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Objective: In Malaysia, there is now a dearth of recommendations pertaining to the priority of biologic treatments for the effective management of psoriasis, given the multitude of available therapeutic alternatives. Present analysis reports results of a cost-effectiveness model that determines the most optimal arrangement of biologic treatments, with a particular focus of adding biosimilars to the existing treatment pathway for psoriasis in Malaysia. Methods: A Markov model was developed to compare the cost effectiveness of various biologic sequential treatments in a hypothetical cohort of moderate to severe psoriasis patient in Malaysia over a lifetime horizon. The model simulated the progression of patients through three lines of active biologic therapy, before transitioning to best supportive care. Costs and effects were discounted annually at a rate of 3%. Results: First line secukinumab has produced lowest incremental cost effectiveness ratios (ICERs) when compared to first line systemic [ICERs value; US$152,474 (first set analysis) and US$110,572 (second set analysis)] and first line phototherapy [ICERs value; US$147,057 (first set analysis) and US$107,616 (second set analysis)]. However, these values were slightly higher than the Malaysian based threshold of three times gross domestic product per capita, US$104,337. A 40% reduction in the unit costs of reference biologics renders most of the evaluated treatment sequences cost-effective. Conclusion: Adding biosimilar to the current treatment sequence could achieve cost savings ranging from 4.3% to 10.8% without significant loss of effectiveness. Given the significant impact of comorbidities and the resulting decline in quality of life among individuals with psoriasis, it may be justifiable to establish a threshold of up to US$184,000 per quality-adjusted life year (QALY) for the provision of therapies in the context of Malaysia. [ABSTRACT FROM AUTHOR]

In this paper, we historically examine the market for Factor VIII concentrate, a collection of blood products used in the treatment of hemophilia A. With the introduction of HIV-1 into the U.S. blood supply, a majority of American hemophiliacs became infected with the virus. In response to contamination, the pharmaceutical manufacturers producing Factor VIII concentrate developed highly purified products which were introduced in the late 1980s at four to five times the price of the older, intermediate purity products. These new products are highly valuable in protecting the 30% of hemophiliacs who are HIV-1 seronegative; however, for those individuals previously infected by the virus, the extra benefit of the more costly products was questionable at the time they were first introduced. We postulate that there has been some level of industry coordination among the producers of Factor VIII concentrates to supply only the more expensive, highly purified products even though there appeared to be significant demand for the intermediate purity products by HIV-1 infected hemophiliacs. We develop and present a model that is useful for testing an inter-product collusion hypothesis. Further, we hypothetically discuss the model's implications and develop some public health policy options that might improve the competitive performance of the market. Key words - hemophilia, Factor VIII, collusion, pharmaceuticals

Recently there have been a number of court cases over the decision to remove life-sustaining medical treatment from critically ill patients. This is only likely to increase in prevalence as the baby boomer population begins to reach the age of 65. This paper explores how wider use of advance directives could bring the competing concerns of clinical ethics, religion, and economics into better alignment so as to avoid many of the legal battles currently being witnessed. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the viability of personal support homes - a policy concept that reduces alternative level of care (ALC) days in Ontario hospitals. It allows people to leverage their empty bedrooms to temporarily house patients awaiting hospital discharge., Method: Data from the Municipal Property Assessment Corporation are used to map geographic supply of empty bedrooms, and Ontario Ministry of Health administrative data are used to assess potential demand., Results: By remunerating certified homeowners $120-150/day, this concept could help decrease ALC patient days by 20% and save the province $1.13-1.95 billion in foregone hospital construction along with relieving current system pressures., Conclusion: As part of a multifaceted policy solution to ALC, this concept is particularly suited for rural/remote locations where excess bedroom supply per capita is the highest., (Copyright © 2021 Longwoods Publishing.)

Social capital, a resource arising from the social interaction among individuals, may be a determinant of medical care use. This study explored the interaction between community- and individual-level social capital and immigrant status on the propensity and frequency of physician visits. The results showed that community social capital, as measured by the Petris Social Capital Index, was not significant in any of the analyses. However, a sense of belonging to the local community tended to decrease the number of doctor visits made by immigrants, while tangible social support increased and affection decreased the frequency of GP consultations by non-immigrants. Further research is required to determine which types of social capital affect utilization of different health services. These findings also highlight the importance of being aware of potential interactions between the formal and informal components of the healthcare system., (Copyright © 2012 Longwoods Publishing.)

In 1997, Ontario implemented a competitive bidding process for purchasing home care services, with the twin objectives of lowering costs and increasing service quality. The authors of this study performed regression analyses to ascertain the relationship between measures of competition, profit status of providers and nursing wages for community-based RNs and LPNs between 1995/1996 and 2000/2001. Using the Herfindahl-Hirschman Index as a measure of competition, we observed that only RN wages significantly increased as competition in home care increased. Furthermore, for-profit agencies paid significantly lower RN wages than their not-for-profit counterparts. By contrast, LPN wages declined over the sample period and did not differ markedly across provider types. The relative distribution of for-profit and not-for-profit agencies changed dramatically over the study period, with large increases in the number and volume of for-profit contracts. The results indicate that (a) greater competition in the home care sector resulted in upward pressure on RN wages independent of the profit status of the provider and (b) the increase appears to have been constrained by the increased presence of for-profit providers over the study period. The results highlight the role of profit status in provider behaviour, even in the context of publicly funded home care services. This finding has implications for both provider mix and the remuneration of nurses., (Copyright © 2009 Longwoods Publishing.)