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1.
Expert Rev Gastroenterol Hepatol ; 13(8): 731-738, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31322440

RESUMO

Introduction: The purpose of this review is to highlight the role of biosimilars in early treatment in IBD and introduce ways to facilitate a patient-centric switching process through multidisciplinary approach. Areas covered: We summarize existing scientific literature related to the role of biosimilars in inflammatory bowel disease in terms of early treatment and cost-saving and implementing switching process. Expert opinion: Use of anti-TNF biosimilars in patients has the potential for large drug-acquisition cost-saving, which can be reinvested into early treatment. Managed switched programs for adalimumab can add further benefits in the future.


Assuntos
Anti-Inflamatórios/uso terapêutico , Medicamentos Biossimilares/uso terapêutico , Doença de Crohn/terapia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab/administração & dosagem , Adalimumab/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/economia , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/economia , Anticorpos Monoclonais/uso terapêutico , Medicamentos Biossimilares/administração & dosagem , Medicamentos Biossimilares/economia , Doença de Crohn/diagnóstico , Doença de Crohn/economia , Doença de Crohn/enfermagem , Custos de Medicamentos , Monitoramento de Medicamentos/economia , Monitoramento de Medicamentos/métodos , Diagnóstico Precoce , Humanos , Doenças Inflamatórias Intestinais/economia , Doenças Inflamatórias Intestinais/enfermagem , Doenças Inflamatórias Intestinais/terapia , Equipe de Assistência ao Paciente , Assistência Centrada no Paciente/economia , Assistência Centrada no Paciente/métodos
2.
Continuum (Minneap Minn) ; 25(3): 845-849, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31162319

RESUMO

This article presents a hypothetical case of a patient with multiple sclerosis (MS), reviewing the use of clinical practice guidelines and incorporation of quality measures into practice. Appropriate diagnosis of MS is important to avoid the cost and consequences of a misdiagnosis. Ensuring that treatment discussion occurs when a patient with MS is receptive is good clinical practice and a guideline recommendation from the American Academy of Neurology. Continuing dialogue about disease-modifying therapy and ongoing monitoring are important for patient care and improved outcomes. Ultimately, cost-effective care in MS relates to using appropriate medicines in patients with active MS, ensuring adherence, and careful monitoring.


Assuntos
Anti-Inflamatórios/administração & dosagem , Análise Custo-Benefício/normas , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/tratamento farmacológico , Guias de Prática Clínica como Assunto/normas , Qualidade da Assistência à Saúde/normas , Adulto , Anti-Inflamatórios/economia , Feminino , Humanos , Metilprednisolona/administração & dosagem , Metilprednisolona/economia , Esclerose Múltipla/economia , Qualidade da Assistência à Saúde/economia
4.
J Manag Care Spec Pharm ; 25(4): 461-467, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30917076

RESUMO

BACKGROUND: Drugs for inflammatory conditions are one of the highest expenditure therapeutic classes for health plans. Published literature for adherence, persistence, nonadherence risk factors, and health care costs are incomplete for newer biologic agents. OBJECTIVES: To (a) examine differences in adherence, persistence, switch patterns, and health care costs among high-cost specialty anti-inflammatory medications and (b) suggest risk factors for nonadherence in rheumatoid arthritis. METHODS: In this exploratory retrospective cohort study, we used medical and pharmacy claims from 1.2 million enrollees in commercial health plans administrated by Premera Blue Cross, the largest not-for-profit health plan in the Pacific Northwest. We included members with rheumatoid arthritis who used the following high-cost disease-modifying antirheumatic drugs: abatacept, adalimumab, anakinra, apremilast, certolizumab, etanercept, golimumab, infliximab, rituximab, sekukinumab, tocilizumab, tofacitinib, and ustekinumab. Adherence was calculated via medication possession ratio. Persistence was calculated as the amount of days between the initial fill and final fill plus days supply. Switch rates for adalimumab and etanercept were calculated as the percentage of members who switched to another target drug during the observation period. Direct medical costs (total health care costs) and health care costs excluding specialty agents were calculated using the net allowable amount per claim for the duration of each therapy. Adherence, persistence, and costs of care were also examined for concurrent methotrexate use for the most used target drugs. RESULTS: The most commonly used drugs were abatacept (n = 47), adalimumab (n = 226), and etanercept (n = 252). Nonadherence in certain subgroups was associated with higher mean monthly health care costs, excluding specialty agents (etanercept cohort: +$1,063 for nonmethotrexate users; +$492 for nonadherent methotrexate users), but adherence was associated with higher total health care costs (+$883 for etanercept). Relative to specialty pharmacies, retail was associated with 9% higher nonadherence. Concurrent methotrexate use was associated with higher persistence (+307 and +192 days with adalimumab and etanercept). The most commonly switched-to drug after adalimumab/etanercept was abatacept (n = 39). CONCLUSIONS: This exploratory study raises signals suggesting that retail pharmacies may be associated with higher nonadherence; nonadherence may be associated with increased health care costs, excluding specialty agents; adherence may increase total health care costs; and methotrexate use may be associated with increased persistence. Future research should confirm these findings. DISCLOSURES: This research was part of an internship awarded to Khilfeh by the AMCP Foundation/Pfizer Summer Internship Program and funded by Pfizer. Gross is an employee of Pfizer. The other authors have nothing to disclose. A portion of this research was presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting as a continuing education session entitled "The Evolving Role of Real-World Data in Health Care Decision Making" on March 29, 2017, in Denver, CO, and at AMCP Nexus 2016 as a poster on October 3-6, 2016, in National Harbor, MD.


