PubMed Health⌕ Search

Biomedical subjects

A H Anis

Publications and source records attributed to A H Anis.

29 records · Page 2Linked to original sources
PubMed1998

Using pharmacoeconomic analysis to make drug insurance coverage decisions.

Our objective was to institute a cost-effectiveness-based reimbursement eligibility and coverage scheme for drugs in the Canadian province of British Columbia. All applications from drug manufacturers requesting Pharmacare (British Columbia government-funded drug insurance plan) coverage were evaluated by the Pharmacoeconomic Initiative (PI) of British Columbia. PI recommendations are according to a majority decision reached by a multidisciplinary volunteer expert committee and are based on a critical evaluation of pharmacoeconomic studies submitted by manufacturers seeking reimbursement eligibility. Coverage for drugs is universal and completely free for the financially indigent. Others are charged a small copayment and/or a deductible. PI assessments are evidence-based. Published guidelines from the Canadian Coordinating Office of Health Technology Assessment (CCOHTA) and/or Ontario Ministry of Health guidelines for the economic evaluation of pharmaceuticals are recommended for preparing submissions to the PI. Between January 1996 and December 1996, the PI made recommendations on 21 submissions; 4 of these were cost-effectiveness or cost-utility analyses; 3 were cost-minimisation analyses; 6 were cost comparisons or cost-consequence analyses; and 8 were provincial formulary budget impact studies. Of the 21 PI recommendations, 18 were accepted by Pharmacare and decisions are pending for 2 others, thus providing a concordance rate of 95% (18/19; kappa = 0.89). A total of 7 of the 21 products were recommended for formulary inclusion by the PI; 4 were as per drug company requests (i.e. full-benefit status) and 3 were recommended under restricted use. Only 5 of 21 submissions, of which 4 had favourable reviews, complied with either the CCOHTA or the Ontario Ministry of Health guidelines. Most studies were conducted, not from a societal perspective, but from the perspective of the provincial healthcare system. Most of the analysis were short term and therefore discounting was not applied. Sensitivity analysis was not performed in more than half (52%) of the submissions, and 48% of applications used inappropriate comparators. Ontario is the only other Canadian province with a similar process, with cost-effectiveness criteria for reimbursement eligibility. However, analysis in that province during the same approximate time period demonstrated a low concordance between Ontario Drug Benefit and PI decisions (kappa = 0.07). Currently, the mandated or suggested use of technology assessments of pharmaceuticals with cost effectiveness as the primary end-point is a reality in several countries worldwide. Our results, based on actual experience from implementing such a programme, suggest that while industry is slow to adapt to the new reporting requirements it may also be sceptical about the importance of cost effectiveness and guideline compliance in decision-making.

British Columbia↗
PubMed1998

Average annual drug cost and its determinants in a population based cohort of HIV-positive adult men and women.

The purpose of this study is to determine drug costs and the sociodemographic and clinical determinants of drug costs in a large open cohort of HIV-positive adult men and women in British Columbia, Canada from 1993 to 1995. The study is descriptive and population-based using time-series data. Individuals included in the study were men and women enrolled in a province-wide HIV/AIDS drug treatment programme who had given consent to access their entire prescription records held by the provincial drug plan. The primary outcome measure was the average annual drug cost for treating HIV/AIDS among programme participants; results were stratified by sociodemographic status, drug category and disease severity. The analysis was restricted to 1271 consenting programme participants. The average annual drug cost per participant in 1996 Canadian dollars ($Can) was $Can3431 in 1993, $Can3892 in 1994 and $Can4377 in 1995. Between 1993 and 1995, the average annual cost of antiretroviral therapies increased by 6.6% ($Can2579 in 1995), anti-infectives increased by 61.4% ($Can2402 in 1995) and other drugs used in the management of patients with HIV disease increased by 35.7% ($Can1146 in 1995). The overall increase over this period was 27.6%. In 1995, the average annual drug cost was $Can4720 for those on social assistance, $Can4545 for seniors and $Can5937 for the general population (nonpoor and nonelderly). In 1995, the average annual drug cost was $Can6887 for those with AIDS and $Can3911 for those without. Multivariate modelling indicated that drug costs were significantly related with CD4+ cell count (p < 0.001), diagnoses of AIDS (p < 0.001), provincial drug plan type (p = 0.002), time participants had spent in the HIV/AIDS Drug Treatment Program (p = 0.003), number of hospitalisations (p = 0.003) and patient's age (p = 0.004). Our data demonstrate that the average annual drug costs for persons with HIV/AIDS in British Columbia have been increasing even though the cost of antiretrovirals has been relatively stable. This was due mainly to the increase in the cost of anti-infectives and other drugs. Important cost drivers were participant's age, socioeconomic status (by provincial drug insurance coverage level) and rate of disease progression as measured by CD4+ cell counts, hospitalisation events and duration of illness.

