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China Pharmacy ; (12): 74-78, 2022.
Article in Chinese | WPRIM | ID: wpr-907016


OBJECTIVE To conduct the pharmacoeconomic evaluation of empagliflozin in the treatment of heart failure with reduced ejection fraction (HFrEF),and to provide evidence-based reference for rational drug use and medical and healthy decision-making. METHODS A Markov model was used to perform a cost-effectiveness analysis of the regimen of empagliflozin in the treatment of HFrEF ,and to evaluate the cost and effectiveness of standard treatment plan plus empagliflozin (empagliflozin group)vs. standard treatment plan (standard treatment group ). Clinical parameters were obtained from the EMPEROR-Reduced study;cost and utility data came from the published literatures. The cycle of the model was 1 month and the simulation time was 20 years. Single-factor sensitivity analysis and probability sensitivity analysis were performed to validate the results of cost-effectiveness analysis. RESULTS Compared with the standard treatment group ,each additional quality-adjusted life year in the empagliflozin group cost 37 995.94 yuan more ,which was less than China ’s 1 time GDP per capita in 2020(72 447 yuan). The results of single factor sensitivity analysis showed that steady-state hospitalization rate of 2 groups was the most important factor affecting the incremental cost-effectiveness ratio . The results of probability sensitivity analysis showed that when the willingness-to-pay threshold (WTP)was 1 time GDP per capita in 2020(72 447 yuan),the probability of empagliflozin group with cost-effectiveness advantage was 58.8%;when the WTP was 3 times GDP per capita in 2020(217 341 yuan),the probability of empagliflozin group with cost-effectiveness advantage was 63.8%. CONCLUSIONS Compared with standard treatment plan alone,standard treatment plan plus empagliflozin is more cost-effective in the treatment of HFrEF. However ,the economic probability is not high.

J. oral res. (Impresa) ; 10(3): 1-10, jun. 30, 2021. ilus
Article in English | LILACS | ID: biblio-1391196


Background: The aim of this study was to elaborate a randomized clinical trial protocol to evaluate the effectiveness of class I restorations in resin-modified glass ionomer cement (RMGIC) and bulk-fill resin in primary molars with untreated early childhood caries in toddlers. Material and Methods: A total of 59 toddlers up to 36 months old with at least two primary molar teeth with untreated dental caries of single surface on different sides of the mouth will be selected at the Pediatric Dentistry Clinics of the Faculty of Dentistry at Federal University of Minas Gerais (UFMG), Brazil. Teeth with untreated dental caries in the left and right sides of each patient's mouth will be randomly distributed into 2 groups: Group 1 (Control): encapsulated RMGIC restoration with Riva light cure (SDI, Florida, USA) and Group 2 (Test): Filtek bulk-fill composite resin restoration (3M/ESPE, St. Paul, USA) with universal single bond adhesive system (3M/ESPE, St. Paul, USA). A single trained dentist will perform all restorative procedures. The restorations will be evaluated after 1, 6, 12, 18 and 24 months by two trained and calibrated examiners. Cost-efficacy analysis will be carried out. Kaplan-Meier survival analysis, Log-rank test, Cox regression, Poisson regression analysis, Mann-Whitney test or Kruskal-Wallis will be performed to analyze data. Conclusion: The protocol will make it possible to determine the most efficacy material for the restoration of cavities in cavities in primary molars of toddlers.

Antecedentes: El objetivo de este estudio fue elaborar un protocolo de ensayo clínico aleatorizado para evaluar la efectividad de las restauraciones de clase I en cemento de ionómero de vidrio modificado con resina (RMGIC) y resina bulk-fill en molares primarios con caries de la primera infancia no tratadas en niños preescolares. Material y Métodos: Un total de 59 niños de hasta 36 meses de edad con al menos dos molares temporales con caries no tratada de superficie única en diferentes lados de la boca serán seleccionados en las Clínicas de Odontología Pediátrica de la Facultad de Odontología de la Universidad Federal de Minas Gerais (UFMG), Brasil. Los dientes con caries no tratada en los lados izquierdo y derecho de la boca de cada paciente se distribuirán aleatoriamente en 2 grupos: Grupo 1 (Control): restauración RMGIC encapsulada con fotopolimerización Riva (SDI, Florida, EE. UU.) Y Grupo 2 (Prueba): Restauración de resina compuesta bulk-fill Filtek (3M / ESPE, St. Paul, EE. UU.) con sistema adhesivo de unión simple universal (3M / ESPE, St. Paul, EE. UU.). Un solo dentista capacitado realizará todos los procedimientos de restauración. Las restauraciones serán evaluadas después de 1, 6, 12, 18 y 24 meses por dos examinadores capacitados y calibrados. Se llevará a cabo un análisis de coste-eficacia. Se realizarán análisis de supervivencia de Kaplan-Meier, prueba de rango logarítmico, regresión de Cox, análisis de regresión de Poisson, prueba de Mann-Whitney o Kruskal-Wallis para analizar los datos. Conclusión: El protocolo permitirá determinar el material más eficaz para la restauración de caries en molares temporales de niños preescolares.

Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Composite Resins/therapeutic use , Glass Ionomer Cements/therapeutic use , Brazil/epidemiology , Pediatric Dentistry , Dental Marginal Adaptation , Dental Caries , Dental Restoration, Permanent/methods , Molar
Coluna/Columna ; 20(1): 38-41, Jan.-Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154021


ABSTRACT Objective: To identify the cost effectiveness of vancomycin powder in the prophylaxis of posterior lumbar spine instrumentation, seeking potential savings. Methods: A retrospective, observational study was performed to evaluate the cost effectiveness. Data were retrieved from patients' files from March 2016 to April 2017; costs were considered for the procedures, as well as which antibiotic was used. Results: A total of 184 patients were included. Of these, 102 received prophylactic treatment with 1g of cephalothin and 82 received 1g of cephalothin and 1g of vancomycin powder, which was applied to the wound prior to tissue closure. Of the 184 patients, 110 were women (59%) and 74 were men (41%), and the mean age was 55 years (24-77). The participants had a median BMI of 28.9 kg/m2 (19-39). The average cost per hospitalized patient was $3974 USD and the average cost of rehospitalization due to infection was, on average, $7700 USD. The use of vancomycin powder led to cost savings of $75,008.79 USD per 100 posterior spinal fusions performed for degenerative spine. Conclusion: The use of vancomycin powder is a cost-effective option for prophylaxis of surgical site infection in spine fusion. Level of evidence III; Economic and decision analysis.

RESUMO Objetivo: Identificar a relação de custo-eficácia da vancomicina em pó como profilaxia da instrumentação posterior da coluna lombar, buscando possíveis economias. Métodos: Foi realizado um estudo retrospectivo e observacional para avaliar a relação custo-eficácia. Os dados foram recuperados dos arquivos dos pacientes de março de 2016 a abril de 2017; foram considerados os custos dos procedimentos, bem como o antibiótico usado. Resultados: Um total de 184 pacientes foi incluído, dos quais 102 receberam tratamento profilático com 1 g de cefalotina e 82 receberam 1 g de cefalotina e 1 g de vancomicina em pó, que foi aplicada na ferida antes do fechamento do tecido. Dos 184 pacientes, 110 eram mulheres (59%) e 74 eram homens (41%), e a média de idade foi de 55 anos (24-77). Os pacientes tinham IMC médio de 28,9 kg m2 (19-39).O custo médio por paciente hospitalizado foi US$ 3.974 e o custo médio de reinternação por infecção foi, em média, US$ 7.700. O uso de vancomicina em pó levou a uma redução de custos de US$ 75.008,79 referentes a 100 fusões que seriam realizadas nos casos de degeneração da coluna. Conclusões: O uso de vancomicina em pó é uma opção de baixo custo para a profilaxia da infecção do sítio cirúrgico na artrodese de coluna. Nível de evidência III; Análise econômica e de decisão.

RESUMEN Objetivo: Identificar la relación de costo-eficacia de la vancomicina en polvo como profilaxis de la instrumentación posterior de la columna lumbar, buscando posibles economías. Métodos: Fue realizado un estudio retrospectivo y observacional para evaluar la relación costo-eficacia. Los datos fueron recuperados de los archivos de los pacientes de marzo de 2016 a abril de 2017; fueron considerados los costos de los procedimientos, bien como el antibiótico usado. Resultados: Fue incluido un total de 184 pacientes, de los cuales 102 recibieron tratamiento profiláctico y 1 g de cefalotina y 82 recibieron 1 g de cefalotina y 1 g de vancomicina en polvo, que fue aplicada en la herida antes del cierre del tejido. De los 184 pacientes, 110 eran mujeres (59%) y 74 eran hombres (41%), y el promedio de edad fue de 55 años (24-77). Los pacientes tenían IMC promedio de 28,9 kg/m2 (19-39). El costo promedio por paciente hospitalizado fue de USD 3.974 y el costo promedio de reinternación por infección fue, en promedio, de USD 7700. El uso de vancomicina en polvo llevó a una reducción de costos de USD 75.008,79 referentes a 100 fusiones que serían realizadas en los casos de degeneración de la columna. Conclusiones: El uso de vancomicina en polvo es una opción de bajo costo para la profilaxis de la infección del sitio quirúrgico en la artrodesis de columna. Nivel de evidencia III; Análisis económico y de decisión.

Humans , Spinal Fusion , Vancomycin , Cost-Benefit Analysis , Antibiotic Prophylaxis
Article in Chinese | WPRIM | ID: wpr-907759


Objective:To analyze the effectiveness and annual cost-effectiveness of extracorporeal cardiopulmonary resuscitation, ECPR) in adults.Methods:Totally 60 patients received ECPR from April 2015 to March 2020 in Emergency Medicine Department of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The patients were grouped by discharge survival/hospital death and shockable/unshockable initial rhythm. Age, gender, initial rhythm, survival rate, ECMO treatment time, time-to-death, length of stay and hospitalization costs were analyzed. All discharged survivors were followed up for 1 year, then cost-effectiveness analysis was performed using total cost of ECPR as the cost and 1-year survival rate as the effect.Results:Fifty-four adult patients with ECPR were enrolled, and 17 (31.5%) patients survived and discharged, of whom 15 (88.2%) patients had good neurological outcomes and survived at 1-year follow-up. The median ECMO time was 5 ( IQR 1-8) d, time-to-death was 4 ( IQR 1-9) d, length of stay was 10 ( IQR 3-18) d, total hospitalization cost was 209 122 ( IQR 121 431-303 822) RMB, and the daily cost was 23 587 ( IQR 13 439-38 217) RMB. The rate of shockable initial rhythm was significantly higher in the discharge survival group than the hospital death group. The survival rate of ECPR patients with shockable initial rhythm was significantly higher than that of patients with unshockable initial rhythm, and there was no difference in cost. Conclusions:ECPR is a resource-intensive treatment with a total cost of about 200 000 RMB. Moreover, the effectiveness and annual cost-effectiveness are superior for patients with shockable initial rhythm.

