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Scoping review to identify and characterize the available instruments or tools developed to assess the quality of economic analyses in health.

Objective To assess the effectiveness, safety and cost of Etanercept biosimilar in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA) compared to the standard drug in real clinical practice. Patients and methods Retrospective observational study. Case series of 138 patients with RA, SpA or PsA treated with at least one dose of Benepali® (n = 79) or Enbrel® (n = 59). Drug retention time was the primary efficacy endpoint compared to the biosimilar and the original. The proportion of patients achieving low disease activity or remission after 52 weeks was used as the secondary outcome. Safety was assessed by means of the adverse effects incidence rate. A cost minimization analysis was performed. Results No differences were observed regarding treatment retention time between drugs (median [95% confidence interval, 95% CI] at 12.0 months [10.2-12.0] for the biosimilar and 12.0 months [12.0-12.0] for the original). Similar improvements, in terms of inflammatory activity and physical function, were obtained after 52 weeks except for patients with SpA and PsA who, in general, experienced improvements of BASDAI and ASDAS with the original compared with the biosimilar. No significant differences were observed in the total number of adverse effects (.43 events/patient-years versus the biosimilar and .53 versus the original). Using the biosimilar in place of the original drug resulted in a net savings of 118,383.55 € (1,747.20 €/patient-years) for the hospital. Conclusion The biosimilar Benepali is as effective and safe as the original and much more cost-effective.

Objective To assess the effectiveness, safety and cost of Etanercept biosimilar in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA) compared to the standard drug in real clinical practice. Patients and methods Retrospective observational study. Case series of 138 patients with RA, SpA or PsA treated with at least one dose of Benepali® (n = 79) or Enbrel® (n = 59). Drug retention time was the primary efficacy endpoint compared to the biosimilar and the original. The proportion of patients achieving low disease activity or remission after 52 weeks was used as the secondary outcome. Safety was assessed by means of the adverse effects incidence rate. A cost minimization analysis was performed. Results No differences were observed regarding treatment retention time between drugs (median [95% confidence interval, 95% CI] at 12.0 months [10.2–12.0] for the biosimilar and 12.0 months [12.0–12.0] for the original). Similar improvements, in terms of inflammatory activity and physical function, were obtained after 52 weeks except for patients with SpA and PsA who, in general, experienced improvements of BASDAI and ASDAS with the original compared with the biosimilar. No significant differences were observed in the total number of adverse effects (.43 events/patient-years versus the biosimilar and .53 versus the original). Using the biosimilar in place of the original drug resulted in a net savings of 118,383.55 € (1,747.20 €/patient-years) for the hospital. Conclusion The biosimilar Benepali is as effective and safe as the original and much more cost-effective.

Aims: Cost-minimization analysis (CMA) comparing the teledermatology service of the State of Santa Catarina, Brazil with the provision of conventional care, from the societal perspective. Patients & methods: All costs related to direct patient care were considered in calculation of outpatient costs. The evaluation was performed using the parameters avoided referrals and profile of hospitalizations. The economic analysis was developed through a decision tree. Results: Totally, 40% of 79,411 tests performed could be managed in primary care, avoiding commuting and expanding the patients’ access. The CMA showed the teledermatology service had a cost per patient of US$196.04, and the conventional care of US$245.66. Conclusion: In this scenario, teledermatology proved to be a cost-saving alternative to conventional care, reducing commuting costs.

SUMMARY Objectives: The aim of this study was to assess four post-retained restorative strategies for endodontically treated teeth using cost-minimization analysis. Methods and Materials: The cost-minimization analysis was based on primary data from a randomized clinical trial and followed the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines. Two hundred twenty-five teeth (141 patients) restored using four strategies—teeth with ferrules+ restored with either glass fiber posts or direct composite or crowns, and teeth without ferrules- restored with either glass fiber or cast metal posts with crowns—were evaluated annually between 2009 and 2018. Initial costs and incremental costs per year were calculated. Survival curves were created using the Kaplan-Meier method and log-rank test. Kruskal-Wallis analysis was followed by Dunn's test, which was used to compare restorative treatments, with a significance level of 5%. Results: Initial costs were greater for cast metal posts without crowns (US$153.14). Glass fiber posts with composite (US$27.11) were least costly; the most failures occurred in this group, but they were primarily repairable restoration fractures. The number of extractions, and thus cost, was greater for glass fiber posts with crowns. The mean annual cost was significantly lower for teeth restored with composite (p

Objective:To evaluate the impact of outpatient parenteral antimicrobial therapy (OPAT) on a public hospital in a middle-income country.Design:A retrospective, observational study analyzing the economic data retrieved on the dehospitalization of patients on antibiotic therapy.Setting:Public university trauma hospital.Patients:Data were collected from June 2017 to May 2020. Antibiotic cost, hospital length of stay, and risk of multidrug-resistant (MDR) infection or colonization were reviewed, along with the break-even point at which a balance occurs between OPAT antimicrobial costs and all in-hospital costs. A cumulative risk curve was constructed showing the incidence of MDR during the review period.Results:In total, 225 patients were studied. The implementation of OPAT resulted in a reduction of $156,681 (49.6%), which is equivalent to an average of $696 per patient, as well as a shortened length of stay, from 33.5 to 15.7 days. OPAT reduces the risk of acquiring infection by MDR bacteria by having the final treatments administered outside of the hospital environment. The breakeven curves, comparing the duration of the OPAT to daily medication costs, allowed for the prediction of the time and dollar costs of antibiotic therapy.Conclusions:OPAT presented a significant cost savings, shortened length of stay, and reduced risk of contamination of patients by MDR.

The aim of this study was to compare the estimated public medical care cost of measures to address metallic dental restorations (MDRs) for head and neck radiotherapy using high-energy mega-voltage X-rays. This was considered a first step to clarify which MDR measure was more cost-effective. We estimated the medical care cost of radiotherapy for two representative MDR measures: (i) with MDR removal or (ii) without MDR removal (non-MDR removal) using magnetic resonance imaging and a spacer. A total of 5520 patients received head and neck radiation therapy in 2018. The mean number of MDRs per person was 4.1 dental crowns and 1.3 dental bridges. The mean cost per person was estimated to be 121 720 yen for MDR removal and 54 940 yen for non-MDR removal. Therefore, the difference in total public medical care cost between MDR removal and non-MDR removal was estimated to be 303 268 800 yen. Our results suggested that non-MDR removal would be more cost-effective than MDR removal for head and neck radiotherapy. In the future, a national survey and cost-effectiveness analysis via a multicenter study are necessary; these investigations should include various outcomes such as the rate of local control, status of oral mucositis, frequency of hospital visits and efforts of the medical professionals.

Background: Asthma and Chronic Obstructive Pulmonary Diseases (COPD) are well known respiratory diseases affecting millions of people in India. In the market, various branded generics, as well as generic drugs, are available for their treatment and how much cost will be saved by utilizing generic medicine is still unclear among physicians. Thus, the main aim of the current investigation was to perform cost-minimization analysis of generic versus branded generic (high and low expensive) drugs and branded generic (high expensive) versus branded generic (least expensive) used in the Department of Pulmonary Medicine of Era Medical University, Lucknow for the treatment of asthma and COPD. Methods: The current index of medical stores (CIMS) was referred for the cost of branded drugs, whereas the cost of generic drugs was taken from the Jan Aushadi scheme of India 2016. The percentage of cost variation, particularly to Asthma and COPD regimens on substituting available generic drugs, was calculated using standard formula and costs were presented in Indian Rupees (as of 2019). Results: The maximum cost variation was found between the respules budesonide high expensive branded generic versus least expensive branded generic drugs and generic versus high expensive branded generic. In combination, the maximum cost variation was observed in the montelukast and levocetirizine combination. Conclusion: In conclusion, this study inferred that substituting generic antiasthmatics and COPD drugs can bring potential cost savings in patients.

