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1.
Gan To Kagaku Ryoho ; 51(5): 541-547, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38881065

RESUMO

OBJECTIVE: Metastatic colorectal cancer with KRAS wild type is treated using a range of drug regimens, including fluorouracil, irinotecan, and Leucovorin(FOLFIRI)plus bevacizumab(Bmab), cetuximab(Cmab), or panitumumab(Pmab). The present study aimed to identify the optimal regimen using a decision analysis method, in combination with clinical and economic evidence. METHOD: A simple Markov model with a monthly cycle time was constructed. Probabilistic variables for input into the model were derived from randomized controlled trials. Direct costs for the drugs, laboratory analyses, and medical staff were calculated and used in the model. RESULTS: The expected survival times and costs of FOLFIRI alone and combination therapies were 20.9 months and 2,299,198 yen for FOLFIRI, 29.9 months and 8,929,888 yen for Bmab, 27.8 months and 11,811,849 yen for Cmab, and 22.6 months and 8,795,622 yen for Pmab. The incremental cost-effectiveness ratios to FOLFIRI were 736,743 yen/month for Bmab, 1,378,645 yen/month for Cmab, and 3,821,426 yen/month for Pmab. CONCLUSIONS: These findings suggested that these regimens were not sufficiently cost-effective, although they have excellent therapeutic efficacy. From the economic point of view, these combination regimens were inferior to FOLFIRI alone.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Camptotecina , Neoplasias Colorretais , Análise Custo-Benefício , Fluoruracila , Leucovorina , Metástase Neoplásica , Leucovorina/economia , Leucovorina/uso terapêutico , Leucovorina/administração & dosagem , Humanos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/economia , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Neoplasias Colorretais/economia , Fluoruracila/administração & dosagem , Fluoruracila/uso terapêutico , Fluoruracila/economia , Camptotecina/análogos & derivados , Camptotecina/economia , Camptotecina/administração & dosagem , Camptotecina/uso terapêutico , Tomada de Decisão Clínica , Análise de Custo-Efetividade
2.
Gan To Kagaku Ryoho ; 50(8): 895-900, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37608416

RESUMO

BACKGROUND: Palbociclib and endocrine therapy has been approved to treat hormone receptor-positive/human epidermal growth factor receptor 2-negative inoperable or recurrent breast cancer in Japan. However, this cotherapy imposes an economic burden on both patients and society because of its high cost. In this study, we assessed the cost-effectiveness of cotherapy with palbociclib and fulvestrant compared to fulvestrant monotherapy for inoperable or recurrent breast cancer. METHODS: The three-state Markov model was built by taking into count health stats in inoperable or recurrent breast cancer. The clinical outcomes of the therapies were drawn from published randomized controlled trials. Total regimen cost was calculated from medical receipts of patients at the Yamagata University Hospital. The cost-effectiveness was evaluated by the incremental cost-effectiveness ratio(ICER), in case that it was below 400,000 Yen per month. Markov chain Monte Carlo simulation was performed to assess probability. RESULTS: Acquisition cost of palbociclib and fulvestrant and fulvestrant monotherapy was 6,209,554 JPY and 780,870 JPY, and 25.7 and 22.8 months were achieved, respectively. ICER for the cotherapy was 1,847,721 JPY/quality adjusted life month(QALM)gained. CONCLUSIONS: The palbociclib and fulvestrant therapy provided better health outcomes than conventional fulvestrant monotherapy, but were costly and suggested to be less cost-effective.


Assuntos
Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/tratamento farmacológico , Fulvestranto/uso terapêutico , Análise de Custo-Efetividade , Quinase 4 Dependente de Ciclina
3.
Support Care Cancer ; 27(10): 3749-3758, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30710243

