• Diabetes mellitus imposes a substantial economic burden on society.The American Diabetes Association has estimated that the cost of diabetes in the United States was approximately $174 billion in 2007.• Previous studies using claims data showed that improved glycemic control was associated with fewer primary care visits and inpatient admissions. Wagner et al. (2001), using claims data from a large Washington HMO from 1992-1996, found that patients with predominantly type 2 diabetes whose hemoglobin A1c improved had lower total health care costs ($685 to $950 less per year) than those without A1c improvement. Shetty et al. (2005) found that in a large MCO, patients with type 2 diabetes whose A1c exceeded a target level (7%) had 32% higher diabetes-related costs than patients at or below the target level (P < 0.001).

After completing this course, the reader will be able to: 1. Describe how academic oncologists view the costs of new treatments in their treatment recommendations. 2. Discuss academic oncologists' perceptions of the cost and benefit of one new treatment in light of published results. 3. Describe how academic oncologists view the cost-effectiveness of new treatments relative to previously accepted standards. Abstract Background. Substantial debate centers on the high cost and relative value of new cancer therapies. Oncologists play a pivotal role in treatment decisions, yet it is unclear whether they perceive high-cost new treatments to offer good value or how therapeutic costs factor into their treatment recommendations. Methods. We surveyed 139 academic medical oncol-ogists at two academic hospitals in Boston. We asked respondents to provide estimates for the cost and effectiveness of bevacizumab and whether they believed the treatment offered "good value." We also asked respondents to judge how large a gain in life expectancy would justify a hypothetical cancer drug that costs $70,000 a year. Using this information, we calculated implied cost-effectiveness thresholds. Finally, we explored respon-dents' views on the role of cost in treatment decisions. Results. Ninety academic oncologists (65%) completed the survey. Seventy-eight percent stated

The aim of this study was to assess the cost-effectiveness of topiramate vs. no preventive treatment in the UK. Model inputs included baseline migraine frequency, treatment discontinuation and response, preventive and acute medical cost per attack [2005 GBP ( pound)] and gain in health utility. Outcomes included monthly migraines averted, acute and preventive treatment costs and cost per quality-adjusted life year (QALY). Topiramate was associated with 1.8 fewer monthly migraines and a QALY gain of 0.0384. The incremental cost of topiramate vs. no preventive treatment was about 10 UK pounds per migraine averted and 5700 UK pounds per QALY. Results are sensitive to baseline monthly migraine frequency, triptan use rate and the gain in utility. Incorporating savings from reduced work loss (about 36 UK pounds per month) suggests that topiramate would be cost saving compared with no preventive treatment. This analysis suggests that topiramate is a cost-effective treatment for migraine prevention compared with no preventive treatment.

Background Malnutrition, which is associated with increased medical complications in older hospitalized patients, can be attenuated by providing nutritional supplements. Objective This study evaluates the cost effectiveness of a specialized oral nutritional supplement (ONS) in malnourished older hospitalized patients. Methods We conducted an economic evaluation alongside a multicenter, randomized, controlled clinical trial (NOURISH Study). The target population was malnourished older hospitalized patients in the USA. We used 90-day (base case) and lifetime (sensitivity analysis) time horizons. The study compared a nutrient-dense ONS, containing high protein and b-hydroxy-b-methylbutyrate to placebo. Outcomes included health-care costs, measured as the product of resource use and per unit cost; quality-adjusted life-years (QALYs) (90-day time horizon); life-years (LYs) saved (lifetime time horizon); and the incremental cost-effectiveness ratio (ICER). All costs were inflated to 2015 US dollars. Results In the base-case analysis, 90-day treatment group costs averaged US$22,506 per person, compared to US$22,133 for the control group. Treatment group patients gained 0.011 more QALYs than control group subjects, reflecting the treatment group's significantly greater probability of survival through 90 days' follow-up, as reported by the clinical trial. Hence, the 90-day follow-up period ICER was US$33,818/QALY. Assuming a lifetime time horizon, estimated treatment group life expectancy exceeded control group life expectancy by 0.71 years. Hence, the lifetime ICER was US$524/LY. The follow-up period for the trial was relatively short. Some of the patients were lost to follow-up, thus reducing collection of health-care utilization data during the clinical trial. Conclusion Our findings suggest that the investigative ONS cost-effectively extends the lives of malnourished hospitalized patients.

Objectives: Combinations of existing therapies are increasingly being developed and marketed across many indications. Whilst they promise substantial clinical benefits, dual-branded therapies may have substantial financial impacts. Obtaining positive HTA approvals and public reimbursement may be a major challenge, which may be amplified if each monotherapy is marketed by a different company. We evaluated whether combination therapies developed by one manufacturer had faster and/or better outcomes than those where each constituent was developed by a separate manufacturer and whether this varied by different HTA archetypes. Methods: ECapproved combination products, comprising at least one on-patent therapy marketed under a separate brand were identified (01/01/2015-31/12/2018) and the number of manufacturers identified. Corresponding HTA reports were identified from G-BA, HAS, SMC, and NCPE websites and relevant data extracted. Results: 114 HTA assessments across 34 combination products:indications were identified (same manufacturer: 58 assessments, two manufacturers: 56 assessments). For clinicaleffectiveness HTA bodies (G-BA and HAS), the rates of positive recommendations (defined as: any additional benefit or ASMR I-III) was similar for combination therapies developed by one vs. two manufacturers (32% vs. 40%). Whereas, for costeffectiveness HTA bodies (NICE, SMC, and NCPE), combination therapies developed by one manufacturer received numerically higher rates of positive recommendations (defined as: "full or optimized/conditional") than those involving two manufacturers (80% vs. 58%). However, there were no corresponding differences in the median time from EC-approval to positive recommendation (5.5 vs. 5.0 months). Conclusions: HTA bodies assessing cost-effectiveness were more likely to issue positive recommendations for dual-branded treatments if each constituent monotherapy was marketed by one company versus two companies. A single company may have more flexibility in its price setting, facilitating higher HTA recommendation rates. Although time to positive HTA decisions were similar, this may not reflect time to launch in some jurisdictions, due to additional time required for pricing negotiations.