Cost-Effectiveness of Upper Extremity Dry Needling in Chronic Stroke

Introduction: Dry needling is a non-pharmacological approach that has proven to be effective in different neurological conditions. Objective: The aim of this study was to evaluate the cost-effectiveness of a single dry needling session in patients with chronic stroke. Methods: A cost-effectiveness analysis was performed based on a randomized controlled clinical trial. The results obtained from the values of the EuroQol-5D questionnaire and the Modified Modified Ashworth Scale were processed in order to obtain the percentage of treatment responders and the quality-adjusted life years (QALYs) for each alternative. The cost analysis was that of the hospital, clinic, or health center, including the equipment and physiotherapist. The cost per respondent and the incremental cost-effectiveness ratio of each alternative were assessed. Results: Twenty-three patients with stroke were selected. The cost of DN treatment was EUR 14.96, and the data analysis showed a favorable cost-effectiveness ratio of both EUR/QALY and EUR/responder for IG, although the sensitivity analysis using limit values did not confirm the dominance (higher effectiveness with less cost) of the dry needling over the sham dry needling. Conclusions: Dry needling is an affordable alternative with good results in the cost-effectiveness analysis—both immediately, and after two weeks of treatment—compared to sham dry needling in persons with chronic stroke.

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Cost-effectiveness Analysis of Submandibular Gland Preservation With Sialendoscopy for the Management of Sialolithiasis

Otolaryngology ◽

10.1177/01945998211026847 ◽

2021 ◽

pp. 019459982110268

Author(s):

Joseph R. Acevedo ◽

Ashley C. Hsu ◽

Jeffrey C. Yu ◽

Dale H. Rice ◽

Daniel I. Kwon ◽

...

Keyword(s):

Cost Effectiveness ◽

Submandibular Gland ◽

Average Cost ◽

Cost Effective ◽

Cost Effectiveness Analysis ◽

Effectiveness Analysis ◽

Life Years ◽

Probability Of Success ◽

Markov Decision Model ◽

The Cost

Objective To compare the cost-effectiveness of sialendoscopy with gland excision for the management of submandibular gland sialolithiasis. Study Design Cost-effectiveness analysis. Setting Outpatient surgery centers. Methods A Markov decision model compared the cost-effectiveness of sialendoscopy versus gland excision for managing submandibular gland sialolithiasis. Surgical outcome probabilities were found in the primary literature. The quality of life of patients was represented by health utilities, and costs were estimated from a third-party payer’s perspective. The effectiveness of each intervention was measured in quality-adjusted life-years (QALYs). The incremental costs and effectiveness of each intervention were compared, and a willingness-to-pay ratio of $150,000 per QALY was considered cost-effective. One-way, multivariate, and probabilistic sensitivity analyses were performed to challenge model conclusions. Results Over 10 years, sialendoscopy yielded 9.00 QALYs at an average cost of $8306, while gland excision produced 8.94 QALYs at an average cost of $6103. The ICER for sialendoscopy was $36,717 per QALY gained, making sialendoscopy cost-effective by our best estimates. The model was sensitive to the probability of success and the cost of sialendoscopy. Sialendoscopy must meet a probability-of-success threshold of 0.61 (61%) and cost ≤$11,996 to remain cost-effective. A Monte Carlo simulation revealed sialendoscopy to be cost-effective 60% of the time. Conclusion Sialendoscopy appears to be a cost-effective management strategy for sialolithiasis of the submandibular gland when certain thresholds are maintained. Further studies elucidating the clinical factors that determine successful sialendoscopy may be aided by these thresholds as well as future comparisons of novel technology.

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Systematic review of cost-effectiveness analysis of behavior change communication apps: Assessment of key methods

Digital Health ◽

10.1177/20552076211000559 ◽

2021 ◽

Vol 7 ◽

pp. 205520762110005

Author(s):

Cynthia Afedi Hazel ◽

Sheana Bull ◽

Elizabeth Greenwell ◽

Maya Bunik ◽

Jini Puma ◽

...

