scholarly journals Fluticasone furoate/Vilanterol 92/22 μg once-a-day vs Beclomethasone dipropionate/ Formoterol 100/6 μg b.i.d.: a 12-week cost analysis in mild-to-moderate asthma

2016 ◽  
Vol 11 ◽  
Author(s):  
Roberto W. Dal Negro ◽  
Chiara Distante ◽  
Luca Bonadiman ◽  
Paola Turco ◽  
Sergio Iannazzo
Keyword(s):  
National Health Service ◽  
Lung Function ◽  
Health Service ◽  
Cost Analysis ◽  
National Health ◽  
Beclomethasone Dipropionate ◽  
Fluticasone Furoate ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Asthma is a disease with high cost for the National Health Service. Two of the most recent LABA/ICS combinations for persistent bronchial asthma are Beclomethasone dipropionate/Formoterol (B/F) delivered via the Nexthaler device and Fluticasone furoate/Vilanterol (F/V) delivered via the Ellipta device. No comparison has been carried out yet in terms of cost analysis in asthma, to our knowledge. Aim of the present monocentric, observational, retrospective study was to calculate and compare the costs of mild-to-moderate asthma patients assuming B/F 100/6 μg b.i.d. to those of patients assuming F/V 92/22 μg once-a-day over a 12-week treatment period from the Italian National Health Service perspective. Methods: Data were obtained automatically and anonymously from the institutional database of the Lung Unit of the Specialist Medical Centre (CEMS), Verona, Italy, UNI EN ISO 9001-2008 validated. FEV1 values, number of relapses, healthcare resources as hospitalizations due to asthma relapses, days of hospitalization, general practitioner (GP), specialist visits, and days of inactivity, were recorded over the study period together with the use of extra medications (systemic steroids and antibiotics). In order to compare the outcomes achieved in both groups, the propensity score matching method was used in STATA, and statistical significance was accepted for p < 0.05. Results: Clinical data of 77 patients treated with B/F b.i.d (Group A) and of 40 patients treated with F/V 92/22 μg once-a-day (Group B) were selected. The PS-matching process, designed as matching on the baseline covariates, gender, age, FEV1 and comorbidities, returned a cohort of 40 group A patients of the entire cohort matched with 40 patients of group B, fully comparable for demographics and clinical characteristics. In the PS-matched cohort, the mean (±SE) number of relapses per patient during the follow-up was 0.53 (±0.12) in group A and 0.28 (±0.07) in group B. In group A, n = 25 (62.50 %), n = 9 (22.50 %), and n = 6 (15 %) patients had 0, 1, 2 relapses, respectively. In group B, n=29 (72.50 %), and n = 11 (27.50 %) had 0 and 1 relapse, respectively. Over the study period, the average number of hospitalizations per patient was 0.15 (±0.06), with 0.28 (±0.12) days of hospitalization in group A, and 0.08 (±0.04) with 0.08 (±0.04) days of hospitalization in group B, respectively. The difference between the two groups in terms of FEV1(L) improvement vs baseline was 0.11 in favour of group B (p = 0.007). When results were compared, the improvement in lung function obtained in group B proved significantly higher both in terms of absolute FEV1 and of FEV1 % predicted. The mean (±SE) cost of hospitalizations per patient was € 345.30 (±133.23) in group A and € 172.65 (±98.18) in group B, respectively, with a mean not significant difference of - € 172.65 in favour of group B (p = 0.9). In particular, the mean (±SE) cost for visits per patient was € 26.82 (±3.73) in group A and € 11.36 (±2.30) in group B (p = 0.002), and the mean cost for rescue medications per patient was € 35.24 (±6.93) in group A, and € 18.73 (±3.38) in group B, respectively (p = 0.05). Conclusions: Even if both ICS/LABA combinations were checked over a limited period of time, they seem characterized by a different profile in terms of effect on lung function and economic impact on mild-tomoderate asthma. The once-daily inhalation of combined Fluticasone furoate/Vilanterol 92/22 μg showed the potential for enhanced clinical outcomes and reduced costs when compared to Beclomethasone dipropionate/Formoterol 100/6 μg b.i.d.

