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Masroor D, Khaliq SA, Ahmad SM, Mazhar F, Azhar I. Pharmacoeconomic evaluation of treatments for Poly Cystic Ovarian Syndrome (PCOS). COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:62. [PMID: 39238017 PMCID: PMC11378486 DOI: 10.1186/s12962-024-00569-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/06/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Treatment cost and high prevalence of Poly Cystic Ovarian Syndrome (PCOS) is a very challenging issue globally. Due to this reason; current study was conducted to determine pharmaco-economy of conventional and non-conventional treatments for the management of PCOS. METHODS Prospective Cross-Sectional study was conducted in the metropolitan city of Karachi from January - December 2019. Primary data of 200 PCOS patients were collected from different hospitals and clinics. An instrument was used to collect data pertaining to the direct and indirect cost associated with the disease management. Collected data was analyzed by the tools for cost analysis and software called Statistical Package of Social Sciences (SPSS) - 22. RESULTS In Cost Minimization Analysis (CMA); Allopathic treatment [Mean cost/month: PKR:4479.32 ± 350.95 (USD:27.46 ± 2.15)], Herbal treatment [Mean cost/month: PKR:1527.78 ± 78.15 (USD:9.37 ± 0.48)], Combination treatment [Mean cost/month: PKR:2803.09 ± 654.22 (USD:17.18 ± 4.01)], and Homoeopathic treatment [Mean cost/month: PKR:976.95 ± 46.19 (USD:5.99 ± 0.28)]. Incremental cost/month for Allopathic treatment is 358%, Herbal treatment is 56%, Combination treatment is 187%. In Cost Effectiveness Analysis (CEA); Allopathic treatment (Incremental cost-effectiveness ratio/month: 1334.24), Herbal treatment (Incremental cost-effectiveness ratio/month: 936.41), Combination treatment (Incremental cost-effectiveness ratio/month: 1017.09). Due to lowest cost of Homeopathic treatment, cost of Homeopathic treatment was considered as a threshold value. In-direct cost/month of Allopathic treatment is PKR:593.33 ± 24.00 (USD:3.64 ± 0.15), Herbal treatment is PKR:307.84 ± 26.69 (USD:1.89 ± 0.16), Combination treatment is PKR:409.09 ± 45.63 (USD:2.51 ± 0.28) and Homoeopathic treatment is PKR:300.00 ± 26.39 (USD:1.84 ± 0.16). CONCLUSION The most cost-effective is treatment is Homeopathic; Herbal treatment is second most cost-effective option for the treatment of PCOS. Lowest direct and indirect costs and short treatment duration collaboratively lessen the %incremental cost per year and incremental cost effectiveness ratio per year.
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Affiliation(s)
- Darakhshan Masroor
- Department of Pharmacognosy, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Sheikh Abdul Khaliq
- Department of Pharmacy Practice & Pharmaceutics, Faculty of Pharmacy, Hamdard University, Karachi, 74600, Pakistan.
| | - Syed Muzzammil Ahmad
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, 91766, USA
| | - Farah Mazhar
- Department of Pharmacognosy, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Iqbal Azhar
- Department of Pharmacognosy, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, 75270, Pakistan
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Wilhelm M, Hermann C, Rief W, Schedlowski M, Bingel U, Winkler A. Working with patients' treatment expectations - what we can learn from homeopathy. Front Psychol 2024; 15:1398865. [PMID: 38860049 PMCID: PMC11163137 DOI: 10.3389/fpsyg.2024.1398865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
The usual homeopathic remedy, "globules," does not contain any pharmacologically active ingredient. However, many patients and practitioners report beneficial effects of homeopathic treatment on various health outcomes. Experimental and clinical research of the last two decades analyzing the underlying mechanisms of the placebo effect could explain this phenomenon, with patients' treatment expectations as the predominant mechanism. Treatment expectations can be optimized through various factors, such as prior information, communication, and treatment context. This narrative review analyses how homeopathy successfully utilizes these factors. Subsequently, it is discussed what evidence-based medicine could learn from homeopathic practice to optimize treatment expectations (e.g., using an empathic, patient-centered communication style, deliberately selecting objects in practice rooms, or using clear treatment rituals and salient contextual stimuli) and thereby treatment effectiveness. Homeopathic remedy does not work beyond the placebo effect but is recommended or prescribed as an active treatment by those who believe in it. Thus, practitioners need to understand the manner in which homeopathy (as an example of inert treatment) works and are advised to reintegrate its underlying effective placebo mechanisms into evidence-based medicine. This promises to increase treatment efficacy, tolerability, satisfaction, and compliance with evidence-based treatments, and addresses the desires patients are trying to satisfy in homeopathy in an ethical, fully informed way that is grounded in evidence-based medicine.
