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Yoon NR, Na YJ, Lee JH, Song I, Lee EK, Park MH. Evaluation of changes in the clinical benefits of oncology drugs over time following reimbursement using the ASCO-VF and the ESMO-MCBS. J Cancer Res Clin Oncol 2024; 150:113. [PMID: 38436796 PMCID: PMC10912263 DOI: 10.1007/s00432-023-05587-0] [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: 10/12/2023] [Accepted: 12/22/2023] [Indexed: 03/05/2024]
Abstract
PURPOSE This study aims to estimate changes in the value of oncology drugs over time from initial data of the reimbursement decisions to subsequent publications in Korea, using two value frameworks. METHODS We retrieved primary publications assessed for reimbursement between 2007 and July 2021 from the decision documents of Health Insurance Review and Assessment and subsequent publications made available following reimbursement decision from ClinicalTrials.Gov and PubMed databases. Changes in the clinical benefit scores were assessed using the American Society of Clinical Oncology Value Framework (ASCO-VF) and the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). A paired t test was performed to test whether there was a difference in the scores between primary and subsequent publications. RESULTS Of 73 anticancer product/indication pairs, 45 (61.6%) had subsequent publications, of which 62.5% were released within 1 year of reimbursement decision. The mean ESMO-MCBS and ASCO-VF Net Health Benefit scores increased from primary to subsequent publications, although the differences were not significant. The mean ASCO-VF bonus score significantly increased from 15.91 to 19.09 (p = 0.05). The ESMO-MCBS and bonus scores increased by 0.25 and 0.21, respectively, and the bonus score had a greater impact on the ESMO-MCBS score than the preliminary score did. CONCLUSION The value of drugs demonstrated in subsequent publications varies considerably among oncology drugs, depending on uncertainty associated with the initial evidence and the availability of updated evidence. As decision-making in the face of uncertainty becomes more prevalent, the value frameworks can serve as simple screening tools for re-evaluation in these cases.
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Affiliation(s)
- Na Ri Yoon
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Young Jin Na
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Jong Hwan Lee
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea
| | - Inmyung Song
- College of Nursing and Health, Kongju National University, 56 Gongjudaehak-ro, Gongju, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea.
| | - Mi-Hai Park
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, Republic of Korea.
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Min S, Kwon SH, Lee EK, Nam JH. Cost-effectiveness of improving patients' adherence to tuberculosis treatment in South Korea using discrete event simulation. J Infect Public Health 2024; 17:478-485. [PMID: 38271751 DOI: 10.1016/j.jiph.2024.01.002] [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: 06/16/2023] [Revised: 11/03/2023] [Accepted: 01/02/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Poor adherence to tuberculosis (TB) treatment is an obstacle to controlling the disease. The Korean government's national TB control plan includes a program on adherence to TB treatment to manage patients with TB. This study aimed to assess the cost-effectiveness of a national TB program for improving patient adherence. METHODS A discrete event simulation (DES) model was developed to estimate the costs and quality-adjusted life-years (QALYs) of adherent and non-adherent patients. In this model, we considered treatment completion, loss to follow-up, recurrence, death, and treatment changes from drug-susceptible to multidrug-resistant TB as clinical events. We obtained input parameters such as costs, probability of events, and time distributions for each event from the Korean National Health Insurance claims data. We estimated the costs and QALYs before implementation of the program (adherence rate = 79%) and at present (current adherence rate = 94%). The incremental cost-effectiveness ratio (ICER) was used to evaluate whether the program was cost-effective given the willingness-to-pay threshold. RESULTS In the simulation, the program increasing the proportion of adherent patients gained 0.018 QALY/patient while spending $162/patient. The ICER of the TB program was $8790/QALY. Given a willingness-to-pay threshold of $20,000, the national TB program was considered cost-effective. CONCLUSION Improvements in adherence to TB treatment through the current TB program were cost-effective. The DES model accurately reflected the real world. Commitment programs to improve patient adherence may help manage TB nationwide.
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Affiliation(s)
- Serim Min
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea; Sheffield Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea.
| | - Jin Hyun Nam
- Divison of Big Data Science, Korea University Sejong Campus, Sejong, Republic of Korea.
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Shim YB, Oh BC, Lee EK, Park MH. Comparison of partitioned survival modeling with state transition modeling approaches with or without consideration of brain metastasis: a case study of Osimertinib versus pemetrexed-platinum. BMC Cancer 2024; 24:189. [PMID: 38336654 PMCID: PMC10858528 DOI: 10.1186/s12885-024-11971-x] [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: 10/12/2023] [Accepted: 02/06/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The partitioned survival model (PSM) and the state transition model (STM) are widely used in cost-effectiveness analyses of anticancer drugs. Using different modeling approaches with or without consideration of brain metastasis, we compared the quality-adjusted life-year (QALY) estimates of Osimertinib and pemetrexed-platinum in advanced non-small cell lung cancer with epidermal growth factor receptor mutations. METHODS We constructed three economic models using parametric curves fitted to patient-level data from the National Health Insurance Review and Assessment claims database from 2009 to 2020. PSM and 3-health state transition model (3-STM) consist of three health states: progression-free, post-progression, and death. The 5-health state transition model (5-STM) has two additional health states (brain metastasis with continuing initial therapy, and with subsequent therapy). Time-dependent transition probabilities were calculated in the state transition models. The incremental life-year (LY) and QALY between the Osimertinib and pemetrexed-platinum cohorts for each modeling approach were estimated over seven years. RESULTS The PSM and 3-STM produced similar incremental LY (0.889 and 0.899, respectively) and QALY (0.827 and 0.840, respectively). However, 5-STM, which considered brain metastasis as separate health states, yielded a slightly higher incremental LY (0.910) but lower incremental QALY (0.695) than PSM and 3-STM. CONCLUSIONS Our findings indicate that incorporating additional health states such as brain metastases into economic models can have a considerable impact on incremental QALY estimates. To ensure appropriate health technology assessment decisions, comparison and justification of different modeling approaches are recommended in the economic evaluation of anticancer drugs.
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Affiliation(s)
- Yoon-Bo Shim
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi- do, Republic of Korea
| | - Byeong-Chan Oh
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi- do, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi- do, Republic of Korea.
| | - Mi-Hai Park
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi- do, Republic of Korea.
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Cho JY, Jang SC, Kang DW, Lee EK, Koh H, Yoon DH, Park MH. A nationwide analysis of the treatment patterns, survival, and medical costs in Korean patients with relapsed or refractory diffuse large B-cell lymphoma. Front Oncol 2024; 14:1282323. [PMID: 38361777 PMCID: PMC10867264 DOI: 10.3389/fonc.2024.1282323] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Background Approximately one-third of patients with diffuse large B-cell lymphoma (DLBCL) are refractory to treatment or experience relapse after initial therapy. Unfortunately, treatment options for older patients and those who experience relapse or become refractory to hematopoietic stem cell transplantation (HSCT) are limited. This nationwide population-based study aimed to identify treatment patterns, survival times, and treatment costs in patients with relapsed/refractory DLBCL (R/R DLBCL). Materials and methods Between 2011 and 2020, data on patients with R/R DLBCL were retrieved from the Korean Health Insurance Review & Assessment Service, encompassing the entire population. We identified the treatment patterns for each treatment line using a Sankey diagram and calculated the median time to the subsequent treatment in line. Median overall and progression-free survival times were estimated using the Kaplan-Meier survival curves. Finally, the medical costs incurred during DLBCL treatment were calculated for each treatment line and the costs related to HSCT were summarized at the episode level. Results A total of 864 patients with R/R DLBCL who received second-line treatment were identified, and a regimen of ifosfamide, carboplatin, and etoposide (ICE) was administered the most. Among them, 353 were refractory or relapsed cases that were treated with third-line treatments. The median times for second-line to third-line, third-line to fourth-line, fourth-line to fifth-line, and fifth-line to sixth-line treatment failures gradually decreased (3.93, 2.86, 1.81, and 1.38 months, respectively). The median overall survival time was 8.90 and 4.73 months following the second-line and third-line treatments, respectively. In the third-line treatment setting, the patients did not show a significant difference in survival time after HSCT. The median medical cost was $39,491 across all treatment lines including the cost of HSCT which was $22,054. Conclusion The treatment patterns in patients with R/R DLBCL, especially at third-line treatments and thereafter, were complicated, and their prognosis was poor despite the high medical costs. Novel and effective treatment options are expected to improve the prognosis and alleviate the economic burden of patients with R/R DLBCL.
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Affiliation(s)
- Jeong-Yeon Cho
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Suk-Chan Jang
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Dong-Won Kang
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
| | | | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Hai Park
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, Republic of Korea
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Baek Y, Park SK, Lee YH, Son KH, Na HJ, Choi HG, Kwon YG, Lee EK. Comparison of Perceived Importance and Performance of Community Pharmacists' Role in South Korea During the Coronavirus Disease 2019 Pandemic. Disaster Med Public Health Prep 2023; 17:e569. [PMID: 38044034 DOI: 10.1017/dmp.2023.221] [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] [Indexed: 12/05/2023]
Abstract
OBJECTIVE This study aimed to identify the roles of community pharmacists (CPs) during the coronavirus disease 2019 (COVID-19) pandemic, the differences in their role performance compared with their perceived importance, and limiting factors. METHODS A cross-sectional online survey of CPs was conducted. The CPs self-measured the importance and performance of each role during the pandemic using a 5-point Likert scale. A paired t-test was used to compare each role's importance and performance scores. A logistic regression analysis of the roles with low performance scores, despite their level of importance, was conducted to determine the factors affecting performance. The limiting factors were also surveyed. RESULTS The 436 responses to the questionnaire were analyzed. The performance scores were significantly lower than the perceived importance scores for 15 of the 17 roles. The source and update frequency of COVID-19 information and participation in outreach pharmaceutical services were associated with low performance scores. Insufficient economic compensation, the lack of communication channels, and legal limitations were the limiting factors in performing the CPs' roles. CONCLUSIONS The participation in outreach pharmaceutical services, economic compensation, and communication channel should be improved to motivate the CPs in performing their roles.
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Affiliation(s)
- Youngsuk Baek
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Sun-Kyeong Park
- College of Pharmacy, The Catholic University of Korea, Bucheon, Gyeonggi-do, South Korea
| | - Yong Hwa Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Kyung-Hwa Son
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Hye-Jung Na
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Hyun-Gyu Choi
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Young-Gyu Kwon
- College of Pharmacy, The Catholic University of Korea, Bucheon, Gyeonggi-do, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
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Adhikari G, Carlin N, Choi JJ, Choi S, Ezeribe AC, França LE, Ha C, Hahn IS, Hollick SJ, Jeon EJ, Jo JH, Joo HW, Kang WG, Kauer M, Kim BH, Kim HJ, Kim J, Kim KW, Kim SH, Kim SK, Kim WK, Kim YD, Kim YH, Ko YJ, Lee DH, Lee EK, Lee H, Lee HS, Lee HY, Lee IS, Lee J, Lee JY, Lee MH, Lee SH, Lee SM, Lee YJ, Leonard DS, Luan NT, Manzato BB, Maruyama RH, Neal RJ, Nikkel JA, Olsen SL, Park BJ, Park HK, Park HS, Park KS, Park SD, Pitta RLC, Prihtiadi H, Ra SJ, Rott C, Shin KA, Cavalcante DFFS, Scarff A, Spooner NJC, Thompson WG, Yang L, Yu GH. Search for Boosted Dark Matter in COSINE-100. Phys Rev Lett 2023; 131:201802. [PMID: 38039466 DOI: 10.1103/physrevlett.131.201802] [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] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
We search for energetic electron recoil signals induced by boosted dark matter (BDM) from the galactic center using the COSINE-100 array of NaI(Tl) crystal detectors at the Yangyang Underground Laboratory. The signal would be an excess of events with energies above 4 MeV over the well-understood background. Because no excess of events are observed in a 97.7 kg·yr exposure, we set limits on BDM interactions under a variety of hypotheses. Notably, we explored the dark photon parameter space, leading to competitive limits compared to direct dark photon search experiments, particularly for dark photon masses below 4 MeV and considering the invisible decay mode. Furthermore, by comparing our results with a previous BDM search conducted by the Super-Kamionkande experiment, we found that the COSINE-100 detector has advantages in searching for low-mass dark matter. This analysis demonstrates the potential of the COSINE-100 detector to search for MeV electron recoil signals produced by the dark sector particle interactions.
