The severity of asthma varies between individuals and over time. As a result individuals may have... more The severity of asthma varies between individuals and over time. As a result individuals may have marked variation in their need for asthma treatment. Adjustable dosing enables patients to assume greater involvement in managing their own condition. To compare the costs and effectiveness of fixed dosing of budesonide/formoterol (Symbicort Turbohaler) with adjustable maintenance dosing. A cost-effectiveness analysis was conducted from the perspective of the UK NHS. Adults with established asthma currently maintained on > or =400 microg per day inhaled corticosteroid were enrolled in 365 primary care centres in the UK. Patients were run-in on 2 inhalations twice daily of budesonide/formoterol 80/4.5 microg or budesonide/formoterol 160/4.5 microg (depending on steroid requirement) for 4 weeks and were then randomised to the Symbicort adjustable maintenance dosing plan (SAMD) (n = 782; budesonide/formoterol 1-4 inhalations twice daily depending on symptoms) or Symbicort fixed dosing (n = 771; 2 inhalations twice daily) for a further 12 weeks. The primary effectiveness variable was clinically meaningful change in quality of life (QoL) assessed by the miniasthma quality of life questionnaire (AQLQ). Secondary effectiveness measures included symptom-free days with no short-acting beta-agonist use. We assessed the costs of study medication, asthma-related concomitant medication, primary care and hospital contacts. Confidence intervals were generated by nonparametric boot-strapping. Clinically meaningful improvement in QoL during the first 4 weeks was reported by 40.8% of enrolled patients. During the following 12 weeks, a net 1% (95% CI: -4%, 6%) of SAMD patients and 6% (95% CI: 1%, 10%) of fixed dosing patients reported further improvement. Effectiveness parameters did not differ significantly between groups during the study period. Mean daily cost per patient was pound sterling 1.13 (95% CI: pound sterling 1.08, pound sterling 1.18) in the SAMD group and pound sterling 1.31 (95% CI: pound sterling 1.27, pound sterling 1.34) in the fixed dosing. The difference in mean daily cost resulted in an annual per patient cost difference of pound sterling 65.70. Adjustable maintenance dosing with budesonide/formoterol provided equivalent QoL to fixed dosing at significantly lower cost.
To determine the cost of achieving pregnancy with different gonadotropin preparations. Cost-minim... more To determine the cost of achieving pregnancy with different gonadotropin preparations. Cost-minimization analysis of a prospective randomized clinical trial. Twenty-two centers in six countries. Women 18 to 36 years of age with infertility for more than 1 year who were undergoing IVF or ICSI. Highly purified hMG or recombinant FSH. Mean cost of achieving an ongoing pregnancy. The mean cost per patient treatment cycle was estimated to be pound 2423 with highly purified hMG (95% CI, pound 2356 to pound 2495) and pound 2745 with recombinant FSH (95% CI, pound 2658 to pound 2830). The ongoing pregnancy rate was 22% with highly purified hMG and 19% with recombinant FSH. The cost per ongoing pregnancy was pound 10781 with highly purified hMG (95% CI, pound 9056 to pound 12919) and pound 14284 with recombinant FSH (95% CI, pound 11883 to pound 17891). Highly purified hMG and recombinant FSH are equally effective, but highly purified hMG is less expensive per cycle. Using highly purified hMG instead of recombinant FSH would translate into a 13% increase in the number of cycles that could be offered.
The complications of diabetes have the potential to greatly impact the health-related quality of ... more The complications of diabetes have the potential to greatly impact the health-related quality of life (HRQOL) of patients with type 2 diabetes. The effect of diabetic complications on HRQOL was assessed in 1233 patients with type 2 diabetes who were not using insulin. Methods and data: Patients were aged 35 and older and had stable fasting serum glucose (FSG) after washout of antidiabetic therapy. Patients who required insulin or suffered from severe cardiovascular or hepatic disease, neuropathy, or retinopathy were excluded. Patients completed the SF-36 generic quality of life questionnaire. Demographic data, including body mass index (BMI), blood glucose hemoglobin A1c (HbA 1c ), FSG, and the presence and severity of eight specified diabetic complications were also collected. A linear regression analysis was performed for each of the SF-36 domains and for the physical and mental health summary scales.
