Cost-efficacy Analysis Research Articles

PMS33 Cost-Efficacy Analysis of Biologic Drugs in Combination With DMARDs in Patients With Active Rheumatoid Arthritis and Inadequate Response to Traditional DMARDs in Portugal – A Simplified Approach

PMS33 Cost-Efficacy Analysis of Biologic Drugs in Combination With DMARDs in Patients With Active Rheumatoid Arthritis and Inadequate Response to Traditional DMARDs in Portugal – A Simplified Approach

PCN46 Cost-Efficacy Analysis of Licensed Drugs for the Treatment of Metastatic Castrate Resistant Prostate Cancer Post Docetaxel Based on Hospital Drug Evaluation Methodology in Spain

To estimate which is the dominant treatment between the only two drugs that had been able to demonstrate overall survival (OS) improvements in patients with metastatic castrate resistant prostate cancer (mCRPC) that have progressed on or after docetaxel treatment, and that were approved by the EMA in 2011 (AA by accelerated procedure): cabazitaxel (CBZ) and abiraterone acetate (AA),. We replicated the methodology most commonly used by Spanish hospitals to estimate the cost-efficacy of oncologic drugs (OS gains and incremental costs vs. those of comparators) by: (i) taking the perspective of the Spanish NHS (ii) estimating treatment costs based on the product labels (i.e. main medication, co-medication, premedication, and primary prophylaxis) at ex-factory prices, and the cost of administering such medications; and (iii) the OS data from the respective pivotal phase III trials: for CBZ vs. mitoxantrone + prednisone (MP) OS was 15.1 vs. 12.7 months. For AA vs. placebo + prednisone (PP) OS was 15.8 vs. 11.2. Input for the base case analysis comes from Phase III randomized clinical trials and from publicly available cost data. Sensitivity analysis was performed on: (i) length of treatment; (ii) median OS; and (iii) G-CSF usage and drug administration costs. In our base case scenario the cost per cycle of CBZ was 4,711.52€ vs. 78.20€ for MP. The cost per cycle of AA was 3,179.26€ vs. 11.85€ for PP. Treatment costs difference for CBZ vs. MP is 27,799.93€ (range 13,665.36€ – 46,646.01€) and for AA vs. PP is 25,386.71€ (range 12,669.65€ - 38,103.76€). OS gain is 2.4 months for CBZ and 4.6 months for AA. In Spain, based on local hospital methodology, AA would be the dominant alternative (higher OS gain and lower incremental cost) to treat mCRPC patients that have progressed on or after a docetaxel based regime.

Use of eculizumab for atypical haemolytic uraemic syndrome and C3 glomerulopathies

In the past decade, a large body of evidence has accumulated in support of the critical role of dysregulation of the alternative complement pathway in atypical haemolytic uraemic syndrome (aHUS) and C3 glomerulopathies. These findings have paved the way for innovative therapeutic strategies based on complement blockade, and eculizumab, a monoclonal antibody targeting the human complement component 5, is now widely used to treat aHUS. In this article, we review 28 case reports and preliminary data from 37 patients enrolled in prospective trials of eculizumab treatment for episodes of aHUS involving either native or transplanted kidneys. Eculizumab may be considered as an optimal first-line therapy when the diagnosis of aHUS is unequivocal and this treatment has the potential to rescue renal function when administered early after onset of the disease. However, a number of important issues require further study, including the appropriate duration of treatment according to an individual's genetic background and medical history, the optimal strategy to prevent post-transplantation recurrence of aHUS and a cost-efficacy analysis. Data regarding the efficacy of eculizumab in the control of C3 glomerulopathies are more limited and less clear, but several observations suggest that eculizumab may act on the most inflammatory forms of this disorder.

