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PIN1 |
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COST-EFFECTIVENESS OF
NEVIRAPINE VERSUS EFAVIRENZ BASED HIGHLY ACTIVE
ANTIRETROVIRAL THERAPY IN HIV-INFECTED PATIENTS IN
THAILAND
Phumipan S1, Kaewnoi C1, Pongchareonsuk P1,
Chaikledkaew U2, 1Mahidol University, Payathai,
Bangkok, Thailand, 2Mahidol University, Bangkok,
Thailand OBJECTIVE:
To
compare the cost-effectiveness of nevirapine (NVP)
versus efavirenz (EFV) based highly active
antiretroviral therapy in HIV-infected patients in
Thailand. METHODS:
A cost-effectiveness model was
developed based on efficacy and cost data in
Thailand. The cost-effectiveness analysis was
conducted using a decision tree analysis. Costs of
physician visit, medication, lab test, physician,
and hospitalization were obtained from Siriraj
Hospital Thailand. Sensitivity analysis was also
performed to test the model robustness. RESULTS:
After receiving nevirapine base regimen for six
months, the probability of virological success was
47%. The probability of virological success was
63% for efavirenz base regimen. Total costs were
43,320 baht(US$ 1057.88)and 44,773 baht (US$
1093.36) for NVP and EFV base groups,
respectively. The EFV base regimen was more
cost-effective and its incremental
cost-effectiveness ratio was 9,023 baht (US$
220.34) when compared to NVP base regimen. In
Thailand, there was the treatment regimen (i.e.,
the fixed-dose combination of stavudine (d4T),
lamivudine (3TC) and nevirapine (NVP). Total cost
of this regimen was 41,694 baht (US$ 1018.17).
When compared to EFV, the incremental
costeffectiveness ratio was 19,121 baht (US$
466.94). CONLUSIONS:
The results were sensitive
to a number of assumptions including the cost and
fixed-dose combination of starvudine, lamivudine
and nevirapine. In developing countries, using
fixed-dose combination regimen will present more
accessibility for HIV patients.
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PIN2 |
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COMPARING COST-EFFECTIVENESS
OF INTERVENTIONS TO REDUCE MOTHER-TO-CHILD
TRANSMISSION OF HIV IN SOUTH AND SOUTH-EAST ASIA
Chang CW, Taipei Medical University,
Taipei, Taiwan OBJECTIVE:
To
compare the cost-effectiveness of different
treatments to prevent motherto- child transmission
(MTCT) of HIV/AIDS in south and southeast Asia
countries. METHODS:
Estimated data from literature
reviews and clinical trials for a hypothetical
cohort study of 20,000 pregnant women in south and
south-east Asia in 2004 is applied within this
study. Comparing cost-effectiveness of five
different treatments of Nevirapine regimen
Universal Treatment (universal HIVNET012),
Nevirapine regimen Targeted Treatment (targeted
HIVNET 012), Petra-B regimen Targeted Treatment
(Petra B), Zidovudine Cote d’ Ivoire Trial regimen
Targeted Treatment (Cote d’ Ivoire), and no
intervention. Main outcome data are measured in
cost per disability adjusted life years saved, and
cost per MTCT case averted. RESULTS:
Universal
HIVNET012AED treatment is the most cost-effective
treatment ($4.37 per DALY; $117.39 per case
averted) among all optional interventions,
followed by targeted HIVNET 012 ($6.97 per DALY;
$187.03 per case averted). Petra B costs $9.26 per
DALY and $239.94 per case averted. Cote d’Ivoire
costs Petra B costs $12.03 per DALY and $306.05
per case averted. The incremental
cost-effectiveness ratio of $1.3750 per DALY saved
moves from no intervention to Universal
HIVNET012AED treatment. CONLUSIONS:
This study is
in favor of the use of Universal HIVNET012AED
treatment for preventing mother-to-child
transmission in south and south-east Asia. Due to
the limited information of the cost and
effectiveness of pre-treatment screenings, the
study can not compare the accurate
cost-effectiveness of different stages of each
different intervention. Therefore, comparing the
cost differences between universal and targeted
treatment may lead to the result of favoring of
intervention without screening (universal
treatment). KEY WORDS: HIV, mother-to-child
transmission (MTCT), cost-effectiveness.