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Affiliation(s)
- G Adhikari
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - N Carlin
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - J J Choi
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S Choi
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
| | - A C Ezeribe
- Department of Physics and Astronomy, University of Sheffield, Sheffield S3 7RH, United Kingdom
| | - L E França
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - C Ha
- Department of Physics, Chung-Ang University, Seoul 06973, Republic of Korea
| | - I S Hahn
- Department of Science Education, Ewha Womans University, Seoul 03760, Republic of Korea
- Center for Exotic Nuclear Studies, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - S J Hollick
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - E J Jeon
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - J H Jo
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - H W Joo
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
| | - W G Kang
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - M Kauer
- Department of Physics and Wisconsin IceCube Particle Astrophysics Center, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - B H Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - H J Kim
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - J Kim
- Department of Physics, Chung-Ang University, Seoul 06973, Republic of Korea
| | - K W Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S H Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S K Kim
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
| | - W K Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - Y D Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
- Department of Physics, Sejong University, Seoul 05006, Republic of Korea
| | - Y H Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
- Korea Research Institute of Standards and Science, Daejeon 34113, Republic of Korea
| | - Y J Ko
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - D H Lee
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - E K Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - H Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - H S Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - H Y Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - I S Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - J Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - J Y Lee
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - M H Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - S H Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - S M Lee
- Department of Physics and Astronomy, Seoul National University, Seoul 08826, Republic of Korea
| | - Y J Lee
- Department of Physics, Chung-Ang University, Seoul 06973, Republic of Korea
| | - D S Leonard
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - N T Luan
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - B B Manzato
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - R H Maruyama
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - R J Neal
- Department of Physics and Astronomy, University of Sheffield, Sheffield S3 7RH, United Kingdom
| | - J A Nikkel
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - S L Olsen
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - B J Park
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- IBS School, University of Science and Technology (UST), Daejeon 34113, Republic of Korea
| | - H K Park
- Department of Accelerator Science, Korea University, Sejong 30019, Republic of Korea
| | - H S Park
- Korea Research Institute of Standards and Science, Daejeon 34113, Republic of Korea
| | - K S Park
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S D Park
- Department of Physics, Kyungpook National University, Daegu 41566, Republic of Korea
| | - R L C Pitta
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - H Prihtiadi
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - S J Ra
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - C Rott
- Department of Physics, Sungkyunkwan University, Suwon 16419, Republic of Korea
- Department of Physics and Astronomy, University of Utah, Salt Lake City, Utah 84112, USA
| | - K A Shin
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
| | - D F F S Cavalcante
- Physics Institute, University of São Paulo, 05508-090, São Paulo, Brazil
| | - A Scarff
- Department of Physics and Astronomy, University of Sheffield, Sheffield S3 7RH, United Kingdom
| | - N J C Spooner
- Department of Physics and Astronomy, University of Sheffield, Sheffield S3 7RH, United Kingdom
| | - W G Thompson
- Department of Physics and Wright Laboratory, Yale University, New Haven, Connecticut 06520, USA
| | - L Yang
- Department of Physics, University of California San Diego, La Jolla, California 92093, USA
| | - G H Yu
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon 34126, Republic of Korea
- Department of Physics, Sungkyunkwan University, Suwon 16419, Republic of Korea
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7
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Lim YC, Lee EK, Park MH. Factors influencing drug switching and changes in low-density lipoprotein-cholesterol levels with atorvastatin: a real-world observational study. Lipids Health Dis 2023; 22:151. [PMID: 37705044 PMCID: PMC10498597 DOI: 10.1186/s12944-023-01903-2] [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: 06/15/2023] [Accepted: 08/11/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Although generic drugs have been approved with the assurance of interchangeable applications with original drugs, some physicians, and patients still view their efficacy and interchangeability negatively. Using real-world data, we aimed to determine factors that impact switching between drugs that contain the same active ingredient, i.e., atorvastatin, and, in turn, whether this 'switch' could alter clinical outcomes. METHODS Using the National Health Insurance Service senior cohort, a retrospective cohort study was conducted to assess patients who had newly started atorvastatin 10 mg and had at least two records of national health examinations from 2010 to 2014. Drug switching, which was defined as a change in the atorvastatin product administered 90 days before the first and second examinations, was assessed. Greedy propensity score matching (1:2) was performed between switchers and non-switchers to control for potential confounders. Factors influencing switching were analyzed using multivariate logistic regression to estimate odds ratios and 95% confidence intervals (CIs). Changes in low-density lipoprotein-cholesterol (LDL-C) levels attributable to drug switching were evaluated using difference-in-differences regression. RESULTS A total of 1,588 patients were included, of whom 25.3% switched drugs (1,187 non-switchers and 401 switchers). Compared to patients taking generics before the first examination, those taking the original drugs had a lower odds ratio (0.31; 95% CI [0.21, 0.46]) for subsequent drug switching. A change in medical institution was associated with a significantly higher odds ratio (6.83; 95% CI [4.66, 10.02]). There were no significant differences in LDL-C alterations between switchers and non-switchers (0.42 mg/dL; 95% CI [-2.29, 3.13]). CONCLUSION The type of first-time drug administered and changes in medical institution can influence drug switching. No significant changes in LDL-C values were observed in the various switching scenarios between the original and generic drugs, suggesting their interchangeable application in real-world clinical practice.
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Affiliation(s)
- Yu-Cheol Lim
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-Do, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-Do, South Korea.
| | - Mi-Hai Park
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-Do, South Korea.
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8
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Lee JE, Kwon SH, Kwon S, Jung HI, Nam JH, Lee EK. Concomitant Use of Proton Pump Inhibitors and Palbociclib Among Patients With Breast Cancer. JAMA Netw Open 2023; 6:e2324852. [PMID: 37477917 PMCID: PMC10362477 DOI: 10.1001/jamanetworkopen.2023.24852] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 03/31/2023] [Accepted: 06/08/2023] [Indexed: 07/22/2023] Open
Abstract
Importance Proton pump inhibitors (PPIs) are commonly used drugs to relieve gastrointestinal tract symptoms, but their acid-inhibitory action negatively affects the bioavailability and clinical outcomes of orally administered concomitant drugs. Objective To identify the clinical outcomes of patients with advanced breast cancer who concomitantly use PPIs and palbociclib. Design, Setting, and Participants This retrospective cohort study used nationwide claims data between November 1, 2016, and July 31, 2021, in South Korea. Patients with breast cancer receiving palbociclib between November 1, 2017, and July 31, 2020, were identified. Patients whose prescriptions for palbociclib and PPI overlapped by at least 33% were classified into a concomitant PPI group. Patients who never received PPI during the palbociclib treatment period were classified into a nonconcomitant PPI group. Patients were selected through 1:3 propensity score matching for analyses. Exposures Concomitant use of PPIs with palbociclib. Main Outcomes and Measures Time to progression and death. These outcomes were presented as progression-free survival (PFS) and overall survival (OS) and were analyzed using the Kaplan-Meier method and log-rank test. Cox proportional hazards regression was used to estimate the hazard ratio (HR) of concomitant PPI use associated with clinical PFS and/or OS. Results A total of 344 women were included in the concomitant PPI group and 966 in the nonconcomitant PPI group. Among 1310 patients identified after matching, 1108 (84.6%) were older than 50 years; 1111 (84.8%) were treated with letrozole and anastrozole (endocrine sensitive); and 199 (15.2%) were treated with fulvestrant (endocrine resistant). The median clinical PFS in the concomitant PPI group was shorter than that of the nonconcomitant PPI group (25.3 [95% CI, 19.6-33.0] vs 39.8 [95% CI, 34.9 to not applicable] months; P < .001), and the HR was 1.76 (95% CI, 1.46-2.13). Concomitant use of PPI was also associated with shorter OS (HR, 2.71 [95% CI, 2.07-3.53]). Both clinical PFS and OS in the concomitant PPI group were consistently poor in patients receiving endocrine-sensitive and endocrine-resistant treatment. Conclusions and Relevance These findings suggest that concomitant use of PPIs with palbociclib may hinder the complete therapeutic benefits of palbociclib in patients with breast cancer.
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Affiliation(s)
- Ju-Eun Lee
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
| | - Swan Kwon
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
| | - Hye-In Jung
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
| | - Jin Hyun Nam
- Division of Big Data Science, Korea University Sejong Campus, Sejong, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
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Oh BC, Cho AR, Nam JH, Yang SY, Kim MJ, Kwon SH, Lee EK. Survival differences between patients with de novo and relapsed/progressed advanced non-small cell lung cancer without epidermal growth factor receptor mutations or anaplastic lymphoma kinase rearrangements. BMC Cancer 2023; 23:482. [PMID: 37248452 DOI: 10.1186/s12885-023-10950-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND We aimed to examine whether patients with de novo and relapsed/progressed stage IIIB-IV non-small cell lung cancer (NSCLC) without epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) mutations have different prognoses. METHODS This retrospective study analyzed the Health Insurance Review and Assessment claims data in South Korea from 2013 to 2020. Patients with stage IIIB-IV NSCLC without EGFR or ALK mutations who received first-line palliative therapy between 2015 and 2019 were identified. Overall survival (OS), time to first subsequent therapy (TFST), and time to second subsequent therapy (TSST) were estimated using the Kaplan-Meier method. Multivariate Cox regression analysis was used to reveal the impact of de novo versus relapsed/progressed disease on OS. Treatment patterns, including treatment sequence, top five most frequent regimens, and time to treatment discontinuation, were described in both groups. RESULTS Of 14,505 patients, 12,811 (88.3%) were de novo, and 1,694 (11.7%) were relapsed/progressed. The median OS in the de novo group was 11.0 versus 11.5 months in the relapsed/progressed group (P = 0.002). The ongoing treatment probability was higher in relapsed/progressed patients than in de novo patients from 6.4 months since the initiation of first-line treatment (P < 0.001). Median TSST was shorter in the de novo group than in the relapsed/progressed group (9.5 vs. 9.9 months, P < 0.001). In multivariate analysis, de novo disease was associated with shorter OS (hazard ratio 1.07; 95% confidence interval 1.01-1.14). The overall treatment patterns for de novo and relapsed/progressed patients were similar. CONCLUSIONS De novo patients had poorer OS and TSST after the initiation of palliative therapy than relapsed/progressed patients. These findings suggest that the stage of the disease at the time of initial diagnosis should be considered in observational studies and clinical trials as a prognostic factor.
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Affiliation(s)
- Byeong-Chan Oh
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi- do, Republic of Korea
| | - Ae-Ryeo Cho
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi- do, Republic of Korea
| | - Jin Hyun Nam
- Division of Big Data Science, Korea University Sejong Campus, Sejong-si, Republic of Korea
| | | | - Min Ji Kim
- Amgen Korea Limited, Seoul, Republic of Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi- do, Republic of Korea.
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi- do, Republic of Korea.
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Min S, Kwon SH, Lee YW, Lee JM, Bae EJ, Lee EK. Estimating the Total Societal Cost of a Hexavalent Vaccine versus a Pentavalent Vaccine with Hepatitis B in South Korea. Vaccines (Basel) 2023; 11:vaccines11050984. [PMID: 37243088 DOI: 10.3390/vaccines11050984] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/02/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
In South Korea, the ready-to-use hexavalent vaccine (against diphtheria, tetanus, pertussis, poliovirus, Haemophilus influenzae type b, and hepatitis B) is not listed despite its facility of no need to reconstitute. It, therefore, has the potential to augment the efficiency of prevention against the six infectious diseases, and it may reduce vaccine-related errors of reconstitution when compared with the currently used vaccination scheme of the pentavalent vaccine with the additional shots against hepatitis B. Given the assumed clinical equivalence between the two vaccination schemes, a cost-minimization analysis has been performed from a societal perspective including all the medical and non-medical direct and indirect costs when vaccinating one birth cohort. The results indicate that the ready-to-use hexavalent vaccine induces a cost reduction of KRW 47,155 (USD36.22) per infant or 12,026 million Korean Won ($9,236,417) in total for the whole birth cohort with 260,500 children. Using the ready-to-use hexavalent vaccine causes a lower infection rate, has fewer vaccination sessions, and may save much time as compared with the current vaccination scheme in place. The ready-to-use hexavalent vaccine may, therefore, benefit the National Immunization Program by reducing the total societal costs of vaccination while improving convenience of infants, parents, and medical care professionals.
