Publisher: Adis   (Total: 21 journals)   [Sort alphabetically]

Showing 1 - 21 of 21 Journals sorted by number of followers
Drugs     Full-text available via subscription   (Followers: 221, SJR: 1.547, CiteScore: 5)
Drug Safety     Full-text available via subscription   (Followers: 188, SJR: 1.447, CiteScore: 3)
Sports Medicine     Full-text available via subscription   (Followers: 36, SJR: 3.367, CiteScore: 7)
PharmacoEconomics     Full-text available via subscription   (Followers: 29, SJR: 1.998, CiteScore: 3)
Clinical Pharmacokinetics     Full-text available via subscription   (Followers: 29, SJR: 1.482, CiteScore: 4)
American J. of Clinical Dermatology     Full-text available via subscription   (Followers: 26, SJR: 1.542, CiteScore: 3)
Applied Health Economics and Health Policy     Full-text available via subscription   (Followers: 23, SJR: 0.991, CiteScore: 2)
The Patient - Patient-Centered Outcomes Research     Full-text available via subscription   (Followers: 11, SJR: 1.095, CiteScore: 3)
BioDrugs     Full-text available via subscription   (Followers: 10, SJR: 1.038, CiteScore: 3)
Drugs & Therapy Perspectives     Full-text available via subscription   (Followers: 9, SJR: 0.115, CiteScore: 0)
Drugs & Aging     Full-text available via subscription   (Followers: 9, SJR: 1.072, CiteScore: 3)
CNS Drugs     Full-text available via subscription   (Followers: 8, SJR: 1.635, CiteScore: 4)
Clinical Drug Investigation     Full-text available via subscription   (Followers: 8, SJR: 0.719, CiteScore: 2)
Pharmaceutical Medicine     Full-text available via subscription   (Followers: 5, SJR: 0.187, CiteScore: 0)
Pediatric Drugs     Full-text available via subscription   (Followers: 4, SJR: 0.814, CiteScore: 2)
PharmacoEconomics & Outcomes News     Full-text available via subscription   (Followers: 4)
Inpharma Weekly     Full-text available via subscription   (Followers: 4)
High Blood Pressure & Cardiovascular Prevention     Full-text available via subscription   (Followers: 2, SJR: 0.524, CiteScore: 1)
Drugs in R & D     Full-text available via subscription   (Followers: 2, SJR: 0.881, CiteScore: 2)
PharmacoEconomics German Research Articles     Full-text available via subscription  
Giornale Italiano di Health Technology Assessment     Full-text available via subscription  
Similar Journals
Journal Cover
PharmacoEconomics German Research Articles
Number of Followers: 0  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 1612-3727 - ISSN (Online) 1868-677X
Published by Adis Homepage  [21 journals]
  • Editorial
    • PubDate: 2014-08-22
       
  • Editorial
    • PubDate: 2014-08-15
       
  • Experimentelle Präferenzmessung im Gesundheitswesen mit Hilfe von
           Best-Worst Scaling (BWS)
    • Abstract: Abstract Best-Worst Scaling (BWS) is a method of multi-attribute preference measurement. Its objective is to determine the preferences with respect to certain properties and characteristics. It is a stated preference method and based on the assumption that people are able to select the best and worst or subjectively most and least important from a set of three or more elements. BWS avoids, like all discrete choice experiments, the known weaknesses of rating and ranking scales. However, BWS promises to generate additional information because participants choose two times, namely the best as well as the worst alternative. This paper describes the potentials of application, the underlying theoretical concepts, and the implementation of the three variants of BWS experiments. It also shows that at least the second variant of BWS (the so-called profile case) is subject to restrictive and unrealistic assumptions.
      PubDate: 2014-08-02
       
