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Health-care systems are currently facing tremendous budget constraints resulting in growing pressure on decision makers and health-care providers to obtain the maximum possible health benefits of the resources available. Choices have to be made, and health economics can help in allocating limited health-care resources among unlimited wants and needs. Attempts to achieve cost reductions often focus on severe pathologies and chronic diseases as they commonly represent high health-care expenditures. In this context, awareness of the considerable financial burden caused by disease-related malnutrition (DRM) is lacking. Possibilities of reducing costs by optimising the management of DRM through medical nutrition will mostly not even be taken into account. During a European expert meeting, the total evaluation of medical nutrition was viewed and discussed. The aim of this meeting was to gain an experts' outline of the key issues relating to the health economic assessment of the use of medical nutrition. This article provides a summary of the observations per discussed item and describes the next steps suggested. European Journal of Clinical Nutrition (2015) 69, 539-545; doi: 10.1038/ejcn.2014.280; published online 21 January 2015, INTRODUCTION The current economic climate and an increasing ageing population cause a need to economize within current health-care systems. Given the scarce health-care resources available, decision makers and health-care providers [...]

Objective: A health economic analysis was performed to assess the cost-effectiveness of oral nutritional supplements (ONS), being a medical nutrition product, in the Netherlands. Methods: This analysis is based on a comparison of the use of ONS versus 'no use' of ONS in patients undergoing abdominal surgery. The costs and benefits of the two treatment strategies were assessed using a linear decision analytical model reflecting treatment patterns and outcomes in abdominal surgery. The incremental cost difference was based on costs associated with ONS and hospitalization. Clinical probabilities and resource utilization were based on clinical trials and published literature; cost data were derived from official price tariffs. Results: The use of ONS reduces the costs with a 252 € (7.6%) cost saving per patient. The hospitalization costs reduce from 3,318 € to 3,044 € per patient, which is a 8.3% cost saving and corresponds with 0.72 days reduction in length of stay. The use of ONS would lead to an annual cost saving of a minimum of 40.4 million € per year. Sensitivity analyses showed that the use of ONS remains cost saving compared with 'no use' of ONS. A threshold analysis on the length of stay shows that at 0.64 days, the use of ONS is still cost-effective, which is an unrealistic value. Conclusions: This analysis shows that the use of medical nutrition, ONS in this case, is a cost-effective treatment in the Netherlands and is dominant over standard care without medical nutrition: it leads to cost savings and a higher effectiveness. European Journal of Clinical Nutrition (2010) 64, 1229-1234; doi: 10.1038/ejcn.2010.147; published online 18 August 2010 Keywords: medical nutrition; cost-effectiveness; health economic model; oral nutritional supplements, Introduction Nutritional depletion in Western countries is usually caused by the joint action of an underlying disease, for example, cancer and dietary deficiency (Naber et al., 1997), also known as [...]

Purpose: We evaluated the economic impact of preventing recurrent stones using a strategy of increased water intake and determined the impact of compliance on cost-effectiveness for the French health care system. Materials and Methods: A Markov model was constructed to compare costs and outcomes for recurrent kidney stone formers with less than 2 L vs 2 L or more daily fluid intake. Model assumptions included an annual prevalence of 120,000 stone episodes in France, 14.4% annual risk of stone recurrence and a 55% risk reduction in subjects with adequate water intake. Costs were based on resource use as estimated by a panel of experts and official national price lists. Outcomes were from the perspective of the public health payer, and encompassed direct and indirect costs. Results: The total cost of an episode of urolithiasis was estimated at €4,267 including the cost of treatment and complications. This corresponds to an annual budget impact of €88 million for recurrent stones based on 21,000 stone events. Assuming 100% compliance with fluid intake recommendations of 2 L daily, 11,572 new stones might be prevented, resulting in a cost savings of €49 million. Compliance with water intake in only 25% of patients would still result in 2,893 fewer stones and a cost savings of €10 million. Varying the costs of managing stones had a smaller impact on outcomes since in many patients stones do not form. Varying the incidence of complications did not change the incidence of stones and had a negligible effect on overall cost. Conclusions: Preventing recurrent urolithiasis has a significant cost savings potential for a payer as a result of a reduced stone burden. However, compliance is an important factor in determining cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background: Reimbursement of new drugs is usually based on the budgetary impact of a new drug but there is also increasing demand for cost-effectiveness data on new drugs.Objective: To present a modelling technique (methodology) for an appropriate assessment of the budgetary impact of a new drug, which can simultaneously be used for a traditional cost-effectiveness analysis. DESIGN AND PERSPECTIVE: To illustrate the methodology, a model was constructed for a new hypothetical drug in Parkinson's disease, which allowed us to determine the budgetary impact and the cost effectiveness of this new antiparkinsonian drug from a societal perspective. The methodology consisted of two steps: (i) a simple population model (Markov model) was constructed to validate the epidemiological data by proving the consistency between the prevalence and incidence of Parkinson's disease for the Dutch population; (ii) this model was extended to a more complex model (semi-Markov model) by incorporation of disease progression for Parkinson's disease and all relevant economic and clinical measures. These included all drug utilisation associated with Parkinson's disease, as well as other resource utilisation patterns associated with outpatient and inpatient care for the treatment of Parkinson's disease.Results: The study showed that the difference in epidemiological data between a simple model and a complex model are substantial, which justifies the development of a complex model with a higher external validity. The complex model allowed an assessment of all potential candidates for the new drug and simultaneously allowed the assessment of the cost effectiveness of the new drug versus usual care.Conclusion: One model can be used for an appropriate assessment of the budgetary impact and the cost effectiveness of a new drug. [ABSTRACT FROM AUTHOR]

