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INTRODUCTION: Subtotal Parathyroidectomy (S-PTx) and total Parathyroidectomy with immediate Autograft (PTx-AG) are well-established techniques for the treatment of refractory Secondary Hyperparathyroidism (SHPT), with comparable improvements in patients' quality of life and survival. However, the long-term costs after these operations may impact the choice of surgical technique. The objective of the study is to analyze the impact of surgical treatment on medication costs and whether there is any difference between medication use after each procedure, considering impacts on the health system. MATERIAL AND METHODS: Prospective and randomized study in patients with severe SHPT undergoing S-PTx and PTx-AG. Analysis of prescribed medication costs in the month before the postoperative period at 1-, 3-, 6-, 12-, and 18 months. Costs were estimated according to government payment system values. The medications of 65 patients after PTx-AG were compared with those of 24 patients after S-PTx. A comparison of the total costs of the period between 38 men and 51 women was also made. RESULTS: There were 89 evaluable cases. Surgery reduced medication costs after 12 months. The median of total drug costs in the analyzed period was R$ 8,375.00 per patient. There was no difference in costs per patient in the S-PTx group compared to the PTx-AG group. The median total costs were R$ 11,063.0 for men and R$ 7,651.0 for women (p = 0.0078). CONCLUSIONS: The type of parathyroidectomy did not impact costs after surgery. In the first year after surgery, the use of calcium and calcitriol was more significant than the use of other medications. In the following months, the use of sevelamer is responsible for the highest costs. Men have higher costs in outpatient follow-up after surgery.
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Costos de los Medicamentos , Hiperparatiroidismo Secundario , Paratiroidectomía , Humanos , Hiperparatiroidismo Secundario/cirugía , Hiperparatiroidismo Secundario/economía , Hiperparatiroidismo Secundario/tratamiento farmacológico , Paratiroidectomía/economía , Masculino , Femenino , Persona de Mediana Edad , Estudios Prospectivos , Adulto , Costos de los Medicamentos/estadística & datos numéricos , Resultado del Tratamiento , Factores de Tiempo , AncianoRESUMEN
BACKGROUND: Evidence describing the types and annual costs of biological treatments for psoriasis in Latin America is scarce. This study aimed to estimate the frequency of use and costs of biologic therapy for psoriasis in Colombia in 2019. METHODS: This secondary data analysis uses the International Classification of Diseases terms associated with psoriasis, excluding those related to psoriatic arthritis, based on data from the registry of the Colombian Ministry of Health. We estimated the prevalence of psoriasis per 100,000 inhabitants; then, we retrieved the frequency of use of biologic therapy in patients with psoriasis and estimated the cost per year of each and overall therapies in 2019 in US dollars (USD). RESULTS: There were 100,823 patients with psoriasis in Colombia in 2019, which amounts to a prevalence of 0.2% in the general population. Of those patients, 4.9% received biologic therapy, most frequently males (60%). The most commonly used biological therapies for psoriasis in Colombia in 2019 were ustekinumab (35.2%), with an annual cost per patient of $12,880 USD; adalimumab (26%), with a yearly cost per patient of $7130 USD; and secukinumab (19.8%), with an annual cost per patient of $6825 USD. CONCLUSION: This is the first study to describe the use and cost of biological therapy for psoriasis in Colombia. It provides valuable cost-awareness information for the Colombian health system.
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Adalimumab , Terapia Biológica , Psoriasis , Humanos , Psoriasis/economía , Psoriasis/tratamiento farmacológico , Psoriasis/terapia , Psoriasis/epidemiología , Colombia/epidemiología , Masculino , Femenino , Adalimumab/uso terapéutico , Adalimumab/economía , Adulto , Persona de Mediana Edad , Terapia Biológica/economía , Terapia Biológica/estadística & datos numéricos , Anticuerpos Monoclonales Humanizados/economía , Anticuerpos Monoclonales Humanizados/uso terapéutico , Ustekinumab/uso terapéutico , Ustekinumab/economía , Prevalencia , Adulto Joven , Fármacos Dermatológicos/economía , Fármacos Dermatológicos/uso terapéutico , Anciano , Sistema de Registros/estadística & datos numéricos , Costos de los Medicamentos/estadística & datos numéricos , Costos de la Atención en Salud/estadística & datos numéricos , AdolescenteRESUMEN
INTRODUCTION: The economic consequences of mandatory coverage, through judicial means, of high-priced medications constitutes a growing problem, which merits knowing its local characteristics to provide possible solutions. OBJECTIVE: To identify medications, diseases involved, economic impact and contextual factors of the judicialization of high-priced medications in the Argentine Health System(MEP). METHODS: Quali-quantitative descriptive study that retrospectively analyzed legal protection resources by MEP from three national and provincial databases from January 2017 to December 2020, evaluating the existing relationship between lawsuits with regulatory approval, inclusion in benefit packages and relationship with journalistic articles for the three most frequently prosecuted drugs. RESULTS: 405 lawsuits were included, mainly from the Ministry of National Health. The three most prosecuted medications were nusinersen (21.7%), palbociclib (5.9%) and agalsidase-alfa (4.7%). Only 69.4% of medications were approved for marketing in Argentina at the time of the protection; 45.7% were incorporated into the Single Reimbursement System, and 16.8% had a report from the National Commission for the Evaluation of Health Technologies and Clinical Excellence (CONETEC), which was negative in 87.1% of cases. The average time from request to provision of the medication was 150 days. A temporal correlation was observed between the appearance of the MEP in the national graphic press and the appeals occurrence. CONCLUSIONS: Judicialization focused on very highpriced medications for rare or oncological diseases. The rulings were mostly in favor of the plaintiff, and access times to the medication took a long time. The mass media anticipated the judicial processes.