  • Ist ein neues Arzneimittel sein Geld wert' Wessen Geld' –
           Bewertung eines neuen Diabetes-Präparats mit Hilfe eines
           Discrete-Choice-Experiments
    • Abstract: Abstract This study seeks to provide evidence for deciding whether or not a new preparation for the treatment of diabetes should be included in the benefit list of social health insurance. A discrete-choice experiment (DCE) was conducted in Germany to measure preferences for modern insulin therapy using long-acting insulin analogue “insulin detemir” in comparison to NPH insulin. The DCE contains two price attributes, co-payment and increased contributions to health insurance, as well as four properties of the insulin, i.e. risk of hypoglycemia, weight gain, need for preparing the insulin before injection, and flexibility in time of the injection. Of the 1,110 individuals interviewed in 2007, 202 suffered from type 1, 154 from insulin-treated type 2, and 152 from insulin-naive type 2 diabetes. This allows to compare ex-ante and ex-post willingness-to-pay (WTP). Non-diabetics and insulin-naive diabetics exhibit higher WTP values through co-payment, while affected type 1 and insulin-treated type 2 diabetics have higher WTP through increased contributions. However, WTP values exceed the extra treatment cost in both financing alternatives, justifying inclusion of the new drug in the benefit list from a cost-benefit point of view.
      PubDate: 2014-06-03
       
  • Der Analytic Hierarchy Process (AHP): Eine Methode zur
           Entscheidungsunterstützung im Gesundheitswesen
    • Abstract: Problem Regulatory decision bodies and clinical decision-makers have to decide on the approval, pricing and individualized treatment of patients. This decision is based on the assessment of the risk-benefit or cost-benefit ratios. The assessment of benefits often relies on multiple patient-relevant endpoints. Thereby the results of the clinical effects can be contrary. The more endpoints and the more heterogeneous the results, the more complex is the decision-making. The Analytic Hierarchy Process (AHP) is proposed to solve this problem by weighting multiple decision criteria. Objective The aim of the systematic review was to analyze how the AHP can be used for decision-making in health care in terms of the prioritization of patient-relevant outcomes. Method Based on a systematic literature review, the study design of the AHP method, applicability and possible limitations for the weighting of patient-relevant outcomes are reported and discussed. The methodological principles are presented and specific concerns during implementation and due to the eigenvalue approach are analyzed. Results The AHP is suitable to structure group decisions of e.g. different providers, for the management of organizations or the transparent decision-making in regulatory decision bodies. The weakness of AHP is his problematic applicability within large patient populations and the documentation of their preferences. In the future it should be decided to what extent the methodological limitations of the AHP ask for the use of other stated preferences techniques.
      PubDate: 2014-04-29
       
  • Allokation medizinischer Ressourcen – Eine Übersicht experimenteller
           Ergebnisse zur Akzeptanz von Verteilungsregeln
    • Abstract: Objective/Background The aim of this series of experimental studies is to elicit preferences of participants on distributive principles when a bounded amount of a medical resource like treatment time has to be allocated to hypothetical patients. Patients may differ in some of several aspects, a minimal amount of treatment time they need, a productivity factor indicating their ability to benefit from treatment time, or health levels before treatment. We characterize distributive decisions by matching them with allocations that result from theoretically founded distributive rules. Study Design The study consists of several classroom experiments in the form of a questionnaire study. Each questionnaire contained a sequence of distributive problems framed either in a medical or in a neutral context. Most of the experiments were conducted with monetary incentives for distributors in the role of a physician or an allocator in the neutral frame and also for participants in the role of patients or recipients. A follow up study did not use monetary incentives. Patients and Methods Participants were advanced students of economics, medicine and law from the universities of Halle and Jena. The studies took place between 2008 and 2012 as a series of classroom experiments with paper and pencil. Monetary payoffs were paid directly after the experiment. Main Results Students from different disciplines differed in their decision patterns. Frequencies of observed distributive principles also differed between medical and neutral context and were dependent on parameter constellations of decision problems. Students of economics took effectivity more often into account than students from medicine and law, especially in the neutral frame. Medical and law students preferred distributive rules that are defined by some kind of egalitarian principles, mainly focussing on amounts of resources, especially in the medical context. In case health levels of patients were reported, equality of health after treatment also played a role; however, equality of health gains was applied more often. If it was feasible to treat all patients, nearly no participant excluded a patient from treatment. If exclusion was unavoidable most participants excluded the patient with the lowest health effectivity of treatment time. Conclusions The frequencies of revealed allocation principles differed between medical and neutral contexts, fields of study of participants and sometimes also quantitative aspects of the problems. Exclusion of patients from treatment is in general avoided; if unavoidable low effectivity of a treatment seems to be a dominant criterion for prioritization.
      PubDate: 2014-04-15
       
