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Major depressive disorder (MDD) represents a sizable economic burden in Spain. Pharmacogenetic (PGx) screening to guide the choice of antidepressant medication (ADM) in MDD patients yields higher response and remission rates, which could reduce both healthcare and indirect costs. We built a cost-effectiveness probabilistic Markov model with microsimulation using Tree Age Pro 2022, simulating a patient cohort from the SNHS starting ADM for MDD, and comparing PGx screening before starting ADM versus no screening (No PGx). We carried out a probabilistic sensitivity analysis using the Monte Carlo simulation with microsimulation, set for 1000 iterations and 1000 microsimulation trials, both from societal and healthcare provider perspectives, for a time horizon of 3 years. From a societal perspective, the model estimated a mean cost of 3172.85€ and effectiveness of 2.64 quality-adjusted life years (QALYs) for the No PGx strategy, and a mean cost of 1687.02€ and effectiveness of 2.84 QALYs for the PGx strategy. The mean ICER was −7820.56 €/QALY. From a healthcare provider perspective (no indirect costs considered), the mean cost was 662.62€ for the No PGx strategy, and 446.60€ for the PGx strategy. The mean ICER was −1130.16 €/QALY. The heterogeneity of input data from the literature, the need for assumptions of homogeneous distribution of variables and events across population and time, and the inherent limitations of cost-effectiveness analysis should be considered. The model omits combined therapies (ADMs with mood stabilizers, antipsychotics, cognitive behavioral therapy...). PGx screening in MDD prior to ADM start is a dominant strategy in the SNHS. • Treatment failure rates in major depressive disorder are high and contribute to its economic impact • Pharmacogenetics-guided choice of antidepressants lower failure rates, which could reduce the associated economic burden • We analyzed the cost-effectiveness of this strategy with a Markov model • Microsimulation allows for a more accurate simulation of individual patients' characteristics • Pharmacogenetic screening when starting antidepressants is a dominant strategy [ABSTRACT FROM AUTHOR]

Objective: The aim of the current study was to evaluate the cost-effectiveness of serplulimab plus chemotherapy compared chemotherapy alone as first-line strategy for patients with ES-SCLC in China. Methods: A decision-analytic model that based on the Chinese health-care system perspective was conducted to evaluate the economic benefits for the two competing first-line treatment. The clinical survival and safety data were obtained from the ASTRUM-005 trial, cost and utility values were gathered from the local charges and previously published study. Both cost and utility values were discounted at an annual rate of 5%. Sensitivity analyses and subgroup analyses were performed to examine the robustness of the model results. Results: Serplulimab plus chemotherapy could bring additional 0.25 QALYs with the marginal cost of $37,569.32, resulting in an ICER of $147,908.74 per additional QALY gained. Sensitivity analyses confirmed that model results were robust. Subgroup analyses revealed that adding serplulimab to first-line chemotherapy were unlikely to be the cost-effective option for all subgroup patients. Conclusions: Serplulimab plus chemotherapy was unlikely to be the cost-effective first-line strategy compared with chemotherapy alone for patients with ES-SCLC in China. Reduced the price of serplulimab could increase its cost-effective. [ABSTRACT FROM AUTHOR]

Introduction: The Individualized Neuromuscular Quality of Life Questionnaire (INQoL) is used to measure quality of life in neuromuscular disorders such as non-dystrophic myotonia (NDM). Here we report methods to estimate utilities, with a focus on NDM, from this questionnaire based on two preference elicitation exercises. Methods: Eight items from the INQoL were selected with input from three neuromuscular disorder clinical experts with expertise in treating NDM. A discrete choice experiment (DCE) survey of UK general public respondents (n = 508) described outcomes defined by the INQoL items. The same 8 items were also valued using time trade-off (TTO) face-to-face interviews (n = 200). A hybrid regression modelling approach combined both datasets to inform the utility weights. Results: Hybrid modelling of DCE and TTO data in conjunction improved out-of-sample predictive accuracy. The selected INQoL utility model indicates substantial disutility associated with all eight dimensions of health, with the greatest losses associated with subjective items such as pain and depression. Discussion: The hybrid modelling approach allows us to combine data from the two methodologies and maximize the information from each to inform the utility weights for the INQoL. The TTO is the more conventional valuation method, but combined with the larger DCE study produced better descriptive coverage. This is a relatively novel method for estimating weights which we think is particularly well suited to economic evaluations of orphan drugs. [ABSTRACT FROM AUTHOR]

Background: Basiliximab is a high‐cost induction agent typically given as two doses in liver transplant recipients. This study evaluated renal outcomes in live‐donor liver transplant recipients (LDLTRs) with stable renal function at the time of transplant receiving one versus two doses of basiliximab. Methods: We retrospectively identified 231 adult LDLTR with a serum creatinine (SCr) <1.5 mg/dL on post‐transplant Day 5. The primary endpoint was a change in SCr from post‐transplant Days 5 to 30 between the groups. Secondary endpoints included incidence of acute kidney injury (AKI), liver rejection, and culture‐positive infections within 3 and 6 months of transplant. Basiliximab‐related cost savings were also evaluated. Results: Median change in SCr from post‐transplant Days 5 to 30 was no different between the single‐dose or two‐dose groups (0.1 [IQR: −0.1–0.3] vs. 0.2 [IQR: −0.1–0.4], p = 0.08). Incidence of AKI was 56.9% in the two‐dose group versus 39.0% in the single‐dose group (p = 0.01). There was no difference in bacterial (p = 0.40), fungal (p = 0.59), or viral (p = 0.78) infections. Acute cellular rejection through 6 months post‐transplant was noted in 9.7% of patients receiving two doses and 6.3% in the single‐dose arm (p = 0.42). Basiliximab‐related cost savings in the single‐dose arm was ∼$697 863.72 over 159 transplants. Conclusions: Single‐dose basiliximab appears to be safe and effective in place of two doses in LDLTR with stable renal function on post‐transplant Day 5. Utilization of a single basiliximab dose significantly reduced medication‐related costs. [ABSTRACT FROM AUTHOR]

Purpose: In this study, prescriptions of 391 patients with type 2 diabetes mellitus selected from pharmacies in Sivas city center by mass sampling method were analyzed and the aim was to investigate the pharmacoeconomic suitability of these drugs considering the chronic complications associated with diabetes. Material and Methods: This study is characterized as a descriptive cost analysis in which retrospective analysis was conducted on 391 prescriptions issued to Type-2 Diabetes Patients after obtaining the required permissions, including approval from the Ethics Committee. Patient prescription data were collected from pharmacies comprising the sample group over a three-month period in Sivas Province. The demographic features such as age and gender of the patients and the medications prescribed for Type 2 Diabetes were analyzed, and the costs associated with these prescription drugs were calculated. In addition, additional diseases of Type 2 Diabetes patients were also scrutinized within the scope of the study. Results: According to the data obtained, the drugs prescribed to diabetic patients with chronic diseases were found to be appropriate. However, when all diabetic patients were examined, it was determined that the prescribed amount of insulin preparations was high and not pharmaceutically appropriate. It was revealed that the cost of type 2 diabetes medications for 391 patients was 77.852,79₺, and the prescription price was 199.11₺. Conclusion: Type 2 diabetes is characterized by insulin resistance in tissues such as liver, muscle and fat as a result of detectable damage to pancreatic beta cells. The disease is also associated with genetics, environmental factors and lifestyle. In our country, 22.6% of the health budget is allocated to the treatment of diabetes and its complications. Due to the increasing frequency of patients with type 2 diabetes, effective and rational treatments to reduce the burden of the disease on the health budget have become an important issue for both payers and policy makers, but it needs to be emphasized and examined from a pharmacoeconomic perspective in future studies. [ABSTRACT FROM AUTHOR]

Background: Bevacizumab shows superior efficacy in cerebral radiation necrosis (CRN) therapy, but its economic burden remains heavy due to the high drug price. This study aims to evaluate the cost-effectiveness of bevacizumab for CRN treatment from the Chinese payers' perspective. Methods: A decision tree model was developed to compare the costs and health outcomes of bevacizumab and corticosteroids for CRN therapy. Efficacy and safety data were derived from the NCT01621880 trial, which compared the effectiveness and safety of bevacizumab monotherapy with corticosteroids for CRN in nasopharyngeal cancer patients, and demonstrated that bevacizumab invoked a significantly higher response than corticosteroids (65.5% vs. 31.5%, P < 0.001) with no significant differences in adverse events between two groups. The utility value of the "non-recurrence" status was derived from real-world data. Costs and other utility values were collected from an authoritative Chinese network database and published literature. The primary outcomes were total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). The uncertainty of the model was evaluated via one-way and probabilistic sensitivity analyses. Results: Bevacizumab treatment added 0.12 (0.48 vs. 0.36) QALYs compared to corticosteroid therapy, along with incremental costs of $ 2010 ($ 4260 vs. $ 2160). The resultant ICER was $ 16,866/QALY, which was lower than the willingness-to-pay threshold of $ 38,223/QALY in China. The price of bevacizumab, body weight, and the utility value of recurrence status were the key influential parameters for ICER. Probabilistic sensitivity analysis revealed that the probability of bevacizumab being cost-effectiveness was 84.9%. Conclusion: Compared with corticosteroids, bevacizumab is an economical option for CRN treatment in China. [ABSTRACT FROM AUTHOR]

