scholarly journals Cost of coils for intracranial aneurysms: clinical decision analysis for implementation of a capitation model

2018 ◽  
Vol 128 (6) ◽  
pp. 1792-1798 ◽  
Author(s):  
Gurpreet S. Gandhoke ◽  
Yash K. Pandya ◽  
Ashutosh P. Jadhav ◽  
Tudor Jovin ◽  
Robert M. Friedlander ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Savings ◽  
Clinical Decision ◽  
Sensitivity Analyses ◽  
List Price ◽  
Maximum Dimension ◽  
Total Length ◽  
The Mean ◽  
Mean Cost

OBJECTIVEThe price of coils used for intracranial aneurysm embolization has continued to rise despite an increase in competition in the marketplace. Coils on the US market range in list price from $500 to $3000. The purpose of this study was to investigate potential cost savings with the use of a price capitation model.METHODSThe authors built a clinical decision analytical tree and compared their institution’s current expenditure on endovascular coils to the costs if a capped-price model were implemented. They retrospectively reviewed coil and cost data for 148 patients who underwent coil embolization from January 2015 through September 2016. Data on the length and number of coils used in all patients were collected and analyzed. The probabilities of a treated aneurysm being ≤/> 10 mm in maximum dimension, the total number of coils used for a case being ≤/> 5, and the total length of coils used for a case being ≤/> 50 cm were calculated, as was the mean cost of the currently used coils for all possible combinations of events with these probabilities. Using the same probabilities, the authors calculated the expected value of the capped-price strategy in comparison with the current one. They also conducted multiple 1-way sensitivity analyses by applying plausible ranges to the probabilities and cost variables. The robustness of the results was confirmed by applying individual distributions to all studied variables and conducting probabilistic sensitivity analysis.RESULTSNinety-five (64%) of 148 patients presented with a rupture, and 53 (36%) were treated on an elective basis. The mean aneurysm size was 6.7 mm. A total of 1061 coils were used from a total of 4 different providers. Companies A (72%) and B (16%) accounted for the major share of coil consumption. The mean number of coils per case was 7.3. The mean cost per case (for all coils) was $10,434. The median total length of coils used, for all coils, was 42 cm. The calculated probability of treating an aneurysm less than 10 mm in maximum dimension was 0.83, for using 5 coils or fewer per case it was 0.42, and for coil length of 50 cm or less it was 0.89. The expected cost per case with the capped policy was calculated to be $4000, a cost savings of $6564 in comparison with using the price of Company A. Multiple 1-way sensitivity analyses revealed that the capped policy was cost saving if its cost was less than $10,500. In probabilistic sensitivity analyses, the lowest cost difference between current and capped policies was $2750.CONCLUSIONSIn comparison with the cost of coils from the authors’ current provider, their decision model and probabilistic sensitivity analysis predicted a minimum $407,000 to a maximum $1,799,976 cost savings in 148 cases by adapting the capped-price policy for coils.

Uncertainty about facts and heterogeneity in values

2020 ◽  
pp. 303-320
Author(s):  
Susan Griffin
Keyword(s):  
Sensitivity Analysis ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Uncertainty Analysis ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Information Analysis ◽  
Value Judgments

This chapter covers methods for describing how lack of knowledge impacts on the conduct and findings of distributional cost-effectiveness analysis (DCEA). It also sets out methods for describing how different value judgments can alter the findings. It explains why and how to distinguish uncertainty about facts from heterogeneity in values, and the role of each in informing decisions. It shows how the standard tools of uncertainty analysis in economic evaluation—including deterministic and probabilistic sensitivity analysis, and value of information analysis—can be applied to DCEA to provide information about uncertainty in the estimated health distributions and summary measures of equity impact. The chapter also shows how to use deterministic sensitivity analyses to investigate the implications of alternative value judgments and inequality metrics for DCEA findings and recommendations.

