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Background: Urinary tract infections (UTIs) are one of the commonly encountered infections and a large number of drugs are indicated in UTI ranging from oral conventional drugs to most advanced injectable drugs. Cost-minimization analysis (CMA) is employed to project the least costly drug when two treatments are shown to be therapeutic equivalents. Aims and Objectives: This study aims to perform a CMA at a tertiary care center to determine the least expensive drug for UTI and to project a cheapest alternative from available options based on the results of CMA. Materials and Methods: This was a cross-sectional study conducted over duration of 3 months in the clinical departments on patients diagnosed to have UTI and prescribed empirical antimicrobial treatment. The approval of Institutional Ethics Committee was sought before beginning the study. Pattern of drug prescription and average cost incurred in the treatment of patients with empirical antimicrobial therapy was calculated. CMA included the projection of the least expensive drug based on average cost incurred per patient in outpatients and inpatients respectively. Results: A total of 59 patients of UTI given empirical treatment were included in the study. Fluoroquinolones and cephalosporins were commonly used drugs for empirical treatment of UTI. Nitrofurantoin (average cost of 11–14 Rs. per patient) can be projected as the cheapest drug for empirical treatment of UTI on outpatient basis as well as a drug to supplement injectables in indoor patients. Injectable ciprofloxacin can be projected as the most inexpensive alternative for empirical treatment of UTI in patients of the inpatient department. Conclusion: Nitrofurantoin for oral treatment and ciprofloxacin in injectable form are cheapest among available alternatives for empirical treatment of UTI. To prevent treatment failures and increase in cost of treatment, correlation of results of CMA with local antimicrobial sensitivity pattern is important.
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Background: Containing expenditure and efficient resource use is essential to limit the increasing costs of health research. Electronic data collection (EDC) is thought to reduce the costs compared to paper-based data collection (PDC). Objectives: As economic evidence in this area is scanty, especially in low- and middle-income countries, the objectives of the study are to perform an economic evaluation and compare the cost between EDC and PDC. Methods: A cost-comparison study was conducted to compare between EDC and PDC from the institutional perspective for the year 2018, based on a community?based survey. Step?down cost accounting was adopted with a bottom?up approach for cost estimation. Total and unit costs were estimated with the base case comparison between EDC and PDC while using SPSS software (e?SPSS and p?SPSS, respectively). We conducted scenario analyses based on the usage of different software, R and STATA for both EDC and PDC (e-R, p-R, e-STATA, and p-STATA, respectively). One-way and probabilistic sensitivity analysis (PSA) was performed to examine the robustness of the observed results. Results: In the base-case analysis, total costs of EDC and PDC were ?72,617 ($1060.9) and 87,717 ($1281.5), respectively, with estimated cost reduction of ?15,100 ($220.6). In other scenarios, the estimated cost reduction for e?R, e-STATA, p-R, p-STATA was ??274 ($4.0), 98 ($1.4), 14826 ($216.6), and 15,002 ($219.2), respectively, when compared to EDC?SPSS. On one-way and PSA, the results of the cost-comparison analysis were robust. Conclusion: EDC minimizes institutional cost for conducting health research. This finding will help researchers in efficiently planning for the budget for their research.