RESUMO

PURPOSE: Neurokinin-1 receptor antagonist (NK1RA) is recommended to prevent chemotherapy-induced nausea and vomiting (CINV) in patients who receive highly or moderately emetogenic chemotherapy (HEC or MEC, respectively). We previously reported that aprepitant, an NK1RA, was needed to control CINV in 43% and 12% of patients who received HEC and MEC, respectively (Support Care Cancer 23:905-912, 2015). To elucidate the cost-effectiveness of aprepitant in these patients, a cost-utility analysis according to the necessity of aprepitant was performed. METHODS: A decision-analytic model was developed according to the necessity of aprepitant and CINV responses in both acute and delayed phases of chemotherapy. Probabilities of health states and medical costs were derived from the results of the abovementioned trial. RESULT: In patients who received HEC and needed aprepitant, the incremental cost-effectiveness ratio (ICER) with aprepitant, relative to the regimen with no aprepitant, was 7912 US dollars (USD) per quality-adjusted life year (QALY) gained, which was far below the commonly accepted threshold of 50,000 USD/QALY. The ICER was 27,457 USD/QALY in patients who received MEC and needed aprepitant. In contrast, in patients who received HEC or MEC but did not need aprepitant, the ICER was 175,959 or 478,844 USD/QALY, respectively. CONCLUSION: Regardless of whether a patient received HEC or MEC, aprepitant use was highly cost-effective for patients who truly needed it. These results warrant further research to predict the necessity of NK1RA treatment before initiating emetogenic chemotherapies.


Assuntos
Antieméticos/economia , Aprepitanto/economia , Análise Custo-Benefício/economia , Antagonistas dos Receptores de Neurocinina-1/economia , Antieméticos/uso terapêutico , Antineoplásicos/efeitos adversos , Aprepitanto/uso terapêutico , Eméticos/efeitos adversos , Humanos , Japão , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/tratamento farmacológico , Náusea/prevenção & controle , Antagonistas dos Receptores de Neurocinina-1/uso terapêutico , Anos de Vida Ajustados por Qualidade de Vida , Vômito/induzido quimicamente , Vômito/tratamento farmacológico , Vômito/prevenção & controle
4.
Cancer Sci ; 109(9): 2881-2888, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29999572

RESUMO

Chemotherapy-induced nausea and vomiting (CINV) remains a major adverse event in cancer chemotherapy. Although aprepitant is effective in preventing CINV, an increment in financial burden for uniform use of aprepitant is a concern. The aim of the present study was to define the cost-effectiveness of aprepitant from the perspective of the Japanese National Health Insurance system. Based on the results of a randomized phase II trial comparing an aprepitant-containing regimen versus a nonaprepitant regimen in Japanese patients who received cisplatin-containing highly emetogenic chemotherapy, a decision analytic model was developed. The incremental cost-effectiveness ratio (ICER) was calculated both in the outpatient care setting (OCS) and in the inpatient care setting (ICS). The use of the aprepitant-containing regimen was associated with improved quality of life compared with the nonaprepitant regimen, with an increment in quality-adjusted life years (QALY) of 0.0016. The incremental total medical costs associated with the use of the aprepitant regimen were lower in the OCS than in the ICS, 6192 JPY (56.92 USD) and 9820 JPY (90.27 USD), respectively. The ICER was calculated as 3 906 698 JPY (35 910 USD) per QALY gained in the OCS and 6 195 781 JPY (56 952 USD) per QALY gained in the ICS. Cost-effectiveness of the aprepitant-containing antiemetic therapy was limited to the OCS, considering the threshold of willingness-to-pay commonly accepted (5 million JPY [45 960 USD] in Japan and 50 000 USD in the USA). The efficacy of aprepitant offsets the costs for revisiting clinics or rehospitalization added with rescue medications in the OCS.


Assuntos
Antieméticos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cisplatino/efeitos adversos , Morfolinas/uso terapêutico , Aprepitanto , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos
6.
Yakugaku Zasshi ; 138(1): 83-90, 2018.
Artigo em Japonês | MEDLINE | ID: mdl-29311468