Assuntos
Anti-Inflamatórios/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Idoso , Anti-Inflamatórios/economia , Antirreumáticos/economia , Artrite Reumatoide/economia , Estudos de Coortes , Custos de Medicamentos/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Fatores Imunológicos/economia , Fatores Imunológicos/uso terapêutico , Masculino , Programas de Assistência Gerenciada/economia , Pessoa de Meia-Idade , Noroeste dos Estados Unidos , Estudos Retrospectivos , Fatores de Risco
5.
J Med Econ ; 22(6): 554-566, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30663455

RESUMO

Aims: Non-adherence is associated with poor clinical outcomes among patients with asthma. While cost-effectiveness analysis (CEA) is increasingly used to inform value assessment of the interventions, most do not take into account adherence in the analyses. This study aims to: (1) Understand the extent of studies considering adherence as part of the economic analyses, and (2) summarize the methods of incorporating adherence in the economic models. Materials and methods: A literature search was performed from the inception to February 2018 using four databases: PubMed, EMBASE, NHS EED, and the Tufts CEA registry. Decision model-based CEA of asthma were identified. Outcomes of interest were the number of studies incorporating adherence in the economic models, and the incorporating methods. All data were extracted using a standardized data collection form. Results: From 1,587 articles, 23 studies were decision model-based CEA of asthma, of which four CEA (17.4%) incorporated adherence in the analyses. Only the method of incorporating adherence by adjusting treatment effectiveness according to adherence levels was demonstrated in this review. Two approaches were used to derive the associations between adherence and effectiveness. The first approach was to apply a mathematical formula, developed by an expert panel, and the second was to extrapolate the associations from previous published studies. The adherence-adjusted effectiveness was then incorporated in the economic models. Conclusions: A very low number of CEA of asthma incorporated adherence in the analyses. All the CEA adjusted treatment effectiveness according to adherence levels, applied to the economic models.


Assuntos
Asma/tratamento farmacológico , Asma/economia , Análise Custo-Benefício/métodos , Adesão à Medicação/estatística & dados numéricos , Modelos Econômicos , Antiasmáticos/economia , Antiasmáticos/uso terapêutico , Anti-Inflamatórios/economia , Anti-Inflamatórios/uso terapêutico , Broncodilatadores/economia , Broncodilatadores/uso terapêutico , Técnicas de Apoio para a Decisão , Combinação de Medicamentos , Quimioterapia Combinada , Humanos , Modelos Teóricos , Anos de Vida Ajustados por Qualidade de Vida , Índice de Gravidade de Doença
8.
Eur J Health Econ ; 20(2): 195-203, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29362899