China Pharmacy ; (12): 713-719, 2021.
Article in Chinese | WPRIM | ID: wpr-875653


OBJECTIVE:To s ystematically review the economics of osimertinib for advanced non-small cell lung cancer (NSCLC),and to provide the reference for clinical application and healthcare decision makers. METHODS :Retrieved from PubMed,Embase,the Cochrane L ibrary,Health Technology Assessment ,CNKI,Wanfang database ,VIP,CBM,etc., pharmacoeconomic studies on osimertinib in the treatment of advanced NSCLC were collected from the inception to Apr. 2020. After screening and extracting relevant data ,the quality of the included studies was evaluated by using the Quality of Health Economics Studies (QHES),and the economic research results of the included literatures were systematically evaluated by using descriptive analysis method. RESULTS & CONCLUSIONS :A total of 10 studies from 7 different countries were included ;QHES scores of the included literatures were 73-93,with an average of 86.8,and the quality of the researches was generally high. All the 10 studies were cost-effectiveness analysis ,including 6 first-line treatment ,4 second-line treatment. Six studies reported the cost discount rate ;only one study used the cost of osimertinib after price reduction for evaluation and analysis. Compared with other epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI),six studies from different countries showed that osimertinib as the first-line treatment drug had no cost-effectiveness advantage ;cost-effectiveness of second-line treatment of osimertinib was controversial ,compared to chemotherapy. For advanced NSCLC patients ,the second-line treatment of osimertinib after the national centralized negotiation of price reduction has a more cost-effectiveness advantage in China ’s medical service system,while the first-line treatment of osimertinib before price reduction does not have this advantage compared with other EGFR-TKI drugs.

Article in Chinese | WPRIM | ID: wpr-930280


Objective:To compare the cost-effectiveness of parathyroidectomy (PTX) and cinacalcet in treatment of refractory secondary hyperparathyroidism (SHPT) on hemodialysis.Methods:Hemodialysis patients with refractory SHPT treated in China-Japan Friendship Hospital from Jan. 2016 to Jan. 2019 were retrospective studied. 77 patients treated with PTX and 47 patients treated with cinacalcet were included in the study. The two groups were matched according to the baseline variables, and then a cost-effectiveness analysis from the perspective of the whole society was conducted. The effect index was the total effective rate of treatment for each group for 1 year (the treatment was effective if the parathyroid hormone decreases by≥30% after treatment) , and the cost included the direct cost and indirect cost within 1 year of treatment. Then the incremental cost-effectiveness ratio (ICER) of the two treatment options was calculated, and a single-factor sensitivity analysis on the cost was performed.Results:58 cases in PTX group and 30 cases in cinacalcet drug treatment group were finally matched. The average ages were 47.0±10.1 years and 49.7±12.2 years, respectively. There was no statistical difference between baselines ( P>0.05) . The results of probability density regression (Probit regression) showed that the total effective rate of the PTX group was 27.3% higher than that of the cinacalcet drug group at 1 year of treatment ( P<0.01) . The average total cost of 1 year after PTX was 125,700 yuan, the average cost of cinacalcet drug group was 111,000 yuan, and the ICER of PTX relative to cinacalcet was 53,500 yuan. When each cost changes within the set value range, ICER changes from 30,000 yuan to 62,000 yuan. Conclusion:For patients with hemodialysis complicated with refractory SHPT, if the willing payment for each additional effective treatment case is more than 53500 yuan, the PTX treatment scheme is more economical than the drug treatment of cinacalcet, and the research results are stable.

J. bras. econ. saúde (Impr.) ; 12(3): 241-254, Dezembro/2020.
Article in Portuguese | LILACS, ECOS | ID: biblio-1141314


Objetivo: Analisar o custo-efetividade da trombólise com alteplase no tratamento de acidente vascular isquêmico (AVCi) agudo em até 4,5 horas após início dos sintomas em comparação com tratamento clínico conservador, sob a perspectiva do Sistema Único de Saúde (SUS) no Brasil. Métodos: Construiu-se um modelo de Markov para simular o tratamento de AVCi agudo e suas consequências em curto e longo prazo. Foram conduzidas análises de custo-efetividade (anos de vida ganhos, AVG) e custo-utilidade (anos de vida ajustados pela qualidade de vida, QALY), considerando um horizonte temporal de tempo de vida. Parâmetros de eficácia e segurança foram obtidos em uma metanálise de dados individuais, considerando tratamento em até 3 horas e 3-4,5 horas. Os custos agudos e crônicos foram obtidos por análise secundária de dados de um hospital público brasileiro e expressos em reais (R$). Foram conduzidas análises de sensibilidade determinística e probabilística. Utilizou-se como limiar de disposição a pagar (LDP) 1 PIB (produto interno bruto) per capita para 2019 no Brasil (R$ 31.833,50). Resultados: O tratamento com alteplase vs. conservador resultou em incremento de 0,22 AVG, 0,32 QALY e R$ 4.320,12 em custo, com razão de custo-efetividade incremental (RCEI) estimada em R$ 19.996,43/AVG e R$ 13.383,64/QALY. Ambas as estimativas foram mais sensíveis a variações na efetividade e nos custos de tratamento agudo com alteplase. Para RCEI/AVG e RCEI/QALY, 70,7% e 93,1% das simulações na análise de sensibilidade probabilística estavam abaixo do LDP, respectivamente. Conclusões: O tratamento com alteplase até 4,5 horas após o início dos sintomas tem elevada probabilidade de ser custo-efetivo na perspectiva do SUS.

