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Background/Purpose of the Study The costs of chemotherapy drugs which are vital in the treatment of lung cancer can be exorbitant. The current study was undertaken to ascertain cost minimization analysis by comparing costliest and cheapest branded with Jan Aushadhi (JA) drugs marketed in India. Methods The cost of costliest, cheapest branded, and JA drugs were collected from the designated reference sites. The cost difference, cost ratio, and percentage of cost variation were calculated as per cost minimization study guidelines. Results The results of the analysis suggest that the JA drugs were much cheaper than the branded drugs and when used in regimens resulted in substantial cost savings. The biggest financial advantage was seen in the commonly used cisplatin–pemetrexed regimen where cost saving of Rs. 268,002 was observed for the whole treatment of six cycles. Using JA drugs also reduced the cost for the targeted therapy with gefitinib and erlotinib. Conclusion The cost minimization study, which is the first in this field of lung cancer, clearly indicates the usefulness of JA drugs in reducing financial costs for the patient. [ABSTRACT FROM AUTHOR]

This document provides a cost analysis of antipsychotic drugs marketed in India. The study found significant price variations among different brands and doses of antipsychotic medications. The highest cost ratio and percentage of price variation were observed in risperidone 1mg, while clozapine 50mg had the lowest cost ratio and percentage of price variation. The study also discusses the impact of government regulations and drug pricing policies on the cost of medications. The findings suggest that atypical antipsychotics tend to be more expensive than typical antipsychotics. This document discusses a study on the cost analysis of antipsychotic drugs available in India. The study found that there is a wide variation in the prices of different antipsychotics, which can impact treatment adherence for patients with chronic conditions like schizophrenia. The authors suggest that drug manufacturers and regulatory bodies should be made aware of these price disparities in order to minimize costs and make medications more affordable for patients. They also recommend that physicians consider the affordability of prescription drugs and that future prescribers be educated on the variation in drug costs. [Extracted from the article]

Background: Branded generics are off-patent medications with proprietary names which are bioequivalent to the innovator medications. Cardiovascular diseases, driven by diabetes, hypertension, and dyslipidemia, are major health concerns, where patient compliance is crucial for long-term management. This analysis investigates cost variations of first-line branded generics for these conditions in Indian primary care settings. Methods: First-line medications preferred for type 2 diabetes, hypertension, and dyslipidemia were identified through an online survey of prescribers. Data from 1mg.com, an Indian online pharmacy, was used to compile a list of available brands for each medication. The study compared the prices of the five most prescribed brands, the three lowest-cost and one highest-cost brand per medication, and calculated the percentage cost difference. Results: First-line medications preferred for type 2 diabetes, hypertension, and dyslipidemia in India include Metformin 500mg, Enalapril 5mg, Telmisartan 40mg, Amlodipine 5 mg, and Atorvastatin 20mg. The analysis reveals significant cost disparities among commonly prescribed brands, with Metformin, Enalapril, Telmisartan, and Atorvastatin being notably more expensive (up to 1177%) than lower-cost alternatives, potentially placing a financial burden on patients. Amlodipine, however, exhibits modest cost variation (26-113%), with commonly prescribed brands leaning toward lower-cost options. Conclusion: Cost disparities among commonly prescribed brands could harm patient compliance and outcomes, emphasizing the need for cost-effective medication selection. This study offers crucial insights into cost variations in India's treatment of Type 2 Diabetes, Hypertension, and Dyslipidemia, underscoring the importance of cost awareness for improved patient compliance and healthcare system sustainability.

According to recent studies, head and neck cancers (HNC) make up a substantial proportion of all cancers in India and are proportionately high in the lower socioeconomic people practising tobacco and alcohol. Chemotherapy is a crucial component of treating HNC, and this study was carried out to determine the Cost Minimization Analysis (CMA) by comparing the price of the high and least expensive branded drugs marketed in India. This study was performed to understand the cost difference (CD), Cost ratio (CR) and percentage of cost variation (PCV) of both individual drugs and the standard anticancer regimens. The Current Index of Medical Stores was used to determine the costs of the most and least expensive branded medications and analysed. The results indicated that Paclitaxel-Cisplatin-5 Fluoruracil chemotherapy regimen exhibited the greatest variance in cost, with the Jan Aushadhi brand of medicine costing 8.1 times and 4.3 times less than the most expensive and cheapest branded drugs, respectively. The cost of the concurrent cisplatin regimen with Jan Aushadi Medicine was Rs 1764, Rs 3489.64 with the lowest branded drug, and Rs 8477 with the most expensive branded drug. Also when compared to Jan Aushadhi medication, the cost of Ciplatin was 4.8 times higher with the most expensive branded drug and 2 times higher with the least expensive branded drug. As far as the authors are aware of this is the first study that addresses the pharmacoeconomic appraisal of treating HNC with various chemotherapy and chemoirradiation regimens. This study will help oncologists, pharmacists, and healthcare workers comprehend the financial advantages of treating breast cancer with less expensive chemotherapeutic agents instead of brand-name medications. [ABSTRACT FROM AUTHOR]

Background and Objectives: Iron deficiency and anemia characterize patients on chronic hemodialysis (HD). Available intravenous iron agents, such as ferric gluconate (FG) and ferric carboxymaltose (FCM), vary in dosing regimens and safety profiles. The aim of the present study was to analyze the modification of the iron status, the correction of anemia, and the economic implications after the shift from FG to FCM therapy in chronic HD patients. We evaluated, during the study, the variations in iron metabolism, assessing ferritin and transferrin saturation, erythropoietin-stimulating agent (ESA) doses and the number of administrations, the effects on anemic status, and consequent costs. Materials and Methods: A retrospective study was performed with a follow-up period of 24 months, enrolling forty-two HD patients. The enrolment phase started in January 2015, when patients were treated with iv FG, and continued until December 2015, when FG was discontinued, and, after a wash-out period, the same patients were treated with FCM. Results: The iron switch reduced the administered dose of ESA by 1610.500 UI (31% of reduction; p < 0.001) during the entire study period and reduced the erythropoietin resistance index (ERI) (10.1 ± 0.4 vs. 14.8 ± 0.5; p < 0.0001). The FCM group had the highest percentage of patients who did not require ESA treatment during the study period. The FCM patients were characterized by higher levels of iron (p = 0.04), ferritin (p < 0.001), and TSAT levels (p < 0.001) compared to the FG patients. The annual cost during FG infusion was estimated at EUR 105,390.2, while one year of treatment with FCM had a total cost of EUR 84,180.7 (a difference of EUR 21,209.51 (20%), saving EUR 42.1 per patient/month (p < 0.0001). Conclusions: FCM was a more effective treatment option than FG, reducing ESA dose requirements, increasing Hb levels, and improving iron status. The reduced ESA doses and the decreased number of patients needing ESA were the main factors for reducing overall costs. [ABSTRACT FROM AUTHOR]

This article describes pharmacoeconomic analysis methods of which follow themodern requirements to this type of health technology assessment. Special attention is paid to the adaptation of pharmacoeconomic analysis methods to a specific nosology. The present paper demonstrates that each pharmacoeconomic study requires an individual approach, which takes into account both a specific disease peculiarities and the burden it poses on the patient, the community and the society.