  • Prioritäten bei der Therapie des Multiplen Myeloms: Eine Analyse der
           Perspektive von Ärzten
    • Abstract: Background Currently there is no cure for patients with Multiple Myeloma. Hence the primary objective of treatment is to extend survival time at the best possible quality of life. A study for eliciting patient preferences in multiple myeloma was conducted in summer/autumn of 2007. Target audiences have been the patients themselves. In the present study the questionnaire for preferences was presented to physicians, asking about their opinion as to what patients might consider most important. The aim of this second preference survey was to determine the physicians’ notions of their patients’ preference patterns, and to find out whether they were consistent with the patients’ actual preferences. Study Design (Including Statistical Design) The study consisted of two parts: a pre-test as a qualitative preliminary survey aimed at establishing relevant parameters, and a quantitative principal study with the objective of determining patients’ preferences as seen from the perspective of physicians as decision-makers. This part includes a direct assessment for levels of importance in a total of 17 aspects (5-point Likert scale) and a Discrete-choice experiment for measuring preferences, consisting of eight pairs with eight characteristics each. Sample & Methods The principal survey was conducted from early February to early March 2008 by means of online questionnaires or by use of a paper. In total N=511 physicians’ were asked by e-mail to participate in the survey; physicians without an e-mail address (N=614) were sent a paper questionnaire. A total of 243 physicians answered the questionnaire; 76 % male, 62 % with a specialization in haematology. Results In the direct measurement of patients’ preferences, physicians rated physical quality of life, rare side effects, and effectiveness aspects as most important attributes from the patients’ perspective, followed by emotional quality of life and therapy-free-intervals. Especially further treatment options and dosage were more important to patients than physicians believed. In this case, the physicians had underestimated the importance of these attributes from the perspective of those affected. The experiment revealed that both groups agree that openness to further therapy options and maximum extension of life are the most important factors. Physicians ranked prolonged life expectancy as significantly more important than all other treatment attributes. A further treatment option was the second most important attribute and significant compared to the attributes breaks in therapy and physical quality of life. Conclusions Asking physicians about the patients’ treatment preferences, the combination of direct assessment and Discrete-choice experiment proves to be a valid survey technique. Both the direct assessment of importance in order to rank the patients’ perceptions and the Discrete-choice experiment provide important insights into the preference structure of patients with Multiple Myeloma.
      PubDate: 2014-03-11
       
