Comparative analysis of cost–effectiveness between isosorbide-5-mononitrate and isosorbide: a retrospective real-world evaluation

2020 ◽  
Vol 9 (6) ◽  
pp. 405-412
Author(s):  
Guimin Zhang ◽  
Xinling Liu ◽  
Jian Xu ◽  
Guoliang Cheng ◽  
Juntang Xu
Keyword(s):  
Cost Effectiveness ◽  
Hospital Stay ◽  
Real World ◽  
Length Of Hospital Stay ◽  
Clinical Aspects ◽  
Sublingual Nitroglycerin ◽  
Hospitalization Cost ◽  
Tertiary Hospitals ◽  
Main Component ◽  
The Cost

Aim: The cost–effectiveness of isosorbide-5-mononitrate (5-ISMN) and isosorbide dinitrate (ISDN) in real-world use in patients with coronary heart disease (CHD; either angina pectoris or myocardial infarction) was retrospectively compared. Method: In this retrospective real-world evaluation, patients with established CHD satisfying the following criteria were selected from information system of two tertiary hospitals in China: with pharmacy claiming for at least one injection of 5-ISMN or ISDN between July 2008 and May 2017; and, CHD patients. By using propensity score matching (PSM), we compared clinical aspects of efficacy, safety, length of hospital stay and cost during hospitalization between 5-ISMN and ISDN group. All data were processed by R statistical package v.2.13.1 (R Foundation for Statistical Computing, Vienna, Austria). Result: Of 5609 patients selected, 4047 received 5-ISMN and 1562 received ISDN. After PSM, we acquired 1555 pairs based on balancing of age, sex, insurance and comorbidities on admission. The frequency (4.2 ± 6.6-times vs 6.5 ± 9.5-times; p < 0.05) and total dosage (47.5 ± 153.4 vs 136.4 ± 261.0 mg; p < 0.05) of sublingual nitroglycerin use decreased and hypotension incidence lowered (8.0 vs 13.0%; p < 0.05) in 5-ISMN group compared with ISDN group. Hospital stay (16.0 ± 11.3 days vs 17.7 ± 13.2; p < 0.05) and hospitalization expenditure ([the ratio of cost in the study to the average hospitalization cost in the city] [odds ratio: 2.5 vs 2.6; p < 0.05]) were reduced in 5-ISMN group as with that of ISDN group. Moreover, the main component of hospitalization cost was medical consumables and medications in both the groups. Conclusion: In the present retrospective real-world evaluation, by using PSM analysis, we found that newer injection agent of 5-ISMN was associated with fewer use of sublingual nitroglycerin, less hypotension incidence, shorter length of hospital stay and less hospitalization expenditure related to its comparator ISDN in patients with established CHD. Further evaluation and clinical experience are need in different circumference for the usage of ISDN.

scholarly journals PARENTERAL ANTIBIOTIC USAGE PATTERNS AND EFFECTS OF INTRAVENOUS TO ORAL SWITCHING ON THE LENGTH AND COST OF HOSPITALIZATION

2017 ◽  
Vol 9 ◽  
pp. 85
Author(s):  
Rengganis Pranandari ◽  
Sudibyo Supardi ◽  
Retnosari Andrajati
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Chi Square ◽  
Parenteral Antibiotic ◽  
Exact Test ◽  
Hospitalization Cost ◽  
Switching Patterns ◽  
Intravenous Antibiotics ◽  
Usage Patterns ◽  
The Cost

Objective: The prolonged use of intravenous antibiotics might increase the length and cost of hospitalization. The research objective, therefore, was toevaluate the effect of switching antibiotics on the length of hospital stay and hospitalization cost. The prospective cohort research design was adopted.The inclusion criteria were in patients who had received intravenous antibiotics.Methods: The sample comprised 39 patients who switched antibiotics as an exposed group and 39 patients who did not switch as an unexposedgroup. The data were collected using the patient medical records and the financial data from the hospital information system. The Mann–Whitney testand Chi-square or Fisher’s exact test was applied in the analysis.Results: The results revealed that the antibiotics most commonly switched were intravenous ceftriaxone (83.3%) and oral cefixime (94.8%). From thefive switching patterns observed, the most common switch was from intravenous ceftriaxone to oral cefixime in patients with acute gastroenteritis.All antibiotics were administered in accordance with the National Formulary (NF) guidelines. Only metronidazole (5 mg/ml dose) was inconsistentwith NF. Switching antibiotics did not impact the length of hospital stay and hospitalization cost; however, comorbidities did have an influence here.Conclusions: Further, switching antibiotics impacted the duration over which intravenous antibiotics were administered and the cost of antibiotics.