Objective: To assess the cost difference of various branded and generic antimalarial drugs available in the Indian market. Background: Malaria is a highly prevalent infectious disease in India. There are innumerable brands of antimalarials in the market with variation in the cost. The cost of treatment is an important aspect of health economics. Cost-related poor patient compliance is a significant problem resulting in incomplete treatment which tends to increase morbidity and mortality. Hence this study was done to assess the cost variation of various preparations of antimalarials (branded and generic) available in India. Materials and Methods: The maximum and minimum price of each antimalarial drug in rupees (INR) was noted by using CIMS July to October 2018 edition, Drug Today July to October 2018, and www.1mg.com. The cost ratio and the percentage of cost variation for individual drugs were calculated and compared. Results: There is a very high variation in the cost of various antimalarials available in India. The highest variation in cost ratio and percentage of cost variation was seen with Chloroquine 500 mg, Mefloquine 250 mg, and Sulfadoxine-Pyrimethamine 500+25 mg. The lowest cost ratio and percentage of cost variation were seen with Artesunate 120 mg injection, Arteether-Lumefantrine 20 + 120 mg, and Artemether 40 mg. Conclusion: This study reveals the need to further improve the drug price regulatory mechanism concerning antimalarials available in India to improve patient compliance and thus cure rates of malaria. Keywords: Antimalarials, Cost minimization analysis, Cost ratio, Pharmacoeconomics, Percentage of cost variation.

Aim: The objective was to estimate the cost of care associated with two negative pressure wound therapy (NPWT) technologies used to treat patients admitted to the hospital with moderate-to-severe foot infections. Materials & methods: A decision tree simulation model was developed to estimate the hospital costs associated with two different NPWT technologies: Cardinal Health™ PRO (NPWT-C) and V.A.C. ULTA™ (NPWT-K). Clinical data were obtained from a previously completed single-site prospective trial. One-way and probabilistic sensitivity analyses were performed to gauge the robustness of the results. Results: The total expected per-patient costs were US$41,206 (SD: US$8,194) for NPWT-C and US$44,439 (SD: US$8,963) for NPWT-K. Conclusion: This study found that NPWT-C was expected to minimize the total costs over the episode of treatment. Larger and more clinically diverse studies are recommended to confirm these findings.

Objective The standard-of-care treatment for age-related macular degeneration (AMD) and diabetic macular edema (DME) includes inhibiting blood vessel proliferation and reducing macular edema or swelling using anti–vascular endothelial growth factor therapies, such as ranibizumab and aflibercept. To conduct a cost-minimization analysis of ranibizumab and aflibercept for treating Saudi patients with visual impairment owing to AMD or DME. Methods Cost minimization was analyzed assuming that ranibizumab and aflibercept have equivalent clinical effectiveness. The third-party payer’s perspective was used in several clinical scenarios. The base-case scenario was DME cases followed monthly using a protocol-specific follow-up. In scenario 1, AMD cases followed a treat-and-extend protocol over 2 years. In scenario 2, AMD cases followed the PRN (pro re nata) regimen over 2 years. In scenario 3, DME cases followed the PRN regimen for 1 year only. Results Aflibercept yielded cost savings of 25.75%, 31.54%, 51.30%, and 9.28% compared with ranibizumab for the base case, scenario 1, scenario 2, and scenario 3, respectively, which supports the premise that aflibercept is more cost saving than ranibizumab. Conclusions From the third-party payer perspective, aflibercept is a cost-containment option that provides substantial savings over ranibizumab for treating Saudi patients with AMD or DME.

In 2020 Colombia may expect to have close to 231,700 patients with neovascular age-related macular degeneration (ARMD). Treatment of neovascular ARMD involves the sequential Intra-vitreal injections of anti-vascular endothelial growth factor (anti-VEGF therapy) medications. The efficacy and safety of anti-VEGF therapy on a treat-and-extend (TE) dosing scheme are similar when ranibizumab or aflibercept are administered.

Candidiasis is a group of fungal diseases of the skin, mucous membranes and internal organs caused by fungi of the genus Candida. Candidiasis treatment is mainly carried out with antifungal agents for systemic use. Fluconazole preparations, which have proven clinical efficacy and safety, and are also most often used in Ukraine, are presented in the largest number of TN in the pharmaceutical market. The aim of the work is to analyze cost minimization when using fluconazole preparations for pharmacotherapy of three different pharmacotherapy schemes for candidiasis. The analysis of minimizing the costs of fluconazole preparations was carried out using the retail cost of medicines according to the Morion company Pharmexplorer analytical market research system (as of February 2019). In the process of calculating the cost of the course of treatment of patients with candidiasis, fluconazole preparations used for pharmacotherapy of 1) vaginal candidiasis were used; 2) dermatomycosis, atrophic candidiasis of the mucous membranes, oropharyngeal candidiasis; 3) candidiasis of the esophagus, candiduria. The study evaluated only the direct costs of treating patients with candidiasis with fluconazole preparations. Calculation of the cost of pharmacotherapy with fluconazole was carried out taking into account the price per package of drugs, the daily dose of drugs with the determination of the cost of one unit (tablets, capsules), one day of treatment and the course of treatment. Based on the results obtained, using the pharmacoeconomic method of «cost minimization», the least costly drugs were selected for the course of treatment with fluconazole. The calculation results showed that the minimum direct costs for the course of pharmacotherapy of the vaginal candidiasis are 9.88 UAH; the minimum direct costs for the treatment of dermatomycoses, atrophic candidiasis of the mucous membranes, oropharyngeal candidiasis are UAH 26.01, and for the treatment of candidiasis of the esophagus and candiduria – UAH 50.28. In a difficult socio-economic situation in Ukraine, the use of the least expensive representatives of antifungal drugs for systemic use is economically feasible. The results of this study will allow the doctor or pharmacist to choose fluconazole preparations in various doses and dosage forms for patients with low solvency.

OBJECTIVES: Prosthetic joint infections (PJI) are treated with prolonged periods of intravenous (IV) antibiotics combined with one or more appropriate surgical procedures. In Belgium, patients receive their IV treatments as inpatients, whereas in other parts of the world similar IV antibiotics can be given as outpatient parenteral antibiotic therapy (OPAT), without jeopardising patient outcomes. The purpose of this paper was to analyse the financial feasibility of OPAT for PJI in Belgium. METHODS: Patients with PJI treated with a two-stage revision between January 2013 and June 2016 were selected for analysis of in-hospital costs. An OPAT cost simulation was made for comparable lengths of stay, for the different antimicrobial regimens used. A cost minimization analysis comparing the non-OPAT costs and the OPAT cost simulation was performed, with a sensitivity analysis accounting for cost uncertainties. RESULTS: Based on the financial data of 12 two-stage revisions and 4 different antibiotic regimens, the average simulated cost difference for OPAT was €2.402 surplus for the patient, €-25.950 for health care and €-23.548 in total. CONCLUSION: Projected cost savings for OPAT-treatment of PJI are substantial. However, OPAT within the current Belgian system was significantly more expensive for the patients. This can be attributed to the Belgian health insurance system; its current reimbursement regulations prevent OPAT from truly making a breakthrough in Belgium.

