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Access to new cardiovascular therapies in Canadian hospitals: a national survey of the formulary process.

https://arctichealth.org/en/permalink/ahliterature186545
Source
Can J Cardiol. 2003 Feb;19(2):173-9
Publication Type
Article
Date
Feb-2003
Author
Stephen J Shalansky
Roohina Virk
Margaret Ackman
Cynthia Jackevicius
Heather Kertland
Ross Tsuyuki
Karin Humphries
Author Affiliation
Pharmacy Department, St. Paul's Hospital, Vancouver, British Columbia. shalansk@interchange.ubc.ca
Source
Can J Cardiol. 2003 Feb;19(2):173-9
Date
Feb-2003
Language
English
Publication Type
Article
Keywords
Antibodies, Monoclonal - economics - therapeutic use
Canada
Cardiovascular Agents - economics - therapeutic use
Dalteparin - economics - therapeutic use
Data Collection
Drug Utilization
Enoxaparin - economics - therapeutic use
Formularies, Hospital - standards
Health Services Accessibility - economics - organization & administration
Hematologic Agents - economics - therapeutic use
Humans
Immunoglobulin Fab Fragments - economics - therapeutic use
Peptides - economics - therapeutic use
Pharmacy and Therapeutics Committee - economics - organization & administration - standards
Ticlopidine - analogs & derivatives - economics - therapeutic use
Tyrosine - analogs & derivatives - economics - therapeutic use
Abstract
Access to new therapies in hospitals depends upon both clinical trial evidence and local Pharmacy and Therapeutics (P&T) committee approval. The process of formulary evaluation by P&T committees is not well-understood.
To describe the formulary decision-making process in Canadian hospitals for cardiovascular medications recently made available on the Canadian market.
Postal survey of hospital pharmacy directors in all Canadian hospitals with more than 50 beds. Target drugs included abciximab, enoxaparin, dalteparin, clopidogrel, eptifibatide and tirofiban.
Of 428 surveys mailed, responses were received from 164 P&T committees representing 350 hospitals for an effective response rate of 82%. While physicians make up the largest proportion of committee membership, pharmacists play an influential role. Information most commonly cited as influencing formulary decisions included published clinical trials (97%), regional guidelines (90%), pharmacoeconomic data (84%), decisions at peer hospitals (73%) and local opinion leaders (60%). However, this information was often not required on formulary applications. Approval timelines varied widely for target medications but there were no regional, hospital or P&T committee characteristics that were independent predictors of early formulary application or approval.
There is wide variability in the time taken for Canadian institutions to adopt new cardiovascular therapies, which is not explained by regional, hospital or P&T committee characteristics. Standardization of the formulary application and evaluation processes, including sharing of information amongst institutions, would lead to broader understanding of the applicable issues, more objectivity and improved efficiency.
PubMed ID
12601443 View in PubMed
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Budget impact analysis of secukinumab versus adalimumab in the treatment of ankylosing spondylitis.