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ABSTRACT Introduction: Cytomegalovirus may cause severe disease in immunocompromised patients. Nowadays, quantitative polymerase chain reaction is the gold-standard for both diagnosis and monitoring of cytomegalovirus infection. Most of these assays use cytomegalovirus automated molecular kits which are expensive and therefore not an option for small laboratories, particularly in the developing world. Objective: This study aimed to optimize and validate an in-house cytomegalovirus quantitative polymerase chain reaction test calibrated using the World Health Organization Standards, and to perform a cost-minimization analysis, in comparison to a commercial cytomegalovirus quantitative polymerase chain reaction test. Study design: The methodology consisted of determining: optimization, analytical sensitivity, analytical specificity, precision, curve variability analysis, and inter-laboratorial reproducibility. Patients (n = 30) with known results for cytomegalovirus tested with m2000 RealTime System (Abbott Laboratories, BR) were tested with the in-house assay, as well as patients infected with other human herpes virus, in addition to BK virus. A cost-minimization analysis was performed, from a perspective of the laboratory, assuming diagnostic equivalence of the methodologies applied in the study. Results: The in-house assay had a limit of detection and quantification of 60.3 IU/mL, with no cross-reactivity with the other viral agents tested. Moreover, the test was precise and had a R 2 of 0.954 when compared with the m2000 equipment. The cost analysis showed that the assay was economically advantageous costing a median value of 37.8% and 82.2% in comparison to the molecular test in use at the hospital and the m2000 equipment, respectively. Conclusions: These results demonstrated that in-house quantitative polymerase chain reaction testing is an attractive alternative in comparison to automated molecular platforms, being considerably less expensive and as efficacious as the commercial methods.
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Humans , Reagent Kits, Diagnostic , Cytomegalovirus Infections/diagnosis , Cytomegalovirus , DNA, Viral , Reproducibility of Results , Sensitivity and Specificity , Viral Load , Costs and Cost Analysis , Real-Time Polymerase Chain ReactionABSTRACT
Objective To compare three different anti-hypertension therapeutic projects by pharmacoeconomic evaluation and to find out the best therapeutic project.Methods Retrospective study was used.120 patients with hypertension were ran-domly assigned to group A(fosinopril sodium),group B(valsartan),group C(amlodipine besylate tablet),the therapeutic effects were observed and were evaluated by cost minimization analysis.Results The total efficiency of A,B,C group were 90·7%, 92·3%,92.1%(P>0.05)respectively.The incidence of adverse reaction were 16.7%,7.7%,13.2%(P>0.05)respective-ly.The costs were 287.3 yuan,378.7 yuan and 320.4 yuan respectively.Conclution The effectiveness of the three groups was similar.In terms of pharmacoeconomics,group A was the best therapeutic project.
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OBJECTIVE: To evaluate the economical efficiency of 3 therapeutic regimens for hyperthyroidism. METHODS: Medical records of 564 hyperthyroid outpatients were selected from our hospital in 2016, and they were divided into group A (185 cases), group B(191 cases) and group C(188 cases) according to drug use. Group A received Thiamazole tablets 2-4 tablet, once asthecondition gradually reduce th amount to 0. 5-2 tablets orally; group B received Thiamazole tablets (cusage and dosage are the same as group A)+Yikang pills 6 g, bid orally; group C received Thiamazole tablets (cusage and dosage are the same as group A)+ Xiakucao tablets 6 tablets, bid orally. The treatment courses of 3 groups lasted for 10 months. Clinical efficacy the occurrence of ADR and recurrence were observed in 3 groups. The pharmacoeconomic cost-effectiveness analysis was adopted for the economic evaluation of 3 therapeutic regimens. RESULTS: The tolal response rates of group A, B, C were 94. 06％, 95. 29％, 95. 75％, respectively; total incidence of ADR were 11. 36％, 10. 48％, 10. 11％; there was no statistical significance (P>0. 05). No recurrence occurred in the 3 groups. The average cost of 3 groups were 633. 80, 3 548. 89, 3 596. 00 yuan, respectively. The cost of group A was the lowest. The results of sensitivity analysis were also that the cost of group A was the lowest. CONCLUSIONS: 3 therapeutic regimens show good therapeutic efficacy and safety for hyperthyroidism, among which thiamazole alone has relatively higher pharmacoeconomic significance.
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OBJECTIVE: To conduct an economic evaluation of Baofukang versus Langyi in the treatment of pregnancy with vulvovaginal candidiasis by means of cost-minimization analysis. Furthermore, provide reference for reasonable clinical prescription and decision-making. METHODS: Meta-analysis was conducted to support the safety data and effectiveness data of pharmacoeconomic evaluation based on literature review; guidelines and clinical experts' suggestion were used to find out treatment routes to calculate total direct medical costs. Cost-minimization analysis was conducted from the societal perspective. RESULTS: The total direct medical costs of group Baofukang was lower than group Langyi's. Sensitivity analysis indicated the results were robust. CONCLUSION: In contrast with Langyi, Baofukang is a more economic therapy in the treatment of pregnancy with vulvovaginal candidiasis.