RESUMO

AIMS: We determined adalimumab utilisation and associated drug costs in patients with ulcerative colitis (UC), focusing on patients requiring dose escalation. METHODS: The retrospective cohort study analysed the de-identified prescription data of the Arvato Health Analytics (Munich, Germany) database (2010-2015) in adult UC patients undergoing adalimumab therapy. RESULTS: A total of 154 patients were newly treated with adalimumab (average 39.6 years, 53% females), with a mean dose of 2.93 mg/day. Within 12 months, 69 patients (45%) received a dose increase of > 50% (doubled dose in 48 patients; 32%), with the escalation reported at 169.3 ± 99.3 days. A subsequent dose de-escalation to the standard dose occurred in 50 (32%) of patients that initially had a dose increase of > 50% (after 94.7 ± 49.6 days). Direct drug costs were 28,846 € in the overall study population, 24,934 € in patients on standard dose, 36,094 € in patients with dose increase, and 32,742 € in patients with increase and subsequent decrease. CONCLUSION: Dose escalation occurred frequently, and in one third of patients the dose was at least doubled. Dose escalations were associated with substantial increases in direct drug costs. Dose escalation of adalimumab can severely affect both the health care system and the drug budget of the physician. It needs to be considered that other biologic medications may constitute a more cost-effective alternative.


Assuntos
Adalimumab/administração & dosagem , Adalimumab/economia , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/economia , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/economia , Adulto , Custos e Análise de Custo , Bases de Dados Factuais , Custos de Medicamentos/estatística & dados numéricos , Uso de Medicamentos/economia , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Farm Hosp ; 42(6): 244-250, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30381045

RESUMO

OBJECTIVE: To assess the economic impact following the inclusion of an intravitreal implant of dexamethasone for the treatment of diabetic macular oedema in a healthcare area in Spain. METHOD: A 3-year budget impact model was designed to estimate healthcare  direct costs for adult patients with diabetic macular oedema from the National  Health System perspective. The approved therapies in use  (aflibercept/ranibizumab/dexamethasone) were considered. The target  population was estimated from published diabetic macular oedema prevalence  (6.41%) and incidence (0.82%) for a population of 25,000 adults.  Dexamethasone was assumed to be used annually in 20%, 30% and 40% of  patients, respectively. Annual total costs included: drug acquisition (based on  frequency of injections per every year, considering exfactory prices with  mandatory deduction and split of vials), intravitreal administration, patient  monitoring, management of cardiovascular and ocular adverse events  (cataracts, increased intraocular pressure, endophthalmitis, vitreous  haemorrhage and retinal detachment). Detailed resource consumption reflecting  clinical practice was provided from local experts in retina and vitreous. Unitary  costs (€, 2016) were obtained from national databases and literature. Sensitivity  analyses were performed to assess model robustness. RESULTS: The inclusion of intravitreal dexamethasone implant would lead to  annual cost savings of €35,030 (-4.2%), €10,743 (-1.8%) and €5,051 (-0.9%), years 1-3 respectively. Total costs were reduced mainly by the fewer annual  injections required by dexamethasone. The average annual incremental costs  were -€350, -€96 and -€41 per patient. CONCLUSIONS: The inclusion of an intravitreal dexamethasone implant for the  treatment of diabetic macular oedema would lead to cost-savings for the  considered health area, mainly by reducing the administration costs.


Assuntos
Anti-Inflamatórios/economia , Anti-Inflamatórios/uso terapêutico , Dexametasona/economia , Dexametasona/uso terapêutico , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/economia , Edema Macular/tratamento farmacológico , Edema Macular/economia , Corpo Vítreo , Idoso , Anti-Inflamatórios/administração & dosagem , Dexametasona/administração & dosagem , Implantes de Medicamento/economia , Feminino , Custos de Cuidados de Saúde , Humanos , Incidência , Injeções Intravítreas/economia , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Prevalência , Espanha
11.
Curr Opin Lipidol ; 29(6): 467-473, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30320614

RESUMO

PURPOSE OF REVIEW: Inflammation has been shown to be central to the development and progression of atherosclerosis. Despite detailed understanding of its central role and the cellular dynamics, which contribute to atherosclerotic inflammation, there has been slow progress in finding suitable agents to treat it. The recent CANTOS trial showed that the interleukin-1ß inhibitor canakinumab can improve outcomes after acute coronary syndromes. Being a monoclonal antibody, it is expensive and inconvenient to administer for long-term treatment. This review summarizes recent work in finding effective, affordable alternatives to canakinumab. RECENT FINDINGS: Statin drugs have anti-inflammatory properties but separating their LDL lowering effect from their anti-inflammatory effect has been difficult. Drugs acting on targets outside of the interleukin-1ß (IL-1ß) pathway have been tested without finding a suitable candidate. Following the proof of principle provided by the success of canakinumab, other candidates targeting the IL-1ß pathway are undergoing detailed evaluation. The most likely candidates are low-dose methotrexate and low-dose colchicine. The potential mechanisms and ongoing clinical trials are described. SUMMARY: Targeting the IL-1ß pathway has already been successful with canakinumab but its expense and inconvenience of administration may limit its widespread uptake for controlling inflammation in atherosclerosis. Low-dose methotrexate and low-dose colchicine are affordable and more accessible alternatives, currently undergoing detailed evaluation for safety and efficacy in large randomized controlled trials.