Objective: To assess the cost-effectiveness of thrombolysis with alteplase for the treatment of acute ischemic stroke up to 4.5 hours after the onset of symptoms as compared to conservative medical treatment from the perspective of the Brazilian Public Health System. Methods: A Markov model was used to simulate the treatment of acute stroke and the associated short- and long-term consequences. Cost-effectiveness (life-years gained, LYG) and cost-utility (quality-adjusted life years, QALY) analyses were performed considering a lifetime horizon. Efficacy and safety parameters were obtained from a meta-analysis of individual data, considering treatment within 3 hours and 3-4.5 hours after the onset of symptoms. Acute and chronic costs were derived from a secondary analysis of data obtained from a Brazilian public hospital and expressed in Brazilian reais (R$). Probabilistic and deterministic sensitivity analyses were performed. The willingness to pay threshold (WPT) was established as 1 GDP per capita for 2019 in Brazil (R$ 31,833.50). Results: Treatment with alteplase vs. conservative medical treatment was associated with an increase of 0.22 in LYG, 0.32 in QALY, and R$ 4,320.12 in cost. The incremental cost-effectiveness ratio (ICER) was estimated as R$ 19,996.43/LYG and R$ 13,383.64/QALY. Variations in effectiveness and costs of acute alteplase treatment had the greatest impact on sensitivity analyses. Considering ICER/LYG and ICER /QALY, 70.7% and 93.1% of the simulations in probabilistic sensitivity analysis were below the WPT, respectively. Conclusions: Treatment with alteplase up to 4.5 hours after the onset of symptoms has a high probability of being cost-effective from the perspective of the Brazilian Public Health System.

Unified Health System , Cost-Benefit Analysis , Tissue Plasminogen Activator , Stroke
Int J Pharm Pharm Sci ; 2020 Jun; 12(6): 72-75
Article | IMSEAR | ID: sea-206112


Objective: To assess the utility of number needed to treat (NNT) as a tool for cost effectiveness analysis. Methods: Two monoclonal antibodies (MAbs), used for induction therapy viz basiliximab and daclizumab in renal transplantation, were identified. Pivotal placebo controlled clinical trials, mentioned in the innovator package inserts, were compared and analyzed for acute graft rejection and graft survival at 12 mo. NNT viz-a-vis cost was calculated and compared. Results: Daclizumab was comparable to basiliximab for acute graft rejection (NNT 10 vs. 9) but better for graft survival (20 vs. 25) at 12 mo, when used along with triple drug regimen (cyclosporine, azathioprine and corticosteroid). However, considering the cost of regimen for these drugs, in terms of NNT, basiliximab was more cost effective (INR 12,52,044 vs. 28,70,400 for acute rejection and INR 34,77,900 vs. 57,40,800 for graft survival). On the other hand, when these MAbs were used along with dual drug regimen (cyclosporine and corticosteroid), daclizumab was more cost effective for graft survival at 12 mo. The higher cost of daclizumab regimen (INR 2,87,040 vs. 1,39,116 for basiliximab) was offset by its substantially lower NNT (20 vs. 58-75 for one extra graft survival at 12 mo). Conclusion: This study demonstrates the utility of NNT in ascertaining relative effectiveness of treatment modalities that would help to formulate appropriate healthcare policies.

J. bras. econ. saúde (Impr.) ; 12(1): 56-65, Abril/2020.
Article in Portuguese | LILACS, ECOS | ID: biblio-1096410


Objetivo: Avaliar a relação de custo-efetividade de mirabegrona como tratamento de primeira escolha de pacientes adultos com síndrome da bexiga hiperativa (SBH) comparada a antimuscarínicos orais comumente prescritos no manejo dessa condição. Métodos: O modelo de Markov foi utilizado, com ciclos mensais e horizonte temporal de um ano, para analisar a relação de custo-efetividade de mirabegrona em comparação a tolterodina, oxibutinina, darifenacina e solifenacina. Os pacientes iniciaram o modelo em tratamento com mirabegrona ou um dos comparadores, sendo distribuídos em cinco níveis de gravidade da doença, de acordo com a frequência miccional e número de episódios de incontinência, e a cada ciclo mensal poderiam melhorar, piorar ou permanecer no mesmo nível de severidade do ciclo anterior. Os resultados foram apresentados por meio de uma razão de custo-efetividade incremental. Resultados: Considerando a perspectiva do sistema de saúde suplementar, o custo total do tratamento com mirabegrona foi de R$ 2.455,26 e os parâmetros de efetividade em 0,491 e 0,498 (melhora na gravidade da incontinência e frequência miccional, respectivamente), sendo mais efetivo que os comparadores. Com relação à perspectiva pública, foi estimado um custo com o tratamento de R$ 1.396,01, com características similares de efetividade. De maneira geral, o tratamento com mirabegrona foi dominante quando comparado à tolterodina e custo-efetivo na comparação com os demais antimuscarínicos, em ambas as perspectivas analisadas. Conclusão: Mirabegrona demonstrou ser a melhor opção para tratamento de primeira escolha da SBH com potencial de redução de custos ao longo do tempo, tanto para o sistema público quanto para o sistema de saúde suplementar brasileiro.

Objective: To assess the cost-effectiveness of mirabegron as first-choice treatment in adult patients with of overactive bladder (OAB) compared to oral antimuscarinics, usually prescribed for this condition. Methods: A Markov model has been adopted, with monthly cycles and a one-year time horizon, to analyze the cost-effectiveness of mirabegron compared to antimuscarinic agents: tolterodine; oxybutynin; darifenacin; and solifenacin. The model started with patients receiving treatment with mirabegron or one of the comparators and then, they were assigned to five disease severity levels according to micturition frequency and number of incontinence episodes, and within each monthly cycle they could improve, worsen or remain at the same symptom severity level. Results were presented using an incremental cost-effectiveness ratio. Results: Considering the Brazilian private perspective, treatment with mirabegron resulted in a total cost of R$ 2,455.26 and effectiveness parameters at 0.491 and 0.498 (improvement in incontinence severity and micturition, respectively), being more effective than the comparators. Regarding the Brazilian public perspective, treatment with mirabegron resulted in a total cost of R$ 1,396.01 with similar effectiveness estimation. In general, a dominance was observed when mirabegron was compared to tolterodine and a cost-effectiveness profile against the other muscarinic antagonists, considering both health perspectives. Conclusion: Mirabegron has proven to be the best option for OAB first-line treatment with potential cost savings over time for both the public and private health care systems in Brazil.