Introducción: Las consecuencias económicas de la cobertura obligatoria, vía judicial, de medicamentos de alto precio constituye un problema creciente, que amerita conocer sus características locales para aportar posibles soluciones. OBJETIVO: Identificar medicamentos, enfermedades, impacto económico y factores contextuales de la judicialización de medicamentos de alto precio (MEP) Argentina. Métodos: Estudio descriptivo cuali-cuantitativo que analizó retrospectivamente recursos de amparos legales por MEP de tres bases de datos nacionales y provinciales durante 4 años, evaluando relación existente entre amparos con aprobación regulatoria, inclusión de los MEP al paquete de beneficios y relación con notas periodísticas. RESULTADOS: Se incluyeron 405 amparos provenientes principalmente del Ministerio de Salud Nacional. Los tres medicamentos más judicializados fueron nusinersen (21.7%), palbociclib (5.9%) y agalsidasa-alfa (4.7%). Solo el 69.4% de los medicamentos se encontraban aprobados para la comercialización en Argentina al momento del amparo; el 45.7% se encontraban incorporados al Sistema Único de Reintegros y el 16.8% contaban con informe de la Comisión Nacional de Evaluación de Tecnologías Sanitarias y Excelencia Clínica (CONETEC), negativa en el 87.1% de casos. El tiempo promedio desde la solicitud hasta la provisión del medicamento fue de 150 días. Se observó una correlación temporal entre la aparición del MEP en la prensa nacional gráfica y la presentación de amparos de dicho MEP. CONCLUSIONES: La judicialización se concentró en medicamentos de altísimo precio para enfermedades poco frecuentes u oncológicas. Los fallos fueron mayoritariamente a favor del demandante, siendo los tiempos de acceso al medicamento prolongados. Los medios de comunicación anticiparon los procesos judiciales.
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Costos de los Medicamentos , Argentina , Humanos , Estudios Retrospectivos , Costos de los Medicamentos/legislación & jurisprudencia , Costos de los Medicamentos/estadística & datos numéricosAsunto(s)
Industria Farmacéutica , Argentina , Humanos , Industria Farmacéutica/legislación & jurisprudencia , Preparaciones Farmacéuticas/economía , Preparaciones Farmacéuticas/provisión & distribución , Costos de los Medicamentos/estadística & datos numéricos , Costos de los Medicamentos/legislación & jurisprudenciaRESUMEN
Objetivos. Analizar el circuito de utilización de los medicamentos de alto costo (MAC) y los resultados clínicos obtenidos en un hospital de pediatría público de alta complejidad de Argentina y presentar una estrategia de selección replicable para otras instituciones de similares características de la región. Métodos: Estudio prospectivo, descriptivo, aleatorizado, conducido en el Hospital de Pediatría Juan P. Garrahan de la Ciudad Autónoma de Buenos Aires en el período entre el 1 de setiembre de 2018 y el 31 de marzo de 2019. Se evaluaron dos unidades de estudio, la unidad paciente y la unidad MAC. Resultados: Los MAC consumen 7.921.200 dólares estadounidenses (USD) anuales y representan el 41% del costo de los medicamentos del hospital de alta complejidad. El 50% del costo de los MAC estuvo representado por la gammaglobulina (medicamento utilizado en diferentes enfermedades). Los pacientes proceden de toda la Argentina y otros países y un 44% tiene cobertura de salud. Los diagnósticos para los que se prescribieron MAC con mayor frecuencia fueron los relacionados con patología oncológica (leucemia linfoide aguda, leucemia mieloblástica aguda). El 54% de los pacientes presentó mejoría atribuible directamente a la administración de los MAC, 39% no presentó cambios y el 7% empeoró. Conclusiones: La efectividad en los resultados clínicos y el análisis de los circuitos de aprobación indican que, además de la aprobación por las entidades nacional e internacionales, la evaluación responsable por parte de las instituciones efectoras, mediante la discusión interdisciplinaria basada en la mejor evidencia, contribuye a optimizar la utilización de los MAC y la seguridad de los pacientes (AU)
Objectives. To analyze the utilization circuit of high-cost medications (HCM) and the clinical results obtained in a tertiarycare public pediatric hospital in Argentina and to present a selection strategy that may be disseminated to other institutions of similar characteristics in the region. Methods: A prospective, descriptive, randomized study was conducted at Hospital de Pediatría Juan P. Garrahan in Buenos Aires between September 1, 2018 and March 31, 2019. Two study units were evaluated, the patient and the HCM. Results: HCMs account for 7,921,200 US dollars (USD) per year and represent 41% of the cost of drugs in this tertiary-care hospital. Gamma globulin (a drug used for different diseases) accounted for 50% of the cost of HCMs. Patients came from Argentina and other countries and 44% had a health insurance. Cancer (acute lymphoid leukemia, acute myeloblastic leukemia) was the diagnosis for which HCMs were most frequently prescribed. Fifty-four percent of patients showed improvement directly attributable to the administration of HCMs, 39% showed no change, and 7% worsened. Conclusions: The effectiveness in clinical outcomes and the analysis of approval circuits show that, in addition to approval by national and international entities, responsible evaluation by the effector institutions through interdisciplinary discussion based on the best evidence contributes to optimizing the use of HCMs and patient safety (AU)
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Comité Farmacéutico y Terapéutico , Preparaciones Farmacéuticas/economía , Comités de Ética , Costos de los Medicamentos/estadística & datos numéricos , Utilización de Medicamentos , Hospitales Pediátricos , Hospitales Públicos , Estudios Prospectivos , Seguridad del Paciente , Análisis de Costo-EfectividadRESUMEN