Assuntos
Anti-Inflamatórios/economia , Anti-Inflamatórios/farmacologia , Aterosclerose/tratamento farmacológico , Colchicina/economia , Colchicina/farmacologia , Custos e Análise de Custo , Animais , Anti-Inflamatórios/uso terapêutico , Colchicina/uso terapêutico , Humanos
12.
J Manag Care Spec Pharm ; 24(10): 1028-1033, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30247103

RESUMO

BACKGROUND: Infliximab dose rounding is a commonly accepted practice at many institutions to contain costs. Currently, there is limited data on the clinical and financial implications of infliximab dose rounding standardization. OBJECTIVE: To determine whether standardized infliximab dose rounding is comparable with nonstandardized dosing in patients with Crohn's disease or ulcerative colitis in terms of cost and efficiency, using a cost comparison between the 2 dosing methods at an outpatient infusion center attached to a community teaching hospital. METHODS: A retrospective electronic chart review was conducted to identify patients who received infliximab for ulcerative colitis or Crohn's disease over a 6-month period. The primary endpoint was cost comparison between the 2 dosing methods. The secondary outcomes were estimated time taken for order verification, number of order clarifications, increase in dose or frequency of infliximab, number of patients who switched to alternative therapy, and use of medications for adverse drug effects. Descriptive statistics and Fisher's exact test were used for data analysis. RESULTS: 72 patients met the inclusion criteria. Because of patient overlap during the study period, 45 patients (62.5%) were in the standardized rounding arm, and 69 patients (95.8%) were in the nonstandardized rounding arm. One patient in each arm required an increased dose or frequency of infusion (2.2% vs. 1.5%, P = 1.000). Standardized infliximab dose rounding had a theoretical cost savings of at least $104,640 per year (based on our rough annual census of 480 patients) compared with the nonstandardized method that had been used previously. The cost savings can also be translated as $218 per patient per month on average. The mean times to order verification were 10 vs. 12 minutes in the nonstandardized and standardized groups, respectively. Two patients in the nonstandardized group switched to alternative therapy. There was no difference in usage of rescue medications for adverse drug effects. CONCLUSIONS: Standardization of infliximab dose rounding resulted in increased efficiency in the pharmacy workflow by reducing time for order verification. Furthermore, standardized dose rounding resulted in a significant reduction in expenditure for infliximab for the institution. DISCLOSURES: No outside funding supported this research. The authors have nothing to disclose. This research was presented as a poster at the ASHP Midyear Clinical Meeting & Exhibition 2017; December 3-7, 2017; Orlando, FL.


Assuntos
Assistência Ambulatorial/economia , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/economia , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/economia , Doença de Crohn/tratamento farmacológico , Doença de Crohn/economia , Custos de Medicamentos , Custos Hospitalares , Infliximab/administração & dosagem , Infliximab/economia , Ambulatório Hospitalar/economia , Adulto , Colite Ulcerativa/diagnóstico , Redução de Custos , Análise Custo-Benefício , Doença de Crohn/diagnóstico , Cálculos da Dosagem de Medicamento , Feminino , Gastos em Saúde , Hospitais Comunitários/economia , Hospitais de Ensino/economia , Humanos , Masculino , Serviço de Farmácia Hospitalar/economia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Fluxo de Trabalho
13.
Dermatol Ther ; 31(5): e12632, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30253049