Adult↗
PubMed1998

Modelling the potential economic impact of viral load-driven triple drug combination antiretroviral therapy.

The purpose of this study is to model the potential economic impact of viral load-driven triple drug combination (including a protease inhibitor) antiretroviral therapy on incremental drug and hospitalisation costs among individuals with HIV disease. Individuals included in the study were HIV-positive men and women from the province of British Columbia, Canada, who were aged 18 years or older and had given consent to access their medical records. The study employed pharmacoeconomic modelling of drug- and hospital-utilisation patterns among a population-based cohort with free access to antiretroviral therapy. Protease inhibitor use and associated costs based on actual use in a subsequent period was modelled upon men and women who were able to maintain stable CD4+ cell counts (slope > or = 0) for at least 6 months (baseline period) with an average follow-up period of 30 months (protease-like group). A control was modelled upon individuals with declining CD4+ cell counts (slope < 0) during similar baseline and follow-up periods. The primary outcome measure was average annual incremental cost of triple drug therapy net of hospitalisation and testing costs in 1996 Canadian dollars ($Can). The utilisation pattern of drugs and hospitals was modelled from actual use among a total of 1271 individuals who were eligible for this analysis. Programme participants who gave consent to access their medical records were more likely to be men (p < 0.001), older (p < 0.020), and on antiretroviral therapy (p < 0.001) than programme participants who did not give consent. No differences were observed between the protease-like and comparison groups with respect to age (p = 0.65) and CD4+ cell count (p = 0.30) at study entry. Over a period of 1 year, the protease-like group was shown to spend less time in hospital (2.7 vs 6.6 days; p < 0.001). This difference in hospitalisation remained in multivariate models, adjusting for prior AIDS-defining illnesses and gender. The average annual incremental cost of adding a protease inhibitor to a 2-drug antiretroviral regimen was estimated to be $Can2318 per person. The cost implications of hospital stay while using a protease inhibitor drug and 2 nucleosides translated into an average annual incremental cost (savings if negative) of between -$Can4798 and -$Can2227 per person. The overall average annual incremental cost impact per person associated with triple drug therapy with a protease inhibitor varied between -$Can2288 to $Can283. Negative incremental costs imply overall savings from adopting triple combination therapy. This modelling exercise demonstrated that the cost of triple drug combination antiretroviral therapy with a protease inhibitor among HIV-positive men and women was considerably less than the expected acquisition cost of the drug alone due to hospitalisation savings in the province of British Columbia.

Adult↗
PubMed1997

Practice guideline for arterial blood gas measurement in the intensive care unit decreases numbers and increases appropriateness of tests.