RESUMO

We evaluated four representative chemotherapy regimens for unresectable advanced or recurrent KRAS-wild type colorectal cancer: mFOLFOX6, mFOLFOX6+bevacizumab (Bmab), cetuximab (Cmab), or panitumumab (Pmab). We employed a decision analysis method in combination with clinical and economic evidence. The health outcomes of the regimens were analyzed on the basis of overall and progression-free survival. The data were drawn from the literature on randomized controlled clinical trials of the above-mentioned drugs. The total costs of the regimens were calculated on the basis of direct costs obtained from the medical records of patients diagnosed with unresectable advanced or recurrent colorectal cancer at Yamagata University Hospital and Yamagata Prefecture Central Hospital. Cost effectiveness was analyzed using a Markov chain Monte Carlo (MCMC) method. The study was designed from the viewpoint of public medical care. The MCMC analysis revealed that expected life months and expected cost were 20 months/3,527,119 yen for mFOLFOX6, 27 months/8,270,625 yen for mFOLFOX6+Bmab, 29 months/13,174,6297 yen for mFOLFOX6+Cmab, and 6 months/12,613,445 yen for mFOLFOX6+Pmab. Incremental costs per effectiveness ratios per life month against mFOLFOX6 were 637,592 yen for mFOLFOX6+Bmab, 1,075,162 yen for mFOLFOX6+Cmab, and 587,455 yen for mFOLFOX6+Pmab. Compared to the conventional mFOLFOX6 regimen, molecular-targeted drug regimens provide better health outcomes, but the cost increases accordingly. mFOLFOX 6+Pmab is the most cost-effective regimen among those surveyed in this study.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/economia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/economia , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Recidiva Local de Neoplasia/dietoterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/economia , Bevacizumab/administração & dosagem , Bevacizumab/economia , Cetuximab/administração & dosagem , Cetuximab/economia , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Feminino , Fluoruracila/economia , Humanos , Leucovorina/economia , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Compostos Organoplatínicos/economia , Panitumumabe , Taxa de Sobrevida , Resultado do Tratamento
7.
J Gastrointest Cancer ; 48(4): 326-332, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27785685

RESUMO

OBJECTIVES: This study assessed the cost-effectiveness of combination treatment with gemcitabine and cisplatin compared to treatment with gemcitabine alone for advanced biliary tract cancer (BTC) in Japan. METHODS: A monthly transmitted Markov model of three states was constructed based on the Japan BT-22 trial. Transition probabilities among the health states were derived from a trial conducted in Japan and converted to appropriate parameters for our model. The associated cost components, obtained from a receipt-based survey undertaken at the Aichi Medical University Hospital, were those related to inpatient care, outpatient care, and treatment for BTC. Costs for palliative care and treatment of adverse events were obtained from the National Health Insurance price list. We estimated cost-effectiveness per quality-adjusted life year (QALY) at a time horizon of 36 months. An annual discount of 3 % for both cost and outcome was considered. RESULTS: The base case outcomes indicated that combination therapy was less cost-effective than monotherapy when the incremental cost-effectiveness ratio (ICER) was approximately 14 million yen per QALY gained. The deterministic sensitivity analysis of the ICER revealed that the ICER of the base case was robust. A probabilistic analysis conducted with 10,000-time Monte Carlo simulations demonstrated efficacy at the willingness to pay threshold of 6 million yen per QALY gained for approximately 33 % of the population. CONCLUSION: In Japan, combination therapy is less cost-effective than monotherapy for treating advanced BTC, regardless of the statistical significance of the two therapies. Useful information on the cost-effectiveness of chemotherapy is much needed for the treatment of advanced BTC in Japan.


Assuntos
Antineoplásicos/economia , Neoplasias do Sistema Biliar/tratamento farmacológico , Cisplatino/economia , Análise Custo-Benefício/métodos , Desoxicitidina/análogos & derivados , Antineoplásicos/uso terapêutico , Cisplatino/uso terapêutico , Desoxicitidina/economia , Desoxicitidina/uso terapêutico , Feminino , Humanos , Japão , Masculino , Gencitabina
8.
Gan To Kagaku Ryoho ; 43(10): 1201-1205, 2016 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-27760938

RESUMO

Phase III clinical trials have comfirmed that the S-1 plus oxaliplatin(SOX)is inferior to the capecitabine plus oxaliplatin (COX)regimen in the treatment of metastatic colorectal cancer.On the basis of these findings, we compared, using a clinical decision analysis-based approach, the cost-effectiveness of the SOX and COX regimens.Herein, we simulated the expected effects and costs of the SOX and COX regimens using the markov model.Clinical data were obtained from Hong's 2012 report.The cost data comprised the costs for pharmacist labor, material, inspection, and treatment for adverse event, as well as the total cost of care at the advanced stage.The result showed that the expected cost of the SOX and COX regimen was 1,538,330 yen, and 1,429,596 yen, respectively, with an expected survival rate of 29.18 months, and 28.63 months, respectively.The incremental cost-effectiveness ratio of the SOX regimen was 197,698 yen/month; thus, the SOX regimen was found to be more cost-effective that the COX regimen.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/economia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/economia , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/economia , Idoso , Capecitabina/administração & dosagem , Capecitabina/economia , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Organoplatínicos/administração & dosagem , Compostos Organoplatínicos/economia , Oxaliplatina , Ácido Oxônico/administração & dosagem , Ácido Oxônico/economia , Recidiva , Tegafur/administração & dosagem , Tegafur/economia
9.
Gan To Kagaku Ryoho ; 36(8): 1299-309, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19692769