RESUMO

To assess the efficacy, safety, and cost-effectiveness of all-trans retinoic acid/Clobetasol Propionate Compound Ointment and calcipotriol/betamethasone dipropionate ointment in the treatment of mild-to-moderate patients with psoriasis vulgaris. This was a randomized, single-blind, multicenter clinical trial. A total of 240 patients were randomized to receive twice-daily all-trans retinoic acid/Clobetasol Propionate Compound Ointment (treatment group) or once-daily calcipotriol/betamethasone dipropionate ointment (control group) for 4 weeks. The efficacy, safety, and cost-effectiveness were assessed at Weeks 2 and 4. After 4 weeks, both groups showed a significant clinical improvement compared to baseline (88.33% vs. 89.83%, respectively, p = .7112). But PASI 75 response in the treatment group was superior to the control group (44.12% vs. 28.57%, respectively, p = .0200), at Week 4. SSRI improvement rate in the treatment group was also superior to control group (67.11% vs. 59.43%, respectively, p = .0119) at Week 4. All-trans retinoic acid/Clobetasol Propionate Compound Ointment showed a significant clinical improvement in erythema, infiltration, and scales of skin lesions and PASI score compared to baseline. 1.67% of patients (treatment group) reported adverse reactions compared to 2.50% (control group) with no statistical significance. In addition, the cost-effectiveness assessment showed a higher cost-effectiveness of the treatment group compared to the control group in 4 weeks (199.25 vs. 801.51). All-trans retinoic acid/Clobetasol Propionate Compound Ointment was effective and safe in the treatment of psoriasis vulgaris with similar efficacy as calcipotriol/betamethasone dipropionate ointment and lower treatment costs.


Assuntos
Anti-Inflamatórios/uso terapêutico , Betametasona/análogos & derivados , Calcitriol/análogos & derivados , Clobetasol/uso terapêutico , Ceratolíticos/uso terapêutico , Psoríase/tratamento farmacológico , Tretinoína/uso terapêutico , Adolescente , Adulto , Idoso , Anti-Inflamatórios/efeitos adversos , Anti-Inflamatórios/economia , Betametasona/efeitos adversos , Betametasona/economia , Betametasona/uso terapêutico , Calcitriol/efeitos adversos , Calcitriol/economia , Calcitriol/uso terapêutico , Clobetasol/efeitos adversos , Clobetasol/economia , Análise Custo-Benefício , Fármacos Dermatológicos/economia , Fármacos Dermatológicos/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Ceratolíticos/efeitos adversos , Ceratolíticos/economia , Masculino , Pessoa de Meia-Idade , Pomadas , Índice de Gravidade de Doença , Método Simples-Cego , Tretinoína/efeitos adversos , Tretinoína/economia , Adulto Jovem
14.
AMA J Ethics ; 20(9): E841-848, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30242815

RESUMO

As clinicians have begun to provide targeted pharmacotherapy for children with inflammatory bowel disease (IBD), several ethical challenges have arisen. In this paper, we review 3 challenges related to applying a precision health approach to pediatric IBD populations: selection of a disease monitoring method, pharmacotherapy optimization, and economic considerations in clinical decision making.


Assuntos
Saúde da Criança/ética , Doenças Inflamatórias Intestinais/tratamento farmacológico , Pediatria/ética , Padrões de Prática Médica/ética , Medicina de Precisão/ética , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/economia , Criança , Custos de Cuidados de Saúde , Humanos , Doenças Inflamatórias Intestinais/economia , Pediatria/economia , Pediatria/métodos , Padrões de Prática Médica/economia , Medicina de Precisão/economia , Medicina de Precisão/métodos
16.
J Med Econ ; 21(9): 869-877, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29857775