OBJECTIVE: The objective of this study was to describe national changes in utilization and associated costs of antidiabetic medications in the United States from 2014 to 2019, across different drug classes and insurance plans. RESEARCH DESIGN AND METHODS: This retrospective, cross-sectional study examined administrative claims from a large national pharmacy benefits manager from January 1, 2014, to December 31, 2019. Patients aged 18 years and above enrolled in commercial, Medicare, or Medicaid health plans who filled ≥1 prescription claim for an antidiabetic medication(s) during the 6-year period were included. Utilization was examined as the total number of 30-day adjusted prescription fills per user per month (PUPM). Gross costs were calculated as the sum of plan costs (net of rebates) and member out-of-pocket costs. Differences in mean utilization and costs PUPM between 2014 and 2019 for each medication class were calculated. RESULTS: The final analytic sample increased from 745,290 patients in 2014 to 1,596,006 in 2019. Antidiabetic medication utilization increased by 8.8% from 2014 to 2019, driven by increases in sodium-glucose cotransporter 2 inhibitor (48.7%; P<0.001), glucagon-like peptide 1 receptor agonist (11.8%; P<0.001), insulin (8.1%; P<0.001), and metformin (2.9%; P<0.05) utilization. Average costs PUPM rose 47.5% (P<0.001), from $126.52 in 2014 to $186.58 in 2019. Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and combination drugs contributed significantly to these increased costs, with 6-year cost differences of 57.3%, 46.9%, and 47.2%, respectively (all P<0.001). CONCLUSION: Our study demonstrates a shift in antidiabetic medication class utilization from 2014 to 2019, where associated costs net of rebates significantly increased to a disproportionately greater extent than the significant increase in utilization PUPM.
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Diabetes Mellitus Tipo 2/tratamiento farmacológico , Gastos en Salud/estadística & datos numéricos , Hipoglucemiantes/economía , Insulina/economía , Adulto , Anciano , Estudios Transversales , Diabetes Mellitus Tipo 2/economía , Costos de los Medicamentos/estadística & datos numéricos , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Seguro de Servicios Farmacéuticos , Masculino , Medicaid , Medicare , Persona de Mediana Edad , Estudios Retrospectivos , Estados UnidosRESUMEN
OBJECTIVES: To estimate the budget impact of the expansion of liposomal amphotericin B use for all confirmed cases of visceral leishmaniasis (VL) in Brazil. Currently, the first-line medicine for VL treatment is meglumine antimoniate. Liposomal amphotericin B is indicated only for patients with a greater risk of severity by the disease. METHODS: The analysis was performed from the perspective of the Brazilian public healthcare system over 3 years, considering the following 2 scenarios: the reference scenario with the current recommendations for VL treatment and the alternative scenario based on the use of liposomal amphotericin B for all patients. A diffusion rate of 60% was used in the first year, 80% in the second year, and 100% in the third year. The epidemiological parameters used in the analysis came from the Notifiable Diseases Information System and from a clinical trial that evaluated the efficacy and safety of medicines for the treatment of VL in the country. The costs were related to the treatment of VL and to hospital and outpatient care. RESULTS: In the reference scenario, the total cost for treatment of the 3453 VL confirmed cases in 2014 was $1 447 611.75. The incremental budget impact with the use of liposomal amphotericin B for all the VL confirmed cases was $299 646.43 in the third year. CONCLUSIONS: The analysis presented will support the decision process for the use and expansion of liposomal amphotericin B for all VL confirmed cases in Brazil.
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Anfotericina B/economía , Presupuestos/tendencias , Análisis Costo-Beneficio/métodos , Leishmaniasis Visceral/tratamiento farmacológico , Anfotericina B/uso terapéutico , Brasil , Análisis Costo-Beneficio/estadística & datos numéricos , Costos de los Medicamentos/normas , Costos de los Medicamentos/estadística & datos numéricos , Humanos , Leishmaniasis Visceral/economíaRESUMEN
OBJECTIVE: Using the 2016 Medicare Part D coverage gap as an example, we explored effects of increased out-of-pocket costs on adherence to branded dipeptidyl peptidase 4 inhibitors (DPP-4i) in patients without financial subsidies relative to subsidized patients who do not experience increased spending during the gap. We also explored seasonality of reinitiation, because discontinuers may be more likely to reinitiate in January when benefits reset. RESEARCH DESIGN AND METHODS: We identified DPP-4i or sulfonylurea initiators, aged ≥66 years, from a 20% sample of 2015-2016 Medicare claims. Difference-in-differences Poisson regression was used to compare adherence before and after entering the coverage gap between nonsubsidized and subsidized patients. Among discontinuers, monthly hazard ratios (HRs) for reinitiation relative to January 2016 were derived with Cox models. As a second control, we repeated analyses using sulfonylureas, generic low-cost alternatives. RESULTS: In 2016, 8,096 subsidized and 6,173 nonsubsidized DPP-4i initiators entered the coverage gap. For nonsubsidized patients, copayment in the coverage gap was 45% ($227 per DPP-4i prescription), and adherence decreased from 68.4% to 49.0% after gap entry. Accounting for adherence differences in subsidized patients, nonsubsidized patients demonstrated reduced adherence to DPP-4i (difference-in-difference: -16.9%; 95% CI -18.7%, -15.1%) but not sulfonylureas (-1.6%; 95% CI -3.4%, 0.2%). Reinitiation was lowest in the months before January (HR 0.4-0.5) among nonsubsidized DPP-4i patients, demonstrating a strong seasonal pattern. CONCLUSIONS: Increased out-of-pocket costs negatively affect adherence and reinitiation of branded antihyperglycemic drugs among patients without financial subsidies. Despite closure of the coverage gap, affordability remains a concern given increasing list prices for many drugs on Medicare and the growing use of deductibles and coinsurance by commercial health plans.
