Volume 6, 2003
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Comparisons of efficacy and cost-effectiveness of topical immunomodulators in
the management of atopic dermatitis
W Abramovits, M Boguniewicz, MM Prendergast, M Tokar, KB Tong
Pages 1-14 ¦ Abstract ¦ PDF (123 KB)
Postmenopausal breast cancer: incidence-based cost of illness
V Cocquyt, K Moeremans, P Clarys, S Van Belle, L Annemans
Pages 15-30 ¦ Abstract ¦ PDF (184 KB)
Cost-effectiveness of amisulpride compared with risperidone in patients with
schizophrenia
CJ Nicholls, AS Hale, N Freemantle
Pages 31-41¦ Abstract ¦ PDF (105 KB)
Estimating the cost of an emergency room visit for migraine headache
R Barron, J Carlsen, SB Duff, C Burk
Pages 43-53 ¦ Abstract ¦ PDF (141 KB)
Cost-effectiveness analysis of clopidogrel versus aspirin in patients with atherothrombosis
based on the CAPRIE trial
L Annemans, M Lamotte, E Levy, X Lenne
Pages 55-68 ¦ Abstract ¦ PDF (370 KB)
Cost and effectiveness of brinzolamide versus dorzolamide in current practice:
an analysis based on the UK-GPRD
C Deschaseaux-Voinet, A Lafuma, G Berdeaux
Pages 69-78 ¦ Abstract ¦ PDF (105 KB)
A cost analysis of the management of attention-deficit/hyperactivity disorder
(ADHD) in children in the UK
N Vanoverbeke, L Annemans, M Ingham, I Adriaenssen
Pages 79-94 ¦ Abstract ¦ PDF (136 KB)
Abramovits W, Boguniewicz M, Prendergast MM, Tokar M, Tong KB
Comparisons of efficacy and cost-effectiveness of topical immunomodulators in
the management of atopic dermatitis
J Med Econ 2003; 6: 1-14
The availability of new topical immunomodulators greatly improves treatment options
for patients with atopic dermatitis (AD). Unfortunately, head-to-head studies
have not been conducted to allow comparisons in treatment efficacy and cost-effectiveness.
The study aims to compare the efficacy and cost-effectiveness of tacrolimus ointment
and pimecrolimus cream as monotherapy for the treatment of AD patients with moderate
disease, who are not responsive to or not well-controlled with topical corticosteroids.
In the absence of head-to-head comparative data, relative treatment efficacy was
estimated based on existing outcomes, which were reported in the published literature
and data from clinical trials. Comparisons were made between Eczema Area and Severity
Index (EASI) scores and converted to disease-controlled days (DCDs) on treatment.
Other assumptions about resource utilization, changes in management and patient
outcomes were based on opinions of a physician panel and from previously published
reports. Medical resources costs were derived from fee schedules and product average
wholesale prices (AWPs). A Markov model was developed to determine the cost-effectiveness
ratios for each treatment. Sensitivity analyses were conducted for key variables
to assess their impact on the results. Study designs and efficacy endpoints differed
between tacrolimus and pimecrolimus clinical studies. In tacrolimus studies, a
quantitative physician global assessment was performed, which tracked percentage
improvement relative to baseline. In contrast, pimecrolimus studies relied on
investigator global assessments scored on a Likert scale. Studies of both agents
used the Eczema Area and Severity Index (EASI). A comparison of EASI scores for
tacrolimus and pimecrolimus found that pimecrolimus was approximately 60% as efficacious
as tacrolimus after 2 to 4 weeks of treatment. Based on these efficacy rates,
average cost-effectiveness ratios were estimated at $7.34 per DCD for tacrolimus
and $11.34 per DCD for pimecrolimus. Sensitivity analyses found that pimecrolimus
would only be cost-effective if its efficacy approached 90% of tacrolimus efficacy
or if the costs of the products were significantly different than current AWPs.