Abstract Objectives This study addresses the growing importance of health economics and pharmacoeconomics in preparing healthcare professionals for economic decision-making, particularly in China’s evolving healthcare system. Despite their significance, these subjects are inconsistently included in health education in Southwest China, making it crucial to assess students' proficiency and educational needs. Methods A cross-sectional study was conducted from July to October 2023, involving medical and pharmaceutical programs across universities in Sichuan, Chongqing, Guizhou, and Yunnan. Data on students' knowledge, attitudes, and proficiency were captured using a structured questionnaire. Advanced statistical methods, including descriptive analysis, ANOVA, regression analysis, PCA, and Spearman correlation heatmaps, were employed for data analysis using IBM SPSS and Python. The sample consisted of 781 students, with the survey facilitated via the Questionnaire Star platform. Results The survey revealed moderate comprehension of health economics and pharmacoeconomics among 781 health-related students, with an average knowledge score of 2.9. The majority were pharmacy students (45.58%) and aged 21–24 years (65.81%) with a significant female majority (64.92%). Academic year significantly influenced understanding, while gender differences were minimal. Spearman correlation indicated a strong linkage (0.78) between Supply and Demand and Cost Effectiveness, with minimal correlations between knowledge and attitudes towards the educational importance of health economics. Multiple regression analysis highlighted the impact of gender and academic progression on students' comprehension of Supply and Demand concepts, as well as the influence of knowledge levels on their attitudes towards the importance of health economics education. PCA indicated the complex structure of knowledge and attitudes. Conclusions The study found moderate knowledge levels in health economics among health professions students in Southwest China, with academic year affecting comprehension and minimal gender differences. Pharmacy students had higher proficiency in pharmaceutical-related areas, but gaps in complex topics like 'Economic Evaluation' highlight the need for targeted educational improvements to better prepare students for healthcare economic decision-making.

This document provides a comprehensive list of references and citations for articles and studies related to the use of trastuzumab emtansine and trastuzumab deruxtecan in the treatment of HER2-positive/mutated malignancies. The articles cover various topics, including the mechanism of action of trastuzumab, the safety profile of trastuzumab-based antibody-drug conjugates, and the evolving therapeutic landscape of trastuzumab-drug conjugates. [Extracted from the article]

Fungal infection after lung transplantation can lead to poor clinical outcome, for which lung transplant recipients require prophylaxis. One of the antifungal agents used after lung transplantation is nebulized amphotericin B (AMB). Nebulized AMB causes adverse events such as dyspnea and airway irritation, and long-term use leads to high economic costs. So far, prophylactic regimens employing AMB deoxycholate (AMB-d) and liposomal AMB (L-AMB) have been developed. This study compared the efficacy, safety, and cost of AMB-d and L-AMB. Patients who underwent lung transplantation at Kyoto University Hospital from January 2021 to May 2023 were included in this study. Thirty-three patients received nebulized AMB-d, whereas 29 received nebulized L-AMB. Both regimens maintained comparable prophylactic efficacy regarding the development of fungal infection in the AMB-d and L-AMB groups (3.0% vs. 3.4%, P = 0.877). Patients treated with nebulized L-AMB experienced fewer respiratory-related adverse reactions than those treated with nebulized AMB-d (6.9% vs. 30.3%, P < 0.05), leading to a longer treatment duration with L-AMB than with AMB-d. Additionally, the daily cost of administering L-AMB was lower than that of administering AMB-d (3609 Japanese yen vs. 1792.3 Japanese yen, P < 0.05). These results suggest that nebulized L-AMB is safer and more cost-effective than nebulized AMB-d, with comparable efficacy. [ABSTRACT FROM AUTHOR]

A combination of improvements in patient survival, increasing treatment duration, and the development of more expensive agents has led to a doubling of per-capita spending on cancer medicines in Ireland (2008–2018). Despite this, access to new drugs is poor in comparison to other EU countries. We examine methods to optimise oncology drug spending to facilitate access to newer anticancer agents. Key targets for spending optimisation (biosimilar use, clinical trials and expanded access programs, waste reduction, avoidance of futile treatment, and altered drug scheduling) were identified through an exploratory analysis. A structured literature search was performed, with a focus on articles relevant to the Irish Healthcare system, supplemented by reports from statutory bodies. At the present time, EMA-approved agents are available once approved by the NCPE. Optimising drug costs occurs through guideline-based practice and biosimilar integration, the latter provides €80 million in cost savings annually. Access to novel therapies can occur via over 50 clinical trials and 28 currently available expanded access programmes. Additional strategies include reversion to weight-based immunotherapy dosing, potentially saving €400,000 per year in our centre alone, vial sharing, and optimisation of treatment schedules. A variety of techniques are being employed by oncologists to optimise costs and increase access to innovation for patients. Use of biosimilars, drug wastage, and prescribing at end of life should be audited as key performance indicators, which may lead to reflective practice on treatment planning. Such measures could further optimise oncology drug expenditure nationally facilitating approval of new agents. [ABSTRACT FROM AUTHOR]

Background: Medicines reviews by general practice pharmacists improve patient outcomes, but little is known about the associated economic outcomes, particularly in patients at higher risk of medicines-related harm. Aim: To conduct an economic cost-benefit analysis of pharmacists providing person-centred medicines reviews to patients with hyperpolypharmacy (prescribed ≥ 10 regular medicines) and/or at high risk of medicines-related harm across multiple general practice settings. Method: Service delivery costs were calculated based on the pharmacist's salary, recorded timings, and a general practitioner fee. Direct cost savings were calculated from the cost change of patients' medicines post review, projected over 1 year. Indirect savings were calculated using two models, a population-based model for avoidance of hospital admissions due to adverse drug reactions and an intervention-based model applying a probability of adverse drug reaction avoidance. Sensitivity analyses were performed using varying workday scenarios. Results: Based on 1471 patients (88.4% with hyperpolypharmacy), the cost of service delivery was €153 per review. Using the population-based model, net cost savings ranging from €198 to €288 per patient review and from €73,317 to €177,696 per annum per pharmacist were calculated. Using the intervention-based model, net cost savings of €651–€741 per review, with corresponding annual savings of €240,870–€457,197 per annum per pharmacist, were calculated. Savings ratios ranged from 181 to 584% across all models and inputs. Conclusion: Person-centred medicines reviews by general practice pharmacists for patients at high risk of medicines-related harm result in substantial cost savings. Wider investment in general practice pharmacists will be beneficial to minimise both patient harm and healthcare system expenditure. [ABSTRACT FROM AUTHOR]

Health authorities use value-based pricing models to determine the value of innovative drugs and to establish a price. Pharmaceutical companies prefer value-based pricing over cost-based pricing. It is ambiguous whether valuebased pricing has the same meaning to these stakeholders. We aimed to identify the elements that attribute to value-based pricing of innovative drugs from a pharmaceutical industry's perspective and as possible starting point for (valuebased) contracting of drugs. We performed a scoping review of publications available in scientific databases with terms such as 'value-based pricing', 'pharmacoeconomics', 'drug cost', 'innovative drug' and 'drug therapy'. We included 31 publications, covering value elements of innovative drugs from a pharmaceutical industry's perspective. Overall, all found elements of value-based pricing were congruent with the elements of value-based pricing from a health authority's perspective. However, the emphasis placed on the elements differed. The most frequently mentioned elements in our review were economic considerations and cost aspects. Least mentioned were elements regarding cost-effectiveness, disease characteristics and patient characteristics. Although all elements in the drug value framework were present which indicate congruity, there seems controversy on the importance of cost-effectiveness as an element of value. Consequently, establishing a coherent and to all stakeholders' acceptable framework to value and price innovative drugs seems complicated. Mutual understanding can be found in the value elements societal considerations and healthcare process benefits. Our results supported the importance of economic and cost aspects regarding determination of prices of innovative drugs. Further research is required to quantify the weights of all relevant elements in the drug value framework, observe their possible interlinkages, and to weigh them over time. [ABSTRACT FROM AUTHOR]

