RESUMEN
ObjectiveTo investigate the clinical efficacy of oral dydrogesterone alone for luteal phase support in natural cycle frozen-thawed embryo transfer （NC-FET）. MethodsThe clinical data of 1 530 NC-FET cycles enrolled in our Reproductive Center from January 2019 to September 2021 were retrospectively analyzed. According to different luteal support protocols， the patients were divided into oral dydrogesterone alone （group A， n=524）， vaginal progesterone soft capsules （group B， n=401） and vaginal progesterone soft capsules combined with dydrogesterone （group C， n=605）. The clinical outcomes and cost-effectiveness ratio were compared among the three groups. The primary outcome was live birth rate. ResultsThe live birth rate was 43.13% （226/524） in group A， 39.15% （157/401） in group B， and 42.64% （258/605） in group C. There was no statistical difference among the three groups （P > 0.05）. No statistical difference was observed in the HCG positive rate， implantation rate， biochemical pregnancy rate， clinical pregnancy rate， spontaneous miscarriage rate， ectopic pregnancy rate， twin delivery rate， premature delivery rate and newborn weight among the three groups （P>0.05）. Logistic regression analysis revealed that the three luteal support regimens did not affect live birth rate. Pharmacoeconomic analysis showed that taking group B as a reference， the cost increased by 19 227.30 yuan for every 1% increase in live birth rate in group A. ConclusionsIn NC-FET cycle， oral dydrogesterone alone can achieve the same clinical outcomes as vaginal progesterone soft capsules and vaginal progesterone soft capsules combined with dydrogesterone. Compared with that of progesterone soft capsules， the cost of oral dydrogesterone alone is increased， a large sample and multicenter prospective study is needed to further confirm our results.
RESUMEN
OBJECTIVE： To analyze effectiveness and economy of domestic vancomycin hydrochloride for injection （trade name： Laikexin） vs. imported vancomycin hydrochloride for injection （trade name： Vancocin） in treatment of intracranial infection induced by MRSA， and to provide decision-making reference for the selection of clinical drugs. METHODS： Clinical data of patients with suspected MRSA intracranial infections receiving Laikexin or Vancocin were collected by retrospective study method from neurosurgery department of our hospital during Jan. 2016 to Jun. 2017， including 115 cases of Laikexin and 42 cases of Vancocin. Using response rate （including clinical cure and clinical improvement） as indexes， cost-effectiveness analysis was performed for Laikexin and Vancocin in the treatment of intracranial infection induced by MRSA by using decision tree model. Sensitivity analysis was conducted for 10％ decrease of cost and response rate. RESULTS： Response rate and excepted cost of Laikexin were 85.21％ and 13 125.96 yuan， cost-effectiveness ratio （CER） was 15 404.25. Response rate and excepted cost of Vancocin were 78.57％ and 15 619.17 yuan， CER was 19 879.31. There was no statistical significance in response rate between Laikexin and Vancocin （P＜0.05）. There was no difference between sensitivity analysis and cost-effectiveness analysis. CONCLUSIONS： The efficacy of Laikexin and Vancocin in the treatment of MRSA intracranial infection is similar， but the CER of Laikexin is lower than that of Wenkexin.
RESUMEN
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.
RESUMEN
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.
RESUMEN
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.
RESUMEN
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.
RESUMEN
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).
RESUMEN
Objective To study the clinical efficacy,safety,and economic efficiency of ginkgolide injection and conventional therapy of patients with cerebral arterial thrombosis in multi center,and to evaluate the economic value of drugs.Methods A prospective cohort study was conducted in this study,patients with ischemic stroke were collected from August 2013 to December 2014.Patients (354 cases) in treatment group were treated with Ginkgolide Injection and routine treatment,and patients (180 cases) in control group could be treated with other drugs for activating blood circulation to dissipate blood stasis on the basis of routine treatment.The patients were telephone followed-up visited 3,6,and 12 months after discharge for pharmacodynamic indexes:evaluation of activities of daily living (ADL) score,self-care rate,cure rate,recurrence rate,and all-cause mortality;economic indicators:the patient work recovery rate,cost effectiveness ratio (CER),and the incidence,and severity of adverse events,to assess the differences in the long-term benefits of different treatment regimens.Results Follow-up in 3,6,and 12 months showed that ADL score,cure rate,self-care rate,and work recovery rate of the treatment group were better than those of control group,and the difference was statistically significant.Follow-up in 12 months showed that,recurrence rate and mortality rate in the treatment group was better than that in the control group,with statistical difference.Follow-up in 6 and 12 months showed that CER of treatment group was smaller than that of the control group.The incidence of adverse reactions was low in the two groups.Conclusion Long term evaluation showed that patients treated with Ginkgolide Injection had better clinical outcomes and better CER than those without it,which proved the effectiveness and economic efficacy of Ginkgolide Inj ection in the treatment of stroke.