Background: Oral anticancer drugs (OACDs) have been used since the 1950s and are expected to be linked with enhanced life quality which helps patients receive treatment at home. Although more convenient in use than intravenous or other infused drugs, the high costs of these OACDs have been proven controversial. Methods: The literature was searched systematically from PubMed, Cochrane, Embase, and Scopus according to the PRISMA guidelines. The inclusion criteria included studies in the English language, evaluating Pharmacoeconomics, and evaluating cost-utility and cost-effectiveness related to OACDs. The information on the included studies was synthesized in the form of summary tables. Results: Thirteen studies were included for quantitative analysis, which evaluated the costs or cost-effectiveness of different OACDs used for various types of cancer. It was found that the average cost for the OACDs was $80979/year in attaining (quality-adjusted life per year) QALY across different countries. The costs of different OACDs were highly varied alone in the US. The included studies' results were highly varied, limiting the findings' interpretations. Conclusion: Various studies about cost-effectiveness persist insufficiently represented in the literature regarding OACDs, suggesting the requirement of more cost-effectiveness analysis shortly. The increased costs of these OACDs require careful evaluation of the cost-effectiveness studies.

In a rapidly growing and aging population, heart failure (HF) has become recognised as a public health concern that imposes high economic and societal costs worldwide. HF management stems from the use of highly cost-effective angiotensin converting enzyme inhibitors (ACEi) and ß-blockers to the use of newer drugs such as sodium-glucose cotransporter-2 inhibitors (SGLT2i), ivabradine, and vericiguat. Modelling studies of pharmacological treatments that report on cost effectiveness in HF is important in order to guide clinical decision making. Multiple costeffectiveness analysis of dapagliflozin for heart failure with reduced ejection fraction (HFrEF) suggests that it is not only cost-effective and has the potential to improve long-term clinical outcomes, but is also likely to meet conventional cost-effectiveness thresholds in many countries. Similar promising results have also been shown for vericiguat while a cost effectiveness analysis (CEA) of empagliflozin has shown cost effectiveness in HF patients with Type 2 diabetes. Despite the recent FDA approval of dapagliflozin and empagliflozin in HF, it might take time for these SGLT2i to be widely used in real-world practice. A recent economic evaluation of vericiguat found it to be cost effective at a higher cost per QALY threshold than SGLT2i. However, there is a lack of clinical or realworld data regarding whether vericiguat would be prescribed on top of newer treatments or in lieu of them. Sacubitril/valsartan has been commonly compared to enalapril in cost effectiveness analysis and has been found to be similar to that of SGLT2i but was not considered a cost-effective treatment for heart failure with reduced ejection fraction in Thailand and Singapore with the current economic evaluation evidences. In order for more precise analysis on cost effectiveness analysis, it is necessary to take into account the income level of various countries as it is certainly easier to allocate more financial resources for the intervention, with greater effectiveness, in high- and middleincome countries than in low-income countries. This review aims to evaluate evidence and cost effectiveness studies in more recent HF drugs i.e., SGLT2i, ARNi, ivabradine, vericiguat and omecamtiv, and gaps in current literature on pharmacoeconomic studies in HF. [ABSTRACT FROM AUTHOR]

Dialysis patients are often iron deficient due to a multiple factors. Ferric pyrophosphate citrate is a complex iron salt that can be given via dialysate allowing maintenance of hemoglobin (Hgb) concentration and iron balance while reducing the need for IV iron. The purpose of this study is to perform a cost evaluation of FPC and the effect it has on lowering the dose/use of ESAs and IV iron therapy. This study reviewed the same 100 hemodialysis patient's charts before and after the use of FPC. The data points that were collected and analyzed are as follows: hemoglobin, ferritin levels, average weekly ESA dosing, and IV iron replacement therapy dose. Out of 100 patients, there was no statistical difference in the average hemoglobin, ferritin, and iron saturation levels observed in the patients before and after FPC use. The average weekly dose of darbepoetin alfa per patient was 52.74 μg before the FPC group compared to 39.27 μg in the post FPC group (P <.0001). The total dose of ferric gluconate per patient was 3290.01 mg in the before FPC group and 585.60 mg in the post FPC group (P <.0001). The average total iron sucrose dose per patient in the before FPC group was 3097.92 mg versus 1216.67 mg in the post FPC group (P <.1563). When comparing FPC's cost and implementation into both of our outpatient dialysis centers, this yielded a net savings of $296 751.49. [ABSTRACT FROM AUTHOR]

Introduction: The extended half-life of dalbavancin justifies a once-a-week dosing schedule and is supposed to favour early discharge. These advantages may therefore compensate for the cost of dalbavancin, but no real-life assessment has been conducted to date. We aimed to assess the real-life budget impact of dalbavancin through its impact on the length of stay in French hospitals. Methods: A multicentre cohort based on the French registry of dalbavancin use in 2019 was compared to the French national discharge summary database. Lengths of stay and budget impact related to the infection type, the time of introduction of dalbavancin, the type of catheter and patient subgroups were assessed. An early switch was defined when dalbavancin was administered as the first or second treatment and within less than 11 days of hospitalization. Results: A total of 179 patients were identified in the registry, and 154 were included in our study. Dalbavancin was mostly used for bone and joint infections (56.0%), infective endocarditis (19.0%) and acute bacterial skin and skin structure infections (6.0%). When compared to the data for similar patients in the national database, the length of stay was almost always shorter for patients treated with dalbavancin (up to a reduction of 13 days). The budget impact for dalbavancin was heterogeneous but frequently generated savings (up to 2257.0 €). Early switching (within less than 11 days) was associated with savings (or lesser costs), with even greater benefits within 7 days of hospitalization. Patients who required a deep venous catheter as well as the most severe patients benefited the most from dalbavancin. Conclusion: Our study confirms that dalbavancin is associated with early discharge, which can offset its cost and generate savings. The greatest benefit is achieved with an early switch. [ABSTRACT FROM AUTHOR]

