Abstract:
:Cost-utility analysis (CUA) is a technique that can potentially be used as a guide to allocating healthcare resources so as to obtain the maximum health benefits possible under a given budget constraint. However, it is not clear that current practice captures societal preferences regarding health benefits. In analyses of healthcare interventions providing survival benefits, the market rate of interest is the sole empirical variable that reflects societal preferences. This approach is based on the assumptions that: (i) healthcare interventions should be ranked using cost-effectiveness (CE) ratios; (ii) the discount rate for costs in CUA should be equal to that used in cost-benefit analysis (CBA); (iii) the discount rate in CBA should be the market rate of interest on long-term government bonds; and (iv) the Keeler-Cretin paradox is applicable to CUA of healthcare interventions, so that the discount rate for benefits in CUA should be set equal to the discount rate for costs. This approach ignores a fundamental difference between CBA and CUA, namely that CUA assumes that a budget constraint has been specified prior to the analysis. It starts with the assumption that a given amount of funds have been withdrawn from the economy to fund healthcare, so there is no opportunity cost to consider. For that reason, the principles on which the choice of discount rate rests differ in the two techniques. Furthermore, use of CE ratios to rank interventions assumes that the budget constraint can be expressed as a single constraint. But healthcare budgets are multiyear budgets that are roughly constant from year to year. A more realistic model would involve multiple constraints and would require linear programming for solution. This can be reduced to a series of single constraints, thereby allowing use of the simpler CE ratio approach, if we assume that the budget being allocated is intended for one cohort at a time, i.e. all people for whom a new funding decision must be made in a given year. In general, we assume that future cohorts will be allotted comparable funding. However, the Keeler-Cretin paradox depends on the assumption that cohorts are competing with each other for resources, and is therefore not applicable to CUA of healthcare. Other approaches are therefore needed to assign utilities to healthcare interventions providing survival benefits. Methods should be developed that allow analyses to reflect a range of philosophical approaches through sensitivity analysis.
journal_name
Pharmacoeconomicsjournal_title
PharmacoEconomicsauthors
Cohen BJdoi
10.2165/00019053-200321020-00001subject
Has Abstractpub_date
2003-01-01 00:00:00pages
75-87issue
2eissn
1170-7690issn
1179-2027pii
210201journal_volume
21pub_type
杂志文章abstract:OBJECTIVE:The objective of this article was to summarize the findings of all the available studies on alternative pharmacological treatments for asthma and assess their methodological quality, as well as to identify the main drivers of the cost effectiveness of pharmacological treatments for the disease. METHODS:A sys...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-018-0668-8
更新日期:2018-10-01 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:OBJECTIVE:To estimate the cost effectiveness (from the UK NHS and personal social services perspective) of the cholinesterase inhibitors donepezil, rivastigmine and galantamine compared with usual care in the treatment of mild to moderately severe Alzheimer's disease. Patients had a mean age of 74 years, a mean disease...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200523120-00010
更新日期:2005-01-01 00:00:00
abstract::Since the inception of the National Health Service in 1948, successive British governments have taken various measures to restrain the growth of the medicines bill. A total of 10 different measures have been introduced with very limited success. The most effective measures have been those directed at increasing the le...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199610030-00003
更新日期:1996-09-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to examine the cost effectiveness of fluvoxamine compared with tricyclic antidepressants (TCAs) in the treatment of patients with depressive episodes. DESIGN AND SETTING:A Markov process model was constructed to model the effectiveness, as measured by time without depression, ...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-199814040-00009
更新日期:1998-10-01 00:00:00
abstract:OBJECTIVE:To estimate indirect costs in Spanish ambulatory patients with HIV/AIDS and to identify changes in employment status and their current QOL. METHOD:Information was obtained through 32 interviews/enquiries carried out with ambulatory patients receiving medical attention at Gregorio Marañón and Puerta de Hierro...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200321150-00005
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVE:Economic evaluations of new diabetes therapies rely heavily upon the UK Prospective Diabetes Study (UKPDS) equations for prediction of cardiovascular events; however, concerns persist regarding their relevance to current clinical practice and appropriate use in populations other than newly diagnosed patients....
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-014-0225-z
更新日期:2015-02-01 00:00:00
abstract::This tutorial presents practical guidance on transforming various types of information published in journals, or available online from government and other sources, into transition probabilities for use in state-transition models, including cost-effectiveness models. Much, but not all, of the guidance has been previou...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-020-00937-z
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:Potential differences in toxicity, potency and acquisition price among the liposomal amphotericin B formulations makes it unclear which agent is less costly when total resource consumption and treatment-associated costs are considered. DESIGN:A retrospective cost-minimisation analysis in 51 patients was per...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200422050-00004
更新日期:2004-01-01 00:00:00
abstract::Several randomised comparative trials have shown that granulocyte colony-stimulating factor (G-CSF) reduces the duration of neutropenia, hospitalisation and intravenous antibacterial use in patients with cancer who are receiving high-dosage antineoplastic therapy. However, one area that has received less attention is ...