New antiepileptic drugs, cost-efficacy analysis

Objective: to optimize pharmacotherapy in patients with epilepsy and to evaluate the clinical and cost-effectiveness of its therapy with the new antiepileptic drugs (AED): levetiracetam, lamotrigine, topiramate, and oxcarbazepine. Patients and methods. The study enrolled 134 patients (women, 69.03%; men, 30.97%) with different types of seizures, who had previously received antiepileptic therapy. The patients visited their physician at least twice; after correcting therapy by an epileptologist, the mono- or polytherapy regimen included new AEDs. The patients' mean age was 29.8±8.7 years; disease duration was 13.01±6.7 years; mean age at onset was 16.8±8.5 years. In the groups of working and nonworking patients with different types of seizures, the authors calculated the cost of epilepsy therapy, by taking into account the use of new AEDs and the pharmacoeconomic index "cost-benefit" before and after therapy optimization. Results. When the new AEDs were incorporated into the therapy, the low incidence rate of seizures following a year averaged 75 to 92%. The index cost-effectiveness was decreased by 2—3 times in all types of seizures when the new AEDs were used despite the increased direct cost of treatment. Also, there was a significant reduction in the cost of epilepsy treatment in practically all the groups under study. The findings suggest that the index cost-efficacy directly depends on the rational choice of an AED in an adequate dose. Rational therapy with the new AEDs makes it possible to reduce not only the total cost of epilepsy treatment, but also to lower the index cost-efficacy.

A cost-efficacy analysis of subcutaneous anti–tumor necrosis factor therapy in the treatment of psoriatic arthritis

A cost-efficacy analysis of subcutaneous anti–tumor necrosis factor therapy in the treatment of psoriatic arthritis

On the Evaluation of Urban Logistics Intermodal Terminal Projects

This paper is looking to incorporate uncertainty and risk in the financial assessment of an urban logistics investment project – a ““rail-road” intermodal terminal performing urban logistic distribution functions. A “cost benefit analysis” (CBA) is performed for four decision scenarios (with different destinations and technologies). The variables included in the CBA are treated as random variables with different distribution functions (uniform, binomial, normal). The net present value (NPV) used to rank the different decision scenarios is based on results from a Monte Carlo simulation. NPV obtained as a discrete variable has been used to evaluate risk (expressed with specific indicators) and for the comparison with a NPV of a similar project in operation. A comparison with CBA that expresses NPV deterministically and the “states of nature” with known probabilities is made. Under uncertainty conditions (the “states of nature” completely unknown) the preferences of the decision maker are analysed for a certain scenario depending on his/her attitude towards risk (cautious, optimistic, pessimistic). The CBA is complemented by a “cost-efficacy analysis” (CEA) which reflects the manner in which the non-financial, social consequences of the project can be used to rank the decision scenarios. In conclusion, the paper pleads for the professionalism required by CBA and CEA, when risk and uncertainty cannot be ignored, this being the case of most infrastructure investments with social implications difficult to estimate financially.

Cost-Efficacy Analysis of the MONET Trial Using UK Antiretroviral Drug Prices

In virologically suppressed patients, switching to darunavir/ritonavir (DRV/r) monotherapy maintains HIV RNA suppression, and could also lower treatment costs. The purpose of this analysis was to calculate the potential cost savings from the use of DRV/r monotherapy in the UK. In the MONET trial, 256 patients with HIV RNA < 50 copies/mL on current highly active antiretroviral therapy (HAART) for over 24 weeks (non-nucleoside reverse-transcriptase inhibitor [NNRTI] based [43%] or protease inhibitor [PI] based [57%]), switched to DRV/r 800/100 mg once daily, either as monotherapy (n = 127) or with two NRTIs (n = 129). The UK costs per patient with HIV RNA < 50 copies/mL at week 48 (responders) were calculated using a 'switch included' analysis to account for additional antiretrovirals taken after initial treatment failure. By this analysis, efficacy was 93.5% versus 95.1% in the DRV/r monotherapy and triple therapy arms, respectively. British National Formulary 2009 values were used. Before the trial, the mean annual cost of antiretrovirals was £6906 for patients receiving NNRTI-based HAART, and £8348 for patients receiving PI-based HAART. During the MONET trial, the mean annual per-patient cost of antiretrovirals was £8642 in the triple therapy arm, of which 55% was from NRTIs and 45% from PIs. The mean per-patient cost in the monotherapy arm was £4126, a saving of 52% versus triple therapy. The mean cost per responder was £9085 in the triple therapy arm versus £4413 in the DRV/r monotherapy arm. Based on the MONET results, the lower cost of DRV/r monotherapy versus triple therapy in the UK would allow more patients to be treated for fixed budgets, while maintaining HIV RNA suppression at < 50 copies/mL. If all patients meeting the inclusion criteria of the MONET trial in the UK were switched to DRV/r monotherapy, there is the potential to save up to £60 million in antiretroviral drug costs from the UK NHS budget.

