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Sebastian E, Bykersma C, Eggleston A, Eddy KE, Chim ST, Zahroh RI, Scott N, Chou D, Oladapo OT, Vogel JP. Cost-effectiveness of antenatal corticosteroids and tocolytic agents in the management of preterm birth: A systematic review. EClinicalMedicine 2022; 49:101496. [PMID: 35747187 PMCID: PMC9167884 DOI: 10.1016/j.eclinm.2022.101496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Preterm birth is a leading cause of neonatal mortality and morbidity, and imposes high health and societal costs. Antenatal corticosteroids (ACS) to accelerate fetal lung maturation are commonly used in conjunction with tocolytics for arresting preterm labour in women at risk of imminent preterm birth. METHODS We conducted a systematic review on the cost-effectiveness of ACS and/or tocolytics as part of preterm birth management. We systematically searched MEDLINE and Embase (December 2021), as well as a maternal health economic evidence repository collated from NHS Economic Evaluation Database, EconLit, PubMed, Embase, CINAHL and PsycInfo, with no date cutoff. Eligible studies were economic evaluations of ACS and/or tocolytics for preterm birth. Two reviewers independently screened citations, extracted data on cost-effectiveness and assessed study quality using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. FINDINGS 35 studies were included: 11 studies on ACS, eight on tocolytics to facilitate ACS administration, 12 on acute and maintenance tocolysis, and four studies on a combination of ACS and tocolytics. ACS was cost-effective prior to 34 weeks' gestation, but economic evidence on ACS use at 34-<37 weeks was conflicting. No single tocolytic was identified as the most cost-effective. Studies disagreed on whether ACS and tocolytic in combination were cost-saving when compared to no intervention. INTERPRETATION ACS use prior to 34 weeks' gestation appears cost-effective. Further studies are required to identify what (if any) tocolytic option is most cost-effective for facilitating ACS administration, and the economic consequences of ACS use in the late preterm period. FUNDING UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by WHO.
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Affiliation(s)
- Elizabeth Sebastian
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Chloe Bykersma
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Alexander Eggleston
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Katherine E. Eddy
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Sher Ting Chim
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Rana Islamiah Zahroh
- Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Nick Scott
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
| | - Doris Chou
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Joshua P. Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Corresponding author at: Burnet Institute, Melbourne, Australia.
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Daykhes AN, Jakovljevic M, Reshetnikov VA, Kozlov VV. Promises and Hurdles of Medical Tourism Development in the Russian Federation. Front Psychol 2020; 11:1380. [PMID: 32655455 PMCID: PMC7324547 DOI: 10.3389/fpsyg.2020.01380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/22/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Development of medical tourism improves access to healthcare in countries where the necessary medical procedures are not available or accessible to its citizens. In the country of destination, medical tourism stimulates economic development and raises the quality of healthcare provided. There are both microeconomic and macroeconomic factors affecting the development of medical tourism. Microeconomic factors relate to the receivers and providers of healthcare. Macroeconomic factors relate to the government policy being implemented to support the development of medical tourism. This study aims to identify factors affecting the development of medical tourism in Russia. Methodology: An expert survey of 36 heads of medical organizations in Russia was conducted to assess the problems that impede the development of the medical care system to foreign patients in Russia, as well as propose possible solutions. The degree of covariation among experts was calculated using the Kendall concordance coefficient. Results: The experts gave consistent evaluation to numerous sets of problems that impede the development and proposed concrete measures for the development of inbound medical tourism in Russia. These measures ranged from microeconomic to macroeconomic approaches and were directed toward a holistic and coordinated development of medical tourism within Russia. Conclusion: Based on the results, Russia has several micro- and macroeconomic competitive advantages and disadvantages in facilitating medical tourism. The study yielded a set of measures for the development of inbound medical tourism and the promotion of the export of medical services in the Russian Federation, which can be extended to other countries or parties who are seeking to develop medical tourism.
