scholarly journals Valutazione economica di Infliximab (Remicade®) vs Etanercept (Enbrel®) nel trattamento dell’artrite reumatoide

2003 ◽  
Vol 4 (2) ◽  
pp. 77-86
Author(s):  
G. L. Colombo ◽  
A. Muzio ◽  
A. Longhi
Keyword(s):  
Drug Administration ◽  
Cost Minimization ◽  
National Health System ◽  
Drug Acquisition ◽  
Joint Damage ◽  
New Drugs ◽  
Lower Drug ◽  
Acquisition Costs ◽  
Differential Costs ◽  
The Cost

Rheumatoid arthritis is one of the most severe chronic pathologies, affecting the whole organism, with invalidating outcomes that affect the quality of life of the patients. Its prevalence is estimated to be about 0,5% in Italy, with elevated costs for the national health system (NHS) and the society, in spite of the best treatment with traditional therapies that include anti-inflammatory and disease modifying antirheumatic drugs (DMARDs). The introduction of new drugs with biological activity, mainly acting through an antagonism of tumor necrosis factor (anti-TNF), is a great advance in the management of the disease, as their use has been shown to be effective in slowing the progression of the joint damage, and sometimes in reversing it,. The present article present a cost-minimization study conducted by comparing the two anti-TNFs available in Italy, etanercept and infliximab, assuming equal efficacy and approached from the perspectives of the Italian NHS and society. Only differential costs were considered, i.e. drug acquisition, drug administration and patient monitoring costs, and the analysis comprised two treatment years, in order two account for the cost differences between the first treatment year and the following. The analysis showed that infliximab represents the more convenient alternative from both the NHS and the society points of view, mainly due to lower drug acquisition costs, which offset the higher drug administration costs: the total two year treatment costs per patient with etanercept resulted of 20.173 euro and 22.164 euro from the societal and NHS perspectives, respectively, while the same costs resulted of 13.715 euro and 14.795 euro with infliximab. These results were tested with thorough sensitive analyses, conducted by varying the principal cost and time consumption estimates, that showed that etanercept results less convenient in all the hypothesis tested.

scholarly journals Valutazione farmacoeconomica dell’uso di tramadolo vs ketorolac nella gestione del dolore postoperatorio

2003 ◽  
Vol 4 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Lorenzo G. Mantovani
Keyword(s):  
Economic Evaluation ◽  
Cost Minimization ◽  
Drug Acquisition ◽  
Economic Consequences ◽  
Analgesic Action ◽  
Surgical Pain ◽  
Consumption Data ◽  
Lower Drug ◽  
Acquisition Costs ◽  
The Mean

This article represents the first evaluation that compares the economic consequences of managing postsurgical pain with tramadol or ketorolac in the Italian setting. The economic evaluation was based on 5 clinical trials that directly compared the efficacy and tolerability of tramadol and ketorolac treatments in different settings and that contained drug consumption data. Since the review of these data confirmed that their efficacy is comparable (tramadol showed a quicker onset of the analgesic action, which was not considered for the purposes of the economic evaluation), it was chosen to conduct a cost minimization analysis. The calculations were made considering two different drug acquisition costs: the hypothetical price for the hospital, computed by discounting 50% off the retail price, and the mean price really paid by hospitals according to the IHS. The analyses showed that, when the discounted price is applied, tramadol induces costs that are similar to those induced by ketorolac in 2/3 of the cases and lower in the remaining 1/3. Considering the mean price paid by hospitals, tramadol results economically more advantageous than ketorolac in all considered settings. In conclusion, ketorolac and tramadol are two effective and tolerable drugs in the management of post-surgical pain, although they differ in the adverse event pattern and in the rapidity of their action. In the Italian setting, tramadol appears to be economically more efficient, due to lesser consumption and lower drug acquisition costs.

AN ECONOMIC EVALUATION OF PAIN THERAPY AFTER HYSTERECTOMY

1999 ◽  
Vol 15 (3) ◽  
pp. 548-562 ◽  
Author(s):  
Brian E. Rittenhouse ◽  
Manon Choinière
Keyword(s):  
Pain Management ◽  
Cost Minimization ◽  
Study Drug ◽  
Independent Study ◽  
Nursing Time ◽  
Treatment Groups ◽  
Wage Rates ◽  
Acquisition Costs ◽  
The Cost ◽  
Activity Costs