  • Drei Jahre frühe Nutzenbewertung nach §35a SGB V – kritische
           Würdigung und Lösungsvorschlag
    • Abstract: Background Against the background of increasing cost pressure in the German Health Care system German health policy introduced several law changes to increase competition within German health care system for both, payers and health care providers. At the same time law changes included centralization of decisions—counteracting a real competition. Both approaches are part of an austerity plan. The latest example for this approach is the new drug law (AMNOG) in 2011 with the core element of centralized early benefit assessment (§ 35a SGB V) for new drugs and therapies and price negotiations between federal association of health insurances and pharmaceutical company. In this review we examine the implementation of the new drug law with respect to the achievement of political objectives: Ensure sustainable financing of innovations in the German health care system, provide innovations early to the patient, decrease overregulation and establish a transparent environment in which efforts of the pharmaceutical industry are being honored by fair prices. Methods We reviewed the new AMNOG process since its implementation on 1st January 2011 and first 64 values dossiers from pharmaceutical companies that have been evaluated by G-BA (Federal Joint Committee) between January 2011 and December 2013 with respect to the above mentioned political objectives. Parameters such as added value, determination of an adequate competitor, patient relevant endpoint surrogate parameter and subgroup analysis are being discussed. Results AMNOG process has been implemented as a learning system and indeed several issues have already been addressed, such as the determination of the adequate comparator by G-BA as well as the treatment of orphan drugs in this process. Basically implementation of AMNOG and early benefit assessment is a necessary step on the way to transparent priorisation of health care benefits. But the AMNOG process is one step further towards centralization of the German health care system and therefore contradicts a healthy and fair competition within the system. As a consequence the development of high quality solutions for patients might be hampered. The analysis of the first 64 value dossiers shows that less of half of the affected patient populations (40 %) have access to new therapies being reimbursed by health insurances with a premium price. There is a major inbalance in assessment of drugs in different therapeutic areas. In combination with increased uncertainty for the pharmaceutical companies the AMNOG process on the middle and long-term might jeopardize the commitment of pharmaceutical industry in the German market. This in turn endagers the political objective to ensure patients early access to innovative therapies. Besides this, centralization of the subjective parameter “added value” seems to be problematic, since value decisions should be taken by democratic processes. We therefore suggest a model in which only objectively measurable value decisions are being taken centrally and subjective value decisions are as much as possible decentralized. This results in both a stronger competition of qualitatively best solutions for patients and in a higher fault tolerance. Instruments such as health care research and conditional reimbursement can help to enhance a fair competition for more quality in regionally organized health care and more economical allocation of short resources.
      PubDate: 2014-03-11
       
  • Kosteneffektivität von Apixaban zur Verhinderung von Schlaganfällen bei
           Vorhofflimmern in Deutschland
    • Abstract: Background and Objective Apixaban was shown to be superior to warfarin and acetylsalicylic acid in preventing stroke in patients with atrial fibrillation and at least one additional risk factor. This study compared the cost effectiveness of apixaban versus warfarin and acetylsalicylic acid in this patient population in Germany. Methods We constructed a lifetime Markov model with 12 health states, based on the results of the Aristotle and Averroes trial, to evaluate the cost effectiveness of apixaban from the social healthcare perspective. Our base-case assumed a cohort of 65-year old patients with a CHADS2 Score of 2.1. We used a 1-month cycle-length. The outcome was measured in quality-adjusted life-years (QALYs), costs and incremental-cost-effectiveness ratios (ICER). The robustness of the model was tested with one and two way sensitivity analyses. A probabilistic sensitivity analysis was also performed. Results Under base case conditions, total costs per patient were € 33,427 and € 33,118 for apixaban and warfarin. Corresponding QALYs were 10.79 and 10.06 in the lifetime Markov model. The ICER was € 423 per QALY. Monte Carlo simulation demonstrated apixaban was cost-effective in 86 % and 100 % of 10,000 iterations at willingness-to-pay thresholds of € 5,000 and € 50,000 per QALY, respectively. Compared to acetylsalicylic acid or the combination of acetylsalicylic acid and clopidogrel apixaban was the economic dominant therapeutic strategy. Conclusion The Markov model strongly suggests that apixaban therapy in the German health care setting is a cost-effective alternative to warfarin and phenprocoumon, respectively.
      PubDate: 2014-02-12
       
