Variability of Cost-Effectiveness Estimates for Pharmaceuticals in Western Europe: Lessons for Inferring Generalizability

Barbieri, Marco; Drummond, Michael; Willke, Richard J.; Chancellor, Jeremy; Jolain, B; Towse, Adrian

doi:10.1111/j.1524-4733.2005.03070.x

Cited by 112 publications

(88 citation statements)

References 63 publications

(5 reference statements)

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“…In conclusione, pur considerando i limiti posti dal modello, i risultati della nostra analisi indicano che pregabalin è significativamente più efficace di gabapentin nel controllo del dolore neuropatico associato a DPN e PHN, e che i benefici clinici aggiuntivi ottenibili con il suo utilizzo si producono a un costo inferiore a quello fissato come limite della disponibilità a pagare delle società avanzate [25]. …”

Section: Discussione E Conclusioniunclassified

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Pregabalin versus gabapentin nel trattamento dei pazienti con neuropatia periferica: adattamento di un modello internazionale per la valutazione di costo/efficacia e costo/utilità alla realtà nazionale

Marchettini

Deppo

Pradelli³

2005

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OBJECTIVE: To compare the economic impact of treating neuropathic pain with pregabalin versus gabapentin. DESIGN: A cost effectiveness analysis comparing costs and effects of pregabalin 375 mg/die versus gabapentin 1800 mg/die in the perspective of the Italian National Healthcare Service was developed. The cost effectiveness analysis is examined alternatively in terms of the incremental cost per additional day with no or mild pain, and the incremental cost per quality-adjusted life-year (QALY) gained. Effects were derived from a pregabalin randomised clinical study 1008-155 and gabapentin 645-210 and 945-211 studies. Effects are expressed as reduction score of the VAS pain scale. Pharmacological costs were quantified according to the Italian market price of the drugs; healthcare procedure and hospitalisation costs were quantified on the basis of the National Tariff. Other healthcare services consumption data were derived from a Delphi Panel. To estimate the impact of pregabalin and gabapentin on daily pain experience in patients with neuropatic pain a Markov model is used. The dynamic simulation focuses on a hypothetical cohort of 1000 patients and simulates their daily pain experience over 12 weeks, to estimate clinical and economic outcomes for the group as a whole. MAIN OUTCOME MEASURES AND RESULTS: The cost-effectiveness ratio for the use of pregabalin is less than 1 euro per additional day with no or mild pain and 468 euros per QALY. The sensitivity analysis conducted to examine the effects of decreasing gabapentin dose to 1200 mg/die showes the consistency of the model results. CONCLUSIONS AND RESULTS: Although pregabalin pure costs are higher than gabapentin costs, the analyses prove pregabalin to be more effective with a small additional cost per day with no or mild pain. Keywords INTRODUZIONEIl dolore neuropatico è definito come "dolore causato da lesioni primarie o disfunzioni del sistema nervoso" [1,2], è invalidante e con tendenza alla cronicizzazione. Il dolore neuropatico può essere classificato in centrale e periferico, in base all'eziologia del danno o alla sede anatomica [3].I dolori neuropatici periferici più frequenti sono la neuropatia diabetica, la neuropatia posterpetica, la neuropatia correlata all'HIV, il dolore neuropatico correlato al cancro e il dolore a collo e schiena con componente neuropatica (radicolopatie). Sono considerati sindromi neuropatiche centrali la disestesia conseguente a lesioni del midollo spinale e dolore post infarto del tronco cerebrale o dell'encefalo [1,2].La neuropatia diabetica rappresenta la causa di neuropatia periferica più frequente nel mondo occidentale. Nella neuropatia diabetica i sintomi variano da un lieve intorpidimento a un dolore profondo e lancinante oppure forte e incessante e possono essere estremamente fastidiosi alterando completamente la qualità di vita del paziente [4]. Uno studio statunitense ha evidenziato che circa due terzi dei pazienti diabetici presentano una neuropatia periferica [5]. Negli USA, il costo per il trattamento de...

