头孢吡肟和头孢他啶治疗中重度肺炎的成本效用比较

目的对头孢吡肟和头孢他啶治疗中、重度肺炎的成本效用进行分析。方法118例中、重度肺炎病人前瞻性临床随机对照研究,头孢吡肟组(n=60),中度感染1g,重度感染2g,ivgtt,bid×7～10d;头孢他啶组(n=58),中度感染1g,重度感染2g,ivgtt,bid×7～10d。结果2组治疗总有效率分别为88%和79%,差别无显著意义(P＞0.05)。头孢吡肟在用药过程中能够更有效地改善病人生活质量。头孢吡肟组每例可节省直接医疗费用3800元左右。结论头孢吡肟ivgtt治疗中、重度肺炎比头孢他啶ivgtt更具成本效果。     

Cost-utility analysis of survival with epoetin-alfa versus placebo in stage IV breast cancer

BACKGROUND: In a multinational trial of anaemic patients with cancer receiving nonplatinum-containing chemotherapy, epoetin-alfa effectively increased haemoglobin levels, reduced red blood cell transfusion requirements, and improved QOL. Although the study was not designed or powered to evaluate survival, a survival trend was noted favouring epoetin-alfa compared with placebo (median survival 17 vs 11 months [p = 0.126]). OBJECTIVES: To determine the incremental cost utility of epoetin-alfa versus placebo in anaemic patients with stage IV breast cancer from a UK National Health Service perspective. METHODS: Patient data regarding transfusions, epoetin-alfa usage, chemotherapy treatment cycles, and adverse events were recorded, with survival follow-up for 12-36 months post-study. Stage IV breast cancer therapy costs were collected by surveying UK oncologists, and utilities for associated health states were from published sources. Costs were in British pounds and year 2000 values. Costs and benefits were jointly determined for the stage IV breast cancer subgroup (n = 55). Incremental cost-utility ratios (ICURs) were calculated assuming a 6% annual discount rate for costs and a 1.5% annual discount rate for benefits. Bootstrap simulations (10,000 iterations) were conducted to account for uncertainty, and sensitivity analyses were conducted to establish robustness. RESULTS: The ICUR for epoetin-alfa treatment was pounds 8,851 per QALY, with a 99% probability of a positive net benefit in QALYs (net benefit = 0.4805 years of perfect life) and a 94% probability of being acceptable using a threshold ICUR of pounds 30,000/QALY. The main cost drivers distinguishing epoetin-alfa from placebo were the costs of drug and patient care due to increased survival. CONCLUSIONS: The available data suggest a high probability of favourable cost-utility outcomes with epoetin-alfa treatment for anaemia in patients with stage IV breast cancer receiving nonplatinum-containing chemotherapy. Additional studies are warranted.     

曲美替尼联合达拉非尼对比维莫非尼治疗伴有BRAF V600突变的转移性黑色素瘤的成本-效用分析

目的: 对曲美替尼联合达拉非尼对比维莫非尼一线治疗伴有BRAF V600突变的不可切除或转移性黑色素瘤进行药物经济学评价,为我国医疗卫生决策提供参考。方法: 从卫生体系角度出发,结合Combi-v研究和针对东亚人群进行的临床试验中的患者生存数据,建立马尔可夫模型模拟伴有BRAF V600突变的不可切除或转移性黑色素瘤患者10年的疾病进展情况,模型循环周期为1个月,贴现率为5%,收集成本为直接医疗成本。采用单因素敏感性分析和概率敏感性分析对基础分析结果的稳健性进行验证。结果: 达拉非尼和曲美替尼联合疗法与维莫非尼单药疗法的增量-成本效用比(ICUR)为22 117.06元/质量调整生命年(QALY)。敏感性分析表明基础分析结果可靠。结论: 在意愿支付阈值(WTP)为1倍中国人均GDP时,达拉非尼联合曲美替尼治疗伴有BRAF V600突变的转移性黑色素瘤患者十分具有经济性。     