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Affiliation(s)
- Serim Min
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Yeon-Woo Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
| | - Jung-Min Lee
- Sanofi Korea Co., Ltd., Seoul 06578, Republic of Korea
| | - Eun Jin Bae
- Sanofi Korea Co., Ltd., Seoul 06578, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Republic of Korea
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Park SY, Hahn KI, Kang WG, Kazalov V, Kim GW, Kim YD, Lee EK, Lee MH, Leonard DS, Sala E, So JH, Yoon SC. Detection efficiency calibration for an array of fourteen HPGe detectors. Appl Radiat Isot 2023; 193:110654. [PMID: 36646029 DOI: 10.1016/j.apradiso.2023.110654] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/08/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
The CUP array of germanium (CAGe) is an array of fourteen high-purity germanium (HPGe) detectors. The detection efficiency of full-energy-peak emitted from the various samples assayed on the CAGe was calculated using the Monte Carlo simulation toolkit GEANT4. If the dead layer on the surface of the crystal is treated in the simulation as a continuous part of the active crystal, then the detection efficiency will be overestimated. Thus, the detection efficiency of the CAGe was adjusted using multi-nuclide source data and Monte Carlo simulations. The gamma spectra of the known activity source were obtained for each HPGe detector of the CAGe. The detection efficiency measured by the multi-source data was smaller than that of simulation data if the simulation treated the whole volume of germanium crystals as active for gamma detection. By optimizing the dead layers' thicknesses in the simulation, the detection efficiency calculated by the simulation could be matched to that of multi-source data.
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Affiliation(s)
- S Y Park
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - K I Hahn
- Center for Exotic Nuclear Studies, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - W G Kang
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - V Kazalov
- Baksan Neutrino Observatory, Institute for Nuclear Research of the Russian Academy of Science, Kabardino-Balkaria, 361609, Russia
| | - G W Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea.
| | - Y D Kim
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea; Department of Physics and Astronomy, Sejong University, Seoul, 05006, South Korea; IBS School, University of Science and Technology (UST), Daejeon, 34113, South Korea
| | - E K Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - M H Lee
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea; IBS School, University of Science and Technology (UST), Daejeon, 34113, South Korea
| | - D S Leonard
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - E Sala
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - J H So
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
| | - S C Yoon
- Center for Underground Physics, Institute for Basic Science (IBS), Daejeon, 34126, South Korea
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Na H, Kwon SH, Son KH, Baek Y, Kim J, Lee EK. Comparative Safety Profiles of Oncology Biosimilars: A Systematic Review and Network Meta-analysis. BioDrugs 2023; 37:205-218. [PMID: 36729329 DOI: 10.1007/s40259-023-00576-8] [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] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND It is crucial that the safety profiles of biosimilars are similar to those of the original biologics. A better understanding of biosimilars and their relative safety and immunogenicity profiles are required for healthcare providers to prescribe them to patients with life-threatening cancer diseases who receive chemotherapies with potentially serious adverse events (AEs). OBJECTIVES The purpose of this study was to collate and analyze currently available safety and immunogenicity outcomes of biosimilars used in oncology and compare their safety information with those of the original biologics. METHODS The MEDLINE and Cochrane Library databases were searched as at 28 February 2022. Four anti-cancer biosimilar molecules were considered: bevacizumab, trastuzumab, rituximab, and (peg)filgrastim. Through a systematic review, we selected the randomized controlled trials (RCTs) comparing safety outcomes between the biosimilars and original biologics of the four molecules. As safety outcomes, various treatment-emergent adverse events (TEAEs) were collated, such as any TEAE, serious AE, and TEAE higher than grade 3. A risk ratio (RR) per category of TEAE was estimated through a meta-analysis. A network meta-analysis (NMA) was also conducted to compare the safety among the biosimilar brands for TEAEs over 25% with higher variability in addition to the serious AE cases. RESULTS Forty-nine RCTs were identified. The results from the meta-analysis showed that the safety and immunogenicity profiles of all four biosimilar molecules are comparable with that of the original biologics at the TEAE level without statistically significant differences, except for diarrhea for (peg)filgrastim. The incidence of diarrhea with (peg)filgrastim was less than that with the original biologic (RR 0.66, 95% confidence interval 0.50-0.89). The NMA results showed similar safety profiles among the biosimilar brands for all four biosimilar molecules, except for the serious adverse event of a trastuzumab biosimilar (RR 0.296, 95% credible interval 0.109-0.840). CONCLUSION The meta-analysis and NMA for all four biosimilars showed that the safety and immunogenicity profiles of biosimilar products in oncology are generally comparable with that of the original biologics at the TEAE level. However, additional evidence needs to be collected since several TEAEs of specific biosimilars were out of the equivalent range. The results of this study provide comparative safety information and a better understanding of oncology biosimilars for healthcare providers to prescribe them to patients.
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Affiliation(s)
- HyeJung Na
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, Republic of Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, Republic of Korea.
| | - Kyung-Hwa Son
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, Republic of Korea
| | - Youngsuk Baek
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, Republic of Korea
| | - Jiye Kim
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, Republic of Korea.
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Oh BC, Lee JE, Nam JH, Hong JY, Kwon SH, Lee EK. Health-related quality of life in adult patients with asthma according to asthma control and severity: A systematic review and meta-analysis. Front Pharmacol 2022; 13:908837. [DOI: 10.3389/fphar.2022.908837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background: The utility values are increasingly being used in economic evaluations and health policy decision making. This study aims to conduct a systematic literature review and meta-analysis of the utility values for asthma, particularly with respect to severity and asthma control.Materials and methods: A literature search was conducted using the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases for studies published until July, 2020, reporting the utilities of adult asthma. We extracted utility values derived by nine indirect and four direct utility instruments. Meta-analyses were performed for each utility instrument according to health states based on the level of asthma control and severity.Results: Fifty-two eligible studies were included in our systematic review, of which forty studies were used in the meta-analyses. Among the 13 utility instruments, the most used was EQ-5D-3L, whereas EQ-5D-5L showed the narrowest 95% confidence interval (95% CI, 0.83–0.86) of pooled utility. The pooled utility of asthma declined with worsening control levels and severity. The pooled utility value of EQ-5D-3L was 0.72 (95% CI, 0.63–0.80) for uncontrolled, 0.82 (95% CI, 0.75–0.88) for partly controlled, and 0.87 (95% CI, 0.84–0.90) for well-controlled asthma.Conclusion: Our study shows that EQ-5D-3L and EQ-5D-5L are appropriate for economic evaluations in terms of availability and variability of information, respectively. Asthma patients had poorer utility values with worsened severity and level of asthma control. This study will be useful for health economists conducting economic evaluations of asthma treatments.
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Park SK, Kang DW, Lee EK. Cost-Effectiveness Analysis of Smoking Cessation Interventions With Behavioral Support: A Study Based on the Benefits of Smoking Cessation on Outcomes (BENESCO) Model. Nicotine Tob Res 2022; 24:2011-2017. [PMID: 35862219 DOI: 10.1093/ntr/ntac172] [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] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/20/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Few studies have compared cost-effectiveness of different smoking cessation interventions (SCIs) that include behavioral support, considering smoking-related diseases. Therefore, we compare the cost-effectiveness of SCIs with behavioral support in South Korea using the Benefits of Smoking Cessation on Outcomes (BENESCO) model. AIMS AND METHODS We used the BENESCO model to estimate the cost and utility of the SCIs with behavioral support, including pharmacist counseling with nicotine replacement therapy (pharmacist+NRT), expert counseling with NRT (expert+NRT), and expert counseling with varenicline (expert+varenicline). The target population was adult smokers who wanted to cease smoking within 1 month. We applied transitional probabilities and epidemiological data from the literature. Medical costs and utilities were calculated using claims and national survey data, respectively. Cost-effectiveness was evaluated within the threshold (17 926 USD per quality-adjusted life years [QALYs]) by incremental cost-effectiveness ratio (ICER). RESULTS The model cohort included 1 219 390 male and 298 511 female smokers. The pharmacist+NRT group had 32 842 more QALYs gained and 26 689 958 USD less expended than the expert+NRT group. The ICER for the expert+varenicline group versus the pharmacist+NRT and expert+NRT groups was 27 247 and 4074 USD per QALY, respectively. The robustness of the results was confirmed by sensitivity analyses, except for the discount rate and cost of the expert+varenicline group. CONCLUSIONS In Korea, pharmacist counseling with NRT showed higher QALY gains and lower costs than expert counseling with NRT. Expert counseling with varenicline was more effective for smoking cessation and more cost-effective than expert counseling with NRT but was not cost-effective compared with pharmacist counseling with NRT. IMPLICATIONS This study provides evidence for decision-making on smoking cessation programs by evaluating the cost-effectiveness of SCIs. Furthermore, we attempted to use the BENESCO model to compare and evaluate the cost-effectiveness of SCIs with behavioral support. It is meaningful because this study showed the availability of using the BENESCO model in the future cost-effectiveness analysis of various SCIs.
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Affiliation(s)
- Sun-Kyeong Park
- College of Pharmacy, Catholic University of Korea, Bucheon, Gyeonggi-do, South Korea
| | - Dong-Won Kang
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
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Cho JY, Won YK, Park J, Nam JH, Hong JY, Min S, Kim N, Chung TY, Lee EK, Kwon SH, Lim DH. Visual Outcomes and Optical Quality of Accommodative, Multifocal, Extended Depth-of-Focus, and Monofocal Intraocular Lenses in Presbyopia-Correcting Cataract Surgery: A Systematic Review and Bayesian Network Meta-analysis. JAMA Ophthalmol 2022; 140:1045-1053. [PMID: 36136323 PMCID: PMC9501783 DOI: 10.1001/jamaophthalmol.2022.3667] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/26/2022] [Indexed: 12/15/2022]
Abstract
Importance A bayesian network meta-analysis (NMA) can help compare the various types of multifocal and monofocal intraocular lenses (IOLs) used in clinical practice. Objective To compare outcomes of presbyopia-correcting IOLs frequently recommended in clinical practice through a bayesian NMA based on a systematic review. Data Sources Medline (PubMed) and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on May 15, 2021, from inception. Study Selection Based on the research question, randomized clinical trials assessing multifocal IOLs in patients who underwent bilateral cataract extraction were searched. Nonrandomized studies, studies in patients with unilateral or contralateral cataract extractions, duplicated studies, conference abstracts, and nonpeer-reviewed articles were excluded. Data Extraction and Synthesis Descriptive statistics and outcomes were extracted. The NMA was conducted to compare different types of IOLs. The mean differences for continuous variables, odds ratios for binary variables, 95% credible intervals (CrIs), and ranks of interventions were estimated. Main Outcomes and Measures The outcomes examined included binocular visual acuities by distance and optical quality, including glare, halos, and spectacle independence. Results This NMA included 27 studies comprising 2605 patients. For uncorrected near visual acuity, trifocal IOLs (mean difference, -0.32 [95% CrI, -0.46 to -0.19]) and old bifocal diffractive IOLs (mean difference, -0.33 [95% CrI, -0.50 to -0.14]) afforded better visual acuity than monofocal IOLs. Regarding uncorrected intermediate visual acuity, extended depth-of-focus IOLs provided better visual acuity than monofocal IOLs. However, there were no differences between extended depth-of-focus and trifocal diffractive IOLs in pairwise comparisons. For uncorrected distant visual acuity, all multifocal IOLs were comparable with monofocal IOLs. There were no statistical differences between multifocal and monofocal IOLs regarding contrast sensitivity, glare, or halos. Conclusions and Relevance For patients considering a multifocal IOL due to presbyopia, bilateral implantation of a trifocal IOL might be an optimal option for patients without compromising distant visual acuity.
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Affiliation(s)
- Jeong-Yeon Cho
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Yeo Kyoung Won
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jongyeop Park
- Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Republic of Korea
| | - Jin Hyun Nam
- Division of Big Data Science, Korea University Sejong Campus, Sejong, Republic of Korea
| | - Ji-Yoon Hong
- Health Insurance Research Institute, National Health Insurance Service, Wonju, Gangwon, Republic of Korea
| | - Serim Min
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Nahyun Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
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Abstract
BACKGROUND The potential to lower pharmaceutical spending exists if physicians prescribe low-priced generics. This study aimed to empirically investigate the determinants of choosing low-priced generic drugs in South Korea. METHODS The 2018 HIRA-NPS dataset was used for this study. Among 1.45 million individuals, we identified the patients who were prescribed atorvastatin 10 mg for more than 60 days in 2018 as the study subjects, separated the subjects into high- and low-priced groups based on their average unit price, and applied a series of logistic regression models to elucidate the factors affecting low-priced drug choice. RESULTS Out of 60,984 subjects, only 10,228 (17%) were categorized into the low-priced group. The majority of the subjects (31%) were prescribed drugs at the maximum reimbursement price. Age of the subject, the frequency of visits to the institution, the existence of a usual source of care, and the institution type that a subject mainly visited for prescriptions were associated with being prescribed low-priced generics. CONCLUSION The association of being prescribed low-priced generics with the primary care institution and the usual source of care could be interpreted as evidence for the role of primary care in the continuity of patient-centred care. Creating health systems under which professionals act as perfect agents of a patient and/or an insurer is required.
