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1.
Einstein (Sao Paulo) ; 18: eGS4442, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576910

RESUMO

OBJECTIVE: To analyze the legal demands of tiotropium bromide to treat chronic obstructive pulmonary disease. METHODS: We included secondary data from the pharmaceutical care management systems made available by the Paraná State Drug Center. RESULTS: Public interest civil action and ordinary procedures, among others, were the most common used by the patients to obtain the medicine. Two Health Centers in Paraná (Londrina and Umuarama) concentrated more than 50% of the actions. The most common specialty of physicians who prescribed (33.8%) was pulmonology. There is a small financial impact of tiotropium bromide on general costs with medicines of the Paraná State Drug Center. However, a significant individual financial impact was observed because one unit of the medicine represents 38% of the Brazilian minimum wage. CONCLUSION: Our study highlights the need of incorporating this medicine in the class of long-acting anticholinergic bronchodilator in the Brazilian public health system.


Assuntos
Broncodilatadores/economia , Medicamentos Essenciais/provisão & distribução , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Função Jurisdicional , Doença Pulmonar Obstrutiva Crônica/economia , Brometo de Tiotrópio/economia , Brasil , Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Programas Nacionais de Saúde , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo
2.
BMJ ; 365: l2191, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208954

RESUMO

Much of the burden on healthcare systems is related to the management of chronic conditions such as cardiovascular disease and chronic obstructive pulmonary disease. Although conventional outpatient cardiopulmonary rehabilitation programs significantly decrease morbidity and mortality and improve function and health related quality of life for people with chronic diseases, rehabilitation programs are underused. Barriers to enrollment are multifactorial and include failure to recommend and refer patients to these services; poor communication with patients about potential benefits; and patient factors including logistical and financial barriers, comorbidities, and competing demands that make participation in facility based programs difficult. Recent advances in rehabilitation programs that involve remotely delivered technology could help deliver services to more people who might benefit. Problems with intensity, adherence, and safety of home based programs have been investigated in recent clinical trials, and larger dissemination and implementation trials are under way. This review summarizes the evidence for benefit of in-person cardiac and pulmonary rehabilitation programs. It also reviews the literature on newer developments, such as home based remotely mediated exercise programs developed to decrease cost and improve accessibility, high intensity interval training in cardiac rehabilitation, and alternative therapies such as tai chi and yoga for people with chronic obstructive pulmonary disease.


Assuntos
Reabilitação Cardíaca/economia , Doença Crônica/economia , Doença Crônica/reabilitação , Custos de Cuidados de Saúde , Doença Pulmonar Obstrutiva Crônica/reabilitação , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/terapia , Humanos , Doença Pulmonar Obstrutiva Crônica/economia , Melhoria de Qualidade , Estados Unidos
3.
Value Health Reg Issues ; 18: 121-131, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31051330

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a significant and disabling condition that entails high economic burden for society. OBJECTIVE: The aim of this article is to assess cost studies of COPD and analyze cross-country cost comparisons in Asia-Pacific. METHODS: A systematic literature search from October 2000 to October 2018 was conducted using PubMed, MEDLINE, and EMBASE to identify relevant studies. Costs reported by the different studies were converted to 2017 US dollars using the consumer price index for medical care. The quality of the studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards. RESULTS: Ten studies (6 countries and 11 estimates) were identified and included for full review after consideration of the inclusion and exclusion criteria. Annual total societal costs of COPD ranged from $4398 to $23 049 per capita in Japan and $453 to $12 167 in South Korea. There were no intracountry comparison estimates for the remaining countries (Singapore: $2700; Taiwan: $4000; China: $3942; and Thailand: $1105). In addition, there were estimates of partial costs in Singapore and Taiwan. CONCLUSIONS: Results of this review showed high cost variations between countries, with estimates in 2 countries (Japan and South Korea) exceeding those in UK and USA. Wide variation in disease cost estimates will continue to exist as long as there are differences in cost methodologies, disease severities included, and data limitation. We propose that researchers conducting burden-of-illness studies use standard methods and reporting formats to support cross-country comparisons.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/economia , Ásia/epidemiologia , Custos de Cuidados de Saúde/normas , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia
4.
J Manag Care Spec Pharm ; 25(5): 612-620, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039058

RESUMO

BACKGROUND: Chronic disease is associated with increased health care resource utilization and costs. Effective development and implementation of health care management and clinical intervention programs require an understanding of health plan member enrollment and disenrollment behavior. OBJECTIVE: To examine the health plan enrollment and disenrollment behavior of commercially insured and Medicare Advantage members with established chronic disease compared with matched members without the disease of interest, using data from a large national health insurer in the United States. METHODS: This retrospective matched cohort study used administrative claims data from the HealthCore Integrated Research Database from January 1, 2006, to November 30, 2015, to identify adults with chronic disease (type 2 diabetes mellitus [T2DM], cardiovascular disease [CVD], chronic obstructive pulmonary disease [COPD], rheumatoid arthritis [RA], and breast cancer [BC]). Members with no established chronic disease (controls) were directly matched to members with established chronic disease (cases) on demographic characteristics. The earliest date on which members met the criteria for a given disease was defined as the index date. Controls had the same index date as the matched cases. All members had ≥ 12 months of continuous health plan enrollment before the index date. Outcomes included health plan member disenrollment and enrollment duration. Incidence rates per 1,000 member-years for member disenrollment were evaluated along with incidence rate ratios (relative risk) using a Poisson model. Time to disenrollment was analyzed by Cox proportional hazard models and Kaplan-Meier survival curves. Sensitivity analyses were conducted where death was included as a disenrollment event. RESULTS: 70,907 health plan members with BC (99.7% female, mean age 60.5 years); 28,883 members with COPD (52.3% female, mean age 66.7); 835,358 members with CVD (50.5% female, mean age 62.7 years); 210,936 members with T2DM (45.2% female, mean age 53.6 years); and 31,954 members with RA (72.0% female, mean age 55.5 years) were matched to controls and met the study criteria. The incidence rates of health plan disenrollment ranged from 155 to 192 members per 1,000 members per year. Compared with controls, members with chronic disease were 30%-40% less likely to disenroll from a health plan (P < 0.001 for all comparisons). Among those who disenrolled, enrollment duration ranged from 2.3 to 2.7 years among cases and 1.5 to 1.8 years among matched controls (P ≤ 0.001 for all comparisons). CONCLUSIONS: This real-world study demonstrated that members with chronic disease had a significantly lower rate of disenrollment and a longer duration of enrollment compared with matched controls and were continuously enrolled for almost a year longer than members without a diagnosed chronic disease. Understanding health plan enrollment and disenrollment behavior may provide a valuable context for determining the time frame for the effect of health care programs and initiatives. DISCLOSURES: Funding for this study was provided by HealthCore, a wholly owned subsidiary of Anthem. Chung, Deshpande, Zolotarjova, Quimbo, and Willey are employees of HealthCore. Kern and Cochetti are former employees of HealthCore. Quimbo, Cochetti, and Willey are shareholders of Anthem. HealthCore receives funding from multiple pharmaceutical companies to perform various research studies outside of the submitted work. The preliminary results of this study were presented at AMCP Nexus 2015; March 26-29, 2015; Orlando, FL, and the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2017 Conference; May 20-24, 2017; Boston, MA.


