Pharmacoeconomic evaluation of treatments for Poly Cystic Ovarian Syndrome (PCOS).

BACKGROUND: Treatment cost and high prevalence of Poly Cystic Ovarian Syndrome (PCOS) is a very challenging issue globally. Due to this reason; current study was conducted to determine pharmaco-economy of conventional and non-conventional treatments for the management of PCOS. METHODS: Prospective Cross-Sectional study was conducted in the metropolitan city of Karachi from January - December 2019. Primary data of 200 PCOS patients were collected from different hospitals and clinics. An instrument was used to collect data pertaining to the direct and indirect cost associated with the disease management. Collected data was analyzed by the tools for cost analysis and software called Statistical Package of Social Sciences (SPSS) - 22. RESULTS: In Cost Minimization Analysis (CMA); Allopathic treatment [Mean cost/month: PKR:4479.32 ± 350.95 (USD:27.46 ± 2.15)], Herbal treatment [Mean cost/month: PKR:1527.78 ± 78.15 (USD:9.37 ± 0.48)], Combination treatment [Mean cost/month: PKR:2803.09 ± 654.22 (USD:17.18 ± 4.01)], and Homoeopathic treatment [Mean cost/month: PKR:976.95 ± 46.19 (USD:5.99 ± 0.28)]. Incremental cost/month for Allopathic treatment is 358%, Herbal treatment is 56%, Combination treatment is 187%. In Cost Effectiveness Analysis (CEA); Allopathic treatment (Incremental cost-effectiveness ratio/month: 1334.24), Herbal treatment (Incremental cost-effectiveness ratio/month: 936.41), Combination treatment (Incremental cost-effectiveness ratio/month: 1017.09). Due to lowest cost of Homeopathic treatment, cost of Homeopathic treatment was considered as a threshold value. In-direct cost/month of Allopathic treatment is PKR:593.33 ± 24.00 (USD:3.64 ± 0.15), Herbal treatment is PKR:307.84 ± 26.69 (USD:1.89 ± 0.16), Combination treatment is PKR:409.09 ± 45.63 (USD:2.51 ± 0.28) and Homoeopathic treatment is PKR:300.00 ± 26.39 (USD:1.84 ± 0.16). CONCLUSION: The most cost-effective is treatment is Homeopathic; Herbal treatment is second most cost-effective option for the treatment of PCOS. Lowest direct and indirect costs and short treatment duration collaboratively lessen the %incremental cost per year and incremental cost effectiveness ratio per year.

Cost-effectiveness analysis for SilAtro-5-90 adjuvant treatment in the management of recurrent tonsillitis, compared with usual care only.

PURPOSE: Antibiotics are one possible treatment for patients with recurrent acute throat infections (ATI), but effectiveness can be modest. In view of worries over antibiotic resistance, treatment pathways that reduce recurrence of ATI are essential from a public health perspective. Integrative treatment strategies can be an option but there is still a high demand to provide evidence of their cost effectiveness. METHODS: We constructed a 4-state Markov model to compare the cost-effectiveness of SilAtro-5-90 as adjuvant homeopathic therapy to care as usual with care as usual alone in reducing the recurrence of ATI for children and adults with suspected moderate recurrent tonsillitis. The analysis was performed from a societal perspective in Germany over a 2-year period. Results are reported separately for children < 12 and for individuals aged 12 and over. The model draws on evidence from a multi-centre randomised clinical trial that found this strategy effective in reducing recurrence of ATI. Costs in 2019 € and outcomes after 1 year are discounted at a rate of 3% per annum. RESULTS: For adults and adolescents aged 12 years and over, incremental cost per ATI averted in the adjuvant therapy group was €156.64. If individuals enter the model on average with a history of 3.33 previous ATIs, adjuvant therapy has both lower costs and better outcomes than care as usual. For children (< 12 years) adjuvant therapy had both lower costs and ATI than care as usual. The economic case is stronger if adjuvant treatment reduces surgical referral. At a hypothetical cost per ATI averted threshold of €1000 probabilistic sensitivity analysis suggests Silatro-5-90 has a 65% (adults) and 71% (children) chance of being cost-effective. CONCLUSION: Our results indicate the importance of considering homeopathy as adjuvant therapy in the treatment of ATIs in individuals with recurrent tonsillitis from a socio-economic perspective. Further evaluation should assess how differences in uptake and sustained use of homeopathic adjuvant therapy, as well as changing patterns of antibiotic prescribing, impact on cost effectiveness.

