Budget Of Healthcare System Research Articles

Pharmacoeconomic analysis fenofibrate + rosuvastatin of fixed combination compare to loose-pill combination in patients with atherogenic dyslipidemia

This article presents the results of a pharmacoeconomic analysis of the use of a combination of rosuvastatin + fenofibrate in a single film-coated tablet (“Suprozafen”) and fenofibrate + rosuvastatin in the loose-pill combination of various trade names in the treatment of patients with atherogenic dyslip- idemia. In the pharmacoeconomic evaluation cost-effectiveness analysis and budget impact analysis were used. From the point of view of clinical efficacy, it was found that the fixed combination has an advantage compared to loose-pill combination, expressed in a decrease in the incidence of serious cardiovas- cular events when prescribing a fixed combination of drugs by 8.64%. The results of cost analysis calculations showed that annual cost of of treatment with the fixed combination drug Suprozafen is 11,184 rubles, while treatment with loose-pill combination of rosuvastatin and fenofibrate will be accompa- nied by costs of 10,775 rubles. Thus, the cost of a fixed combination is only 409 rubles. (per year per patient) or 3.7% more higher than when prescrib- ing rosuvastatin and fenofibrate separately, that reflects the comparability of this expenditures. Cost savings for the treatment of serious cardiovascular events when using the fixed combination drug (Suprozafen), which arose due to higher adherence to treatment and a decrease in the risk of these events, is 11,188.9 rubles. per patient per year. Taking into account the results of the cost analysis, the savings in the healthcare system budget for a time hori- zon of one year per 100 patients using a fixed combination of rosuvastatin + fenofibrate is 1,078,001 rubles. The results of the pharmacoeconomic study confirm and allow us to accept the hypothesis that the fixed combination of the drug rosuvastatin and fenofibrate (drug Suprozafen) has a pharmacoeco- nomic advantage compared to the appointment of loose-pill combination. At an almost comparable cost of treatment, the fixed combination, due to higher patient adherence, allows achieving better disease control, reducing the risk of developing serious cardiovascular events and the associated economic burden.

Updated pharmacoeconomic analysis of atesolizumab efficiency compared with other PD-1 inhibitors in patients with advanced non-small cell lung cancer after chemotherapy

Objective: to evaluate the pharmacoeconomic efficiency of atezolizumab (inhibitor of programmed death ligand 1 (PD-L1)) in comparison with other checkpoint inhibitors (inhibitors of programmed cell death protein 1 (PD-1)) in patients with advanced non-small cell lung cancer (NSCLC) after previous chemotherapy in the current conditions of the Russian healthcare system.Material and methods. The study design was a retrospective analysis of publications and modeling. The previously performed pharmacoeconomic study was updated considering a decrease in the cost of pembrolizumab after the generic form was released on the market and actualization of calculated target population. Cost minimization analysis was carried out and the impact on the healthcare system budget was estimated when treating all NSCLC patients provided with PD-1/ PD-L1 inhibitors in the second and third lines of therapy with atezolizumab. For calculations, we used registered prices according to the state register of maximum selling prices and average weighted marginal wholesale markup according to the Federal Antimonopoly Service.Results. In the cost minimization analysis, atezolizumab showed greater clinical and economic efficiency, its use reduces costs by 28.6% over 3 years compared to nivolumab and by 8.8% compared to pembrolizumab in the second and third lines of NSCLC therapy. The budget impact analysis demonstrated that if all patients in the target group currently receiving various PD-1/PD-L1 inhibitors in the second and third lines of NSCLC therapy were initially provided with atezolizumab, it would reduce the budget load over 3 years by 11.6%, or by 722.4 mln rubles.Conclusion. The use of atezolizumab is pharmacoeconomically justified and feasible compared to nivolumab and pembrolizumab, even after a release of the generic version of the latter, and will reduce the costs of PD-1/PD-L1 inhibitors in the second and third lines of NSCLC therapy.

