A869 0,9% saline on the costs of IV fluids and costs associated with fluid-related complications. The target population was adult patients (age ≥ 18 years) meeting SIRS criteria and receiving solely crystalloid IV fluids. The interventions compared were: patients mainly receiving BAL fluid mix versus patients receiving IV fluid therapy without BAL fluid mix considering an increasing adoption rate over 5-year period. Results: The base case was defined as a 300-bed hospital with 90% occupancy, a 2.7% SIRS frequency among inpatients, current BAL adoption level of 2%, projected year 5 BAL adoption levels of 20%. The patient number per month requiring fluid resuscitation calculated was 47 (564 per year). The overall savings were calculated by subtracting the costs of complications and treatments associated with BAL adoption level for a given year from costs associated with current BAL adoption level and adding the incremental costs.
Acupuncture use was nearly six times more common among chiropractic users than in the overall population (2.2% vs. 0.37%); similarly, nearly half (42.5%) of acupuncture users also had a claim for chiropractic. Over one-in-five patients (21.0%) with general joint or back pain used chiropractic, of which 2.65% also used acupuncture. CONCLUSIONS: Despite trends suggesting increased use of chiropractic and acupuncture, their use remains very low in commercial health insurance plans, including patients with inflammation and pain-related conditions. While still very low, acupuncture use was more common among chiropractic users than in the overall population.
The addition of IVIG to standard treatment in the treatment of childhood ITP with life threatening bleeding is a cost-effective intervention in Thailand. This evidence supported the decision-making that IVIG should be included in the health-benefit package as the first-line therapy of childhood ITP with life threatening bleeding.
Kong SLE patients compared to standard care. METHODS: A lifetime microsimulation model was adapted with epidemiological and cost data from Hong Kong. The model compares the use of belimumab against standard care and incorporates the BLISS-52 and BLISS-76 trial data for the short term outcomes within one year, while long-term outcomes were based on a natural history model developed using the Johns Hopkins Lupus registry. The natural history model describes the relationship between disease activity and other covariates on the risk of dying and developing organ damage. Data available from the SLE population in Hong Kong was used as input in the modified model. The analysis was performed from a Hong Kong health-care perspective. In the base case, cost and effectiveness were discounted to the year of analysis at 5% p.a. RESULTS: The base case analysis showed that compared to standard care, treatment with belimumab increased life expectancy by 0.80 (2.77 undiscounted) and QALY by 0.60 (1.68 undiscounted) years respectively.
retreatment regimens, which allows continuous or paused therapeutic schemes. This study aims to perform cost-effectiveness and cost-utility analyses of biologic alternatives for moderate to severe psoriasis in Venezuela, from a public payer=s perspective. METHODS: A decision-tree model simulates psoriasis evolution after treatment with etanercept continuous (50mg twice a week for 12 weeks, followed by 25mg twice a week) or paused (12-week treatment cycle and 12-week interruption), adalimumab (80mg at first week, followed by 40mg in the second week, then 40mg every 2 weeks), infliximab (5 mg/kg at weeks 0, 2 and 6, then every 8 weeks) or ustekinumab (45mg in weeks 0 and 4, then 45mg every 12 weeks) and their associated costs in a 96-week time horizon. Therapy continuation or switch was evaluated at week 24. Effectiveness measures were PASI 75 success rate and quality adjusted life years (QALY) gained. Costs included biologicals, medical follow-up and adverse events management, from Venezuela official databases (values represented 2010 USD). Probabilistic sensitivity analyses were performed through Monte Carlo simulation. A 5% discount rate was applied for costs and benefits. RESULTS: Effectiveness resulted in [
OBJECTIVES: Condoliase, an enzyme that specifically degrades glycosaminoglycans, main constituents of the nucleus pulposus, and reduces the compressions on nerves, can serve as a less-invasive curative treatment for patients with lumbar disc herniation and is expected to reduce associated medical cost due to shortened hospital stays. This study aims to evaluate the cost-effectiveness of the treatment with condoliase compared with conventional surgical therapy in the Japanese healthcare system. METHODS: A Markov model was developed to estimate quality-adjusted life year (QALY) and associated costs over 1 year. QOL scores were converted from corresponding Oswestry Disability Index (ODI). ODI of condoliase group came from the results of a phase 3, multicenter, double-blind, randomized placebo-controlled study conducted in Japan. ODI of surgery group was estimated from the values obtained from published literatures. The risk of re-operation after treatment was considered during calculation. Surgical treatment costs and re-operation costs were collected and estimated using a Japanese administrative claims database (Japan Medical Data Center, JMDC). Payer perspective was adopted, and discounting was not applied due to the short timeframe of the analysis. One-way