The goal of this study was to determine the clinical and economic impact of using tulathromycin as first line treatment for bovine respiratory disease (BRD) compared with other commonly used antimicrobials. Two decision trees were developed simulating the consequences of treating cattle at high risk of developing BRD [control model (CM)] or cattle with first clinical BRD episode [treatment model (TM)]. As comparators florfenicol and tilmicosin were considered in both models whereas enrofloxacin was included in the TM because it was only labeled for treatment of BRD at the time of development of the calculators. A total of 5 (CM) and 10 (TM) comparative clinical studies that reported efficacy data for the selected drugs and indications were identified as suitable for model population. The following outcomes were considered: first treatment success, number of subsequent BRD treatments, chronics, and mortalities. Cost parameters were considered from the perspective of the producer and included treatment costs (first treatment and retreatments) and costs of chronics and deaths derived from published sources for 2010 (default). The models allowed the estimation of clinical and economic consequences according to each individual trial outcomes. Treatment with tulathromycin resulted in more first treatment successes and fewer removals (chronics and deaths) in all comparisons. The average total number of antimicrobial treatments required for the management of BRD was also least with tulathromycin as first treatment option. Because of better efficacy, total costs over the entire study periods were always lowest with tulathromycin. Depending on the study selected as the basis for the efficacy evaluation, cost savings with tulathromycin were calculated in the CM between US$21.00 and $47.86 (vs. florfenicol) and $11.37 and $72.64 (vs. tilmicosin); cost savings in the TM ranged between $28.47 and $143.87 (vs. florfenicol) and $7.75 and $84.91 (vs. tilmicosin) as well as between $23.22 and $47.82 (vs. enrofloxacin), with the ranges reflecting a variety of settings in different trials. Thus, the higher drug costs of tulathromycin were more than offset by reduced BRD treatments, chronics, and mortalities in the herd. Fewer BRD episodes in cattle treated with tulathromycin not only contributes to overall savings in BRD management but also reduces the necessity of repeated antibiotic treatment, supporting prudent use of antimicrobials in livestock.
OBJECTIVES: Mastitis is one of the most frequent and costly diseases in the dairy industry with gram-negative bacteria being the main causal agent. Since most antibiotics have minimal effect on shortening the duration of clinical mastitis caused by gram-negative pathogens (gram-CM) and because of a high spontaneous cure rate, antibiotics are often not recommended for treating Gram-CM. The purpose of this study was to develop a model comparing 5-day treatment with ceftiofur hydrochloride to no treatment of gram-CM, also allowing easy adaptations to reflect the high variability of prices and cost data in livestock. METHODS: A decision tree was developed in MS Excel considering first and recurrent CM episodes, culling and death of cows with gram-CM. Cure rates and other clinical data were derived from published studies. Costs and losses associated with CM and its treatment, culled or dead cows as well as income generated from saleable milk production or sold cows were considered. Cost and income values were derived from public sources (US-2010, perspective of the producer). All input parameters were varied extensively in one-way sensitivity analyses. RESULTS: With US-2010 cost/ prices, income from saleable milk was $3,039.35 (ceftiofur) and $3069.67 (no treatment), and costs associated with the disease and treatment totaled to $215.12 (ceftiofur) and $246.60 (no treatment) over the entire lactation period, resulting in a $1.16 higher margin per treated cow with a 5-day treatment with ceftiofur compared to no treatment of gram-CM. More cows were cured and fewer cows culled or died with ceftiofur. The model was most sensitive to ceftiofur cure rate and selfcure rate. CONCLUSIONS: Compared to no treatment, ceftiofur's higher treatment costs and less income due to milk discard were offset by a better efficacy, resulting in less disease associated costs of gram-CM.
OBJECTIVES: The risk of blindness from glaucoma can be reduced by early detection and treatment. A domestic large-scale surveillance (Tajimi Study) shows that approximately 90% of glaucoma patients of 40 years or older are undiagnosed, and initiation of the treatment is delayed. In this study the glaucoma treatment was investigated to understand the real-world situation of glaucoma therapy using claim data in Japan. METHODS: This was a retrospective cohort study. The data were extracted from a Japanese healthcare database (MinaCare Co., Ltd), which contained claim data obtained from approximately 2.0 million members of employment-based health insurance groups and their dependents. The ICD-10 classification was used to identify glaucoma patients. A washout period of 6 months before enrollment was set during which there were no records of prescriptions of antiglaucoma drugs or glaucoma surgery. Antiglaucoma ophthalmic solutions or surgery for initial treatment, persistence and change in medication were investigated. RESULTS: Out of 2,074,499 people in the database as of August 2014, we identified 42,470 glaucoma patients and the target group who met the wash-out conditions involved 6,333 patients (male: 3,618; female: 2,715). About 75% of the patients were between 40 to 69 years old and about 10% were 70 years or older. Regarding the initial treatment, most patients started with topical antiglaucoma treatment and only 24 patients underwent surgery. The first prescription of antiglaucoma drug included 1 agent in 87%, and cases with 2 agents (10%), 3 agents (3%), or more than 3 agents (0.3%) were also identified. The most prescribed one was latanoprost (26%) followed by tafluprost (17%), and carteolol (10%). CONCLUSIONS: In this study, the initial treatment in most of the patients followed the treatment guidelines. However, lack of disease awareness among potential patients and accessibility to early screening and diagnosis of glaucoma may exist, and it should be given sufficient consideration.OBJECTIVES: Psoriasis (PSO) and psoriatic arthritis (PsA) are immune-mediated systemic inflammatory diseases; adalimumab (ADA) and etanercept (ETN) are among the most commonly used first-line biologic agents. As per FDA-approved dosage and administration, newly initiated PSO patients receive a higher loading dose followed by a regular maintenance dose. In clinical practice, however, patients may receive higher than recommended (increased) doses even during the maintenance phase of treatment. Given linear pricing of these medications, our objective was to determine if the increased dosing schedule increases payer costs and to what degree. METHODS: Continuously enrolled adult patients with ≥ 2 outpatient diagnoses of PSO (ICD-9 code: 696.1) or PsA (ICD-9 code: 696.0) were selected from the Symphony PTD Claims Database if their first biologic prescription date (index date) fell between May 2010 and April 2013. Patients were required to be treatment-naïve only to ADA or ETN pre-index. The cost analysis took place over 12 months po...
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