The European journal of health economics : HEPAC : health economics in prevention and care
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Comparative Study
Economic impact of simplified de Gramont regimen in first-line therapy in metastatic colorectal cancer.
The cost of chemotherapy has dramatically increased in advanced colorectal cancer patients, and the schedule of fluorouracil administration appears to be a determining factor. This retrospective study compared direct medical costs related to two different de Gramont schedules (standard vs. simplified) given in first-line chemotherapy with oxaliplatin or irinotecan. This cost-minimization analysis was performed from the French Health System perspective. ⋯ The opposition between health system perspective and hospital perspective is worth examining and may affect daily practices. In conclusion, our study shows that the simplified de Gramont schedule in combination with oxaliplatin or irinotecan is an attractive option from the French Health System perspective. This safe and less costly regimen must compared to alternative options such as oral fluoropyrimidines.
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A 'health benefit basket' is a range of publicly entitled health-related goods and services. Primary legislation ensures the provision of broad categories of health care, but this provision is subject to political discretion. ⋯ Regulation may, however, be important in determining citizens' rights. With reference to 'services of curative care', this paper explores whether the NHS is moving towards a more explicit definition of a health basket.
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Randomized Controlled Trial
Trial-based cost-utility comparison of percutaneous myocardial laser revascularisation and continued medical therapy for treatment of refractory angina pectoris.
This study examined from a health service perspective whether percutaneous myocardial laser revascularisation (PMR) plus standard medical management is cost-effective when compared with standard medical management alone in the treatment of refractory angina. This involved a cost-utility analysis using patient-specific data from a single-centre, randomised, controlled trial carried out in the United Kingdom. Of 73 patients diagnosed as having refractory angina and not suitable for conventional forms of revascularisation, 36 were randomised to PMR plus medical management and 37 to medical management alone. ⋯ The mean QALY difference favoured PMR at 0.126, giving an incremental cost per QALY of 50,873 pounds. The cost-effectiveness acceptability curve indicates that the probability of PMR being cost-effective over the first 12 months is quite low. Whilst a longer period of follow-up might indicate continued benefit from PMR, which would make the intervention economically more attractive, PMR could not be considered cost-effective based on 1-year follow-up data.
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The Danish health care system is decentralized and tax financed. Reimbursable drugs are financed by the national health insurance, which despite its official name, is a tax-funded system for paying for drugs,practicing physicians outside hospitals, dentists, etc. Most issues related to pricing and reimbursement of drugs are placed centrally, however, with the Danish Medicines Agency, and in contrast to most of the health care system reimbursement is thoroughly grounded in legislation. ⋯ The criteria for granting general reimbursement are relatively clear. Economic evaluations on a voluntary basis can be used to support documentation of a reasonable relationship between price and therapeutic effects. Reimbursement is calculated on the basis of an average European price level.