Musculoskeletal Disorders in Pakistani Women during Pregnancy: A Population Base Study

Introduction: Changes in posture, blood physiology, weight increase, changes in musculotendinous strength, and joints and ligaments laxity are only some of the physical changes that occur during pregnancy. According to several studies, pregnancy-related back discomfort affects 25% to 75% of women. The primary goal of this research is to provide a comprehensive picture of women's musculoskeletal issues during pregnancy and identify the most prevalent triggers of pregnancy-related musculoskeletal discomfort.
 Methodology: From Jan 2019 to Jan 2020, the Department of Orthopedic Surgery Territory Care Hospital performed this investigation. In this research, 92 women were enrolled after the IRB (Institutional Review Board) of the Territory Care Hospital approved the study's ethical standards. This research monitored patients throughout their pregnancies to see if they had any musculoskeletal issues. Pregnant women between the ages of 18 and 45 who had a term pregnancy (37-42 weeks) were included in the research. The authors didn't include women with any history of rheumatoid arthritis, osteoarthritis, or SLE, a systemic autoimmune disease.
 Findings: Participants in the research were 32.18 years old on average with a standard deviation of 7.82 years. Moreover, half of the participants were college graduates, 71. (76.44%) while pregnant, participants gained an average weight of 14.70 and 7.82 kg. Only four (4 %) of these women engaged in aerobic activity. Most study participants reported musculoskeletal complaints at night with 75 reporting nighttime symptoms (85%). There were 82 (90%) people with low back pain, 10 (10%) participants with arthralgia, 35 (40%) participants with arthritis, and 32 (35%) participants with neck pain in the study. Pregnancy-related musculoskeletal issues substantially drain the health care system's budget. Arthritis and neck discomfort is among the most prevalent musculoskeletal complaints. Pregnancy-related weight gain and inactivity exacerbate these issues. The findings of this research need to be validated in more extensive trials.

Pharmacoeconomic analysis of acalabrutinib in patients with chronic lymphocytic leukemia

Aim. Pharmacoeconomic analysis of new Bruton tyrosine kinase inhibitor for the treatment of high-risk adult patients with chronic lymphocytic leukemia (CLL) within the framework of health state budget.
 Materials and methods. In the course of this study, an analytical decision-making model was built in MS Excel, which allows to provide pharmacoeconomic analysis and analysis of the budget impact of acalabrutinib in comparison with the combination of venetoclax with obinutuzumab in the first line of therapy for high-risk CLL, as well as acalabrutinib and the combination of venetoclax with rituximab in the treatment of high-risk relapses and refractory forms of CLL. The model took into account only direct medical costs per patient (drug therapy costs).
 Results. The cost minimization analysis showed that the use of the drug acalabrutinib in the 1st line and for the treatment of relapses and refractory forms of high-risk CLL is the preferred option compared to comparators, having comparable efficacy and lower cost. The cost reduction in the first-line therapy of high-risk CLL and the treatment of relapses and refractory forms of high-risk CLL compared with ibrutinib amounted to 0.8 million rubles or 15.4%, in the first-line therapy of high-risk CLL compared with the combination of venetoclax + obinutuzumab 1.2 million rubles or 21.0%, in the treatment of relapses and refractory forms of high-risk CLL in comparison with the combination of venetoclax + rituximab 0.9 million rubles or 17.6%. Budget impact showed that in the case of initiation of first-line acalabrutinib and treatment of relapses and refractory forms in high-risk CLL patients, the burden on the health care system budget can be reduced by 0.813 billion rubles or 16.0% for 1 year of therapy and by 1.219 billion rubles or 9.1% over 3 years of therapy, taking into account only the costs of drugs.