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Behavior Change ◽

Quantitative Measure ◽

Cost Effectiveness Analysis ◽

Behavior Change Communication ◽

Change Communication ◽

Effectiveness Analysis ◽

Life Years ◽

The Cost

Objective Evidence backing the effectiveness of mobile health technology is growing, and behavior change communication applications (apps) are fast becoming a useful platform for behavioral health programs. However, data to support the cost-effectiveness of these interventions are limited. Suggestions for overcoming the low output of economic data include addressing the methodological challenges for conducting cost-effectiveness analysis of behavior change app programs. This study is a systematic review of cost-effectiveness analyses of behavior change communication apps and a documentation of the reported challenges for investigating their cost-effectiveness. Materials and methods Four academic databases: Medline (Ovid), CINAHL, EMBASE and Google Scholar, were searched. Eligibility criteria included original articles that use a cost-effectiveness evaluation method, published between 2008 and 2018, and in the English language. Results Out of the 60 potentially eligible studies, 6 used cost-effectiveness analysis method and met the inclusion criteria. Conclusion The evidence to support the cost-effectiveness of behavior change communication apps is insufficient, with all studies reporting significant study challenges for estimating program costs and outcomes. The main challenges included limited or lack of cost data, inappropriate cost measures, difficulty with identifying and quantifying app effectiveness, representing app effects as Quality-adjusted Life Years, and aggregating cost and effects into a single quantitative measure like Incremental Cost Effectiveness Ratio. These challenges highlight the need for comprehensive economic evaluation methods that balance app data quality issues with practical concerns. This would likely improve the usefulness of cost-effectiveness data for decisions on adoption, implementation, scalability, sustainability, and the benefits of broader healthcare investments.

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Cost-effectiveness analysis of a physician deployment program to improve access to healthcare in rural and underserved areas in the Philippines

BMJ Open ◽

10.1136/bmjopen-2019-033455 ◽

2019 ◽

Vol 9 (12) ◽

pp. e033455

Author(s):

Anton L.V. Avanceña ◽

Kim Patrick S Tejano ◽

David W. Hutton

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

The Philippines ◽

Cost Effectiveness Analysis ◽

Base Case ◽

Rural Municipality ◽

Healthcare Perspective ◽

Effectiveness Analysis ◽

Life Years ◽

The Cost

ObjectivesThe objective of this study is to explore the cost-effectiveness of Doctor to the Barrios (DTTB), a physician deployment program in the Philippines.DesignCost-effectiveness analysis using decision tree models with a lifetime time horizon and probabilistic sensitivity analysis.SettingSocietal and healthcare perspectives.PopulationHypothetical cohort of children under 5 years in two provinces (Aklan and Nueva Ecija) and in a representative rural municipality.ParticipantsNone.InterventionsDTTB’s impact on paediatric pneumonia and diarrhoea outcomes compared with a scenario without DTTB.Main outcome measuresCosts, effectiveness (in terms of lives saved and quality-adjusted life years (QALYs) gained) and incremental cost-effectiveness ratio (ICER).ResultsDTTB is cost-effective in the two provinces that were included in the study from societal and healthcare perspectives. Looking at a representative rural municipality, base case analysis and probabilistic sensitivity analyses suggest that DTTB has an ICER of 27 192 per QALY gained from a societal perspective. From a healthcare perspective, the base case ICER of DTTB is Philippine pesos (PHP) 71 839 per QALY gained and PHP 2 064 167 per life saved, and 10 000 Monte Carlo simulations produced similar average estimates. The cost per QALY of DTTB from a healthcare perspective is lower than the WHO recommended willingness-to-pay threshold of 100% of the country’s per-capita gross domestic product.ConclusionsDTTB can be a cost-effective intervention, but its value varies by setting and the conditions of the municipality where it is implemented. By focusing on a narrow set of paediatric outcomes, this study has likely underestimated the health benefits of DTTB. Additional research is needed to understand the full extent of DTTB’s impact on the health of communities in rural and remote areas. Future cost-effectiveness analysis should empirically estimate various parameters and include other health conditions in addition to pneumonia and diarrhoea in children.

