Official Price Lists Research Articles

Under what conditions is feedback microwave thermotherapy (ProstaLund Feedback Treatment) cost-effective in comparison with alpha-blockade in the treatment of benign prostatic hyperplasia and lower urinary tract symptoms?

Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are a common condition in men, and their incidence increases with age. The objective of this study was to evaluate the potential cost-utility of microwave thermotherapy, specifically the ProstaLund Feedback Treatment (PLFT), versus alpha-blockade in Swedish patients with LUTS due to BPH. A health-economic simulation model, based on long-term disease progression and costs, was developed to analyse the cost-utility of PLFT in comparison with alpha-blockade over a 3-year period based on data from published literature, treatment programmes and official price lists. Outcome measures used in the analysis were quality of life, survival and reduction in International Prostate Symptom Score. Sensitivity analyses were performed for a number of essential variables. The perspective of the study is the healthcare sector. All costs are expressed as 2003 prices. Three years after an intervention with PLFT or initiation of drug treatment the cost-utility of PLFT was estimated at approximately euro 6600-9500 per quality-adjusted life-year gained. The cost-utility was further improved over a longer time period, and PLFT appears to be cost-saving after 5 years. One important finding from the model simulation was that PLFT also seems to be favourable in patients with less pronounced symptoms. This result may be further validated when additional results from controlled clinical trials become available. The present model simulation indicates that treatment with PLFT seems to be cost-effective compared with drug therapy with alpha-blockade. The result shows that the time-frame of the analysis has a great impact on the cost-effectiveness ratio.

Economic Evaluation of Tramadol/Paracetamol Combination Tablets for??Osteoarthritis Pain in The Netherlands

To compare the costs of treating osteoarthritis (OA) pain using combination tramadol/paracetamol tablets, NSAIDs alone, NSAIDs plus proton pump inhibitors (PPIs), or NSAIDs plus histamine H(2)-receptor antagonists (H(2)RAs) from the perspective of the Dutch healthcare system. A decision-analytical model was constructed to model the cost outcomes of the four treatment strategies over 6 months. A cost-minimisation approach was used, which considered data related to resource utilisation, medication costs and costs for the treatment of adverse events. Data, derived mainly from the clinical literature, were supplemented by inputs from a Delphi panel as well as official price and tariff lists. The base-case analysis considered direct medical costs, including those for treating all adverse events with tramadol/paracetamol and gastrointestinal (GI) adverse events with NSAIDs. Separate scenario analyses explored costs of NSAID-based regimens: (i) according to 21 levels of risk for GI adverse events, and (ii) when renal events attributable to NSAIDs were considered. Robustness of the model was tested using univariate sensitivity analysis. In the base-case analysis, costs for 6 months' treatment of OA pain using tramadol/paracetamol were euro244.45, compared with euro317.32 for NSAIDs + PPIs, euro200.67 for NSAIDs + H(2)RAs, and euro125.86 for NSAIDs alone. This provided a cost saving of euro72.87 per patient over 6 months for tramadol/paracetamol compared with NSAIDs + PPIs. Tramadol/paracetamol became cost saving compared with NSAIDs alone and NSAIDs + H(2)RAs for GI risk levels >13 and >10, respectively. When renal adverse events of NSAIDs were con- sidered, tramadol/paracetamol was cost saving compared with all NSAID-based regimens (saving euro228.40 vs NSAIDs, euro418.42 vs NSAIDs + PPIs, and euro302.69 vs NSAIDs + H(2)RAs [year of costing 2005]). Sensitivity analysis confirmed the model was robust to wide-ranging changes in the value of input parameters. Tramadol/paracetamol is cost saving compared with NSAIDs + PPIs for the treatment of OA pain over a period of 6 months regardless of the risk of GI or renal complications. Tramadol/paracetamol is also cost saving compared with treatment with NSAIDs alone and NSAIDs + H(2)RAs for patients at medium and high risk of GI adverse events and in all cases if considering renal adverse events. Despite not being quantified in monetary terms, the lower incidence of adverse events with tramadol/paracetamol is a clinical benefit.