Different Scenarios of Providing Drugs for Patients with Primary Immunodeficiency in Russia: Analysis of Costs and Effectiveness

The only source of financing for immunoglobulin replacement therapy needed by patients with primary immunodeficiencies (PID) in Russian Federation is the compulsory health insurance system: payment is based on diagnosis-related groups (DRG), including the DRG for immunoglobulin treatment at day care and inpatient setting. PID are not included either into regional program for rare diseases, or into federal program of 12 high-cost diseases. This leads to limited coverage of patients with effective drug treatment. Furthermore, currently in Russian Federation there is no neonatal screening for PID, which could facilitate early detection of the disease and timely start of treatment. Goal of the study: to conduct the analysis of cost and effectiveness of different scenarios of drug provision for the patients with PID, which differ in coverage of patients with therapy and by presence/absence of neonatal screening. Materials and methods. The model compared three scenarios of drug provision for patients with PID: a) current practice, when in accordance with available data not all patients get necessary immunoglobulin replacement therapy, b) new scenario 1 – financing of drugs for all registered patients with PID when large-scale neonatal screening for PID is absent; c) new scenario 2 – financing of drugs for all registered patients with PID when large-scale neonatal screening is implemented. In each scenario direct medical costs and number of prevented deaths was calculated. Comparison of scenarios was planned to be made by calculation of additional costs per prevented death due to PID, or by assessment of difference of costs and effectiveness (number of prevented deaths) with identification of a dominant scenario. Results. Both new scenarios including financing of drugs for all registered patients with PID lead to the prevention of significant number of deaths and also to cost savings if compared with current practice. Total costs for current, 1st new and 2nd new scenario for 15 year was^ 2 285,54, 616,49 and 1 318,61 billions of rubles respectively. Also when comparing 1st and 2nd new scenarios with current practice we expect prevention of 243 and 2076 deaths respectively. Conclusion. Most effective approach is the introduction of large-scale neonatal screening for PID combined with the new source of financing: this scenario saves less money, but helps to prevent highest number of deaths compared with current practice. This scenario can prevent deaths of patients who would not have been diagnosed with PID in the absence of screening, and also helps to save healthcare system budget by centralization of government procurement of drugs.

PNS196 EXPERIENCES WITH SUPPLEMENTARY HEALTH INSURANCE POLICIES IN HUNGARY AND OTHER EUROPEAN COUNTRIES

The basic financing problems of social security have been clearly observed since the beginning of the 2000s years. Although there have been and there are reform paths, because of the specialities of the social security system new approaches should be searched in order to supply all the strata of society on the basis of the principle of solidarity. The aim of our study is to reveal the way on which supplementary health insurances and welfare funds relieve the burdens of health care system, furthermore, whether the effects of operation of them can be detected in the budget of health care system. We obtained data through an online questionnaire survey applying total 189 assessable questionnaires in November and December 2018 in Hungary. Furthermore, we analysed national and international data registered by OECD, Eurostat, the Central Bank of Hungary and the Hungarian Central Statistical Office. Supplementary health insurances keep gaining new segments in the fields of prevention and health care. It can be seen that the person who has a supplementary health insurance and makes use of preventive services will take medical examinations and hospital treatments financed by the health insurance funds less times (p=0.001). The fact of having a welfare fund membership offers several opportunities, which can be applied in the fields of either prevention or health care or healthy way of lifestyle. By contrast, it is absolutely not sure that the opportunities are known and taken advantage of as well; no direct relationship was detected on the basis of our samples (p=0.85). Health care expenditures are continually growing, which will not be able to be financed by the government, thus the role of the supplementary health insurance is greatly appreciated not only in Hungary but in the European Union also.

Evaluation of disability and quality of life in adults over 60 years old injured in traffic accident in the city of Medellin-Colombia

