Clinical and economic evaluation of exenatide for formulary decisions

Summary

This study was designed to provide an assessment for healthcare organisations to make formulary decisions on Byetta®* (exenatide).

The drug was shown to be efficacious in treating type 2 diabetes mellitus when used as adjunctive therapy with other oral antidiabetic drugs. The Centre for Outcomes Research Diabetes Model analyses suggested that the drug treatment fails to achieve a threshold level of the incremental cost-effectiveness ratio until 50 years have passed. Sensitivity analyses suggested that maintaining an appropriate haemoglobin A_1c level is essential for the treatment to be cost effective. A budget impact analysis with a hypothetical plan produced a 2.1 cent base case compliance-adjusted, per member per month cost in Year 1. One-way sensitivity analyses indicated that the two major determinants are compliance and the percentage of individuals expected to be on exenatide.

The author's conclude that further research is needed to include exenatide for the formulary decision.     

Clinical and economic evaluation of olanzapine-fluoxetine HCl combination in the treatment of bipolar depression: a managed care approach

Summary

This study was aimed to provide a clinical and economic assessmentfor health care organisations to make formulary decisions on Symbyax? (olanzapine-fluoxetine HCl combination). The combination drug was shown to be efficacious in treating bipolar depression. However, more compelling evidence is needed for the long-term effect, the effect in a more general population, its comparative advantage over other treatments, its adverse effects, and its efficacy and safety in sub-populations. Results of the budget impact analysis indicated that adding the drug to the formulary would increase medication cost per member per month (PMPM) from $1.150 to $1.172 in the base case scenario. One-way sensitivity analysis showed a rough band of a $0.21 decrease to a $0.26 increase in PMPM cost, by varying one factor at a time while holding all others at base-case levels. Further research is needed for the formulary decision of adding olanzapine-fluoxetine HCI combination drug.     

Budget impact analysis of darbepoetin alfa every 3 weeks versus epoetin alfa every week for the treatment of chemotherapy-induced anaemia from a US payer's perspective

Abstract

Objective: This analysis was conducted to compare the direct medical costs of treatment with darbepoetin alfa every 3 weeks (Q3W) and epoetin alfa every week (QW) in patients with chemotherapy-induced anaemia (CIA) from the payer's perspective.

Methods: An analysis was conducted from a US health plan perspective to compare the annual budget impact for CIA with darbepoetin alfa Q3W and epoetin alfa QW over a 16-week treatment period. Dosing regimens were obtained from registration clinical trials.

Results: Mean doses, including dose adjustments, were 375.6 μg Q3W for darbepoetin alfa and 43,187 U QW for epoetin alfa. Costs of medical resources included drug acquisition and administration costs. The base case analysis resulted in a per-patient budget impact of $8,544 and $8,667 for darbepoetin alfa and epoetin alfa, respectively. Per member per month cost was $0.90 for darbepoetin alfa and $0.91 for epoetin alfa, based on an estimate of 2,735 CIA patients in a health plan population of 2.17 million. The analysis was most sensitive to drug dose, treatment period and drug price.

Conclusions: Results suggest that per-patient direct medical costs of CIA treatment, when initiated at labelled starting doses, are comparable for darbepoetin alfa Q3W and epoetin alfa QW.     

Clinical and economic impact of rivaroxaban on the burden of atrial fibrillation: The case study of Japan

Objectives: Atrial fibrillation (AF) affects an estimated 1.5 million individuals in Japan, increasing their stroke risk and imposing considerable costs on the Japanese healthcare system. To reduce stroke incidence, guidelines recommend using anticoagulants in moderate-to-high risk non-valvular AF (NVAF) patients; however, many patients receive no treatment, aspirin only, or remain poorly-controlled on vitamin K antagonists (VKAs) due to high VKA discontinuation rates and non-adherence to guidelines. A prevalence-based Markov model was developed to estimate the clinical and budgetary impact of treating these patients with Xarelto^TM (rivaroxaban, Bayer AG) in Japan.

Methods: Population, baseline risk of events, and associated management costs were estimated using data from Japanese publications where available. Treatment efficacy and safety were derived from published data and the J-ROCKET AF trial. Drug and physician visit costs were based on data from the Ministry of Health, Labor, and Welfare, the J-ROCKET AF trial, and Japanese clinical guidelines.

Results: This model demonstrates that increased use of rivaroxaban in inadequately-managed NVAF patients could avoid 456 081 non-fatal ischemic strokes (IS) and 76 975 cardiovascular deaths over 10 years in Japan. This clinical benefit offsets the increased incidence of myocardial infarctions and anticoagulant-related bleeding. Decreased event costs could lead to a ¥188.4 billion decrease in net spending over the analysis time horizon.

Conclusions: Introducing rivaroxaban may decrease the burden of NVAF in Japanese society. From a clinical perspective, the reduction in IS and embolic events outweighs the increased risk of anticoagulant-related bleeding; from an economic perspective, reduced event costs offset drug and physician visit costs, resulting in cost savings.     

