Compared with no treatment, aspirin is less costly and more effective for preventing CHD events in middle-aged men whose 10-year risk for CHD is 7.5% or higher. The addition of a statin to aspirin therapy becomes more cost-effective when the patient's 10-year CHD risk before treatment is higher than 10%.

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A budget impact analysis for a new pharmaceutical product provides estimates of the likely impact of the new drug on a healthcare decision maker's short- and longer-term annual budgets. Budget impact analysis are an essential part of a comprehensive economic assessment of a new pharmaceutical product and are increasingly required, along with cost-effectiveness analyses, before national or local formulary approval or reimbursement. Standards for the development, content and presentation of the results of a budget impact analysis have recently been proposed but detailed guidance on alternative methods for estimating budget impacts are not yet available. Methods for performing these analyses require either static or dynamic analysis techniques depending on the type of health condition and health impact of the new drug. Several factors, that are not generally needed for cost-effectiveness analysis, should be part of a comprehensive budget impact analysis including the size of the treated population, second-order costs, market diffusion rates for the new drug, and off-label use. A review of the recent literature indicates that there is only a limited number of published budget impact analyses and these vary greatly in the methods used. Instead of publication in peer-reviewed journals, budget impact analyses are more frequently presented directly to decision makers as interactive computer programs designed to compute the budget impact for specific health plans using plan-specific inputs. It is recommend that a comprehensive approach to budget impact estimation be adopted, with the results being presented from both a societal perspective as well as from more limited perspectives depending on the needs of the decision maker.

Background:The cost-effectiveness of aspirin for primary prevention of cardiovascular events in women is unclear. We sought to perform a cost-utility analysis to address this issue. Methods:We developed a Markov model, based on published literature, to compare aspirin prevention with no therapy. We used the perspective of a third-party payer and a lifetime time horizon. Our main outcome measure was cost per quality-adjusted life-year (QALY) gained. Our base case analysis considered 65-year-old women with a 7.5% 10-year risk of coronary heart disease events and a 2.8% risk of stroke.Results: Aspirin use cost $13 300 per additional QALY gained in the base case. Results were sensitive to age, cardiovascular disease risk, relative risk reductions with aspirin for ischemic strokes and myocardial infarction, ex-cess risk of hemorrhagic stroke and gastrointestinal bleeding, and the disutility of taking medication. Probabilistic sensitivity analysis for 65-year-old women at moderate cardiovascular disease risk found a 27% chance that aspirin produces fewer QALYs than no treatment, a 35% chance that the cost-utility ratio was less than $50 000 per QALY gained, and a 37% probability that it was greater than $50 000 per QALY gained.Conclusions: Aspirin use appears to have a favorable costutility ratio for older women with moderate cardiovascular risk, but firm conclusions about its effects are limited by the imprecision of available evidence, which comes mainly from 1 trial. Aspirin is indicated for women at higher risk for stroke but should not be prescribed for low-risk women, including most younger women.

Given the initiatives to improve resource allocation decisions for HIV prevention activities, a linear programming model was designed specifically for use by state and local decision-makers. A pilot study using information from the state of Florida was conducted and studied under a series of scenarios depicting the impact of common resource allocation constraints. Improvements over the past allocation strategy in the number of potential infections averted were observed in all scenarios with a maximal improvement of 73%. When allocating limited resources, policymakers must balance efficiency and equity. In this pilot study, the optimal allocation (i.e., most-efficient strategy) would not distribute resources in an equitable manner. Instead, only 12% of at-risk people would receive prevention funds. We find that less efficient strategies, where 58% fewer infections are averted, result in significantly more equitable allocations. This tool serves as a guide for allocating funds for prevention activities.

Background and Purpose-Intracerebral hemorrhage (ICH) is among the most costly and debilitating forms of stroke.Results from a recent Phase IIb clinical trial demonstrate that administration of recombinant activated factor VII (rFVIIa) reduces ICH mortality and improves functional outcome. In the current analysis, we examine the cost-effectiveness of early treatment with rFVIIa for ICH in the United States. Methods-A decision-analytic model was developed to estimate the lifetime costs and outcomes associated with rFVIIa treatment at doses of 40, 80 and 160 g/kg compared with current standard of care in treating ICH, from a US third-party payer perspective. The patient population was similar to that of the Phase IIb clinical trial. Model structure and inputs were obtained from published literature, clinical trial data, claims databases, and expert opinion. All costs are presented in 2005 US dollars. Outcomes included incremental cost per life-year (LY) saved and incremental cost per quality-adjusted life-year (QALY) gained. Costs and outcomes were discounted at 3% annually. Univariate and multivariate sensitivity analyses were conducted to assess model robustness. Results-Compared with standard care, treatment with rFVIIa 40 g/kg, and 160 g/kg results in total lifetime cost-effectiveness ratios of $6308/QALY and $3152/QALY, respectively. Treatment with rFVIIa 80 g/kg was found to be cost saving and a gain of 1.67 QALYs is achieved over a patient's lifetime. These results are robust to changes in input parameters. Conclusions-Treatment of ICH with rFVIIa 40 g/kg and 160 g/kg appears to be cost-effective (Յ$50 000/QALY). At the 80 g/kg dose, rFVIIa was not only cost-effective, but also cost saving. (Stroke. 2006;37:2751-2758.)

Treatment of COPD with fluticasone propionate/salmeterol 500/50 microg appears to be cost-effective (

GA or NZ in RRMS patients is associated with increased benefits compared with symptom management, albeit at higher costs. Although year 1 and 2 disease progression and relapse rates were better for NZ than GA, long-term evidence may show GA to have similar, if not improved, clinical benefit.