Is adding maternal vaccination to prevent whooping cough cost-effective in Australia?

Pertussis or whooping cough, a highly infectious respiratory infection, causes significant morbidity and mortality in infants. In adolescents and adults, pertussis presents with atypical symptoms often resulting in under-diagnosis and under-reporting, increasing the risk of transmission to more vulnerable groups. Maternal vaccination against pertussis protects mothers and newborns.

Cost effectiveness of darunavir/ritonavir 600/100 mg bid in treatment-experienced, lopinavir-naive, protease inhibitor-resistant, HIV-infected adults in Belgium, Italy, Sweden and the UK.

Background: Using data from the phase IIb POWER trials, darunavir boosted with low-dose ritonavir (DRV/r; 600/100 mg twice daily; bid)-based highly active antiretroviral therapy (HAART) was shown to be significantly more efficacious and cost effective than other protease inhibitor (PI)-based therapy in highly treatment-experienced, HIV-1-infected adults. Furthermore, in the phase III TITAN trial (TMC114-C214), DRV/r 600/100 mg bid-based HAART generated a superior 48-week virological response rate compared with standard-of-care lopinavir/ritonavir (LPV/r; 400/100 mg bid)-based therapy in treatment-experienced, lopinavir-naive patients, and in particular those with one or more International AIDS Society - USA (IAS-USA) primary PI resistance-associated mutations at baseline. These patients had a broader degree of previous PI use/failure (0 - ≥ 2) than the POWER patients.

Cost effectiveness of darunavir/ritonavir 600/100 mg bid in protease inhibitor-experienced, HIV-1-infected adults in Belgium, Italy, Sweden and the UK.

Background: Two phase II trials (POWER 1 and 2) have demonstrated that darunavir co-administered with low-dose ritonavir (DRV/r) provides significant clinical benefit compared with control protease inhibitors (PIs) in highly treatment-experienced, HIV-1-infected adults, when co-administered with optimized background therapy (OBR).

Objective: To determine whether DRV/r is cost effective compared with control PIs, from the perspective of Belgian, Italian, Swedish and UK reimbursement authorities, when used in treatment-experienced patients similar to those included in the POWER 1 and 2 trials.

Methods: An existing Markov model containing health states defined by CD4 cell count ranges (> 500, 351-500, 201-350, 101-200, 51-100 and 0-50 cells/mm³) and death was adapted for use in four European healthcare settings.

Critical appraisal of scientific posters comparing anemia treatments for cancer patients: applying ISPOR Task Force guidelines on methodological quality of retrospective studies.

Two independent reviewers used the methodological criteria published by the ISPOR Task Force on Retrospective Data to assess the quality of four posters presenting the results of retrospective database studies on the use of erythropoiesis-stimulating agents (epoetin alfa, epoetin beta, or darbepoetin alfa) for treating patients with cancer. A third reviewer consolidated the results. Overall, from the information reported in the four posters, their methodological quality ranged from poor to very poor; only a few of the criteria were satisfactorily addressed.

Estimating the cost-effectiveness of quality-improving interventions in oral anticoagulation management within general practice.

Objectives: A clinical trial, "Belgian Improvement Study on Oral Anticoagulation Therapy (BISOAT)," significantly improved the quality after implementing four different quality-improving interventions in four randomly divided groups of general practitioners (GPs). The quality-improving interventions consisted of multifaceted education with or without feedback reports on their performance, international normalized ratio (INR) testing by the GP with a CoaguChek device or computer-assisted advice for adapting oral anticoagulation therapy. The quality improvement in INR control versus baseline was similar in the four groups.

Economic evaluation of the prevention and management of systemic fungal infections in neutropenic patients.

Systemic fungal infections in neutropenic patients remain a clinical problem that is associated with morbidity and mortality. Continuing efforts are being made to develop improved (i.e.

Cost-effectiveness of anastrozole compared to tamoxifen in hormone receptor-positive early breast cancer. Analysis based on the ATAC trial.

The 5-year completed treatment analysis of the Anastrozole and Tamoxifen-Alone or in Combination (ATAC) trial showed the superiority of anastrozole over tamoxifen for reduction of disease progression in patients with hormone receptor-positive (HR+) early breast cancer (EBC). The objective was to evaluate the cost-effectiveness of anastrozole versus tamoxifen in this setting. A health economic model was developed comparing the natural history of EBC patients treated with anastrozole or tamoxifen.

An update: health economics of managing multiple myeloma.

Based on Medline search, a summary is provided of recent health economic evidence in published literature relating to the management of multiple myeloma. The following major components of current multiple myeloma treatments are discussed: induction chemotherapy, high-dose chemotherapy supported by autologous peripheral stem cell transplantation (ASCT), long-term biphosphonates therapy to prevent skeletal events and recent advances for the treatment of relapsed or refractory multiple myeloma and under evaluation in primary treatment (thalidomide and bortezomib). Our study shows that there still appears to be a need for health economic information to confirm the cost-effectiveness of stem cell support versus high-dose chemotherapy without stem cell support, as well as to assess optimal biphosphonate treatment regimens.