Introduction Interventions are needed to improve early detection of indications for dialysis before development of severe symptoms or complications. This may reduce suboptimal dialysis starts, prevent hospitalizations, and decrease costs. Our objectives were to explore assumptions around a nurse-led virtual case management intervention for patients with late-stage chronic kidney disease (CKD) with a 2-year Kidney Failure Risk Equation (KFRE) estimated risk of kidney failure ≥80% and to estimate how these assumptions affect potential cost savings. Methods We performed a cost-minimization analysis by developing a decision analytic microsimulation model constructed from the perspective of the health payer. Our primary outcome was the break-even point, defined as the maximum amount a health payer could spend on the intervention without incurring any net financial loss or gain. The intervention group received remote telemonitoring, including daily measurement of several health metrics (blood pressure, oxygen saturation, and weight), and a validated symptom questionnaire accompanied by nurse-led case management, whereas the comparator group received usual care. We assumed patients received the intervention for a maximum of 2 years. Results The break-even point was $7339 per late-stage CKD patient enrolled in the intervention. Based on the distribution of time receiving the intervention, we determined a maximum monthly intervention cost of $703.37. In probabilistic sensitivity analyses, we found that 75% of simulations produced break-even points between $3929 and $9460. Conclusion Nurse-led virtual home monitoring interventions in patients with CKD at high risk of kidney failure have the potential for significant cost savings from the perspective of the health payer., Graphical abstract

Background To assess the economic impact of powered stapler use in video-assisted thoracic surgery (VATS) lobectomy for lung cancer in a Chinese tertiary care hospital. Methods This study identified 388 patients who received VATS lobectomy using the ECHELON powered stapler (n = 296) or the ECHELON manual stapler (n = 92) for lung cancer in a Chinese tertiary hospital. Multiple generalized linear regression analyses were conducted using data on hospital costs and patient characteristics to develop predictive equations for hospital costs in a cost-minimization analysis (CMA) model comparing hospital costs associated with the ECHELON powered stapler and the ECHELON manual stapler. CMA model was used to conduct scenario analysis to compare the ECHELON powered stapler with another manual stapler (Victor Medical). Results The multiple generalized linear regression analyses identified that using the ECHELON powered stapler in VATS lobectomy for lung cancer was associated with significantly lower drug costs than using the ECHELON manual stapler (coefficient − 0.256, 95% confidence interval: − 0.375 to − 0.139). The CMA model estimated that the ECHELON powered stapler could save hospital costs by ¥1653 when compared with the ECHELON manual stapler (¥65,531 vs. ¥67,184). The use of the ECHELON powered stapler also saved hospital costs by ¥4411 when compared with the Victor Medical manual stapler (¥65,531 vs. ¥69,942) in the scenario analysis. Conclusions Compared to the two manual staplers used for VATS lobectomy for lung cancer in a Chinese tertiary hospital, the ECHELON powered stapler had 100% probability to save total hospital costs under present prices of the three staplers according to the CMA.

Primary immunodeficiency diseases (PID), which are comprised of over 400 genetic disorders, occur when a component of the immune system is diminished or dysfunctional. Patients with PID who require immunoglobulin (IG) replacement therapy receive intravenous IG (IVIG) or subcutaneous IG (SCIG), each of which provides equivalent efficacy. We developed a cost-minimization model to evaluate costs of IVIG versus SCIG from the Spanish National Healthcare System perspective. The base case modeled the annual cost per patient of IVIG and SCIG for the mean doses (per current expert clinical practice) over 1 year in terms of direct (drug and administration) and indirect (lost productivity for adults and parents/guardians of pediatric patients) costs. It was assumed that all IVIG infusions were administered in a day hospital, and 95% of SCIG infusions were administered at home. Drug costs were calculated from ex-factory prices obtained from local databases minus the mandatory deduction. Costs were valued on 2018 euros. The annual modeled costs were €4,266 lower for patients with PID who received SCIG (total €14,466) compared with those who received IVIG (total €18,732). The two largest contributors were differences in annual IG costs as a function of dosage (- €1,927) and hospital administration costs (- €2,688). However, SCIG incurred training costs for home administration (€695). Sensitivity analyses for two dose-rounding scenarios were consistent with the base case. Our model suggests that SCIG may be a cost-saving alternative to IVIG for patients with PID in Spain.

Cutaneous lupus erythematosus (CLE) can be treated with multiple oral immunosuppressants but cost analyses of these treatments are lacking. We aimed to assess the relative cost difference between various oral medications for CLE using a cost-minimization analysis. Annual direct costs for 10 oral medications used in CLE were calculated including cost of medications and patient monitoring, which include office visits, laboratory and radiological studies, and procedures. Medication costs were taken from the National Average Drug Acquisition Cost calculated by the Centers of Medicare and Medicaid Services or the Average Wholesale Price. Monitoring guidelines were obtained from expert consensus and FDA-approved recommendations. Methotrexate had the lowest total direct cost ($899.31), followed by hydroxychloroquine ($1007.38), mycophenolate mofetil ($1162.12), azathioprine ($1193.71), chloroquine ($2525.01), dapsone ($2750.68), cyclosporine ($2976.32), thalidomide ($75,831.44), and lenalidomide ($316,104.03). For medications used for CLE patients, the medication cost contributes the most to differences between direct costs. Limitations include insufficient patient outcome data to ascertain medication efficacy, exclusion of cost of medication-related adverse events and hospitalizations, and medication cost data not reflecting all payers. Clinicians can use this data to help discern which medication to prescribe CLE patients with financial constraints and reduce healthcare spending.

Background: Appendicitis has a high occurrence and is frequently indicated in pediatric abdominal surgery. However, up to 33% of affected children may not present with distinct symptoms, and young children may be a typical or show delayed presentation of symptoms. Appendectomy is one of the most common emergent surgeries to treat appendicitis. After an appendectomy, prophylaxis antibiotics are required to abate infections at the location of surgery and have been shown to reduce postoperative surgical complications significantly. Objective: The purpose of this investigation was to determine the most cost-effective prophylactic antibiotic combination between ceftriaxone-metronidazole and cefotaxime-metronidazole following appendectomy. Methods: A retrospective observational study was conducted using investigations with a similar design and pediatric medical records from 2011 until 2013 from a referral hospital in Bandung City. All direct medical costs related to pediatric appendectomy were collected and discounted. Independent Student’s t-test and chi-square analysis were used. Results: The average total cost of ceftriaxone-metronidazole was USD 393.83/patient and that of cefotaxime-metronidazole was USD 397.89/patient. There were no significant differences in average direct medical costs between treatments with ceftriaxone-metronidazole and cefotaxime-metronidazole (p=0.383). The analysis suggests that both antibiotic combinations have the same effectiveness and cost. For the combinations of ceftriaxone-metronidazole and cefotaxime-metronidazole, approximately USD 1.88 and USD 2.28 were required, respectively, to reduce one day of hospitalization after an appendectomy. Additionally, to increase one percent of cure rate, an amount of USD 19.70 and USD 24.89 was required for ceftriaxone-metronidazole and cefotaxime-metronidazole, respectively. Conclusion: Both therapies investigated were effective as a postoperative antibiotic. However, the combination of ceftriaxone and metronidazole may be more cost-efficient.

