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Gallop K, Pham N, Maclaine G, Saunders E, Black B, Acaster S. Exploring the impact of caring for an individual with neurogenic orthostatic hypotension: a qualitative study. Neurodegener Dis Manag 2023. [PMID: 37313784 DOI: 10.2217/nmt-2022-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Aim: This study aimed to explore the impact of caring for an individual with neurogenic orthostatic hypotension (nOH). Methods: Informal caregivers of individuals with nOH and either Parkinson's disease, multiple system atrophy, pure autonomic failure or dementia with Lewy bodies completed semi-structured interviews. Data were analyzed using thematic analysis; the identified concepts were used to develop a conceptual model. Results: Twenty informal caregivers were interviewed. Analysis identified several areas of caregiver impact due to nOH including impact on their time, particularly a need to supervise the patient to prevent falls as well as a lack of freedom and negative physical, work and social impacts. Many reported negative emotional impacts, including worry, stress or fear about the patient falling, depression and frustration. The conceptual model shows the relationships between concepts. Conclusion: The results highlight the wide-ranging impact of nOH, and the specific impact of the fear of falls on informal caregivers' lives.
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Affiliation(s)
- Katy Gallop
- Acaster Lloyd Consulting Ltd, London, WC1X 8NL, UK
| | - Ngan Pham
- HEOR and Value Strategy, Theravance Biopharma US, Inc., San Francisco, CA 94080, USA
| | - Grant Maclaine
- HEOR and Value Strategy, Theravance Biopharma Ireland Limited, Dublin, D04 N9W8, Ireland
| | | | - Bonnie Black
- Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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Gallop K, Pham N, Maclaine G, Saunders E, Black B, Hubig L, Acaster S. Health-related quality-of-life and burden for caregivers of individuals with neurogenic orthostatic hypotension. Neurodegener Dis Manag 2023; 13:35-45. [PMID: 36382590 DOI: 10.2217/nmt-2022-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim: This study explores the burden of caring for an individual with neurogenic orthostatic hypotension (nOH) and an underlying neurodegenerative disease (Parkinson's disease, multiple system atrophy, pure autonomic failure or dementia with Lewy bodies). Materials & methods: A survey including several validated instruments was conducted with informal caregivers of individuals with Parkinson's disease, multiple system atrophy, pure autonomic failure or dementia with Lewy bodies. Results: Caregivers of patients with nOH (n = 60) reported greater burden across all outcomes compared with those without nOH (n = 60). Receiving pharmacological treatment for nOH was the variable most consistently associated with significantly better caregiver health-related quality-of-life (p < 0.05). Conclusion: This study demonstrates the burden of nOH on informal caregivers and highlights the potential benefit of pharmacological treatment not only for patients but also indirectly, their caregivers.
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Affiliation(s)
- Katy Gallop
- Acaster Lloyd Consulting Ltd, London, WC1X 8NL, UK
| | - Ngan Pham
- HEOR and Value Strategy, Theravance Biopharma US, Inc. San Francisco, CA 94080, USA
| | - Grant Maclaine
- HEOR and Value Strategy, Theravance Biopharma Ireland, Dublin, D04 N9W8, Ireland
| | | | - Bonnie Black
- Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lena Hubig
- Acaster Lloyd Consulting Ltd, London, WC1X 8NL, UK
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De Cock E, Leung G, Maclaine G, Shah H, Kuhn B, Nichols B. A US Time and Motion Pilot Study of Nebulized COPD Therapy in an Inpatient and a Long-Term Care Setting. Pulm Ther 2022; 8:225-232. [PMID: 35246821 PMCID: PMC8896414 DOI: 10.1007/s41030-022-00186-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction There is a lack of quantitative data on healthcare professionals’ (HCPs) time dedicated to nebulized chronic obstructive pulmonary disease (COPD) therapy in inpatient and long-term care (LTC) settings. Using time and motion methodology, we quantified HCP time and opportunity costs (time and materials) associated with nebulized COPD