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To evaluate the economy and applicability of Jinye Baidu Granules in the treatment of acute upper respiratory tract infection, a randomized, double-blind, positive drug parallel control clinical trial was conducted in this study. Stratified block random, double-blind and double simulation test was used. The experimental group took Jinye Baidu Granules, 10 g/time, three times a day, and Compound Shuanghua Granules placebo, 6 g/time, four times a day. The control group took Compound Shuanghua Granules, 6 g/time, 4 times a day, and Jinye Baidu Granules placebo, 10 g/time, 3 times a day. The course of treatment was 5 days. The total cost of this study included direct medical cost and indirect medical cost. The incremental cost-effect analysis method was used for evaluation. Treeage Pro software was used to build a pharmaco-economics model and make statistical analysis. Patients from 10 hospitals were divided into experimental group(304 cases) and control group(302 cases). The baseline values of age, sex ratio, clinical symptoms and signs scores, and important physical examination indexes of the two groups were compared. After 5 days of treatment, the cost per capita of the experimental group was(388.06±94.17) Yuan, and that of the control group was(378.47±95.46) Yuan. The cost of direct medical treatment per capita was(271.24±54.11) Yuan for the experimental group and(264.88±112.71) Yuan for the control group. The average cost of indirect medical treatment was(116.82±82.75) Yuan in the experimental group and(113.59±87.77) Yuan in the control group, with no significant difference in the cost of medical treatment per capita, the cost of direct medical treatment per capita and the cost of indirect medical treatment per capita between both groups. The results of incremental cost-effect analysis based on the total score difference in symptoms and signs after 5 days of treatment showed that ICER=23.39 Yuan/score, which was less than the willingness to pay 100 Yuan/score determined through expert interviews. The experimental group had economic advantages over the experimental group, with the economic probability of 53%. Sensitivity analysis supported the robustness of the results. The results of incremental cost-effect analysis based on the total recovery rate of symptoms and signs showed that compared with the experimental group, the control group had lower cost, better effect and absolute economic advantage, with a corresponding probability of 55%. Based on the above results, it is concluded that there is no significant difference in economic outcome between Jinye Baidu Gra-nules and Compound Shuanghua Granules in the treatment of acute upper respiratory tract infection.
Subject(s)
Humans , Cost-Benefit Analysis , Double-Blind Method , Marketing , Respiratory Tract InfectionsABSTRACT
The ultimate goal of the development of parenteral and enteral nutrition is to achieve T3 transfer of translational medicine in this field. This study is an international cooperative, multicenter and observational clinical study conducted by CSPEN-NUSOC cooperative group for 15 years which is aimed to observe the effect of standardized nutritional support on clinical outcome and cost/effect and verify the clinical value parenteral and enteral nutrition through investigating the prevalence of nutritional risk and malnutrition and the application of nutritional support in adult in-patients.
ABSTRACT
The ultimate goal of the development of parenteral and enteral nutrition is to achieve T3 transfer of translational medicine in this field. This study is an international cooperative, multicenter and observational clinical study conducted by CSPEN-NUSOC cooperative group for 15 years which is aimed to observe the effect of standardized nutritional support on clinical outcome and cost/ effect and verify the clinical value parenteral and enteral nutrition through investigating the prevalence of nutritional risk and malnutrition and the application of nutritional support in adult in-patients.
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In this study we have compared two different types of therapies i.e. herbal and allopathic system of therapies for Depression and studied them from the social perspectives. The Hypericum perforatum is compared with Fluoxetine [HCL] in terms of cost-utility and financial savings thereby evaluating its influence on annual expenditure of depressive patients that were randomly selected from 178 union councils of the city of Karachi, Pakistan. For both system of therapies a total of 356 patients were selected by stratified random sampling. Taking frequency of depression as '1' annually with discount rate at 3% for calculating the burden-of-illness in terms of disability-adjusted-life-years. The cost-utility and the budget-impact assessments were carried out to assess incremental-cost-effectiveness-ratio, and the budget-impact-per-onset as well as budget-impact-per-year values. In comparison with the Fluoxetine therapy, the Hypericum perforatum was found to relieve symptoms in 21.47% less cost; owing 29.23% less disability-adjusted-life-years and 21.45% less budget-impact-per-onset as well as budget-impact-per-year. The annual mean incremental-cost-effectiveness-ratio was found to be at 36.95±270.74 (less than GDP per capita threshold of Rs. 38,173.02). Hypericum perforatum provide the optimal utility with less impact on budget of a patient in comparison with the treatment of symptoms of depression with Fluoxetine.