Assuntos
Artrite Reumatoide/economia , Comércio/estatística & dados numéricos , Diabetes Mellitus Tipo 2/economia , Medicare Part C/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/economia , Adulto , Idoso , Artrite Reumatoide/terapia , Doença Crônica/economia , Doença Crônica/terapia , Comércio/economia , Diabetes Mellitus Tipo 2/terapia , Feminino , Custos de Cuidados de Saúde , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Masculino , Medicare Part C/economia , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/terapia , Estudos Retrospectivos , Estados Unidos
5.
Int Arch Allergy Immunol ; 179(4): 273-280, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30999310

RESUMO

BACKGROUND: Asthma, allergic conditions, and COPD overlap, but the effect of them and their combinations on disease severity, need for drugs, use of healthcare, and costs is poorly known. OBJECTIVE: To study how different allergic diseases co-occur in asthma and allergy patients and evaluate the use of medication well as drug and healthcare costs. METHODS: Nationwide Allergy Barometer Survey was carried out in the Finnish pharmacies during 1 week in September 2016. Altogether, 956 patients (5-75 years) who purchased asthma or allergy drugs with prescription participated in 351 pharmacies. RESULTS: Of the participants, 78% reported physician-diagnosed asthma, 57% allergic rhinitis, 24% atopic eczema, 21% food allergy, 20% allergic conjunctivitis, 8% anaphylaxis, and 8% COPD. One-third of the patients had at least three conditions, and multimorbidity was common across all age groups. Disease severity increased with the number of coexisting conditions, and asthma severity also with age. Patients with asthma alone used on average 3.8 drugs with the annual costs of EUR 661. This increased to 4.9 drugs and EUR 847 in asthmatics with multimorbidity. For all participants, costs of drugs and healthcare services together during the preceding year were on average EUR 1,214, of which 56% were drug costs. The costs doubled to EUR 2,714 in 65 subjects (7%) who had both asthma and COPD. CONCLUSIONS: In asthma and allergy, multimorbidity and polypharmacy are major concerns. Disease severity, drug use, and costs increased with multimorbid conditions. To reduce the burden, allergy management should be better integrated and more comprehensive.


Assuntos
Asma/epidemiologia , Hipersensibilidade/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/economia , Criança , Pré-Escolar , Comorbidade , Custos e Análise de Custo , Uso de Medicamentos , Finlândia/epidemiologia , Humanos , Hipersensibilidade/economia , Pessoa de Meia-Idade , Farmácia , Doença Pulmonar Obstrutiva Crônica/economia , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
6.
Med Sci Monit ; 25: 2879-2885, 2019 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-31002103

RESUMO

BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common disease that occurs all over the world. Models of care, initially accessed from the clinical point of view, must also be evaluated in terms of their economic effectiveness, as health care systems are limited. The Integrated Care Model (ICM) is a procedure dedicated to patients suffering from advanced COPD that offers home-oriented support from a multidisciplinary team. The main aim of the present study was to evaluate the cost-effectiveness of the ICM. MATERIAL AND METHODS We included 44 patients in the study (31 males, 13 females) with an average age 72 years (Me=71). Costs of care were estimated based on data received from public payer records and included general costs, COPD-related costs, and exacerbation-related costs. To evaluate cost-effectiveness, cost-effectiveness analysis (CEA) was used. The incremental cost-effectiveness ratio (ICER) was calculated based on changes in health care resources utilization and the value of costs observed in 2 consecutive 6-month periods before and after introducing ICM. RESULTS Costs of care of all types decreased after introducing ICM. Demand for ambulatory visits changed significantly (p=0.037) together with a substantial decrease in the number of emergency department appointments and hospitalizations (p=0.033). ICER was more profitable for integrated care than for standard care when assessing costs of avoiding negative parameters such as hospitalizations (-227 EUR), exacerbations-related hospitalizations (-312 EUR), or emergency procedures (-119 EUR). CONCLUSIONS ICM is a procedure that meets the criteria of cost-effectiveness. It allows for avoiding negative parameters such as unplanned hospitalizations with higher economic effectiveness than the standard type of care used in managing COPD.


