The European journal of health economics : HEPAC : health economics in prevention and care
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Opioid analgesics are known to impact on the central nervous system (CNS). These CNS side effects, such as dizziness and confusion, have been shown to lead to an increased risk of falling with subsequent fractures in elderly patients being treated with opioids. The risk of experiencing fractures has been shown to be dependent on the substance administered. ⋯ From the GSS perspective, the ICER is
2,496.77 per life year gained and 2,850.83 per QALY gained. The model is robust regarding probabilistic variations of all parameters in the sensitivity analyses. Focussing on fractures due to the prior administration of strong opioids, TD buprenorphine is less costly and more effective than TD fentanyl and oxycodone and represents a cost-effective treatment option versus morphine in patients with chronic pain from both the SHI and GSS perspective in Germany. -
Comparative Study
SF-6D versus EQ-5D: reasons for differences in utility scores and impact on reported cost-utility.
The choice of instrument (e.g. EQ-5D vs. SF-6D) can lead to different health-related utility scores, but it is unclear why these differences arise and whether they change cost utility analysis (CUA) results. ⋯ The paper examines reasons for this difference. This paper finds that an important factor was the inclusion in the SF-6D descriptive system of separate items for "vitality" and "social functioning", not explicitly included in EQ-5D. Further studies are required that examine the impact of the choice of instrument on cost-utility.
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Comparative Study
Cost-effectiveness of linezolid versus vancomycin for hospitalised patients with complicated skin and soft-tissue infections in Germany.
This study used a decision analytic model approach to evaluate the cost-effectiveness of linezolid versus vancomycin in the empirical treatment of complicated skin and soft-tissue infection (cSSTI) due to suspected methicillin-resistant Staphylococcus aureus (MRSA) from the German hospital and health care system perspective. Clinical probabilities were obtained from trial data, resource utilisation and MRSA prevalence rates were obtained through German physician interviews, and costs from published sources were applied to resource units. Outcomes included total cost/patient and cure. ⋯ Average total cost/episode was 8,232 euro for linezolid versus 9,206 euro for vancomycin. The model outcomes were sensitive to changes in length of stay (LOS), isolation days, rate of confirmed MRSA and price of linezolid. Linezolid was expected to result in a shorter intravenous treatment duration and shorter LOS that offset its higher acquisition cost versus vancomycin in cSSTI in Germany.
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This article focuses on the redistributive effects of different measures to finance public health insurance. We analyse the implications of different financing options for public health insurance on the redistribution of income from good to bad health risks and from high-income to low-income individuals. The financing options considered are either income-related (namely income taxes, payroll taxes, and indirect taxes), health-related (co-insurance, deductibles, and no-claim), or neither (flat fee). We show that governments who treat access to health care as a basic right for everyone should consider redistributive effects when reforming health care financing.
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The Federal Joint Committee (FJC; Gemeinsamer Bundesausschuss, G-BA) defines the health-care elements that are to be reimbursed by sickness funds. To define a directive, the FJC can commission benefit assessments, which provide an overview of the scientific evidence regarding the efficacy and benefits of an intervention. This paper describes the operational implementation of the legal requirements with regard to the benefit assessments of medicines. ⋯ During the writing of the final report, a separation between the evidence assessment and the evidence-appraisal phase should be implemented. Ideally, this separation should be legally enforced to prevent any confusion about conflict of interests. Such a process guarantees a feasible combination of the legal requirements for transparency and involvement of relevant parties with international standards of EBM to ensure that the benefit assessments of medicines in Germany are performed according to the highest standards.