therapy in inpatient and LTC settings and estimated efficiencies of changing to once-daily therapy. Methods A case report form was built to reflect local nebulization workflow. Primary outcomes were mean active HCP time per predefined task and mean total active HCP time associated with short-acting beta agonist (SABA) and SABA/short-acting muscarinic antagonist (SAMA) combination nebulization processes. Results Twenty observations occurred within each setting. Inpatient observations included three SABA and 17 SABA/SAMA (from 18 different patients), and LTC observations included five SABA and 15 SABA/SAMA (from eight different patients). Mean total process time was 16.12 min in the inpatient setting (95% CI 14.48–17.76) and 21.0 min in the LTC setting (95% CI 18.8–23.2), with the actual nebulization comprising over 50% of process time for both. In LTC, CIs suggest a difference by cognitive impairment status: mean 24.1 min (95% CI 21.3–26.9) if cognitively impaired versus 19.0 min (95% CI 16.1–21.8) if not. In the inpatient setting, the estimated process time/admission was 7.8 h; a once-daily nebulized drug would require only 2.3 h. In LTC, the estimated process time was 32.1 h/month; a once-daily nebulized drug would require only 13.7 h/month. Estimated nebulization cost was $243/admission for current versus $72 for once-daily dosing in inpatient, and $1177/month versus $504 in LTC. Conclusions The nebulization process for COPD patients in both inpatient and LTC settings consumes considerable HCP time. A switch from SABA or SABA/SAMA to a drug with a once-daily nebulization frequency could generate substantial time savings depending on the setting and site characteristics.
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Affiliation(s)
- Erwin De Cock
- Syneos Health, Carrer Pau Claris, 196, 5º, 08037, Barcelona, Spain.
| | - Grace Leung
- Theravance Biopharma US, Inc., South San Francisco, CA, USA
| | | | | | - Brooks Kuhn
- UC Davis School of Medicine, Sacramento, CA, USA
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Gelhorn HL, Ye X, Speck RM, Tong S, Healey JH, Bukata SV, Lackman RD, Murray L, Maclaine G, Lenderking WR, Hsu HH, Lin PS, Tap WD. The measurement of physical functioning among patients with Tenosynovial Giant Cell Tumor (TGCT) using the Patient-Reported Outcomes Measurement Information System (PROMIS). J Patient Rep Outcomes 2019; 3:6. [PMID: 30714073 PMCID: PMC6360193 DOI: 10.1186/s41687-019-0099-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/16/2019] [Indexed: 12/22/2022] Open
Abstract
Background Tenosynovial giant cell tumor (TGCT), a rare, locally aggressive neoplasm of the synovium of joints and tendon sheaths, is associated with joint destruction, pain and swelling. Impacts on physical function (PF) vary depending on tumor size and location. The aim of this study was to identify relevant items, and demonstrate the content validity of custom measures of lower extremity PF from the Patient-Reported Outcomes Measurement Information System Physical Function Physical Function (PROMIS-PF) item bank among patients with TGCT. Methods Patients were recruited for qualitative research interviews to identify predominant TGCT symptoms and impacts. Patients completed a checklist to evaluate the relevance of each PROMIS-PF item. The publicly available PROMIS-PF item response theory (IRT) parameters were used to select items representing the range of the latent PF trait. Results Participants (n = 20) were 75% female, mean age 42.5 years. TGCTs were located in the knee (n = 15), hip (n = 3), and ankle (n = 2). Fifty-four PROMIS-PF items were identified as relevant by ≥20% of the participants. PF concepts discussed by participants during the qualitative interviews were also used to select relevant items. Selected items (n = 13) were used to create a physical function subscale specific to lower extremity tumors. Conclusions We describe a novel method of combining qualitative research and IRT-based item information to select a relevant and content valid subset of PROMIS-PF items to assess heterogeneous impacts on PF in TGCT, a rare disease population. Electronic supplementary material The online version of this article (10.1186/s41687-019-0099-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heather L Gelhorn
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA.