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PIN3 |
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COST-EFFECTIVENESS OF
SINGLE-DOSE PERINATAL NEVIRAPINE PLUS STANDARD
ZIDOVUDINE TO PREVENT MOTHER-TO-CHILD TRANSMISSION
OF HIV IN THAILAND
Yuwaree V1, Ponsoongnern K1, Pongcharoensuk
P2, Chaikledkaew U2, 1mahidol university, Bangkok,
Thailand, 2Mahidol University, Rajathevi, Bangkok,
Thailand OBJECTIVE:
Recently published clinical trails in Thailand
have demonstrated that perinatal nevirapine added
to zidovudine could further reduce mother-to-child
transmission of HIV in Thailand. Cost of providing
antiretroviral drugs and other services to mother
and children has never been considered. The
objective of this study is to compare the
cost-effectiveness of standard zidovudine alone
with single-dose perinatal nevirapine plus
standard zidovudine regimen to prevent
mother-to-child transmission of HIV in Thailand.
METHODS:
Decision tree model who used to conduct
cost-effectiveness analysis. Cost data were
obtained from the government hospital and
effectiveness data were derived from published
study. The main outcome measure is cost of perinatal HIV infection avert in children follow
up six months. RESULTS:
Single-dose perinatal
nevirapine plus standard zidovidine to prevent
mother-to-child transmission ( PMTCT ) of HIV-1
cost 5421.23 baht ( $135.53 ) per HIV infection
avert in children whereas the cost per HIV
infection avert in children of standard zidovudine
is 5770.22 baht ( $ 144.26 ). This is much less
than the standard zidovudine cost per HIV
infection avert in children. CONLUSIONS:
Based on
the results, it is cost-effective to add
single-dose nevirapine in standard zidovudine
regimen to PMTCT HIV-1 in Thailand.
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PIN4 |
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CAN REDUCTION OF
OPPORTUNISTIC INFECTION TREATMENT COST OUTWEIGH
COST OF TRIPLE ANTIRETROVIRAL THERAPY?
Loongbarn S, Kulsomboon V, Chulalongkorn
University, Bangkok, Thailand
OBJECTIVE:
To determine whether the reduction of
opportunistic infection treatment cost among HIV
patients offsets their increased cost after
providing the triple ARV combination drug, GPO-VIR®
, which costs only US $ 1 (40 baht) per day.
METHODS:
Only the HIV patients who had CD4 cell
count less than 200 cell/mm3 at the initiation of
receiving GPOVIR were recruited in the study.
Clinical and cost data of the HIV patients, one
year before and at least 6 months after receiving
GPO-VIR, were collected. Cost-consequences
analysis was employed based upon provider
perspective. RESULTS:
Of the 78 HIV patients,
52.6% were females and 80.8% had the CD4 cell
count level less than 100 cell/mm3 at the initial
treatment. The mean of the CD4 cell count level
(179.2 ± 94.00) after receiving GPO-VIR
significantly increased from baseline (56.5 ±
52.9) at the initial treatment (P=0.000). The
incidence rate of specific OI at OPD visit
substantially decreased including Pneumocystis
Carinii Pneumonia (PCP), Cytomegolovirus (CMV),
Tuberculosis (TB), and Cryptococcal Meningitis.
Four HIV patients (5.1%) were admitted with severe
ADR including two cases of acidosis, one case of
renal failure, and one case of hepatic failure.
The treatment costs before receiving GPO-VIR were
108.7 US $ per patient per year (PPPY). After
receiving GPO-VIR, the total costs were 567.1 $
PPPY including 459.2 $ PPPY for the GPO-VIR cost.
The hospitalization cost reduced from 49.5 $ PPPY
to 20.4 $ PPPY after receiving GPO-VIR. Cost of
ADR treatment was 48.4% of overall hospitalization
cost. CONCLUSION: After receiving GPO-VIR,
although the overall cost did not outweigh the
cost prior to the ARV treatment, it substantially
decreased severe OI and hospitalization cost. The
positive impact of GPO-VIR enhances provider to
increase universal coverage of GPOVIR for all
eligible HIV patients in Thailand.
