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Objective: To compare the cost effectiveness and achievement of glycemic goals in patients inadequately controlled by conventional drugs receiving either intensified treatment or DPP4 inhibitor as an add on. It shall help us to identify a preferred choice of treatment. Materials and Methods: As per study protocol, 52 patients with inadequately controlled type 2 diabetes mellitus (DM) were included in the study. They received either intensified treatment or add-on with DPP4 inhibitor. Glycated hemoglobin (HbA1c), fasting blood sugar (FBS), postprandial blood sugar (PPBS), adverse drug reactions, and their cost were calculated for the next 6 months of therapy. Results: Add on therapy with DPP4 inhibitor showed a greater achievement of glycemic goals. Target HbA1c was achieved by 58.6% (P < 0.0001) versus 40% (P < 0.05), FBS was achieved by 78.50% (P < 0.0001) versus 50% (P < 0.16), and PPBS was achieved by 63.6% (P < 0.0001) versus 42.8% (P < 0.03) in the add-on with DPP4 inhibitor versus intensified treatment group. No hypoglycemic episodes were documented in both the groups. Add-on with DPP4 inhibitor cost (×5.13) as compared to intensified treatment. Conclusions: Add-on with DPP4 inhibitor therapy achieved glycemic goals in greater proportion of patients as compared to treatment intensification but at 5 times the cost of therapy. Since the patent restrictions for DPP4 inhibitors such as vildagliptin and teneligliptin are over, the cost of therapy has come down. Hence their benefits should be extended to a greater proportion of patients with inadequately controlled type 2 DM.
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Background: Chemotherapy induced Nausea and Vomiting (CINV) is one the most common adverse effects associated with chemotherapeutic management of carcinoma breast. Preventing CINV becomes a vital part in treatment of these cancer patients for better compliance. The conventional regimen of newer 5-HT3 receptor antagonist and dexamethasone along with newer agents - Aprepitant, a NK-1 receptor antagonist and a recently approved atypical antipsychotic, Olanzapine have shown better control of CINV. These newer agents are effective but also very expensive.Methods: The study included carcinoma breast patients scheduled for chemotherapy (n = 55 in each group) who either received aprepitant or olanzapine or a combination of both as the anti-emetic regimen. Considering Cost-Effectiveness Analysis (CEA), the cost included was the cost of anti-emetic agents (sponsor’s perspective) and outcome measured as control of nausea and vomiting - as Complete Protection (CP), Complete Response to Best (CRB) and Incomplete Response (IR) for acute (0-24 hours) and delayed (24-120 hours) phases. The cost effectiveness(CE) ratio for emesis and CINV free days were calculated.Results: CP was seen better during the acute period than the delayed period. With Aprepitant, delayed CRB and IR was seen with 13 (23.6%) and 10 (18.2%) subjects. 16 (29.1%) showed IR with Olanzapine during the delayed period.The average number of Emesis and CINV free days were 4.65, 4.51, 4.89 and 3.38, 3.96, 4.15 for the three groups respectively. The cost required to achieve 1 emesis and 1 CINV free day per subject in the 3 groups was INR 351.19, INR 27.20, INR 339.54 and INR 483.36, INR 30.94, INR 400.60 respectively.Conclusions: The newer anti-emetic even though being expensive at cost, pharmacoeconomically provide better outcomes and seem to have better control rates than the conventional regimen.
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Background: To study cost-effective and cost-benefit analysis of antibiotic prescription in patients who had enteric fever and was given intravenous ceftriaxone. Methods: This was a prospective observational study conducted in a tertiary care hospital. 200 patients who have been diagnosed with enteric fever and were prescribed ceftriaxone were studied and their prescriptions were analyzed. 5 brands of most commonly prescribed ceftriaxone injections were chosen to analyse costeffective and cost-benefit analysis. Our study showed that there was a major difference of prizes between generic and 5 most commonly prescribed brands of the same drug. Use of branded drugs was associated with increase cost of treatment and in many cases was responsible for failure to take complete treatment as prescribed by treating physician. Results: This Study was conducted on 100 patients, 68 males and 32 females, diagnosed with enteric fever. Out of these patients Maximum number of patients were seen between age group of 30-40 years (34) and minimum patients belonged to age group of more than 60 years (8). Analysis of prescriptions revealed that 80 patients were prescribed Branded drugs and 20% were prescribed generic drugs. Out of these 80 patients who were prescribed branded drugs most common 5 brands were studied. The analysis of the cost of single dose of inj ceftriaxone revealed that branded drugs were 3.12 % to 200.84 % more in comparison with generic IV ceftriaxone. Analysis of cost of 1 day of treatment with IV ceftriaxone 1gm revealed similar figures. Total cost of treatment was Rs 595 for generic drug and 1790 for branded drug with maximum MRP. The Analysis of patients who discountinued treatment before completion revealed that most of them belonged to Brand E (30%) and minimum number of patients belonged to Generic group (5%.Conclusion: The cost of most commonly prescribed branded drugs was significantly higher (3%-200%) than generic drug and prescribing branded drugs was associated with failure to take complete treatment as prescribed by treating physician.
