scholarly journals A cost-minimization analysis of combination therapy in hypertension: fixed-dose vs extemporary combinations

2013 ◽  
Vol 14 (4) ◽  
pp. 153-160
Author(s):  
Marco Bellone ◽  
Pierluigi Sbarra
Keyword(s):  
National Health ◽  
Cost Minimization ◽  
National Health System ◽  
Antihypertensive Agents ◽  
Cost Savings ◽  
Cost Driver ◽  
Fixed Dose ◽  
Daily Cost ◽  
Cost Minimization Analysis ◽  
Acquisition Costs

BACKGROUND: Cardiovascular disease management and prevention represent the leading cost driver in Italian healthcare expenditure. In order to reach the target blood pressure, a large majority of patients require simultaneous administration of multiple antihypertensive agents.OBJECTIVE: To assess the economic impact of the use of fixed dose combinations of antihypertensive agents, compared to the extemporary combination of the same principles.METHODS: A cost minimization analysis was conducted to determine the pharmaceutical daily cost of five fixed dose combinations (olmesartan 20 mg + amlodipine 5 mg, perindopril 5 mg + amlodipine 5 mg, enalapril 20 mg + lercanidipine 10 mg, felodipine 5 mg + ramipril 5 mg, and delapril 30 mg + manidipine 10 mg) compared with extemporary combination of the same principles in the perspective of the Italian NHS. Daily acquisition costs are estimated based on current Italian prices and tariffs.RESULTS: In three cases the use of fixed‑dose combination instead of extemporary combination induces a lower daily cost. Fixed combination treatment with delapril 30 mg + manidipine 10 mg induces greater cost savings for the National Health System (95,47 €/pts/year), as compared to free drugs combination therapy.CONCLUSIONS: Compared with free drug combinations, fixed‑dose combinations of antihypertensive agents are associated with lower daily National Health Service acquisition costs.

Cost-minimization analysis of drugs used in the treatment of Asthma and COPD diseases in India

2020 ◽  
Vol 15 ◽  
Author(s):  
Billu Payal ◽  
Anoop Kumar ◽  
Harsh Saxena
Keyword(s):  
Generic Drugs ◽  
Cost Minimization ◽  
Cost Savings ◽  
Chronic Obstructive ◽  
Pulmonary Medicine ◽  
Potential Cost ◽  
Maximum Cost ◽  
Cost Minimization Analysis ◽  
Cost Variation ◽  
The Cost

Background: Asthma and Chronic Obstructive Pulmonary Diseases (COPD) are well known respiratory diseases affecting millions of peoples in India. In the market, various branded generics, as well as generic drugs, are available for their treatment and how much cost will be saved by utilizing generic medicine is still unclear among physicians. Thus, the main aim of the current investigation was to perform cost-minimization analysis of generic versus branded generic (high and low expensive) drugs and branded generic (high expensive) versus branded generic (least expensive) used in the Department of Pulmonary Medicine of Era Medical University, Lucknow for the treatment of asthma and COPD. Methodology: The current index of medical stores (CIMS) was referred for the cost of branded drugs whereas the cost of generic drugs was taken from Jan Aushadi scheme of India 2016. The percentage of cost variation particularly to Asthma and COPD regimens on substituting available generic drugs was calculated using standard formula and costs were presented in Indian Rupees (as of 2019). Results: The maximum cost variation was found between the respules budesonide high expensive branded generic versus least expensive branded generic drugs and generic versus high expensive branded generic. In combination, the maximum cost variation was observed in the montelukast and levocetirizine combination. Conclusion: In conclusion, this study inferred that substituting generic antiasthmatics and COPD drugs can bring potential cost savings in patients.

Economic analysis of alternative pembrolizumab and nivolumab dosing strategies at an academic cancer center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6504-6504
Author(s):  
Evan Thomas Hall ◽  
Jenny Zhang ◽  
Eun-Jeong Kim ◽  
Grace Hwang ◽  
Shailender Bhatia ◽  
...  
Keyword(s):  
Cost Minimization ◽  
Pharmaceutical Expenditure ◽  
Cost Savings ◽  
Fixed Dose ◽  
Cancer Center ◽  
Data Repository ◽  
Cancer Therapies ◽  
Medicine Research ◽  
Dosing Strategies ◽  
The Impact

