Today, in various countries, especially in Indonesia, the cost of health services is increasing. Hypertension is a degenerative disease that requires health costs for a long time. Increasing costs ...due to increasing chronic diseases threaten access and quality of health services, by which it is necessary to find a solution to overcome the problem of health financing. One method used is to analyze the guidelines for hypertension therapy and drug classes in the pharmacoeconomic aspects, namely Cost Effectiveness Analysis. This study aims to analyze the effectiveness of antihypertensive combination therapy in hypertensive patients at Bhayangkara Hospital, Kendari in 2019. The research method is descriptive with cross sectional study design. The analysis conducted is the cost effectiveness analysis (CEA) performed by calculating direct medical costs, the effectiveness of therapy based on blood pressure that reaches the target and calculating the value of ACER (Average Cost Effectiveness Ratio) and ICER (Incremenal Cost Effectiveness Ratio). Data were collected prospectively which fulfilled the inclusion and exclusion criteria. The results showed the therapeutic effectiveness and the value of ACER obtained from 31 hypertensive patients were a combination of Candesartan – Bisoprolol that was ACER value of 85.71% (2,314), and combination of Candesartan – Amlodipin of 70.58% (2,643). ICER value of 7,832 indicates that the price of drugs is more expensive but more effective therapy.Keywords : cost effective, ACER, ICER, Hypertension, Candesartan, Amlodipin Abstrak: Dewasa ini, diberbagai negara khususnya di Indonesia biaya pelayanan kesehatan semakin meningkat. Hipertensi merupakan salah satu penyakit degeneratif yang membutuhkan biaya kesehatan dalam jangka waktu yang lama. Peningkatan biaya akibat semakin meningkatnya penyakit kronik mengancam akses dan mutu pelayanan kesehatan, olehnya itu perlu dicari solusi untuk mengatasi masalah pembiayaan kesehatan. Salah satu metode yang dilakukan yaitu dengan menganalisis pedoman terapi hipertensi dan golongan obat dalam aspek farmakoekonomi, yaitu Analisis Efektivitas Biaya. Penelitian ini bertujuan untuk menganalisis efektivitas terapi kombinasi antihipertensi pada pasien hipertensi di Rumah Sakit Bhayangkara Kendari tahun 2019. Metode penelitian ialah deskriptif dengan rancangan cross sectional study. Data diambil secara prospektif yang memenuhi kriteria inklusi dan eksklusi. Analisis yang dilakukan adalah cost effectiveness analysis (CEA) dilakukan dengan menghitung biaya medik langsung, efektivitas terapi berdasarkan tekanan darah yang mencapai target dan menghitung nilai ACER (Average Cost Effectiveness Ratio) dan ICER (Incremenal Cost Effectiveness Ratio). Hasil penelitian menunjukkan efektifitas terapi dan nilai ACER yang diperoleh dari 31 pasien hipertensi ialah kombinasi Candesartan – Bisoprolol yaitu nilai ACER sebesar 85,71% (2.314), dan kombinasi Candesartan – Amlodipin sebesar 70,58% (2.643). Nilai ICER sebesar 7.832 menunjukkan bahwa harga obat lebih mahal namun terapi lebih efektif. Kata Kunci : Efektivitas biaya, ACER, ICER, Hipertensi, Candesartan, Amlodipin
Abstract
Background
Irritable bowel syndrome (IBS) is a common, often disabling gastrointestinal (GI) disorder for which there is no satisfactory medical treatment but is responsive to cognitive ...behavior therapy (CBT).
Purpose
To evaluate the costs and cost-effectiveness of a minimal contact version of CBT (MC-CBT) condition for N = 145 for IBS relative to a standard, clinic-based CBT (S-CBT; N = 146) and a nonspecific comparator emphasizing education/support (EDU; N = 145).
Method
We estimated the per-patient cost of each treatment condition using an activity-based costing approach that allowed us to identify and estimate costs for specific components of each intervention as well as the overall total costs. Using simple means analysis and multiple regression models, we estimated the incremental effectiveness of MC-CBT relative to S-CBT and EDU. We then evaluated the cost-effectiveness of MC-CBT relative to these alternatives for selected outcomes at immediate posttreatment and 6 months posttreatment, using both an intent-to-treatment and per-protocol methodology. Key outcomes included scores on the Clinical Global Impressions-Improvement Scale and the percentage of patients who positively responded to treatment.
Results
The average per-patient cost of delivering MC-CBT was $348, which was significantly less than the cost of S-CBT ($644) and EDU ($457) (p < .01). Furthermore, MC-CBT produced better average patient outcomes at immediate and 6 months posttreatment relative to S-CBT and EDU (p < .01). The current findings indicated that MC-CBT is a cost-effective option relative to S-CBT and EDU.
Conclusion
As predicted, MC-CBT was delivered at a lower cost per patient than S-CBT and performed better over time on the primary outcome of global IBS symptom improvement.