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Affiliation(s)
- Kyung-Bok Son
- School of Pharmacy, Sungkyunkwan University, Suwon-si, Gyeonggi-do, South Korea.,Division of Cancer Prevention and Early Detection, National Cancer Center, Goyang-si, Gyeonggi-do, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon-si, Gyeonggi-do, South Korea
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Shim YB, Byun JY, Lee JY, Lee EK, Park MH. Economic burden of brain metastases in non-small cell lung cancer patients in South Korea: A retrospective cohort study using nationwide claims data. PLoS One 2022; 17:e0274876. [PMID: 36126084 PMCID: PMC9488774 DOI: 10.1371/journal.pone.0274876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/06/2022] [Indexed: 11/19/2022] Open
Abstract
Brain metastases (BM) are common in patients with non-small cell lung cancer (NSCLC). However, the pure economic burden of BM is unknown. This study aimed to evaluate the impact of BM on healthcare costs and resource utilization in patients with NSCLC by comparing patients with and without BM. This was a retrospective cohort analysis of South Korean health insurance review and assessment claims data. Patients with stage IIIB or IV NSCLC were identified (March 1, 2013 to February 28, 2018). We compared their two-year and per-patient-per-month (PPPM) healthcare costs and resource utilization with 1:3 propensity score-matched patients without the condition. A generalized linear model was used to estimate the impact of BM and other covariates on healthcare costs. After propensity score matching with the 33 402 newly diagnosed cases of stage IIIB or IV NSCLC, 3435 and 10 305 patients were classified as having or not having BM, respectively. Mean healthcare costs were significantly greater in patients with BM for both the two years (US$ 44 692 vs. US$ 32 230, p < .0001) and PPPM (US$ 3510 vs. US$ 2573, p < .0001). The length of hospital stay was longer in patients with BM (79.15 vs. 69.41 days for two years, p < .0001; 7.69 vs. 6.86 days PPPM, p < .0001), and patients with BM had more outpatient visits (50.61 vs. 46.43 times for two years, p < .0001; 3.64 vs. 3.40 times PPPM costs, p < .0001). The costs of drugs, radiology/radiotherapy, and admission comprised the majority of PPPM costs and were higher in patients with BM. The generalized linear model analysis suggested that patients with BM had significantly increased healthcare costs (by 1.29-fold, 95% confidence interval 1.26–1.32). BM is a significant economic burden for patients with NSCLC. Therefore, it is important to prevent BM in patients with NSCLC to reduce their economic burden.
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Affiliation(s)
- Yoon-Bo Shim
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, South Korea
| | - Joo-Young Byun
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, South Korea
| | - Ju-Yong Lee
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, South Korea
- AstraZeneca Korea, Seoul, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, South Korea
| | - Mi-Hai Park
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, South Korea
- * E-mail:
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18
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Son KB, Lee EK, Lee SW. Understanding patient and physician responses to various cost-sharing programs for prescription drugs in South Korea: A multilevel analysis. Front Public Health 2022; 10:924992. [PMID: 36117604 PMCID: PMC9471326 DOI: 10.3389/fpubh.2022.924992] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/11/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Patient and/or physician responses are a pivotal issue in designing rational cost-sharing programs under health insurance systems. Objectives This study aims to understand patient and/or physician responses to cost-sharing programs designed for prescription drugs in South Korea. Methods As a framework, we took advantage of a tiered cost-sharing program, including from copayment to coinsurance (threshold 1) and reduced coinsurance (threshold 2). Given the hierarchical structure of prescriptions nested within patients, we utilized a multilevel analysis to assess effects of various cost-sharing programs on patient and/or physician responses using National Health Insurance claims data from 2018. Results We found that a tiered cost-sharing program was effective in changing the behaviors of patients and/or physicians. Threshold 1 was found to be more effective than threshold 2 in changing their behaviors. At the prescription level, sensitivity to cost-sharing programs was associated with prescribed days of treatment and locations of prescription. In a similar vein, sensitivity to cost-sharing programs was associated with gender and age group of patients. Conclusion A simplified cost-sharing program with extended intervals should be considered to rationalize cost-sharing programs. Specifically, a cost-sharing program designed for long-term prescriptions for chronic diseases together with an emphasis on cost transparency is required to better guide price-conscious decisions by patients and/or physicians.
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Affiliation(s)
- Kyung-Bok Son
- College of Pharmacy, Hanyang University, Ansan-si, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon-si, South Korea
| | - Sang-Won Lee
- School of Pharmacy, Sungkyunkwan University, Suwon-si, South Korea,*Correspondence: Sang-Won Lee
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19
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Jang SC, Kwon SH, Min S, Jo AR, Lee EK, Nam JH. Optimal Indicator of Death for Using Real-World Cancer Patients' Data From the Healthcare System. Front Pharmacol 2022; 13:906211. [PMID: 35784684 PMCID: PMC9243505 DOI: 10.3389/fphar.2022.906211] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022] Open
Abstract
Background: Information on patient’s death is a major outcome of health-related research, but it is not always available in claim-based databases. Herein, we suggested the operational definition of death as an optimal indicator of real death and aim to examine its validity and application in patients with cancer. Materials and methods: Data of newly diagnosed patients with cancer between 2006 and 2015 from the Korean National Health Insurance Service—National Sample Cohort data were used. Death indicators were operationally defined as follows: 1) in-hospital death (the result of treatment or disease diagnosis code from claims data), or 2) case wherein there are no claims within 365 days of the last claim. We estimated true-positive rates (TPR) and false-positive rates (FPR) for real death and operational definition of death in patients with high-, middle-, and low-mortality cancers. Kaplan−Meier survival curves and log-rank tests were conducted to determine whether real death and operational definition of death rates were consistent. Results: A total of 40,970 patients with cancer were recruited for this study. Among them, 12,604 patients were officially reported as dead. These patients were stratified into high- (lung, liver, and pancreatic), middle- (stomach, skin, and kidney), and low- (thyroid) mortality groups consisting of 6,626 (death: 4,287), 7,282 (1,858), and 6,316 (93) patients, respectively. The TPR was 97.08% and the FPR was 0.98% in the high mortality group. In the case of the middle and low mortality groups, the TPR (FPR) was 95.86% (1.77%) and 97.85% (0.58%), respectively. The overall TPR and FPR were 96.68 and 1.27%. There was no significant difference between the real and operational definition of death in the log-rank test for all types of cancers except for thyroid cancer. Conclusion: Defining deaths operationally using in-hospital death data and periods after the last claim is a robust alternative to identifying mortality in patients with cancer. This optimal indicator of death will promote research using claim-based data lacking death information.
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Affiliation(s)
- Suk-Chan Jang
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Serim Min
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Ae-Ryeo Jo
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- *Correspondence: Eui-Kyung Lee, ; Jin Hyun Nam,
| | - Jin Hyun Nam
- Divison of Big Data Science, Korea University Sejong Campus, Sejong, South Korea
- *Correspondence: Eui-Kyung Lee, ; Jin Hyun Nam,
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20
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Kang DW, Shim YB, Lee EK, Park MH. Healthcare resource utilization and medical costs in patients with terminal cancer during best supportive care. PLoS One 2022; 17:e0269565. [PMID: 35657991 PMCID: PMC9165859 DOI: 10.1371/journal.pone.0269565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/13/2021] [Accepted: 05/24/2022] [Indexed: 12/24/2022] Open
Abstract
Patients with terminal cancer have different physical symptoms, prognoses, emotional distress, and end-of-life care plans from those receiving aggressive chemotherapy; few studies have assessed healthcare resource use in these patients. Therefore, this study aimed to assess healthcare resource utilization and medical costs incurred during best supportive care after the last anticancer drug treatment in patients with terminal cancer. This retrospective observational study was conducted using national sample cohort data from the National Health Insurance Service in South Korea. Only patients with cancer who were treated with the last anticancer drugs from January 1, 2006, to June 30, 2015, were included in the study. The period of best supportive care was defined as the time from the date of use of the last anticancer drug to death. Healthcare resource utilization and medical costs were estimated during the best supportive care. A generalized linear model with a log-link function and gamma distribution was used to evaluate the impact of demographic and healthcare utilization factors on total medical costs. Among the 2,480 patients in the study, 93.9% were hospitalized, and hospitalization days (30.8 days) accounted for 39.7% of the surviving period (77.5 days). The proportions of intensive care unit admissions and emergency department visits were 15.8% and 18.9%, respectively. The average total medical cost per patient was $6,310, with the inpatient cost ($5,705) being approximately 9.4 times higher than the outpatient cost ($605). The length of hospitalization had the greatest impact on the total medical costs. Pancreatic cancer had the highest proportion of patients who were hospitalized (97.4%) and the highest medical cost ($7,702). Hospital-based resources were utilized by most patients with terminal cancer, and hospitalization was a major driver of the total medical cost. An alternative system for hospitalization should be developed to support patients with terminal cancer, both clinically and financially.
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Affiliation(s)
- Dong-Won Kang
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Yoon-Bo Shim
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Mi-Hai Park
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
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21
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Yang SY, Kang DW, Nam JH, Choi EK, Lee EK, Shin JY, Kwon SH. Adherence is an optimal factor for maximizing the effective and safe use of oral anticoagulants in patients with atrial fibrillation. Sci Rep 2022; 12:3413. [PMID: 35233055 PMCID: PMC8888574 DOI: 10.1038/s41598-022-07316-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 02/15/2022] [Indexed: 11/24/2022] Open
Abstract
Few studies assessed the association between major adverse cardiovascular events and adherence to warfarin and direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF). Therefore, we aimed to evaluate the effects of adherence to oral anticoagulants (OACs) in patients with AF using claims data (July 2014–April 2019). Using the initial 3-month medication possession rate (MPR), patients were categorized into adherent (MPR ≥ 0.8) or non-adherent (MPR < 0.8) groups. Propensity score matching of non-adherent group to adherent group was conducted for warfarin (1:1) and DOAC (1:3), respectively. Incidence of ischemic stroke, myocardial infarction (MI), intracranial hemorrhage, and all-cause death was assessed in the matched cohort (67,147 patients). The hazard ratio (HR) for adherence to OAC was estimated using the Cox proportional hazard model with adjusting covariate including age and sex. The risk for ischemic stroke, MI, and all-cause death was lower in the DOAC adherent group than in the DOAC non-adherent group (HR: 0.78; 95% confidence intervals: 0.73–0.84; 0.75, 0.60–0.94; 0.54, 0.51–0.57, respectively). Adherence to OAC was not associated with the risk of intracranial hemorrhage (1.01, 0.85–1.20). Commitment programs to improve adherence in patients with AF could maximize drug effectiveness and safety.
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Affiliation(s)
- So-Young Yang
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Dong-Won Kang
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Jin Hyun Nam
- Department of Big Data Science, Korea University Sejong Campus, Sejong, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea. .,Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, Republic of Korea.
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea.
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22
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Byun JY, Kim HL, Lee EK, Kwon SH. A Systematic Review of Economic Evaluations of Active Tuberculosis Treatments. Front Pharmacol 2021; 12:736986. [PMID: 34966276 PMCID: PMC8710595 DOI: 10.3389/fphar.2021.736986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/06/2021] [Accepted: 11/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The disease burden of active tuberculosis (TB) is considerable, but systematic reviews of economic evaluations of active TB treatments are scarce. Methods: PubMed, EMBASE, and the Cochrane Library databases were used to search for articles on cost-effectiveness analysis or cost-utility analysis that economically evaluated active TB treatments, which were then systematically reviewed by two independent reviewers. We extracted vital components of the included studies, such as country, population, intervention/comparator, primary outcome, values of outcomes, thresholds, model type, time horizon, and health states included in the model. Results: Seventeen studies were included in this systematic review. Thirteen dealt with interventions of medications, and the remaining four compared care strategies. The Markov model was the most commonly used tool to compare medications, whereas studies on care plans mainly used decision trees. The most commonly used primary outcome was disability-adjusted life years, followed by quality-adjusted life years. For treatment-naïve TB, the 4-month regimen was more cost-effective than the 6-month regimen mainly in low- and middle-income countries. For multidrug-resistant TB, a bedaquiline-based regimen was cost-effective. For multidrug-resistant TB, decentralized care that employed the use of home or mobile devices was more cost-effective than hospital-based centralized care in low- and middle-income countries. Conclusion: New treatment strategies to improve therapeutic outcomes by enhancing treatment adherence, such as regimens with shorter durations (2 or 4 months) and decentralized care, or new anti-TB agents (e.g., bedaquiline) have been suggested as cost-effective interventions for active TB. This review provides information on the economic evaluation of active TB from good-quality studies, thus aiding the future economic evaluation of active TB.