STUDY DESIGN Retrospective database review. OBJECTIVE Compare 1-year episode of care costs between single-level decompression and decompression plus fusion for lumbar stenosis. SUMMARY OF BACKGROUND DATA Lumbar stenosis is the most common indication for surgery in patients over 65. Medicare direct hospital costs for lumbar surgery reached $1.65 billion in 2007. Despite stenosis being a common indication for surgery, there is debate as to the preferred surgical treatment. Cost-minimization analysis is a framework that identifies potential cost savings between treatment options that have similar outcomes. We performed a cost-minimization analysis of decompression versus decompression with fusion for lumbar stenosis from the payer perspective. METHODS An administrative claims database of privately insured patients (Humana) identified patients who underwent decompression (n = 5349) or decompression with fusion (n = 8540) for lumbar stenosis with and without spondylolisthesis and compared overall costs. All patients were identified and costs identified for a 1-year period. Complication rates and costs were described using summary statistics. RESULTS Mean treatment costs at 1 year after surgery were higher for patients who underwent decompression and fusion compared to patients who underwent decompression alone ($20,892 for fusion vs. $6329 for decompression; P

Aim: This study aimed to perform an economic evaluation of Hemophilia ambulatory service delivery model (HASDM) comparing to the traditional home-episodic treatment model. Study Design: Tehran university of medical science, department pharmacoeconomics and pharmaceutical administration, between Jun 2016 and September 2018. Methods: A cost-minimization analysis (CMA) was conducted for evaluating potential savings of HASDM in comparison to the traditional home-episodic treatment model. The main cost of regular episodic service delivery, basic arm, consists of the cost of recombinant factor VIII (FVIII). In the comparator arm, HASDM, the costs of HASDM for 1660 hemophilia A patients (HAPs) in Tehran were calculated. One-way sensitivity analysis was done to investigate the robustness of the results and to investigate the impact of uncertainty in the percentage of mistakes in bleeding sensation. Results: There were 1660 patients with severe Hemophilia A (PWSHA) in Tehran in 2018. The mean utilization of annual per patient FVIII was 44814 international units (IUs) in Iran. The total annual cost of FVIII concentrate for 1660 hemophilic patients in Tehran was estimated at $ 11,001,816. The cost of running HASDM, personal, and equipment is equal to $ 580,956. The cost of FVIII in HASDM would be $ 4,004,661. Therefore, the total cost of HASDM is estimated at $ 4,585,617. The amount of savings was $ 6,416,199. Sensitivity analysis indicated the robustness of the results up to 94.64% of the variation in the model parameters. Conclusions: HASDM, compared to episodic model, can save 58.32% of the funding for controlling bleeding in HAPs annually. This can save more than 38 times of HAPs annual cost over their lifetime.

What is known and objective Direct-acting antivirals (DAAs) have become the most widely used treatment of chronic hepatitis C infection. Comparative studies on DAAs regimens approved by the Egyptian Ministry of Health for easy-to-treat genotype 4 (G4) Egyptian patients are still deficient. In this prospective study, we compared the efficacy and cost of two DAA regimens that are used in the treatment of Egyptian chronic hepatitis C virus (HCV) G4. The cost-saving regimen is determined. Methods Eligible patients were randomized into 2 groups. Group 1 (Gp 1) received sofosbuvir plus daclatasvir, and group 2 (Gp 2) received ombitasvir, paritaprevir and ritonavir plus ribavirin (RBV) for 12 weeks. Data were collected and evaluated at baseline and at weeks 4, 8 and 12. Sustained virologic response 12 weeks after the end of treatment (SVR12 ) was evaluated. Cost-minimization analysis (CMA) was performed. Results and discussion Eligibility was achieved in 107 patients, Gp1 included 57 patients, and Gp 2 included 50 patients. Two patients dropped out from Gp 2 due to non-compliance. All patients in the two groups showed negative HCV blood levels at the end of treatment. At the 24th week, 3 relapsers (5.2%) were detected in Gp1 and 2 relapsers (4.1%) were detected in Gp 2. SVR12 was 54/57 (94.7%) and 46/48 (95.8%) for Gp 1 and Gp 2, respectively. After the 12th week of treatment, a significant decrease in aspartate aminotransferase (AST), alanine aminotransferase (ALT) and haemoglobin levels were observed in both groups. Albumin levels declined in Gp 2 only. CMA showed higher cost in Gp 2 than Gp 1, although similar efficacy and safety. What is new and conclusion The two DAA regimens showed high SVR12 and safety in Egyptian HCV G4 patients. Sofosbuvir plus daclatasvir is the cost-saving regimen.

Introduction Bundling of services, typically into a 90-day episode of care, is intended to facilitate cost reduction. The purpose of this study was to determine the impact of a private insurance bundling program on the costs of outpatient total shoulder arthroplasty (TSA) at a freestanding ambulatory surgery center. Methods A cost minimization analysis was done of patients who had anatomic TSA by a single surgeon at a single freestanding ambulatory surgery center, including line-by-line comparisons of demographic and comorbidity factors for all patients treated within the 90-day episode of care. Results Seventy-six primary anatomic TSAs were included, 39 in the bundled group and 37 outside of the program. The bundled group was on average older (58 years) than the unbundled group (54 years, P = 0.021), but the groups were otherwise similar in demographics. The average total implant charges were significantly less for the bundled group ($24,822.43 versus $28,405.51, P = 0.014). Average total surgery supply charges and anesthesia supply charges were similar (P > 0.05). Mean total outpatient surgical day charges (implants, surgical, and anesthesia equipment) were significantly less for the bundled group ($29,782.43 versus $33,238.68, P = 0.022), as were average operating room staffing costs ($135.37 versus $162.55, P = 0.015). During the 90-day postoperative period, charges were similar. Conclusions Primary anatomic TSA using a bundled care program in an outpatient setting coincides with markedly lower charges. The primary driver of this reduction is implant pricing, which is negotiated as part of the bundle. Surgeons must carefully analyze their unique practices in the changing economic health care environment when creating an outpatient TSA and/or bundling program. Level of evidence Level III economic analysis.

Background: Telemedicine as a technology is expected to resolve issues such as doctor shortages and disparities in medical services. However, high costs of system installation and maintena...

An estimated 250,000 rotator cuff repair (RCR) surgical procedures are performed every year in the United States. Although arthroscopic RCR has been shown to be a cost-effective operation, little is known about what specific factors affect the overall cost of surgery. This study examines the primary cost drivers of RCR surgery in the United States.Univariate analysis was performed to determine the patient- and surgeon-specific variables for a multiple linear regression model investigating the cost of RCR surgery. The 2014 State Ambulatory Surgery and Services Databases were used, yielding 40,618 cases with Current Procedural Terminology code 29827 ("arthroscopic shoulder rotator cuff repair").The average cost of RCR surgery was $25,353. Patient-specific cost drivers that were significant under multiple linear regression included black race (P.001), presence of at least 1 comorbidity (P.001), income quartile (P.001), male sex (P = .012), and Medicare insurance (P = .035). Surgical factors included operative time (P.001), use of regional anesthesia (P.001), quarter of the year (January to March, April to June, July to September, and October to December) (P.001), concomitant subacromial decompression or distal clavicle excision (P.001), and number of suture anchors used (P.001). The largest cost driver was subacromial decompression, adding $4992 when performed alongside the RCR.There are several patient-specific variables that can affect the cost of RCR surgery. There are also surgeon-controllable factors that significantly increase cost, most notably subacromial decompression, distal clavicle excision, use of regional anesthesia, and number of suture anchors. Surgeons must consider these factors in an effort to minimize cost, particularly as bundled payments become more common.

