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Adams R.,National Center for Pharmacoeconomics | Walsh C.,National Center for Pharmacoeconomics | Walsh C.,Trinity College Dublin | Veale D.,St Vincents University Hospital | And 3 more authors.
PharmacoEconomics | Year: 2010

Background: The growth of economic analyses and in particular cost-utility analyses (CUA), which use the QALY as a measure of outcome, has heightened the interest in the methodologies used to calculate the QALY. The EQ-5D has produced quite different utility values from that of the SF-6D. This article seeks to understand these differences using a cohort of patients with inflammatory arthritis. Objective: To examine the relationship between the disease-specific measure, Health Assessment Questionnaire (HAQ) disability index (DI) and the preference-based measures, SF-6D, EQ-5D and European League Against Arthritis (EULAR) Disease Activity Score (DAS) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Methods: Patients with RA and PsA (n = 504) attending a tertiary rheumatology referral centre completed the HAQ, SF-6D and the EQ-5D before starting biological therapy and again 12 months later. The SF-36 was converted into a utility using the preference-based SF-6D. Clinical outcomes such as the DAS, joint counts and laboratory measures were also recorded. We calculated single index utility scores from the preference-based instruments using UK population norms. We used regression analysis to derive a mapping function and calculated utility scores from the HAQDI and the DAS 28. Results: The mean utility observed at baseline for RA was 0.43 for the EQ-5D and 0.54 for the SF-6D and for PsA was 0.49 for the EQ-5D and 0.57 for the SF-6D. The utility gain demonstrated by the EQ-5D was over twice that of the SF-6D. The EQ-5D scored 17% of the RA group as less than 0 (state defined as worse than death); 7% of this group remained less than 0 at followup. The distribution of the utility estimates was similar for both RA and PsA. Conclusions: Our findings draw attention to the impact of states worse than death on the overall distribution for the EQ-5D derived utilities and how these impact on its use in practice. EQ-5D-derived QALY changes are over twice that of the SF-6D. The implication of this for decision makers is that cost-effectiveness evaluations for treatments in this disease class are likely to be very sensitive to the choice of utility measure. © 2010 Adis Data Information BV. All rights reserved.

Adams R.,National Center for Pharmacoeconomics | Craig B.M.,Moffitt Cancer Center | Walsh C.D.,National Center for Pharmacoeconomics | Walsh C.D.,Trinity College Dublin | And 4 more authors.
Value in Health | Year: 2011

Background and Objective: It is well established that there are problems with the EQ-5D. This is due to the original scoring methods used and how negative time trade-off (TTO) values were treated. A revised scoring method has been published. This article applies this to an inflammatory arthritis cohort. The objective is to examine the impact of a revised scoring system for the EQ-5D (UK) TTO on the utility estimates and in the case of rheumatoid arthritis, to explore the impact of using different utility metrics on the incremental cost-effectiveness ratio (ICER) results of an economic model. Methods: A total of 504 patients with inflammatory arthritis were rescored using revised EQ-5D scoring, which uses an episodic random utility model to deal with negative TTO values. Differences in utility scores were compared and the new mapping coefficients were obtained. These were then used in an economic model to examine the impact on the ICER. Results: In rheumatoid arthritis, the overall change is less for the revised EQ-5D scoring than with the original EQ-5D (TTO) but greater than the SF-6D: EQ-5D UK -0.22 (95% confidence interval [CI] -0.30 to -0.15), revised EQ-5D UK -0.16 (95% CI -0.21 to -0.10) and SF-6D -0.08 (95% CI -0.11 to -0.05). A similar trend is seen in the psoriatic arthritis group. The economic model produced different ICERs, when different utility measures were used; EQ-5D (TTO) €42,402, SF-6D €111,788, and revised EQ-5D (TTO) €57,747. Conclusion: In the context of inflammatory arthritis, this article demonstrates that a revised scoring for EQ-5D may have a significant impact on utility estimates and on the output of the economic model. © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

Fogarty E.,National Center for Pharmacoeconomics | Walsh C.,Trinity College Dublin | McGuigan C.,St Vincents University Hospital | Tubridy N.,St Vincents University Hospital | Barry M.,National Center for Pharmacoeconomics
Applied Health Economics and Health Policy | Year: 2014

