Outlook of Pharmacoeconomics and its status in Nepal

Pharmacoeconomics is a branch of health economics which is derived from latin word “Pharmacon”- and “Economia”- It deals with the economic aspect of health that is the costs of health services. There are different types of costs which is affecting the health services. There is not only the direct medical cost, but also direct nonmedical cost, indirect nonmedical costs and intangible cost. The consequences of therapy are evaluated from economic, clinical and humanistic perspective, also known as the ECHO model. There are partial and full pharmacoeconomic analyses. The partial analyses are cost of illness and cost of consequence. The full analyses are cost effective, cost benefit, cost utility and cost minimization analyses. The cost effective analysis is the most commonly used analysis.

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The economic challenges of palliative medicine

10.1093/med/9780199656097.003.0010 ◽

2015 ◽

Author(s):

Thomas J. Smith ◽

J. Brian Cassel

Keyword(s):

Palliative Care ◽

Lower Cost ◽

Hospice Care ◽

Cost Minimization ◽

Cost Benefit ◽

Cost Utility ◽

Utility Analysis ◽

New Directions ◽

Hospice And Palliative Care ◽

Benefit Cost

The compelling reasons for palliative care continue to be better symptom management, better advanced care planning and medically appropriate goal setting, and transitions to hospice care. Other new-found compelling reasons include better survival with hospice care, better survival with concurrent palliative care, and lower cost to hospitals and government and insurance funders. In studies to date, hospice and palliative care have been associated with equal or better survival and equal or lower cost. This chapter defines the various types of cost and clinical studies (including cost minimization, cost-effectiveness, cost utility analysis, cost-benefit, cost avoidance) and discusses the available data about the economic challenges of palliative care, how to apply the available data, how to collect and present some useful and useable data, and new directions for research.

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Cost-effectiveness of primary prophylaxis (PP) with colony-simulating factor (CSF) when compared with secondary prophylaxis (SP) in elderly patients with diffuse aggressive lymphoma undergoing curative chemotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.6558 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 6558-6558

Author(s):

K. K. Chan ◽

K. R. Imrie ◽

S. M. Alibhai

Keyword(s):

Cost Effectiveness ◽

Elderly Patients ◽

Cost Minimization ◽

Cost Effective ◽

Primary Prophylaxis ◽

Cost Utility ◽

Sensitivity Analyses ◽

Aggressive Lymphoma ◽

Base Case ◽

The Cost

6558 Background: The 2006 ASCO guideline recommends PP with CSF for elderly patients with diffuse aggressive lymphoma, partially based on previous cost-minimization analyses showing that CSF saved costs when compared with no CSF by reducing hospitalization from febrile neutropenia (FN) when the risk of FN was > 20%. However, these studies examined only one cycle of chemotherapy and did not account for costs of CSF in subsequent cycles, did not consider SP, and did not consider patients’ preferences. Methods: We conducted a cost-utility analysis to compare PP with SP in this setting using a Markov model for a time horizon of 8 cycles of chemotherapy with a government payer perspective. Costs were adjusted to 2006 $CAD. Ontario health economic data were used. The cost of hospitalization for FN was obtained from Ontario Case Costing Initiative. Data for efficacies of CSF, probabilities and utilities were obtained from published literature. Sensitivity analyses were conducted using a threshold of $100,000/QALY. Results: The base case costs for PP and SP were $22,077 and $17,641. The QALYs of PP and SP were 0.254 and 0.248. The incremental cost effectiveness ratio of PP to SP was $739,999/QALY. One-way sensitivity analyses showed that in order for PP to be cost-effective, the cost of hospitalization per episode of FN had to be > $31,138 (i.e. 2.5 times > base case), the cost of CSF per cycle had to be < $896 (base case = $1,960), the risk of FN in the 1st cycle had to be > 48% (base case = 24%), or the relative risk reduction of FN with CSF had to be > 97% (base case = 41%). Our result was robust to all other cost, probability and utility variables. First order microsimulation showed that < 17% of simulations were cost-effective. Conclusions: PP is not cost-effective when compared with SP for this population under most assumptions. PP only becomes attractive in places where the cost of hospitalization for FN is much more than that of Ontario, or the cost of CSF is under $896 per cycle. The costs of CSF and hospitalization in all cycles (instead of just one cycle) should be accounted for in any economic evaluation of CSF. Current guidelines recommending PP in this population should be revisited. No significant financial relationships to disclose.