Method: We used a previously described economic model created in the context of the UK National H... more Method: We used a previously described economic model created in the context of the UK National Health Service and applied it to St. Thomas’ Hospital, London. A clinical review to determine the number of medical admissions that would require thromboprophylaxis at St. Thomas’ Hospital, based on the inclusion criteria of a medical thromboprophylaxis trial (MEDENOX), was conducted. Costs and effectiveness were determined, based on the provision of thromboprophylaxis to 2000 medical patients. Results: Comparing treatment with low-molecular-weight heparin (enoxaparin, 40 mg once daily), unfractionated heparin (5000 IU twice daily), or no prophylaxis, the highest cost of thromboprophylaxis was associated with unfractionated heparin (£199,000=€306,000), compared with enoxaparin (£198,000=€305,000) or no prophylaxis (£176,000=€271,000). The model suggested that enoxaparin thromboprophylaxis would result in fewer thromboembolic-related events. Using sensitivity analysis, incorporating certain St. Thomas’-specific costs showed enoxaparin compared with unfractionated heparin or no thromboprophylaxis was cost saving. The cost savings of £65,000 (=€100,000) and £31,000 (=€48,000) respectively are based on maximum uptake of thromboprophylaxis. Conclusions: The graded implementation of enoxaparin thromboprophylaxis over a four-year period would require funding redistribution. The funding Health Authority would save overall but St. Thomas’ would require an increase in drug expenditure across the clinical directorates of £35,000 (= €54,000) after 4 years.
Aim: To estimate the costs and benefits for a UK hospital pharmacy of stocking a single low molec... more Aim: To estimate the costs and benefits for a UK hospital pharmacy of stocking a single low molecular weight heparin (LMWH), enoxaparin, compared to stocking unfractionated heparin (UFH) and stocking both UFH and multiple different LMWHs. Methods: A decision-tree model was developed which considered the use of heparins for five indications: prophylaxis against venous thromboembolism (VTE) in major orthopaedic surgery; VTE prophylaxis in major general surgery; VTE prophylaxis in acute medical inpatients; treatment of diagnosed VTE; and anticoagulation for patients with unstable angina and non-ST-elevation myocardial infarction (UA/NSTEMI). Previously published cost-effectiveness analyses for each indication were combined into a single model and updated to 2002 prices. The number of patients given heparin in each indication was estimated from the pharmacy records of a large UK teaching hospital. The model estimated the use of drugs, staff time, clinical events and resource use resulting from anti-coagulation. Costs were estimated from the perspective of the hospital and the UK National Health Service. Results: Total annual cost was estimated to be £3.2 m (single LMWH), £4.4 m (UFH only) and £3.7 m (multiple heparins). The largest expected cost savings from using a single LMWH compared to UFH only resulted from reduced hospital stay for DVT treatment, reduced revascularisation in UA/NSTEMI and fewer VTE events in orthopaedic surgery. Expected cost savings from using a single LMWH compared to multiple heparins were more modest. Conclusion: Sub-optimal choice of anticoagulants may result in substantial excess costs elsewhere in the hospital.
e u r o p e a n u r o l o g y 5 0 ( 2 0 0 6 ) 1 0 5 0 -1 0 5 7 a v a i l a b l e a t w w w . s c ... more e u r o p e a n u r o l o g y 5 0 ( 2 0 0 6 ) 1 0 5 0 -1 0 5 7 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Objective: To estimate and compare the current and future direct cost of overactive bladder (OAB) to the health care systems of five European countries. Method: A health economic model was created to estimate the number of people currently affected by OAB symptoms, the expected number to be affected in the future, and the resultant economic burden on health care systems in Germany, Italy, Spain, Sweden, and the United Kingdom. Results: The model estimated that in 2000, 20.2 million people over age 40 in the five countries experienced the symptoms of OAB; 7 million of these had urgency with urge incontinence. This figure is expected to rise to 25.5 million by 2020, including 9 million who will have urgency with urge incontinence. Average annual direct costs of OAB management ranged from s269 to s706 per patient per year. The largest cost was the use of incontinence pads, accounting for an average of 63% of the annual per patient cost of OAB management. Total cost to health care systems across all five countries was estimated at s4.2 billion in 2000, and by 2020, the expected total cost was estimated to be s5.2 billion, an increase of s1 billion (26%). Conclusion: OAB is prevalent, with a substantial direct cost that is anticipated to increase in the future in line with aging populations. The overall burden, including indirect costs, may be considerably larger, and will fall predominantly on the elderly OAB population with urge incontinence. Recommended medical treatments could help manage those costs and should be evaluated.