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OBJECTIVE:To systematically evaluate the pharnacoeconomic effect of venlafaxine and escitalopram in the treat-ment of depressive disorders. METHODS:Usingvenlafaxineescitalopramdepressiondepressive episodeantidepressantas key words,retrieved from CNKI,VIP and Wanfang database during base creation date to Dec. 2015,related literatures about venlafaxine and escitalopram in the treatment of depressive disorders were selected. The cure rate of two therapy plans for depres-sive disorders and HAMD score were analyzed statistically by cost-effectiveness analysis of pharnacoeconomics. RESULTS:There was no statistical significance in cure rate and HAMD score between 2 groups(P>0.05),so minimum-cost analysis was adopted. The costs of venlafaxine and escitalopram in the treatment of depressive disorders were 772.03 yuan and 935.77 yuan. CONCLU-SIONS:Therapeutic efficacy of venlafaxine is similar to that of escitalopram in the treatment of depressive disorders,but the for-mer scheme is more economical.
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Objective:To evaluate the short-term economic effects of four kinds of premixed insulin in newly diagnosed type 2 dia-betes mellitus. Methods:A total of 120 newly diagnosed patients with type 2 diabetes mellitus were divided into four groups according to the kind of premixed insulin, group A was treated with insulin aspart 30 injection, group B was treated with insulin lispro 25 injec-tion, group C was treated with isophane protamine biosynthetic human insulin injection and group D was treated with protamine zinc re-combinant human insulin injection. The course of treatment was three months. The therapy efficacy was assessed by the remission rate in three months. The short-term economic effect was evaluated by the cost-minimization analysis method. Results:The remission rate of group A, B, C and D respectively was 48. 39%, 48. 28%, 51. 61% and 51. 72% without significant difference (P>0. 05). The average cost per person of the four groups was 1195. 52, 1202. 41, 1220. 69 and 1258. 84 yuan, and the average medicine cost per person was 750. 52, 689. 41, 754. 69 and 764. 34 yuan, respectively. There was no significant difference in cost among the four groups (P >0. 05). Conclusion:All the four kinds of premixed insulin can be used for the starting treatment with the similar total cost, and in relative terms, aspart 30 injection and insulin lispro 25 injection are better for the initial treatment of diabetes.
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BACKGROUND: The subcutaneous formulation of biologic disease-modifying antirheumatic drugs (DMARDs) was preferred due to favored self-administration and would be an economical treatment option for patients with rheumatoid arthritis. This study was to compare the economic impact of biologic DMARDs administered by subcutaneous injection in patients with rheumatoid arthritis who had inadequate response to conventional DMARDs. METHODS: The cost-minimization analysis was conducted to estimate the lifetime health care costs of treatment sequences with subcutaneous biologic DMARDs as first-line therapy from a health care system perspective. The Markov model was developed to represent the transitions through treatment sequences based on American College of Rheumatology response rate and discontinuation rate. The health care costs comprised the cost of medications, administration, dispensing, outpatient visits, test/diagnostic examination, palliative therapy and treatment of serious infection. All costs were expressed in 2016 Korean Won (KRW) and discounted at 5%. RESULTS: The mean lifetime health care cost per patient was lowest in the etanercept sequence, which was estimated at KRW 63,441,679. The incremental costs of the treatment sequence started with adalimumab, golimumab, abatacept, and tocilizumab were KRW 7,985,730, KRW 4,064,669, KRW 2,869,947, and KRW 4,282,833, respectively, relative to etanercept sequence. These differences in costs mainly were attributable to medication costs. One-way and probabilistic sensitivity analyses confirmed that etanercept represented the option with the lowest cost compared with comparators. CONCLUSION: This study found that etanercept is likely a cost-saving treatment option among subcutaneous biologic DMARDs in patients with rheumatoid arthritis.