| | - Xin Ye
- Daiichi Sankyo Pharma Development, 399 Thornall St, Edison, NJ, 08837, USA
| | - Rebecca M Speck
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | - Sandra Tong
- Plexxikon Inc., 91 Bolivar Dr, Berkeley, CA, 94710, USA
| | - John H Healey
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | | | - Richard D Lackman
- Cooper University Health Center, 1 Cooper Plaza, Camden, NJ, 08103, USA
| | - Lindsey Murray
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | - Grant Maclaine
- Daiichi Sankyo UK Ltd., Chiltern Place, 1 Chalfont Park, Chalfont St Peter, Gerrards Cross, SL9 0GA, UK
| | | | - Henry H Hsu
- Plexxikon Inc., 91 Bolivar Dr, Berkeley, CA, 94710, USA
| | - Paul S Lin
- Plexxikon Inc., 91 Bolivar Dr, Berkeley, CA, 94710, USA
| | - William D Tap
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
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Al Shakarchi J, Inston N, Jones RG, Maclaine G, Hollinworth D. Cost analysis of the Hemodialysis Reliable Outflow (HeRO) Graft compared to the tunneled dialysis catheter. J Vasc Surg 2016; 63:1026-33. [DOI: 10.1016/j.jvs.2015.10.089] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/21/2015] [Indexed: 11/25/2022]
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Gelhorn HL, Tong S, McQuarrie K, Vernon C, Hanlon J, Maclaine G, Lenderking W, Ye X, Speck RM, Lackman RD, Bukata SV, Healey JH, Keedy VL, Anthony SP, Wagner AJ, Von Hoff DD, Singh AS, Becerra CR, Hsu HH, Lin PS, Tap WD. Patient-reported Symptoms of Tenosynovial Giant Cell Tumors. Clin Ther 2016; 38:778-93. [PMID: 27041409 PMCID: PMC5469507 DOI: 10.1016/j.clinthera.2016.03.008] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [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: 12/29/2015] [Revised: 03/01/2016] [Accepted: 03/07/2016] [Indexed: 01/03/2023]
Abstract
Purpose Tenosynovial giant cell tumor (TGCT), a rare locally aggressive neoplasm of the synovium of joints and tendon sheaths, is associated with joint destruction, inflammation, pain, and swelling, in part due to colony-stimulating factor 1 receptor–bearing macrophages recruited to the tumor by genetic elevation of colony-stimulating factor 1 activity. The most common treatment is surgery, although promising pharmacologic treatments are in development. Patient-reported outcome (PRO) instruments are critical end points in demonstrating the clinical relevance of standard oncologic outcome measures and the overall impact of novel pharmacologic therapies in nonmalignant neoplastic conditions such as TGCT. The content validity of PROs relevant to patients with TGCT has not been formally investigated, and instruments to evaluate such outcomes do not exist for this condition. Methods PRO instruments of potential relevance were evaluated by using a literature review and by clinical and PRO experts. Patients with TGCT were recruited through clinical sites and the Internet for participation in qualitative research interviews to identify predominant symptoms and to test the relevance and content validity of several PRO measures. Select PRO measures were included in a Phase I clinical trial, and preliminary results of the PRO end points are reported descriptively. Findings Of the 22 subjects who participated in qualitative interviews, 73% were female, and their mean age was 42.5 years (range, 27–56 years). The TGCTs (19 diffuse and 3 localized) were located in the knee (n = 15), hip (n = 3), ankle (n = 2), elbow (n= 1), and forearm (n = 1). The most common symptoms cited were pain (82%), swelling (86%), stiffness (73%), reduced range of motion (64%), and joint instability (64%), which were consistent with clinical expert input and with the content of instruments chosen by PRO experts. The worst pain numeric rating scale, Patient Reported Outcomes Measurement Information System physical functioning items, and the Western Ontario and McMaster Universities Osteoarthritis Index, as well as a worst stiffness numeric rating scale developed for TGCT, were confirmed as meaningful measures of TGCT patient symptoms and were well understood in qualitative interviews. Results from the Phase I trial showed trends of improvement in both pain and stiffness over time. Implications This study is the first to gather information directly from patients with TGCT regarding their symptom experiences. Pain, stiffness, and physical functioning are important treatment outcomes in patients with TGCT. We have identified content-valid PRO measures of these concepts, which are included in an ongoing Phase III TGCT clinical trial with pexidartinib (PLX3397) (NCT02371369).