6504 Background: Pembrolizumab (P) and nivolumab (N) were initially investigated and FDA-approved with weight-based dosing strategies, but later the approval label was amended to a fixed dose administration. Given increasing concerns about financial toxicity of cancer therapies, we hypothesize that weight-based dosing of P and N and allowing vial sharing among patients will result in substantial cost savings. Methods: We obtained IRB approval to retrospectively examine all outpatient doses of P and N given at three Stanford Medicine infusion centers between July 1, 2018 and Oct 31, 2018 using the Stanford Medicine Research Data Repository (STARR) database. We performed cost-minimization analysis modeling the impact of dosing strategies based upon patient weight versus fixed dosing (2 mg/kg vs 200 mg q3wks for P; 3 mg/kg vs 240 mg q2wks or 6 mg/kg vs 480 q4wks for N). “Dose-minimization” (DM) was defined as whichever dose was lower (weight-based or fixed dose). The impact of allowing vial sharing (considering commercially available vial sizes) between patients treated at the same site and on the same date was assessed. Average sales price (ASP) from Center for Medicare and Medicaid Services for Part B drugs was used for cost estimates. Results: A total of 1,029 doses of P or N were administered across a variety of cancer types. For most doses (N = 789, 77%), the calculated weight-based dose was less than the fixed dose. DM resulted in decreased usage and expenditures of both P and N, and a further decrease was observed with vial sharing. Total savings estimated with DM and vial sharing strategy were > $1.4 million (Table). This amounted to savings of > 22,000 mg of P (112 fixed doses) and > 11000 mg of N (47 fixed doses). Savings were greatest at the highest volume infusion center. Conclusions: Alternative dosing strategies of P and N would result in significantly less drug utilization and pharmaceutical expenditure without anticipated impact on efficacy. Potential barriers to this approach include existing policies regarding vial sharing and drug vial sizes. [Table: see text]

scholarly journals A Model-Based Cost-Minimization Analysis as a Decision Tool in Obstetric Care in Helgeland, Northern Norway

2016 ◽  
Vol 9 (1) ◽  
pp. 191
Author(s):  
Halvard Angelsen ◽  
Jan Norum ◽  
Villy Angelsen ◽  
Fred A. Mürer ◽  
Randi Erlandsen
Keyword(s):  
Quality Of Care ◽  
Maternity Care ◽  
Cost Minimization ◽  
Cost Savings ◽  
Obstetric Care ◽  
Birth Registry ◽  
Cost Minimization Analysis ◽  
Model Based ◽  
Hospital Trust

BACKGROUND: Quality of care is of utmost importance in maternity care. Today, we base the choice of institution on risk factors. Recently, a Norwegian national plan introduced new guidelines concerning quality and staffing. Consequently, the hospital trusts had to increase the number of obstetricians and midwives and handle raised costs. One way to meet such challenges is to reduce the number of delivery units.OBJECTIVES: We aimed to clarify the costs and benefits of two alternative strategies in obstetric care in Helgeland hospital trust using a model-based cost-minimization analysis (CMA).METHODS: The consequences, in terms of cost/savings and mothers´ time of travelling, by closing two midwife-administered maternity units (MAMUs) and keeping the two departments of obstetrics (DOGs) running was analyzed. We implemented data from the Helgeland hospital trust and the Medical Birth Registry of Norway (MBRN) and the selected period was 2010-2012. The comparator was today’s organization. Costs were converted into Euros at the rate of € 1 = NOK 9.527.RESULTS: The model concluded the closing of two MAMUs created an annual net saving of € 584,346. The mothers´ mean time of travelling increased by 11 minutes and by 91 minutes for those directly affected by the closure. The organizational changes were concluded safe and of low risk with regard to quality of care. A sensitivity analysis revealed the number of midwives dismissed being the most important variable. CONCLUSION: A model-based CMA may be a supportive tool when evaluating maternity care.

scholarly journals Utility of Intraoperative Frozen Section in Large Thyroid Nodules

2018 ◽  
Vol 160 (1) ◽  
pp. 49-56
Author(s):  
Craig A. Bollig ◽  
Jeffrey B. Jorgensen ◽  
Robert P. Zitsch ◽  
Laura M. Dooley
Keyword(s):  
Thyroid Nodules ◽  
Cost Minimization ◽  
Frozen Section ◽  
Case Series ◽  
Cost Savings ◽  
Care Utilization ◽  
Intraoperative Frozen Section ◽  
Cost Minimization Analysis ◽  
Thyroid Lobectomy ◽  
Follicular Lesions