Although head-to-head comparative studies have not been completed to date, there
are likely to be differences in efficacy between topical immunomodulators. Based
on published data, we estimate that the efficacy of pimecrolimus to be 60% of
the efficacy of tacrolimus and therefore, tacrolimus to be more cost-effective
for the treatment of moderate AD. Sensitivity analyses revealed that pimecrolimus
cream would need to be 90% as efficacious as tacrolimus ointment in order to be
cost-effective in this patient population.
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Cocquyt V, Moeremans K, Clarys P, Van Belle S, Annemans L
Postmenopausal breast cancer: incidence-based cost of illness
J Med Econ 2003; 6: 15-30
A Markov state transition model was developed to predict 10-year cumulative incidence-based
costs of postmenopausal breast cancer. Using published clinical data, the model
simulates, during 10 periods of one year each, the disease progression through
nine health states: node-negative and node-positive early cancer; local relapse;
metastasis (each with its follow-up states) and death. The health insurance perspective
was taken and a 3% annual discount rate on future costs was applied. The cost
per health state was obtained from a chart review of 118 patients with different
disease states. The average cumulative 10-year cost per patient was 31,774 euros (95%
confidence interval 30,536 - 33,012 euros ), of which 30% was due to hospitalisation
and 28% to systemic treatment and radiotherapy. The model provided a valid simulation
of long-term breast cancer outcome. This model may serve as a valid baseline for
economic assessment of new interventions in prevention or early treatment.
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Nicholls CJ, Hale AS, Freemantle N
Cost-effectiveness of amisulpride compared with risperidone in patients with schizophrenia
J Med Econ 2003; 6: 31-41
Amisulpride is an atypical antipsychotic, which has demonstrated efficacy across
the range of symptoms of schizophrenia. This study compares the treatment costs
of amisulpride (including drug costs, hospital costs, and costs of clinician and
nurse visits) with those of risperidone over a six-month treatment period, from
the perspective of the UK National Health Service. Resource utilisation data
were collected alongside an international, multicentre clinical trial comparing
amisulpride (400-1000 mg/day) with risperidone (4-10 mg/day) in 198 patients with
schizophrenia. As this trial demonstrated that amisulpride had at least equivalent
efficacy to risperidone, the present study was a cost-minimisation analysis.
Unit cost data for the UK were obtained from published sources and applied to
the clinical data to calculate direct treatment costs. Amisulpride was associated
with lower drug acquisition costs and lower resource utilisation costs than risperidone,
although the differences did not reach statistical significance. Overall, the
average total cost per patient for six months treatment with amisulpride (£12,673;
95% CI: 10,628, 14,717) was £2,145 less than for risperidone (£14,818; 95% CI:
12,323, 17,312). These findings are similar to those of a previous study that
compared the treatment costs of amisulpride with those of haloperidol, and found
that amisulpride was associated with significantly lower direct treatment costs
than haloperidol. Amisulpride is a valuable treatment option in patients with
schizophrenia.
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Barron R, Carlsen J, Duff SB, Burk C
Estimating the cost of an emergency room visit for migraine headache
J Med Econ 2003; 6: 43-53
To provide a more comprehensive accounting of direct cost of treating headaches,
it is imperative to quantify the cost of emergency room (ER) services specific
to treating headaches. Published cost estimates for migraine-specific ER visits
are currently not available. This study estimated the cost of treating migraine
headaches in the ER from a payer's perspective, using ER discharge data for migraine
from the 2000 National Hospital Ambulatory Medical Care Survey (NHAMCS). Costs
were estimated using Medicare reimbursement rates. The total cost of an ER visit
for migraine headache, defined as the ER visit and all additional services and
procedures, was US$238.16. Based on the migraine prevalence of 9% to 27%, tha
annual estimate for total ER visit costs for migraine headache in the US in 2000
ranged from US$646 million to US$1.94 billion, which is substantial. ER costs
for migraine may be much larger than previously estimated.
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Annemans L, Lamotte M, Levy E, Lenne X
Cost-effectiveness analysis of clopidogrel versus aspirin in patients with atherothrombosis
based on the CAPRIE trial
J Med Econ 2003; 6: 55-68
Clopidogrel has been shown to reduce the secondary risk of ischaemic events in
vascular disease compared to aspirin. This article compares the economics of the
two drugs for this condition, by providing an incremental cost-effectiveness ration
(iCER) of clopidogrel versus aspirin, using Belgium as a case setting.