Effectiveness and cost-effectiveness of treatment with additional enrollment to a homeopathic integrated care contract in Germany.

BACKGROUND: A number of German statutory health insurance companies are offering integrated care contracts for homeopathy (ICCHs) that cover the reimbursement of homeopathic treatment. The effectiveness and cost-effectiveness of these contracts are highly debated. METHODS: To evaluate the effectiveness and cost-effectiveness of treatment after an additional enrollment in an ICCH, a comparative, prospective, observational study was conducted in which participants in the ICCH (HOM group) were compared with matched (on diagnosis, sex and age) insured individuals (CON group) who received usual care alone. Those insured with either migraine or headache, allergic rhinitis, asthma, atopic dermatitis and depression were included. Primary effectiveness outcomes were the baseline adjusted scores of diagnosis-specific questionnaires (e.g. RQLQ, AQLQ, DLQI, BDI-II) after 6 months. Primary cost-effectiveness endpoints were the baseline adjusted total costs from an insurer perspective in relation to the achieved quality-adjusted life years (QALYs). Costs were derived from health claims data and QALYs were calculated based on SF-12 data. RESULTS: Data from 2524 participants (1543 HOM group) were analyzed. The primary effectiveness outcomes after six months were statistically significant in favor of the HOM group for migraine or headache (Δ = difference between groups, days with headache: - 0.9, p = 0.042), asthma (Δ-AQLQ(S): + 0.4, p = 0.014), atopic dermatitis (Δ-DLQI: - 5.6, p ≤ 0.001) and depression (Δ-BDI-II: - 5.6, p ≤ 0.001). BDI-II differences reached the minimal clinically important difference. For all diagnoses, the adjusted mean total costs over 12 months were higher in the HOM group from an insurer perspective, with migraine or headache, atopic dermatitis and depression suggesting cost-effectiveness in terms of additional costs per QALY gained. CONCLUSION: After an additional enrollment in the ICCH, the treatment of participants with depression showed minimally clinically relevant improvements. From an insurer perspective, treatment with an ICCH enrollment resulted in higher costs over all diagnoses but seemed to be cost-effective for migraine or headache, atopic dermatitis and depression according to international used threshold values. Based on the study design and further limitations, our findings should be considered cautiously and no conclusions regarding the effectiveness of specific treatment components can be made. Further research is needed to overcome limitations of this study and to confirm our findings. TRIAL REGISTRATION: clinicaltrials.gov , NCT01854580. Registered 15 March 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01854580.

Depression treated by homeopaths: a study protocol for a pragmatic cohort multiple randomised controlled trial.

BACKGROUND: The most commonly recommended treatments for depression are psychological/psychotherapeutic treatments, and antidepressant drugs. However, 38 percent of patients with depression do not use these recommended treatments. Some patients seek homeopathic treatment for depression, but insufficient evidence exists to conclude as to the effectiveness, cost-effectiveness and safety of treatment by homeopaths for patients with depression. The aim of this trial is to evaluate the acceptability and comparative clinical and cost-effectiveness of the offer of adjunctive treatment provided by homeopaths for patients with self-reported depression. METHOD: This pragmatic randomised controlled trial is embedded within the population based South Yorkshire Cohort (SYC) of whom nine percent self-report long-term depression. The SYC is designed to facilitate 'cohort multiple' randomised controlled trials (cmRCT). A self-completed questionnaire will be used to both screen and collect baseline data from potential trial participants. The primary outcome is PHQ-9. One-hundred-and-sixty-two participants will be randomly selected to the intervention group (Offer of treatment by a homeopath). The results of the Offer and the No Offer groups will be compared at 6 and 12 months using both an intention to treat (ITT) and complier average causal effect (CACE) analysis. Cost-effectiveness analysis will involve calculation of quality adjusted life year (QALY). In order to help interpret the quantitative findings a selection of up to 30 patients in the offer group will be invited to participate in qualitative interviews after the first consultation and after a minimum of 6 months. Interviews will be assessed by two researchers and results will be analysed using thematic analysis. Triangulation will be used to combine results from qualitative and quantitative methodologies at the interpretation stage, to see if results agree, offer complementary information on the same issue or contradict each other.