Objectives: To assess the economics of patient-controlled analgesia (PCA) treatment versus regular intramuscular (IM) injections of opioid analgesia for pain management after hysterectomy.Methods: Cost-minimization analysis was used based on the comparable pain control results achieved in the two treatment groups. Observations were taken of treatment-related events with personnel (mostly nursing) time implications during the trial. Times were then associated with these events in an independent study of personnel activity. Costs were linked by using average wage rates for the various personnel for the Montreal area during the time of the study. Drug and material costs were hospital acquisition costs for all items. The cost of the PCA pump itself was not included in the analysis. Several analyses were performed to test the sensitivity of the results to various assumptions.Results: The results for total costs of the two therapies generally showed PCA to be more costly than regular IM injections despite no costs of the pump being included in the analyses. These results were robust with respect to changes in assumptions. Even when intentionally biasing the analysis against IM therapy, it was difficult to obtain results that favored PCA.Conclusions: Based upon the institutions and assumptions in this analysis, PCA offers no cost advantages over regular IM therapy in the pain management after hysterectomy. Regular IM injections provided less costly analgesia.

scholarly journals Pharmaceutical Lemons: Innovation and Regulation in the Drug Industry

2016 ◽  
Author(s):  
Ariel Katz
Keyword(s):  
Drug Administration ◽  
Cost Benefit ◽  
Drug Regulation ◽  
Conventional Wisdom ◽  
New Drugs ◽  
Expected Returns ◽  
Private Market ◽  
Central Argument ◽  
The Cost ◽  
Valuable Service

Before a new drug can be marketed the Food and Drug Administration must be satisfied that it is safe and effective. According to conventional wisdom, the cost and delay involved in this process diminish the incentives to invest in the development of new drugs. Accordingly, several reforms aimed at restoring such incentives have been implemented and others have been advocated.This paper challenges the central argument in the debate on the topic, namely that drug regulation and drug innovation are necessarily at odds with each other. Although intuitively appealing, the argument that drug regulation negatively affects the incentives to innovate does not fully capture the role that regulation plays in this industry. This paper shows that the regulatory framework is not solely a burden imposed on the industry; it also provides a valuable service to the industry.Specifically, drug regulation provides certification of drug quality. Such certification, which may not be easily achieved by private market-based mechanisms, prevents the market from becoming a market for lemons. Therefore, rather than decreasing the expected returns to innovation, this aspect of regulation contributes to the value of new drugs and may actually encourage innovation. This point has largely been absent from most cost-benefit analyses of drug regulation, yet without it any discussion of the merits of regulation is incomplete.

scholarly journals A cost-minimization analysis of combination therapy in hypertension: fixed-dose vs extemporary combinations

2013 ◽  
Vol 14 (4) ◽  
pp. 153-160
Author(s):  
Marco Bellone ◽  
Pierluigi Sbarra
Keyword(s):  
National Health ◽  
Cost Minimization ◽  
National Health System ◽  
Antihypertensive Agents ◽  
Cost Savings ◽  
Cost Driver ◽  
Fixed Dose ◽  
Daily Cost ◽  
Cost Minimization Analysis ◽  
Acquisition Costs

BACKGROUND: Cardiovascular disease management and prevention represent the leading cost driver in Italian healthcare expenditure. In order to reach the target blood pressure, a large majority of patients require simultaneous administration of multiple antihypertensive agents.OBJECTIVE: To assess the economic impact of the use of fixed dose combinations of antihypertensive agents, compared to the extemporary combination of the same principles.METHODS: A cost minimization analysis was conducted to determine the pharmaceutical daily cost of five fixed dose combinations (olmesartan 20 mg + amlodipine 5 mg, perindopril 5 mg + amlodipine 5 mg, enalapril 20 mg + lercanidipine 10 mg, felodipine 5 mg + ramipril 5 mg, and delapril 30 mg + manidipine 10 mg) compared with extemporary combination of the same principles in the perspective of the Italian NHS. Daily acquisition costs are estimated based on current Italian prices and tariffs.RESULTS: In three cases the use of fixed‑dose combination instead of extemporary combination induces a lower daily cost. Fixed combination treatment with delapril 30 mg + manidipine 10 mg induces greater cost savings for the National Health System (95,47 €/pts/year), as compared to free drugs combination therapy.CONCLUSIONS: Compared with free drug combinations, fixed‑dose combinations of antihypertensive agents are associated with lower daily National Health Service acquisition costs.

Is There Cost Reduction Potential for Extended Half-Life Cephalosporins?