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Cost-effectiveness analysis of caplacizumab in the new standard of care for immune Thrombotic Thrombocytopenic Purpura in Italy

Global & Regional Health Technology Assessment Italian Northern Europe and Spanish ◽

10.33393/grhta.2021.2191 ◽

2021 ◽

Vol 8 ◽

pp. 43-52

Author(s):

Giovanni Di Minno ◽

Roberto Ravasio

Keyword(s):

Cost Effectiveness ◽

Cost Effective ◽

Standard Of Care ◽

Cost Effectiveness Analysis ◽

Lifetime Horizon ◽

Effectiveness Analysis ◽

Life Years ◽

Life Threatening ◽

The Cost

Objectives: To evaluate the cost-effectiveness analysis (CEA) of caplacizumab in combination with plasmapheresis (PEX) and immunosuppression compared to PEX and immunosuppression in the treatment of acute episodes of iTTP. Methods: A Markov model was used to conduct the CEA from the perspective of the hospital, over a lifetime horizon. Clinical data derived from HERCULES trial and a systematic literature review. Economic input included direct costs only. Utility and disutility values were obtained from literature. Data on healthcare resources and costs were retrieved from HERCULES trial, literature, TTP guidelines and Italian tariffs. A sensitivity analysis was conducted. The cost-effectiveness probability was tested for several options of discount levels considering a suggested willingness to pay (WTP) threshold of € 60,000 in Italy. Results: The use of caplacizumab in combination with PEX and immunosuppression is associated with a positive difference in survival of 3.27 life years (24.53 vs 21.26) and in quality of life of 3.06 QALY (22.01 vs 18.96) when compared to PEX and immunosuppression. Caplacizumab leads to an ICER per life years of € 41,653 and an ICER per QALY of € 44,572. For the suggested WTP threshold, the probability of caplacizumab being cost-effective is 82.4% (no discount), 92.8% (15% discount), 95.3% (20% discount), 96.9% (25% discount) and 98.2% (30% discount). Conclusions: Caplacizumab in addition to PEX and immunosuppression is cost-effective, allowing the hospital to achieve greater efficiency in managing the burden of a life-threatening disease such as iTTP.

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Cost Recommendations in the Second Edition of Cost-Effectiveness in Health and Medicine: A Review

MDM Policy & Practice ◽

10.1177/2381468318765162 ◽

2018 ◽

Vol 3 (1) ◽

pp. 238146831876516 ◽

Cited By ~ 4

Author(s):

John A. Nyman

Keyword(s):

Cost Effectiveness ◽

Medical Decision Making ◽

Steering Committee ◽

Cost Effectiveness Analysis ◽

Medical Decision ◽

Quality Adjusted Life Years ◽

Cost Effectiveness Ratio ◽

Effectiveness Analysis ◽

Life Years ◽

Quality Adjusted Life

A 2nd edition of Cost-Effectiveness in Health and Medicine has now been published by a group of medical decision-making experts known collectively as the 2nd Panel. This is a critical review of the recommendations for how to deal with costs in cost-effectiveness analysis, recommendations that are contained in Chapter 8 of that edition, titled “Estimating Costs and Valuations of Non-Health Benefits in Cost-Effectiveness Analysis,” authored primarily but not exclusively by Anirban Basu. This review focuses on the correspondence between the costs in the numerator of the incremental cost-effectiveness ratio (ICER) and what is measured in the denominator of the ICER by the quality-adjusted life years (QALYs). Although it raises a number of issues regarding what is actually being measured in the numerator and denominator of the ICER, it primarily challenges the 2nd Panel’s recommendation that the costs of non-health consumption in any additional years of life generated by the intervention in question be accounted for in the numerator, even though no measures of the benefits are included in the QALYs in the denominator. This review is adapted from a review of the entire 2nd edition that was sent to the 2nd Panel steering committee on January 8, 2016.

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Cost Effectiveness Kombinasi Antihipertensi Candesartan-Bisoprolol dan Candesartan-Amlodipin Pada Pasien Rawat Jalan Penderita Hipertensi

Jurnal Profesi Medika Jurnal Kedokteran dan Kesehatan ◽

10.33533/jpm.v13i2.1284 ◽

2019 ◽

Vol 13 (2) ◽

Author(s):

Eny Nurhikma ◽

Randa Wulaisfan ◽

Musdalipah Musdalipah

Keyword(s):

