Jonathan D. Campbell

The Costs of Treating Breast Cancer in the US : A Synthesis of Published Evidence

AbstractPublished estimates for the treatment costs of breast cancer vary widely in methodology, perspective, patient populations and time horizon. We systematically summarized and analysed the published literature on per-patient costs of breast cancer, and highlight the perspectives, populations studied, time horizons and future directions for cost studies in breast cancer.This review included 29 US cost-of-illness studies for breast cancer. The estimates of lifetime per-patient costs of breast cancer ranged from

Comparison of Anticancer Drug Coverage Decisions in the United States and United Kingdom: Does the Evidence Support the Rhetoric?

US20 000 to

Burden of multiple sclerosis on direct, indirect costs and quality of life: National US estimates.

US100 000. Payer perspectives were popular, while disease stages I and II were emphasized. The costs of initial and terminal therapy were greater than continuing care on a per-unit time basis, but continuing care accounts for the largest share of lifetime cost due to the relatively long survival of breast cancer patients. Costs of different surgeries were relatively similar (breast-conserving surgery vs mastectomy) but, all else equal, significant costs (

Multiple sclerosis prevalence in the United States commercially insured population

US23 000–31 000) were observed for patients who received adjuvant chemotherapy compared with those who did not. Multiple studies confirmed that costs increased with increased stage of disease and costs decreased with increased age of diagnosis. The question remains whether or not lower costs for elderly patients are associated with lower quality of care. The patient, employer and societal perspectives were rarely presented.Experts in the field have recommended the societal perspective for US-based cost-effectiveness analyses. Most lifetime cost estimates were likely an underestimate for today’s lifetime cost of treating breast cancer because of changes in practice patterns and improved survival. Further societal-based cost studies that differentiate costs by stage, age and treatment time (initial, continuing and terminal), and include the latest practice patterns would be valuable toward informing US-based cost-effectiveness studies for preventive as well as breast cancer treatment interventions.

Association between antiepileptic drug switching and epilepsy-related events

PURPOSE In contrast to the United States, several European countries have health technology assessment programs for drugs, many of which assess cost effectiveness. Coverage decisions that consider cost effectiveness may lead to restrictions in access. METHODS For a purposive sample of five decision-making bodies, we analyzed US and United Kingdom coverage decisions on all anticancer drugs approved by the US Food and Drug Administration (FDA) from 2004 to 2008. Data sources for the timing and outcome of licensing and coverage decisions included published and unpublished documentation, Web sites, and personal communication. RESULTS The FDA approved 59 anticancer drugs over the study period, of which 46 were also approved by the European Medicines Agency. In the United States, 100% of drugs were covered, mostly without restriction. However, the United Kingdom bodies made positive coverage decisions for less than half of licensed drugs (National Institute for Health and Clinical Excellence [NICE]: 39%; Scottish Medicines Consortium [SMC]: 43%). Whereas the Centers for Medicare and Medicaid Services (CMS) and the Department of Veterans Affairs (VA) covered all 59 drugs from the FDA license date, delays were evident for some Regence Group decisions that were informed by cost effectiveness (median, 0 days; semi-interquartile range [SIQR], 122 days; n = 22). Relative to the European Medicines Agency license date, median time to coverage was 783 days (SIQR, 170 days) for NICE and 231 days (SIQR, 129 days) for the SMC. CONCLUSION Anticancer drug coverage decisions that consider cost effectiveness are associated with greater restrictions and slower time to coverage. However, this approach may represent an explicit alternative to rationing achieved through the use of patient copayments.

Health economics of asthma: assessing the value of asthma interventions

BACKGROUND MS imposes a significant burden on patients, caregivers, employers, and the healthcare system. OBJECTIVE To comprehensively evaluate the US MS burden using nationally representative data from the Medical Expenditure Panel Survey. METHODS We identified non-institutionalized patients aged ≥18 with MS (ICD-9 code 340) from 1998 to 2009 and compared them to individuals without an MS diagnosis (non-MS) during the interview year. The cohorts were compared using multivariate regression on direct costs, indirect costs (measured in terms of employment status, annual wages, and workdays missed), and health-related quality of life (HRQoL; measured using Short Form 12, SF-6 Dimensions, and quality-adjusted life years [QALYs]). RESULTS MS prevalence was 572,312 (95% CI: 397,004, 747,619). Annual direct costs were

Treatment success for overactive bladder with urinary urge incontinence refractory to oral antimuscarinics: a review of published evidence

24,327 higher for the MS population (n=526) vs. the non-MS population (n=270,345) (95% CI:

Assessing the value of mepolizumab for severe eosinophilic asthma: a cost-effectiveness analysis

22,320,

The “E” in Cost-Effectiveness Analyses. A Case Study of Omalizumab Efficacy and Effectiveness for Cost-Effectiveness Analysis Evidence

26,333). MS patients had an adjusted 3.3-fold (95% CI: 2.4, 4.5) increase in the odds of not being employed vs. non-MS individuals and a 4.4-fold higher adjusted number of days in bed (95% CI 2.97, 6.45). On average, MS patients lost 10.04 QALYs vs. non-MS cohort. CONCLUSIONS MS was associated with higher healthcare costs across all components, reduced productivity due to unemployment and days spent in bed, and lower HRQoL.

Comparative Effectiveness of Quality Improvement Interventions for Pressure Ulcer Prevention in Academic Medical Centers in the United States

Objective: To estimate the US commercially insured multiple sclerosis (MS) annual prevalence from 2008 to 2012. Methods: The study was a retrospective analysis using PharMetrics Plus, a nationwide claims database for over 42 million covered US representative lives. Annual point prevalence required insurance eligibility during an entire year. Our primary annual MS identification algorithm required 2 inpatient claims coded ICD-9 340 or 3 outpatient claims coded ICD-9 340 or 1 MS-indicated disease-modifying therapy claim. Age-adjusted annual prevalence estimates were extrapolated to the US population using US Census data. Results: The 2012 MS prevalence was 149.2 per 100,000 individuals (95% confidence interval 147.6–150.9). Prevalence was consistent over 2008–2012. Female participants were 3.13 times more likely to have MS. The highest prevalence was in participants aged 45–49 years (303.5 per 100,000 individuals [295.6–311.5]). The East Census region recorded the highest prevalence (192.1 [188.2–196.0]); the West Census region recorded the lowest prevalence (110.7 [105.5–116.0]). The US annual 2012 MS extrapolated population was 403,630 (387,445–419,833). Conclusions: MS prevalence rates from a representative commercially insured database were higher than or consistent with prior US estimates. For further accuracy improvement of US prevalence estimates, results should be confirmed after validation of MS identification algorithms, and should be expanded to other US populations, including the government-insured and the uninsured.