Assuntos
Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/métodos , Programas de Assistência Gerenciada/economia , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Análise Custo-Benefício , Progressão da Doença , Feminino , Custos de Cuidados de Saúde , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econométricos , Polônia
7.
Int J Med Inform ; 126: 147-155, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31029256

RESUMO

INTRODUCTION: The clinical course of chronic obstructive pulmonary disease (COPD) is marked by acute exacerbation events that increase hospitalization rates and healthcare spending. The early identification of future high-cost patients with COPD may decrease healthcare spending by informing individualized interventions that prevent exacerbation events and decelerate disease progression. Existing studies of cost prediction of other chronic diseases have applied regression and machine-learning methods that cannot capture the complex causal relationships between COPD factors. Thus, the exploration of these factors through nonlinear, high-dimensional but explainable modeling is greatly needed. OBJECTIVES: We aimed to develop a machine-learning model to identify future high-cost patients with COPD. Such a model should incorporate expert knowledge about causal relationships, and the method for estimating the model could provide more accurate predictions than other machine learning methods. METHODS: We used the 2011-2013 medical insurance data of patients with COPD in a large city. The data set included demographic information and admission records. Leveraging on developments in graphical modeling methods, we proposed a smooth Bayesian network (SBN) model for the prediction of high-cost individuals using medical insurance data. The modeling method incorporated some expert knowledge about causal relationships (i.e., about the Bayesian network structure). We employed a smoothing kernel based on the weighted nearest neighborhood method in the SBN model to address overfitting, case-mix effect, and data sparsity (i.e., using data about "similar patients"). RESULTS: The proposed SBN achieved the area under curve (AUC) of 0.80 and showed considerable improvement over the baseline machine-learning methods. Besides confirming the known factors from the literature, we found "region" (i.e., a suburban or urban area) to be a significant factor, and that in a 3-tier system with primary, secondary and tertiary hospitals, COPD patients who had been admitted to primary hospitals were more likely to develop into future high-cost patients than patients who had been admitted to tertiary hospitals. CONCLUSION: The proposed SBN model not only obtained higher prediction accuracy and stronger generalizability than a number of benchmark machine-learning methods, but also used the Bayesian network to capture the complex causal relationships between different predictors by incorporating expert knowledge. Furthermore, a framework was developed to establish the relationships between exposure to historical trajectory and future outcome, which can also be applied to other temporal data to model different trajectory information and predict other outcomes.


Assuntos
Teorema de Bayes , Efeitos Psicossociais da Doença , Aprendizado de Máquina , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/terapia , Idoso , Progressão da Doença , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/patologia , Medição de Risco , Máquina de Vetores de Suporte
8.
Artigo em Inglês | MEDLINE | ID: mdl-30863045

RESUMO

Purpose: Combinations of long-acting bronchodilators are recommended to reduce the rate of COPD exacerbations. Evidence from the DYNAGITO trial showed that the fixed-dose combination of tiotropium + olodaterol reduced the annual rate of total exacerbations (P<0.05) compared with tiotropium monotherapy. This study aimed to estimate the cost-effectiveness of the fixed-dose combination of tiotropium + olodaterol vs tiotropium monotherapy in COPD patients in the French setting. Patients and methods: A recently developed COPD patient-level simulation model was used to simulate the lifetime effects and costs for 15,000 patients receiving either tiotropium + olodaterol or tiotropium monotherapy by applying the reduction in annual exacerbation rate as observed in the DYNAGITO trial. The model was adapted to the French setting by including French unit costs for treatment medication, COPD maintenance treatment, COPD exacerbations (moderate or severe), and pneumonia. The main outcomes were the annual (severe) exacerbation rate, the number of quality-adjusted life-years (QALYs), and total lifetime costs. Results: The number of QALYs for treatment with tiotropium + olodaterol was 0.042 higher compared with tiotropium monotherapy. Using a societal perspective, tiotropium + olodaterol resulted in a cost increase of +€123 and an incremental cost-effectiveness ratio (ICER) of €2,900 per QALY compared with tiotropium monotherapy. From a French National Sickness Fund perspective, total lifetime costs were reduced by €272 with tiotropium + olodaterol, resulting in tiotropium + olodaterol being the dominant treatment option, that is, more effects with less costs. Sensitivity analyses showed that reducing the cost of exacerbations by 34% increased the ICER to €15,400, which could still be considered cost-effective in the French setting. Conclusion: Treatment with tiotropium + olodaterol resulted in a gain in QALYs and savings in costs compared with tiotropium monotherapy using a National Sickness Fund perspective in France. From the societal perspective, tiotropium + olodaterol was found to be cost-effective with a low cost per QALY.


Assuntos
Benzoxazinas/economia , Benzoxazinas/uso terapêutico , Broncodilatadores/economia , Broncodilatadores/uso terapêutico , Custos de Medicamentos , Pulmão/efeitos dos fármacos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/economia , Brometo de Tiotrópio/economia , Brometo de Tiotrópio/uso terapêutico , Idoso , Benzoxazinas/efeitos adversos , Broncodilatadores/efeitos adversos , Simulação por Computador , Redução de Custos , Análise Custo-Benefício , Progressão da Doença , Combinação de Medicamentos , Feminino , Volume Expiratório Forçado , França , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Brometo de Tiotrópio/efeitos adversos , Resultado do Tratamento
9.
Value Health ; 22(3): 313-321, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30832969

RESUMO

OBJECTIVES: To develop a health economic model that included a great diversity of patient characteristics and outcomes for chronic obstructive pulmonary disease (COPD), which can be used to inform decisions about stratified medicine in COPD. METHODS: The choice of patient characteristics and outcomes to include in the model was based on 3 literature reviews on multidimensional prognostic COPD indices, COPD phenotypes, and treatment effects in subgroups. A conceptual model was constructed including 14 patient characteristics, 7 intermediate outcomes (lung function, physical activity, exercise capacity, symptoms, disease-specific quality of life, exacerbations, and pneumonias), and 3 final outcomes (mortality, quality-adjusted life-years [QALYs], and costs). Regression equations describing the statistical associations between the patient characteristics and intermediate and final outcomes were estimated using the longitudinal data of 5 large COPD trials (19,378 patients). A patient-level simulation model was developed in which individual patients from the baseline population of the 5 trials are sampled and their outcomes over lifetime are predicted based on the regression equations. RESULTS: The base-case analysis (single-arm simulation representing treatment with tiotropium) showed that patients had a mean lung function decline of 43 mL/year, 0.62 exacerbations/year, a worsening of their physical activity and quality of life with 1.48 and 1.10 points/year, a life expectancy of 11.2 years, 7.25 QALYs, and total lifetime costs of £24,891. Results for a selection of treatment scenarios and subgroups were shown to demonstrate the potential of the model. CONCLUSIONS: We developed a unique patient-level simulation model that can be used to evaluate COPD treatment options for a variety of subgroups.