Introduction: Multiple sclerosis (MS) has significant financial consequences for healthcare systems, individual patients and households, and the wider society. This study examines the distribution of MS costs and resource utilisation across cost categories and from various perspectives, as MS disability increases.Methods: Two hundred and fourteen patients with MS were recruited from a specialist MS outpatient clinic in Ireland and included in an interview-based study on MS-related healthcare resource consumption and costs. Patients were grouped into three categories based on disability: mild [Expanded Disability Status Scale (EDSS) score 0–3.5, n = 114], moderate (EDSS 4.0–6.5, n = 72) and severe (EDSS 7.0–9.5, n = 27). The mean annual direct and indirect costs (in year 2012 values) were estimated using non-parametric bootstrapping.Results: Participants were 66.4 % female, with a mean age of 47.6 years and a mean EDSS score of 3.6. The majority had relapsing-remitting MS (RRMS) (53 %). The mean annual direct (indirect) costs per person were €10,249 (€9,447), €13,045 (€31,806) and €56,528 (€39,440) in mild, moderate and severe MS, respectively. Direct costs are driven by the cost of disease-modifying therapies and professional home help in mild and severe MS, respectively. Between 74 % (severe MS) and 96 % (mild MS) of all direct costs are borne by the healthcare payer, the remainder being incurred by patients, their families or other non-healthcare organisations.Conclusions: MS is associated with high levels of healthcare resource consumption and costs, and these costs increase with increasing disability. There is potential to significantly reduce the economic burden of MS through interventions that prevent progression from mild or moderate MS to severe MS, help support independent living at home and keep people with MS in the work force. © 2014, Springer International Publishing Switzerland.

O'Connell K.,Park University | Kelly S.B.,Park University | Fogarty E.,Park University | Fogarty E.,National Center for Pharmacoeconomics | And 5 more authors.
Multiple Sclerosis and Related Disorders | Year: 2014

Background: Multiple sclerosis (MS) commonly affects young adults and can be associated with significant disability resulting in considerable socioeconomic burden for both patient and society. Aims: The aim was to determine the direct and indirect cost of an MS relapse. Methods: This was a prospective audit composed of medical chart review and patient questionnaire. Relapses were stratified into 3 groups: low, moderate and high intensity. Age, gender, MS subtype, disease duration, expanded disability status scale (EDSS) score, disease modifying therapy (DMT) use and employment status were recorded. Direct costs included GP visits, investigations, clinic visit, consultations with medical staff, medication and admission costs. Indirect costs assessed loss of earnings, partner's loss of earnings, childcare, meals and travel costs. Results: Fifty-three patients had a clinically confirmed relapse. Thirteen were of low intensity; 23 moderate intensity and 17 high intensity with mean costs of €503, €1395 and €8862, respectively. Those with high intensity episodes tended to be older with higher baseline EDSS (p<0.003) and change in EDSS (p<0.002). Direct costs were consistent in both low and moderate intensity groups but varied with length of hospital stay in the high intensity group. Loss of earnings was the biggest contributor to indirect costs. A decision to change therapy as a result of the relapse was made in 23% of cases, further adding to annual MS related costs. Conclusions: The cost of an MS relapse is dependent on severity of the episode but even low intensity episodes can have a significant financial impact for the patient in terms of loss of earnings and for society with higher annual MS related costs. © 2014 Elsevier B.V. All rights reserved.

Cahir C.,Royal College of Surgeons in Ireland | Fahey T.,Royal College of Surgeons in Ireland | Tilson L.,National Center for Pharmacoeconomics | Teljeur C.,Health Information and Quality Authority HIQA | Bennett K.,Trinity Center for Health science
BMC Health Services Research | Year: 2012

Background: There are concerns that proton pump inhibitors (PPI) are being over prescribed in both primary and secondary care. This study aims to establish potential cost savings in a community drug scheme for a one year period according to published clinical and cost-effective guidelines for PPI prescribing. Methods. Retrospective population-based cohort study in the Republic of Ireland using the Health Services Executive (HSE) Primary Care Reimbursement Services (PCRS) pharmacy claims database. The HSE-PCRS scheme is means tested and provides free health care including medications to approximately 30% of the Irish population. Prescription items are WHO ATC coded and details of every drug dispensed and claimants' demographic data are available. Potential cost savings (net ingredient cost) were estimated according to UK NICE clinical guidelines for all HSE-PCRS claimants on PPI therapy for ≥3 consecutive months starting in 2007 with a one year follow up (n=167,747). Five scenarios were evaluated; (i) change to PPI initiation (cheapest brand); and after 3 months (ii) therapeutic switching (cheaper brand/generic equivalent); (iii) dose reduction (maintenance therapy); (iv) therapeutic switching and dose reduction and (v) therapeutic substitution (H2 antagonist). Results: Total net ingredient cost was 88,153,174 for claimants on PPI therapy during 2007. The estimated costing savings for each of the five scenarios in a one year period were: (i) 36,943,348 (42% reduction); (ii) 29,568,475 (34%); (iii) 21,289,322 (24%); (iv) 40,505,013 (46%); (v) 34,991,569 (40%). Conclusion: There are opportunities for substantial cost savings in relation to PPI prescribing if implementation of clinical guidelines in terms of generic substitution and step-down therapy is implemented on a national basis. © 2012 Cahir et al.; licensee BioMed Central Ltd.

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