Daniel M. Huse

Childhood vaccination against chickenpox: An analysis of benefits and costs

OBJECTIVE To estimate the economic costs and benefits of routine childhood vaccination against varicella infection. DESIGN Decision-analytic model of the incidence and costs of chickenpox in children assumed to receive varicella vaccine at age 15 months in conjunction with the measles-mumps-rubella vaccine, or not to be vaccinated against varicella. PATIENTS Hypothetical cohort of 100,000 children. MAIN OUTCOME MEASURES Costs of vaccination, cumulative incidence of chickenpox to age 25 years, and related disease costs, including medical treatment and work loss. RESULTS Vaccination of 100,000 children against varicella at age 15 months would cost

Cost-effectiveness of statins ☆

4,812,000. The expected number of cases of chickenpox to age 25 years would be reduced from 95,400 to 4800; costs of medical treatment and work loss would correspondingly decline by

Prevention of Deep-Vein Thrombosis following Total Hip Replacement Surgery with Enoxaparin versus Unfractionated Heparin: A Pharmacoeconomic Evaluation:

1,678,000 and

The Risks and Benefits of an Rx-to-otc Switch: The Case of Over-the-counter H2-blockers

9,781,000, respectively. On balance, vaccination is estimated to yield net economic benefits of

Effects of Recombinant Human DNase Therapy on Healthcare use and Costs in Patients with Cystic Fibrosis

6,647,000, or

Cimetidine and adverse reactions: a meta-analysis of randomized clinical trials of short-term therapy.

66.47 per vaccinee. CONCLUSION Vaccination against varicella infection is cost-effective and should be part of the routine immunization schedule for U.S. children.

Physicians' Knowledge, Attitudes, and Practice of Pharmacologic Treatment of Hypertension

Currently, 6 hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are marketed in the United States (US). Given the wide variation in the prices and efficacy of statins, formal cost-effectiveness analysis may improve drug selection decisions. To assess the cost-effectiveness of statin therapy in primary and secondary prevention of coronary heart disease, we developed a model of the costs and consequences of lipid-regulating therapy and estimated the incremental cost-effectiveness of 5 statins (atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin) at usual starting doses versus no therapy. Drug effects on serum lipids were assessed using data approved by the US Food and Drug Administration for product labeling. Annual risks of coronary event occurrence were estimated using Framingham Heart Study coronary risk equations developed for use in this model. Current estimates of direct medical costs of coronary heart disease were used to assign costs to health states and acute coronary events. Main outcome measurements were net cost (statin therapy minus savings in coronary heart disease treatment), gain in life expectancy, and cost per life-year saved. The maximum gain in life expectancy was achieved with atorvastatin, which also had a lower net cost than lovastatin, pravastatin, and simvastatin. Compared with fluvastatin, atorvastatins greater effectiveness is attained at a lower cost per life-year saved. The cost-effectiveness of HMG-CoA reductase inhibition in primary and secondary prevention of coronary heart disease has been improved with the introduction of atorvastatin.

Cost effectiveness of adding ezetimibe to atorvastatin therapy in patients not at cholesterol treatment goal in Canada

OBJECTIVE: To compare the use of healthcare services in patients receiving enoxaparin, a low molecular weight heparin versus those receiving unfractionated heparin as prophylaxis against deep-vein thrombosis (DVT) following total hip replacement surgery. DESIGN: Economic evaluation undertaken in conjunction with a randomized, open-label, parallel group, Phase III clinical trial. SETTING: 32 US acute-care hospitals. PATIENTS: 607 patients undergoing elective total hip replacement. INTERVENTIONS: Enoxaparin 30 mg q12h, enoxaparin 40 mg qd, or unfractionated heparin 5000 units q8h started within 24 hours following surgery and continued for 7 days. MAIN OUTCOME MEASURES: (1) Use of selected tests and treatments for DVT; (2) use of selected tests and treatments related to post-operative bleeding; (3) length of stay in hospital; and (4) readmissions to hospital within 14 days. RESULTS: Although the use of selected tests and treatments related to DVT or postoperative bleeding did not differ significantly between the three treatment groups, mean length of stay in the hospital (following the start of study therapy) was shorter among patients receiving enoxaparin 30 mg (9.5 days; p=0.01) or 40 mg (9.9 days; p<0.05) than those receiving unfractionated heparin (11.3 days). There was also a trend toward fewer hospital readmissions in both of the enoxaparin groups. CONCLUSIONS: Compared with unfractionated heparin, use of enoxaparin following total hip replacement may decrease the risk of DVT and length of hospital stay.