Assuntos
Simulação por Computador/economia , Análise Custo-Benefício/métodos , Modelos Econômicos , Doença Pulmonar Obstrutiva Crônica/economia , Simulação por Computador/tendências , Análise Custo-Benefício/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/terapia , Anos de Vida Ajustados por Qualidade de Vida
10.
PLoS One ; 14(1): e0211222, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30682190

RESUMO

PURPOSE: The objectives of this study were to analyze the characteristics of male and female patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease (AE-COPD) during 2006-2014 according to the presence or absence of bronchiectasis and to study the factors associated with in-hospital mortality (IHM) in patients hospitalized with AE-COPD and concomitant bronchiectasis. METHODS: We used the Spanish National Hospital Database to analyze patients admitted with AE-COPD as their primary diagnosis. Patients included in the study were stratified according to the presence or absence of bronchiectasis as their secondary diagnosis. RESULTS: We identified 386,646 admissions for AE-COPD, of which 19,679 (5.09%) involved patients with concomitant bronchiectasis. When patients with and without bronchiectasis were compared, we observed that the incidence of infection by Pseudomonas aeruginosa was substantially higher in the former, as were the mean stay, cost, and percentage of readmissions, although IHM and comorbidity were lower. The course of patients with AE-COPD and bronchiectasis was characterized by a gradual increase in prevalence and mean age among men and no differences in prevalence or lower mean age in women. Mortality was 4.24% and 5.02% in patients with and without bronchiectasis, respectively, although significance was lost after a multivariate adjustment (OR 0.94; 95% CI, 0.88-1.01). The factors associated with IHM were older age, higher comorbidity, isolation of P. aeruginosa, mechanical ventilation and readmission. CONCLUSIONS: The prevalence of admission with AE-COPD and bronchiectasis increased in men but not in women during the study period. In patients hospitalized with AE-COPD, we did not find differences in mortality when comparing the presence and absence of bronchiectasis. The analysis of temporal trends revealed a significant reduction in mortality from 2006 to 2014 in male patients with COPD and concomitant bronchiectasis, but not among women. It is important to consider the factors associated with IHM such as age, comorbidity, isolation of P. aeruginosa, mechanical ventilation and readmission to better identify those patients who are at greater risk of dying during hospitalization.


Assuntos
Bronquiectasia/epidemiologia , Mortalidade Hospitalar/tendências , Hospitalização/economia , Infecções por Pseudomonas/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bronquiectasia/economia , Bronquiectasia/mortalidade , Comorbidade , Feminino , Custos Hospitalares , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Prevalência , Infecções por Pseudomonas/economia , Infecções por Pseudomonas/mortalidade , Pseudomonas aeruginosa/isolamento & purificação , Pseudomonas aeruginosa/patogenicidade , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Fatores Sexuais , Espanha/epidemiologia
11.
J Manag Care Spec Pharm ; 25(2): 205-217, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30698096

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality and is associated with substantial economic burden. There is a lack of data regarding COPD outcomes and costs in a real-world setting, particularly by Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity. OBJECTIVES: To (a) characterize a commercially insured U.S. population with COPD and (b) assess prevalence of exacerbations, health care resource utilization (HCRU), costs, and treatment patterns in a cohort of patients with confirmed COPD, overall and stratified by GOLD stage. METHODS: This retrospective observational cohort study used administrative claims data from the HealthCore Integrated Research Database to identify patients with ≥ 1 inpatient, emergency room (ER), or office visit claim for COPD between January 1, 2012, and November 30, 2013, and continuous enrollment for 1 year before and 2 years after the first COPD diagnosis date. Patients with a spirometry claim within 12 months were eligible for medical record abstraction to confirm COPD diagnosis (forced expiratory volume in 1 second [FEV1]/forced vital capacity ratio < 0.7) and GOLD 1-4 classification (based on postbronchodilator FEV1 percent predicted). HCRU, costs, treatment patterns, and rate of moderate/severe exacerbation were identified from diagnosis up to 24 months. Outcomes were analyzed by univariate analysis stratified by GOLD classification. Multivariable analysis was conducted to assess associations between GOLD classification and outcomes of interest. RESULTS: 53,484 patients newly diagnosed with COPD were identified who met initial inclusion criteria: 14,293 (27%) had a qualifying spirometry claim, and 1,505 had confirmed COPD (GOLD 1, 333 [22%]; GOLD 2, 823 [55%]; GOLD 3, 317 [21%]; GOLD 4, 32 [2%]). Patients with greater disease severity had higher rates of moderate/severe COPD exacerbations (GOLD 1 and 2, 40.4 and 48.9 per 100 person-years, respectively; GOLD 3 and 4, 83.6 and 89.1 per 100 person-years, respectively). All-cause and COPD-related inpatient admissions, COPD-related office visits, and COPD-related ER visits were more prevalent with more severe GOLD classification. Mean annual COPD-related medical costs increased with GOLD classification ($5,945 for GOLD 1 patients, $18,070 for GOLD 4). COPD maintenance medication was filled by 42%, 56%, 73%, and 75% of patients in GOLD 1-4 (57% overall), respectively; combination corticosteroid/long-acting beta2-agonist inhalers were the most commonly used medication, regardless of GOLD classification. Patients with more severe disease had greater adherence (range 44%-68% of days covered for GOLD 1-4) and persistence (range 107-209 days for GOLD 1-4). CONCLUSIONS: Trends toward increases in exacerbations, HCRU, and costs were observed as airflow limitation worsened. Adherence and persistence with COPD maintenance therapy was suboptimal even with severe disease. DISCLOSURES: This study was supported by Boehringer Ingelheim Pharmaceuticals (Ridgefield, CT), which was given the opportunity to review the manuscript for medical and scientific accuracy, as well as intellectual property considerations. Willey and Singer are employees of HealthCore (parent company Anthem), which received funding from Boehringer Ingelheim to complete this study. Wallace and Shinde were employed by HealthCore at the time of this study. Wallace and Singer report stock ownership in Anthem. Napier is an employee of Anthem. Kaila, Bayer, and Shaikh are employees of Boehringer Ingelheim Pharmaceuticsls. Portions of this research were presented at the following conferences: (a) A. Wallace, S. Kaila, V. Zubek, A. Shaikh, M. Shinde, V. Willey, M. Napier, and J. Singer, Healthcare resource utilization, costs, and exacerbation rates in patients with COPD stratified by GOLD airflow limitation classification in a US commercially insured population, presented at AMCP Nexus 2017; October 16-19, 2017; Dallas, TX; and (b) A.E. Wallace, V. Zubek, S. Kaila, A. Shaikh, M. Shinde, V. Willey, M.B. Napier, and J.R. Singer, Real-world treatment patterns among newly diagnosed COPD patients according to GOLD airflow limitation severity classification in a U.S. commercially insured/Medicare Advantage population, presented at CHEST 2017 Annual Meeting; October 28-November 1, 2017; Toronto, Ontario, Canada.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Seguro Saúde/economia , Doença Pulmonar Obstrutiva Crônica/terapia , Adulto , Idoso , Estudos de Coortes , Bases de Dados Factuais , Assistência à Saúde/economia , Assistência à Saúde/estatística & dados numéricos , Feminino , Volume Expiratório Forçado , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Espirometria , Estados Unidos , Capacidade Vital
12.
Artigo em Inglês | MEDLINE | ID: mdl-30613140