According to data from the World Health Organization (WHO), cancer is considered to be one of the leading causes of death worldwide, and new therapeutic approaches, especially improved novel cancer treatment regimens, are in high demand. Considering that many chemotherapeutic drugs tend to have poor pharmacokinetic profiles, including rapid clearance and limited on-site accumulation, a combined approach with tumor-homing peptide (THP)-functionalized magnetic nanoparticles could lead to remarkable improvements. This is confirmed by an increasing number of papers in this field, showing that the on-target peptide functionalization of magnetic nanoparticles improves their penetration properties and ensures tumor-specific binding, which results in an increased clinical response. This review aims to highlight the potential applications of THPs in combination with magnetic carriers across various fields, including a pharmacoeconomic perspective. [ABSTRACT FROM AUTHOR]

Background: Empirical use of pharmacogenetic test(PGT) is advocated for many drugs, and resource-rich setting hospitals are using the same commonly. The clinical translation of pharmacogenetic tests in terms of cost and clinical utility is yet to be examined in hospitals of low middle income countries (LMICs). Aim: The present study assessed the clinical utility of PGT by comparing the pharmacogenetically(PGT) guided- versus standard of care(SOC)- warfarin therapy, including the health economics of the two warfarin therapies. Methods: An open-label, randomized, controlled clinical trial recruited warfarin-receiving patients in pharmacogenetically(PGT) guided- versus standard of care(SOC)- study arms. Pharmacogenetic analysis of CYP2C9*2(rs1799853), CYP2C9*3(rs1057910) and VKORC1(rs9923231) was performed for patients recruited to the PGT-guided arm. PT(Prothrombin Time)-INR(international normalized ratio) testing and dose titrations were allowed as per routine clinical practice. The primary endpoint was the percent time spent in the therapeutic INR range(TTR) during the 90-day observation period. Secondary endpoints were time to reach therapeutic INR(TRT), the proportion of adverse events, and economic comparison between two modes of therapy in a Markov model built for the commonest warfarin indication- atrial fibrillation. Results: The study enrolled 168 patients, 84 in each arm. Per-protocol analysis showed a significantly high median time spent in therapeutic INR in the genotype-guided arm(42.85%; CI 21.4-66.75) as compared to the SOC arm(8.8%; CI 0-27.2)(p < 0.00001). The TRT was less in the PG-guided warfarin dosing group than the standard-of-care dosing warfarin group (17.85 vs. 33.92 days) (p = 0.002). Bleeding and thromboembolic events were similar in the two study groups. Lifetime expenditure was ₹1,26,830 in the PGT arm compared to ₹1,17,907 in the SOC arm. The QALY gain did not differ in the two groups(3.9 vs. 3.65). Compared to SOC, the incremental cost-utility ratio was ₹35,962 per QALY gain with PGT test opting. In deterministic and probabilistic sensitivity analysis, the base case results were found to be insensitive to the variation in model parameters. In the cost-effectiveness-acceptability curve analysis, a 90% probability of cost-effectiveness was reached at a willingness-to-pay(WTP) of ₹ 71,630 well below one time GDP threshold of WTP used. Conclusion: Clinical efficacy and the cost-effectiveness of the warfarin pharmacogenetic test suggest its routine use as a point of care investigation for patient care in LMICs. [ABSTRACT FROM AUTHOR]

The health and economic consequences of inadequately treated opioid use disorder (OUD) are substantial. Healthcare systems in the United States (US) and other countries are facing a growing healthcare crisis due to opioids. Although effective medications for OUD exist, relying solely on clinical information is insufficient for addressing the opioid crisis. In this review, the role of pharmacoeconomic studies in informing evidence-based medication treatment for OUD is discussed, with a particular emphasis on the US healthcare system, where the economic burden is significantly higher than the global average. The scope/objective of pharmacoeconomics as a distinct scientific research program is briefly defined, followed by a discussion of existing evidence informed by data from systematic reviews, in addition to a convenience sample of recently published pharmacoeconomic studies and protocols. The review also explores the need for methodological advancements in the field. Despite the potential of pharmacoeconomic research in shaping evidence-based medicine for OUD, significant challenges limiting its real-world application remain. How to address these challenges are explored, including how to combine cost-effectiveness and budget impact analyses to address the needs of the healthcare system as a whole and specific stakeholders interested in adopting new OUD treatment strategies. [ABSTRACT FROM AUTHOR]

Introduction: Proton pump inhibitors (PPIs) constitute a widely utilized pharmaceutical class, frequently associated with notable instances of therapeutic inappropriateness. Such patterns of misuse not only contribute to elevated healthcare expenditure, but may also exacerbate clinical conditions in certain patients. Methods: A comprehensive analysis was conducted between 2019 and 2023 to assess all prescriptions dispensed using the Anatomical, Therapeutic and Chemical (ATC) classification system, which allowed trends among primary PPIs to be visualized. This was achieved by calculating the defined daily dose (DDD) and then defining the total expenditure incurred on these drugs. Results: With regard to the prescription of PPIs, an upward trend in consumption was observed with a decreasing expenditure, due to the phenomena of drug generics and increased competition between pharmaceutical companies, ranging from €9,512,481.22 in the first six months of 2019 to €8,509,820.80 in the first six months of 2023. From 2019 to 2023, consumption increased by approximately 3 million DDDs for a total ranging from 18,483,167.59 DDDs to 21,480,871.00 DDDs. Pantoprazole and esomeprazole, the most expensive drugs compared to omeprazole, rabeprazole and lansoprazole, accounted for 61.4% of therapies in the first six months of 2023, up from 2019, where these two drugs were prescribed 54.9%. Conclusion: Within this analysis, we provide an illustrative representation of the prescribing trends for PPIs within a European context. Omeprazole, rabeprazole and lansoprazole appear to be the cheapest drugs compared to pantoprazole and esomeprazole. However, the results show that the most widely used PPIs, despite their therapeutic equivalence, are precisely the high-cost ones, thus generating higher expenditure for central governments. [ABSTRACT FROM AUTHOR]

AimsAssessing the cost-effectiveness of Nivolumab with Gemcitabine–Cisplatin for Advanced Urothelial Carcinoma (aUC) treatment from the perspective of Chinese payers.MethodsA Markov model assessed economic outcomes, estimating health outcomes in quality-adjusted life years (QALYs). One-way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainties on the results.ResultsThe base-case analysis showed Nivolumab plus Gemcitabine–Cisplatin yielded 0.59 QALYs at an extra cost of $78,780.61, leading to an incremental cost-effectiveness ratios (ICER) of $133,526.46/QALY. One-way sensitivity analysis highlighted Nivolumab’s cost as the key factor, while probabilistic sensitivity analysis showed a 0% chance of cost-effectiveness for Nivolumab plus Gemcitabine–Cisplatin in aUC treatment.ConclusionNivolumab plus Gemcitabine–Cisplatin is not cost-effective in the treatment of aUC.

Sergio Di Matteo,1 Roberto Freilone,2 Giacomo Matteo Bruno,1,3 Rosario Notaro,4 Sabrin Moumene,1 Nicoletta Martone,5 Cristina Teruzzi,5 Antonio Ciccarone,1 Giorgio Lorenzo Colombo1,3 1Center of Research, SAVE Studi - Health Economics and Outcomes Research, Milan, Italy; 2Dipartimento di Oncologia - Direttore SC Ematologia, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino e componente Tumor Molecular Board (TMB) Regione Piemonte, Torino, Italy; 3Department of Drug Sciences, University of Pavia, Pavia, Italy; 4Direttore S.C. Core Research Laboratory in ISPRO, Firenze, Italy; 5Sobi S.r.l., Milano, ItalyCorrespondence: Giorgio Lorenzo Colombo, Email giorgio.colombo@unipv.itBackground: Paroxysmal nocturnal hemoglobinuria is a rare, acquired disease characterized by hemolytic episodes and associated with significant clinical burden. The introduction of C5 inhibitory monoclonal antibodies (C5i) represented a major breakthrough in PNH treatment, effectively reducing intravascular hemolysis (IVH) but showing limited impact on extravascular hemolysis (EVH). In 2021, the C3 inhibitor pegcetacoplan was approved by EMA and recently reimbursed in Italy, which also has the advantages in the reduction of both IVH and EVH, increasing hemoglobin values and simultaneously improving the quality of life and fatigue of patients. A cost-utility analysis was developed to compare pegcetacoplan to C5i (eculizumab and ravulizumab) in the PNH population who remain anemic after treatment with C5i for at least 3 months.Materials and Methods: The analysis employed a Markov model with a 5-year time horizon whereby patients can transition among 3 PNH health states, adopting the perspective of the Italian NHS. Efficacy data were sourced from the PEGASUS study, with drug prices reflecting ex-factory costs. Additionally, costs associated with resource utilization, adverse events, and complications were estimated based on outpatient and hospital care rates, excluding indirect expenses. Utility and disutility values related to transfusions were also considered, with pegcetacoplan allowing for dose escalation.Results: The cumulative cost of treatment per individual patient at 5 years was estimated to be € 1,483,454 for pegcetacoplan, € 1,585,763 for eculizumab, and € 1,574,826 for ravulizumab. Pegcetacoplan demonstrated a superior increase in quality-adjusted life years (QALYs) compared to both eculizumab (0.51 increase) and ravulizumab (0.27 increase). Furthermore, pegcetacoplan showed a reduction in complication management costs (€ 22,891 less compared to eculizumab and € 22,611 less compared to ravulizumab) and lower transfusion-related expenses (€ 14,147 less than both C5i treatments).Conclusion: Pegcetacoplan emerged as the dominant strategy in this analysis, being more effective, less expensive and improves quality of life in the analyzed population affected by PNH.Keywords: PNH, pegcetacoplan, eculizumab, ravulizumab, IVH, EVH, cost-utility analysis, pharmacoeconomics

