The cost of relapse in schizophrenia and schizoaffective disorder.

OBJECTIVE: The aim of this study was to quantify the costs and resource utilization associated with a relapse of schizophrenia or schizoaffective disorder. METHODS: The study comprised a retrospective audit of data from 200 patients diagnosed with schizophrenia or schizoaffective disorder who were admitted to hospital for a relapse of their disorder in two mental health services in Australia between 1 June 2001 and 31 May 2002. Resource use and costing data were collected for 12 months before and 12 months after the hospitalization. RESULTS: There was an increase in contacts per month and associated outpatient costs after the index admission which persisted for the full 12 month data collection period (total of AUD $637). There was also a total increase in hospital costs but this did not persist beyond the first 2 months of the follow-up period and is likely explained by the index admission. CONCLUSIONS: Increased healthcare resource utilization and costs results from relapse in patients with schizophrenia or schizoaffective disorder. An increase in service use and costs persist for a considerable time period after an episode of relapse.

Cost-effectiveness of anastrozole versus tamoxifen as first-line therapy for postmenopausal women with advanced breast cancer.

BACKGROUND: In a recent trial of first-line therapy in 353 postmenopausal women with predominantly hormone receptor-positive advanced breast cancer (the North American trial), anastrozole 1 mg QD produced a significantly longer time to disease progression (TTP) than tamoxifen 20 mg QD (11.1 months vs 5.6 months; P = 0.005). Both treatments were well tolerated, but there were fewer thromboembolic events and a reduced incidence of vaginal bleeding with anastrozole. OBJECTIVE: The aim of this study was to conduct an economic analysis of anastrozole versus tamoxifen based on data from the North American trial. METHODS: Quality-adjusted TTP (QATTP) was determined by combining TTP values with uniform or graded weights for adverse events using the Quality-adjusted Time Without Symptoms and Toxicity method. Direct health care costs before and after disease progression were determined from the perspective of 4 types of health care insurers in the United States: health maintenance organizations (HMOs), indemnity plans, preferred provider organizations (PPOs), and point-of-service (POS) plans. RESULTS: Median QATTP with graded weights was 9.7 months for anastrozole, compared with 4.6 months for tamoxifen (P = 0.003). A resultant reduction in health care resource utilization was observed, particularly the requirements for hospitalization, outpatient visits, and chemotherapy, but the statistical significance of this observation was not assessed. Incremental cost savings per patient before and after disease progression were observed with anastrozole compared with tamoxifen (9064 dollars for HMO, 9678 dollars for indemnity plan, 14,273 dollars for PPO, and 12,715 dollars for POS; all P < 0.01). CONCLUSIONS: In the US managed care setting, anastrozole produced a higher QATTP and incurred lower treatment costs than tamoxifen in a population of postmenopausal women with predominantly hormone receptor-positive advanced breast cancer. Therefore, anastrozole was more cost-effective than tamoxifen as first-line endocrine therapy in the population studied.

Comparative cost effectiveness of angiotensin II receptor blockers in a US managed care setting: olmesartan medoxomil compared with losartan, valsartan, and irbesartan.