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Affiliation(s)
| | | | | | | | | | - Grant Maclaine
- Daiichi Sankyo Development Ltd, Buckinghamshire, United Kingdom
| | | | - Xin Ye
- Daiichi Sankyo Pharma Development, Edison, New Jersey
| | | | - Richard D Lackman
- Cooper University Health Center, Orthopaedic Oncology Center, Camden, New Jersey
| | - Susan V Bukata
- Ronal Reagan UCLA Medical Center, Los Angeles, California
| | - John H Healey
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Vicki L Keedy
- Vanderbilt University Medical Center, Hematology/Oncology, Nashville, Tennessee
| | | | | | - Daniel D Von Hoff
- HonorHealth & Translational Genomics Research Institute, Scottsdale, Arizona
| | - Arun S Singh
- Ronal Reagan UCLA Medical Center, Los Angeles, California
| | | | | | | | - William D Tap
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
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Gelhorn H, Tong S, Maclaine G, Healey JH, Bukata SV, Keedy VL, Anthony SP, Wagner AJ, Von Hoff DD, Singh AS, Becerra C, Hanlon J, Lenderking W, Murray L, Hsu HH, Lin PS, Tap WD. Patient-reported outcome instruments meaningful and relevant for tenosynovial giant cell tumor (TGCT): A qualitative study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.10521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hartz S, Getsios D, Tao S, Blume S, Maclaine G. Evaluating the cost effectiveness of donepezil in the treatment of Alzheimer's disease in Germany using discrete event simulation. BMC Neurol 2012; 12:2. [PMID: 22316501 PMCID: PMC3296601 DOI: 10.1186/1471-2377-12-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 02/08/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Previous cost-effectiveness studies of cholinesterase inhibitors have modeled Alzheimer's disease (AD) progression and treatment effects through single or global severity measures, or progression to "Full Time Care". This analysis evaluates the cost-effectiveness of donepezil versus memantine or no treatment in Germany by considering correlated changes in cognition, behavior and function. METHODS Rates of change were modeled using trial and registry-based patient level data. A discrete event simulation projected outcomes for three identical patient groups: donepezil 10 mg, memantine 20 mg and no therapy. Patient mix, mortality and costs were developed using Germany-specific sources. RESULTS Treatment of patients with mild to moderately severe AD with donepezil compared to no treatment was associated with 0.13 QALYs gained per patient, and 0.01 QALYs gained per caregiver and resulted in average savings of €7,007 and €9,893 per patient from the healthcare system and societal perspectives, respectively. In patients with moderate to moderately-severe AD, donepezil compared to memantine resulted in QALY gains averaging 0.01 per patient, and savings averaging €1,960 and €2,825 from the healthcare system and societal perspective, respectively.In probabilistic sensitivity analyses, donepezil dominated no treatment in most replications and memantine in over 70% of the replications. Donepezil leads to savings in 95% of replications versus memantine. CONCLUSIONS Donepezil is highly cost-effective in patients with AD in Germany, leading to improvements in health outcomes and substantial savings compared to no treatment. This holds across a variety of sensitivity analyses.