Transurethral Prostatectomy and Inguinal Hernia Repair in a Single Session

Introduction: We aimed at evaluating the outcomes of transurethral prostatectomy and inguinal hernia repair performed in a single session. Patients and Methods: Fifty-six patients (mean age 68 ± 8.3 years) in whom transurethral prostatectomy was performed combined with an inguinal hernia repair were included into the study. Type of anesthesia, technique of inguinal hernia repair, hospitalization time, and the complications encountered were recorded. Cost comparisons were made using the official price-lists of the Turkish Medical Assocation. All patients were asked whether they were satisfied with the outcome of both operations performed in one session. The data obtained from the patients who underwent both operations in one session were compared with those obtained from 56 patients who underwent transurethral prostatectomy only (control group). Statistical analysis was performed using the chi-square test corrected for continuity according to the Yates or the Fisher exact test. Results: The operations were performed in 19 patients under general, in 20 patients under epidural, and in 14 patients under spinal anesthesia. Three patients were given general anesthesia and spinal anesthesia combined. In 6 patients bilateral and in 50 patients unilateral hernia repair was performed. In 11 repairs, polyprolene mesh grafts were utilized; in 2 repairs, a laparoscopic method was used, and in the remaining 49 repairs, one of the conventional techniques (McVay, Bassini, or Shouldice) was employed. There were no significant differences with regard to early and late postoperative complications and satisfaction between study group and control group (p > 0.05). Combined prostatectomy and hernia repair allows approximately 30% cost profit. Conclusions: Performing transurethral prostatectomy and inguinal hernia repair in one session decreased the number of the operations and anesthesias, hospital stay, and thus health costs and did not cause an increase in operative and postoperative morbidity.

PHP1 ASSESSMENT OF PROPOSED GUIDELINES FOR PHARMACOECONOMIC SUBMISSIONS IN GREECE: OVERVIEW AND IMPLEMENTATION PROBLEMS

OBJECTIVES: Greek authorities have proposed draft pharmacoeconomic (PE) guidelines for reimbursement submissions. Our objective is to compare these to guideline documents in the EU countries, Australia and Canada in terms of purpose and methodology and identify potential implementation problems. METHODS: We reviewed and compared the proposed guidelines along the following criteria: purpose of PE analysis, responsibility and conduct, type of analysis, comparator choice, perspective, resource use and cost assessment, outcome measurement and validation of results. Based on the above as well as current Greek literature we assessed potential problems in implementing the proposed guidelines. RESULTS: In terms of comparison, pharmacoeconomic submissions in Greece aim at reimbursement. PE studies can be conducted either by the pharmaceutical industry, CROs or academia. Cost-minimization analysis is sufficient when effectiveness of the alternatives is equal. Otherwise, cost consequence analysis is mandatory followed by costeffectiveness, cost-benefit or cost-utility analyses. Standard and least costly existing therapies are mandatory comparators. The perspective of analysis is not clearly stated. Cost outcomes should reflect detailed resource use description. Effectiveness measures should be based on RCTs or meta-analysis results. No explicit reference is made of naturalistic studies. Modeling is accepted. QoL outcomes are accepted. Discounting and sensitivity analyses are obligatory. As a result of our comparative analysis, the following issues should be investigated in the transition phase. Applying monetary values is difficult given the absence of official price lists and concurrent use of public and private providers. Epidemiological data and databases regarding clinical practice are scant. Extensive modeling assumptions are required to transfer international clinical data to the Greek environment. Experience with PE is rare among researchers and government. CONCLUSIONS: Proposed guidelines are similar with published ones, with minor country-specific differences. The implementation problems identified require a transition phase to establish methodological grounds and generate experience.

PCN20: COST MINIMIZATION ANALYSIS OF CEFEPIME VERSUS IMIPENEM-CILASTATINE IN CANCER PATIENTS WITH SHORT-DURATION FEBRILE NEUTROPENIA

OBJECTIVE: To perform pharmacoeconomical comparison of cefepime versus imipenem-cilastatine used for empiric therapy in cancer patients with short-duration febrile neutropenia in Russia. METHODS: The decision tree was designed to analyse the costs and outcomes of studied treatment. Probabilities of clinical success, adverse events, switching to a new drug and adding extra antibiotics were extracted from a published multicentral randomised clinical trial. Firstly the study was planned to be a cost-effectiveness analysis, but data obtained from the trial, demonstrated equal efficacy of both drugs. So finally the study was performed as cost-minimization analysis. The following costs were taken into account: the drug acquisition price, drug preparation and administration, medications to treat failures and adverse events, including antibiotics added to main medication. Schemes of treatment for adverse events and choice of antibiotics for treating clinical failures typical for clinical practice in this country were obtained from expert panel. Costs of drugs were derived from official price-lists of pharmacies. Hospital costs were excluded, as there was no difference in the length of treatment between the groups according to the results of the trial. RESULTS: According to clinical trial the probability of clinical success for short-duration febrile neutropenia treatment in cancer patients is equal in both drugs (79 % for cefepime and 72% for imipenem, equivalence, p < 0.0001). Cost of treatment of 1 patient with imipenem-cilastatine including added antibiotics, drugs for treating failures and adverse events was 21 207,2 roubles (757,4 USD), for cefepime—10 512, 32 roubles (375,44 USD). CONCLUSION: Cefepime monotherapy being clinically as effective as imipenem-cilastatine is twice less costly for the empirical treatment of fever in short-duration neutropenia. Changing of widely recommended for empiric therapy of febrile neutropenia imipenem-cilastatine for cefepime will save 10 694,88 roubles (382 USD) in each treated patient.