  • Eine vergleichende Kostenanalyse von sechs Anticholinergika zur Behandlung
           der überaktiven Blase und Inkontinenz in Deutschland
    • Abstract: Objective Comparing the costs of solifenacin, oxybutynin, trospium chloride, tolterodine, propiverine, and darifenacin for the treatment of overactive bladder (OAB) and incontinence in Germany. Data and methods Costs are assessed from a (public) health insurance perspective. The study is based on a unique sickness fund dataset of 2.9 million insured persons which includes records on outpatient care, inpatient care, pharmaceuticals, adjuvant therapies, and medical aids for 2009. 24,039 persons received anticholinergics and were thus classified as OAB patients. 4,152 of these patients also suffered from incontinence. Multiple linear regression models were performed, controlling for age and gender effects on costs. Results OAB patients caused additional costs of € 782 compared to non-OAB patients. Patients treated with propiverine had the lowest additional costs (€ 691) and patients treated with tolterodine the highest (€ 1,124). In the special case of incontinence, patients treated with solifenacin incurred by far the lowest additional costs (€ 1,320), patients treated with tolterodine the highest (€ 2,198). The low treatment costs for solifenacin are mainly driven by lower spending on medical aids, especially due to lower pad usage. All results are highly significant (p<0.01). Conclusion OAB patients treated with propiverine and incontinent patients treated with solifenacin have the lowest additional costs. In both patient groups tolterodine is associated with the highest additional cost of treatment.
      PubDate: 2014-01-31
       
  • Budget Impact Analyse von Paliperidon Palmitat im österreichischen
           Versorgungskontext
    • Abstract: Background The costs of schizophrenia in Austria are high and new long acting injectable (LAI) antipsychotics might be able to reduce costs due to a reduction of hospital stays. We aim to estimate budget effects of the introduction of a new LAI (Paliperidone Palmitate) in Austria. Methods A budget impact analysis was conducted that took direct costs of illness into account (i.e. costs for inpatient and outpatient services and drug costs). We used official Austrian remuneration prices as input parameters. The robustness of the model was checked by means of a sensitivity analysis. Results According to our calculations, direct total costs of schizophrenia reach € 254 million a year. These costs remain constant after the introduction of Paliperidone Palmitate. Conclusions The introduction of a new treatment of schizophrenia in Austria is budget neutral.
      PubDate: 2014-01-24
       
  • AMNOG – Erste Erfahrungen und mögliche Auswirkungen auf die
           Klinische Forschung
    • Abstract: Background and Objective On January 1st 2012 the German Law for Reforming the Market for Pharmaceuticals (Arzneimittelverordnungsgesetz: AMNOG) came into force. This law stipulated an early benefit assessment for new drugs for the first time. The acknowledgement of an additional benefit compared to the standard of care is a precondition for price negotiations with payers. 13 Pharmaceutical companies, launching a new agent in 2011, provided 19 benefit assessment dossiers to the Federal Joint Committee. The German Scientific Association for Market Access (DFGMA) decided to execute an expert survey as early as possible. The aim of the expert survey was to explore experiences during the compilation of the early benefit dossier, the implication of the law on clinical research and the requirements for the benefit assessment process. Method 10 experts, directly involved in the production of the early benefit dossier, from 9 pharmaceutical companies reported in telephone interviews of about 60 minute duration on their experiences, and discussed possible implications. Results The most important issues are: (a) the appropriate comparator set forth by the G-BA (Gemeinsamer Bundesausschuss), (b) post-hoc groupings of subgroups and subgroup analyses and, (c) exclusion of surrogate parameters. The criteria for the selection of the appropriate comparator are not clearly defined. Without clinical trials with the required comparator it seems to be nearly impossible to get a positive benefit assessment. Post-hoc subgroup analyses are critical for methodological reasons, because for unplanned subgroups the numbers for statistical analyses are inadequate and the results are lacking appropriate confidence levels. The exclusion of surrogate parameters also dilutes the results of clinical trials. Conclusion The requirements of the early benefit assessment in Germany should be considered in the very early phases of the development of a new drug. For pipeline candidates in phase I a sound analysis of reimbursement and market access issues should be performed. Phase II should include a much broader investigation than nowadays of the potential of the new agent, i.e. searching for patient groups with higher risk or special benefits, proof of concept studies optionally with several comparators and the assessment of appropriate patient relevant endpoints. Phase III trials must aim for superiority at least for a specified patient group. With regard to the benefit assessment process, improved coordination and unification of the requirements for the regulatory and reimbursement authorities seem to be desirable. The requirements should be clear, pragmatic and feasible to ensure medical innovations in Germany.
      PubDate: 2013-08-14
       
