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Perrier Q, Minoves M, Cerana S, Reymond F, Ducki C, Decaens T, Lehmann A, Bedouch P. Evaluation of drug cost savings related to clinical trials from the perspective of a university hospital. Eur J Hosp Pharm 2023:ejhpharm-2022-003671. [PMID: 37248032 DOI: 10.1136/ejhpharm-2022-003671] [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: 12/26/2022] [Accepted: 05/10/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES Clinical trials are an opportunity for patients to access innovative therapy, but patient inclusion in clinical trials can also result in cost savings for hospitals. Our objective was to evaluate the economic impact of clinical trials drug cost savings in a French academic institution from the perspectives of both the French Health Insurance (FHI) and hospitals. METHODS A retrospective, observational, cost saving analysis was performed on all the clinical trials initiated in our university hospital between 2015 and 2020. Only trials involving an investigational medicinal product were considered. Drug cost savings were defined as the best standard of care, defined in the protocol, whose cost was covered by a sponsor. RESULTS Of the 646 trials undertaken during the 6 years analysed, 21% (212/646) led to cost savings, mostly driven by the industrial sponsor (92%, €6 984 283/€7 591 612) for a total of €7 591 612 (91% from the FHI's perspective (€6 959 115/€7 591 612)). Oncology trials generated 79.1% (€6 004 966/€7 591 612) of global cost savings, mostly driven by onco-haematology (33.1%, €1 983 146/€6 004 966), onco-pneumology (29.2%, €1 754 333/€6 004 966) and onco-dermatology (23.5%, €1 409 553/€6 004 966) followed by hepatogastroenterology trials (6.9%, €413 113/€6 004 966). Of the 162 drugs, the top 15 generated 75.3% (€5 715 479/€7 591 612) of savings and were grouped together: 12 antineoplastic agents (six per os and six intravenous) and three per os antiviral for hepatitis C. CONCLUSIONS With ever-changing prices and new innovative treatments, such cost avoidance must be regularly evaluated. We provided objective evidence that clinical trials could achieve potential cost savings for the FHI and hospitals, in addition to the potential benefit to patients of having access to innovative investigational medicinal products.
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Affiliation(s)
- Quentin Perrier
- Univ. Grenoble Alpes, LBFA, INSERM, U1055, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Mélanie Minoves
- Univ. Grenoble Alpes, Hp2, INSERM, U1300, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Sophie Cerana
- Grenoble Alpes University, Grenoble Alpes University Hospital, Pôle Pharmacie, Grenoble, France
| | - Fabienne Reymond
- Grenoble Alpes University, Grenoble Alpes University Hospital, Pôle Pharmacie, Grenoble, France
| | - Camille Ducki
- Univ. Grenoble Alpes, IAB-INSERM U1209/ CNRS UMR 5309, Clinique Universitaire d'Hépato-gastroentérologie, Grenoble Alpes University Hospital, Grenoble, France
| | - Thomas Decaens
- Univ. Grenoble Alpes, IAB-INSERM U1209/ CNRS UMR 5309, Clinique Universitaire d'Hépato-gastroentérologie, Grenoble Alpes University Hospital, Grenoble, France
| | - Audrey Lehmann
- Univ. Grenoble Alpes, TIMC, CNRS, UMR5525, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Pierrick Bedouch
- Univ. Grenoble Alpes, TIMC, CNRS, UMR5525, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
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Perrier Q, Hosni A, Leenhardt J, Desruet MD, Durand M, Bedouch P. Automation of parenteral nutrition: impact on process and cost analysis. Eur J Hosp Pharm 2023:ejhpharm-2022-003602. [PMID: 37068926 DOI: 10.1136/ejhpharm-2022-003602] [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: 11/06/2022] [Accepted: 03/27/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES On the basis of its safety and accuracy, automation is recommended for parenteral nutrition (PN). The aim of this study was to highlight the changes in practices related to the automation of PN and to perform a cost study comparing manual vs automated production costs. METHODS We conducted a micro-costing study using 1 year of manual production data for adult, neonatal and paediatric PN bagsat a hospital. We used the data to estimate the costs of automating the production process for adult, neonatal and paediatric bags. RESULTS Major modification to the PN production process resulted in: rationalisation of raw materials, computerisation and optimisation of human needs. Switching from a manual to an automated process reduced the cost of neonatal/paediatric custom bags (€130.73 vs €124.58) and semi-custom bags (€172.08 vs €166.86); but increased the cost of adult bags (€93.06 vs €127.92). CONCLUSIONS The changes resulting from the automation and revision of the production process globally increased annual expenditures by approximately 9.7%. However, automation minimised the risk of misproduction, bag contamination, and led to a more secure production process that reduced risks incurred by the teams. In view of the gain in patient and staff safety (linked to the use of an automated compounding device) the moderate economic impact (<10%) should not deter the automation of PN production circuits.