PROBABILISTIC SENSITIVITY ANALYSIS IN COST-EFFECTIVENESS

1999 ◽  
Vol 15 (3) ◽  
pp. 563-572 ◽  
Author(s):  
William Whang ◽  
Jane E. Sisk ◽  
Daniel F. Heitjan ◽  
Alan J. Moskowitz
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Probabilistic Sensitivity Analysis ◽  
Probabilistic Methods ◽  
Policy Implications ◽  
Sensitivity Analyses ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Worst Case ◽  
The Cost

Objectives: We explore the policy implications of probabilistic sensitivity analysis in cost-effectiveness analysis by applying simulation methods to a decision model.Methods: We present the multiway sensitivity analysis results of a study of the cost-effectiveness of vaccination against pneumococcal bacteremia in the elderly. We then execute a probabilistic sensitivity analysis of the cost-effectiveness ratio by specifying posterior distributions for the uncertain parameters in our decision analysis model. In order to estimate probability intervals, we rank the numerical values of the simulated incremental cost-effectiveness ratios (ICERs) to take into account preferences along the cost-effectiveness plane.Results: The 95% probability intervals for the ICER were generally much narrower than the difference between the best case and worst case results from a multiway sensitivity analysis. Although the multiway sensitivity analysis had indicated that, in the worst case, vaccination in the 85 and older age group was not acceptable from a policy standpoint, probabilistic methods indicated that the cost-effectiveness of vaccination was below $50,000 per quality-adjusted life-year in greater than 92% of the simulations and below $100,000 in greater than 95% of the simulations.Conclusions: Probabilistic methods can supplement multiway sensitivity analyses to provide a more comprehensive picture of the uncertainty associated with cost-effectiveness ratios and thereby inform policy decisions.

P1383ECONOMIC BENEFITS OF SWITCHING FROM INTRAVENOUS TO SUBCUTANEOUS ERTHROPOIESIS-SIMULATING AGENTS THERAPY FOR MANAGEMENT OF ANEMIA IN HEMODIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Bhanu Prasad ◽  
Maryam Jafari ◽  
Joanne Kappel ◽  
Julie Toppings ◽  
Linda Gross
Keyword(s):  
Transferrin Saturation ◽  
Cost Savings ◽  
Hemodialysis Patients ◽  
T Test ◽  
Epoetin Alfa ◽  
Epoetin Alpha ◽  
Iv Iron ◽  
The Mean ◽  
The Cost ◽  
Mean Cost

Abstract Background and Aims Erythropoiesis stimulating agents (ESA’s) were introduced in the treatment of anemia in 1989 and it immediately led to a marked decline in the number of blood transfusions and improved quality of life in patients across the spectrum of chronic kidney disease. Several studies from the mid 1990s have shown that the required doses of Epoetin alpha were lower when administered subcutaneously (SQ). These studies led to guidelines by NKF (1997) and KDOQI (2001) recommending the use of SQ over intravenous (IV) as considerable cost savings could be achieved without compromising care. The rise in the reported cases of pure red cell aplasia (PRCA) led to a change in guidelines in 2006 and led to units changing exclusively to IV route. It was subsequently identified that polysorbate 80 from uncoated rubber stoppers in pre-filled syringes rather than the route of administration was the most plausible cause of PRCA. However, higher doses of ESAs, have been associated with adverse health outcomes across all hematocrit categories in hemodialysis patients. While the current practice is to administer ESAs to patients through IV route, SQ ESAs achieve the same target hemoglobin level at a reduced dose and cost. Given the dose -sparing advantages of SQ Epoetin alpha administration, we decided to gradually transition our patients to SQ and examined the cost of IV versus SQ treatment. The objective of our study was to determine the economic benefit of the change in the route of administration from IV to SQ ESA in hemodialysis patients. Method We conducted a retrospective cohort study in 215 hemodialysis patients who transitioned from IV Epoetin alfa to SQ at four hemodialysis sites in the province of Saskatchewan, Canada from September 2014 to July 2017. The dose and cost of different routes of Epoetin alfa administration per patient per month was calculated. Also, blood hemoglobin, markers of erythropoiesis (transferrin saturation and Ferritin), IV iron dose and cost were determined in relation to route of Epoetin alfa administration. The dependent t-test was used to compare mean variables between pre-switch and post-switch period. Differences in variables across three serum hemoglobin ranges (<95, 95-115, >115 gram/liter) were assessed using the independent t-test. Results The mean Epoetin alfa doses per patient per month (47,327.9±33,133.0 international unit) during pre-switch (IV) period were greater than of post-switch (SQ) period (34,253±24,858.1), a decrease of 27.62% (p<0.001). The mean hemoglobin concentration for patients in both periods remained stable (103.3±9.2 versus 104.3±13.3, p=0.34) and within the target range. The reduction in the dose of Epoetin alfa per patient per month (IU± standard deviation) upon conversion remained similar (IV versus SQ) in all the subcategories: hemoglobin <95 g/L (65,941 versus 52,717), hemoglobin 95-115g/L (42,120 versus 29,619) and (35,289 versus 17,651) for hemoglobin >115 g/L. There were no significant differences in transferrin saturation, Ferritin and IV iron dose and cost between the two study periods. The mean cost (CAD± SD) of Epoetin alfa per patient per month decreased from 674.4±477.4 pre-switch to 484.8±354.3 post-switch (p<0.001), a decrease of 28.11%; whereas, the cost of IV iron remained similar in pre- and post-switch period. Conclusion The (mean) cost of Epoetin alfa per patient per year in our study when given IV was $ 8,088 (CAD) and once converted to SQ was $ 5,817 (CAD) while achieving equivalent hemoglobin levels, a saving of $ 2271 (CAD) per year. Based on these values, if we extrapolate our savings to 900 prevalent patients to SQ Epoetin alfa we can realize a cost saving of $2,043,900 per year. Conversion of Epoetin alfa from IV to SQ led to substantial cost savings at our hemodialysis units.

