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

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.

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

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.

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

2017 ◽  
Vol 6 (3) ◽  
pp. 552
Author(s):  
Iram Shaifali ◽  
H. K. Singh
Keyword(s):  
Blood Pressure ◽  
Cost Effectiveness ◽  
Pharmacoeconomic Analysis ◽  
Tertiary Care ◽  
Cost Effective ◽  
Mean Blood Pressure ◽  
Open Label ◽  
Compliance Cost ◽  
Hypertensive Patients ◽  
The Cost

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.

scholarly journals Vancomycin-resistant enterococci (VRE) screening and isolation in the general medicine ward: a cost-effectiveness analysis

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Stephen Mac ◽  
Tiffany Fitzpatrick ◽  
Jennie Johnstone ◽  
Beate Sander
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
General Medicine ◽  
Cost Effective ◽  
Infection Prevention And Control ◽  
Care Hospital ◽  
Vancomycin Resistant Enterococci ◽  
Life Years ◽  
Vancomycin Resistant ◽  
The Cost

Abstract Background Vancomycin-resistant enterococci (VRE) are a serious antimicrobial resistant threat in the healthcare setting. We assessed the cost-effectiveness of VRE screening and isolation for patients at high-risk for colonisation on a general medicine ward compared to no VRE screening and isolation from the healthcare payer perspective. Methods We developed a microsimulation model using local data and VRE literature, to simulate a 20-bed general medicine ward at a tertiary-care hospital with up to 1000 admissions, approximating 1 year. Primary outcomes were accrued over the patient’s lifetime, discounted at 1.5%, and included expected health outcomes (VRE colonisations, VRE infections, VRE-related bacteremia, and deaths subsequent to VRE infection), quality-adjusted life years (QALYs), healthcare costs, and incremental cost-effectiveness ratio (ICER). Probabilistic sensitivity analysis (PSA) and scenario analyses were conducted to assess parameter uncertainty. Results In our base-case analysis, VRE screening and isolation prevented six healthcare-associated VRE colonisations per 1000 admissions (6/1000), 0.6/1000 VRE-related infections, 0.2/1000 VRE-related bacteremia, and 0.1/1000 deaths subsequent to VRE infection. VRE screening and isolation accrued 0.0142 incremental QALYs at an incremental cost of $112, affording an ICER of $7850 per QALY. VRE screening and isolation practice was more likely to be cost-effective (> 50%) at a cost-effectiveness threshold of $50,000/QALY. Stochasticity (randomness) had a significant impact on the cost-effectiveness. Conclusion VRE screening and isolation can be cost-effective in majority of model simulations at commonly used cost-effectiveness thresholds, and is likely economically attractive in general medicine settings. Our findings strengthen the understanding of VRE prevention strategies and are of importance to hospital program planners and infection prevention and control.

scholarly journals APPROPRIATE EMPIRICAL MANAGEMENT OF MICROBIAL INFECTIONS IN A TERTIARY CARE HOSPITAL: A COST- EFFECTIVENESS APPROACH.

2018 ◽  
Vol 11 (2) ◽  
pp. 124 ◽  
Author(s):  
Onchari Divinah N ◽  
Josin Mary Simon ◽  
Sneha Tomy ◽  
Arun Prasath R ◽  
Sivakumar V
Keyword(s):  
Cost Effectiveness ◽  
Tract Infection ◽  
Tertiary Care ◽  
Cost Effective ◽  
Klebsiella Pneumonia ◽  
Care Hospital ◽  
Microbial Infection ◽  
Sensitivity Pattern ◽  
Microbial Infections ◽  
Effective Drugs