Comparative Cost-Efficacy Analysis of Darunavir/ritonavir and Other Ritonavir-Boosted Protease Inhibitors for First-Line Treatment of HIV-1 Infection in the United States

Purpose: A comprehensive study comparing the costs and efficacies of darunavir/ritonavir 800/100 mg qd and the other ritonavir-boosted (/r) protease inhibitors (PIs) recommended for treatment-naïve individuals with HIV-1 infection would help health care decision makers identify the value of each boosted PI. Methods: A cost-efficacy model was developed to compare the five recommended boosted PIs, each used with a tenofovir-based nucleotide/nucleoside reverse transcriptase inhibitor backbone. Efficacy was measured by virologic response (ie, HIV-1 ribonucleic acid < 50 copies/mL) at 48 weeks, based on a systematic review and meta-analysis of recent clinical trials. One-year antiretroviral therapy costs and 48-week efficacy values were used to generate the efficiency frontier and cost-efficacy ratios. Results: Darunavir/r was the most efficacious boosted PI, with an incremental cost-efficacy ratio of $27,390 per additional individual with virologic response, compared with fosamprenavir/r. All other regimens were dominated. Darunavir/r combination therapy also had one of the lowest average costs ($26,287) per individual with virologic response, resulting in a maximal number of individuals successfully treated within a fixed budget. The model results were robust in variability and sensitivity analyses. Conclusion: Darunavir/r 800/100 mg qd combination therapy represents a cost-efficacious option for treatment-naïve individuals with HIV-1 infection in the United States.

International multicenter randomized phase III study of first-line erlotinib (E) followed by second-line cisplatin plus gemcitabine (CG) versus first-line CG followed by second-line E in advanced non-small cell lung cancer (aNSCLC): The TORCH trial.

7508 Background: In a placebo-controlled trial, E prolonged survival of unselected aNSCLC patients (pts) not eligible for further chemotherapy. Two phase II studies suggested that first-line treatment with E might be a valid alternative to chemotherapy. Methods: An independent non profit phase 3 trial was designed to test whether overall survival in the experimental arm, first-line E (150 mg/d po) followed at progression by CG (C 80 mg/m2 d1 + G 1,200 mg/m2 dd1&8, q3w), was not inferior than in the standard first-line CG followed at progression by E. Stage IV/IIIb (with supraclavicular nodes or pleural effusion) NSCLC pts, PS 0-1, were eligible. With a 1.25 upper limit of 95% CI of hazard ratio (HR) of death, 80% power, 0.025 1-sided alpha, a sample size of 900 pts was calculated. Secondary end-points: progression-free survival, response, toxicity, quality of life, cost-efficacy analysis, correlative studies on tumor and blood samples. Results: From Dec 06 to Nov 09, 760 pts were randomized, 380 in each arm, 612 in Italy, 148 in Canada. Baseline characteristics were balanced between arms. Median age (range) was 62 (27-81); females were 256 (33.7%); 422 (55.5%) pts had adenocarcinoma; 157 (20.6%) were never smokers; 24 (3.2%) were East-Asian. At the planned interim analysis done after 340 deaths (half of the events required for final analysis), 151 and 189 in the standard and experimental arms, HR of death in the experimental arm was 1.40 (95% CI 1.13-1.73), p = 0.002; the boundary of study interruption for inferiority was crossed. Median survival was 10.8 months in the standard and 7.7 in the experimental arm. There was no heterogeneity of the HR across gender, smoking habit, and histotype subgroups. The IDMC recommended early study termination and cross-over to CG was offered to pts receiving first- line E. Conclusions: A strategy based on first-line E followed by CG at progression is inferior than the reverse standard one, in unselected patients with aNSCLC. Data on compliance and selected secondary end-points will also be presented. Supported by Roche. Eudract #2005-005968-90; NCT00349219. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Roche Roche Roche