OBJECTIVE: To test the hypothesis that implementation of a practice guideline for blood gas measurement would decrease numbers and increase appropriateness of tests (according to criteria in the guideline) for up to 1 yr after introduction of the guideline. DESIGN: Numbers of tests and appropriateness of each test were measured retrospectively during each of five periods: two baseline periods 2 yrs and 1 yr before introduction of the guideline and three follow-up periods 2 to 3 months, 6 to 7 months, and 12 to 13 months after introduction of the guideline. SETTING: A ten-bed multidisciplinary intensive care unit (ICU) within a 500-bed tertiary teaching hospital. PATIENTS: A random sample of 30 patients admitted to the ICU during each of the periods specified above. INTERVENTIONS: The nominal group process was used to develop a new guideline and a multipronged educational approach was used to facilitate implementation of the guideline. MEASUREMENTS AND MAIN RESULTS: At 2 to 3 months, test numbers decreased from 4.9 +/- 1.6 to 3.1 +/- 1.8 (SD) tests/patient/day and to 2.4 +/- 1.2 tests/patient/day at 12 to 13 months. Appropriateness increased from a mean of 44% at baseline to 78% at 2 to 3 months and 79% at 12 to 13 months. There were no differences in Acute Physiology and Chronic Health Evaluation scores or ICU mortality among the patient groups and no differences in number of ventilator days or time to wean from ventilation. Cost-minimization analysis showed that the incremental cost-saving 1 yr after introduction of the guideline was $19.18 per patient per day. CONCLUSIONS: Implementation of this guideline for arterial blood gas measurement increases efficiency of test utilization without prolonging mechanical ventilation or affecting outcome.

APACHE↗
PubMed1996

Variability in prescription drug utilization: issues for research.

The authors report the results of a literature review to identify research issues relating to physician prescribing practices and evaluate the potential for existing Canadian databases to support initiatives to improve prescribing practices. Methodologies such as small-area variation analysis and drug utilization reviews are discussed, and Canadian data sources relating to drug prescribing are assessed. The authors conclude that small-area variation analysis can be used to identify differences in drug utilization rates. A ranking method to identify drugs with the greatest variability in utilization can then be used to establish priorities for further analysis. After statistically significant factors associated with prescribing patterns are identified, intervention and policy formation will be possible. This will involve a more sophisticated integration of existing provincial information sources and the adoption of uniform guidelines to promote rational prescribing practices.

Aged↗
PubMed1996

A cost effectiveness analysis of cyclosporine in rheumatoid arthritis.

OBJECTIVE: To perform a cost effectiveness analysis of cyclosporine (CyA) in the treatment of rheumatoid arthritis (RA). METHODS: Five randomized controlled parallel group clinical trials were selected for metaanalysis. A fixed effects model was used to calculate the treatment effects among the studies. An incremental economic analysis was performed from both a societal perspective and the perspective of Ontario Ministry of Health (MOH). A placebo comparison and 2 head to head comparisons were performed. The total treatment cost was calculated for a typical patient based on a modified intent to treat approach modelled over a one year period. RESULTS: CyA produced a 25% or greater improvement in tender joint account in 35% of the patients relative to 17% of patients receiving placebo. There was no significant difference in improvement between CyA and azathioprine (Aza) or D-penicillamine (D-Pen). From the perspective of the Ontario MOH, the annual incremental cost of achieving the same level of improvement between CyA and Aza was found to be $1,473, and between CyA and D-Pen, $1,618; the annual incremental cost effectiveness ratio per patient improved of adopting CyA over placebo was $11,547. From a societal perspective, the incremental cost of CyA was $2,886 and $3,731 between Aza and D-Pen, respectively. The annual incremental cost effectiveness ratio against placebo was $20,698. CONCLUSION: Given budgetary constraints on provincial drug plans, guidelines identifying patients in whom the cost effectiveness of CyA may be expected to be most favorable need to be explored. When CyA is the last option available to alleviate RA, whether it is "good value for money" depends upon the importance placed on patient improvement by the patients and/or by society, and on the alternative uses of the same scarce resources.

Antirheumatic Agents↗
PubMed1995

Cost-effectiveness analysis of the Ottawa Ankle Rules.