不同免疫抑制治疗方案对肾移植的成本效用分析

随着越来越多的免疫抑制药物进入临床应用,肾移植术后发生急性排斥反应率明显降低,而且患者生存率和器官存活率也明显增加[1]。本研究旨在探讨肾移植治疗方案的综合效果,既充分提高患者的健康水平,又有效利用有限的卫生资源。1研究对象与方法资料来源于1999-09—2003-09,本院移植中心接受的同种异体肾移植患者249例。进入MMF方案有117例,男57例,女114例,年龄为(43±12.2)岁;进入Aza方案有78例,男26例,女52例,年龄为(46.1±11.9)岁。药物霉酚酸酯胶囊,为上海罗氏制药公司生产($770/包);硫唑嘌呤,为葛兰素-威康公司生产($272/瓶)。治疗MMF…     

Cost-of-illness study of severe haemophilia A and B in five French haemophilia treatment centres

Objective The aim of this study was to assess the consumption of anti-haemophilic drugs by adults and children with severe haemophilia A or B (residual activity of FVIII or FIX ≤2%) and to quantify the average direct medical costs. Method A retrospective multicentre cost-of-illness study from the perspective of French national health insurance system. The costs include only the use of clotting factors. Main outcome measure Consumption was expressed in UI/kg/year and costs in euros/kg/year. Results From January 1, 2001 to December 31, 2002, data from 81 adults and 30 children with severe haemophilia A (n = 92) or B (n = 19) and included in the “SNH” were collected and analysed. A coagulation factor inhibitor was present in 10 patients (9%). Four of them were high responders. Mean age and body weight were respectively 28 ± 17 years and 58 ± 24 kg. Except for one adult patient, all (99%) had outpatient treatment, 44 patients (40%) were hospitalized and treated by recombinant or/and plasma-derived FVIII or FIX or/and rFVIIa. Overall median annual consumption of anti-haemophilic drugs per patient was estimated at 1,333 UI/kg, with a median cost-of-illness of 1,156 euros/kg. Patients with severe haemophilia B consumed more than patients with severe haemophilia A, though not significantly (P = 0.096), with a median of 2,167 vs. 1,100 UI/kg/year and a median cost of 1,760 vs. 917 euros/kg/year (P = 0.13). Children consumed respectively more than adults (P = 0.008), with a median of 3,204 vs. 1,106 UI/kg/year and a median cost of 2,614 vs. 913 euros/kg/year (P = 0.012). The median cost for patients with an inhibitor was 3,291 euros/kg/year, approximately threefold higher than that of patients without an inhibitor (926 euros/kg/year) (P = 0.022). Conclusion It suggests a higher consumption and cost of anti-haemophilic drugs among children when compared to adults. Haemophilia B patients did not consume significantly more than haemophilia A patients, whereas the consumption and cost for patients with or without inhibitors differed significantly.     

Cost-utility analysis of methadone maintenance treatment: a methodological approach

Economic considerations influence the substance user treatment system. These considerations influence who gets treatment and for how long, as well as determining what services they receive and in what setting. Current medical literature argues that maintenance treatment reduces risk-taking behavior, such as injection drug use and needle sharing. Treatment also reduces the mortality associated with abuse of opiates by injection and can cause decreases in costs incurred by the criminal justice system and social services agencies. This suggests the need for complex economic evaluations of a maintenance treatment to find out the optimum treatment program. This paper describes methods of economic evaluation in health care and reviews the methodology of cost-utility analysis in economic evaluations of methadone maintenance treatment.     

Cost-utility analysis of a pharmacy-led self-management programme for patients with COPD

Objective: To undertake a cost-utility analysis (CUA) of a pharmacy-led self-management programme for Chronic Obstructive Pulmonary Disease (COPD). Setting: A single outpatient COPD clinic at the Mater Hospital, Belfast, Northern Ireland between. Method: CUA alongside a randomised control trial. The economic analysis used data from 127 COPD patients aged over 45 years, with an FEV1 of 30?C80% of the predicted normal value. Participants received either a pharmacy-led education and self-management programme, or usual care. One year costs were estimated from the perspective of the National Health Service and Personal Social Services and quality-adjusted life years (QALYs) were calculated based on responses to the EQ-5D at baseline, 6 and 12 months. Main outcome measure: Cost per QALY gained. Results: The mean differences in costs and effects between the self-management and education programme and usual care were ?£671.59 (95 CI%: ?£1,584.73 to ?£68.14) and 0.065 (95% CI; 0.000?C0.128). Thus the intervention was the dominant strategy as it was both less costly and more effective than usual care. The probability of the intervention being cost-effective was 95% at a threshold of £20,000/QALY gained. Sensitivity analyses indicated that conclusions were robust to variations in most of the key parameters. Conclusion: The self-management and education programme was found to be highly cost-effective compared to usual care. Further research is required to establish what aspects of self-management and education programmes have the greatest impact on cost-effectiveness.     