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Diabetes Mellitus , Costos de los Medicamentos , Hipoglucemiantes/economía , Hipoglucemiantes/uso terapéutico , Medicare Part D , Anciano , Anciano de 80 o más Años , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/economía , Diabetes Mellitus/epidemiología , Inhibidores de la Dipeptidil-Peptidasa IV/economía , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Costos de los Medicamentos/estadística & datos numéricos , Femenino , Gastos en Salud/estadística & datos numéricos , Gastos en Salud/tendencias , Humanos , Masculino , Medicare Part D/economía , Medicare Part D/estadística & datos numéricos , Persona de Mediana Edad , Compuestos de Sulfonilurea/economía , Compuestos de Sulfonilurea/uso terapéutico , Estados Unidos/epidemiologíaRESUMEN
The objectives of the study were to determine the cost variability of antipsychotics in public (hospi tals) and private pharmaceutical establishments (pharmacies and clinics), calculate the cost variability of antipsychotics between establishments and estimate the cost of monthly maintenance treatment with antipsychotics. A cost analysis study was performed, unit costs of antipsychotics were obtained from the Peruvian Pharmaceutical Products Observatory. The results show that the cost variability of antipsycho tics was greater in pharmacies and clinics than in hospitals, and the analysis of cost variability between pharmaceutical establishments showed that the cost of an antipsychotic in a pharmacy and clinic was 1.3 to 140 times and 2.8 to 124 times, respectively, the cost of the drug in a hospital. The cost of monthly maintenance treatment varied from S/3 to S/2130 according to the drug and pharmaceutical establish ment.
Los objetivos del estudio fueron determinar la variabilidad de costos de antipsicóticos en establecimien tos farmacéuticos públicos (hospitales) y privados (farmacias y clínicas), calcular la variabilidad de cos tos de antipsicóticos entre establecimientos y estimar el costo de tratamiento mensual de mantenimiento con antipsicóticos. Se realizó un estudio de análisis de costos, los costos unitarios de los antipsicóticos se obtuvieron del Observatorio Peruano de Productos Farmacéuticos. Los resultados muestran que la va riabilidad de costos de los antipsicóticos fue mayor en farmacias y clínicas que en hospitales, y el análisis de variabilidad de costos entre establecimientos farmacéuticos mostró que el costo de un antipsicótico en una farmacia y clínica fue 1,3 a 140 veces y de 2,8 a 124 veces, respectivamente, el costo que tuvo el fármaco en un hospital. El costo de tratamiento mensual de mantenimiento varió de S/ 3 a S/ 2130 según el fármaco y establecimiento farmacéutico.
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Antipsicóticos , Costos de los Medicamentos , Farmacias , Antipsicóticos/economía , Costos de los Medicamentos/estadística & datos numéricos , Humanos , PerúRESUMEN
INTRODUCTION: The acquisition of medicines accounts for a significant proportion of private health expenditures. The objective of this study was to analyse the private spending with the purchase of medicines and the commitment of the family income, by the elderly. METHODS: Population survey conducted in Praia Grande, São Paulo, Brazil. The monthly expenditure and the per capita family income commitment with the purchase of medicines were calculated from the information obtained in the interviews. The variables were described in absolute and relative frequencies and the hypothesis test was Pearson's χ2, Student's t and Anova, with a significance level of 5%. RESULTS: The prevalence of drug use was 61.2%. The average monthly expenditure per capita was R$ 34.59, with significantly higher income impairment for individuals with higher levels of education, without chronic diseases and health plan beneficiaries. CONCLUSION: The prevalence of drug use was low. The cost generated by the purchase of medicines is one of the ways in which inequality can manifest in society. The expansion of free drug provision would be necessary to expand access and avoid spending, especially those who have private health plans but cannot afford drug treatment.