RESUMO

AIMS: Budesonide with multi-matrix technology (MMX) is an oral corticosteroid, shown to have high topical activity against ulcerative colitis (UC) while maintaining low systemic bioavailability with few adverse events. The aim of this study was to evaluate the cost-effectiveness of budesonide MMX versus commonly used corticosteroids, in the second-line treatment of active mild-to-moderate UC in the Netherlands. MATERIALS AND METHODS: An eight-state Markov model with an 8 week cycle length captured remission, four distinct therapy stages, hospitalization, possible colectomy and mortality. Remission probability for budesonide MMX was based on the CORE-II study. Population characteristics were derived from the Dutch Inflammatory Bowel Disease South Limburg cohort (n = 598) and included patients with proctitis (39%), left-sided (42%) and extensive disease (19%). Comparators (topical budesonide foam and enema, oral budesonide and prednisolone) were selected based on current Dutch clinical practice. Treatment effects were evaluated by network meta-analysis using a Bayesian framework. Cost-effectiveness analysis was performed over a 5 year time horizon from a societal perspective, with costs, health-state and adverse event utilities derived from published sources. Outcomes were weighted by disease extent distribution and corresponding comparators. RESULTS: Budesonide MMX was associated with comparable quality-adjusted life year (QALY) gain versus foam and oral formulations (+0.01 QALYs) in the total UC population, whilst being cost-saving (EUR 366 per patient). Probabilistic sensitivity analysis evaluated an 86.6% probability of budesonide MMX being dominant (cost-saving with QALY gain) versus these comparators. Exploratory analysis showed similar findings versus prednisolone. LIMITATIONS: Differing definitions of trial end-points and remission across trials meant indirect comparison was not ideal. However, in the absence of head-to-head clinical data, these comparisons are reasonable alternatives and currently offer the only comparison of second-line UC treatments. CONCLUSIONS: In the present analysis, budesonide MMX was shown to be cost-effective versus comparators in the total UC population, for the second-line treatment of active mild-to-moderate UC in the Netherlands.


Assuntos
Anti-Inflamatórios/uso terapêutico , Budesonida/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Adulto , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/economia , Budesonida/administração & dosagem , Budesonida/economia , Colite Ulcerativa/patologia , Análise Custo-Benefício , Feminino , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Hospitalização/economia , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Econométricos , Países Baixos , Prednisolona/economia , Prednisolona/uso terapêutico , Anos de Vida Ajustados por Qualidade de Vida , Indução de Remissão , Índice de Gravidade de Doença
17.
Eur J Gastroenterol Hepatol ; 30(8): 868-875, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29757772

RESUMO

BACKGROUND AND AIMS: Real-life data on health resource utilization and costs of hospitalized patients with inflammatory bowel disease are lacking in Switzerland. We aimed to assess health resource utilization and costs during a 1-year follow-up period starting with an index hospitalization. PATIENTS AND METHODS: On the basis of claims data of the Helsana health insurance group, health resource utilization was assessed and costs reimbursed by mandatory basic health insurance [in Swiss Francs (CHF); 1 CHF=0.991 US$] were calculated during a 1-year follow-up period starting with an index hospitalization in the time period between 1 January 2013 and 31 December 2014. RESULTS: Of 202 002 patients with at least one hospitalization in 2013-2014, a total of 270 (0.13%) patients had inflammatory bowel disease as main diagnosis [112 (41.5%) ulcerative colitis (UC), 158 (58.5%) Crohn's disease (CD), 154/270 (57.0%) females]. In comparison with patients with UC, patients with CD were significantly more frequently treated with biologics (45.6 vs. 20.5%, P<0.001) and more frequently underwent surgery during index hospitalization (27.8 vs. 9.8%, P=0.002). Compared with patients with UC, those with CD had significantly more consultations [odds ratio (OR): 1.06, 95% confidence interval (CI): 1.01-1.12, P=0.016], higher median annual total costs (OR: 1.25, 95% CI: 1.05-1.48, P=0.012), and higher outpatient costs (OR: 1.33, 95% CI: 1.07-1.66, P=0.011). In the bivariate model, median total costs for patients with CD and those with UC were 24 270 and 17 270 CHF, respectively (P=0.032). CONCLUSION: When compared with patients with UC, hospitalized patients with CD have during a 1-year follow-up a higher rate of outpatient consultations and generate higher costs.


Assuntos
Colite Ulcerativa/economia , Colite Ulcerativa/terapia , Doença de Crohn/economia , Doença de Crohn/terapia , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Custos Hospitalares , Hospitalização/economia , /economia , Adolescente , Adulto , Assistência Ambulatorial/economia , Anti-Inflamatórios/economia , Anti-Inflamatórios/uso terapêutico , Produtos Biológicos/economia , Produtos Biológicos/uso terapêutico , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/epidemiologia , Doença de Crohn/diagnóstico , Doença de Crohn/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório/economia , Custos de Medicamentos , Feminino , Fármacos Gastrointestinais/economia , Fármacos Gastrointestinais/uso terapêutico , Humanos , Lactente , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Encaminhamento e Consulta/economia , Estudos Retrospectivos , Suíça/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
BMJ Open ; 8(4): e019184, 2018 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-29705751