Objective To determine if the routine use of intraoperative frozen section (iFS) results in cost savings among patients with nodules >4 cm with nonmalignant cytology undergoing a thyroid lobectomy. Study Design Case series with chart review; cost minimization analysis. Setting Single academic center. Subjects and Methods Records were reviewed on a consecutive sample of 48 patients with thyroid nodules >4 cm and nonmalignant cytology who were undergoing thyroid lobectomy in which iFS was performed between 2010 and 2015. A decision tree model of thyroid lobectomy with iFS was created. Comparative parameters were obtained from the literature. A cost minimization analysis was performed comparing lobectomy with and without iFS and the need for completion thyroidectomy with costs estimated according to 2014 data from Medicare, the Bureau of Labor Statistics, and the Nationwide Inpatient Sample. Results The overall malignancy rate was 25%, and 33% of these malignancies were identified intraoperatively. When the malignancy rates obtained from our cohort were applied, performing routine iFS was the less costly scenario, resulting in a savings of $486 per case. When the rate of malignancy identified on iFS was adjusted, obtaining iFS remained the less costly scenario as long as the rate of malignancies identified on iFS exceeded 12%. If patients with follicular lesions on cytology were excluded, 50% of malignancies were identified intraoperatively, resulting in a savings of $768 per case. Conclusions For patients with nodules >4 cm who are undergoing a diagnostic lobectomy, the routine use of iFS may result in decreased health care utilization. Additional cost savings could be obtained if iFS is avoided among patients with follicular lesions.

VALUE AND PERFORMANCE OF ACCOUNTABLE CARE ORGANIZATIONS: A COST-MINIMIZATION ANALYSIS

2018 ◽  
Vol 34 (4) ◽  
pp. 388-392
Author(s):  
Sonal Parasrampuria ◽  
Allison H. Oakes ◽  
Shannon S. Wu ◽  
Megha A. Parikh ◽  
William V. Padula
Keyword(s):  
Cost Minimization ◽  
Cost Savings ◽  
Quality Data ◽  
Quality Level ◽  
Care Organization ◽  
Coordination Of Care ◽  
Accountable Care ◽  
Cost Minimization Analysis

Objectives:Determine the relationship between quality of an accountable care organization (ACO) and its long-term reduction in healthcare costs.Methods:We conducted a cost minimization analysis. Using Centers for Medicare and Medicaid cost and quality data, we calculated weighted composite quality scores for each ACO and organization-level cost savings. We used Markov modeling to compute the probability that an ACO transitioned between different quality levels in successive years. Considering a health-systems perspective with costs discounted at 3 percent, we conducted 10,000 Monte Carlo simulations to project long-term cost savings by quality level over a 10-year period. We compared the change in per-member expenditures of Pioneer (early-adopters) ACOs versus Medicare Shared Savings Program (MSSP) ACOs to assess the impact of coordination of care, the main mechanism for cost savings.Results:Overall, Pioneer ACOs saved USD 641.24 per beneficiary and MSSP ACOs saved USD 535.59 per beneficiary. By quality level: (a) high quality organizations saved the most money (Pioneer: USD 459; MSSP: USD 816); (b) medium quality saved some money (Pioneer: USD 222; MSSP: USD 105); and (c) low quality suffered financial losses (Pioneer: USD -40; MSSP: USD -386).Conclusions:Within the existing fee-for-service healthcare model, ACOs are a mechanism for decreasing costs by improving quality of care. Higher quality organizations incorporate greater levels of coordination of care, which is associated with greater cost savings. Pioneer ACOs have the highest level of integration of services; hence, they save the most money.

Cost-minimization analysis of teledermatology versus conventional care in the Brazilian National Health System

2021 ◽  
Author(s):  
Francisco de Assis Acurcio ◽  
Augusto Afonso Guerra Junior ◽  
Maria Cristina Marino Calvo ◽  
Daniel Holthausen Nunes ◽  
Marco Akerman ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Saving ◽  
Decision Tree ◽  
Economic Analysis ◽  
Health System ◽  
Cost Minimization ◽  
National Health System ◽  
Conventional Care ◽  
Direct Patient Care ◽  
Cost Minimization Analysis

Aims: Cost-minimization analysis (CMA) comparing the teledermatology service of the State of Santa Catarina, Brazil with the provision of conventional care, from the societal perspective. Patients & methods: All costs related to direct patient care were considered in calculation of outpatient costs. The evaluation was performed using the parameters avoided referrals and profile of hospitalizations. The economic analysis was developed through a decision tree. Results: Totally, 40% of 79,411 tests performed could be managed in primary care, avoiding commuting and expanding the patients’ access. The CMA showed the teledermatology service had a cost per patient of US$196.04, and the conventional care of US$245.66. Conclusion: In this scenario, teledermatology proved to be a cost-saving alternative to conventional care, reducing commuting costs.