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Gastos en Salud/estadística & datos numéricos , Renta/estadística & datos numéricos , Preparaciones Farmacéuticas/economía , Anciano , Anciano de 80 o más Años , Brasil , Ciudades , Costos de los Medicamentos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/estadística & datos numéricos , Preparaciones Farmacéuticas/provisión & distribución , Factores Socioeconómicos , Estadísticas no ParamétricasRESUMEN
PURPOSE: To study the cost-effectiveness of ranibizumab and bevacizumab for the treatment of age-related macular degeneration. METHODS: We used a decision tree model to analyze the cost-effectiveness of ranibizumab and bevacizumab for the treatment of age-related macular degeneration, from the Brazilian Public Health System (SUS) perspective. Ranibizumab and bevacizumab were administered to patients with the same treatment procedure, and the difference in treatment costs was calculated based on the cost of the drugs. Direct costs were estimated using the information provided by the Brazilian SUS. Effectiveness in terms of quality-adjusted life years (QALYs) was calculated based on the utility values for visual impairment. Incremental cost-effectiveness ratio was calculated by comparing both treatments. The analytical horizon was one year. RESULTS: The decision tree analysis showed that the difference in treatment effectiveness was 0.01 QALY. Incremental cost-effectiveness ratio showed that ranibizumab treatment required an incremental annual cost of more than R$ 2 million to generate 1 additional QALY, as compared to bevacizumab. CONCLUSIONS: From the Brazilian SUS perspective, bevacizumab is more cost-effective than ranibizumab for the treatment of neovascular age-related macular degeneration. Its use could allow potential annual savings in health budget.
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Inhibidores de la Angiogénesis/economía , Bevacizumab/economía , Ranibizumab/economía , Trastornos de la Visión/tratamiento farmacológico , Trastornos de la Visión/economía , Inhibidores de la Angiogénesis/administración & dosificación , Bevacizumab/administración & dosificación , Brasil , Análisis Costo-Beneficio , Costos de los Medicamentos/estadística & datos numéricos , Costos de la Atención en Salud , Humanos , Programas Nacionales de Salud , Años de Vida Ajustados por Calidad de Vida , Ranibizumab/administración & dosificación , Agudeza VisualRESUMEN
RESUMEN Los objetivos del estudio fueron determinar la variabilidad de costos de antipsicóticos en establecimien tos farmacéuticos públicos (hospitales) y privados (farmacias y clínicas), calcular la variabilidad de cos tos de antipsicóticos entre establecimientos y estimar el costo de tratamiento mensual de mantenimiento con antipsicóticos. Se realizó un estudio de análisis de costos, los costos unitarios de los antipsicóticos se obtuvieron del Observatorio Peruano de Productos Farmacéuticos. Los resultados muestran que la va riabilidad de costos de los antipsicóticos fue mayor en farmacias y clínicas que en hospitales, y el análisis de variabilidad de costos entre establecimientos farmacéuticos mostró que el costo de un antipsicótico en una farmacia y clínica fue 1,3 a 140 veces y de 2,8 a 124 veces, respectivamente, el costo que tuvo el fármaco en un hospital. El costo de tratamiento mensual de mantenimiento varió de S/ 3 a S/ 2130 según el fármaco y establecimiento farmacéutico.
ABSTRACT The objectives of the study were to determine the cost variability of antipsychotics in public (hospi tals) and private pharmaceutical establishments (pharmacies and clinics), calculate the cost variability of antipsychotics between establishments and estimate the cost of monthly maintenance treatment with antipsychotics. A cost analysis study was performed, unit costs of antipsychotics were obtained from the Peruvian Pharmaceutical Products Observatory. The results show that the cost variability of antipsycho tics was greater in pharmacies and clinics than in hospitals, and the analysis of cost variability between pharmaceutical establishments showed that the cost of an antipsychotic in a pharmacy and clinic was 1.3 to 140 times and 2.8 to 124 times, respectively, the cost of the drug in a hospital. The cost of monthly maintenance treatment varied from S/3 to S/2130 according to the drug and pharmaceutical establish ment.
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Humanos , Farmacias , Antipsicóticos , Costos de los Medicamentos , Perú , Antipsicóticos/economía , Costos de los Medicamentos/estadística & datos numéricosRESUMEN
ABSTRACT Purpose: To study the cost-effectiveness of ranibizumab and bevacizumab for the treatment of age-related macular degeneration. Methods: We used a decision tree model to analyze the cost-effectiveness of ranibizumab and bevacizumab for the treatment of age-related macular degeneration, from the Brazilian Public Health System (SUS) perspective. Ranibizumab and bevacizumab were administered to patients with the same treatment procedure, and the difference in treatment costs was calculated based on the cost of the drugs. Direct costs were estimated using the information provided by the Brazilian SUS. Effectiveness in terms of quality-adjusted life years (QALYs) was calculated based on the utility values for visual impairment. Incremental cost-effectiveness ratio was calculated by comparing both treatments. The analytical horizon was one year. Results: The decision tree analysis showed that the difference in treatment effectiveness was 0.01 QALY. Incremental cost-effectiveness ratio showed that ranibizumab treatment required an incremental annual cost of more than R$ 2 million to generate 1 additional QALY, as compared to bevacizumab. Conclusions: From the Brazilian SUS perspective, bevacizumab is more cost-effective than ranibizumab for the treatment of neovascular age-related macular degeneration. Its use could allow potential annual savings in health budget.