To estimate the burden of failing to achieve targets for blood pressure (BP) control in France, G... more To estimate the burden of failing to achieve targets for blood pressure (BP) control in France, Germany, Italy, Sweden and the UK. A cost of illness model was constructed to estimate the impact of uncontrolled hypertension to each national healthcare system. Prevalence of uncontrolled hypertension was taken from published data. Relationships between achieved BP and the cardiovascular events of symptomatic acute myocardial infarction, congestive heart failure and stroke were estimated from the HOT study. Costs were taken from public sources. The acute medical costs of these events were estimated at current prevalence of uncontrolled hypertension and if BP were treated to target. The model estimated that 29 million adults in the five countries (13% population) have BP levels above 160/95 mmHg, and an additional 46 million (21% population) have BP in the range 140/90-160/95 mmHg. The model estimated that healthcare system costs of 1.26 billion euros could be avoided if hypertension management did achieve BP targets. This does not consider the cost of interventions required to reduce the risk of cardiovascular disease. Failing to achieve BP targets contributes substantially to healthcare system costs and preventable events in the countries studies.
Baclofen and tizanidine are both used for the treatment of muscle spasticity of spinal origin. Th... more Baclofen and tizanidine are both used for the treatment of muscle spasticity of spinal origin. Their effectiveness, cost and adverse-effect profiles differ. This paper sets out to estimate the cost effectiveness of each drug, and the impact of changing from baclofen to tizanidine. A simplified but realistic model of physician behaviour and patient response was developed as a decision tree and populated with data derived from the available published clinical comparative trials. We considered patients with spasticity caused by multiple sclerosis or spinal cord injury. The outcome measure used was 'cost per successfully treated day' (STD). Costs were estimated from the perspective of the UK National Health Service at 2000 values. Expected cost for a cohort of 100 patients over 1 year was estimated to be pound 181 545 with baclofen and pound 211 930 with tizanidine. The estimated number of STDs was 20,192 with tizanidine and 17,289 with baclofen. The overall cost effectiveness of managing spasticity using baclofen and tizanidine was very similar ( pound 10.50 and pound 10.49 per STD respectively). The incremental cost effectiveness (ICE) of using tinzanidine as an alternative to baclofen for first-line treatment was pound 10.47 per STD. Sensitivity analysis found the model to be robust to changes in key parameters Drug cost should not be a determining factor in making this treatment choice, as the cost effectiveness ratios are similar for both products.