Introduction. HER2-positive breast cancer represents 10-20% of all breast tumors. This study aimed to create a model-based cost-minimization analysis that compared non-drug related costs of different therapies used in the treatment of HER2-positive breast cancer in Poland: pertuzumab SC plus trastuzumab SC (Pert/TrasSC) vs. pertuzumab IV plus trastuzumab IV (PertIV + TrasIV) vs. pertuzumab IV plus trastuzumab SC (PertIV + TrasSC). Material and methods. The cost-minimization analysis was based on the results of a questionnaire addressed to leading oncology centers in Poland. The model was broken down into three categories of cost savings: reduced labor costs of nurses, pharmacists and non-drug related consumables, and from two categories of treatment time reduction: occupation of infusion chair and duration of hospital stay. Data on resources used and costs were collected in the first half of 2022. Results. Data were obtained from four oncology centers. The savings generated per patient from healthcare personnel's work and from non-drug consumables for the Pert/TrasSC arm were 178 PLN compared to PertIV + TrasIV and 168 PLN compared to PertIV + TrasSC. Full adaptation of Pert/TrasSC was estimated to result in average 8-fold higher savings in healthcare personnel workload per patient and in a treatment capacity increase of 241 patients. Conclusions. Our model shows that Pert/TrasSC treatment is associated with significantly lower labor costs for nurses and pharmacists and lower costs of non-drug consumables compared to the other treatment options. Moreover, it reduced patients' chair time due to shorter administration/observation time and released capacity in chemotherapy infusion sites. [ABSTRACT FROM AUTHOR]

There are no standards in diagnostic and therapeutic approaches to eye care in incomplete eyelid closure due to unresolved facial palsy (FP). Loading of the upper eyelid (UELL) with gold weights (GWs) or platinum chains (PCs) is a highly effective procedure for the correction of lagophthalmos. Despite this, the procedure is used infrequently in our country because of the relatively high price of the implant and the lack of reimbursement. The aim of this research was to assess the factors influencing medical expenditures in this group of patients and to analyze utility costs for the UELL procedure with the use of GW and PC compared to tarsorrhaphy. Material and methods The costs of 88 surgical procedures (40 GWs, 11 PCs and 37 tarsorrhaphies) and medical expenditures before and after surgery were calculated based on reporting of materials, staff salaries and the SF-36 questionnaire. Distribution quartiles of the cost per QALY measure (dependent variable) was assessed via an ordered logistic regression model with eight explanatory variables. Results The calculated total cost of the surgery was US$209 for tarsorrhaphy, US$758 for UELL with a GW and US$1,676 for UELL with a PC. Bootstrapped costs per QALY values (CUI) in 88% of cases were below the US$100,000 cutoff. Etiology and duration of facial palsy and presence of Bell's phenomenon were factors that significantly influenced the CUI. Patient gender and age, history of previous eyelid surgery, and presence of corneal sensation were found to be not significant (p > 0.1). Calculated ICER for GW was US$1,241.74/1QALY and ICER for PC was US$13,181.05/1QALY compared to tarsorrhaphy. Conclusions Eye protection in patients with FP should be a crucial element of health policy. Findings suggest UELL procedure with a GW or a PC to be a cost-effective procedure with GW being the most cost-effective. [ABSTRACT FROM AUTHOR]

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]

OBJECTIVE: To evaluate the economics of Sophora flavescens gel in the treatment of vulvovaginal Candidiasis (VVC, dampness-heat syndrome). METHODS: From the perspective of health system, based on a published randomized controlled trial study on the treatment of VVC by Sophora flavescens gel, the negative conversion rate of candida in this study was used as the effect parameter, the cost parameters were obtained from the database of Menet. com, and the cost-effectiveness analysis was conducted by using TreeAge Pro software for Sophora flavescens gel in the treatment of VVC. RESULTS: Simulation results of decision tree model showed that after 14 d of treatment, the cost of Sophora flavescens gel combined with Clotrimazole vaginal tablet was 123. 28 yuan, and the conversion rate of candida in vulva vagina was 0. 93. The cost of using Clotrimazole vaginal tablet alone was 86. 56 yuan, and the negative conversion rate of candida was 0. 71. Compared with Clotrimazole vaginal tablet alone, Sophora flavescens gel combined with Clotrimazole vaginal tablet had higher cost and better efficacy, with an incremental cost-effectiveness ratio of 166. 91 yuan, about 0. 52% of per capita disposable income in China in 2020 (32 189 yuan), and sensitivity analysis showed that the results were relatively robust. CONCLUSIONS: Based on the assumption that per capita disposable income is the patient’ s willing to pay threshold in China in 2020, the treatment regimen of Sophora flavescens gel combined with Clotrimazole vaginal tablet for VVC is more economical than Clotrimazole vaginal tablet alone. The development of this study is beneficial for clinicians to rationally use drugs or select more economical regimens, and can provide optimized reference for the allocation of health care resources. [ABSTRACT FROM AUTHOR]

Background: The coronavirus pandemic has led to the creation of clinical guidelines by a large number of professional medical communities. However, the quality and methodology of development of Russian clinical guidelines has been little studied. The continued relevance of studying the use of DOACs (Direct oral anticoagulants) in patients with COVID-19 was the basis for conducting this study. Aim: The objective of this study was to assess DOAC consumption and expenditure in the Russian Federation during the COVID-19 pandemic and to analyze whether it was supported by the domestic evidence base for the use of DOACs in COVID-19 patients through identifying all publicly available Russian-produced CPGs (Clinical practice guidelines) for the treatment of COVID-19 and assessing their quality as the source of recommendations for the use of oral anticoagulants for the prevention of thrombotic complications in COVID-19 patients. We searched Russian databases for CPGs, published between 2020 and 2023. We identified seven relevant documents that met our inclusion criteria. Three authors analyzed Russian clinical guidelines using an AGREE II questionnaire. We calculated DOAC DDD (defined daily dose) consumption according to Russian clinical guidelines and DDD consumption in patients with COVID-19 for the period 2020–2022. Results: Seven clinical CPGs were analyzed with the AGREE II tool. It was revealed that experts gave the highest scores for the sections on scope and purpose (from 62.98% to 100%), and clarity of presentation (from 96.30% to 100%). The lowest scores were given for the sections on stakeholder involvement (33.33% to 64.81%), rigour of development (from 0% to 49.31%), applicability (from 23.61% to 50%), and editorial independence (from 0% to 50%). When comparing the total score, it was found that two clinical guidelines received the highest scores—ROPNIZ (Livzan), and ROPNIZ (Drapkina). The minimum score was registered with the NIIOZMM (Khripun) clinical guideline. No guideline received a total score of more than 70%. According to clinical recommendations, the consumption of apixaban and rivaroxaban is 15 DDD (30-day course of therapy), or 22.5 DDD (45-day course of therapy). Consumption of apixaban in the Russian Federation in 2020 and 2021 corresponds to the indicators presented in clinical recommendations (in 2020—26.59 DDD per patient with COVID-19; in 2021—15.75 DDD per patient with COVID-19), and in 2022—10.67 DDD, which is below the recommended values. In 2020, consumption of rivaroxaban in the Russian Federation was 26.59 which corresponds to data from clinical recommendations; in 2021, consumption decreased to 7.87 DDD; in 2022 it decreased to 5.48 DDD, which is 2.74 times less than recommended. Conclusions: Analysis of seven clinical recommendations revealed that such sections of clinical recommendations as scope, purpose, and clarity of presentation had the highest degree of assessment in accordance with AGREE II. The lowest scores were given for the sections on stakeholder involvement, rigour of development, applicability, and editorial independence. When comparing the total score, it was found that two clinical guidelines received the highest scores—the Russian Society for the Prevention of Non-communicable Diseases (Livzan), and the Russian Society for the Prevention of Non-communicable Diseases (Drapkina). The minimum score was registered with the Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department clinical guideline. No guideline received a total score of more than 70%. During the pandemic, the highest DDD consumption of DOACs was in 2020, which exceeded the DOACs' recommended DDD by Russian clinical guidelines. DOAC consumption had decreased by 2022. There was a decrease in the consumption of rivaroxaban, with an increase in apixaban's share in the structure of DOAC consumption during the coronavirus pandemic. Obtained data indicate that in 2021 the apixaban consumption in the Russian Federation corresponded to the recommended DDD in the national guidelines, which indicates the most correct use of apixaban according to Russian GPGs. [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]