RESUMO Objetivo: Estudar o custo-efetividade do ranibizumabe e bevacizumabe no tratamento da degeneração macular relacionada à idade neovascular. Métodos: Utilizamos um modelo de árvore de decisão para analisar a relação custo-efetividade do ranibizumabe e bevacizumabe no tratamento da degeneração macular relacionada à idade, sob a perspectiva do Sistema Único de Saúde. O ranibizumabe e bevacizumabe foram administrados a pacientes com o mesmo procedimento de tratamento, e a diferença nos custos do tratamernto foi calculada com base no custo dos medicamentos. Os custos diretos foram estimados utilizando as informações fornecidas pelo SUS. A efetividade foi determinada em anos de vida ajustados pela qualidade (QALY) baseados em valores de utilidade em deficiênciavisual. A razãoincremental custo-efetividadefoicalculada comparando os dois tratamentos. O horizonte analítico foi de um ano. Resultados: A análise da árvore de decisão mostrou que a diferença na efetividade do tratamento foi de 0,01 QALY. A razão incremental de custo-efetividade mostrou que o tratamento com ranibizumabe exigiu um custo anual incremental de R$ 2 milhões para gerar um QALY adicional, em comparação ao bevacizumabe. Conclusões: Do ponto de vista do SUS, o bevacizumabe é mais custo-efetivo que o ranibizumabe no tratamento da degeneração macular relacionada à idade neovascular. O seu uso poderia gerar uma grande economia anual para o orçamento em saúde.
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Humanos , Trastornos de la Visión/economía , Trastornos de la Visión/tratamiento farmacológico , Inhibidores de la Angiogénesis/economía , Bevacizumab/economía , Ranibizumab/economía , Brasil , Agudeza Visual , Costos de la Atención en Salud , Costos de los Medicamentos/estadística & datos numéricos , Análisis Costo-Beneficio , Años de Vida Ajustados por Calidad de Vida , Inhibidores de la Angiogénesis/administración & dosificación , Bevacizumab/administración & dosificación , Ranibizumab/administración & dosificación , Programas Nacionales de SaludRESUMEN
BACKGROUND: Symptomatic hypocalcemia is a common complication of total thyroidectomy. Management strategies include responsive treatment initiation for symptoms or prevention by routine or parathyroid hormone-directed calcium supplementation. The comparative cost-effectiveness of even the most often utilized strategies is unclear. METHODS: A Markov cohort model was created to compare routine supplementation with calcium alone (RS), postoperative parathyroid hormone-based selective supplementation with calcium and calcitriol (SS), and no supplementation (NS) in asymptomatic patients. Patients could remain asymptomatic or develop symptomatic hypocalcemia, managed with outpatient oral supplementation or intravenous calcium infusion and administered either inpatient or outpatient. Effectiveness was measured in quality-adjusted life years. Sensitivity analyses were performed to test model parameter assumptions. RESULTS: RS was the preferred strategy, costing $329/patient and resulting in 0.497 quality-adjusted life years, which was only marginally better compared to SS ($373 for 0.495 quality-adjusted life years). NS was most costly at $4,955 for 0.491 quality-adjusted life years. Preference for RS over SS was sensitive to the probability of developing symptoms and the probability of symptom treatment with intravenous supplementation. On probabilistic sensitivity analysis, RS was preferred in 75.4% of scenarios. CONCLUSION: After total thyroidectomy, a preventative calcium supplementation strategy should be strongly considered. In this data-driven theoretical model, RS was the least costly option and resulted in an incremental gain in quality-adjusted life years.
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Análisis Costo-Beneficio , Suplementos Dietéticos/economía , Hipocalcemia/economía , Complicaciones Posoperatorias/tratamiento farmacológico , Tiroidectomía/efectos adversos , Calcitriol/administración & dosificación , Calcitriol/economía , Calcio/administración & dosificación , Calcio/economía , Simulación por Computador , Costos de los Medicamentos/estadística & datos numéricos , Humanos , Hipocalcemia/tratamiento farmacológico , Hipocalcemia/etiología , Hipocalcemia/prevención & control , Cadenas de Markov , Modelos Económicos , Hormona Paratiroidea/sangre , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/etiología , Años de Vida Ajustados por Calidad de VidaRESUMEN
Objective: Although the efficacy of systemic corticosteroids (SCs) in acute asthma exacerbations is well established, the fact that many children still require admission to hospital and that SCs have a slow onset of action are cause of concern. For this reason, the use of inhaled corticosteroids (ICS) as a therapy added to SCs has been explored, with no clarity about its cost-effectiveness. The aim of the present study was to evaluate the cost-effectiveness of ICS in addition to SCs (ICS + SCs) compared to standard therapy with SCs for treating pediatric asthma exacerbations.Methods: A decision-analysis model was developed to estimate the cost-effectiveness of SCs compared to ICS + SCs for treating pediatric patients with acute asthma exacerbations. Effectiveness parameters were obtained from a systematic review of the literature. Cost data obtained from hospital bills and from the national manual of drug prices. The study was carried out from the perspective of the national healthcare system in Colombia. The main outcome of the model was avoidance of hospital admission.Results: For the base-case analysis, the model showed that compared to SCs, therapy with ICS + SCs was associated with lower total costs (US$88.76 vs.US$97.71 average cost per patient) and a lower probability of hospital admission (0.9060 vs. 0.9000), thus showing dominance.Conclusions: This study shows that compared with standard therapy with SCs, ICS + SCs for treating pediatric patients with acute asthma exacerbations is the preferred strategy because it was associated with a lower probability of hospital admission, at lower total treatment costs.