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Affiliation(s)
- Quentin Perrier
- Univ. Grenoble Alpes, LBFA, INSERM, U1055, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Amor Hosni
- Univ. Grenoble Alpes, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Julien Leenhardt
- Univ. Grenoble Alpes, LRB, INSERM, U1039, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Marjorie Durand
- Univ. Grenoble Alpes, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
| | - Pierrick Bedouch
- Univ. Grenoble Alpes, TIMC, CNRS, UMR5525, Pôle Pharmacie, Grenoble Alpes University Hospital, Grenoble, France
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Preston C, King C, Hinds M, Burnett F, Extavour RM. Pharmaceutical procurement among public sector procurers in CARICOM. Rev Panam Salud Publica 2021; 45:e57. [PMID: 34025728 PMCID: PMC8132958 DOI: 10.26633/rpsp.2021.57] [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: 08/29/2020] [Accepted: 12/15/2020] [Indexed: 11/24/2022] Open
Abstract
Objective. To examine multiple aspects of the medicines in CARICOM procurement markets, including manufacturer headquarters location, regulatory history, and type (innovator versus generic); the proportion of World Health Organization (WHO) essential medicines; and the most expensive medicines procured. Methods. An analysis of procurement information from selected CARICOM procurers. Four public sector procurement lists were obtained based on public availability or sharing of data from public sector procurers. Analyses were based on parameters available or deduced from these data. Results. The majority of products come from manufacturers headquartered in North America and Europe (63%–67%). The percentage of medicines procured from generic companies is 60%–87%; and 25%–50% of medicines procured are on the WHO Essential Medicines List. Wide price variations exist in the most expensive medicines purchased. Conclusions. The analysis identifies vulnerabilities and opportunities in the procurement situation of CARICOM states, particularly related to quality and rational use of medicines. This analysis represents a baseline that governments and other stakeholders can use in the future.
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Affiliation(s)
- Charles Preston
- Ex officer of Pan American Health Organization Washington, D.C United States of America Ex officer of Pan American Health Organization, Washington, D.C., United States of America
| | - Claire King
- Baylor Scott and White Medical Center Taylor, Tex United States of America Baylor Scott and White Medical Center, Taylor, Tex., United States of America
| | - Maryam Hinds
- Barbados Drug Service St. Michael Barbados Barbados Drug Service, St. Michael, Barbados
| | - Francis Burnett
- Organisation of Eastern Caribbean States Castries Saint Lucia Organisation of Eastern Caribbean States, Castries, Saint Lucia
| | - Rian Marie Extavour
- Caribbean Public Health Agency Port of Spain Trinidad and Tobago Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
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Aguiar P, Barreto CMN, Roitberg F, Lopes G, del Giglio A. Potential life years not saved due to lack of access to anti-EGFR tyrosine kinase inhibitors for lung cancer treatment in the Brazilian public healthcare system: Budget impact and strategies to improve access. A pharmacoeconomic study. SAO PAULO MED J 2019; 137:505-511. [PMID: 32159636 PMCID: PMC9754282 DOI: 10.1590/1516-3180.2018.0256170919] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 09/17/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Lung cancer is the fourth most common cancer in Brazil. In the 2000s, better understanding of molecular pathways led to development of epidermal growth factor receptor (EGFR)-targeted treatments that have improved outcomes. However, these treatments are unavailable in most Brazilian public healthcare services (Sistema Único de Saúde, SUS). OBJECTIVE To assess the potential number of years of life not saved, the budget impact of the treatment and strategies to improve access. DESIGN AND SETTING Pharmacoeconomic study assessing the potential societal and economic impact of adopting EGFR-targeted therapy within SUS. METHODS We estimated the number of cases eligible for treatment, using epidemiological data from the National Cancer Institute. We used data from a single meta-analysis and from the Lung Cancer Mutation Consortium (LCMC) study as the basis for assessing differences in patients' survival between use of targeted therapy and use of chemotherapy. The costs of targeted treatment were based on the national reference and were compared with the amount reimbursed for chemotherapy through SUS. RESULTS There was no life-year gain with EGFR-targeted therapy in the single meta-analysis (hazard ratio, HR, 1.01). The LCMC showed that 1,556 potential life-years were not saved annually. We estimated that the annual budget impact was 125 million Brazilian reais (BRL) with erlotinib, 48 million BRL with gefitinib and 52 million BRL with afatinib. Their incremental costs over chemotherapy per life-year saved were 80,329 BRL, 31,011 BRL and 33,225 BRL, respectively. A drug acquisition discount may decrease the budget impact by 30% (with a 20% discount). A fixed cost of 1,000 BRL may decrease the budget impact by 95%. CONCLUSION Reducing drug acquisition costs may improve access to EGFR-targeted therapy for lung cancer.
