Abstract:
:In an effort to control escalating health expenditures, especially in hospitals, many countries are planning or experimenting with prospective budgeting systems. Belgium is no exception and has recently introduced, with some success, limited fixed charges per hospital admission and/or per hospitalisation day for laboratory tests and radiographic investigations. More recently, the focus has shifted to hospital drug expenditures, which have shown high growth rates over the past few years. Until now, such expenditures have been reimbursed on a fee-for-service system, often with limited out-of-pocket charges for hospitalised patients. In order to curb the growth of drug expenditures, it is appropriate to investigate whether the financing of hospital drugs through a prospective budgeting system could be a feasible solution. Therefore, we constructed a database of over 270 000 admissions from a sample of 23 Belgian general and teaching (university) hospitals for the year 1991. Data were obtained from the official Minimum Basic Data Set or Résumé Clinique Minimum, which contains summarised clinical and administrative information, plus detailed expenditures (including medications) for each hospital stay. This information allowed us to categorize each stay into an appropriate diagnosis-related group (DRG). Our first descriptive analysis identified a number of major variables that influenced patients' drug expenditures: all-patient DRG (APDRG), age, disease severity, length of stay in an intensive care unit, emergency admission, death during hospitalisation, and hospital type (teaching or general). A covariance analysis was then performed on all hospital stays combined, and separately on surgical and medical stays. The results indicated that these variables taken together account for between 56.5 and 76.3% of drug expenditures in medical and surgical stays, respectively, with the major variance explained by differences in APDRG category. However, when the data were disaggregated according to major diagnosis category, a large degree of heterogeneity in the explained variance was observed. In patients with drug use- and alcohol-related disorders, 5.2% of drug billings/expenditures were attributable to the APDRG, and the corresponding figure in patients undergoing circulatory system surgery was 84%. This means that, if DRGs are used to define a global prospective drug budget for a hospital, using the hospital's historical case mix as a weighting factor, we should pay particular attention to the hospital profile because the predictive power of such a system could be relatively low in some hospitals. Consequently, we need to construct larger confidence intervals for hospitals in which historical drug expenditures have low predictive power, or search for additional explanatory variables for expenditures in these hospitals.
journal_name
Pharmacoeconomicsjournal_title
PharmacoEconomicsauthors
Closon MC,Crott R,Even-Adin Ddoi
10.2165/00019053-199609030-00006subject
Has Abstractpub_date
1996-03-01 00:00:00pages
246-63issue
3eissn
1170-7690issn
1179-2027journal_volume
9pub_type
杂志文章abstract:OBJECTIVE:The study aimed to conduct a systematic literature search to identify health state utilities for weight change in type 2 diabetes mellitus (T2DM) and to review those values for appropriateness for inclusion in a submission to the National Institute for Health and Clinical Excellence (NICE). METHODS:The searc...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/11599420-000000000-00000
更新日期:2012-12-01 00:00:00
abstract::Pharmacoeconomic data may be obtained within the context of randomised clinical trials (RCTs) and from effectiveness studies in the 'real world'. The differences between the 2 types of study design have implications for the types of data that can be obtained and the interpretation of the resulting findings. Because RC...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199915050-00001
更新日期:1999-05-01 00:00:00
abstract::Weight Reduction is Cost-Effective for the Treatment of Non-alcoholic Fatty Liver Disease in Thailand. ...
