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Rheumatology (Oxford, England) Sep 2004In the past, treatment options for ankylosing spondylitis (AS) have been limited, and the introduction of new treatments such as infliximab will have a noticeable impact... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
OBJECTIVES
In the past, treatment options for ankylosing spondylitis (AS) have been limited, and the introduction of new treatments such as infliximab will have a noticeable impact on health-care budgets. The objective of this study was therefore to assess the current burden of the disease and estimate the cost-effectiveness of infliximab treatments.
METHODS
A cross-sectional retrospective observational study of resource consumption and utility related to disease severity was performed in patients who had participated in a population survey between 1992 and 1994 at the University of Bath and patients regularly followed at the Royal National Hospital for Rheumatic Diseases in Bath for up to 9 years. Mean costs and utility were estimated using a regression model including age, gender, disease duration, disease activity and functional status, and disease development was expressed as annual progression of functional disability. Cost-effectiveness of infliximab was modelled using a 3-month placebo-controlled clinical trial with open 1-yr extension in 70 patients, over a total time frame of 2 yr. In the model, costs and utility controlled for disease severity and age from the observational study were assigned to individual patients. The effect of long-term treatment was evaluated in a hypothetical model over 30 yr.
RESULTS
Fifty-seven per cent of patients answered the questionnaires. The mean age was 57 (s.d. 11.2) yr, 74% were male and mean disease duration was 30.2 (11.7) yr. Mean total costs were estimated at pound 6765 (s.d. pound 166). Indirect costs represented 57.9% and non-medical costs such as investments and informal care accounted for 16.5% of total costs. Mean utility was 0.67 (0.21). In the main model, mean costs for untreated patients are estimated at pound 25,128. For the infliximab group, mean costs (excluding treatment) are estimated at pound 17,240, a reduction of 31%. Thus, part of the treatment cost was offset by savings in other resources ( pound 7888), leaving an incremental cost of pound 6214. Treatment increased the number of quality-adjusted live years (QALYs) by 0.175 QALYs, leading to a cost per QALY gained of pound 35,400 for the first year of treatment. When treatment is assumed to continue for the full 2 yr, the cost per QALY is pound 32,800. When infliximab infusions are given every 8 weeks instead of every 6 weeks, the cost per QALY is reduced to pound 17,300. In the long-term model, the cost per QALY is estimated at pound 9600.
CONCLUSIONS
Non-medical costs and production losses dominate costs in AS, and economic evaluation must therefore adopt a societal perspective. The cost of treatment with infliximab is partly offset by reductions in the cost of the disease and patients' quality of life is increased, leading to a cost per QALY gained in the vicinity of pound 30,000 to pound 40,000 in the short term, but potentially below pound 10,000 in the long term.
Topics: Antibodies, Monoclonal; Antirheumatic Agents; Cost of Illness; Cost-Benefit Analysis; Cross-Sectional Studies; Disability Evaluation; Double-Blind Method; Female; Humans; Infliximab; Male; Middle Aged; Models, Economic; Quality of Life; Retrospective Studies; Severity of Illness Index; Spondylitis, Ankylosing
PubMed: 15226514
DOI: 10.1093/rheumatology/keh271 -
Diabetic Medicine : a Journal of the... Jun 2003To develop a model for estimating the immediate and long-term healthcare costs associated with seven diabetes-related complications in patients with Type 2 diabetes...
AIMS
To develop a model for estimating the immediate and long-term healthcare costs associated with seven diabetes-related complications in patients with Type 2 diabetes participating in the UK Prospective Diabetes Study (UKPDS).
METHODS
The costs associated with some major complications were estimated using data on 5102 UKPDS patients (mean age 52.4 years at diagnosis). In-patient and out-patient costs were estimated using multiple regression analysis based on costs calculated from the length of admission multiplied by the average specialty cost and a survey of 3488 UKPDS patients' healthcare usage conducted in 1996-1997.