Oral sotalol, used in adults for sinus rhythm control, is initiated at 80 mg b.i.d. and titrated to a maximum safe dose. The US Food and Drug Administration recommends monitoring the corrected QT interval (QTc ) for at least 3 days, until steady-state exposure of the drug is reached, before patient discharge, which can significantly impact the total cost of treatment. The objectives of this research were to design an accelerated intravenous sotalol loading and maintenance therapy that will reduce the hospital length of stay and to also evaluate the pharmacoeconomic impact in a hospital setting. Pharmacokinetic simulations of sotalol plasma concentrations vs. times profiles were performed to determine the optimal intravenous/oral transition regimen. A cost minimization analysis from the health sector perspective was conducted to assess the cost savings for these proposed accelerated regimens. For a chosen target dose of 120 mg b.i.d., two infusions of 40 mg over 1 hour and 20 mg over 0.5 hour, each followed up by an evaluation of QTc , can be administered followed immediately by the target oral maintenance dose of 120 mg at the end of the second infusion. Consequently, steady-state exposure and, therefore, steady-state QTc are obtained on the first day of therapy, facilitating an earlier hospital discharge. Two and 1-day mean total cost of -$3,123 (95% confidence interval (CI), -$3,640, -$2,607) -$4,820 (95% CI, -$5,352, -$4,288) were observed for this strategy, respectively. We are proposing an intravenous to oral transition strategy for sotalol that has the potential to significantly reduce cost and increase patient convenience.

Healthcare facilities could minimize the cost of surgical instrument and implant processing by using single-use devices. The main objective was to prospectively compare the total cost of a single-use and reusable device used in short lumbar spine fusion. A 1-year, single-centre, prospective study was performed on patients requiring a one- or two-level lumbar arthrodesis. Patients were randomized in two groups treated with either reusable or single-use device. A cost minimization analysis was performed using a micro-costing approach from a hospital perspective. Every step of the preparation process was timed and costed based on hourly wages of hospital employees, cleaning supplies and hospital waste costs. Forty cases were evaluated. No significant difference in operation time was noted (reusable 176.1 ± 68.4 min; single use 190.4 ± 71.7 min; p = 0.569). Mean processing time for single-use devices was lower than for reusable devices (33 min vs. 176 min) representing a cost of 14€ versus 58€ (p

Breast cancer (BC) stands first with high incidence and mortality in India. Most of the oncologists are unaware of cost savings by utilising generic drugs.To perform a cost minimization analysis of generic versus branded chemotherapeutic regimen for treatment of BC.CIMS (current index of medical stores) was referred for the cost of branded drugs and the generic cost was taken from Jan Aushadhi scheme. The percentage cost variation and potential cost-saving particular to BC regimens on substituting available generic drug was calculated using standard formula and costs were presented in Indian Rupees and US Dollars (as of 2019).Among the branded agents considered, a range of 25% to 606.11% cost variation was observed with cyclophosphamide and 5-Fluorouracil respectively. Gemcitabine proposed the highest cost variation (373.68%-990.78%) and cyclophosphamide (71.42%-114.28%) with the lowest variation when compared to generic drugs. The highest level of cost-saving (₹60,807.3 to ₹1,31,864.1) with TAC regimen and the lowest range (₹12,15.84 to ₹15,667.2) with AC regimen was observed among adjuvant therapy regimens.Our evaluation inferred that substituting generic chemotherapeutic drugs can bring potential cost savings. Healthcare professionals and patients should aware and opt generic drugs to achieve goals of BC therapy.

AIMS Sacral neuromodulation (SNM) is a standard therapy for refractory overactive bladder (OAB). Traditionally, SNM placement involves placement of an S3 lead with 1-3 weeks of testing before considering a permanent implant. Given the potential risk of bacterial contamination during testing and high success rates published by some experts, we compared the costs of traditional 2-stage against single-stage SNM placement for OAB. METHODS We performed a cost minimization analysis using published data on 2-stage SNM success rates, SNM infection rates, and direct reimbursements from Medicare for 2017. We compared the costs associated with a 2-stage vs single-stage approach. We performed sensitivity analyses of the primary variables listed above to assess where threshold values occurred and used separate models for freestanding ambulatory surgery centers (ASC) and outpatient hospital departments (OHD). RESULTS Based on published literature, our base case assumed a 69% SNM success rate, a 5% 2-stage approach infection rate, a 1.7% single-stage approach infection rate, and removal of 50% of non-working single-stage SNMs. In both ASC ($17 613 vs $18 194) and OHD ($19 832 vs $21 181) settings, single-stage SNM placement was less costly than 2-stage placement. The minimum SNM success rates to achieve savings with a single-stage approach occur at 65.4% and 61.3% for ASC and OHD, respectively. CONCLUSIONS Using Medicare reimbursement, single-stage SNM placement is likely to be less costly than 2-stage placement for most practitioners. The savings are tied to SNM success rates and reimbursement rates, with reduced costs up to $5014 per case in centers of excellence (≥ 90% success).

Background Two large acute Irish University teaching hospitals changed the manner in which they treated human epidermal growth factor receptor (HER)2-positive breast cancer patients by implementing the administration of trastuzumab via the subcutaneous (SC) route into their clinical practice. The study objective is to compare the trastuzumab SC and trastuzuamb intravenous (IV) treatment pathways in both hospitals and assess which route is more cost-effective and time saving in relation to active health care professional (HCP) time. Materials and Methods A prospective observational study in the form of cost minimization analysis constituted the study design. Active HCP time for trastuzumab SC- and IV-related tasks were recorded. Staff costs were calculated using fully loaded salary costs. Loss of productivity costs for patients were calculated using the human capital method. Results On average, the total HCP time saved per trastuzumab SC treatment cycle relative to trastuzumab IV treatment cycle was 59.21 minutes. Time savings in favor of trastuzumab SC resulted from quicker drug reconstitution, no IV catheter installation/removal, and less HCP monitoring. Over a full treatment course of 17 cycles, average HCP time saved accumulates to 16.78 hours, with an estimated direct cost saving of €1609.99. Loss of productivity for patients receiving trastuzumab IV (2.15 days) was greater than that of trastuzumab SC (0.60 days) for a full treatment course. Conclusion Trastuzumab SC treatment has proven to be a more cost-effective option than trastuzumab IV treatment that generated greater HCP time savings in both study sites. Healthcare policymakers should consider replacing trastuzumab IV with trastuzumab SC treatment in all eligible patients.