National Complication Rates and Disposition After Posterior Lumbar Fusion for Acquired Spondylolisthesis

Database study using Nationwide Inpatient Sample (NIS) administrative data from 1993 to 2002. To determine rates of in-hospital complications and complex disposition for patients undergoing posterior lumbar fusion for degenerative spondylolisthesis, and the association of demographic factors. Spondylolisthesis affects primarily elderly populations. Recent data suggests a benefit of surgical treatment for acquired lumbar spondylolisthesis. However, the risks of these procedures, and the impact of patient demographics on risk, have not been nationally quantified. Data from 66,601 patients in the NIS (1993-2002) with diagnostic and procedure codes specifying posterior lumbar fusion for acquired spondylolisthesis were included. Patients were grouped by age, sex, race, number of comorbidities, hospital size, and time period of procedure. Multivariate analysis correlated patient and hospital characteristics with complex disposition and complications. Mortality rate was 0.15%. Eleven percent of patients had one or more in-hospital complications; overall complication rate was 13 per 100 operations. Hematoma/seroma (5.4 per 100) was the most common complication, followed by pulmonary (2.6), renal (1.8), and cardiac (1.2) complications. Infection and neurologic injury occurred in <1% of patients. Older patients and those with a number of comorbidities had greater rates of in-hospital complication and complex disposition. Compared to those aged 45 to 64, patients aged 65 to 84 were almost 70% more likely to have complications (OR: 1.67) and 5 times as likely to have complex disposition (OR: 5.84). Having 3 or greater comorbidities, compared to no comorbidities, was also associated with increased risk of complication (OR: 1.6) and complex disposition (OR: 2.3). Posterior lumbar fusion for acquired lumbar spondylolisthesis is safe. However, age and comorbidity independently increase in-hospital complications and complex disposition. These data may improve national estimates of surgical risk, patient selection, informed consent, and cost-efficacy analysis for posterior lumbar fusion operations for acquired spondylolisthesis.

A multicenter, randomized study to test immunosuppressive therapy with oral prednisone for the prevention of restenosis after percutaneous coronary interventions: cortisone plus BMS or DES versus BMS alone to eliminate restenosis (CEREA-DES) – study design and rationale

Several randomized trials and registries have shown a reduction of restenosis after coronary angioplasty with drug-eluting stents (DESs) compared with bare metal stents (BMSs). However, cost-efficacy analysis and long-term outcome of DESs compared to BMSs deserve further assessment. Moreover, concern has been raised regarding adverse clinical events occurring late after DES implantation, in particular, late stent thrombosis related to the suspension of dual antiplatelet therapy. The use of a short-cycle oral treatment with prednisone at immunosuppressive dose after BMS implantation has shown remarkable efficacy in reducing restenosis in nondiabetic patients, with very low additional cost and without the need for long-term dual antiplatelet therapy. Such results are however limited by small sample size. Cortisone plus BMS or DES versus BMS alone to Eliminate Restenosis is an independent, prospective, multicenter, randomized study. It will randomize 375 nondiabetic patients with coronary artery disease in three different arms to BMS (control group), DES (DES group) or BMS followed by a 40-day prednisone treatment (prednisone group). The DES and the prednisone groups will be compared to the control group to investigate the expected clinical advantage. The primary endpoint of the study is the event-free survival of cardiovascular death, myocardial infarction and recurrence of ischemia-needing repeated target vessel revascularization at 1 year. Secondary endpoints are the event-free survival analysis at 2 and 3 years, the restenosis rate at 9 months, and cost-effectiveness at 1, 2 and 3 years. The expected primary endpoint rates are 90% for DESs and for prednisone-treated patients and 77% for BMSs. The study was designed as a superiority trial, to compare DES, and BMS and prednisone, with BMS alone. A sample size of 118 patients per group provides an 80% power, assuming a complete 12-month follow-up information available for each patient. To obviate for cases of drop out, the sample size was increased to 375 patients to be enrolled in five Italian hospitals. This study will provide a magnitude of the net clinical and economic benefits of DES and of the safety and efficacy of BMS and cortisone compared to the standard use of BMS alone in nondiabetic patients with coronary artery disease.

Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes: modeled lifetime analysis.

OBJECTIVETo estimate the cost-effectiveness of surgically induced weight loss relative to conventional therapy for the management of recently diagnosed type 2 diabetes in class I/II obese patients.RESEARCH DESIGN AND METHODSThis study builds on a within-trial cost-efficacy analysis. The analysis compares the lifetime costs and quality-adjusted life-years (QALYs) between the two intervention groups. Intervention costs were extrapolated based on observed resource utilization during the trial. The proportion of patients in each intervention group with remission of diabetes at 2 years was the same as that observed in the trial. Health care costs for patients with type 2 diabetes and outcome variables required to derive estimates of QALYs were sourced from published literature. A health care system perspective was adopted. Costs and outcomes were discounted annually at 3%. Costs are presented in 2006 Australian dollars (AUD) (currency exchange: 1 AUD = 0.74 USD).RESULTSThe mean number of years in diabetes remission over a lifetime was 11.4 for surgical therapy patients and 2.1 for conventional therapy patients. Over the remainder of their lifetime, surgical and conventional therapy patients lived 15.7 and 14.5 discounted QALYs, respectively. The mean discounted lifetime costs were 98,900 AUD per surgical therapy patient and 101,400 AUD per conventional therapy patient. Relative to conventional therapy, surgically induced weight loss was associated with a mean health care saving of 2,400 AUD and 1.2 additional QALYs per patient.CONCLUSIONSSurgically induced weight loss is a dominant intervention (it both saves health care costs and generates health benefits) for managing recently diagnosed type 2 diabetes in class I/II obese patients in Australia.

THE COMPARATIVE COST-EFFICACY ANALYSIS OF VARIOUS ANTIHYPERTENSIVE THERAPIES

Aim. To perform the comparative cost-efficacy analysis of various antihypertensive therapies in hypertensives patients. Material and methods. 140 hypertensive patients with history of ineffective antihypertensive therapy were randomized in to 4 groups, 35 patients in each one. Patients of Group A received indapamide retard plus perindopril; group B - indapamide retard plus amlodipine; group C - amlodipine plus lisinopril; group D - amlodipine plus bisoprolol. The Russian version of general questionnaire MOS-SF-36 was applied for quality of a life estimated. Endothelium function was evaluated with B-mode ultrasonography (Acuson 128 ХР/10). Albuminuria level was detected by immunoturbometric method (Integra-700, Roche). Results. The drug combination B had the least cost. The drug combination C was the most effective. The drug combination C was the most economically rational. The drug combination A was the least economically rational for BP reduction. However the drug combination A was comparable with drug combination C in effects on quality of life and on endothelium function, and it was the most economically rational for albuminuria reduction. Conclusion. Indapamide retard plus perindopril combination is the most economically rational in patients with target-organ lesions (nephropathy). Lisinopril plus amlodipine combination is economically rational in patients without target-organ lesions.