Urinary Bladder , Cost-Benefit Analysis , Adrenergic beta-Agonists , Muscarinic Antagonists , Urinary Bladder, Overactive
Article | IMSEAR | ID: sea-202099


Background: Nigeria ranks third just behind India and China in the global disease burden of pneumococcal disease. The current sustainability approach for an affordable pneumococcal conjugate vaccine (PCV) for the national immunization program from 2014 till 2025 involves a cost sharing plan funded with a 75% financial support from GAVI and a subsidy from Pfizer pharmaceuticals. There is a strong need to generate evidence on the cost-effectiveness of the national PCV program in Nigeria from 2014-2025 and beyond 2025.Methods: The following parameters (demography, disease burden, health services utilization and costs, vaccination coverage, vaccine efficacy, and vaccination costs) were used in a static cohort model to estimate the total cost, health and economic benefit, and cost-effectiveness of the implementation of PCV vaccination program, compared with no PCV vaccination among under-five children in Nigeria from 2014-2025 and from 2026-2033. A sensitivity analysis was conducted to evaluate the robustness of the data used.Results: The national PCV vaccination program would have an approximated 31.4% and 30% reduction of the total burden of pneumococcal diseases over the period of 2014-2025 and 2026-2033 respectively. One-way sensitivity analysis reveals vaccine efficacy as most sensitive parameter followed by disease incidence rate and treatment cost. Removal and addition of DTP3 and 3+1 (measles vaccine) dose respectively resulted to a similar ICER from both.Conclusions: The estimated ICER suggests that the national PCV program in Nigeria will be cost-effective post 2025 era. In addition, it is recommended for policy-makers adoption considering the budget and equity impact of the intervention in Nigeria.

China Pharmacy ; (12): 75-80, 2020.
Article in Chinese | WPRIM | ID: wpr-817381


ABSTRACT OBJECTIVE:To compare the effectiveness and economics of peramivir and oseltamivir in the treatment of influenza complicated with febrile seizures in children. METHODS:In retrospective study,152 children with influenza complicated with febrile seizures were collected from our hospital during Dec. 2018 to Mar. 2019.They were divided into peramivir group(81 cases) and oseltamivir group (71 cases). Fever remission time, medication duration, hospital duration, clinical efficacy (determined by convulsion,cough,nasal obstruction,runny nose,sore throat,etc.),the incidence of rash,the number of children with combined antibiotic and TCM were compared between 2 groups. Cost-effectiveness analysis was used to evaluate cost-effectiveness ratio(CER)and incremental cost-effectiveness ratio(ICER)of medication regimen in 2 groups. The sensitivity analysis of the effect and total cost were carried out with Logistic regression and multiple linear regression respectively through CER and ICER calculated by reducing 15% drug price. RESULTS:There was no statistical significance in fever remission time, medication duration,hospitalization duration,the incidence of rash and proportion of children with combined antibiotics between 2 groups(P>0.05). There was statistical significance in proportion of children with combined TCM and clinical effect,and the proportion of children with combined TCM in peramivir group was significantly lower than oseltamivir group(P<0.001). Clinical effect of peramivir group was significantly better than that of oseltamivir group(P=0.021). Total cost of peramivir group and oseltamivir group were 5 442.84 yuan/person and 5 571.71 yuan/person(P=0.795);CER of them were 54.47 and 56.51;ICER of peramivir group was - 89.38. The results of sensitivity analysis were consistent with those of basic analysis.CONCLUSIONS: Compared with oseltamivir,peramivir is more effective and less costly for children with influenza and febrile seizures.

China Pharmacy ; (12): 473-477, 2020.
Article in Chinese | WPRIM | ID: wpr-817295


OBJECTIVE:To provide reference for choosing a more economical first-line treatment for advanced or recurrent squamous cell NSCLC and reducting patients ’cost burden. METHODS :Based on a published high-quality phase Ⅲ randomized clinical controlled trial ,Markov model was established according to the disease development process. The disease development process of patients with squamous cell NSCLC was divided into non-progressive free survival state ,disease progress state and death state. The cost-effectiveness analysis of ND regimen containing nedaplatin and CD regimen containing cisplatin was carried out on the basis of the treatment cost data of our hospital. The uncertainty of the results was evaluated with single factor sensitivity analysis and probability sensitivity analysis. RESULTS :According to the results of analysis Markov model ,the cost-effectiveness in ND regimen was 54 995.58 yuan/QALYs,in CD regimen was 50 274.36 yuan/QALYs,and incremental cost-effectiveness ratio was 86 327.27 yuan/QALYs,which was lower than the willing payment threshold (193 932.00 yuan/QALYs). The results of single factor sensitivity analysis showed that non-progressive free survival of patients accepted two regimens had the greatest influence on the cost-effectiveness analysis results. The probability sensitivity analysis showed that with the increase of per capita GDP in China , the probability of cost-effectiveness of ND regimen increased gradually. CONCLUSIONS :Compared with CD regimen ,ND regimen is more cost-effective in the treatment of advanced or recurrent squamous cell NSCLC.