Journal of The American Academy of Dermatology, 2004
A new two-compound formulation containing calcipotriene 50 g/g and betamethasone dipropionate 0.5... more A new two-compound formulation containing calcipotriene 50 g/g and betamethasone dipropionate 0.5 mg/g is licensed for once daily treatment of psoriasis. Four international, multicentre, prospective, randomised, double-blind trials have been conducted within which 1534 patients have received this combination ointment once daily for 4 weeks. This pooled analysis was conducted to compare the average percentage change in PASI from baseline to end of up to 4 weeks treatment for patients with extensive (Ͼ20% coverage at baseline) psoriasis and less extensive psoriasis (Յ20% coverage) Furthermore, the same comparison was made for PASI50, PASI75 and for PASI90 for the two groups. 294 patients with extensive psoriasis had a mean percentage change in PASI of -70.4% after 4 weeks treatment compared to Ϫ68.6% in the group of 1240 patients with less extensive psoriasis. The results for PASI50, PASI75 and PASI90 were consistent with the mean percentage change in PASI. The percentage of patients with at least 50% reduction in PASI at the end of 4 weeks treatment was similar for patients with extensive disease at baseline (84.7%) compared to patients with less extensive disease (80.6%). The percentage of patients with at least 75% reduction in PASI at the end of 4 weeks treatment was similar for patients with extensive disease (50.3%) compared to patients with less extensive disease(50.2%). The percentage of patients with at least 90% reduction in PASI at the end of 4 weeks was 22.1% in the group with extensive disease and similar to the group of patients with less extensive disease at 19.4%. In conclusion, a new two-compound topical formulation of calciprotriene 50g/g and betamethasone dipropionate 0.5 mg/g used once daily has similar efficacy for patients with extensive psoriasis (Ͼ20%) at baseline compared to patients with less extensive psoriasis at baseline.
To evaluate the cost-effectiveness and budget impact of a new heat wrap therapy for low back pain... more To evaluate the cost-effectiveness and budget impact of a new heat wrap therapy for low back pain compared to paracetamol and ibuprofen from the perspective of the UK National Health Service (NHS). Methods: We evaluated cost-effectiveness using data from a phase III trial comparing the three therapies in 371 patients aged 18 to 55 years presenting with acute uncomplicated low back pain. The primary effectiveness measure used was successful treatment, defined as both clinically meaningful pain relief and clinically meaningful reduction in disability. We conducted a simple evaluation using NHS prescription costs and a modeled extrapolation including the costs of further treatment and consultations for patients treated unsuccessfully or with adverse events. Uncertainty was addressed using nonparametric bootstrapping and sensitivity analyses. Results: Successful treatment was reported by 57% of patients treated with heat wrap therapy, 26% treated with paracetamol and 18% treated with ibuprofen (P < 0.05 for heat wrap vs. both other groups). NHS prescription cost per patient was estimated to be £1.35 for heat wrap therapy, £0.26 for paracetamol, and £0.28 for ibuprofen and cost per successful treatment was £3.52 for heat wrap therapy compared to paracetamol, and £2.72 compared to ibuprofen. In the modeled extrapolation, NHS cost per patient was £27.77 for heat wrap therapy, £34.20 for paracetamol, and £36.04 for ibuprofen. Sensitivity analyses indicated that the findings were robust to plausible changes in data and assumptions. Conclusions: Economic evaluation of this study suggests that the NHS cost of introducing heat wrap therapy in place of oral analgesics would be modest and heat wrap therapy might potentially reduce the total cost of managing episodes of lower back pain.
In Germany, the seven-valent conjugate vaccine Prevenar is recommended for use in children at hig... more In Germany, the seven-valent conjugate vaccine Prevenar is recommended for use in children at high risk of pneumococcal disease. Recent data suggest that giving conjugate vaccine to all children may lead to a decline in pneumococcal disease in unvaccinated adults, a phenomenon known as herd immunity. This analysis evaluated the cost and economic consequences in Germany of vaccinating (1) children at high risk, (2) all children when considering only benefits for vaccinated individuals and (3) all children when also considering herd immunity benefits. Costs in the model included vaccination, management of meningitis, bacteraemia, pneumonia and acute otitis media, insurance payments to parents and the costs of care for long-term disabilities. The model estimated that the cost-effectiveness of vaccination would be 38,222 euros per life year gained in children at high risk and 100,636 euros per life year gained in all children when not considering herd immunity. When considering herd immunity effects, the model estimated that offering vaccination for all children would reduce adult deaths by 3,027 per year, and vaccination would be broadly cost neutral. The findings are sensitive to the effect of conjugate vaccine on the rates of pneumonia and invasive disease in the elderly. If the herd immunity effect of conjugate vaccination in Germany is similar to that observed elsewhere, offering vaccine to all children will be more attractive than the current policy of restricting vaccination to children at high risk of pneumococcal disease.