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PIN5 |
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QUALITY OF LIFE INSTRUMENTS
IN HIV/AIDS PATIENTS: AN APPROPRIATE INSTRUMENT
FOR THAI PATIENTS
Inngam P, Pratheepawanit N, Tripop S, Johns
J, Khon Kaen University, Khon Kaen, Thailand OBJECTIVE:
In the year
2005, there are approximately 670,000 people in
Thailand living with HIV/AIDS. New pharmaceutical
interventions may extend the survival of these
patients. Health related quality of life (HRQOL)
is increasingly of interest for a comprehensive
outcome of care in these patients. To select an
appropriate instrument for Thai patients, this
article comprehensively reviews the psychometric
properties of HRQOL instruments used in HIV/AIDS
patients that were published from 1990 to 2005 in
the Medline database. METHODS:
These were found
using the search terms ‘quality of life’, ‘HIV’,
and ‘instrument’. Of 19 instruments reviewed, 8
are generic and 11 are disease-specific
instruments. To evaluate these instruments, we
considered the content, administration, depth of HRQOL measured and psychometric properties.
Overall, generic instruments do not adequately
cover the important issues for HIV/AIDS patients
and are not responsive. The disease specific
instruments consist of aspects not assessed by
generic instruments, such as medication, sexual
and financial aspects. RESULTS:
The MOS-HIV, FAHI,
and AIDS-HAQ exhibit high reliability in all
domains, and have evidence of responsiveness.
However, they still lack evidence of testretest
reliability, which is important for assessing the
stability of the instrument over time. The MOS-HIV
is claimed to have higher responsiveness than the
other tools, making it the most appropriate among
these instruments. However, the weakness lies in
its high ceiling effects that weaken its ability
to capture change, particularly with asymptomatic
patients. The MOS-HIV is the only instrument that
has been translated into Thai language to date.
CONLUSIONS:
The single study published reported
that this version had even higher ceiling effects.
Revision of this instrument to enhance this
shortcoming and adding content about medication
and symptoms to increase its content coverage are
necessary for the development of a Thai HRQOL
instrument for HIV patients.
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PIN6 |
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ECONOMIC EVALUATION OF
INFLUENZA VACCINATION AMONG THE ELDERLY IN BANGKOK
Plasai V, Viputsiri OA2, Pongpanich S3,
Lertmaharit S4, Panichpathompong U5,
Tarnmaneewongse V5, Cheunkitmongkol S5, Baron-Papillon
F6, 1College of Public health Chulalongkorn
University, Bangkok, TN, Thailand, 2Dept.
Preventive & Social Medicine Chulalongkorn
University, Bangkok, Thailand, bangkok, Thailand,
3college of public Health Chulalongkorn
University, Bangkok, Thailand, 4Dept. Preventive &
Social Medicine Faculty of Medicine, Bangkok,
Thailand, 5sanofi pasteur, Bangkok, Thailand,
6sanofi pasteur, Lyon cedex 07, France
Influenza causes substantial morbidity and
mortality in elderly people. Despite
recommendations for annual vaccination against
influenza and the availability of effective
vaccines to deal with this disease, most elderly
Thais are not vaccinated. Evaluation of the
economic impact of influenza vaccination among
elderly in Bangkok can support public health
policy decisions concerning vaccination and also
help influence medical practices. OBJECTIVE:
To determine (i) the effectiveness of influenza
vaccination among the elderly in Bangkok in
reducing influenza like illness (ILI) and
influenza-related complications and (ii) the
costeffectiveness from the societal perspective.
METHODS:
Using nonrandomized,
non-controlled, prospective study, we studied
active living people aged 60 or over who enrolled
in two Elderly Co-ordination Centers (ECC). The
two study arms were vaccinated and a nonvaccinated
group with sample size of 520 each. The occurrence
of influenza and its complications in each group
was examined and cost-effectiveness evaluation of
influenza vaccination performed. RESULTS:
During the 12-month study, vaccination was
associated with a reduction in the rate of
visiting doctors and reported ILI (7.7% of
vaccinated vs 13.3% of non-vaccinated). Under
Thailand’s 30 Baht health insurance program
(governmental co-payment scheme), the
out-of-pocket expenditures were lower in the
vaccinated group (B9,896: B23,562) and mean value
per person of vaccinated elderly was lower than
non-vaccinated elderly (B206:B277) even though
they were not significantly different. Annual
direct saving in cost of illness if vaccination
averaged B71 per elderly vaccinated, with
cumulative saving of B36,920. Vaccination was
associated with a reduction in ILI episodes during
the influenza season. CONLUSIONS:
Although
the results indicated the benefit and
effectiveness of influenza vaccination for the
elderly in Bangkok, the vaccine availability and
affordability is still a discussion issue. It is
clear that strategies targeting elderly and/or
other groups are needed to improve vaccination
policy and ensure better health of Thai
population.
