Drug Costs

Spinal cord stimulation (SCS) is an effective method of relieving chronic intractable pain, and one of its key indications is failed back surgery syndrome (FBSS). The objective of the current study was to evaluate the cost effectiveness of 10 kHz high-frequency SCS (HF10 SCS) compared to conventional medical management (CMM), reoperation, and traditional nonrechargeable (TNR-SCS) and rechargeable SCS (TR-SCS). A health economic model of SCS in the United Kingdom was reproduced in the perspective of the health care system to simulate costs and quality adjusted life years (QALYs) over 15 years. In the model, both a decision tree and the Markov model were used to describe the health outcomes of the evaluated therapies. HF10 SCS therapy showed a favorable incremental cost-effectiveness ratio (ICER) of £3,153 per QALY gained as compared to CMM and established dominance (less costly, more QALYs) compared to TNR-SCS (£8,802 per QALY vs. CMM) and TR-SCS (£5,101 per QALY vs. CMM). This first...

Deep vein thromboses (DVTs) cause significant morbidity and mortality in the general population. Oral anticoagulation therapy may reduce thrombus propagation but does not cause clot lysis and therefore does not prevent postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) can be used to treat DVTs as an adjunct to medical therapy, but there is no consensus defining exact indications. Current evidence suggests that CDT can reduce clot burden and DVT recurrence and consequently prevents the formation of PTS compared with systemic anticoagulation. Appropriate indications include younger individuals with acute proximal thromboses, a long life expectancy, and relatively few comorbidities. Limbthreatening thromboses may also be treated with CDT, although the subsequent mortality remains high. A number of randomized controlled trials are currently under way comparing the longer-term outcomes of CDT compared with anticoagulation alone. Initial reports suggest that venous patency and valvular function are better maintained after CDT. The effectiveness of combined pharmacomechanical thrombectomy and the role of vena cava filters need to be investigated further before strong recommendations can be made. The reported short-term outcomes following catheter-based intervention for DVT are encouraging in selected patients. Further evidence is required to establish long-term benefits and cost-effectiveness. (Arterioscler Thromb Vasc Biol. 2010;30:669-674.)

We review behavioral- and neuroeconomic research that identifies temporal discounting as an important component in the development and maintenance of drug addiction. First we review behavioral economic research that explains and documents the contribution of temporal discounting to addiction. This is followed with recent insights from neuroeconomics that may provide an explanation of why drug dependent individuals discount the future. Specifically, neuroeconomics has identified two competing neural systems that are related to temporal discounting using brain-imaging techniques that examine the relative activation of different brain regions for temporal discounting. According to the competing neural systems account, choices for delayed outcomes are related to the prefrontal cortex (i.e., the “executive system”) and choices for immediate outcomes are related to the limbic brain regions (i.e., the “impulsive system”). Temporal discounting provides a useful framework for future imaging research, and suggests a novel approach to designing effective drug dependence prevention and treatment programs.

Introduction: Over-consumption of antibiotics has led to increased bacterial resistance and higher prevalence of hospital -acquired infections, resulting in rising treatment costs and prolonged length of hospital stay. The purpose of the study was to correlate the use of restricted antibiotics with recommended diagnosis and cost.

Objectives: To compare data on statin utilisation and costs across Europe from routine administrative databases with those from a commercial source. Methods: Observational study in European Union member states and Norway. Comparison of data collected from national administrative databases used to reimburse pharmacists and data from a standard commercial source (Intercontinental Marketing Services Health): detailed data by drug for the year 2000. Results: There were differences among the data from administrative databases and those from the commercial source; these differences were of a consistent pattern in each country. In general, the commercial data recorded greater utilisation (reflecting both public and private use, range from 0 to +55%, median +15%), lower cost per defined daily doses (as commercial data sources used ex-factory price rather than expenditure to the state used in administrative databases, range from À70% to -6%, median À39%) and similar utilisation per 1000 head of population per day (range from À15 to +47%, median À1%).

Previous research has shown that pharmacoeconomic (PE) data are considered important but may not be optimally utilized by decision makers. No research has compared the effectiveness of different types of PE models. The purpose of this study was to examine the perceived value and understanding of PE models among decision makers in managed care organizations. The perspective of this study was from research scientists working in the pharmaceutical industry who present PE models to managed care clients. The study objectives were to (1) examine what types of models are best received by decision makers, (2) investigate the barriers to using PE models, and (3) recommend methods for improving PE models. A telephone survey of 39 items was conducted with 20 PE research scientists from various U.S. pharmaceutical and biotechnology companies. Topics addressed included factors contributing to how well PE models are received, barriers to using PE models, and recommendations for improving PE model...