Irritable bowel syndrome (IBS) is a clinical pathology, accompanied by significant physical and psychological discomfort, and leading to certain economic losses. Women suffer from IBS 2.2 times more often than men.The purpose of the study is to conduct a comparative analysis of recommended drugs for treating patients with IBS by minimizing costs and choosing treatment regimens that allow you to save money with the same efficacy of therapy.Materials and methods. The cost minimization analysis (CMA) of drugs are using data on the cost of drugs for 2018. The course of primary pharmacotherapy was calculated on a combination of antispasmodic and Loperamide, lasting 4 weeks (28 days).Results and its discussion. For the treatment of IBS is important combination of diet, pharmacotherapy and psychotherapy. Therefore, the calculation was maden for the treatment of IBS with a predominance of diarrhea of two drugs - antispasmodic and Loperamide.After analyzing the cost of treatment regimens, we can note that the cheapest regimen with INN Mebeverin was the regimen with drugs ASPASMIN and LOPERAMIDE HYDROCHLORIDE. The total cost of the scheme was UAH 287.94.Otilonium bromide is represented by only one TN, and the final price of the treatment regimen with this drug depends on Loperamide. The treatment regimen with LOPERAMIDE HYDROCHLORIDE of Ukrainian production (UAH 320.65 per course) turned out to be cheaper.The cheapest treatment regimen with Drotaverin was the one with two drugs of domestic production - NO-KH-SHA® and LOPERAMIDE HYDROCHLORIDE (141.01 UAH).Conclution. It has been established that the difference in costs for different treatment schemes depends on the price of drugs, and also on whether it is generic or original (brand), imported or domestic. Most domestic drugs are generic, so treatment regimens will be cheaper and will help save money.

Purpose To analyze the individual costs associated with anterior crucial ligament reconstruction (ACLR), accounting for patient demographics, perioperative decision making, and location of the surgical procedure (hospital vs ambulatory surgery center), utilizing a cost-minimization analysis in a large national database. Methods Univariate analysis and multiple linear regression were performed to determine which patient and surgical variables were the largest cost drivers for ACLR in the United States according to the State Ambulatory Surgery and Services Database. Results The average cost for ACLR (n = 14,713) was $24,707 (standard deviation, $15,644). When patient variables were considered, younger age (P 1 chronic medical condition ($1,749). Male sex, time in operating room, and older age also significantly increased ACLR cost. Conclusions The greatest contributor to cost of ACLR was the use of general anesthesia alone. Time spent in the operating room increased ACLR cost by $108 per minute. Patient factors included greater age, male sex, Hispanic ethnicity, number of chronic medical conditions, Medicare insurance, and annual income. Meniscal repair and regional nerve block did not significantly affect cost as determined by multivariate regression.

Aim: Compare the 1-year costs of three catheter ablation technologies for the treatment of paroxysmal atrial fibrillation (PAF). Materials & methods: A decision tree model was developed to estimate 1-year hospital costs associated with an index and potential repeat PAF ablation procedure using the Thermocool ® Smarttouch ® Catheter (ST), Thermocool SF Catheter (SF) or Arctic Front Advance Cryoballoon (CB). Model parameters were estimated using the results of two recently published studies. Results: The ST resulted in average per-patient savings for combined inpatient and outpatient populations of US$1488 and US$4494 compared with SF and CB, respectively. These cost savings were greater in the inpatient setting. Conclusion: The 1-year expected hospital visit costs for PAF ablation were lower with ST than with SF or CB.

Aim: China’s cost-containment measures increasingly focus solely on the prices of consumable medical supplies without taking a broader perspective on differences in features and overall costs. This study compared two types of endoscopic staplers in video-assisted thoracoscopic surgery (VATS) lobectomy. Materials & methods: Electronic medical records for video-assisted thoracoscopic surgery from 2016 to 2017 were collected from a hospital in Anhui province. Two cohorts were retroactively defined based on stapler type. Total costs were compared using a cost-minimization analysis model. Probabilistic sensitivity analysis was performed. Results: In the base case, the group using more expensive staplers achieved overall cost savings of about $300 per procedure. Sensitivity analysis confirmed this result in 86.5% of cases. Conclusion: A price-only supply selection strategy may have unintended cost consequences.

Introduction Pheochromocytomas and paragangliomas (PPGLs) are highly heritable tumours, with up to 40% of cases carrying germline variants. Current guidelines recommend genetic testing for all patients with PPGLs. Next-generation sequencing (NGS) enables accurate, fast, and inexpensive genetic testing. This study aimed to compare the costs related to PPGL genetic testing between the sequential testing using the decisional algorithm proposed in the 2014 Endocrine Society guidelines and targeted NGS gene panels. Methods Patients with proven PPGLs were enrolled. A gene list covering 17 susceptibility genes related to hereditary PPGLs was developed for targeted sequencing. Validation was carried out by Sanger sequencing. We simulated the diagnostic workflow to examine the anticipated costs based on each strategy for genetic testing. Results Twenty-nine patients were included, among whom a germline variant was identified in 34.5%. A total of 22.7% with apparently sporadic PPGL carried a variant. Five genes were involved (RET, n = 3; SDHB, n = 3; SDHD, n = 2; EGLN1, n = 1; and NF1, n = 1). According to the diagnostic workflow, the average cost of the targeted NGS (534.7 US dollars per patient) is lower than that of the sequential testing (734.5 US dollars per patient). The targeted NGS can also reduce the number of hospital visits from 4.1 to 1 per person. The cost can be further reduced to 496.24 US dollars per person (32% reduction) if we apply a new syndromic-driven diagnostic algorithm to establish priorities for specific genetic testing for syndromic and selected cases, and targeted NGS for non-syndromic patients. Conclusions Targeted NGS can reduce both the cost of PPGL genetic testing and the number of hospital visits, compared with the conventional approach. Our proposed algorithm is the preferred approach due to its significant reduction of the cost of genetic testing.Key messagePheochromocytomas and paragangliomas are highly heritable neoplasms.The targeted next-generation sequencing (NGS) gene panels have proven to be fast, accurate, and inexpensive for the genetic analysis.According to this cost analysis, it is economically reasonable to use targeted NGS gene panels for genetic screening.

Purpose: INVICOST, a medico-economic analysis, compared costs of managing treatment-naive patients with diabetic macular edema (DME) receiving intravitreal injections (IVIs) of aflibercept (AFL), dexamethasone implant (DXI) or ranibizumab (RAN) over 1 year. Methods: Healthcare resource use and associated costs were estimated using individual patient data from INVICTUS, a prospective, open-label, monocentric study. Healthcare costs comprised direct medical costs such as drug acquisition and administration, consultations and ophthalmological procedures. Costs were assessed from the French National Health Insurance perspective using published national tariffs expressed in 2019 euros. Results: Of the 60 treated eyes, 48 had no treatment switch; 14 received AFL, 19 received DXI and 15 received RAN. AFL-treated eyes received an average of 6.5 IVIs, DXI-treated patients received 2 IVIs and RAN-treated received 6.8 IVIs. All treated eyes received an initial prescription for adjunctive ocular medications and 349 follow-up procedures were performed including an average of 3.9 optical coherence tomography and 3.2 retinography procedures per eye. Average total direct cost of per-eye treatment was €4516 (€1128–€8257). Average cost was €5782 for eyes treated with AFL, €2779 with DXI and €5536 with RAN. Drug therapy was the cost driver: €4394 (76%) for AFL, €1915 for DXI (69%) and €4268 (77%) for RAN. Conclusion: The difference in total treatment cost is largely explained by the significantly lower frequency of IVI and annual cost of therapy with DXI, compared with AFL and RAN. INVICOST is the first study comparing treatment costs with AFL, DXI and RAN in France in current clinical practice.

BACKGROUND: Promacta (eltrombopag; EPAG) and Nplate (romiplostim; ROMI) have not been compared in head-to-head trials for treatment of chronic immune thrombocytopenia (cITP); however, indirect trea...