RESUMO

OBJECTIVES: To undertake an economic analysis assessing the cost-effectiveness of a single dose of oral dexamethasone compared with placebo for the relief of sore throat. DESIGN: A UK-based, multicentre, two arm, individually randomised, double blind trial. SETTING AND POPULATION: Adults (≥18 years) with acute sore throat and painful swallowing judged to be infective in origin, recruited and randomised in primary care. INTERVENTION: a single dose of 10 mg oral dexamethasone compared with placebo given at primary care visit. MAIN OUTCOME: Incremental cost-effectiveness ratios (ICERs), cost per quality-adjusted symptom resolution using the EuroQol-five dimensions-five levels instrument, were estimated as part of a cost-utility analysis performed on an intention-to-treat cohort adopting a health payers perspective. RESULTS: Differences in health-related quality of life (HRQoL) over 7 days from baseline and at 24 hours in the dexamethasone compared with the placebo group (2.9% and 2.5% higher, respectively) were observed. After controlling for the baseline HRQoL imbalances, the economic impact of the intervention was not statistically significant: the quality-adjusted life year difference was -0.00005 (95% CI -0.0002 to 0.00011) equivalent to a loss in HRQoL of a half hour in the dexamethasone group. The average cost per patient associated in the dexamethasone and placebo groups in the basecase analysis was £73 and £69, respectively. In the basecase probabilistic analysis, the mean ICER was -£6440 (95% CI -£132 151 to £126 335) and the median ICER was -£304 (IQR-£5816 to £3877); suggesting considerable uncertainty. CONCLUSIONS AND RELEVANCE: The economic burden associated with sore throat is substantial and was estimated at £2.35 billion to the healthcare services payer based on reported resource use and 2015 UK unit costs. There is considerable uncertainty regarding the cost-effectiveness of a single dose of oral dexamethasone as a treatment strategy and therefore insufficient evidence to support its use in clinical practice. TRIAL REGISTRATION NUMBER: ISRCTN17435450; Post-results.


Assuntos
Anti-Inflamatórios , Dexametasona , Faringite , Adolescente , Adulto , Idoso , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/economia , Análise Custo-Benefício , Dexametasona/administração & dosagem , Dexametasona/economia , Método Duplo-Cego , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Faringite/tratamento farmacológico , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Adulto Jovem
19.
Int J Rheum Dis ; 21(5): 1106-1113, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29611342

RESUMO

AIM: The onset and progression of ankylosing spondylitis (AS) usually occurs during the life stage when individuals are more likely to be working and receiving an income, but little is known about the effects of interventions that reduce pain and improve the economic circumstances of patients out of the labour force due to AS. This study evaluates the economic benefits of pain reduction among people aged 19-64 with AS using adalimumab (Humira® ) from the patient and governmental perspectives. METHODS: We estimated the benefits of adalimumab for reducing pain in people aged 19-64 with AS in terms of labor force participation and earnings, and to the Australian Government in terms of income tax revenue and welfare payments using economic simulation. The simulation model integrated data from the Adalimumab Trial Evaluating Long-Term Safety and Efficacy for Ankylosing Spondylitis (ATLAS), the Household Income and Labour Dynamics in Australia (HILDA) Survey - Wave 10, and Static Incomes Model (STINMOD). All benefits are expressed in 2014 real Australian dollars. RESULTS: We estimated an additional 131 people aged 19-64 with AS (111 males, 20 females) would be in the labour force after using adalimumab for 24 weeks. National benefits consisted of an increase in annual earnings of AU$7.4 million for patients through increased labour force participation, savings of $2 million in annual welfare payments, and an increase of $1.3 million in income tax revenue in 2014 (after 24 weeks). CONCLUSION: Adalimumab therapy generates substantial economic benefits in addition to health benefits for individuals, and savings for government.