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PIN7 |
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EFFECT OF INTEGRATED
TRADITIONAL CHINESE MEDICINE AND WESTERN MEDICINE
ON SARS TREATMENTS: SYSTEMATIC REVIEW AND META
ANALYSIS
Chen Y1, Guo JJ1, Daniel PH1, Zhan SY2,
1University of Cincinnati, Cincinnati, OH, USA,
2Peking University, Beijing, China
OBJECTIVE:
To assess the effect of integrated TCM
(Traditional Chinese Medicine)/WM (Western
Medicine) on severe acute respiratory syndrome (SARS)
treatments compared with those patients treated
with WM alone. METHODS:
A systematic review and metaanalysis of controlled clinical studies. Data
were collected from published and unpublished
controlled clinical studies, and systematic
clinical reviews indexed in either Medline,
Chinese National Knowledge Infrastructure (CNKI),
or other important official reports from 2003 to
2005. A total of 4122 patients from 30 controlled
clinical studies fulfilling the inclusion criteria
were identified for this study. Outcome
measurements: mortality rate, resolution of lung
infiltrate, the use of corticosteroid, time to
defervesence, immune functions tests, duration of
hospitalization,the Adverse Drug Reactions.
RESULTS:
Of 30 selected studies, there were 2110
patients from 20 randomized controlled studies and
2012 patients from ten non-randomized controlled
studies. The pooled estimated mortality rates in
the integrated TCM /WM and WM groups were 40.1 per
1,000 and 136.4 per 1,000, respectively (Relative
Risk= 0.31, 95%CI =0.20- 0.48, p<0.0001). Analysis
of the clinical cure rate showed a significant
treatment effect for integrative treatments
(p=0.004). Patients with integrated TCM/WM used
less corticosteroid in terms of daily dosage
(p<0.00001). Last, patients with TCM/WM had better
resolution rate of lung infiltrate (p=0.0002),
more rapid resolution of fever (p=0.001), higher
counts of CD4 + lymphocyte (p=0.0008), and less
duration of hospitalization (p=0.04). In addition,
through the literatures review, we found that
integrated TCM/WM also could lower the abnormal
level of ALT and AST resulted from the medications
and reduce the possibility of the occurrence of
ADR or other complications. CONLUSIONS:
The
integrated TCM/WM for SARS treatments was superior
to the treatment with WM alone in terms of lower
mortality rate, high curative rate, and other
clinical outcomes. It is clinically important to
consider the integrated TCM/WM treatment for SARS
treatment.
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PIN8 |
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ECONOMIC EVALUATION COMPARING
VORICONAZOLE WITH CONVENTIONAL AMPHOTERICIN B AS
THE PRIMARY TREATMENT REGIMENS OF INVASIVE
ASPERGILLOSIS IN TAIWAN
Lin SSF1, Chu CHY1, Li MPY1, Chen YJ2, Roberts C3,
Chen NCC1, 1Pfizer Limited
Taiwan, Pfizer Global Pharmaceutical, Tamsui,
Taipei County, Taiwan, Taiwan,
2National Taiwan University Hospital, Taipei,
Taiwan, 3Pfizer Inc, New York, NY, USA Voriconazole (VOR)
is a broad-spectrum triazole that has been shown
to be superior to amphotericin B deoxylate (AMB)
as initial therapy for invasive aspergillosis (IA)
in terms of response, survival, and safety in the
largest comparative trial of IA to date (Herbrecht
et al. NEJM 2002, 347:408-15). No economic
evaluation has been conducted to assess the
cost-effectiveness of VOR in Taiwan. OBJECTIVE:
To
assess treatment costs and costeffectiveness of
VOR compared with AMB as initial therapy of
invasive aspergillosis. METHODS:
Cost-effectiveness of VOR compared with AMB for
treatment of invasive aspergillosis in Taiwan was
evaluated with a decision-analytic model developed
from clinical trial data supplemented with local
data. Clinical success, survival, hospital stay by
treatment pathway, and need for second line
therapies were obtained from the clinical trial.