scholarly journals Fluticasone furoate/Vilanterol 92/22 μg once-a-day vs Beclomethasone dipropionate/Formoterol 100/6 μg b.I.D.: a 12-month comparison of outcomes in mild-to-moderate asthma

2018 ◽  
Vol 13 ◽  
Author(s):  
Roberto W. Dal Negro ◽  
Luca Bonadiman ◽  
Paola Turco
Keyword(s):  
Beclomethasone Dipropionate ◽  
Time Dependent ◽  
Adherence To Treatment ◽  
Fluticasone Furoate ◽  
Once Daily ◽  
Hospitalization Rates ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Bronchial asthma is an inflammatory disease of the airways. Beclomethasone dipropionate/Formoterol (BDP/F) and Fluticasone furoate/Vilanterol (FF/V) are two of the most effective LABA/ICS combinations for managing persistent bronchial asthma. Aim of the study was to compare the outcomes achieved in mild-tomoderate asthma patients assuming BDP/F 100/6 μg b.i.d. (Group A) or FF/V 92/22 μg once-daily (Group B) for 12-months. No head-to-head long-term comparison is available at present. Methods: Data were automatically and anonymously obtained from the institutional database: FEV1% predicted values; the exacerbation and hospitalization rates; days of hospitalization; GP and/or specialist visits; days of inactivity; courses of systemic steroids and/or antibiotics were recorded at baseline and after 3, 6 and 12 months of both treatments. The overall adherence to treatments was also calculated. The propensity score method was used for matching and comparing the two cohorts of patients; Anova and Wilcoxon tests were used for checking the trends and time-to-time comparisons over the period; statistical significance was accepted for p < 0.05. Results: The PS-matching process returned a cohort of 40 group A patients matched with 40 patients of group B, fully comparable for demographics, clinical characteristics, and comorbidities. The improvement in lung function was significant in both groups (p < 0.001), even if it was significantly higher and time-dependent in group B. The mean (±SE) exacerbation rate/patient changed from 0.63 (±0.13) at baseline to 0.53 (±0.12) after three; to 0.58 (±0.13) after six, and to 0.60 (±0.18) after twelve months in group A (p = ns), while from of 1.05 (±0.16) at baseline, to 0.28 (±0.07) after three; to 0.33 (±0.08) after six, and to 0.18 (±0.08) after twelve months in group B (p < 0.001), respectively. The mean hospitalization rate/patient changed from 0.25 ± 0.07 at baseline to 0.15 (±0.06) after three; to 0.08 (±0.04) after six, and to 0.13 (±0.05) after twelve months in group A (p = ns), while from 0.30 (±0.07) at baseline to 0.08 (±0.04) after three; to 0.10 (±0.05) after six, and to 0.03 (±0.03) after twelve months in group B (p < 0.001), respectively. Also mean duration of hospitalization and days of inactivity were in favour of FF/V treatment over time (in both cases p < 0.001). GP’s visits were reduced by both treatments (p < 0.007 in group A and p < 0.001 in group B, respectively, while Specialist’s visits only dropped during FF/V (p < 0.001). Steroid and antibiotic courses were significantly reduced by both treatments, even if more systematically in group B (p < 0.001 vs p < 0.007, and p < 0.001 vs p < 0.044, respectively). Moreover, changes in all outcomes considered proved time-dependent during the FF/V treatment only, particularly over the second semester. Finally, the overtime adherence to treatment was higher by 22 days during FF/V . Conclusions: Both the ICS/LABA combinations proved effective, even if characterized by different patterns of effectiveness either in terms of lung function and of long-term clinical outcomes. Only the once-daily inhalation of combined FF/V 92/22 μg once-daily optimized systematically the exacerbation and hospitalization rates in mild-tomoderate asthma, together with all other outcomes over time. The effectiveness of FF/V 92/22 once-daily μg proved progressive and time-dependent over the twelve-month period of the study, and associated to a higher adherence to treatment.

scholarly journals Correction to: Fluticasone furoate/Vilanterol 92/22 μg once-a-day vs Beclomethasone dipropionate/Formoterol 100/6 μg b.I.D.: a 12-month comparison of outcomes in mild-to-moderate asthma