Asunto(s)
Asma/tratamiento farmacológico , Análisis Costo-Beneficio , Glucocorticoides/administración & dosificación , Admisión del Paciente/economía , Brote de los Síntomas , Administración por Inhalación , Administración Oral , Adolescente , Asma/economía , Niño , Preescolar , Costos de los Medicamentos/estadística & datos numéricos , Quimioterapia Combinada/economía , Quimioterapia Combinada/métodos , Femenino , Glucocorticoides/economía , Costos de Hospital/estadística & datos numéricos , Humanos , Masculino , Modelos Económicos , Admisión del Paciente/estadística & datos numéricos , Resultado del TratamientoRESUMEN
BACKGROUND: Antineoplastic agents approved in recent decades are a marked advancement in cancer treatment, but they come at considerable cost. These drugs may widen survival disparities between patients who receive these agents and those who do not. We examine factors associated with the use of high-cost antineoplastic agents for the treatment of metastatic non-small cell lung cancer. METHODS: We conducted a retrospective observational study using 2007-2015 Surveillance, Epidemiology, and End-Results-Medicare data supplemented with the Area Health Resource File. Patients were aged 66 years and older, were enrolled in fee-for-service Medicare Part D, were diagnosed with a first primary diagnosis of metastatic non-small cell lung cancer, and had received an antineoplastic agent. "High-cost agents" were defined as agents costing $5000 or more per month. Independent variables include race/ethnicity, urban or rural residency, census tract poverty, and treatment facility type (eg, National Cancer Institute designation). RESULTS: Patients who lived in areas of high poverty were 4 percentage points less likely to receive high-cost agents (two-sided P < .001). Patients who were not treated at a National Cancer Institute-designated center were 10 percentage points less likely to receive these agents (two-sided P < .001). A 27 percentage-point increase in the likelihood of receiving a high-cost agent was observed in 2015, as compared to 2007, highlighting the rapid change in practice patterns (two-sided P < .001). CONCLUSION: Potential policy and care delivery solutions involve outreach and support to community physicians who treat patients in remote areas. We estimate that widespread use of these agents conservatively cost approximately $3 billion per year for the treatment of metastatic non-small cell lung cancer alone.
Asunto(s)
Antineoplásicos/economía , Antineoplásicos/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Costos de los Medicamentos , Neoplasias Pulmonares/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/economía , Carcinoma de Pulmón de Células no Pequeñas/epidemiología , Carcinoma de Pulmón de Células no Pequeñas/patología , Costos de los Medicamentos/estadística & datos numéricos , Femenino , Costos de la Atención en Salud , Humanos , Neoplasias Pulmonares/economía , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/patología , Masculino , Medicare/economía , Metástasis de la Neoplasia , Estudios Retrospectivos , Factores de Riesgo , Programa de VERF , Estados Unidos/epidemiologíaRESUMEN
RESUMO: Introdução: A aquisição de medicamentos responde por proporção importante dos gastos privados em saúde. O objetivo deste trabalho foi analisar o gasto privado com a compra de medicamentos e o comprometimento da renda familiar por idosos. Métodos: Inquérito populacional realizado em Praia Grande, São Paulo, 2013. O gasto mensal e o comprometimento da renda familiar per capita com a compra de medicamentos foram calculados com base nas informações obtidas nas entrevistas. As variáveis foram descritas em frequências absolutas e relativas, e os testes de hipótese utilizados foram o χ2 de Pearson, o t de Student e a análise de variância (Anova), com nível de significância de 5%. Resultados: A prevalência de utilização de medicamentos foi de 61,2%, e o gasto médio mensal per capita, de R$ 34,59, sendo significativamente maior o comprometimento da renda para os indivíduos com maior escolaridade, sem doenças crônicas e beneficiários de planos de saúde. Conclusão: A prevalência de utilização de medicamentos foi baixa. O custo gerado pela aquisição de medicamentos é uma das formas pelas quais pode se manifestar a desigualdade na sociedade. A ampliação da provisão gratuita de medicamentos seria necessária para expandir o acesso e evitar gastos, sobretudo àqueles que possuem planos de saúde privados, mas que não conseguem arcar com as despesas de tratamento medicamentoso.
