Wendy Kennedy

Canadian Guidelines for Economic Evaluation of Pharmaceuticals

SummaryIn 1994, p]Canada became the second country to release national guidelines for the economic evaluation of pharmaceuticals. The guidelines were developed over a period of 18 months through an elaborate process of broad consultation with a wide variety of relevant stakeholders. The intent of the guidelines is to provide guidance to doers and users of studies, by laying out the general ‘state of the art’ regarding methods, and by providing specific methodological advice on many matters. The aim is to improve the scientific quality and integrity of studies, and to enhance consistency and comparability across studies.This article presents the Canadian guidelines, both in summary and in detail. Because the techniques of economic evaluation are widely applicable beyond pharmaceuticals, the guidelines will be of interest to researchers and decision makers in all fields of healthcare. Because the methods are not country specific, the guidelines will be of interest to those in other countries as well as in Canada.

High-dose intravenous proton pump inhibition following endoscopic therapy in the acute management of patients with bleeding peptic ulcers in the USA and Canada: a cost-effectiveness analysis

Background : The efficacy of high‐dose intravenous proton pump inhibition has recently been shown, yet its cost‐effectiveness remains poorly studied.

The cost-effectiveness of high-dose oral proton pump inhibition after endoscopy in the acute treatment of peptic ulcer bleeding

Background : Recent data suggest a role for high‐dose oral proton pump inhibition in ulcer bleeding.

Occurrence and risk factors of oral candidiasis treated with oral antifungals in seniors using inhaled steroids

Oral candidiasis (OC) is a frequent side effect of inhaled corticosteroids (iCSTs). This study estimated occurrence and significance of risk factors of OC treated with antifungals in users of iCSTs under conditions of normal use. This retrospective analysis used data drawn from drug insurance plan records in Quebec, Canada. The sample contained 27,000 seniors using anti-asthma medications during 1990. Three years of data (1989-1991) were searched for use of oral antifungals concurrent with exposure to iCSTs. A case-control study examined factors leading to increased probability of first incidence of OC in new users of iCSTs. Three-year occurrence for OC was 7%. Increased risk for a first occurrence of OC was significantly associated with higher doses of iCST, increased length of iCST exposure, use of antibiotics, use of oral steroids, having three or more prescribers, a history of use of both high and low strengths of iCST, and concurrent use of oral steroids and diabetes medications. The occurrence of OC is relatively high. Knowledge of factors leading to increased risk could facilitate the targetting of patients who need timely intervention, under conditions of normal use.

Cost Utility of Chemotherapy and Best Supportive Care in Non-Small Cell Lung Cancer

SummaryPolychemotherapy is the therapeutic option recommended for nonresectable, non-small cell lung cancer (NSCLC). However, the modest gains in survival, and the frequent and often serious adverse effects, associated with chemotherapy should also be considered when deciding on therapy. We therefore performed a cost-utility analysis of chemotherapy and best supportive care in NSCLC. Effectiveness and costs were analysed on 70 patients who were randomised to receive one of 3 treatments: VP (vindesine and cisplatin), CAP (cyclophosphamide, doxorubicin and cisplatin), or best supportive care. Subsequently, an assessment of the value of polychemotherapy and best supportive care was performed by oncology personnel using the time trade-off technique. Polychemotherapy was found to be more effective than best supportive care, but was also more costly and had a lower value score. Because of its cost utility and its higher value, best supportive care should not be discarded as an alternative for the treatment of NSCLC.

Health Survey Data on Potentially Inappropriate Geriatric Drug Use

BACKGROUND: Studies have suggested that elderly patients do not always use medications appropriately. Investigations that have relied on prescription claim databases or clinical records focus on acquisition or prescription, and hypotheses must be made to assess actual consumption. Population survey data constitute an alternative way to study inappropriate use. OBJECTIVE: To estimate the prevalence of potentially inappropriate use of medications in elderly patients in Québec based on self-reported use. METHODS: Using a cross-sectional, general population, health survey in which self-reported medication use in the 2 days prior to the survey was recorded, we estimated the prevalence of inappropriate medication use in elderly patients (≥65 y old) who responded. Two sets of published criteria were used to define inappropriate use: one to assess use of inappropriate drugs, and another to assess concomitant duplications and potential interactions. RESULTS: Of the 3400 patients surveyed, 6.5% had used ≥1 inappropriate drugs, 2.5% had ≥1 occurrences of potentially inappropriate duplication of medications, and 2.7% had ≥1 potential medication interactions. Concomitant use of at least 2 benzodiazepines was reported by 8.5% of respondents using these drugs. Use of ≥1 long-acting benzodiazepines was reported by 4.2% of the sample. CONCLUSIONS: Population health surveys are a useful tool for detecting potentially inappropriate medication use in the elderly. In particular, the high prevalence of inappropriate use of benzodiazepines signals a need for improved detection and intervention in this group. TRANSFONDO: Existen estudios que demuestran que los ciudadanos viejos no siempre usan sus medicamentos adecuadamente. Estudios basados en los bancos de datos de los reclamos de prescripción o expedientes clínicos se hacen a base de la adquisición o prescripción de medicamentos. De estos se crean hipótesis para estimar el consumo real de medicamentos. Una manera alterna de realizar estudios sobre el uso inapropiado de medicamentos lo es a través de datos obtenidos de encuestas poblacionales.

Cost-Effectiveness of Various Diagnostic Approaches for Occupational Asthma

BACKGROUND Diagnosis of occupational asthma (OA) by specific inhalation challenge (SIC) can be costly and is not always available. The use of sputum testing to avoid this in some patients may be a more cost-effective alternative. OBJECTIVES To compare the cost-effectiveness of SIC with serial measurements of sputum cell counts (sputum testing) and peak expiratory flow (PEF) monitoring. METHODS Clinical data and testing costs for OA in 49 patients were collected during a previously published trial, modelled and compared using TreeAge Pro. Clinical outcome was the percentage of accurately diagnosed patients, using SIC as the gold standard. The PEF approach used the most accurate assessment of five experts who were blinded to SIC results. Differences in the proportion of eosinophils during periods on and off work were used for the sputum testing approach and in PEF/sputum for the combined approach. Unit costs were estimated from charges in Canadian hospitals. Data were analyzed by one-way and two-way analyses, and by probabilistic sensitivity analysis using a Monte Carlo simulation technique. RESULTS The PEF approach had an estimated accuracy of 52% and cost

DOES CLINICAL TRIAL SUBJECT SELECTION RESTRICT THE ABILITY TO GENERALIZE USE AND COST OF HEALTH SERVICES TO “REAL LIFE” SUBJECTS?

365 per patient tested. Compared with PEF monitoring, sputum testing was more accurate and cost an estimated

Effect of age on the conformity rate to short-acting beta-agonist use criteria in asthma.

255 for each additional OA patient correctly diagnosed. SIC costs per additional correct diagnosis were

A one-year economic evaluation of six alternative strategies for the management of uninvestigated upper gastrointestinal symptoms in Canadian primary care

11,032 compared with sputum testing and