RESUMO

An optimal adjuvant endocrine therapy is yet to be established for post menopausal women with hormone receptor positive breast cancer. The current therapeutic options include initial, switch, and extended adjuvant therapies. We aimed to determine the most cost-effective therapeutic option using the clinical decision analysis method. It was suggested that aromatase inhibitor monotherapy in initial adjuvant therapy is the most cost-effective and optimal adjuvant endocrine therapy for post menopausal women with hormone receptor-positive breast cancer.


Assuntos
Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante/economia , Técnicas de Apoio para a Decisão , Quimioterapia Adjuvante/métodos , Análise Custo-Benefício , Feminino , Humanos , Método de Monte Carlo , Neoplasias Hormônio-Dependentes/tratamento farmacológico , Pós-Menopausa , Tamoxifeno/uso terapêutico
10.
Clin Ther ; 31 Pt 2: 2433-41, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-20110051

RESUMO

BACKGROUND: Randomized, controlled trials (RCTs) in 220 patients with advanced colorectal cancer reported no significant differences in survival periods between folinic acid/5-fluorouracil/irinotecan (FOLFIRI) and folinic acid/5-fluorouracil/oxaliplatin (FOLFOX6) therapies, irrespective of the treatment sequence. Based on a literature search, an economic assessment of both treatments given in 1 of 2 sequences (FOLFIRI and FOLFOX6, or FOLFOX6 and FOLFIRI) has not been conducted in Japan. OBJECTIVE: The present cost-minimization analysis used a mathematical Markov model to assess health care costs of these 2 treatment sequences from the perspective of National Health Insurance (NHI) in Japan. METHODS: The analysis simulated the expected costs resulting from the influence of treatment sequence in a hypothetical cohort of 10,000 patients with nonresectable advanced colorectal cancer over a period of 100 months using a hypothetical Markov model. Clinical parameters were obtained from the RCTs. Cost parameters included those for physical examination, medication, and personnel. Medication and physical examination costs were based on 2008 NHI drug prices and medical service fees, respectively. Costs were discounted at a monthly rate of 0.4575% (equivalent to an annual rate of 3%). The influence of each parameter (clinical and cost parameters) was assessed using a probabilistic sensitivity analysis by the 10,000-time Monte Carlo simulation. RESULTS: When FOLFIRI was used as the initial treatment in this analysis, costs to the NHI were reduced. On analysis of the influence of each parameter, the expected reduction in costs, compared with FOLFOX administered as the initial treatment, was significant ( 7,787,828 yen [95% CI, 6,098,517 yen - 9,499,952 yen]). CONCLUSIONS: The findings of this cost-minimization analysis suggest that using FOLFIRI followed by FOLFOX versus the reverse strategy produced cost savings from the perspective of the NHI in Japan. However, differences in adverse-events profiles may warrant treatment adjustments in individual patients.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/economia , Neoplasias Colorretais/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Camptotecina/economia , Camptotecina/uso terapêutico , Custos e Análise de Custo , Esquema de Medicação , Fluoruracila/administração & dosagem , Fluoruracila/economia , Fluoruracila/uso terapêutico , Humanos , Japão , Leucovorina/administração & dosagem , Leucovorina/economia , Leucovorina/uso terapêutico , Compostos Organoplatínicos/administração & dosagem , Compostos Organoplatínicos/economia , Compostos Organoplatínicos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
11.
Gan To Kagaku Ryoho ; 35(4): 619-23, 2008 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-18408430

