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Olivera I, Pérez CG, Lazarov L, Lopez E, Oddo C, Dibarboure H. Cost minimization analysis of a hexavalent vaccine in Argentina. BMC Health Serv Res 2023; 23:1067. [PMID: 37803345 PMCID: PMC10557326 DOI: 10.1186/s12913-023-10038-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 09/15/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Argentina currently uses a pentavalent vaccine containing diphtheria, tetanus, pertussis (whole cell), Haemophilus influenza type b and hepatitis B antigens, administered concomitantly with the inactivated polio vaccine (IPV) (DTwP-Hib-HB plus IPV) in its childhood vaccination schedule. However, hexavalent vaccines containing acellular pertussis antigens (DTaP-Hib-HB-IPV) and providing protection against the same diseases are also licensed, but are only available with a private prescription or for high-risk pre-term infants in the public health program. We analyzed the cost of switching from the current schedule to the alternative schedule with the hexavalent vaccine in Argentina, assuming similar levels of effectiveness. METHODS The study population was infants ≤ 1 year of age born in Argentina from 2015 to 2019. The analysis considered adverse events, programmatic, logistic, and vaccine costs of both schemes from the societal perspective. The societal costs were disaggregated to summarize costs incurred in the public sector and with vaccination pre-term infants in the public sector. Costs were expressed in 2021 US Dollars (US$). RESULTS Although the cost of vaccines with the alternative scheme would be US$39.8 million (M) more than with the current scheme, these additional costs are in large part offset by fewer adverse event-associated costs and lower programmatic costs such that the overall cost of the alternative scheme would only be an additional US$3.6 M from the societal perspective. The additional cost associated with switching to the alternative scheme in the public sector and with the vaccination of pre-term infants in the public sector would be US$2.1 M and US$84,023, respectively. CONCLUSIONS The switch to an alternative scheme with the hexavalent vaccine in Argentina would result in marginally higher vaccine costs, which are mostly offset by the lower costs associated with improved logistics, fewer separate vaccines, and a reduction in adverse events.
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Affiliation(s)
- Ignacio Olivera
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
| | - Carlos Grau Pérez
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
| | - Luis Lazarov
- Centro de Investigaciones Económicas, CINVE, Salud, Montevideo, Uruguay
| | - Eduardo Lopez
- Facultad de Medicina, Universidad del Salvador, Buenos Aires, Argentina
| | - Cristian Oddo
- Sanofi Vaccines, Buenos Aires, Argentina.
- , Cuyo 3512, Martinez, Buenos Aires, B1640GIY, Argentina.
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Quinsten AS, Apel M, Oliveira S. Remote MR scanning - A solution for shortage of skilled radiographers. J Med Imaging Radiat Sci 2023; 54:410-414. [PMID: 37355361 DOI: 10.1016/j.jmir.2023.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Anton S Quinsten
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
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Melidis C, Seghour S, Noblet S. Does cost minimization of hypofractionated radiation therapy content all health stakeholders? J Med Imaging Radiat Sci 2023; 54:405-409. [PMID: 37328357 PMCID: PMC10266558 DOI: 10.1016/j.jmir.2023.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/12/2023] [Accepted: 05/23/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Christos Melidis
- Radiation Therapy Department, CAP Santé, Bastia, France; milliVolt.eu, Bastia, France.
