Gabriel Raggio

Direct medical costs of complications resulting from type 2 diabetes in the U.S.

OBJECTIVE To estimate direct medical costs of managing the complications of type 2 diabetes. RESEARCH DESIGN AND METHODS Costs were estimated for 15 diabetic complications by applying unit costs to typical resource-use profiles. Resource use and unit costs were estimated from many sources, including acute care discharge databases, clinical guidelines, government reports, fee schedules, and peer-reviewed literature. For each complication, the event costs are those associated with resource use that is specific to the acute episode and any subsequent care occurring in the 1st year. State costs are the annual costs of continued management. All costs are expressed in 1996 U.S. dollars. RESULTS As expected, the more severe or debilitating events, such as acute myocardial infarction (

Economic assessment of troglitazone as an adjunct to sulfonylurea therapy in the treatment of type 2 diabetes.

27,630 event cost;

Economic analysis of initial HIV treatment. Efavirenz- versus indinavir-containing triple therapy.

2,185 state cost), generate a greater financial burden than do early-stage complications, such as microalbuminuria (

Treatment of Migraine in Canada With Naratriptan: A Cost-Effectiveness Analysis

62 event cost;

The Migraine ACE Model: Evaluating the Impact on Time Lost and Medical Resource Use

14 state cost). Yet, complications that are initially relatively low in cost (e.g., microalbuminuria) can progress to more costly advanced stages (e.g., end-stage renal disease,

The impact of compliance with osteoporosis therapy on fracture rates in actual practice.

53,659 state cost); therefore, minor complications should also be considered in any economic analysis of diabetes. CONCLUSIONS The recent literature has lacked cost estimates that may be readily translated into patient-level cost inputs for an economic model. Emerging therapies that may reduce the incidence of some diabetic complications will need to be scrutinized economically in todays cost-conscious environment. The cost estimates from this study provide one piece of the economic analysis needed to evaluate these new interventional therapies.

Persistence with treatment for hypertension in actual practice

OBJECTIVE To assess the economic efficiency of adding troglitazone to sulfonylurea therapy to improve glycemic control. BACKGROUND Despite the high prevalence of type 2 diabetes, existing treatment strategies often fail. New oral agents give a wider segment of the population with type 2 diabetes hope of achieving near-normal blood-glucose levels. Troglitazone, a novel chemical entity, is one promising new agent. METHODS We conducted an economic analysis based on glycemic-control data from a randomized clinical trial comparing troglitazone with placebo, each added to glyburide. A patient simulation model was used to translate these data to long-term outcomes associated with diabetes. Patients had poorly controlled type 2 diabetes mellitus despite glyburide therapy. Risk functions of developing and progressing through nephropathy, retinopathy, neuropathy, hypoglycemia, and macrovascular disease were developed from the Diabetes Control and Complications Trial and large epidemiologic studies. Cost estimates were based on data from 5 states, all payor databases, surveys, and literature. The main outcomes of the model were cost-consequences, number of patients developing each type of complication, mean time to development of the complication, cost per life-year gained (LYG), and cost per quality-adjusted life-year. RESULTS The model predicts that for every 1000 patients treated with troglitazone, the improved glycemic control could mean that 95 to 140 fewer patients would experience one of the most severe diabetic complications (eg, blindness, end-stage renal disease, amputation), which may increase life expectancy by 2.0 years. These benefits are obtained at an additional

Effect of initial drug choice on persistence with antihypertensive therapy: the importance of actual practice data

2100 per LYG (undiscounted). The ratio remains <

Modeling the Efficiency of Reaching a Target Intermediate End Point: A Case Study in Type 2 Diabetes in the United States

50,000 per LYG for most variations in input. CONCLUSIONS The clinical trial demonstrated that troglitazone + glyburide improves glycemic control compared with glyburide alone. Based on these results, the model estimates fewer diabetic complications at a cost well below accepted cost-effective thresholds.

PHV16: AN UNUSUAL ECONOMIC EVALUATION OF EFAVIRENZ COMPARED TO INDINAVIR

AbstractObjective: To compare the clinical and economic outcomes associated with triple therapy containing efavirenz or indinavir and 2 nucleoside reverse transcriptase inhibitors (NRTIs; zidovudine and lamivudine) in HIV-positive patients. Design and setting: An economic model based on viral load and CD4+ cell counts to predict long term outcomes such as progression to AIDS and AIDS-related death was developed and then analysed using data from a randomised clinical trial. Cost estimates from the healthcare system perspective were based on data from 6 state, all-payor databases, the AIDS Cost and Services Utilisation Study, and other literature. Analyses were carried out for time horizons between 5 and 15 years. Patients and interventions: HIV-positive patients with limited exposure to NRTIs. Initial regimens consisted of efavirenz or indinavir, each combined with 2 NRTIs. A maximum of 2 switches to other regimens was permitted. Main outcome measures and results: The efavirenz-containing triple therapy regimen was predicted to prolong survival at a savings of up to 10 923 US dollars (1998 values) relative to initial therapy with the indinavir-containing regimen. Patients who receive efavirenz are expected to have 11% greater survival at 5 years and fewer treatment failures (28 vs 52%, at 2 years). Overall, the economic and health benefits predicted for the efavirenz-containing regimen were robust to reasonable variation in key parameters. Conclusions: The superior clinical trial outcomes for efavirenz-containing regimens should translate into substantial economic and health benefits.