RESUMO

Purpose: The aim of this study was to examine real-world differences in health care resource use (HRU) and costs among COPD patients in the USA treated with a dry powder inhaler (DPI) or pressurized metered-dose inhaler (pMDI) following a COPD-related hospitalization. Methods: This retrospective analysis used the Truven MarketScan® databases. Eligibility criteria included 1) age ≥40 years, 2) COPD diagnosis, 3) inpatient admission with a diagnosis of COPD exacerbation, 4) inhaled corticosteroid (ICS)/long-acting ß2-agonist (LABA) prescription within 10 days of hospital discharge (index date), and 5) continuous enrollment for 12 months preindex and 90 days postindex. Outcomes included pre- and postindex HRU and costs. DPI and pMDI groups were compared on postindex outcomes via multivariate models controlling for demographic and baseline characteristics. Results: The sample included 1,960 DPI and 1,086 pMDI ICS/LABA patients. During the preindex period, pMDI patients were significantly more likely to be prescribed a short-acting ß-agonist, experienced more COPD exacerbation-related hospital days, and had a greater number of pulmonologist visits compared to DPI patients (P<0.05), all suggestive of greater disease severity. However, multivariate models revealed that pMDI patients incurred 10% lower all-cause postindex costs (predicted mean costs [2016 US dollars]: $2,673 vs $2,956) and 19% lower COPD-related costs (predicted mean costs: $138 vs $169; P<0.05). Additionally, pMDI patients were 28% less likely to experience a COPD exacerbation-related hospital readmission within 60 days postdischarge compared to the DPI patients (OR: 0.72, 95% CI: 0.52-0.99, P<0.05). Conclusion: Despite greater COPD-related HRU and costs preceding index hospitalization, US patients using a pMDI after hospital discharge incurred significantly lower all-cause and COPD-related health care costs compared with those using a DPI, in addition to a decreased likelihood of a COPD exacerbation-related hospital readmission. Results suggest that inhaler device type may influence COPD outcomes and that COPD patients may derive greater clinical benefit from treatment delivered via pMDI vs DPI.


Assuntos
Corticosteroides/administração & dosagem , Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Inaladores de Pó Seco , Pulmão/efeitos dos fármacos , Inaladores Dosimetrados , Alta do Paciente , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Administração por Inalação , Corticosteroides/efeitos adversos , Corticosteroides/economia , Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Agonistas de Receptores Adrenérgicos beta 2/economia , Adulto , Idoso , Tomada de Decisão Clínica , Análise Custo-Benefício , Bases de Dados Factuais , Progressão da Doença , Combinação de Medicamentos , Custos de Medicamentos , Feminino , Custos Hospitalares , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Alta do Paciente/economia , Readmissão do Paciente , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
13.
Artigo em Inglês | MEDLINE | ID: mdl-30697043

RESUMO

Background: While the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines advise exercise to reduce disease progression, little investment in promoting physical activity (PA) is made by health care authorities. The purpose of this study was to estimate the cost-effectiveness of regular PA vs sedentary lifestyle in people with COPD in the UK. Methods: Efficacy, quality of life, and economic evidence on the PA effects in COPD patients were retrieved from literature to serve as input for a Markov microsimulation model comparing a COPD population performing PA vs a COPD population with sedentary lifestyle. The GOLD classification defined the model health states. For the base case, the cost of PA was estimated at zero, a lifetime horizon was used, and costs and effects were discounted at 3.5%. Analyses were performed from the UK National Health Service (NHS) perspective. Uncertainty around inputs and assumptions were explored via scenario and sensitivity analyses, including a cost threshold analysis. Outcomes were cost/quality-adjusted life year (QALY) gained and cost/year gained. Results: Based on our model, the effects of PA in the UK COPD population would be lower mortality (-6%), fewer hospitalizations (-2%), gains in years (+0.82) and QALYs (+0.66), and total cost savings of £2,568. The cost/QALY and cost/year gained were dominant. PA was cost-saving at costs <£35/month and cost-effective at cost <£202/month. The main model drivers were age and PA impact on death and hospital-treated exacerbations. Conclusion: Including PA in the management of COPD leads to long-term clinical benefits. If the NHS promotes only exercise via medical advice, this would lead to health care cost savings. If the NHS chose to fund PA, it would still likely be cost-effective.