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Affiliation(s)
- Joo-Young Byun
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Hye-Lin Kim
- College of Pharmacy, Sahmyook University, Seoul, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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23
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Cho JY, Kwon SH, Lee EK, Lee JH, Kim HL. Cost-Effectiveness of Adjuvant Immunotherapy With Cytokine-Induced Killer Cell for Hepatocellular Carcinoma Based on a Randomized Controlled Trial and Real-World Data. Front Oncol 2021; 11:728740. [PMID: 34926248 PMCID: PMC8682810 DOI: 10.3389/fonc.2021.728740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/22/2021] [Accepted: 11/16/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Studies using data from randomized controlled trials (RCTs) and real-world data (RWD) have suggested that adjuvant cytokine-induced killer (CIK) cell immunotherapy after curative treatment for hepatocellular carcinoma (HCC) prolongs recurrence-free survival (RFS) and overall survival (OS). However, the cost-effectiveness of CIK cell immunotherapy as an adjuvant therapy for HCC compared to no adjuvant therapy is uncertain. METHODS We constructed a partitioned survival model to compare the expected costs, life-year (LY), and quality-adjusted life-year (QALY) of a hypothetical population of 10,000 patients between CIK cell immunotherapy and no adjuvant therapy groups. Patients with HCC aged 55 years who underwent a potentially curative treatment were simulated with the model over a 20-year time horizon, from a healthcare system perspective. To model the effectiveness, we used OS and RFS data from RCTs and RWD. We estimated the incremental cost-effectiveness ratios (ICERs) and performed extensive sensitivity analyses. RESULTS Based on the RCT data, the CIK cell immunotherapy incrementally incurred a cost of $61,813, 2.07 LYs, and 1.87 QALYs per patient compared to no adjuvant therapy, and the estimated ICER was $33,077/QALY. Being less than the willingness-to-pay threshold of $50,000/QALY, CIK cell immunotherapy was cost-effective. Using the RWD, the ICER was estimated as $25,107/QALY, which is lower than that obtained using RCT. The time horizon and cost of productivity loss were the most influential factors on the ICER. CONCLUSION We showed that receiving adjuvant CIK cell immunotherapy was more cost-effective than no adjuvant therapy in patients with HCC who underwent a potentially curative treatment, attributed to prolonged survival, reduced recurrence of HCC, and better prognosis of recurrence. Receiving CIK cell immunotherapy may be more cost-effective in real-world clinical practice.
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Affiliation(s)
- Jeong-Yeon Cho
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Hye-Lin Kim
- College of Pharmacy, Sahmyook University, Seoul, South Korea
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24
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Kim HL, Kim GA, Park JA, Kang HR, Lee EK, Lim YS. Cost-effectiveness of antiviral treatment in adult patients with immune-tolerant phase chronic hepatitis B. Gut 2021; 70:2172-2182. [PMID: 33239344 DOI: 10.1136/gutjnl-2020-321309] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/15/2020] [Accepted: 11/07/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The cost-effectiveness of antiviral treatment in adult immune-tolerant (IT) phase chronic hepatitis B (CHB) patients is uncertain. DESIGN We designed a Markov model to compare expected costs and quality-adjusted life-years (QALYs) of starting antiviral treatment at IT-phase ('treat-IT') vs delaying the therapy until active hepatitis phase ('untreat-IT') in CHB patients over a 20-year horizon. A cohort of 10 000 non-cirrhotic 35-year-old patients in IT-phase CHB (hepatitis B e antigen-positive, mean serum hepatitis B virus (HBV) DNA levels 7.6 log10 IU/mL, and normal alanine aminotransferase levels) was simulated. Input parameters were obtained from previous studies at Asan Medical Center, Korea. The incremental cost-effectiveness ratio (ICER) between the treat-IT and untreat-IT strategies was calculated. RESULTS From a healthcare system perspective, the treat-IT strategy with entecavir or tenofovir had an ICER of US$16 516/QALY, with an annual hepatocellular carcinoma (HCC) incidence of 0.73% in the untreat-IT group. With the annual HCC risk ≥0.54%, the treat-IT strategy was cost-effective at a willingness-to-pay threshold of US$20 000/QALY. From a societal perspective considering productivity loss by premature death, the treat-IT strategy was extremely cost-effective, and was dominant (ICER <0) if the HCC risk was ≥0.43%, suggesting that the treat-IT strategy incurs less costs than the untreat-IT strategy. The most influential parameters on cost-effectiveness of the treat-IT strategy were those related with HCC risk (HBV DNA levels, platelet counts and age) and drug cost. CONCLUSION Starting antiviral therapy in IT phase is cost-effective compared with delaying the treatment until the active hepatitis phase in CHB patients, especially with increasing HCC risk, decreasing drug costs and consideration of productivity loss.
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Affiliation(s)
- Hye-Lin Kim
- College of Pharmacy, Sahmyook University, Seoul, Republic of Korea
| | - Gi-Ae Kim
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Jae-A Park
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Hye-Rim Kang
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hwang SH, Ah YM, Jun KH, Jung JW, Kang MG, Park HK, Lee EK, Park HK, Chung JE, Kim SH, Lee JY. Development and Validation of a Trigger Tool for Identifying Drug-Related Emergency Department Visits. Int J Environ Res Public Health 2021; 18:ijerph18168572. [PMID: 34444320 PMCID: PMC8391800 DOI: 10.3390/ijerph18168572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022]
Abstract
There are various trigger tools for detecting adverse drug events (ADEs), however, a drug-related emergency department (ED) visit trigger tool (DrEDTT) has not yet been developed. We aimed to develop and validate a DrEDTT with a multi-center cohort. In this cross-sectional study, we developed the DrEDTT consisting of 28 triggers through a comprehensive literature review and three phase expert group discussion. Next, we evaluated the performance of the DrEDTT by applying it to relevant medical records retrieved from four hospitals from January 2016 to June 2016. Two experts performed an in-depth chart review of a 25% of random sample of trigger flagged and unflagged ED visits and a true ADE was determined through causality assessment. Among 66,564 patients who visited the ED for reasons other than traffic accident and trauma during the study period, at least one trigger was found in 21,268 (32.0%) patients. A total of 959 true ADE cases (5.8%) were identified from a randomly selected 25% of ED visit cases. The overall positive predictive value was 14.0% (range: 8.3-66.7%). Sensitivity and specificity of DrEDTT were 77.7% and 70.4%, respectively. In conclusion, this newly developed trigger tool might be helpful to detect ADE-related ED visits.
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Affiliation(s)
- Sung-Hee Hwang
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan 15588, Korea; (S.-H.H.); (J.-E.C.)
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsan 38541, Korea;
| | - Kwang-Hee Jun
- Institute of Pharmaceutical Sciences, College of Pharmacy and Research, Seoul National University, Seoul 08826, Korea;
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul 06974, Korea;
| | - Min-Gyu Kang
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju 28644, Korea;
| | - Hye-Kyung Park
- Department of Internal Medicine, Pusan National University College of Medicine, Busan 50612, Korea;
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea; (E.-K.L.); (H.-K.P.)
| | - Hye-Kyung Park
- School of Pharmacy, Sungkyunkwan University, Suwon 16419, Korea; (E.-K.L.); (H.-K.P.)
| | - Jee-Eun Chung
- College of Pharmacy and Institute of Pharmaceutical Science and Technology, Hanyang University, Ansan 15588, Korea; (S.-H.H.); (J.-E.C.)
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea
- Correspondence: (S.-H.K.); (J.-Y.L.); Tel.: +82-2-2290-8336 (S.-H.K.); +82-2-3668-7472 (J.-Y.L.)
| | - Ju-Yeun Lee
- Institute of Pharmaceutical Sciences, College of Pharmacy and Research, Seoul National University, Seoul 08826, Korea;
- Correspondence: (S.-H.K.); (J.-Y.L.); Tel.: +82-2-2290-8336 (S.-H.K.); +82-2-3668-7472 (J.-Y.L.)
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Park H, Park CM, Woo JM, Shin JY, Lee EK, Kwon SH. Real-world data analysis of the clinical and economic burden and risk factors in patients with major depressive disorder with an inadequate response to initial antidepressants. J Med Econ 2021; 24:589-597. [PMID: 33879031 DOI: 10.1080/13696998.2021.1918922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/28/2022]
Abstract
AIM We aimed to determine the incidence of and identify the factors associated with treatment-resistant depression (TRD), psychiatric conditions, hospitalization, and cost in patients with major depressive disorder (MDD) who were treated using second-line strategies after an inadequate response to initial antidepressants (AD). MATERIALS AND METHODS Using South Korean National Health Insurance claims data (1 January 2013 to 30 June 2018), we conducted a retrospective cohort analysis in newly treated patients with MDD who subsequently switched or added AD, or added atypical antipsychotics (AAPs) as a second-line treatment. We assessed the incidence of treatment-resistant depression (TRD), psychiatric conditions, and hospitalization for the first 2 years and costs in the third year. Odds ratios (ORs) or relative ratios were estimated using logistic and linear regression models to identify the risk factors for clinical and economic outcomes. RESULTS In 15,887 patients, the TRD was 16.81% during the 24-month follow-up period (14.14% in switching AD, 19.65% in adding AD, and 19.91% in adding AAP; p < 0.0001). When adding AD or AAP, the OR of TRD was 1.43 (95% confidence interval (CI): 1.30-1.56) and 1.42 (95% CI: 1.23-1.65), respectively, compared to switching AD. However, these factors were not associated with the incidence of psychiatric conditions. Adding AAP increased hospitalization (OR = 1.25, 95% CI: 1.11-1.41), the number of inpatient days by 2.57-fold (95% CI: 1.75-3.76), and cost by 1.20-fold (95% CI: 1.02-1.40), compared to switching AD; adding AD did not show a significant association with these outcomes. CONCLUSIONS In patients with MDD with inadequate responses to initial AD, TRD still occurred after subsequent treatments according to clinical guidelines. Since the effectiveness of second treatment strategies can differ in reality, further analysis of the clinical and economic evidence regarding second treatment strategies, such as adding AD or AAP, is needed using real-world data.
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Affiliation(s)
- HyeJin Park
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
| | - Chan Mi Park
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Jong-Min Woo
- Hanbyul Psychiatric Hospital, Gyeonggi-do, Republic of Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea
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Yang SY, Park SK, Kang HR, Kim HL, Lee EK, Kwon SH. Haematological cancer versus solid tumour end-of-life care: a longitudinal data analysis. BMJ Support Palliat Care 2020:bmjspcare-2020-002453. [PMID: 33376113 DOI: 10.1136/bmjspcare-2020-002453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/27/2020] [Revised: 11/14/2020] [Accepted: 11/20/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To explore differences in end-of-life healthcare utilisation and medication costs between patients with haematological malignancies and patients with solid tumours. METHODS Data on deceased patients with cancer were selected from the sample cohort data of health insurance claims from 2008 to 2015 in South Korea. They were categorised into two groups: patients with haematological malignancies and patients with solid tumours. Longitudinal data comprised the patient-month unit and aggregated healthcare utilisation and medication cost for 1 year before death. Healthcare utilisation included emergency room visits, hospitalisation and blood transfusions. Medication costs were subdivided into anticancer drugs, antibiotics, opioids, sedatives and blood preparation. Generalised linear mixed models were used to evaluate differences between the two groups and time trends. RESULTS Of the 8719 deceased patients with cancer, 349 died from haematological malignancies. Compared with solid tumours, patients with haematological malignancies were more likely to visit the emergency room (OR=1.36, 95% CI 1.10 to 1.69) and receive blood transfusions (OR=5.44, 95% CI 4.29 to 6.90). The length of hospitalisation of patients was significantly different (difference=2.49 days, 95% CI 1.75 to 3.22). Medication costs, except for anticancer treatment, increased as death approached. The costs of antibiotics and blood preparations were higher in patients with haematological malignancies than in those with solid tumours: 3.24 (95% CI 2.14 to 4.90) and 4.10 (95% CI 2.77 to 6.09) times higher, respectively. CONCLUSIONS Patients with haematological malignancies are at a higher risk for aggressive care and economic burden at the end of life compared with those with solid tumours. Detailed attention is required when developing care plans for end-of-life care of haematological patients.