The severity of asthma varies between individuals and over time. As a result individuals may have... more The severity of asthma varies between individuals and over time. As a result individuals may have marked variation in their need for asthma treatment. Adjustable dosing enables patients to assume greater involvement in managing their own condition. To compare the costs and effectiveness of fixed dosing of budesonide/formoterol (Symbicort Turbohaler) with adjustable maintenance dosing. A cost-effectiveness analysis was conducted from the perspective of the UK NHS. Adults with established asthma currently maintained on &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or =400 microg per day inhaled corticosteroid were enrolled in 365 primary care centres in the UK. Patients were run-in on 2 inhalations twice daily of budesonide/formoterol 80/4.5 microg or budesonide/formoterol 160/4.5 microg (depending on steroid requirement) for 4 weeks and were then randomised to the Symbicort adjustable maintenance dosing plan (SAMD) (n = 782; budesonide/formoterol 1-4 inhalations twice daily depending on symptoms) or Symbicort fixed dosing (n = 771; 2 inhalations twice daily) for a further 12 weeks. The primary effectiveness variable was clinically meaningful change in quality of life (QoL) assessed by the miniasthma quality of life questionnaire (AQLQ). Secondary effectiveness measures included symptom-free days with no short-acting beta-agonist use. We assessed the costs of study medication, asthma-related concomitant medication, primary care and hospital contacts. Confidence intervals were generated by nonparametric boot-strapping. Clinically meaningful improvement in QoL during the first 4 weeks was reported by 40.8% of enrolled patients. During the following 12 weeks, a net 1% (95% CI: -4%, 6%) of SAMD patients and 6% (95% CI: 1%, 10%) of fixed dosing patients reported further improvement. Effectiveness parameters did not differ significantly between groups during the study period. Mean daily cost per patient was pound sterling 1.13 (95% CI: pound sterling 1.08, pound sterling 1.18) in the SAMD group and pound sterling 1.31 (95% CI: pound sterling 1.27, pound sterling 1.34) in the fixed dosing. The difference in mean daily cost resulted in an annual per patient cost difference of pound sterling 65.70. Adjustable maintenance dosing with budesonide/formoterol provided equivalent QoL to fixed dosing at significantly lower cost.
To determine the cost of achieving pregnancy with different gonadotropin preparations. Cost-minim... more To determine the cost of achieving pregnancy with different gonadotropin preparations. Cost-minimization analysis of a prospective randomized clinical trial. Twenty-two centers in six countries. Women 18 to 36 years of age with infertility for more than 1 year who were undergoing IVF or ICSI. Highly purified hMG or recombinant FSH. Mean cost of achieving an ongoing pregnancy. The mean cost per patient treatment cycle was estimated to be pound 2423 with highly purified hMG (95% CI, pound 2356 to pound 2495) and pound 2745 with recombinant FSH (95% CI, pound 2658 to pound 2830). The ongoing pregnancy rate was 22% with highly purified hMG and 19% with recombinant FSH. The cost per ongoing pregnancy was pound 10781 with highly purified hMG (95% CI, pound 9056 to pound 12919) and pound 14284 with recombinant FSH (95% CI, pound 11883 to pound 17891). Highly purified hMG and recombinant FSH are equally effective, but highly purified hMG is less expensive per cycle. Using highly purified hMG instead of recombinant FSH would translate into a 13% increase in the number of cycles that could be offered.
The complications of diabetes have the potential to greatly impact the health-related quality of ... more The complications of diabetes have the potential to greatly impact the health-related quality of life (HRQOL) of patients with type 2 diabetes. The effect of diabetic complications on HRQOL was assessed in 1233 patients with type 2 diabetes who were not using insulin. Methods and data: Patients were aged 35 and older and had stable fasting serum glucose (FSG) after washout of antidiabetic therapy. Patients who required insulin or suffered from severe cardiovascular or hepatic disease, neuropathy, or retinopathy were excluded. Patients completed the SF-36 generic quality of life questionnaire. Demographic data, including body mass index (BMI), blood glucose hemoglobin A1c (HbA 1c ), FSG, and the presence and severity of eight specified diabetic complications were also collected. A linear regression analysis was performed for each of the SF-36 domains and for the physical and mental health summary scales.