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Cost-Effectiveness of Adherence-Enhancing Interventions: A Quality Assessment of the Evidence

Annals of Pharmacotherapy ◽

10.1345/aph.1e398 ◽

2005 ◽

Vol 39 (3) ◽

pp. 508-515 ◽

Cited By ~ 52

Author(s):

Rachel A Elliott ◽

Nick Barber ◽

Rob Horne

Keyword(s):

Cost Effectiveness ◽

English Language ◽

Cost Minimization ◽

Data Extraction ◽

Cost Benefit ◽

Quality Criteria ◽

Cost Utility ◽

Outcome Data ◽

Study Selection ◽

The Cost

OBJECTIVE: To determine whether the current cost-effectiveness evidence on adherence-enhancing interventions (AEIs) was of sufficient quality to aid in decision-making regarding medication adherence policies. DATA SOURCES: A computerized search of Embase, MEDLINE, Cinahl, Econlit, NHSEED, Psychlit, EPIC, and Cochrane databases (1980–April 2004) was performed. English-language human subject articles were identified using the key words compliance, adherence, concordance, patient assistance, therapeutic alliance, costs, economics, efficiency, resource use/utilization, cost-of illness, cost-effectiveness, cost-minimization, cost-utility, and cost-benefit. STUDY SELECTION AND DATA EXTRACTION: Studies that appeared to assess the cost-effectiveness of medication AEIs were included. Methodologic rigor was assessed using 15 minimum quality criteria. DATA SYNTHESIS: We found 45 comparative studies in 43 publications. Asthma (14 studies) and psychiatric illness (12 studies) were most commonly investigated. In 33 studies, interventions were educational, 18 had multiple components, and 23 did not appear to be linked to proven reasons for nonadherence. Reporting of adherence and outcome results was often unclear. Cost data were poorer quality than outcome data, using average or estimated costs and omitting some cost elements. Nine studies carried out incremental economic analysis. No study met all quality criteria. CONCLUSIONS: We were not able to make definitive conclusions about the cost-effectiveness of AEIs due to the heterogeneity of the studies found and incomplete reporting of results. Important policy decisions need to be made about nonadherence; however, they are currently being made in a vacuum of adequate information. AEIs must be based on reasons for nonadherence and be evaluated using accepted clinical and economic quality criteria.

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Evaluating Population Programs: International Experience with Cost-Effective Analysis and Cost-Benefit Analysis

Population Studies ◽

10.1080/0032472031000142266 ◽

1986 ◽

Vol 40 (2) ◽

pp. 333-334

Author(s):

C. Chandrasekaran

Keyword(s):

Cost Benefit Analysis ◽

Cost Benefit ◽

Cost Effective ◽

International Experience ◽

Benefit Analysis ◽

Effective Analysis

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OP0198-HPR A STRUCTURED MODEL FOR OA CARE IN PRIMARY HEALTHCARE IS A COST-EFFECTIVE ALTERNATIVE COMPARED TO USUAL CARE FOR PEOPLE WITH HIP AND KNEE OA

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.950 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 119-120

Author(s):

N. Østerås ◽

E. Aas ◽

T. Moseng ◽

L. Van Bodegom-Vos ◽

K. Dziedzic ◽

...

Keyword(s):

