Patrik Sobocki

Estimating the cost of epilepsy in Europe: a review with economic modeling.

Purpose: Based on available epidemiologic, health economic, and international population statistics literature, the cost of epilepsy in Europe was estimated.

The mission is remission: health economic consequences of achieving full remission with antidepressant treatment for depression.

The aim of the present study was to determine the magnitude of the impact of treating depression to full remission on cost and health‐related quality of life. In a naturalistic longitudinal survey recordings of resource use and quality of life were carried out among depressed patients treated with antidepressant therapy in 56 Swedish primary care clinics. We found that a total of 52% of the patients achieved full remission during the study period. Remitting patients had, on average, three outpatient visits less than non‐remitting patients (p < 0.01), 22 fewer sick leave days (p = 0.01), which translated into a significantly lower total cost (€2700) compared with non‐remitting patients (p < 0.01). Health‐related quality‐of‐life scores improved by 40% for remitting patients when compared with non‐remitting ones (p < 0.01). We conclude that remission has a substantial health economic impact on patients treated for depression, which further strengthens the importance of aiming for full remission in the treatment of depression.

Estimation of the cost of MS in Europe : Extrapolations from a multinational cost study

The present study aims at estimating the total cost of MS in Europe based on actual cost data from nine countries and published epidemiological evidence. The epidemiological data are reported as 12 months prevalence estimates and cost data calculated as annual cost per patient at given levels of disease severity. Cost data are extrapolated to the rest of Europe based on a model, using economic indexes adjusting for price level differences in different sectors between countries. The aggregated annual cost estimates are presented in Euro for 2005. In 28 European countries with a population of 466 million, an estimated 380 000 individuals are affected by MS. The total annual cost of MS in Europe is estimated at 12.5 billion in year 2005, corresponding to a cost of 27 per European inhabitant. Direct costs represent slightly more than half of the total cost (6.0 billion). Informal care is estimated at 3.2 billion, and indirect costs due to morbidity at 3.2 billion. Thus, the largest component of costs is found outside the formal health care sector. Although our model appears to predict costs reasonably well, when comparing to previous national studies not included in the estimates, there are considerable uncertainties when extrapolating cost data across countries even within Europe. These weaknesses can only be overcome by collecting primary data. Multiple Sclerosis 2007; 13: 1054—1064. http://msj.sagepub.com

The burden of ankylosing spondylitis in Spain.

OBJECTIVE To investigate the burden of ankylosing spondylitis (AS) in Spain, as baseline for economic evaluation of the use of biological agents. METHODS A cross-sectional retrospective observational study was performed in 601 patients with AS in Spain, using a methodology developed in studies in the United Kingdom and Canada. Patients were mailed a questionnaire asking about their health-care consumption, out-of-pocket expenses, work capacity, need for informal care during the past 3 months, as well as quality of life. Patients current functional status and disease activity level was assessed using the Bath functional and disease activity indexes (BASFI and BASDAI). RESULTS The mean age (median) was 47.8 (12.4) years, and the mean disease duration was 18.8 years. Eighty percent of patients were male, and slightly more than half of patients below 65 years of age were working. The mean (median) BASDAI and BASFI scores were 4.3 (2.5) and 3.8 (2.9),respectively, and all levels of disease severity were represented. The mean (median) total annual cost per patient is estimated at euro 20,328 (euro 7920). Direct health care represented 22.8%, investments (adaptations of house and devices) and informal care 43.5%, and productivity losses 33.7%. Costs increased significantly with worsening disease, in particular diminishing physical function, covering a range between euro 5000 and euro 75,000 per patient and year. The mean (median) utility was 0.59 (0.30). Utility showed a significant inverse relation with BASFI and BASDAI, covering a range from 0.80 for patients with BASFI/BASDAI below 3 to 0.25 for patients with BASFI/BASDAI greater than 7. CONCLUSIONS As in studies in other countries, all types of costs accelerate steeply with worsening disease while utility decreases significantly, indicating the need to prevent disease progression.

