Cost-effectiveness of prasugrel in a US managed care population

Abstract

Objective:

Decision-makers in the US may be interested in the applicability to their populations of cost-effectiveness results generated from clinical trial populations.

Methods:

An economic model estimating the cost-effectiveness of prasugrel plus aspirin relative to clopidogrel plus aspirin for patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) was developed from a managed care organization (MCO) perspective. The model estimated 15-month cardiovascular events or bleeding-related outcomes, life expectancy, and costs for patients who received thienopyridine treatment during and after a PCI following a diagnosis of ACS. Post-ACS event rates for patients treated with clopidogrel were from an MCO. The relative risks of these events with prasugrel compared with clopidogrel were from a head-to-head clinical trial.

Results:

The results of the base-case analysis indicated that, in an MCO population, use of prasugrel-based therapy rather than clopidogrel-based therapy at current prices resulted in cost-savings and fewer clinical events over the 15 months after an ACS diagnosis followed by PCI. At possible lower prices for generic clopidogrel-based therapy, the cost-effectiveness ratio for prasugrel-based therapy compared with clopidogrel-based therapy was between $6643 and $13,906 per life-year gained. The results were most sensitive to the relative costs of the two treatments and the cost for hospital stays.

Limitations:

Limitations of the study included lack of follow-up of patients disenrolling from the MCO before the end of the 15-month observation period, the assumption of equal relative risks of events in an MCO as in the clinical trial, and the lack of information on the ratio of cost to charges in the MCO database.

Conclusions:

Use of prasugrel-based therapy compared with clopidogrel-based therapy in ACS patients having a PCI resulted in cost-savings at current prices and favorable cost-effective ratios at likely generic prices for clopidogrel-based therapy because of offsetting savings in the costs of rehospitalization.     

Is transcatheter aortic valve implantation (TAVI) a cost-effective treatment in patients who are ineligible for surgical aortic valve replacement? A systematic review of economic evaluations

Objectives:

Health Technology Assessment (HTA) agencies often undertake a review of economic evaluations of an intervention during an appraisal in order to identify published estimates of cost-effectiveness, to elicit comparisons with the results of their own model, and to support local reimbursement decision-making. The aim of this research is to determine whether Transcatheter Aortic Valve Implantation (TAVI) compared to medical management (MM) is cost-effective in patients ineligible for surgical aortic valve replacement (SAVR), across different jurisdictions and country-specific evaluations.

Methods:

A systematic review of the literature from 2007–2012 was performed in the MEDLINE, MEDLINE in-process, EMBASE, and UK NHS EED databases according to standard methods, supplemented by a search of published HTA models. All identified publications were reviewed independently by two health economists. The British Medical Journal (BMJ) 35-point checklist for economic evaluations was used to assess study reporting. To compare results, incremental cost effectiveness ratios (ICERs) were converted to 2012 dollars using purchasing power parity (PPP) techniques.

Results:

Six studies were identified representing five reimbursement jurisdictions (England/Wales, Scotland, the US, Canada, and Belgium) and different modeling techniques. The identified economic evaluations represent different willingness-to-pay thresholds, discount rates, medical costs, and healthcare systems. In addition, the model structures, time horizons, and cycle lengths varied. When adjusting for differences in currencies, the ICERs ranged from $27K–$65K per QALY gained.

Conclusions:

Despite notable differences in modeling approach, under the thresholds defined by using either the local threshold value or that recommended by the World Health Organization (WHO) threshold value, each study showed that TAVI was likely to be a cost-effective intervention for patients ineligible for SAVR.     