Usual Care ◽

Primary Healthcare ◽

Intervention Group ◽

Cost Effective ◽

Cost Utility ◽

Control Group ◽

Structured Model ◽

Knee Oa ◽

Cost Effective Alternative ◽

The Cost

Background:To improve quality of care for patients with hip and knee osteoarthritis (OA), a structured model for integrated OA care was developed based on international treatment recommendations. A previous analysis of a cluster RCT (cRCT) showed that compared to usual care, the intervention group reported higher quality of care and greater satisfaction with care. Also, more patients were treated according to international guidelines and fulfilled recommendations for physical activity at the 6-month follow-up.Objectives:To assess the cost-utility of a structured model for hip or knee OA care.Methods:A cRCT with stepped-wedge cohort design was conducted in 6 Norwegian municipalities (clusters) in 2015-17. The OA care model was implemented in one cluster at the time by switching from “usual care” to the structured model. The implementation of the model was facilitated by interactive workshops for general practitioners (GPs) and physiotherapists (PTs) with an update on OA treatment recommendations. The GPs explained the OA diagnosis and treatment alternatives, provided pharmacological treatment when appropriate, and suggested referral to physiotherapy. The PT-led patient OA education programme was group-based and lasted 3 hours followed by an 8–12-week individually tailored resistance exercise programme with twice weekly 1-hour supervised group sessions (5–10 patients per PT). An optional 10-hours Healthy Eating Program was available. Participants were ≥45 years with symptomatic hip or knee OA.Costs were measured from the healthcare perspective and collected from several sources. Patients self-reported visits in primary healthcare at 3, 6, 9 and 12 months. Secondary healthcare visits and joint surgery data were extracted from the Norwegian Patient Register. The health outcome, quality-adjusted life-year (QALY), was estimated based on the EQ-5D-5L scores at baseline, 3, 6, 9 and 12 months. The result of the cost-utility analysis was reported using the incremental cost-effectiveness ratio (ICER), defined as the incremental costs relative to incremental QALYs (QALYs gained). Based on Norwegian guidelines, the threshold is €27500. Sensitivity analyses were performed using bootstrapping to assess the robustness of reported results and presented in a cost-effectiveness plane (Figure 1).Results:The 393 patients’ mean age was 63 years (SD 9.6) and 74% were women. 109 patients were recruited during control periods (control group), and 284 patients were recruited during interventions periods (intervention group). Only the intervention group had a significant increase in EQ-5D-5L utility scores from baseline to 12 months follow-up (mean change 0.03; 95% CI 0.01, 0.05) with QALYs gained: 0.02 (95% CI -0.08, 0.12). The structured OA model cost approx. €301 p.p. with an additional €50 for the Healthy Eating Program. Total 12 months healthcare cost p.p. was €1281 in the intervention and €3147 in the control group, resulting in an incremental cost of -€1866 (95% CI -3147, -584) p.p. Costs related to surgical procedures had the largest impact on total healthcare costs in both groups. During the 12-months follow-up period, 5% (n=14) in the intervention compared to 12% (n=13) in the control group underwent joint surgery; resulting in a mean surgical procedure cost of €553 p.p. in the intervention as compared to €1624 p.p. in the control group. The ICER was -€93300, indicating that the OA care model resulted in QALYs gained and cost-savings. At a threshold of €27500, it is 99% likely that the OA care model is a cost-effective alternative.Conclusion:The results of the cost-utility analysis show that implementing a structured model for OA care in primary healthcare based on international guidelines is highly likely a cost-effective alternative compared to usual care for people with hip and knee OA. More studies are needed to confirm this finding, but this study results indicate that implementing structured OA care models in primary healthcare may be beneficial for the individual as well as for the society.Disclosure of Interests:None declared

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ANN-Based Decision Making in Station Keeping for Geotechnical Drilling Vessel

Journal of Marine Science and Engineering ◽

10.3390/jmse9060596 ◽

2021 ◽

Vol 9 (6) ◽

pp. 596

Author(s):

Murugan Ramasamy ◽

Mohammed Abdul Hannan ◽

Yaseen Adnan Ahmed ◽

Arun Kr Dev

Keyword(s):

Decision Making ◽

Water Depth ◽

Business Models ◽

Cost Benefit ◽

Cost Effective ◽

Station Keeping ◽

Operational Information ◽

Effective Option ◽

The Cost ◽

Cost Factors

Offshore vessels (OVs) often require precise station-keeping and some vessels, for example, vessels involved in geotechnical drilling, generally use Spread Mooring (SM) or Dynamic Positioning (DP) systems. Most of these vessels are equipped with both systems to cover all ranges of water depths. However, determining which system to use for a particular operational scenario depends on many factors and requires significant balancing in terms of cost-benefit. Therefore, this research aims to develop a platform that will determine the cost factors for both the SM and DP station-keeping systems. Operational information and cost data are collected for several field operations, and Artificial Neural Networks (ANN) are trained using those data samples. After that, the trained ANN is used to predict the components of cost for any given environmental situation, fieldwork duration and water depth. Later, the total cost is investigated against water depth for both DP and SM systems to determine the most cost-effective option. The results are validated using two operational scenarios for a specific geotechnical vessel. This decision-making algorithm can be further developed by adding up more operational data for various vessels and can be applied in the development of sustainable decision-making business models for OVs operators.

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Cost–effectiveness and cost-benefit analysis of oliceridine in the treatment of acute pain

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2021-0107 ◽

2021 ◽

Author(s):

Kit N Simpson ◽

Michael J Fossler ◽

Linda Wase ◽

Mark A Demitrack

Keyword(s):

Cost Benefit Analysis ◽

Cost Savings ◽

Cost Benefit ◽

Cost Effective ◽

Adverse Outcomes ◽

Protein Signaling ◽

Opioid Receptor Agonist ◽

Cost Effective Alternative ◽

Μ Opioid Receptor ◽

The Cost

Aim: Oliceridine, a new class of μ-opioid receptor agonist, is selective for G-protein signaling (analgesia) with limited recruitment of β-arrestin (associated with adverse outcomes) and may provide a cost-effective alternative versus conventional opioid morphine for postoperative pain. Patients & methods: Using a decision tree with a 24-h time horizon, we calculated costs for medication and management of three most common adverse events (AEs; oxygen saturation <90%, vomiting and somnolence) following postoperative oliceridine or morphine use. Results: Using oliceridine, the cost for managing AEs was US$528,424 versus $852,429 for morphine, with a net cost savings of $324,005. Conclusion: Oliceridine has a favorable overall impact on the total cost of postoperative care compared with the use of the conventional opioid morphine.

