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Sivaprasad S, Bailey C, Downey L, Gilbert R, Gale R, Kotagiri A, Mahmood S, Morgan-Warren P, Napier J, Narendran N, Pearce I, Rennie C, Talks J, Wojcik R, Jandhyala R. Real-world service costs for neovascular-AMD clinics in the United Kingdom: structured literature review and scenario analysis. Curr Med Res Opin 2024; 40:1221-1233. [PMID: 38814914 DOI: 10.1080/03007995.2024.2362278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/28/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVE Current cost-effectiveness analyses (CEA) emphasize drug costs as the differentiator between NICE recommended anti-VEGF treatments but may neglect real-world non-drug costs of running nAMD services in the UK. To address this, this study identified real-world non-drug service cost items relevant to UK NHS nAMD clinics, including costs arising from operational strain (demand exceeding capacity). METHODS Cost items were identified by a structured literature review of peer-reviewed and grey literature, and an expert panel of 10 UK-based ophthalmologists with relevance to real-world practice. These items underwent meta-synthesis and were then determined in a consensus exercise. RESULTS Of 237 cost items identified, 217 (91.6%) met the consensus threshold of >0.51 and were included in the nAMD Service Non-Drug Cost Instrument (nAS). Sensitivity of cost items taken from UK Health Technology Assessment (HTA) using the nAS as the reference standard was low (HTAmin: 1.84%, 95% CI 0.50-4.65%; HTAmax: 70.51%, 95% CI 63.96-76.49%). False negative rates showed variable likelihood of misclassifying a service by cost burden depending on prevalence. Scenario analysis using cost magnitudes estimated annual per-patient clinic cost at £845 (within capacity) to £13,960 (under strain) compared to an HTAmin estimate of £210. Accounting for cost of strain under an assumed 50% increase in health resource utilization influenced cost-effectiveness in a hypothetical genericisation scenario. CONCLUSION Findings suggested that HTA underestimates UK NHS nAMD clinic cost burden with cost of strain contributing substantial additional unmeasured expense with impact on CEA. Given potential undertreatment due to strain, durability is suggested as one of the relevant factors in CEA of nAMD anti-VEGF treatments due to robustness under limited capacity conditions affecting UK ophthalmology services.
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Affiliation(s)
- Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Clare Bailey
- University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Louise Downey
- Ophthalmology Research Team, Hull and East Yorkshire Hospital, UK
| | - Rose Gilbert
- Department of Ophthalmology, Bayer PLC, Reading, UK
| | - Richard Gale
- Department of Ophthalmology, Bayer PLC, Reading, UK
- Ophthalmology and Clinical Visual Science, Hull York Medical School, University of York, York, UK
- Department of Ophthalmology, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Ajay Kotagiri
- Sunderland Eye Infirmary, South Tyneside and Sunderland NHS Foundation Trust, South Shields UK
| | - Sajjad Mahmood
- Manchester Eye Hospital, University of Manchester, Manchester, UK
| | | | | | - Nirodhini Narendran
- Department of Ophthalmology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Ian Pearce
- Department of Ophthalmology, Royal Liverpool and Broadgreen University Hospitals NHS Foundation Trust, UK
| | - Christina Rennie
- Department of Ophthalmology, University Hospital Southampton NHS Foundation Trust, UK
| | - James Talks
- Department of Ophthalmology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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Murphy JP, Kgowedi S, Naidoo N, Girdwood S, Jamieson L, Soeteman D, Resch S, Meyer-Rath G. Role of data from cost and other economic analyses in healthcare decision-making for HIV, TB and sexual/reproductive health programmes in South Africa. Health Policy Plan 2021; 36:1545-1551. [PMID: 34212192 PMCID: PMC8597963 DOI: 10.1093/heapol/czab071] [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: 02/11/2021] [Revised: 05/23/2021] [Accepted: 06/13/2021] [Indexed: 11/19/2022] Open
Abstract
An increasing focus on the use of the results of cost analyses and other economic evaluations in health programme decision-making by governments, donors and technical support partners working in low- and middle-income countries is accompanied by recognition that this use is impeded by several factors, including the lack of skills, data and coordination between spheres of the government. We describe our experience generating economic evaluation data for human immunodeficiency virus, tuberculosis and sexual/reproductive health programmes in South Africa alongside the results of a series of in-depth interviews (IDIs) among decision-makers within the South African government and implementing organizations (data users) and producers of economic evaluations (data producers). We summarize results across (1) the process of implementing a new intervention; (2) barriers to the use of cost data and suggested solutions and (3) the transferability of experiences to the planned South African implementation of universal health coverage (UHC). Based on our experience and the IDIs, we suggest concrete steps towards the improvement of economic data use in the planning and the establishment of structures mandated under the transition to UHC. Our key recommendations include the following: (1) compile a publicly available and regularly updated in-country cost repository; (2) increase the availability of programmatic outcomes data at the aggregate level; (3) agree upon and implement a set of primary decision criteria for the adoption and funding of interventions; (4) combine the efforts of health economics institutions into a stringent system for health technology assessments and (5) improve the link between national and provincial planning and budgeting.
