2020. This study is a descriptive study with a pharmacoeconomic analysis approach using the Cost-Effectiveness Analysis (CEA) method which was carried out retrospectively. The sampling technique used is total sampling. The data were grouped based on the patient's therapy pattern and then analyzed based on ACER and ICER. The most widely used combination antihypertensive therapy pattern was a combination of two drugs (53%). The therapy with the lowest ACER was Diuretica + ARB + Blockers (Rp. 15.257). The ICER result of the combination of ACEI + CCB + Blocker + Diureticb + Central α2 Agonist + ACEI has the lowest value with Rp. 25,353 when compared to standard therapy. However, CCB + Blocker, Diuretica + ACEI + CCB, Diuretic + ARB + Blocker, ARB + CCB + Blocker + Central α2 Agonist are dominant over standard therapy on the cost-effectiveness grid. Thus, the most cost-effective therapy based on ACER and ICER is Diuretica + ARB + Blockers.

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Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department

CJEM ◽

10.1017/cem.2015.88 ◽

2015 ◽

Vol 18 (3) ◽

pp. 191-204 ◽

Cited By ~ 4

Author(s):

Ivy Cheng ◽

Maaret Castren ◽

Alex Kiss ◽

Merrick Zwarenstein ◽

Mats Brommels ◽

...

Keyword(s):

Emergency Department ◽

Cost Effectiveness ◽

Tertiary Care ◽

Cost Benefit ◽

Cost Effective ◽

Additional Patient ◽

Patient Volume ◽

Benefit Ratio ◽

Cost Benefit Ratio ◽

The Cost

ABSTRACTObjectiveThe purpose of this study was to evaluate the cost-effectiveness of physician-nurse supplementary triage assistance team (MDRNSTAT) from a hospital and patient perspective.MethodsThis was a cost-effectiveness evaluation of a cluster randomized control trial comparing the MDRNSTAT with nurse-only triage in the emergency department (ED) between the hours of 0800 and 1500. Cost was MDRNSTAT salary. Revenue was from Ontario’s Pay-for-Results and patient volume-case mix payment programs. The incremental cost-effectiveness ratio was based on MDRNSTAT cost and three consequence assessments: 1) per additional patient-seen; 2) per physician initial assessment (PIA) hour saved; and 3) per ED length of stay (EDLOS) hour saved. Patient opportunity cost was determined. Patient satisfaction was quantified by a cost-benefit ratio. A sensitivity analysis extrapolating MDRNSTAT to different working hours, salary, and willingness-to-pay data was performed.ResultsThe added cost of the MDRNSTAT was $3,597.27 [$1,729.47 to ∞] per additional patient-seen, $75.37 [$67.99 to $105.30] per PIA hour saved, and $112.99 [$74.68 to $251.43] per EDLOS hour saved. From the hospital perspective, the cost-benefit ratio was 38.6 [19.0 to ∞] and net present value of –$447,996 [–$435,646 to –$459,900]. For patients, the cost-benefit ratio for satisfaction was 2.8 [2.3 to 4.6]. If MDRNSTAT performance were consistently implemented from noon to midnight, it would be more cost-effective.ConclusionsThe MDRNSTAT is not a cost-effective daytime strategy but appears to be more feasible during time periods with higher patient volume, such as late morning to evening.

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A Study to Evaluate Pharmacoeconomics of Antihypertensive Drugs in a Tertiary Care Teaching Hospital

Journal of Drug Delivery and Therapeutics ◽

10.22270/jddt.v10i4-s.4227 ◽

2020 ◽

Vol 10 (4-s) ◽

pp. 176-180

Author(s):

Nimmy N John ◽

Athira Krishnan ◽

JV Midhun ◽

Riya Juan

Keyword(s):

Blood Pressure ◽

Cost Effectiveness ◽

Combination Therapy ◽

Financial Burden ◽

Tertiary Care ◽

Cost Effective ◽

Effective Therapy ◽

P Value ◽

Major Public Health Problem ◽

Care Hospital

Background: Hypertension is a major public health problem associated with large health burden as well as high economic burden at individual and population levels. A prospective observational study carried out in in-patients admitted to general medicine department of tertiary care hospital to evaluate the most cost effective therapy among the monotherapy of Amlodipine and combination therapy of telmisartan + hydrochlorthiazide. Methods: A total of 120 Hypertensive patients case records prescribed with monotherapy of Amlodipine and combination therapy of Telma H were reviewed and evaluated using descriptive statistics and ‘p’ value and assessed for their financial burden based on the cost per tablet for an year, Cost effectiveness ratio for the patients with controlled Blood Pressure by using a particular drug. Results: Out of 120 patients females were more (59.2%) and most of them were under the age group of 41-60 years. Majority of the patients had a known history of hypertension (65%). Most of the patients were prescribed with Telma H 40/12.5mg (40%) followed with Amlong 5mg (35.8%). There was a significant positive correlation (i.e., p value= 0.05) between persistence patterns of patients with drug therapy. Probability of patients with controlled Blood Pressure taking Amlong 10 mg were 82.35% followed by patients with Amlong 5mg. Conclusion: This study clearly showed that monotherapy of amlodipine is the most cost effective therapy than combination therapy of Telma H in order to reduce financial burden to the patient as well as to decrease the complications. Keywords: Hypertension, Pharmacoeconomics, Cost effectiveness, Blood Pressure.