sensitivity analysis was performed to assess the impact of parameter uncertainty on the model's conclusion. RESULTS: Average cost and effectiveness gained per patient for condoliase group and surgery group were 385,344 JPY vs. 798,919 JPY, 0.694 QALY vs. 0.685 QALY, respectively, meaning condoliase group was dominant compared to surgery group. One-way sensitivity analysis showed the robustness of this result. CONCLUSIONS: From the payer perspective, treatment with condoliase for patients with lumbar disc herniation in Japan is expected to reduce medical costs compared to conventional surgery treatment even taking into account the uncertainties.OBJECTIVES: Rheumatoid Arthritis (RA) destroys synovial joints and generates pain. Its prevalence in Chile has been estimated to be 0.46% (IC 95% 0.24-0.8). Available drugs for treatment include conventional synthetic Disease-Modifying Antirheumatic Drugs (csDMARDs), biological therapies and a new drug approved for treatment after failure of csDMARDs: tofacitinib. The aim of this study is to compare the costs-effectiveness of tofacitinib relative to biological therapies as an initial treatment in adults with RA after failure of methotrexate in Chile. METHODS: A simulation model of individual patients compared two treatment sequences for RA: tofacitinib vs biological therapy as initial medications; always assuming a combination therapy with methotrexate; biological therapies validated with rheumatologists and included in the model were etanercept, infliximab, tocilizumab, adalimumab, rituximab and salvage therapy (defined by experts). The characteristics of the patient included: age, weight, initial HAQ score, and clinical response to short and long term treatment. HAQ scores were used to calculate utilities, measured in Q...
Gout is the most common and progressive arthritic condition. Its severity is assumed to have implications for the humanistic and economic burden of the illness. The objective of this study is to examine the burden of gout between patients with and without tophi using electronic health records (EHR). METHODS: The Humedica EHR database was searched starting on January 1, 2008 through February 28, 2013 for patients having an initial gout diagnosis (ICD-9 274.xx) and a confirmatory gout diagnosis at least 30 days later. Deidentified patients with enrollment from 6-months pre/12-months post initial gout diagnosis and at least one serum uric acid (SUA) level were included in the study. Patients (n= 933) with a diagnosis of tophaceous gout (274.03, 274.81, and 274.82) during the 12-months postindex period were compared to all other gout (non-tophaceous) patients (n= 45,512). Demographic characteristics and comorbidities, SUA levels, and use of colchicine for acute flares during the 12-months post-index period were compared using chisquare tests. RESULTS: Gout patients with tophi were more likely to be female (p< 0.01) and have uncontrolled (SUA= 6-8) or severely uncontrolled (SUA = > 10) SUA (p< 0.0001) than patients without tophi. Colchicine use was higher in patients with tophi (p< .0001). There were significantly higher levels of cardiovascular comorbidities in the gout patients with tophi vs those without: hypertension (p< 0.05), myocardial infarction (p< 0.01), atherosclerosis (p< 0.0001), dyslipidemia (p< 0.0001), peripheral arterial disease (p< 0.0001), congestive heart failure (p< 0.0001), chronic heart disease (p< 0.0001), cardiomyopathy(p< 0.0001), ischemic and valvular heart disease (p< 0.0001) and left ventricular hypertrophy (p< 0.001). Gout patients with tophi had higher levels of chronic kidney disease, Stages 3-5, (p< 0.0001), osteoarthritis (p< 0.0001), rheumatoid arthritis (p< 0.0001). CONCLUSIONS: Gout patients with tophi had significantly greater burden of disease and greater frequency of comorbidities than those without. Preventing the development of tophi may reduce comorbidities and frequency of colchicine use and warrants further investigation.
A27Objectives: Cost effectiveness analyses play a critical role in determining coverage of novel drugs and devices. Increasingly, payers are demanding subgroup analyses to determine indications which would be covered by the national health system or insurance agency. MethOds: To understand and review trends in the use of subgroup cost effectiveness analysis, we analyzed NICE HTAs for products approved between 2011-2012. Manufacturer submissions for CEA were compared to final review and decision by HTA agency. Analogs were identified and case studies were developed to further understand the use of subgroup analyses and cost effectiveness models. Results: Decisions made by NICE in 2011-2012 show increasing trends towards the use of subgroup analysis for determining indications for coverage by national payer bodies. Between 2011-2012, 80% of the assessments included subgroup analyses. Approximately half of them included cost effectiveness analyses for various subgroups. Interestingly, the ICER values estimated by NICE for the same subgroups showed a large variation (1X-3X fold difference) compared to ICER values estimated by manufacturers. Selected case studies highlighted that for several products, NICE is recommending treatments only for subgroups whose ICER values are within the cost effectiveness threshold. cOnclusiOns: New products need robust broader population and subgroup analyses for insurance coverage.
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