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Gregorian Jr. R.S.,Canal Partners | Gasik A.,Canal Partners | Kwong W.J.,Johnson and Johnson Pharmaceutical Services LLC | Voeller S.,Canal Partners | Kavanagh S.,Health Economics
Journal of Pain | Year: 2010

This study examined the relative impact of pain relief and opioid side effects on patients' and physicians' preferences for medication. An Internet survey was completed by 618 patients (302 acute pain, 316 chronic pain) and 325 physicians (83 primary care, 80 pain specialists, 41 oncologists, 40 general surgeons, 40 orthopedic surgeons, 20 rheumatologists, 21 neurologists). Respondents completed an Adaptive Conjoint Analysis (ACA) exercise in which they indicated their relative preference for 20 pairs of hypothetical opioid pain medications described by varying levels of pain relief and side-effect incidence. Almost all patients (96% of chronic, 92% of acute) reported experiencing at least 1 side effect while on opioid medication, but physician-estimated incidence rates of most opioid side effects were much lower than those reported by patients. Opioid side effects, rather than pain relief, explained the majority of variance for medication preference for both patients (74% for chronic, 73% for acute) and treating physicians (73% for chronic, 74% for acute) in this exercise. Nausea and vomiting were major determinants of opioid medication preference, with each explaining as much of the variance in preference as did pain relief (21% to 25%). Nausea and vomiting were the most important side effects based on the amount of pain relief that respondents were willing to give up for reducing the incidence of side effects. The importance of side effects was confirmed in an open-ended question where 51% of patients and 58% of physicians identified side-effect reduction as an unmet need for pain medications. Perspective: This study provided insights into patient and physician preferences of the risk and benefit balance of opioid therapy. This information could improve understanding of patient needs and facilitate the incorporation of patient preference into therapy choice. © 2010 by the American Pain Society.

Walker D.G.,Health Economics | Hutubessy R.,World Health Organization | Beutels P.,Universiteitsplein 1
Vaccine | Year: 2010

Traditional EPI vaccines are considered to be among the most efficient uses of scarce health care resources. Today, there are many under-used and new vaccines available. In the short- to medium-term, these vaccines will not cost the few cents per dose the traditional vaccines do, but will be 'multi-dollar' vaccines. Decision-makers will need information, among other things, on their relative cost-effectiveness. A number of reviews have indicated that there is scope for improving the transparency, completeness and comparability of economic evaluations of vaccination programmes. Thus, there is a need to improve the quality of economic evaluations of vaccination programmes. Adherence to general guidelines would increase the quality, interpretability and transferability of future analyses. However, there is reason to believe that there might also be a need for more specific advice for vaccination programmes. For example, there are inconsistencies in the methods used to estimate the future benefits of vaccination programmes and the relative efficiency of these programmes can be sensitive to some of the more controversial aspects of general guidelines, such as the inclusion of indirect costs and the discounting of health outcomes. This guide has been developed in order to meet the needs of decision-makers for relevant, reliable and consistent economic information. They aim to provide clear and concise, practical and high quality guidance for those who conduct economic evaluations. © 2009 Elsevier Ltd. All rights reserved.

Objective: To assess the cost-effectiveness of solifenacin vs other antimuscarinic strategies commonly used in UK clinical practice, based on the Results of a recent published review. METHODS Overactive bladder (OAB) syndrome is characterized by symptoms of urgency, frequency, incontinence and nocturia. Pharmacological treatment comprises oral antimuscarinic agents, which are divided into older-generation treatments, including oxybutynin, and new-generation treatments, comprising solifenacin, tolterodine, darifenacin and fesoterodine. The latter have reduced central nervous system penetration and have better selectivity for the M3 subclass of acetylcholine receptors, resulting in improved tolerability. A recent systematic review and meta-analysis of the efficacy and safety of antimuscarinics provided an opportunity for an economic evaluation of these agents using a rigorous assessment of efficacy. A cost-utility analysis was undertaken using a 1-year decision-tree model. Treatment success was defined separately for urgency, frequency and incontinence, with efficacy data taken from the recent review. Treatment persistence rates were taken from the Information Management System database. Utility values for the calculation of quality-adjusted life-years (QALYs) were taken from published sources. The analysis included costs directly associated with treatment for OAB, i.e. antimuscarinic therapy, consultations with general practitioners, and outpatient contacts. Resource use was based on expert opinion. Costs were reported at 2007/2008 prices. Extensive deterministic and probabilistic analyses were conducted to test the robustness of the base-case Results. Results: Solifenacin was associated with the highest QALY gains (per 1000 patients) for all three outcomes of interest, i.e. urgency (712.3), frequency (723.1) and incontinence (695.0). Solifenacin was dominant relative to fesoterodine, tolterodine extended-release (ER) and tolterodine immediate-release (IR), and cost-effective relative to propiverine ER for urgency, frequency and incontinence. Solifenacin was not found to be cost-effective relative to oxybutynin IR for the frequency and incontinence outcomes, with an incremental cost-effectiveness ratio of >£30 000/QALY threshold. Conclusions: Solifenacin provided the greatest clinical benefit and associated QALYs for all three outcomes of interest across all therapies considered, and to be either dominant or cost-effective relative to all other new-generation agents, but not cost-effective relative to oxybutynin for frequency and incontinence. Journal Compilation © 2009 BJU International.