Cost-effectiveness of darbepoetin alfa (DA) 500 mcg every three weeks (Q3W) with IV iron compared to DA Q3W alone in cancer patients (pts) with chemotherapy-induced anaemia (CIA)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19531-19531 ◽  
Author(s):  
N. Demarteau ◽  
L. Annemans ◽  
T. Mossman ◽  
A. Bracco
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Savings ◽  
Oral Iron ◽  
Hourly Wage ◽  
Open Label ◽  
Medical Resources ◽  
Life Years ◽  
Iv Iron

19531 Background: IV iron supplementation during erythropoiesis-stimulating agent treatment in anaemic cancer pts may help to optimize anaemia management. We assessed the cost-effectiveness of DA Q3W with IV iron (net 200 mg Q3W; DA+IV iron) to DA Q3W without IV iron (standard practice [SP]= oral iron allowed; DA+SP) from a French societal perspective. Methods: A prospective 16-week, randomized, open-label, multicenter study in 396 pts with non-myeloid malignancy and CIA (hemoglobin [Hb] < 11g/dL) was conducted to evaluate the safety and efficacy of DA+IV iron vs. DA+SP. Data collected include: cumulative doses (IV iron, oral iron, and DA), number of transfusions, and Hb values. Quality adjusted life years (QALY) weights were obtained using the EQ-5D at baseline and at end of treatment. The medical resources used for one DA administration and one transfusion, including pts’ time, were determined by a panel of 20 French clinical experts. Costs were applied to both time (valued at the gross hourly wage) and medical resources (extracted from official sources: AMELI; INSEE). Effectiveness was expressed in average Hb values over the treatment period and the change from baseline in QALY weights. A 5,000- replication probabilistic sensitivity analysis was performed with RISK® after applying distributions to medical resources used and effectiveness parameters. Results: Compared to DA+SP, DA+IV iron showed higher average Hb values (+0.2 g/dL [95% CI: -0.0, 0.4]; 10.9g/dL [10.8, 11.1] vs. 11.1g/dL [11.0, 11.3] respectively), higher QALY weights (+0.017 [-0.028, 0.064]; 0.016 [-0.019, 0.050] vs. 0.033 [0.002, 0.064]) and lower cost (-647.5€ [-938.0, -352.4]; 4,788.3€ [4,561.2, 5,018.2] vs. 4,140.8€ [3,955.4, 4,319.8]). Probabilistic sensitivity analysis revealed that DA+IV iron had a 94% chance of a higher average Hb value and lower costs and 73% chance of a higher QALY level and lower costs. Conclusions: DA Q3W with IV iron is a cost effective alternative to Q3W without IV iron. Further studies in this patient population are needed to determine whether systematic administration of IV iron with DA Q3W will demonstrate cost savings, higher average Hb values, and more QALYs. No significant financial relationships to disclose.

VP131 Comparison Of Variation Methods For One-Way Sensitivity Analyses

2017 ◽  
Vol 33 (S1) ◽  
pp. 208-209
Author(s):  
Robert McQueen ◽  
Jonathan Campbell
Keyword(s):  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Probability Distributions ◽  
Mean Difference ◽  
Sensitivity Analyses ◽  
Variation Method ◽  
Evidence Based ◽  
Reference Case ◽  
The Mean ◽  
Constant Percentage

