Daniel E. Ball

Cost-effectiveness of drotrecogin alfa (activated) in the treatment of severe sepsis

ObjectiveTo assess the cost-effectiveness of drotrecogin alfa (activated) therapy, which was recently shown to reduce mortality in severe sepsis. DesignEstimates of effectiveness and resource use were based on data collected prospectively as part of a multicenter international trial. Estimates of hospital costs were based on a subset of the patients treated in the United States (33% of all enrolled patients). Lifetime projections were modeled from published sources and tested in sensitivity analyses. Analyses were conducted from the United States societal perspective, limited to healthcare costs, and using a 3% annual discount rate. SettingA total of 164 medical institutions in 11 countries. PatientsAdults ≥18 yrs of age with severe sepsis. InterventionsEligible patients were randomly assigned to receive a 96-hr intravenous infusion of drotrecogin alfa (acti-vated) at 24 &mgr;g/kg/hr (n = 850) or placebo (n = 840). Measurements and Main ResultsBase Case: incremental short-term (days 1–28) healthcare costs per day-28 survivor; Panel on Cost-Effectiveness in Health and Medicine Reference Case: incremental lifetime healthcare costs per quality-adjusted life-year. Over the first 28 days (short-term Base Case), drotrecogin alfa (activated) increased the costs of care by

Out-of-Pocket Drug Costs and Drug Utilization Patterns of Postmenopausal Medicare Beneficiaries with Osteoporosis

9,800 and survival by 0.061 lives saved per treated patient. Thus, drotrecogin alfa (activated) cost

Metastatic pancreatic adenocarcinoma treatment patterns, health care resource use, and outcomes in France and the United Kingdom between 2009 and 2012: A retrospective study

160,000 per life saved (with 84.7% probability that ratio is <

Antipsychotic adherence, switching, and health care service utilization among Medicaid recipients with schizophrenia

250,000 per life saved). Projected to lifetime (lifetime Reference Case), drotrecogin alfa (activated) increased the costs of care by

Timing of drotrecogin alfa (activated) initiation in treatment of severe sepsis: a database cohort study of hospital mortality, length of stay, and costs

16,000 and quality-adjusted survival by 0.33 quality-adjusted life-years per treated patient. Thus, drotrecogin alfa (activated) cost

Frequency of skeletal-related events and associated healthcare resource use and costs in US patients with multiple myeloma

48,800 per quality-adjusted life-year (with 82% probability that ratio is <

Increased olanzapine discontinuation and health care resource utilization following a Medicaid policy change.

100,000 per quality-adjusted life-year). Estimates were generally robust to sensitivity analyses, although cost-effectiveness deteriorated to >

Estimating the incremental net health benefit of requirements for cardiovascular risk evaluation for diabetes therapies

100,000 per quality-adjusted life-year if survivors lived <4.6 yrs on average. Drotrecogin alfa (activated) cost

Promising therapies, prohibitive costs: a qualitative assessment of the effects of the Medicare Part D doughnut hole on access to costly cancer medications

27,400 per quality-adjusted life-year when limited to patients with an Acute Physiology and Chronic Health Evaluation II score ≥25 and was cost-ineffective when limited to patients with a score <25. ConclusionsDrotrecogin alfa has a cost-effectiveness profile similar to that of many well-accepted healthcare strategies and below commonly quoted thresholds.

Treatment patterns and cost-effectiveness of first line treatment of advanced non-squamous non-small cell lung cancer in Medicare patients

BACKGROUND The Medicare Part D coverage gap has been associated with lower adherence and drug utilization and higher discontinuation. Because osteoporosis has a relatively high prevalence among Medicare-eligible postmenopausal women, we examined changes in utilization of osteoporosis medications during this coverage gap. OBJECTIVES The purpose of this study was to investigate changes in out-of-pocket (OOP) drug costs and utilization associated with the Medicare Part D coverage gap among postmenopausal beneficiaries with osteoporosis. METHODS This retrospective analysis of 2007 pharmacy claims focuses on postmenopausal female Medicare beneficiaries enrolled in full-, partial-, or no-gap exposure standard or Medicare Advantage prescription drug plans (PDPs), retiree drug subsidy (RDS) plans, or the low-income subsidy program. We compared beneficiaries with osteoporosis who were taking teriparatide (Eli Lilly and Company, Indianapolis, Indiana) (n = 5657) with matched samples of beneficiaries who were taking nonteriparatide osteoporosis medications (NTO; n = 16,971) or who had other chronic conditions (OCC; n = 16,971). We measured average monthly prescription drug fills and OOP costs, medication discontinuation, and skipping. RESULTS More than half the sample reached the coverage gap; OOP costs then rose for teriparatide users enrolled in partial- or full-gap exposure plans (increase of 121% and 186%;