2018 ◽  
Vol 13 ◽  
Author(s):  
Roberto W. Dal Negro ◽  
Luca Bonadiman ◽  
Paola Turco
Keyword(s):  
Beclomethasone Dipropionate ◽  
Respiratory Medicine ◽  
Original Research ◽  
Original Research Article ◽  
Fluticasone Furoate ◽  
Moderate Asthma ◽  
Research Article ◽  
Group A ◽  
The Mean ◽  
Group B

Correction to: Multidisciplinary Respiratory Medicine (2018) 13:18 DOI: 10.1186/s40248-018-0131-x After publication of the Original research article [1] it was brought to our attention that the sentence at pag 6 (between Fig. 3 and Fig. 4)) must be corrected as follows: “The mean duration of inactivity was 2.88 (0.63) at baseline; 1.53 (0.27) after 3; 1.40 (0.27) after 6, and 1.45 days (0.58) after twelve months (Anova: p = 0.11) in group A, while the corresponding duration in group B was 3.35 (0.63) at baseline; 0.60 (0.19) after 3; 1.10 (0.21) after 6, and 0.83 days (0.39) after 12 months (Anova; p <0.001), respectively.” In addition at pag. 7 Fig. 5 entitled “Changes in mean duration of inactivity/p. over 12 months” must be substituted with the new Fig. 5 because there is a mistake regarding anova p = 0.11 and consequently in the whole image. This Correction shows the revised Fig. 5. The original article has been updated.

Free drugs in clinical trials and their potential cost saving impact on the National Health Service: A retrospective cost analysis in Italy

Lung Cancer ◽  
2013 ◽  
Vol 81 (2) ◽  
pp. 236-240 ◽  
Author(s):  
Francesco Grossi ◽  
Carlo Genova ◽  
Nidia Diaz Gaitan ◽  
Maria Giovanna Dal Bello ◽  
Erika Rijavec ◽  
...  
Keyword(s):  
Clinical Trials ◽  
National Health Service ◽  
Health Service ◽  
Cost Saving ◽  
Cost Analysis ◽  
National Health ◽  
Potential Cost Saving ◽  
Potential Cost

Crisis in Admission Beds

1995 ◽  
Vol 167 (6) ◽  
pp. 765-769 ◽  
Author(s):  
Robin B. Powell ◽  
Doris Hollander ◽  
Robert I. Tobiansky
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Corrective Action ◽  
Clear Correlation ◽  
Bed Occupancy ◽  
Careful Monitoring ◽  
Psychiatric Units ◽  
The Mean ◽  
Occupancy Rates

BackgroundThis study was carried out to measure bed occupancy in Greater London's psychiatric units, in response to the apparent shortage of admission beds.MethodThe bed occupancy of London's 54 National Health Service (NHS) acute psychiatric units within 29 districts was ascertained by telephone on 16 bank holidays covering the period 1990–93.ResultsThe mean occupancy level for all London over the 4 years was 97.54% (95% CI = ±0.94%). The number of beds occupied in inner London was significantly greater (99.79 ± 1.11%) than in outer London (95.1 ± 1.49%) (t = 3.85, d.f. = 462, P < 0.001). Bed occupancy for inner London units was ≥ 100% on over 49% of occasions. There has been a steady decline in the number of beds over the four-year period. There was a clear correlation between occupancy levels and the Jarman UPA8 Underprivilege Score (r = 0.504) and between bed provision and the UPA8 (r = 0.67).ConclusionOccupancy rates have become unacceptably high and require careful monitoring. Corrective action may be required in order to prevent a breakdown in services.

Cataract surgery refractive outcomes: representative standards in a National Health Service setting

2018 ◽  
Vol 103 (4) ◽  
pp. 539-543 ◽  
Author(s):  
Kerr Brogan ◽  
Charles J M Diaper ◽  
Alan P Rotchford
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Cataract Surgery ◽  
National Health ◽  
Postoperative Outcome ◽  
Absolute Error ◽  
European Guidelines ◽  
Refractive Outcomes ◽  
Service Setting ◽  
The Mean