  • Editorial
    • PubDate: 2012-06-01
       
  • Gesundheitsökonomische Forschung im Kontext Individualisierter Medizin
           — Forschungsethische und datenschutzrechtliche Aspekte am Beispiel des
           GANI_MED-Projekts
    • Abstract: Abstract Research activities dealing with economic aspects of Individualized Medicine (IM) are part of many multidisciplinary IM-related projects in Germany. One important example is the Greifswald Approach to Individualized Medicine (GANI_MED). This paper presents basic principles of data protection and research ethics which are indispensable in order to guarantee that IM-related economic research which uses encoded, but reidentifiable data is in accordance with the regulatory framework and well established ethical standards in Germany. With respect to the patient-related economic research activities in GANI_MED the article also provides an example of a complete integration of an economic sub-project into the Informed Consent and Data Management Concept of a complex IM project. Last but not least the article provides initial data on the response of the GANI_MED patients to those modules of the GANI_MED consent form which enable the economic research group to receive patient-related data from health insurance companies and the “Kassenärztliche Vereinigung”. The response pattern confirms the hypothesis that patients who take part in an IM study do not automatically agree with the scientific usage of data dealing with the costs of their treatment.
      PubDate: 2012-06-01
       
  • Personalisierte Krebstherapie
    • Abstract: Abstract Background and Objective: Personalized Medicine (PM) allows the tailoring of medical interventions, such as screening, diagnostic or therapeutic strategies, to individual patients and aims to improve their effectiveness, reduce adverse events and allocate resources cost-effectively. In this article, we analyze methodological challenges and specific characteristics of health-economic evaluations focusing on personalized cancer medicine (PCM) using a published decision-analytic modeling study comparing different diagnostic tests for the HER-2 status of women with metastatic breast cancer. Methods: The paper is structured in three parts: 1) brief introduction to the general concept of PM and PCM, as well as specific aspects of health-economic evaluations in PCM; 2) case example demonstrating the evaluation of different testing strategies and consecutive personalized treatment decisions; and 3) discussion of methodological aspects of health-economic evaluations in PCM. Results: The analysis of the case example showed that treating metastatic breast cancer patients with trastzumab depends on the willingness to pay. With the application of a decision-analytic model, different testing strategies could be evaluated and the tests could be linked with consecutive treatment algorithms, the treatment effect and patient-relevant outcomes. Results of the cost-effectiveness analysis (CEA) differed from current guideline recommendations, as they included efficiency as an explicit criterion, and current recommended strategies were dominated. In general, the following challenges in the evaluation of PCM are recognized: often times surrogate endpoints are the only endpoints available and need to be extrapolated; combined test algorithms can be complex; comparison of multiple personalized strategies can be difficult or unfeasible in randomized controlled trials; and the evaluation of a lifelong time horizon is often required and duration and quality of life need to be integrated. Conclusion: Pharmacoeconomic modeling plays an important role in the evaluation of personalized cancer medicine. The assessment of personalized approaches for prevention and treatment of cancer may need to take into account different indications, such as preventive, adjuvant or palliative settings. Furthermore, the current benefit from technology needs to be complemented by the long-term benefit from innovation.
      PubDate: 2012-06-01
       
  • Individualisierte Medizin: vom Innovationskeimling zur Makroinnovation
    • Abstract: Abstract Prevention, diagnosis and treatment of chronic degenerative diseases require the consideration of multiple factors and non-linear stochastic relations between these factors and their potential health impacts. This calls for a strong emphasis on the genetic, metabolic, behavioral and environmental characteristics of the individual. Thus, a one-fits-all medicine seems to be inappropriate for an aging society with a high burden of chronic degenerative diseases. ‘Individualized Medicine’ (IM) is a concept that was developed to respond to this new epidemiological paradigm. It has the potential to change the relationship between doctors and patients, to alter the rules, institutions and regulations of the health care sector and even to influence societal values. However, there are major barriers preventing the key stakeholders from adopting this new approach to medicine. This paper analyses these barriers and whether IM is due to become a macro innovation. It concludes that IM is still in an early stage of the development and adoption process and that it must mature in a niche before it can become the new standard solution for the health-care system.
      PubDate: 2012-06-01
       