10 Years History of Cost-Effectiveness for 209 Newly Diagnosed Multiple Myeloma Patients at a Single-Institute in Japan

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5620-5620
Author(s):  
Kenshi Suzuki ◽  
Tomofumi Yamamoto ◽  
Masahiro Ikeda ◽  
Tomomi Takei ◽  
Nobuhiro Tsukada ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Hospital Stay ◽  
Median Survival ◽  
Health Care Costs ◽  
Length Of Hospital Stay ◽  
Novel Agents ◽  
Newly Diagnosed ◽  
The Cost ◽  
Care Costs

Abstract Background & Objective The therapy of multiple myeloma (MM) has improved greatly over the last decade. However, the rise in health care costs has become a big problem. Therefore, it is necessary to consider the cost-effectiveness including Quality of Life (QoL). In this study, we assessed the real-world cost-effectiveness of MM treatment. Methods & Patients A total of 209 MM patients who were newly diagnosed and treated only at Japanese Red Cross Medical Center (JRC-MC) from January 2006 to December 2015 were registered for this retrospective research. Those patients who were treated at other institute than JRC-MC were excluded. All of the costs for MM treatment in hematology department were analyzed. The costs were calculated based on the health care costs spent in hematology department. Overall survival was evaluated by the Kaplan-Meier method. All of the costs were calculated in US dollars based on average value from 2006 to 2015 (1USD = 100.294 Japanese yen). Result First, the cost paid for treatment of 84 patients who died from symptom onset to death was about 0.14 million USD. We also calculated the total annual health care cost for their patients from 2006 to 2015. Annual cost of all MM patients at 2006 was 0.454 million USD, and the cost at 2015 was 7.505 million USD. The cost/patient-year of 2006, when novel agents were not obtainable was 21,656 USD, and that cost of 2015, when three new agents were available was 55,608 USD. These results showed that the costs of MM treatment became 2.56 times higher in the past 10 years. Individual costs for bortezomib, thalidomide, and lenalidomide is shown in Fig.1. Since 2011 to 2014, the ratio of cost of novel agents exceeded 50%. Secondly, overall survival was evaluated by statistical analysis. The median survival from diagnosis was 56 (range, 0-117) months 95% CI (45.12-66.88). We divided patients into 5 subgroups, according to the time of diagnosis. (1)2006: 21 patients, (2)2007-2008: 26 patients, (3)2009-2010: 38 patients, (4)2011-2012: 42 patients, (5)2013-2015: 82 patients. In Japan, the novel agents such as bortezomib, thalidomide, lenalidomide were approved the year 2006, 2008, 2010 respectively. Median survival of subgroup (1), (2), and (3) were 56 months 95% CI (42.66-69.33), 55 months 95% CI (19.12-90.87) and 54 months 95% CI (36.42-71.57) respectively. Median survival of subgroup (4) and (5) have not been reached. Then we investigated the treatment costs in these groups. In each subgroup the average annual cost was 332, 518, 507, 588 and 631 USD respectively. Compared to subgroup (1), the cost of other groups were significantly high. These results showed that the impact of three novel agents on medical cost were significant. We also investigated the relationship between health care costs and the length of hospital stay or autologous stem cell transplantation. There were no statistically significant differences among them, however, there was tendency that the length of hospital stay shortened by time; Average length of total hospital stay the subgroup (1), (2), and (3) were 205, 125 and 56 days respectively. Subgroup (4) and (5) showed also shortened length of hospital stays, although observation years subgroup (4) and (5) were short (date was not shown). Among 5 subgroups the cases of received autologous stem cell transplantation were not stastically differences (total 56 patients). Conclusion We revealed the real-world costs of MM treatment in a single-institute, by following up individual patients sequentially. Health care costs for treatment of MM increased drastically, by introduction of three novel agents. We also showed that the introduction of three novel agents shorten hospital stay, which leads to improve QoL. Therefore, bortezomib, thalidomide and lenalidomide had the significant impact of QoL. After the further approval of novel agents in Japan, health care costs will be even higher but on the other hand, they might bring positive impacts on OS and QoL. Our study clearly indicated the importance of considering the balance of cost and effectiveness for the MM treatment is important. Character count: 3477(excluding spaces) Disclosures No relevant conflicts of interest to declare.