https://arctichealth.org/en/permalink/ahliterature300316
Source
J Med Econ. 2019 Feb; 22(2):151-157
Publication Type
Journal Article
Date
Feb-2019
Author
Timo Purmonen
Soili Törmälehto
Hanna Wahlman
Kari Puolakka
Author Affiliation
a Novartis Finland Oy , Espoo , Finland.
Source
J Med Econ. 2019 Feb; 22(2):151-157
Date
Feb-2019
Language
English
Publication Type
Journal Article
Keywords
Adalimumab - economics - therapeutic use
Antibodies, Monoclonal - economics - therapeutic use
Antirheumatic Agents - economics - therapeutic use
Budgets
Cost-Benefit Analysis
Finland
Health Expenditures
Humans
Interleukin-17 - antagonists & inhibitors
Models, Econometric
Severity of Illness Index
Spondylitis, Ankylosing - drug therapy
Tumor Necrosis Factor-alpha - antagonists & inhibitors
Abstract
Biologic treatments have enhanced the treatment outcomes of patients with active ankylosing spondylitis (AS). Until recently, TNF-alpha-inhibitors have been the only biologics approved for the treatment of active AS. The objective of this study was to assess the potential financial impact of the first non-TNF-alpha biologic secukinumab (fully human IL-17A-inhibitor) vs adalimumab (TNF-alpha-inhibitor) in the treatment of AS in Finland.
In this model-based budget impact analysis, patients were treated either with secukinumab (150?mg) or adalimumab (40?mg). The number of patients and market share of different biologics were based on national reimbursement registry data. Adalimumab was the most commonly used biologic treatment for AS, and in the base case analysis all adalimumab patients are assumed to switch to secukinumab. Response rates were based on a matching-adjusted indirect comparison between secukinumab and adalimumab. Patients not achieving response were switched to another biologic treatment.
Treating AS patients with secukinumab instead of adalimumab leads to potential savings of 18.2 million euros within a 5-year time period. The total costs within the follow-up time were 59.5 million euros and 77.7 million euros with and without secukinumab, respectively. According to sensitivity analyses, a higher adoption rate of secukinumab corresponds to higher potential savings.
Secukinumab is a cost-saving treatment option compared with adalimumab in the treatment of AS in Finland. More patients could be treated with a biologic by allocating resources more efficiently.
PubMed ID
30474450 View in PubMed
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Budget impact analysis of trastuzumab in early breast cancer: a hospital district perspective.

https://arctichealth.org/en/permalink/ahliterature144209
Source
Int J Technol Assess Health Care. 2010 Apr;26(2):163-9
Publication Type
Article
Date
Apr-2010
Author
Timo T Purmonen
Päivi K Auvinen
Janne A Martikainen
Author Affiliation
Department of Social Pharmacy, Center for Pharmaceutical Policy and Economics, University of Kuopio, Kuopio, Finland. timo.purmonen@uef.fi
Source
Int J Technol Assess Health Care. 2010 Apr;26(2):163-9
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Antibodies, Monoclonal - economics - therapeutic use
Antibodies, Monoclonal, Humanized
Antineoplastic Agents - economics - therapeutic use
Breast Neoplasms - drug therapy
Budgets
Computer simulation
Costs and Cost Analysis - methods
Economics, Medical
Female
Finland
Hospitals, District - economics
Humans
Abstract
Adjuvant trastuzumab is widely used in HER2-positive (HER2+) early breast cancer, and despite its cost-effectiveness, it causes substantial costs for health care. The purpose of the study was to develop a tool for estimating the budget impact of new cancer treatments. With this tool, we were able to estimate the budget impact of adjuvant trastuzumab, as well as the probability of staying within a given budget constraint.
The created model-based evaluation tool was used to explore the budget impact of trastuzumab in early breast cancer in a single Finnish hospital district with 250,000 inhabitants. The used model took into account the number of patients, HER2+ prevalence, length and cost of treatment, and the effectiveness of the therapy. Probabilistic sensitivity analysis and alternative case scenarios were performed to ensure the robustness of the results.
Introduction of adjuvant trastuzumab caused substantial costs for a relatively small hospital district. In base-case analysis the 4-year net budget impact was 1.3 million euro. The trastuzumab acquisition costs were partially offset by the reduction in costs associated with the treatment of cancer recurrence and metastatic disease.
Budget impact analyses provide important information about the overall economic impact of new treatments, and thus offer complementary information to cost-effectiveness analyses. Inclusion of treatment outcomes and probabilistic sensitivity analysis provides more realistic estimates of the net budget impact. The length of trastuzumab treatment has a strong effect on the budget impact.
PubMed ID
20392319 View in PubMed
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The burden of rheumatoid arthritis and access to treatment: uptake of new therapies.

