Cost-effectiveness in Clostridium difficile treatment decision-making.

AIM: To develop a framework for the clinical and health economic assessment for management of Clostridium difficile infection (CDI). METHODS: CDI has vast economic consequences emphasizing the need for innovative and cost effective solutions, which were aim of this study. A guidance model was developed for coverage decisions and guideline development in CDI. The model included pharmacotherapy with oral metronidazole or oral vancomycin, which is the mainstay for pharmacological treatment of CDI and is recommended by most treatment guidelines. RESULTS: A design for a patient-based cost-effectiveness model was developed, which can be used to estimate the cost-effectiveness of current and future treatment strategies in CDI. Patient-based outcomes were extrapolated to the population by including factors like, e.g., person-to-person transmission, isolation precautions and closing and cleaning wards of hospitals. CONCLUSION: The proposed framework for a population-based CDI model may be used for clinical and health economic assessments of CDI guidelines and coverage decisions for emerging treatments for CDI.

Oral fixed drug combination analgesic tramadol/paracetamol: benefits for patients and budgets.

Although pain can present in many different ways, acute, subacute and chronic pain are frequently used and helpful categories that cover a wide range of pain phenomena. This paper reviews five cost-minimization studies of tramadol/paracetamol compared with codeine/paracetamol, immediate-release tramadol and nonsteroidal anti-inflammatory drugs for the treatment of postsurgical pain, lower back pain and osteoarthritis. These conditions represent the main general indications for the combination analgesic. This economic modeling data is preceded by a discussion of each pain type, focusing on the published clinical literature of the efficacy of tramadol/paracetamol and relevant comparators. For the cost-minimization studies, each model employed a similar decision analytical framework, with data derived from clinical trials, Delphi panels and official price and tariff lists. Rollback analyses were used to calculate the cost of treatment per patient. The initial hypothesis in each study was that higher drug costs for tramadol/paracetamol would be offset by a reduction of costs associated with the treatment of side effects. In addition, a cost-utility model carried out among patients with moderate or severe back pain could also underline a benefit-adjusted outcome (quality of life) for patients treated with tramadol/paracetamol. Results of the published clinical literature and these recent economic analyses suggest that tramadol/paracetamol, by reducing the incidence of adverse events, provides benefits for both patients and budgets.