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Periodic deworming programme in Brazil

Research Society and Development ◽

10.33448/rsd-v9i11.10722 ◽

2020 ◽

Vol 9 (11) ◽

pp. e100091110722

Author(s):

Ariel Oliveira Celestino ◽

Pablo Amercio Silva Lima ◽

Larissa Maria Cardoso Lima Rodrigues ◽

Camila Mendonça França ◽

Isabel Ribeiro Santana Lopes ◽

...

Keyword(s):

Helminth Infection ◽

Cost Minimization ◽

Parasitic Infection ◽

Cost Benefit ◽

Treatment Method ◽

Annual Average ◽

Epidemiological Analysis ◽

Group 5 ◽

The Cost ◽

Observational Descriptive Study

To evaluate the periodic deworming programme (PDP) against soil-transmitted helminth infection and estimate the cost-benefit of this action in a Northeastern Brazilian State. An observational descriptive study was peformed by two branches: an epidemiological analysis of parasitological stool tests positivity in the 7 health micro-regions of Sergipe State, from January to June 2019, and a cost-benefitial analysis through comparison between estimated costs of PDP and conventional diagnose and treatment method from 2014 to 2018. From the 1110 parasitological stool tests evaluated, 317 were positive: 20 (1.8 %) for helminths and 307 (26.7%) for protozoan parasites. Among positive tests, 61 (19.2%) were in PDP age target group (5-14 years). An annual average of 255,283 Albendazole tablets (400mg, single dose) were distributed with an annual average coverage rate of 84.2%. To support the programme, approximately R$ 281,859.25 (US$ 89,775.67) were transferred per year to the state of Sergipe. PDP estimated cost-effectiveness was R$ 1.10 (US$ 0.34) per event prevented and generated a cost-minimization of approximately R$ 335.617,60 (US$124,568.00) when compared to the conventional diagnose and treat method. The positive rates of soil-transmitted helminth infection in parasitological tests in Sergipe were low and the recommendation for PDP seems to be currently inadequate. Most positive tests were for commensal protozoa species. PDP estimated cost is lower than conventional diagnose and treatment method. Protozoa infections prevention policies should be evaluated as they are the major parasitic infection in our community after PDP.

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Costs and efficacy ofolanzapine and risperidone in schizophrenia

Farmeconomia Health economics and therapeutic pathways ◽

10.7175/fe.v8i2.241 ◽

2007 ◽

Vol 8 (2) ◽

pp. 53-60

Author(s):

Vittorio Mapelli

Keyword(s):

Cost Minimization ◽

Cost Effective ◽

Psychiatric Disease ◽

Global Functioning ◽

Differential Effectiveness ◽

Health Authorities ◽

First Choice ◽

Italian National Health Service ◽

The Cost ◽

Effectiveness Studies

Introduction: schizophrenia is a serious and long lasting psychiatric disease. The new “atypical” antipsychotic drugs, introduced in the 90s, have substantially improved the effectiveness of medical treatments, compared to previous neuroleptic drugs. Nowadays they tend to be used as first choice drugs. The ddd cost of atypicals may differ by 20% and health authorities may have an incentive to deliver the less costly drug, especially if they are generic. However the various drugs show differential effectiveness rates and a rational choice should consider both cost and effectiveness. Objective: the purpose of this analysis is to review the existing evidence on cost-effectiveness studies of olanzapine and risperidone, the two most prescribed drugs in Italy. Six published studies were identified, but attention was focused on two articles that reported consistent and methodologically sound results. Results: most reviewed studies are cost-minimization analyses, since effectiveness indicators show no significant statistical difference between the two drugs, and are inconclusive since the results depend on the evaluation setting. However one observational retrospective study showed a significant severity reduction over 12 months for patients treated with olanzapine (-2.46 on HoNOS scale; p<0.05), compared to a smaller non significant reduction of the risperidone group (-0.57). Despite the higher drug cost, the average total cost per reduced severity score was lower for olanzapine than for risperidone patients (€ 4,554 vs. € 10,897). The only medical and related health care costs for risperidone patients were higher than total costs for olanzapine patients. Another study comparing cohorts of patients with similar starting severity showed a significant severity reduction and global functioning increase over 12 months for olanzapine but no significant increase for risperidone patients (-0.35, p<0.01 on CGI scale; +3.66, p <0.05 on GAF scale, compared respectively to -0.27, p<0.05 and +2.00 n.s.). Again average cost per reduced severity/increased functioning score was higher for risperidone than olanzapine patients (€ 4,568 vs. € 4,170 for CGI and € 2,284 vs. € 1,139 for GAF scales respectively). Conclusion: the use of olanzapine in the treatment of schizophrenia is the most cost-effective alternative for the SSN (Italian National health service), as it minimizes the cost per score of severity reduction or functioning increase. Even if the price of risperidone were to be reduced by 50% (becoming a generic), total 12 months treatment costs would exceed those of olanzapine in its highest ddd (30 mg).