1986 ◽  
Vol 20 (12) ◽  
pp. 975-980 ◽  
Author(s):  
Robert D. Scalley ◽  
Clifford C. Stuart
Keyword(s):  
Half Life ◽  
Cost Reduction ◽  
Drug Acquisition ◽  
Cost Effective ◽  
Generation Cephalosporin ◽  
Nursing Time ◽  
Personnel Costs ◽  
Acquisition Costs ◽  
The Cost ◽  
The Impact

Two new second-generation cephalosporin derivatives with extended half-lives, ceforanide and cefonicid, have recently entered the U.S. marketplace. Because longer dosing intervals require fewer daily doses, potential exists for overall cost reduction if pharmacy and nursing time can be effectively saved. Reduction in personnel costs, however, must be sufficient for these more expensive products to be truly cost effective. We studied the impact of substituting these newer agents for older, less expensive products with formulary status at our 200-bed community hospital. Results show that no nursing expenses could be recovered, and there is little chance of consistently reducing pharmacy compounding expenses. Within the constraints of these studies, particularly physician prescribing habits, the GRASP (Grace Reynolds Application and Study of PETO) system of determining nurse staffing, and our drug acquisition costs, we find that the newer extended half-life products have very limited usefulness and may only increase the cost of antibiotic utilization.

Pharmacoeconomic Assessment of Ciclopirox Topical Solution, 8%, Oral Terbinafine, and Oral Itraconazole for Onychomycosis

2006 ◽  
Vol 10 (6_suppl) ◽  
pp. S54-S62 ◽  
Author(s):  
Aditya K. Gupta ◽  
Charles W. Lynde ◽  
Kirk Barber
Keyword(s):  
Drug Acquisition ◽  
Cost Effective ◽  
Canadian Health Care System ◽  
Nail Lacquer ◽  
Canadian Health ◽  
Canadian Health Care ◽  
Acquisition Costs ◽  
The Cost ◽  
Relapse Rates ◽  
Oral Terbinafine

Most pharmacoeconomic data available for antifungal agents are based on US or European cost parameters. Similar data have not been reported in a Canadian health care system. A pharmacoeconomic analysis was performed considering the costs of drug acquisition and medical management, which were representative of the Canadian health care system, for each of the therapies approved for use in toenail onychomycosis in Canada: continuous oral terbinafine, oral pulse itraconazole, and topical ciclopirox 8% nail lacquer. A survey of provincial fee schedules was conducted to determine the representative costs of parameters relating to onychomycosis treatment, such as consultation visit cost, return visit cost, mycology testing, liver function testing, and complete blood count analysis. Manufacturers' costs were used to calculate representative drug acquisition costs. Meta-analysis was used to determine the average mycologic cure rates of each therapy, and the medical literature was consulted to determine the relapse rates for each therapy. Ciclopirox nail lacquer had the lowest drug acquisition costs compared with continuous terbinafine and pulse itraconazole ($197.89 vs $311.39 and $323.40, respectively). Using the pharmacoeconomic model with three 1-year treatment phases, in which failures or relapses were re-treated with the primary drug, the expected cost per patient was $601.52 with ciclopirox nail lacquer, $746.72 with oral terbinafine, and $938.42 with itraconazole. The main analysis assumed that two bottles of ciclopirox nail lacquer were required per treatment. The cost for the ciclopirox lacquer exceeded continuous terbinafine but remained lower than pulse itraconazole when three bottles of ciclopirox nail lacquer were considered in the calculation of cost per mycological cure. A variety of relapse rates were tested, and ciclopirox using two or fewer bottles remained cost-effective compared with continuous terbinafine or pulse itraconazole, regardless of the relapse rate. Where three bottles are required, the cost-effectiveness of ciclopirox nail lacquer is less than that of continuous terbinafine but more cost-effective than that of pulse itraconazole.

scholarly journals Fluvoxamina: profilo farmacoeconomico

2001 ◽  
Vol 2 (3) ◽  
pp. 175-184
Author(s):  
Mario Eandi
Keyword(s):  
Cost Minimization ◽  
Economic Benefits ◽  
Pharmacoeconomic Evaluation ◽  
Term Therapy ◽  
Purchase Cost ◽  
Antidepressant Use ◽  
Differential Costs ◽  
Long Term Therapy ◽  
The Cost

In this study we mean to outline a brief pharmacoeconomic review of fluvoxamine, considering only its antidepressant use. Essential objective is to highlight all the variables of cost effectiveness, tolerance and safety that can lead some types of differential costs. This study analyses the epidemiology and the economic burden of depression and a pharmacoeconomic profile of fluvoxamine, with its characteristics of effectiveness, tolerance, safety and handiness. The pharmacoeconomic evaluation is conducted according to the cost minimization analysis (CMA), considering fluvoxamine, Selective Serotonine Reuptake Inhibitors (SSRI) and antidepressant tricycic as native treatments. Fluvoxamine differs from the others SSRI far the purchase cost and it’s more convenient than the antidepressant tricycic treatment, especially for long term therapy. Economic benefits can be distributed in a balanced way between the Italian national healthcare system (NACS), the society and the patients.