高校如何实现财务预决算执行效益

预算是财政年度的开始,决算是财政年度的结果,预算又是国家管理社会经济事务、实施宏观调控的重要手段,并为深化财税体制改革,建立完善社会主义市场经济给公共财政、审计机关开展预算执行审计检查工作指明了方向。本文就审视的层面对预算编制、执行过程中存在的具体问题举一反三分析探究,最终实现效益为目标。     

Addressing shortfalls in TIA care in the UK: an economic perspective

Abstract

Objective: To estimate the clinical outcomes and costs associated with reconfiguring the management of TIA in the UK to offer patients rapid access to outpatient clinics for specialist assessment and treatment.

Methods: An economic deterministic model was run comparing two pathways – one arm representing current clinical care based on national guidelines and clinical practice and patient referral to a weekly outpatient clinic, and a revised care pathway replicating phase 2 of the EXPRESS study with patient referral to a daily outpatient clinic. The outcomes of the model were measured in terms of recurrent strokes avoided and net budget impact to secondary care.

Results: Reconfiguring TIA care pathways in the UK could result in the avoidance of 8,164 recurrent stroke events. The model predicts savings of £25,573,279 for the UK healthcare system over 12 months. Annual net savings are predicted in England (£24,916,011), Scotland (£80,554) and Northern Ireland (£1,041,817). In Wales, increased costs of £450,435 are estimated.

Limitations: Using the data published from the EXPRESS study, it is not possible to model a stepwise approach to implementing the revised TIA care pathway. It is therefore assumed that it would be possible to implement the revised TIA care pathway as detailed in the EXPRESS study across the UK and achieve the reduction in recurrent stroke risk that was reported.

Conclusions: The model suggests that the reconfiguration of TIA care pathways in the UK to offer rapid access to treatment and assessment could prevent TIA-related future stroke events and potentially result in cost savings to the healthcare system.     

当前我国政府预算存在的突出问题及对策

在当前政府预算中存在着透明度低、预算不完整、约束力弱等问题,这使得在预算执行时公众对预算的监督软弱无力、刚性约束不足,也易滋生腐败.解决这些问题的根本办法,在于实行公开预算、接受公众监督,编制统一预算、避免预算外收支不受控制,细化部门预算、实现零基预算,落实刚性预算,不断提高公共预算的法律权威.     

后金融危机时代英国科研经费投入的特点和趋势

科学预算是2010年英国科学界的一件大事。2010年12520日英国商业、创新与技能部具体公布了4年经费分配方案,标志着政府新科学预算的最终出台。按照英国财政的复合预算体系,本次科学预算包括资源性预算和资本性预算两部分,共计年平均投入50．5亿英镑,与2007年实际投入相比下降33．76％,主要以支持“核心科研”为主,其中,资本性经费大幅消减。这种预算支出规模,意味着英国在未来4年不太可能启动新的重大项目,对购买和建设大型科学设施、参与国际科学计划等都将产生重大影响。     

Estimated cost savings associated with the use of valsartan in heart failure in a large US health plan

Summary

Results from a large, randomised clinical trial demonstrated reduced rates of hospitalisation and mortality, and reduced length of stay associated with valsartan added to the usual care of heart failure patients not currently receiving angiotensin-converting enzyme inhibitors (ACEIs). These results were used in a budget impact model for a large US health plan. Administrative claims data were used to estimate cost savings over 1 year. In the study health plan, 63,218 patients were identified with heart failure, with 55% not currently receiving ACEI or valsartan. Using health plan-specific cost data, care for the untreated heart failure patients with valsartan would reduce hospitalisation costs from $135 million to $43 million owing to averted heart failure-related hospitalisations and shortened length of stay for the remaining hospitalisations. Economic effects of other aspects of treatment with valsartan (e.g. outpatient or physician visits or adverse events) were not considered. Taking into account only hospitalisations and the costs of valsartan therapy, net savings in the study health plan would be expected to be $64 million.     

A patent-based cross impact analysis for quantitative estimation of technological impact: The case of information and communication technology

The increasing syntheses and interactions between various technologies increase the usefulness of cross impact analysis (CIA) as a method for forecasting and analyzing them. Conventional CIA depends on an expert's qualitative judgment or intuition and thus it is difficult to evaluate quantitatively the impact of one technology on another. In this study, we employ patent analysis in CIA to examine such impacts between technologies based on multiple patent classifications. Patent information is used for facilitating quantitative and systematic approach in CIA. The distinctive feature and main contribution of the proposed approach is the overcoming of the limitations of conventional CIA, by employing conditional probabilities based on the patent information. The classification of patents, particularly the multiple classifications, is used to evaluate the relationships between technologies. As an illustration, a patent-based CIA with information and communication technologies (ICTs) was conducted. Firstly, the patent-based cross impact among ICTs was calculated. Secondly, the technology pairs were classified based on the cross impact score between ICTs. Thirdly, a cross impact network was constructed to identify the complex relation among ICTs. Finally, the changes in cross impact scores between technologies over time were analyzed. The results of this research are expected to help practitioners to forecast future trends and to develop better R&D strategies.     

构建企业全面预算管理体系的探讨

企业预算管理是国外大中型企业普遍实行的一种现代管理机制。全面预算管理制度设计是管理会计制度的一个重 要组部分。探讨上下结合的全面预算组织过程的特点及其弊端-预算松弛现象,结合中国企业自身的特点,及其全面预算管 理体系的设计原则及其制定,是十分必要的。