https://arctichealth.org/en/permalink/ahliterature86974
Source
Eur J Health Econ. 2008 Jan;8 Suppl 2:S61-86
Publication Type
Article
Date
Jan-2008
Author
Jönsson B.
Kobelt G.
Smolen J.
Author Affiliation
Department of Economics, Stockholm School of Economics, Stockholm, Sweden. hebj@hhs.se
Source
Eur J Health Econ. 2008 Jan;8 Suppl 2:S61-86
Date
Jan-2008
Language
English
Publication Type
Article
Keywords
Antibodies, Monoclonal - economics - therapeutic use
Antirheumatic Agents - economics - therapeutic use
Arthritis, Rheumatoid - drug therapy - economics
Cost of Illness
Cost-Benefit Analysis
Drug Costs
Health Care Costs
Health Expenditures
Health Services Accessibility - economics
Humans
Immunoglobulin G - economics - therapeutic use
Income
Internationality
Receptors, Tumor Necrosis Factor - therapeutic use
Tumor Necrosis Factor-alpha - antagonists & inhibitors
World Health
Abstract
This paper presents data on international differences in use of TNF inhibitors. It is part of a study on burden and cost of RA, access to new therapies and the role of HTA in determining access and cost-effectiveness. United States has the fastest most extensive use of the new drugs, about three times the average in the western European countries and Canada. Eastern and central European countries as well as Australia, South Africa and Turkey lag far behind. However, some smaller European countries, most notably Norway and Sweden have use of the new drugs not far behind the United States. While the income level of the country, and thus the health care expenditures per capita is a major factor for determining use in low and middle income countries, there are still considerable differences among countries with similar high total health care expenditures. Differences in prices are considerable between the US and Europe due to the changes in exchange rates between the US dollar and the Euro, but high and low use is not systematically related to differences in price.
PubMed ID
18097697 View in PubMed
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Canadian cost-utility analysis of initiation and maintenance treatment with anti-TNF-a drugs for refractory Crohn's disease.

https://arctichealth.org/en/permalink/ahliterature127813
Source
J Crohns Colitis. 2012 Feb;6(1):77-85
Publication Type
Article
Date
Feb-2012
Author
Gord Blackhouse
Nazila Assasi
Feng Xie
John Marshall
E Jan Irvine
Kathryn Gaebel
Kaitryn Campbell
Rob Hopkins
Daria O'Reilly
Jean-Eric Tarride
Ron Goeree
Author Affiliation
Programs for Assessment of Technology in Health Research Institute, McMaster University, Hamilton, ON, Canada. blackhou@mcmaster.ca
Source
J Crohns Colitis. 2012 Feb;6(1):77-85
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Anti-Inflammatory Agents - economics - therapeutic use
Antibodies, Monoclonal - economics - therapeutic use
Antibodies, Monoclonal, Humanized - economics - therapeutic use
Canada
Cost-Benefit Analysis
Crohn Disease - drug therapy - economics
Health Care Costs
Humans
Markov Chains
Quality-Adjusted Life Years
Abstract
Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. Symptoms include but are not limited to abdominal pain, nausea, emesis, and diarrhea. Anti-TNF-a drugs are increasingly being used in patients with CD who have inadequate response to conventional therapy. However, these medications are quite expensive. The objective of this study is to evaluate the cost-utility of two anti-TNF-a drugs (infliximab, adalimumab) for refractory CD.
A Markov model was used to estimate the costs and QALYs of three treatments (usual care, infliximab, adalimumab) over a 5 year time horizon. After initial treatment, patients achieve remission, achieve treatment response or remain in the drug refractory health state. Patients who achieve remission or treatment response are at risk of relapse each 3 month model cycle. Patients in the drug refractory health state either remain in the health state or have surgery in each cycle. Different costs and utility values were assigned to the various model health states. Model input parameters including initial response rates, relapse rates, utility values were derived from published literature.
Usual care had both the lowest expected costs ($17,017) and QALYs (2.555), while infliximab had both the highest expected costs ($54,084) and QALYs (2.721). The incremental cost per QALY moving from usual care to adalimumab and from adalimumab to infliximab was estimated to be to be $193,305 and $451,165, respectively.
Based on common willingness to pay thresholds, ant-TNF-a drugs would not be perceived as a cost effective treatment for refractory CD.
PubMed ID
22261531 View in PubMed
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Canadian variation by province in rheumatoid arthritis initiating anti-tumor necrosis factor therapy: results from the optimization of adalimumab trial.