European guidelines for the management of chemotherapy-induced anaemia and health economic aspects of treatment.

Patients with cancer receiving myelosuppressive chemotherapy frequently develop anaemia; platinum-based chemotherapy, in particular, leads to reduced production of the bone marrow-stimulating hormone erythropoietin. The European Cancer Anaemia Survey showed that many patients do not receive erythropoiesis-stimulating agent (ESA) therapy and highlighted the need for clear guidelines for the diagnosis and treatment of anaemia in cancer patients. In response to a fast-moving therapeutic environment and guidelines produced in the USA, the European Organisation for Research and Treatment of Cancer established an independent task force to develop evidence-based guidelines for the use of ESAs in European anaemic cancer patients that were first published in 2004.

Assessment of the economic value of the INTERCEPT blood system in Belgium.

Emerging pathogens continue to threaten blood safety, requiring novel safety approaches. INTERCEPT Blood System for platelets (IBSP) inactivates pathogens, aiming at eliminating the risk of transmitting current and emerging pathogens. The objective was to evaluate the incremental cost-effectiveness ratio (ICER) for IBSP in Belgium.

Second line pharmacological management of paroxysmal and persistent atrial fibrillation in france: a cost analysis.

Objectives: Despite optimal pharmacological treatment a large proportion of patients with atrial fibrillation (Afib) are not arrhythmia-free, and remain at risk for complications such as stroke and cardiac morbidity. If first-line treatment fails, most patients receive second-line pharmacological treatment. The emergence of new technologies aimed at restoring and maintaining sinus rhythm, such as catheter ablation techniques, has increased the interest in the economic aspects of second-line pharmacological treatment.

Economic evaluation of intravenous itraconazole for presumed systemic fungal infections in neutropenic patients in Korea.

Systemic fungal infections remain a major clinical problem in immunocompromised patients. Presumed systemic fungal infections (PSFI) are treated empirically with an intravenous antifungal agent to reduce the occurrence of documented infections and associated mortality. The objective of this study was to compare the cost-effectiveness of intravenous itraconazole (IVitra) treatment with the current first-line empirical treatment of PSFI with conventional amphotericin B (CAB) in cases of neutropenic cancer and bone marrow transplantation (BMT).

Cost-effectiveness analysis of bicalutamide (Casodex) for adjuvant treatment of early prostate cancer.

Objectives: To assess the cost-effectiveness of bicalutamide (Casodex) as adjuvant treatment in early prostate cancer (EPC).

Methods: A Markov state transition model was developed, using disease progression rates from a large (N = 8113) clinical trial program comparing bicalutamide in addition to standard care with standard care alone. Utility scores for different disease stages were obtained from published reports.

Long-term medical costs of postmenopausal breast cancer therapy.

Background: Since the incidence of breast cancer is growing, prevention programs can be expected to have a large economic impact on the health care system. From a health economic point of view, one is interested in the costs saved by disease prevention.

Patients And Methods: To predict 10-year cumulative incidence-based costs of postmenopausal breast cancer, a state transitional model was developed based on published clinical data.

Incidence, medical resource utilisation and costs of hyperuricemia and tumour lysis syndrome in patients with acute leukaemia and non-Hodgkin's lymphoma in four European countries.

Hyperuricemia (HU) and tumour lysis syndrome (TLS) are complications of acute leukaemia and non-Hodgkin lymphoma (NHL) leading to increased morbidity and mortality. The objective of this study was to define incidence and calculate health care cost associated with HU and TLS. 788 acute leukaemia and NHL patients from Belgium, The Netherlands, Spain and UK were screened retrospectively for HU and TLS.

Pan-European multicentre economic evaluation of recombinant urate oxidase (rasburicase) in prevention and treatment of hyperuricaemia and tumour lysis syndrome in haematological cancer patients.

Goals: Hyperuricaemia (HU) and tumour lysis syndrome (TLS) are complications of acute myeloid/lymphoid leukaemia (AML/ALL) and non-Hodgkin lymphoma (NHL) leading to increased morbidity and mortality. The objective was to assess incremental cost-effectiveness ratios (ICER) of preventing/treating HU and TLS with recombinant urate oxidase, rasburicase (Fasturtec/Elitek).

Patients And Methods: Incidence and costs of HU and TLS were based on a multi-country chart review.

Modeling costs and cost-effectiveness of different CMV management strategies in liver transplant recipients as a support for current and future decision making.

Objectives: To develop a generic decision-analytic model to predict health and economic outcomes of different management options for cytomegalovirus (CMV) infection and disease in liver transplant patients.

Methods And Data: The model considers different CMV management strategies, thereby emphasizing the important difference between infection and disease. The first strategy starts with prophylaxis prior to transplantation, followed by preemptive treatment if infection, based on positive CMV diagnostic tests, is confirmed.