Pharmacoeconomics: theory and practice
№4, 2014, Vol.2
Objective: To evaluate the cost-effectiveness of genetic screening for Apolipoprotein ε4 (APOE ε4) allele in combination with preventive donepezil treatment in comparison to the standard of care for Amnestic Mild Cognitive Impairment (AMCI) patients in Canada.
Methods: We performed a cost-effectiveness analysis using a Markov model with a societal perspective and a time horizon of 30 years. For each strategy, we calculated quality-adjusted life years (QALYs) and cost. One-way and probabilistic sensitivity analyses were performed. Expected value of perfect information (EVPI) was conducted to explore the value of future research.
Results: The base case results in our exploratory study suggest combined genetic testing and preventive donepezil treatment resulted in a gain of 0.027 QALYs and an incremental cost of CAD $870 compared to standard of care. The incremental cost-effectiveness ratio (ICER) for the base case was $32,585 per QALY. The ICER was sensitive to the and effectiveness of donepezil in slowing rate of progression to AD, Donepezil treatment cost and treatment of AD patients. EVPI analysis showed that additional information on these parameters would be of value.
Conclusion: Using presently available clinical evidence, this exploratory study illustrates genetic testing combined with preventive donepezil treatment for AMCI patients may be economically attractive. Since our results were based on a secondary post-hoc analysis, our study alone is insufficient to warrant recommending APOE genotyping in AMCI patients.
Reamberin is a form of succinic acid for injections. Clinical economic effectiveness of reamberin was estimated for urgent diseases occurring while acute myocardial infarction, ischemic stroke and extensive liver resections. Reamberin addition to standard therapeutic schemes shortens hospital stay, diminishes complication rates, need for narcotic analgesics and use of expensive antibiotics combinations. Moreover, vegetative homeostasis was also normalized in reamberin using patients. Costs for gain of clinically valuable effect point were reduces down to 50% in reamberin subgroup.
Main points on financing of healthcare at the regional level are presented, the interrelation between expenditures of regional budgets and the working-age mortality, between the average duration of one case of the temporary disability and the level of public satisfaction with the quality of healthcare is showed. A brief description of the analysis was performed, the types of behavior were highlighted, the results were presented and common trends were emphasized.
Breast cancer is a global problem due to its wide prevalence which is increasing every year. The comparative pharmacoeconomic study of Herceptin in subcutaneous and intravenous formulations was conducted for optimization of drug supply for this nosology. Direct medical expenses without taking into account the drug price were compared. As a result of pharmacoeconomic evaluation of the alternative treatment options, it was established that subcutaneous Herceptin saves 39,806 roubles per patient during one treatment year due to the cost differences related to administration, medical staff, as well as hospitalization. Moreover, when IV formulation is used for one treatment year per patient, the medicinal substance is lost due to « throwing out» the remaining part of the drug in the vial, which may not be used in connection with breach of sterile dosage forms. The loss is as high as 166,208 roubles; this translates into 11% monetary loss from the whole treatment cycle.
For the first time in Russia, economic burden of chronic kidney disease on a national scale was determined The economic burden of chronic kidney disease was calculated based on the methodology of a special kind of pharmacoeconomic analysis, the «cost of illness» analysis. The analysis included both direct and indirect costs associated with the disease in question. In the course of the study, the cost of individual stages of chronic kidney disease per patient per year was determined. The most expensive stages were those, at which the patients received renal replacement therapy. At the same time, the cost of illness analysis based on the entire population carried out at the next stage revealed that most of the cost falls on the early stages of chronic kidney disease as a result of a significant number of patients at these stages. The cumulative economic burden of chronic kidney disease in Russia exceeded 451 billion rubles.
Main aspects and possible directions of pharmacoeconomic and clinical economic studies on tuberculosis are covered. The main directions of the described possibilities of pharmacoeconomics are the analysis of both individual health technologies (drugs and diagnostic tests), modes of therapy, and assessment of changes in clinical guidelines and standards of treatment of TB patients. Described changing epidemic affect the structure of the disease, the innovative antituberculosis drugs and new practice in the treatment of patients affect on the effectiveness of the treatment and its cost. Features of the methodology of pharmacoeconomic analysis in tuberculosis are paid attention to in this article.
Main presentations and educational seminars which took place during Annual European congress of International Society For Pharmacoeconomics and Outcomes Research (ISPOR) are covered