Unit costs of medications and resources of medical
care were obtained from Taiwan’s national
reimbursement system database. Data were collected
from local experts on use of concomitant therapy,
monitoring, and second line therapies.
Cost-effectiveness was expressed as incremental
cost per successful case and incremental cost per
life saved. RESULTS:
The average cost of treating
invasive aspergillosis primarily with VOR was
547,002 New Taiwan Dollars compared with 493,060
NTD with AMB. Hospitalization costs and the cost
of antifungal therapies were the largest
contributors to cost in both the treatments. The
incremental costs per life saved for VOR vs. AMB
was 254,444 NTD (7,951 USD) and the incremental
cost per successfully treated patient was 418,155
NTD (13,067 USD), respectively. CONLUSIONS:
Although treating patients with invasive aspergillosis with voriconazole costs more than
AMB, the incremental costs per successful case and
life saved for VOR is reasonable. VOR is likely to
be a cost-effective treatment for invasive
aspergillosis in Taiwan.
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PIN9
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HBE-ANTIGEN NEGATIVE CHRONIC
HEPATITIS B: COST-EFFECTIVENESS OF PEGINTERFERON
ALFA-2A COMPARED TO LAMIVUDINE TREATMENT IN
TAIWAN.
Veenstra DL1, Sullivan SD1, Lai MY2, Lee
CM3, Tsai CM4, Patel KK5, 1University of
Washington, Seattle, WA, USA, 2National Taiwan
University Hospital, Taipei, Taiwan,
3Chang Gung Memorial Hospital, Kaohsiung, Taiwan,
4Roche Products Ltd, Taipei,
Taiwan, 5Hoffmann-La Roche, Nutley, NJ, USA
In Taiwan, the carrier rate of HBsAg is 15-20%,
one of the highest in the world. Among chronic
hepatitis B (CHB) patients, HBeAg-negative disease
accounts for roughly 40-50% of patients. A recent
trial showed that peginterferon alfa-2a (40KD)
(PEG) was more effective than lamivudine (LAM) in
treating HBeAg-negative CHB. The
cost-effectiveness of PEG compared to LAM has not
been evaluated. OBJECTIVE:
To evaluate the
incremental costeffectiveness of 48 weeks of PEG
compared to 48 weeks of LAM, from the perspective
of the Taiwan Bureau of National Health Insurance.
METHODS: A Markov model was developed to simulate
the natural history of HBeAg-negative CHB in a
cohort of 40-year old patients. Efficacy, disease
progression, economic, and quality of life data
were extracted from the published literature and
validated by clinical experts in Taiwan. Life
expectancy, quality-adjusted life expectancy,
lifetime costs (NTD$), and incremental
cost-effectiveness ratios (ICERs) were computed.
Sensitivity analyses were undertaken. RESULTS:
The
gain in quality adjusted life years (QALYs) for 48
weeks of PEG compared to 48 weeks of LAM was 0.45
at an additional cost of NTD$157,000 (US$5,000),
resulting in an ICER of NTD$347,000 (US$11,000)
per QALY gained. Despite plausible variation in
each parameter used in the analysis, the ICER did
not exceed NTD$448,000 (US$14,000) per QALY
gained. CONLUSIONS:
In HBeAg-negative CHB, 48
weeks of treatment with PEG compared to 48 weeks
of LAM appears to offer life expectancy and
quality of life improvements at a favorable
cost-effectiveness ratio.
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PIN10 |
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COST-EFFECTIVENESS OF
PEGINTERFERON ALFA-2A COMPARED TO LAMIVUDINE
TREATMENT IN PATIENTS WITH HBE-ANTIGEN POSITIVE
CHRONIC HEPATITIS B IN TAIWAN.