Assuntos
Exercício , Custos de Cuidados de Saúde , Promoção da Saúde/economia , Estilo de Vida Saudável , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/terapia , Comportamento de Redução do Risco , Idoso , Idoso de 80 Anos ou mais , Simulação por Computador , Redução de Custos , Análise Custo-Benefício , Progressão da Doença , Tolerância ao Exercício , Feminino , Promoção da Saúde/métodos , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Econômicos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Anos de Vida Ajustados por Qualidade de Vida , Comportamento Sedentário , Fatores de Tempo , Reino Unido
14.
Int J Chron Obstruct Pulmon Dis ; 13: 3867-3877, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30568438

RESUMO

Background: Indacaterol 27.5 µg/glycopyrrolate 15.6 µg (IND/GLY 27.5/15.6 µg) inhalation powder, a twice-daily, fixed-dose combination of a long-acting beta2-agonist (LABA) and a long-acting antimuscarinic antagonist (LAMA), is indicated in the US for long-term maintenance treatment of airflow obstruction in patients with COPD. The safety and efficacy of IND/GLY 27.5/15.6 µg have been established, but cost-effectiveness is not yet known. This study compared the cost-effectiveness of IND/GLY 27.5/15.6 µg with other long-acting COPD maintenance therapies. Methods: A Markov model was constructed from the US payer perspective. Health states were defined as mild (post-bronchodilator FEV1 ≥80% of predicted), moderate (50% ≤FEV1 <80% of predicted), severe (30% ≤FEV1 <50% of predicted), and very severe (FEV1 <30% of predicted) COPD. Patients entering the model transitioned through health states based on placebo-adjusted change from baseline in trough FEV1 for each comparator at week 12. Comparators included other US Food and Drug Administration-approved LABA/LAMA fixed-dose combinations as well as commonly prescribed LAMA and LABA/inhaled corticosteroid agents. One-way and probabilistic sensitivity analyses were conducted to test the model assumptions and the overall robustness of the results. Results: Using the model, IND/GLY 27.5/15.6 µg treatment for 12 weeks resulted in total costs of US $23,375 vs US $9,365 for placebo. Compared with placebo, IND/GLY 27.5/15.6 treatment resulted in the highest improvement in FEV1 across all comparators and the lowest cost per decline in 100 mL FEV1. IND/GLY 27.5/15.6 µg was also among the most cost-effective treatment option as measured by St George's Respiratory Questionnaire response rate, at US $3,518 per additional responder at 12 weeks compared with placebo. In addition, IND/GLY 27.5/15.6 µg had the lowest cost per severe exacerbation avoided vs placebo across all comparators (US $87,686). Conclusion: This model, developed from the US payer perspective with a 5-year time horizon, found IND/GLY 27.5/15.6 µg to be a cost-effective treatment option for patients with moderate to severe COPD.


Assuntos
Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Agonistas de Receptores Adrenérgicos beta 2/economia , Broncodilatadores/administração & dosagem , Broncodilatadores/economia , Custos de Medicamentos , Glicopirrolato/administração & dosagem , Glicopirrolato/economia , Indanos/administração & dosagem , Indanos/economia , Pulmão/efeitos dos fármacos , Antagonistas Muscarínicos/administração & dosagem , Antagonistas Muscarínicos/economia , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/economia , Quinolonas/administração & dosagem , Quinolonas/economia , Administração por Inalação , Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Broncodilatadores/efeitos adversos , Análise Custo-Benefício , Esquema de Medicação , Volume Expiratório Forçado , Glicopirrolato/efeitos adversos , Humanos , Indanos/efeitos adversos , Pulmão/fisiopatologia , Cadeias de Markov , Modelos Econômicos , Antagonistas Muscarínicos/efeitos adversos , Nebulizadores e Vaporizadores/economia , Pós , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Quinolonas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
15.
Value Health Reg Issues ; 16: 112-118, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30539739

RESUMO

BACKGROUND: Chronic obstructive pulmonary disease (COPD) represents an illness with significant healthcare and societal impacts. Fixed combinations of long-acting beta-agonists (LABA) and inhaled corticosteroids have been used for COPD treatment as the standard of care for many years. A daily dose of indacaterol and glycopyrronium (IND/GLY) at 110/50 µg has recently been gaining attention due to its improved efficacy and tolerability versus the standard of care.The study aims to evaluate the cost-effectiveness of once daily IND/GLY vs. twice daily salmeterol/fluticasone propionate (SFC) at 50/500 µg in COPD patients. METHODS: A microsimulation model in MS Excel was adapted to the Czech setting. Effectiveness data and disease severity stages were obtained from the FLAME study, which is a head-to head trial comparing IND/GLY vs. SFC. Quality of life data were derived from a literature review. Costs (medication, monitoring and complications) were taken from published Czech sources. The incremental cost-effectiveness ratio (ICER) was expressed as cost per quality-adjusted life year (QALY) gained. Costs and outcomes were discounted at 3 %. A lifetime horizon was used for the analysis. Cost-effectiveness was studied from the perspective of a health care system in the Czech Republic. RESULTS: Mean QALYs were higher in the IND/GLY arm (difference 0.167 QALYs). The ICER of IND/GLY compared with SFC was €13,628 per QALY gained. Deterministic sensitivity analyses and probabilistic sensitivity analyses confirmed the base-case result to be robust. CONCLUSIONS: From the perspective of the Czech health care system, managing COPD using IND/GLY is cost-effective in this analysis because the base-case is clearly below the willingness-to-pay threshold in the Czech Republic, which is automatically set at 3 times GDP/capita (approximately €44,000/ QALY). This is the first available economic analysis utilizing FLAME study results in the Central East European (CEE) countries showing IND/ GLY as a highly cost-effective investment into COPD patients.