INTRODUCTION:A common approach to one-way sensitivity analysis is to vary inputs by a constant percentage. An alternative is to derive ranges using evidence-based probability distributions from published sources. Our objective was to compare one-way sensitivity analysis results when using these two approaches for a reference case model, along with two additional case studies.METHODS:For the reference case, we replicated a published Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) cost-effectiveness Markov model (zidovudine versus zidovudine plus lamivudine in the UK) using TreeAge®. Health states included three HIV/AIDS states and death. We generated one-way sensitivity analyses by varying inputs in two ways: (i) using ±15 percent for all inputs, and (ii) using the 2.5 and 97.5 percentile values of the evidence-based probability distributions for all inputs. Our outcome was the mean difference between lower and upper incremental cost-effectiveness ratios (ICERs) for each variation method for the ten most influential inputs. We assessed the number of inputs with a mean difference between lower and upper ICERs of >10 percent of the deterministic ICER.RESULTS:The deterministic ICER was GBP7,654/QALY (quality adjusted life year) for combination therapy versus monotherapy. The mean difference in ICER uncertainty for the evidence-based vs. ±15 percent variation method was GBP3,251/QALY (p = .0096). Six inputs had a mean difference in ICER uncertainty of >10 percent of GBP7,654/QALY (that is, mean difference in ICER uncertainty > GBP765) for the evidence-based variation method, compared to only two inputs for the constant percentage variation method.CONCLUSIONS:For the reference case, the magnitude of uncertainty in the outcome was larger for the evidence-based variation method compared to the constant percentage variation method. Evidence-based uncertainty in inputs should be used in all sensitivity analyses to reflect realistic uncertainty in an outcome and aid decision-making about future research strategies. Additional case studies will be presented using validated models in diabetes and asthma.

scholarly journals Community-based continuity of midwifery care versus standard hospital care: a cost analysis

2001 ◽  
Vol 24 (1) ◽  
pp. 85 ◽  
Author(s):  
Caroline S Homer ◽  
Deborah V Matha ◽  
Lesley G Jordan ◽  
Jo Wills ◽  
Gregory K Davis
Keyword(s):  
Standard Care ◽  
Caesarean Section Rate ◽  
Cost Savings ◽  
Model Of Care ◽  
Community Based ◽  
Midwifery Care ◽  
New Model ◽  
The Mean ◽  
The Cost ◽  
Mean Cost

This paper reports the costs of providing a new model of maternity care compared to standard care in anAustralian public hospital. The mean cost of providing care per woman was lower in the group who had the newmodel of care compared with standard care ($2 579 versus $3 483). Cost savings associated with new model of carewere maintained even after costs associated with admission to special care nursery were excluded. The cost saving wasalso sustained even when the caesarean section rate in the new model of care increased to beyond that of the standardcare group.

scholarly journals Evaluation of the Cost of a High-Dose Intravenous Iron Protocol in a Regional Hemodialysis Program: Research Letter

2021 ◽  
Vol 8 ◽  
pp. 205435812110639
Author(s):  
Adam Papini ◽  
Braden J. Manns ◽  
Meghan J. Elliott
Keyword(s):  
Cost Savings ◽  
Sensitivity Analyses ◽  
High Dose ◽  
Pivotal Trial ◽  
Potential Cost ◽  
Medication Utilization ◽  
Hemodialysis Unit ◽  
Iv Iron ◽  
The Mean ◽  
The Cost