Sullivan SD1, Veenstra DL1, Chen PJ2, Chang TT3,
Chuang WL4, Tsai CM5, Patel KK6, 1University of
Washington, Seattle, WA, USA, 2National Taiwan
University, Taipei, Taiwan, 3National Cheng Kung
University Hospital, Tainan, Taiwan, 4Kaohsiung
Medical University Hospital, Kaohsiung, Taiwan,
5Roche Products Ltd, Taipei, Taiwan, 6Hoffmann-La
Roche, Nutley, NJ, USA
Peginterferon alfa-2a (40KD) (PEG), a new
treatment option for patients with chronic
hepatitis B (CHB), offers improved efficacy with a
defined treatment duration compared with
lamivudine (LAM), but at a higher cost.
OBJECTIVE:
We undertook a cost-effectiveness analysis from
the perspective of the Taiwan Bureau of National
Health Insurance to assess the clinical outcomes
and costs of PEG for the treatment of patients
with HBeAg-positive CHB, compared to LAM treatment
for 48 weeks. METHODS:
An economic evaluation
using a state-transition Markov model simulating
the natural history of HBeAg-positive CHB was
used. Efficacy data were obtained from a
randomized clinical trial of 820 patients (87%
were Oriental) comparing PEG to LAM. We modeled a
hypothetical cohort of 32-year old patients with
HBeAg-positive CHB. Life expectancy,
quality-adjusted life expectancy, lifetime costs (NTD$),
and incremental cost-effectiveness ratios (ICERs)
were estimated. RESULTS:
48 week treatment with
PEG compared to LAM resulted in higher total
costs, but greater quality-adjusted life
expectancy, yielding an ICER of NTD$381,000
(US$12,000) per quality-adjusted life year (QALY)
gained. Although there is uncertainty associated
with the prognosis of HBeAg-positive CHB, the ICER
did not exceed NTD$485,000 (US$15,000) per QALY
gained despite variation in each parameter used in
the analysis. CONLUSIONS:
48 week treatment with
PEG compared to 48 week of LAM treatment in CHB
patients who are HBeAg-positive appears to offer
life expectancy benefits at a favorable
cost-effectiveness ratio for the Taiwan Bureau of
National Health Insurance.
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PIN11 |
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COST-MINIMIZATION ANALYSIS OF
DURAPREP AND AQUEOUS IODOPHOR SCRUB FOR SKIN
PREPARATION IN CABG SURGERY IN SOUTH KOREA: A
RANDOMIZED CONTROLLED TRIAL
Jo MW1, Kim YS2, Lee SI1, 1University of
Ulsan College of Medicine, Seoul, South Korea,
2University of Ulsan, College of Medicine, Asan
Medical Center, Seoul, South Korea
OBJECTIVE:
To conduct the economic evaluation of
iodophor-in-alcohol, film-forming, water-insoluble
skin prep (Duraprep Surgical Solution, 3M company
St. Paul, MN) and aqueous iodophor scrub for skin
preparation in coronary artery bypass graft(CABG)
in South Korea. METHODS:
A prospective
randomization controlled trial was conducted after
approval of Institutional Review Board in Asan
Medical Center, Seoul, South Korea. A total of 189
patients were assigned by block randomization to
apply Duraprep or aqueous iodophor for measurement
of 30 days-postoperative infection rate as a
outcome. For costanalysis, 64 patients among them
were recruited and time-dependent cost variables
such as cost for anesthesia, healthcare
professionals, and drugs and cost of consumables
variables such as surgical glove, gauze, bowl,
iodophor etc were collected. Sensitivity analyses
for each assumption also were done. RESULTS:
We
conducted cost-minimization analysis because
postoperative infection rate was equivalent(3.2%
in Duraprep group vs 5.3% in aqueous iodophor
scrub group, p=0.497). In social and patient
perspectives, each cost in Duraprep group was
$37.2 & $6 and in aqueous iodophor scrub group was
$49.1 & $11.6. In insurer perspectives, cost in
Duraprep group was $ 23.2 and in aqueous iodophor
scrub group was $14.8. In sensitivity analysis,
most results were similar to basic analysis.
CONLUSIONS:
In conclusion, using Duraprep for
skin preparation in CABG surgery in South Korea
might save cost in social and patient
perspectives.