Overview and quality assessment of health economic evaluations for homeopathic therapy: an updated systematic review.

INTRODUCTION: Likewise other medical interventions, economic evaluations of homeopathy contribute to the evidence base of therapeutic concepts and are needed for socioeconomic decision-making. A 2013 review was updated and extended to gain a current overview. METHODS: A systematic literature search of the terms 'cost' and 'homeopathy' from January 2012 to July 2022 was performed in electronic databases. Two independent reviewers checked records, extracted data, and assessed study quality using the Consensus on Health Economic Criteria (CHEC) list. RESULTS: Six studies were added to 15 from the previous review. Synthesizing both health outcomes and costs showed homeopathic treatment being at least equally effective for less or similar costs than control in 14 of 21 studies. Three found improved outcomes at higher costs, two of which showed cost-effectiveness for homeopathy by incremental analysis. One found similar results and three similar outcomes at higher costs for homeopathy. CHEC values ranged between two and 16, with studies before 2009 having lower values (Mean ± SD: 6.7 ± 3.4) than newer studies (9.4 ± 4.3). CONCLUSION: Although results of the CHEC assessment show a positive chronological development, the favorable cost-effectiveness of homeopathic treatments seen in a small number of high-quality studies is undercut by too many examples of methodologically poor research.

To help make decisions about homeopathy in healthcare, it is important, as with other medical treatments, to look at whether this treatment is effective in relation to its costs; in other words, to see if it is cost-effective. The aim of the current work was to update the picture of scientific studies available on this topic until 2012. To this purpose, two different researchers screened electronic literature databases for studies between January 2012 and July 2022 which assessed both the costs and the effects of a homeopathic treatment. They did this according to strict rules to make sure that no important study was missed. They reviewed the search results, gathered information from the studies, and assessed the quality of the studies using a set of criteria. They detected six additional new studies to the 15 already known from the previous work. Overall, they found that in 14 out of 21 studies, homeopathic treatment was at least equally effective for less or similar costs. For the remaining seven studies, costs were equal or higher for homeopathy. Of these seven, two were shown to be advantageous for homeopathy: indeed, specific economic analyses demonstrated that the benefit of the homeopathic treatment compensated for the higher costs. For the remaining five studies, the higher or equal costs of homeopathic treatment were not compensated by a better effect. The quality of the studies varied, with older studies generally being of lower quality compared to newer ones. The authors concluded that although the quality of research on homeopathy's cost-effectiveness has improved over time, and some high-quality studies show that it can be a cost-effective option, there are still many poorly conducted studies which make it difficult to offer a definitive statement. In other words, while there is some evidence that homeopathy can be effective in relation to its costs, there are still many studies that are not very reliable, which means that interested parties need to be cautious about drawing conclusions.

Homeopathic medications as clinical alternatives for symptomatic care of acute otitis media and upper respiratory infections in children.

