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May 2026 DOI 10.14302/issn.2641-4538.jphi-26-6161
J GonzalezCorresponding author
Objectives Motor fluctuations and non-motor disorders not manageable by first-line treatments in advanced Parkinson's disease require continuous dopaminergic stimulation strategies such as subcutaneous infusions of apomorphine (APO) or foslevodopa/foscarbidopa (FLD/FCD). A Budget Impact Analysis (BIA) was performed to estimate the cost difference between both treatments assuming equivalent clinical efficacy and safety. Material and methods The efficacy results of pivotal clinical trials at 12 and 52 weeks of treatment and the safety profile of APO vs FLD/FCD were compared, based on latest scientific publications and other available clinical data. A comparative BIA was performed, based on estimated annual drug treatment costs at Spanish published prices. Results The efficacy of APO (16 h/day) and FLD/FCD (24 h/day) in reduction of OFF hours (2.47 vs 2.75, 12 weeks; 3.66 vs 3.50, 52 weeks; respectively) and increase of ON hours without disabling dyskinesias (2.77 vs 2.72, 12 weeks; 3.31 vs 3.80, 52 weeks; respectively) could be considered clinically equivalent, as well as their safety profiles. However, a significant discrepancy is observed in the costs of the aforementioned alternatives. Considering published prices and the average dose reported in the literature, in Spain the annual cost of APO would be €13,980 compared to €55,198 for FLD/FCD. Consequently, the financial resources required for the treatment of FLD/FCD would enable the treatment of approximately three to four patients with APO. The BIA indicated the potential for annual savings in more than €2,500 million, considering a total target population of over 60,000 patients per year. Finally, an univariant sensitivity analysis was performed, considering a scenario in which the hospital acquisition cost of FLD/FCD decreased between 20%-30% (€44,159- €38,638/year). In this scenario, the total annual savings range between €1,875-€1,532 million per year. Conclusions Overall APO is more efficient than FLD/FCD, as it provides similar clinical efficacy at a lower treatment cost. The selection of an appropriate treatment option is to be determined by clinical criteria and patient characteristics, but cost evaluation should be considered to select the most cost-effective therapeutic option.
Sep 2017 DOI 10.14302/issn.2474-7785.jarh-17-1727
Akazawa ManabuCorresponding author
Public Health and Epidemiology, Meiji Pharmaceutical University
Background: Healthcare services provided to patients should vary depending on disease severity. However, disease severity bias, a type of selection bias, is a commonly encountered problem in administrative database studies. Herein, we selected chronic obstructive pulmonary disease (COPD), which commonly affects elderly Japanese citizens, for the development and validation of a severity classification system based on a health insurance claims database. Methods: Patients who received COPD-related diagnostic codes in 2011 were selected from a commercially based health insurance claims database. COPD patients were randomly divided into two groups to develop and validate severity scores. A principal component analysis was used to estimate factor loadings used to weight calculations of COPD severity scores. Score validity was evaluated using a linear trend test to predict COPD treatment costs and acute exacerbation events. Results: Using records from 880 patients, ten variables were created: acute exacerbation events, emphysema diagnoses, laboratory test and oxygen therapy procedures, prescribed anticholinergic, inhaled corticosteroid (ICS), short acting beta-agonist, and long acting bronchodilator (LABA) agents, asthma diagnosis and patient birth years. Factor loadings from LABA and ICS prescriptions had the strongest impacts on estimated severity scores (0.50 and 0.49, respectively). Among 300 validation group patients, scores were found to associate with increasing trends of median costs and exacerbation risks (p for trend < 0.05). Conclusions: Estimatedseverity scores would help to predict COPD-related medical costs and exacerbation events. For further clinical implementation, this classification system should be re-evaluated using clinical lung functions information indicative COPD severity and treatment choices.
Aug 2017 DOI 10.14302/issn.2470-5020.jnrt-17-1530
Suslo RobertCorresponding author
Gerontology Unit, Public Health Department, Health Sciences Faculty, Wroclaw Medical University,
It is crucial for the society, the government and the medical community to retrieve the full and reliable statistical information on malignant brain neoplasms (C71-C71.9 ICD-10) to adjust the medical financing, staff and equipment properly. In order to retrieve information useful for public health policies, data from the years 2006-2012 concerning relevant cases registered by the Polish public healthcare insurance provider Narodowy Fundusz Zdrowia in Lower Silesia region of Poland (NFZ) and by the Polish national neoplasms registry Krajowy Rejestr Nowotworow (KRN) were analyzed. The number of new malignant brain neoplasms cases registered by the KRN has risen slightly in the years 2006-2012. At the same time the number of cases reported by the NFZ rose dynamically, which means a significant increase in medical care intensity, and thus also workload on the medical facilities and stuff associated with the care for grossly the same amount of brain malignant neoplasms patients and, supposedly, their longer survival times. It indicates that the level of public financing of the malignant neoplasms of brain treatment shall be adjusted adequately. The study revealed growing popularity among reporting Polish physicians of the least specific malignant neoplasms of brain ICD-10 categories, despite the rapid diagnostic techniques development and availability. It is alarming since the medical statistics data quality in the field of malignant brain neoplasms is deteriorating that way and proper evaluation of treatment costs and planning future financial allocations by both the public healthcare insurance provider NFZ and the Polish government becomes difficult.