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Annual medical expenditure in Japan is continuously increasing. This may be caused by technology advancement as well as population ageing. Some new and high cost technologies, including new drugs, have been introduced. In order to balance technology advancement with medical expenditure, economic evaluation of new technologies is one way to approach the issue. In 2016 a pilot program stared at the Central Social Insurance Medical Council to evaluate cost effectiveness of some drugs and medical devices. In the pilot program, companies of selected products were asked to submit primary data and analyses to the Ministry of Health, Labour and Welfare. The ministry, together with some experts, reviewed the submitted data and re-analyzed if necessary. After these assessment process, not only cost effectiveness of each product, but also ethical or social aspects are considered in the appraisal phase. Finally results will be used to adjust reimbursement prices in the 2018 price revision. In the council, some issues toward full implementation of the new system will be discussed by 2019.
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OBJECTIVE: This study presented the analysis period, the complexity of combined therapy and comparator choice as the key limitations in the economic evaluation of new drugs, and discussed programs for coping with these limitations. METHODS: This study evaluated the post-evaluation, risk-sharing agreement, extra funding program, and flexible incremental cost-effectiveness ratio (ICER) threshold as actions or programs that would increase accessibility to costly new drugs. The study also presented the cases of other countries. The application of the post-evaluation was considered to deal with high uncertainty regarding new drugs. RESULTS: The risk-sharing agreement was introduced in European countries as well as South Korea and has been responsible for the shift from using the financial schemes to outcome-based schemes. The drug funding program has had troubled in securing stable extra funds. The application of higher ICER in the economic evaluation of expensive and innovative oncology drugs was criticized because of the inequity between oncology patients and patients with other diseases. CONCLUSION: Therefore, introducing and applying actions that would increase the accessibility to costly new drugs in South Korea have been deemed necessary after careful reviews and discussions with various stakeholders (insurer, policy makers, pharmaceutical companies and patients).
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Objective To evaluate the impact of fish oil (ω-3 fatty acids) parenteral nutrition (PN) on outcomes for non-ICU postoperative patients.Methods PubMed,Embase,Cochrane,China National Knowledge Infrastructure (CNKI) and Wanfang Database etc.were searched to retrieve the eligible studies published from January 2010 to June 2016.The studies included were randomized controlled trials (RCTs) that evaluated the effects of supplementation of fish oil (Omegawen) in PN regimens for postoperative patients on clinical outcomes.The methodological quality assessment was based on Jadad scale and Schulz allocation concealment tool.Meta-analysis was conducted by RevMan 5.3 software.Results 19 RCTs,1 170 surgical patients,were included.Meta-analysis indicated that short-term fish oil supplementation significantly reduced the incidence of infectious complications [RR =0.44,95％ CI (0.31,0.64),P ＜0.000 1] and shortened the length of hospital stay [MD =-0.85,95％ CI (-1.67,-0.03),P=0.04],while with no significant effect on mortality [RR =0.42,95％ CI (0.07,2.63),P =0.36] and total expenditure of hospitalization [MD =-216.60,95％ CI (-718.94,285.75),P =0.40].Sensitivity analysis showed similar results.Conclusion According to existing evidence,fish oil in PN for surgical patients could reduce the incidence of postoperative infectious com-plications and shorten the length of hospital stay.