Selective use of calcium channel blockers to treat high-risk hypertensive patients

In recent years, many new over-the-counter (OTC) medications have resulted from the granting of OTC status by the U.S. Food and Drug Administration to drug entities that previously were available only by prescription (Rx). While the benefits to consumers of Rx-to-OTC switches may be substantial, they also involve some degree of risk, as usage typically expands and physician supervision diminishes. This study explores the potential utility of techniques of decision analysis in evaluating the balance of these benefits and risks. Histamine H2 receptor antagonists (H2-blockers), which are currently available only by prescription, are presented as a case study and were examined to determine how OTC availability of these agents would alter the patterns, effectiveness, and risks of self-treatment for acid-peptic disorders. Currently, about 5.7 million persons experience an episode of dyspepsia during any given quarter, of whom 3.5 million self-medicate with antacids. Study results indicate that OTC availability of H2-blockers would: 1) increase the proportion of persons with dyspepsia who self-medicate from 61.8% currently to 64.1%; 2) increase the proportion of persons who experience complete relief of their symptoms while self-medicating from 37.9% currently to 43.2%; 3) result in 14 additional cases of serious hematologic disorders and an additional 22,000 instances of minor side effects per quarter, but cause the overall rate of side effects among persons who self-medicate to decline; 4) cause an additional 300 persons per quarter with gastric cancer to self-medicate before seeking professional care, but cause no change in the median time between onset of symptoms and the decision to seek such care; and 5) decrease by 277,000 the number of persons per quarter who seek professional care for dyspepsia. On balance, results suggest that OTC H2-blockers may be a relatively safe and effective means of self-care for acid-peptic disorders, and may substantially reduce the number of patient encounters with the medical care system for minor gastrointestinal complaints. This study also illustrates the potential utility of the techniques of decision analysis to the formulation of drug regulatory policy.

Economic Evaluation of Oral Ofloxacin Versus Standard Parenteral Therapy in the Treatment of Pneumonia

Objective: To assess the effects of recombinant human DNase (rhDNase) therapy on the cost of treating respiratory tract infections (RTIs) in patients with cystic fibrosis. Design: We prospectively documented the use of healthcare services among 968 patients with cystic fibrosis who participated in a recent Phase III double-blind, multicenter, clinical trial in which patients were assigned randomly to receive either rhDNase 2.5 mg once daily, rhDNase 2.5 mg twice daily, or placebo. All patients were followed for 24 weeks. Data from secondary sources were used to estimate a total cost of RTI-related care (excluding the cost of study therapy) for each trial participant, based on observed levels of resource use. Main Outcome Measures: Number of RTI-related hospital admissions, days of RTI-related outpatient antibiotic therapy (intravenous and oral), and total costs of RTI-related care (excluding the cost of study therapy). Results: Patients randomized to receive rhDNase once daily averaged 0.15 fewer RTI-related hospital admissions (0.41 vs 0.56 for placebo; p < 0.05) and 1.5 fewer days of RTI-related outpatient intravenous antibiotic therapy (2.9 vs 4.4; p < 0.05). Patients randomized to receive rhDNase twice daily had 0.14 fewer hospital admissions (p < 0.01), but no reduction in outpatient intravenous antibiotic therapy. Compared with placebo, the cost of treating RTIs over 24 weeks was