Introduction: The financial impact of breast cancer has been discussed due to its high incidence and the increased costs of systemic therapy and is even more relevant in countries with low and medium socioeconomic development. Objective: To evaluate the financial viability of using the MammaPrint™ (MP) genetic signature in a public and private system in a country with a medium socioeconomic development index. Material and method: A pharmacoeconomic trial with a cost-benefit analysis evaluating the reduction in costs of chemotherapy, support drugs, and materials used during chemotherapy infusion in high-risk hormone receptor-positive (HR+) breast cancer patients submitted to analysis using the MammaPrint™ genetic signature. Results: The value of using MammaPrint™ in the Unified Health System (SUS) would bring an additional cost of US$ 1,334.56 per patient in the over-50 age group. In private medicine, the use of MammaPrint™ in the same population would result in cost savings ranging from US$ 2,422.53 to US$ 9,989.95 per patient. Conclusion: The use of MP in RH + breast cancer patients with high clinical risk and low genomic risk in Brazil leads to significant savings in resources when applied to supplementary healthcare. In the SUS, reducing the costs of MP for large-scale use could make its application viable. These values need to be re-evaluated in each institution, using the methodology applied in the trial, adjusting according to costs, to obtain a result that reflects its reality.

Aim: The objective of this study was to compare adverse event (AE) management costs for fruquintinib, regorafenib, trifluridine/tipiracil (T/T) and trifluridine/tipiracil+bevacizumab (T/T+bev) for patients with metastatic colorectal cancer (mCRC) previously treated with at least two prior lines of therapy from the US commercial and Medicare payer perspectives. Materials & methods: A cost-consequence model was developed to calculate the per-patient and per-patient-per-month (PPPM) AE costs using rates of grade 3/4 AEs with incidence ≥5% in clinical trials, event-specific management costs and duration treatment. Anchored comparisons of AE costs were calculated using a difference-in-differences approach with best supportive care (BSC) as a common reference. AE rates and treatment duration were obtained from clinical trials: FRESCO and FRESCO-2 (fruquintinib), RECOURSE (T/T), CORRECT (regorafenib) and SUNLIGHT (T/T, T/T+bev). AE management costs for the commercial and Medicare perspectives were obtained from publicly available sources. Results: From the commercial perspective, the AE costs (presented as perpatient, PPPM) were: $4015, $1091 for fruquintinib (FRESCO); $4253, $1390 for fruquintinib (FRESCO-2); $17,110, $11,104 for T/T (RECOURSE); $9851, $4691 for T/T (SUNLIGHT); $8199, $4823 for regorafenib; and $11,620, $2324 for T/T+bev. These results were consistent in anchored comparisons: the differencein-difference for fruquintinib based on FRESCO was -$1929 versus regorafenib and -$11,427 versus T/T; for fruquintinib based on FRESCO-2 was -$2257 versus regorafenib and -$11,756 versus T/T. Across all analyses, results were consistent from theMedicare perspective. Conclusion: Fruquintinib was associated with lower AE management costs compared with regorafenib, T/T and T/T+bev for patients with previously treated mCRC. This evidence has direct implications for treatment, formulary and pathways decision-making in this patient population.

Health authorities use value-based pricing models to determine the value of innovative drugs and to establish a price. Pharmaceutical companies prefer value-based pricing over cost-based pricing. It is ambiguous whether value-based pricing has the same meaning to these stakeholders. We aimed to identify the elements that attribute to value-based pricing of innovative drugs from a pharmaceutical industry’s perspective and as possible starting point for (value-based) contracting of drugs. We performed a scoping review of publications available in scientific databases with terms such as ‘value-based pricing’, ‘pharmacoeconomics’, ‘drug cost’, ‘innovative drug’ and ‘drug therapy’. We included 31 publications, covering value elements of innovative drugs from a pharmaceutical industry’s perspective. Overall, all found elements of value-based pricing were congruent with the elements of value-based pricing from a health authority’s perspective. However, the emphasis placed on the elements differed. The most frequently mentioned elements in our review were economic considerations and cost aspects. Least mentioned were elements regarding cost-effectiveness, disease characteristics and patient characteristics. Although all elements in the drug value framework were present which indicate congruity, there seems controversy on the importance of cost-effectiveness as an element of value. Consequently, establishing a coherent and to all stakeholders’ acceptable framework to value and price innovative drugs seems complicated. Mutual understanding can be found in the value elements societal considerations and healthcare process benefits. Our results supported the importance of economic and cost aspects regarding determination of prices of innovative drugs. Further research is required to quantify the weights of all relevant elements in the drug value framework, observe their possible interlinkages, and to weigh them over time.

ObjectiveTo systematically evaluate the pharmacoeconomic research on herpes zoster (HZ) vaccine administration, providing reference for related research and prevention of HZ. MethodsBased on the theme words such as 'herpes zoster', 'herpes zoster vaccines', 'pharmacoeconomics', 'cost-effectiveness analysis', the literature of pharmacoeconomic study on herpes zoster vaccination was retrieved from 4 Chinese databases and 4 English databases from our library to January 2023. Two researchers independently screened the retrieved literature twice. Relevant information of the included literature was extracted according to the Guidelines for Conducting Economic Evaluation of Immunization Programs of the World Health Organization. The quality of pharmacoeconomic studies on herpes zoster vaccination in the included literature was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS2022). Descriptive analysis and qualitative systematic evaluation were conducted on research perspectives, model structures, parameter selection, evaluation results, and sensitivity analyses. ResultsA total of 43 English literature on the economic study of herpes zoster vaccine vaccination drugs were included, published from April 2001 to June 2022, among which 3 articles focused on the Chinese population. The research quality scores of 23 articles were > 80% (high quality), and 20 articles scored between 65% and 80% (mid-high quality). Among the 39 articles, the economic study of herpes zoster vaccine vaccination drugs was evaluated using cost-utility analysis (CUA); 31 articles evaluated the economic study of herpes zoster vaccine vaccination drugs from a societal perspective. The results of 42 articles showed that immunocompetent individuals who received herpes zoster vaccine had economic benefits, and the age of vaccination, threshold, vaccine cost, and vaccination scheme had significant effects on the results. Among the 3 articles focusing on the Chinese population, 2 articles showed that vaccination with herpes zoster vaccine was economically beneficial, and 1 article showed that the elderly aged 60 to 70 years had the most economic benefits from herpes zoster vaccine vaccination. ConclusionThe economic study of vaccination with high-quality herpes zoster vaccine based on domestic data in China is recommended to provide evidence for immunization and prevention of HZ.

Objective: The objective of this study was to explore the safety, efficacy, economy, and other aspects of frequently-used antitumor Chinese patent medicine injections through a comprehensive evaluation of evidence-based medical research to provide scientific information and decision-making basis for drug selection, rational drug use, public awareness of safe drug use, and medical insurance. Materials and Methods: The names of five frequently used antitumor Chinese patent medicine injections were used as search terms, including the compound Sophora flavescens injection, Kangai injection, Aidi injection, Kanglaite injection, and Brucea javanica oil emulsion injection. Relevant evidence-based medical research was extracted from the databases. A descriptive evaluation was conducted, and the Markov model was used for the cost-benefit analysis. Finally, the above injections are ranked by comprehensive scores using the multi-criteria decision analysis and Delphi method. Results: The five injections had their own advantages in enhancing the effectiveness of anti-tumor treatments, improving the quality of life for cancer patients, and reducing the incidence of adverse reactions. From the perspective of economy and other attributes, compound S. flavescens was superior to B. javanica oil, Aidi, Kangai, and Kanglaite. After a comprehensive evaluation of the above five injections, the compound S. flavescens injection received the highest score. Conclusions: Compound S. flavescens, Kangai, Aidi, B. javanica oil, and Kanglaite have their own advantages in effectiveness and no significant difference in safety. Compound S. flavescens injection has the highest comprehensive score. Clinical attention should be paid to monitoring the initial stage of medication and special groups.

