Jörg Mahlich

Economic burden of osteoporotic fractures in Austria

ObjectiveOsteoporotic fractures impose a huge economic burden on society. Though several cost of illness studies from other countries exist, no equivalent study has been conducted in Austria. Our study aims at assessing costs resulting from osteoporotic fractures in Austria in the year 2008 from a societal perspective.MethodsWe took both direct and indirect costs into consideration. Direct costs encompass medical costs such as expenses for pharmaceuticals, inpatient and outpatient medical care costs, as well as other medical services (e.g., occupational therapies). Non-medical direct costs include transportation costs and medical devices (e.g., wheel chairs or crutches). Indirect costs refer to costs of productivity losses due to absence of work. Moreover, we included costs for early retirement and opportunity costs of informal care provided by family members. For our analysis, we combined data of official statistics, expert estimates as well as unique patient surveys that are currently conducted in the course of an international osteoporotic fracture study in Austria.ResultsFor the year 2008, the total annual financial burden incurred by osteoporotic fractures in Austria amounted to approx. €685.2 million, the largest fraction of which was due to the opportunity cost of family care (30.2%), followed by costs for hospitalization (26.6%).ConclusionsThe financial burden of osteoporotic fractures in Austria is substantial. Our findings may have implications for future economic analyses, and also support health care authorities in their decision making.

Patient preferences for HIV/AIDS therapy - a discrete choice experiment

ObjectivesAn increasing emphasis on patient-centred health care and shared decision making requires an intensive consideration of patient preferences. In the present study, patient preferences regarding treatment of HIV/AIDS were explored using direct assessment and discrete choice experiment (DCE).MethodsBased on literature research about preferences of HIV/AIDS patients we conducted a qualitative pre-study. The results were used to compose a questionnaire on relevant aspects of HIV/AIDS treatment which underwent a pre-test. In the subsequent quantitative study phase presented here, the following data were collected online or on paper including socio-demographic data, SF12v2, data on HIV/AIDS, antiretroviral treatment and patient preferences for therapy characteristics using direct measurement, as well as a discrete choice experiment.Results218 patients completed the quantitative main study, 82% of these on paper. 86% were male and the most frequent age group was between 45 and 54 years (37.6%). The SF12v2 showed a mean value of 43 points for the “mental health” component sum score. In the direct measurement the most relevant therapy characteristics were “Self-application of the drug (at home or on-the-go) possible”, “Drug has very high efficacy (reduction of viral load)” and “Long term (hidden) damage (e.g. organ damage) is unlikely”. Based on a factor analysis, six treatment characteristics were selected and used to generate eight virtual therapies. To evaluate the patient assessments a random effect logit model was employed. All of the characteristics were statistically significant predictors of the model of patient preference. The most important therapy characteristic was that the disease is not obvious for others.ConclusionsThe main result is the high impact of quality of life, in particular the emotional quality of life on patient preferences on the selection of treatments. Thus, the selection of particular treatment options should be accompanied by a deliberate consideration of treatment features, which need to be considered in order to maximize patient adherence and compliance.

Persistence with biologic agents for the treatment of rheumatoid arthritis in Japan.

Background To assess persistence rates of biologic agents for the treatment of rheumatoid arthritis in Japan. Methods Based on Japanese claims data of 16,214 patients between 2012 and 2014, 6-, 12-, and 18-month persistence rates of different biologic agents were calculated. Determinants of persistence were assessed by means of a multivariate Cox proportional hazard model controlling for age, sex, and comorbidities. A sensitivity analysis was performed with different definitions of persistence and parametric survival analysis. Results Overall persistence rates in Japan are high and reach 86% after 1 year in the entire sample. The persistence rate for the biologic-naïve subpopulation is above 95%. Persistence is higher for older patients (hazard ratio 0.60 [95% confidence interval 0.40–0.91] for >75 years compared to ≤60 years) and lower for patients with a high comorbidity score (hazard ratio 1.33; 95% confidence interval 1.03–1.70 for Charlson Comorbidity Index score 3–5 compared to ≤2). We found a high variation of persistence between different drugs. Conclusion Japanese rheumatoid arthritis patients have a high persistence rate of biologic treatments. However, multiple factors affect the persistence rate of Japanese patients, including age, comorbidities, and patient type. Naïve patients tend to have a higher persistence rate than continuing biologic patients.

Adherence and rehospitalizations in patients with schizophrenia: evidence from Japanese claims data.

Background The aim of this study is to analyze if there is a relationship between adherence to antipsychotic medication and rehospitalization for patients diagnosed with schizophrenia in Japan. Methods Based on Japanese claims data, we constructed three patient groups based on their medication possession ratio (MPR). Controlling for potential confounders, a Cox proportional hazard model was employed to assess if medication adherence affects the risk of rehospitalization. Results Patients with good adherence (MPRs from 0.8–1.1) had the lowest rates of admission. Both poor adherence (MPRs <0.8) and overadherence (MPRs >1.1) were associated with a significant higher risk of rehospitalization with hazard ratios of 4.7 and 2.0, respectively. Conclusion The results of this study support the notion that good adherence to antipsychotic medication reduces the risk of rehospitalization of schizophrenia patients. Appropriate measures should be taken to improve adherence of schizophrenia patients.