A 2 year Markov model, in which patients with vascular disease were assumed to
receive either clopidogrel or aspirin, was developed from a healthcare payer's
perspective. Survival data were based on the Saskatchewan Health database. Costs
included treatment and adverse events. Cost-effectiveness was expressed as the
cost per life year gained (LYG).
The iCER of clopidogrel versus aspirin was 13,390euros/LYG (95%CI: 6,990 euros;
26,470 euros). The robustnedd of these results was shown by univariate and probabilistic
senstivity analyses.
This analysis shows that clopidogrel is cost-effective for the secondary prevention
of ischaemic events in the Belgian setting.
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Deschaseaux-Voinet C, Lafuma A, Berdeaux G
Cost and effectiveness of brinzolamide versus dorzolamide in current practice:
an analysis based on the UK-GPRD
J Med Econ 2003; 6: 69-78
This study compared both the costs and effectiveness of brinzolamide and dorzolamide
according to data in the United Kingdom General Practitioner Research Database
(UK-GPRD). Files of patients with a diagnosis of ocular hypertension or glacoma
who also received topical treatments were extracted. Patients who began dorzolamide
or brinzolamide treatment after August 2000 were then selected. Treatment failure
was defined as a prescription change (adding or removing a topical treatment),
laser treatment or surgery. The time to treatment failure was compares using actuarial
methods. The economic viewpoint of the UK National Health Service (NHS) was adopted.
The cost of switching was calculated using resource costs for the the year 2000.
Data on 49,799 glaucoma patients were extracted from the database, of these patients
107 were treated with brinzolomide and 1,005 with dorzolomide. The differences
between groups were not statistically significant at the start of treatment. Patients'
mean age was 74.3 years, 56% were female and 44% male. Their prescriptions were
24.1% for monotherapy and 18.3% first-line. Treatment failure at 1 year was experienced
by 31% of patients treated with brinzolomide and 45% treated with dorzolomide
(p‹0.01). The daily cost of glaucoma treatment for patients who switched (failures)
was higher (£1.14 per day) than for patients who continued their treatment (£0.88
per day). The mean cost of treating glaucoma with brinzolamide was less (£162.5)
than with dorzolamide (£201.4). Brinzolamide not only costs the NHS less than
dorzolamide, but patients treated with brinzolamide also experience fewer treatment
failures, according to the UK-GPRD, which leads to further cost savings for the
NHS.
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Vanoverbeke N, Annemans L, Ingham M, Adriaenssen I
A cost analysis of the management of attention-deficit/hyperactivity disorder
(ADHD) in children in the UK
J Med Econ 2003; 6: 79-94
A decision analysis was performed to model the effects and health economic differences
of current UK management approaches to attention-deficit/hyperactivity disorder
(ADHD) in children aged betweem 6 and 16 years. The approaches modelled were:
medication using a standard immediate-release methylphenidate (MPH-IR) (once,
twice or three times daily); medication using CONCERTA®XL (OROS® methylphenidate;
MPH), a long-acting, once-daily formulation of methylphenidate; or behavioural
therapy (BEH). Starting treatment with BEH alone resulted in the highest annual
cost (UK£2,147), while the costs of starting treatment with MPH-IR alone (£1,332),
or OROS® MPH alone (£1,362) were comparable. Treatment switches to behavioural
treatment or combined treatment (medication and behavioural) due to treatment
failure occurred in 11.8% of OROS®MPH and 24.2% of MPH-IR patients. Probabilistic
sensitivity analyses showed that the results were sensitive towards treatment
success and the proportion of patients with comorbidities, although conclusions
were not altered. UK treatment costs over 1 year appear comparable regardless
of whether patients were treated first with OROS®MPH or MPH-IR. Treating patients
first with BEH and then adding stimulant medication if needed resulted in higher
overall annual treatment costs.
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