Background
To estimate the incremental cost-effectiveness ratio (ICER) of the use of continuous subcutaneous insulin infusion (CSII) therapy versus multiple daily injections (MDI) therapy in adult patients with type 1 diabetes (T1D) at the Mexican Institute of Social Security (IMSS).
Methods
An analysis was developed using the internationally validated Core Diabetes Model (CDM) with which the incidence and progression of acute and chronic complications and the mortality of T1D was simulated throughout life. The baseline characteristics of the simulated cohorts were obtained from Mexican T1D adult patients aged ≥ 18 years that received care at two national IMSS medical centres in 2016. In the base case, the costs of the complications and treatment of the disease with both therapies were estimated in Mexican currency from the perspective of the institution, using Diagnosis Related Groups for outpatient and inpatient care. Utilities were taken from the international bibliography. In a secondary analysis, indirect costs were included using a human capital approach. The model used a lifetime time horizon, and a discount rate of 5% was applied for health outcomes and costs. A one-way sensitivity analysis was conducted on key variables and patient sub-groups; uncertainty was evaluated using a Cost-Effectiveness Acceptability Curve.
Results
The average age of the cohort was 32 years, with diabetes duration of 19 years, an average HbA1c of 9.2%; 29% were men. A gain of 0.614 Quality Adjusted Life Years (QALYs) was estimated with the use of CSII therapy. The estimated ICER was MXN$478,020 per QALY in the base case, and MXN$369,593 when indirect costs were considered. The sensitivity analysis showed that, in adult patients with HbA1c > 9.0%, the ICER was MXN$262,237.
Conclusions
This is the first economic evaluation study that compares CSII therapy versus MDI therapy for T1D adult patients in Mexico. The insulin pump therapy can be considered cost-effective in the context of the IMSS when considering a threshold of three GDPs per capita with 43.9% probability. Results improve substantially when patients have an HbA1c above 9%.
To evaluate clinical and economic value of ipilimumab in the treatment of advanced melanoma compared with drugs available for the treatment of advanced cancer. MethOds: An analysis was performed comparing ipilimumab and other drugs for advanced cancer regarding overall survival (OS) and costs associated with improvement in survival. Parameters analyzed were: improvement in median/mean OS, improvement on survival rate at 1 year and the number needed to treat (NNT) to avoid one death. Monthly costs for improvement in mean OS were evaluated. Efficacy data were obtained from clinical trials. Medications costs were obtained from official price lists, such as Banco de Dados de Preços do Sistema de Saúde do Ministério da Saúde Brasileiro and Lista da Câmara de Regulação do Mercado de Medicamentos da Agência Nacional de Vigilância Sanitária (CMED). Results: Improvement in median OS ranged from +2.8 (sorafenib) to +4.8 (transtuzumab), and improvements in mean OS ranged from +1.6 (sorafenib) to +6.1 (ipilimumab). Only ipilimumab showed better mean OS compared with the median OS (6.1 vs. 3.7). This demonstrates the effect of ipilimumab in prolonging OS in long term, which is observed in a considerable proportion of patients treated with this drug. Major improvement in the survival rate in 1 year occurred with ipilimumab (20%). The NNT to prevent 1 death ranged from 7 (ipilimumab) to 61 (bevacizumab for lung cancer). Costs per month of mean OS improvement ranged from BRL 34,906 (sorafenib) to BRL 64,410 (bevacizumab for lung cancer). cOnclusiOns: This comparative analysis of drugs used for treatment of advanced cancer used key parameters for decision making in health sciences. The results suggest that ipilimumab delivers superior clinical and economic benefits when compared with other drugs available in Brazil for the treatment of advanced cancer.
to -4.67) and oral anticoagulants . The effect of pharmacy closures on adherence, on average, was greater among individuals using independent pharmacies (-7.1%, CI -7.47 to -6.67), filling all their prescriptions at a single store (-7.1%, CI -7.35 to -6.76) or living in neighborhoods with fewer pharmacies (-5.9%, CI -6.26 to -5.51). ConCluSionS: Pharmacy closures are associated with persistent and clinically significant declines in adherence to essential cardiovascular medications among older adults in the U.S
the respective countries were elicited from local experts and clinical guidelines in addition to 1L> 2L BEV sequences obtained from the ML18147 trial. Results: When 1L> 2L BEV replaces sequences which include 1L anti-EGFR regimens, it results in an average potential cost reduction of 796
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