RESULTS
Using the model, the estimate of the cost of first complications were as follows: amputation pound 8459 (95% confidence interval pound 5295, pound 13 200); non-fatal myocardial infarction pound 4070 ( pound 3580, pound 4722); fatal myocardial infarction pound 1152 ( pound 941, pound 1396); fatal stroke pound 3383 ( pound 1935, pound 5431); non-fatal stroke pound 2367 ( pound 1599, pound 3274); ischaemic heart disease pound 1959 ( pound 1467, pound 2541); heart failure pound 2221 ( pound 1690, pound 2896); cataract extraction pound 1553 ( pound 1320, pound 1855); and blindness in one eye pound 872 ( pound 526, pound 1299). The annual average in-patient cost of events in subsequent years ranged from pound 631 ( pound 403, pound 896) for heart failure to pound 105 ( pound 80, pound 142) for cataract extraction. Non-in-patient costs for macrovascular complications were pound 315 ( pound 247, pound 394) and for microvascular complications were pound 273 ( pound 215, pound 343) in the year of the event. In each subsequent year the costs were, respectively, pound 258 ( pound 228, pound 297) and pound 204 ( pound 181, pound 255).
CONCLUSIONS
These results provide estimates of the immediate and long-term healthcare costs associated with seven diabetes-related complications.
Topics: Ambulatory Care; Amputation, Surgical; Blindness; Cataract Extraction; Coronary Disease; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Female; Health Care Costs; Hospitalization; Humans; Male; Middle Aged; Models, Economic; Myocardial Infarction; Prospective Studies; Stroke; United Kingdom
PubMed: 12786677
DOI: 10.1046/j.1464-5491.2003.00972.x -
Anaesthesia Jan 1993The daily costs of 90 critically ill patients treated on an intensive therapy unit were calculated on an individual patient basis. Twenty-one patients (23%) died on the...
The daily costs of 90 critically ill patients treated on an intensive therapy unit were calculated on an individual patient basis. Twenty-one patients (23%) died on the intensive therapy unit and another 13 (15%) died within one year of discharge. The results demonstrate that there is wide variation in costs among the patients and the diagnoses. The mean daily cost of nonsurvivors was almost 300 pounds greater than that of survivors (816 pounds (95% confidence interval = 649-982 pounds) versus 550 pounds (498-601 pounds). Renal failure, sepsis and pneumonia proved to be some of the most expensive conditions to treat, and postoperative respiratory failure the cheapest. The cost of the first day of management was significantly related to the APACHE II score and individual costs on the first day may be predicted from admission APACHE II score. Patients who die in the intensive therapy unit continue to incur the same level of expenditure throughout admission. The study could not provide conclusive answers concerning the trend in daily costs for survivors.
Topics: Adult; Aged; Cost-Benefit Analysis; Critical Care; Humans; Length of Stay; Middle Aged; Scotland; Severity of Illness Index; Survival Rate
PubMed: 8434741
DOI: 10.1111/j.1365-2044.1993.tb06783.x -
Medizinische Klinik (Munich, Germany :... Jul 1996The costs of drug treatment were evaluated for Parkinson's disease, focal dystonias and epilepsy. (Comparative Study)
Comparative Study Review
AIM
The costs of drug treatment were evaluated for Parkinson's disease, focal dystonias and epilepsy.
METHODS
Retrospective analysis over a period of 12 months of 785 patients who visited regularly a neurological out-patient department.
