Cost effectiveness of posaconazole in the prophylaxis of invasive fungal infections in acute leukaemia patients for the French healthcare system

Abstract

Background:

Acute myeloblastic leukaemia (AML) patients are at high risk of suffering from invasive fungal infections (IFI). Posaconazole demonstrated higher efficacy than standard azole agents (SAA) in the prophylaxis of IFI in this population.

The authors estimated the cost effectiveness of posaconazole versus SAA in France.

Methods:

A decision-tree model was developed to compare posaconazole with SAA with the results of a published clinical trial. Clinical events were modelled with chance nodes reflecting probabilities of IFI, IFI-related death, and death from other causes. Medical resource consumption and costs were obtained from results of the clinical trial and from a dedicated survey on the costs of treating IFI using a retrospective chart review design.

Results:

IFI treatment costs were estimated using medical files from 50 AML patients from six French centres, with a proven and probable IFI, who had been followed-up for 298 days on average. Direct costs directly related to IFI were estimated at €51,033, including extra costs of index hospitalisation, costs of antifungal therapy and additional hospitalisations related to IFI treatment. The model indicated that the healthcare costs for the posaconazole strategy were €5,223 (€2,697 for prophylaxis and €2,526 for IFI management), which was €859 less than the €6,083 in costs with SAA (€469 for prophylaxis and €5614 for IFI management). A sensitivity analysis indicated that there was an 80% probability that prophylaxis using the posaconazole strategy would be superior.

Conclusion:

The findings from this analysis suggest that posaconazole use is a clinically and economically dominant strategy in the prophylaxis of IFI in AML patients, given the usual limits of economic models and the uncertainty of costs estimates.     

A cost-effectiveness analysis of using azacitidine vs. decitabine in treating patients with myelodysplastic syndromes

Abstract

Objective:

Azacitidine and decitabine are used to treat patients with myelodysplastic syndromes (MDS) in the United States (US). This study sought to assess their relative cost-effectiveness.

Design and methods:

The authors developed a cost-effectiveness Markov model (1-month cycles) tracking hypothetical cohorts of MDS patients treated with azacitidine or decitabine over 2 years. The model used a US payer perspective and 2009 costs. Health states modeled included MDS with Transfusion Dependence, MDS with Transfusion Independence, Progression to Acute Myelogenous Leukemia (AML), and Death. Incremental cost-effectiveness outcomes included cost per quality-adjusted life year (QALY), cost per life year (LY), cost per patient-month of transfusion independence, and cost per case of AML progression avoided. One-way sensitivity analyses were performed on key model parameters.

Results:

Compared to decitabine, azacitidine was associated with better survival (1.512 LYs vs 1.292), more QALYs gained (1.041 vs 0.870), more patient-months with transfusion independence (8.328 vs 6.224), and a greater proportion of patients avoiding progression to AML (50.9% vs 28.5%). Total per-patient costs over 2 years for azacitidine were lower than for decitabine ($150,322 vs $166, 212).

Limitations:

To inform and update the model over time, it will be important that randomized or observational clinical studies be conducted to directly compare azacitidine and decitabine, provide new information on how these medicines are used, and on their relative clinical effectiveness.

Conclusion:

Results demonstrate that azacitidine provides greater clinical benefit and costs less than decitabine across all key outcomes. These results accentuate the positive role of azacitidine in providing cost-effective care for MDS.     

Prasugrel vs clopidogrel in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a model-based cost-effectiveness analysis for Germany,Sweden, the Netherlands,and Turkey

Abstract

Objective:

To evaluate the long-term cost-effectiveness of 12-months treatment with prasugrel vs clopidogrel from four European healthcare systems’ perspectives (Germany, Sweden, the Netherlands, and Turkey).

Methods:

In the TRITON-TIMI 38 trial, patients with an acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) were treated with prasugrel or clopidogrel. Prasugrel reduced the composite end-point (cardiovascular death, MI, or stroke), but increased TIMI major bleeding. A Markov model was constructed to facilitate a lifetime horizon for the analysis. A series of risk equations constructed using individual patient data from TRITON-TIMI 38 was used to estimate risks of clinical events. Quality-adjusted life-years (QALYs) were derived by weighting survival time by estimates of health-related quality-of-life. Incremental cost-effectiveness is presented based on differences in treatments’ mean costs and QALYs for the licensed population in TRITON-TIMI 38, and the sub-groups of UA-NSTEMI, STEMI, diabetes, and the ‘core clinical cohort’ (<75 years, ≥60?kg, no history of stroke or TIA).

Results:

Mean cost of study drug was €364 (Turkey) to €818 (Germany) higher for prasugrel vs clopidogrel. Rehospitalization costs at 12 months were lower for prasugrel due to reduced rates of revascularization, although hospitalization costs beyond 12 months were higher due to longer life expectancy associated with lower rates of non-fatal MI in the prasugrel group. The incremental cost per QALY saved with prasugrel in the licensed population ranged from €6520 (for Sweden) to €14,350 for (Germany). Prasugrel’s cost per QALY was more favourable still in the STEMI and diabetes sub-groups of the licensed population.

Limitations:

Probabilistic analyses of the whole trial population is impractical due to the number of individual patient profiles over which population level results are calculated.

Conclusion:

Among patients undergoing PCI for ACS, treatment with prasugrel compared with clopidogrel resulted in favourable cost-effectiveness profiles from these healthcare systems’ perspectives.     

