This is the first study assessing the costs of palliative care and the quality of life of patients with CRC in real-world health-care delivery in Germany. It could be shown that CRC treatment represents an enormous economic burden to the German health-care system. Increased efforts in promoting effective and efficient treatment options, or performance-based medication reimbursement schemes, might be helpful in reducing the costs.
BackgroundSeveral lists of potentially inappropriate medication (PIM) for elderly patients have been developed worldwide in recent years. Those lists intend to reduce prescriptions of drugs that carry an unnecessarily high risk of adverse drug events in elderly patients. In 2010, an expert panel published the PRISCUS list for the German drug market. This study calculates the amount of drug reimbursement for PIM in Germany and potential cost effects from the perspective of statutory health insurance when these are replaced by the substitutes recommended by the PRISCUS list.MethodsRegister-based data for the 30 top-selling drugs on the PRISCUS list in 2009 for patients greater than or equal to 65 years of age were provided by the Scientific Institute of the German Local Health Care Fund. We calculated the percentage of sales and defined daily doses for patients greater than or equal to 65 years of age compared with the total statutory health insurance population. Reimbursement costs for the recommended substitutions were estimated by considering different scenarios.ResultsIn 2009, drug reimbursement for the 30 top-selling PIM prescribed to patients greater than or equal to 65 years of age were calculated to be €305.7 million. Prescribing the recommended substitution medication instead of PIM would lead to an increased total reimbursement cost for the German health care system ranging between from €325.9 million to €810.0 million.ConclusionsThe results show that the substitution of PIM by medication deemed to be more appropriate for the elderly comes along with additional costs. Consequently, there is no short-term incentive for doing so from a payer perspective. Future studies have to consider the long-term effects and other sectors.
Purpose: The aim of this study was to evaluate the quality of care and interdisciplinary cooperation in the palliative treatment of colorectal cancer (CRC), including the associated costs. Patients and Methods: 103 patients were enrolled from 13 institutions to reflect the existing clinical treatment reality and costs of palliative CRC treatment. We present the clinical outcome of the patients and compare the results obtained in the 3 centers with double-figure recruitment numbers (centers A, B, and C). Results: First-line treatment with 5-fluorouracil monotherapy was applied in exceptional cases. The regular treatment method comprised either an irinotecan- (30%) or an oxaliplatin-based regimen (32%). Biological agents were added to the treatment of 33 patients (32%). The median overall survival (OS) of the total patient collective was 25 months. The OS differed significantly in 2 out of the 3 centers, ranging between 27 and 11 months. Secondary metastasis resections were performed in 26% of the total patient collective. The center with the most favorable outcome results also had the lowest costs for palliative treatment and care, including the lowest drug costs. Conclusion: A combined chemotherapy treatment was the rule. Concerning biological agents, a significant lack of their application in first-line treatment and the quality of interdisciplinary cooperation have to be addressed. © 2014 S. Karger AG, Basel
to result in any great changes, although in certain areas, price reductions can be expected. ConClusions: Some downward pressure on prices in other EU markets is likely as Croatia becomes a reference market for IRP, although this is likely to be limited in scope in the short term, with only particular products and therapeutic groups affected. Over the longer term, as more markets add Croatia to their reference-pricing baskets, this pressure is likely to intensify.
Objectives: Cost is considered one of the major barriers to greater use of LARC (Long-Acting Reversible Contraceptive) methods, especially cost of treatment initiation. However, when considering their contraceptive efficacy alongside cost of pregnancy, LARC methods are deemed by NICE to be more cost-effective than combined oral contraceptive pills even at one year of use. (NICE LARC CG30 2005). MethOds: A 3 year time-horizon cost-benefit model was developed to assess budgetary impact of increasing LARC uptake (implant, IUD, IUS and injectable) compared to the oral contraceptive pill, in UK women aged 16-49 who currently use the following contraceptives of interest: non-LARC method (defined as contraceptive pill only) or LARC methods (IUD, IUS, injectable, implant). A weighted-average price based on current market shares was calculated, for all contraceptive pills currently available in the UK. Increased uptake of any LARC method was offset against a reduction in contraceptive pill usage. Unintended pregnancies, based on typical failure rate, occurring with all treatments considered was taken into account. Results: Of approximately 14,750,000 women aged 16-49 in the UK, official statistics confirm 37% use contraceptive methods of interest to our model. This proportion formed our cohort of approximately 5,500,000 UK women aged 16-49, which was followed over a 3 year time horizon. A 100% increase in uptake of each LARC method would lead to a 49% decrease in oral contraceptive pill uptake. Over a three year period this would save 374,794 unintended pregnancies, and elicit financial savings of £630,831,022, on which £54,098,847 is attributable to treatment costs (ingredient, consultations, removal/insertion costs) and £576,732,175 to the cost of unintended pregnancies (live birth, miscarriage, abortion, ectopic pregnancy). cOnclusiOns: The model projects that increasing LARC uptake will result in a significant reduction in the number of unintended pregnancies, with consequent savings to the NHS across the UK.Objectives: Our aim was to assess the costs and consequences of labour induction using misoprostol vaginal insert (MVI) compared with currently used technologies using a specifically developed user-friendly decision model developed and Slovakia. MethOds: The model was developed in Microsoft Office Excel and compares clinical and safety aspects like time to vaginal delivery, time to active labour, occurrence of cesarean delivery and adverse events of MVI with selected comparators. Efficacy and safety data were retrieved from targeted literature review, conducted in the main medical databases. Country-specific information about costs and resource use was incorporated into the model. Local data were collected for each country via a specifically developed questionnaire. The model considered the hospital and public payer perspectives. The model generated results as an incremental difference between the total costs related to labour induction with MVI or a comparator. The threshold price of MVI was also calculated. Resu...
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