A cost-efficacy analysis model for physician administered anti-tumor Necrosis factor agents in Crohnʼs Disease

A cost-efficacy analysis model for physician administered anti-tumor Necrosis factor agents in Crohnʼs Disease

A cost-efficacy analysis model for physician administered anti-tumor Necrosis factor agents In Crohnʼs Disease

A cost-efficacy analysis model for physician administered anti-tumor Necrosis factor agents In Crohnʼs Disease

Cost-efficacy analysis of hormonal treatments for advanced prostate cancer

Introduction: prostatic cancer is the second more frequent cancer in Italy (after lung cancer) and is the third cancer-related death cause. Age is the principal risk factor and, given the ageing process undergoing in the Italian population, it seems clear that the public sanitary expenditure to treat the disease is bound to increase, arising the need to perform pharmacoeconomic evaluations of the therapeutic strategies available. Methods: we performed a cost/utility analysis, through a Markov model, of several hormonal therapies in patients with advanced prostate cancer who underwent radical prostatectomy, from the biochemical recurrence to death. Nine androgen suppression therapies were considered: orchiectomy, two nonsteroidal antiandrogens (NSAA), four luteinizing hormone-releasing hormone (LHRH) agonists, cyproterone acetate and the association of a NSAA and a LHRH (BAT). In the simulation the androgen suppression therapies were started at the PSA recurrence and never stopped until death. The model used the Italian NHS prospective and a time horizon corresponding to patient’s lifetime. Drug costs were calculated for each therapy, considering the less costly brand. Results: all the considered therapies produced a life expectancy (LE) of about 12 life years (LYs) with a small variability ranging from 12.3 LYs for BAT (the most effective) to 11.37 LYs for NSAA-flutamide (the least effective). Quality adjusted life expectancy ranged from 9.98 QALYs for BAT to 9.28 QALYs for NSAA-flutamide. The average cost per patient presented a more enhanced variability, from 12,538 Euro for orchiectomy to 59,496 Euro for NSAA-bicalutamide. Among all the alternatives orchiectomy resulted the most cost/effective alternative with a cost/utility ratio of about 1,300 Euro/QALY. In the LHRH-agonists class leuprorelin was the most cost/effective with about 2,200 Euro/QALY. A one-way sensitivity analysis showed a substantial stability of the results. Conclusions: BAT resulted the most effective therapy, but also the one associated with the highest expected cost. Orchiectomy was marginally less effective but at the same time generated the lowest cost and, thus, represented the most cost/effective strategy. Nonetheless, its application in actual clinical practice is difficult and quite always refused by patients. Among the class of LHRH-agonists leuprorelin (considering the less costly brand, Eligard®) dominated the alternatives and, thus, could provide an excellent therapeutic strategy.

A Cost-Efficacy Analysis Model for Physician Administered Anti-Tumor Necrosis Factor Agents in Crohnʼs Disease

Purpose: To provide a cost-efficacy (CE) analysis of achieving remission in Crohn's disease (CD) patients following treatment with infliximab or certolizumab pegol from a payer perspective. Methods: An Excel-based CE model was developed to estimate cost per successful remission of CD using published data for infliximab and certolizumab pegol. Dosing information was obtained from the product labels. Drug costs were obtained from First Databank data for April 2008 wholesale acquisition cost (WAC). The cost for one 100 mg vial of infliximab was $604, and for one 200 mg syringe of certolizumab pegol was $658. The medical cost for infliximab infusions was estimated to be $237 per infusion based on the Medicare 2005 infusion schedule. The medical cost per certolizumab pegol administration was estimated at $37 based on HCPCs code 99212, for an office outpatient visit. The cost of adverse events was not included in the model. Remission rates, defined as the percentage of patients achieving a Crohn's Disease Activity Index (CDAI) score of less than or equal to 150, were used as the efficacy measure. A remission rate of 39.0% was reported at week 30 in the ACCENT I trial for infliximab. A remission rate of 29.0% was reported at week 26 in the PRECISE I trial for certolizumab pegol. The time horizon on the study was 30 weeks, as long-term effectiveness data are not yet available for certolizumab pegol. Results: The average cost per successfully treated patient, those achieving remission based on the CDAI score was $33,922 for infliximab and $37,324 for certolizumab pegol. Conclusion: Based on this model, the cost of a successfully treated patient is higher for certolizumab pegol than infliximab, suggesting that infliximab is more cost effective than certolizumab pegol for treatment of CD. Direct comparative trials and real world data are needed to confirm these findings.

