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Objective: To assess patient preferences for health states associated with diabetic peripheral neuropathy (DPN).Design and Intervention: Seven health states describing varying stages of disease severity in DPN were developed: mild neuropathy, painful neuropathy, severe neuropathy, minor ulcer, severe ulcer, minor amputation and major amputation. Using a computer interview, both rating scale (RS) and standard gamble (SG) preference scores were elicited from 52 patients with diabetes mellitus.Setting: A US university medical centre and a Veterans Affairs clinic.Study Participants: Adult patients with type 1 and type 2 diabetes mellitus between the ages of 18 and 80 years. Patients were excluded if they had been diagnosed with DPN.Results: Preference scores decreased in accordance with greater symptomatic and functional impairment. Median RS scores ranged from 0.89 to 0.23 for the seven health states. Median SG scores ranged from 0.96 to 0.65.Conclusions: Patient preferences for health states decrease as a function of increasing disease severity in DPN. The result is robust across the RS and SG methods of preference measurement. These results may be useful in informing policy analyses for resource allocation in patients with diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: The Academy of Managed Care Pharmacy has recently created guidelines for the submission of pharmacoeconomic models. Although these guidelines provide a general framework for the integration of pharmacoeconomic models in the drug selection process, a more disease-specific and practical ‘hands-on’ approach is needed for pharmacy staff and Pharmacy and Therapeutics (P&T) committee members. Objective: To answer the question, ‘How can pharmacoeconomic models comparing treatments for diabetes and its complications be evaluated and used to make more informed formulary decisions?’ Methods: We determined the information needs of a managed care organisation (MCO) making coverage decisions for diabetes therapies and reviewed current guidelines for the submission of pharmacoeconomic models to MCOs. We then developed a set of practical questions for evaluating models of diabetes treatment in a managed-care environment. Results: Information needed by P&T committees in relation to new diabetes medications includes the long-term benefits of reduced micro- and macrovascular complications and changes in drug utilisation patterns, in addition to the immediate drug budget impact. Because diabetes is a complex disease, the peer-review process should be relied on as a first step to help ensure the validity of a model. Then, the end-user of a model should evaluate the sources of data to inform the model, the generalisability of the model for an MCO population, and the face validity of the assumptions of the model. Conclusion: Pharmacoeconomic models in diabetes offer potential for assisting P&T committee members in making more informed decisions. The guidelines presented here provide a practical approach for model assessment. However, additional expertise will be needed by MCOs to appropriately evaluate these models, and joint educational programmes between managed care, academia, and industry should be considered as a mechanism for improving technology assessment in diabetes care. [ABSTRACT FROM AUTHOR]

Objective: To determine the cost of using systemic therapy to treat newly diagnosed cytomegalovirus (CMV) retinitis in persons with AIDS. Design: Incidence-based simulation model of CMV treatment from a government payer perspective. Setting: Swiss healthcare system. Patients and participants: Patients with AIDS and newly diagnosed CMV retinitis. Interventions: Patients were assigned to 1 of 4 treatment regimens for induction and maintenance therapy: intravenous (IV) cidofovir induction and maintenance (cidofovir IV/IV); IV foscarnet induction and maintenance (foscarnet IV/IV); IV ganciclovir induction and maintenance (ganciclovir IV/IV); and IV ganciclovir induction and oral (PO) ganciclovir maintenance (ganciclovir IV/PO). Following a second relapse, patients were assigned to one of the other regimens. Main outcome measures: Time to first and subsequent progression, duration of maintenance treatment and direct medical expenditures [1998 Swiss francs (SwF)]. Results: The median time to first progression was longest for cidofovir IV/IV, followed by foscarnet IV/IV, ganciclovir IV/IV and ganciclovir IV/PO. Mean survival was 13 months and mean costs for this period in the base case were lowest in those initially treated with cidofovir (SwF146 742), followed by initial treatment with foscarnet IV/IV (SwF194 809), ganciclovir IV/PO (SwF195 190) and ganciclovir IV/IV (SwF243 964). Costs were most sensitive to changes in efficacy estimates. Conclusions: Of the regimens studied, initiation of treatment with systemic cidofovir appears least costly over a 13-month period. [ABSTRACT FROM AUTHOR]

Meta-analysis is used to statistically pool the results from individual studies, usually randomised trials, to obtain an estimate of the summary effect size across studies. The summary measure from a meta-analysis is often used to derive the probability of treatment success in a cost-effectiveness analysis. Recently, LeLorier and colleagues questioned the ability of meta-analysis to accurately predict the results of a subsequent large-scale trial, implying that the use of a summary measure from a meta-analysis may be inappropriate in an economic evaluation. We comment on this potential shortcoming by first providing an outline of the use of meta-analysis results in a cost-effectiveness analysis. Then, using examples of discrepancies between meta-analyses and subsequent large trials noted by LeLorier and colleagues, we examine the potential impact of using the results from a small trial versus a meta-analysis. We found that the meta-analyses were comparable to or better than small trials at predicting the results of subsequent large trials. We, therefore, argue that a meta-analysis of homogeneous studies can provide a reasonable estimate of the treatment effect for use in a cost-effectiveness analysis when no large, definitive clinical trial has been performed. However, care must be taken not to over-interpret the precision of the estimate, since both the homogeneity and quality of the primary studies need to be considered. We conclude by providing guidance on the appropriate use of summary measures derived from meta-analyses for cost-effectiveness studies. [ABSTRACT FROM AUTHOR]