Traffic accidents (TA) are increasing problem worldwide, affecting this population's health, disability, quality of life and the health care system's budget, being this population the most vulnerable regarding frequency, severity and mortality. In 71,2% of the cases the injured were pedestrians. Aim: evaluate the quality of Life and disability in adults over 60 years of age injured in TA with moderate and serious injuries happened in traffic accidents in Medellin, Colombia and its metropolitan area in the years 2015-2016 with a 3 months follow up. It is a prospective cohort study according to the severity of the injury, measured by the NISS (New Injury Severity Score), to evaluate disability (WHO-DAS II), and quality of life (SF-36), by interviews at 1 and a 3 months follow up. The patients were treated with surgical, medical and rehabilitation interventions according to the protocols of each institution. Of 247 patients, 241 of them (97.6%) fulfilled the 3 month follow up. The functioning improved with significant changes ( P < 0.05). The differences in means were; daily life activities [−36.28 (49.99)], self-care [−30.12 (29.64)], mobility [−20.28 (31.72)], social participation [−11.65 (28.95)]. The domains; understanding and communicating and interpersonal interactions showed small changes ( Table 1 ). Regarding quality of life, the SF-36 domains that improved with significant changes ( P < 0.05) were: physical functioning, differences in means [25.02 (26.15)], role-physical [13.80 (36.46], bodily pain [13.73 (33.82)], and social function [13 (41.09)]. Role emotional, general health, mental health and vitality did not show significant clinical changes ( Table 2 ). Although there was an improvement in functioning, three months later, the domains remain considerably affected. Quality of life continues even more altered than functioning in this group of people over 60 years. There was an improvement in the physical aspect but not in the emotional.

PHARMACOECONOMIC ANALYSIS OF CHRONIC HEART FAILURE DRUG THERAPY IN PATIENTS WITH COMORBID CONDITIONS

Aim. To perform pharmacoeconomic analysis of CHF therapy with supramolecular sacubitril/valsartan complex compared to routine therapy in patients with diabetes type 2 and ACE inhibitor intolerance within context of Russian healthcare system. Material and methods. A Markov model based on Russian Standards of treatment and clinical practice results was built. Cost-effectiveness analysis was done by comparing two patient groups of 1000 people each. Budget impact analysis required 27,451 simulated patients. Randomized controlled clinical trials results of sacubitril/valsartan vs. routine practice were used as source of efficacy and safety data. Time horizon was set at 3 years. Quality Adjusted Life Years (QALY) were used as effectiveness. Single-factor sensitivity analysis (SA) was used to ensure the results are robust to changes in market situation. Results. Cost-effectiveness ratio for sacubitril/valsartan is 301,145.7 rub. per QALY while cost-effectiveness ratio for routine practice is 510,621 rub. Budget impact analysis results indicate that during three years, in case of sacubitril/valsartan usage budgetary burden can be reduced by more than 220,000 rubles per patient and leads to savings of more than six billion rubles in terms of the whole population. Sensitivity analysis has confirmed the robustness of results. Conclusion. These results indicate benefits of sacubitril/valsartan using for CHF patients with type 2 diabetes and ACE inhibitor intolerance and justify inclusion of this drug into reimbursement lists that allow to reduce risk of hospitalization, lethal outcomes and budget of healthcare system.

Analysis of economic and social costs of adverse events associated with blood transfusions in Spain

ObjectiveTo calculate, for the first time, the direct and social costs of transfusion-related adverse events in order to include them in the National Healthcare System's budget, calculation and studies. In Spain more than 1,500 patients yearly are diagnosed with such adverse events. MethodBlood transfusion-related adverse events recorded yearly in Spanish haemovigilance reports were studied retrospectively (2010-2015). The adverse events were coded according to the classification of Diagnosis-Related Groups. The direct healthcare costs were obtained from public information sources. The productivity loss (social cost) associated with adverse events was calculated using the human capital and hedonic salary methodologies. ResultsIn 2015, 1,588 patients had adverse events that resulted in direct health care costs (4,568,914€) and social costs due to hospitalization (200,724€). Three adverse reactions resulted in patient death (at a social cost of 1,364,805€). In total, the cost of blood transfusion-related adverse events was 6,134,443€ in Spain. For the period 2010-2015: the trends show a reduction in the total amount of transfusions (2 vs. 1.91M€; -4.4%). The number of adverse events increased (822 vs. 1,588; +93%), as well as their related direct healthcare cost (3.22 vs. 4.57M€; +42%) and the social cost of hospitalization (110 vs 200M€; +83%). Mortality costs decreased (2.65 vs. 1.36M€; -48%). DiscussionThis is the first time that the costs of post-transfusion adverse events have been calculated in Spain. These new figures and trends should be taken into consideration in any cost-effectiveness study or trial of new surgical techniques or sanitary policies that influence blood transfusion activities.