Identifying the key purchase factors for organic food among Chinese consumers

The current study primarily aims to identify the critical purchase factors that affect Chinese consumer purchase intention and purchase decision with regard to organic food consumption, in accordance with a modified theory of planned behavior and the alphabet theory. Specifically, this study builds a conceptual research framework by which to delve into the relationships between purchase factors and purchase intention, and elucidate the mediating roles of purchase factors in the relationships between purchase intention and purchase decision. Moreover, by leveraging a modified theory of planned behavior and the alphabet theory, the current study also determines the critical roles of subjective norms and reveals the information and knowledge that impact consumer attitude toward the purchase of organic food. The current study leverages the purposive sampling method and captures 310 records within Beijing, China. The results indicate that purchase attitude correlates positively with subjective norms and knowledge, while purchase intention correlates positively with purchase attitude, perceived behavior control, and food therapy culture. Furthermore, purchase intention can significantly mediate relationships between each of purchase attitude, perceived behavior control, food therapy culture, and purchase decision. Finally, we discuss the theoretical and practical significance of the framework, and propose subsequent research directions regarding organic food purchase behavior.     

Cost-effectiveness of insulin degludec compared with insulin glargine in a basal-bolus regimen in patients with type 1 diabetes mellitus in the UK

Abstract

Objective:

The aim of this study was to evaluate the cost-effectiveness of insulin degludec (IDeg) vs insulin glargine (IGlar) as part of a basal-bolus treatment regimen in adults with T1DM, using a short-term economic model.

Methods:

Data from two phase III clinical studies were used to populate a simple and transparent short-term model. The costs and effects of treatment with IDeg vs IGlar were calculated over a 12-month period. The analysis was conducted from the perspective of the UK National Health Service. Sensitivity analyses were conducted to assess the degree of uncertainty surrounding the results. The main outcome measure, the incremental cost-effectiveness ratio (ICER), was the cost per quality-adjusted life-year (QALY).

Results:

IDeg is a cost-effective treatment option vs IGlar in patients with T1DM on a basal-bolus regimen. The base case ICER was estimated at £16,895/QALY, which is below commonly accepted thresholds for cost-effectiveness in the UK. Sensitivity analyses demonstrated that the ICER was stable to variations in the majority of input parameters. The parameters that exerted the most influence on the ICER were hypoglycemia event rates, daily insulin dose, and disutility associated with non-severe nocturnal hypoglycemic events. However, even under extreme assumptions in the majority of analyses the ICERs remained below the commonly accepted threshold of £20,000–£30,000 per QALY gained.

Conclusions:

This short-term modeling approach accommodates the treat-to-target trial design required by regulatory bodies, and focuses on the impact of important aspects of insulin therapy such as hypoglycemia and dosing. For patients with T1DM who are treated with a basal-bolus insulin regimen, IDeg is a cost-effective treatment option compared with IGlar. IDeg may be particularly cost-effective for sub-groups of patients, such as those suffering from recurrent nocturnal hypoglycemia and those with impaired awareness of hypoglycemia.     

Cost effectiveness of atazanavir-ritonavir versus lopinavir-ritonavir in treatment-naïve human immunodeficiency virus-infected patients in the United States

Abstract

Objective:

To evaluate lifetime cost effectiveness of atazanavir-ritonavir (ATV?+?r) versus lopinavir-ritonavir (LPV/r), both with tenofovir-emtricitabine, in US HIV-infected patients initiating first-line antiretroviral therapy.

Methods:

A Markov microsimulation model was developed to calculate quality-adjusted life-years (QALYs) based on CD4 and HIV RNA levels, coronary heart disease (CHD), AIDS, opportunistic infections (OIs), diarrhea, and hyperbilirubinemia. A million-member cohort of HIV-1-infected, treatment-naïve adults progressed at 3-month intervals through eight health states. Baseline characteristics, virologic suppression, cholesterol changes, and diarrhea and hyperbilirubinemia rates were based on 96-week CASTLE trial results. HIV mortality, OI rates, adherence, costs, utilities, and CHD risk were from literature and experts.

Limitations:

The incremental cost-effectiveness ratio (ICER) may be overestimated because the ATV?+?r treatment effect was based on an intention-to-treat analysis. The QALY weights used for diarrhea, hyperbilirubinemia, and CHD events are uncertain; however, the ICER remained <$50,000/QALY when these values were varied in sensitivity analyses.