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Section: Discussione E Conclusioniunclassified

“…È comunque da notare che i rapporti di costo/utilità calcolati prendendo in considerazione sia il complesso dei costi sanitari associati alle due terapie, sia i soli costi farmaceutici rimangono ampiamente entro la soglia della disponibilità a pagare delle società industrializzate, convenzionalmente fissato in circa 50.000 euro [25].…”

Section: Analisi DI Sensibilitàunclassified

Pregabalin versus gabapentin nel trattamento dei pazienti con neuropatia periferica: adattamento di un modello internazionale per la valutazione di costo/efficacia e costo/utilità alla realtà nazionale

Marchettini

Deppo

Pradelli³

2005

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“…The extent to which the study is applicable (or transferrable) to the question of interest depends on a number of potential factors (24)(25)(26)(27). Currently, neither consensus nor instrument is available to rate the impact of on the transferability of results.…”

Section: Transferabilitymentioning

confidence: 99%

A methodological framework of preparing economic evidence for selection of medicines in the Chinese setting

Sun

Faunce

2010

J Evidence Based Medicine

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Medicines are becoming a major component of health expenditure in China. Selection of effective and cost-effective medicines represents an important effort to improve medicines use. A guideline on cost-effectiveness studies has been available in China. This guideline, however, fails to be a practical tool to prepare and critically appraise economic evidence. This article discusses, in the Chinese context, the approach to integrating economic component into the medicines selection, and elaborates the methods of producing economic evidence, including conducing economic reviews and primary economic studies.Medicines are an increasingly significant component of health expenditure in China. The medicines expenditure of hospitalized patients, for example, usually accounts for around 45% of their total medical bill (1). Rapid increases in price are rendering medicines unaffordable to many Chinese patients. The demand for more efficient, quality use of medicines has become increasingly strident, and the implementation of an Essential Medicines List in patient care represents one of the efforts to improve medicines use.Selection of effective and cost-effective medicines is the key to implementing an efficient Essential Medicines List. In the last decade, extensive methodological work has been undertaken in China to improve the assessment of effectiveness of medicines (2, 3). However, little was done to explore best approaches to addressing cost-effectiveness. Despite increasing publication of cost-effectiveness studies in the Chinese medical literature (4, 5). the methodological quality varies substantially.In an effort to improve the conduct of cost-effectiveness studies, China has developed a guideline on economic evaluation of medicines (6). This endeavor-which follows a stream of similar attempts in other countries (7-11)-offers methodological standards of conducting economic studies. However, it fails to provide policy makers and researchers with practical tools for preparing and using economic evidence for selection of medicines. This article offers a methodological framework to address issues about economic evidence in the context of medicines selection for a Chinese Essential Medicines List. Integrating economic evidence into the selection of medicinesIntegrating economic evidence in the process of medicines selection for an Essential Medicines List typically starts with formulation of a focused economic question that reflects policy maker's perspective. It is followed with a systematic review of existing studies that assesses the strength of economic evidence. The subsequent decisions will then be made on the basis of strength of economic evidence, which can be categorized into three levels.r Strong evidence without uncertainty. The existing evidence provides precise and unbiased estimates of comparative cost effectiveness, and the study settings-including patients, interventions, outcomes, and clinical practice patterns-are applicable to the question being evaluated. In such case, a decision about accep...

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“…Proponents of CEA emphasize the necessity of reporting health consequences, especially when reporting health intervention evaluation results, while questioning the CBA for the attribution of a monetary value to health benefits on ethical grounds and the uncertainty regarding the level of the assigned value (Johannesson, 1995;Barbieri et al, 2001;Willan et al, 2001;Laxminarayan et al, 2006). As a consequence, economic evaluation studies of health interventions are mainly based on CEA, while the CBA is less preferred in the (environmental) health (care) sector (WHO, 2000;Grosse et al, 2007;Ngorsuraches, 2008).…”

Section: The Cost-effectiveness Of Health Interventionsmentioning

confidence: 99%

Market Potential of Folate Biofortified Rice in China

Steur

Gellynck

Blancquaert

et al. 2013

Handbook of Food Fortification and Health

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Variability of Cost-Effectiveness Estimates for Pharmaceuticals in Western Europe: Lessons for Inferring Generalizability

Cited by 112 publications

References 63 publications

Pregabalin versus gabapentin nel trattamento dei pazienti con neuropatia periferica: adattamento di un modello internazionale per la valutazione di costo/efficacia e costo/utilità alla realtà nazionale

Pregabalin versus gabapentin nel trattamento dei pazienti con neuropatia periferica: adattamento di un modello internazionale per la valutazione di costo/efficacia e costo/utilità alla realtà nazionale

A methodological framework of preparing economic evidence for selection of medicines in the Chinese setting

Market Potential of Folate Biofortified Rice in China

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