Resource allocation to brain research in Europe (RABRE)

This article is a markedly condensed summary of a longer report [Resource allocation to brain research in Europe (RABRE), part 2] that is simultaneously published on line: (i) as supplementary material linked to this European Journal of Neuroscience article (http://www.blackwell‐synergy.com/loi/ejn) and (ii) on the website of the European Brain Council (http://www.europeanbraincouncil.org/publications). We have recently shown that brain diseases account for 35% of the overall disease burden and cost European society almost €400 billion per year (a billion is understood to mean one thousand million throughout this report). The aim of the present study was to estimate funding for brain research in Europe and the cost–benefit of further investments in this area of research. The assessment of funding included public sources (governmental agencies plus charities) and industry funding. The assessment of publicly financed research support for brain research was based on a comprehensive survey, and industry investment in brain research was assessed based on published data on pharmaceutical development. The total funding of brain research in Europe was estimated at €4.1 billion in 2005, of which public grants amounted to < €900 million. Thus, industry funding accounted for 79%. Although cancer only incurred 50% of the cost of brain diseases in 2005, public grants for cancer research were almost twice as high as the public financial support of brain research. US‐based funding of brain research was almost four times higher than European funding. We assessed the cost–benefit of further investment in brain research using different methods. They all showed that increased investment in brain research is likely to be highly cost‐effective. We conclude that European spending on brain research, particularly public spending, is low compared to other fields of research and to the US, and that increased investment in brain research seems warranted.

Economic evaluations of leukemia: a review of the literature.

OBJECTIVES Leukemia, together with lymphoma and multiple myeloma, are hematological malignancies, malignancies of the blood-forming organs. There are four major types of leukemia: acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and chronic lymphocytic leukemia (CLL). There is a growing amount of literature of the health economic aspects of leukemia. However, no comprehensive review is yet performed on the health economic evidence for the disease. Hence, our aim was to review and analyze the existing literature on economic evaluations of the different types of leukemia. METHODS A systematic literature search used electronic databases to identify published cost analyses and economic evaluations of leukemia treatments. After reviewing all identified studies, sixty studies were considered relevant for the purpose of the review. RESULTS The identified studies were published after 1990, with a few exceptions. Many of the identified economic evaluations in leukemia, particularly for ALL and AML, may be defined as cost-minimization analyses, where only the costs of different treatment strategies are compared. In CML, a new treatment, imatinib, was introduced in 2001 and several cost-effectiveness analyses have since then been conducted comparing imatinib with previous first line treatments. CONCLUSIONS This review indicates that there is a shortage of cost-effectiveness information in leukemia. The introduction of new therapies will stress the need for new economic evaluations in this group of diseases. More information about the total costs, that is, including indirect costs, and quality of life effects would be valuable in future evaluations in leukemia.

Comparison of the cost-effectiveness of infliximab in the treatment of ankylosing spondylitis in the United Kingdom based on two different clinical trials

OBJECTIVES To compare the cost-effectiveness of the treatment of ankylosing spondylitis (AS) with infliximab in the United Kingdom over lifetime estimated from two different clinical trials and adjusted for clinical practice guidelines. METHODS A cost-effectiveness model was developed to incorporate clinical, epidemiological, and economic data and allow extrapolation of trial results and incorporation of long-term treatment. Assumptions regarding treatment beyond the trials were based on open extensions from the trials and treatment guidelines by the British Society for Rheumatology. Results are presented for both the societal perspective and the perspective of the National Health Service (UK pound, discounted 3.5 percent). RESULTS Under the assumption that disease activity would be controlled and functional capacity would remain stable while on drug, treatment with infliximab (5 mg/kg every 6 weeks) dominates standard treatment in the societal perspective. In the National Health Service perspective, the cost per quality-adjusted life-year (QALY) gained over lifetime was pound28,300 and pound26,800 for the two trials. If functional capacity were to deteriorate at half the rate of untreated patients, the cost per QALY gained would be pound35,300 and pound34,100, respectively. The results are sensitive to the dosing regimen adopted, the discontinuation rate, and assumptions concerning disease progression while on treatment. CONCLUSIONS The two clinical trials yield the same cost-effectiveness results and the cost per QALY gained with treatment was found to be in the acceptable range.