The public health and individual risks of inappropriate antibiotic prescribing and conventional over-the-counter symptomatic drugs in pediatric treatment of acute otitis media (AOM) and upper respiratory infections (URIs) are significant. Clinical research suggests that over-the-counter homeopathic medicines offer pragmatic treatment alternatives to conventional drugs for symptom relief in children with uncomplicated AOM or URIs. Homeopathy is a controversial but demonstrably safe and effective 200-year-old whole system of complementary and alternative medicine used worldwide. Numerous clinical studies demonstrate that homeopathy accelerates early symptom relief in acute illnesses at much lower risk than conventional drug approaches. Evidence-based advantages for homeopathy include lower antibiotic fill rates during watchful waiting in otitis media, fewer and less serious side effects, absence of drug-drug interactions, and reduced parental sick leave from work. Emerging evidence from basic and preclinical science research counter the skeptics' claims that homeopathic remedies are biologically inert placebos. Consumers already accept and use homeopathic medicines for self care, as evidenced by annual US consumer expenditures of $2.9 billion on homeopathic remedies. Homeopathy appears equivalent to and safer than conventional standard care in comparative effectiveness trials, but additional well-designed efficacy trials are indicated. Nonetheless, the existing research evidence on safety supports pragmatic use of homeopathy in order to "first do no harm" in the early symptom management of otherwise uncomplicated AOM and URIs in children.

La salud pública y los riesgos individuales de la receta inapropiada de antibióticos y de los fármacos sintomáticos sin receta tradicionales en el tratamiento pediátrico de la otitis media aguda y de las infecciones de las vías respiratorias superiores son importantes. La investigación clínica indica que los fármacos homeopáticos sin receta ofrecen alternativas pragmáticas de tratamiento a los fármacos tradicionales para el alivio de los síntomas en niños con otitis media agua o infecciones de las vías respiratorias superiores sin complicaciones. La homeopatía es un completo sistema de medicina alternativa y complementaria que lleva utilizándose 200 años en todo el mundo y, aunque controvertida, ha demostrado ser segura y eficaz. Numerosos estudios clínicos demuestran que la homeopatía acelera el alivio temprano de los síntomas en las enfermedades agudas con un riesgo muy inferior a los enfoques farmacéuticos tradicionales. Las ventajas basadas en las pruebas para la homeopatía incluyen unas tasas de relleno de antibióticos inferiores durante la espera con vigilancia en la otitis media, menos efectos secundarios y de menor gravedad, ausencia de interacciones entre los fármacos y reducción de los permisos laborales por enfermedad de los padres. Las pruebas que surgen a partir de la investigación científica básica y preclínica desmienten las afirmaciones de los escépticos que indican que los remedios homeopáticos son placebos biológicamente inertes. Los consumidores ya aceptan y utilizan fármacos homeopáticos para su propio cuidado, según lo prueban los gastos anuales en Estados Unidos con un consumo de 2900 millones de dólares en remedios homeopáticos. La homeopatía parece corresponderse y ser más segura que la atención tradicional estándar en los ensayos comparativos de eficacia, pero se indica la realización de ensayos adicionales sobre eficacia bien diseñados. No obstante, las pruebas existentes derivadas de la investigación sobre seguridad apoyan el uso pragmático de la homeopatía para, en primer lugar, «no causar daño¼ en la gestión y tratamiento tempranos de los síntomas de la otitis media aguda y las infecciones de las vías respiratorias superiores sin complicaciones en niños.

Public-private partnerships in the provision of homeopathic services in the city of Delhi, India

Homeopathy is one among the popular medical systems in India. Over the years, the government has been attempting to mainstream homeopathy in the public health system, nevertheless, most service providers are in the private sector. Therefore, increase of quality and availability to all population classes by means of public-private partnerships is seen as a viable policy option. In Delhi, 90% of homeopathic services providers belong to the private sector, including charity trusts. Most of them provide services to the low-income population in urban slams. In 2003, Delhi government launched a program involving the private sector to provide homeopathic services in underserved city areas. This project funded private agencies to run homeopathic clinics. This paper provides an overview on this program, addressing in particular the lessons taught by six case studies represented by non-governmental organizations (NGOs). It also discusses expectations of private providers and concludes with specific recommendations for wider participation of the private sector.(AU)