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Affiliation(s)
- Susanne Hartz
- B214 Baquba Building, Conington Road, SE13 7FF London, UK
| | - Denis Getsios
- United BioSource Corporation, 430 Bedford Street, Suite 300, Lexington Office Park, Lexington, MA 02420, USA
| | - Sunning Tao
- United BioSource Corporation, 185 Dorval Avenue Suite 500, Dorval, Quebec H9S 5J9, Canada
| | - Steve Blume
- United BioSource Corporation, 7101 Wisconsin Avenue, Bethesda, MD 20814, USA
| | - Grant Maclaine
- Becton, Dickinson UK Limited, The Danby Building, Edmund Halley Road, Oxford Science Park, Oxford OX4 4DQ, UK
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Getsios D, Blume S, Ishak KJ, Maclaine G, Hernández L. An economic evaluation of early assessment for Alzheimer's disease in the United Kingdom. Alzheimers Dement 2011; 8:22-30. [DOI: 10.1016/j.jalz.2010.07.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 06/08/2010] [Accepted: 07/21/2010] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | | | - Luis Hernández
- United BioSource CorporationBogotáColombia
- Industrial Engineering Department Universidad de los AndesBogotáColombia
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Eldabe S, Lloyd A, Verdian L, Meguro M, Maclaine G, Dewilde S. Eliciting health state utilities from the general public for severe chronic pain. Eur J Health Econ 2010; 11:323-30. [PMID: 19680700 DOI: 10.1007/s10198-009-0178-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 07/14/2009] [Indexed: 05/15/2023]
Abstract
OBJECTIVE There is an absence of data on public preferences for health states (HSs) associated with severe chronic pain. The aim of this study was to develop accurate HS descriptions for severe chronic pain requiring intrathecal (IT) therapy and to derive utility weights that describe the health-related quality of life (HRQL) impact of chronic pain associated with malignant (MP) and non-malignant (NMP) aetiologies. RESEARCH DESIGN AND METHOD Eight visual analogue scale pain index (VAS-PI) HSs were defined using ranges 0-40, 41-60, 61-80 and 81-100 applied to both MP and NMP. Additionally, eight HSs representing common adverse events associated with IT therapy were identified. The content and description of the HSs were ascertained by interviews with five United Kingdom clinical experts. In total, 16 HSs were compiled. These HS descriptions and HS questionnaires were administered to 102 members of the public, utilising a time trade off (TTO) approach to estimate utilities for the HSs. RESULTS Participants generally were well matched to the general public in England and Wales, with some differences in mean age, race and education. A substantial decline in utility was observed with more severe VAS-PI values. The mean TTO utility values also decreased from mild pain to severe pain. Participants were able to differentiate between the side effects. CONCLUSION The study shows a clear decrement in utility moving from different severity levels of severe chronic pain.
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Affiliation(s)
- S Eldabe
- Department of Pain and Anaesthesia, The James Cook University Hospital, Middlesbrough, UK
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Abstract
Lennox-Gastaut syndrome (LGS) is a catastrophic childhood form of epilepsy. The syndrome is characterized by mental impairment, frequent seizures of multiple types that are particularly resistant to treatment, and high rates of seizure-related injury. With the introduction of newer, but more costly, antiepileptic drugs (AEDs), it is important that decision makers are able to assess their value in the management of this rare and difficult-to-treat condition. To evaluate the cost effectiveness, from the UK NHS perspective, of rufinamide in patients with LGS. An individual patient-simulation model was developed to estimate the total treatment-related costs and clinical benefits of rufinamide compared with topiramate and lamotrigine over a 3-year time horizon. The model examines the treatment scenarios of adding rufinamide, lamotrigine or topiramate to older AEDs (standard therapy), or standard therapy alone within a primary-care or community setting. Three placebo-controlled clinical trials of adjunctive AED treatment for children with LGS were analysed. There are no head-to-head comparator studies. Between 98 and 139 patients were randomized in each study and the mean age in each study was 10, 11 and 14 years. A mixed-treatment comparison using a random-effects model was carried out on the number of patients in each response category, using the placebo arms of the respective trials. The primary outcome measure was the percentage of successfully treated patients, defined as >50% reduction in the frequency of total seizures and drop attacks. The hypothesis being tested was formulated after data collection. Costs ( pound, year 2006/07 values) of patient monitoring, switching treatments, hospitalization due to seizure, treatment of adverse effects, and personal and social services were included in the analysis. Results of 10,000 Monte Carlo simulations were bootstrapped to conduct probabilistic sensitivity analysis. Over 3 years, adjunctive rufinamide resulted in higher total costs than topiramate and lamotrigine; however, with more patients being treated successfully, this leads to acceptable incremental cost-effectiveness ratios. If society is prepared to pay at least 250 pounds for a 1% increase in the number of successfully treated LGS patients, in terms of a 50% reduction in the frequency of drop attacks, the probability of the treatment with rufinamide being cost effective is >80%. This cost-effectiveness analysis suggests that rufinamide results in more LGS patients being treated successfully at a reasonable cost from a UK NHS perspective.