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PIN12 |
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ESTIMATION OF CLINICAL AND
ECONOMIC CONSEQUENCES OF COUNTERFEIT ANTIMALARIAL
MEDICINES IN LAO PDR: USING AN EPIDEMIOLOGIC MODEL
Suyavong P1, Chaiyakunapruk N2,
Patmasiriwat D2, 1National University of Laos,
Vientiane, Vientiane, Laos, 2Naresuan University,
Muang, Phitsanulok, Thailand
OBJECTIVE:
Counterfeit antimalarial medicines have
worsened the malaria situation in Laos because its
use placed patients at risk of developing
complications and death. This study aims to
estimate its clinical and economic consequences in
Lao PDR. METHODS:
An epidemiologic model was
structured and analyzed from the societal
perspective. The population of Lao PDR was
simulated through the model under 1) current
situation (existence of counterfeit drugs) and 2)
idealistic situation (no counterfeit drugs). The
prevalence of counterfeit artesunate (41.18%) was
used in the model. Several probability data were
derived from literature, while others were based
on interviews of providers in the settings. The
cost of medications was taken from the wholesale
price of a pharmaceutical company, while medical
visit and hospitalization costs were converted
from the hospital charges using a cost-to-charge
ratio. The indirect cost was estimated using
human-capital approach. The model was used to
compute the differences of the number of
hospitalizations, deaths, and total costs between
both situations. A series of sensitivity analysis
were performed. Since the time horizon of this
study was one year, discounting was not needed.
RESULTS:
In the base-case analysis, 65 deaths,
4,741 hospital days, and $US 50,633 were incurred
due to counterfeit antimalarial medicines. It was
found that the probability of becoming severe
malaria when using counterfeit medicines was very
influential to clinical consequences, while the
cure rate of counterfeit antimalarial medicines
was influential to economic consequences. Scenario
analyses demonstrated that counterfeit
antimalarial medicines resulted in 539 of deaths
in worst-case sensitivity analysis, and 9 deaths
in best-case sensitivity analysis. CONLUSIONS:
In
Lao PDR, an existence of counterfeit antimalarial
medicines results in substantial increases in
morbidity, mortality, and costs. Our research
findings could be used as part of information to
help policy makers prioritize problems and
properly allocate budget to eliminate them.
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PIN14 |
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PREDICTING TREATMENT COST OF
BACTERIAL DIARRHEA
Riewpaiboon A, Mahidol University, Bangkok,
Thailand, Intraprakan K, Phobpra Hospital, Amphur
Phobpra, Tak, Thailand, Phoungkatesunthorn S,
Saraburi Hospital, Amphur Muang, Saraburi,
Thailand OBJECTIVE:
This study
was aimed to formulate the treatment cost function
of bacterial diarrhea from provider perspective at Saraburi regional hospital in Thailand.
METHODS:
This study was a retrospective study using the
incidence-based approach. The study covered both
out and in-patients (ICD code A00-A05, DRG group
182-184) received treatment during October 1, 2000
to July 31, 2003. There were 878 out-patients and
233 inpatients. Sample size of out-patients were
calculated based on a preliminary cost analysis
and selected by convenience sampling. All
in-patients were included. Stepwise multiple
regressions were employed to create the cost
function. RESULTS:
The study covered 393 episodes.
All costs were calculated at 2002 prices. The
average costs were 451 THB, 3,903 THB, and 2,250
THB per outpatient episode, inpatient episode, and
average episode, respectively (approximately Thai
baht; THB 40 = US$ 1). It was found that the cost
of out-patients was associated with number of
visits, out-patient clinics, and antibiotic
prescribing. Costs of inpatients were associated
with length of stay, type of pathogens (ICD),
antibiotic prescribing, fever, age, and payment
scheme. In case of forecasting at the beginning of
treatment, type of patient (out or inpatient),
type of pathogen (ICD), antibiotic prescribing,
fever, age, and payment scheme were significant
variables. The three models had high determination
coefficients of 0.845-0.880. CONLUSIONS:
Treatment cost of nearly 90% of bacterial diarrhea
episodes could be explained by number of visits,
hospitalized days, type of patients, clinics,
pathogens, antibiotics use, fever, age, payment
scheme.