Background Pembrolizumab monotherapy and nivolumab in combination with ipilimumab are US FDA-approved first-line (1L) regimens for patients with metastatic non-small cell lung cancer (NSCLC) without epidermal growth factor receptor or anaplastic lymphoma kinase genomic aberrations and with a programmed death ligand 1 (PD-L1) tumor proportion score (TPS) of ≥ 1%. A published matching-adjusted indirect comparison found the two regimens yield comparable overall and progression-free survival outcomes. Objective The aim of this study was to compare direct medical costs of pembrolizumab and nivolumab plus ipilimumab for PD-L1-positive metastatic NSCLC treatment within the first 3 years following treatment initiation from a US payer perspective. Methods A cost-minimization model was built to estimate and compare treatment, disease management, and adverse event costs based on KEYNOTE-024 and -042, and CheckMate 227 Part 1a trial survival and adverse event data. Results 1L pembrolizumab generates $54,343, $75,744, and $76,259 per patient cost savings compared with 1L nivolumab plus ipilimumab for patients with NSCLC with PD-L1 TPS ≥ 1% within 1, 2, and 3 years of treatment initiation, respectively. Conclusion Pembrolizumab is cost saving as 1L treatment for PD-L1-positive metastatic NSCLC in comparison with nivolumab plus ipilimumab, at least for the short term.

BACKGROUND: Coronary physiology is a routine diagnostic tool when assessing whether coronary revascularization is indicated. The iFR-SWEDEHEART trial demonstrated similar clinical outcomes when using instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) to guide revascularization. The objective of this analysis was to assess a cost-minimization analysis of iFR-guided compared with FFR-guided revascularization.METHODS: In this cost-minimization analysis we used a decision-tree model from a healthcare perspective with a time-horizon of one year to estimate the cost difference between iFR and FFR in a Nordic setting and a United States (US) setting. Treatment pathways and health care utilizations were constructed from the iFR-SWEDEHEART trial. Unit cost for revascularization and myocardial infarction in the Nordic setting and US setting were derived from the Nordic diagnosis-related group versus Medicare cost data. Unit cost of intravenous adenosine administration and cost per stent placed were based on the average costs from the enrolled centers in the iFR-SWEDEHEART trial. Deterministic and probabilistic sensitivity analyses were carried out to test the robustness of the result.RESULTS: The cost-minimization analysis demonstrated a cost saving per patient of $681 (95% CI: $641 - $723) in the Nordic setting and $1024 (95% CI: $934 - $1114) in the US setting, when using iFR-guided compared with FFR-guided revascularization. The results were not sensitive to changes in uncertain parameters or assumptions.CONCLUSIONS: IFR-guided revascularization is associated with significant savings in cost compared with FFR-guided revascularization.

Background Diabetes mellitus, cardiovascular diseases, chronic kidney disease, and thyroid diseases are chronic diseases that require regular monitoring through blood tests. This paper first investigates the experiences of chronic care patients with venipuncture and their expectations of an at-home blood-sampling device, and then assesses the impact on societal costs of implementing such a device in current practice. Methods An online survey was distributed among chronic care patients to gain insight into their experience of blood sampling in current practice, and their expectations of an at-home blood-sampling device. The survey results were used as input parameters in a patient-level monte carlo analysis developed to represent a hypothetical cohort of Dutch chronically ill patients to investigate the impact on societal costs compared to usual care. Results In total, 1311 patients participated in the survey, of which 31% experience the time spent on the phlebotomy appointment as a burden. Of all respondents, 71% prefer to use an at-home blood-sampling device to monitor their chronic disease. The cost analysis indicated that implementing an at-home blood-sampling device increases the cost of phlebotomy itself by €27.25 per patient per year, but it reduces the overall societal costs by €24.86 per patient per year, mainly due to limiting productivity loss. Conclusions Patients consider an at-home blood-sampling device to be more user-friendly than venous phlebotomy on location. Long waiting times and crowded locations can be avoided by using an at-home blood-sampling device. Implementing such a device is likely cost-saving as it is expected to reduce societal costs.

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): EuroCMR registry (Life Sciences GE Healthcare, Medtronic Inc., Minneapolis MN, USA; Novartis International AG, Basel, Switzerland; Siemens Healthcare, Erlangen, Germany), SPINS registry (Siemens Healthineers, Erlangen, Germany; Bayer AG, Leverkusen, Germany) Background Coronary artery disease (CAD) is a major contributor to the public health burden. Stress perfusion cardiac magnetic resonance (CMR) has an excellent accuracy to detect CAD, but data on its cost effectiveness are scarce. Purpose To compare the costs of a CMR-guided strategy vs 2 invasive strategies based on 2 large international CMR registries. Methods In the EuroCMR registry (n = 3’647, 59 centers, 18 countries) and the US-based SPINS registry (n = 2’349, 13 centers, 11 states) costs were calculated for 12 healthcare systems (8 Europe, US, 2 Latin America, 1 Asia). They included diagnostic examinations (CMR, X-ray coronarography (CXA) with/without FFR), revascularizations, and complications during a 1-year follow-up. Endpoints in both registries were all-cause and cardiovascular (CV) death, sudden cardiac death (SCD), aborted SCD, non-fatal myocardial infarction (nf-MI), and stroke. 7 sub-group analyses covered low to high-risk cohorts. Patients with ischemia-positive CMR underwent CXA and revascularization (percuteneous and surgical intervention) at the treating physician’s discretion (=CMR + CXA-strategy). In the hypothetical invasive CXA + FFR-strategy, costs were calculated for an initial CXA and an FFR in vessels with ≥50% stenoses assuming the same proportion of revascularizations/complications as in the CMR + CXA-strategy and FFR positive rates as given in the literature. In the CXA-only strategy, costs included CXA and revascularizations of ≥50% stenoses. Results Revascularizations were performed in 8.0% and 6.2% (p Conclusions In 12 healthcare systems, a CMR + CXA-strategy yielded consistent moderate to high cost savings compared to a hypothetical CXA + FFR-strategy over the entire spectrum of risk. Cost savings were consistently high vs a CXA-only strategy for all risk groups. Figure 1: SPINS refers to the subgroup of patients with suspected CAD (n = 1’530), EuroCMR (= suspected CAD; n = 3’647). EuroCMR vs SPINS ns. Countries per region are listed in alphabetical order. Figure 2: Top: CMR + CXA vs CXA + FFR: ANOVA: overall p = 0.0017, * vs EuroCMR typ angina: p

This meta‐analysis was performed to compare the safety, efficacy, and pharmacoeconomic of bivalirudin versus heparin in high‐risk patients for percutaneous coronary interventions (PCI). Earlier meta‐analysis comparing bivalirudin and heparin during PCI demonstrated that bivalirudin caused less bleeding with more stent thrombosis. However, little data were available on the safety of bivalirudin versus heparin in high‐risk patients for PCI. Thus, we performed a meta‐analysis to evaluate the efficacy and safety in the “high‐risk” patients. A systematic search of electronic databases was conducted up to July 30, 2020. The Cochrane Risk of Bias assessment tool was used to assess the quality of included studies. The primary outcomes were all‐cause death and major adverse cardiac events (MACE); secondary outcomes were major and minor bleeding, followed by a cost‐minimization analysis comparing bivalirudin and heparin using a local drug and medical costs reported in China. Subgroup analysis was based on the type of disease of the high‐risk population. Finally, a total of 10 randomized controlled trials involved 42,699 patients were collected. The Cochrane Risk of Bias Tool was employed to appraise the research quality. No significant difference was noted between bivalirudin and heparin regarding all‐cause death and MACE. However, subgroup analysis showed that bivalirudin caused less major bleeding in female (OR:0.65, 95% CI:0.53–0.79), diabetes (OR:0.55, 95%CI:0.42–0.73), and CKD (OR:0.59, 95%CI:0.63–1.65). The scatterers of the included literature were approximately symmetrical, and no research was outside the funnel plot. Additionally, cost‐minimization analysis showed that heparin was likely to represent a cost‐effective option compared with bivalirudin in China, with potential savings of 2129.53 Chinese Yuan (CNY) per patient for one PCI. Overall, the meta‐analysis showed that although bivalirudin appeared to have a lower risk of major bleeding rate, the overall effectiveness and safety between the two groups showed no significant difference in high‐risk patients for PCI. But the results of the cost‐minimization analysis showed that heparin could be a potential cost‐saving drug than bivalirudin in patients for PCI in China., This meta‐analysis showed that although bivalirudin appeared to have a lower risk of major bleeding rate, the overall effectiveness and safety between the two groups showed no significant difference in high‐risk patients for PCI. But the results of the cost‐minimization analysis showed that heparin could be a potential cost‐saving drug than bivalirudin in patients for PCI in China. ​