A largely home-based regimen of cognitive behavioral therapy for irritable bowel syndrome was delivered at a lower cost per patient than traditional office-based CBT and performed better over time in relieving core gastrointestinal symptoms (e.g., abdominal pain, altered bowel habits such as diarrhea and/or constipation) refractory to conventional medical treatments.
ICER is a transcriptional repressor that is mono- or poly-ubiquitinated. This either causes ICER to be translocated from the nucleus, or degraded via the proteasome, respectively. In order to further ...studies the proteins involved in ICER regulation mass spectrometry analysis was performed to identify potential candidates. We identified twenty eight ICER-interacting proteins in human melanoma cells, Sk-Mel-24. In this study we focus on two proteins with potential roles in ICER proteasomal degradation in response to the N-end rule for ubiquitination: the N-alpha-acetyltransferase 15 (NAA15) and the E3 ubiquitin-protein ligase UBR4. Using an HA-tag on the N- or C-terminus of ICER (NHAICER or ICERCHA) it was found that the N-terminus of ICER is important for its interaction to UBR4, whereas NARG1 interaction is independent of HA-tag position. Silencing RNA experiments show that both NAA15 and UBR4 up-regulates ICER levels and that ICER's N-terminus is important for this regulation. The N-terminus of ICER was found to have dire consequences on its regulation by ubiquitination and cellular functions. The half-life of NHAICER was found to be about twice as long as ICERCHA. Polyubiquitination of ICER was found to be dependent on its N-terminus and mediated by UBR4. This data strongly suggests that ICER is ubiquitinated as a response to the N-end rule that governs protein degradation rate through recognition of the N-terminal residue of proteins. Furthermore, we found that NHAICER inhibits transcription two times more efficiently than ICERCHA, and causes apoptosis 5 times more efficiently than ICERCHA. As forced expression of ICER has been shown before to block cells in mitosis, our data represent a potentially novel mechanism for apoptosis of cells in mitotic arrest.
•The N-terminus of ICER is important for ICER's regulation.•NARG1 and UBR4 interact with ICER.•Altering ICER's N-terminus increases its half-life and elicits apoptosis.
The purpose of this commentary is to focus on the downside of assumption-driven simulation modeling, the potential creation of a multitude of competing models, the mathematically impossible quality ...adjusted life year (QALY) and the failure to observe the axioms of fundamental measurement in mapping ordinal EQ-5D-5L preferences from the ordinal Quantitative Myasthenia Gravis (QMG) score. A second aspect of this commentary is to propose standards that should be set for the creation and evaluation of value claims in health technology assessment, in particular need fulfillment quality of life (QoL), that meet the demarcation test to distinguish science from non-science. The result is that the present ICER pricing claims for eculizumab and efgartigimod in myasthenia gravis should not be applied without consideration of more relevant evidence.
Introduction:
Remote telemonitoring (RTM) for patients with chronic heart failure (HF) holds promise to improve prognosis and well-being beyond the standard of care (SoC). The CardioBBEAT trial ...assessed the health economic and clinical impact of an interactive bidirectional RTM system (Motiva
®
) versus SoC for patients with HF and a reduced ejection fraction (HFrEF), in Germany.
Methods:
This multicenter, randomized controlled trial enrolled 621 patients with HFrEF (mean age 63.0 ± 11.5 years, 88% men). The primary endpoint was the integrated effect of the intervention on total costs and nonhospitalized days alive after 12 months, reported as incremental cost-effectiveness ratio (ICER). Costs (in k€) were based on actual charges of patients' statutory health insurance. Among secondary outcome measures were mortality and disease-specific quality of life.
Results:
We found a neutral effect on nonhospitalized days alive (RTM mean 341 ± 59 days, SoC 346 ± 45 days;
p
= 0.298) associated with increased total costs (RTM 18.5 ± 39.5 k€, SoC 12.8 ± 22.0 k€;
p
= 0.046). This yielded an ICER of −1.15 k€/day. RTM did not impact mortality risk. All quality of life scales were consistently and meaningfully improved in the RTM group at 12 months compared to SoC (all
p
< 0.01).
Conclusions:
The first 12 months of RTM were not cost-effective compared to SoC in patients with HFrEF, but associated with a relevant improvement in disease-specific quality of life. The balanced assessment of the potential benefit of RTM requires integration of both the societal and patient perspective.
ClinTrials.gov
(NCT02293252).
Nivolumab (NIV) was recently approved in several countries for patients with pretreated advanced NSCLC. NIV is not cost-effective compared with docetaxel (DOC) for the treatment of squamous NSCLC. ...However, its cost-effectiveness for nonsquamous NSCLC and the consequences of programmed death ligand 1 (PD-L1) testing are unknown.
This literature-based health economic study used CheckMate-057 trial data to model the incremental cost-effectiveness ratio (ICER) of NIV versus DOC in the Swiss health care setting. The effect of PD-L1 positivity for patient selection was assessed.
