PharmacoEconomics
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The reliability and validity of generic utility measures have not yet been summarized in people with multiple sclerosis (MS). It is important to assess the psychometric properties of these measures, to ensure that the values obtained by the scoring system are valid for interpretation and utilization by clinicians, researchers and policy makers. Therefore, the objective of this review was to summarize the evidence from published literature on the psychometric properties of generic utility measures in MS. ⋯ To our knowledge this is the first study to review the validity and reliability of generic utility measures in MS. The HUI3 demonstrated the strongest psychometric properties when compared with other utility measures. However, the HUI3 only measures impairment and excludes important components of HRQL such as participation restrictions. The EQ-5D, the SF-6D and the QWB scale, on the other hand, do include items on participation. However, these measures demonstrated a lack of content validity in MS by missing certain domains that were important to the disease, as well as difficulty in differentiating between different levels of disability. The addition of MS-specific 'bolt-ons' to generic utility measures and the development of an MS specific utility measure are possible areas of exploration for future research.
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Fibromyalgia (FM) primarily affects women, and it is increasingly recognized by health care providers as more patients seek assistance for their chronic pain conditions. FM patients suffer from reduced quality of life, daily functioning and productivity. A single FM patient can cost society tens of thousands of dollars each year, with the overall expense increasing alongside disease severity. ⋯ Medications with the best efficacy in the treatment of FM include the tricyclic antidepressants amitriptyline and nortriptyline, cyclobenzaprine (a skeletal muscle relaxant), tramadol, duloxetine, milnacipran, pregabalin and gabapentin. Corticosteroids, nonsteroidal anti-inflammatory drugs, benzodiazepines and opioid analgesics, with the exception of tramadol, are not considered efficacious. Medication selection should be individualized and influenced by the severity of illness and the presence of comorbidities and functional disabilities.
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The aim of this study was to establish an EQ-5D-3L value set using the time trade-off (TTO) method to elicit the health preferences of the general Singaporean population. ⋯ The EQ-5D-3L value set can be estimated using the TTO method in the multi-cultural, multi-ethnic Singapore. Although the estimation precision is not optimal, the health-state preference values generated in this study are useful to health service researchers in the country before estimates with smaller errors are available.
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Postoperative adjuvant chemotherapy with capecitabine and oxaliplatin was first recommended for resectable gastric cancer patients in the 2011 Chinese National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Gastric Cancer, but the economic influence of this therapy in China is unknown. ⋯ For patients in China with resectable disease, our results suggest that adjuvant chemotherapy with capecitabine plus oxaliplatin after a D2 gastrectomy is cost-saving and dominant in the long run on the basis of a current clinical trial, compared with treatment with a D2 gastrectomy alone.
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Before the new round of healthcare reform in China, primary healthcare providers could obtain a fixed 15 % or greater mark-up of profits by prescribing and selling medicines. There were concerns that this perverse incentive was a key cause of irrational medicine use. China's new Essential Medicines Program (EMP) was launched in 2009 as part of the national health sector reform initiatives. One of its core policies was to eliminate primary care providers' economic incentives to overprescribe or prescribe unnecessarily expensive drugs, which were regarded as consequences of China's traditional financing system for health institutions. ⋯ It seems that the removal of a perverse economic incentive alone would not lead to improvement of healthcare providers' prescribing patterns. The rationality of the Essential Medicines List and the lack of payers' and providers' meaningful involvement in the development of the policy possibly contribute to the lack of significant changes in prescribing behaviors. It is suggested that China should adopt more comprehensive policies for healthcare facilities, physicians, patients, and payers, rather than just relying on economic incentives to improve rational use of medicines.