Background: Intravenous (IV) iron and erythropoietin stimulating agents (ESAs) are standard treatments for anemia in patients receiving maintenance hemodialysis. These medications are associated with significant costs to hemodialysis programs and patients. Recent trial evidence demonstrated that a high-dose IV iron protocol reduces ESA usage and improves cardiovascular outcomes. The cost of implementing a high-dose iron protocol within the Canadian public healthcare context remains unknown. Objective: Our primary aim was to estimate the costs of a high-dose IV iron protocol in a large Canadian hemodialysis program that currently uses a low-dose and reactive IV iron strategy. Our secondary aim was to estimate the reduction in ESA use required to maintain cost neutrality with a high-dose IV iron protocol. Design: In this modeling study of IV iron and ESA utilization from a regional hemodialysis program, changes in medication utilization were calculated based on observed effects from published trial data. Using data from a quality improvement audit of regional anemia management and medication utilization, we estimated potential cost differences under various modeling conditions. Setting: Four adult hospital-based and 9 community in-center hemodialysis units in the Alberta Kidney Care—South renal program during the observation period of September 1, 2018, to November 30, 2018. Patients: In total, data from 826 patients were included. Measurements: Mean monthly IV iron and ESA doses were obtained from routine audit data captured within an electronic medical record. Costs were determined from provincially negotiated medication prices. Methods: Current IV iron and erythropoietin dosages were aggregated at the hemodialysis unit level. We used the results from the PIVOTAL trial to estimate the expected increase in IV iron dose and reduction in ESA dose with a high-dose IV iron protocol. We assumed the split between various manufactures of IV iron and ESA were maintained in our cost model. Total medication costs were aggregated by hemodialysis unit, and the mean costs in each unit were used to estimate per-patient costs. Sensitivity analyses included models that assumed 100% IV iron sucrose usage, as well as models where community hemodialysis units and hospital-based hemodialysis units were examined separately. Finally, we calculated a break-even point for ESA dose reduction required to maintain cost neutrality. Results: Actual baseline IV iron and ESA dose utilization across 13 adult HD units were 118 mg/patient/month (95% confidence interval [CI]: 102-134 mg) and 20,764 IU/pt./mo. (95% CI: 18,104-23,424 IU), respectively. The mean combined cost of ESA and IV iron was $315/pt./mo. (95% CI: $274-$355). In comparison, using the results of the PIVOTAL trial and assuming a high-dose IV iron scenario, we estimated mean IV iron use of 215 mg/pt./mo. (95% CI: 187-243 mg/pt./mo.) and a reduction in mean ESA use to 15,923 IU/pt./mo. (95% CI: 13,883-17,962 IU/pt./mo.). This resulted in an estimated cost savings of $38/pt./mo. (95% CI: $33–$42/pt./mo.) and a total program savings of $370,000 per year (95% CI: $325,000-$420,000). Sensitivity analyses under various alternate conditions also showed potential cost savings. We estimated that a dose reduction of ESA of 10% would be required for cost neutrality with a high-dose IV iron protocol. Limitations: Our study is limited in its use of data from a single randomized controlled trial (RCT) to estimate cost savings rather than actualized utilization. Our models do not take into consideration anticipated reductions in transfusions and hospitalizations that could be realized from a high-dose IV iron protocol. Conclusions: Based on cost modeling, a high-dose IV iron protocol could be integrated in large Canadian regional hemodialysis program in a cost saving manner. Programs implementing such a protocol should monitor IV iron and EPO use prospectively to determine if the trial protocol as applied in a real-world setting translates into cost savings.

scholarly journals Canadian Economic Evaluation of Budesonide-Formoterol as Maintenance and Reliever Treatment in Patients with Moderate to Severe Asthma

2007 ◽  
Vol 14 (5) ◽  
pp. 269-275 ◽  
Author(s):  
Elizabeth Miller ◽  
Malcolm R Sears ◽  
Andrew McIvor ◽  
Anna Liovas
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Economic Evaluation ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Severe Exacerbation ◽  
Sensitivity Testing ◽  
Reliever Medication ◽  
The Mean ◽  
Mean Cost

OBJECTIVES: To compare the cost-effectiveness of budesonide-formoterol in a single inhaler used as both maintenance and reliever medication versus clinician-directed titration of salmeterol-fluticasone as maintenance medication, plus salbutamol taken as needed, in controlling asthma in adults and adolescents.METHODS: A Canadian economic evaluation was conducted based on the results of a large (n=2143), open-label, randomized, controlled effectiveness trial in which health resource use was prospectively collected. The primary outcome measurement was the time to the first severe exacerbation. Costs included direct medical costs (physician and emergency room visits, hospitalizations, asthma drug costs, etc) and productivity (absenteeism). The time horizon was one year, which corresponded to the duration of the clinical trial. Prices were obtained from 2005 Canadian sources. Both health care and societal perspectives were considered, and deterministic univariate sensitivity analyses were conducted.RESULTS: In the clinical trial, budesonide-formoterol as maintenance and reliever treatment was superior to salmeterol-fluticasone with respect to the time to the first severe exacerbation, overall rate of exacerbations and use of as-needed reliever medication. The annualized rate of severe exacerbations was 0.24 events/patient in the budesonide-formoterol arm and 0.31 events/patient in the salmeterol-fluticasone arm (P=0.0025). From a health care perspective, the mean cost per patient-year was $1,315 in the budesonide-formoterol arm versus $1,541 in the salmeterol-fluticasone arm. From a societal perspective, the mean cost per patient-year was $1,538 in the budesonide-formoterol arm and $1,854 in the salmeterol-fluticasone arm. Budesonide-formoterol was dominant (more effective and less expensive) in the base case analysis from both perspectives. The results were robust under sensitivity testing.CONCLUSIONS: The strategy that allows budesonide-formoterol to be used in a single inhaler as both maintenance and reliever medication proved to be more effective and less expensive than a strategy of clinician-directed titration of salmeterol-fluticasone with salbutamol as reliever therapy.