Across European countries, differences exist in biosimilar policies, leading to variations in uptake of biosimilars and divergences in savings all over Europe. The aim of this article is to provide an overview of different initiatives and policies that may influence the uptake of biosimilars in different European countries. Recommendations will be formulated on how to create sustainable uptake. An overview of policies on biosimilars was obtained via a questionnaire, supplemented with relevant articles. Topics were organized in five themes: availability, pricing, reimbursement, demand-side policies, and recommendations to enhance uptake. In all countries studied, biological medicines are available. Restrictions are mainly dependent on local organization of the healthcare system. Countries are willing to include biosimilars for reimbursement, but for commercial reasons they are not always marketed. In two thirds of countries, originator and biosimilar products may be subjected to inte...

To estimate the economic consequences of the current Brazilian government policy for attention-deficit/hyperactivity disorder (ADHD) treatment and how much the country would save if treatment with immediate-release methylphenidate (MPH-IR), as suggested by the World Health Organization (WHO), was offered to patients with ADHD. Based on conservative previous analyses, we assumed that 257,662 patients aged 5 to 19 years are not receiving ADHD treatment in Brazil. We estimated the direct costs and savings of treating and not treating ADHD on the basis of the following data: a) spending on ADHD patients directly attributable to grade retention and emergency department visits; and b) savings due to impact of ADHD treatment on these outcomes. Considering outcomes for which data on the impact of MPH-IR treatment are available, Brazil is probably wasting approximately R$ 1.841 billion/year on the direct consequences of not treating ADHD in this age range alone. On the other hand, treating A...

T h i s s t u d y e s t i m a t e d t h e v a l u e o f c o n t r a c e p t i v e s , t h ro u g h a r a n d o md i g i t -d i a l e d s u rv e y o f w i l l i n g n e s s t o p a y f o r h e a l t h i n s u r a n c e c o v e r a g e o f c o n t r a c e p t i v e s a m o n g 6 5 9 Wa s hington State adults. People valued contraceptives at 5 times the actua r i a l c o s t ; i n g e n e r a l , w o m e n a n d re p ro d u c t i v e -a g e d p e r s o n s w e re w i l l i n g t o p a y m o re , b u t l o w -i n c o m e men highly valued contraceptives. M o s t re s p o n d e n t s ( 8 5 % ) s a i d t h a t c o n t r a c e p t i v e s s h o u l d b e c o v e re d by health insurance plans. The full b e n e f i t o f c o n t r a c e p t i v e s e x c e e d s t h e i r c o s t . (A m J P u b l i c H e a l t h . 2 0 0 4 ; 94:1330-1332)

Background: Trypanosomosis, via causing anaemia, emaciation, production loss and death, is arguably the most important constraint to livestock development in Sub-Saharan countries, including Ethiopia and its impact in Baro-Akobo and Gojeb river basins (endemic areas for tsetse flies) is unknown. This study was carried out from November 2011 to April 2012 to assess farmers' perception on the presence, impact, management and the need of intervention programs of bovine trypanosomosis and tsetse fly in selected districts located in Baro-Akobo and Gojeb river basins, Southwestern Ethiopia. A standardized questionnaire survey was employed to collect the relevant information from the farmers. Results: The result of this study showed that 94.1% of the respondents considered bovine trypanosomosis as an economically important cattle disease which accounted for 64.6% of the total annual deaths in the year 2011/2012. Estimated mean annual financial loss via mortality due to trypanosomosis was reported to be 3501 Ethiopian Birr (US$200)/household. The reported trypanosomosis suggestive signs were consistent with published reports and farmers strongly associated the occurrence of the disease with biting flies (particularly, tsetse fly). Respondents also explained that the seasonality of the disease and its vectors, i.e. May and June are peak risk months of the year. Chemotherapy was reported the major method to combating the problem, mean frequency of treatment being 5.7 times per animal per year. Because of the economic burden of the disease, farmers expressed their strong interest and support for the establishment of intervention program in their area. Conclusion: The study revealed that livestock keepers are familiar with bovine trypanosomosis and its vectors as well as its impacts. Thus, trypanosomosis and tsetse control strategies should be integrated with the local communities' participation to minimize the impacts of the disease and its vectors in the area.

to the editor: Osterberg and Blaschke (Aug. 4 issue) 1 discuss interventions that can be used to improve adherence to medication regimens. However, I am surprised that they do not include interventions by pharmacists among the recommendations in Table 3 of their article, which listed strategies for improving adherence.