Cost Effectiveness ◽

Average Cost ◽

Cross Sectional Study ◽

Cost Effectiveness Analysis ◽

Sectional Study ◽

Cost Effectiveness Ratio ◽

Cross Sectional ◽

Hypertensive Patients ◽

Effectiveness Analysis ◽

The Cost

Today, in various countries, especially in Indonesia, the cost of health services is increasing. Hypertension is a degenerative disease that requires health costs for a long time. Increasing costs due to increasing chronic diseases threaten access and quality of health services, by which it is necessary to find a solution to overcome the problem of health financing. One method used is to analyze the guidelines for hypertension therapy and drug classes in the pharmacoeconomic aspects, namely Cost Effectiveness Analysis. This study aims to analyze the effectiveness of antihypertensive combination therapy in hypertensive patients at Bhayangkara Hospital, Kendari in 2019. The research method is descriptive with cross sectional study design. The analysis conducted is the cost effectiveness analysis (CEA) performed by calculating direct medical costs, the effectiveness of therapy based on blood pressure that reaches the target and calculating the value of ACER (Average Cost Effectiveness Ratio) and ICER (Incremenal Cost Effectiveness Ratio). Data were collected prospectively which fulfilled the inclusion and exclusion criteria. The results showed the therapeutic effectiveness and the value of ACER obtained from 31 hypertensive patients were a combination of Candesartan – Bisoprolol that was ACER value of 85.71% (2,314), and combination of Candesartan – Amlodipin of 70.58% (2,643). ICER value of 7,832 indicates that the price of drugs is more expensive but more effective therapy.Keywords : cost effective, ACER, ICER, Hypertension, Candesartan, Amlodipin Abstrak: Dewasa ini, diberbagai negara khususnya di Indonesia biaya pelayanan kesehatan semakin meningkat. Hipertensi merupakan salah satu penyakit degeneratif yang membutuhkan biaya kesehatan dalam jangka waktu yang lama. Peningkatan biaya akibat semakin meningkatnya penyakit kronik mengancam akses dan mutu pelayanan kesehatan, olehnya itu perlu dicari solusi untuk mengatasi masalah pembiayaan kesehatan. Salah satu metode yang dilakukan yaitu dengan menganalisis pedoman terapi hipertensi dan golongan obat dalam aspek farmakoekonomi, yaitu Analisis Efektivitas Biaya. Penelitian ini bertujuan untuk menganalisis efektivitas terapi kombinasi antihipertensi pada pasien hipertensi di Rumah Sakit Bhayangkara Kendari tahun 2019. Metode penelitian ialah deskriptif dengan rancangan cross sectional study. Data diambil secara prospektif yang memenuhi kriteria inklusi dan eksklusi. Analisis yang dilakukan adalah cost effectiveness analysis (CEA) dilakukan dengan menghitung biaya medik langsung, efektivitas terapi berdasarkan tekanan darah yang mencapai target dan menghitung nilai ACER (Average Cost Effectiveness Ratio) dan ICER (Incremenal Cost Effectiveness Ratio). Hasil penelitian menunjukkan efektifitas terapi dan nilai ACER yang diperoleh dari 31 pasien hipertensi ialah kombinasi Candesartan – Bisoprolol yaitu nilai ACER sebesar 85,71% (2.314), dan kombinasi Candesartan – Amlodipin sebesar 70,58% (2.643). Nilai ICER sebesar 7.832 menunjukkan bahwa harga obat lebih mahal namun terapi lebih efektif. Kata Kunci : Efektivitas biaya, ACER, ICER, Hipertensi, Candesartan, Amlodipin

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Cost-effectiveness analyses for mirtazapine and sertraline in dementia: randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.112.115212 ◽

2013 ◽

Vol 202 (2) ◽

pp. 121-128 ◽

Cited By ~ 25

Author(s):

Renee Romeo ◽

Martin Knapp ◽

Jennifer Hellier ◽

Michael Dewey ◽

Clive Ballard ◽

...