https://arctichealth.org/en/permalink/ahliterature140779
Source
J Rheumatol. 2010 Dec;37(12):2469-74
Publication Type
Article
Date
Dec-2010
Author
Christopher Pease
Janet E Pope
Carter Thorne
Boulos Paul Haraoui
Don Truong
Claire Bombardier
Jessica Widdifield
Eliofotisti Psaradellis
John S Sampalis
Ashley Bonner
Author Affiliation
University of Western Ontario, London, Ontario, Canada.
Source
J Rheumatol. 2010 Dec;37(12):2469-74
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antibodies, Monoclonal - economics - therapeutic use
Antirheumatic Agents - economics - therapeutic use
Arthritis, Rheumatoid - drug therapy - pathology - physiopathology
Canada
Female
Humans
Insurance, Health, Reimbursement
Middle Aged
Multicenter Studies as Topic
Questionnaires
Randomized Controlled Trials as Topic
Registries
Treatment Outcome
Tumor Necrosis Factor-alpha - immunology
Abstract
We compared variations among Canadian provinces in rheumatoid arthritis (RA) initiating anti-tumor necrosis factor (TNF) therapy.
Data were obtained from the Optimization of Humira trial (OH) and from the Ontario Biologics Research Initiative (OBRI). Baseline characteristics were compared between regions: Ontario (ON), Quebec (QC), and other provinces (OTH). We compared Ontario OH to OBRI patients who were initiating anti-TNF therapy.
In 300 OH patients, mean age was 54.8 years (13.3). There were 151 (50.3%) ON patients, 57 from QC (19%), and 92 from OTH (30.7%). Regional differences were seen in the number of disease-modifying antirheumatic drugs (DMARD) ever taken (ON: 3.8 ± 1.4, QC: 3.1 ± 1.1, OTH: 3.3 ± 1.4; p
PubMed ID
20843910 View in PubMed
Less detail

The case of tumour necrosis factor-alpha inhibitors in the treatment of rheumatoid arthritis: a budget impact analysis.

https://arctichealth.org/en/permalink/ahliterature13752
Source
Pharmacoeconomics. 2005;23(3):289-98
Publication Type
Article
Date
2005
Author
Jan Sørensen
Lis S Andersen
Author Affiliation
Centre for Applied Health Services Research and Technology Assessment (CAST), University of Southern Denmark, Odense, Denmark. jas@cast.sdu.dk
Source
Pharmacoeconomics. 2005;23(3):289-98
Date
2005
Language
English
Publication Type
Article
Keywords
Antibodies, Monoclonal - economics - therapeutic use
Antirheumatic Agents - economics - therapeutic use
Arthritis, Rheumatoid - drug therapy - economics
Costs and Cost Analysis
Denmark
Humans
Immunoglobulin G - economics - therapeutic use
Receptors, Tumor Necrosis Factor - therapeutic use
Tumor Necrosis Factor-alpha - antagonists & inhibitors
Abstract
BACKGROUND: Treatment with tumour necrosis factor (TNF)-alpha inhibitors offers promising new opportunities to improve the health-related QOL of patients with rheumatoid arthritis (RA) in Denmark. As of September 2003, two such compounds -- infliximab and etanercept -- were registered for use by patients with RA. These drugs have shown the ability to reduce disease activity and to slow down or halt the development of new joint damage in otherwise treatment-resistant patients with RA. The acquisition cost of the drugs is high, with 1 year of treatment costing euros 9000-12,000 per patient. OBJECTIVE: The aim of this study was to assess the potential impact on the Danish healthcare budget of prescribing infliximab or etanercept to patients with RA. METHOD: Two treatment implementation scenarios were investigated. In the progressive scenario, all patients newly diagnosed with RA were offered TNFalpha inhibitors as the drug of first choice. In the modest scenario, only patients with insufficient disease suppression by conventional therapy with disease-modifying anti-rheumatic drugs (DMARDs) were offered TNFalpha inhibitor therapy. The budget impact analysis, which was part of a Danish health technology assessment of TNFalpha inhibitors, focused on the number of patients offered treatment during a 5-year period and resource use related to drug and staff costs. Simple sensitivity analyses assessed the consequences of changing the drug dosage, the number of patients offered treatment and the rate of treatment cessation. RESULTS: The results suggested that both implementation strategies would impose additional costs per year on the Danish healthcare service, in the range of euros 67-188 million for the progressive scenario and euros 17-49 million for the modest scenario (price level August 2002). These costs represent between half and up to five times the amount currently used on treating patients with RA. CONCLUSION: This analysis suggests that the introduction of TNFalpha inhibitors into the treatment regimen of patients with RA could pose a considerable financial burden on the Danish healthcare system.
PubMed ID
15836009 View in PubMed
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Comment and reply on: The cost-effectiveness of palivizumab for respiratory syncytial virus prophylaxis in premature infants with a gestational age of 32-35 weeks: a Canadian-based analysis.