scholarly journals Valutazione economica di Infliximab (Remicade®) vs Etanercept (Enbrel®) nel trattamento dell’artrite reumatoide

2003 ◽  
Vol 4 (2) ◽  
pp. 77-86
Author(s):  
G. L. Colombo ◽  
A. Muzio ◽  
A. Longhi
Keyword(s):  
Drug Administration ◽  
Cost Minimization ◽  
National Health System ◽  
Drug Acquisition ◽  
Joint Damage ◽  
New Drugs ◽  
Lower Drug ◽  
Acquisition Costs ◽  
Differential Costs ◽  
The Cost

Rheumatoid arthritis is one of the most severe chronic pathologies, affecting the whole organism, with invalidating outcomes that affect the quality of life of the patients. Its prevalence is estimated to be about 0,5% in Italy, with elevated costs for the national health system (NHS) and the society, in spite of the best treatment with traditional therapies that include anti-inflammatory and disease modifying antirheumatic drugs (DMARDs). The introduction of new drugs with biological activity, mainly acting through an antagonism of tumor necrosis factor (anti-TNF), is a great advance in the management of the disease, as their use has been shown to be effective in slowing the progression of the joint damage, and sometimes in reversing it,. The present article present a cost-minimization study conducted by comparing the two anti-TNFs available in Italy, etanercept and infliximab, assuming equal efficacy and approached from the perspectives of the Italian NHS and society. Only differential costs were considered, i.e. drug acquisition, drug administration and patient monitoring costs, and the analysis comprised two treatment years, in order two account for the cost differences between the first treatment year and the following. The analysis showed that infliximab represents the more convenient alternative from both the NHS and the society points of view, mainly due to lower drug acquisition costs, which offset the higher drug administration costs: the total two year treatment costs per patient with etanercept resulted of 20.173 euro and 22.164 euro from the societal and NHS perspectives, respectively, while the same costs resulted of 13.715 euro and 14.795 euro with infliximab. These results were tested with thorough sensitive analyses, conducted by varying the principal cost and time consumption estimates, that showed that etanercept results less convenient in all the hypothesis tested.

scholarly journals Budget impact of rosiglitazone in type 2 diabetes

2007 ◽  
Vol 8 (1) ◽  
pp. 15-26
Author(s):  
Orietta Zaniolo ◽  
Francesco Bamfi ◽  
Sergio Iannazzo
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycaemic Control ◽  
Health System ◽  
National Health ◽  
Budget Impact ◽  
National Health System ◽  
Cost Savings ◽  
Blood Glucose Monitoring

BACKGROUND: in type 2 diabetes, the maintenance of non-diabetic glycaemic levels has been shown to decrease the onset of long term complications and consequently their high management costs. In order to achieve and maintain normal blood glucose levels, lifestyle interventions are highly cost/effective, but require good compliance, strong motivation and efforts by the patients. For this reason, a majority of patients needs to start pharmacological therapy shortly after diagnosis. Rosiglitazone, an insulin-sensitising drug, is indicated for subjects with inadequate glycaemic control both as monotherapy, in those contraindicated to metformin, especially if overweight, and as combination therapy with metformin, sulphanilureas or both. OBJECTIVES: rosiglitazone offers clinical advantages over the alternatives, decreasing and/or postponing the need for insulin treatment. Its high acquisition cost may therefore be totally or partially offset by the reduction in future health care resources consumption, and by short-term practical advantages, such as the decrease in the need for blood glucose monitoring and of adverse events. Aim of this study was to investigate the impact of the use of rosiglitazone in eligible diabetic patients on the National Health System budget. METHODS: for this scope an analytic model was implemented, which pathway may be summarized as follows: a) estimate of the number type 2 diabetes patients living in Italy, grouped according to current therapeutic classes; b) estimate of the number of patients with inadequate glycaemic control for each subgroup; c) identification of patients eligible to rosiglitazone treatment; d) identification of the comparator strategy for each patient sub-group; e) comparison of costs for each couple of alternative options; f) calculation of budget impact. RESULTS: use of rosiglitazone monotherapy instead of sulphanilurea monotherapy induces a mild costs increase. Combination treatment with rosiglitazone added to metformin- or sulphanilurea- based therapies induces significant cost savings for the National Health System, related to lower resources consumption for glycaemic auto-monitoring and for hypoglycaemic events management, as compared to standard combination therapies. The hypothetical scenario in which all eligible patients are treated with rosiglitazone was estimated to induce net cost savings of about 260 millions Euro per year.

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