China Pharmacy ; (12): 1113-1118, 2020.
Article in Chinese | WPRIM | ID: wpr-821503


OBJECTIVE:To evalua te the economics of glecaprevir/pibrentasvir (G/P)versus elbasvir/grazoprevir (EBR/GZR) in chronic hepatitis C genotype 1b(GT1b)treatment-naive patients without cirrhosis ,and to provide evidence support for medical and health decision-making. METHODS :Under assuming the bid price of G/P and EBR/GZR therapy schemes before medical insurance negotiation was adopted (scenario 1)and assuming that the price of EBR/GZR was reduced by 85% and the price of G/P was reduced by 80%(scenario 2),Markov model was developed to simulate the lifetime cost and health outcomes progress of 10 000 untreated chronic hepatitis C GT 1b treatment-naive patients without cirrhosis and calculate incremental cost-effectiveness ratio(ICER). Single factor sensitivity analysis and probability sensitivity analysis were conducted to verify the results. The highest price(price reduction ratio )of G/P scheme was analyzed with cost-effectiveness advantage ,when other parametes kept stable under scenario 2. RESULTS :Under 2 kinds of scenarios ,compared with EBR/GZR scheme ,G/P scheme had higher cost (scenario 1:68 800 yuan vs. 62 338 yuan;scenario 2:13 760 yuan vs. 11 490 yuan)and healty utility (scenario 1:14.97 QALY vs. 14.90 QALY;scenario 2:14.97 QALY vs. 14.90 QALY),and ICER value of G/P was lower than willingness-to-pay threshold (scenario 1:92 314 yuan/QALY;scenario 2:32 428 yuan/QALY). The change of most parameters in single factor sensitivity analysis didn ’t influence the results of base-case analysis ,and the findings from the base-case analysis were confirmed by probability sensitivity analyses. The price of G/P scheme needed to be reduced by at least 62% to realize cost-effective advantage. CONCLUSIONS : Under the set price scenario ,G/P scheme has cost-effectiveness advantages than EBR/GZR scheme in chronic hepatitis C GT 1b treatment-naive patients without cirrhosis.

Article in Chinese | WPRIM | ID: wpr-880762


OBJECTIVE@#To assess the clinical value of individualized pharmaceutical services for patients receiving vancomycin for severe infections and establish clinical monitoring procedures during vancomycin treatment.@*METHODS@#Data were collected from patients with severe infections who received vancomycin treatment with individualized pharmacy services (test group, 144 cases) or without such services (control group, 884 cases) between January, 2017 and December, 2018. Using propensity score matching, the patients in the two groups with comparable baseline data were selected for inclusion in the study (62 in each group), and the efficacy, safety and economic indicators were compared between the two groups.@*RESULTS@#The curative effects of the treatment did not differ significantly between the two groups, with the overall response rates of 95.16% in the test group and 91.94% in the control group (@*CONCLUSIONS@#The participation of clinical pharmacists during the treatment can improve the clinical benefits of vancomycin in patients with severe infections.

Anti-Bacterial Agents/therapeutic use , Humans , Infections/drug therapy , Pharmaceutical Services , Retrospective Studies , Vancomycin/therapeutic use
Rev. Soc. Bras. Med. Trop ; 53: e20190594, 2020. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136866


Abstract INTRODUCTION We conducted a cost-utility analysis of available interferon-free treatments for patients with early-stage genotype 1 chronic hepatitis C based on a Brazilian public health system perspective. METHODS A Markov model was derived using a cohort of stage F0-F2 patients treated as recommended by the Brazilian national guidelines. RESULTS: Glecaprevir plus pibrentasvir was superior to all other treatments, followed by sofosbuvir plus velpatasvir. Sofosbuvir plus daclatasvir was identified as the least cost-effective option. CONCLUSIONS: The above findings were confirmed via probabilistic sensitivity analysis and the tested scenarios.

Humans , Antiviral Agents/economics , Hepacivirus/genetics , Hepatitis C, Chronic/economics , Hepatitis C, Chronic/drug therapy , Drug Therapy, Combination/economics , Antiviral Agents/administration & dosage , Cost-Benefit Analysis , Drug Therapy, Combination/methods , Genotype
Rev. bras. oftalmol ; 78(4): 233-238, July-Aug. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1013691


Resumo Objetivo: Avaliar a relação custo-utilidade do tratamento inicial com laser ou medicamentos do glaucoma primário de ângulo aberto (GPAA) no Brasil, considerando de um lado os custos totais e de outro lado o impacto na qualidade de vida dos pacientes. Métodos: O estudo foi realizado com base em um modelo de Markov, onde uma coorte teórica de portadores de GPAA em estágio inicial foi gerada. Os parâmetros usados no modelo foram obtidos na literatura e incluíram: custos médicos diretos (consultas, exames, tratamento); custos não médicos diretos (gasto com hospedagem, transporte, alimentação, acompanhante); custos indiretos (relacionados à incapacidade para o trabalho); valores de utilidade (qualidade de vida medida em QALY - quality-adjusted life year); e probabilidade de transição entre os estágios de saúde. Três estratégias de tratamento foram testadas no modelo: (1) sem tratamento; (2) tratamento inicial com colírios; (3) tratamento inicial com trabeculoplastia a laser. A medida de desfecho foi a razão de custo-utilidade incremental (RCUI). A robustez do modelo foi testada através de análise de sensibilidade. Resultados: As estratégias (2) e (3) de tratamento inicial do GPAA geraram ganhos em qualidade de vida em relação à (1) no Brasil. Iniciar o tratamento com laser gerou ganho médio de 1 QALY, enquanto que com medicamentos propiciou um ganho de 2 QALYs em média. Dentre as três estratégias testadas, a estratégia (2) foi a custo-efetiva e foi dominante sobre as demais, pois foi ao mesmo tempo a mais barata e a mais efetiva. Conclusão: Tanto a trabeculoplastia a laser quanto os medicamentos como tratamentos primários do GPAA inicial geraram ganhos significativos de qualidade de vida. A estratégia de se iniciar o tratamento com medicações foi custo-efetiva, quando se considera os custos totais. A alternativa de tratamento inicial através de trabeculoplastia a laser não foi custo-efetiva.