Background/aimsTo report refractive outcomes from an National Health Service (NHS) cataract surgery service and assess if results meet suggested benchmark standard.MethodsDetails of all patients undergoing cataract surgery in the Southern General and New Victoria hospitals in Glasgow, UK, between November 2006 and December 2016 were prospectively entered into an electronic database. Patients were reviewed 4 weeks postoperatively in the eye clinic and underwent refraction at their local optometrist prior to this appointment. Surgically uncomplicated cases with in the bag’ non-toric intraocular lens implantation were included. Patients with previous laser refractive procedures or failing to achieve 6/12 acuity or better postoperatively were excluded. Proximity to targeted postoperative refraction was documented.ResultsOver this 10-year period, 11 083 eyes underwent cataract surgery. Of these, 8943 eyes of 6936 patients (80.69%) met the inclusion criteria and had both target and postoperative outcome refraction recorded. The mean difference between the targeted and outcome refraction was −0.07 D (SD 0.67). The mean absolute error was 0.50 D. Postoperative refraction was within 1 D of target refraction for 7938 eyes (88.76%) and within 0.50 D for 5577 eyes (62.36%).ConclusionRefractive outcomes following routine cataract surgery reported here are well within the targets recommended by the Royal College of Ophthalmologists and European guidelines, but suggest that higher cataract refractive outcome benchmark standards may not yet be a realistic expectation for all NHS units with current biometry practice.

scholarly journals Impact of the Manchester Glaucoma Enhanced Referral Scheme on NHS costs

2019 ◽  
Vol 4 (1) ◽  
pp. e000278 ◽  
Author(s):  
Hannah Forbes ◽  
Matt Sutton ◽  
David F Edgar ◽  
John Lawrenson ◽  
Anne Fiona Spencer ◽  
...  
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Observational Study ◽  
Cost Analysis ◽  
National Health ◽  
False Positive ◽  
Waiting Times ◽  
Outpatient Visits ◽  
Audit Data ◽  
The Cost

ObjectivesGlaucoma filtering schemes such as the Manchester Glaucoma Enhanced Referral Scheme (GERS) aim to reduce the number of false positive cases referred to Hospital Eye Services. Such schemes can also have wider system benefits, as they may reduce waiting times for other patients. However, previous studies of the cost consequences and wider system benefits of glaucoma filtering schemes are inconclusive. We investigate the cost consequences of the Manchester GERS.DesignObservational study.MethodsA cost analysis from the perspective of the National Health Service (NHS) was conducted using audit data from the Manchester GERS.Results2405 patients passed through the Manchester GERS from April 2013 to November 2016. 53.3% were not referred on to Manchester Royal Eye Hospital (MREH). Assuming an average of 2.3 outpatient visits to MREH were avoided for each filtered patient, the scheme saved the NHS approximately £2.76 per patient passing through the scheme.ConclusionOur results indicate that glaucoma filtering schemes have the potential to reduce false positive referrals and costs to the NHS.

scholarly journals Assessing the impact of England's National Health Service R&D Health Technology Assessment program using the “payback” approach

2009 ◽  
Vol 25 (01) ◽  
pp. 1-5 ◽  
Author(s):  
James Raftery ◽  
Stephen Hanney ◽  
Colin Green ◽  
Martin Buxton
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Health Technology Assessment ◽  
Case Studies ◽  
National Health ◽  
Technology Assessment ◽  
Clinical Excellence ◽  
Health Technology ◽  
The Mean ◽  
The Impact

Objectives:This study assesses the impact of the English National Health Service (NHS) Health Technology Assessment (HTA) program using the “payback” framework.Methods:A survey of lead investigators of all research projects funded by the HTA program 1993–2003 supplemented by more detailed case studies of sixteen projects.Results:Of 204 eligible projects, replies were received from 133 or 65 percent. The mean number of peer-reviewed publications per project was 2.9. Seventy-three percent of projects claimed to have had had an impact on policy and 42 percent on behavior. Technology Assessment Reports for the National Institute for Health and Clinical Excellence (NICE) had fewer than average publications but greater impact on policy. Half of all projects went on to secure further funding. The case studies confirmed the survey findings and indicated factors associated with impact.Conclusions:The HTA program performed relatively well in terms of “payback.” Facilitating factors included the program's emphasis on topics that matter to the NHS, rigorous methods and the existence of “policy customers” such as NICE.

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