OBJECTIVE: To compare the cost effectiveness of the angiotensin II receptor blockers (ARBs) olmesartan medoxomil, losartan, valsartan and irbesartan for the treatment of hypertension, from the perspective of a US managed care setting. METHODS: The evaluation was based on a recently completed, prospective, randomised, double-blind clinical trial comparing the antihypertensive efficacy of these agents. Differences in diastolic blood pressure reductions among the comparative agents were used to estimate reductions in the annualised risk of cardiovascular (CV) and cerebrovascular events using the Framingham model. These annualised risks were translated into reductions in healthcare expenditures associated with treating CV events covered by managed care in the US. Data sources included: the recently published clinical trial of ARB antihypertensive efficacy, the Framingham Heart Study and a managed care database. Actual reimbursed amounts were used. RESULTS: Based on antihypertensive efficacy data versus irbesartan, the use of olmesartan medoxomil is expected to reduce the number of new cases of CV disease, resulting in a first-year reduction in cost in a cohort of 100,000 patients of 906,000 US dollars. Similarly, a reduction in new cases of coronary heart disease (CHD) resulted in a cost reduction of 701,000 US dollars; a cost reduction of 196,000 US dollars for fewer myocardial infarctions (MI); and a cost reduction of 28,000 US dollars for fewer strokes. Over 5 years, these estimates increase to 5,410,000 US dollars for fewer cases of CV disease; 3,975,000 US dollars for fewer cases of CHD; 1,430,000 US dollars for fewer MI; and 497,000 US dollars for fewer strokes. Compared with valsartan, the use of olmesartan medoxomil is estimated to reduce by 3,397,000 US dollars the expected cost of treating a cohort of 100 000 patients in the first year for fewer cases of CV disease; by 2,426,000 US dollars for fewer cases of CHD; by 565,000 US dollars for fewer MI; and by 124,000 US dollars for fewer strokes. Over 5 years, these estimates increase to 16,231,000 US dollars for CV disease; 11,955,000 US dollars for CHD; 4,505,000 US dollars for MI; and 1,741,000 dollars for stroke. Compared with losartan, the estimated reduction in first-year cost is 2,969,000 US dollars for CV disease for the cohort of 100,000 patients; 2,163,000 US dollars for CHD; 732,000 US dollars for MI; and 124,000 US dollars for stroke. Over 5 years, these estimates increase to 15,149,000 US dollars for CV disease; 11,107,000 US dollars for CHD; 4,057,000 US dollars for MI; and 1,437,000 dollars for stroke. CONCLUSION: Based on comparative antihypertensive efficacy data, treatment of hypertensive patients with olmesartan medoxomil instead of the other leading ARBs has the potential to reduce overall cost of medical care in a US managed care setting.

The economic value of lamotrigine as a mood stabilizer: a U.S. managed care perspective.

This study attempts to provide real-world evidence of the economic value of lamotrigine as a mood stabilizer for patients with bipolar disorder. Researchers examined longitudinal administrative claims data obtained for patients with a diagnosis of affective disorder between 1997 and 2001. The study compared outcomes for the 12 months preceding initiation of lamotrigine with the 12 months following initiation of lamotrigine in patients previously treated with lithium, carbamazepine or valproic acid, other anticonvulsants, selective serotonin-reuptake inhibitors, or other antidepressants. Outcomes were analyzed using logistic and Tobit regression models. The data suggest that initiation of lamotrigine is associated with reductions in hospital days, a reduction in hospital days of greater than 17 days for some patients, and net cost savings of more than $400 per patient per year.

The economic consequences of rheumatoid arthritis: analysis of Medical Expenditure Panel Survey 2004, 2005, and 2006 data.

OBJECTIVE: Determine the prevalence and costs of rheumatoid arthritis (RA) during three consecutive years: 2004, 2005, and 2006. METHODS: Medical Expenditure Panel Survey was used for persons with RA. Regressions estimate health care costs and income loss. Absenteeism and age-adjusted workforce participation compared means and rates. RESULTS: The prevalence of RA was 0.40% in 2004, 0.44% in 2005, and 0.43% in 2006. Health care cost associated with RA was $4422, $2902, and $1882 (all P < 0.01) in 2004, 2005, and 2006, respectively. Rheumatoid arthritis sufferers were employed, 36.8%, 39.5%, and 44% compared with 70.5%, 69.8%, and 71%. Individuals with RA also missed more days of work, 4.86 in 2004 (P = 0.04), 1.70 in 2005 (P = 0.22), and 2.99 in 2006 (P = 0.04). Rheumatoid arthritis reduced income by $2404 (P = 0.03), $2207 (P < 0.001), and $1212 (P = 0.002). CONCLUSIONS: Costs of RA are considerable.

Comparative effectiveness of dalteparin and enoxaparin in a hospital setting.