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PIN15 |
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INITIAL CONTENT VALIDATION OF
A DISEASE-TARGETED HEALTH-RELATED QUALITY OF LIFE
(HRQOL) INSTRUMENT IN CHRONIC HEPATITIS B VIRUS
(HBV) INFECTION
Spiegel B1, Bolus R1, Han S2, Talley J1, Ong
SH3, Chang J4, Kanwal F1, 1UCLA/VA Center for
Outcomes Research and Education (CORE), Los
Angeles, CA, USA, 2UCLA Medical Center, Los
Angeles, CA, USA, 3Novartis Pharmaceuticals,
Basel, Switzerland, 4Novartis Pharmaceuticals,
East Hanover, NJ, USA
OBJECTIVE:
The burden of illness of HBV is
significant in Asia-Pacific, not only because of
its high prevalence, but also because of its HRQOL
decrement. Despite the importance of HRQOL in HBV,
there are no disease-targeted instruments
currently available. We are therefore developing a
new, disease-targeted HRQOL instrument in HBV.
This presentation describes the candidate items
and scales resulting from our initial content
validation process. METHODS:
“Content validity” is
the degree to which an instrument contains a
representative range of items and scales relevant
to the disease under study. In order to establish
content validity for our evolving instrument, we
initially conducted a systematic review to
identify published HRQOL instruments in chronic
liver disease and related conditions. We then
convened a panel of five hepatologists experienced
in HBV. Using a semistructured protocol, we
elicited the domains perceived as most relevant in
HBV, and asked the panel to comment on the
relevance of the items from systematic review.
Finally, in concert with three psychometricians,
we developed a conceptual model of the scales in
HBV. RESULTS:
We selected five scales on the basis
of their content validity and potential
responsiveness (i.e. ability to detect HRQOL
change after successful treatment); 1)
Anticipation Anxiety/Psychological Well Being
(e.g. fear of cancer/cirrhosis);2) Disease
Stigma/Social Well Being (e.g. embarrassment,
concern for job); 3) Sexual Well Being/Intimacy
(e.g. transmission concern, impact on sexuality);
4) Daily Functioning (e.g. impact on diet or
medication use); and 5) Vitality/Physical Well
Being (e.g. feeling worn out, low energy).
CONLUSIONS:
Five scales may capture HRQOL in HBV
across a range of psychological, social, and
physical factors. The breadth and depth of
symptoms in HBV highlights the significant HRQOL
burden of this condition. Future research will
test these scales with patient focus groups, and
will prospectively measure the psychometrics of
our evolving instrument.
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PIN16 |
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QUALITY OF LIFE AND COST OF
DIFFERENT TREATMENT STRATEGIES FOR HEPATITIS C
PATIENTS IN TAIWAN
Yang MC, Wen CY, National Taiwan
University, Taipei, Taiwan
OBJECTIVE:
The Bureau of National Health Insurance
in Taiwan implemented an experimental plan for
strengthening the chronic hepatitis C patient
treatment on October 1, 2003. The purpose of this
study was to analyze the medical cost (including
direct cost and indirect cost) and Health-Related
Quality of Life (HRQoL) during the period of
treatment with different treatment strategies (peginterferon
versus interferon), from the societal perspective.
METHODS:
We used a cross-sectional survey method
to interview 45 patients with chronic hepatitis C
and were receiving treatment in an academic
medical center. The medical expenditures were
provided by the hospital and the personal expenses
reported by patients. The HRQoL questionnaire
contained the Short Form-12 (SF-12), the Fatigue
symptom inventory (FSI), and the Hospital Anxiety
and Depression Scale (HADS). RESULTS:
The total
medical costs per month for insurance claims was
NT$23,666 for peginterferon group and NT$14,125
for interferon. Indirect cost of Peginterferon
group is NT$1618, and NT$77 for interferon. Mean
scores for PCS was 40.26 and 39.58 in the MCS of
the SF-12. Patients’ quality of life was lower
than that of general people during the treatment.
In addition, patients during treatment were worse
in fatigue intensity, duration, and interference
with quality of life. The same results were
observed in the anxiety and depression status.
Patients with peginterferon were significantly
worse than those on interferon in MCS of SF-12,
duration of FSI, and depression of HADS.
CONLUSIONS:
We suggest that the genetic type of
virus should be identified before the treatment is
given. This may let patients receive more
appropriate care and also let the health insurance
allocate the resource better.SF-12, duration of FSI, and depression of HADS. CONLUSIONS:
We
suggest that the genetic type of virus should be
identified before the treatment is given. This may
let patients receive more appropriate care and
also let the health insurance allocate the
resource better. |
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