| | | | - Sandrine Noblet
- University of Corsica Pascal Paoli, UMR CNRS LISA 6240, Corte, France
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Jean Baptiste AE, Van der Schans J, Bawa S, Masresha B, Wagai J, Oteri J, Dieng B, Soyemi M, Eshuchi R, Yehualashet YG, Afolabi O, Braka F, Bita A, Hak E. The cost of implementing measles campaign in Nigeria: comparing the stand-alone and the integrated strategy. Health Econ Rev 2023; 13:36. [PMID: 37310530 PMCID: PMC10262122 DOI: 10.1186/s13561-023-00441-y] [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] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 04/22/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Effective integration, one of the seven strategic priorities of the Immunization Agenda 2030, can contribute to increasing vaccination coverage and efficiency. The objective of the study is to measure and compare input costs of "non-selective" measles vaccination campaign as a stand-alone strategy and when integrated with another vaccination campaign. METHODS We conducted a cost-minimization study using a matched design and data from five states of Nigeria. We carried-out our analysis in 3 states that integrated measles vaccination with Meningitis A and the 2 states that implemented a stand-alone measles campaign. The operational costs (e.g., costs of personnel, training, supervision etc.) were extracted from the budgeted costs, the financial and technical reports. We further used the results of the coverage surveys to demonstrate that the strategies have similar health outputs. RESULTS The analysis of the impact on campaign budget (currency year: 2019) estimated that savings were up to 420,000 United States Dollar (USD) with the integrated strategies; Over 200 USD per 1,000 children in the target population for measles vaccination (0.2 USD per children) was saved in the studied states. The savings on the coverage survey components were accrued by lower costs in the integration of trainings, and through reduced field work and quality assurance measures costs. CONCLUSIONS Integration translated to greater value in improving access and efficiency, as through sharing of costs, more life-saving interventions are made accessible to the communities. Important considerations for integration are resource needs, micro-planning adjustments, and health systems delivery platforms.
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Affiliation(s)
| | - Jurjen Van der Schans
- Department of Economics, Econometrics and Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
| | - Samuel Bawa
- World Health Organization, Country Office, Abuja, Nigeria
| | - Balcha Masresha
- World Health Organization, African Regional Office, Brazzaville, Congo
| | - John Wagai
- World Health Organization, Country Office, Abuja, Nigeria
| | - Joseph Oteri
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Boubacar Dieng
- Technical Assistance Consultant, Global Alliance for Vaccines and Immunizations (GAVI), Abuja, Nigeria
| | - Margaret Soyemi
- United Nations Children's Fund (UNICEF) - Country Office for Nigeria, Abuja, Nigeria
| | - Rufus Eshuchi
- United Nations Children's Fund (UNICEF) - Country Office for Nigeria, Abuja, Nigeria
| | | | | | - Fiona Braka
- World Health Organization, Country Office, Abuja, Nigeria
| | - André Bita
- World Health Organization, African Regional Office, Brazzaville, Congo
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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Ellis AK, Gagnon R, Hammerby E, Shen J, Gosain S. Sublingual immunotherapy tablet: a cost-minimizing alternative in the treatment of tree pollen-induced seasonal allergic rhinitis in Canada. Allergy Asthma Clin Immunol 2021; 17:66. [PMID: 34238358 PMCID: PMC8264484 DOI: 10.1186/s13223-021-00565-y] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND A cost-minimization analysis (CMA) was performed to evaluate the economic implications of introducing the SQ Tree sublingual immunotherapy (SLIT)-tablets marketed as ITULATEK® (Health Canada regulatory approval in April 2020) for the treatment of pollen-induced (birch, alder and/or hazel) seasonal allergic rhinitis in Canada (Ontario and Quebec), where Tree Pollen subcutaneous immunotherapy (SCIT) is already an available treatment option. METHODS A CMA was deemed appropriate and was based on the assumption that the SQ Tree SLIT-tablets have comparable efficacy to Tree Pollen SCIT. A societal perspective was adopted in the model, including relevant costs of medications, costs of health care services, and productivity losses. The time horizon in the model was three years, which corresponds to a minimal treatment course of allergy immunotherapy. Resource use and costs were based on published sources, where available, and validated by Canadian specialist clinicians (allergists) in active practice in Ontario and in Quebec, where applicable. A discount rate of 1.5% was applied in accordance with the Canadian Agency for Drugs and Technologies in Health (CADTH) guidelines. To assess the robustness of the results, scenario analyses were performed by testing alternative assumptions for selected parameters (e.g., Tree Pollen SCIT resource use, discount rates, number of injections, annual SCIT dosing with maintenance injections, and nurse time support), to evaluate their impact on the results of the analysis. RESULTS The direct costs, including the drug costs, and physician services costs, for three years of treatment, were similar for both SQ Tree SLIT-tablets vs. Tree Pollen SCIT in both Ontario and Quebec ($2799.01 and $2838.70 vs. $2233.76 and $2266.05 respectively). However, when the indirect costs (including patient's travel expenses and lost working hours) are included in the model, total savings for the treatment with SQ Tree SLIT-tablets of $1111.79 for Ontario and $1199.87 for Quebec were observed. Scenario analyses were conducted and showed that changes in assumptions continue to result in the savings of SQ Tree SLIT- tablets over Tree Pollen SCIT. CONCLUSIONS The CMA indicates that SQ Tree SLIT-tablets are a cost-minimizing alternative to Tree Pollen SCIT when considered from a societal perspective in Ontario and Quebec.