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Affiliation(s)
- Agnes Benedict
- United BioSource Corporation, Health Care Analytics, London, UK
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Quilici S, Chancellor J, Maclaine G, McGuire A, Andersson D, Chiasson JL. Cost-effectiveness of acarbose for the management of impaired glucose tolerance in Sweden. Int J Clin Pract 2005; 59:1143-52. [PMID: 16178980 DOI: 10.1111/j.1368-5031.2005.00629.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [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: 11/29/2022] Open
Abstract
We assessed the cost-effectiveness of acarbose in the management of patients with impaired glucose tolerance (IGT) in Sweden, based on progression to type 2 diabetes (T2D) and cardiovascular (CV) events reported in the STOP-NIDDM trial population, including high-risk subgroups. The cost per patient free from T2D was SEK28,000 or SEK1260 per diabetes free month prior to progression to T2D. The cost per patient free from CV events was SEK101,000 or SEK5000 per CV event free month. For the high CV risk subgroups, acarbose treatment dominated placebo (i.e. acarbose was more effective, less costly). Acarbose significantly reduces the incidence of diabetes and CV events in IGT patients. We predict this may translate into healthcare cost savings that partially or, in patients at high CV risk, fully offset the cost of acarbose. We conclude that acarbose is likely to be cost-effective in the management of impaired glucose tolerance.
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Affiliation(s)
- S Quilici
- Innovus Research (UK) Ltd, High Wycombe, UK
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Mauskopf JA, Richter A, Annemans L, Maclaine G. Cost-effectiveness model of cytomegalovirus management strategies in renal transplantation. Comparing valaciclovir prophylaxis with current practice. Pharmacoeconomics 2000; 18:239-251. [PMID: 11147391 DOI: 10.2165/00019053-200018030-00004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) disease may occur following renal transplantation and has been shown to have health and cost consequences in this setting. OBJECTIVE To compare the cost effectiveness of different CMV management strategies for renal transplant patients: prophylaxis with (i) oral valaciclovir or (ii) intravenous ganciclovir; viral testing for CMV followed by (iii) pre-emptive therapy with intravenous ganciclovir or (iv) adjustment of immunosuppression and intensive monitoring; or (v) waiting to treat when CMV disease develops. METHODS A decision-tree model was constructed that included the different management strategies for the donor seropositive/recipient seronegative (D+R-) population. Clinical outcomes for the D+R- population came from clinical trials. Treatment algorithms and costs for CMV syndrome and tissue invasive disease were developed from published literature and UK physician interviews. One- and 2-way sensitivity analyses were performed. STUDY PERSPECTIVE UK National Health Service. RESULTS Prophylaxis with either oral valaciclovir or intravenous ganciclovir dominated (lower costs and fewer cases of CMV disease) the pre-emptive treatment and wait-and-treat strategies. The cost per patient was from 157 Pounds to 438 Pounds higher with oral valaciclovir prophylaxis compared with intravenous ganciclovir prophylaxis and the incremental cost per case of CMV disease avoided with valaciclovir prophylaxis ranged from 2243 Pounds to 8111 Pounds (1996 values). These results are sensitive to the efficacy of intravenous ganciclovir prophylaxis and CMV management costs. CONCLUSIONS For D+R- renal transplant patients, prophylaxis is the dominant (more effective and less costly) management strategy compared with pre-emptive and wait-and-treat strategies. The cost per patient with oral valaciclovir prophylaxis compared with intravenous ganciclovir prophylaxis is slightly higher in our base case scenario, but may be lower under reasonable alternative assumptions.
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Affiliation(s)
- J A Mauskopf
- Research Triangle Institute, Research Triangle Park, North Carolina, USA.
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