ABSTRACT: Introduction: The acquisition of medicines accounts for a significant proportion of private health expenditures. The objective of this study was to analyse the private spending with the purchase of medicines and the commitment of the family income, by the elderly. Methods: Population survey conducted in Praia Grande, São Paulo, Brazil. The monthly expenditure and the per capita family income commitment with the purchase of medicines were calculated from the information obtained in the interviews. The variables were described in absolute and relative frequencies and the hypothesis test was Pearson's χ2, Student's t and Anova, with a significance level of 5%. Results: The prevalence of drug use was 61.2%. The average monthly expenditure per capita was R$ 34.59, with significantly higher income impairment for individuals with higher levels of education, without chronic diseases and health plan beneficiaries. Conclusion: The prevalence of drug use was low. The cost generated by the purchase of medicines is one of the ways in which inequality can manifest in society. The expansion of free drug provision would be necessary to expand access and avoid spending, especially those who have private health plans but cannot afford drug treatment.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Preparaciones Farmacéuticas/economía , Gastos en Salud/estadística & datos numéricos , Renta/estadística & datos numéricos , Factores Socioeconómicos , Brasil , Preparaciones Farmacéuticas/provisión & distribución , Ciudades , Costos de los Medicamentos/estadística & datos numéricos , Estadísticas no Paramétricas , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/estadística & datos numéricosRESUMEN
OBJECTIVE: A resolution passed by the government of the Brazilian state of São Paulo established a protocol for requesting free COPD medications, including tiotropium bromide, creating regional authorization centers to evaluate and approve such requests, given the high cost of those medications. Our objective was to analyze the requests received by an authorization center that serves cities in the greater metropolitan area of (the city of) São Paulo between 2011 and 2016. METHODS: Data regarding the authorization, return, or rejection of the requests were compiled and analyzed in order to explain those outcomes. Subsequently, the clinical and functional data related to the patients were evaluated. RESULTS: A total of 7,762 requests for dispensing COPD medication were analyzed. Requests related to male patients predominated. Among the corresponding patients, the mean age was 66 years, 12% were smokers, 88% had frequent exacerbations, and 84% had severe/very severe dyspnea. The mean FEV1 was 37.2% of the predicted value. The total number of requests decreased by 24.5% from 2012 to 2013 and was lowest in 2015. Most (65%) of the requests were accepted. The main reasons for the rejection/return of a request were a post-bronchodilator FEV1/FVC ratio > 0.7, a post-bronchodilator FEV1 > 50% of the predicted value, and failure to provide information regarding previous use of a long-acting ß2 agonist. During the study period, the total number of requests returned/rejected decreased slightly, and there was improvement in the quality of the data included on the forms. CONCLUSIONS: Here, we have identified the characteristics of the requests for COPD medications and of the corresponding patients per region served by the authorization center analyzed, thus contributing to the improvement of local public health care measures.
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Broncodilatadores/economía , Broncodilatadores/provisión & distribución , Enfermedad Pulmonar Obstructiva Crónica/economía , Bromuro de Tiotropio/economía , Bromuro de Tiotropio/provisión & distribución , Anciano , Brasil , Costos de los Medicamentos/estadística & datos numéricos , Femenino , Volumen Espiratorio Forzado , Accesibilidad a los Servicios de Salud/economía , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Factores de Tiempo , Capacidad Vital/fisiologíaRESUMEN
The high cost of drugs for hepatitis C limits access and adherence to treatment. In 2017, the Colombian health care system decided to design a strategy. It consisted of centralized purchasing, regulations, clinical practice guidelines, and direct observation of the treatment and follow-up of patients. The main objective of this study was to assess the centralized purchasing strategy in Colombia. The study design was a policy implementation assessment. We analyzed the change in prices, the clinical outcomes, and the opinions of stakeholders using data from the Ministry of Health. Additional information about effectiveness came from the Colombian Fund for High-Cost Diseases and semi-structured interviews of the stakeholders. The follow-up was from October, 2017 to October, 2018. The total number of patients reported in the cohort period was 1069. The number that finished 12 weeks of treatment, completed the follow-up for the case closure, and were considered cured through the end of October, 2018 was 563 (53%). The remainder, 506 patients (47%), are currently in treatment. A total of 543 of these treated patients (96%) were cured. After implementing this strategy, the drug prices decreased by more than 90% overall. Before implementation, the total direct cost was $100 102 171.75 dollars. Afterward, the cost was $8 378 747 dollars.
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Antivirales/economía , Atención a la Salud/organización & administración , Costos de los Medicamentos/legislación & jurisprudencia , Implementación de Plan de Salud , Hepatitis C/tratamiento farmacológico , Antivirales/uso terapéutico , Colombia/epidemiología , Ahorro de Costo/economía , Ahorro de Costo/estadística & datos numéricos , Análisis Costo-Beneficio , Atención a la Salud/economía , Atención a la Salud/legislación & jurisprudencia , Atención a la Salud/normas , Costos de los Medicamentos/estadística & datos numéricos , Industria Farmacéutica/economía , Industria Farmacéutica/estadística & datos numéricos , Femenino , Adquisición en Grupo/economía , Adquisición en Grupo/legislación & jurisprudencia , Adquisición en Grupo/organización & administración , Adquisición en Grupo/normas , Hepacivirus/aislamiento & purificación , Hepatitis C/epidemiología , Hepatitis C/virología , Humanos , Masculino , Persona de Mediana Edad , Negociación , Políticas , Guías de Práctica Clínica como Asunto , Evaluación de Programas y Proyectos de Salud , Participación de los Interesados , Resultado del TratamientoRESUMEN
BACKGROUND: Metabolic syndrome (MetS) is a combination of risk factors for cardiovascular disease and type 2 diabetes mellitus. The prevalence of MetS worldwide is increasing. There is no study investigating the economic burden of MetS, especially in developing countries, on medication-related expenditure. The aim of this study was to investigate the association of medication-related expenditures with MetS and to explore how physical activity (PA) may influence this association. METHODS: A total of 620 participants, 50 years or older, randomly selected in the city of Bauru, Brazil. Participants were followed from 2010 to 2014, and data on health care expenditure were collected annually. PA questionnaire was applied at baseline, 2 (2012), and 4 (2014) years later. RESULTS: Mean age was 64.7 (95% confidence interval, 64.1-65.3). MetS was associated with higher medication expenditure related to diseases of the circulatory (P <.01) and endocrine (P <.01) systems. MetS explained 17.2% of medication-related expenditures, whereas PA slightly attenuated this association, explaining 1.1% of all health care costs. CONCLUSION: This study demonstrates that MetS has a significant burden on health care expenditures among adults, whereas PA seems to affect this phenomenon significantly, but in low magnitude.