PURPOSE: This study compared the effectiveness of a change from enoxaparin to dalteparin for the prophylaxis of patients at risk of venous thromboembolism (VTE). METHODS: A retrospective cohort study identified hospitalized patients with VTE risk admitted at Wellmont Health System between August 1, 2008 and July 31, 2009. On February 1, 2009, a therapeutic interchange from enoxaparin to dalteparin occurred. All patient records were reviewed from billing data collected 6 months prior and following conversion. Statistical tests of heterogeneity compared distributions of demography between study cohorts and Cochran tests were used to compare pre- versus postchange in the outcomes. RESULTS: A total of 3557 and 3465 patient discharges were analyzed in the 6 months prior and following the interchange, respectively. Of these discharges, 1870 were administered enoxaparin and 1639 dalteparin. VTE rates were similar between the 2 groups. Data showed no significant difference in-hospital length of stay (LOS), readmittance, and bleeding rates in the populations. The system achieved a $40 788 savings over 6 months following the conversion using approved prophylactic dosing per patient indication. CONCLUSIONS: Dalteparin is similarly effective as enoxaparin and an alternative for the prophylaxis of VTE in a hospital setting while providing cost savings.

An economic evaluation of colesevelam when added to metformin-, insulin- or sulfonylurea-based therapies in patients with uncontrolled type 2 diabetes mellitus.

BACKGROUND: Several early studies demonstrated that bile acid sequestrants were useful for lowering lipid levels in patients with hypercholesterolaemia and may also be useful for lowering glucose levels in patients with type 2 diabetes mellitus (T2DM) uncontrolled on existing treatment (metformin-, insulin- or sulfonylurea-based therapies). OBJECTIVE: This study modelled efficacy and safety data from the three clinical trials to evaluate the cost effectiveness to US Managed Care Organizations of add-on treatment with colesevelam for reducing diabetes-related complications. METHODS: Three randomized controlled trials in patients with T2DM and one in hyperlipidaemia established that colesevelam lowered both glycaemic and lipid parameters in adult patients participating in the studies. The validated 'diabetic risk equation' (DRE) and the 'LIPID cardiovascular risk equation' (LCRE) were used to translate the observed clinical benefits (surrogate markers related to T2DM [glycosylated haemoglobin {HbA(1c)} and fasting plasma glucose] and cardiovascular disease [low-density lipoprotein cholesterol {LDL-C}]). Performing an appropriate economic evaluation required the use of both the DRE and the LCRE. These equations parameterize the clinical efficacy measures as continuous, facilitating their application to clinical trial results as well as the replication of other well established epidemiological data. Tobit regressions were applied to a large commercially available managed care administrative claims database (2000-6), Integrated Health Care Services (IHCS), to evaluate the incremental costs associated with each type of diabetic complication. Costs were inflated to 2010 values using the Healthcare Consumer Price Index, while second- and third-year cost savings were discounted at 5% to the current year. Bootstrap sampling with 5000 samples of 100 patients per cohort was conducted, varying the number of events avoided as well as their associated cost. RESULTS: With established metformin-, insulin- or sulfonylurea-based therapies, the addition of colesevelam significantly reduced HbA(1c) by approximately 0.5% (p < 0.001) in all three studies. In addition, colesevelam reduced placebo-adjusted LDL-C by 12.8-16.7% (p < 0.001). Using the DRE and LCRE equations, the total savings from reductions in diabetes-related and cardiovascular events were $US3543, $US4074 and $US3855 for colesevelam added to metformin-, insulin- and sulfonylurea-based regimens in patients with normal lipid levels. After subtracting the cost of colesevelam, first-year savings were $US1326, $US1852 and $US1629 in the metformin, insulin and sulfonylurea studies, respectively, for patients with raised lipid levels. CONCLUSIONS: In adult patients with T2DM, the addition of colesevelam to metformin-, insulin- or sulfonylurea-based therapies significantly improves glycaemic control while also reducing LDL-C, and these improvements could translate into substantial cost reductions due to reductions in the rates of diabetes-related and cardiovascular complications.