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Affiliation(s)
- Pedro Aguiar
- MD, MSc. Physician and Consultant, Department of Oncology, Faculdade de Medicina do ABC (FMABC), Santo André (SP), and Physician and Consultant, Américas Centro de Oncologia Integrado, São Paulo (SP), Brazil.
| | | | - Felipe Roitberg
- MD. Physician and Consultant, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo (SP), Brazil.
| | - Gilberto Lopes
- MD, FAMS, MBA. Physician, Head of Global Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, USA.
| | - Auro del Giglio
- MD, PhD. Physician and Professor, Centro de Estudos em Hematologia e Oncologia, Faculdade de Medicina do ABC, Santo André (SP), Brazil.
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JING M, ZHANG R. [Economic studies of in vitro fertilization and embryo transfer]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:580-585. [PMID: 31901035 PMCID: PMC8800743 DOI: 10.3785/j.issn.1008-9292.2019.10.18] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/25/2019] [Indexed: 06/10/2023]
Abstract
In vitro fertilization and embryo transplantation (IVF-ET) technology is one of the main treatments for infertility. But IVF-ET is expensive and has not be covered by health insurance in most developing countries. Therefore, how to obtain the maximum success rate with the minimum cost is a common concern of clinicians and patients. At present, the economic studies on IVF-ET mainly focus on different ovulation stimulating drugs, different ovulation stimulating protocols, different transplantation methods and the number of transplants. But the process of IVF-ET is complex, the relevant methods of economic study are diverse, and there are no unified standard for outcome indicators, so there is no unified conclusion for more economical and effective protocol by now. Therefore, to analyze the economic studies of IVF-ET, and to explore appropriate evaluation methods and cost-effective protocols will be helpful for reasonable allocation of medical resources and guidance of clinical selection. It would provide policy reference to include the costs of IVF-ET treatment in health insurance in the future.
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Affiliation(s)
| | - Runju ZHANG
- 张润驹(1978-), 男, 博士, 副主任医师, 硕士生导师, 主要从事生殖内分泌、子宫内膜容受性、胚胎着床研究; E-mail:
;
https://orcid.org/0000-0003-4438-4416
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Santos AS, Guerra-Junior AA, Godman B, Morton A, Ruas CM. Cost-effectiveness thresholds: methods for setting and examples from around the world. Expert Rev Pharmacoecon Outcomes Res 2018; 18:277-288. [PMID: 29468951 DOI: 10.1080/14737167.2018.1443810] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 10/18/2022]
Abstract
INTRODUCTION Cost-effectiveness thresholds (CETs) are used to judge if an intervention represents sufficient value for money to merit adoption in healthcare systems. The study was motivated by the Brazilian context of HTA, where meetings are being conducted to decide on the definition of a threshold. AREAS COVERED An electronic search was conducted on Medline (via PubMed), Lilacs (via BVS) and ScienceDirect followed by a complementary search of references of included studies, Google Scholar and conference abstracts. Cost-effectiveness thresholds are usually calculated through three different approaches: the willingness-to-pay, representative of welfare economics; the precedent method, based on the value of an already funded technology; and the opportunity cost method, which links the threshold to the volume of health displaced. An explicit threshold has never been formally adopted in most places. Some countries have defined thresholds, with some flexibility to consider other factors. An implicit threshold could be determined by research of funded cases. EXPERT COMMENTARY CETs have had an important role as a 'bridging concept' between the world of academic research and the 'real world' of healthcare prioritization. The definition of a cost-effectiveness threshold is paramount for the construction of a transparent and efficient Health Technology Assessment system.