scholarly journals Cost per Progression Free Survival (PFS) of Daratumumab, Elotuzumab, Carfilzomib and Ixazomib Combinations with Lenalidomide/Dexamethasone (DRd, ERd, KRd, IRd) in Patients with Relapsed/Refractory Multiple Myeloma (RRMM)

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3149-3149
Author(s):  
Pamela Santana ◽  
Ricardo Saad ◽  
Adrielle Kolanian ◽  
Cyntia Fioratti ◽  
Marcela Junqueira ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Hematological Malignancy ◽  
Drug Acquisition ◽  
Progression Free Survival ◽  
Drug Label ◽  
Free Survival ◽  
Total Cost ◽  
Acquisition Costs ◽  
The Cost

OBJECTIVES: Multiple myeloma (MM) is the second most common hematological malignancy with several available therapies and an extensive pipeline. A metanalysis comparing pivotal relapsed/refractory (RRMM) studies that assessed DRd, ERd, KRd and IRd showed that DRd had the best PFS results. The goal of this analysis was to compare the cost per progression-free survival (PFS) for each of the comparators from the perspective of the Brazilian private healthcare system. METHODS: We calculated the cost per PFS individually using the most recent available data from follow-up (FUP) studies of the therapies assessed. PFS values were based on POLLUX 3-year FUP (DRd), ENDEAVOR 4-year FUP (ERd), ASPIRE 3-year FUP (KRd) and TOURMALINE-MM1 (IRd). Only drug acquisition costs (with wastage) were considered in the analysis (according to drug label dosage) and were retrieved from the Brazilian official price list (Jul/19). Cost per PFS was calculated by dividing the total cost in the PFS period by time in PFS (in months). Cost in 18 months was assessed because it is the maximum time that carfilzomib is recommended to be used. RESULTS: DRd showed the best PFS result compared with ERd, KRd and IRd (42.0 vs. 19.4, 26.1, 20.6, respectively). Total costs in the period of PFS for each of the comparators were BRL 2.02 million (DRd), BRL 1.29 million (ERd), BRL 1.14 million (KRd) and BRL 0.98 million (IRd). Costs per PFS- were BRL 48,060, BRL 66,343, BRL 43,822, BRL 47,760 and costs in the 18 first months were BRL 1.01 million, BRL 1,13 million, BRL 0.95 million and BRL 0.84 million for DRd, ERd, KRd and IRd, respectively. CONCLUSIONS: DRd showed the best PFS result, however its cost per PFS is the 3rd lowest among the comparators. As costs are directly dependent on PFS, the longer the PFS the higher are the costs. Additionally, daratumumab has continuous usage meanwhile carfilzomib has label recommended usage for just 18 cycles due to toxicity and tolerability-related events. Disclosures Santana: Janssen pharmaceuticals: Employment. Saad:Janssen pharmaceuticals: Employment. Kolanian:Janssen pharmaceuticals: Employment. Fioratti:Janssen pharmaceuticals: Employment. Junqueira:Janssen pharmaceuticals: Employment. Decimoni:Janssen Pharmaceuticals: Employment.

scholarly journals Costi sanitari di un programma vaccinale: analisi di minimizzazione dei costi

2003 ◽  
Vol 4 (1) ◽  
pp. 25-32
Author(s):  
G. L. Colombo ◽  
A. Muzio ◽  
R. Giordani
Keyword(s):  
Cost Minimization ◽  
First Year ◽  
Liquid Formulation ◽  
Italian Market ◽  
Global Cost ◽  
Differential Costs ◽  
Mandatory Vaccination ◽  
First Year Of Life ◽  
The Cost ◽  
Cost Components

The global cost of a vaccination program is made up by many more cost components than the acquisition expense, although the former is the first cost usually taken into consideration when comparing two or more alternatives. The present article analyses the economical impact consequent to the use of two different hexavalent vaccine formulations (Hexavac, liquid ready for injection, and Infanrix Hexa, dry, to be re-hydrated) available on the Italian market for the mandatory vaccination of newborns during their first year of life. The cost minimization analysis was conducted considering only differential costs, i.e. those costs than can differ with the use of one of the two products, and not those common to the two competing products, such as acquisition cost (33 euro in average for both), the costs for the organization, the call of the infants to be vaccinated, etc.. The differences among the considered alternatives detected by this study regard the work for the preparation and administration of the vaccines, the quantity of special waste they produce and the incidence of serious febrile reactions leading to pharmacological treatment and physician consultation (body temperature > 40°C). The liquid formulation resulted more convenient in terms of cost for nurse work (0,63 euro saved per patient), waste disposal, and adverse reactions management. The robustness of these results was confirmed by sensitivity analysis and an estimate of the global saving for the Italian health system associated with the universal utilization of the liquid formulation is furnished.