Background: Big data and real-world data (RWD) have been increasingly used to measure the effectiveness and costs in cost-effectiveness analysis (CEA). However, the characteristics and methodologies of CEA based on big data and RWD remain unknown. The objectives of this study were to review the characteristics and methodologies of the CEA studies based on big data and RWD and to compare the characteristics and methodologies between the CEA studies with or without decision-analytic models. Methods: The literature search was conducted in Medline (Pubmed), Embase, Web of Science, and Cochrane Library (as of June 2020). Full CEA studies with an incremental analysis that used big data and RWD for both effectiveness and costs written in English were included. There were no restrictions regarding publication date. Results: 70 studies on CEA using RWD (37 with decision-analytic models and 33 without) were included. The majority of the studies were published between 2011 and 2020, and the number of CEA based on RWD has been increasing over the years. Few CEA studies used big data. Pharmacological interventions were the most frequently studied intervention, and they were more frequently evaluated by the studies without decision-analytic models, while those with the model focused on treatment regimen. Compared to CEA studies using decision-analytic models, both effectiveness and costs of those using the model were more likely to be obtained from literature review. All the studies using decision-analytic models included sensitivity analyses, while four studies no using the model neither used sensitivity analysis nor controlled for confounders. Conclusion: The review shows that RWD has been increasingly applied in conducting the cost-effectiveness analysis. However, few CEA studies are based on big data. In future CEA studies using big data and RWD, it is encouraged to control confounders and to discount in long-term research when decision-analytic models are not used. [ABSTRACT FROM AUTHOR]

Background: Sars-Cov-2 is a novel corona virus associated with significant morbidity and mortality. Remdesivir and Dexamethasone are two treatments that have shown to be effective against the Sars-Cov-2 associated disease. However, a cost-effectiveness analysis of the two treatments is still lacking.Objective: The cost-utility of Remdesivir, Dexamethasone and a simultaneous use of the two drugs with respect to standard of care for treatment Covid-19 hospitalized patients is evaluated, together with the effect of Remdesivir compared to the base model but based on alernative assumptions.Methods: A decision tree for an hypothetical cohort of Covid-19 hospitalized patients, from an health care perspective and a one year horizon is specified. Efficacy data are retrieved from a literature review of clinical trials, whilst costs and utility are obtained from other published studies.Results: Remdesivir, if health care costs are related to the days of hospitalization, is a cost saving strategy. Dexamethasone is cost effective with an ICER of 5208/QALY, and the concurrent use of Remdesivir and Dexamethasone is the most favorable strategy for higher level of willingness to pay thresholds. Moreover, if Remdesivir has a positive effect on mortality the utility is three times higher respect to base case. Whereas, if health care costs are not related to the length of patient hospitalization Remdesivir has an ICER respect to standard of care of 384412.8/QALY gained, which is not cost effective. We also find that Dexaamethasone is cost effective respect to standard care if we compute the cost for live saved with an ICER of 313.79 for life saved. The uncertainty of the model parameters is also tested through both a one-way deterministic sensitivity analysis and a probabilistic sensitivity analysis.Conclusion: We find that the use of Remdesivir and/or Dexamethasone is effective from an economic standpoint. [ABSTRACT FROM AUTHOR]

Pharmaceuticals are priced uniformly by convention, but vary in their degree of effectiveness for different disease indications. As more high-cost therapies have launched, the demand for alternative payment models (APMs) has been increasing in many advanced markets, despite their well-documented limitations and challenges to implementation. Among policy justifications for such contracts is the maximization of value given scarce resources. We show that while uniform pricing rules can handle variable effectiveness in efficient markets, market inefficiencies of other kinds create a role for different value-based pricing structures. We first present a stylized theoretical model of efficient interaction among drug manufacturers, payers, and beneficiaries. In this stylized setting, uniform pricing works well, even when treatment effects are variable. We then use this framework to define market failures that result in obstacles to uniform pricing. The market failures we identify include: (1) uncertainty of patient distribution, (2) asymmetric beliefs, (3) agency imperfection by payer, (4) agency imperfection by provider, and (5) patient behavior and treatment adherence. We then apply our insights to real-world examples of alternative payment models, and highlight challenges related to contract implementation. [ABSTRACT FROM AUTHOR]

Prostate cancer (PC) is one of the major health problems of the male population. The most difficult is the treatment of metastatic castration-resistant prostate cancer (mCRPC), which is the main cause of mortality from PC. In the course of treatment of PC, it inevitably becomes refractory to castration, characterized by the growth of PSA and clinical signs of progression. Octreotidedepo, a representative of the synthetic analogue of somatostatin of prolonged action, has a therapeutic effect in patients with CRPC with a positive total response in the form of a decrease or stabilization of the PSA level, the drug has a favorable safety profile and is easily tolerated by patients. The economic benefit of Octreotide-depo is estimated in the article. Cost-effectiveness analysis has shown its high clinical and economic efficiency. After the establishment of CRPC, first of all, the preparation Oсtreotide-depo will allow to postpone the start of chemotherapy with docetaxel or hormonal therapy of the 2nd line by 7–8 months and save up to 17% of funds in the first year of treatment.

Context: Surgical site infections are frequently observed despite the availability of national guideline on surgical antimicrobial prophylaxis (SAP). These infections increase patient morbidity, mortality, and direct and indirect health-care costs. Open reduction internal fixation (ORIF) is a common orthopedic surgery for fracture. There is a paucity of Indian data on SAP in ORIF surgery. Aims: The present study was taken up aiming at the evaluation of appropriateness and pharmacoeconomics of SAP in ORIF based on the national guidelines. Subjects and Methods: One-year observational prospective cohort study was conducted among 412 participants, who underwent ORIF in the Department of Orthopedics in a Tertiary Care Hospital. Name, dose, route, timing, frequency, and duration of administration of prophylactic antimicrobials used were recorded. Statistical Analysis Used: Descriptive statistics were used wherever required. Results: The mean age of participants was 39.24 years, majority (60.92%) were male, and 49.52% had fracture of lower-limb bones. The appropriateness of preoperative SAP in terms of indication in ORIF, timing, and route of administration was 100%. Selection and dose of preoperative and postoperative antimicrobials were appropriate in only 13% of cases. Omission of intraoperative dose was appropriate in all participants. Duration of postoperative Antimicrobial agent administration was inappropriately long in all participants. None of the cases received completely appropriate regimen. Cost analysis showed the mean cost of SAP practiced in our hospital was eleven times higher than that with recommended SAP. Conclusions: Considering the inappropriateness of SAP practiced, monitoring of guideline implementation and awareness among health-care professionals are necessary to prevent SSI and to decrease economic burden on the patients.