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Affiliation(s)
- Joshua P Murphy
- Health Economics and Epidemiology Research Office (HE2RO), University of the Witwatersrand, 39 Empire Rd, Johannesburg 2193, South Africa
| | - Sharon Kgowedi
- Health Economics and Epidemiology Research Office (HE2RO), University of the Witwatersrand, 39 Empire Rd, Johannesburg 2193, South Africa
| | - Nalini Naidoo
- Health Economics and Epidemiology Research Office (HE2RO), University of the Witwatersrand, 39 Empire Rd, Johannesburg 2193, South Africa
| | - Sarah Girdwood
- Health Economics and Epidemiology Research Office (HE2RO), University of the Witwatersrand, 39 Empire Rd, Johannesburg 2193, South Africa
| | - Lise Jamieson
- Health Economics and Epidemiology Research Office (HE2RO), University of the Witwatersrand, 39 Empire Rd, Johannesburg 2193, South Africa
| | - Djøra Soeteman
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, Boston, MA 02115, USA
| | - Stephen Resch
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Ave, Boston, MA 02115, USA
| | - Gesine Meyer-Rath
- Health Economics and Epidemiology Research Office (HE2RO), University of the Witwatersrand, 39 Empire Rd, Johannesburg 2193, South Africa.,Department of Global Health, School of Public Health, Boston University, 801 Massachusetts Ave, Boston, MA 02118, USA
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Bedson E, Bell D, Carr D, Carter B, Hughes D, Jorgensen A, Lewis H, Lloyd K, McCaddon A, Moat S, Pink J, Pirmohamed M, Roberts S, Russell I, Sylvestre Y, Tranter R, Whitaker R, Wilkinson C, Williams N. Folate Augmentation of Treatment--Evaluation for Depression (FolATED): randomised trial and economic evaluation. Health Technol Assess 2015; 18:vii-viii, 1-159. [PMID: 25052890 DOI: 10.3310/hta18480] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Folate deficiency is associated with depression. Despite the biological plausibility of a causal link, the evidence that adding folate enhances antidepressant treatment is weak. OBJECTIVES (1) Estimate the clinical effectiveness and cost-effectiveness of folic acid as adjunct to antidepressant medication (ADM). (2) Explore whether baseline folate and homocysteine predict response to treatment. (3) Investigate whether response to treatment depends on genetic polymorphisms related to folate metabolism. DESIGN FolATED (Folate Augmentation of Treatment - Evaluation for Depression) was a double-blind and placebo-controlled, but otherwise pragmatic, randomised trial including cost-utility analysis. To yield 80% power of detecting standardised difference on the Beck Depression Inventory version 2 (BDI-II) of 0.3 between groups (a 'small' effect), FolATED trialists sought to analyse 358 participants. To allow for an estimated loss of 21% of participants over three time points, we planned to randomise 453. SETTINGS Clinical - Three centres in Wales - North East Wales, North West Wales and Swansea. Trial management - North Wales Organisation for Randomised Trials in Health in Bangor University. Biochemical analysis - University Hospital of Wales, Cardiff. Genetic analysis - University of Liverpool. PARTICIPANTS Four hundred and seventy-five adult patients presenting to primary or secondary care with confirmed moderate to severe depression for which they were taking or about to start ADM, and able to consent and complete assessments, but not (1) folate deficient, vitamin B12 deficient, or taking folic acid or anticonvulsants; (2) misusing drugs or alcohol, or suffering from psychosis, bipolar disorder, malignancy or other unstable or terminal illness; (3) (planning to become) pregnant; or (4) participating in other clinical research. INTERVENTIONS Once a day for 12 weeks experimental participants added 5 mg of folic acid to their ADM, and control participants added an indistinguishable placebo. All participants followed pragmatic management plans initiated by a trial psychiatrist and maintained by their general medical practitioners. MAIN OUTCOME MEASURES Assessed at baseline, and 4, 12 and 25 weeks thereafter, and analysed by 'area under curve' (main); by analysis of covariance at each time point (secondary); and