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Richards F, Kodjamanova P, Chen X, Li N, Atanasov P, Bennetts L, Patterson BJ, Yektashenas B, Mesa-Frias M, Tronczynski K, Buyukkaramikli N, El Khoury AC. Economic Burden of COVID-19: A Systematic Review. Clinicoecon Outcomes Res 2022; 14:293-307. [PMID: 35509962 PMCID: PMC9060810 DOI: 10.2147/ceor.s338225] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/23/2022] [Indexed: 12/26/2022]
Abstract
Objective To review and qualitatively synthesize the evidence related to the economic burden of COVID-19, including healthcare resource utilization and costs. Methods A systematic review of studies that assessed the economic burden [eg, direct costs, productivity, macroeconomic impact due to non-pharmaceutical interventions (NPIs) and equity] of COVID-19 was conducted by searches in EMBASE, MEDLINE, MEDLINE-IN-PROCESS, and The Cochrane Library, as well as manual searches of unpublished research for the period between January 2020 to February 2021. Single reviewer data extraction was confirmed independently by a second reviewer. Results The screening process resulted in a total of 27 studies: 25 individual publications, and 2 systematic literature reviews, of narrower scopes, that fulfilled the inclusion criteria. The patients diagnosed with more severe COVID-19 were associated with higher costs. The main drivers for higher costs were consistent across countries and included ICU admission, in-hospital resource use such as mechanical ventilation, which lead to increase costs of $2082.65 ± 345.04 to $2990.76 ± 545.98. The most frequently reported indirect costs were due to productivity losses. On average, older COVID-19 patients incurred higher costs when compared to younger age groups. An estimation of a 20% COVID-19 infection rate based on a Monte Carlo simulation in the United States led to a total direct medical cost of $163.4 billion over the course of the pandemic. Conclusion The COVID-19 pandemic has generated a considerable economic burden on patients and the general population. Preventative measures such as NPIs only have partial success in lowering the economic costs of the pandemic. Implementing additional preventative measures such as large-scale vaccination is vital in reducing direct and indirect medical costs, decreased productivity, and GDP losses.
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Affiliation(s)
| | | | - Xue Chen
- HEMA Amaris, Shanghai, People's Republic of China
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Nicholson S, Peterson J, Yektashenas B. Pharmaceutical industry perspective on risk evaluation and mitigation strategies: manufacturer take heed. Expert Opin Drug Saf 2012; 11:299-314. [DOI: 10.1517/14740338.2012.650689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Peterson J, Yektashenas B, Fisher AC. Levofloxacin for the treatment of pneumonia caused by Streptococcus pneumoniae including multidrug-resistant strains: pooled analysis. Curr Med Res Opin 2009; 25:559-68. [PMID: 19196225 DOI: 10.1185/03007990802694741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the clinical and microbiologic efficacy of levofloxacin for the treatment of subjects with pneumonia caused by multidrug-resistant (MDR) Streptococcus pneumoniae (MDRSP) and non-MDRSP strains. RESEARCH DESIGN AND METHODS A pooled analysis was conducted using data from ten clinical studies in pneumonia: five comparative studies and five noncomparative studies conducted from 1992 to 2002. This analysis included data from levofloxacin-treated subjects with S. pneumoniae isolated at study entry. Susceptibility of S. pneumoniae isolated from subjects at study entry was determined against representative agents from five antimicrobial classes: tetracyclines, sulfonamides, second-generation cephalosporins, penicillins, and macrolides. Isolates were classified as MDRSP (based on resistance to two or more antimicrobial classes) or non-MDRSP (intermediate resistance or susceptible to all classes or resistant to 1 antimicrobial class). Clinical and microbiologic efficacy of levofloxacin (i.v., p.o., or i.v./p.o. for 5 to 14 days) in the microbiologically evaluable population was determined at post-therapy; a test for homogeneity of the odds ratio of the difference in clinical success for comparative versus noncomparative studies was performed. MAIN OUTCOME MEASURES AND RESULTS The main outcome measures were clinical success rates and microbiologic eradication rates of 419 microbiologically evaluable levofloxacin-treated subjects with MDRSP or non-MDRSP. Clinical success rates were 96.3% (52/54) and 95.1% (347/365), respectively (difference -1.2; 95% confidence interval [CI]: -6.7, 4.3). Similarly, per pathogen microbiologic eradication rates for MDRSP and non-MDRSP were 96.3% (52/54) and 95.6% (350/366), respectively (difference -0.7; 95% CI: -6.1, 4.8). Study limitations include the use of data from comparative and noncomparative studies. A test for homogeneity of the odds ratios for clinical success in comparative versus noncomparative studies showed no significant difference (p = 0.27). CONCLUSIONS These data support the use of levofloxacin for patients with community-acquired pneumonia caused by S. pneumoniae, including MDR strains.