The Cost-Effectiveness of Pre-school Peanut Oral Immunotherapy in the Real World Setting

2021 ◽  
Author(s):  
Marcus Shaker ◽  
Edmond S. Chan ◽  
Jennifer LP. Protudjer ◽  
Lianne Soller ◽  
Elissa M. Abrams ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Real World ◽  
Oral Immunotherapy ◽  
The Real ◽  
Real World Setting ◽  
The Cost

scholarly journals Locked intramedullary nailing technique of the femur without brilliance amplifier at the trauma and orthopedics department of the university hospital of peace series on 35 cases during 1 year

2021 ◽  
Vol 13 (5) ◽  
pp. 95-97
Author(s):  
Augustin Delange Hendrick ◽  
Almenord Pharol ◽  
Khawly Clifford PG ◽  
Augustin Delange ◽  
Pierre Marie Woolley
Keyword(s):  
Hospital Stay ◽  
Intramedullary Nailing ◽  
Femoral Fractures ◽  
Length Of Hospital Stay ◽  
University Hospital ◽  
Patient Morbidity ◽  
Duration Of Hospitalization ◽  
The Cost ◽  
The University

Femoral fractures increase the length of hospital stay for our patients for several reasons such as lack of blood, economic resources, and lack of infrastructure. The use of a C-arm has been shown to reduce patient morbidity due to early functional recovery and reduced hospital stay. Objective: To develop an intramedullary nailing technique without c-arm with a closed focus to reduce the duration of hospitalization of its patients as well as the cost related to the equipment used for follow-up. Methodology: prospective study on 35 patients for 1 year August 2020 to August 2021 Results: We followed 35 patients in which the mean age was 37.83 years with extremes of 18 and 78 years. The male sex predominates 21 against 14 women or 60% against 40% respectively. The sex ratio is 1.5. A total of 19 diaphyseal fractures (54.3%) were nailed, 9 supracondylar (25.7%) and 7 subtrochanteric (20%). Twenty-seven were closed fractures (71.1%), and 8 were open fractures (22.9%). The length of hospitalization was less than 3 days for 30 patients (85.7%), and more than 3 days for 5 patients (14.3%). Conclusion: We recommend that we promote this closed-hearth technique because it improves the postoperative follow-up of patients. Additionally, it would reduce exposure to radiation from c-arm in hospitals that have this equipment.

scholarly journals The cost-effectiveness of initiating ranibizumab therapy in eyes with neovascular AMD with good vision: an economic model using real-world outcomes

BMJ Open ◽  
2015 ◽  
Vol 5 (5) ◽  
pp. e006535-e006535 ◽  
Author(s):  
T. Butt ◽  
A. Lee ◽  
C. Lee ◽  
A. Tufail ◽  
W. Xing ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Real World ◽  
Economic Model ◽  
Neovascular Amd ◽  
The Cost ◽  
Good Vision

Abstract W P273: The Cost-Effectiveness of Telestroke Varies by Implementation Cost and Stroke Severity: Real World Data From a Pacific Northwest Network