Background: The cost of the medications plays a major role in patient compliance and positive therapeutic outcomes towards their affordability. Prescribing highly cost medicines may increase the chance of reducing the course of the treatment regimen. In the Indian Pharma market, the cost of medicines has a vast difference between different brands of the same drugs. Even though authorities like WHO, MCI made the guidelines to write the generic name of the drugs in the prescription, but still it not yet implemented effectively. Prescribing the lowest cost medicines to the patients is a vital part of the rational prescription. Materials and Methods: 200 prescriptions from the department of cardiology were collected from the Outpatient pharmacy of the tertiary care teaching hospital. Cost variation of an individual drug in INR (per 10 tablets) with the same strength and dosage form being manufactured by different pharmaceutical companies were analyzed by using the "current index of medical specialities" January to April 2019 edition and "CIMS application software". Results: The cost of the drugs manufactured by different pharmaceutical companies have vast differences. The tablet Prasugrel-5mg has a price variation of 2455.5%. (54INR -1380INR) followed by Azithromycin-500mg-1049.82% (57.40INR -660INR), Cefuroxime-250mg 1018.64% (59INR-660 INR). The drugs like Ranitidine-300mg (14.7INR-16.28INR), Aspirin-75mg [2.6INR-3.25INR], Gabapentin-100mg [45INR-57INR], Olmesartan 10mg [65.20INR-73.85INR], Ivabradine-5mg [153INR-216.45INR] have cost variation between 1-50%. Most of the drugs which are commonly used are having above 100% of cost variation. Conclusion: This study shows there is a huge cost variation among the different brands of the same drug. So the awareness is needed for rational prescription with the lowest cost to improve medication adherence by the patients. And also the government, pharmaceutical manufacturing companies, regulatory authorities, physician and the pharmacist has to work together in controlling the drug cost to improve the patient's drug compliance. [ABSTRACT FROM AUTHOR]

A pharmacoeconomic study is a comprehensive scientific and research activity, which should take into account specific characteristics of a research subject as well as nosology based on common methodological approaches of pharmacoeconomics,. The growing significance of the results obtained when performing pharmacoeconomic analysis involves higher requirements to the quality pharmacoeconomic studies, which is largely stipulated by the methodology used. The analysis of the features that have influence when conducting pharmacoeconomic studies has been studied as exemplified by chronic kidney disease. The aspects of the choice of effectiveness criteria for pharmacoeconomic analysis when performing the analysis of «cost-effectiveness», when analyzing «impact on the budget», have been described. It has been shown that the specificity of the analyzed disease is reflected at all stages of pharmacoeconomic studies: elaboration of study design, choice of performance criteria, determination of the research costs profile, implementation of particular methods of pharmacoeconomic analysis, interpretation of the results of pharmacoeconomic evaluation. It was found that pharmacoeconomic analysis of renal replacement therapy in patients with chronic kidney disease is the most specific.

This study aimed to conduct a pharmacoeconomic evaluation of the treatment of diabetic patients in a charitable hospital. A retrospective study was carried out for a period of 8 months from August 2016-March 2017. Patients admitted in general medicine with age above 18 years diagnosed with diabetes and on at least one antidiabetic medication. Patient's data was collected by referring patient's treatment charts and case notes, hospital billing system, medical record department and hospital pharmacy department. In this study, the direct medical cost was analysed. A total number of 212 diabetic patients were enrolled in the study of which 131 (61.8 %) were males, and 81 (38.2 %) were females. It was found that 67 % of patients had comorbid conditions and 33 % without any complications. One hundred and eleven (52.35 %) patients were prescribed a combination of insulin and oral hypoglycaemic agents, 66 (31.13 %) patients received insulin alone and 35 (16.50 %) patients received only oral hypoglycaemic agents. The annual median cost incurred for the management of diabetes with and without complications per patient was INR 14 959.60 and INR 8619.90, respectively. The study revealed that the costs for males with and without diabetes complications were INR 21 095 and INR 11 644.70, respectively. The corresponding figure for females was INR 12 030 and INR 8515. The cost incurred for nephropathy and peripheral circulatory co-morbidities was the highest (INR 53 795.50), whereas the cost for managing diabetes with nephropathy, neuropathy, retinopathy and peripheral circulatory comorbidities was INR 37 888.00. The study concluded that the cost of treatment could be drastically reduced by early identification and treatment of diabetes thereby preventing the development of diabetes-associated comorbidities. [ABSTRACT FROM AUTHOR]

Background and Aims : Rising health costs are challenging anesthesiologists to search for cost-effective anesthetic techniques. We conducted a study to estimate variable cost per case and cost of drug wastage as percentage of total drug cost associated with different modalities of general anesthesia (GA). Material and Methods: This prospective study was carried out after approval by institutional ethical committee in 258 adult patients aged 18–60 years of either sex, American Society of Anesthesiologists physical status I or II, with a surgical duration of 1–4 hours, posted for elective surgery under GA with endotracheal intubation. At the end of surgery, total utilization of each drug, anesthetic gases, and consumables were noted and remaining drug was regarded as wastage. Cost was recorded as per maximum retail price for that particular brand in the market at start of study and total cost was calculated. For purpose of analysis, cases were divided into low flow sevoflurane, high flow sevoflurane, high flow isoflurane, low flow isoflurane, and total intravenous anesthesia (TIVA). Results: The mean variable cost was highest with TIVA (₹2713.82 ± 509.57) and lowest with low flow isoflurane (₹1981.62 ± 335.03; P < 0.001). Drug wastage was 13.1% overall, with highest in low sevoflurane group and lowest in TIVA. Conclusion: Low flow anesthesia with isoflurane is more cost-effective as compared to high flow techniques and TIVA even for short duration surgeries. Rational use of drugs and consumables and minimizing wastage can further reduce anesthesia costs. [ABSTRACT FROM AUTHOR]

Objectives: The only recommended pharmacological treatments for specific dementias are donepezil, galantamine, rivastigmine, and memantine (recommended drugs, RD). However, other drugs without recommendations (not recommended drugs, NRD) are often used to treat patients with cognitive impairment (CI) in Argentina. The INSSJyP is the largest health insurance in Argentina. The objective of this study is to analyze the prescription pattern, cost, and implications of NRD used for the treatment of CI in the INSSJyP.Materials: This is a retrospective, population-based study of the INSSJyP outpatients' prescriptions database for drugs usually prescribed for CI during 2015. These data were compared with the same database in 2009. The number of "prescriptions" always refers to dispensed packages.Results: A total of 3 255 438 packages of drugs usually indicated for CI were prescribed during 2015: 1 912 476 packages of RD (59%) and 1 342 962 packages of NRD (41%).Comparing the results with those obtained in 2009, there is a 148% gross increase in the prescription of both RD and NRD for CI, although the rates/1000 affiliates/year show a lesser rise for NRD (70.1%) compared to RD (103.9 %).The expenditure on CI drugs prescribed during 2015 was 77 million USD. NRD cost represented approximately 20 million USD.Conclusion: Inappropriate drug use increases health costs in developing countries. We found a high number of patients with a probable diagnosis of CI treated with NRD. It is extremely relevant that all the healthcare professionals can update their knowledge and modify behavioral insights about appropriate prescription for specific dementias. [ABSTRACT FROM AUTHOR]