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Affiliation(s)
- Anne K. Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Rémi Gagnon
- Service D’Allergie Et Immunologie, Département de Médecine, CHU de Québec, Québec City, QC Canada
| | | | - Julia Shen
- PDCI Market Access Inc., Ottawa, ON Canada
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Cuadrado A, Cobo C, Mateo M, Blasco AJ, Cabezas J, Llerena S, Fortea JI, Lázaro P, Crespo J. Telemedicine efficiently improves access to hepatitis C management to achieve HCV elimination in the penitentiary setting. Int J Drug Policy 2020; 88:103031. [PMID: 33221615 DOI: 10.1016/j.drugpo.2020.103031] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Linkage to care for hepatitis C includes a new tool: teleconsultation. Micro-elimination in prison is a recommendation and is feasible. An economic evaluation of telemedicine for hepatitis C virus (HCV) treatment in prisons has not yet been performed. This study aimed to provide a cost-minimization analysis comparing two strategies of HCV treatment in a prison: telemedicine clinical practice (TCP) and the usual clinical practice (UCP). METHODS An observational cost-minimization study was carried out on a cohort of inmates who received anti-HCV treatment in El Dueso prison (May 2016-November 2017). A decision tree was constructed, incorporating different clinical profiles according to the severity of the disease, the results of diagnostic tests, and treatment outcomes as well as the costs of each profile. Satisfaction with telemedicine was evaluated through an 11-question questionnaire with a 5-point Likert scale. RESULTS Seventy-five inmates were treated and underwent TCP with a follow-up of one year. The average cost per patient with the TCP strategy was €1,172 (€1,151 direct costs). Had UCP been carried out, the cost would have been €1,687 (€1,630 direct). Telemedicine consultation practice produced savings of €516 (30.6%) per patient, with total savings of €38,677. The transfer costs from prison to hospital represented the most important saving item, accounting for 99.3% of the TCP-related savings. The questionnaire revealed high levels of satisfaction with TCP, with a median score of 5 in each question. Sustained virological response rates were 94.7% after the first treatment and 100% after retreatment of the four relapses. CONCLUSION Telemedicine consultation practice is a more efficient strategy than UCP, mainly due to the reduction of transfer costs while preserving effectiveness and user satisfaction.
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Affiliation(s)
- Antonio Cuadrado
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Avda. de Valdecilla s/n., Santander 39008, Cantabria, Spain; Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish)
| | - Carmen Cobo
- Medical Department of "El Dueso" Penitentiary Center, Cantabria, Spain
| | - Miguel Mateo
- Medical Department of the "José Hierro" Social Integration Center of Santander (Cantabria), Spain
| | - Antonio J Blasco
- Independent Researcher in Health Services Research, Madrid, Spain
| | - Joaquin Cabezas
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Avda. de Valdecilla s/n., Santander 39008, Cantabria, Spain; Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish).