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Affiliation(s)
- Arkady N Daykhes
- N.A. Semashko Department of Public Health and Healthcare, F.F. Erisman Institute of Public Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
| | - Mihajlo Jakovljevic
- N.A. Semashko Department of Public Health and Healthcare, F.F. Erisman Institute of Public Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia.,Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia.,Institute of Comparative Economic Studies, Hosei University, Tokyo, Japan
| | - Vladimir A Reshetnikov
- N.A. Semashko Department of Public Health and Healthcare, F.F. Erisman Institute of Public Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
| | - Vasily V Kozlov
- N.A. Semashko Department of Public Health and Healthcare, F.F. Erisman Institute of Public Health, I.M. Sechenov First Moscow State Medical University, Sechenov University, Moscow, Russia
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El Alili M, van Dongen JM, Huirne JAF, van Tulder MW, Bosmans JE. Reporting and Analysis of Trial-Based Cost-Effectiveness Evaluations in Obstetrics and Gynaecology. PHARMACOECONOMICS 2017; 35:1007-1033. [PMID: 28674846 PMCID: PMC5606992 DOI: 10.1007/s40273-017-0531-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND OBJECTIVES The aim was to systematically review whether the reporting and analysis of trial-based cost-effectiveness evaluations in the field of obstetrics and gynaecology comply with guidelines and recommendations, and whether this has improved over time. DATA SOURCES AND SELECTION CRITERIA A literature search was performed in MEDLINE, the NHS Economic Evaluation Database (NHS EED) and the Health Technology Assessment (HTA) database to identify trial-based cost-effectiveness evaluations in obstetrics and gynaecology published between January 1, 2000 and May 16, 2017. Studies performed in middle- and low-income countries and studies related to prevention, midwifery, and reproduction were excluded. DATA COLLECTION AND ANALYSIS Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standard (CHEERS) statement (a modified version with 21 items, as we focused on trial-based cost-effectiveness evaluations) and the statistical quality was assessed using a literature-based list of criteria (8 items). Exploratory regression analyses were performed to assess the association between reporting and statistical quality scores and publication year. RESULTS The electronic search resulted in 5482 potentially eligible studies. Forty-five studies fulfilled the inclusion criteria, 22 in obstetrics and 23 in gynaecology. Twenty-seven (60%) studies did not adhere to 50% (n = 10) or more of the reporting quality items and 32 studies (71%) did not meet 50% (n = 4) or more of the statistical quality items. As for the statistical quality, no study used the appropriate method to assess cost differences, no advanced methods were used to deal with missing data, and clustering of data was ignored in all studies. No significant improvements over time were found in reporting or statistical quality in gynaecology, whereas in obstetrics a significant improvement in reporting and statistical quality was found over time. LIMITATIONS The focus of this review was on trial-based cost-effectiveness evaluations in obstetrics and gynaecology, so further research is needed to explore whether results from this review are generalizable to other medical disciplines. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS The reporting and analysis of trial-based cost-effectiveness evaluations in gynaecology and obstetrics is generally poor. Since this can result in biased results, incorrect conclusions, and inappropriate healthcare decisions, there is an urgent need for improvement in the methods of cost-effectiveness evaluations in this field.
