The pharmacoeconomic benefits of cholesterol reduction.
(33/4244)
Recent studies show that cholesterol-lowering therapy can reduce morbidity and mortality in hypercholesterolemic patients without preexisting coronary heart disease (primary prevention) and with coronary heart disease (secondary prevention). The high cost of treatment per event prevented, especially for primary prevention, raises concerns about widespread use of cholesterol-lowering therapy. Does cholesterol reduction reduce utilization of healthcare resources, and can society afford to pay for reducing cholesterol in all patients with hypercholesterolemia, irrespective of risk factors? Is cost-effectiveness of therapy affected by differing cholesterol levels, age of the patients, the duration of therapy, or the presence of risk factors? Current pharmacoeconomic studies support the use of the statins for secondary prevention, and primary prevention in high-risk patients, and provide key information for policy decision making in the treatment of patients with hypercholesterolemia. (+info)
Treatment of schizophrenia: let's talk dollars and sense.
(34/4244)
Schizophrenia is a major neurologic illness with an impact on public health that has been unappreciated. Newer and arguably more effective medication treatments are now available and hold considerable promise. The higher up-front cost of these drugs is, on current evidence, offset by other economic advantages and, from a humanitarian perspective, by the expectation of improved patient outcome with less drug toxicity. The extent to which these drugs replace older drug treatments will be determined by the relative influences of clinical, pharmacoeconomic, mental health administrative, and advocacy factors over the coming years. (+info)
Ivermectin distribution using community volunteers in Kabarole district, Uganda.
(35/4244)
Ivermectin mass distribution for the control of onchocerciasis in Uganda began in 1991. This report describes a community based ivermectin distribution programme covering two foci in the Kabarole district which have an estimated 32,000 persons infected and another 110,000 at risk. Through nodule palpation in adult males, 143 villages were identified where nodule prevalence exceeded 20%. Skin snips were also taken from a sample of the population to measure changes in community microfilarial load (CMFL) with treatment. The delivery programme was integrated into the district health management structure, and used community volunteers supervised by medical assistants from adjacent health facilities for annual ivermectin distribution campaigns. After initial efforts by the community to support distributors in-kind proved inadequate, ivermectin distributors earned money retailing condoms as part of the social marketing component of district STD/AIDS programme. Reduction in the CMFL ranged from 40-62% twelve months after the second ivermectin treatment in three villages, and from 69-84% six months after the fourth round of treatment in two villages. After four years of treatment, 85% of eligible persons were receiving ivermectin from community volunteers in each treatment cycle. Drop out rates among volunteers did not exceed 20% over the four years reported here. The direct cost of treatment was US $0.29 per person. Among the reasons for low per-person treatment costs were the strong supervisory structure, the presence of health centres in the foci and a well developed and capable district Primary Health Care management team. (+info)
A pharmacoeconomic analysis of rimexolone for the treatment of ophthalmic inflammatory conditions.
(36/4244)
Topical steroids are the standard first-line therapy for treating ophthalmic inflammatory conditions. However, potent ophthalmic steroids can lead to an elevation of intraocular pressure (IOP), which can result in greater medical resource utilization and increased costs. We have developed a decision analysis model from a societal perspective to evaluate the costs and consequences of the treatment of ophthalmic inflammatory conditions with two potent topical steroids: prednisolone and rimexolone. Data for the model are based on information from clinical trials, national data-bases, published literature, and responses by ophthalmologists to a questionnaire on treatment patterns for elevated IOP. Three steroid-responsive conditions are examined separately with the model: uveitis; postoperative inflammation following cataract surgery; and other ophthalmic inflammatory conditions (blepharitis, episcleritis, postoperative refractive surgery, and corneal transplant). The model evaluates patients with acute conditions versus those with chronic conditions and those with mild to moderate elevation of IOP versus those with severe elevation of IOP. Although the unit cost of rimexolone is higher than that of prednisolone, use of rimexolone leads to cost savings because the incidence of elevated IOP is decreased. If rimexolone is used instead of prednisolone for the treatment of ophthalmic inflammatory conditions, the estimated cost saved (at 1995 AWP prices) is approximately $10 million across the entire US population. The savings across the health maintenance organization population on an annualized basis is approximately $3.9 million. Even if rimexolone were priced higher than current market charges (at 130% to 150% of the AWP of prednisolone), cost savings ranging from the $2.9 million to $720,000 would accrue with use of rimexolone compared with prednisolone. However if, rimexolone were priced at 160% of the AWP of prednisolone, its use would incur an additional cost of $300,000. The primary medical resource utilized in treating elevated IOP in ophthalmic inflammatory conditions is physician visits. Medications are responsible for only one-fifth to one-third of the total cost of treating elevated IOP. This analysis indicates that rimexolone is associated with decreased medical resource utilization and cost savings to the entire healthcare system. (+info)
The cost-effectiveness of treatment with lamivudine and zidovudine compared with zidovudine alone: a comparison of Markov model and trial data estimates.