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Affiliation(s)
- Marcel Wilhelm
- Department of Clinical Psychology, Philipps-University Marburg, Marburg, Germany
| | - Christiane Hermann
- Department of Clinical Psychology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Winfried Rief
- Department of Clinical Psychology, Philipps-University Marburg, Marburg, Germany
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, University Clinic Essen, Essen, Germany
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro-and Behavioral Sciences, University Medicine Essen, Essen, Germany
- Translational Pain Research Unit, University Medicine Essen, Essen, Germany
| | - Alexander Winkler
- Department of Clinical Psychology, Justus-Liebig-University Giessen, Giessen, Germany
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Ostermann T, Burkart J, De Jaegere S, Raak C, Simoens S. Overview and quality assessment of health economic evaluations for homeopathic therapy: an updated systematic review. Expert Rev Pharmacoecon Outcomes Res 2024; 24:117-142. [PMID: 37795998 DOI: 10.1080/14737167.2023.2266136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Likewise other medical interventions, economic evaluations of homeopathy contribute to the evidence base of therapeutic concepts and are needed for socioeconomic decision-making. A 2013 review was updated and extended to gain a current overview. METHODS A systematic literature search of the terms 'cost' and 'homeopathy' from January 2012 to July 2022 was performed in electronic databases. Two independent reviewers checked records, extracted data, and assessed study quality using the Consensus on Health Economic Criteria (CHEC) list. RESULTS Six studies were added to 15 from the previous review. Synthesizing both health outcomes and costs showed homeopathic treatment being at least equally effective for less or similar costs than control in 14 of 21 studies. Three found improved outcomes at higher costs, two of which showed cost-effectiveness for homeopathy by incremental analysis. One found similar results and three similar outcomes at higher costs for homeopathy. CHEC values ranged between two and 16, with studies before 2009 having lower values (Mean ± SD: 6.7 ± 3.4) than newer studies (9.4 ± 4.3). CONCLUSION Although results of the CHEC assessment show a positive chronological development, the favorable cost-effectiveness of homeopathic treatments seen in a small number of high-quality studies is undercut by too many examples of methodologically poor research.
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Affiliation(s)
- Thomas Ostermann
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Julia Burkart
- Medical Scientific Services/Medical Affairs, Deutsche Homöopathie-Union DHU-Arzneimittel GmbH & Co. KG, Karlsruhe, Germany
| | - Sabine De Jaegere
- Medical Scientific Services/Medical Affairs, Deutsche Homöopathie-Union DHU-Arzneimittel GmbH & Co. KG, Karlsruhe, Germany
| | - Christa Raak
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Medioni J, Scimeca D, Marquez YL, Leray E, Dalichampt M, Hoertel N, Bennani M, Trempat P, Boujedaini N. Benefits of Homeopathic Complementary Treatment in Patients With Breast Cancer: A Retrospective Cohort Study Based on the French Nationwide Healthcare Database. Clin Breast Cancer 2023; 23:60-70. [PMID: 36376237 DOI: 10.1016/j.clbc.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 09/21/2022] [Accepted: 10/01/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Complementary therapy in oncology aims to help patients better cope with the illness and side effects (SEs) of cancer treatments that affect their quality of life (QOL). This study aimed to assess the benefits of homeopathic treatment on the health-related QOL (HRQOL) of patients with non-metastatic breast cancer (BC) prescribed in postsurgical complementary therapy. PATIENTS AND METHODS An extraction from the French nationwide healthcare database targeted all patients who underwent mastectomy for newly diagnosed BC between 2012 and 2013. HRQOL was proxied by the quantity of medication used to palliate the SEs of cancer treatments. RESULTS A total of 98,009 patients were included (mean age: 61 ± 13 years). Homeopathy was used in 11%, 26%, and 22% of patients respectively during the 7 to 12 months before surgery, the 6 months before, and 6 months after. Thereafter, the use remained stable at 15% for 4 years. Six months after surgery, there was a significant overall decrease (RR = 0.88, confidence interval (CI)95 = 0.87-0.89) in the dispensing of medication associated with SEs in patients treated with ≥ 3 dispensing of homeopathy compared to none. The decrease appeared to be greater for immunostimulants (RR = 0.79, (CI)95 = 0.74-0.84), corticosteroids (RR = 0.82, (CI)95 = 0.79-0.85), and antidiarrheals (RR = 0.83, (CI)95 = 0.77-0.88). CONCLUSION The study showed an increasing use of homeopathy in patients with BC following diagnosis. This use was maintained after surgery and seemed to play a role in helping patients to better tolerate the SEs of cancer treatments.
