BackgroundWe conducted an economic assessment using test data from the phase III TRIPLE study, which examined the efficacy of a 5-hydroxytryptamine 3 receptor antagonist as part of a standard triplet antiemetic regimen including aprepitant and dexamethasone in preventing chemotherapy-induced nausea and vomiting in patients receiving cisplatin-based highly emetogenic chemotherapy (HEC).MethodsWe retrospectively investigated all medicines prescribed for antiemetic purposes within 120 h after the initiation of cisplatin administration during hospitalization. In the TRIPLE study, patients were assigned to treatment with granisetron (GRA) 1 mg (n = 413) or palonosetron (PALO) 0.75 mg (n = 414). The evaluation measure was the cost-effectiveness ratio (CER) assessed as the cost per complete response (CR; no vomiting/retching and no rescue medication). The analysis was conducted from the public healthcare payer’s perspective.ResultsThe CR rates were 59.1% in the GRA group and 65.7% in the PALO group (P = 0.0539), and the total frequencies of rescue medication use for these groups were 717 (153/413 patients) and 573 (123/414 patients), respectively. In both groups, drugs with antidopaminergic effects were chosen as rescue medication in 86% of patients. The costs of including GRA and PALO in the standard triplet antiemetic regimen were 15,342.8 and 27,863.8 Japanese yen (JPY), respectively. In addition, the total costs of rescue medication use were 73,883.8 (range, 71,106.4–79,017.1) JPY for the GRA group and 59,292.7 (range, 57,707.5–60,972.8) JPY for the PALO group. The CERs (JPY/CR) were 26,263.4 and 42,628.6 for the GRA and PALO groups, respectively, and the incremental cost-effectiveness ratio (ICER) between the groups was 189,171.6 (189,044.8–189,215.5) JPY/CR.ConclusionsWe found that PALO was more expensive than GRA in patients who received a cisplatin-based HEC regimen.Electronic supplementary materialThe online version of this article (10.1186/s40780-018-0128-9) contains supplementary material, which is available to authorized users.
Antimicrobial resistance is a major health concern. A primary cause is the inappropriate use of antimicrobials, particularly by patients with upper respiratory tract infection. However, baseline information for antibiotic use for common cold before being applied the National Action Plan on Antimicrobial Resistance in Japan is lacking. Here, we analyzed the inappropriate use of antibiotics in the working-age workers. We used large claims data from an annual health check-up for at least 5 consecutive years. Among 201,223 participants, we included 18,659 working-age workers who were diagnosed with common cold at a clinic/hospital. We calculated the proportion of patients with common cold who were prescribed antibiotics and analyzed predictive factors associated with antibiotics prescription. Antibiotics were prescribed to 49.2% (n = 9180) of patients diagnosed with common cold. In the logistic regression analysis, the group taking antibiotics was predominantly younger, male, without chronic diseases, and diagnosed at a small hospital/clinic (where the number of beds was 0–19). Cephems accounted for the highest proportion of prescribed antibiotics, with 40–45% of patients being prescribed antibiotics. Our data may be applied to prioritize resources such as medical staff-intervention or education of working-age people without chronic diseases who visit clinics for common cold to avoid the potential inappropriate use of antibiotics and prevent antimicrobial resistance acceleration.
The eŠectiveness and safety of angiotensin-converting enzyme (ACE) inhibitors for the treatment of hypertension have been conˆrmed during long-term use. Therefore, ACE inhibitors were selected as one candidate for the switch from ethical drugs to over-the-counter (OTC) medications. The objective of this study was to perform a cost-eŠectiveness analysis if ACE inhibitors were switched to OTC medications and used by grade I hypertension patients in Japan. We conducted a cost-eŠectiveness analysis from a social perspective over a lifetime horizon using a Markov Model in 50-year-old men and women with grade I hypertension. They were divided into 3 groups: 1) untreated group; 2) consultation group visiting a clinic and receiving prescriptions for ACE inhibitors; and 3) OTC group purchasing OTC ACE inhibitors. The cost of OTC medications was estimated based on a previous study of willingness to pay (¥7,237/month). Average life expectancies in both the OTC and consultation groups were 20.20 for men and 22.63 for women, while in the untreated group it was 19.97 for men and 22.47 for women. Incremental costs per expected life-year (ICER) were ¥1,743,557 for men and ¥8,647,069 for women in the OTC group and ¥3,819,861 for men and ¥9,639,844 for women in the consultation group. These results suggest that longer life expectancies can be achieved with ACE inhibitors, and the total cost is decreased using OTC ACE inhibitors compared with ethical drugs. OTC ACE inhibitors therefore appear be a useful alternative for patients who do not have time to visit a clinic regularly.Key words-cost-eŠectiveness; over-the-counter (OTC) medication; stroke; hypertension; angiotensin-converting enzyme (ACE) inhibitor; pharmacoeconomics
Drug selection for the treatment of non-steroidal anti-in‰ammatory drug (NSAID)-induced gastric ulcer was analyzed pharmacoeconomically. Two patterns consisting of continuation of an NSAID plus administration of the prostaglandin (PG) preparation misoprostol (PG model) for 8 weeks and continuation of an NSAID plus administration of the proton-pump inhibitors omeprazole and lansoprazole (PPI model) for 8 weeks were examined. Decision analysis models were created on the basis of reports of clinical studies and epidemiologic studies relating to the drugs and gastric ulcer, and cost-comparative analyses were conducted based on the number of persons who had ulcer healing as health outcomes. Costs were estimated with respect to health expenditures from the third-party payer (public) perspective. In the case of continuation of an NSAID plus administration of the proton-pump inhibitor omeprazole for 8 weeks, the health outcomes improved and costs were reduced in comparison with continuation of an NSAID plus administration of misoprostol, thus making the administration of omeprazole the dominant choice. With continuation of an NSAID plus administration of lansoprazole for 8 weeks, the cost-savings of lansoprazole were inferior to those of misoprostol. The generic omeprazole product was the most cost-saving among the four drugs (misoprostol, original omeprazole product, generic omeprazole product, and lansoprazole) examined.
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