Modeling economic implications of alternative treatment strategies for acute bacterial skin and skin structure infections

Objective:

The economic implications from the US Medicare perspective of adopting alternative treatment strategies for acute bacterial skin and skin structure infections (ABSSSIs) are substantial. The objective of this study is to describe a modeling framework that explores the impact of decisions related to both the location of care and switching to different antibiotics at discharge.

Methods:

A discrete event simulation (DES) was developed to model the treatment pathway of each patient through various locations (emergency department [ED], inpatient, and outpatient) and the treatments prescribed (empiric antibiotic, switching to a different antibiotic at discharge, or a second antibiotic). Costs are reported in 2012 USD.

Results:

The mean number of days on antibiotic in a cohort assigned to a full course of vancomycin was 11.2 days, with 64% of the treatment course being administered in the outpatient setting. Mean total costs per patient were $8671, with inpatient care accounting for 58% of the costs accrued. The majority of outpatient costs were associated with parenteral administration rather than drug acquisition or monitoring. Scenarios modifying the treatment pathway to increase the proportion of patients receiving the first dose in the ED, and then managing them in the outpatient setting or prescribing an oral antibiotic at discharge to avoid the cost associated with administering parenteral therapy, therefore have a major impact and lower the typical cost per patient by 11–20%. Since vancomycin is commonly used as empiric therapy in clinical practice, based on these analyses, a shift in treatment practice could result in substantial savings from the Medicare perspective.

Conclusions:

The choice of antibiotic and location of care influence the costs and resource use associated with the management of ABSSSIs. The DES framework presented here can provide insight into the potential economic implications of decisions that modify the treatment pathway.     

脑梗死合并肺部感染临床分析

目的分析探讨急性脑梗死合并肺部感染的危险因素,以便积极预防及治疗,提高疗效,降低死亡风险。方法回顾性分析2006年12月～2013年8月本院收治的180例急性脑梗死患者,分为肺部感染组90例和非感染组90例,对相关危险因素进行对照分析。结果肺部感染组合并吞咽困难、意识障碍、大面积脑梗死以及慢性阻塞性肺疾病、冠心病、糖尿病等基础疾病较非感染组明显升高。结论年龄、COPD病史、吞咽困难、意识障碍、大面积脑梗死以及基础疾病冠心病、糖尿病是脑梗死合并肺部感染的危险因素,临床应高度重视,并积极预防及治疗。     

Acute medical unit design – The impact of rearranged patient flows

Acute Medical Units (AMUs) are instigated in many hospitals across the world. An AMU admits acute patients, mainly arriving via the emergency department, for further assessment, care and treatment for a maximum designated period. Thereafter, patients who require additional care are transferred to regular wards that also admit elective patients. The literature reports several benefits (including reductions in in-patient mortality and in the length of stay), with these conclusions mostly based on empirical findings from studies focused on acute patient performance only. This paper sheds light on the potential hospital-wide impact of implementing a range of AMU designs in terms of length of the designated period, size and transfer policy. A simulation study is performed based on data from a large Dutch hospital. When establishing an AMU, hospitals usually transfer resources from existing wards to the new AMU. This seems logical since these wards receive fewer acute admissions once an AMU is in place. However, our research shows that this transfer of resources decreases the overall performance (of the AMU and the wards) for all the AMU designs investigated. We report on the scale of these negative effects and the required reduction in the length of acute patients' stays required to compensate for these effects.     

依达拉奉联合阿托伐他汀钙治疗急性脑梗死患者的临床疗效

目的 探讨依达拉奉联合阿托伐他汀钙治疗急性脑梗死患者的疗效.方法 选取2019年1月至2020年1月于大连市中心医院神经内科住院治疗的急性脑梗死患者68例作为研究对象,据其住院病例号码随机分为他汀组与联合组,各34例.两组患者接受抗血小板聚集、改善循环、降低颅内压、改善脑水肿等基础治疗,并监测各项生命指征指标,如血压、...     

Epidemics,labour markets and unemployment: the impact of SARS on human resource management in the Hong Kong service sector

This article examines the links between epidemics and their economic consequences, specifically in terms of their impacts on labour markets and jobs. To exemplify the above, we examine the effects of SARS (Severe Acute Respiratory Syndrome) on the Hong Kong economy, its labour market and its level of employment and unemployment. The article hypothesizes that the greatest impact would be on human resource management (HRM) in the service industries and on particular sub-sectors, such as the hotel sector. It concludes that the dramatic demand and supply ‘shocks’ significantly affected both the demand for and the supply of labour in the sector, with discernible HRM consequences.     

喜炎平注射液联合抗菌药物治疗小儿急性上呼吸道感染患儿的疗效

目的 探讨喜炎平注射液联合抗菌药物治疗小儿急性上呼吸道感染患儿的疗效.方法 选取2019年7月至2020年9月沈阳市儿童医院收治的160例小儿急性上呼吸道感染患儿作为研究对象,随机分为联合组与抗菌药物组,各80例.抗菌药物组仅用抗菌药物治疗,联合组实施喜炎平注射液联合抗菌药物治疗,比较两组的治疗效果.结果 治疗后,两组...     

除湿消疹饮治疗湿热证急性湿疹36例疗效观察

目的探讨除湿消疹饮治疗急性湿疹的疗效。方法 66例皮肤科门诊患者,采取随机数字表法分为治疗组和对照组,对照组采用常规西药治疗,治疗组采用经验方除湿消疹饮治疗,比较两组疗效。结果从治疗后EASI评分分析,两组比较治疗组优于对照组。结论采用我科经验方除湿消疹饮的患者急性湿疹的症状明显好转或痊愈,效果较好。