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Affiliation(s)
- Jacques Medioni
- APHP Hôpital Européen Georges Pompidou, Paris, France; Université Paris Cité, Paris, France
| | | | | | - Emmanuelle Leray
- Univ Rennes, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, F-35000 Rennes, France
| | | | - Nicolas Hoertel
- Université Paris Cité, Paris, France; APHP Corentin Celton, Paris, France
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Burden of Atopic Dermatitis in Adults and Adolescents: a Systematic Literature Review. Dermatol Ther (Heidelb) 2022; 12:2653-2668. [PMID: 36197589 DOI: 10.1007/s13555-022-00819-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/15/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Although previously regarded as a children's disease, it is clear that atopic dermatitis (AD) is also highly prevalent in adults. Because AD is not associated with mortality, it is usually neglected compared with other, fatal diseases. However, several studies have highlighted that AD burden is significant due to its substantial humanistic burden and psychosocial effects. This study aims to summarize and quantify the clinical, economic, and humanistic burden of AD in adults and adolescents. METHODS A systematic literature search was performed in PubMed, Scopus, Cochrane, Centre for Reviews and Dissemination (CRD), EconPapers, The Professional Society for Health Economics and Outcomes Research (ISPOR), The National Institute for Health and Care Excellence (NICE), and The Canadian Agency for Drugs and Technologies in Health (CADTH). Studies were included if they reported clinical, economic, or humanistic effects of AD on adults or adolescents, from January 2011 to December 2020. The Grading of Recommendations Assessment tool was used to assess risk of bias for the included studies. Regression models were used to explain the correlation between factors such as disease severity and quality of life (QoL). RESULTS Among 3400 identified records, 233 studies were included. Itch, depression, sleep disturbance, and anxiety were the most frequently reported parameters related to the clinical and humanistic burden of AD. The average utility value in studies not stratifying patients by severity was 0.779. The average direct cost of AD was 4411 USD, while the average indirect cost was 9068 USD annually. CONCLUSIONS The burden of AD is significant. The hidden disease burden is reflected in its high indirect costs and the psychological effect on QoL. The magnitude of the burden is affected by the severity level. The main limitation of this study is the heterogeneity of different studies in terms of data reporting, which led to the exclusion of potentially relevant data points from the summary statistics.
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Niszczota P, Petrova D. Treatment choice in the presence of conflicting information: The role of physician likeability in the choice of non-proven therapies against conventional treatment. Br J Health Psychol 2021; 27:501-515. [PMID: 34542194 DOI: 10.1111/bjhp.12559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 09/02/2021] [Indexed: 11/27/2022]
Abstract
Research on why patients sometimes choose non-proven therapies (NPT) instead of conventional treatments is limited. We investigated how physician likeability influences the choice of NPT instead of conventional treatment. In an experiment with three medical scenarios, participants (N = 384) consulted two physicians who gave conflicting recommendations: The first physician recommended a conventional treatment and the second one recommended a NPT. We manipulated the likeability of the first physician, who was either likeable or unlikeable. Using mediation analyses, we explored how the effect of likeability was channelled and whether time pressure influenced treatment choice. Participants chose the NPT more often (OR = 1.43, 95% CI [1.03-2.00]), had more positive affective responses, and perceived more benefit from NPT when the conventional treatment was recommended by an unlikeable (vs. likeable) physician. Time pressure had no effect on treatment choice. Physicians' likeability might play an important role in treatment choice in the presence of conflicting information. Providers should be cognizant that poor communication might push patients to prefer the advice of more likeable physicians, even when they prescribe NPT instead of conventional treatment.