  • Bewertung der Einsparpotenziale in der Arzneimitteltherapie durch
           Dosisanpassung an die Polymorphismen im Cytochrom P450
    • Abstract: Abstract Objective: The cytochrome P450 superfamily is an important enzyme complex which aids in the metabolization of approximately 80% of pharmaceuticals currently on the market. Genetic variation leads to different phenotypes of metabolization: extensive metabolizer (EM), intermediate metabolizer (IM), poor metabolizer (PM) and ultra-rapid metabolizer (UM). Depending on polymorphism, different doses are appropriate. The information about 2D6, 2C9 and 2C19 is especially relevant from an economic point of view. The authors aim to determine how large the economic savings can be for the statutory health insurance by adapting the dose rate according to the CYP450 genotype. Therefore, they explored the top ten groups of the Anatomical Therapeutic Chemical (ATC) Classification System in sales in 2010. Methods: To calculate potential savings, a formula was designed, which includes the relevant agents, the frequency in which polymorphisms occur, the average defined daily doses and their costs, the number of patients, and the average intake period. Results: 36 appropriate agents were identified for calculation. They incurred a total cost of h2.3 billion for the statutory health insurance in 2010. The maximum saving potential lies in the ATC-group of psychoanaleptics, amounting to h96.1 million. Aripiprazol (h948.60), perphenazin (h352.40) and thiordiazin (€319.10) head the list of agents with the best saving potential per patient and treatment phase. Regarding the costs of diagnostic tests (€100 or €300), only four out of eight drugs are cost-covering. Conclusion: Pharmacogenetic testing and subsequent dose optimization is partially efficient. Mainly for agents with high €/DDD (DDD: Defined Daily Dose) and long duration of treatment, positive cost-aspects have been calculated in total or on a per patient basis. For final economic appraisal, further information is needed, such as the effect on adverse drug reaction or synergy effects for multi-medicated patients. Finally, dose optimization based on genetic information is likely to be efficient for several agents.
      PubDate: 2012-06-01
       
  • Outcome Assessment in der Rehabilitation — Eine empirische Untersuchung
           der Lebensqualität von Rehabilitanden mit orthopädischen Erkrankungen
    • Abstract: Abstract Intoduction: Evaluation of health-related quality of life is of great importance as patients’ morbidity has changed over the years. Due to the increase in chronic diseases, patient-reported outcomes are an important complementary outcome parameter in addition to the traditional mortality and morbidity data. The present study aims to investigate the changes in patients’ health-related quality of life after orthopaedic rehabilitation. Methods: In a rehabilitation clinic, 100 orthopaedic patients were asked about their health-related quality of life using EQ-5D at admission (T1), discharge (T2) and six weeks after hospitalization (T3) (pre-post design with one follow-up measurement). Results: At the end of rehabilitation (T2), the surveyed sample shows a significantly higher quality of life compared to the commencement (T1) of the rehabilitative treatment. Six weeks after discharge from the rehabilitation hospital (T3) there are no remarkable quality of life gains; quality of life remains almost constant. Conclusion: Due to the increase in chronic diseases, an aging society and the need for appropriate economic allocation of available resources, it is increasingly important to generate empirical evidence on the effectiveness and efficiency of medical interventions and, specifically, rehabilitative measures. Both, the present work as well as other available empirical studies, have identified the need to optimize the enduring effects of rehabilitation. Therefore, future efforts should work on and enhance a multi-professional treatment, including appropriate follow-up activities, taking into account individual patient needs.
      PubDate: 2012-03-01
       