Background: Diffusion-weighted MRI is shown to be equally effective, as a CT scan, in diagnosing ischemic and hemorrhagic strokes. Would it be cost-effective to perform an early MRI instead of a CT head? Methods: A retrospective chart review was conducted between October 1, 2015, through October 1, 2017, for patients admitted for possible cerebrovascular accident (CVA). Inclusion criteria were age >/= 18 years and symptoms suggestive of a stroke. Exclusion criteria were pregnancy and age

Introduction- Containing expenditure and efficient resource use is essential to limit the increasing costs of health research. Electronic data collection (EDC) is thought to reduce the costs compared to paper-based data collection (PDC). Economic evidence in this area is scanty, especially in low and middle-income countries. Hence, an economic evaluation was conducted to compare the cost between EDC and PDCMethods- A cost-minimization study was conducted to compare between EDC and PDC from the institutional perspective for the year 2018, based on a community-based survey. Step-down cost accounting was adopted with a bottom-up approach for cost estimation. Total and unit costs were estimated with the base case comparison between EDC and PDC while using SPSS software (e-SPSS and p-SPSS, respectively). We conducted scenario analyses based on usage of different software, R and STATA for both EDC and PDC (e-R, p-R, e-STATA and p-STATA respectively). One-way and probabilistic sensitivity analysis (PSA) was performed to examine the robustness of the observed results. Results- In the base-case analysis, total costs of EDC and PDC were ₹72,617 ($1060.9) and 87,717 ($1281.5) respectively- with estimated cost minimization of ₹ 15,100 ($220.6). In other scenarios, the estimated cost minimization for e-R, e-STATA, p-R, p-STATA were ₹ -274 ($4.0), 98 ($1.4), 14826 ($216.6), and 15,002 ($219.2) respectively when compared to EDC-SPSS. On one-way and PSA, the results of the cost-minimization analysis were robust.Conclusion- The EDC minimizes institutional cost for conducting health research. This finding will help researchers in planning for the budget for their research to use the resources efficiently

Ключевым механизмом развития сахарного диабета (СД) 2-го типа считается инсулинорезистентность. Сахарный диабет 2-го типа является фактором риска развития сердечно-сосудистых заболеваний. Применение препаратов, повышающих чувствительность тканей к инсулину, обоснованно у пациентов с выраженной инсулинорезистентностью для профилактики сердечно-сосудистых событий. Пиоглитазон обладает плейотропным действием, в том числе кардиопротективным. Нами был проведен клинико-экономический анализ и анализ влияния на бюджет применения фиксированной комбинации алоглиптин + пиоглитазон в сравнении с комбинацией препараты сульфонилмочевины (ПСМ) + ингибиторы дипептидилпептидазы-4 (иДПП-4) для терапии взрослых пациентов с СД 2-го типа в рамках льготного лекарственного обеспечения на основании аналитической модели принятия решений. В модели были учтены только прямые медицинские затраты на 1 пациента (затраты на лекарственную терапию). Результаты анализа эффективности показали, что стратегия применения целевых доз сравниваемых препаратов при СД 2-го типа обладает сопоставимой эффективностью по такому критерию, как изменение уровня гликированного гемоглобина (HbA1c) через 26 нед, что позволяет использовать анализ минимизации затрат. Анализ минимизации затрат показал, что, с учетом данных о равнозначной эффективности сравниваемых альтернативных стратегий в отношении снижения уровня HbA1c, использование комбинации алоглиптин + пиоглитазон для интенсификации терапии метформином экономически целесообразно, так как приводит к снижению показателя затрат на 10,1% в сравнении с комбинацией ПСМ + иДПП-4. Анализ влияния на бюджет показал, что увеличение доли пациентов, получающих комбинированную терапию алоглиптином и пиоглитазоном в дополнение к терапии метформином, приводит к снижению нагрузки на бюджет в сравнении с назначением комбинации ПСМ + иДПП-4 в дополнение к монотерапии метформином. Анализ чувствительности подтвердил устойчивость результатов исследования к изменению цен на лекарственные препараты, численности целевой популяции пациентов, доли пациентов, получающих алоглиптин + пиоглитазон. Положительный эффект комбинации алоглиптин + пиоглитазон на метаболические параметры и сердечно-сосудистый риск в сочетании с превосходящими параметрами клинико-экономической целесообразности делают ее применение предпочтительным в сравнении с комбинацией ПСМ + иДПП-4 для терапии взрослых пациентов с СД 2-го типа., Insulin resistance is considered to be the key mechanism for the development of type 2 diabetes mellitus (DM). Type 2 diabetes mellitus is a risk factor for cardiovascular diseases. The use of drugs that improve tissue sensitivity to insulin is a reasonable approach to prevention of cardiovascular events for patients with severe insulin resistance. Pioglitazone has pleiotropic effects, including cardioprotective action. We conducted a clinical, economic, and budget impact analysis of the use of the fixed-dose combination of alogliptin/pioglitazone versus combined treatment with sulfonylureas (SU) and dipeptidyl peptidase 4 inhibitors (DPP4i) for treatment of adult patients with type 2 DM as part of preferential drug supply, based on decision analytical modeling. The model only addressed direct medical costs per patient (drug therapy costs). The results of the efficiency analysis demonstrated that the strategies of using targeted doses of the compared drug agents in type 2 DM are equally effective in terms of the criterion of change in the levels of glycated hemoglobin (HbA1c) after 26 weeks, allowing the use of cost-minimization analysis. Cost-minimization analysis showed that, taking into account the data on the equal efficiency of the compared alternative strategies in reducing HbA1c levels, the use of the fixed-dose combination of alogliptin/pioglitazone for intensification of metformin therapy is economically feasible, since it leads to a 10.1% cost reduction in comparison to the SU + DPP4i combination. The budget impact analysis showed that an increase in the proportion of patients receiving treatment with fixed-dose combination of alogliptin/pioglitazone in addition to metformin leads to a decrease in the budget burden as compared to prescribing the SU + DPP4i combination in addition to metformin monotherapy. Sensitivity analysis confirmed that the study results were not susceptible to drug prices, size of the target patient population, and the proportion of patients receiving alogliptin/pioglitazone. The positive effect of the fixed-drug combination of alogliptin/pioglitazone on metabolic parameters and cardiovascular risk, paired with superior performance in clinical and economic feasibility, makes this treatment more preferable than the SU + DPP4i combination for adult patients with type 2 diabetes mellitus.