journal_title:PharmacoEconomics
pub_type: 已发布勘误
doi:10.1007/s40273-018-0754-y
更新日期:2019-02-01 00:00:00
abstract::Given the policy relevance and growing volume of research measuring individuals' willingness to pay (WTP) for health-related goods and services, meta-analysis provides a potentially rich set of tools for answering key questions about this research area. In particular, when taken as a whole, what does the existing empi...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200826110-00003
更新日期:2008-01-01 00:00:00
abstract:INTRODUCTION:The objective of this study was to evaluate the potential economic implications of using etoricoxib versus non-selective NSAID alternatives in the treatment of patients with osteoarthritis (OA) or rheumatoid arthritis (RA) in the UK. STUDY DESIGN:Decision-analytical modelling was used to calculate the exp...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200422100-00003
更新日期:2004-01-01 00:00:00
abstract::Lung cancer remains the leading cause of cancer-related death and economic burden worldwide. Despite the heavy toll of lung cancer, multiple new advances have improved patient outcomes, largely through precision medicine and targeted therapy. The associated rising economic burden however may impact the uptake of novel...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-017-0563-8
更新日期:2017-12-01 00:00:00
abstract:OBJECTIVE:To examine the relative cost effectiveness of topical calcipotriol and short-contact dithranol in the treatment of mild to moderate plaque psoriasis. DESIGN AND SETTING:This was a modelling study from the perspective of the UK National Health Service as payer. METHODS:The interventions were compared using 2...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200018050-00006
更新日期:2000-11-01 00:00:00
abstract::The purpose of this study was to establish the incidence of surgical amputation for critical leg ischaemia in New Zealand, and estimate the hospital, prostheses and indirect costs of this intervention. The cost of amputations was then compared with the cost of treating such patients with iloprost. The study was retr...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199406020-00007
更新日期:1994-08-01 00:00:00
abstract::The progressive increase in the prevalence of obesity and aging in the population is resulting in increased healthcare and disability spending. The burden of obesity is particularly relevant in old age, due to accumulating co-morbidities and changes in body composition. Sarcopenic obesity, a mix of over- and under-nut...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-014-0237-8
更新日期:2015-07-01 00:00:00
abstract::There is an inevitable tension between robust reimbursement processes and providing speedy access to new and novel technologies, given uncertainties about key pieces of evidence and subsequent concerns regarding their overall efficiency. The public perception of these treatments as 'breakthrough', combined with substa...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/11530850-000000000-00000
更新日期:2010-01-01 00:00:00
abstract::The efficacy of granisetron in preventing acute nausea and vomiting during the 24 hours following chemotherapy in patients with cancer is equivalent to that of other serotonin 5-HT3 receptor antagonists (ondansetron and tropisetron) and similar to or greater than that of conventional antiemetic regimens such as metocl...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199609040-00009
更新日期:1996-04-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Patient heterogeneity is the part of variability that can be explained by certain patient characteristics (e.g. age, disease stage). Population reimbursement decisions that acknowledge patient heterogeneity could potentially save money and increase population health. To date, however, economic ...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-012-0015-4
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:Low-dose aspirin (ASA) is effective for secondary prevention of ischemic stroke but can increase the risks of hemorrhagic stroke, upper gastrointestinal bleeding (UGIB), and dyspepsia. Prophylactic administration of proton pump inhibitors (PPIs) reduces the risks of these digestive symptoms. We investigated ...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-015-0289-4
更新日期:2015-10-01 00:00:00
abstract:BACKGROUND:Results from the PROVE IT trial suggest that patients with acute coronary syndrome (ACS) treated with atorvastatin 80 mg/day (A80) have significantly lower rates of cardiovascular events compared with patients treated with pravastatin 40 mg/day (P40). In a genetic post hoc substudy of the PROVE IT trial, the...
journal_title:PharmacoEconomics
pub_type: 杂志文章,随机对照试验
doi:10.1007/s40273-013-0054-5
更新日期:2013-06-01 00:00:00
abstract::This article explores the need to perform pharmacoeconomic evaluations of herbal medicines and assesses the extent to which this approach has been applied so far to these products. There seems to be no compelling need for pharmacoeconomic analyses of herbal over-the-counter medicines, but such analyses are certainly w...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200018010-00001
更新日期:2000-07-01 00:00:00
abstract:BACKGROUND:Over 200 million people have chronic obstructive pulmonary disease (COPD) worldwide. The number of disease-year equivalents and deaths attributable to COPD are high. Guidelines for the pharmacological treatment of the disease recommend an individualized step-up approach in which treatment is intensified when...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/11589270-000000000-00000
更新日期:2012-04-01 00:00:00