Several cases of expensive drugs designed for large patient populations (e.g. sofosbuvir) have raised a complex question in terms of drug pricing. Even assuming value-based pricing, the treatment with these drugs of all eligible patients would have an immense budgetary impact, which is unsustainable also for the richest countries. This raises the need to reduce the prices of these agents in comparison with those suggested by the value-based approach and to devise new pricing methods that can achieve this goal. The present study discusses in detail the following two methods: (i) The approach based on setting nation-wide budget thresholds for individual innovative agents in which a fixed proportion of the historical pharmaceutical expenditure represents the maximum budget attributable to an innovative treatment; (ii) The approach based on nation-wide price-volume agreements in which drug prices are progressively reduced as more patients receive the treatment. The first approach has be...

AAIM is the largest academically focused specialty organization representing departments of internal medicine at medical schools and teaching hospitals in the United States and Canada. As a consortium of five organizations, AAIM represents department chairs and chiefs; clerkship, residency, and fellowship program directors; division chiefs; and academic and business administrators as well as other faculty and staff in departments of internal medicine and their divisions.

Background: Autism is characterized by a clinical triad of symptoms that affect social, language, and behavioral domains. Aggression and self-injury may be associated symptoms of autism and can result in significant harm to those affected as well as marked distress for their families. The precise nature of the relationship between aggressive or self-injurious behavior (SIB) and autism remains unclear and as a result, these symptoms are treated with a broad range of pharmacological approaches. This review seeks to systematically and critically examine the evidence for the pharmacological management of aggression and SIB in children with autism spectrum disorders. Method: The entire PubMed database was searched for English language biomedical articles on clinical trials with medication in autism spectrum disorders. Studies were selected based on the following inclusion criteria: (1) randomized placebo-controlled trials; (2) a sample population that included children and adolescents; (3) at least one standardized assessment of aggression as a primary outcome measure of the study. Results: Twenty one trials with 12 medications were identified. Five medications produced significant improvement as compared to placebo, including tianeptine, methylphenidate, risperidone, clonidine, and naltrexone. Only risperidone and methylphenidate demonstrate results that have been replicated across at least two studies. Conclusions: Although many medications have been studied under placebo-controlled conditions, few produce significant improvement. Additional placebo-controlled trials are needed to increase the number of therapeutic options available in the treatment of aggression in autism.

Purpose To investigate the attitudes of senior anaesthetists toward issues of anaesthesia drug cost control, utilization, and education, and to determine patterns of drug use of common clinical scenarios. Methods A questionnaire mailed to heads of ...

Background: Psychological treatments for dementia are widely used in the UK and internationally, but only rarely have they been standardised, adequately evaluated or systematically implemented. There is increasing recognition that psychosocial interventions may have similar levels of effectiveness to medication, and both can be used in combination. Cognitive Stimulation Therapy (CST) is a 7-week cognitive-based approach for dementia that has been shown to be beneficial for cognition and quality of life and is cost-effective, but there is less conclusive evidence for the effects of CST over an extended period.

The socio-economic impact of cystic echinococcosis (CE), caused by Echinococcus granulosus, is reviewed with special reference to the following topics: consequences in man and livestock, costs and benefits of control programmes and economic procedures for evaluating control programmes. Examples of some important costs and benefits are given. Many consequences in man and livestock are difficult to evaluate from an economic point of view, because some basic data are difficult to obtain in many countries. However, the socio-economic evaluation of the consequences of CE and of the present and future control actions proves indispensable to best use available resources and possibly tailor control stategies.

