药物经济学：开放获取

Introduction: After a gap of ten years the information regarding morbidity and health expenditure in Indian states were collected in detail National Sample Survey Organization (NSSO) and were published on June 30th 2015. During this decade the country and health system has undergone major changes including introduction of public funded health insurance schemes (PFHI). This paper was done with the objectives to study the OOP health expenditure and factors affecting it and to understand the impact PFHI on OOP in India.
Methods: Study done by reviewing, analysing the availing data from NSSO survey conducted during 2014 and 2004 and for assessing the impact of PFHI schemes on OOP other published studies on evaluation of PFHI schemes were included.
Results: Proportion of Ailing Persons (PAP) was 104 per 1000 with 13 points increase during the last ten years. The utilization of public services for outpatient (O P) care like subcenters, primary health enter , Community health centres were 25% and inpatient (IP) care was 40%. OP expenditure has increased > 100% and IP care expenditure almost 300% increased during last ten years. More than 80% of the expenditure are met by out of pocket (OOP).Rural households primarily depended on their ‘household income / savings’ (68%) and on ‘borrowings’ (25%), the urban households relied much more on their ‘income / saving’ (75%) for financing expenditure on hospitalizations, and on ‘(18%) borrowings. Even from the upper quintile, both rural and urban areas have borrowed money to meet the hospital expenditure which was 23%and 14% respectively. Only 12% urban and 13% rural population received any protection coverage through any of the PFHI like “Rashtriya Swasthya Bhima yojana” (RSBY).
Conclusion: The morbidities cost per illness episode were inevitably increased in the last decade in India. The increase in life expectancy, demographic change of more aged population coupled with chronic disease will increase the morbidity and health expenditure in the future. Unless overt reliance on unregulated private sector are systematically corrected by alternative health financing mechanisms and strengthening public health system “right for health” will be a distant dream for common citizens.

Background: Attention-deficit hyperactivity disorder (ADHD) frequently persists into adulthood and leads to a significant burden of illness. Many adults with ADHD suffer from comorbid conditions such as substance and alcohol use disorders and anxiety. Atomoxetine is the only drug therapy approved in Spain for the treatment of adult ADHD. This study estimates the cost-utility of atomoxetine compared with no treatment in adults with ADHD in Spain and in two specific subgroups: patients with comorbid anxiety or comorbid alcohol abuse.
Method: A simple, state-transition Markov model with three health-states (treatment initiation, response and no-response) was developed. The model estimated the incremental cost per quality-adjusted life year (QALY). Treatment effectiveness and discontinuation rates were estimated from nine atomoxetine clinical trials. Utilities were estimated from a vignette study. Costs and outcomes were estimated over a one-year period from the perspective of the Spanish National Healthcare System.
Results: The incremental cost per QALY gained with atomoxetine versus no treatment was €23,645 in the general ADHD population, €20,860 in patients with comorbid anxiety, and €24,675 in the comorbid alcohol abuse population. These values were below the willingness-to-pay threshold of €30,000 per QALY considered acceptable in Spain. The model was most sensitive to changes in the utility value of patients in the no-response health state. With the exception of some of the utility values, a positive net monetary benefit value was maintained following variations in all model parameters.
Conclusion: Atomoxetine represents a cost-effective option compared

Background: Severe asthma is a major cause of morbidity and mortality around the world, associated with a heavy societal burden. The aim of this study was to evaluate the economic value of omalizumab in the treatment of adult patients with severe asthma in Greece, from a societal perspective, based on both data collected via a clinical trial and data from a prospective observational study with real-world evidence (RWE) using a simulation model.
Method: A Markov cohort model was developed in Microsoft Excel to compare the costs and outcomes of omalizumab plus standard therapy (ST) versus ST alone. The time horizon was that of a lifetime. Costs and health outcomes were discounted annually at 3.5%. A primary analysis was based on clinical data from the INNOVATE trial, and a secondary analysis, was based on recently published real-world evidence on effectiveness of omalizumab. Both direct and indirect costs were incorporated. Unit costs were taken from publically available sources, Productivity losses were calculated based on published data, while utility values were taken from the INNOVATE study. Deterministic and probabilistic sensitivity analyses were undertaken to test the robustness of the model results.
Results: The addition of omalizumab to ST led to an incremental cost of €27,888 and € 27,255 per QALY gained in the primary and secondary analyses, respectively. The model appeared to be most sensitive to changes in the time horizon and the age of retirement. The results of the probabilistic sensitivity analysis showed that the probability of omalizumab being cost effective was 58% and 84%, at a threshold of €30,000 and € 40,000 (willingness to pay for one QALY), respectively.
Conclusion: Omalizumab appears to be a cost-effective treatment option for patients with severe asthma compared to ST in Greece, and this result is confirmed both with trial and real-world data.

Introduction: Ireland had one of the highest pharmaceutical spends per capita in the EU in 2012. The General Medical Services (GMS) scheme is the largest community drug scheme in Ireland with approximately 40% of the population eligible for free drugs and appliances in 2012. The total cost of GMS prescriptions increased by 414% between 1998 and 2012. This paper projects Irish GMS cost from 2016 to 2026 and examines the implications of the estimated impact on GMS expenditure.

Method: Central Statistics Office (CSO) population projections (2013) and HSE-PCRS GMS population prescription data (2012) were used to develop four variables; population, GMS coverage, average cost per claimant and claims rate. A Monte Carlo Simulation (MCS) model simulated the effect of these four variables on GMS costs, by health board region, age cohort and sex.

Results: Irish population is projected to grow by approximately 10% between 2012 and 2026. The over 70s population is estimated to grow by 64% with the proportion of males growing by 72%. GMS expenditure is estimated to increase by 64%, from €1.1 billion in 2016 to €1.8 billion by 2026. Age is a key driver of GMS expenditure, specifically those aged under 11 and over 70. The MCS results project that males, the Mid-Western and South- Eastern regions are driving GMS costs in the under 11s. Females, Midlands and Southern regions are driving GMS costs in the over 70s.

Conclusion: Population growth coupled with an aging population will impact future GMS costs. Targeted GMS policy changes such as co-payment charges, reference pricing, and generic substitution can help to contain future GMS expenditure.

Background: Little information on costs and quality of life (QoL) of patients with Multiple Sclerosis (MS) has been published for Greece so far.

Objective: The objective of the study was to assess the socio-economic burden that MS imposes to Greek patients with relapsing forms of multiple sclerosis.

Methods: Information on demographics, disease history, resource consumption and productivity losses was collected from 200 patients recruited in six MS centres throughout Greece. Annual costs were estimated in 2011 unit costs. Health-related QoL (HRQoL) was measured with the EQ-5D questionnaire. Using the Expanded Disability Status Scale (EDSS), patients were stratified into those with mild (EDSS 0-3), moderate (EDSS 3.5-6.0) and severe (EDSS 6.5-7.5) disability. The perspective of the analysis was that of the national security fund (EOPYY).

Results: The mean annual cost per patient was estimated at €26,118. Higher disability increased costs substantially; €20,702 for mild, €32,126 for moderate and €45.442 for high severity patients. HRQoL was considerably impaired by disease progression. Patients with Secondary Progressive (SPMS) as expected had higher costs and lower HRQoL than Relapsing Remitting Multiple Sclerosis (RRMS) subjects, attributed to higher mean disability.

Conclusion: In accordance with other studies, MS imposes a considerable health and economic burden in Greece, which increases significantly with advancing disability.