Cost-utility of erlotinib combined with bevacizumab versus bevacizumab alone after completion of chemotherapy with bevacizumab for first-line treatment of advanced non-small-cell lung cancer

Bevacizumab plus erlotinib prolonged patients’ progression-free survive (PFS) versus bevacizumab alone for the maintenance treatment of none-small cell lung cancer (NSCLC) in phase III clinical trial ATLAS (ClinicalTrials. gov identifier NCT00257608), which repealed a benefit outcome and acceptable side-effects, but whether its cost performance would be accepted by patients is blurry. The aim of our research is to figure out which strategy is the best option in clinic and would spread broadly. Markov Model was used to calculate incremental cost-utility radios (ICURs) and 10-year quality-adjusted life years (QALY) of both strategies. The clinical data were collected from phase III clinical trial ATLAS (ClinicalTrials. gov identifier NCT00257608).The cost data were obtained from Chinese health care system. In the research, one-way sensitivity analysis, probabilistic sensitivity analysis (PSA) and Monte-Carlo analysis were performed to test the stability of the results.The better strategy was bevacizumab alone strategy, and the cumulative costs of both strategies were $178 648.47 and $46 445.28, respectively, and the QALY was 12.506 and 10.643, respectively. The ICUR of combined application was $70 962.53/QALY, which was much higher than 3 times of mean gross domestic product (GDP) in China, suggesting that this strategy was no economical at all. In one-way analysis, the change of willingness-to-pay could not influence the consequence. In addition, in Monte-Carlo analysis, the probability distribution of cost, effectiveness and ICUR was in normal distribution.Taken together, bevacizumab alone strategy was the better strategy in terms of cost-effectiveness.     

Cost-utility analysis of early thrombolytic therapy

167 patients suffering from acute myocardial infarction (AMI) were recruited from 12 cardiology centres and given thrombolytic treatment. Cost-utility analyses were performed and a cost-utility ratio was computed according to time of initiation of thrombolysis after the AMI and the location of the infarct. Early thrombolysis ( less than 3 hours) proved to cost about the same per QALY ($US3734 vs $US3577) as late thrombolysis ( greater than 3 hours), although posterior infarcts cost slightly more per QALY ($3433 vs $2996) than anterior infarcts. Quality of life coefficients for all patients after the AMI were judged to be about 40% less than before the AMI. Thus, in terms of resources consumed and patient well-being, time of treatment initiation or location of the infarct were less significant than the fact of having an AMI. In terms of quality of life, the best strategy is that which seeks to prevent AMI occurring.     

Patterns of bleeding in adolescents with severe haemophilia A.

Eighty-two boys with severe haemophilia A who spent some time at Lord Mayor Treloar College during 1973-7 were studied. All episodes of bleeding that occurred during term time were recorded, along with the number of transfusions. The bleeding frequency among these boys, most of them aged 10-17 years, increased steadily from 8,31 episodes/100 days in 1973 to 12,63 episodes/100 days in 1977. At the same time there was a steady fall in bleeding frequency with age. Altogether 24% of bleeding episodes were into the elbow joint, 22% into the knee, and 15% into the ankle. As the boys grew older the proportion of bleeding episodes in the legs declined and that in the arms increased. The overall results reflect the fact that special schools now see only the severest cases of haemophilia. The pattern of bleeding during adolescence suggests that concepts of management of arm bleeding need modifying.     