Systematic review of cost-effectiveness analyses of treatments for psoriasis.

Psoriasis is a chronic inflammatory disease of the skin that has a major effect on an individual's physical and mental function. The disease is associated with increased healthcare resource use and costs, therefore cost-effectiveness analysis (CEA) can be used to assist decision makers with determining which treatments are optimal within a constrained healthcare system budget. Our aim was to systematically review the current literature on the CEA of existing treatment options for psoriasis, assess the quality of these studies, and summarize the evidence on the drivers of cost effectiveness. A literature search using Medical Subject Headings and keywords was performed in the MEDLINE, EMBASE and Health Technology Assessment databases, as well as the National Health Service Economic Evaluation Database; the CEA Registry was searched using keywords only. All references within the relevant review articles were examined manually. Two researchers independently determined the final articles and a third researcher resolved any discrepancies. We evaluated study quality in terms of the study perspective, effectiveness measures, cost measures, economic model, and time horizon. Any sensitivity analyses conducted in the studies were examined to identify the drivers of cost effectiveness, which included any variables leading to changes in the study conclusions. Fifty-three articles were included in our final review: 70% did not explicitly include costs related to adverse events; approximately one-quarter used quality-adjusted life-years; and 34% applied a time horizon under 1 year. In 18 of the 38 studies that conducted a sensitivity analysis, the cost-effectiveness results were impacted by uncertainty. The main key drivers of cost effectiveness were the costs related to the treatment, values and choice of efficacy, utility values, hospitalization for non-responders, time horizon, model structure, and utility mapping method. High-quality cost-effectiveness studies are required to facilitate resource allocation decision making. To improve study quality, future research should provide evidence on the long-term experience with psoriasis treatments, and resolve the uncertainty associated with key drivers of cost effectiveness.

Toward a new model of pharmacy management comprehensive care of patients with chronic kidney disease

The treatment of chronic kidney disease represents 2.5% of the National Healthcare System budget. Given the panorama of economic crisis, actions aimed at containing the costs in this kind of pathologies should be implemented. Centralization of the management of the medications used for the treatment of chronic kidney disease and its complications aims at reducing the pharmaceutical expenditure. The new contracts of public healthcare administrations with companies of dialysis centers establish a single price by which the contractor takes care of the integral management of the patients, including the dialysis therapy and pharmacological treatment. Drug management at dialysis centers will be handled by specialized pharmacists by means of the creation of pharmacy departments or drug warehouse. these measures aim at improving healthcare of the patient in hemodialysis program, with health benefits at a lower healthcare cost.

PCN46 - Estimating the Budget Impact of Adding Avastin (Bevacizumab) to Front Line Treatment for Advanced Ovarian Cancer in Brazilian Supplementary Health Care System

Ovarian cancer (OC) is one of the most lethal gynecologic cancers worldwide. According to Brazilian Institute of Cancer (INCA), 6,190 new OC cases were estimated in 2012. During the last 15 years, carboplatin plus paclitaxel (CP) has been established as front-line (FL) standard of care therapy for advanced ovarian cancer, with no significant advances in treatment ever since. Bevacizumab (Bev) in combination with CP was approved in Brazil for FL treatment of advanced epithelial OC on May/2013. Therefore, this study aimed to estimate the economic impact of bevacizumab reimbursement for advanced OC in Brazilian Supplementary Healthcare System. The potential number of eligible patients for CP + Bev in FL therapy for advanced OC was estimated following an epidemiologic approach. It was assumed that Supplementary Healthcare System attendance accounts for 40% of all patients. Additional drug costs and infusion fees were evaluated. The ex-factory price (VAT 18%) and labeled dose were considered. Average therapy duration of CP + bevacizumab was 15 months based on GOG-0218 trial. Costs were reported in Brazilian Reais (BRL1.00≈USD0.44; Jun/2013). A total health assistance budget of BRL 88.1 billion was forecasted for 2013, based on the last updated data from Brazilian National Regulatory Agency for Private Health Insurance and Plans (ANS). A total of 1,287 eligible cases in CP + Bev FL therapy for advanced OC are expected in 2013 in the private setting. Adding bevacizumab to the treatment of all these potential patients would yield an increase of BRL 267 million, corresponding only to an increment around 0.30% on health assistance expenses. Treating all eligible FL advanced OC patients with CP + Bev will potentially result in a low impact in Supplementary Healthcare System budget, associated to unprecedented clinical benefits for this population with a high medical unmet need.

