The polypill: at what price would it become cost effective?

INTRODUCTION: A promising concept in cardiovascular disease prevention (the polypill) was introduced in 2003. Although the polypill may seem as an effective intervention, data on its costs and cost effectiveness remain unknown. The aim of this study was to determine the maximum price of the polypill for it to be a cost effective alternative in the primary prevention of cardiovascular disease. METHODS: Data on the hypothetical effects of the polypill were taken from the literature. Using data from the Framingham heart study and the Framingham offspring study, life tables were built to model the assumed benefits of the polypill. Using a third party payer perspective and a 10 years time horizon, the authors calculated what should be the maximum drug cost of the polypill for it to be cost effective (using a 20,000 euro/year of life saved threshold) in the primary prevention of cardiovascular disease among populations at different levels of absolute risk of coronary heart disease and age. RESULTS: To be cost effective among populations at levels of 10 year coronary heart disease risk over 20% (high risk), the annual cost of medication for the polypill therapy should be no more than 302 euro or 410 euro for men at age 50 and 60 years respectively. For cost effective prevention in populations at levels of coronary heart disease risk between 10% and 20% the costs should be two to three times lower. CONCLUSION: Although the polypill could theoretically be a highly effective intervention, the costs of the medication could be its caveat for implementation in the primary prevention of cardiovascular disease.     

Cutting costs: it can be done. But at what price?

Through tough negotiating, an in-house doctor, and strict plan limits, Tamar Inns spent $745 per covered life on health care last year. Is it too low?     

Accreditation at what cost?

Analyses the implications of the management of labour for an organization undertaking an accreditation exercise. Considers the King's Fund Organizational Audit (KFOA) accreditation scheme, which is concerned with process and facilities, and assesses the quality of the hospital environment in which the health care product is supplied. Concludes that, given the current enthusiasm for finding best practice in health care and the ever-increasing number of cost-effectiveness analyses of therapeutic interventions, it seems somewhat contradictory that interventions which cover the whole environment in which health care interventions are performed are not treated in the same way.     

At what price significance? The effect of price estimates on statistical inference in economic evaluation.

Because data on resource utilization are now collected in many comparative trials of health interventions, statistical analysis of between-group differences in mean costs has become common. Statistical analyses of costs are generally performed conditional on a set of resource prices (or unit costs), thereby suppressing any uncertainty associated with those price estimates. Results presented here demonstrate that varying price estimates can have a non-negligible effect on statistical inference regarding between-group cost differences. Depending on the relative prices used in an analysis, between-group differences in total costs per patient may be either statistically significant or insignificant, regardless of whether differences in utilization of the underlying resources are statistically significant. These results highlight the importance of recognizing that evaluations based on patient-level economic data may be sensitive to assumptions regarding the values of unobserved variables, such as the relative prices of resources. Traditional methods of sensitivity analysis remain a valuable tool for analysing the implications of uncertainty around estimates of those unobserved variables.     

Patient safety: what is really at issue?

The Veterans Health Administration found that a number of components were key to implementing a meaningful and effective patient safety program. To truly improve patient safety, the overall goal of your organization must be to prevent harm to the patient, not to eliminate errors. Create a system that is perceived as fair, and mitigate perceived barriers to improving patient safety. Create a transparent system for prioritizing and establishing how resources will be applied to the patient safety effort. Provide tools that support root cause analysis that moves beyond superficial and inadequate questions such as, Whose fault is this? Action that results in improvement, not simply analysis of the problem, is needed. Finally, leadership and management must be visibly involved in the patient safety program.     

Cost-utility analysis of 10- and 13-valent pneumococcal conjugate vaccines: Protection at what price in the Thai context?

Objective

This study aims to evaluate the costs and outcomes of offering the 10-valent pneumococcal conjugate vaccine (PCV10) and 13-valent pneumococcal conjugate vaccine (PCV13) in Thailand compared to the current situation of no PCV vaccination.

Methods

Two vaccination schedules were considered: two-dose primary series plus a booster dose (2 + 1) and three-dose primary series plus a booster dose (3 + 1). A cost-utility analysis was conducted using a societal perspective. A Markov simulation model was used to estimate the relevant costs and health outcomes for a lifetime horizon. Costs were collected and values were calculated for the year 2010. The results were reported as incremental cost-effectiveness ratios (ICERs) in Thai Baht (THB) per quality adjusted life year (QALY) gained, with future costs and outcomes being discounted at 3% per annum. One-way sensitivity analysis and probabilistic sensitivity analysis using a Monte Carlo simulation were performed to assess parameter uncertainty.

Results

Under the base case-scenario of 2 + 1 dose schedule and a five-year protection, without indirect vaccine effects, the ICER for PCV10 and PCV13 were THB 1,368,072 and THB 1,490,305 per QALY gained, respectively. With indirect vaccine effects, the ICER of PCV10 was THB 519,399, and for PCV13 was THB 527,378. The model was sensitive to discount rate, the change in duration of vaccine protection and the incidence of pneumonia for all age groups.

Conclusions

At current prices, PCV10 and PCV13 are not cost-effective in Thailand. Inclusion of indirect vaccine effects substantially reduced the ICERs for both vaccines, but did not result in cost effectiveness.     

Making Better Influenza Virus Vaccines?

Killed and live influenza virus vaccines are effective in preventing and curbing the spread of disease, but new technologies such as reverse genetics could be used to improve them and to shorten the lengthy process of preparing vaccine seed viruses. By taking advantage of these new technologies, we could develop live vaccines that would be safe, cross-protective against variant strains, and require less virus per dose than conventional vaccines. Furthermore, pandemic vaccines against highly virulent strains such as the H5N1 virus can only be generated by reverse genetics techniques. Other technologic breakthroughs should result in effective adjuvants for use with killed and live vaccines, increasing the number of available doses. Finally, universal influenza virus vaccines seem to be within reach. These new strategies will be successful if they are supported by regulatory agencies and if a robust market for influenza virus vaccines against inter-pandemic and pandemic threats is made and sustained.     

Music at home with the under fives: what is happening?

The study reported in this paper explores parents’ musical practices with children under the age of five in the home environment. A survey was sent to parents in three preschools, asking about parental music background, young children’s involvement in music programmes, types of music children were exposed to in the home and frequency of musical activities conducted in the home. Results from the survey were used as discussion points in focus groups, revealing: (1) parents highlighted a lack of time to engage in music‐making on a regular basis with young children; (2) parental belief that preschool and other educational settings provided a complete musical experience for children; (3) lack of parental knowledge about music; (4) reliance on commercially available products such as CDs and DVDs for music in the home; and (5) parental focus on the extra‐musical effects of music. Implications of these results are discussed.