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Objective:To provide more details and guide the management and usage as well as purchasing for medical equipment, so as to realize the optimization and utilization of the medical resources and impel Precision Medicine Initiative.Methods:The cost-effective analysis and the rate of return analysis of two large-scale precision equipments (MRI and Fundus camera usage) during January 2015 and June 2016 were performed. Besides, the equipment cost was divides into several more detailed projects in the research.Results: The rate of return of MRI in the first half year of 2016 was 8.5%, which was obviously higher than the one of 2015 which was 4.1%; the rate of return of Fundus camera usage in the first half year of 2016 was 25.9%, which was also obviously higher than the one of 2015 that was 15.0%. In the analysis, the depreciation of equipment was the main cost.Conclusion: It was critical and necessary to strengthen the standardized operation and routine maintenance in operation, in order to improve their safety usage rate.
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To study the cost-effectiveness of temozolomide combined with radiotherapy in the treatment of glioblasto-ma. Methods:According to the clinical trial data, cost-effectiveness and sensitivity of the results was analyzed based on the domestic cost and consumption level. Results:Temozolomide combined with radiotherapy could prolong one month of overall survival with the additional cost of RMB 58 959. 7 yuan in each case when compared with radiotherapy alone. Conclusion:Temozolomide combined with radiotherapy has no advantage on cost-effectiveness when compared with radiotherapy alone.
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Objective: To optimize the Shenzhen universal infant hepatitis B immunization method. Methods: To analyze the long effectiveness of different immunization strategies and disease transition after hepatitis B virus infection by using cost-effectiveness method through decision-tree and Markov models among the Shenzhen newborns cohort in 2010 based on the local parameters. Results:Through the current strategies, the program of screening all pregnant women for HBsAg and vaccinating newborns of single-positive mothers combing with HBIG and vaccine would not only prevent more new cases, hepatic carcinoma and related deaths; but also gain more living years and QALYs. From the social prospect, it will save about RMB 40 million compared with the current program. Conclusion: It is suggested that Shenzhen Government should amend the current universal infant hepatitis B immunization program to gain more economic and social benefits.
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Through the analysis of evaluation indexes, efficiency analysis of a hospital introducting large medical equipment beyond millions yuan in recent 3 years,suggestions of hospital equipment management are proposed.
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Background: Edible salt iodization and iodized oil injections are the two most commonly used vehicles for iodine supplementation. In year 1989, the state government of Sikkim was planning to implement Iodine Deficiency Disorder control program in state and had following two options to choose from, based on existing knowledge; a) a salt iodization program, b) an iodized oil injection program. No information was available at that point of time on comparative advantages of the above stated two approaches. Objectives: To identify the most cost-effective alternative for IDD elimination in Sikkim, amongst the following 3 alternatives: a) Iodized salt program (ISP), b) Iodized oil injection program (IOP) to high risk group, c) no preventive program. Materials and Methods: Study population was the general population of state of Sikkim, India in year 1990. Cost- effective analysis was undertaken comparing 3 alternative programs, targeted towards IDD elimination in state of Sikkim. Identification, measurement and valuation of the costs of ISP and IOP and identification and measurement of the consequences of IDD were done to carry out the cost-effective analysis. Visible goiter person years (VGPY), endemic cretinism, IDD attributable death were used to assess the health consequences/disease burden of IDD. Results: The cost per VGPY, endemic cretinism and IDD attributable death were Rs 76.67, Rs 24,469 and Rs 9,720, respectively for ISP. The cost per VGPY, endemic cretinism and IDD attributable death were Rs 75.82, Rs 19,106 and Rs 7,709, respectively for IOP. Conclusion: The results of the analysis showed that iodized oil program is more cost-effective for prevention of irreversible IDDs than the iodated salt program in state of Sikkim, India.
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Interview about direct cost and record results of screening in 1451 vaccinated people at Tropical Hospital and Medic from 2001 September to 2002 May. All subjects were divided into 2 groups: 933 people in 20-39 years old group and 518 in the group of >40 years old. Results: group of 20-39 years old: the rate of HBV exposure was 55.8%, people in this group have high income and vaccinate themselves. Analysis of sensitivity showed that screening methods predominate. In >40 years old group: rate of HBV exposure was 58.4%. Cost-effective analysis showed that people in this group have to be screening before vaccination. Screening methods are predominant, and it could be chosen without consideration before vaccination
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Hepatitis B , Cost-Benefit Analysis , DiseaseABSTRACT
0.05).There was a littel difference in the costs for an identical effect between two drugs,the cost of Risperidon being lower.CONCLUSION:The total effective rates and costs of Risperidon and Clozapine were almost equal in the treatment of schizophrenia.