Exploring the Economic Benefits of Modafinil for Post-Stroke Fatigue in Australia: A Cost-Effectiveness Evaluation.

BACKGROUND: In stroke survivors, post-stroke fatigue predicts dependency in daily living and failure to return to work. Modafinil shows promise as a pharmacotherapy to reduce post-stroke fatigue and related sequelae, e.g., poorer functional and clinical outcomes. AIMS: This study explored the cost-effectiveness of modafinil in treating post-stroke fatigue in the Australian context, by determining its incremental cost-effectiveness ratio (ICER) and by simulating the potential cost-savings on a national scale, through a re-analysis of MIDAS trial data. METHODS: A post hoc cost-effectiveness analysis was undertaken. Part A: patient-level cost and health effect data (Multidimensional Fatigue Inventory (MFI) scores) were derived from the MIDAS trial and analysis undertaken from a health-system perspective. Part B: a secondary analysis simulated the societal impact of modafinil therapy in terms of national productivity costs. RESULTS: Part A: Mean cost of modafinil treatment was AUD$3.60/day/patient for a minimally clinically important change (10 points) in total MFI fatigue score, i.e., AUD$0.36/day/unit change in fatigue score per patient. For the base case scenario, the ICER of using modafinil (versus placebo) was AUD$131.73 ($90.17 - 248.15, for minimum and maximum costs, respectively). Part B: The potential productivity cost-savings to society were calculated as nearly AUD$467 million over 1 year, and up to $383,471,991,248 over 10 years, from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors, representing a significant societal benefit. CONCLUSIONS: Modafinil is a highly cost-effective treatment for post-stroke fatigue, offering significant productivity gains and potential cost-savings to society from the widespread use of modafinil treatment in the Australian population of working-age stroke-survivors.

Higher Drug Prices from Anticompetitive Conduct: Three Case Studies.

U.S. consumers pay high drug prices. Brand-name drug companies claim that these prices are justified by pathbreaking research and development. But, sometimes the prices result from anticompetitive conduct. This article offers three case studies of how such behavior can increase price based on wakefulness drug Provigil, the allergic-reaction-treating EpiPen, and infection-treating Daraprim. The article contends that behavior that makes no sense other than by harming a competitor, that undercuts a regulatory regime, or that involves collusive conduct should not be protected. In targeting this behavior, antitrust scrutiny promises to lower drug prices.

The availability and acquisition of modafinil on the internet.

INTRODUCTION AND AIMS: Prescription medications are readily accessible on both the dark and surface web. This study focuses specifically on modafinil. Modafinal is a medication that is used to treat sleepiness due to a range of sleep disorders, but is also used off-label as a cognitive enhancer. This study aimed to evaluate surface websites which sold modafinil to Australia to provide an overview of and to document the characteristics of surface web retailers. DESIGN AND METHODS: An online search to identify online retailers selling modafinil was performed using three search engines. Retailers were included if they sold modafinil to Australia, as verified through the purchasing process. Thirteen retailers were included in the final sample. RESULTS: Most retailers sold more than one product, with products being sold in tablet form the most common (88%). Retailers offered products of multiple strength, with the 200 mg product most common (51%). Most retailers included information on the side effects of the substances (77%), few listed any supporting evidence. Few listed information regarding legal status (24%). Most retailers used a number of features to indicate legitimacy. DISCUSSION AND CONCLUSION: This is the first study to document the characteristics of surface web retailers purporting to sell modafinil to Australia. Future studies may analyse purchased samples to identify potential counterfeit or poor-quality medications.