| | - Susana Llerena
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Avda. de Valdecilla s/n., Santander 39008, Cantabria, Spain; Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish)
| | - José I Fortea
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Avda. de Valdecilla s/n., Santander 39008, Cantabria, Spain; Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish)
| | - Pablo Lázaro
- Independent Researcher in Health Services Research, Madrid, Spain
| | - Javier Crespo
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, School of Medicine, University of Cantabria, Avda. de Valdecilla s/n., Santander 39008, Cantabria, Spain; Marqués de Valdecilla Research Institute (IDIVAL, initials in Spanish)
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Bulula N, Mwiru DP, Swalehe O, Thomas Mori A. Vaccine storage and distribution between expanded program on immunization and medical store department in Tanzania: a cost-minimization analysis. Vaccine 2020; 38:8130-5. [PMID: 33162205 DOI: 10.1016/j.vaccine.2020.10.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 2016, the Tanzanian government shifted the vaccine supply chain responsibilities from the Medical Store Department (MSD) to the Expanded Program on Immunization (EPI) to reduce costs. However, cost estimates that informed the decision were based on invoice value of vaccines and related supplies, rather than a proper economic evaluation study. Therefore, this study aims to compare the actual storage and distribution costs of vaccines and related supplies between MSD to EPI. METHOD Micro-costing approach was used to estimate resource use at MSD and EPI for the year 2018. Data were collected through a review of documents, warehouse databases, and interviews with key staff at MSD and EPI. We included both capital and recurrent costs. Microsoft Excel® was used for analysis with input data from the UNICEF forecasting tool, WHOs vaccine volume and capacity estimation tool, diesel generator calculator, and supply chain service fee estimator version 1.02. RESULTS The total vaccine storage and distribution costs were estimated to be USD 1,996,286 at MSD and USD 543,648 at EPI. Distribution and program management costs represented 41% (USD 819,288) and 38% (USD 762,968) of the total costs at MSD, while storage and distribution costs represented 43% (USD 234,423) and 34% (USD 184,620) of the total costs at EPI, respectively. The cost drivers at MSD were fuel and transport (21%), receiving and dispatch (19%) and, program management personnel cost (14%), while at EPI were storage space (20%), program management personnel cost (18%) and fuel and transport (15%). CONCLUSION The storage and distribution of vaccines in Tanzania via the EPI reduced the vaccine supply chain cost to about 27% of the program costs at MSD.
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Ellis AK, Gagnon R, Hammerby E, Lau A. Sublingual immunotherapy tablet for the treatment of house dust mite allergic rhinitis in Canada: an alternative to minimize treatment costs? Allergy Asthma Clin Immunol 2019; 15:27. [PMID: 31061666 PMCID: PMC6487002 DOI: 10.1186/s13223-019-0344-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/17/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND A cost-minimization analysis (CMA) was performed to estimate the economic impact of introducing the SQ house dust mite sublingual immunotherapy (SQ HDM SLIT)-tablet marketed as ACARIZAX™ (regulatory approval May 2017) for the treatment of HDM-induced allergic rhinitis in Canada (Ontario and Quebec), where house dust mite subcutaneous immunotherapy (HDM SCIT) is already an available treatment option. METHODS A CMA was deemed appropriate and was based on the assumption that the SQ HDM SLIT-tablet has comparable efficacy to HDM SCIT. A societal perspective was adopted in the model, including relevant costs of medications, health care services and productivity loss. A 3 year time horizon was used corresponding to a recommended treatment course of allergy immunotherapy. Resource use and costs were based on published sources, where possible, and validated and complemented by a Canadian specialist clinician (allergist) in active practice in Ontario and in Quebec, respectively, where applicable. A discount rate of 1.5% was applied in accordance with the Canadian Agency for Drugs and Technologies in Health (CADTH) guidelines. To assess the robustness of the results, sensitivity analyses were performed by testing alternative assumptions for selected parameters, to understand their impact on the results of the analysis. RESULTS The direct treatment costs for a 3-year treatment with SQ HDM SLIT-tablets were higher than for HDM SCIT for both provinces, Ontario and Quebec ($4732.12 and $4829.03 vs. $3434.51 and $2987.74). However, when adding the indirect costs to the model, total savings for the treatment with SQ HDM SLIT-tablets of $1833.00 for Ontario and $769.03 for Quebec were observed. Sensitivity analyses with varying HDM SCIT resource use, discount rates, titration and maintenance injections, nurse time, and number of injections per vial resulted in savings of SQ HDM SLIT-tablets over HDM SCIT in all scenarios analysed. CONCLUSIONS The CMA indicates that SQ HDM SLIT-tablets are a cost-minimizing alternative to HDM SCIT when considered from a societal perspective in Ontario and Quebec.