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Humans , Antirheumatic Agents , Arthritis, Rheumatoid , Delivery of Health Care , Health Care Costs , Injections, Subcutaneous , Outpatients , Palliative Care , Rheumatology , Abatacept , Adalimumab , EtanerceptABSTRACT
OBJECTIVE:To compare the economics of interferon α1b and α2b in the treatment of chronic hepatitis C. METH-ODS:By retrospective study,114 patients with chronic hepatitis C who received interferon were selected,60 patients received interfer-on α1b were divided into group A and 54 patients received interferon α2b were divided into group B. Negative conversion rate of HCV-RNA,normalization rate of ALT and the incidence of ADR in 2 groups were compared,and pharmacoeconomic analysis was conducted. RESULTS:Negative conversion rates of HCV-RNA in group A in 4,12,24,36,48 weeks were 55.00%,71.67%, 63.33%,61.67% and 65.00%,group B were 64.81%,66.67%,62.96%,55.56% and 61.11%,respectively,there were no signifi-cant differences between 2 groups (P>0.05);after treatment,normalization rate of ALT in group A was 95.23%,group B was 96.10%,there was no significant difference between 2 groups(P>0.05);and there were no significant differences in the incidence of ADR between 2 groups (P>0.05),so cost-minimization analysis was used to evaluate pharmacoeconomics. Therapy cost in group A was 13 216.56 yuan,group B was 7 929.60 yuan,group B was lower to group A;sensitivity analysis received the same results. CON-CLUSIONS:Interferonα2b is more economical thanα1b in the treatment of chronic hepatitis C.
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OBJECTIVE:To evaluate the clinical efficacy of liraglutide and insulin glargine in the treatment of type 2 diabetes mellitus (T2DM) and conduct pharmacoeconomic analysis, and to provide economical and reasonable T2DM treatment plan. METHODS:80 T2DM patients were randomized into liraglutide group and insulin glargine group,with 40 cases in each group. Both groups were given Metformin hydrochloride sustained-release tablet orally 0.5-2.0 g/d,and diabetes mellitus diet and sport training guide after oral antidiabetic drug withdrawal of previous treatment plan. Liraglutide group was given Liraglutide injection hypodermically,0.6-1.2 mg,qd;insulin glargine group was given insulin glargine hypodermically at 22 o’clock,initial dose of 0.2 IU/(kg·d),adjusted according to the levels of PG,FBG,nocturnal blood glucose level till FBG≤7 mmo1/L and 2 h PG ≤10 mmol/L in both group. Treatment course of 2 groups lasted for 12 weeks. The changes of FBG,2 h PG,HbA1c and BMI were ob-served in 2 groups before and after treatment. 2 therapy plans were evaluated and compared by cost-minimization analysis. RE-SULTS:After treatment,the levels of FBG,2 h PG and HbA1c decreased significantly in 2 groups,compared to before treatment, with statistical significance (P0.05). After treat-ment,BMI of liraglutide group decreased significantly compared with before treatment and insulin glargine group,with statistical significance (P0.05). Cost-minimization analysis showed that the cost of insulin glargine group in reducing FBG,2 h PG and HbA1c were less than liraglutide group,but were more than liraglutide group in reducing BMI. Sensitivity analysis demonstrated the stability and reliability of cost-minimization analysis. CONCLUSIONS:Lira-glutide and insulin glargine have the same clinical efficacy,but insulin glargine need lower cost in blood glucose control,and liraglutide is better therapy plan for body weight control.
