Cost‐utility analysis of idelalisib in combination with rituximab in relapsed or refractory chronic lymphocytic leukaemia

Objective

To evaluate the incremental cost‐utility ratio (ICUR) of idelalisib in combination with rituximab (IR) versus rituximab monotherapy (R) in the treatment of patients with relapsed or refractory (R/R) chronic lymphocytic leukaemia (CLL), from the Spanish National Health System (NHS) perspective.

Methods

A partitioned survival Markov model for a lifetime horizon (30 years) was developed to estimate costs (€, 2016) and quality‐adjusted life years (QALY) with IR and R. Initial cohort included patients with CLL receiving a second or subsequent line (2L) of treatment with IR or R. Survival data were based on CLL clinical trial. Drug, administration, monitoring, adverse events and clinical management of CLL costs were included in the model. Costs and outcomes were discounted using a 3% annually. Deterministic and probabilistic sensitivity analyses (PSA) were performed.

Results

Compared to R, 2L IR treatment resulted in QALY gain of 3.147 (4.965 versus 1.818). Total costs were €118 254 for IR versus €23 874 for R. ICUR was €29 990/QALY gained with IR versus R. In the PSA, IR was cost‐effective in 78% of iterations using a threshold of €45 000/QALY.

Conclusion

IR can be considered a cost‐effective treatment compared to R, in the treatment of R/R CLL patients for the Spanish NHS.     

Baduanjin exercise improved premenstrual syndrome symptoms in Macau women

ObjectiveTo investigate the effect of Baduanjin, a traditional Chinese medical exercise, on improving premenstrual syndrome (PMS) symptoms in women.MethodsForty reproductive age women with PMS in Macau practiced standardized Baduanjin exercise for three menstrual cycles. A questionnaire, the daily record of severity of problems (DRSP), was used to measure symptom severity. DRSP was filled out every day starting from the last cycle before exercise (i.e., the first menstrual cycle) to the third cycle after exercise initiation (i.e., the fourth menstrual cycle). The total scores and the scores of each item during the 5 premenstrual days and follicular phase (5-9 postmenstrual days) were calculated.ResultsAfter exercise, the total DRSP scores during the 5 premenstrual days and differences in the total DRSP scores between the 5 premenstrual days and the follicular phase were both significantly reduced. Of note, the physical symptom total scores in the 5 premenstrual days and the differences between its total score in the 5 premenstrual days and in the follicular phase were both significantly reduced. The differences between the total scores of depressed mood, anxious mood, loss of interest, and reduction in social activity during the 5 premenstrual days and the follicular phase were also reduced.ConclusionsBaduanjin exercise was able to improve the mental and especially the physical symptoms of PMS.     

补阳还五汤加减在社区脑卒中后疲劳患者中的运用

目的观察补阳还五汤加减治疗社区脑卒中后疲劳患者的临床疗效。方法本研究于2016年6月～2018年6月将符合入组标准的63例北京社区脑卒中患者,随机分为对照组和治疗组。对照组接受内科常规药物对症治疗。治疗组在补阳还五汤的基础上根据患者的症状进行加减。4周后对患者的疲劳严重度、生存质量和日常生活能力进行评分,与治疗前评分进行比较分析。结果入组的脑卒中后疲劳患者经过治疗后,疲劳严重度评分、生存质量评分和日常生活能力评分均较治疗前改善(P0.05);补阳还五汤治疗组患者在改善疲劳严重度评分、日常生活能力评分方面优于对照组(P0.05),两组在改善生存质量改善方面效果相近(P0.05)。结论应用补阳还五汤加减治疗脑卒中后疲劳,能显著改善患者的疲劳程度和日常生活能力,提高生存质量,对临床指导具有较好的参考意义。     

The economic burden of schizophrenia in Canada in 2004

ABSTRACT

Objective: To estimate the financial burden of schizophrenia in Canada in 2004.

Methods: A prevalence-based cost-of-illness (COI) approach was used. The primary sources of information for the study included a review of the published literature, a review of published reports and documents, secondary analysis of administrative datasets, and information collected directly from various federal and provincial government programs and services. The literature review included publications up to April 2005 reported in MedLine, EMBASE and PsychINFO. Where specific information from a province was not available, the method of mean substitution from other provinces was used. Costs incurred by various levels/departments of government were separated into healthcare and non-healthcare costs. Also included in the analysis was the value of lost productivity for premature mortality and morbidity associated with schizophrenia. Sensitivity analysis was used to test major cost assumptions used in the analysis. Where possible, all resource utilization estimates for the financial burden of schizophrenia were obtained for 2004 and are expressed in 2004 Canadian dollars (CAN$).