Drug cost, health care costs, generic Drugs, prescription drugs, health policy, pharmacoeconomics, Sovaldi, Harvoni, linezolid, truvada, medical ethics, cost-benefit analysis, practice guidelines. [Extracted from the article]

Objective: clinical and economic analysis of including of secukinumab (SEC) in the essential drug list (EDL) and Federal Reimbursement (ONLS) to ensure the availability of the drug to patients with ankylosing spondylitis (AS) at the expense of health. Material and methods. A budget impact analysis was used. Only cost of drugs was taken into account. Adalimumab (ADA) and infliximab (INF) were used for comparison. Basing on the calculated number of patients treated with these drugs in 2016 from the budget of health care system impact on 3-years budgets of State Guarantee Program (SGP) and ONLS was analyzed. The analysis scenario was based on the replacement of ADA and INF with SEC. Results. Expenditure of a 3-year therapy cycle with SEC amounted to 1.703 million rubles, which was 41.6% less than that with ADA (2.917 million rubles) and 57.7% less than that with INF (4.022 million rubles) in the same period. The budget impact analysis to estimate the cost of SGP demonstrated that the use of SEC during a 3-year period would result in a reduction in expenses by 51.2% (saving of 3.8 billion rubles). When SEC is used within the ONLS, its cost during 3 years will be reduced by 51.9% (savings of 1.9 billion rubles). Conclusion. The inclusion of SEC in EDL and ONLS is appropriately and economically justified, as it enables a substantial reduction in the expenditure of health care budgets to treat patients with AS and to maintain the clinical effectiveness of therapy.

Introduction: Diabetes mellitus is a chronic disorder requiring life-long treatment to maintain the blood glucose levels. The total economic cost of diabetes was $245 billion in 2012. In India, one spends approximately 20% of their income for the treatment of diabetes per year which affects the patients’ compliance and there is also a huge discrepancy in the cost of drugs. Aim: To study the pattern of oral hypoglycaemic agents’ usage among Type-2 diabetic patients and also compare their costanalyses, to determine the percentage cost variation and to arrive at the economical oral hypoglycaemic drugs. Materials and Methods: This observational cross-sectional study was conducted among Type-2 diabetic patients attending the diabetology department over a period of three months in a tertiary care teaching hospital. Three hundred prescriptions (both old and new cases) were used to extract information like number of oral hypoglycaemic agents prescribed, their strength, duration, price, generic or branded and manufacturer’s details. The percentage cost variation was calculated using the cost difference between the highest and lowest priced brand. Data were analysed using chi-square test (to elicit the association between duration of treatment and mono/combination therapy) using SPSS Software 20.0 version. Results: Majority of the patients (59.3%) were above 50 years of age with female preponderance (54%). Branded drugs were prescribed to 87.7% of patients. 85.3% received combination therapy (Metformin, Glimepiride, Gliptins) and 14.7% received monotherapy (Metformin, Teneligliptin). Commonly used monotherapy was metformin with cost of about 2.75 INR/day and the combination therapy was teneligliptin and metformin with a minimum cost of 13.31 INR/day. The most economical combination therapy was found to be of glimepiride and metformin with cost of 8.25 INR/day. Percentage cost variation of different brands ranged from 5.88% to 177.57%. There was a significant association between combination therapy and disease duration greater than five years (p

Context: Surgical site infections are frequently observed despite the availability of national guideline on surgical antimicrobial prophylaxis (SAP). These infections increase patient morbidity, mortality, and direct and indirect health-care costs. Open reduction internal fixation (ORIF) is a common orthopedic surgery for fracture. There is a paucity of Indian data on SAP in ORIF surgery. Aims: The present study was taken up aiming at the evaluation of appropriateness and pharmacoeconomics of SAP in ORIF based on the national guidelines. Subjects and Methods: One-year observational prospective cohort study was conducted among 412 participants, who underwent ORIF in the Department of Orthopedics in a Tertiary Care Hospital. Name, dose, route, timing, frequency, and duration of administration of prophylactic antimicrobials used were recorded. Statistical Analysis Used: Descriptive statistics were used wherever required. Results: The mean age of participants was 39.24 years, majority (60.92%) were male, and 49.52% had fracture of lower-limb bones. The appropriateness of preoperative SAP in terms of indication in ORIF, timing, and route of administration was 100%. Selection and dose of preoperative and postoperative antimicrobials were appropriate in only 13% of cases. Omission of intraoperative dose was appropriate in all participants. Duration of postoperative Antimicrobial agent administration was inappropriately long in all participants. None of the cases received completely appropriate regimen. Cost analysis showed the mean cost of SAP practiced in our hospital was eleven times higher than that with recommended SAP. Conclusions: Considering the inappropriateness of SAP practiced, monitoring of guideline implementation and awareness among health-care professionals are necessary to prevent SSI and to decrease economic burden on the patients. [ABSTRACT FROM AUTHOR]

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Introduction: Diabetes mellitus is a chronic disorder requiring life-long treatment to maintain the blood glucose levels. The total economic cost of diabetes was $245 billion in 2012. In India, one spends approximately 20% of their income for the treatment of diabetes per year which affects the patients' compliance and there is also a huge discrepancy in the cost of drugs. Aim: To study the pattern of oral hypoglycaemic agents' usage among Type-2 diabetic patients and also compare their costanalyses, to determine the percentage cost variation and to arrive at the economical oral hypoglycaemic drugs. Materials and Methods: This observational cross-sectional study was conducted among Type-2 diabetic patients attending the diabetology department over a period of three months in a tertiary care teaching hospital. Three hundred prescriptions (both old and new cases) were used to extract information like number of oral hypoglycaemic agents prescribed, their strength, duration, price, generic or branded and manufacturer's details. The percentage cost variation was calculated using the cost difference between the highest and lowest priced brand. Data were analysed using chi-square test (to elicit the association between duration of treatment and mono/combination therapy) using SPSS Software 20.0 version. Results: Majority of the patients (59.3%) were above 50 years of age with female preponderance (54%). Branded drugs were prescribed to 87.7% of patients. 85.3% received combination therapy (Metformin, Glimepiride, Gliptins) and 14.7% received monotherapy (Metformin, Teneligliptin). Commonly used monotherapy was metformin with cost of about 2.75 INR/day and the combination therapy was teneligliptin and metformin with a minimum cost of 13.31 INR/day. The most economical combination therapy was found to be of glimepiride and metformin with cost of 8.25 INR/day. Percentage cost variation of different brands ranged from 5.88% to 177.57%. There was a significant association between combination therapy and disease duration greater than five years (p<0.01). Conclusion: It was observed from this study that there is a wide variation in cost of different drugs. Hence, it is necessary for regulatory authorities to regulate the wide variation that exists among the drug cost. This study will be useful to the clinicians to choose most economic drugs without change in quality of treatment in diabetic patients. Metformin is the most commonly used economic monotherapy and combination therapy was Glimepiride+Metformin. [ABSTRACT FROM AUTHOR]