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Preventive Antibiotics in Stroke Study (PASS)

Neurology ◽

10.1212/wnl.0000000000005412 ◽

2018 ◽

Vol 90 (18) ◽

pp. e1553-e1560 ◽

Cited By ~ 5

Author(s):

Willeke F. Westendorp ◽

Elles Zock ◽

Jan-Dirk Vermeij ◽

Henk Kerkhoff ◽

Paul J. Nederkoorn ◽

...

Keyword(s):

Cost Effectiveness ◽

Acute Stroke ◽

Resource Use ◽

Institutional Care ◽

Cost Effective ◽

Quality Adjusted Life Year ◽

Cost Utility ◽

Control Group ◽

Open Label ◽

The Cost

ObjectiveTo evaluate the cost-effectiveness of preventive ceftriaxone vs standard stroke unit care without preventive antimicrobial therapy in acute stroke patients.MethodsIn this multicenter, randomized, open-label trial with masked endpoint assessment, 2,550 patients with acute stroke were included between 2010 and 2014. Economic evaluation was performed from a societal perspective with a time horizon of 3 months. Volumes and costs of direct, indirect, medical, and nonmedical care were assessed. Primary outcome was cost per unit of the modified Rankin Scale (mRS) and per quality-adjusted life year (QALY) for cost-effectiveness and cost-utility analysis. Incremental cost-effectiveness analyses were performed.ResultsA total of 2,538 patients were available for the intention-to-treat analysis. For the cost-effectiveness analysis, 2,538 patients were available for in-hospital resource use and 1,453 for other resource use. Use of institutional care resources, out-of-pocket expenses, and productivity losses was comparable between treatment groups. The mean score on mRS was 2.38 (95% confidence interval [CI] 2.31–2.44) vs 2.44 (95% CI 2.37–2.51) in the ceftriaxone vs control group, the decrease by 0.06 (95% CI −0.04 to 0.16) in favor of ceftriaxone treatment being nonsignificant. However, the number of QALYs was 0.163 (95% CI 0.159–0.166) vs 0.155 (95% CI 0.152–0.158) in the ceftriaxone vs control group, with the difference of 0.008 (95% CI 0.003–0.012) in favor of ceftriaxone (p = 0.006) at 3 months. The probability of ceftriaxone being cost-effective ranged between 0.67 and 0.89. Probability of 0.75 was attained at a willing-to-pay level of €2,290 per unit decrease in the mRS score and of €12,200 per QALY.ConclusionsPreventive ceftriaxone has a probability of 0.7 of being less costly than standard treatment per unit decrease in mRS and per QALY gained.

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Incremental cost-effectiveness and tolerability of Diclofenac + Proton pump inhibitor compared to tramadol in the treatment of knee osteoarthritis

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20180094 ◽

2018 ◽

Vol 7 (2) ◽

pp. 252

Author(s):

Mehwish Majeed ◽

Shaheena Rasool ◽

Afkat Ahmad

Keyword(s):

Cost Effectiveness ◽

Knee Osteoarthritis ◽

Incremental Cost ◽

Proton Pump ◽

Tertiary Care ◽

Clinical Effectiveness ◽

Cost Effective ◽

Care Hospital ◽

Open Label ◽

Hospital Patients

Background: In a climate of economic uncertainty, cost effectiveness analysis is a potentially important tool for making choices about health care interventions. Patients with knee osteoarthritis are treated mostly with Diclofenac (NSAID) + Proton Pump Inhibitors (PPI) and Tramadol (Opioids) in everyday practice.Aim: Present study was aimed to assess clinical effectiveness, adverse events and cost-effectiveness between Diclofenac + PPI and Tramadol.Methods: Authors conducted prospective randomised control open label study on 40 patients at Orthopedic OPD of tertiary care hospital. Patients were given either Tramadol controlled releases tablets (200mg CR OD) or Diclofenac sustained release tablets (100mg SR OD) + PPI (Omeprazole 20mg OD) for two weeks. Clinical effectiveness was assessed by KOOS osteoarthritis index score consisting of five parameters and visual analogue scale. Suspected ADRs were recorded and incremental cost effective ratio for both drugs was calculated.Results: After application of KOOS questionnaire Authors found net quality gain in symptoms was 24.45 in diclofenac +PPI group which was much higher against 14.15 found in tramadol group. Again ADR profile of tramadol was 29 with nausea and somnolence topping the list which was far more than only 10 in DIC +PPI group. Lastly cost-effective analysis was done where again DIC+PPI showed average cost effective ratio 5.73 verses tramadol 11.8 with an incremental cost-effectiveness ratio (ICER) of -2.72.Conclusions: Diclofenac +PPI is as effective as tramadol in the treatment of pain due to knee osteoarthritis with the potential for feAuthorsr side effects. Diclofenac + PPI was also found to be cost-effective when compared with tramado.