Assuntos
Broncodilatadores/administração & dosagem , Análise Custo-Benefício , Combinação Fluticasona-Salmeterol/administração & dosagem , Glicopirrolato/administração & dosagem , Indanos/administração & dosagem , Antagonistas Muscarínicos/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Quinolonas/administração & dosagem , República Tcheca , Feminino , Humanos , Masculino , Doença Pulmonar Obstrutiva Crônica/economia , Anos de Vida Ajustados por Qualidade de Vida
16.
Curr Med Sci ; 38(3): 558-566, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30074226

RESUMO

In the past few decades, Chinese government attempted to reduce the economic burden of chronic diseases and lower family financial risk of patients by establishing a nationwide coverage of Social Health Insurance system. However, the payment mode of Social Health Insurance varies across Chinese healthcare settings, and the effectiveness of each mode differs. This study aimed to evaluate the effects of integrated case payment on medical expenditure and readmission of inpatients with chronic obstructive pulmonary disease (COPD), a complex, multicomponent, chronic condition. A nonrandomized, comparative method was used in this study. Inpatients with COPD before (n=1569) and after the integrated case payment reform (n=4764) were selected from the inpatient information database of the New Cooperative Medical Scheme Agency of Xi County. The integrated case payment comprises the case payment (including price-cap case payment and fixed-reimbursement case payment) and clinical pathway (including clinical pathway A, clinical pathway B and clinical pathway C). Effects of integrated case payment were evaluated with indicators of per capita total medical expense and readmission within 30 days. A multivariate linear regression and a binary logistic regression were used to conduct statistical analysis. The results showed that case payment, comprising price-cap case payment ß=2382.988, P<0.001) and fixed-reimbursement case payment ß=2613.564, P<0.001), and clinical pathway C ß=1996.467, P<0.001) were risk factors of per capita total medical expenses. Clinical pathway A ß=1443.409, P<0.001) and clinical pathway B ß=1583.791, P<0.001) were protective factors. The interactive effects of case payment with hospital level ß=0.710, P<0.001) lowered the readmission rate within 30 days. Meanwhile, clinical pathways A ß=18.949, P<0.001), B (ß=19.152, PO.OOl) and C ß=1.882, P<0.001) were associated with the rate increase. The findings revealed that integrated case payment ensured the quality of care for inpatients with COPD to some extent. However, this payment mode increased the per capita total medical expense. Further, policy-makers should set reasonable reimbursement standards of case payment, unify the type of case payment, and strengthen the supervision of the reform to enhance its function on medical cost control.


Assuntos
Gastos em Saúde , Pacientes Internados , Readmissão do Paciente/economia , Doença Pulmonar Obstrutiva Crônica/economia , Idoso , China , Procedimentos Clínicos , Hospitais , Humanos , Tempo de Internação , Modelos Lineares , Análise Multivariada
17.
Int J Chron Obstruct Pulmon Dis ; 13: 1289-1296, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29719384

RESUMO

Background and aim: Deprivation is associated with the incidence of COPD, but its independent impact on clinical outcomes is still relatively unknown. This study aimed to explore the influence of deprivation on health care use, costs, and survival. Methods: A total of 424 outpatients with COPD were assessed for deprivation across two hospitals. The English Index of Multiple Deprivation (IMD) was used to establish a deprivation score for each patient. The relationship between deprivation and 1-year health care use, costs, and mortality was examined, controlling for potential confounding variables (age, malnutrition risk, COPD severity, and smoking status). Results: IMD was significantly and independently associated with emergency hospitalization (ß-coefficient 0.022, SE 0.007; p=0.001), length of hospital stay, secondary health care costs (ß-coefficient £101, SE £30; p=0.001), and mortality (HR 1.042, 95% CI 1.015-1.070; p=0.002). IMD was inversely related to participation in exercise rehabilitation (OR 0.961, 95% CI 0.930-0.994; p=0.002) and secondary care appointments. Deprivation was also significantly related to modifiable risk factors (smoking status and malnutrition risk). Conclusion: Deprivation in patients with COPD is associated with increased emergency health care use, health care costs, and mortality. Tackling deprivation is complex; however, strategies targeting high-risk groups and modifiable risk factors, such as malnutrition and smoking, could reduce the clinical and economic burden.


Assuntos
Custos de Cuidados de Saúde , Recursos em Saúde , Disparidades em Assistência à Saúde , Pobreza , Doença Pulmonar Obstrutiva Crônica , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Comorbidade , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Humanos , Tempo de Internação/economia , Masculino , Desnutrição/economia , Desnutrição/mortalidade , Desnutrição/terapia , Pessoa de Meia-Idade , Estado Nutricional , Admissão do Paciente/economia , Prognóstico , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fumar/efeitos adversos , Fumar/mortalidade , Fatores de Tempo
18.
Int J Chron Obstruct Pulmon Dis ; 13: 1251-1260, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29713158

RESUMO

Background: Asthma and COPD are heterogeneous diseases. Patients with both disease features (asthma-COPD overlap [ACO]) are common. However, clinical characteristics and socio-economic burden of ACO are still controversial. The aim of this study was to identify the heterogeneity of ACO and to find out the subtypes with clinical impact among ACO subtypes. Methods: In the Korean National Health and Nutrition Examination Survey (KNHANES) conducted between 2007 and 2012, subjects who were ≥40 years and had prebronchodilator FEV1/FVC <0.7 and FEV1 ≥50% predicted were included. The presence or absence of self-reported wheezing was indicated by W+ or W- and used as an index of airway hyper-responsiveness. S+/S- was defined as subjects who were smokers/never smokers. The subjects were divided into the following four groups: W-S-, W-S+, W+S-, and W+S+. W+S- and W+S+ were asthma-predominant ACO and COPD-predominant ACO, respectively. KNHANES and linked National Health Insurance data were analyzed. Results: The asthma-predominant ACO group showed the lowest socioeconomic status, FEV1, FVC% predicted, and quality of life (QoL) levels. The COPD-predominant ACO group showed the highest hospitalization rate, outpatient medical cost, and total and outpatient health care utilization. COPD-predominant ACO was associated with exacerbations compared to the W-S- group (adjusted odds ratio [aOR], 1.79; 95% confidence interval [CI], 1.12-2.85; P=0.015) and W-S+ group (OR 2.11; 95% CI 1.43-3.10; P<0.001). COPD-predominant ACO was associated with increased medical cost. Conclusion: Asthma-predominant ACO individuals displayed poorer socioeconomic status and QoL compared to the COPD-predominant ACO group. The COPD-predominant ACO group displayed more frequent exacerbations and greater medical costs. Considering the heterogeneity of ACO, it is desirable to identify subtypes of ACO patients and appropriately allocate limited medical resources.