Objective: To determine the cost effectiveness of adjunctive therapy with entacapone versus standard treatment (levodopa) without entacapone for patients in the US with Parkinson's disease (PD) who experience 'off-time' (re-emergence of the symptoms of PD) while receiving levodopa.Study Design: A Markov model was used to estimate 5-year costs and effectiveness of standard treatment with and without entacapone.Methods: Probabilities, unit costs, resource utilisation data and utilities were obtained from published literature, clinical trial reports, a national database, and clinical experts. PD disability was measured using the daily proportion of off-time and Hoehn and Yahr scale scores. The analysis measured costs from a societal and third-party payer perspective, and effectiveness as gains in quality-adjusted life-years (QALYs) and years without progression to >25% off-time.Results: From a societal perspective, entacapone therapy resulted in an incremental cost of US dollars 9327 per QALY gained compared with standard treatment. Treatment with entacapone also provided an additional 7.6 months with < or =25% off-time/day compared with standard treatment. Sensitivity analyses indicated that the model is sensitive to changes in rates of improvement/deterioration of off-time, and to the number of doses per day of levodopa with adjunctive entacapone.Conclusions: The addition of entacapone to standard treatment for patients receiving levodopa who experience off-time provides additional QALYs and gain in time with minimal fluctuations. Results of this modelling exercise suggest that therapy with entacapone may be cost effective when compared with standard treatment for PD. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare the total costs associated with the administration of two different tumour necrosis factor (TNF) strategies used in the treatment of rheumatoid arthritis (RA): etanercept, a soluble TNF receptor that can be administered at home by subcutaneous injection, versus infliximab, an antibody that requires an intravenous infusion in a hospital outpatient setting. Design and setting: The main analytical framework of the study was a cost-cost analysis comparing the total annual costs associated with the administration of etanercept and infliximab in adult RA patients. The perspective of the study was that of the Dutch society. An economic model was constructed to determine the costs of both treatments. The cost evaluation included direct medical costs, direct nonmedical costs and indirect costs. The base-case analysis compared monotherapy with etanercept versus a combination therapy with infliximab and methotrexate. Data for the economic model came from published literature, expert opinion and official price and tariff lists. All costs were in 1999 values. Patients and participants: The analysis was performed for the adult RA population eligible for treatment with etanercept or infliximab in The Netherlands. Main outcome measures and results: The analysis showed that the total annual drug costs per patient do not differ substantially between infliximab and etanercept, with costs of Netherland guilders (NLG)31 526 ($US12 610) and NLG31 334 ($US12 534), respectively. However, the other medical costs (i.e. excluding the costs of the two drugs themselves) are substantially higher for infliximab due to the additional costs associated with administration in an outpatient clinic and the use of methotrexate [NLG12 621 ($US5048) versus NLG269 ($US107) for etanercept]. The impact of direct nonmedical costs (transportation) and indirect costs were negligible. Overall treatment with infliximab is more expensive than treatment with etanercept with total costs of NLG45 115 ($US18 046) and NLG31 621 ($US12 648), respectively (42.7% increase). Conclusions: Based on the assumptions used in the model, we may conclude that the use of etanercept compares favourably with infliximab from a budgetary and health economic perspective: the total costs are substantially lower when the efficacy of etanercept is assumed to be at least equivalent to the efficacy of infliximab. [ABSTRACT FROM AUTHOR]