Method: We used a previously described economic model created in the context of the UK National H... more Method: We used a previously described economic model created in the context of the UK National Health Service and applied it to St. Thomas’ Hospital, London. A clinical review to determine the number of medical admissions that would require thromboprophylaxis at St. Thomas’ Hospital, based on the inclusion criteria of a medical thromboprophylaxis trial (MEDENOX), was conducted. Costs and effectiveness were determined, based on the provision of thromboprophylaxis to 2000 medical patients. Results: Comparing treatment with low-molecular-weight heparin (enoxaparin, 40 mg once daily), unfractionated heparin (5000 IU twice daily), or no prophylaxis, the highest cost of thromboprophylaxis was associated with unfractionated heparin (£199,000=€306,000), compared with enoxaparin (£198,000=€305,000) or no prophylaxis (£176,000=€271,000). The model suggested that enoxaparin thromboprophylaxis would result in fewer thromboembolic-related events. Using sensitivity analysis, incorporating certain St. Thomas’-specific costs showed enoxaparin compared with unfractionated heparin or no thromboprophylaxis was cost saving. The cost savings of £65,000 (=€100,000) and £31,000 (=€48,000) respectively are based on maximum uptake of thromboprophylaxis. Conclusions: The graded implementation of enoxaparin thromboprophylaxis over a four-year period would require funding redistribution. The funding Health Authority would save overall but St. Thomas’ would require an increase in drug expenditure across the clinical directorates of £35,000 (= €54,000) after 4 years.
Aim: To estimate the costs and benefits for a UK hospital pharmacy of stocking a single low molec... more Aim: To estimate the costs and benefits for a UK hospital pharmacy of stocking a single low molecular weight heparin (LMWH), enoxaparin, compared to stocking unfractionated heparin (UFH) and stocking both UFH and multiple different LMWHs. Methods: A decision-tree model was developed which considered the use of heparins for five indications: prophylaxis against venous thromboembolism (VTE) in major orthopaedic surgery; VTE prophylaxis in major general surgery; VTE prophylaxis in acute medical inpatients; treatment of diagnosed VTE; and anticoagulation for patients with unstable angina and non-ST-elevation myocardial infarction (UA/NSTEMI). Previously published cost-effectiveness analyses for each indication were combined into a single model and updated to 2002 prices. The number of patients given heparin in each indication was estimated from the pharmacy records of a large UK teaching hospital. The model estimated the use of drugs, staff time, clinical events and resource use resulting from anti-coagulation. Costs were estimated from the perspective of the hospital and the UK National Health Service. Results: Total annual cost was estimated to be £3.2 m (single LMWH), £4.4 m (UFH only) and £3.7 m (multiple heparins). The largest expected cost savings from using a single LMWH compared to UFH only resulted from reduced hospital stay for DVT treatment, reduced revascularisation in UA/NSTEMI and fewer VTE events in orthopaedic surgery. Expected cost savings from using a single LMWH compared to multiple heparins were more modest. Conclusion: Sub-optimal choice of anticoagulants may result in substantial excess costs elsewhere in the hospital.
e u r o p e a n u r o l o g y 5 0 ( 2 0 0 6 ) 1 0 5 0 -1 0 5 7 a v a i l a b l e a t w w w . s c ... more e u r o p e a n u r o l o g y 5 0 ( 2 0 0 6 ) 1 0 5 0 -1 0 5 7 a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Objective: To estimate and compare the current and future direct cost of overactive bladder (OAB) to the health care systems of five European countries. Method: A health economic model was created to estimate the number of people currently affected by OAB symptoms, the expected number to be affected in the future, and the resultant economic burden on health care systems in Germany, Italy, Spain, Sweden, and the United Kingdom. Results: The model estimated that in 2000, 20.2 million people over age 40 in the five countries experienced the symptoms of OAB; 7 million of these had urgency with urge incontinence. This figure is expected to rise to 25.5 million by 2020, including 9 million who will have urgency with urge incontinence. Average annual direct costs of OAB management ranged from s269 to s706 per patient per year. The largest cost was the use of incontinence pads, accounting for an average of 63% of the annual per patient cost of OAB management. Total cost to health care systems across all five countries was estimated at s4.2 billion in 2000, and by 2020, the expected total cost was estimated to be s5.2 billion, an increase of s1 billion (26%). Conclusion: OAB is prevalent, with a substantial direct cost that is anticipated to increase in the future in line with aging populations. The overall burden, including indirect costs, may be considerably larger, and will fall predominantly on the elderly OAB population with urge incontinence. Recommended medical treatments could help manage those costs and should be evaluated.