(37/4244)
In this paper, we present a Markov model for estimating the cost-effectiveness of combination therapy with lamivudine (LMV) and zidovudine (ZDV) compared with ZDV alone. We also compare the predictions of the Markov model for the impact of combination therapy on trial period costs with the actual impact of combination therapy on selected trial period costs estimated from data collected during the clinical trials. In the Markov model, disease stages were defined by CD4 cell count. Based on clinical trial data for patients with CD4 counts higher than 100 cells/mm3, the model assumed that the CD4 cell count level could be maintained above the level at the initiation of therapy for 6.5 months with monotherapy and for 18 months with combination therapy. After this period, transition rates for natural disease progression were used. Incremental lifetime costs and quality-adjusted life years gained with LMV/ZDV compared with ZDV alone were estimated for cohorts of patients initiating antiretroviral therapy at four different CD4 cell count stages. Cost per life year gained varied from $10,000 to $18,000, and cost per quality-adjusted life year gained varied from $14,000 to $27,000. In both cases, the combination therapy was more cost-effective when started earlier in disease progression. These estimates were not sensitive to changes in key parameter values. In addition, the model was used to estimate the impact of combination therapy on healthcare costs during the trial period; these estimated costs were compared with data on the cost of resource use collected during the clinical trial for hospital stays, unscheduled visits, medications, and outpatient procedures. Both the Markov model estimates and the trial data estimates for the trial period showed cost savings in other medical costs, though these were not large enough to completely offset the increased cost for antiretroviral therapy. The model estimates were more conservative than the estimates based on the trial data. (+info)
Patient consultation in a managed care setting: guiding pharmacy into the future.
(38/4244)
Managed care organizations are excellent environments for pharmaceutical care programs to demonstrate their impact on patient care outcomes and to decrease costs. Patient consultation is the cornerstone in implementing pharmaceutical care because it increases patient contact with the pharmacists while improving patient compliance with drug therapy (adherence). Implementation of a patient consultation program that verifies patients' understanding of their disease and therapy gives the pharmacist information necessary to monitor drug therapy. Use of strategic planning to overcome barriers, followed by the development of local standards of practice, will refocus the practice philosophy to one of improving patient outcomes. Pharmacy managers must demonstrate and document the value that patient consultation brings to the patient and the healthcare system. Then, they must integrate their counseling effort with other health education efforts of the managed care system. Pharmacists will gain the support of other disciplines by reinforcing their efforts. Together they can work to decrease the problems that are inherent with drug therapy. These goals can be accomplished with minimal expense and have the potential to produce significant savings in healthcare costs. (+info)
Compliance with antihypertensive therapy: raising the bar of expectations.
(39/4244)
Recent advances in the effectiveness of antihypertensive therapies and the measurement of medication-taking behavior have raised the bar of expectations, both for patients and prescribing clinicians. This article reviews the principal findings and makes recommendations to improve pill taking among patients with hypertension. It summarizes several studies related to hypertension epidemiology, component behaviors contributing to suboptimal compliance with prescribed antihypertensive medications, the direct and indirect costs of nonadherent behaviors, and measures of pill-taking behavior. Based on this analysis, current levels of hypertension detection, treatment, and control remain suboptimal. Heuristics for adjusting antihypertensive regimens may be misleading and too simplistic. More than half of those patients failing to achieve goal blood pressure display suboptimal compliance rather than an inadequate regimen. In conclusion, there is a need for enhanced sophistication about medication-taking behavior, especially for hypertension, so that more patients with this condition can fully benefit from effective treatments. (+info)
In vitro and skin testing for allergy: comparable clinical utility and costs.
(40/4244)
Controversy exists concerning the appropriate use of skin testing and in vitro testing for the diagnosis of allergy, particularly inhalant allergy. Earlier comparisons of skin testing and in vitro testing concluded that skin testing had superior accuracy at lower expense. In light of new developments with in vitro allergy testing, however, this issue should be reconsidered. A review of the recent scientific literature indicates that in vitro and skin testing are highly correlated. However, without the existence of an independent gold standard for inhalant allergy, it is not possible to determine which test is more accurate. The accuracy of either test can be compromised if conducted using different protocols or having insufficient quality control. Given their respective trajectories for technological advancement, quantification, and quality control, in vitro testing may offer the more standardized approach. Although the cost per test of in vitro testing remains greater than that of skin testing, the per-patient costs of the two modalities appear to be comparable, given the greater number of allergens typically used in skin testing. In summary, both skin testing and in vitro testing are acceptable as frontline diagnostic tools. (+info)