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Affiliation(s)
| | - Dafina Petrova
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Andalusian School of Public Health (Escuela Andaluza de Salud Pública), Granada, Spain.,Biomedical Research Institute ibs.GRANADA (Instituto de Investigación Biosanitaria ibs.GRANADA), Spain.,University of Granada, Spain
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Wilhelm M, Euteneuer F. Does Health Literacy Make a Difference? Comparing the Effect of Conventional Medicine Versus Homeopathic Prescribing on Treatment Credibility and Expectancy. Front Psychol 2021; 12:581255. [PMID: 34140910 PMCID: PMC8204743 DOI: 10.3389/fpsyg.2021.581255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective While homeopathic remedies are often used to treat non-specific complaints such as headaches, empirical evidence suggests their treatment effect is due to the placebo effect. Low health literacy seems to be connected to higher use of complementary and alternative medicine (CAM). The aim of this study was to examine what people with occasional headaches expect from conventional medicine or homeopathic remedies and if health literacy interacts with this expectation. Methods In this experimental study, n = 582 participants with occasional headaches were randomized to read one of two vignettes, which described the prescription of either conventional medicine or a homeopathic remedy. Subsequently, the participants were asked to rate treatment credibility and expectancy with regard to their assigned vignette. Health literacy was assessed as a potential moderator. Results Participants in the conventional medicine group rated treatment credibility and expectancy higher than in the homeopathic remedy group. Moderation analysis revealed that when being offered conventional medicine, participant reports of treatment credibility and expectancy decreased with lower health literacy, while these outcomes increased with lower health literacy for homeopathic remedies. Discussion People with occasional headaches estimate the effectiveness of conventional medication properly. However, health care professionals should pay special attention to patients with low health literacy, as they might need more time and information to give their informed consent.
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Affiliation(s)
- Marcel Wilhelm
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Frank Euteneuer
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany.,Department of Psychology, Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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Kass B, Icke K, Witt CM, Reinhold T. Effectiveness and cost-effectiveness of treatment with additional enrollment to a homeopathic integrated care contract in Germany. BMC Health Serv Res 2020; 20:872. [PMID: 32933511 PMCID: PMC7493372 DOI: 10.1186/s12913-020-05706-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A number of German statutory health insurance companies are offering integrated care contracts for homeopathy (ICCHs) that cover the reimbursement of homeopathic treatment. The effectiveness and cost-effectiveness of these contracts are highly debated. METHODS To evaluate the effectiveness and cost-effectiveness of treatment after an additional enrollment in an ICCH, a comparative, prospective, observational study was conducted in which participants in the ICCH (HOM group) were compared with matched (on diagnosis, sex and age) insured individuals (CON group) who received usual care alone. Those insured with either migraine or headache, allergic rhinitis, asthma, atopic dermatitis and depression were included. Primary effectiveness outcomes were the baseline adjusted scores of diagnosis-specific questionnaires (e.g. RQLQ, AQLQ, DLQI, BDI-II) after 6 months. Primary cost-effectiveness endpoints were the baseline adjusted total costs from an insurer perspective in relation to the achieved quality-adjusted life years (QALYs). Costs were derived from health claims data and QALYs were calculated based on SF-12 data. RESULTS Data from 2524 participants (1543 HOM group) were analyzed. The primary effectiveness outcomes after six months were statistically significant in favor of the HOM group for migraine or headache (Δ = difference between groups, days with headache: - 0.9, p = 0.042), asthma (Δ-AQLQ(S): + 0.4, p = 0.014), atopic dermatitis (Δ-DLQI: - 5.6, p ≤ 0.001) and depression (Δ-BDI-II: - 5.6, p ≤ 0.001). BDI-II differences reached the minimal clinically important difference. For all diagnoses, the adjusted mean total costs over 12 months were higher in the HOM group from an insurer perspective, with migraine or headache, atopic dermatitis and depression suggesting cost-effectiveness in terms of additional costs per QALY gained. CONCLUSION After an additional enrollment in the ICCH, the treatment of participants with depression showed minimally clinically relevant improvements. From an insurer perspective, treatment with an ICCH enrollment resulted in higher costs over all diagnoses but seemed to be cost-effective for migraine or headache, atopic dermatitis and depression according to international used threshold values. Based on the study design and further limitations, our findings should be considered cautiously and no conclusions regarding the effectiveness of specific treatment components can be made. Further research is needed to overcome limitations of this study and to confirm our findings. TRIAL REGISTRATION clinicaltrials.gov , NCT01854580. Registered 15 March 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01854580.
