A multinational decision analytic model was developed to examine the treatment of major depressive disorder (MDD) in 10 European and American countries. Input to the model was obtained from a meta-analysis of current clinical trial data obtained from the published literature, and local clinical and health economic experts in each market. The patient- and policy-level impact of MDD treatment was measured in each of the 10 markets. The total expected cost per patient for treating MDD with venlafaxine XR during the six-month acute phase of MDD was the lowest expected cost in nine of the 10 countries studied, resulting in savings to the primary payer in almost all markets. As well as the cost savings, the higher efficacy and lower rate of dropout found for venlafaxine XR translate to a greater number of symptom-free-days (SFDs) per patient. The results of this investigation show that use of venlafaxine XR in most settings across Europe and the Americas will have a favourable impact on healthcare payer budgets and the overall mental health of MDD patients.
Introduction Valbenazine and deutetrabenazine (vesicular monoamine transporter 2 inhibitors) are approved for tardive dyskinesia (TD) treatment in adults. To prevent potential drug-drug interactions (DDIs), valbenazine labeling recommends doses 40 mg/day when taking strong CYP3A4 or CYP2D6 inhibitors and avoidance of strong CYP3A4 inducers and monoamine oxidase inhibitors (MAOIs). Deutetrabenazine labeling recommends doses ≤36-mg/day when taking strong CYP2D6 inhibitors and avoidance of MAOIs. This study estimated proportions of patients with TD at risk of DDIs with valbenazine/deutetrabenazine in real-world practice. Methods Patients aged ≥18 years with TD and ≥1 antipsychotic claim(s) and no valbenazine/ deutetrabenazine claims ≥3 months prior and ≥12 months after diagnosis were identified in the Symphony Health Sciences database (US-based medical, hospital, and pharmacy claims database). Proportions of patients meeting valbenazine/deutetrabenazine concomitant medication labeling restrictions were summarized descriptively. Results 14,264/66,046 patients with TD met inclusion criteria. Proportions of patients at potential risk of DDIs were lower with deutetrabenazine ≤36 mg/day (0.2%) and >36 mg/day (21%) versus valbenazine 40 mg/day (4.4%; 22-times difference) and >40 mg/day (28%; 1.3-times difference). Across age groups, underlying conditions (major depressive, mood, and bipolar disorders; schizophrenia), and payer types, proportions of patients at potential risk of DDIs were lower with deutetrabenazine ≤36 mg/day (0.0%– 0.5%) and >36 mg/day (14%– 30%) versus valbenazine 40 mg/day (3%– 5%; 8.0- to >40.0times difference) and >40 mg/day (22%– 35%; 1.2- to >1.5-times difference). Conclusions Estimated proportions of patients with TD at potential risk of DDIs was lower with deutetrabenazine versus valbenazine overall and across age, underlying conditions, and payer types. Funding Teva Branded Pharmaceutical Products R&D, Inc.
An analysis of resource utilization and hospital costs associated with recurrent venous thromboembolism (VTE) is presented.A retrospective cohort analysis was conducted using a large U.S. hospital database. Patients with VTE-related hospitalization events during the period January-December 2010 were identified; data collection extended for up to 12 months after the index event. Postdischarge hospital resource use and total costs were compared in cohorts of patients with and without recurrent VTE. Regression analysis was performed to compare hospital costs and length of stay (LOS) during initial and subsequent VTE encounters.Among the study population of 43,734 patients, 4% had postdischarge VTE-related events during the data collection period. The median and mean ± S.D. times to VTE recurrence were 48 days and 98 ± 106 days, respectively. Patients with recurrent VTE had more all-cause hospitalizations than those without recurrent VTE (mean ± S.D., 1.07 ± 0.96 versus 0.15 ± 0.53; p < 0.0001), more all-cause emergency room visits (mean ± S.D., 0.31 ± 0.66 versus 0.05 ± 0.31; p < 0.0001), and greater total costs (mean ± S.D., $28,353 ± $39,624 versus $17,712 ± $33,461; p < 0.0001). Relative to initial VTE admissions, admissions for recurrent VTE were, on average, associated with a 14% longer LOS (p = 0.0002) and a 22% higher total cost (p < 0.001).Patients with recurrent VTE used more hospital resources than those without recurrent VTE. Readmissions for VTE were significantly longer and more costly than index encounters.