RESUMEN
Objectives: To implement cost effective evaluation on the interventions to personality dysfunction in adolescents, so as to provide scientific evidences for extending the interventions. Methods: Cost identification, measurement of the cost, and valuing the cost were implemented to calculate the cost of the interventions. Effects of the interventions were measured based on three indicators: (1) differences of the decreasing scores of Personality Diagnostic Questionnaire-4 (PDQ-4) between intervention group and control group from grade one to three, (2) differences of the decrease number of students with personality dysfunction between intervention group and control group from grade one to three, and (3) differences of the incidence of personality dysfunction between intervention group and control group. Cost-effectiveness ratios (CERs) were calculated for the economic evaluation of the interventions. Results: The total cost of the interventions was 67, 860 Yuan. After intervention, among all of the students in intervention group, the cost of reducing one score of PDQ-4 was 9. 25 Yuan. The cost of reducing one person with personality dysfunction was 6169 Yuan. And the cost of avoiding one person developed personality dysfunction was 2714 Yuan. The cost effectiveness were not balanced among Cluster A, Cluster B and Cluster C personality dysfunction. Similar tendency was found among 10 types of personality dysfunction. Conclusion: The "Intervention Measure on Personality Dysfunction" in adolescents is easy to implement and has relative low costs. Further interventions of the specific cluster or type of personality dysfunction can be carried out based on the findings from this study.
RESUMEN
Objective To study the safety, efficiency and efficacy economics of local application of domestic fluconazole in treatment of chronic obstruction pulmonary disease (COPD) complicated with oral candidiasis. Methods Selected 74 patients with chronic obstruction pulmonary disease (COPD) complicated with oral candidiasis from May, 2013 to Oct. 2015 in our hospital were divided into the observation group in 35 cases and the control group in 39 cases according to table of random number. The observation group was given local application of domestic fluconazole, and the control group was given systemic application of imported fluconazole. The clinical effects and side effects of both groups were observed and compared. Results The total effect rate in observation group (100%) was higher than that in the control group (97.4%) without significant difference (P > 0.05). The cute rate in observation group (94.3%) was higher than that in control group (87.2.4%) without significant difference (P > 0.05). The average course of treatment was shorter in the observation group (2.9 d) than that in control group(5.2 d), with significant difference (P 0.05). The cost of antifungal drugs in the observation group was lower than that in the control group, (t = -23.398, P = 0.000). The cost-effectiveness ratio in the observation group was lower than that in the control group. Conclusion Local application of domestic fluconazole has similar effect and side effect to systemic application of imported fluconazole in treatment of COPD complicated with oral candidiasis,but has short course of treatment and low cost .
RESUMEN
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.
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Angioplastia Coronaria con Balón , Pueblo Asiatico/estadística & datos numéricos , Enfermedad de la Arteria Coronaria/etiología , Análisis Costo-Beneficio , Stents Liberadores de Fármacos/economía , Inmunosupresores/administración & dosificación , Infarto del Miocardio/terapia , Programas Nacionales de Salud/estadística & datos numéricos , Paclitaxel/administración & dosificación , República de Corea/epidemiología , Estudios Retrospectivos , Riesgo , Sirolimus/administración & dosificación , Stents/efectos adversos , Resultado del TratamientoRESUMEN
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.
RESUMEN
OBJECTIVE: Statins reduce risk of cardiovascular disease through lowering of LDL-C (Low Density Lipoprotein cholesterol). We analyzed cost-effectiveness of statins in the reduction of serum LDL-C level among Korean population at high cardiovascular risk. METHODS: Rosuvastatin (5, 10, and 20 mg), atorvastatin (10, 20, 40, and 80 mg) and simvastatin (20, 40, and 80 mg) were included for the analysis, because those statins and doses were mostly prescribed in Korea. We determined effectiveness as % reduction of LDL cholesterol (LDL-C) levels per mg dose and % population reached to the ideal LDL-C level (<100 mg/dL), which is the target goal of LDL-C level for the high cardiovascular risk group as recommended by NCEP-ATP III guideline. The annual cost, which included overall cost for the drug price and management during follow up, was calculated. Average cost-effectiveness ratio (ACER) was calculated and used as the parameter representing cost-effectiveness of each statins. RESULTS: The lowest dose of each statins showed that achieving LDL-C target level was not high even in subjects showing relatively low basal LDL-C levels (<160 mg/dL). Also in case basal LDL-C level was over 160 mg/dL, the majority of statins were not sufficient to control LDL-C levels except atorvastatin 80 mg. In case of basal LDL-C level was lower than 160 mg/dl, atorvastatin 20 mg was the most cost-effective statin for LDL-C reduction regardless of considering basal LDL-C level. Simvastatin 40 mg was also cost-effective if basal LDL-C levels were between 100-129 mg/dL. CONCLUSIONS: For the reduction of LDL-C level in high risk subjects showing moderately elevated basal LDL-C level, atorvastatin 20 mg is the most cost-effective statin treatment strategy and then simvastatin 40 mg or rosuvastatin 10 mg was the second best option.
Asunto(s)
Enfermedades Cardiovasculares , LDL-Colesterol , Fluorobencenos , Estudios de Seguimiento , Ácidos Heptanoicos , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Corea (Geográfico) , Lipoproteínas , Pirimidinas , Pirroles , Simvastatina , Sulfonamidas , Atorvastatina , Rosuvastatina CálcicaRESUMEN
OBJECTIVE:To provide a simple and reliable method to estimate confidence intervals of incremental cost-effectiveness ratios for pharmacoeconomics evaluation in China. METHODS:Through retrieving relevant foreign literature,the idea and mathematical properties of non-parametric Bootstrap method were described and the method for calculating confidence intervals were explained by giving an example. RESULTS&CONCLUSION:Non-parametric Bootstrap method is simple and reliable for the calculation of confidence intervals of pharmacoeconomics. When the distribution of samples is skewed significantly or the sample size is not plenty enough,we still need to be cautious to adopt non-parametric Bootstrap method.