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Elizabeth Baraban ◽  
Richard Nelson ◽  
Alexandra Lesko ◽  
Jennifer Majersik ◽  
Archit Bhatt ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Pacific Northwest ◽  
Real World ◽  
Cost Effective ◽  
Stroke Severity ◽  
Real World Data ◽  
World Data ◽  
Life Years ◽  
Implementation Costs ◽  
The Cost

Objective: An obstacle for community hospitals in joining a telestroke network is often the cost of implementation. Yet, previous analyses examining the cost and cost-effectiveness have only used estimates from the literature. Using real-world data from a Pacific Northwest telestroke network, we examined the cost-effectiveness of telestroke for spokes by level of financial responsibility for these costs and how this changes with patient stroke severity. Methods: We constructed a decision analytic model and parameterized it using patient-level clinical and financial data from the Providence Telestroke Network (PTN) pre and post telestroke implementation. Data included patients presenting at 17 spokes within 4.5 hours of symptom onset. Probability inputs included observed IV-tPA treatment rates, transfer status and hospital costs and reimbursements. Effectiveness, measured as quality-adjusted life years (QALYs), and cost per patient were used to calculate incremental cost effectiveness ratios (ICERs). ICER’s of <$50,000-$120,000/QALY are considered cost-effective. Outcomes were generated overall and separately by admit NIHSS, defined as low (0-10), medium (11-20) and high (>20) and percentage of implementation costs paid by spokes (0%, 50%, 100%). Results: Data for 594 patients, 105 pre- and 489 post-implementation, were included. See Table 1. Conclusions: Our results support previous theoretic models showing good value, overall. However, costs and ICERs varied by stroke severity, with telestroke being most cost-effective for severe strokes. Telestroke was least cost effective if spokes paid for half or more of implementation costs.

scholarly journals Cost-Effectiveness Analysis of Xiyanping Injection (Andrographolide Sulfonate) for Treatment of Adult Community Acquired Pneumonia: A Retrospective, Propensity Score-Matched Cohort Study

2019 ◽  
Vol 2019 ◽  
pp. 1-11
Author(s):  
Honghao Shi ◽  
Wanjie Guo ◽  
He Zhu ◽  
Meng Li ◽  
Carolina Oi Lam Ung ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Conventional Treatment ◽  
Length Of Hospital Stay ◽  
Cost Effective ◽  
Daily Practice ◽  
Community Acquired Pneumonia ◽  
Clinical Effects ◽  
Effectiveness Analysis ◽  
Effectiveness Index ◽  
The Cost

Xiyanping injection (andrographolide sulfonate) has shown clinical effects on community acquired pneumonia. However, there is little known about the effectiveness and costs of combining Xiyanping injection with conventional treatment on adult community acquired pneumonia in daily practice. The aim of this study was to evaluate the cost-effectiveness of combining Xiyanping injection with conventional treatment for treatment of adult community acquired pneumonia by comparing with conventional treatment from a societal perspective. Using retrospective cohort method, this study demonstrates that Xiyanping injection combined with conventional treatment is superior to conventional treatment for patients using cephalosporins and antibiotics under the effectiveness index of length of hospital stay and is more cost-effective.

scholarly journals Evaluating the Cost-Effectiveness of Early Compared with Late or No Biologic Treatment to Manage Crohn’s Disease using Real-World Data

2019 ◽  
Vol 14 (4) ◽  
pp. 490-500 ◽  
Author(s):  
Nadia Pillai ◽  
Judith E Lupatsch ◽  
Mark Dusheiko ◽  
Matthias Schwenkglenks ◽  
Michel Maillard ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Cost Effectiveness ◽  
Crohn's Disease ◽  
Health System ◽  
Real World ◽  
Transition Probabilities ◽  
Cost Effective ◽  
Real World Data ◽  
World Data ◽  
The Cost