Abstract Objective: To evaluate the cost-utility relation of the initial treatment with laser or primary open-angle glaucoma medications (PLA) in Brazil, considering on the one hand the total costs and on the other side the impact on patients' quality of life. Methods: The study was performed based on a Markov model, where a theoretical cohort of early-stage GPAA carriers was generated. The parameters used in the model were obtained in the literature and included: direct medical costs (consultations, examinations, treatment); direct non-medical costs (accommodation, transportation, meals, companions); indirect costs (related to incapacity for work); utility values (quality of life measured in QALY - quality-adjusted life year); and probability of transition between stages of health. Three treatment strategies were tested in the model: (1) without treatment; (2) initial treatment with eye drops; (3) initial treatment with laser trabeculoplasty. The measure of outcome was the incremental cost-utility ratio (RCUI). The robustness of the model was tested through sensitivity analysis. Results: The strategies (2) and (3) of the initial treatment of POAG generated gains in quality of life in relation to (1) in Brazil. Initiating the laser treatment generated an average gain of 1 QALY, whereas with medication it gave a gain of 2 QALYs on average. Among the three strategies tested, strategy (2) was cost-effective and was dominant over the other strategies, since it was at the same time the cheapest and the most effective strategy. Conclusion: Both laser trabeculoplasty and medications as primary treatments of early-stage POAG have generated significant gains in quality of life. The strategy of starting treatment with medications was cost-effective, whereas laser trabeculoplasty strategy was not cost-effective, when non-medical costs (direct and indirect) are included.

Quality of Life , Glaucoma, Open-Angle/drug therapy , Glaucoma, Open-Angle/therapy , Cost-Benefit Analysis , Laser Therapy , Brazil
Rev. colomb. cardiol ; 26(1): 17-23, ene.-feb. 2019. tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1058375


Resumen Objetivo: Estimar la razón de costo-efectividad de la reanimación cardiopulmonar con el uso del desfibrilador externo automático (DEA), comparado con la reanimación cardiopulmonar básica, para la reanimación de personas con pérdida de conciencia en espacios de afluencia masiva de público en Colombia. Métodos: Para estimar los costos y desenlaces de las dos alternativas de comparación, se diseñó un árbol de decisiones en el cual se reflejan los principales desenlaces posterior a la pérdida de conciencia y la reanimación con cualquiera de las dos alternativas. Se asumió la perspectiva del sistema de salud colombiano en un horizonte temporal comprendido entre el momento de la pérdida de conciencia de la persona hasta el ingreso al hospital. Las probabilidades de los eventos se obtuvieron de un meta-análisis de ensayos clínicos y la información de costos de fuentes oficiales y consulta directa a proveedores de DEA en Colombia. Los costos fueron expresados en pesos colombianos de 2016 y la efectividad en muertes evitadas. Se realizaron análisis de sensibilidad determinísticos y probabilísticos para estimar el impacto de la incertidumbre sobre las conclusiones. Resultados: La razón de costo-efectividad de la reanimación cardiopulmonar con DEA fue de $3.267.777 por muerte evitada. La probabilidad de que esta intervención sea costo-efectiva es superior al 90% para un umbral de costo-efectividad superior a 10 millones de pesos. Conclusión: Un programa de reanimación cardiopulmonar con desfibrilación temprana mediante el uso de DEA, en espacios de afluencia masiva de público, es una alternativa costo-efectiva para el sistema de salud colombiano.

Abstract Objective: To estimate the cost-effectiveness of cardiopulmonary resuscitation using an automated external defibrillator (AED) compared with basic cardiopulmonary resuscitation, for the resuscitation of unconscious patients in crowded public spaces in Colombia. Methods: A decision tree was designed in order to estimate the costs and outcomes of the two alternatives. This included the main outcomes after the loss of consciousness and resuscitation by any of the two alternatives. The perspective of the Colombian Health System was adopted in a time scale consisting of the time of loss of consciousness until hospital admission. The probabilities of the events were obtained from a meta-analysis of clinical trials, and the information on costs from official sources and direct consultations with AED providers in Colombia. The costs were expressed in Colombian pesos of 2016, and the effectiveness in deaths prevented. Deterministic and probabilistic sensitivity analyses were performed to estimate the impact of uncertainty on the conclusions. Results: The cost-effectiveness of cardiopulmonary resuscitation with AED was COP $3,267,777 per death avoided. The probability that this intervention would be cost-effective is greater than 90% for cost-effectiveness threshold greater than 10 million Colombian pesos. Conclusion: A cardiopulmonary resuscitation program with early defibrillation using an AED in crowded public spaces is a cost-effective alternative for the Colombian Health System.

Humans , Costs and Cost Analysis , Defibrillators , Cost-Effectiveness Evaluation , Unconsciousness , Cardiopulmonary Resuscitation , Community Participation
Cogit. Enferm. (Online) ; 24: e60877, 2019. graf
Article in Portuguese | LILACS, BDENF | ID: biblio-1055914


RESUMO Objetivo: analisar o custo-efetividade da central de mistura intravenosa na redução de erros de doses no preparo de medicamentos injetáveis em terapia intensiva neonatal. Método: modelo matemático proposto em 2017 para avaliar o custo-efetividade, comparando duas tecnologias em saúde em cenários hipotéticos utilizando o programa Software TreeAge® Pro Suite 2011. Simulação de Monte Carlo analisou a robustez do modelo. Resultados: o modelo prediz que a central de mistura de injetáveis é custo-efetivo, com efetividade média de 0,96 para se evitar erros de dose na administração de medicamentos intravenosos, com razão de custo-efetividade incremental de R$ 26.785,61. Conclusão: o uso da central de mistura intravenosa foi a alternativa mais custo-efetiva, considerando a disposição de pagar assumida no modelo. O estudo pode contribuir para reduzir incertezas na tomada de decisões acerca da incorporação de tecnologias para redução de erros de dose na administração de medicamentos em UTI pediátrica e neonatal.