Cost of disorders of the brain in Italy

The aim of this study was to estimate the cost of “brain” disorders in Italy. Country-specific prevalence and health-economic data on addiction, affective, anxiety and psychotic disorders, tumours, dementia, epilepsy, migraine/other headaches, multiple sclerosis, Parkinson’s disease, stroke and head trauma were reviewed. Direct medical/non-medical and indirect costs were computed. Population-based samples and national or regional registries were used. The Italian population expected with a brain disorder was 12.4 million in 2004. The highest cost per case was for tumours and multiple sclerosis; the lowest was for anxiety disorders and migraine. Dementia (€8.6 billion), psychotic and affective disorders (€18.7 billion), migraine (€3.5 billion) and stroke (€3.4 billion) represented the highest total costs. Direct medical costs were predominant for psychiatric and neurosurgical disorders, direct non-medical costs for dementia, and indirect costs for neurological disorders. The total cost of brain disorders in Italy was €40.8 billion, 3% of the gross national product, and €706 per Italian citizen/year. This figure is however likely to be underestimated as it is based on retrospective methodology and samples of brain disorders, and does not include intangible costs.SommarioObbiettiviStimare il costo delle “malattie del cervello” in Italia.DisegnoDati epidemiologici ed economici specifici della nostra popolazione sono stati raccolti dalla letteratura per dipendenza da droga ed alcol, disturbi affettivi, psicotici e ansia, tumori cerebrali, demenza, epilessia, emicrania/altre cefalee, sclerosi multipla, M. Parkinson, ictus e traumi cranici. I costi diretti medici/non medici e quegli indiretti sono stati calcolati.SettingCampioni di popolazione e registri nazionali o regionali.Metodi e RisultatiLe stime indicano che 12.4 milioni di Italiani erano affetti da una di queste patologie nel 2004. I costi più elevati per paziente sono stati ricavati per tumori cerebrali e sclerosi multipla, i più bassi per il disturbo d’ansia e l’emicrania. Demenza (8.6 miliardi), disturbo psicotico/affettivo (18.7 miliardi), emicrania (3.5 miliardi) ed ictus cerebrale (3.4 miliardi) rappresentano i costi totali più elevati. I costi diretti medici sono predominanti per le patologie psichiatriche e neurochirurgiche, i costi diretti non medici per la demenza, ed i costi indiretti per altre malattie neurologiche.ConclusioniIl costo totale delle “malattie del cervello” in Italia è di 40.8 miliardi, il 3% del prodotto nazionale lordo, e 706 per cittadino Italiano/anno. Questo valore è tuttavia sicuramente sottostimato, in relazione all’utilizzo di una metodologia retrospettiva, di un piccolo campione di queste patologie, e non include i costi intangibili.

The cost-utility of maintenance treatment with venlafaxine in patients with recurrent major depressive disorder

Aims:  The Prevention of Recurrent Episodes of Depression with venlafaxine XR for Two Years trial has reported advantages with maintenance treatment for patients with recurrent depressive disorder. The aim of this study was to assess the cost‐utility of maintenance treatment with venlafaxine in patients with recurrent major depressive disorder, based on a recent clinical trial.

The cost-effectiveness of infliximab in the treatment of ankylosing spondylitis in Spain. Comparison of clinical trial and clinical practice data.

Objective: To estimate the cost‐effectiveness of treating ankylosing spondylitis (AS) with infliximab (Remicade®) in Spain for up to 40 years. Methods: A previously published disease model was adapted to the Spanish setting using resource consumption from a cross‐sectional burden of an illness study in 601 patients in Spain. Cost‐effectiveness estimates were based on a placebo‐controlled clinical trial as well as an open clinical study in Spain. In the model, patients with insufficient response to treatment at 12 weeks [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) <4 or ⩾50% reduction] discontinue treatment. The results are presented in 2005 euros, from societal and health‐care payer perspectives. Results: In the societal perspective, infliximab treatment dominates standard treatment in both analyses. In the perspective of the health‐care system, with the assumption that, over the long term, functional ability of patients on treatment would decline at half the natural rate, the cost per quality‐adjusted life year (QALY) gained was estimated at EUR 22 519 (double‐blind trial) and EUR 8866 (open study). Assuming that patients’ function on treatment remains stable, the cost‐effectiveness ratios are EUR 15 157 and EUR 5307, respectively. Under the most conservative assumption (no effect of treatment on progression), the ratios are EUR 31 721 and EUR 13 659, respectively. In addition, the results are sensitive to the time horizon and discontinuation rates. Conclusions: Our results indicate that infliximab therapy for patients with active AS should be cost‐effective both in the societal perspective (dominating) and in the perspective of the health‐care system (ranges from EUR 5300 to EUR 32 000 per QALY) in Spain.