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OBJECTIVE:To compare the cost of Xiangdan injection and Danshen chuanxiongqin injection in the treatment of unstable angina pectoris of coronary heart disease,and to provide reference for rational and economic drug selection. METHODS:42 inpatients with unstable angina pectoris of coronary heart disease were divided into Xiangdan injection group(group A,20 cas-es) and Danshen chuanxiongqin injection group (group B,22 cases). Two groups were given conventional symptomatic treatment according to the specific clinical situation;on this basis,group A was given Xiangdan injection 20 ml intravenously,qd;group B was given Danshen chuanxiongqin injection 10 ml intravenously,qd,for 14 d. Clinical efficacy and the occurrence of ADR were compared between 2 groups,and cost-minimization analysis was conducted. RESULTS:After treatment,total effective rate of group A and B was 95.00% and 95.45%,without statistical significance(P>0.05);there was also no statistical significance in the incidence of ADR (P>0.05). The costs of 2 groups were equal in addition to the cost of drugs. According to cost-minimization analysis,the drug cost of group A was 77.28 yuan and total cost was 705.88 yuan;the drug cost of group B was 1 310.40 yuan and total cost was 1 939.00 yuan;the drug cost and total cost of group A were far more less than that of group B,with statistical significance(P<0.05). The results of sensitivity analysis were consistent with it. CONCLUSIONS:The cost of Xiangdan injection is lower and more economical than that of Danshen chuanxiongqin injection in the treatment of unstable angina pectoris of coronary heart disease.
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OBJECTIVE:To explore the pharmacoeconomic effect of Ginkgo dipyidamolum,argatroban or sodium ozagerl combined with edaravone in the treatment of acute cerebral infarction(ACI). METHODS:In retrospective study,64 ACI patients were divided into group A(Ginkgo dipyidamolum+edaravone,22 cases),group B(argatroban+edaravone,19 cases)and group C (sodium ozagerl+edaravone,23 cases). Therapeutic efficacies were observed after 7-14 days of treatment;therapy cost was calculat-ed,and cost-minimization analysis was used to evaluate pharmacoeconomics. RESULTS:There was no statistical significance in to-tal effective rate among 3 groups(P>0.05);the costs of group A,group B and group C were 8 746.36 yuan,10 770.64 yuan and 8 264.67 yuan. Results of sensitivity analysis were in line with those of cost-minimization analysis. CONCLUSIONS:Therapy plan of sodium ozagerl+edaravone is the economical regime in the treatment of ACI .
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OBJECTIVE:To evaluate the economic effect of 3 therapeutic regimens in the treatment of skin allergy. METH-ODS:54 patients with skin allergy in our hospital were randomly divided into A,B,C groups. They were given calcium+Vc+Ma-lay bolt chlorpheniramine (Puermin),calcium+Vc+Loratadine tablets (Kairuitan),calcium+Vc+Cetirizine hydrochloride tablets (Xikewei),respectively. Short-term efficacy was observed,and analyzed with the minimum cost analysis. RESULTS:Effective rates of A,B,C groups were 94.44%,88.89% and 94.44%,respectively,there was no statistical significance (P>0.05);the cure rates of 3 groups were 55.56%,38.89% and 83.33%,there was statistical significance(P<0.05). The cost were 169.70 yu-an,195.70 yuan and 180.40 yuan,respectively. The cost of group A was the lowest. CONCLUSIONS:The regimens of A group is economical,but that of group C the best after comprehensive comparison.
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Objective:To evaluate the efficacy and pharmacoeconomics of rhIL-11(Ⅰ) and rhTPO in the treatment of thrombocy-topenia caused by gemcitabine chemotherapy in lung cancer patients. Methods:A retrospective analysis was used. Totally 58 hospital-ized lung cancer patients who suffered thrombocytopenia caused by gemcitabine chemotherapy and treated with rhIL-11(Ⅰ) or rhTPO from June 2011 to June 2014 were involved in the study, and the efficacy and pharmacoeconomics of rhIL-11(Ⅰ) and rhTPO were e-valuated and compared. Results:The lowest platelet value after the chemotherapy in rhIL-11(Ⅰ) group was higher than that in rhTPO group (P0. 05). The results of cost-minimization anal-ysis showed that the average cost of rhIL-11(Ⅰ) group was lower than that of rhTPO group(P<0. 01), furthermore, the average cost of the patients with GP, GC or the other gemcitabine chemotherapy regimens in rhIL-11 (Ⅰ) group was lower than that in rhTPO group. Conclusion:The effect of rhIL-11 (Ⅰ) in the treatment of thrombocytopenia caused by gemcitabine based-chemotherapy in lung cancer patients is not inferior to that of rhTPO, and shows certain advantages in economic cost.