 Objective: Antibiotics are mostly prescribed empirically to decrease health-care costs. This has led to the misuse of antibiotics thereby making them inefficient in the treatment of infections. The aim of this study was to determine the appropriate, cost-effective drug for the empirical therapy in microbial infections.Methods: A prospective observational study was conducted for a period of 6 months. Cost-effectiveness ratio (CER) of these antibiotics prescribed was calculated to determine the cost-effective drugs for the common microorganisms and common infections.Results: In a population of 205 patients, 54.6% were treated based on antibiotic sensitivity pattern whereas 45.3% were treated empirically. In known microbial infections, the prevailing microorganism was extended-spectrum beta-lactamase (ESBL) producing Escherichia-coli (14.3%), Staphylococcus aureus (10.6%), Pseudomonas aeruginosa (9.8%), Klebsiella pneumonia (9.8%), and K. pneumoniae ESBL (6.81%). Based on the CER, the most cost-effective drugs for these organisms were found to be ciprofloxacin, clindamycin, ofloxacin, levofloxacin, and amikacin, respectively. In unknown microbial infection (empirical treatment), Diabetic Foot Infection (DFT) (25.8%), respiratory tract infection (RTI) (23.6%), and urinary tract infection (UTI) (16.1%) were the most common infections. The most cost-effective drugs for these infections were clindamycin, levofloxacin, and azithromycin, respectively. The predominant microorganism in DFT was found to be S. aureus (71%), in UTI was found to be E. coli ESBL (52%), and in RTI were found to be P. aeruginosa (42.4%) and K. pneumonia (32.3%).Conclusion: Appropriate empirical antibiotic treatment is associated with a lower medical cost and a better success rate in patients with microbial infections.

scholarly journals Comparative study of effectiveness and safety of nonsteroidal anti-inflammatory drugs in patients of knee joint osteoarthritis of knee, tertiary care hospital, Bidar, India

2019 ◽  
Vol 8 (2) ◽  
pp. 181
Author(s):  
Vivekanand . ◽  
G. P. Kulkarni
Keyword(s):  
Knee Joint ◽  
Tertiary Care ◽  
Cardiovascular Effects ◽  
Clinical Effectiveness ◽  
Joint Disease ◽  
Care Hospital ◽  
Open Label ◽  
American College Of Rheumatology ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background: Osteoarthritis (OA) is a joint failure and OA is the most frequent chronic joint disease causing pain and disability. Where all the structures of joints have undergone pathological changes and they are hyaline articular cartilage loss which may be focal or non-uniform, initially it will be focal then spread all over non-uniformly. Non-Steroidal Anti Inflammatory Drugs (NSAID) are the mainstay of medical management of OA. Increased in reports suggests that GIT adverse effect with old NSAID’s and cardiovascular effects with selective cyclooxygenase-2 (COX2) inhibitors had precipitated to chase for better NSAID’s with minimal adverse effects. The current study compares the clinical effectiveness and safety of newer NSAID’s, etoricoxib, lornoxicam, to diclofenac which has been standard therapy in patients of OA of the knee joint.Methods: The current study is randomized, prospective, open-label, parallel group study conducted in 120 patients with OA of the knee joint diagnosed using American College of Rheumatology criteria. After getting the informed consent, they were randomized in three groups of 40 patients each who received tablet etoricoxib 120mg BID, tablet Lornoxicam 16mg BID, tablet diclofenac 50mg TID respectively. The duration of the study is 12 weeks. Data are calculated, tabulated and analyzed using analysis of variance (ANOVA) test, and level of significance was determined by its P value.Results: After 12weeks of treatment, the severity of pain and functional indices using visual analog scale and Western Ontario and McMaster Universities Osteoarthritis score were significantly better (P <0.05) in etoricoxib group as compared to lornoxicam or diclofenac group along with a lesser rate of adverse effects.Conclusions: It is concluded that etoricoxib is more effective and tolerated NSAID than lornoxicam and diclofenac in the treatment of knee joint OA.

scholarly journals Cost–utility analysis of antimicrobial stewardship programme at a tertiary teaching hospital in Ethiopia

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e047515
Author(s):  
Gebremedhin Beedemariam Gebretekle ◽  
Damen Haile Mariam ◽  
Stephen Mac ◽  
Workeabeba Abebe ◽  
Tinsae Alemayehu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Health Outcomes ◽  
Incremental Cost ◽  
Usual Care ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cost Utility ◽  
Care Hospital ◽  
Life Years ◽  
The Cost