To estimate the burden of failing to achieve targets for blood pressure (BP) control in France, G... more To estimate the burden of failing to achieve targets for blood pressure (BP) control in France, Germany, Italy, Sweden and the UK. A cost of illness model was constructed to estimate the impact of uncontrolled hypertension to each national healthcare system. Prevalence of uncontrolled hypertension was taken from published data. Relationships between achieved BP and the cardiovascular events of symptomatic acute myocardial infarction, congestive heart failure and stroke were estimated from the HOT study. Costs were taken from public sources. The acute medical costs of these events were estimated at current prevalence of uncontrolled hypertension and if BP were treated to target. The model estimated that 29 million adults in the five countries (13% population) have BP levels above 160/95 mmHg, and an additional 46 million (21% population) have BP in the range 140/90-160/95 mmHg. The model estimated that healthcare system costs of 1.26 billion euros could be avoided if hypertension management did achieve BP targets. This does not consider the cost of interventions required to reduce the risk of cardiovascular disease. Failing to achieve BP targets contributes substantially to healthcare system costs and preventable events in the countries studies.
Baclofen and tizanidine are both used for the treatment of muscle spasticity of spinal origin. Th... more Baclofen and tizanidine are both used for the treatment of muscle spasticity of spinal origin. Their effectiveness, cost and adverse-effect profiles differ. This paper sets out to estimate the cost effectiveness of each drug, and the impact of changing from baclofen to tizanidine. A simplified but realistic model of physician behaviour and patient response was developed as a decision tree and populated with data derived from the available published clinical comparative trials. We considered patients with spasticity caused by multiple sclerosis or spinal cord injury. The outcome measure used was &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;cost per successfully treated day&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (STD). Costs were estimated from the perspective of the UK National Health Service at 2000 values. Expected cost for a cohort of 100 patients over 1 year was estimated to be pound 181 545 with baclofen and pound 211 930 with tizanidine. The estimated number of STDs was 20,192 with tizanidine and 17,289 with baclofen. The overall cost effectiveness of managing spasticity using baclofen and tizanidine was very similar ( pound 10.50 and pound 10.49 per STD respectively). The incremental cost effectiveness (ICE) of using tinzanidine as an alternative to baclofen for first-line treatment was pound 10.47 per STD. Sensitivity analysis found the model to be robust to changes in key parameters Drug cost should not be a determining factor in making this treatment choice, as the cost effectiveness ratios are similar for both products.