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Affiliation(s)
- So-Young Yang
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea (the Republic of)
| | - Sun-Kyeong Park
- College of Pharmacy, Catholic University of Korea, Bucheon, Korea (the Republic of)
| | - Hye-Rim Kang
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea (the Republic of)
| | - Hye-Lin Kim
- College of Pharmacy, Sahmyook University, Nowon-gu, Seoul, Korea (the Republic of)
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea (the Republic of)
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea (the Republic of)
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Park SK, Nam JH, Lee H, Chung H, Lee EK, Shin JY. Beyond uncertainty: Negative findings for the association between the use of proton pump inhibitors and risk of dementia. J Gastroenterol Hepatol 2019; 34:2135-2143. [PMID: 31145825 DOI: 10.1111/jgh.14745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/29/2019] [Accepted: 05/26/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We investigated the risk of dementia associated with the use of proton pump inhibitors (PPIs) as compared with the use of histamine-2 receptor antagonist (H2RA). METHODS We conducted retrospective propensity score-matched cohort study using the National Health Insurance Service-National Sample Cohort. Subjects were defined as the patients newly prescribed with PPI or H2RA between 2003 and 2013 without prior prescriptions of PPI/H2RA or diagnosis of dementia from their history within the past 1 year. We followed up participants until dementia occurrence, death, or the end of the study, whichever occurred first, with an intention-to-treat approach. A 1-year lag time between exposure and outcome measure was used to reduce protopathic bias. The incidence rate per 1000 person-years was estimated. The incidence rate of PPI was compared with that of H2RA, defined as incidence rate ratio (IRR), calculated with a 95% confidence interval. To control for potential confounds, propensity score matching at a 1:1 ratio was conducted, and the crude IRR was adjusted by risk factors. RESULTS Our propensity score-matched cohort included 87 562 patients on PPIs and 87 562 patients on H2RAs. The IRR was 1.01 (95% confidence interval 0.96-1.06) with 1-year lag time. IRR showed the decreased trend as the longer lag time. Also, no treatment duration or dose-response relationship was observed. CONCLUSIONS Our finding demonstrated that PPIs did not associate with dementia more strongly than did H2RA. On this basis, we suggest that the previously reported risk for dementia associated with PPI may have been overestimated.
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Affiliation(s)
- Sun-Kyeong Park
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Jin Hyun Nam
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Hyunsoo Chung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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Thi Nguyen NT, Jung S, Lee SH, Bae ON, Lee EK. Mono-PEGylates of exenatide in branched and dimeric structures can improve in vivo stability and hypoglycemic bioactivity. J Biotechnol 2019; 306:89-96. [PMID: 31580912 DOI: 10.1016/j.jbiotec.2019.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/25/2019] [Accepted: 09/29/2019] [Indexed: 02/08/2023]
Abstract
Exenatide, a synthetic version of exendin-4, is a glucagon-like peptide-1 receptor agonist (GLP-1RA) used for treating diabetes, but its relatively short half-life is a major disadvantage. In this study, we attempted residue-specific mono-PEGylation to the middle of the amino acid backbone to extend its in vivo half-life. Exenatide was point-mutated from Lys to Cys at the 12th residue to yield a variant (K12C), and PEG-maleimide of varying molecular weights (MW) (5, 10, 20, 40 kD) was site-specifically conjugated to yield a mono-PEGylate with branched T-shape molecular structure. In another approach, we conjugated a bis-maleimide PEG (10 kD) to the middle of two K12Cs to yield an H-shape homodimer PEGylate In vitro bioactivity assays indicated that: (1) PEGylates conjugated with higher MW PEG lead to stronger receptor binding, (2) the branched form was superior to the linear configuration in the binding, and (3) both T-shape and H-shape mono-PEGylates demonstrated better potency than the native exenatide, evidenced by lower EC50. Db/db mouse experiments to evaluate in vivo hypoglycemic activity indicated that: (1) all mono-PEGylates resulted in improved glucose tolerance compared to the native exenatide, (2) the homodimer PEGylate demonstrated much stronger hypoglycemic activity, especially during the initial period, and (3) the H-shape and T-shape mono-PEGylates (40 kD) maintained hypoglycemia for up to ca. 168 and 140 h, representing approximately 12- and 14-fold increase, respectively, compared with the native exenatide. Our findings suggest that the exenatide mono-PEGylates in unclassical molecular structures can improve in vivo pharmacokinetics properties.
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Affiliation(s)
| | - Sujin Jung
- Dept. of Bionanotechnology, Graduate School, South Korea
| | - Seung Hwan Lee
- Dept. of Bionanotechnology, Graduate School, South Korea.
| | - Ok Nam Bae
- Dept. of Bionanotechnology, Graduate School, South Korea
| | - E K Lee
- College of Pharmacy, Hanyang University - ERICA, Ansan, 15588, South Korea.
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Park SK, Hong SH, Kim H, Kim S, Lee EK. Cost-Utility Analysis of Sacubitril/Valsartan Use Compared With Standard Care in Chronic Heart Failure Patients With Reduced Ejection Fraction in South Korea. Clin Ther 2019; 41:1066-1079. [DOI: 10.1016/j.clinthera.2019.04.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 01/14/2023]
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Kang HR, Kim JH, Lee EK, Shin JY. Risk of neuropsychiatric adverse events associated with the use of oseltamivir: a nationwide population-based case-crossover study-authors' response. J Antimicrob Chemother 2019; 74:1764-1765. [PMID: 30989178 DOI: 10.1093/jac/dkz131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Hye-Rim Kang
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
| | - Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
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Lee MS, Lee JY, Kang MG, Jung JW, Park HK, Park HK, Kim SH, Lee EK. Cost implications of adverse drug event-related emergency department visits - a multicenter study in South Korea. Expert Rev Pharmacoecon Outcomes Res 2019; 20:139-146. [PMID: 31012333 DOI: 10.1080/14737167.2019.1608825] [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: 10/27/2022]
Abstract
Background: Adverse drug reactions (ADRs) increase health-care resource utilization, including that for emergency department (ED) visits. However, cost analyses of ADRs resulting in ED visits are scarce. Therefore, we aimed to estimate the direct medical costs before and after ADR occurrence and analyzed the cost-driving factors.Methods: The ADR cases were identified by a retrospective review of medical records of patients who visited the ED of three tertiary hospitals in South Korea from July to December 2014. The direct medical cost was estimated by the difference in costs six months before and after the ED visit. A generalized linear model was used to identify the ADR-associated cost-driving factors.Results: The mean cost per ADR increased by 26.1% (±SD = 4.3) during the six-month follow-up compared with that during the six months before the ED visit (p < 0.05). Preventable ADRs accounted for approximately 19.9% of the cost increase among all ADR cases. The regression analysis revealed that 'ADR-related hospitalization' was a significant (p < 0.05) factor leading to an increase in the direct medical costs.Conclusion: Drug-related ED visits increase the burden on health insurance systems and patients' out-of-pocket costs, mostly due to the hospitalization costs.
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Affiliation(s)
- Min-Sun Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, Korea
| | - Min-Gyu Kang
- Department of Internal Medicine, subdivision of Allergy, Chungbuk National University Hospital, Cheongju, Korea
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye-Kyung Park
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Hye-Kyung Park
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Sang-Heon Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.,Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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Kang HR, Hong SH, Ha SY, Kim TB, Lee EK. Differences in the risk of mood disorders in patients with asthma-COPD overlap and in patients with COPD alone: a nationwide population-based retrospective cohort study in Korea. Respir Res 2019; 20:80. [PMID: 31039780 PMCID: PMC6492426 DOI: 10.1186/s12931-019-1039-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 04/01/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although feelings of anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), little is known about the estimates of their incidence in patients with asthma-COPD overlap (ACO), which has been described and acknowledged as a distinct clinical entity. We aimed to estimate the risk of depression and anxiety among patients with ACO and compare it with the risk among those with COPD alone in the general population. METHODS We conducted a nationwide population-based retrospective cohort study using the Korean National Sample Cohort database between 1 January, 2002, and 31 December, 2013. Patients who were diagnosed with COPD (International Classification of Diseases, 10th revision [ICD-10] codes J42-J44) at least twice and prescribed COPD medications at least once between 2003 and 2011 were classified into two categories: patients who were diagnosed with asthma (ICD-10 codes J45-J46) more than twice and at least once prescribed asthma medications comprised the ACO group, and the remaining COPD patients comprised the COPD alone group. Patients who had been diagnosed with depression or anxiety within a year before the index date were excluded. We defined the outcome as time to first diagnosis with depression and anxiety. Matched Cox regression models were used to compare the risk of depression and anxiety among patients with ACO and patients with COPD alone after propensity score matching with a 1:1 ratio. RESULTS After propensity score estimation and matching in a 1:1 ratio, the cohort used in the analysis included 15,644 patients. The risk of depression during the entire study period was higher for patients with ACO than for patients with COPD alone (adjusted hazard ratio, 1.10; 95% confidence interval, 1.03-1.18; P value = 0.0039), with an elevated risk in patients aged 40-64 years (1.21; 1.10-1.34; 0.0001) and in women (1.18; 1.07-1.29; 0.0005). The risk of anxiety was higher for patients with ACO than for patients with COPD alone (1.06; 1.01-1.12; 0.0272), with a higher risk in patients aged 40-64 years (1.08; 1.00-1.17; 0.0392); however, the risk was not significant when stratified by sex. CONCLUSIONS This population-based study revealed a higher incidence of depression and anxiety in patients with ACO than in patients with COPD alone.
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Affiliation(s)
- Hye-Rim Kang
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea
| | - Sung-Hyun Hong
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea
| | - So-Young Ha
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon-si, Gyeonggi-do, 16419, South Korea.
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Kim HL, An J, Park JA, Park SH, Lim YS, Lee EK. Magnetic Resonance Imaging Is Cost-Effective for Hepatocellular Carcinoma Surveillance in High-Risk Patients With Cirrhosis. Hepatology 2019; 69:1599-1613. [PMID: 30365164 DOI: 10.1002/hep.30330] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/21/2018] [Indexed: 12/21/2022]
Abstract
Ultrasonography (US) is generally recommended for the surveillance of hepatocellular carcinoma (HCC) in patients at risk. However, in patients with cirrhosis who have sufficiently high HCC incidence, surveillance using magnetic resonance imaging (MRI) with liver-specific contrast showed markedly higher sensitivity in detecting early-stage HCC than US. This study aimed to compare the cost-effectiveness of semiannual surveillance using MRI versus US in patients with compensated cirrhosis and to identify the population that would gain optimal cost-effectiveness through MRI surveillance. We designed a Markov model to compare the expected costs and quality-adjusted life-years (QALYs), between MRI and US, with a 20-year time horizon, from the health care system perspective. The starting age of the cohort was 50 years, and 71% had hepatitis B virus-associated cirrhosis. The cycle length was 6 months. Transition probabilities and costs were obtained mainly from a prospective cohort study (the PRIUS study, NCT01446666). Cost and effectiveness were discounted at 5%. An incremental cost-effectiveness ratio (ICER) was calculated and tested using sensitivity analyses. The cost-effectiveness analysis indicated that the use of MRI incurred $5,562 incremental costs, 0.384 incremental life-years (LYs), and 0.221 incremental QALYs compared to US. The annual HCC incidence was the most influential factor on the ICER. The ICERs were $14,474/LY and $25,202/QALY at an annual HCC incidence of 3%. When the HCC incidence rate was >1.81%, the ICER was below $50,000/QALY. With increased HCC incidence, MRI surveillance was acceptable as a cost-effective option, even with an increased MRI/US cost ratio. Conclusion: Semiannual surveillance using MRI with liver-specific contrast may be more cost-effective than US in patients with virus-associated compensated cirrhosis at sufficiently high HCC risk despite the higher test cost of MRI.