ObjectiveAntimicrobial stewardship (AMS) significantly reduces inappropriate antibiotic use and improves patient outcomes. In low-resource settings, AMS implementation may require concurrent strengthening of clinical microbiology capacity therefore additional investments. We assessed the cost-effectiveness of implementing AMS at Tikur Anbessa Specialised Hospital (TASH), a tertiary care hospital in Ethiopia.DesignWe developed a Markov cohort model to assess the cost–utility of pharmacist-led AMS with concurrent strengthening of laboratory capacity compared with usual care from a ‘restricted societal’ perspective. We used a lifetime time horizon and discounted health outcomes and cost at 3% annually. Data were extracted from a prospective study of bloodstream infections among patients hospitalised at TASH, supplemented by published literature. We assessed parameter uncertainty using deterministic and probabilistic sensitivity analyses.SettingTertiary care hospital in Ethiopia, with 800 beds and serves over half a million patients per year.PopulationCohort of adults and children inpatient population aged 19.8 years at baseline.InterventionLaboratory-supported pharmacist-led AMS compared with usual care. Usual care is defined as empirical initiation of antibiotic therapy in the absence of strong laboratory and AMS.Outcome measuresExpected life-years, quality-adjusted life-years (QALYs), costs (US$2018) and incremental cost-effectiveness ratio.ResultsLaboratory-supported AMS strategy dominated usual care, that is, AMS was associated with an expected incremental gain of 38.8 QALYs at lower expected cost (incremental cost savings:US$82 370) per 1000 patients compared with usual care. Findings were sensitive to medication cost, infection-associated mortality and AMS-associated mortality reduction. Probabilistic sensitivity analysis demonstrated that AMS programme was likely to be cost-effective at 100% of the simulation compared with usual care at 1%–51% of gross domestic product/capita.ConclusionOur study indicates that laboratory-supported pharmacist-led AMS can result in improved health outcomes and substantial healthcare cost savings, demonstrating its economic advantage in a tertiary care hospital despite greater upfront investments in a low-resource setting.

scholarly journals 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

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.

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.

Cost-effectiveness of dual-mobility components in patients with displaced femoral neck fractures

2021 ◽  
Vol 103-B (12) ◽  
pp. 1783-1790
Author(s):  
Spencer Montgomery ◽  
Jonathan Bourget-Murray ◽  
Daniel Z. You ◽  
Leo Nherera ◽  
Amir Khoshbin ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Femoral Neck ◽  
Incremental Cost ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Effective ◽  
Physiological Age ◽  
Base Case ◽  
Dual Mobility ◽  
Displaced Femoral Neck Fractures

Aims Total hip arthroplasty (THA) with dual-mobility components (DM-THA) has been shown to decrease the risk of dislocation in the setting of a displaced neck of femur fracture compared to conventional single-bearing THA (SB-THA). This study assesses if the clinical benefit of a reduced dislocation rate can justify the incremental cost increase of DM-THA compared to SB-THA. Methods Costs and benefits were established for patients aged 75 to 79 years over a five-year time period in the base case from the Canadian Health Payer’s perspective. One-way and probabilistic sensitivity analysis assessed the robustness of the base case model conclusions. Results DM-THA was found to be cost-effective, with an estimated incremental cost-effectiveness ratio (ICER) of CAD $46,556 (£27,074) per quality-adjusted life year (QALY). Sensitivity analysis revealed DM-THA was not cost-effective across all age groups in the first two years. DM-THA becomes cost-effective for those aged under 80 years at time periods from five to 15 years, but was not cost-effective for those aged 80 years and over at any timepoint. To be cost-effective at ten years in the base case, DM-THA must reduce the risk of dislocation compared to SB-THA by at least 62%. Probabilistic sensitivity analysis showed DM-THA was 58% likely to be cost-effective in the base case. Conclusion Treating patients with a displaced femoral neck fracture using DM-THA components may be cost-effective compared to SB-THA in patients aged under 80 years. However, future research will help determine if the modelled rates of adverse events hold true. Surgeons should continue to use clinical judgement and consider individual patients’ physiological age and risk factors for dislocation. Cite this article: Bone Joint J 2021;103-B(12):1783–1790.

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