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Affiliation(s)
- Benjamin Kass
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Katja Icke
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia M Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Reinhold
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Sach T, McManus E, Levell N. Understanding economic evidence for the prevention and treatment of atopic eczema. Br J Dermatol 2019; 181:707-716. [PMID: 30693473 PMCID: PMC6790711 DOI: 10.1111/bjd.17696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Atopic eczema is an inflammatory skin condition, with a similar impact on health-related quality of life as other chronic diseases. Increasing pressures on resources within the National Health Service increase the importance of having good economic evidence to inform their allocation. OBJECTIVES To educate dermatologists about economic methods with reference to currently available economic evidence on eczema. METHODS The role of different types of economic evidence is illustrated by evidence found in a systematic literature search conducted across 12 online databases up to 22 May 2017. Primary empirical studies either reporting the results of a cost-of-illness study or evaluating the cost, utility or full economic evaluation of interventions for preventing or treating eczema were included. Two reviewers independently assessed studies for eligibility and performed data abstraction, with disagreements resolved by a third reviewer. Evidence tables of results were produced for narrative discussion. The reporting quality of economic evaluations was assessed. RESULTS Seventy-eight studies (described in 80 papers) were deemed eligible. Thirty-three (42%) were judged to be economic evaluations, 12 (15%) cost analyses, six (8%) utility analyses, 26 (33%) cost-of-illness studies and one a feasibility study (1%). The calcineurin inhibitors tacrolimus and pimecrolimus, as well as barrier creams, had the most economic evidence available. Partially hydrolysed infant formula was the most commonly evaluated prevention. CONCLUSIONS The current level of economic evidence for interventions aimed at preventing and treating eczema is limited compared with that available for clinical outcomes, suggesting that greater collaboration between clinicians and economists might be beneficial.
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Affiliation(s)
- T.H. Sach
- Health Economics Group, Norwich Medical SchoolUniversity of East AngliaNorwichNR4 7TJU.K.
| | - E. McManus
- Health Economics Group, Norwich Medical SchoolUniversity of East AngliaNorwichNR4 7TJU.K.
| | - N.J. Levell
- Dermatology DepartmentNorfolk and Norwich University Hospitals NHS Foundation TrustColney LaneNorwichNR4 7UYU.K.
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Efficacy of individualized homeopathy in bronchial asthma in adults: Double-blind, randomized, placebo-controlled, clinical trial in the context of usual care. ADVANCES IN INTEGRATIVE MEDICINE 2019. [DOI: 10.1016/j.aimed.2018.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Sundberg T, Hussain-Alkhateeb L, Inghilesi Larsson A, Sibbritt D, Falkenberg T. Exploring Sick Leave in Integrative Care-Retrospective Observations and Future Study Recommendations. J Altern Complement Med 2019; 25:377-384. [PMID: 30807200 DOI: 10.1089/acm.2018.0257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To describe and contrast the prevalence and trends of sick leave in patients with pain or stress disorders referred to inpatient care that integrates conventional and complementary therapies, that is, integrative care (IC). METHODS County council and social insurance data were used to retrospectively observe cross-sectional sick leave prevalence at four time points: 1 year before the first registered inpatient visit with the target diagnosis, after referral at index, and at 1 and 2 years after index. To contrast the IC findings, observations of patients with similar background characteristics referred to conventional care (CC) were used. RESULTS The sick leave prevalence of IC pain patients and IC stress patients increased from the preceding year to peak at index, where after it decreased back toward preindex levels over 2 years. Overall sick leave prevalence was higher in IC than in CC, where analogous but lower prevalence trends of sick leave changes were observed. CONCLUSIONS Observed sick leave prevalences, which were higher in IC than in CC, gradually decreased over time following IC or CC referral. While natural recovery or other reasons for change of sick leave cannot be excluded, future prospective and randomized clinical trials are recommended.