La homeopatía es uno de los sistemas médicos populares en India. El gobierno intenta hace varios años difundir la homeopatía en el sistema público de salud, sin embargo, la mayoría de los prestadores de servicios pertenece al sector privado. Por ese motivo, se considera que la formación de sociedades público-privadas podría representar una política viable para mejorar la calidad y el acceso de todas las clases de la población. En Delhi, 90% de los prestadores de servicios homeopáticos pertenecen al sector privado, incluyendo fundaciones filantrópicas. La mayoría atiende a la población de bajos recursos en villas miseria urbanas. En 2003, el gobierno de Delhi lanzó un programa involucrando al sector privado en la prestación de servicios homeopáticos en áreas asistencialmente poco cubiertas. Este proyecto financió entidades privadas que operasen consultorios homeopáticos. Este artículo presenta un panorama de este programa, con atención especial para las lecciones aprendidas a partir de seis estudios de caso representados por organizaciones no gubernamentales (ONGs). También discute las expectativas de los prestadores privados y concluye con recomendaciones específicas para la participación más amplia del sector privado.(AU)

A homeopatia é um dos sistemas médicos populares na Índia. Ao longo do tempo, o governo tem tentado difundir a homeopatia no sistema público de saúde, no entanto, a maioria dos prestadores do serviço pertence ao setor privado. Portanto, considera-se que uma política viável para melhorar a qualidade e a disponibilidade para todas as classes da população consistiria em parcerias entre os setores público e privado. Em Delhi, 90% dos prestadores de serviços homeopáticos pertencem ao setor privado, incluindo fundações filantrópicas. A maioria deles atende a população de baixa renda em favelas urbanas. Em 2003, o governo de Delhi lançou um programa envolvendo o setor privado na prestação de serviços homeopáticos em áreas urbanas pouco cobertas por assistência médica. Esse projetou financiou entidades privadas para desenvolverem ambulatórios homeopáticos. Este artigo apresenta um panorama desse programa, focando em particular as lições que ensinam seis casos de estudo representados por organizações não governamentais (ONGs). Também discute as expectativas dos prestadores privados e conclui com recomendações específicas para uma participação mais ampla do setor privado(AU)

Public-private partnerships in the provision of homeopathic services in the city of Delhi, India / Parcerias entre os setores público e privado na prestação de serviços homeopáticos na cidade de Delhi, Índia / Asociación de los sectores público y privado para atención homeopática en la ciudad de Delhi, Índia

Homeopathy is one among the popular medical systems in India. Over the years, the government has been attempting to mainstream homeopathy in the public health system, nevertheless, most service providers are in the private sector. Therefore, increase of quality and availability to all population classes by means of public-private partnerships is seen as a viable policy option. In Delhi, 90% of homeopathic services providers belong to the private sector, including charity trusts. Most of them provide services to the low-income population in urban slams. In 2003, Delhi government launched a program involving the private sector to provide homeopathic services in underserved city areas. This project funded private agencies to run homeopathic clinics. This paper provides an overview on this program, addressing in particular the lessons taught by six case studies represented by non-governmental organizations (NGOs). It also discusses expectations of private providers and concludes with specific recommendations for wider participation of the private sector.(AU)

La homeopatía es uno de los sistemas médicos populares en India. El gobierno intenta hace varios años difundir la homeopatía en el sistema público de salud, sin embargo, la mayoría de los prestadores de servicios pertenece al sector privado. Por ese motivo, se considera que la formación de sociedades público-privadas podría representar una política viable para mejorar la calidad y el acceso de todas las clases de la población. En Delhi, 90% de los prestadores de servicios homeopáticos pertenecen al sector privado, incluyendo fundaciones filantrópicas. La mayoría atiende a la población de bajos recursos en villas miseria urbanas. En 2003, el gobierno de Delhi lanzó un programa involucrando al sector privado en la prestación de servicios homeopáticos en áreas asistencialmente poco cubiertas. Este proyecto financió entidades privadas que operasen consultorios homeopáticos. Este artículo presenta un panorama de este programa, con atención especial para las lecciones aprendidas a partir de seis estudios de caso representados por organizaciones no gubernamentales (ONGs). También discute las expectativas de los prestadores privados y concluye con recomendaciones específicas para la participación más amplia del sector privado.(AU)