A cost-effectiveness analysis of primary versus hospital-based specialist care for direct acting antiviral hepatitis C treatment

BackgroundHepatitis C virus elimination may be possible by scaling up direct-acting antiviral (DAA) treatment. Due to the safety and simplicity of DAA treatment, primary care-based treatment delivery is now feasible, efficacious and may be cheaper than hospital-based specialist care. In this paper, we use Prime Study data – a randomised controlled trial comparing the uptake of DAA treatment between primary and hospital-based care settings amongst people who inject drugs (PWID) – to estimate the cost of initiating treatment for PWID diagnosed with hepatitis C in primary care compared to hospital-based care.MethodsThe total economic costs associated with delivering DAA treatment (post hepatitis C diagnosis) within the Prime study – including health provider time/training, medical tests, equipment, logistics and pharmacy costs – were collected. Appointment data were used to estimate the number/type of appointments required to initiate treatment in each case, or the stage at which loss to follow up occurred.ResultsAmong the hepatitis C patients randomised to be treated within primary care, 43/57 (75%) commenced treatment at a mean cost of A$885 (95% CI: A$850–938) per patient initiating treatment. In hospital-based care, 18/53 hepatitis C patients (34%) commenced treatment at a mean cost of A$2078 (range: A$2052–2394) per patient initiating treatment – more than twice as high as primary care. The lower cost in the primary care arm was predominantly the result of increased retention in care compared to the hospital-based arm.ConclusionsCompared to hospital-based care, providing hepatitis C services for PWID in primary care can improve treatment uptake and approximately halve the average cost of treatment initiation. To improve treatment uptake and cure, countries should consider primary care as the main model for hepatitis C treatment scale-up.     

灯盏生脉胶囊用于缺血性脑卒中二级预防的成本效用分析

目的:对于中国缺血性脑卒中患者,分析使用灯盏生脉胶囊联合标准二级预防方案或单用标准预防方案进行二级预防的成本效用.方法:基于全社会视角,构建Markov模型,模拟患者5年的成本和质量调整生命年.模型包括4个健康状态,分别是未复发卒中、复发卒中不依赖他人照料(mRSO-2)、复发卒中依赖他人照料(mRS3-5)和死亡.临...     

急性缺血性脑卒中两种治疗方案的成本-效用分析

目的:本研究对脑卒中疾病的治疗方案进行评价,寻找具有较好的成本-效用比的治疗方案。方法:选择入组2007-2008年间到全国近21家临床试验基地就诊的急性缺血性脑卒中患者145例,对照组(B,n=75)用药奥扎格雷钠注射液和阿斯匹林,试验组(A,n=70)用药丁苯酞氯化钠注射液和阿司匹林。采用EQ-5D量表测试受试者的效用值并给出质量调整生命年(QALYS)的干预路径图,比较两种方案的成本/QALYS,并运用非参数Bootstrapping法对结果进行敏感性分析,确定结果置信区间,并给出成本-效果可接受曲线。结果:从EQ-5D评分可以看出,丁苯酞治疗组的评分在8~14 d和15~90 d的改善值局高于对照组(B),成本/QALY约为22.58万元,对照组(B)约为23.75万元。进一步作增量的成本-效用分析(ICUR),可知ΔC(B-A)/ΔQALY(B-A)=450 892.9元,选择非参数Bootstrapping法确定95%的ICUR可信区间下限为21.9万元,说明丁苯酞治疗组的经济性优于奥扎格雷钠组,从ICUR生成的可接受曲线可以看出,奥扎格雷钠组的增量成本19.2万元以下具有ICUR优势的可能性为零...     

Cost-utility analysis of treatment with olanzapine compared with other antipsychotic treatments in patients with schizophrenia in the pan-European SOHO study