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Affiliation(s)
- Tobias Sundberg
- 1 Unit for Studies of Integrative Health Care, Division of Nursing, Department of Neurobiology Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.,2 Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Laith Hussain-Alkhateeb
- 3 Occupational and Environmental Medicine Unit, Department of Public Health and Community Medicine, University of Gothenburg, Göteborg, Sweden
| | | | - David Sibbritt
- 2 Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Torkel Falkenberg
- 1 Unit for Studies of Integrative Health Care, Division of Nursing, Department of Neurobiology Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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Gutknecht M, Reinert R, Augustin M. Review of health economic analyses in atopic dermatitis: how diverse is the literature? Expert Rev Pharmacoecon Outcomes Res 2018; 19:127-145. [DOI: 10.1080/14737167.2019.1549491] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Mandy Gutknecht
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Rabea Reinert
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), German Center for Health Services Research in Dermatology (CVderm), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Abstract
Homeopathy is used by just over 2% of the U.S. population, predominantly for respiratory, otorhinolaryngology, and musculoskeletal complaints. Individual users who see a homeopathic provider for care are more likely to perceive the therapy as helpful than those who do not; however, only 19% of users in the United States see a provider. The rest presumably rely upon over-the-counter products. Recent clinical trials highlight several areas in which homeopathy may play a role in improving public health, including infectious diseases, pain management, mental health, and cancer care. This review examines recent studies in these fields, studies assessing costs associated with homeopathic care, safety, and regulations in the United States. Data suggest the potential for public health benefit from homeopathy, especially for conditions such as upper respiratory infections and fibromyalgia.
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Affiliation(s)
- Michelle L. Dossett
- Benson-Henry Institute for Mind Body Medicine and Division of General Internal Medicine, Massachusetts General Hospital, 151 Merrimac St., 4 floor, Boston, MA, 02114 USA
| | - Gloria Y. Yeh
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave., CO-215, Boston, MA 02215 USA
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Vandenplas O, Vinnikov D, Blanc PD, Agache I, Bachert C, Bewick M, Cardell LO, Cullinan P, Demoly P, Descatha A, Fonseca J, Haahtela T, Hellings PW, Jamart J, Jantunen J, Kalayci Ö, Price D, Samolinski B, Sastre J, Tian L, Valero AL, Zhang X, Bousquet J. Impact of Rhinitis on Work Productivity: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:1274-1286.e9. [PMID: 29017832 DOI: 10.1016/j.jaip.2017.09.002] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/02/2017] [Accepted: 09/06/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) is increasingly acknowledged as having a substantial socioeconomic impact associated with impaired work productivity, although available information remains fragmented. OBJECTIVE This systematic review summarizes recently available information to provide a quantitative estimate of the burden of AR on work productivity including lost work time (ie, absenteeism) and reduced performance while working (ie, presenteeism). METHODS A Medline search retrieved original studies from 2005 to 2015 pertaining to the impact of AR on work productivity. A pooled analysis of results was carried out with studies reporting data collected through the validated Work Productivity and Activity Impairment (WPAI) questionnaire. RESULTS The search identified 19 observational surveys and 9 interventional studies. Six studies reported economic evaluations. Pooled analysis of WPAI-based studies found an estimated 3.6% (95% confidence interval [CI], 2.4; 4.8%) missed work time and 35.9% (95% CI, 29.7; 42.1%) had impairment in at-work performance due to AR. Economic evaluations indicated that indirect costs associated with lost work productivity are the principal contributor to the total AR costs and result mainly from impaired presenteeism. The severity of AR symptoms was the most consistent disease-related factor associated with a greater impact of AR on work productivity, although ocular symptoms and sleep disturbances may independently affect work productivity. Overall, the pharmacologic treatment of AR showed a beneficial effect on work productivity. CONCLUSIONS This systematic review provides summary estimates of the magnitude of work productivity impairment due to AR and identifies its main determinant factors. This information may help guide both clinicians and health policy makers.