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ANALISIS USAHA DAN PEMASARAN GULA SEMUT DI DESA HARGOTIRTO, KECAMATAN KOKAP, KABUPATEN KOKAP

SEPA Jurnal Sosial Ekonomi Pertanian dan Agribisnis ◽

10.20961/sepa.v16i1.22470 ◽

2019 ◽

Vol 16 (1) ◽

pp. 74

Author(s):

Mega Nugraheni Apriza Putri ◽

Raden Kunto Adi ◽

Isti Khomah

Keyword(s):

Cost Benefit ◽

Marketing Channel ◽

Snowball Sampling ◽

Brown Colour ◽

Business Analysis ◽

Marketing Efficiency ◽

The Cost ◽

Benefit Cost ◽

Descriptive Method ◽

Made In

Gula semut adalah produk inovatif dari pengolahan nira kelapa dalam bentuk bubuk atau butiran bewarna kuning sampai cokelat. Sebanyak 433.820 kg produksi gula semut dibuat di Desa Hargotirto. Penelitian bertujuan untuk menganalisis pendapatan usaha, pola saluran pemasaran, biaya, keuntungan, marjin pemasaran, dan efisiensi pemasaran secara ekonomi masing-masing saluran pemasaran di Desa Hargotirto. Metode dasar yang digunakan adalah metode deskriptif analisis. Metode penentuan lokasi secara purposive di Desa Hargotirto, Kecamatan Kokap, Kabupaten Kulon Progo. Metode pengambilan responden secara random dengan teknik undian sejumlah 93 responden. Pengambilan responden saluran pemasaran dengan snowball sampling. Analisis data yang digunakan dalam menghitung analisis usaha dan pemasaran untuk mengetahui biaya, penerimaan, pendapatan usaha, biaya pemasaran, keuntungan pemasaran, dan marjin pemasaran. Hasil penelitian menunjukkan rata-rata penerimaan sebesar Rp51.366,22, biaya total sebesar Rp25.401,16, danrata-rata pendapatan sebesar Rp25.959,05. Terdapat tiga pola saluran pemasaran di Desa Hargotirto. Total biaya pemasaran masing-masing saluran pemasaran yaitu Rp5.845,30, Rp5.374,72, dan Rp3.407,73. Total keuntungan pemasaran masing-masing saluran pemasaran yaitu Rp7.640,39, Rp7.343,56, dan sebesar Rp9.960,95. Total marjin pemasaran pada masing-masing saluran yaitu Rp6.636,36, Rp5.000,00, dan Rp4.849,91. Nilai farmer’s share untuk masing-masing saluran pemasaran yaitu 72,35%, 77,99%, dan 78,20%. Crystal coconut sugar is an innovative product from processing coconut palm in the powder or granular form that have a yellow to brown colour. A total of 433,820 kg of crystal coconut sugar made in Hargotirto Village. The aim of this research is to analyse the cost, revenue, income, marketing cost, benefit cost, marginal marketing, and marketing efficiency economically in Hargotiro Village. The method applied is the descriptive method. The sample area is chosen on purposive sampling. The sample of producent is taken by random and take 93 sample. The method of take snowball sampling marketing channel respondents. The data analysis used is the cost analysis, revenue, income, marketing cost, benefit cost, and marginal marketing. The result of the research business analysis shows that are total rate revenue of crystal coconut sugar Rp51,360.22. That are three pattern of marketing channel of crystal coconut sugarin Hargotirto Village. Total benefit for each marketing channel is Rp7,640.39, Rp7,343.56, and Rp9,960.95. Total Marginal marketing for each marketing channel is Rp6.636,36, Rp5.000,00, and Rp4.840,91. Farmer’s share for each marketing channel is 72,35%, 77,99%, and 78,20%.

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