In this work we estimated the budgetary impact of the samples produced by the biobank of the "Instituto Nacional de Cancerología" (BT-INCan) to set a recuperation fee from the perspective of the Health Ministry of Mexico. The study is an observational retrospective review of the direct medical costs (DMCs) of the processes involved in cryopreservation of the samples collected, on a per sample basis, including materials, laboratory tests, personnel, and administrative costs. Materials and labor costs were determined by information collected from the BT-INCan. DMCs were provided depending on the type of sample: plasma, tissue and biopsy; they were calculated according to the process required to preserve them. Sensitivity analysis was performed using bootstrap. Recuperation costs ranged from 130 to 155 USD. Costs were considered on a 5-year time frame for the maintenance per sample, which is the average time that a sample is kept in the BT-INCan. The cost analysis is perceived as an approximation to the most adequate recuperation fee per sample needed to guarantee the correct development of the BT-INCan. This work provides a basis and valuable information about costs, to enable several health institutions to strategically plan and manage a biobank or even motivate to establish their own biobank. [ABSTRACT FROM AUTHOR]

the research work was conducted for the pharmacoeconomic evaluation and optimization of fluid therapy for patients, suffering from peritonitis disease. Reamberin, Ringer's solution, Plasma-Lyte and Sterofundin drugs were compared during the analysis. A cost analysis, cost-effectiveness analysis, budget impact analysis and sensitivity analysis were conducted. The survival rate of patients was used as the effectiveness criterion. The CER amounted to 440,759 roubles for Reamberin, 543,991 roubles for the Ringer's solution, 529,498 roubles for Plasma-Lyte and 502,842 roubles for Sterofundin. The analysis showed that the scheme of peritonitis therapy included Reamberin is the dominant. The « budget impact» analysis was carried out from the perspective of health care facilities. The budget impact analysis shown that the 100% switching patients to Reamberin saves respectively: from the Ringer’s solution 5,654,594 roubles, from Plasma-Lyte 2,215,117 roubles and from Sterofundin 2,218,280 roubles. For the interpretation of the survey data for a particular health facility pharmacoeconomic simulation model was designed.

Cost of illness is one of the basic methods of pharmacoeconomical estimation and in substance consists in calculation of the expenses connected any given disease, without notice of effectiveness of therapy. Cost of illness analysis is a useful tool for effective planning of distribution of economical recourses of public health services at all levels of management for various diseases. Despite of seeming to the nonprofessional in this sphere simplicity of carrying out of the cost of illness researches, the methodology of the given analysis represents difficult structure of consecutive actions, from a choice and observance of which the final results depends, and the choice of a source of the data often causes difficulties

Objective: To identify, evaluate, and characterize the variety, quality, and intent of the health economics and outcomes research studies being conducted in SAARC (South Asian Association for Regional Cooperation) nations. Methods: Studies published in English language between 1990 and 2015 were retrieved from Medline databases using relevant search strategies. Studies were independently reviewed as per Cochrane methodology and information on the type of research and outcomes were extracted. Quality of reporting was assessed. Results: Of the 2638 studies screened from eight SAARC nations, a total of 179 were included for review (India = 140; Bangladesh = 12; Sri Lanka = 8; Pakistan = 7; Afghanistan = 5; Nepal = 4; Bhutan = 2; Maldives = 1). The broad study categories were cost-effectiveness analyses (CEAs =76 studies), cost analyses (35 studies), and burden of illness (BOI=26 studies). The outcomes evaluated were direct costs, indirect costs, and incremental cost-effectiveness ratio (ICER), quality-adjusted life-years (QALYs), and disability-adjusted life-years (DALYs). Cost of medicines, consultation and hospital charges, and monitoring costs were assessed as direct medical costs along with non-direct medical costs such as travel and food for patients and caregivers. The components of indirect costs were loss of income of patients and caregivers and loss of productivity. Quality of life (QoL) was assessed in 48 studies. The most commonly used instrument for assessing QoL was the WHOQuality of Life BREF (WHOQOL-BREF) questionnaire (76%). The Quality of Health Economic Studies (QHES) score was used for quality assessment of full economic studies (44 studies). The mean QHES score was 43.76. Conclusion: This review identifies various patterns of health economic studies in eight SAARC nations. The quality of economic evaluation studies for health care in India, Bangladesh, Sri Lanka, Pakistan, Afghanistan, Nepal, Bhutan, and Maldives needs improvement. There is a need to generate the capacity of researchers to undertake quality economic evaluations as well as an orientation of the policy makers so that there is a demand for such studies as well as a scope for its use in policy making. [ABSTRACT FROM AUTHOR]

Objective: Asthma as the most common chronic disease in childhood reduces the quality of life of children and their families. We aimed to estimate the cost of managing childhood asthma in Iran and to examine its variability depending on asthma severity. Methods: The cost of asthma was estimated by building a cost assessment model regarding the factors that influence the cost of asthma in children including age and sex distribution, prevalence of disease severity, level of resource utilization depending on disease severity (3 groups of controlled, partly controlled and uncontrolled were defined). The model was comprised of both medical (cost of medication, physician visit and respiratory tests) and non-medical (transportation and hoteling) costs. Furthermore, the average family income in each category was figured and the share of asthma managing costs from the average income was calculated in different groups. Findings: According to model, the total cost of childhood asthma in Iran was around 516.5 million dollars. Moreover, direct medical cost represented 49% of the total costs, among which 66% accounting for medication cost. Direct non-medical costs were estimated 51% with the majority (93%) expended on transportation. In addition, the mean annual cost per child was approximately 466 dollars. In addition, the results indicate the vast majority of patients (46%) are categorized in the uncontrolled group. Conclusion: The cost of childhood asthma in Iran is extremely high comparing to the average income of Iranian families in all categories of asthma severity. Considering the high amount of transportation cost, the accessibility of asthma treatment does not appear to be acceptable. The major source of costs is found to be related to medicine expenditure. Since it has been proven that using medicine does not necessarily result in a well-controlled disease status, alternative approaches should be considered in asthma management.