In the base case model, NIV (mean cost CHF66,208; mean effect 0.69 quality-adjusted life-years QALYs) compared with DOC (mean cost CHF37,618; mean effect 0.53 QALYs) resulted in an ICER of CHF177,478/QALY gained. Treating only patients with PD-L1–positive tumors (threshold ≥10%) with NIV compared with treating all patients with DOC produced a base case ICER of CHF124,891/QALY gained. Reduced drug price, dose, or treatment duration decreased the ICER partly below a willingness-to-pay threshold of CHF100,000/QALY. Health state utilities strongly influenced cost-effectiveness.
Compared with DOC, NIV is not cost-effective for the treatment of nonsquamous NSCLC at current prices in the Swiss health care setting. Price reduction or PD-L1 testing and selection of patients for NIV on the basis of test positivity improves cost-effectiveness compared with DOC.
The DC de-icer installation has been widely used in the ice protection of power system. Because of the difference between the design and the actual operation of the installation, the resonance ...overvoltage has been threatening the device body from the distribution parameters of the de-icer transmissions. In this paper, based on the analysis on the mechanism of the resonance overvoltage, the estimate expression of the resonant length of the transmission has been derived. Through the simulation modeling by PSCAD/EMTDC, the effectiveness of the estimate expression has been verified. The suppression measures of the resonance overvoltage have been proposed.
Endoscopic treatment is recommended for patients with Barrett's esophagus (BE) with high-grade dysplasia, yet clinical management recommendations are inconsistent for patients with BE without ...dysplasia (NDBE) or with low-grade dysplasia (LGD). We used a comparative modeling analysis to identify optimal management strategies for these patients.
We used 3 independent population-based models to simulate cohorts of 60-year-old individuals with BE in the United States. We followed up each cohort until death without surveillance and treatment (natural disease progression), compared with 78 different strategies of management for patients with NDBE or LGD. We determined the optimal strategy using cost-effectiveness analyses, at a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY).
In the 3 models, the average cumulative incidence of esophageal adenocarcinoma was 111 cases, with costs totaling $5.7 million per 1000 men with BE. Surveillance and treatment of men with BE prevented 23% to 75% of cases of esophageal adenocarcinoma, but increased costs to $6.2 to $17.3 million per 1000 men with BE. The optimal strategy was surveillance every 3 years for men with NDBE and treatment of LGD after confirmation by repeat endoscopy (incremental cost-effectiveness ratio, $53,044/QALY). The average results for women were consistent with the results for men for LGD management, but the optimal surveillance interval for women with NDBE was 5 years (incremental cost-effectiveness ratio, $36,045/QALY).
Based on analyses from 3 population-based models, the optimal management strategy for patient with BE and LGD is endoscopic eradication, but only after LGD is confirmed by a repeat endoscopy. The optimal strategy for patients with NDBE is endoscopic surveillance, using a 3-year interval for men and a 5-year interval for women.
Studies on economic evaluations of the 13-valent pneumococcal conjugate vaccine (PCV13) have been increasing over the last decade. No systematic reviews have synthesized the evidence of economic ...evaluations of the PCV13.
We systematically searched the literature which published on peer-reviewed journals from January 2010 to June 2022. The literature search was conducted in the following electronic databases: PubMed, Web of Science, Embase, the Cochrane Library, CNKI, Wanfang database, VIP database. We identified 1827 records from the database search. After excluding 511 duplicates, 1314 records were screened, of which 156 records were retained for the full-text reviews. A total of 44 studies were included in the review. Among the included studies, 33 studies were economic evaluations of PCV13 among children, and 11 studies were conducted among adults. The literature search initiated in April, 2022, and updated in June 2022.
Vaccination with PCV13 was found to significantly reduce the mortality and morbidity of pneumococcal diseases and was cost-effective compared to no vaccine or several other pneumococcal vaccines (e.g. PCV10, PPV23). Future research is advised to expand economic evaluations of PCV13 combined with dynamic model to enhance methodologic rigor and prediction accuracy.
Surgery for symptomatic spinal metastases is effective at prolonging ambulation and life, but it can appear costly at first glance. We have studied the difference between the cost of surgery and ...reimbursement received, and the cost-effectiveness of surgery in a U.K. tertiary referral spinal center.
A cost-versus-reimbursement and cost–utility analysis was performed in a prospective cohort of patients admitted for surgical treatment of spinal metastases. Outcome measures were health-related quality of life using the EuroQol EQ-5D-3L, Frankel score, quality-adjusted life years (QALYs), and treatment and reimbursement costs.
One hundred thirty consecutive patients were prospectively recruited, of whom 92 had information available for cost and reimbursement comparison, and 100 had information to complete cost–utility analysis. Median cost of hospital treatment per patient was £20,752; median reimbursement received was £18,291, with a median shortfall of £1,967. Surgery in addition to radiotherapy over a lifetime horizon was both more effective and less costly than radiotherapy alone, and therefore was found to be cost-effective.
Our results demonstrate that reimbursement to hospitals for surgical management of symptomatic spinal metastases in the United Kingdom is broadly in line with costs, and that there was an overall saving as a result of community care costs being mitigated by patients walking for longer, which is within the expected National Health Service threshold. Surgery for metastatic spinal tumors is effective and a good value for the money.
PDF