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Affiliation(s)
- Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium.
| | - Denis Vinnikov
- Department of Biostatistics and Evidence-Based Medicine, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Paul D Blanc
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, San Francisco, Calif
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | | | - Lars-Olaf Cardell
- Department of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Paul Cullinan
- Department of Occupational and Environmental Medicine, Royal Brompton Hospital and Imperial College (NHLI), London, UK
| | - Pascal Demoly
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - Alexis Descatha
- AP-HP, Occupational Health Department, Unité de pathologie professionnelle, University Hospital of West Suburb of Paris, Poincaré, Garches, and Versailles St-Quentin University, INSERM, Villejuif, France
| | - Joao Fonseca
- Center for Health Technology and Services Research-CINTESIS, Faculdade de Medicina, Universidade do Porto; and Allergy Unit, CUF Porto Instituto & Hospital, Porto, Portugal
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Peter W Hellings
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Jacques Jamart
- Scientific Support Unit, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Juha Jantunen
- South Karelia Allergy and Environment Institute, Imatra, Finland
| | - Ömer Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, UK; Academic Centre of Primary Care, University of Aberdeen, Aberdeen, UK
| | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Joaquin Sastre
- Allergy Department, Fundacion Jimenez Diaz, Universidad Autonoma de Madrid, CIBER de Enfermedades Respiratorias (CIBERES), Institute Carlos III, Madrid, Spain
| | - Longxiu Tian
- Ross School of Business, University of Michigan, Ann Arbor, Mich
| | - Antonio L Valero
- Pneumology and Allergy Department Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
| | | | - Jean Bousquet
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France; INSERM, VIMA: Ageing and chronic diseases Epidemiological and public health approaches, U1168, Paris, France; UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Versailles, France
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Ostermann JK, Witt CM, Reinhold T. A retrospective cost-analysis of additional homeopathic treatment in Germany: Long-term economic outcomes. PLoS One 2017; 12:e0182897. [PMID: 28915242 PMCID: PMC5600367 DOI: 10.1371/journal.pone.0182897] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 07/24/2017] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES This study aimed to provide a long-term cost comparison of patients using additional homeopathic treatment (homeopathy group) with patients using usual care (control group) over an observation period of 33 months. METHODS Health claims data from a large statutory health insurance company were analysed from both the societal perspective (primary outcome) and from the statutory health insurance perspective (secondary outcome). To compare costs between patient groups, homeopathy and control patients were matched in a 1:1 ratio using propensity scores. Predictor variables for the propensity scores included health care costs and both medical and demographic variables. Health care costs were analysed using an analysis of covariance, adjusted for baseline costs, between groups both across diagnoses and for specific diagnoses over a period of 33 months. Specific diagnoses included depression, migraine, allergic rhinitis, asthma, atopic dermatitis, and headache. RESULTS Data from 21,939 patients in the homeopathy group (67.4% females) and 21,861 patients in the control group (67.2% females) were analysed. Health care costs over the 33 months were 12,414 EUR [95% CI 12,022-12,805] in the homeopathy group and 10,428 EUR [95% CI 10,036-10,820] in the control group (p<0.0001). The largest cost differences were attributed to productivity losses (homeopathy: EUR 6,289 [6,118-6,460]; control: EUR 5,498 [5,326-5,670], p<0.0001) and outpatient costs (homeopathy: EUR 1,794 [1,770-1,818]; control: EUR 1,438 [1,414-1,462], p<0.0001). Although the costs of the two groups converged over time, cost differences remained over the full 33 months. For all diagnoses, homeopathy patients generated higher costs than control patients. CONCLUSION The analysis showed that even when following-up over 33 months, there were still cost differences between groups, with higher costs in the homeopathy group.
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Affiliation(s)
- Julia K. Ostermann
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - University Medical Center, Berlin, Germany
- * E-mail:
| | - Claudia M. Witt
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - University Medical Center, Berlin, Germany
- University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, Maryland, United States of America
| | - Thomas Reinhold
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - University Medical Center, Berlin, Germany
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16
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Ostermann T, Baars E, McDaid D. Time to stand up and be counted: The need for an economic case for investment. Complement Ther Med 2016; 27:137-8. [PMID: 27515888 DOI: 10.1016/j.ctim.2016.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Thomas Ostermann
- Department of Psychology and Psychotherapy, University of Witten/Herdecke, 58448 Witten, Germany.
| | - Erik Baars
- University of Applied Sciences, 2333 CK Leiden, Netherlands; Department of Healthcare and Nutrition, Louis Bolk Institute, 3972 LA Driebergen, Netherlands
| | - David McDaid
- Personal Social Services Research Unit, London School of Economics and Political Science, London WC2A 2AE, UK.
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