Assuntos
Adalimumab/economia , Adalimumab/uso terapêutico , Anti-Inflamatórios/economia , Anti-Inflamatórios/uso terapêutico , Dor nas Costas/tratamento farmacológico , Dor nas Costas/economia , Custos de Medicamentos , Manejo da Dor/economia , Espondilite Anquilosante/tratamento farmacológico , Espondilite Anquilosante/economia , Absenteísmo , Adalimumab/efeitos adversos , Adulto , Anti-Inflamatórios/efeitos adversos , Austrália/epidemiologia , Dor nas Costas/diagnóstico , Dor nas Costas/epidemiologia , Simulação por Computador , Redução de Custos , Análise Custo-Benefício , Eficiência , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Manejo da Dor/efeitos adversos , Medição da Dor , Licença Médica/economia , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/epidemiologia , Fatores de Tempo , Resultado do Tratamento
20.
J Manag Care Spec Pharm ; 24(1): 12-19, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29290173

RESUMO

BACKGROUND: The Affordable Care Act of 2010 allows the purchase of health insurance through special marketplaces called "health exchanges." The majority of individuals enrolling in the exchanges were previously uninsured, older, and sicker than other commercially insured members. Early evidence also suggests that exchange plan members use more costly specialty drugs compared with other commercially insured members. OBJECTIVES: To (a) examine patient characteristics and specialty drug use for common chronic inflammatory diseases (CIDs) among exchange plan members compared with other commercially insured members and (b) explore variations in specialty drug use within exchange plans by metal tiers (bronze, silver, gold, and platinum), as well as across local markets. METHODS: This analysis included adults aged ≥ 18 years who were enrolled in exchange plans (exchange population) and other commercial health plans (nonexchange population). The primary outcome was the likelihood of using specialty drugs prescribed to treat common CIDs, such as rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, ulcerative colitis, psoriatic arthritis, and psoriasis. The adjusted likelihood of using CID specialty drugs was calculated from logistic regression controlling for prevalence of CIDs and other health risk factors. RESULTS: A total of 931,384 exchange plan members and 2,682,855 nonexchange plan members were included in the analysis. Compared with the nonexchange population, the exchange population was older, more likely to be female, had more comorbid conditions, but filled fewer prescriptions. The 2 groups were similar in terms of CID prevalence. The observed likelihood of CID specialty drug use was 20.0% lower in the exchange versus the nonexchange populations (341 users per 100,000 exchange members vs. 427 users per 100,000 nonexchange members; P < 0.001). Within the exchange population, the observed likelihood of CID specialty drug use was 132 per 100,000 bronze plan members (69.1% lower than nonexchange); 326 per 100,000 silver plan members (23.5% lower than nonexchange); 579 per 100,000 gold plan members (35.6% higher than nonexchange); and 672 per 100,000 platinum plan members (57.5% higher than nonexchange). All differences were statistically significant at P < 0.001. There were also large differences by local market, ranging from 49.1% lower to 75.8% higher CID use in the exchange population than in the nonexchange population. After adjustment, the exchange population was 16.6% less likely to use CID specialty drugs than the nonexchange population (P < 0.001). Large variation in specialty drug use within the exchange plan metal tiers was reduced. After adjustment, the higher use of CID specialty drugs among the exchange population in certain local plans was no longer statistically significant. CONCLUSIONS: Members insured through exchange plans were older and sicker than those with nonexchange plans, but they did not use more CID specialty drugs compared with the nonexchange population. Large variations were seen among the exchange plan metal tiers and by local markets, which were often related to the risk profiles of exchange plan enrollees. DISCLOSURES: Funding for this study was provided by Anthem. Anthem had no role in study design, data interpretation, manuscript development, or the decision to publish. Chen, Gautam, DeVries, and Sylwestrzak are employees of HealthCore, a wholly owned subsidiary of Anthem. Richards is an employee of Anthem. Ruggieri is a former employee of Anthem and a current employee of MedImpact Healthcare Systems. Study concept and design were contributed by Ruggieri, Richards, DeVries, and Sylwestrzak. Chen took the lead in data collection, along with Gautam. Data interpretation was performed by Chen, along with the other authors. The manuscript was written by Chen, Gautam, Sylwestrzak, and DeVries and revised by Chen, Gautam, and Sylwestrzak, along with the other authors.


Assuntos
Anti-Inflamatórios/economia , Inflamação/tratamento farmacológico , Seguro de Serviços Farmacêuticos/economia , Patient Protection and Affordable Care Act/economia , Medicamentos sob Prescrição/economia , Adulto , Fatores Etários , Idoso , Anti-Inflamatórios/uso terapêutico , Doença Crônica/tratamento farmacológico , Doença Crônica/economia , Feminino , Humanos , Inflamação/economia , Seguro de Serviços Farmacêuticos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act/estatística & dados numéricos , Medicamentos sob Prescrição/uso terapêutico , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
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