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Pharmacoeconomic analysis of different therapeutic regimens prescribed to ACNE patients coming to out-patient department (OPD) of dermatology, venereology and leprosy in tertiary care hospital of northern India

MedPulse International Journal of Pharmacology ◽

10.26611/10101611 ◽

2020 ◽

Vol 16 (1) ◽

pp. 01-14

Author(s):

Suchi Jain ◽

Keyword(s):

Cost Effectiveness ◽

Pharmacoeconomic Analysis ◽

Tertiary Care ◽

Cost Effective ◽

Care Hospital ◽

Cost Effectiveness Ratio ◽

Case Record ◽

Number Of Patients ◽

The Mean ◽

Group B

Background: Acne is a cosmetic disease with long treatment duration and expenditure. Therefore, this study was performed to evaluate pharmaoeconomic analysis of different acne treatment in northern population. Materials and Methods: It was a prospective observational study for a period of nine months. A total of 60 patients suffering from mild to moderate acne were enrolled and randomly divided into three groups of 20 each categorized as treatment A, treatment B and treatment C. The study tool used were case record form, Dermatology Life Quality Index (DLQI), Cardiff Acne Disability Index (CADI). Results: In a total of 60 acne patients, 1:1 ratio of male to female was observed. Maximum number of patients (50%) fell in the age group 21-30 yrs. Improvement in severity of acne was highest in group B. The minimum cost per unit was observed in treatment A group (rupees 73 for 15 gm). Large cost variation was observed in treatment B (rupees 178.15, with a range 76-254.15). The Mean+SD of total cost of therapy for duration of three months was observed to be lowest for treatment B (526.57+223.32). For reduction in GAGS score the Mean+SD of treatment B was found to be the most effective (20.75+4.36). The Mean+SD scores for Average cost effectiveness ratio (ACER), was found to be lowest for treatment B (28.47+19.76). This ACER analysis reflected treatment B as most cost effective. Incremental cost effectiveness ratio (ICER) of treatment A as compared to treatment B was -1.67 while that of treatment C as compared to treatment B was -202.98. This ICER analysis also reflected treatment B as the most cost effective. Mean (DLQI) score and mean CADI score was lowest in treatment group B at third visit. Conclusion: Pharmacoeconomic analysis helps to find disease treatment that is cost economical and equally effective.

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Cost-Effectiveness Analysis of BCG Vaccination against Tuberculosis in Indonesia: A Model-Based Study

Vaccines ◽

10.3390/vaccines8040707 ◽

2020 ◽

Vol 8 (4) ◽

pp. 707

Author(s):

Afifah Machlaurin ◽

Franklin Christiaan Karel Dolk ◽

Didik Setiawan ◽

Tjipke Sytse van der Werf ◽

Maarten J. Postma

Keyword(s):

Cost Effectiveness ◽

Univariate Analysis ◽

Cost Effective ◽

Epidemiological Data ◽

Control Programme ◽

Detection Rates ◽

Middle Income ◽

Bcg Vaccination ◽

Life Years ◽

The Cost

Bacillus Calmette–Guerin (BCG), the only available vaccine for tuberculosis (TB), has been applied for decades. The Indonesian government recently introduced a national TB disease control programme that includes several action plans, notably enhanced vaccination coverage, which can be strengthened through underpinning its favourable cost-effectiveness. We designed a Markov model to assess the cost-effectiveness of Indonesia’s current BCG vaccination programme. Incremental cost-effectiveness ratios (ICERs) were evaluated from the perspectives of both society and healthcare. The robustness of the analysis was confirmed through univariate and probabilistic sensitivity analysis (PSA). Using epidemiological data compiled for Indonesia, BCG vaccination at a price US$14 was estimated to be a cost-effective strategy in controlling TB disease. From societal and healthcare perspectives, ICERs were US$104 and US$112 per quality-adjusted life years (QALYs), respectively. The results were robust for variations of most variables in the univariate analysis. Notably, the vaccine’s effectiveness regarding disease protection, vaccination costs, and case detection rates were key drivers for cost-effectiveness. The PSA results indicated that vaccination was cost-effective even at US$175 threshold in 95% of cases, approximating the monthly GDP per capita. Our findings suggest that this strategy was highly cost-effective and merits prioritization and extension within the national TB programme. Our results may be relevant for other high endemic low- and middle-income countries.

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Cost Effectiveness of Transbronchial Needle Aspiration

Canadian Respiratory Journal ◽

10.1155/1999/508741 ◽

1999 ◽

Vol 6 (4) ◽

pp. 332-335 ◽

Cited By ~ 14

Author(s):

Jennifer A Crocket ◽

Eric YL Wong ◽

Dale C Lien ◽

Khanh Gia Nguyen ◽

Michelle R Chaput ◽

...

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Diagnostic Procedures ◽

Needle Aspiration ◽

Benign Disease ◽

University Hospital ◽

High Yield ◽

Transbronchial Needle Aspiration ◽

Computed Tomographic ◽

The Cost

OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.DESIGN: Retrospective study.SETTING: A university hospital.POPULATION STUDIED: Ninety-six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy.RESULTS: Ninety-nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented.CONCLUSIONS: TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.

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