by multi-level repeated measures (sensitivity analysis): Mental health - BDI-II (primary), Clinical Global Impression (CGI), Montgomery-Åsberg Depression Rating Scale (MADRS), UKU side effects scale, and Mini International Neuropsychiatric Interview (MINI) suicidality subscale; General health - UK 12-item Short Form Health Survey (SF-12), European Quality of Life scale - 5 Dimensions (EQ-5D); Biochemistry - serum folate, B12, homocysteine; Adherence - Morisky Questionnaire; Economics - resource use. RESULTS Folic acid did not significantly improve any of these measures. For example it gained a mean of just 2.9 quality-adjusted life-days [95% confidence interval (CI) from -12.7 to 7.0 days] and saved a mean of just £48 (95% CI from -£292 to £389). In contrast it significantly reduced mental health scores on the SF-12 by 3.0% (95% CI from -5.2% to -0.8%). CONCLUSIONS The FolATED trial generated no evidence that folic acid was clinically effective or cost-effective in augmenting ADM. This negative finding is consistent with improving understanding of the one-carbon folate pathway suggesting that methylfolate is a better candidate for augmenting ADM. Hence the findings of FolATED undermine treatment guidelines that advocate folic acid for treating depression, and suggest future trials of methylfolate to augment ADM. TRIAL REGISTRATION Current Controlled Trials ISRCTN37558856. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 18, No. 48. See the HTA programme website for further project information.
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Affiliation(s)
- Emma Bedson
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Diana Bell
- Ysbyty Gwynedd, Betsi Cadwalladr University Health Board, Bangor, UK
| | - Daniel Carr
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | - Ben Carter
- School of Medicine, Cardiff University, Cardiff, UK
| | - Dyfrig Hughes
- Centre for Economics and Policy in Health, Bangor University, Bangor, UK
| | - Andrea Jorgensen
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Helen Lewis
- Department of Health Sciences, University of York, York, UK
| | - Keith Lloyd
- College of Medicine, Swansea University, Swansea, UK
| | - Andrew McCaddon
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Stuart Moat
- Medical Biochemistry & Immunology, University Hospital of Wales, Cardiff, UK
| | - Joshua Pink
- Centre for Economics and Policy in Health, Bangor University, Bangor, UK
| | - Munir Pirmohamed
- Wolfson Centre for Personalised Medicine, University of Liverpool, Liverpool, UK
| | - Seren Roberts
- Centre for Mental Health & Society, Bangor University, Bangor, UK
| | - Ian Russell
- College of Medicine, Swansea University, Swansea, UK
| | | | - Richard Tranter
- Department of Psychological Medicine, University of Otago, Christchurch, NZ
| | - Rhiannon Whitaker
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Clare Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Nefyn Williams
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
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Thorn JC, Noble SM, Hollingworth W. Methodological developments in randomized controlled trial-based economic evaluations. Expert Rev Pharmacoecon Outcomes Res 2014; 14:843-56. [PMID: 25179207 DOI: 10.1586/14737167.2014.953934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Economic evaluation is a key contributor to decision making in health care, and it is important that it is carried out as effectively and reliably as possible. Studies carried out alongside randomised controlled trials are required to contribute real-world evidence to the decision-making process. However, the requirement that resource use be measured as well as effectiveness data within a trial results in additional complexity for trialists, and there are a number of methodological areas in which improvement is needed. This article reviews the literature in methodological work carried out to inform economic evaluation studies conducted alongside randomised controlled trials. Recent advances in areas including overall trial design, measuring resource use, measuring outcomes and reporting economic evaluations are discussed.