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Affiliation(s)
- Mohamed El Alili
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
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Jurisevic M. Book Review: Health Economics and Policy Challenges in Global Emerging Markets. Front Public Health 2017. [PMCID: PMC5600920 DOI: 10.3389/fpubh.2017.00244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Milena Jurisevic
- Faculty of Medical Sciences, Department of Pharmacy, University of Kragujevac, Kragujevac, Serbia
- *Correspondence: Milena Jurisevic,
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Jakovljevic MM, Arsenijevic J, Pavlova M, Verhaeghe N, Laaser U, Groot W. Within the triangle of healthcare legacies: comparing the performance of South-Eastern European health systems. J Med Econ 2017; 20:483-492. [PMID: 28035843 DOI: 10.1080/13696998.2016.1277228] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Inter-regional comparison of health-reform outcomes in south-eastern Europe (SEE). METHODS Macro-indicators were obtained from the WHO Health for All Database. Inter-regional comparison among post-Semashko, former Yugoslavia, and prior-1989-free-market SEE economies was conducted. RESULTS United Nations Development Program Human Development Index growth was strongest among prior-free-market SEE, followed by former Yugoslavia and post-Semashko. Policy cuts to hospital beds and nursing-staff capacities were highest in post-Semashko. Physician density increased the most in prior-free-market SEE. Length of hospital stay was reduced in most countries; frequency of outpatient visits and inpatient discharges doubled in prior-free-market SEE. Fertility rates fell for one third in Post-Semashko and prior-free-market SEE. Crude death rates slightly decreased in prior-free-market-SEE and post-Semashko, while growing in the former Yugoslavia region. Life expectancy increased by 4 years on average in all regions; prior-free-market SEE achieving the highest longevity. Childhood and maternal mortality rates decreased throughout SEE, while post-Semashko countries recorded the most progress. CONCLUSIONS Significant differences in healthcare resources and outcomes were observed among three historical health-policy legacies in south-eastern Europe. These different routes towards common goals created a golden opportunity for these economies to learn from each other.
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Affiliation(s)
- Mihajlo Michael Jakovljevic
- a Health Economics and Pharmacoeconomics, Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Jelena Arsenijevic
- b Department of Health Services Research , CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands
| | - Milena Pavlova
- b Department of Health Services Research , CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands
| | - Nick Verhaeghe
- c Department of Public Health , I-CHER Interuniversity Centre for Health Economics Research, Ghent University , Ghent , Belgium
| | - Ulrich Laaser
- d Section of International Public Health (S-IPH), Faculty of Health Sciences , University of Bielefeld , Bielefeld , Germany
| | - Wim Groot
- b Department of Health Services Research , CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University , Maastricht , The Netherlands
- e Top Institute Evidence-Based Education Research (TIER); Maastricht University , Maastricht , The Netherlands
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Jakovljevic M, Varjacic M. Commentary: Do health care workforce, population, and service provision significantly contribute to the total health expenditure? An econometric analysis of Serbia. Front Pharmacol 2017; 8:33. [PMID: 28220072 PMCID: PMC5292403 DOI: 10.3389/fphar.2017.00033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/17/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Mihajlo Jakovljevic
- Health Economics and Pharmacoeconomics, The Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
| | - Mirjana Varjacic
- Gynaecology Department, The Faculty of Medical Sciences, University of KragujevacKragujevac, Serbia
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Djukic SM, Lekovic D, Jovic N, Varjacic M. Unnecessary Hysterectomy due to Menorrhagia and Disorders of Hemostasis: An Example of Overuse and Excessive Demand for Medical Services. Front Pharmacol 2017; 7:507. [PMID: 28066253 PMCID: PMC5179537 DOI: 10.3389/fphar.2016.00507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/07/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Svetlana M Djukic
- Clinic for Hematology, Faculty of Medical Sciences University of Kragujevac Kragujevac, Serbia
| | - Danijela Lekovic
- Clinic for Hematology, Medical Faculty University of Belgrade Belgrade, Serbia
| | - Nikola Jovic
- Clinic for Hematology, Faculty of Medical Sciences University of Kragujevac Kragujevac, Serbia
| | - Mirjana Varjacic
- Clinic for Hematology, Faculty of Medical Sciences University of Kragujevac Kragujevac, Serbia
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Mihailovic N, Kocic S, Jakovljevic M. Review of Diagnosis-Related Group-Based Financing of Hospital Care. Health Serv Res Manag Epidemiol 2016; 3:2333392816647892. [PMID: 28462278 PMCID: PMC5266471 DOI: 10.1177/2333392816647892] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 11/17/2022] Open
Abstract
Since the 1990s, diagnosis-related group (DRG)-based payment systems were gradually introduced in many countries. The main design characteristics of a DRG-based payment system are an exhaustive patient case classification system (ie, the system of diagnosis-related groupings) and the payment formula, which is based on the base rate multiplied by a relative cost weight specific for each DRG. Cases within the same DRG code group are expected to undergo similar clinical evolution. Consecutively, they should incur the costs of diagnostics and treatment within a predefined scale. Such predictability was proven in a number of cost-of-illness studies conducted on major prosperity diseases alongside clinical trials on efficiency. This was the case with risky pregnancies, chronic obstructive pulmonary disease, diabetes, depression, alcohol addiction, hepatitis, and cancer. This article presents experience of introduced DRG-based payments in countries of western and eastern Europe, Scandinavia, United States, Canada, and Australia. This article presents the results of few selected reviews and systematic reviews of the following evidence: published reports on health system reforms by World Health Organization, World Bank, Organization for Economic Co-operation and Development, Canadian Institute for Health Information, Canadian Health Services Research Foundation, and Centre for Health Economics University of York. Diverse payment systems have different strengths and weaknesses in relation to the various objectives. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay. The disadvantage of DRG is creating financial incentives toward earlier hospital discharges. Occasionally, such polices are not in full accordance with the clinical benefit priorities.