Resumen: Antecedentes y objetivo: No se dispone de datos españoles sobre el coste asociado al linfoma cutáneo de células T (LCCT). Además, la incorporación de nuevos tratamientos hace necesario analizar el coste real de la enfermedad. El estudio MICADOS analizó dos objetivos principales: Por un lado, evaluó el impacto en la calidad de vida en los pacientes con LCCT, y por otro lado, estudió los costes de la enfermedad. En esta publicación se recoge el segundo de los objetivos del estudio. Métodos: El coste de la enfermedad se estudió bajo la perspectiva del Sistema Nacional de Salud (SNS) con un horizonte temporal de un año. Participaron 23 dermatólogos y hematólogos de 15 hospitales públicos españoles. Se incluyeron pacientes adultos con LCCT del tipo micosis fungoide (MF) y síndrome de Sézary (SS). Resultados: Se incluyeron 141 pacientes, el 57,4% masculinos, con una edad media de 63,6 años (IC 95%: 61,4-65,7). Los costes directos anuales medios por pacientes del estudio fueron de 34.214€, siendo de 11.952,47€ en estadio I, 23.506,21€ en estadio II, 38.771,81€ en estadio III y 72.748,84€ en estadio IV. El coste anual directo total estimado de todos los pacientes en España con MF/SS resultó en 78.301.171€, donde el 81% de los costes fueron atribuibles a pacientes en estadio I, el 7% al estadio II, el 6% al estadio III y el 6% al estadio IV. Conclusiones: Este estudio ofrece una evaluación precisa del coste directo del LCCT en pacientes con MF/SS en España, mostrando costes que varían sustancialmente en función del estadio. Los costes soportados por el paciente y los costes indirectos deberán considerarse en futuras investigaciones. Abstract: Background and objective: The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1) to evaluate the impact of CTCL on patient quality of life, and 2) to evaluate the costs associated with the disease. This article reports the results of the cost analysis. Methods: We estimated the cost of treating CTCL over a period of 1 year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). Results: A total of 141 patients (57.4% male) with a mean age of 63.6 years (95% CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was €34,214 per patient. The corresponding costs by stage were €11,952.47 for stage I disease, €23,506.21 for stage II disease, €38,771.81 for stage III disease, and €72,748.84 for stage IV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at €78,301,171; stage I disease accounted for 81% of all costs, stage II for 7%, and stages III and IV for 6% each. Conclusions: The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies.

Relevance Invasive meningococcal infection (IMI) is a significant clinical problem and is associated with a high probability of severe complications and death. Vaccination programs against meningococcus can achieve significant clinical effectiveness and require significant financial costs. This makes it relevant to study the economic burden of meningococcal infection in the conditions of modern healthcare in order to obtain basic data for subsequent research in the field of evaluation of medical technologies.Aims. To assess the economic burden of IMI in children in the conditions of healthcare in the Republic of BelarusMaterial and methods: a retrospective study using the "cost of illness" method was conducted for 22 children hospitalized in the city children's infectious clinical diseases hospital in 2018-2019. All values are presented in belarusian rubles. The average ± standard deviation, minimum – maximum values, median [Q1, Q3], cost shares (%) are calculated for the cost values. The minimum– maximum values and median [Q1, Q3] were calculated for the age of the patients.Results: taking into account the costs of treatment in healthcare organizations of all patients studied, the share of direct costs of hospitalization was 29.0%, the share of direct costs of diagnosis – 7.2%, the share of direct costs of pharmacotherapy - 8.3%. A significant part of the costs accounted for observations after discharge and amounted to 55.4%.Conclusion: a retrospective study of the economic burden of MI in the Republic of Belarus using the "cost of illness" method in patients hospitalized in a public health organization demonstrates a significant economic burden of this disease, which in the long term is primarily due to the presence of complications in the patient, as well as the impact of the patient's death on the value of total costs. The data obtained can be used in conducting national research on the evaluation of medical technologies.

The article presents an overview of specialized medical information systems that perform ABC/VEN analysis. It provides a comparison of specific examples, describes their advantages and disadvantages, as well as the possibility of automating the processes of searching for information on the proven effectiveness of drugs, selecting alternative drugs within one ATC group, selecting alternative drugs within the framework of the current clinical recommendations of the Ministry of Health of the Russian Federation, assessing drug-drug interactions, as well as the reference information from the instructions for use of the drugs.

Background: The coronavirus pandemic has led to the creation of clinical guidelines by a large number of professional medical communities. However, the quality and methodology of development of Russian clinical guidelines has been little studied. The continued relevance of studying the use of DOACs (Direct oral anticoagulants) in patients with COVID-19 was the basis for conducting this study. Aim: The objective of this study was to assess DOAC consumption and expenditure in the Russian Federation during the COVID-19 pandemic and to analyze whether it was supported by the domestic evidence base for the use of DOACs in COVID-19 patients through identifying all publicly available Russian-produced CPGs (Clinical practice guidelines) for the treatment of COVID-19 and assessing their quality as the source of recommendations for the use of oral anticoagulants for the prevention of thrombotic complications in COVID-19 patients. We searched Russian databases for CPGs, published between 2020 and 2023. We identified seven relevant documents that met our inclusion criteria. Three authors analyzed Russian clinical guidelines using an AGREE II questionnaire. We calculated DOAC DDD (defined daily dose) consumption according to Russian clinical guidelines and DDD consumption in patients with COVID-19 for the period 2020–2022. Results: Seven clinical CPGs were analyzed with the AGREE II tool. It was revealed that experts gave the highest scores for the sections on scope and purpose (from 62.98% to 100%), and clarity of presentation (from 96.30% to 100%). The lowest scores were given for the sections on stakeholder involvement (33.33% to 64.81%), rigour of development (from 0% to 49.31%), applicability (from 23.61% to 50%), and editorial independence (from 0% to 50%). When comparing the total score, it was found that two clinical guidelines received the highest scores—ROPNIZ (Livzan), and ROPNIZ (Drapkina). The minimum score was registered with the NIIOZMM (Khripun) clinical guideline. No guideline received a total score of more than 70%. According to clinical recommendations, the consumption of apixaban and rivaroxaban is 15 DDD (30-day course of therapy), or 22.5 DDD (45-day course of therapy). Consumption of apixaban in the Russian Federation in 2020 and 2021 corresponds to the indicators presented in clinical recommendations (in 2020—26.59 DDD per patient with COVID-19; in 2021—15.75 DDD per patient with COVID-19), and in 2022—10.67 DDD, which is below the recommended values. In 2020, consumption of rivaroxaban in the Russian Federation was 26.59 which corresponds to data from clinical recommendations; in 2021, consumption decreased to 7.87 DDD; in 2022 it decreased to 5.48 DDD, which is 2.74 times less than recommended. Conclusions: Analysis of seven clinical recommendations revealed that such sections of clinical recommendations as scope, purpose, and clarity of presentation had the highest degree of assessment in accordance with AGREE II. The lowest scores were given for the sections on stakeholder involvement, rigour of development, applicability, and editorial independence. When comparing the total score, it was found that two clinical guidelines received the highest scores—the Russian Society for the Prevention of Non-communicable Diseases (Livzan), and the Russian Society for the Prevention of Non-communicable Diseases (Drapkina). The minimum score was registered with the Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department clinical guideline. No guideline received a total score of more than 70%. During the pandemic, the highest DDD consumption of DOACs was in 2020, which exceeded the DOACs’ recommended DDD by Russian clinical guidelines. DOAC consumption had decreased by 2022. There was a decrease in the consumption of rivaroxaban, with an increase in apixaban’s share in the structure of DOAC consumption during the coronavirus pandemic. Obtained data indicate that in 2021 the apixaban consumption in the Russian Federation corresponded to the recommended DDD in the national guidelines, which indicates the most correct use of apixaban according to Russian GPGs.