RESUMO

Recently, ambulatory treatment centers (ATC) are markedly increasingboth in number and scale. It is therefore important to consolidate an efficient therapeutic system. A decrease in both treatment time and waitingtime leads to not only the improvement of the quality of life (QOL) for patients but also the efficient use of personnel and running costs for medical institutions by reducingthe bed occupation rate. In ATC, 5-HT3 receptor antagonists are extensively used for high emetic risk patients. However, their high cost and prolonged treatment causes one of the problems in improvingthe efficiency of the therapeutic system when they are administered by intravenous infusion. Amongthe 4 types of 5-HT3 receptor antagonists (injections) currently available in Japan, azasetron is the only drugthat is not designated as a powerful drug and that can be administered by bolus intravenous infusion. In this study, we investigated azasetron and granisetron from the standpoint of pharmacoeconomics with a simulation model using the results of clinical studies in Japan. Accordingto the results of cost-effectiveness analysis, therapeutic and time costs per patient for azasetron 10 mgand granisetron 2 mg (calculated in consideration of both medical institutions and patients) was 8,219 and 10,193 yen, respectively. This gap was attributable to the time loss due to the difference in administration methods. The result suggests that this time loss is more significant not only for patients but also for medical staff than the loss attributable to the drugcost. Furthermore, the bolus intravenous infusion of azasetron is considered superior to the non-bolus intravenous infusion of granisetron from a pharmacoeconomic standpoint. It is desirable to choose the appropriate administration method of 5-HT3 receptor antagonists in various chemotherapy regimens for the purpose of reducingthe treatment time and promotingthe efficiency of the therapeutic system at ATCs.


Assuntos
Antineoplásicos/economia , Antineoplásicos/uso terapêutico , Neoplasias/tratamento farmacológico , Neoplasias/economia , Antagonistas do Receptor 5-HT3 de Serotonina , Antineoplásicos/efeitos adversos , Ensaios Clínicos como Assunto , Análise Custo-Benefício , Relação Dose-Resposta a Droga , Humanos , Neoplasias/metabolismo , Receptores 5-HT3 de Serotonina/metabolismo , Sensibilidade e Especificidade
12.
Gan To Kagaku Ryoho ; 34(11): 1807-13, 2007 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-18030014

RESUMO

OBJECTIVE: To assess the cost-effectiveness of chemoradiotherapy (CRT) regimens for patients with esophageal cancer, we compared two regimens consisting of 5-fluorouracil (5-FU) and cisplatin (CDDP) or 5-FU and nedaplatin (CDGP) with radiotherapy. METHODS: Medical records of 108 patients with esophageal cancer who received CRT of 5-FU+CDDP (CDDP group) or 5-FU+CDGP (CDGP group) were analyzed. In both groups, most of the patients were men with a pathological diagnosis of squamous cell carcinoma. A Markov model was used to show the clinical courses of esophageal cancer after the CRT therapy. An outcome used for economic evaluation was life year gained (LYG). We calculated the cost per-effectiveness ratio (CER) and incremental cost effectiveness ratio (ICER). Clinical effectiveness and costs in this model were investigated retrospectively, and the costs were estimated from the perspective of the medical institution. Sensitivity analysis was used to check the robustness of this model. RESULTS: In CDDP and CDGP group, LYG was 18.23 and 16.31 years and CER was 270,373 and 406,264 yen/LYG, respectively. As a result, ICER was .883,999 yen/LYG. The sensitivity analysis showed that this model was definitely robust. CONCLUSION: Our results suggested that CDDP could prolong LYG with less cost than CDGP and that CRT of 5-FU and CDDP was markedly cost effective treatment.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/economia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Cisplatino/administração & dosagem , Análise Custo-Benefício , Esquema de Medicação , Neoplasias Esofágicas/economia , Neoplasias Esofágicas/mortalidade , Feminino , Fluoruracila/administração & dosagem , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Compostos Organoplatínicos/administração & dosagem , Taxa de Sobrevida
13.
Circ J ; 70(4): 453-8, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16565564

RESUMO

BACKGROUND: The antiplatelet agent, cilostazol, is known to reduce the risk of subsequent cerebral infarction. However, the cost effectiveness of such treatment in comparison to aspirin has not been studied. METHODS AND RESULTS: A Markov model was developed to calculate the health outcomes and associated costs for 65-year-old patients with cerebral infarction who were treated with 200 mg/day cilostazol or 81 mg/day aspirin. Cilostazol was more effective, but also more expensive than aspirin. Cilostazol would extend quality-adjusted life years (QALY) by 0.64, while increasing life-time costs by approximately Yen 1.1 million. The incremental cost-effectiveness ratio of cilostazol in comparison with aspirin was estimated to be Yen 1.8 million per QALY. CONCLUSIONS: The use of cilostazol to prevent recurrence of cerebral infarction appears to be cost effective.