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Affiliation(s)
| | - Sanja Kocic
- Institute for Public Health Kragujevac, Kragujevac, Serbia
- Department of Social Medicine, The Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Mihajlo Jakovljevic
- Health Economics and Pharmacoeconomics, The Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Cupurdija V, Lazic Z, Petrovic M, Mojsilovic S, Cekerevac I, Rancic N, Jakovljevic M. Community-acquired pneumonia: economics of inpatient medical care vis-à-vis clinical severity. J Bras Pneumol 2015; 41:48-57. [PMID: 25750674 PMCID: PMC4350825 DOI: 10.1590/s1806-37132015000100007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 12/05/2014] [Indexed: 12/26/2022] Open
Abstract
Objective: To assess the direct and indirect costs of diagnosing and treating community-acquired pneumonia (CAP), correlating those costs with CAP severity at diagnosis and identifying the major cost drivers. Methods: This was a prospective cost analysis study using bottom-up costing. Clinical severity and mortality risk were assessed with the pneumonia severity index (PSI) and the mental Confusion-Urea-Respiratory rate-Blood pressure-age ≥ 65 years (CURB-65) scale, respectively. The sample comprised 95 inpatients hospitalized for newly diagnosed CAP. The analysis was run from a societal perspective with a time horizon of one year. Results: Expressed as mean ± standard deviation, in Euros, the direct and indirect medical costs per CAP patient were 696 ± 531 and 410 ± 283, respectively, the total per-patient cost therefore being 1,106 ± 657. The combined budget impact of our patient cohort, in Euros, was 105,087 (66,109 and 38,979 in direct and indirect costs, respectively). The major cost drivers, in descending order, were the opportunity cost (lost productivity); diagnosis and treatment of comorbidities; and administration of medications, oxygen, and blood derivatives. The CURB-65 and PSI scores both correlated with the indirect costs of CAP treatment. The PSI score correlated positively with the overall frequency of use of health care services. Neither score showed any clear relationship with the direct costs of CAP treatment. Conclusions: Clinical severity at admission appears to be unrelated to the costs of CAP treatment. This is mostly attributable to unwarranted hospital admission (or unnecessarily long hospital stays) in cases of mild pneumonia, as well as to over-prescription of antibiotics. Authorities should strive to improve adherence to guidelines and promote cost-effective prescribing practices among physicians in southeastern Europe.