Objective: To compare the intervention effects and pharmacoeconomic advantages of Fufang Huangbai Fluid (FFHB) hydropathic compress versus Antimicrobial Calcium Alginate Wound Dressing (ACAWD) in the treatment of diabetic foot infections (DFI). Methods: Patients with DF who were hospitalized in the peripheral vascular Department of Dongzhimen Hospital of Beijing University of Chinese Medicine from December 2020 to February 2022 and met the inclusion and excluding criteria were allocated into the experimental group and control group through minimization randomization. The experimental group was treated with FFHB hydropathic compress for 2 weeks, while the control group was treated with ACAWD for the same duration. The wound healing of both groups was monitored for 1 month post-discharge. Clinical data from all eligible patients were collected, and differences in various indices between cohorts were analyzed. Results: 22 in the experimental group (including two fell off) and 20 in the control group. After the treatment, the negative rate of wound culture in the experimental group was 30% and that in the control group was 10%, There was no significant difference in the negative rate of wound culture and change trend of minimum inhibitory concentration (MIC) value of drug sensitivity (p > 0.05). The infection control rate of the experimental groupwas 60%, and that of the control group was 25%. The difference between the two groups was statistically significant (χ² = 5.013, p = 0.025). The median wound healing rate of the experimental group was 34.4% and that of the control group was 33.3%. There was no significant difference between the two groups (p > 0.05). During the follow-up 1month later, the wound healing rate in the experimental group was higher, and the difference was statistically significant (p = 0.047). Pharmacoeconomic evaluations indicated that the experimental group had greater cost-effectiveness compared to the control group. Conclusion: In the preliminary study, FFHB demonstrated comparable pathogenic and clinical efficacy to ACAWD in the treatment of mild DF infection, and exhibited superior pharmacoeconomic advantages. With the aid of infection control, the wound healing rate in the FFHB group showed notable improvement. Nevertheless, due to the limited sample size, larger-scale studies are warranted to further validate these findings. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the economical efficiency of Luobufukebiri pills in the treatment of asthenospermia. METHODS: The cost-effectiveness of Luobufukebiri pills in the treatment of asthenospermia was analyzed based on the published randomized controlled trials of Luobufukebiri pills for the treatment of asthenospermia. RESULTS: After patient administration, the therapeutic regimen of Luobufukebiri pills was higher than the therapeutic regimen of Vitamin E soft capsules in terms of improving the percentage of forward sperm motility and total effective rate. Taking Vitamin E soft capsule as a reference, for the difference value in the percentage of forward sperm motility before and after, the incremental cost-effectiveness ratio ( ICER) of Luobufukebiri pills was calculated to be 11 452. 30, and the additional cost to reach the clinical significance cut-off value was 3 664. 74 yuan, which is about 10. 43% of China’s per capita disposable income (PCDI, 35 128. 00 yuan) in 2021; for the total effective rate after treatment, the ICER of Luobufukebiri pills was calculated to be 4 094. 10, which is about 11. 65% of PCDI in China in 2021. CONCLUSIONS: Based on the assumption of China’s PCDI in 2021 as the threshold of patients’ willingness to pay, the application of Luobufukebiri pills has more economical efficiency than that of the Vitamin E soft capsules in improving the difference value in the percentage of forward sperm motility and promoting the clinical total effective rate. Carrying out the economic evaluation of Luobufukebiri pills in the treatment of asthenospermia contributes to improving the overall efficiency of medical resource allocation. [ABSTRACT FROM AUTHOR]

Background: Cancer pain is one of the main causes of human suffering, which can generate disabilities and compromise quality of life, giving rise to several psychosocial and economic consequences. Aims: This quantitative study sought to perform a cost‐effectiveness pharmacoeconomic analysis to assess the impact of implanting epidural morphine associated with ropivacaine treatment in gastrointestinal cancer patients with pain that is difficult clinical control, compared with conventional oral treatment. Materials and Methods: The study population consisted of 24 patients with gastrointestinal neoplasia who underwent treatment for cancer pain that was difficult to clinically control. 12 patients each were recruited into the control and intervention groups, respectively. While patients in the control group were administered drug treatment orally, patients in the intervention group underwent a surgical procedure for subcutaneous implantation of a catheter that allowed epidural administration of morphine and ropivacaine. For pain assessment, the Visual Analogue Scale was applied. Data analysis had a descriptive character of costs, taking into account the costs for the year 2021. The study perspective was the Brazilian public healthcare provider, referred to as the Unified Health System (Sistema Único de—SUS in Portuguese). Costs were computed over the time horizon corresponding to the duration of treatment, from the first medical consultation (when the treatment was defined) to the end (end of treatment, disease progression, or death). Treatment duration was divided into three phases (first 60 days, support with palliative care, and end‐of‐life care). To assess the robustness of the economic analysis, sensitivity analyses were performed, considering the effectiveness of pain reduction on the Visual Analogue Scale, and a comparison of results using the median prices of pharmaceutical components used in the study. Results: The mean age of patients was 59.3 years. The results from the cost‐effectiveness analysis showed the epidural morphine/ropivacaine treatment to be more effective with regard to pain reduction on the pain scale, particularly for end‐of‐life care, when compared to the conventional oral treatment, however, at a significantly higher cost. Discussion: From the accomplishment of this research, it was observed that the application of the pain assessment scale is a way to better interpret and understand the patient's pain, facilitating care planning and decision‐making by health professionals, as well as monitoring the effectiveness of the proposed new treatment. Conclusion: To present a better cost‐effectiveness ratio, a reduction in the cost of the new epidural technology or an increase in the value of the existing oral intervention would be required. However, the latter is not feasible and unlikely to occur. A value judgement to decide whether the incremental benefit associated with the use of the new intervention is worth the extra cost will have to be made by the healthcare provider. Interventions that can relieve cancer pain symptoms should be investigated continuously, in search of evidence to support clinical practice and promote better quality of life for patients. [ABSTRACT FROM AUTHOR]

Objectives　To evaluate the cost-effectiveness of typical pharmaceutical smoking cessation intervention strategies in China in the context of primary cancer prevention. Methods　Markov cohort simulation models were established to simulate the burden of 12 smoking caused cancer, including lung cancer, oral cancer, nasopharyngeal cancer, laryngeal cancer, esophageal cancer, gastric cancer, pancreatic cancer, liver cancer, kidney cancer, bladder cancer, cervical cancer, and acute myeloid leukemia. Taking incremental cost effectiveness ratio (ICER) as the main indicator, the model sets one year as the cycling period for 50 periods and simulates the cohort of 10 000 thirty-five-year-old current smokers with various smoking cessation strategies. To ensure the robustness of conclusion, univariate sensitivity analysis, probability sensitivity analysis, and age-group sensitivity analysis were conducted. Results　The results showed that varenicline intervention was the most cost-effective intervention. Compared to the next most effective option, incremental cost of each additional quality-adjusted life year is 11 140.28 yuan, which is below the threshold of willingness to pay (1 year GDP per capita). The value of ICER increased as the increasing age group of adopting intervention, but neither exceeded the threshold of willingness to pay. One-way sensitivity analysis showed that the value of discount rate, the hazard ratio and cost of intervention strategy had a greater impact on the result of ICER. Conclusion　In China, the use of varenicline to quit smoking is highly cost effective in the context of cancer primary prevention, especially for younger smokers. [ABSTRACT FROM AUTHOR]

Background. There is sufficient scientific literature on the effectiveness of registered vaccines in preventing SARS-CoV-2 infection, but research on the impact of the COVID-19 vaccination program on social and economic aspects is lacking. In connection with the above, this study aimed to assess the impact of vaccinations on presenteeism and absenteeism among healthcare professionals in the workplace caused by the COVID-19 pandemic. Methods. A post-marketing, cross-sectional survey-based study was carried out on a sample of 736 actively employed healthcare professionals. Among them, 215 individuals (29.21%) were unvaccinated (control group). The study group consisted of 521 vaccinated respondents, with 52.97% being women and 47.03% men. A self-administered questionnaire was developed and delivered online to the target population group of healthcare workers. Results. A significant association (p < 0.01) was observed between the number of doses of the COVID-19 vaccine received and presenteeism among the respondents. Among the unvaccinated respondents (2.30 ± 1.19) or those vaccinated with only one dose of the SARS-CoV-2 vaccine (2.16 ± 1.11), the COVID-19 pandemic had a significantly higher impact on work performance compared to individuals vaccinated with three doses of the vaccine (1.19 ± 1.11). Moreover, a significant association was found (p = 0.0265) between the number of workdays missed (over the last twelve months) due to COVID-19-related sick leave and the number of doses of the COVID-19 vaccine received. The number of workdays missed due to COVID-19 sick leave was lowest in the group vaccinated with three doses (2.00 ± 6.75) and highest in the unvaccinated group (5.32 ± 16.24). Conclusions. Our results clearly show that the widely implemented national COVID-19 vaccination program brings tangible benefits both in medical and economic terms. The extent of reducing absenteeism and presenteeism caused by the coronavirus disease depended on the number of vaccine doses administered. [ABSTRACT FROM AUTHOR]