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Affiliation(s)
- Joanna C Thorn
- MRC ConDuCT Hub, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Tetteh E, Morris S. Systematic review of drug administration costs and implications for biopharmaceutical manufacturing. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:445-456. [PMID: 23846573 DOI: 10.1007/s40258-013-0045-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The acquisition costs of biologic drugs are often considered to be relatively high compared with those of nonbiologics. However, the total costs of delivering these drugs also depend on the cost of administration. Ignoring drug administration costs may distort resource allocation decisions because these affect cost effectiveness. OBJECTIVES The objectives of this systematic review were to develop a framework of drug administration costs that considers both the costs of physical administration and the associated proximal costs; and, as a case example, to use this framework to evaluate administration costs for biologics within the UK National Health Service (NHS). METHODS We reviewed literature that reported estimates of administration costs for biologics within the UK NHS to identify how these costs were quantified and to examine how differences in dosage forms and regimens influenced administration costs. The literature reviewed were identified by searching the Centre for Review and Dissemination Databases (DARE, NHS EED and HTA); EMBASE (The Excerpta Medica Database); MEDLINE (using the OVID interface); Econlit (EBSCO); Tufts Medical Center Cost Effectiveness Analysis (CEA) Registry; and Google Scholar. RESULTS We identified 4,344 potentially relevant studies, of which 43 studies were selected for this systematic review. We extracted estimates of the administration costs of biologics from these studies. We found evidence of variation in the way that administration costs were measured, and that this affected the magnitude of costs reported, which could then influence cost effectiveness. CONCLUSIONS Our findings suggested that manufacturers of biologic medicines should pay attention to formulation issues and their impact on administration costs, because these affect the total costs of healthcare delivery and cost effectiveness.
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Affiliation(s)
- Ebenezer Tetteh
- Department of Applied Health Research, EPSRC Centre for Innovative Manufacturing in Emergent Macromolecular Therapies, University College of London, 1-19 Torrington Place, London, WC1E 7HB, UK,
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Stoddart A, Hanley J, Wild S, Pagliari C, Paterson M, Lewis S, Sheikh A, Krishan A, Padfield P, McKinstry B. Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial. BMJ Open 2013; 3:e002681. [PMID: 23793650 PMCID: PMC3657667 DOI: 10.1136/bmjopen-2013-002681] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 04/11/2013] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To compare the costs and cost-effectiveness of managing patients with uncontrolled blood pressure (BP) using telemonitoring versus usual care from the perspective of the National Health Service (NHS). DESIGN Within trial post hoc economic evaluation of data from a pragmatic randomised controlled trial using an intention-to-treat approach. SETTING 20 socioeconomically diverse general practices in Lothian, Scotland. PARTICIPANTS 401 primary care patients aged 29-95 with uncontrolled daytime ambulatory blood pressure (ABP) (≥135/85, but <210/135 mm Hg). INTERVENTION Participants were centrally randomised to 6 months of a telemonitoring service comprising of self-monitoring of BP transmitted to a secure website for review by the attending nurse/doctor and patient, with optional automated patient decision-support by text/email (n=200) or usual care (n-201). Randomisation was undertaken with minimisation for age, sex, family practice, use of three or more hypertension drugs and self-monitoring history. MAIN OUTCOME MEASURES Mean difference in total NHS costs between trial arms and blinded assessment of mean cost per 1 mm Hg systolic BP point reduced. RESULTS Home telemonitoring of BP costs significantly more than usual care (mean difference per patient £115.32 (95% CI £83.49 to £146.63; p<0.001)). Increased costs were due to telemonitoring service costs, patient training and additional general practitioner and nurse consultations. The mean cost of systolic BP reduction was £25.56/mm Hg (95% CI £16.06 to £46.89) per patient. CONCLUSIONS Over the 6-month trial period, supported telemonitoring was more effective at reducing BP than usual care but also more expensive. If clinical gains are maintained, these additional costs would be very likely to be compensated for by reductions in the cost of future cardiovascular events. Longer-term modelling of costs and outcomes is required to fully examine the cost-effectiveness implications. TRIAL REGISTRATION International Standard Randomised Controlled Trials, number ISRCTN72614272.