Assuntos
Asma/epidemiologia , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/economia , Asma/fisiopatologia , Asma/terapia , Progressão da Doença , Feminino , Volume Expiratório Forçado , Custos de Cuidados de Saúde , Recursos em Saúde/estatística & dados numéricos , Nível de Saúde , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Fenótipo , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , República da Coreia/epidemiologia , Índice de Gravidade de Doença , Fatores Socioeconômicos , Capacidade Vital
19.
Ther Innov Regul Sci ; 52(1): 94-99, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29714617

RESUMO

BACKGROUND: The care transition is the time when more medication errors occur. The aim of this study is to analyze the usefulness of a pharmacotherapeutic report model at hospital discharge to prevent medication errors and to simplify pharmacotherapy during a patient's transition from the hospital to primary care. METHODS: Prospective study including patients diagnosed with chronic obstructive pulmonary disease who were admitted to a short-stay unit or an emergency room. Relevant variables were extracted from the patients' clinical history and SPSS software was used to carry out the statistical analysis. Direct costs were also calculated. RESULTS: 79.3% of patients were polymedicated, 15.5% of patients were identified as nonadherent to the treatment, 12.1% were users of alternative therapies, and 10.3% had been prescribed drugs that could be monitored. In 32.8% of the reports, reference was made to the primary care pharmacists with a view to resolve any pharmacotherapeutic discrepancies. A total of 132 discrepancies were identified, the majority being related to medicinal requirements (necessary/unnecessary medication). The major cause of drug-related problems (DRPs) were prescription errors. The drugs that were mainly involved in the onset of DRPs belonged to the R group, and the degree of simplification of the pharmacotherapy was 7.6%. The total cost avoided with the reconciliation was 200€/patient. CONCLUSION: A continuity program was implemented based on the drafting of a pharmacotherapeutic report, which allowed for detecting discrepancies and updating the patients' pharmacotherapeutic history, resulting in financial savings after its implementation.


Assuntos
Erros de Medicação/prevenção & controle , Reconciliação de Medicamentos/métodos , Alta do Paciente , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Redução de Custos , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Doença Pulmonar Obstrutiva Crônica/economia
20.
Int J Chron Obstruct Pulmon Dis ; 13: 1079-1088, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29670344

RESUMO

Objective: The aim of this study was to evaluate the cost-effectiveness of the long-acting beta-2 agonist (LABA)/long-acting muscarinic antagonist (LAMA) dual bronchodilator indacaterol/glycopyrronium (IND/GLY) as a maintenance treatment for COPD patients from the perspective of health care payer in Taiwan. Patients and methods: We adopted a patient-level simulation model, which included a cohort of COPD patients aged ≥40 years. The intervention used in the study was the treatment using IND/GLY, and comparators were tiotropium or salmeterol/fluticasone combination (SFC). Data related to the efficacy of drugs, incidence of exacerbation, and utility were obtained from clinical studies. Direct costs were estimated from claims data based on the severity of COPD. The cycle length was 6 months (to match forced expiratory volume in 1 second [FEV1] data), and the time horizons included 1, 3, 5, 10 years, and lifetime. Deterministic and probabilistic sensitivity analyses were conducted to test the robustness of the model results. Costs were expressed in US dollars with a discount rate of 3.0%. Results: Compared to tiotropium and SFC, the incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year (QALY) gained of patients treated with IND/GLY were US$5,987 and US$14,990, respectively. One-way sensitivity analysis revealed that the improvement in FEV1 provided by IND/GLY, the distribution of patients with regard to the severity of COPD, and acute exacerbation rate ratio were the key drivers behind cost-effectiveness. Adopting a willingness to pay of US$60,000 per QALY gained as the threshold, there was a 98.7% probability that IND/GLY was cost-effective compared to tiotropium. Similarly, there was a 99.9% probability that IND/GLY was cost-effective compared to SFC. Conclusion: As a maintenance treatment for COPD, we consider the dual bronchodilator IND/GLY as a cost-effective strategy when compared to either tiotropium or SFC.


Assuntos
Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Agonistas de Receptores Adrenérgicos beta 2/economia , Broncodilatadores/administração & dosagem , Broncodilatadores/economia , Custos de Medicamentos , Glicopirrolato/administração & dosagem , Glicopirrolato/economia , Indanos/administração & dosagem , Indanos/economia , Pulmão/efeitos dos fármacos , Antagonistas Muscarínicos/administração & dosagem , Antagonistas Muscarínicos/economia , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/economia , Quinolonas/administração & dosagem , Quinolonas/economia , Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Adulto , Broncodilatadores/efeitos adversos , Simulação por Computador , Análise Custo-Benefício , Progressão da Doença , Feminino , Volume Expiratório Forçado , Glicopirrolato/efeitos adversos , Humanos , Indanos/efeitos adversos , Pulmão/fisiopatologia , Masculino , Modelos Econômicos , Antagonistas Muscarínicos/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Quinolonas/efeitos adversos , Índice de Gravidade de Doença , Taiwan , Fatores de Tempo , Resultado do Tratamento
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