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Affiliation(s)
- Janet Peterson
- Ortho-McNeil Janssen Scientific Affairs, LLC, Raritan, NJ 08869, USA.
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Moyo VM, Lefebvre P, Vekeman F, Duh MS, Yektashenas B, Mundle S. Comparison of erythroid response (ER) rates to epoetin alfa (EPO) alone or in combination versus non-erythropoiesis-stimulating agents (non-ESAs) in treatment-naïve anemic MDS patients: A meta-analysis approach. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.7094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Moyo V, Lefebvre P, Duh MS, Yektashenas B, Mundle S. Erythropoiesis-stimulating agents in the treatment of anemia in myelodysplastic syndromes: a meta-analysis. Ann Hematol 2008; 87:527-36. [DOI: 10.1007/s00277-008-0450-7] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 01/23/2008] [Indexed: 11/24/2022]
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Moyo VM, Lefebvre P, Duh M, Yektashenas B, Mundle S. Treating the anemia of MDS with erythropoietin: Impact of higher dose compared to combination with G/GM-CSF. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7082 Background: Recombinant human erythropoietin (EPO) is extensively used to improve erythropoiesis and reduce transfusions in anemic MDS pts. The addition of G/GM-CSF to EPO alfa or beta has been associated with higher erythroid response (ER) rates vs. EPO alone. Studies suggest higher ER rates could be achieved with EPO monotherapy if higher initiation doses were used. To study this question a meta-analysis was performed on studies of MDS pts treated with EPO alfa or beta + G/GM-CSF. Methods: Data extraction was performed on studies from PubMed, ASCO and ASH proceedings from 1990–2006 in MDS pts treated with EPO (alfa or beta) ± G/GM-CSF. To allow for cross comparisons, only studies including IWG or IWG-like ER criteria were selected for analysis. Pooled estimates of ER rates were calculated using fixed-effect (F-E) meta-analysis methods. Results were stratified by: (i) EPO-alfa at standard doses, (ii) EPO- alfa at high doses, (iii) EPO-alfa + G/GM-CSF, and (iv) EPO-beta + G/GM-CSF. Results: From 39 studies identified, 19 met inclusion criteria. Most pts (>55%) had RA/RARS. Studies using EPO-alfa at standard doses showed comparable ER rates to studies using EPO- alfa + G/GM-CSF (49.0% vs. 50.6%; p=0.731) ( Table ). Among EPO-alfa studies, those using higher EPO doses had higher ER rates vs. studies using standard EPO doses (p<0.001) or EPO + G/GM-CSF combination (p=0.007). Overall ER rates were not available for studies using EPO- beta + G/GM-CSF, however, 52 pts (37.7%) had major ER, similar to that observed in all EPO-alfa monotherapy studies (195/589=33.1%). Conclusions: These findings suggest increasing EPO-alfa dose may have a greater impact on ER than addition of G/GM-CSF. Further validation is warranted. [Table: see text] [Table: see text]
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Affiliation(s)
- V. M. Moyo
- Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Groupe d’Analyse, Montréal, PQ, Canada; Analysis Group Inc, Boston, MA
| | - P. Lefebvre
- Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Groupe d’Analyse, Montréal, PQ, Canada; Analysis Group Inc, Boston, MA
| | - M. Duh
- Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Groupe d’Analyse, Montréal, PQ, Canada; Analysis Group Inc, Boston, MA
| | - B. Yektashenas
- Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Groupe d’Analyse, Montréal, PQ, Canada; Analysis Group Inc, Boston, MA
| | - S. Mundle
- Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Groupe d’Analyse, Montréal, PQ, Canada; Analysis Group Inc, Boston, MA