RESULTS
Drug treatment caused a mean annual expenditure of DM 3,920.- (US-($) 2590, pounds 1690) for Parkinson's disease (n = 409), DM 3,620.- (US-($) 2390; pounds 1550) for focal dystonias (n = 140) and DM 660.- (US-($) 435, pounds 280) for hemifacial spasm (n = 35) per patient.- In Parkinson's disease costs are dependent on the extent of the disease, the type involved and the presence or absence of motor fluctuations. In Hoehn and Yahr stage I we calculated costs of DM 2,230.- (US-($) 1470; pounds 960), in contrast to DM 11,870.- (US-($) 7830; pounds 5100) in Hoehn and Yahr stage V. The occurrence of fluctuations in motor ability increased annual costs to DM 6,010.- (US-($) 3970, pounds 2580); patients' treatment without motor fluctuations was cheaper (DM 2,700.-; US-($) 1780, pounds 1160).- The annual treatment costs of focal dystonias and facial hemispasm varied due to the location of the involuntary movement and the extent of symptoms: DM 4,900.- (US-($) 3300; pounds 2100) were calculated for the treatment of cervical dystonias, DM 1,480.- (US-($) 930; pounds 600) for the treatment of blepharo-spasm (oromandibular dystonia: DM 1,710.-; US-($) 1200; pounds 800) and DM 600.- (US-($) 470; pounds 300) for the treatment of facial hemispasm.- The drug treatment of epilepsy caused mean costs of DM 1,740.- (US-($) 1160; pounds 750) per year. There were marked differences concerning the different epileptic syndromes and types of seizure.
CONCLUSION
Costs of drug treatment varied considerably in the three diseases depending on the course, the type and the different forms of the respective disease.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anticonvulsants; Antiparkinson Agents; Child; Child, Preschool; Cross-Cultural Comparison; Dystonia; Epilepsy; Female; Germany; Humans; Male; Middle Aged; Parasympatholytics; Parkinson Disease; United Kingdom; United States
PubMed: 8756119
DOI: No ID Found -
The New England Journal of Medicine Sep 1949
Topics: Humans; Medicine
PubMed: 18140773
DOI: 10.1056/NEJM194909082411001 -
QJM : Monthly Journal of the... May 2002Hip fracture is an important and costly problem. Bisphosphonate therapy prevents hip and other fractures among women with established osteoporosis, but there are few...
BACKGROUND
Hip fracture is an important and costly problem. Bisphosphonate therapy prevents hip and other fractures among women with established osteoporosis, but there are few published economic evaluations of this treatment.
AIM
To assess the cost-effectiveness of risedronate, a recently launched bisphosphonate for the prevention of fractures among women with established osteoporosis.
METHODS
A state transition Markov model of established post-menopausal osteoporosis based upon randomized clinical trial data was developed. Uncertainty underlying model parameters and outcomes was dealt with using traditional sensitivity analysis and stochastic sensitivity analysis to produce quasi-95%CIs. We focussed on patients aged approximately 75 years, since this population most closely matches the randomized controlled trial, and is typical of osteoporosis patients in the UK.
RESULTS
The baseline model of treating a cohort of 1000 75-year-old women for 3 years with risedronate and then modelling the costs and benefits over their expected lifetimes, produced net savings of pound sterling 786 000 for the treatment group per 1000 treated women, (95%CI pound sterling 1.55m savings to pound sterling 47000 extra costs). Restricting the horizon of the analysis to only three years led to a small net cost of pound sterling 138 000 per 1000 treated women (95%CI pound sterling 196 000 savings to pound sterling 477 000 extra costs) with a net increment in Quality Adjusted Life years (QALYs) of 16 per 1000 treated women. This resulted in a cost per QALY of pound sterling 8625 per treated woman.
CONCLUSIONS
In this example, the use of risedronate therapy in 75-year-old women at high risk of hip fracture leads to an improvement in quality of life with possible cost savings. Restricting the analysis to a time horizon of only three years leads to a QALY gain at a modest net cost.
Topics: Aged; Calcium Channel Blockers; Cost-Benefit Analysis; Etidronic Acid; Female; Hip Fractures; Humans; Models, Econometric; Osteoporosis, Postmenopausal; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Risedronic Acid; Time Factors
PubMed: 11978902
DOI: 10.1093/qjmed/95.5.305 -
BJOG : An International Journal of... Mar 2000To analyse the cost, effectiveness and cost effectiveness of two endometrial thinning agents prior to laser ablation for dysfunctional uterine bleeding: danazol and... (Clinical Trial)
Clinical Trial Comparative Study
OBJECTIVE
To analyse the cost, effectiveness and cost effectiveness of two endometrial thinning agents prior to laser ablation for dysfunctional uterine bleeding: danazol and goserelin.