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Objective: Drugs for hepatoprotection and enzymes reduction are widely used in China but their economic analysis has been ignored in a rather long period of time. A suitable protocol for hepatoprotection and enzymes reduction was recommended in Longhua Hospital. Methods: This study was conducted as a retrospective piece. Three therapeutic protocols (compound glycyrrhizic glycoside combined with aspartic ornithine injection, compound glycyrrhizic glycoside combined with phosphatidylcholine, and compound glycyrrhizic glycoside combined with tiopronin) were selected. Seventy inpatient cases from January 2011 to February 2012 were enrolled and divided into three groups according to different regimens. The cost effectiveness of the three groups was respectively evaluated by incremental cost-effectiveness ratios (ICERs). A decision tree model and multi attribution utility theory were also adopted to analyze the data. Results: All the three regimens exhibited good effects on protecting liver functions and reducing the levels of enzymes. Among them, the protocol of compound glycyrrhizic glycoside combined with tioproni expressed the least ICER, the lowest cost but the highest score in the multi-utility. Conclusion: The therapeutic method of compound glycyrrhizic glycoside combined with tiopronin is the most cost-effective option in this study.
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PURPOSE: The aim of this study was to evaluate the cost-effectiveness of the use of drug-eluting stents (DESs), as compared with bare-metal stents (BMSs) in Korea. MATERIALS AND METHODS: A retrospective cohort study was conducted between January 2000 and December 2007. Subjects were stent-treated for the first time between 2004 and 2005, with four years of follow-up (2004-2007) (n=43674). The incremental cost-effectiveness ratio (ICER) was used to calculate the costs of DESs compared with BMSs among patients with coronary artery disease (CAD). Cost-effectiveness was assessed with effectiveness defined as a reduction in major adverse cardiac events after six months and after one, two, three, and four years. RESULTS: The total costs of a DESs were 674108 Korean won (KRW) higher than that of a BMSs at the end of the follow-up; 13635 thousand KRW per patient treated with DESs and 12960 thousand KRW per patient treated with BMSs. The ICER was 256315 per KRW/death avoided and 293090 per KRW/re-stenting avoided among the CAD patients at the end of the follow-up. CONCLUSION: The ICER for the high-risk patients was lower than that for the low-risk patients. The use of DESs is clinically more useful than the use of BMSs for CAD and myocardial infarction patients, especially for those considered to be high-risk patients in Korea.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Asian People/statistics & numerical data , Coronary Artery Disease/etiology , Cost-Benefit Analysis , Drug-Eluting Stents/economics , Immunosuppressive Agents/administration & dosage , Myocardial Infarction/therapy , National Health Programs/statistics & numerical data , Paclitaxel/administration & dosage , Republic of Korea/epidemiology , Retrospective Studies , Risk , Sirolimus/administration & dosage , Stents/adverse effects , Treatment OutcomeABSTRACT
Objective To evaluate the impact of nutrition support on the clinical outcomes of gastrointestinal disease patients at nutritional risk and explore the the cost-effectiveness of various nutrition support options.Methods A prospective cohort study was designed.The patients who met the predetermined inclusion criteria were followed up during the hospital stay.Nutritional risk was determined using the Nutrition Risk Screening 2002 on admission.The information with respect to nutritional support,occurrence and treatment of complications,length of hospital stay,and discharge destination was monitored and recorded.The direct costs of nutritional support and the costs of diagnosing and treating complications were calculated after discharge.Infectious complication-free patient was used as the effectiveness indicator in the cost-effectiveness analysis.Results Patients who had received nutrition support had significantly lower infectious complications incidence (6.8％ vs.19.6％,x2 =9.0,P=0.003) and significantly higher total hospitalization costs (P =0.0001).The adjusted (by general linear model) cost of parenteral nutrition (PN) cohort,enteral nutrition (EN) cohort,PN combined EN cohort,and the cohort without nutritional support were 5635,1212,5220,and 1339 China Yuan,respectively.The incremental cost effectiveness ratios were 36 101,-794,and 33 748 China Yuan for PN,EN,and PN-EN combination groups,respectively.Conclusions For the patients at nutritional risk,nutritional support can remarkably reduce the incidence of infectious complications.The preliminary resuits of cost-effectiveness:due to lack of enough data required by health economic professional,it can not be cited directly.