scholarly journals Cost-minimization analysis of community pharmacy-based point-of-care testing for strep throat in 5 Canadian provinces

2018 ◽  
Vol 151 (5) ◽  
pp. 322-331 ◽  
Author(s):  
Nina Lathia ◽  
Karen Sullivan ◽  
Kathy Tam ◽  
Margaret Brna ◽  
Paula MacNeil ◽  
...  
Keyword(s):  
Sore Throat ◽  
Cost Minimization ◽  
Point Of Care ◽  
Cost Savings ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Community Pharmacies ◽  
Canadian Provinces ◽  
Mean Cost ◽  
Strep Throat

Background: Strep throat point-of-care (POC) testing in community pharmacies will enable pharmacist-based care for this condition. Our objective was to conduct an economic evaluation of treating severe sore throat when this service was offered in pharmacies in 5 Canadian provinces. Methods: We conducted 5 separate cost-minimization analyses for the provinces of Alberta, British Columbia, Nova Scotia, Ontario and Saskatchewan, from the public payer perspective, to estimate mean cost per patient of treating severe sore throat in 2 scenarios: 1) physician-based usual care in a family physician’s office, a walk-in clinic or an emergency room (ER) and 2) a new scenario where patients received care described above or in a pharmacy offering strep throat POC testing. One-way sensitivity analyses were conducted to account for model uncertainty. Results: Mean cost per patient for each pathway in the base-case analyses for the 5 provinces ranged from 1) $37.55 to $61.57 for family physician, 2) $37.55 to $61.57 for walk-in clinic, 3) $38.88 to $57.56 for ER and 4) $19.12 to $21.83 for pharmacy, representing savings ranging from $12.47 to $24.36 per patient for the new scenario. Approximate total cost savings range from $1.3 million to $2.6 million per year across the 5 provinces. All sensitivity analyses yielded cost savings for the new scenario. Discussion: Across 5 provinces, strep throat POC testing in pharmacies was cost saving compared to physician-based care. Sensitivity analyses demonstrated the robustness of these results. Conclusions: Funding strep throat POC testing in community pharmacies in these 5 provinces would lead to public health system cost savings and potentially improve patients’ access to care for severe sore throat.

scholarly journals Magnesium Alginate in Gastro-Esophageal Reflux: A Randomized Multicenter Cross-Over Study in Infants

2019 ◽  
Vol 17 (1) ◽  
pp. 83 ◽  
Author(s):  
Maria Elisabetta Baldassarre ◽  
Antonio Di Mauro ◽  
Maria Cristina Pignatelli ◽  
Margherita Fanelli ◽  
Silvia Salvatore ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Lower Cost ◽  
Cost Savings ◽  
Cost Benefit ◽  
Cost Benefit Ratio ◽  
The Mean ◽  
The Cost ◽  
Mean Cost ◽  
To Receive ◽  
Breast Fed

The aims of this study were to evaluate the efficacy of magnesium alginate in decreasing functional regurgitation symptoms in infants, and to assess the cost–benefit ratio of magnesium alginate compared to a thickened formula. A multicenter perspective cross-over study was conducted in formula-fed infants with persisting regurgitation, randomly assigned to receive two weeks of a magnesium-alginate-based formulation followed by two weeks of thickened formula, or vice-versa. Infants, exclusively breast-fed, were followed up for two weeks while receiving magnesium alginate. Symptoms of gastroesophageal reflux (GER) were evaluated through the Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R). Direct cost of treatments was also calculated. Seventy-two infants completed the study. We found a significant reduction of I-GERQ-R scores over time (F = 55.387; p < 0.001) in all groups with no difference between the sequences of administration (F = 0.268; p = 0.848) in formula-fed infants and between exclusively breast-fed and formula-fed infants receiving magnesium alginate (t = 1.55; p = 0.126). The mean cost savings per infant was € 4.60 (±11.2) in formula-fed infants treated with magnesium alginate compared to thickened formula (t = 2.91, p < 0.0005). Conclusions were that the magnesium-alginate formulation reduces GER symptoms both in formula-fed and breast-fed infants. In formula-fed infants, clinical efficacy is similar to thickened formulas with a slightly lower cost of treatment.

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