A homeopatia é um dos sistemas médicos populares na Índia. Ao longo do tempo, o governo tem tentado difundir a homeopatia no sistema público de saúde, no entanto, a maioria dos prestadores do serviço pertence ao setor privado. Portanto, considera-se que uma política viável para melhorar a qualidade e a disponibilidade para todas as classes da população consistiria em parcerias entre os setores público e privado. Em Delhi, 90% dos prestadores de serviços homeopáticos pertencem ao setor privado, incluindo fundações filantrópicas. A maioria deles atende a população de baixa renda em favelas urbanas. Em 2003, o governo de Delhi lançou um programa envolvendo o setor privado na prestação de serviços homeopáticos em áreas urbanas pouco cobertas por assistência médica. Esse projetou financiou entidades privadas para desenvolverem ambulatórios homeopáticos. Este artigo apresenta um panorama desse programa, focando em particular as lições que ensinam seis casos de estudo representados por organizações não governamentais (ONGs). Também discute as expectativas dos prestadores privados e conclui com recomendações específicas para uma participação mais ampla do setor privado(AU)

Public-private partnerships in the provision of homeopathic services in the city of Delhi, India / Parcerias entre os setores público e privado na prestação de serviços homeopáticos na cidade de Delhi, Índia / Asociación de los sectores público y privado para atención homeopática en la ciudad de Delhi, Índia

Homeopathy is one among the popular medical systems in India. Over the years, the government has been attempting to mainstream homeopathy in the public health system, nevertheless, most service providers are in the private sector. Therefore, increase of quality and availability to all population classes by means of public-private partnerships is seen as a viable policy option. In Delhi, 90% of homeopathic services providers belong to the private sector, including charity trusts. Most of them provide services to the low-income population in urban slams. In 2003, Delhi government launched a program involving the private sector to provide homeopathic services in underserved city areas. This project funded private agencies to run homeopathic clinics. This paper provides an overview on this program, addressing in particular the lessons taught by six case studies represented by non-governmental organizations (NGOs). It also discusses expectations of private providers and concludes with specific recommendations for wider participation of the private sector.

La homeopatía es uno de los sistemas médicos populares en India. El gobierno intenta hace varios años difundir la homeopatía en el sistema público de salud, sin embargo, la mayoría de los prestadores de servicios pertenece al sector privado. Por ese motivo, se considera que la formación de sociedades público-privadas podría representar una política viable para mejorar la calidad y el acceso de todas las clases de la población. En Delhi, 90% de los prestadores de servicios homeopáticos pertenecen al sector privado, incluyendo fundaciones filantrópicas. La mayoría atiende a la población de bajos recursos en villas miseria urbanas. En 2003, el gobierno de Delhi lanzó un programa involucrando al sector privado en la prestación de servicios homeopáticos en áreas asistencialmente poco cubiertas. Este proyecto financió entidades privadas que operasen consultorios homeopáticos. Este artículo presenta un panorama de este programa, con atención especial para las lecciones aprendidas a partir de seis estudios de caso representados por organizaciones no gubernamentales (ONGs). También discute las expectativas de los prestadores privados y concluye con recomendaciones específicas para la participación más amplia del sector privado.

A homeopatia é um dos sistemas médicos populares na Índia. Ao longo do tempo, o governo tem tentado difundir a homeopatia no sistema público de saúde, no entanto, a maioria dos prestadores do serviço pertence ao setor privado. Portanto, considera-se que uma política viável para melhorar a qualidade e a disponibilidade para todas as classes da população consistiria em parcerias entre os setores público e privado. Em Delhi, 90% dos prestadores de serviços homeopáticos pertencem ao setor privado, incluindo fundações filantrópicas. A maioria deles atende a população de baixa renda em favelas urbanas. Em 2003, o governo de Delhi lançou um programa envolvendo o setor privado na prestação de serviços homeopáticos em áreas urbanas pouco cobertas por assistência médica. Esse projetou financiou entidades privadas para desenvolverem ambulatórios homeopáticos. Este artigo apresenta um panorama desse programa, focando em particular as lições que ensinam seis casos de estudo representados por organizações não governamentais (ONGs). Também discute as expectativas dos prestadores privados e conclui com recomendações específicas para uma participação mais ampla do setor privado.