https://arctichealth.org/en/permalink/ahliterature150689
Source
Curr Med Res Opin. 2009 Jul;25(7):1631-2; author reply 1632-3
Publication Type
Article
Date
Jul-2009

The comparison of trial data-based and registry data-based cost-effectiveness of infliximab treatment for rheumatoid arthritis in Sweden using a modeling approach.

https://arctichealth.org/en/permalink/ahliterature115153
Source
Value Health. 2013 Mar-Apr;16(2):251-8
Publication Type
Article
Author
Ingrid Lekander
Gisela Kobelt
Patrick Svarvar
Tryggve Ljung
Ronald van Vollenhoven
Fredrik Borgström
Author Affiliation
i3 Innovus, Stockholm, Sweden. ingrid.lekander@ki.se
Source
Value Health. 2013 Mar-Apr;16(2):251-8
Language
English
Publication Type
Article
Keywords
Antibodies, Monoclonal - economics - therapeutic use
Antirheumatic Agents - economics - therapeutic use
Arthritis, Rheumatoid - drug therapy - economics
Cohort Studies
Cost-Benefit Analysis - methods
Data Collection - standards
Female
Humans
Male
Methotrexate - economics - therapeutic use
Middle Aged
Models, Economic
Quality-Adjusted Life Years
Randomized Controlled Trials as Topic - statistics & numerical data
Registries - statistics & numerical data
Sweden
Abstract
To evaluate the precision of the predictive cost-effectiveness assessment based on a phase 3 clinical trial with infliximab for the treatment of rheumatoid arthritis in Swedish clinical practice.
Three patient cohorts were identified: the patients included in the infliximab trial (ATTRACT), patients initially treated with infliximab from a Swedish registry (STURE), a subset of these registry patients meeting inclusion criteria for the ATTRACT trial was the third patient cohort; two sets of assumptions in relation to the efficacy data were evaluated: "ATTRACT" (efficacy data over the duration of the trial) and "STURE" (effectiveness data over 10 years). In addition, the impact of including the placebo effect for the comparator was evaluated as a basis for the calculation of cost-effectiveness by using a modeling approach. A health economic model was utilized to estimate the cost per quality-adjusted life-year (QALY) gained.
The results for the three patient cohorts ranged from cost saving to a cost per QALY gained of €2,400 and €24,900 to €26,000 when the ATTRACT and STURE assumptions were used, respectively. Sensitivity analyses indicated that the inclusion of placebo effect had the largest effect on the results, increasing the cost per QALY gained to approximately €50,000 for all patient cohorts.
The treatment effect of infliximab measured in clinical trials and clinical practice results in comparable cost-effectiveness ratios, as calculated by using a modeling approach, whereas the assumptions made in relation to the effectiveness data and the chosen comparator have a large impact on the results. This reinforces the value of early modeling studies based on randomized clinical trial data, but assumptions made need to be carefully assessed.
PubMed ID
23538176 View in PubMed
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39 records – page 1 of 4.