Objective: This article aims to calculate the impact of orphan drugs on the Belgian drug budget in 2008 and to forecast its impact over the following 5 years.Method: The 2008 budget impact was calculated by triangulating information derived from multiple Belgian data sources. The 2008–2013 budget impact analysis was based on three scenarios reflecting different levels of growth in the number of registered orphan drugs in the European Union, the number of drugs reimbursed in Belgium, and the average annual cost per patient per drug in Belgium.Results: The orphan drug budget impact amounted to €66.2 million (or 5% of the Belgian hospital drug budget) in 2008. The impact would increase to €130–204 million in 2013, depending on the scenario.Conclusions: This static analysis measured orphan drug costs only, assuming that other components of health expenditure do not change over time. The analysis showed that the budget impact of orphan drugs in Belgium is substantial and rising, thereby putting pressure on total drug expenditure. Policy options to address the rising budget impact include pricing linked to return on investment, risk-sharing arrangements and re-appraisal of orphan drug status if additional indications are approved. 相似文献
Objective: One quit attempt with varenicline has been found to be a cost-effective smoking cessation intervention. The purpose of this study was to analyze varenicline’s cost-effectiveness in patients who relapse during or after the first treatment. A comparison was made between re-treatment schema with varenicline and re-treatment schema with bupropion, NRT and unaided cessation, and treatment once with varenicline in a Finnish context.
Methods: The two-quit version of BENESCO Markov model was used to follow a cohort of smokers making up to two quit attempts over a lifetime. The abstinence rates of the interventions were derived from a Cochrane review. Gender- and age-specific data on the incidence and prevalence of five smoking-related diseases were included in the model. Quality-adjusted life-years, total expected costs, and the lifetime cumulative incidence of smoking-related morbidities and mortality were the primary outcomes evaluated.
Results: The study cohort comprised 116,533 smokers who were willing to make a quit attempt. In the lifetime simulation, re-treatment with varenicline yielded 6,150–20,250 extra quitters, depending on the comparator. Among these quitters it was possible to prevent 899–2,972 additional cases of smoking-related diseases, and 395–1,307 deaths attributable to smoking. Re-treatment with varenicline resulted in cost savings of up to 54.9 million Euros. Re-treatment with varenicline dominated all the other smoking cessation interventions used in the analysis. Sensitivity analysis supported the robustness of the base case results.
Limitations: The analysis did not consider adverse events, and included only five major smoking-related diseases, which is a conservative approach, and probably leads to under-estimation of cost-effectiveness of cessation interventions. Furthermore, assumptions of constant relative risks for smoking-related diseases for each smoking status and the proxy values used as efficacy estimates of second quit attempts for other interventions than varenicline are limitations.
Conclusions: A second quitting effort with varenicline is economically justifiable. 相似文献
We test the predictive accuracy of forecasts of the number of COVID-19 fatalities produced by several forecasting teams and collected by the United States Centers for Disease Control and Prevention for the epidemic in the United States. We find three main results. First, at the short horizon (1 week ahead) no forecasting team outperforms a simple time-series benchmark. Second, at longer horizons (3 and 4 week ahead) forecasters are more successful and sometimes outperform the benchmark. Third, one of the best performing forecasts is the Ensemble forecast, that combines all available predictions using uniform weights. In view of these results, collecting a wide range of forecasts and combining them in an ensemble forecast may be a superior approach for health authorities, rather than relying on a small number of forecasts. 相似文献
This article studies the optimal intertemporal allocation of resources devoted to the prevention of deterministic infectious diseases that admit an endemic steady-state. Under general assumptions, the optimal control problem is shown to be formally similar to an optimal growth model with endogenous discounting. The optimal dynamics then depends on the interplay between the epidemiological characteristics of the disease, the labor productivity and the degree of intergenerational equity. Phase diagrams analysis reveals that multiple trajectories, which converge to endemic steady-states with or without prevention or to the elimination of the disease, are feasible. Elimination implies initially a larger prevention than in other trajectories, but after a finite date, prevention is equal to zero. This “sooner-the-better” strategy is shown to be optimal if the pure discount rate is sufficiently low. 相似文献