Abstract Background and Aims We evaluated the cost-effectiveness of early [≤2 years after diagnosis] compared with late or no biologic initiation [starting biologics &gt;2 years after diagnosis or no biologic use] for adults with Crohn’s disease in Switzerland. Methods We developed a Markov cohort model over the patient’s lifetime, from the health system and societal perspectives. Transition probabilities, quality of life, and costs were estimated using real-world data. Propensity score matching was used to ensure comparability between patients in the early [intervention] and late/no [comparator] biologic initiation strategies. The incremental cost-effectiveness ratio [ICER] per quality-adjusted life year [QALY] gained is reported in Swiss francs [CHF]. Sensitivity and scenario analyses were performed. Results Total costs and QALYs were higher for the intervention [CHF384 607; 16.84 QALYs] compared with the comparator [CHF340 800; 16.75 QALYs] strategy, resulting in high ICERs [health system: CHF887 450 per QALY; societal: CHF449 130 per QALY]. In probabilistic sensitivity analysis, assuming a threshold of CHF100 000 per QALY, the probability that the intervention strategy was cost-effective was 0.1 and 0.25 from the health system and societal perspectives, respectively. In addition, ICERs improved when we assumed a 30% reduction in biologic prices [health system: CHF134 502 per QALY; societal: intervention dominant]. Conclusions Early biologic use was not cost-effective, considering a threshold of CHF100 000 per QALY compared with late/no biologic use. However, early identification of patients likely to need biologics and future drug price reductions through increased availability of biosimilars may improve the cost-effectiveness of an early treatment approach.

scholarly journals Cost-Effectiveness Analysis of Direct Oral Anticoagulants Vs. Vitamin K Antagonists in the Elderly With Atrial Fibrillation: Insights From the Evidence in a Real-World Setting

2021 ◽  
Vol 8 ◽  
Author(s):  
Yue Wu ◽  
Chi Zhang ◽  
Zhi-Chun Gu
Keyword(s):  
Atrial Fibrillation ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Real World ◽  
Treatment Strategy ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Cost Effective ◽  
The Cost

Background: In the clinical setting, the economic benefits of direct oral anticoagulants (DOACs) in elderly patients with atrial fibrillation (AF) remain unclear. This study aimed to estimate and compare the cost-effectiveness of DOACs (dabigatran, rivaroxaban, apixaban, and edoxaban) and vitamin K antagonists (VKAs; warfarin) in preventing stroke among AF patients aged &gt;75 years in real-world practice.Methods: A Markov model with a 10-year span was constructed to estimate the long-term clinical and economic outcomes among AF patients aged &gt;75 years treated with DOACs and warfarin. The study was populated with a hypothetical cohort of 10,000 AF patients aged &gt;75 years. Probabilities of clinical outcomes were obtained from the pooled observational studies (OSs), comparing DOACs (dabigatran, rivaroxaban, apixaban, and edoxaban) with VKAs. Other model inputs, including the utilities and the costs, were all estimated from public sources and the published literature. The costs, quality-adjusted life-years (QAYLs), and incremental cost-effectiveness ratios (ICER) were estimated for each treatment strategy. Subgroup analyses of individual DOACs and the scenario analysis were performed. Uncertainty was evaluated by deterministic sensitivity analysis and probabilistic sensitivity analysis (PSA).Results: Compared to warfarin, DOACs were associated with a gain of 0.36 QALY at an additional cost of $15,234.65, resulting in an ICER of $42,318.47 per QALY. Sensitivity analysis revealed that the ICER was sensitive to the cost of DOACs. Direct oral anticoagulants also shifted from dominating to dominated status When their annual costs of DOACs were over $3,802.84 or the risk ratio of death compared to warfarin was over 1.077%/year. Probabilistic sensitivity analysis (PSA) suggested that DOACs had a 53.83 and 90.7% probability of being cost-effective when the willingness-to-pay threshold was set at $50,000 and $100,000, respectively. Among all the four individual DOACs, edoxaban treatment was revealed as the preferred treatment strategy for the AF patients aged over 75 years by yielding the most significant health gain with the relatively low total cost.Conclusions: Despite the high risk for major bleeding in elderly patients with AF, DOACs are more cost-effective treatment options than warfarin in real-world practice. Edoxaban was the preferred treatment strategy among four kinds of DOACs for AF patients aged over 75 years. Furthermore, beyond their safety profiles, the treatment benefits of DOACs assumed greater relevance and importance in older adults.

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