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Affiliation(s)
- André Soares Santos
- a Department of Social Pharmacy, College of Pharmacy , Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte , Brazil
| | - Augusto Afonso Guerra-Junior
- a Department of Social Pharmacy, College of Pharmacy , Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte , Brazil.,b SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), College of Pharmacy , Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte , Brazil
| | - Brian Godman
- c Department of Pharmacoepidemiology , Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde , Glasgow , United Kingdom.,d Division of Clinical Pharmacology , Karolinska Institute, Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Alec Morton
- e Department of Management Science , University of Strathclyde Business School , Glasgow , UK
| | - Cristina Mariano Ruas
- a Department of Social Pharmacy, College of Pharmacy , Universidade Federal de Minas Gerais (UFMG) , Belo Horizonte , Brazil
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de Toledo LAK, Noblat ACB, do Nascimento HF, Noblat LDACB. Economic evaluation of human albumin use in patients with nephrotic syndrome in four Brazilian public hospitals: pharmacoeconomic study. SAO PAULO MED J 2017; 135:92-99. [PMID: 28443947 PMCID: PMC9977339 DOI: 10.1590/1516-3180.2016.0048030516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 05/03/2016] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE: In 2004, the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária, ANVISA) published a resolution establishing guidelines for albumin use. Although the published data do not indicate any definitive conclusions about the benefits of albumin use in patients with nephrotic syndrome (NS), the guidelines recommend this procedure only in cases of edema that is refractory to use of diuretics. The aim here was to analyze albumin use among patients with nephrotic syndrome. DESIGN AND SETTING: Pharmacoeconomic study conducted in four large public referral hospitals for nephrology services in northeastern Brazil. METHOD: Cost-effectiveness and cost-utility economic evaluations were performed on a concurrent cohort of patients with nephrotic syndrome, who were divided into two groups according to compliance or noncompliance with the guidelines. Quality-of-life data were obtained from the SF36 and CHQ-PF50 questionnaires. RESULTS: This study enrolled 109 patients (60% adults and 56% women); 41.3% were using albumin in accordance with the guidelines. The weight, diuresis and fluid balance parameters were more cost-effective for patients who adhered to the guidelines. Regarding days of hospitalization avoided, the incremental ratio showed a daily cost of R$ 55.33, and guideline-compliant patients were hospitalized for five days or fewer. The quality of life improved by 8%, and savings of R$ 3,458.13/QALY (quality-adjusted life year) for the healthcare system were generated through guideline compliance. CONCLUSION: The economic analyses of this study demonstrated that there were greater cost benefits for patients whose treatment followed the guidelines.
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Affiliation(s)
- Leonardo Augusto Kister de Toledo
- MSc. Pharmacist, Hospital Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
| | - Antônio Carlos Beisl Noblat
- MD, PhD. Nephrologist, Head of Complex Care Management Division, Hospital Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
| | | | - Lúcia de Araújo Costa Beisl Noblat
- Pharmacyst, PhD. Professor, School of Pharmacy, Universidade Federal da Bahia (UFBA), and Education and Research Manager, Hospital Universitário Professor Edgard Santos (HUPES), Salvador (BA), Brazil.
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Salinas-Escudero G, Vargas-Valencia J, García-García EG, Munciño-Ortega E, Galindo-Suárez RM. [Cost-effectiveness analysis of etanercept compared with other biologic therapies in the treatment of rheumatoid arthritis]. Rev Med Inst Mex Seguro Soc 2013; 51:514-521. [PMID: 24144145] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE to conduct cost-effectiveness analysis of etanercept compared with other biologic therapies in the treatment of moderate or severe rheumatoid arthritis in patients with previous unresponse to immune selective anti-inflammatory derivatives failure. METHODS a pharmacoeconomic model based on decision analysis to assess the clinical outcome after giving etanercept, infliximab, adalimumab or tocilizumab to treat moderate or severe rheumatoid arthritis was employed. Effectiveness of medications was assessed with improvement rates of 20 % or 70 % of the parameters established by the American College of Rheumatology (ACR 20 and ACR 70). RESULTS the model showed that etanercept had the most effective therapeutic response rate: 79.7 % for ACR 20 and 31.4 % for ACR 70, compared with the response to other treatments. Also, etanercept had the lowest cost ($149,629.10 per patient) and had the most cost-effective average ($187,740.40 for clinical success for ACR 20 and $476,525.80 for clinical success for ACR 70) than the other biologic therapies. CONCLUSIONS we demonstrated that treatment with etanercept is more effective and less expensive compared to the other drugs, thus making it more efficient therapeutic option both in terms of means and incremental cost-effectiveness ratios for the treatment of rheumatoid arthritis.
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Affiliation(s)
- Guillermo Salinas-Escudero
- Centro de Estudios Económicos y Sociales en Salud, Hospital Infantil de México "Federico Gómez," Distrito Federal, México, Mexico.
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