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Affiliation(s)
- Hye-Lin Kim
- College of Pharmacy, Sahmyook University, Seoul, Korea
| | - Jihyun An
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-A Park
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Korea
| | - Seung-Hoo Park
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Korea
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Song HJ, Park H, Park SY, Lee EK, Ha SY, Park SY, Bae EJ, Ku H. Estimation of Health Utilities Based on the Response to Treatment in Atopic Dermatitis: a Population-based Study. Clin Ther 2019; 41:700-713. [PMID: 30827751 DOI: 10.1016/j.clinthera.2019.02.007] [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] [Received: 12/06/2018] [Revised: 01/19/2019] [Accepted: 02/10/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE This study estimated utility weights based on the response to treatment for atopic dermatitis in the general population. METHODS The Korean general population aged 20-60 years was stratified by using a random sampling method based on age and sex. Two hypothetical health states of atopic dermatitis were developed: response to treatment and no response to treatment. Health utility values were estimated by using time trade-off (TTO) based on a period of 10 years, TTO based on life expectancy, and EuroQol 5-Dimension (EQ-5D) including a visual analog scale (VAS). The mean utility value and 95% CI were derived, and comparisons of subgroups using the t test and ANOVA were performed. We conducted a multilevel analysis after controlling the sociodemographic variables to consider repeated measures. FINDINGS A total of 155 participants were included in the survey. Their mean age was 39.7 years; 58.7% of participants were women. The mean health utility values for response and no response using TTO based on 10 years were 0.847 and 0.380, respectively. The estimated health utility values of response and no response were 0.865 and 0.476 using TTO based on life expectancy, and 0.814 and 0.279 using EQ-5D. For VAS, the response and no response were 0.744 and 0.322. After controlling the covariates, the important factors that affected utility values were response and no response to treatment (P < 0.001). IMPLICATIONS This study showed that the utility weights of people with no response to atopic dermatitis treatment were lower compared with response from the general population. Health care providers should therefore consider symptom control as an important factor affecting the quality of life of those with atopic dermatitis.
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Affiliation(s)
- Hyun Jin Song
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | | | | | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - So-Young Ha
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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Shin JY, Shin E, Jeong HE, Kim JH, Lee EK. Current status of pharmacovigilance regulatory structures, processes, and outcomes in the Asia-Pacific region: Survey results from 15 countries. Pharmacoepidemiol Drug Saf 2019; 28:362-369. [DOI: 10.1002/pds.4717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 10/23/2018] [Accepted: 11/28/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Ju-Young Shin
- School of Pharmacy; Sungkyunkwan University; Suwon South Korea
| | - Eungyeong Shin
- School of Pharmacy; Sungkyunkwan University; Suwon South Korea
| | - Han Eol Jeong
- School of Pharmacy; Sungkyunkwan University; Suwon South Korea
| | - Ju Hwan Kim
- School of Pharmacy; Sungkyunkwan University; Suwon South Korea
| | - Eui-Kyung Lee
- School of Pharmacy; Sungkyunkwan University; Suwon South Korea
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Ha D, Song I, Lee EK, Shin JY. Projection of future pharmacy service fees using the dispensing claims in hospital and clinic outpatient pharmacies: national health insurance database between 2006 and 2012. BMC Health Serv Res 2018; 18:327. [PMID: 29724220 PMCID: PMC5934792 DOI: 10.1186/s12913-018-3067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/27/2018] [Indexed: 11/24/2022] Open
Abstract
Background Predicting pharmacy service fees is crucial to sustain the health insurance budget and maintain pharmacy management. However, there is no evidence on how to predict pharmacy service fees at the population level. This study compares the status of pharmacy services and constructs regression model to project annual pharmacy service fees in Korea. Methods We conducted a time-series analysis by using sample data from the national health insurance database from 2006 and 2012. To reflect the latest trend, we categorized pharmacies into general hospital, special hospital, and clinic outpatient pharmacies based on the major source of service fees, using a 1% sample of the 2012 data. We estimated the daily number of prescriptions, pharmacy service fees, and drugs costs according to these three types of pharmacy services. To forecast pharmacy service fees, a regression model was constructed to estimate annual fees in the following year (2013). The dependent variable was pharmacy service fees and the independent variables were the number of prescriptions and service fees per pharmacy, ratio of patients (≥ 65 years), conversion factor, change of policy, and types of pharmacy services. Results Among the 21,283 pharmacies identified, 5.0% (1064), 4.6% (974), and 77.5% (16,340) were general hospital, special hospital, and clinic outpatient pharmacies, respectively, in 2012. General hospital pharmacies showed a higher daily number of prescriptions (111.9), higher pharmacy service fees ($25,546,342), and higher annual drugs costs ($215,728,000) per pharmacy than any other pharmacy (p < 0.05). The regression model to project found the ratio of patients aged 65 years and older and the conversion factor to be associated with an increase in pharmacy service fees. It also estimated the future rate of increase in pharmacy service fees to be between 3.1% and 7.8%. Conclusions General hospital outpatient pharmacies spent more on annual pharmacy service fees than any other type of pharmacy. The forecast of annual pharmacy service fees in Korea was similar to that of Australia, but not that of the United Kingdom.
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Kwon HY, Bae S, Choi SE, Park S, Lee EK, Park S, Kim J. Easy cuts, easy rebound: Drug expenditures with massive price cuts in Korea. Health Policy 2018; 123:388-392. [PMID: 30503763 DOI: 10.1016/j.healthpol.2018.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 06/11/2018] [Revised: 10/31/2018] [Accepted: 11/04/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUNDS Since 2012, the Korean government has introduced 46.5% price cut for off-patent medicines in order to reign everescalating drug expenditure. This study sought to appraise the impact of the price cut measure (in the context of Korean National Health Insurance system). METHODS We employed Korean National Health Insurance database from January 2007 until December 2016 for 120 month period. An interrupted time series analysis with segmented regression analysis was conducted to estimate the impact of price cut on overall drug spending. RESULTS Drug spending significantly dropped with the price cut by 186.22 billlion Korean Won (KRW) (p < 0.0001) and the trend after the price cut has also significantly decreased by 1.33 billion KRW (p = 0.002). However, it was predicted that total expenditures showed an increasing trend and bounced back to the original level. Quantity prescribed had no significance with the price cut. Unit price had a substantial drop (β = -41.68, p < 0.0001) with the price-cut, but the trend after the intervention has increased (β = 0.16, p = 0.656) with no significance. CONCLUSIONS Although the price cut has successfully countered the everescalating pharmaceutical expenditures in Korea, the impact was temporary. A lack of demand-side measures resulted in an ineffectiveness and unsustainability of policy effect. Thus, more aggressive demand-side measures should be introduced in the Korean context,and both the demand and supply-sides should be balanced.
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Affiliation(s)
- Hye-Young Kwon
- Division of Biology & Public Health, Mokwon University, Daejeon, Republic of Korea
| | - Seungjin Bae
- College of Pharmacy, Ewha Women's University, Seoul, Republic of Korea.
| | - Sang-Eun Choi
- College of Pharmacy, Korea University, Osong, Republic of Korea
| | - Sylvia Park
- Korean Institute of Health and Social Affairs, Sejong, Republic of Korea
| | - Eui-Kyung Lee
- College of Pharmacy, Sungkyunkwon University, Suwon, Republic of Korea
| | | | - Jinhyun Kim
- College of Nursing, Seoul National University, Seoul, Republic of Korea.
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Kang HR, Lee EK, Kim WJ, Shin JY. Risk of neuropsychiatric adverse events associated with the use of oseltamivir: a nationwide population-based case-crossover study. J Antimicrob Chemother 2018; 74:453-461. [DOI: 10.1093/jac/dky445] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/02/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Hye-Rim Kang
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
| | - Woo Jung Kim
- Department of Psychiatry, Myongji Hospital, Hanyang University Medical Center, 55, Hwasu-ro 14beon-gil, Deogyang-gu, Goyang, Gyeonggi-do, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
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Park KR, Kim KB, Baek YH, Sung HG, Park JT, Lee EK, Shin JY. Signal detection of benzodiazepine use and risk of dementia: sequence symmetry analysis using South Korean national healthcare database. Int J Clin Pharm 2018; 40:1568-1576. [DOI: 10.1007/s11096-018-0739-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
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Abstract
Cost-effectiveness is 1 of the most important factors in medicine reimbursement, and social willingness to pay (WTP) can provide evidence for the threshold of cost-effectiveness analysis. Recently, the concept of curative medicines has been introduced, so it is necessary to study their cost-effectiveness. This study aimed to estimate WTP per quality-adjusted life year (QALY) for a cure in the Korean general population.A total of 507 people from the general population, proportionally assigned by sex, age, and region, participated in face-to-face interviews. The contingent valuation survey was conducted with scenarios involving 4 EuroQol-5 dimensions (EQ-5D) with different health statuses. We assumed a treatment that moved the health status of each scenario to perfect health. WTP for 1 year of treatment was derived using a double-bounded format followed by open-ended answers. In the cure scenario, the post-treatment effect continued for a lifetime; in the non-cure scenario, the effect instantly stopped when treatment was terminated. Additionally, prolonged treatment effects lasting 5 and 10 years were added. To identify the factors influencing WTP, a multi-level analysis was performed.WTP per QALY for the non-cure scenario was KRW 15 million/QALY. For the cure scenario, WTP was 2.3 times higher (KRW 35 million/QALY) than in the non-cure scenario. The results for the prolonged treatment effect scenarios were KRW 22 million/QALY and KRW 27 million/QALY, which are 1.4 and 1.8 times higher than the non-cure scenario, respectively. In all scenarios, the statistically significant factors affecting WTP per QALY were higher education, higher household income, and healthcare provider.This study revealed that WTP for a cure treatment was higher than that for non-cure; this higher WTP should be considered in future decision-making regarding curative treatments.
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Affiliation(s)
- Hyun Jin Song
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
- College of Pharmacy, University of Florida, Gainesville, FL
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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Ha D, Lee J, Kim D, Oh IS, Lee EK, Shin JY. Healthcare utilization and medical expenditure of Korean psoriasis patients: A descriptive result using a health insurance database. Medicine (Baltimore) 2018; 97:e11070. [PMID: 29901614 PMCID: PMC6024228 DOI: 10.1097/md.0000000000011070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Epidemiological evidence regarding healthcare utilization and medical expenditure of patients with psoriasis in Korea is needed. To analyze the differences in healthcare utilization and financial burdens between patients with and without psoriasis and compare these patterns according to the disease severity. METHODS We conducted a descriptive cross-sectional study using a sample of the National Health Insurance database between January 1, 2012 and December 31, 2013. We included patients diagnosed with psoriasis and those with nonpsoriasis skin diseases, matched for age, sex, income, and geographical region. The patients with psoriasis were further divided into mild and moderate-to-severe psoriasis groups. Each patient was followed up for 1 year to estimate their healthcare utilization and medical expenditure since their initial diagnosis. Healthcare utilization was defined as the sum of outpatient visits and inpatient stays per person. We conducted McNemar test or Bowker test of symmetry to compare the baseline characteristics and used the Wilcoxon matched-pair signed-rank test to compare the healthcare utilization and direct costs with a 5% significance level. RESULTS Our study subjects were 4016 patients with psoriasis and equally matched 4016 patients with nonpsoriasis skin diseases. Compared with patients without psoriasis, those with psoriasis had more days of healthcare service use (5.26 vs 4.19, P < .001) and higher medical expenditures within 1 year per person (209,320 vs 117,968 won, P < .001). Patients with moderate-to-severe psoriasis had more days of healthcare service use (12.71 vs 3.25, P < .001) and higher medical expenditures within 1 year per person (611,688 vs 107,445 won, P < .001) than those with mild psoriasis. CONCLUSION Patients with psoriasis had higher burdens of healthcare utilization than those without psoriasis, and patients with moderate-to-severe psoriasis had the greatest burdens.
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Park SY, Jang EJ, Shin JY, Lee MY, Kim D, Lee EK. Prevalence and predictors of hypoglycemia in South Korea. Am J Manag Care 2018; 24:278-286. [PMID: 29939502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study aimed to identify the prevalence and predictors of hypoglycemia in patients with type 2 diabetes (T2D) using South Korea's nationwide healthcare database. STUDY DESIGN Retrospective cohort and nested case-control analyses were conducted to estimate the prevalence and predictors of hypoglycemia, respectively. METHODS A cohort of 2,273,481 patients with T2D was followed to estimate the 1-year prevalence of hypoglycemia. Total hypoglycemia was identified using outpatient, inpatient, or emergency department visit data containing a diagnosis code for hypoglycemia. Severe hypoglycemia was defined as an event with inpatient admission or emergency care. Within the T2D cohort, cases with hypoglycemia were identified, and up to 4 controls were randomly selected after matching by sex, age, and cohort entry date. Possible predictive factors included insurance type, medical institution type, hypoglycemic history, antidiabetic drugs, Charlson Comorbidity Index score, and diabetic complications. We conducted conditional logistic regression analyses to estimate adjusted odds ratios (aORs) and 95% CIs to identify predictors of hypoglycemia. RESULTS The prevalences of total and severe hypoglycemia were 1.38% and 0.96%, respectively. Those with a history of hypoglycemia had the highest risk for a further hypoglycemic event (aOR, 16.71; 95% CI, 15.62-17.88). Use of combination therapy with insulin and sulfonylurea was highly associated with severe hypoglycemia (aOR, 15.09; 95% CI, 13.60-16.74). Among diabetic complications, the presence of nephropathy was the greatest predictive factor (aOR, 1.79; 95% CI, 1.73-1.85). CONCLUSIONS Patients with a history of hypoglycemia or receiving combined antidiabetic therapy must be appropriately managed to achieve optimal glycemic control without significant risk of hypoglycemia.