PCN26 - Estimating The Potential Budget Impact Of Zelboraf (Vemurafenib) For Advanced Melanoma Treatment In Brazilian Private Health Care System

Melanoma accounts for less than 5% of skin cancers, but is responsible for 90% of skin cancer-related deaths worldwide. According to Brazilian Institute of Cancer 2012 statistics, it was estimated 6,230 cases of melanoma. BRAF mutations occur in approximately 50% of cases, being associated with poorer patient prognosis in advanced melanoma. Historically, there have been limited treatment options for advanced melanoma, resulting in a critical unmet clinical need for more effective therapies. Vemurafenib is a novel targeted therapy, effective for BRAF-V600 mutation-positive unresectable or metastatic melanoma treatment, orally administrated and available in Brazilian market since 2012. Therefore, the aim of this study was estimate the economic impact of vemurafenib reimbursement in Brazilian Private Healthcare System Budget. Based on an epidemiologic approach, the potential number of patients for vemurafenib was estimated. Only the private market was considered, accounting for 40% of all patients and only drug costs were evaluated. The ex-factory price and labeled dose of 960mg b.i.d. were used. Average therapy duration of 6 months was assumed. Costs were reported in Brazilian Reais (BRL1.00~USD0.48 Dec. 2012). A total health assistance budget of BRL67.9 billion was considered, according to Brazilian National Agency for Supplementary Health data from 2012. A total of 756 cases of advanced melanoma are expected in 2013 in the private system, corresponding potentially to 378 patients harboring BRAF-V600E mutation. Treating all potential patients with vemurafenib would yield a total drug cost of BRL59.101.395, corresponding to a potential budget impact of 0.087%, considering health assistance budget. Cost savings owing to oral administration was not considered. By identifying the patients with BRAF-V600E mutation, therapy can be targeted to those who present a higher chance to respond to treatment, resulting in a potential low impact of vemurafenib in private health care system budget, mainly because of its very selected and specific eligible population.

Burden of Disease and Economic Impact of Dengue and Severe Dengue in Colombia, 2011

ObjectiveTo assess the burden of dengue disease in Colombia and its associated costs. MethodsWe estimated the burden of dengue and severe dengue in Colombia for the period 2011 to 2014 on the basis of a dynamic model calibrated against Colombian surveillance data. The model estimated the annual number of dengue and severe dengue cases for those receiving medical care and those who do not. We calculated the average cost of care per patient on the basis of a bottom-up costing of cases, and additional costs were estimated for activities of vector control and other community interventions. Economic information from a sample of local and departmental vector control programs was reviewed. ResultsThe dynamic model estimated that for 2011 and 2012 there would be 56,998 dengue cases requiring medical attention (22,799 ambulatory and 34,199 hospitalized), 1851 cases of severe dengue, and 205 deaths. The economic analysis, with 2011 data, showed that Colombia would spend between US $52.2 and US $61.0 million for dengue control activities and case management in an average year. Medical management costs would amount to US $16.9 million (CI 95% 15.2–18.5 million), while vector control activities and other community interventions would cost between US $37.08 and US $42.41 million. ConclusionsDengue infection has an important impact on the health care system budget in Colombia. Most of the economic impact corresponds to community activities directed to prevent vector infestation (68.7%–71.0%), which are expensive and whose effectiveness is controversial.