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Affiliation(s)
- Vojislav Cupurdija
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Zorica Lazic
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; and Head. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Marina Petrovic
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department, Kragujevac, Serbia. Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia; and Internist. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Slavica Mojsilovic
- University of Kragujevac, Center for Clinical Medicine, Pulmonology Department. Pulmonology Department, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Ivan Cekerevac
- University of Kragujevac, Center for Clinical Medicine, Kragujevac, Serbia. Intensive Care Unit, University of Kragujevac Center for Clinical Medicine, Kragujevac, Serbia
| | - Nemanja Rancic
- University of Defence, Military Medical Academy, Medical Faculty, Belgrade, Serbia. Centre for Clinical Pharmacology, Medical Faculty, Military Medical Academy, University of Defence, Belgrade, Serbia
| | - Mihajlo Jakovljevic
- University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia. Graduate Program in Health Economics and Pharmacoeconomics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Wex J, Abou-Setta AM, Clerici G, Di Renzo GC. Atosiban versus betamimetics in the treatment of preterm labour in Italy: clinical and economic importance of side-effects. Eur J Obstet Gynecol Reprod Biol 2011; 157:128-35. [DOI: 10.1016/j.ejogrb.2011.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 03/09/2011] [Accepted: 04/14/2011] [Indexed: 11/29/2022]
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Guo Y, Longo CJ, Xie R, Wen SW, Walker MC, Smith GN. Cost-effectiveness of transdermal nitroglycerin use for preterm labor. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:240-246. [PMID: 21296600 DOI: 10.1016/j.jval.2010.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The objective of this study was to determine the cost-effectiveness of using transdermal nitroglycerin (GTN) for cases of preterm labor. METHODS The study included 153 women with clinical preterm labor, who were randomly allocated to either a GTN or placebo arm. All randomized cases were included in the final economic analysis. Differences between the two arms in gestational age at delivery, neonatal intensive care unit (NICU) admission, length of NICU stay, and NICU cost were assessed. Costs for non-NICU cases were calculated using Ottawa Hospital data through the Ontario Case Costing Initiative (OCCI). Cost-effectiveness and sensitivity analyses using a hospital perspective were both conducted. RESULTS In the 153 randomized cases, 55 babies were admitted to NICU (GTN = 24; placebo = 31). We found no significant differences between the two arms in gestational age at delivery, NICU admission rate (32.4% vs. 39.2%), NICU length of stay (42.7 days vs. 52.8 days), or NICU cost (CAN $34,306 vs. CAN $44,326). Overall, (based on all randomized cases) the cost-effectiveness analyses showed that the GTN arm was the dominant strategy, with both lower cost (CAN $13,397 vs. CAN $18,427) and higher NICU admission avoided rate (67.6% vs. 60.8%) compared to the placebo arm. This dominance persisted in all sensitivity analyses. CONCLUSION The use of GTN patch for preterm labor could reduce NICU costs, while improving important neonatal outcomes.
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Affiliation(s)
- Yanfang Guo
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada
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Cost-effectiveness of four immunomodulatory therapies for relapsing-remitting multiple sclerosis: a Markov model based on data a Balkan country in socioeconomic transition. VOJNOSANIT PREGL 2009; 66:556-62. [PMID: 19678581 DOI: 10.2298/vsp0907556j] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIM A cost-effectiveness analyses of immunomodulatory treatments for relapsing-remitting multiple sclerosis (RRMS) in developed countries have shown that any benefit from these drugs is achieved at very high cost. The aim of our study was to compare the cost-effectiveness of five treatment strategies in patients diagnosed with RRMS (symptom management alone and in combination with subcutaneous glatiramer acetate, intramuscular interferon beta-1a, subcutaneous interferon beta-1a, or intramuscular interferon [beta-1b) in a Balkan country in socio-economic transition. METHODS The Markov model was developed based on the literature about effectiveness and on local Serbian cost calculations. The duration of a cycle in the model was set to a month. The baseline time horizon was 480 months (40 years). The societal perspective was used for costs and outcomes, and they were discounted for 3% annually. Monte Carlo micro simulation with 1000 virtual patients was done. RESULTS Significant gain with immunomodulatory therapy was achieved only in relapse-free years, while the time spent in health states EDSS 0.0-5.5 was longer with symptomatic therapy only, and gains in life years and QALYs were only marginal. One QALY gained costs more than a billion of Serbian dinars (more than 20 million US dollars), making each of the four immunomodulatory therapies cost-ineffective. CONCLUSION Our study suggests that immunomodulatory therapy of RRMS in a Balkan country in socioeconomic transition is not cost-effective, regardless of the type of the therapy. Moderate gain in relapse-free years does not translate to gain in QALYs, probably due to adverse effects of immunomodulatory therapy.
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