Cost effectiveness analysis of immunotherapy in patients with grass pollen allergic rhinoconjunctivitis in Germany

Abstract

Objectives:

An economic evaluation was conducted to assess the outcomes and costs as well as cost-effectiveness of the following grass-pollen immunotherapies: OA (Oralair; Stallergenes S.A., Antony, France) vs GRZ (Grazax; ALK-Abelló, Hørsholm, Denmark), and ALD (Alk Depot SQ; ALK-Abelló) (immunotherapy agents alongside symptomatic medication) and symptomatic treatment alone for grass pollen allergic rhinoconjunctivitis.

Methods:

The costs and outcomes of 3-year treatment were assessed for a period of 9 years using a Markov model. Treatment efficacy was estimated using an indirect comparison of available clinical trials with placebo as a common comparator. Estimates for immunotherapy discontinuation, occurrence of asthma, health state utilities, drug costs, resource use, and healthcare costs were derived from published sources. The analysis was conducted from the insurant’s perspective including public and private health insurance payments and co-payments by insurants. Outcomes were reported as quality-adjusted life years (QALYs) and symptom-free days. The uncertainty around incremental model results was tested by means of extensive deterministic univariate and probabilistic multivariate sensitivity analyses.

Results:

In the base case analysis the model predicted a cost-utility ratio of OA vs symptomatic treatment of €14,728 per QALY; incremental costs were €1356 (95%CI: €1230; €1484) and incremental QALYs 0.092 (95%CI: 0.052; 0.140). OA was the dominant strategy compared to GRZ and ALD, with estimated incremental costs of ?€1142 (95%CI: ?€1255; ?€1038) and ?€54 (95%CI: ?€188; €85) and incremental QALYs of 0.015 (95%CI: ?0.025; 0.056) and 0.027 (95%CI: ?0.022; 0.075), respectively. At a willingness-to-pay threshold of €20,000, the probability of OA being the most cost-effective treatment was predicted to be 79%. Univariate sensitivity analyses show that incremental outcomes were moderately sensitive to changes in efficacy estimates. The main study limitation was the requirement of an indirect comparison involving several steps to assess relative treatment effects.

Conclusion:

The analysis suggests OA to be cost-effective compared to GRZ and ALD, and a symptomatic treatment. Sensitivity analyses showed that uncertainty surrounding treatment efficacy estimates affected the model outcomes.     

Beyond Technology Adoption: An Embeddedness Approach to Reduce Medication Errors

Medication errors are causing harm, and even death, to hospital inpatients. These preventable errors occur at the hands of the same individuals who are charged to protect and provide care to patients—health care professionals. While decision support technologies are available to assist health care providers, patients continue to experience incorrect medications, inaccurate doses/rates of medication, duplicate doses, medication interactions, and other medication errors. This article investigates the reasons that health care professionals in hospital environments underutilize medication administration technologies and argues that a fusion view can provide guidance to increase their use. A Fusion Model is developed using the concept of embeddedness, the Technology Acceptance Model, the Task-Technology-Fit Model, and drawing on ethnographic fieldwork conducted at a modern hospital in the United States. The most important findings of this research are: (1) the concept of embeddedness can be used to study and frame fusion of technology in an environment; (2) four constructs (i.e., task characteristics, technology characteristics, individual use behavior, environmental characteristics) are identified and used to describe system characteristics needed to support medication decisions; and (3) guidance is provided for design and evaluation of decision support technologies for medication administration in hospitals.     

Does Economic Insecurity Cause Weight Gain Among Canadian Labor Force Participants?

The National Population Health Survey (NPHS) suggests that for labor force participants age 25 to 64, the prevalence of self‐reported obesity in Canada has increased from 16 percent in 1998 to 23 percent in 2008. Using six cycles of NPHS data (1998–2009), I explore Canada's obesity dilemma by considering the effect of economic insecurity—measured as the probability of an individual experiencing a severe negative economic shock. As an identification strategy, a fixed effects model is employed to control for unobserved time‐invariant heterogeneity and a set of instruments based on an individual's economic environment are specified in order to isolate causality. Results suggest that for males age 25 to 64, a 1 percent increase in economic insecurity is predicted to increase their body mass index (BMI) by 0.10 points. For females age 25 to 64, the association between economic insecurity and BMI is statistically insignificant at conventional confidence levels.     

双氢链霉素未知杂质的结构确证与限值设定

为了科学制定双氢链霉素产品中未知杂质的限度标准,从分子结构、来源和质量稳定性等3个方面开展研究。首先,采用制备色谱仪从双氢链霉素产品中制得杂质纯品,借助液相色谱-高分辨质谱(LC-HRMS)和核磁共振谱(NMR)进行波谱分析、研究杂质分子结构;其次,采用高效液相色谱法(HPLC),结合双氢链霉素生产过程开展杂质来源考察;最后,设计了多条件的影响因素实验,考证杂质的稳定性。结果表明：杂质分子结构与双氢链霉素的分子结构类似,同属氨基糖苷类物质;杂质来源于双氢链霉素发酵阶段产生的链霉素类似物,类似物在氢化过程被同步还原成为产品中的杂质;杂质对酸、碱、高温、氧化、光照等因素不敏感,具有较好的稳定性。由链霉素发酵代谢产生的相关性杂质稳定性较好,设定其限度标准为≤1.0%(峰面积分数)是安全、合理的,可为临床用药提供重要参考。     

Older is better: Consumers prefer older drugs

Despite increasing research attention to healthcare marketing in academia and the concerted effort of the pharmaceutical industry to market its latest products, limited research has explored the effect of launch time on individuals' drug choices. Building upon findings in medical literature that many newly launched drugs are indeed no better than existing ones, this study found that the majority of consumers consistently prefer older drugs when both options are claimed equally safe and/or effective. The reason is that consumers disregard declarative information and, instead, make their own inferences. Although there is a small segment that chooses the newer option for what they infer to be its higher efficacy, most consumers believe that an older drug is both safer and more efficacious. Further, promotion-focused consumers are more likely to choose newer drugs. The underlying mechanism for how promotion focus affects choice is identified. A sample of practicing doctors cross-validated our findings, which have implications for practitioners in the pharmaceutical industry.     

Impact of a comprehensive pharmacist medication-therapy management service

Abstract

Objective:

This proof of concept study aimed to determine whether a pharmacist-managed medication therapy management (MTM) program in a private endocrinologist physician’s practice reduced healthcare services utilization and related costs 6 months after patients’ discharge from an institution with a transition of care service.     

Impact of risperidone long-acting injectable on hospitalisation and medication use in Canadian patients with schizophrenia

Summary

A retrospective chart review was used to assess hospitalisation and medication switching in patients with schizophrenia initiated on either intramuscular risperidone long-acting injectable (RLAI) (n=69) or oral atypical antipsychotics (n=93) in Canada.

In the RLAI-treated patients, compared with an identical period prior to RLAI use (40.8 months), there were significant decreases in hospitalisation (50.7 vs. 4.3%; p<0.0001) and duration of hospitalisation (23.5 vs. 0.3 days per patient; p<0.0001) when patients were switched to RLAI (mean treatment period 41.5 months). Compared with patients receiving oral atypicals for 57.2 months, RLAI patients had a reduced risk of hospitalisation (95% confidence interval 1.8–16.5% vs. 54.7–76.4%) and medication switching (95% confidence interval 34.6–58.4% vs. 55.7–76.4%).

By virtue of its periodic intramuscular administration, RLAI offers the efficacy and tolerability of an atypical medication without the compliance issues associated with oral drugs, and leads to significant decreases in hospitalisation.