Keyword(s):

Cost Effectiveness ◽

Primary Outcome ◽

Controlled Trial ◽

Cost Effective ◽

Cost Effectiveness Analysis ◽

Effectiveness Analysis ◽

People With Dementia ◽

Life Years ◽

The Cost ◽

The Impact

BackgroundDepression is a common and costly comorbidity in dementia. There are very few data on the cost-effectiveness of antidepressants for depression in dementia and their effects on carer outcomes.AimsTo evaluate the cost-effectiveness of sertraline and mirtazapine compared with placebo for depression in dementia.MethodA pragmatic, multicentre, randomised placebo-controlled trial with a parallel cost-effectiveness analysis (trial registration: ISRCTN88882979 and EudraCT 2006-000105-38). The primary cost-effectiveness analysis compared differences in treatment costs for patients receiving sertraline, mirtazapine or placebo with differences in effectiveness measured by the primary outcome, total Cornell Scale for Depression in Dementia (CSDD) score, over two time periods: 0–13 weeks and 0–39 weeks. The secondary evaluation was a cost-utility analysis using quality-adjusted life years (QALYs) computed from the Euro-Qual (EQ-5D) and societal weights over those same periods.ResultsThere were 339 participants randomised and 326 with costs data (111 placebo, 107 sertraline, 108 mirtazapine). For the primary outcome, decrease in depression, mirtazapine and sertraline were not cost-effective compared with placebo. However, examining secondary outcomes, the time spent by unpaid carers caring for participants in the mirtazapine group was almost half that for patients receiving placebo (6.74 v. 12.27 hours per week) or sertraline (6.74 v. 12.32 hours per week). Informal care costs over 39 weeks were £1510 and £1522 less for the mirtazapine group compared with placebo and sertraline respectively.ConclusionsIn terms of reducing depression, mirtazapine and sertraline were not cost-effective for treating depression in dementia. However, mirtazapine does appear likely to have been cost-effective if costing includes the impact on unpaid carers and with quality of life included in the outcome. Unpaid (family) carer costs were lower with mirtazapine than sertraline or placebo. This may have been mediated via the putative ability of mirtazapine to ameliorate sleep disturbances and anxiety. Given the priority and the potential value of supporting family carers of people with dementia, further research is warranted to investigate the potential of mirtazapine to help with behavioural and psychological symptoms in dementia and in supporting carers.

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Cost-effectiveness analysis of 3 months of weekly rifapentine and isoniazid compared to isoniazid monotherapy in a Canadian arctic setting

BMJ Open ◽

10.1136/bmjopen-2020-047514 ◽

2021 ◽

Vol 11 (5) ◽

pp. e047514

Author(s):

Christopher Pease ◽

Gonzalo Alvarez ◽

Ranjeeta Mallick ◽

Mike Patterson ◽

Sandy Finn ◽

...

Keyword(s):

Cost Effectiveness ◽

Health Outcomes ◽

Canadian Arctic ◽

Cost Effectiveness Analysis ◽

Model Parameters ◽

Study Region ◽

Ltbi Treatment ◽

Effectiveness Analysis ◽

Life Years ◽

The Cost

ObjectiveTo assess the cost effectiveness of once weekly rifapentine and isoniazid for 12 weeks (3HP) to the current standard care for latent tuberculosis (TB) infection (LTBI) in Iqaluit, Nunavut.DesignA cost-effectiveness analysis using a Markov model reflecting local practices for LTBI treatment.SettingA remote Canadian arctic community with a high incidence of TB.ParticipantsHypothetical patients with LTBI.InterventionsThe cost effectiveness of 3HP was compared with the existing standard of care in the study region which consists of 9 months of twice weekly isoniazid (9H) given by directly observed therapy.Outcome measuresEffectiveness was measured in quality-adjusted life years (QALYs) with model parameters were derived from historical programmatic data, a local implementation study of 3HP and published literature. Costs from the perspective of the Nunavut healthcare system were measured in 2019 US dollars and were obtained primarily from local, empirically collected data. Secondary health outcomes included estimated TB cases and TB deaths averted using 3HP versus 9H. One way and probabilistic sensitivity analyses were performed.ResultsThe 3HP regimen was dominant over 9H: costs were lower (US$628 vs US$924/person) and health outcomes slightly improved (20.14 vs 20.13 QALYs/person). In comparison to 9H, 3HP treatment resulted in fewer TB cases (27.89 vs 30.16/1000 persons) and TB deaths (2.29 vs 2.48/1000 persons). 3HP completion, initiation and risk of fatal adverse events were the primary drivers of cost effectiveness.ConclusionIn a remote Canadian arctic setting, using 3HP instead of 9H for LTBI treatment may result in cost savings and similar or improved health outcomes.