SETTING
A district general hospital.
DESIGN
A retrospective cost effectiveness analysis, from the perspective of the health service, based on data from an open, randomised, parallel group comparative study of 160 pre-menopausal women with dysfunctional uterine bleeding.
METHODS
Within the trial, length of operation and duration of hospital stay was recorded for each woman. Resource use due to complications of surgery and adverse drug events was evaluated by one of the authors (R.G.). Additional surgery after completion of the study was collected using a postal questionnaire which was distributed to every woman who had undergone surgery. Resource use was costed using detailed unit costs from a specific NHS trust and from published sources. A cost effectiveness analysis was undertaken relating differential cost to differential rates of amenorrhoea at women's last point of follow up.
RESULTS
Information on amenorrhoea was available from 138 women, of whom 111 had completed the questionnaire to indicate longer term follow up. Women who did not complete the clinical trial were not included in this economic evaluation. On average, women randomised to goserelin spent less time in theatre and on the ward. Based on longer term follow up, rates of retreatment were similar in the two groups. The mean (SD) health service cost of women in the goserelin group was pound sterling 323.84 (pound sterling 309.94), compared with pound sterling 243.45 (pound sterling 265.23) in the danazol group; median (range) costs were pound sterling 220.29 (pound sterling 191-pound sterling 2127) and pound sterling 159.76 (pound sterling 140-pound sterling 1426) in the two groups, respectively. These costs were significantly higher for goserelin (P = 0.0001). The goserelin group also had a higher rate of amenorrhoea (38.8% vs 28.6%, P = 0.23). Based on mean differences in cost, the incremental cost of goserelin per additional woman with amenorrhoea was pound sterling 788; based on median differences in cost the ratio was pound sterling 590.
CONCLUSIONS
The shorter duration in theatre and stay in hospital provided a modest offset of the higher acquisition cost of goserelin, but the overall cost of management remained significantly higher than managing women with danazol. The rates of amenorrhoea indicated that goserelin was more effective at 24 weeks and approximately two years after surgery, although statistical significance was only achieved at 24 weeks. The economic impact of women withdrawn from treatment was not considered, but sensitivity analysis indicates that these women may have had a large effect on the overall result of this study. Purchasers will need to decide whether the additional cost of management with goserelin is justified by the increased rates of amenorrhoea and the reduced withdrawals from treatment.
Topics: Adult; Antineoplastic Agents, Hormonal; Cost-Benefit Analysis; Danazol; Estrogen Antagonists; Female; Goserelin; Humans; Length of Stay; Randomized Controlled Trials as Topic; Retrospective Studies; Uterine Hemorrhage
PubMed: 10740330
DOI: 10.1111/j.1471-0528.2000.tb13229.x -
Plastic and Reconstructive Surgery Sep 2005A major limitation of functional muscle transfer for facial and intrinsic hand reanimation is the inability to predict the force that will be generated by the...
BACKGROUND
A major limitation of functional muscle transfer for facial and intrinsic hand reanimation is the inability to predict the force that will be generated by the transplanted muscle.
METHODS
The authors studied the contractile force of the slips of the serratus anterior in situ in 10 patients and tested the gracilis muscle in four subjects as a control.
RESULTS
Mean contractile force generated by each serratus slip was 0.178 pound (range, 0.019 to 0.797 pound). This compares favorably with the maximum force generated by smiling (0.307 pound). Muscle strength correlated strongly with age (r = -0.805, p = 0.005). The lowest slip generated less force than those above it (0.133 pound versus 0.191 pound); this difference did not reach statistical significance. When the strength of the lowest slip is compared with the more superior slips as a percentage of total force generated by the slips (to compensate for the effect of age on muscle strength), the lowest slip was significantly weaker (18.6 percent of total force versus 25.5 percent of total force, p = 0.013). Mean contractile force generated by the gracilis was 0.963 pound, significantly different from that generated by a serratus anterior slip (p = 0.009).