Davis K.L.,Health Economics | Edin H.M.,Glaxosmithkline | Allen J.K.,Glaxosmithkline
Movement Disorders | Year: 2010

We estimated the prevalence of medication nonadherence in Parkinson's disease (PD) and the association between treatment nonadherence and healthcare costs. Insurance claims from over 30 US health plans were analyzed. Inclusion criteria were as follows: PD diagnosis, ≥1 PDrelated prescription between 1/1/1997 and 12/31/2004, continuous health plan enrollment for ≥6 months before and ≥12 months after first PD prescription. Adherence, all-cause healthcare utilization, and all-cause costs were evaluated over 12 months post-treatment initiation. Adherence was measured using the medication possession ratio (MPR), with MPR < 0.8 defining nonadherence. Among patients identified for inclusion (N = 3,119), 58% were male and mean age was 69 years. Mean MPR was 0.58 and 61% of patients were nonadherent. Unadjusted mean medical costs were significantly higher (P < 0.01) among nonadherers ($15,826) compared with adherers ($9,228), although nonadherers had lower prescription drug costs ($2,684 vs. $3,854; P < 0.05). After controlling for confounders in multivariable analyses, a large positive relationship between nonadherence and both medical and total healthcare costs remained (+$3,451, P < 0.0001 and 1$2,383, P = 0.0053, respectively). Medication adherence in PD is suboptimal and nonadherence may be associated with increased healthcare costs despite offsets from reduced drug intake. Efforts to promote medication adherence in PD may lead to cost savings for managed care systems. © 2010 Movement Disorder Society.

Meyers J.L.,Health Economics | Candrilli S.D.,Health Economics Data Analytics | Kovacs B.,Boehringer Ingelheim Pharmaceuticals
Postgraduate Medicine | Year: 2011

Objective: To assess rates of diagnosis and antihyperglycemic dose adjustment in patients with moderate to end-stage renal impairment (RI) and type 2 diabetes mellitus (T2DM). Methods: Retrospective database analysis using GE Centricity Outpatient Electronic Medical Records. Patients aged ≥ 18 years with evidence of T2DM (International Classification of Diseases, Ninth Edition, Clinical Modification codes 250.x0 and 250.x2) between January 1, 2000 and June 30, 2009, and ≥ 12 months of data after identification were selected. Moderate to end-stageRI was evaluated using a formula-derived estimated glomerular filtration rate (eGFR) based on serum creatinine (SCr). Patients were classified as moderate (eGFR, 30-59 mL/min/1.73 m2), severe (eGFR, 15-29 mL/min/1.73 m2), or end-stage (eGFR, < 15 mL/min/1.73 m2), per the National Kidney Foundation guidelines, based on the first-observed SCr test. Among patients with a physician diagnosis, the time to diagnosis was reported. Dose adjustment was reported for patients receiving metformin and sitagliptin. Predictors of progression to end-stage RI based on logistic regressions were examined. Results: 35.2% of patients with T2DM had evidence ofmoderate to end-stage RI. Of these patients, 20% had a chart-documented physician diagnosis (range, 16% [moderate RI] to 66% [end-stage RI]). Patients with moderate or severe RI had a physician diagnosis mean of 253.4 (standard deviation [SD], 584.5) and 86.9 (SD, 417.4) days, respectively, after the eGFR calculation indicating RI. Patients with end-stage RI had a physiciandiagnosis mean of 83.6 (SD, 399.2) days before the eGFR calculation. After the eGFR calculation, 15.1% and 0.1% of patients with orders for sitagliptin and metformin, respectively, receiveddoses of the drug appropriate for their degree of RI. Among patients with moderate or severeRI, appropriate diagnosis of RI was associated with significantly lower odds of progressing toend-stage RI (odds ratio, 0.200; 95% confidence interval, 0.188-0.213). Conclusions: Renal impairment is common but often undetected in patients with T2DM. Patients with a documented RI diagnosis have lower odds of progression to end-stage RI. Metformin and sitagliptin are frequently used at inappropriate doses in patients with RI. Further analyses to understand the clinical and economic consequences of these findings are needed. © Postgraduate Medicine.

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