RESUMEN Objetivo: analizar el costo efectividad de la central de mezcla intravenosa en la reducción de errores de dosis, en la preparación de medicamentos inyectables, en terapia intensiva neonatal. Método: modelo matemático, propuesto en 2017, para evaluar el costo efectividad comparando dos tecnologías de la salud, en escenarios hipotéticos utilizando el programa Software TreeAge® Pro Suite 2011. La Simulación de Monte Carlo analizó el grado de robustez del modelo. Resultados: el modelo predice que la central de mezclas de inyectables es costo efectivo para evitar errores de dosis en la administración de medicamentos intravenosos; la efectividad media fue de 0,96 y la razón de costo efectividad incremental de R$ 26.785,61. Conclusión: el uso de la central de mezcla intravenosa fue la mejor alternativa costo efectiva, considerando la disposición de pagar asumida en el modelo. El estudio puede contribuir para reducir incertidumbres en la toma de decisiones acerca de la incorporación de tecnologías para reducción de errores de dosis, en la administración de medicamentos en UTI pediátrica y neonatal.

ABSTRACT Objective: To analyze the cost-effectiveness of the intravenous medication mixing center in reducing dose errors in the preparation of injectable medications in neonatal intensive care. Method: mathematical model proposed in 2017 to assess cost-effectiveness by comparing two health technologies in hypothetical scenarios using the TreeAge® 2011 Pro Suite Software. A Monte Carlo simulation was used to analyze the robustness of the model. Results: the model predicted that the intravenous medication mixing center was cost-effective, with a mean effectiveness of 0.96 in avoiding dose errors in intravenous drug administration, with an incremental cost-effectiveness ratio of R$26,785.61. Conclusion: the use of an intravenous medication mixing center was the most cost-effective alternative, considering the willingness to pay assumed in the model. The study may contribute to reducing uncertainty in decision making regarding the incorporation of dose error reduction technologies in medication administration in pediatric and neonatal ICUs.

Humans , Technology Assessment, Biomedical , Intensive Care Units, Neonatal , Cost-Benefit Analysis , Patient Safety , Medication Errors
Article in Chinese | WPRIM | ID: wpr-797018


Objective@#To evaluate the cost-effectiveness of potential government fully-funded influenza vaccination for diabetics in our country.@*Methods@#From the societal perspective, a decision tree model was developed to compare outcomes (including impact on the influenza-related outpatient consultation, hospitalization and excess mortality, and quality-adjusted life years (QALY), as well as incremental cost-effectiveness ratio (ICER)) of a national fully-funded vaccination programme in the population with diabetes and status quo (i.e., vaccinated with out-of-pocket payment, with a uptake rate of zero), using the published data with regarding to influenza related ILI (influenza-like illness) consultation rate, hospitalization rate and excess mortality rate, health-related quality of life and economic burden, diabetes prevalence, population size, health seeking behaviour, vaccine uptake rate, vaccine efficacy/effectiveness, etc. A time horizon of 1 year was used in the present analysis, and all costs were expressed in CNY in 2016 using the consumer price index. All results are presented in M (P25, P75).@*Results@#In the scenario of 40% vaccination coverage in the population with diabetes, government fully-funded vaccination programme was estimated to cost 1.71 (1.67, 1.75) billions CNY, and expected to prevent 110 000 (81 000, 143 000) influenza-related ILI consultations, 36 000 (28 000, 44 000) influenza-related SARI hospitalizations and 12 000 (9 000, 16 000) influenza-related deaths due to respiratory and cardiovascular diseases. A total of 108 000 (82 000, 142 000) QALY were estimated to be gained. The ICER was 10 088 (7 365, 14 046) CNY per QALY gained. The probability of cost-effectiveness of the fully-funded vaccination programme was 99.1% at a threshold of 53 680 CNY per QALY gained (GDP per capita in 2016).@*Conclusion@#Government fully-funded influenza vaccination in population with diabetes is cost-effective, and thus is recommended as the key strategy of diabetes prevention and control.

Article in Chinese | WPRIM | ID: wpr-797017


Objective@#To evaluate the cost-effectiveness of seasonal influenza vaccination, compared to no vaccination, for the elderly aged ≥60 years old in China.@*Methods@#A static life-time Markov model is conducted to simulate the Chinese elderly population aged ≥60 years old. Taking the health care system perspective, one-year analytic cycle length is used for each influenza season. The model was assumed to be repeated until the individual reaches 100 years old. Three interventions were evaluated, including no vaccination, annual trivalent influenza vaccination, and annual quadrivalent influenza vaccination. Using the threshold of 3 times GDP per capita per Quality-adjusted life year (QALY) (193 932/QALY), the incremental cost-effectiveness ratio (ICER) was calculated to compare the cost-effectiveness of every two interventions.Model inputs like data for costs and utilities were from studies on Chinese population if they were available. QALY was used to measure health utility. One-way sensitivity analysis and probabilistic sensitivity analysis were adopted to quantify the level of confidence of the model output.@*Results@#The total influenza associated costs of no vaccination would be 603 CNY per person, while the total costs of annual trivalent vaccination would be 1 027 CNY. Using trivalent vaccine would result in 0.007 QALY gained per person compared to no vaccination, with an increased cost of 424 CNY per person. The ICER of trivalent vaccination over no vaccination for all the elderly population in China would be 64 026 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita. The total costs of annual quadrivalent vaccination would be 1 988 CNY. Using quadrivalent vaccine would result in 0.008 additional QALY gained per person compared to no vaccination, with an increased cost of 1 385 CNY per person. The ICER of quadrivalent vaccination over no vaccination would be 174 081 CNY per QALY gained, which was less than the threshold of 3 times GDP per capita.@*Conclusion@#Vaccinating elderly population would improve health utilities at higher health care costs for the elderly. Using the threshold of 3 times GDP per capita per QALY (193 932/QALY), both trivalent and quadrivalent vaccination would be cost-effective compared to no vaccination in elderly Chinese population.