Cost-effectiveness evidence

Wailoo A, Bansback N, Chilcott J. Infliximab, etaner-cept and adalimumab for the treatment of ankylosing spondylitis cost-effectiveness evidence and NICE... 

A systematic approach to energy-efficient design can cost-effectively cut energy costs by 25 percent to 50 percent, as has been documented in both new construction and retrofit. The evidence on how energy-efficient design can increase worker productivity has been limited, so the issue has been a controversial one. 

The advantages of combining toxicity testing with chemical analysis when dealing with complex mixtures of environmental chemicals are clearly evident. More useful information can be obtained than would be possible if one or the other were to be used alone. However, chemical analysis can be very expensive, which places a limitation on the extent to which it can be used. There has been a growing interest in the development of new, cost-effective biomarker assays for assessing the toxicity of mixtures. Of particular interest are bioassays that incorporate mechanistic... 

The continuing development of antidepressant agents has increased the availability of newer dmgs that have similar efficacy but are more expensive than the older antidepressants (Song et al, 1993). This chapter addresses the complex question of whether there is clear evidence that the use of any single antidepressant or group of antidepressants is more cost-effective than any other. 

J> < 0.01) and also more cost-effective, mainly because of the higher number of hospital admissions in the TCA group. This study had limitations in that patients prescribed TCAs were not randomly selected, a quarter of the patients in the TCA group failed to receive an effective dose, and objective measurements of outcome were not employed. Multivariate analysis suggested that despite the methodological limitations of the study, the differences in cost were due to the treatment received, and not to differences in patient characteristics. This study provides the first, albeit tentative, evidence of superior cost-effectiveness for SSRIs over TCAs in the UK. 

The evidence that any one antidepressant or group of antidepressant dmgs provides more cost-effective treatment than any other remains inconclusive. Several studies (Sclar et al, 1994, 1995 Bingefors et al, 1995 Simon et al, 1995a, b, 1996 Skaer et al, 1995 ... 

There are four types of economic evaluation cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis. The analytic framework chosen will depend upon the economic questions posed and the clinical evidence of effectiveness for the interventions (Gold et al, 1996 Dmmmondetal, 1997). 

Alternatively, some studies used expert opinion to extrapolate the effectiveness of donepezil over a longer period (Neumann et al, 1999 O Brien et al, 1999). However, it is recognized that expert opinion can be the weakest source of evidence, which introduces considerable uncertainty into the analysis and interpretation of the results. In addition, the cost-effectiveness of acetylcholinesterase inhibitors depends heavily on the distribution of the cohort of patients across different severity states. O Brien s team found that the results of their model were very sensitive to this variable. In this context, the correct... 

The evidence base for clinical decisions based on cost-effectiveness for the affective disorders is less clear than for schizophrenia. In bipolar disorder the primary effectiveness of the mainstay treatments, lithium and anticonvulsant pharmacotherapy, is undergoing considerable revision (Bowden et al, 2000). Until this is clarified, cost-effectiveness studies are probably premature. Nevertheless the cost burden in bipolar disorder is qualitatively similar to that in schizophrenia, with in-patient costs being the primary burden and associated social costs in treated patients. The drug costs are even less than those for schizophrenia. In Chapter 5 John Cookson suggests there is little economic evidence to drive prescribing decisions. The in-patient burden does not seem to have altered with the introduction of lithium. The only drug-related study (Keck et al, 1996) showed an obvious difference in treatment costs only when lithium was compared with sodium valproate. Since these are both cheap drugs this is unlikely to influence clinical decisions. The main question is what impact... 

As health-care professionals we need to identify and solve the problem together with the patient, and we need to do it in a rational and cost-effective way. For a practitioner this is not easy based on the rapidly expanding progress within the medical area, increasing demand from patients, and the manipulation of information from various interests in the field. First we need drugs and other treatments with documented effects (efficacy) in the elderly. Then we need to select the most appropriate drug for the individual patient. The latter is complicated and evidence-based medicine (EBM) has been suggested as the method. Finally we need to communicate with the patient and establish a partnership (concordance). 

E The new therapy is less effective than or is as effective as the existing therapy and is more costly Compelhng evidence for rejechon... 

Is the institute likely to be able to add value by issuing national guidance For instance, in the absence of such guidance is there likely to be significant controversy over the interpretation or significance of the available evidence on clinical and cost effectiveness ... 

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