CONCLUSIONS
Each serratus slip could potentially be used to generate a separate force vector for facial reanimation. Further separation of the flap along preexisting fascial planes may allow generation of up to 10 independent force vectors, making the serratus anterior muscle flap an attractive option for facial reanimation and possibly intrinsic hand muscle reconstruction.
Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Facial Expression; Humans; Middle Aged; Muscle Contraction; Muscle, Skeletal; Tensile Strength
PubMed: 16141824
DOI: 10.1097/01.prs.0000176254.28792.8c -
Frontiers in Psychology 2023This study evaluated the impact and economic benefit of Cautioning and Relationship Abuse (CARA), an intervention which aims to reduce re-offending of first-time...
This study evaluated the impact and economic benefit of Cautioning and Relationship Abuse (CARA), an intervention which aims to reduce re-offending of first-time low-level domestic violence and abuse perpetrators. The analysis was based on two samples drawn from separate UK police force areas. CARA's impact was assessed using a matched sample of similar offenders from a time when CARA was not available. The matching was based on a host of offender and victim characteristics and machine learning methods were employed. The results show that the CARA intervention has a significant impact on the amount of recidivism but no significant reduction in the severity of the crimes. The benefit-cost ratio in both police force areas is greater than one and estimated to be 2.75 and 11.1, respectively, across the two police force areas. Thus, for each pound (£) invested in CARA, there is an economic benefit of 2.75-11.1 pounds, annually.
PubMed: 36874872
DOI: 10.3389/fpsyg.2023.1063701 -
PharmacoEconomics 2007Medication review by pharmacists is increasingly being implemented in the primary care setting and has been incorporated into the new pharmacy contract in the UK. This...
BACKGROUND
Medication review by pharmacists is increasingly being implemented in the primary care setting and has been incorporated into the new pharmacy contract in the UK. This study aims to determine the cost effectiveness of home-based medication review in older people.
METHODS
This economic evaluation was based on a randomised controlled trial (the HOMER [HOME-based medication Review] trial). Patients aged >80 years (n = 872) were recruited if admitted as an emergency to an acute or community hospital in Norfolk or Suffolk (any cause), returning to their own home or warden-controlled accommodation, and taking two or more drugs daily on discharge. Patients randomised to the intervention group received two home visits by a pharmacist within 2 and 8 weeks of discharge to educate patients and carers about their drugs, remove out-of-date drugs, inform GPs of drug reactions or interactions and inform the local pharmacist if an adherence aid was needed. The control arm received usual care. Economic evaluation was performed from the UK NHS perspective, with follow-up for 6 months and cost data from 2000. Resource use data were collected from hospital episode statistics and from a sample of GP records of trial participants. Intervention, hospital, ambulance and general practice costs were considered to determine average costs and incremental cost-effectiveness ratios. Use of the EQ-5D questionnaire permitted outcomes to be expressed as QALYs. Probabilistic sensitivity analysis was employed to calculate cost-effectiveness acceptability curves.
RESULTS
Mortality and admission data were available for 829 of 855 patients included in the study (415 intervention and 414 control patients). Of those patients randomised to the intervention group, 358 had a medication review at a total intervention cost of 51,622 pound (or 124 pound per randomised patient). The intervention did not reduce hospital admissions. The average cost per intervention group patient was 1695 pound compared with 1424 pound for control patients. The incremental cost per life year gained through the intervention was 33,541 pound. The incremental cost per QALY gained in the intervention was 54,454 pound. Sensitivity analysis suggested a 25% probability that home-based medication review is cost effective using a threshold of 30,000 pound per QALY.
CONCLUSION
The current policy imperative for implementing medicines review needs to be reconsidered in the light of the findings of this study: a small, non significant gain in quality of life, no reduction in hospital admissions and a low probability of cost effectiveness.
Topics: Aged, 80 and over; Cost-Benefit Analysis; Drug Therapy; Home Care Services; Humans; Patient Compliance; Patient Education as Topic; Pharmacists; Quality of Life
PubMed: 17249858
DOI: 10.2165/00019053-200725020-00008