Results:

ATV?+?r patients received first-line therapy longer than LPV/r patients (97.3 vs. 70.7 months), had longer quality-adjusted survival (11.02 vs. 10.76 years), similar overall survival (18.52 vs. 18.51 years), and higher costs ($275,986 vs. 269,160). ATR?+?r patients had lower rates of AIDS (19.08 vs. 20.05 cases/1,000 patient-years), OIs (0.44 vs. 0.52), diarrhea (1.27 vs. 6.26), and CHD events (5.44 vs. 5.51), but higher hyperbilirubinemia rates (6.99 vs. 0.25). ATV?+?r added 0.26 QALYs at a cost of $6826, for $26,421/QALY.

Conclusions:

By more effectively reducing viral load with less gastrointestinal toxicity and a better lipid profile, ATV?+?r lowered rates of AIDS and CHD, increased quality-adjusted survival, and was cost effective (<$50,000/QALY) compared with LPV/r.     

计算机模拟在光动力疗法中的应用

光动力学疗法(Photodynamic Therapy,简称PDT)亦称光化学疗法或光辐射疗法,是通过生物光敏作用杀伤肿瘤或其他病理性增生组织而达到治疗目的的一种正在研究发展中的新型医疗技术。该项研究工作在计算机模拟研究光动力治疗肿瘤方面进行了一些有益的尝试,这些尝试对数字化虚拟人体的研究、激光生物医学研究有一定的理论意义,对激光在肿瘤治疗中的临床应用具有一定的参考价值。     

膝关节退行性病变的物理治疗观察

目的:探讨治疗膝关节退行性病的办法,主要是通过物理治疗或者理疗来缓解痛疼控制病情的发。方法:自我手法按摩患处关节15min,扶床蹲下起立及跑车运动各15min后,用超短波治疗,微温量20min,每日1次,10次为1疗程。结果:痊愈3例(33.3%);显效3例(33.3%);好转2例(22.2%);无效1例(11.11%)。总有效率为88.89%。结论:科学的物理治疗对轻、中度患者效果还是比较明显的。     

浅析阅读疗法对当代大学生健康心理的塑造

当代大学生心理健康问题成为社会普遍关注的主要问题,本文通过分析阅读疗法的特点及作用,发现阅读疗法与当代大学生健康心理塑造之间的关系,进而推进二者之间的有效促进作用,以更好的保证当代大学生拥有健康的心理。     

果胶铋联合三联疗法对消化性溃疡患者血清炎症介质及生命质量的影响

目的探讨果胶铋联合三联疗法对消化性溃疡患者血清炎症介质及生命质量的影响。方法选取2019年8月至2020年2月于大石桥市第三人民医院治疗的90例消化性溃疡患者作为研究对象,按随机数字表法分为对照组与观察组,每组45例。对照组患者予以呋喃唑酮片+奥美拉唑肠溶胶囊+阿莫西林治疗,观察组患者在对照组治疗基础上采用胶体果胶铋胶囊治疗。比较两组患者治疗后幽门螺杆菌(Hp)根除率,以及治疗前后血清一氧化氮(NO)、一氧化氮合酶(NOS)、炎症介质、消化病生命质量指数(GLQI)评分。结果治疗后,观察组Hp根除率为97.78%,明显高于对照组的77.78%,差异有统计学意义(P<0.05)。治疗前,两组患者血清NO、NOS、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平及GLQI评分差异无统计学意义(P>0.05);治疗后,两组患者血清NO、NOS、IL-6、IL-8水平及GLQI评分较治疗前有所改善,且观察组明显优于对照组,差异有统计学意义(P<0.05)。结论果胶铋联合三联疗法可通过降低胃溃疡患者血清IL-6、IL-8水平,提高NO、NOS水平,发挥改善胃黏膜微循环、提高黏膜血容量、减轻炎症反应、抑制胃酸形成、保护胃黏膜、提高患者生命质量的作用。