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Cost‐effectiveness analysis of dabigatran, rivaroxaban and warfarin in the prevention of stroke in patients with atrial fibrillation in China

BMC Health Services Research ◽

10.1186/s12913-021-06084-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hongtao Wei ◽

Can Cui ◽

Xiangli Cui ◽

Yi Liu ◽

Dandan Li

Keyword(s):

Atrial Fibrillation ◽

Cost Effectiveness ◽

Incremental Cost ◽

Oral Anticoagulants ◽

Cost Effectiveness Analysis ◽

Chinese Patients ◽

Economic Point ◽

Effectiveness Analysis ◽

Life Years ◽

The Cost

Abstract Background and objective To evaluate the cost-effectiveness of new anticoagulants and warfarin in the prevention of stroke in Chinese patients with atrial fibrillation (AF). Methods The Markov model was constructed to compare patients’ quality-adjusted life-years (QALYs) using drug cost, the cost of the examination after taking a drug, and the incremental cost of other treatments. Both dabigatran (110 and 150 mg, twice a day) and rivaroxaban (20 mg, once a day) were compared with warfarin (3–6 mg, once a day). Willingness to pay, three times the 2018 China GDP per capita (9481.88 $), was the cost-effect threshold in our study. Results The total cost were was 5317.31$, 29673.33$, 23615.49$, and 34324.91$ for warfarin, rivaroxaban, dabigatran 110 mg bid, and dabigatran 150 mg bid, respectively. The QALYs for each of the four interventions were 11.07 years, 15.46 years, 12.4 years, and 15 years, respectively. The cost-effectiveness analysis of the three new oral anticoagulants and warfarin showed that the incremental cost-effectiveness ratio (ICER) was 5548.07$/QALY when rivaroxaban was compared with warfarin. Rivaroxaban was the most cost-effective choice and warfarin was the least. Conclusions In Chinese patients with AF, although warfarin is cheaper, rivaroxaban has a better cost-effectiveness advantage from an economic point of view.

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Cost Effectiveness Analysis Therapy Combination of Candesartan-Amlodipine and Candesartan-Diltiazem on Hypertensive Outpatients

PHARMACY Jurnal Farmasi Indonesia (Pharmaceutical Journal of Indonesia) ◽

10.30595/pharmacy.v14i2.1952 ◽

2018 ◽

Vol 14 (2) ◽

pp. 188

Author(s):

Faridah Baroroh ◽

Andriana Sari

Keyword(s):

Blood Pressure ◽

Cost Effectiveness ◽

Blood Pressure Reduction ◽

Cost Effectiveness Analysis ◽

Pressure Reduction ◽

Research Subjects ◽

Cost Effectiveness Ratio ◽

Cost Component ◽

Effectiveness Analysis ◽

The Cost

Hypertension medication is taken for a long period and thus requires considerable costs. As antihypertensives vary in efficacy, research is needed to assess the cost effectiveness of medication, particularly between candesartan-amlodipine and candesartan-diltiazem combinations on hypertensive outpatients. This study applied a prospective cohort design with outcome observations for three months at a private hospital in Yogyakarta. The outcome used to gauge the cost effectiveness of medication was the achievement of the targeted blood pressure reduction after treatment. The cost effectiveness analysis was conducted through payer’s perspective, namely that of the social security agency (BPJS), with direct medical cost as the cost component measured. Cost effectiveness was analyzed using an average cost effectiveness ratio (ACER), calculated according to the ratio of cost to the outcome percentage of the blood pressure reduction target attainment, and an incremental cost effectiveness ratio (ICER) based on the ratio between differences in cost and outcome in both medication groups. The research subjects consisted of 33 patients, 24 of whom underwent medication with candesartan-amlodipine combination and 9 with candesartan-diltiazem. As many as 81.82% were female and 72.73% were within the age range of 51-70, while their most frequent complication was diabetes mellitus (48.48%). Results revealed the effectiveness of candesartan-amlodipine medication to be 58.33% with an ACER value of IDR 6,617, whereas that of candesartan-diltiazem was 22.22% with an ACER of IDR 29,733. The ICER value was IDR -7607, indicating that candesartan-amlodipine was categorically more cost-effective than candesartan-diltiazem.

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