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OBJECTIVE:To investigate the curative effect and economics of prostaglandins drugs in the treatment of glauco-ma,and to provide reference for clinical medication. METHODS:In retrospective study,a total of 790 glaucoma patients were di-vided into latanoprost group(62 cases),travoprost group(356 cases)and bimatoprost group(372 cases)according to therapy regi-men. They were given relevant medicine. Total effective rate of 3 groups were calculated,and the cost-minimization method was used for pharmacoeconomics evaluation. RESULTS:The total effective rate of 3 groups were 87.10%,84.27%,76.08% respective-ly,without statistical significance(P>0.05). The cost of them were 208.00 yuan,225.00 yuan and 173.00 yuan,and that of bima-toprost group was the lowest. The results of sensitivity analysis was in line with that of cost-minimization analysis. CONCLU-SIONS:For glaucoma,bimatoprost is more economical than latanoprost and travoprost.
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Objective: The hospital revenues are decreasing from the government policy in the universal coverage while increasing the hospital expenses . The cost analysis is a very important tool for the strategic plan in the hospital expenses reduction with standard quality. This study wanted to investigate the cost of 12 orthopaedic diseases using the clinical practice guideline (CPG) at maximum length of stay (LOS) and to compare the cost before and after utilization management in cost minimization analysis in orthopaedic inpatients under the universal coverage policy. Methods: Part 1, The CPG with maximum LOS was studied in detail and the cost analysis was performed using the formula C = S+I+X+P+O+L+A+R while C = unit service cost/case, S = service cost, I = instrument cost, X= X-ray cost, P = prosthetic cost, O = operating cost, L = laboratory cost, A = anesthetic cost, R = recovery room cost. Part 2, the cost minimization analysis (CMA) before and after utilization management was studied in 2 groups. Group A consisted of 236 cases which were studied after utilization management from June 1, 2003 to February 24, 2005. Group B consisted of 89 cases from June 1, 2002 to May 31, 2003 which were studied before utilization management was introduced in the department. The cost of both groups were compared. Results: The cost of the 12 orthopaedic diseases ranged from 13,036.10 baht/case for 3 days LOS in club foot surgery to 99,532.73 baht/case for 21 days LOS in total hip replacement surgery. The reduction of 1 day LOS reduces the service cost by an average 1,844.26 baht. The CMA found that after utilization management in group A, the CMA in the average cost reduction was 3,274.45 baht/case with an average 2.07 days reduction in length of stay. Both groups had the same outcomes. Conclusion: The cost analysis was done in 12 orthopaedic diseases using CPG. The usefulness with cost reduction was found after implementation of utilization management.
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OBJECTIVE:To provide reference for the selection of pharmacoeconomics evaluation methods.METHODS:The source of pharmacoeconomics evaluation method was reviewed.The understanding of people to pharmacoeconomic evaluation method and the development of it were analyzed.The advantage and disadvantage of different pharmacoeconomic sevaluation methods were compared.RESULTS & CONCLUSION:Regardless of the pursuit of economic evaluation index or the requirement of evaluation purposes and subject characteristics of pharmacoeconomics to evaluation method,common economics evaluation method are the first choice for the selection of evaluation methods and index of pharmacoeconomics,i.e.cost-minimization analysis and cost-effectiveness analysis.If above method is not applicable,it is considered to adopt individual index,i.e.effect and effectiveness,to calculate profits.
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0.05),respectively;the total cost for Group A was significantly higher than in Group B (1 276.54 yuan vs.1 117.57 yuan,P
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0.05),respectively.The average cost was 1 314.8 yuan in Group A versus 3 306.5 yuan in Group B(P