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Affiliation(s)
- Anne K. Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Rémi Gagnon
- Service d’Allergie et Immunologie, Département de médecine, CHU de Québec, Quebec, Canada
| | | | - Andrea Lau
- PDCI Market Access Inc., Ottawa, ON Canada
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Gandhoke GS, Pease M, Smith KJ, Sekula RF. Supraorbital Versus Endoscopic Endonasal Approaches for Olfactory Groove Meningiomas: A Cost-Minimization Study. World Neurosurg 2017; 105:126-136. [PMID: 28408255 DOI: 10.1016/j.wneu.2017.03.148] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To perform a cost-minimization study comparing the supraorbital and endoscopic endonasal (EEA) approach with or without craniotomy for the resection of olfactory groove meningiomas (OGMs). METHODS We built a decision tree using probabilities of gross total resection (GTR) and cerebrospinal fluid (CSF) leak rates with the supraorbital approach versus EEA with and without additional craniotomy. The cost (not charge or reimbursement) at each "stem" of this decision tree for both surgical options was obtained from our hospital's finance department. After a base case calculation, we applied plausible ranges to all parameters and carried out multiple 1-way sensitivity analyses. Probabilistic sensitivity analyses confirmed our results. RESULTS The probabilities of GTR (0.8) and CSF leak (0.2) for the supraorbital craniotomy were obtained from our series of 5 patients who underwent a supraorbital approach for the resection of an OGM. The mean tumor volume was 54.6 cm3 (range, 17-94.2 cm3). Literature-reported rates of GTR (0.6) and CSF leak (0.3) with EEA were applied to our economic analysis. Supraorbital craniotomy was the preferred strategy, with an expected value of $29,423, compared with an EEA cost of $83,838. On multiple 1-way sensitivity analyses, supraorbital craniotomy remained the preferred strategy, with a minimum cost savings of $46,000 and a maximum savings of $64,000. Probabilistic sensitivity analysis found the lowest cost difference between the 2 surgical options to be $37,431. CONCLUSION Compared with EEA, supraorbital craniotomy provides substantial cost savings in the treatment of OGMs. Given the potential differences in effectiveness between approaches, a cost-effectiveness analysis should be undertaken.
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Affiliation(s)
- Gurpreet S Gandhoke
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Matthew Pease
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kenneth J Smith
- Section of Decision Sciences, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Raymond F Sekula
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
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Rønborg S, Johnsen CR, Theilgaard S, Winther A, Hahn-Pedersen J, Andreasen JN, Olsen J. Cost-minimization analysis of sublingual immunotherapy versus subcutaneous immunotherapy for house dust mite respiratory allergic disease in Denmark. J Med Econ 2016; 19:735-41. [PMID: 26909663 DOI: 10.3111/13696998.2016.1158718] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objectives Currently, patients with persistent moderate-to-severe house dust mite (HDM) allergic rhinitis despite use of symptom-relieving medication can be offered subcutaneously administered allergy immunotherapy (SQ SCIT; Alutard SQ) as standard care of treatment in Denmark. Recently, a HDM sublingually administered allergy immunotherapy tablet (SQ SLIT-tablet; ACARIZAX) has been developed for at-home treatment. The purpose of this analysis is to compare the costs related to treatment and administration of SQ SLIT-tablet and SQ SCIT. Methods Assuming equal efficacy between ther SQ SLIT-tablet and SQ SCIT, the cost-minimization analysis was the most appropriate for the comparison. According to guidelines and Summary of Product Characteristics, the treatment duration of SQ SLIT-tablet is 3 years and 3-5 years for SQ SCIT. The courses of treatment vary among patients and, therefore, the costs of treatment have been calculated for an average patient with HDM respiratory allergic disease (RAD) receiving either SQ SLIT-tablet or SQ SCIT. All costs associated with allergy immunotherapy were collected, i.e., cost of medication, administration and treatment setting, and discounted according to Danish guidelines. Comprehensive univariate sensitivity analyses were carried out. Results The treatment costs for an average patient with HDM RAD are €3094 for SQ SLIT-tablet and €3799 for SQ SCIT; however, when adding indirect costs to the calculations the total costs of the treatments are €3697 and €6717 for SQ SLIT-tablet and SQ SCIT, respectively. Therefore, if 2500 patients with HDM RAD were treated with SQ SLIT-tablet instead of SQ SCIT, it would elicit a saving to the healthcare system of ∼€1.8 million. The conclusion was robust to any changes in the sensitivity analysis. Conclusion With regards to the cost of treating Danish patients with HDM RAD, it is clearly cost-saving to treat patients with SQ SLIT-tablet compared to SQ SCIT.