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Affiliation(s)
| | | | | | | | | | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do 16419, South Korea.
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Kim J, Ha D, Song I, Park H, Lee SW, Lee EK, Shin JY. Estimation of cost savings between 2011 and 2014 attributed to infliximab biosimilar in the South Korean healthcare market: real-world evidence using a nationwide database. Int J Rheum Dis 2018; 21:1227-1236. [PMID: 29667324 DOI: 10.1111/1756-185x.13295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 12/25/2022]
Abstract
AIM The introduction of biosimilars is expected to reduce the cost of biologic drugs, but the actual cost savings have not yet been quantified in Korea. The aim of this study was to estimate the annual cost savings attributed to the introduction of infliximab biosimilar. METHODS We conducted a retrospective analysis using data from the Health Insurance Review and Assessment Service-National Patients Sample (HIRA-NPS) between 2011 and 2014. The study subjects were patients who were treated with infliximab, adalimumab or etanercept. We compared the drug costs before and after the introduction of infliximab biosimilar in December 2012 (2011-2012 and 2013-2014) to estimate the annual drug cost savings attributed to this and the number of patients who could additionally benefit from the biosimilar in 2013 and 2014. RESULTS A total of 10 986 prescriptions were identified: 2620 for infliximab. The cost savings were estimated at $262 270 for 133 patients in 2013 and $395 220 for 174 patients in 2014. Among the patients who underwent a 1-year maintenance course of infliximab therapy, the annual expenditure on infliximab was lower in 2014 than in 2011. If the cost savings were used to treat additional patients, 13.3%-38.6% more patients per year could be treated by indication. CONCLUSION The introduction of infliximab biosimilar reduced direct medical costs for both patients and the payer, which could then be used to increase patient access to biologic medicines. The entry of infliximab biosimilar could result in further reductions in healthcare costs.
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Affiliation(s)
- Jiyoun Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Dongmun Ha
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Inmyung Song
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Haesun Park
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Sang-Won Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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Kang HR, Song HJ, Nam JH, Hong SH, Yang SY, Ju S, Lee SW, Kim TB, Kim HL, Lee EK. Risk factors of asthma exacerbation based on asthma severity: a nationwide population-based observational study in South Korea. BMJ Open 2018; 8:e020825. [PMID: 29567854 PMCID: PMC5875610 DOI: 10.1136/bmjopen-2017-020825] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Asthma exacerbation, associated with many risks factors, can reflect management failure. However, little is known about how risk factors are associated with exacerbation, according to asthma severity. We aimed to investigate differences in risk factors in patients with different asthma severity and evaluate whether risk factors differed between frequent exacerbators and patients with single exacerbation. DESIGN Nationwide population-based observational study. SETTING Korean National Sample Cohort database. PARTICIPANTS We included 22 130 adults with asthma diagnoses more than twice (ICD-10 (International Classification of Diseases, Tenth revision) codes J45 and J46) and one prescription for asthma medication from 2010 to 2011. OUTCOME MEASURES Asthma exacerbation was defined as having a corticosteroid (CS) burst characterised by a prescription of high-dose oral CS for ≥3 days or one systemic CS injection, hospitalisation or emergency department visit. RESULTS Among severities, history of CS bursts was significantly associated with exacerbation. In mild and moderate asthma, exacerbation was significantly associated with age ≥45 years, being female, gastro-oesophageal reflux disease and chronic rhinitis. High medication possession ratio (MPR≥50%), compared with low MPR (<20%) showed adjusted ORs of 0.828 (95% CI 0.707 to 0.971) and 0.362 (0.185 to 0.708) in moderate and severe asthma, respectively. In severe asthma, compared with mild asthma, only allergic rhinitis and history of hospitalisation were strongly associated with exacerbation. When comparing frequent exacerbators to patients with single exacerbation, age ≥45 years, atopic dermatitis, anxiety and history of CS burst were significant risk factors in mild and moderate asthma, whereas no risk factors were significant in severe asthma. CONCLUSIONS Different associations between risk factors and asthma exacerbations based on asthma severity suggest that patients with mild asthma require greater attention to their age and comorbidities, whereas those with severe asthma require greater attention to hospitalisation history and drug adherence.
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Affiliation(s)
- Hye-Rim Kang
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Hyun Jin Song
- College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Jin Hyun Nam
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sung-Hyun Hong
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - So-Young Yang
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - SangEun Ju
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Sang Won Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Lin Kim
- College of Pharmacy, Sahmyook University, Seoul, Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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Song I, Lee MS, Lee EK, Shin JY. Patient and provider characteristics related with prescribing of ADHD medication: Nationwide health insurance claims database study in Korea. Asia Pac Psychiatry 2018. [PMID: 28631372 DOI: 10.1111/appy.12289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Little is known about the association between prescribing of attention deficit hyperactivity disorder (ADHD) medication and the patient's age, gender, and type of medical institution in Asia region. INTRODUCTION This study investigates the prevalence and factors of diagnosis and pharmacological treatment of ADHD in the pediatric population. METHODS Using the Korea Health Insurance database, study participants were identified as pediatric patients (≤17 years) with at least 1 diagnosis of ADHD (ICD-10, F90) from January 1, 2007 to December 31, 2011. The annual prevalence of ADHD diagnosis and medication was calculated. Annual differences in the prevalence between 2007 and 2011 with 95% confidence intervals (CIs) were estimated. We conducted multiple logistic regression analysis to estimate adjusted odds ratios (aORs) and their 95% CI to investigate predictors associated with prescribing of ADHD medication. RESULTS The prevalence of ADHD medication prescribing increased by 26.57% (95% CI, 26.27-26.88) from 0.53% in 2007 to 0.72% in 2011. The prevalence increased by 41.56% (95% CI, 40.51-42.65) in females compared with 34.91% (95% CI, 34.47-35.36) in males. Whereas the prevalence decreased in patients younger than 6 years old, it increased by 74.30% (95% CI, 72.84-75.79) in the 13 to 17-year group. Males were more likely than females to be treated with ADHD medication (aOR, 1.12; 95% CI, 1.10-1.13). Physician specialty (psychiatry vs non-psychiatry) (aOR, 1.37; 95% CI, 1.34-1.40) were associated with prescribing of ADHD medication. CONCLUSION Rapid increases in the diagnosis and pharmacological treatment of ADHD in the pediatric population have been observed. While demographic characteristics were similar to other countries, provider characteristics were different with others reporting that the majority of patients were treated by physicians specializing in psychiatry.
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Affiliation(s)
- Inmyung Song
- Division of Risk Assessment and International Cooperation, Korea Centers for Disease Control and Prevention, Cheongju, South Korea
| | - Mo Se Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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Kang JE, Yu JM, Choi JH, Chung IM, Pyun WB, Kim SA, Lee EK, Han NY, Yoon JH, Oh JM, Rhie SJ. Development and clinical application of an evidence-based pharmaceutical care service algorithm in acute coronary syndrome. J Clin Pharm Ther 2018; 43:366-376. [PMID: 29468708 DOI: 10.1111/jcpt.12665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/13/2017] [Accepted: 01/02/2018] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Drug therapies are critical for preventing secondary complications in acute coronary syndrome (ACS). The purpose of this study was to develop and apply a pharmaceutical care service (PCS) algorithm for ACS and confirm that it is applicable through a prospective clinical trial. METHODS The ACS-PCS algorithm was developed according to extant evidence-based treatment and pharmaceutical care guidelines. Quality assurance was conducted through two methods: literature comparison and expert panel evaluation. The literature comparison was used to compare the content of the algorithm with the referenced guidelines. Expert evaluations were conducted by nine experts for 75 questionnaire items. A trial was conducted to confirm its effectiveness. Seventy-nine patients were assigned to either the pharmacist-included multidisciplinary team care (MTC) group or the usual care (UC) group. The endpoints of the trial were the prescription rate of two important drugs, readmission, emergency room (ER) visit and mortality. RESULTS AND DISCUSSION The main frame of the algorithm was structured with three tasks: medication reconciliation, medication optimization and transition of care. The contents and context of the algorithm were compliant with class I recommendations and the main service items from the evidence-based guidelines. Opinions from the expert panel were mostly positive. There were significant differences in beta-blocker prescription rates in the overall period (P = .013) and ER visits (four cases, 9.76%, P = .016) in the MTC group compared to the UC group, respectively. WHAT IS NEW AND CONCLUSION We developed a PCS algorithm for ACS based on the contents of evidence-based drug therapy and the core concept of pharmacist services.
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Affiliation(s)
- J E Kang
- Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, National Medical Center, Seoul, Korea
| | - J M Yu
- Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - J H Choi
- Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, Konkuk University Medical Center, Seoul, Korea
| | - I-M Chung
- Division of Cardiology, School of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - W B Pyun
- Division of Cardiology, School of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - S A Kim
- Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - E K Lee
- Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - N Y Han
- College of Pharmacy and Research Institute of Pharmaceutical Science, Seoul National University, Seoul, Korea
| | - J-H Yoon
- College of Pharmacy, Pusan National University, Busan, Korea
| | - J M Oh
- College of Pharmacy and Research Institute of Pharmaceutical Science, Seoul National University, Seoul, Korea
| | - S J Rhie
- Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea.,College of Pharmacy, Ewha Womans University, Seoul, Korea
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Lee MY, Shin JY, Park SY, Kim D, Cha HS, Lee EK. Persistence of biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: An analysis of the South Korean National Health Insurance Database. Semin Arthritis Rheum 2018; 47:485-491. [DOI: 10.1016/j.semarthrit.2017.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/08/2017] [Accepted: 08/24/2017] [Indexed: 10/19/2022]
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Lee SY, Kang KN, Kang JH, Jeong KH, Lee SW, Park HK, Lee EK. Pharmacokinetics of a telmisartan, amlodipine and hydrochlorothiazide fixed-dose combination: A replicate crossover study in healthy Korean male subjects. TROP J PHARM RES 2017. [DOI: 10.4314/tjpr.v16i9.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Abstract
OBJECTIVES Concerns about the use of highly caffeinated energy drinks among Korean adolescents remains. We compared adolescents' perceptions regarding the use of drinks to their behaviours and factors. DESIGN A structured questionnaire based on the Health Belief Model was administered to 850 freshmen and sophomores at three high schools in Bucheon, South Korea. Benefits were defined as beneficial effects from the use of highly caffeinated energy drinks (eg, awakening from sleepiness) and harms as adverse effects of the drinks (eg, cardiac palpitation). Likelihood of action represents the likelihood of taking actions that are perceived to be more beneficial after comparison of the benefits and harms of caffeine use. Descriptive analysis was used to quantify the relationship between their beliefs about highly caffeinated energy drinks and their use. We conducted hierarchical logistic regression to compute ORs and 95% CIs for: (1) demographic factors, (2) health threat, (3) likelihood of action and (4) cues to act. RESULTS Altogether, 833 students responded to the questionnaire (effective response rate=98.0%). About 63.0% reported use of highly caffeinated energy drinks and 35.2% had used them as needed and habitually. The more susceptible the respondents perceived themselves to be to the risk of using these drinks, the less likely they were to use them (OR: 0.73, 95% CI 0.50 to 1.06). The more severe the perception of a health threat, the less that perception was associated with use (OR: 0.44, 95% CI 0.29 to 0.67). Likelihood of action was the strongest predictor of use, explaining 12.5% in use. Benefits and harms (OR: 4.43, 95% CI 2.77 to 7.09; OR: 1.86, 95% CI 1.16 to 2.99) also were significant predictors. CONCLUSIONS Enhancing adolescents' perceptions of benefits and harms regarding using highly caffeinated energy drinks could be an effective way to influence the use of these drinks.
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Affiliation(s)
- Dongmun Ha
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Inmyung Song
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Gyeongil Jang
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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