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Moyo V, Lefebvre P, Duh MS, Bourezak A, Yektashenas B, Woodman RC, Mundle S. Erythroid response (ER) rates in myelodysplastic syndromes (MDS) patients treated with epoetin alfa (EPO): A meta-analysis using the International Working Group criteria (IWGc) for MDS response. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6572 Background: Refractory anemia is a clinical hallmark of MDS. The most consistently used therapy for this anemia is EPO. Prior to the introduction of IWGc in 1997, ER rates varied substantially between studies. The present meta-analysis was undertaken to compare ER rates in studies of EPO-treated patients in MDS when defined by either IWGc or non-IWGc. Methods: A systematic review and data extraction of studies published from 1990–2005 in MDS patients treated with EPO was performed and yielded 21 studies evaluating a total of 895 patients. Pooled estimates of ER rates, stratified by IWGc, were calculated using random-effects meta-analysis methods, which incorporated both between- and within-study variations. Univariate meta-regression analyses were conducted to identify study characteristics that were significant determinants of ER rate. Results: Ten studies (604 patients) used the IWGc to define ER (overall, major, minor), while 11 studies (291 patients) used other definitions. Mean age for all patients was 70.6 years; 45% women. Mean baseline (BL) serum erythropoietin level and proportion of patients with refractory anemia or refractory anemia with ringed sideroblasts were comparable between studies; however, the proportion of transfusion-dependent patients at BL was lower in the IWG studies vs the non-IWG studies (36% vs. 84%, respectively, p<.001). The pooled estimate of ER rate was significantly higher for the IWG studies compared to the non-IWG studies (50.5%, 95% CI: 38.6%-62.3% vs. 27.8%, 95% CI: 22.7%-32.8% respectively, p=.002). Among patients in the IWG studies who achieved an ER, 62% (188/305) achieved a major ER. Studies reporting mean BL serum erythropoietin level <400mU/mL, <65% of patients transfusion-dependent at BL and use of subcutaneous EPO were found to be associated with higher ER rates. Conclusions: This meta-analysis of MDS patients treated with EPO demonstrates significantly higher ER rates in studies utilizing IWGc. These findings may be due to more refined definitions of ER and MDS diagnostic criteria as well as improvement in the management of anemia. [Table: see text]
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Affiliation(s)
- V. Moyo
- Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Groupe d’Analyse, Montréal, PQ, Canada; Analysis Group, Inc., Boston, MA
| | - P. Lefebvre
- Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Groupe d’Analyse, Montréal, PQ, Canada; Analysis Group, Inc., Boston, MA
| | - M. S. Duh
- Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Groupe d’Analyse, Montréal, PQ, Canada; Analysis Group, Inc., Boston, MA
| | - A. Bourezak
- Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Groupe d’Analyse, Montréal, PQ, Canada; Analysis Group, Inc., Boston, MA
| | - B. Yektashenas
- Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Groupe d’Analyse, Montréal, PQ, Canada; Analysis Group, Inc., Boston, MA
| | - R. C. Woodman
- Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Groupe d’Analyse, Montréal, PQ, Canada; Analysis Group, Inc., Boston, MA
| | - S. Mundle
- Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ; Groupe d’Analyse, Montréal, PQ, Canada; Analysis Group, Inc., Boston, MA
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