Problem During the 1990s, the Sudan began several initiatives to establish new medicine-financing mechanisms as part of the health reform process. Initial seed stocks were provided to each hospital. Unfortunately these facility-based funds did not regenerate and the hospitals were left without funds for medicines. The Revolving Drug Fund (RDF) was established in 1989 to facilitate access to medicines in health facilities in Khartoum state. Approach This study used quantitative and qualitative research techniques to collect data from health-care providers and users to evaluate the experience of operating an RDF in Khartoum state. Data from personal observations and from archival and statistical records were also analysed. Seven health facilities were sampled for this research. Local setting The Ministry of Health has a policy to expand the RDF to the whole country and has already commenced roll-out to seven more states. This policy is based on the experience of the RDF within Khartoum state. Relevant changes Khartoum state has a high (97%) level of availability of essential medicines and this is attributed to the RDF. The RDF medicines were mostly considered affordable by users and very few (6%) patients failed to obtain the prescribed medicines for financial reasons. Lessons learned The RDF could be successfully replicated in other states of the Sudan and in low-income countries with similar contexts on condition that they meet success factors, such as gradual implementation, political commitment and availability of hard currency. Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español.

Background: State of the art sedation concepts on intensive care units (ICU) favor propofol for a time period of up to 72 h and midazolam for long-term sedation. However, intravenous sedation is associated with complications such as development of tolerance, insufficient sedation quality, gastrointestinal paralysis, and withdrawal symptoms including cognitive deficits. Therefore, we aimed to investigate whether sevoflurane as a volatile anesthetic technically implemented by the anesthetic-conserving device (ACD) may provide advantages regarding 'weaning time', efficiency, and patient's safety when compared to standard intravenous sedation employing propofol. Method/Design: This currently ongoing trial is designed as a two-armed, monocentric, randomized prospective phase II study including intubated intensive care patients with an expected necessity for sedation exceeding 48 h. Patients are randomly assigned to either receive intravenous sedation with propofol or sevoflurane employing the ACD. Primary endpoint is the comparison of the 'weaning time' defined as the time required from discontinuation of the sedating agent until sufficient spontaneous breathing occurs. Moreover, sedation depth evaluated by Richmond Agitation Sedation Scale and parameters of patient's safety (that is, vital signs, laboratory monitoring of organ function) as well as the duration of mechanical ventilation and overall stay on the ICU are analyzed and compared. An intention-to-treat analysis will be carried out with all patients for whom it will be possible to define a wake-up time. In addition, a per-protocol analysis is envisaged. Completion of patient recruitment is expected by the end of 2012.

Objective: This article models the cost-effectiveness, from a societal viewpoint, of a dental caries prevention program using salt fluoridation for children 12 years of age, compared with non-intervention (or status quo) in Arequipa, Peru. Methods: Standard cost-effectiveness analysis methods were used. The costs associated with implementing and operating the salt-fluoridation program were identified and measured using 2009 prices. Health outcomes were measured as dental caries averted over a 6-year period. Clinical effectiveness data was taken from published data. Costs were measured as direct treatment costs, programs costs and costs of productivity losses as a result of dental treatments. The incremental costeffectiveness ratio was calculated. A hypothetical population of 25,000 12-year-olds living in Arequipa, Peru was used in this analysis. Two-way sensitivity analyses were conducted over a range of values for key parameters. Results: Our primary analysis estimated that if a dental caries prevention program using salt-fluoridation was available for 25,000 6-year-old children for 6 years, the net saving from a societal perspective would total S/. 11.95 [1 US$ = S/. (2009) 3.01] per diseased tooth averted when compared with the status quo group. That is, after 6 years, an investment of S/.0.32 per annum per child would result in a net saving of S/.11.95 per decayed/missing/filled teeth prevented. Conclusions: While the analysis has inherent limitations as a result of its reliance on a range of assumptions, the findings indicate that for the situations prevailing in Peru, there are significant health and economic benefits to be gained from the use of salt fluoridation.

To assess the incremental cost and cost-effectiveness of continuous and discontinuous regimens of bevacizumab (Avastin) and ranibizumab (Lucentis) for neovascular age-related macular degeneration (nAMD) from a UK National Health Service (NHS) perspective.

Public procurement is generally an important sector of the economy and, in most countries, is controlled by the introduction of regulatory and policy mechanisms. In the Greek healthcare sector, recent legislation redefined centralized procurement through the reestablishment of a state Health Procurement Committee (EPY), with an aim to formulate a plan to reduce procurement costs of medical devices and pharmaceuticals, improve payment time, make uniform medical requests, transfer redundant materials from one hospital to another and improve management of expired products. The efforts described in this paper began in early 2010, under the co-ordination of the Ministry of Health (MoH) and with the collaboration of senior staff from the International Monetary Fund (IMF), the European Commission (EC) and the European Central Bank (ECB). The procurement practices and policies set forth by EPY and the first measurable outcomes, in terms of cost savings, resulting from these policies are presented. The importance of these measures is discussed in light of the worst economic crisis faced by Greece since the restoration of democracy in 1974, as a result of both the world financial crisis and uncontrolled government spending.