abstract::Constipation is one of the most common digestive complaints. It is a symptom, not a disease. The subjectivity that this involves means that assessments of clinical epidemiology, socioeconomic costs and pharmacotherapy are difficult, since there is no definition of 'normal' bowel habit. Although constipation can affect...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199507010-00003
更新日期:1995-01-01 00:00:00
abstract::Variable compliance with prescribed drug regimens is a leading source of variability in drug response. Specifics differ by drug and disease. The role of variable compliance was clearly defined in 2 trials of lipid-lowering agents, cholestyramine and gemfibrozil, in which exceptionally careful measurements of complianc...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199915030-00002
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the cost effectiveness of dabrafenib versus dacarbazine and vemurafenib as first-line treatments in patients with BRAF V600 mutation-positive unresectable or metastatic melanoma from a Canadian healthcare system perspective. METHODS:A partitioned-survival analysis model with three mutually exclus...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-014-0241-z
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:The recently completed ALEX trial demonstrated that alectinib improved progression-free survival, and delayed time to central nervous system progression compared with crizotinib in patients with anaplastic lymphoma kinase-positive non-small-cell lung cancer. However, the long-term clinical and economic impac...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-018-0625-6
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVES:To obtain utility estimates suitable for use in economic models for chronic spontaneous (idiopathic) urticaria (CSU). METHODS:Patient-level data from three randomized clinical trials-ASTERIA I, ASTERIA II and GLACIAL-were analysed. Health states were derived from the Urticaria Activity Score over 7 days (UA...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-015-0375-7
更新日期:2016-05-01 00:00:00
abstract::As part of the National Institute for Health and Care Excellence's (NICE) Single Technology Appraisal (STA) process, ruxolitinib was assessed to determine the clinical and cost effectiveness of its use in the treatment of disease-related splenomegaly or symptoms in adults with myelofibrosis. Ruxolitinib had previously...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-016-0447-3
更新日期:2017-02-01 00:00:00
abstract:OBJECTIVE:To estimate the potential savings in overall cardiovascular disease (CVD) treatment costs for the US population with coronary artery disease (CAD) resulting from the use of amlodipine. STUDY DESIGN AND METHODS:Using patient-level data from a retrospective analysis of the Prospective Evaluation of the Vascula...
journal_title:PharmacoEconomics
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.2165/00019053-200220080-00005
更新日期:2002-01-01 00:00:00
abstract::As part of the Single Technology Appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the manufacturer (AstraZeneca) of durvalumab (IMFINZITM) to submit evidence for the clinical and cost effectiveness of durvalumab for the treatment of patients with locally advanced, unresecta...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-019-00870-w
更新日期:2020-04-01 00:00:00
abstract::Direct administration of a drug into a vein guarantees bioavailability, i.e. the total amount of drug is fully available to the bloodstream for transport to all areas of the body. What is not ensured is the safety, need and 'value for money' of this route. Few workers would disagree that there is increased morbidity...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199201020-00007
更新日期:1992-02-01 00:00:00
abstract:BACKGROUND:Before the new round of healthcare reform in China, primary healthcare providers could obtain a fixed 15 % or greater mark-up of profits by prescribing and selling medicines. There were concerns that this perverse incentive was a key cause of irrational medicine use. China's new Essential Medicines Program (...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-013-0068-z
更新日期:2014-03-01 00:00:00
abstract::A variety of problems are associated with the operation, quality, costs, and benefits of therapeutic substitution programmes. Adequate communication of procedures, events, and failures are essential features of a safe therapeutic substitution policy. However, case reports of suboptimal therapy and differences in pha...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199200011-00010
更新日期:1992-01-01 00:00:00
abstract::There is growing interest in using observational data to assess the safety, effectiveness, and cost effectiveness of medical technologies, but operational, technical, and methodological challenges limit its more widespread use. Common data models and federated data networks offer a potential solution to many of these ...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-020-00981-9
更新日期:2020-12-18 00:00:00
abstract::Recent studies have shown that ACE inhibitors reduce morbidity and mortality after myocardial infarction (MI). While these trials have obvious clinical implications, the widespread introduction of a new treatment for a condition as common as MI also has clear cost implications. The results of the post-MI studies with ...
journal_title:PharmacoEconomics
pub_type: 临床试验,杂志文章
doi:10.2165/00019053-199712020-00008
更新日期:1997-08-01 00:00:00
abstract::External genital warts (EGW) are a sexually transmitted infection caused by various strains of human papillomavirus (HPV). Several studies have described the direct and indirect costs of EGW, while others have reported on the burden of EGW in terms of the impact on the quality of life (QOL) of patients. The arrival of...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/11591170-000000000-00000
更新日期:2012-01-01 00:00:00