Adjusting For Drug Wastage In Economic Evaluations Of New Therapies For Hematologic Malignancies: A Systematic Review Of The Literature and Implications

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2928-2928
Author(s):  
Matthew C. Cheung ◽  
Maureen E. Trudeau ◽  
Anca Prica ◽  
Rena Buckstein ◽  
Kelvin KW Chan
Keyword(s):  
Drug Acquisition ◽  
Case Analysis ◽  
Hematologic Malignancies ◽  
Sensitivity Analyses ◽  
Economic Evaluations ◽  
Base Case ◽  
Base Case Analysis ◽  
Drug Wastage ◽  
Acquisition Costs ◽  
The Cost

Abstract The cost of cancer care is rising to levels that appear unsustainable, in large part driven by a rapid increase in expenditures for novel therapies. In 2005, the direct costs of cancer care in the United States were $74 billion, with a prediction that these figures will double this decade as the population ages and we enter an age of biologically-tailored drug development. Historically, the evaluation of the cost-effectiveness of new drug therapies presumes that every milligram of drug is effectively utilized. With manufacturers dictating the availability of vial sizes for parenteral drugs, however, this may not be the case. A recent single-institution study in Canada estimated that an annual loss of $150 000 ($CDN) could be attributed to drug wastage of a parenteral therapy for myelodysplasia (Walker et al., Can J Hosp Pharm 2012). Whether current economic evaluations routinely model the potential for drug wastage, or the strategies to mitigate wastage, has not previously been determined. We sought to identify the frequency of drug wastage modeling in economic evaluations of modern parenteral therapies for hematologic malignancies. All US Food and Drug Administration (FDA) approved parenteral therapies from 2006-2013 (n=14) were identified for review. A systematic review of published English-language economic evaluations for these therapies was conducted and data on the conduct of the cost-analyses were extracted in duplicate. The primary outcome was the proportion of studies that explicitly modeled drug wastage in the base-case analysis, with results presented descriptively. Where possible, we calculated the impact of wastage on incremental cost-effectiveness ratios (ICERs) and drug acquisition costs. Thirty-three publications were retrieved; five of these studies were excluded (3 were non-English language and 2 were review articles). Of the remaining 27 reports, 3 were publicly-funded health technology assessments (HTAs) to inform funding decisions by the UK National Institute for Health and Care Excellence (NICE) and the remainder (n=24) were peer-reviewed publications. Sixteen economic evaluations were of rituximab-based regimens and 6 were bortezomib-based. Drug wastage was considered in the primary or base-case analysis in one third of the publications (9 of 27; 33%); wastage was considered in 2 of the 3 HTAs (67%) and 7 of the 24 peer-reviewed reports (29%). Of the 9 models that considered wastage in the base-case analysis, 2 completed sensitivity analyses in which no drug wastage occurred (i.e. vial sharing between patients). In both studies, consideration of wastage changed the calculated ICER. In one study, the ICER increased by 32% when wastage was incorporated into drug acquisition costs. In the second study, azacitidine (AZA) was compared to decitabine (DEC) for myelodysplasia, with both drugs provided as single-use vials and subject to substantial wastage. When no drug wastage was modeled, AZA was associated with higher costs than DEC (+$2 655 USD) and yielded an ICER of $15 528/QALY. When wastage for both drugs was considered, AZA was associated with lower costs (-$15 890) and AZA dominated DEC. Of the 18 publications that did not model wastage in the primary analysis, no study went on to model wastage in sensitivity analyses. In 4 of these 18 studies, the potential effect of wastage on drug acquisition costs could be calculated from data provided in the publication. The calculated drug acquisition costs if wastage occurred would potentially be +5-16% higher (mean +9%) than the costs modeled in the base-case analyses of these 4 studies. The potential costs associated with drug wastage are considered in only one third of modern cost-effectiveness models. The impact of wastage on calculated ICERs and drug acquisition costs is potentially substantial. The modeling of wastage in base-case and sensitivity analyses is recommended for future economic evaluations of new intravenous therapies for hematologic malignancies. Disclosures: No relevant conflicts of interest to declare.

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