Abstracts study of 100 adult asthmatics. RESULTS: The table reports outcomes over a 10-year period. Results were driven by the impact of ICS on quality of life, rather than on mortality. Findings were stable over most input data ranges. However, at efficacy levels below 3% and toxicity rates greater than 2.9%, the cost-effectiveness estimate exceeded $100,000/QALY. CONCLUSION: Results suggest that inhaled steroids deliver good comparative value in mild-to-moderate adult asthma. More research is needed, however, on the impact of ICS toxicity on patient preferences.

Background. e Borderline personality disorder (BPD) is a highly prevalent, chronic condition. Because of its very problematic nature BPD is expected to be associated with substantial societal costs, although this has never been comprehensively assessed.

薄形化導光板射出壓縮成型之研究 國立高雄應用科技大學 模具工程系 黃俊欽*、馮旭彬 摘要 導光板(LGP)是背光模組(backlight)中引導 LED 的點光源成為平面光源的重 要零組件。其光學特性主要取決於表面微米級的微結構設計，利用表面的微結構 破除光線在導光板內部的全反射現象，使光線由導光板的出光面射出，提供顯示 器面板所需的足夠光源。為了降低背光模組的厚度，導光板將朝薄型化發展，而 其微結構設計及精密成形將更加困難。本文以 2.2 吋、厚度 0.6mm、成型塑料為 聚碳酸樹脂(PC)、微結構為 V-型溝的超薄型導光板為例，以射出/壓縮製程成形 導光板。文中將以壓縮力、壓縮速度、壓縮開始位置、壓縮時間作為控制變因， 配合田口實驗計畫法分析成型條件對導光板微結構成形及導光板翹曲變形的主 要影響因子，並且由輝度量測了解導光板的光學性質。由結果顯示壓縮力及壓縮 速度是主要的影響因子，成型條件的最佳組合可使微結構的成形性明顯提高。與 傳統的射出成形比較，射出/壓縮成形可以明顯改善微結構的均齊性，提高導光 板的整體輝度，並且有效降低導光板在澆口處的應力殘留現象。 關鍵字：導光板、微結構成形、最佳化、射出/壓縮成型 2 Abstract

PURPOSE: Electronic medical record systems improve the quality of patient care and decrease medical errors, but their financial effects have not been as well documented. The purpose of this study was to estimate the net financial benefit or cost of implementing electronic medical record systems in primary care.

Excessive sun exposure is known to be the leading cause of skin cancer. The direct cellular damage inflicted by the ultraviolet (UV) radiation from the sun results in premature aging, DNA damage, and mutations that ultimately lead to skin cancer. Sunscreens are highly recommended to protect against UV radiation. However, little research has been conducted on the economic burden of sunscreen use. In this study, we aimed to evaluate the annual cost of sunscreen under both ideal and actual use conditions while stratifying for the sun protection factor (SPF) and by the name brand or equivalent store brand sunscreen. Pricing data was collected for sunscreens of SPF 30, 50, 70, and 100. For each type of sunscreen, the size and price of the container were recorded. Our results demonstrated that sunscreen prices increased with SPF but purchasing a generic sunscreen resulted in savings of 40%-50%. Our estimates reveal that sunscreens are affordable with annual expenditures ranging from $30.21 to $61.94, depending on brand, for SPF 50 sunscreens used with minimal application density for the average person.

The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this Organization, which was created in 1948, the health professions of over 180 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region -embracing 850 million people living in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of Russia -is unique in that a large proportion of its countries are industrialized, with advanced medical services. The European programme therefore differs from those of other regions in concentrating on the problems associated with industrial society. In its strategy for attaining the goal of "health for all by the year 2000" the Regional Office is arranging its activities in three main areas: promotion of lifestyles conducive to health, reduction of preventable conditions, and provision of care that is adequate, accessible and acceptable to all. ICP/DSE 127 Text editing by Pamela M. Charlton ISBN 92 890 1308 7