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Affiliation(s)
| | - Claus R Johnsen
- b Department of Dermato-Allergology , Copenhagen University Hospital , Gentofte , Denmark
| | | | | | | | | | - Jens Olsen
- f Health Economics Department , Incentive , Holte , Denmark
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DellaVolpe JD, Chakraborti C, Cerreta K, Romero CJ, Firestein CE, Myers L, Nielsen ND. Effects of implementing a protocol for arterial blood gas use on ordering practices and diagnostic yield. Healthc (Amst) 2014; 2:130-5. [PMID: 26250381 DOI: 10.1016/j.hjdsi.2013.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 08/22/2013] [Accepted: 09/16/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The arterial blood gas (ABG) is a valuable and commonly used laboratory test. This prospective cohort study examined the variability of ABG ordering through the implementation of an evidence-based protocol. METHODS The study consisted of two 6-week periods. The protocol consisted of evidence-based and consensus opinion based indications for ABGs. In the first phase (initial 6 weeks), respiratory therapists recorded the indications for ABGs ordered by clinicians. In the second phase, all medical and surgical physicians were trained on the clinical rationale behind the protocol and were instructed to write the indication for each ABG with the order. Rates of ABGs/patient/day were measured in aggregate and per indication. Multivariate regression was used for adjusted comparisons between indications within the protocol. RESULTS After protocol implementation, there was a significant decrease in ABGs from 2158 to 1674 (p=0.001), and after adjusting for daily census, there was a significant decrease from 35.3 ABGs/100 patients/day to 26.5 ABGs/100 patients/day (p<0.001), with no change in mortality or demographic characteristics between the populations. The percent of ABGs with normal range values for pH, PaCO2, and PaO2 decreased from 13.3% to 9.6% after implementation (p<0.001). Multivariate analysis revealed a 14% decrease in daily ABGs (p=0.001), a 15% decrease in weaning trial ABGs (p=0.039), and a 15% increase in ABGs ordered following a change in minute ventilation (p=0.004). Cost minimization analysis estimated annual institutional savings to be $87,565. CONCLUSIONS Implementation of an evidence based protocol for ABG use resulted in fewer ABGs/patient/day largely from reduction of routine, daily ABGs. Ordering patterns for ABGs appeared to shift towards more clinically appropriate/relevant indications. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Jeffrey D DellaVolpe
- Tulane University, Department of Internal Medicine, Tulane University Health Sciences Center, 1430 Tulane Avenue, SL-50, New Orleans, LA, USA.
| | - Chayan Chakraborti
- Tulane University, Department of Internal Medicine, Tulane University Health Sciences Center, 1430 Tulane Avenue, SL-50, New Orleans, LA, USA.
| | - Kenneth Cerreta
- Tulane University, Department of Internal Medicine, Tulane University Health Sciences Center, 1430 Tulane Avenue, SL-50, New Orleans, LA, USA.
| | - Carl J Romero
- Tulane Health Sciences Center, Department of Respiratory Therapy, New Orleans, LA, USA.
| | - Catherine E Firestein
- Tulane University, Department of Internal Medicine, Tulane University Health Sciences Center, 1430 Tulane Avenue, SL-50, New Orleans, LA, USA.
| | - Leann Myers
- Tulane School of Public Health, Department of Biostatistics, New Orleans, LA, USA.
| | - Nathan D Nielsen
- Tulane University, Department of Internal Medicine, Tulane University Health Sciences Center, 1430 Tulane Avenue, SL-50, New Orleans, LA, USA.
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