Objective: To assess the cost effectiveness of emedastine, a new antihistamine, versus levocabastine in the treatment of acute allergic conjunctivitis (AAC) in Belgium, France, Germany, The Netherlands, Norway, Portugal and Sweden.Design and Setting: Randomised double-blind multicountry clinical trial followed by economic modelling from the treatment provider perspective.Patients: A total of 221 patients (109 emedastine, 112 levocabastine) with AAC were included.Methods: The clinical trial compared the efficacy and safety of emedastine 0.05% and levocabastine 0.05%, both twice daily, for 42 days, using ocular redness, itching, days without symptoms and clinical failure as outcome measures. The cost of first-line treatment failure, including visits, drugs and laboratory examinations, was established in each country from a panel of ophthalmologists and general practitioners. Full sensitivity analyses were conducted.Results: From day 7 to 42, patients treated with emedastine had less itching (p < 0.001) and less redness (p < 0.001). The failure rate was 10% less (p < 0.02) with emedastine and patients treated with emedastine had an incremental 8.5 days (p < 0.01) without symptoms. Emedastine and levocabastine were equally well tolerated. In all European countries, the cost of failure was lower with emedastine. Emedastine was found to be economically dominant relative to levocabastine, i.e. more effective and less expensive, in Belgium, Germany, Portugal and Sweden; in France, The Netherlands and Norway the incremental cost was low (less than 1 euro per additional symptom-free day).Conclusion: Through a model based on a randomised clinical trial and cost estimates of treatment failure derived from practitioner interviews, emedastine is a cost-effective treatment of AAC. [ABSTRACT FROM AUTHOR]

This article explores the need to perform pharmacoeconomic evaluations of herbal medicines and assesses the extent to which this approach has been applied so far to these products. There seems to be no compelling need for pharmacoeconomic analyses of herbal over-the-counter medicines, but such analyses are certainly warranted for herbal prescription medicines that have a high level of reimbursement. Such preparations are used in Germany, in particular, where physicians prescribed ginkgo, hawthorn, St John's wort, horse-chestnut and saw palmetto to a value of more than DM50 million each in 1996. In our survey, only a single pharmacoeconomic study, of uncertain quality, was found on these 5 herbs, whereas several pharmacoeconomic reports on synthetic competitors were retrieved. The time has come to submit highly reimbursed herbal prescription medicines to the same rigorous pharmacoeconomic evaluations as their synthetic competitors. At present, such studies are particularly important for Germany, but in the future they may also become relevant for other countries, inside as well as outside Europe. [ABSTRACT FROM AUTHOR]

The ideal study design for demonstrating the possible health outcomes and costs associated with a new drug would be a naturalistic prospective study. However, it is not often feasible to derive the required information from scientifically sound prospective studies. In these cases, decision analytic models may provide some of the missing information. However, the use of a Delphi panel to gather data for these models is a major concern because of potential bias and data accuracy. Because reimbursement of pharmaceuticals is often based on economic data derived from modelling studies, it is obvious that potential bias due to the use of Delphi panels should be minimised. In this manuscript we present an alternative data source for modelling studies: the cross-sectional study. Data from such studies can be used to yield costs and utilities for Markov health states. The overall combined design may be considered a hybrid between a naturalistic prospective study and a modelling study by maximising the pros and minimising the cons of both types of design, including an increase of external validity. This hybrid design is based on bridging the probabilities derived from the literature and clinical trials with information on costs and utilities from a cross-sectional study. This design also has logistical advantages, namely a shorter required study duration compared with prospective naturalistic studies for chronic diseases. This combined design was illustrated using a Markov model for Parkinson's disease. [ABSTRACT FROM AUTHOR]

This article presents the first version of the reporting format for economic valuation that was created in 1995 by a multidisciplinary taskforce. The members of this taskforce come from a broad spectrum of backgrounds within the healthcare field and participated in the exercise voluntarily. The format presented should be understood as the preferred Dutch structure for the reporting of any study on economic evaluation. In view of the many areas of contention that exist within the field, this format only gives normative directions in those areas in which consensus exists, as evidenced by the current published international guidelines. A regular review and adaptation of this format will be needed to reflect advances in the field. [ABSTRACT FROM AUTHOR]

Economic analysis has become increasingly important in healthcare in general, and particularly with respect to pharmaceuticals. Therefore, it is vital that the methods used in such evaluations are carefully scrutinised and refined. However, guidelines contain only a limited number of recommendations for the use of secondary data in modelling studies. In this manuscript, the selection of data sources in modelling studies will be addressed. The objectives of this manuscript are as follows: (i) to present a general strategy on how to determine the appropriateness of a data source for a model; and (ii) to present recommendations on a transparent reporting format for the selection of data sources. [ABSTRACT FROM AUTHOR]

There is increasing use of economic evaluation to support decision-makers in health services for allocation of scarce healthcare resources. However, information necessary for economic evaluations cannot always be derived from well-conducted prospective clinical studies, and decision-analytical models can be used to provide some of the missing information. A number of applications of decision-analytical models are discussed, including submissions to authorities for reimbursement purposes, pharmacoeconomic programme development, portfolio investment decisions, marketing and communication strategies, and applications in disease management. [ABSTRACT FROM AUTHOR]