Results: The estimated number of persons with schizophrenia in Canada in 2004 was 234?305 (95% CI, 136?201–333?402). The direct healthcare and non-healthcare costs were estimated to be CAN$2.02 billion in 2004. There were 374 deaths attributed to schizophrenia. This combined with the high unemployment rate due to schizophrenia resulted in an additional productivity morbidity and mortality loss estimate of CAN$4.83 billion, for a total cost estimate in 2004 of CAN$6.85 billion. By far the largest component of the total cost estimate was for productivity losses associated with morbidity in schizophrenia (70% of total costs) and the results showed that total cost estimates were most sensitive to alternative assumptions regarding the additional unemployment due to schizophrenia in Canada.

Conclusions: Despite significant improvements in the past decade in pharmacotherapy, programs and services available for patients with schizophrenia, the economic burden of schizophrenia in Canada remains high. The most significant factor affecting the cost of schizophrenia in Canada is lost productivity due to morbidity. Programs targeted at improving patient symptoms and functioning to increase workforce participation has the potential to make a significant contribution in reducing the cost of this severe mental illness in Canada.     

Programmatic Costs of the Telehealth Ostomy Self-Management Training: An Application of Time-Driven Activity-Based Costing

ObjectivesProgrammatic cost assessment of novel clinical interventions can inform their widespread dissemination and implementation. This study aimed to determine the programmatic costs of a telehealth Ostomy Self-Management Training (OSMT) intervention for cancer survivors using Time-Driven Activity-Based Costing (TDABC) methodology.MethodsWe demonstrated a step-by-step application of TDABC based on a process map with core OSMT intervention activities and associated procedures and determined resource use and costs, per unit procedure. We also assessed per-patient costs from a payer perspective and provided estimates of total hours and costs by personnel, activity, and procedure.ResultsThe per-patient cost of the OSMT was $1758. Personnel time accounted for 91% of the total cost. Site supervisor and information technology technician time were the most expensive personnel resources. Telehealth technical and communication equipment accounted for 8% of the total cost. Intervention coordination and monitoring efforts represented most of the total time cost (62%), followed by the intervention delivery (35%). The procedures with the highest cost were communication via phone or virtual meetings (24%), email exchanges (18%), and telehealth session delivery (18%).ConclusionsFuture efforts to replicate, disseminate, and implement the OSMT intervention should anticipate funding for nonclinical components of the intervention, including coordination and monitoring, and consider how these activities can be performed most efficiently. For institutions without established telemedicine programs, selection of videoconferencing platforms and adequate staffing for participant technical support should be considered. Our step-by-step application of TDABC serves as a case study demonstrating how interventionists can gather data on resource use and costs of intervention activities concurrently with their collection of trial data.     

A Quality and Cost-Benefit Analysis of Dialyzer Reuse in Hemodialysis Patients

Background. To evaluate the benefits of dialyzer reuse for hemodialysis (HD) patients, including the cost of HD treatment and patient's survival, a comparison was made regarding the standard practice of single-use dialysis. Methods. From January 1, 2005, to December 31, 2005, a total of 128,232 successive HD treatments in 822 patients in Chang Gung Memorial Hospital-Kaohsiung Medical Center were included in this study. Results. Approximately 54.25% (446/822) of patients reused dialyzers. The average times of dialyzer reuse was 2.54. The annual hollow fiber cost is reduced by $241,054.08 U.S. dollars (NT $7,834,257.60). The annual cost of hollow fiber was reduced by $540.48 U.S. dollars (NT $17,565.60) in one patient with dialyzer reuse. The mortality rates in dialyzer reuse and single use groups were 3.1% and 10.9% within one year (p < 0.0001). Multiple logistic regressions showed that single use compared with reuse was associated with higher mortality after adjusting co-morbid conditions including age, diabetes mellitus, etc. Conclusions. We concluded that the benefits of dialyzer reuse included safety in our center and reduction in cost during a 12-month period. Dialyzer reuse may be a safe alternative.