OBJECTIVE: To determine the cost utility of treating schizophrenic patients with olanzapine compared with other antipsychotics in a naturalistic outpatient setting. METHODS: The pan-European SOHO study is a 3-year, prospective, outpatient, observational study of outcomes associated with antipsychotic treatment, focusing on olanzapine, in ten European countries. For the cost-utility analysis, healthcare resource use (inpatient care, day care, outpatient psychiatric consultations and antipsychotic and concomitant medication use) and EQ-5D data were collected at baseline and at 3, 6 and 12 months. The perspective was that of the health service payer. UK healthcare unit costs (year 2004 values) were applied to the resource use data for the ten countries. UK population tariffs were applied to the EQ-5D data to determine utility values.An Epoch analysis was used to analyze the longitudinal data. Multivariate regression analyses that adjusted for baseline covariates were used to estimate the incremental cost and utility gains for patients treated with olanzapine compared with each of the other antipsychotics (risperidone, quetiapine, amisulpride, clozapine and oral or depot typical antipsychotics). RESULTS: A total of 10 972 patients were enrolled at baseline, of which 9107 completed the 12-month study period. Treatment with olanzapine was more effective in terms of QALYs gained than all of the other antipsychotic treatments. Treatment with olanzapine dominated quetiapine and amisulpride. The incremental cost for olanzapine compared with risperidone was pound sterling 226 per patient over 12 months and the incremental cost per QALY gained was pound 5156, with bootstrap analyses showing 100% of the replications falling below a pound sterling 30 000 per QALY gained threshold. Compared with treatment with clozapine, olanzapine was found to be marginally more effective, at an additional cost of pound sterling 13 per patient over 12 months and to have an incremental cost per QALY gained of pound sterling 775. Bootstrap analyses showed that 81% of replications fell below a pound sterling 30 000 per QALY gained threshold. Comparing olanzapine with oral and depot typical antipsychotics, the incremental cost was pound sterling 849 and pound sterling 1106 per patient over 12 months and the incremental cost per QALY gained was pound sterling 15 696 and pound sterling 23 331, respectively. Bootstrap analyses showed that 98% of the replications fell below a pound sterling 30 000 per QALY gained threshold for the comparison with oral typical antipsychotics, and 79% of replications for the comparison with depot preparations. CONCLUSIONS: Among SOHO patients, if a funding threshold of pound sterling 30 000 per QALY gained is assumed, this analysis suggests that olanzapine has a high probability of being the most cost-effective treatment compared with other antipsychotic treatments. However, comparison of olanzapine with clozapine and typical depot antipsychotics should be viewed with caution because clozapine is a second-line treatment and depot treatment is used for patients who do not adhere to their oral medication.     

Onset of action during on-demand treatment with maalox suspension or low-dose ranitidine for heartburn

AIM: To compare the onset of action of the local antacid Maalox and the systemic H2-antagonist ranitidine, during 'on demand' ambulant treatment of a single heartburn episode, using a randomized, parallel group, double-blind, double-dummy design. METHODS: Subjects with self-perceived heartburn without known gastrointestinal disease or interfering treatments were selected with questionnaires. The study was performed unsupervised, whenever heartburn required medication. An electronic patient diary gave instructions when to take study medication, and provided visual analogue scales and five-item relief ratings for heartburn, at frequent time intervals activated by an alarm-clock. RESULTS: After a study of the natural history of heartburn and the feasibility of the study procedures in 23 patients, 49 subjects took Maalox and 45 ranitidine. Half of these experienced meaningful heartburn relief within 19 min after Maalox, and within 70 min after ranitidine. One hour after intake, the average heartburn relief score was 3.43 in the Maalox group and 3.04 in the ranitidine group (3 means 'slight improvement' and 4 'strong improvement'). Heartburn was similar in both groups after 3 h. CONCLUSIONS: Maalox provides faster relief of heartburn than ranitidine. Heartburn can be assessed frequently and reliably under ambulant conditions using an electronic patient diary.     

Botulinum toxin type a versus topical 20% aluminum chloride for the treatment of moderate to severe primary focal axillary hyperhidrosis

Severe hyperhidrosis affects 2.8% of the population and can be emotionally devastating. First-line therapy employs topical agents such as aluminum chloride (AC), but efficacy and tolerability vary widely. Botulinum toxin type A (BTX-A) is FDA-approved for the treatment of primary focal axillary hyperhidrosis unresponsive to topical therapy. A single-center, randomized, parallel, open-label, 12-week study was performed to compare the efficacy and safety of BTX-A with 20% AC for the treatment of primary focal axillary hyperhidrosis. Twenty-five subjects were randomized to either BTX-A or AC treatment, and were evaluated for treatment response by an improvement of > or =2 grades on the Hyperhidrosis Disease Severity Scale (HDSS). At week 4, 92% of the subjects in the BTX-A group achieved treatment response compared with 33% of the subjects in the AC group. Overall, treatment with BTX-A was more effective and provided greater patient satisfaction than with AC. Treatment with AC was effective and tolerated in 29% of the subjects.