  • Schwerwiegende Arzneimittelnebenwirkungen von Phenprocoumon: stationäre
           Kosten der gastrointestinalen Blutungen und Einsparungspotentiale
    • Abstract: Abstract Background and Objective: Adverse drug reactions (ADR) are appreciably harmful or unpleasant effects, resulting from an intervention related to the use of a medicinal product, with a high burden for patients and considerable economic consequences. Comprehensive pharmacoeconomic evaluations of ADR are quite rare in Germany. It is the aim of this study to determine the hospital costs of gastrointestinal bleeding effects among users of phenprocoumon. Furthermore, based on calculations of the costs of genotyping and of new drugs like dabigatran, and also on information about patient self-management (PSM), options for reducing the financial burden are investigated. Methods: The study is based on all patients suffering from ADR included in the database of the Pharmacovigilance Center Greifswald between 2006 and 2009 (n=80). DRGs were calculated on the basis of information provided by the Hospital Information System of the University Medicine Greifswald, which can be regarded as a monopolist within a rural area. Costs of genotyping were calculated by direct assessment of the used resources. Results: Findings for the included 40 men and 40 women were quite similar. The average age was 74 ± 10 years. On average a patient spent 10 ± 7 days in hospital. All patients were multi-morbid (average number of diagnoses: 15 ± 7) and used several drugs (average number of co-medication: 9 ± 3). The hospital received on average €2821 per patient, with a range between €350 and €5900. The total costs of genotyping were €57. In the case of a dabigatran-based therapy avoiding ADR the corresponding DDD-based costs would rise from €0.21 to €7.78. Conclusions: ADR-related costs can be increased by a more stringent application of PSM. The costs of genotyping were quite low. Because false positive test results are quite rare, tests are profitable even at a low bleeding risk. The replacement of vitamin k antagonists by new drugs like dabigatran might first of all improve the corresponding therapy. Whether it is possible to decrease the corresponding economic burden or not depends first of all on the corresponding drug price level.
      PubDate: 2012-03-01
       
  • Lebensqualitätsmessung in klinischen Studien beim Lungenkarzinom —
           Übersicht anhand der Datenbank ClinicalTrials.gov
    • Abstract: Abstract Background: In Germany, and throughout the world, the lung carcinoma is one of the most common and aggressive forms of cancer. Not only is the diagnosis itself stressful for the patients, but also the disease symptoms, such as (blood) cough, shortness of breath, pain in the chest and shoulders, in addition to the (toxic) side effects of therapies such as fatigue, weight loss, nausea, vomiting or diarrhea. While differences in clinical effectiveness decline, therapeutic alternatives must have a unique selling point. Accordingly, from the perspective of the industry, a stronger focus on patients’ quality of life is the consequence which is also requested by researchers and institutions. The aim of this study is to investigate whether a change in clinical research is taking place with reference to the inclusion of health related quality of life as an outcome measure in lung cancer trials and, if applicable, what instruments are used for this purpose. Methods: Using the ClinicalTrials.gov database, we conducted systematic research in late 2010. In particular we examined the quantity of lung cancer trials focusing on health related quality of life as well as on the instruments used. Comparisons were made over time (2005–2010). Results: “Overall survival” still prevails as the primary endpoint, whereas in clinical trials with biotechnology interventions the measurement of “progression-free survival” was claimed more often as the primary study endpoint. In approximately 10% of the trials “Quality of Life” is indicated as an endpoint. Lung cancer-specific questionnaires like the EORTC LC13, LCSS and FACT-L are most frequently used, sometimes in combination with the generic EQ-5D. Symptom-specific measurements are rare. Conclusions: A change in clinical research referring to the inclusion of health related quality of life as an outcome measure in lung cancer trials could not be found.
      PubDate: 2012-03-01
       
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
 


Your IP address: 3.233.229.90
 
Home (Search)
API
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-