Modeling the budget impact of long-acting injectable paliperidone palmitate in the treatment of schizophrenia in Japan

Background The cost of schizophrenia in Japan is high and new long-acting injectable (LAI) antipsychotics might be able to reduce costs by causing a reduction of hospital stays. We aim to estimate budget effects of the introduction of a new 1-month LAI, paliperidone palmitate, in Japan. Methods A budget impact analysis was conducted from a payer perspective. The model took direct costs of illness into account (ie, costs for inpatient and outpatient services, as well as drug costs). The robustness of the model was checked using a sensitivity analysis. Results According to our calculations, direct total costs of schizophrenia reach 710,500 million yen a year (US

Productivity loss of Japanese patients with rheumatoid arthritis – A cross-sectional survey

6 billion). These costs decrease to 691,000 million yen (US

Analysis of contemporary HIV/AIDS health care costs in Germany: Driving factors and distribution across antiretroviral therapy lines.

5.9 billion) 3 years after the introduction of paliperidone palmitate. Conclusion From a payer point of view, the introduction of a new treatment for schizophrenia in Japan helps to save resources and is not associated with a higher financial burden.

Intangibles Kapital und Rentabilität in der Pharmaindustrie

Abstract Objective: The objective of this study was (1) to determine productivity costs due to absenteeism and presenteeism among Japanese workers with rheumatoid arthritis (RA), and (2) to identify additional factors associated with productivity loss among workers with RA. Methods: An online survey of 500 RA Japanese patients was used. The Japanese version of the Stanford Health Assessment Questionnaire (J-HAQ) was used to measure patients’ functional disability. The patient health questionnaire-9 item (PHQ-9) was used to measure symptoms and severity of depression. To assess work productivity the ‘work productivity and activity impairment questionnaire’ for rheumatoid arthritis (WPAI-RA), a six-item validated instrument was used. Results: Percentages of absenteeism and presenteeism were found to be 1% and 23%, respectively. The annual combined productivity costs of both absenteeism and presenteeism was 7877 USD per patient. Factors significantly associated with a higher productivity loss were functional disability, depressive symptoms, and time since RA diagnosis, while age, and biological disease-modifying antirheumatic drugs (bDMARDs) treatment were significantly associated with a lower productivity loss. Conclusion: Treatment of RA with bDMARDs would likely result in decreased productivity loss among Japanese patients.

Shared Decision-Making in Patients With Prostate Cancer in Japan: Patient Preferences Versus Physician Perceptions

AbstractTo analyze contemporary costs of HIV health care and the cost distribution across lines of combination antiretroviral therapy (cART). To identify variations in expenditures with patient characteristics and to identify main cost determinants. To compute cost ratios between patients with varying characteristics.Empirical data on costs are collected in Germany within a 2-year prospective observational noninterventional multicenter study. The database contains information for 1154 HIV-infected patients from 8 medical centers.Means and standard deviations of the total costs are estimated for each cost fraction and across cART lines and regimens. The costs are regressed against various patient characteristics using a generalized linear model. Relative costs are calculated using the resultant coefficients.The average annual total costs (SD) per patient are &OV0556;22,231.03 (8786.13) with a maximum of &OV0556;83,970. cART medication is the major cost fraction (83.8%) with a mean of &OV0556;18,688.62 (5289.48). The major cost-driving factors are cART regimen, CD4-T cell count, cART drug resistance, and concomitant diseases. Viral load, pathology tests, and demographics have no significant impact. Standard non-nucleoside reverse transcriptase inhibitor-based regimens induce 28% lower total costs compared with standard PI/r regimens. Resistance to 3 or more antiretroviral classes induces a significant increase in costs.HIV treatment in Germany continues to be expensive. Majority of costs are attributable to cART. Main cost determinants are CD4-T cells count, comorbidity, genotypic antiviral resistance, and therapy regimen. Combinations of characteristics associated with higher expenditures enhance the increasing effect on the costs and induce high cost cases.

A potential gender bias in assessing quality of life - a standard gamble experiment among university students.

Die Pharmaindustrie gehört auf den ersten Blick zu den rentabelsten Branchen weltweit. In unserer Studie gehen wir den Ursachen der hohen Rentabilität nach. Während in älteren Erklärungsansätzen Marktmacht und Markteintrittsbarrieren eine grosse Rolle spielten, führen neuere Arbeiten hohe Rentabilität in forschungsintensiven Branchen auf Messschwierigkeiten zurück, die dadurch entstehen, dass Forschungsund Entwicklungsinvestitionen als Aufwand anstatt als Vermögensgegenstand mit anschliessenden Abschreibungen behandelt werden. Unter Verwendung von internationalen Firmendaten aus den Jahren 1985 – 2004 aktivieren wir in unserer Arbeit die Forschungsund Entwicklungsinvestitionen und berechnen die korrigierte Rentabilität auf den um Forschungsund Entwicklungsinvestitionen ergänzten Kapitalstock. Die Rentabilität von Pharmafirmen sinkt dabei um zwei bis fünf Prozentpunkte und liegt somit auf ähnlichem Niveau wie die von anderen forschungsintensiven Branchen.