Assuntos
Infarto Cerebral/tratamento farmacológico , Infarto Cerebral/prevenção & controle , Inibidores da Agregação Plaquetária/uso terapêutico , Tetrazóis/uso terapêutico , Idoso , Aspirina/economia , Aspirina/uso terapêutico , Estudos de Casos e Controles , Infarto Cerebral/economia , Cilostazol , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Masculino , Cadeias de Markov , Modelos Econométricos , Modelos Estatísticos , Inibidores da Agregação Plaquetária/economia , Anos de Vida Ajustados por Qualidade de Vida , Tetrazóis/economia , Fatores de Tempo
14.
Clin Drug Investig ; 25(1): 49-63, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-17523746

RESUMO

OBJECTIVES: We constructed a cost-effectiveness decision model to determine a hypothetical 'best treatment' pathway for patients presenting at our institution with influenza virus infection when the choice of treatment was either oseltamivir, zanamivir or a control therapy not active against influenza. METHODS: The decision model was constructed using DATA 3.5 for evaluating the cost-effectiveness analysis of neuraminidase inhibitors from the perspective of the healthcare payer. The time horizon was set at 14 days based on the general duration of influenza infection in Japan. Clinical outcomes were mainly derived from reports and guidance published by the National Institute for Clinical Excellence in the UK. Japan-specific cost parameters incorporated into the decision model were taken from the Medical Fee Point Survey conducted at St Luke's International Hospital in accordance with medical fee receipts kept at our institution. The study included four professionals and a supporter who gathered information required for the analysis. RESULTS: In otherwise healthy adults, cost savings of yen831.6 (approximately $US6.72; 2002 values) in the oseltamivir group and an increment in cost of yen40.5 (approximately $US0.33) in the zanamivir group were achieved in comparison with the control group. In contrast, an incremental cost of yen288.4 (approximately $US2.33) was incurred in the oseltamivir group versus the control group when at-risk patients were assessed, but cost savings of yen159.8 (approximately $US1.29) were achieved in the zanamivir group. As a result of cost-effectiveness and cost-utility analyses in otherwise healthy adults, oseltamivir dominated the control therapy because cost savings in the oseltamivir group were made. In the zanamivir group the cost was incremental and the Incremental Cost-Utility Ratio (ICUR) compared with the control group was about yen13 000 (approximately $US107.34)/quality-adjusted life-year (QALY) gained. As a result of cost-effectiveness and cost-utility analyses in at-risk patients, in the oseltamivir group the cost was incremental and the ICUR compared with the control group was about yen230 000 (approximately $US2138.77)/QALY gained. As cost savings were made, zanamivir dominated the control therapy. CONCLUSION: While the cost effectiveness (from the perspective of a healthcare payer) of the neuraminidase inhibitors was superior to that of the control group in the treatment of otherwise healthy adults with influenza in our study, it seemed necessary to take other factors into consideration before recommending one agent over the other as a first-line therapy. On the other hand, we suggest that zanamivir is the drug of choice for use in at-risk patients, and we recommend, in the light of our results, that if zanamivir is not available another therapy should be given rather than oseltamivir. Since with influenza infections deaths and hospitalisations of at-risk patients impact on the Japanese community, decision-making on the appropriate therapy should take into account the particular patient group involved.

15.
Gan To Kagaku Ryoho ; 31(1): 11-6, 2004 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-14750314

RESUMO

The duties of hospital pharmacists include drug dispensing, drug management, preparation of injections, drug information provision, in-hospital preparation, drug management guidance (centering on patient compliance instructions), tests and research, and education. The Department of Pharmacy conducts most of these activities, which are not noticed by other medical staff. As members of medical care teams, pharmacists must share information and perform their jobs from a pharmaceutical viewpoint in order to fulfill their duties as drug specialists, which include management of patient conditions, patient-oriented patient compliance instructions, risk management, management of dosages and administration methods for anticancer drugs during cancer chemotherapy, discovery of the initial symptoms of adverse drug reactions and prevention of adverse drug reactions to obtain the optimum effect, education on self-care after discharge from the hospital, and evaluation of drug economics for cancer chemotherapy. It is important that they acquire sophisticated expertise and stay in as close contact as possible with patients and their families.


Assuntos
Neoplasias/tratamento farmacológico , Equipe de Assistência ao Paciente , Farmacêuticos , Serviço de Farmácia Hospitalar , Serviços de Informação sobre Medicamentos , Humanos , Corpo Clínico Hospitalar , Gestão de Riscos
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