Background: In India the incidence of end stage renal disease (ESRD) is increasing day by day and the option for the treatment of ESRD is dialysis or transplantation. In the present scenario, due to the cost of treatment normal people can afford only hemodialysis rather than transplantation. Since the cost of hemodialysis differs across the country, research is needed to evaluate its exact cost. Aim: This study is to analyze the healthcare cost of hemodialysis in a private hospital of South India. Materials and Methods: This is a prospective, observational study carried out in a tertiary care hospital. Patients who are undergoing routine hemodialysis in this hospital were selected for the study. Patient data as well as cost details were collected for a period of six months. Thirty patients were selected for the study and a total of 2160 dialysis sessions were studied. Patient perspective was taken for the analysis of cost. Both direct and indirect costs were analyzed. This includes cost of dialysis, investigations, erythropoietin, food, transportation, lost wages etc. Socioeconomic status of the patient was also studied. Result: The total cost per session was found to be around Rs. 4500. Fifty six percent contributes direct medical cost whereas 20% contributes direct non medical cost. Twenty four percent cost was due to indirect costs. Since the patients are paying from their own pocket, only the upper or upper middle class patient can undergo hemodialysis regularly. Conclusion: These findings are important to find out the impact of cost of hemodialysis on patients suffering from ESRD. Further studies related to costs and outcome, otherwise known as pharmacoeconomic studies, are needed to analyze the pros and cons of renal replacement therapy and to improve the quality of life of ESRD patients. Thus pharmacoeconomical studies are needed to realize that government has to take initiative to provide insurance or reimbursement for the common people.

Introduction: Despite the awareness about the increasing rates of Clostridium difficile infection (CDI) and the economic burden arising from its management (prolonged hospitalization, laboratory tests, visits, surgical treatment, environmental sanitation), few studies are available in Italy on the economic costs directly attributable to the CDI. The Florence health care system has designed a study with the aim of describing the costs attributable to the CDI and defines the incremental economic burden associated with the management of this complication. Methods: We conducted a retrospective study in five hospitals of the Florence health care system. The enrolled population included all patients who were hospitalized during the year 2013 with a diagnosis of CDI. Of the 187 total cases reported in 2013, 69 patients were enrolled, for whom the main cause of hospitalization was directly attributable to CDI. Results: We enrolled 69 patients (19 males and 50 females), with a mean age of 82.16 years (minimum 46 to maximum 98). The total number of hospitalization days observed was 886 (12.8 per patient on average). The data from this study show that the mean total incremental cost for a patient with CDI was €3,270.52 per year. The hospital stay length is the most significant cost parameter, having the largest influence on the overall costs, with an impact of 87% on the total cost. The results confirm the costs for the management of CDI in five hospitals of the Florence health care system are in line with data from the international literature. Conclusion: The economic impact of CDI is most evident in the extension of the duration of hospitalization and emergency recurrences requiring new therapeutic options with the need to develop and implement new diagnostic and therapeutic algorithms in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Recent advances in Hepatitis C therapeutics offer the possibility of cure but will be expensive. The cost of treatment may be partially offset by the avoidance of advanced liver disease. We performed a micro-costing study of the ambulatory healthcare utilisation of patients with Hepatitis C supplemented with inpatient diagnosis related group costs.Methods: The staff utilisation costs associated with a Hepatitis C ambulatory visit were measured and combined with the costs of investigations to establish a mean cost per consultation. An annualised estimate of cost was produced by multiplying this by the number of consultations accessed, stratified by degree of liver impairment. Inpatient costs were established by identifying the number of inpatient episodes and multiplying by Irish diagnosis related group costs. Non-parametric bootstrapping was performed to derive mean and 95%CI values.Results: Two hundred and twenty-five patients were identified. The cost of an outpatient medical review was €136 (€3.60 SD). The cost of a Hepatitis C nursing review was €128 (€7.30 SD). The annual mean costs of care were as follows (95%CI): Mild €398 (€336, €482), Moderate €417(€335, €503), Compensated cirrhosis €1790 (€990, €3164), Decompensated cirrhosis €8302 (€3945, €14,637), Transplantation Year 1 €137,176 (€136,024, €138,306), Transplantation after Year 1 €5337 (€4942, €5799), Hepatocellular carcinoma €21,992 (€15,222, €29,467), Sustained virological response €44 (€16, €73).Conclusions: The direct medical cost associated with Hepatitis C care in Ireland is substantial and increases exponentially with progression of liver disease. The follow-up costs of patients with a sustained virological response in this cohort were low in comparison to patients with chronic infection. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that pharmaceutical care can result in favorable clinical outcomes in human immunodeficiency virus (HIV)-infected patients, however, few studies have assessed the economic impact. The objective of this study was to evaluate the clinical and economic impact of pharmaceutical care of HIV-infected patients. Methods: A controlled ambispective study was conducted in Brazil from January 2009 to June 2012. Patients were allocated to either intervention or control group. The control group was followed according to standard care while the intervention group was also followed by a pharmacist at each physician appointment for one year. Effectiveness outcomes included CD4+ count, viral load, absence of co-infections and optimal immune response, and economic outcomes included expenses of physician and pharmaceutical appointments, laboratory tests, procedures, and hospitalizations, at six months and one year. Results: Intervention and control groups included 51 patients each. We observed significant decreases in total pharmacotherapy problems during the study. At six months, the intervention group contained higher percentages of patients without co-infections and of patients with CD4+ >500 cells/mm³. None of the differences between intervention and control group considering clinical outcomes and costs were statistically significant. However, at one year, the intervention group showed higher percentage of better clinical outcomes and generated lower spending (not to procedures). An additional health care system daily investment of US$1.45, 1.09, 2.13, 4.35, 1.09, and 0.87 would be required for each additional outcome of viral load <50 copies/ml, absence of co-infection, CD4+ >200, 350, and 500 cells/mm3, and optimal immune response, respectively. Conclusion: This work demonstrated that pharmaceutical care of HIV-infected patients, for a one-year period, was able to decrease the number of pharmacotherapy problems. However, the clinical outcomes and the costs did not have statistical difference but showed higher percentage of better clinical outcomes and lower costs for some items. [ABSTRACT FROM AUTHOR]