Journal of The American Academy of Dermatology, 2004
A new two-compound formulation containing calcipotriene 50 g/g and betamethasone dipropionate 0.5... more A new two-compound formulation containing calcipotriene 50 g/g and betamethasone dipropionate 0.5 mg/g is licensed for once daily treatment of psoriasis. Four international, multicentre, prospective, randomised, double-blind trials have been conducted within which 1534 patients have received this combination ointment once daily for 4 weeks. This pooled analysis was conducted to compare the average percentage change in PASI from baseline to end of up to 4 weeks treatment for patients with extensive (Ͼ20% coverage at baseline) psoriasis and less extensive psoriasis (Յ20% coverage) Furthermore, the same comparison was made for PASI50, PASI75 and for PASI90 for the two groups. 294 patients with extensive psoriasis had a mean percentage change in PASI of -70.4% after 4 weeks treatment compared to Ϫ68.6% in the group of 1240 patients with less extensive psoriasis. The results for PASI50, PASI75 and PASI90 were consistent with the mean percentage change in PASI. The percentage of patients with at least 50% reduction in PASI at the end of 4 weeks treatment was similar for patients with extensive disease at baseline (84.7%) compared to patients with less extensive disease (80.6%). The percentage of patients with at least 75% reduction in PASI at the end of 4 weeks treatment was similar for patients with extensive disease (50.3%) compared to patients with less extensive disease(50.2%). The percentage of patients with at least 90% reduction in PASI at the end of 4 weeks was 22.1% in the group with extensive disease and similar to the group of patients with less extensive disease at 19.4%. In conclusion, a new two-compound topical formulation of calciprotriene 50g/g and betamethasone dipropionate 0.5 mg/g used once daily has similar efficacy for patients with extensive psoriasis (Ͼ20%) at baseline compared to patients with less extensive psoriasis at baseline.
To evaluate the cost-effectiveness and budget impact of a new heat wrap therapy for low back pain... more To evaluate the cost-effectiveness and budget impact of a new heat wrap therapy for low back pain compared to paracetamol and ibuprofen from the perspective of the UK National Health Service (NHS). Methods: We evaluated cost-effectiveness using data from a phase III trial comparing the three therapies in 371 patients aged 18 to 55 years presenting with acute uncomplicated low back pain. The primary effectiveness measure used was successful treatment, defined as both clinically meaningful pain relief and clinically meaningful reduction in disability. We conducted a simple evaluation using NHS prescription costs and a modeled extrapolation including the costs of further treatment and consultations for patients treated unsuccessfully or with adverse events. Uncertainty was addressed using nonparametric bootstrapping and sensitivity analyses. Results: Successful treatment was reported by 57% of patients treated with heat wrap therapy, 26% treated with paracetamol and 18% treated with ibuprofen (P < 0.05 for heat wrap vs. both other groups). NHS prescription cost per patient was estimated to be £1.35 for heat wrap therapy, £0.26 for paracetamol, and £0.28 for ibuprofen and cost per successful treatment was £3.52 for heat wrap therapy compared to paracetamol, and £2.72 compared to ibuprofen. In the modeled extrapolation, NHS cost per patient was £27.77 for heat wrap therapy, £34.20 for paracetamol, and £36.04 for ibuprofen. Sensitivity analyses indicated that the findings were robust to plausible changes in data and assumptions. Conclusions: Economic evaluation of this study suggests that the NHS cost of introducing heat wrap therapy in place of oral analgesics would be modest and heat wrap therapy might potentially reduce the total cost of managing episodes of lower back pain.
In Germany, the seven-valent conjugate vaccine Prevenar is recommended for use in children at hig... more In Germany, the seven-valent conjugate vaccine Prevenar is recommended for use in children at high risk of pneumococcal disease. Recent data suggest that giving conjugate vaccine to all children may lead to a decline in pneumococcal disease in unvaccinated adults, a phenomenon known as herd immunity. This analysis evaluated the cost and economic consequences in Germany of vaccinating (1) children at high risk, (2) all children when considering only benefits for vaccinated individuals and (3) all children when also considering herd immunity benefits. Costs in the model included vaccination, management of meningitis, bacteraemia, pneumonia and acute otitis media, insurance payments to parents and the costs of care for long-term disabilities. The model estimated that the cost-effectiveness of vaccination would be 38,222 euros per life year gained in children at high risk and 100,636 euros per life year gained in all children when not considering herd immunity. When considering herd immunity effects, the model estimated that offering vaccination for all children would reduce adult deaths by 3,027 per year, and vaccination would be broadly cost neutral. The findings are sensitive to the effect of conjugate vaccine on the rates of pneumonia and invasive disease in the elderly. If the herd immunity effect of conjugate vaccination in Germany is similar to that observed elsewhere, offering vaccine to all children will be more attractive than the current policy of restricting vaccination to children at high risk of pneumococcal disease.
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Papers by Adam Lloyd