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Affiliation(s)
- Andrew Stoddart
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, Midlothian, UK
| | - Janet Hanley
- School of Nursing, Midwifery and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Sarah Wild
- The University of Edinburgh, Centre for Population Health Sciences, Edinburgh, UK
| | - Claudia Pagliari
- The University of Edinburgh, Centre for Population Health Sciences, Edinburgh, UK
| | - Mary Paterson
- The University of Edinburgh, Centre for Population Health Sciences, Edinburgh, UK
| | - Steff Lewis
- The University of Edinburgh, Centre for Population Health Sciences, Edinburgh, UK
| | - Aziz Sheikh
- The University of Edinburgh, Centre for Population Health Sciences, Edinburgh, UK
| | - Ashma Krishan
- Edinburgh Clinical Trials Unit, University of Edinburgh, Western General Hospital, Edinburgh, Midlothian, UK
| | | | - Brian McKinstry
- The University of Edinburgh, Centre for Population Health Sciences, Edinburgh, UK
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Poquet Jornet J, Carrera-Hueso F, Gasent Blesa J, Peris Godoy M. Aspectos farmacoeconómicos de los citostáticos orales. FARMACIA HOSPITALARIA 2011; 35 Suppl 2:25-31. [DOI: 10.1016/s1130-6343(11)70019-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Shi L, Hodges M, Drummond M, Ahn J, Li SC, Hu S, Augustovski F, Hay JW, Smeeding J. Good research practices for measuring drug costs in cost-effectiveness analyses: an international perspective: the ISPOR Drug Cost Task Force report--Part VI. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2010; 13:28-33. [PMID: 19883403 DOI: 10.1111/j.1524-4733.2009.00662.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The pharmacoeconomic guidelines available in the literature or promulgated in many countries are either vague or silent about how drug costs should be established or measured so an international comparison of cost-effectiveness analysis (CEA) results can be made. The objective of this report is to provide guidance and recommendations on how drug costs should be measured for CEAs done from an internationally comparative perspective. METHODS Members of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Task Force on Good Research Practices-Use of Drug Costs for Cost Effectiveness Analysis (Drug Cost Task Force [DCTF]) subgroup from several countries were experienced developers or users of CEA models, and worked in academia, industry, and as advisors to governments. They solicited comments on drafts from a core group of 174 external reviewers and more broadly, from the members of the ISPOR at the ISPOR 12th Annual International meeting and via the ISPOR Web site. RESULTS Drug units should be standardized in terms of volume of active ingredient, regardless of packaging and dosing strength variations across countries. Drug costs should be measured in local currency per unit of active ingredient and should be converted to other currencies using sensitivity analyses of purchasing power parities (PPP) and exchange rates, whichever is more appropriate. When using drug prices from different years, the consumer price index for the local currency should be applied before the PPP and/or exchange rate conversion. CONCLUSION CEA researchers conducting international pharmacoeconomic analysis should tailor the appropriate measure of drug costs to the international perspective, to maintain clarity and transparency on drug cost measurement in the context of international drug comparison and report the sensitivity of CEA results to reasonable cost conversions.
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Affiliation(s)
- Lizheng Shi
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
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Journal Watch. Pharmaceut Med 2009. [DOI: 10.1007/bf03256774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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