What is known and objective The increase in numbers of patients requiring oral anti-coagulation testing in outpatient clinics has focused attention on alternative flexible systems of anti-coagulation management. One option is pharmacist led patient self-testing ( PST) of international normalised ratio ( INR) levels. PST has demonstrated improvements in anti-coagulation control, but its cost-effectiveness is inconclusive. This study reports the first cost-effectiveness evaluation of a randomized controlled trial of an automated direct-to-patient expert system, enabling remote and effective management of patients on oral anti-coagulation therapy. Methods We conducted an economic evaluation alongside a randomised controlled trial investigating a pharmacist led PST method. The primary outcome was to determine the cost effectiveness of PST in comparison with usual care (management in a hospital based anti-coagulation clinic). Long term anti-coagulation patients were recruited to a 6 month cross over study between PST and routine care in an anti-coagulation clinic. Economic evaluation was from the healthcare payer perspective. Results and discussion On a per patient basis over a 6 month period, PST resulted in an incremental cost of €59·08 in comparison with routine care. Patients achieved a significantly higher time in therapeutic range ( TTR) during the PST arm in comparison with routine care, (72 ± 19·7% vs. 59 ± 13·5%). Overall cost of managing a patient through pharmacist supervised PST for a 6 month period is €226·45. Additional analysis of strategies from a societal perspective indicated that PST was the dominant strategy. What is new and conclusion Pharmacist led patient self-testing is a viable method of management. It provides significant increases in anti-coagulation control for a minimal increase in cost. [ABSTRACT FROM AUTHOR]

Our objective was to evaluate a pharmacist-delivered comprehensive medication management ( CMM) service provided to patients with psychiatric disorders. We conducted a retrospective review and analysis of medication-related data, and a return on investment cost analysis. The project consisted of 154 patients with psychiatric disorders who were referred to the CMM service by physicians, therapists, case managers, friends, or family, and were seen by the service between April 2011 and July 2013. CMM evaluates a patient's medications to ensure that they are appropriate, effective, safe, and convenient. Patients were seen by pharmacists trained in CMM and the treatment of mental illnesses, including one board-certified psychiatric pharmacist. All medications were reviewed including prescriptions, over-the-counter medications, and nutritional supplements. The patients' medication-related concerns, goals of treatment, vital signs, and laboratory studies were reviewed. Drug therapy problems such as adverse reactions, unnecessary medications, excessive doses, and poor medication adherence were identified, and written recommendations were mailed to patients and physicians within 1 week. Patients were offered follow-up in 4-6 weeks and were seen as many times as needed to resolve drug therapy problems. The 154 patients completed 256 CMM visits. A mean of 10.1 medical and psychiatric conditions and 13.7 medications/person were assessed. A mean of 5.6 drug therapy problems/patient were identified. A total net cost savings was estimated to be $90,484.00, with a mean savings of $586.55/patient. The cost of providing the service was estimated at $32,185.93. The return on investment was estimated to be 2.8; thus for every dollar spent on providing the service, $2.80 was estimated to be saved. Patients with mental illnesses may benefit from pharmacist-delivered CMM to help resolve drug therapy problems. Medication management may improve clinical outcomes and reduce costs. In addition, patients valued the opportunity to review their medications with a pharmacist. [ABSTRACT FROM AUTHOR]

Abstract: Buprenorphine-medication assisted therapy (B-MAT) is an effective treatment for opioid dependence, but may be considered cost-prohibitive based on ingredient cost alone. The purpose of this study was to use medical and pharmacy claims data to estimate the healthcare service utilization and costs associated with B-MAT adherence among a sample of opioid dependent members. Members were placed into two adherence groups based on 1-year medication possession ratio (≥0.80 vs. <0.80). The B-MAT adherent group incurred significantly higher pharmacy charges (adjusted means; $6,156 vs. $3,581), but lower outpatient ($9,288 vs. $14,570), inpatient ($10,982 vs. $26,470), ER ($1,891 vs. $4,439), and total healthcare charges ($28,458 vs. $49,051; p <0.01) compared to non-adherent members. Adherence effects were confirmed in general linear models. Though B-MAT adherence requires increased pharmacy utilization, adherent individuals were shown to use fewer expensive health care services, resulting in overall reduced healthcare expenditure compared to non-adherent patients. [Copyright &y& Elsevier]

Background: In India the incidence of end stage renal disease (ESRD) is increasing day by day and the option for the treatment of ESRD is dialysis or transplantation. In the present scenario, due to the cost of treatment normal people can afford only hemodialysis rather than transplantation. Since the cost of hemodialysis differs across the country, research is needed to evaluate its exact cost. Aim: This study is to analyze the healthcare cost of hemodialysis in a private hospital of South India. Materials and Methods: This is a prospective, observational study carried out in a tertiary care hospital. Patients who are undergoing routine hemodialysis in this hospital were selected for the study. Patient data as well as cost details were collected for a period of six months. Thirty patients were selected for the study and a total of 2160 dialysis sessions were studied. Patient perspective was taken for the analysis of cost. Both direct and indirect costs were analyzed. This includes cost of dialysis, investigations, erythropoietin, food, transportation, lost wages etc. Socioeconomic status of the patient was also studied. Result: The total cost per session was found to be around Rs. 4500. Fifty six percent contributes direct medical cost whereas 20% contributes direct non medical cost. Twenty four percent cost was due to indirect costs. Since the patients are paying from their own pocket, only the upper or upper middle class patient can undergo hemodialysis regularly. Conclusion: These findings are important to find out the impact of cost of hemodialysis on patients suffering from ESRD. Further studies related to costs and outcome, otherwise known as pharmacoeconomic studies, are needed to analyze the pros and cons of renal replacement therapy and to improve the quality of life of ESRD patients. Thus pharmacoeconomical studies are needed to realize that government has to take initiative to provide insurance or reimbursement for the common people. [ABSTRACT FROM AUTHOR]

Background: Decision analysis (DA) is commonly used to perform economic evaluations of new pharmaceuticals. Using multiples of Malaysia's per capita 2010 gross domestic product (GDP) as the threshold for economic value as suggested by the World Health Organization (WHO), DA was used to estimate a price per dose for bevacizumab, a drug that provides a 1.4-month survival benefit in patients with metastatic colorectal cancer (mCRC). Methods: A decision model was developed to simulate progression-free and overall survival in mCRC patients receiving chemotherapy with and without bevacizumab. Costs for chemotherapy and management of side effects were obtained from public and private hospitals in Malaysia. Utility estimates, measured as quality-adjusted life years (QALYs), were determined by interviewing 24 oncology nurses using the time trade-off technique. The price per dose was then estimated using a target threshold of US$44 400 per QALY gained, which is 3 times the Malaysian per capita GDP. Results: A cost-effective price for bevacizumab could not be determined because the survival benefit provided was insufficient According to the WHO criteria, if the drug was able to improve survival from 1.4 to 3 or 6 months, the price per dose would be $567 and $1258, respectively. Conclusion: The use of decision modelling for estimating drug pricing is a powerful technique to ensure value for money. Such information is of value to drug manufacturers and formulary committees because it facilitates negotiations for value-based pricing in a given jurisdiction. [ABSTRACT FROM AUTHOR]