Summary: Chronic myelogenous leukemia (CML) is a pluripotent hemopoietic stem cell malignancy characterized by the presence of a BCR-ABL1 fusion gene derived from a balanced translocation between the long arms of chromosomes 9 and 22 [t(9;22) (q34; q11)] known as the Philadelphia (Ph) chromosome. CML is an acquired hematopoietic stem cell disease common to myelo- and lymphopoiesis, characterized by uncontrolled proliferation of granulopoiesis (Shuvaev et al. 2015; Yordanov and Varbanova 2019). Relevance and goals: Second-generation tyrosine kinase inhibitors (TKIs) (nilotinib, dasatinib, and bosutinib) have an advantage over imatinib (first-generation) in the frequency and speed of achieving cytogenetic and molecular responses in the treatment of chronic myelogenous leukemia (CML), but they cause severe adverse effects and are much more expensive than imatinib, especially if we compare them to the prices of the registered generic products of Imatinib and Dasatinib. "Novartis Tasigna® trial shows superior results to Glivec® in patients with early-stage chronic myeloid leukemia", reported on 10/20/2021 by Pierre Perrin-Montlouis. In the first direct comparison of these two oral therapies back in 2009 (Tasigna (nilotinib) 2009), as first-line treatment for CML, the results of Tasigna showed statistically significant improvement over Glivec in every measure of efficacy, including major molecular response (MMR), complete cytogenetic response (CCyR) and prevention of progression to accelerated or blast phase, with responses achieved faster in the Tasigna group than in the Glivec group. Furthermore, in the last ten years, CML patients who have achieved a stable deep molecular response for at least 2 years have been included in clinical trials for the management of treatment-free remission (TFR) (Kim et al. 2013; Saußele et al. 2016). On the other hand, the ever-increasing costs of diagnosis, treatment and monitoring of the response of CML to the various therapeutic strategies require conducting pharmacoeconomic analyses of the cost-effectiveness and cost-utility types in order to evaluate which are the cost-effective strategies with a view to introducing them into therapeutic practice. The present study aims to analyze the pharmacoeconomic efficiency of the TKI inhibitors used by the patients with CML-CP in the first and second lines, treated in the hematology clinic at UMHAT "St. George", MU- Plovdiv during the period 2018-2022. Methods: An economic analysis of the medicinal use of TKIs for a 5-year period (2018-2022) was performed at the national level according to data from the National Health Insurance Fund and the availability, accessibility, and usability of original and generic TKIs in Bulgaria were evaluated. The direct medical costs for the therapy of all patients were calculated, including the costs of the TKI therapy, laboratory tests, and monitoring of the molecular response for the entire treatment period from the appointment of the TKI therapy until the end of 2022. A comparative analysis was conducted to assess the cost-effectiveness of the different therapeutic strategies with TKIs on the first and second lines of treatment of patients with CML-CP in the hematology clinic at UMHAT "St. George" Medical University, Plovdiv, using the decision analysis method and conducting one-way and probalistic sensitivity analyses. Results: The sensitivity analyzes of all pharmacoeconomic models showed the robustness and reliability of the obtained results. The threshold limits of medical costs and the frequency of achieving a deep molecular response determining the choice of first- and second-generation tyrosine kinase inhibitors as first- and second-line therapy for patients with chronic myeloid leukemia in the chronic phase have been determined. Prescribing doctors prefer the original MPs to generic analogues, which is also assumed by the current regulations, according to which even for expensive MPs dispensing by protocols, the prescription is by trade and not by international non-proprietary names (INN), which is why the use of the much cheaper generic MPs is negligibly low compared to original MPs. A personalized approach to the patient's therapy and monitoring the patient's molecular response to it, as well as stopping therapy in 25-30% of patients suitable to stop it safely when in TFR phase with a probability of more than 50% of not having a relapse will save additional costs that, by improving the cost-effectiveness of therapy for patients with CML, will be directed towards the treatment of new patients with this or other diseases. Conclusion: These pharmacoeconomic models can be applied to improve diagnostic and therapeutic standards in clinical practice and for the efficient use of the very limited resources for health care in countries like Bulgaria. The conducted cost-effectiveness analyses confirmed that the hematologists at the University Center in Plovdiv adhere to the recommendations of Leukemia Net and the Bulgarian Medical Society of Hematology and achieve not only good therapeutic but also pharmacoeconomic efficiency in the treatment of CML-СР patients in first- and second- line therapy [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the cost-effectiveness of indobufen combined with ticagrelor versus aspirin combined with ticagrelor for antiplatelet therapy after percutaneous coronary intervention (PCI). METHODS: Markov model was used to simulate the economic outcomes of patients treated with indobufen + ticagrelor and aspirin + ticagrelor for antiplatelet therapy after PCI. Quality-adjusted life years (QALY) was set as the effectiveness measure, the total costs, total effectiveness and incremental cost-effectiveness ratios ( ICER) of two treatment regimens were calculated. RESULTS: Over a 10-year time horizon, the total cost of indobufen + ticagrelor was 172 292. 28 yuan, while the total cost of aspirin + ticagrelor was 169 950. 51 yuan. The QALY gained with indobufen + ticagrelor and aspirin + ticagrelor were 6. 540 and 6. 335, respectively. The ICER of indobufen + ticagrelor to aspirin + ticagrelor was 11 472. 09 yuan / QALY, lower than per capita GDP in China. These results suggested that indobufen+ticagrelor is significantly better than aspirin+ticagrelor in cost-effectiveness. Sensitivity analysis demonstrated that the results of the study were robust and reliable. CONCLUSIONS: Results of the study indicate that indobufen + ticagrelor is more cost-effectiveness than aspirin + ticagrelor under the current economic conditions in China, and can be used as the first selection of antiplatelet therapy for patients after PCI. [ABSTRACT FROM AUTHOR]

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Social Security / SGD-Sosyal Güvenlik Dergisi is the property of Journal of Social Security / SGD-Sosyal Güvenlik Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Mei-Juan Lan,1 Di-Fei Yao,2,3 Ling-Ling Zhu,4 Quan Zhou2 1Division of Nursing, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China; 2Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China; 3Key Laboratory of Intelligent Pharmacy and Individualized Therapy of Huzhou, Changxing Campus of the Second Affiliated Hospital of Zhejiang University, Huzhou, Zhejiang Province, People’s Republic of China; 4VIP Geriatric Ward, Division of Nursing, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Quan Zhou, Department of Pharmacy, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road No. 88, Shangcheng District, Hangzhou, Zhejiang Province, 310009, People’s Republic of China, Email zhouquan142602@zju.edu.cn Ling-Ling Zhu, VIP Geriatric Ward, Division of Nursing, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of China, Email 2192022@zju.edu.cnBackground: Infusion rate is one of the essential elements that should be included in all intravenous orders. Patients may experience adverse consequences or risks associated with inappropriate infusion. Meanwhile, there is growing pressure on the chemotherapy unit to deliver treatment quickly, efficiently, and safely, and thus it is very necessary to improve the chemotherapy process and service to cancer patients. Clinicians should consider how to further standardize infusion therapy, and innovate new infusion strategies to increase efficacy, reduce toxicity, improve patient satisfaction and save health resource costs. Sporadic studies have evaluated the effects of infusion rates of anticancer agents on clinical outcomes, economic benefits, and administration efficiency. However, an update review has not been available.Methods: Relevant literature was identified by search of PubMed until September 2023.Results: Infusion rates may have significant effect on the efficacy of anticancer agents (e.g., methotrexate, fluorouracil, and arsenic trioxide). Slow infusion is safer for platinum compounds, doxorubicin and carmustine, whereas fast infusion is safer than slow infusion of gemcitabine. Optimal flow rates of paclitaxel and fluorouracil are based on the balance between multiple risks of toxicity. Optimal infusion rate may bring economic benefits. If efficacy and safety are not compromised, shortened infusion may result in higher patient satisfaction, improved institutional efficiency and more nursing time available for other activities (e.g., biosimilar products, endostar). Other concerns about infusion rate include clinical indications (eg, paclitaxel and rituximab, methotrexate), severity and type of hypersensitivity reactions (e.g., platinum compounds), formulation features (e.g., paclitaxel, doxorubicin), and genetic polymorphism (e.g., gemcitabine, methotrexate).Conclusion: The latest knowledge of infusion rate concerns will enhance the appropriateness and accuracy in intravenous administration. Interdisciplinary teams should collaborate and implement relevant risk management and healthcare policy. It is worthwhile to conduct comparative studies of intravenous therapy with different infusion speeds.Keywords: anticancer agents, efficacy, healthcare policy, infusion rate, medication administration, pharmacoeconomics, safety