journal_title:PharmacoEconomics
pub_type: 临床试验,杂志文章
doi:10.2165/00019053-199711060-00005
更新日期:1997-06-01 00:00:00
abstract::The application of cost-effectiveness methodology is particularly important in widespread diseases such as hypertension. However, because prospective cost-effectiveness analyses comparing different antihypertensive drugs are not currently available, differences in the cost effectiveness of these drugs can only be esti...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199508060-00006
更新日期:1995-12-01 00:00:00
abstract::Clinical studies have shown that the combination of an inhaled corticosteroid (ICS) and a long-acting beta(2)-adrenoceptor agonist (LABA) for patients with asthma is more effective than the use of ICS alone in equivalent or higher doses, as well as the use of other combinations. However, the relatively higher acquisit...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-200624100-00005
更新日期:2006-01-01 00:00:00
abstract:CONTEXT:This study assesses if, and how, existing methods for economic evaluation are applicable to the evaluation of personalized medicine (PM) and, if not, where extension to methods may be required. METHODS:A structured workshop was held with a predefined group of experts (n = 47), and was run using a modified nomi...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-014-0211-5
更新日期:2015-01-01 00:00:00
abstract::The current US drug innovation financing framework rests on the notion that a defined period of marketing exclusivity combined with the expectation of reimbursement for clinically valuable, cost-effective therapies, followed by vigorous price competition from generic drugs and biosimilars ensures a sufficient return o...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.1007/s40273-020-00926-2
更新日期:2020-09-01 00:00:00
abstract::Health economic modelling studies are of interest to many parties with different responsibilities and diverging interests. Therefore, it is obvious that recognising the relevance of statistical uncertainty and dealing with it appropriately are required to obtain unbiased results from health economic modelling studies,...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200422120-00001
更新日期:2004-01-01 00:00:00
abstract:OBJECTIVE:To decompose drug spending in Sweden between the years 1990 and 2000. This paper updates a previous study, which looked at the period 1990-1995, by providing an additional 5 years of data (1995-2000) and extending the previous analysis in a number of ways. METHODS:The paper builds on the earlier work that sh...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200422010-00003
更新日期:2004-01-01 00:00:00
abstract:BACKGROUND:Head and neck cancer (HNC) and its treatment can affect communication, nutrition, and physical appearance, and the global impact of this disease on patients' quality of life may be substantial. OBJECTIVE:The aim of this systematic literature review was to describe the impact of HNC and its treatment on the ...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-014-0199-x
更新日期:2014-12-01 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::Which costs and benefits to consider in economic evaluations of healthcare interventions remains an area of much controversy. Unrelated medical costs in life-years gained is an important cost category that is normally ignored in economic evaluations, irrespective of the perspective chosen for the analysis. National gu...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-200826100-00003
更新日期:2008-01-01 00:00:00
abstract::The original article can be found online. ...
journal_title:PharmacoEconomics
pub_type: 已发布勘误
doi:10.1007/s40273-020-00950-2
更新日期:2020-10-01 00:00:00
abstract::Potential conflict between the goals of the investigators and the sponsors of pharmacoeconomic and clinical research has been well documented. Although there have been efforts to formalise relationships between sponsors and investigators in some areas of clinical research, no set of guidelines or standardised contract...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199507030-00004
更新日期:1995-03-01 00:00:00
abstract::Venetoclax is licensed to treat relapsed or refractory (R/R) chronic lymphocytic leukaemia (CLL). As part of the Single Technology Appraisal (STA) ID944, the National Institute for Health and Care Excellence (NICE) invited AbbVie, the manufacturer, to submit evidence on the use of venetoclax, within its licensed indic...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.1007/s40273-017-0599-9
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:The use of granulocyte colony-stimulating factor (G-CSF) can enable dose intensification of chemotherapy in small-cell lung cancer (SCLC). However, given its acquisition cost, it is important to assess its cost effectiveness within a resource-constrained health service. OBJECTIVE:To assess the cost effectiv...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200624050-00003
更新日期:2006-01-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to assess the cost effectiveness of using epoetin-alpha (erythropoietin) to augment preoperative autologous donation (PAD) of blood prior to elective cardiac surgery. DESIGN AND SETTING:We designed a decision-analytic model incorporating the risk of receiving allogeneic blood,...
journal_title:PharmacoEconomics
pub_type: 杂志文章
doi:10.2165/00019053-200018020-00006
更新日期:2000-08-01 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::A growing body of recent work has identified several problems with economic evaluations undertaken alongside controlled trials that can have potentially serious impacts on the ability of decision makers to draw valid conclusions. At the same time, the use of cost-effectiveness models has been drawn into question, due ...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-200017050-00007
更新日期:2000-05-01 00:00:00
abstract::Open-heart surgery (OHS) is performed to bypass occluded arteries, replace malfunctioning cardiac valves or correct congenital abnormalities. The average cost of OHS varies from $US25 057-$US79 795 (1997 values). The objective of this paper was to review economic studies of pharmacological strategies in open-heart sur...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-200321040-00003
更新日期:2003-01-01 00:00:00
abstract::The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer of golimumab (Schering-Plough/Centocor) to submit evidence for the clinical and cost effectiveness of this drug for the treatment of active and progressive psoriatic arthritis (PsA) in patients who have responded inadequately to ...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/11595920-000000000-00000
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVE:To compare the cost effectiveness of sequential intravenous (i.v.) to oral ciprofloxacin plus metronidazole (CIP/MTZ i.v./PO) with that of i.v. ciprofloxacin plus i.v. metronidazole (CIP/MTZ i.v.) and i.v. imipenem-cilastatin (IMI i.v.) in patients with intra-abdominal infections. DESIGN AND PARTICIPANTS:Pat...
journal_title:PharmacoEconomics
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.2165/00019053-199916050-00011
更新日期:1999-11-01 00:00:00
abstract::Drug utilisation in term and preterm neonates (i.e. less than 28 days of age) has been investigated prospectively in 4 clinical studies during the past 10 years. 3880 neonates with a mean gestational age of 34.5 weeks (corresponding birthweight 2280g) were enrolled in these studies. An overview indicates a high prev...
journal_title:PharmacoEconomics
pub_type: 杂志文章,评审
doi:10.2165/00019053-199304060-00005
更新日期:1993-12-01 00:00:00