Cost-Efficacy of Individual and Combined Treatments for Panic Disorder

The objective of this study was to examine the relative cost-efficacy of empirically supported treatments for panic disorder. As psychosocial, pharmacologic, and combined treatments have all demonstrated efficacy in the treatment of panic disorder, cost-efficacy analysis provides an additional source of information to guide clinical decision making. Cost-efficacy was examined based on results from the Multicenter Comparative Treatment Study of Panic Disorder, a randomized controlled trial of treatment for panic disorder (DSM-III-R). The trial was conducted from May 1991 to April 1998. Cost-efficacy ratios representing the cost per 1-unit improvement in Panic Disorder Severity Scale mean item score were calculated for 3 monotherapies (cognitive-behavioral therapy [CBT], imipramine, and paroxetine) and 2 combination treatments (CBT-imipramine and CBT-paroxetine) at the end of acute, maintenance, and follow-up phases. Results demonstrated consistently greater cost-efficacy for individual over combined treatments, with imipramine representing the most cost-efficacious treatment option at the completion of the acute phase (cost-efficacy ratio = $972) and CBT representing the most cost-efficacious option at the end of maintenance treatment (cost efficacy ratio = $1449) and 6 months after treatment termination (cost-efficacy ratio = $1227). In the context of similar efficacy for combined treatments, but poorer cost-efficacy, current monotherapies should be considered the first-line treatment of choice for panic disorder. Additionally, CBT emerged as the most durable and cost-effective monotherapy and, hence, should be considered as a particularly valuable treatment from the perspective of cost accountability.

Cost analysis applied to postoperative analgesia regimens: a comparison between parecoxib and propacetamol

Postoperative pain management represents a significant part of perioperative costs. Non-opioid analgesics are often used in combination with opiates to improve pain relief and reduce opioid-related side effects. To assess the costs and cost efficacy of intravenous (i.v.) parecoxib versus i.v. propacetamol in postoperative pain. A prospective, randomised, double-blind, clinical evaluation was performed to compare the efficacy of a single bolus injection of 40 mg parecoxib and 2 g propacetamol, administered twice within 12 h following surgical repair of inguinal hernia. Resources for each arm of treatment were collected, and total costs were determined, including costs of drug acquisition, devices and labour for preparation of the two analgesic drugs. Cost-efficacy analysis was performed as the cost to achieve complete satisfaction with analgesia. Incremental cost efficacy was determined as the ratio between the differential costs and the differential patient satisfaction. The analysis was performed from an institutional perspective over a 12 h time frame. A total of 182 patients was evaluated. Pain at rest and morphine consumption were observed to be reduced in the parecoxib group. The percentages of patients totally satisfied with their pain management 12 h after surgery were 87% in the parecoxib-treated group and 70% in the propacetamol-treated group (P < 0.01). The average cost per patient was higher in the parecoxib group, 6.65 euros vs 5.28 euros in the propacetamol group). Cost per patient satisfied was calculated at a mean value of 7.64 euros for parecoxib and 7.54 euros for propacetamol. Incremental cost per additional patient satisfied was 8.02 euros in the parecoxib-treated group when preparation costs were included. Sensitivity analysis (+/-15%), including a bootstrap method applied to costs and efficacy, did not modify these conclusions. Parecoxib exhibits higher cost and greater patient satisfaction than does propacetamol. From a cost-efficacy approach, incremental cost per additional patient satisfied for parecoxib treatment must be analysed in light of overall perioperative pharmaceutical cost.

A cost-efficacy analysis of anti-TNF therapies in psoriasis using PASI scores

A cost-efficacy analysis of anti-TNF therapies in psoriasis using PASI scores