Several antifungal agents are indicated for onychomycosis, a fungal infection of the toenails and fingernails. These agents differ in their dosing regimen, efficacy, adverse events profile, potential for drug interaction, and cost. We conducted a pharmacoeconomic analysis of oral and topical therapies for onychomycosis from the perspective of a hypothetical managed care payer to determine the most cost-effective agent.A decision analytic model was developed to evaluate the pharmacoeconomic profiles of itraconazole-continuous (Sporanox, Janssen Pharmaceutica), itraconazole-pulse (Sporanox, Janssen Pharmaceutica), terbinafine (Lamisil, Novartis Pharmaceuticals), and ciclopirox (Penlac, Dermik Laboratories) in the treatment of fingernail and toenail onychomycosis.We conducted a meta-analysis of the available literature to populate the decision analytic model with clinical point estimates for success, failure, and relapse. A panel of expert dermatologists defined resources consumed during the onychomycosis treatment process. These resources were then assigned values, using publicly available data sources, to reflect the U.S. managed care perspective. These clinical and economic data elements were integrated in the decision analytic model to arrive at the expected cost of treatment for each drug. Additionally, incremental cost-effectiveness was calculated for treatment success and disease-free days achieved by each therapy. Finally, a policy-level analysis of the budgetary impact of using the therapies for onychomycosis in a managed care setting was conducted.The meta-analysis demonstrated terbinafine to be the therapeutic alternative with the highest success rate for both fingernails (96.55 percent) and toenails (81.15 percent). Terbinafine also had the lowest relapse rate (6.42 percent) and the highest number of disease-free days for both fingernails and toenails. Subsequently, in terms of cost-effectiveness, terbinafine dominated all other comparators for fingernails and toenails.Based on the patient-level analysis, we concluded that terbinafine is the most cost-effective therapy in the treatment of onychomycosis from a managed care perspective. Furthermore, at the policy level, increased utilization of terbinafine among onychomycosis patients is likely to reduce the managed care organizations' per member per month cost.
Background We recently reported a novel decision model that integrates both stroke and bleeding risk scores to guide optimal use of anticoagulation (AC) for stroke prevention in atrial fibrillation...
Background The use of anticoagulation (AC) in AF is challenging because stroke risk reduction and increased bleeding risk must be considered simultaneously. We developed a decision model (DA) integrating stroke and bleeding risks to guide optimal use of AC and compared actual warfarin utilization in a real-world database with model recommendations. Methods A Markov model simulated health state transitions for newly diagnosed AF patients (N=64,946; mean age=71, 45% females) from the Thomson Reuters Marketscan database. The model evaluated occurrence and disability associated with stroke, intracranial and extracranial hemorrhage, and mortality with warfarin or aspirin treatment. Probabilistic transitions were based on patient demographics, stroke and bleeding risk assessed by CHADS 2 (Gage 2001), and ATRIA index scores (Fang 2010), respectively, and AC treatment effects from published clinical trials and other sources. The model recommended warfarin if estimated quality adjusted life expectancy was higher than for aspirin. Model recommendations were contrasted with warfarin prescription claims in the Marketscan AF cohort. Results Overall, 74.8% (n=48,548) of the cohort had CHADS 2 ≥1, of which 85.7%, 4.6%, and 9.7% had low (0-3), moderate (4), and high (≥5) ATRIA bleeding risk, respectively. Almost all (91.9% of 48,548) patients with CHADS 2 ≥1 were recommended to receive warfarin. The AC decision was less certain in patients with moderate stroke and moderate/high bleeding risks. Concordance of warfarin recommendation (Rec. W) and utilization (Rx W) was low and decreased with higher bleeding risk. Stroke risk N Rec. W Rx W N Rec. W Rx W N Rec. W Rx W CHADS 2 ≥4 (high risk) 2,558 100% (n=2,558) 58.7% (n=1,501) 339 100% (n=339) 51.9% (n=176) 900 97.1% (n=874) 50.8% (n=444) CHADS 2 = 2 or 3 (moderate risk) 18,093 99.7% (n=18,043) 64.1% (n=11,574) 1,437 76.7% (n=1,102) 59.0% (n=650) 2,873 46.3% (n=1,330) 48.1% (n=640) CHADS 2 = 1 (low risk) 20,930 97.3% (n=20,365) 65.3% (n=13,304) 468 0% 0% 950 0% 0% ATRIA = 0 to 3 (low risk) ATRIA = 4 (moderate risk) ATRIA ≥5 (high risk) Bleeding risk Conclusions This analysis is distinctive in its use of explicit bleed risk (by ATRIA index) and comparison of DA with clinical care. High discordance between actual warfarin use and model recommendation suggests the AC decision is often not based on systematic evaluation of stroke and bleeding risks. Model-based clinical decision aids may improve oral AC decisions.
The objective of this analysis was to assess the cost-effectiveness of achieving 'tight control' versus 'less tight control' of blood pressure, as defined in the UK Prospective Diabetics Study 38, in type II diabetic patients in the UK and Italy. The effect of including doxazosin in a 'tight control' combination therapy was analysed. Given doxazosin's positive impact on lipid levels in addition to its antihypertensive effect, it is hypothesised that treatment including doxazosin will reduce the incidence of macrovascular complications. For each country, a Markov model was constructed to simulate macrovascular outcomes of patients on various drug combinations. Transitional probabilities were based on the risk rates presented in UKPDS 38. Risk rates were adjusted for the ageing of the cohort and the lipid-lowering properties of doxazosin using Framingham risk equations. Incremental cost-effectiveness ratios ranged from 2224 Pounds to 4867 Pounds (US$3225-7057) per life-year saved for the UK and from L1.8-9.3 million (US$818-4159) per life-year saved for Italy. Doxazosin is a cost-effective agent when included in a combination therapy in the treatment of hypertension in the diabetic populations of the UK and Italy.