STUDY OBJECTIVE: To conduct an incremental cost-effectiveness analysis of implementation of the Ottawa Ankle Rules in emergency departments in the United States and Canada. DESIGN: A decision analytic approach to technology assessment. Clinical decision rules that allow physicians to be more selective in their use of radiography were compared with current practice in a decision analytic model. SETTING: A university hospital adult ED. PARTICIPANTS: ED physicians instructed in the use of the Ottawa Ankle Rules for adult patients with ankle injury. RESULTS: Radiography, waiting time, lost productivity, and medicolegal costs were calculated. In the United States, the savings varied between US$614,226 and US$3,145,910 per 100,000 patients, depending on the charge rate for radiography. In Ontario, Canada, the total savings were CAN$730,145 per 100,000 patients. One- and two-way sensitivity analyses that varied the rate of missed fractures, cost of radiography, probability of lawsuits, and cost of lawsuits did not change the results substantially. CONCLUSION: Implementation of the Ottawa Ankle Rules would result in significant savings of health care dollars despite the cost of missed fractures including litigation costs.

Adult↗
PubMed1994

Substitution laws, insurance coverage, and generic drug use.

This study examined the role of various policies (drug product substitution laws) that are usually motivated by cost containment objectives of insurers in facilitating entry by generic firms. Using data for six Canadian provinces over the years 1981-1988, we evaluated the impact of specific aspects of substitution laws on the level of generic use. We find that formularies and the passage of time are not significant determinants of substitution levels. Legal liability, mandatory product selection, deductible and co-payment schemes, and consumer awareness were found to be important variables. Price responsiveness of generic drugs is indicated but the evidence is not strong.

Canada↗
PubMedDate not supplied

The costs of cardiorespiratory disease episodes in a study of emergency department use.

OBJECTIVE: The average per person direct cost of illness of cardiorespiratory disease episodes was estimated based on a prospective study of emergency department visits. METHODS: Economic modelling of health care costs using prospectively collected resource utilization data (9/1/94 to 8/31/95) from hospital emergency department visitors assigned a diagnosis of asthma, chronic obstructive pulmonary disease (COPD), respiratory infections or cardiac conditions. RESULTS: The total direct costs (1997 CDN$) [95% C.I.] per patient were $1,043.55 [$922.65, $1,164.47] for asthma, $1,690.11 [$1,276.92, $2,103.30] for COPD, $676.50 [$574.46, $778.54] for respiratory infections, and $3,318.74 [$2,937.72, $3,699.76] for cardiac conditions. CONCLUSIONS: This study showed that on average, patients diagnosed with a cardiac condition had the highest total direct cost. Hospitalization cost was the largest component of costs for all diagnoses except asthma, for which medications were the single largest component of direct costs.

Adult↗
PubMedDate not supplied

Beyond administrative data: characterizing cardiorespiratory disease episodes among patients visiting the emergency department.

We attempted to address deficiencies in administrative health service data during a study of cardiorespiratory emergency department visits. From 1994-1996, we obtained data on 9,264 visits and conducted 1,772 follow-up interviews. The median interval between symptoms and visit ranged from 0.8 days (95% CI 0-1.7) for cardiac conditions to 4.0 days for chronic obstructive pulmonary disease (COPD) (95% CI 2.7-5.3) and respiratory infections (95% CI 3.5-4.5). Infection was the most common trigger of respiratory visits. Although most had improved at follow-up, symptoms persisted following the visit for a mean of 4.5 days (95% CI 3.8-5.4) for cardiac conditions to 8.4 days (95% CI 7.2-9.5) for COPD. Among adults aged < 70, the mean number of reduced activity days per episode ranged from 4.7 (95% CI 3.9-5.4) for asthma to 6.6 (95% CI 5.9-7.4) for respiratory infections. Our data assist in interpreting epidemiological studies based on administrative data, and illustrate the broad impacts of cardiorespiratory disease episodes.

Adolescent↗